bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-Site Identification and Generalization of Clusters of Walking Behaviors in Individuals With Chronic Stroke and Neurotypical Controls
Authors: Sánchez Natalia , Schweighofer Nicolas , Mulroy Sara J. , Roemmich Ryan T. , Kesar Trisha M. , Torres-Oviedo Gelsy , Fisher Beth E. , Finley James M. , Winstein Carolee J.
Published: November 2023

Background

Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions.

Objectives

We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: (1) identify clusters of walking behaviors in people post-stroke and neurotypical controls and (2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants.

Methods

We gathered data from 81 post-stroke participants across 4 research sites and collected data from 31 control participants. Using sparse K-means clustering, we identified walking clusters based on 17 spatiotemporal and force variables. We analyzed the biomechanical features within each cluster to characterize cluster-specific walking behaviors. We also assessed the generalizability of the clusters using a leave-one-out approach.

Results

We identified 4 stroke clusters: a fast and asymmetric cluster, a moderate speed and asymmetric cluster, a slow cluster with frontal plane force asymmetries, and a slow and symmetric cluster. We also identified a moderate speed and symmetric gait cluster composed of controls and participants post-stroke. The moderate speed and asymmetric stroke cluster did not generalize across sites.

Conclusions

Although post-stroke walking patterns are heterogenous, these patterns can be systematically classified into distinct clusters based on spatiotemporal and force data. Future interventions could target the key features that characterize each cluster to increase the efficacy of interventions to improve mobility in people post-stroke.
Video prompting procedures to teach science electronic journaling to students with intellectual disability: Leveraging students with disabilities’ learning endeavors
Authors: Almumen Huda A
Published: November 2023

The purpose of this research exploration was to investigate the impact of video prompting procedures on the acquisition of electronic journaling skill, and how to create and present scientific knowledge previously learned by students with intellectual disabilities. Using single-subject, multiple probe, and multiple baseline-design across four participants with moderate intellectual disabilities, results revealed that participants could increase their number of correct, completed steps for creating their electronic journals for the science classes. Results also showcased that participants had an opportunity to encounter the tablet-based, evidence-based instructional strategy to learn how to introduce their scientific pieces, talk about and communicate their ideas and thoughts. Implications for future research and practice were provided.
Should 6- or 12-month outcomes be used after carpal tunnel decompression?
Authors: Stirling Paul H. C. , Yapp Liam Z , McEachan Jane E.
Published: November 2023

Preoperative and 6- and 12-month postoperative Quick version of the Disablities of the Arm, Shoulder and Hand (QuickDASH) scores for 336 patients undergoing carpal tunnel decompression were 43.2, 18.2 and 15.9, respectively. There was no significant improvement in QuickDASH between 6 and 12 months. Postoperative scores should not be collected at both end points.
“Unhappy triad” of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes
Authors: Langlais Tristan , Louis Emmanuelle , Badina Alina , Vialle Raphael , Pannier Stéphanie , Le Hanneur Malo , Fitoussi Franck
Published: November 2023

Background:

The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow “unhappy triad” trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury).

Methods:

A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up.

Results:

Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The “unhappy triad” diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%.

Conclusion:

The “unhappy” triad of the child’s elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations.

Level of evidence:

level III.
Ambulatory surgical management of most displaced tibial tubercle fractures in children is safe and efficient
Authors: Zukotynski Brian Kendrick , Brown Danielle , Hori Kellyn , Silva Mauricio
Published: November 2023

Purpose:

The purpose of this study is to compare the outcome of patients with displaced tibial tubercle fractures treated surgically who spent one or more nights in the hospital after surgery with that of patients treated in an ambulatory setting with no perioperative hospitalization. We hypothesized that tibial tubercle fractures have a low rate of complications and that most patients do well without an overnight hospital stay for observation.

Methods:

We retrospectively reviewed all pediatric tibial tubercle fractures treated operatively by a single surgeon over a 13.5-year period. Fractures treated in an inpatient setting, defined as at least one night of overnight hospitalization postoperatively, were compared with fractures treated in an ambulatory setting with no perioperative hospitalization.

Results:

Seventy-one fractures in 70 patients were analyzed. All fractures were treated with open reduction and internal fixation with unicortical screws. Thirty-five fractures (49.3%) were fixed in an ambulatory setting, while 36 (50.7%) were inpatient. There were no significant differences between inpatient demographics (age, gender, body mass index, fracture type). Average operative time was significantly longer in the inpatient group compared with the ambulatory group (97.8 min versus 58.8 min, p < 0.001). There was no significant difference in the incidence of complications between inpatient and ambulatory groups (25.0% versus 11.4%, p = 0.22). No cases of compartment syndrome were noted.

Conclusion:

Ambulatory surgical treatment of select tibial tubercle fractures with same-day discharge is safe and efficient. Not all patients with surgically treated tibial tubercle fractures need to stay overnight in the hospital.
Examining the Crime-Conflict Distinction: Victimization and Political System Support in Colombia
Authors: Angulo Amaya Maria Camila , Littlefield Ned
Published: November 2023

How do crime and conflict compare in relation to victims’ support for their political system? Latin American Politics scholarship has emphasized the distinct motivations of criminal and political violence. However, victims might not distinguish meaningfully between these types of insecurity. Scholars have used surveys extensively to understand crime victimization's consequences, but we know less about conflict victimization's relationship with political attitudes. Analyzing public opinion surveys from Colombia (2012–2018), we find that crime and conflict victimization share a minimal relationship with system support at the national level. In conflict zones, however, victimization from political violence corresponds negatively with system support. Decreased confidence in security forces may be the explanation. Our findings have three implications: scholars risk overemphasizing the crime-conflict distinction without micro-level insight; analyzing public opinion in areas beyond state control is necessary to build such knowledge; and, amidst acute insecurity, attention to victims has systemic importance.
Reversing the eyes and reverse perspectives: Pseudoscopic amplification of reverspectives
Authors: Wade Nicholas J. , Hughes Patrick
Published: November 2023

Stereoscopic photographs of works in reverse perspective do not reveal their three-dimensional structure whereas pseudoscopic photographs enhance the apparent depth effects.
Hypovitaminosis D masking hypercalcemia in primary hyperparathyroidism: case report
Authors: Elsherbiny Tamer Mohamed
Published: November 2023

Hyperparathyroidism (HPTH) is the third most common endocrine disorder. Hypovitaminosis D affects up to 40% of the general population and about a third of hyperparathyroid patients. Such a combination may alter the classic presentation of HPTH. This report presents a premenopausal female with long history of osteoporosis, normocalcemia, and hypovitaminosis D who was initially diagnosed as secondary HPTH. After restoring vitamin D to normal using parenteral loading doses, the patient developed persistent mild to moderate hypercalcemia with persistent parathormone elevation consistent with primary HPTH associated with hypercalciuria and complicated with nephrocalcinosis. Imaging confirmed a left upper parathyroid adenoma and fulfilling several indications for surgery, the patient was operated restoring normocalcemia that was maintained for several years of follow-up. Hypovitaminosis D is common and may mask expected hypercalcemia in patients with primary HPTH, thus delaying diagnosis and proper intervention. Reevaluating patients initially diagnosed as hypovitaminosis D and secondary HPTH may reveal a masked diagnosis of primary hyperparathyroidism.
Knowledge, attitude, and practice of cervical cancer screening and its associated risk factors among family planning service users at Debre Tabor town health facilities, North Central Ethiopia: A cross-sectional study
Authors: Damtie Shewaneh , Legese Biruk , Berhan Ayenew , Kiros Teklehaimanot , Eyayu Tahir , Mihrete Kefiyalew , Taklual Wubet
Published: November 2023

Background:

The fourth most common cancer in women worldwide is cervical cancer. Over 87% of deaths from cervical cancer occur in developing nations. One of the risks of developing cervical cancer is the use of oral contraceptives. However, there is limited evidence on the knowledge, attitude, and practice of cervical cancer screening among family planning service users in Ethiopia.

Objective:

To assess the knowledge, attitude, and practice toward cervical cancer screening and its associated factors among family planning service users.

Methods:

A facility-based cross-sectional study was conducted from January 1 to February 28, 2023. A total of 816 participants were selected using a systematic sampling technique. Data were collected using a pretested, structured, and interviewer-administered questionnaire. The collected data were entered into EPI Data 3.1 and exported to SPSS version 24 (IBM, Armonk, NY, USA) for analysis. Logistic regression was used to identify risk factors. An odds ratio with a 95% confidence interval and a p-value < 0.05 were used to declare statistical significance.

Results:

Overall, 42.5%, 36.6%, and 20.1% of the participants had good knowledge, a positive attitude, and practiced cervical cancer screening, respectively. Being single (adjusted odds ratio (AOR) = 3.39, 95% confidence intervals: 1.15–6.26), having college or university level of education (AOR = 8.03, 95% confidence intervals: 3.45–19.23), having a family history of cervical cancer (AOR = 3.14, 95% confidence intervals: 1.82–8.84), and having a source of information from the media (AOR = 1.74, 95% confidence intervals: 1.09–2.54) were significantly associated with good knowledge of cervical cancer screening. Women who were aged 15–23 years (AOR = 5.62, 95% confidence intervals: 2.76–14.56), had college- or university-level education (AOR = 3.69, 95% confidence intervals: 1.65–8.22), and had good knowledge of cervical cancer (AOR = 4.71, 95% confidence intervals: 3.08–7.55) were significantly associated with a positive attitude toward cervical cancer screening. An earlier age of first sexual intercourse (AOR = 5.0, 95% confidence intervals: 3.80–9.20) and good knowledge of cervical cancer (AOR = 1.52, 1.21–5.82) were positively associated with good practice of cervical cancer screening. Women who attended high school were negatively associated with good practice in cervical cancer screening (AOR = 0.46, 0.23–0.73).

Conclusion:

Knowledge, attitude, and practice toward cervical cancer screening were low. As a result, during patient visits for care delivery, healthcare providers should inform and educate patients about cervical cancer screening.
Severe acute cholecystitis successfully treated with endoscopic nasobiliary drainage tube insertion: A case report
Authors: Ishida Yusuke , Sekiguchi Shunya , Tsuzuki Yumi , Kawachi Aya , Tomino Mikiko
Published: November 2023

In this report, we present a case of a patient with bile peritonitis caused by gallbladder perforation associated with acute cholecystitis, which required intensive postoperative care. The patient was a woman in her 40s who presented with abdominal pain. Upon examination, she was diagnosed as having acute cholecystitis and bile peritonitis caused by gallbladder perforation. Subsequently, a partial cholecystectomy, omental pack, and drainage were performed. Initially, her bile duct enzyme levels improved; however, they subsequently increased again. An endoscopic nasobiliary drainage tube was inserted, and thereafter, a decrease in inflammatory response and bile duct enzyme levels was observed. During the course of treatment, respiratory failure and renal impairment occurred, necessitating mechanical ventilation management and continuous hemodiafiltration. In patients with severe acute cholecystitis, in addition to treating the underlying condition, it is crucial to perform procedures perioperatively, in anticipation of the development of additional organ dysfunctions postoperatively.
Cutaneous mantle cell lymphoma presenting as a diffuse morbilliform rash: A case report
Authors: Tuohy Spencer , Wachuku Christopher , Wang Yixin A , Prasad Aman , Samimi Sara S , Pappas-Taffer Lisa K , Haun Paul L , Wang Leo L
Published: November 2023

This case describes a patient with known mantle cell lymphoma without cutaneous involvement presenting with a diffuse morbilliform rash during an inpatient admission for bacterial pneumonia. The patient was thought to have a hypersensitivity to antibiotics but failed to improve after the offending agents were stopped. A skin biopsy revealed metastatic cutaneous mantle cell lymphoma. Treatment with high-dose corticosteroids and chemotherapy was initiated resulting in the resolution of the rash.
Sizeism in Education: What School Counselors Need to Know
Authors: Muzacz Arien K. , Houston Shelby , Renwick Adrienne S. , Carew Caitlin M.
Published: November 2023

This conceptual article explains how school counselors can increase awareness of size discrimination and address sizeist attitudes and biases in U.S. schools. Sizeism can begin in early childhood and continue into young adulthood, with damaging effects on student wellness. Sizeist biases in society are reflected in school systems. We suggest actions school counselors can take to promote equity in education for students of size, including implementing size-inclusive prevention strategies within a comprehensive school counseling program.
Gender-specific trajectories of offending from adolescence until age 40 among individuals with experience of out-of-home care: A national cohort study
Authors: Brännström Lars , Andershed Anna-Karin , Vinnerljung Bo , Hjern Anders , Almquist Ylva B.
Published: November 2023

It is well-known that experiences of out-of-home care (OHC; foster-family care and residential care) are linked to criminal behavior. Less is known how criminal activity in the OHC population develops over the life course and to what extent such development is characterized by desistance or persistence. Using population-based longitudinal register data for more than 740,000 Swedish men and women, of which around 2.5% have experience of OHC, followed until age 40, results from group-based trajectory modelling and multinomial regression suggest that OHC-experienced individuals with various timing and duration of placement, especially men first placed as teenagers, have substantially elevated likelihood for persistent offending compared to peers without OHC experience. However, most OHC-experienced followed pathways characterized by desistance. Our findings have implications for understanding the dynamics of offending in OHC populations and underscores the necessity for interventions that can prevent the onset of criminal careers, as well as disrupt or modify the ongoing paths of offending within this disadvantaged group of individuals.
A scoping review of mathematics teachers’ learning and professional growth through lesson studies
Authors: Ding Meixia , Huang Rongjin , Pressimone Beckowski Catherine , Li Xiaobao , Li Yeping
Published: November 2023

Lesson study (LS), a teacher-oriented, student-focused professional development approach that originated in Asia, has spread globally. However, findings related to the effect of LS on teacher learning and growth have varied widely. This suggests a need to review current research on LS in the field of mathematics education. This paper focuses on mathematics teachers’ learning and professional growth through LS using Clarke and Hollingworth’s interconnected model of professional growth (IMPG) that contains three components: domains of change, mediating mechanisms, and change environment. With regard to domains of change, we found that although previous LS studies—often small scaled, qualitative studies—attended to all domains of change, they have more frequently reported changes in the personal (or collective) domain (e.g., teacher knowledge) but have relatively less frequently reported changes in other domains. In fact, there is a lack of research on systematic changes across domains in the IMPG. Regarding the mediating mechanisms, research has well explored both enactment (planning and teaching) and reflection (debriefing). For enactment, the planning process is less appreciated, and there is an inconsistent understanding of the role of the knowledgeable others. For reflection, there is a lack of focus on student thinking and constructive feedback during this process. Finally, research has suggested that LS has received support from the change environment but that tensions (e.g., time limits) have remained. These challenges call for systemic support and cross-cultural collaborations to develop sustainable and large-scale LS. We suggest future directions for continued research and practice.
Sequential antigen loss and branching evolution in lymphoma after CD19- and CD20-targeted T-cell–redirecting therapy
Authors: Duell Johannes , Leipold Alexander M. , Appenzeller Silke , Fuhr Viktoria , Rauert-Wunderlich Hilka , Da Via Matteo , Dietrich Oliver , Toussaint Christophe , Imdahl Fabian , Eisele Florian , Afrin Nazia , Grundheber Lars , Einsele Hermann , Weinhold Niels , Rosenwald Andreas , Topp Max S. , Saliba Antoine-Emmanuel , Rasche Leo
Published: November 2023

CD19 chimeric antigen receptor (CAR) T cells and CD20 targeting T-cell–engaging bispecific antibodies (bispecs) have been approved in B-cell non-Hodgkin lymphoma lately, heralding a new clinical setting in which patients are treated with both approaches, sequentially. The aim of our study was to investigate the selective pressure of CD19- and CD20-directed therapy on the clonal architecture in lymphoma. Using a broad analytical pipeline on 28 longitudinally collected specimen from 7 patients, we identified truncating mutations in the gene encoding CD20 conferring antigen loss in 80% of patients relapsing from CD20 bispecs. Pronounced T-cell exhaustion was identified in cases with progressive disease and retained CD20 expression. We also confirmed CD19 loss after CAR T-cell therapy and reported the case of sequential CD19 and CD20 loss. We observed branching evolution with re-emergence of CD20+ subclones at later time points and spatial heterogeneity for CD20 expression in response to targeted therapy. Our results highlight immunotherapy as not only an evolutionary bottleneck selecting for antigen loss variants but also complex evolutionary pathways underlying disease progression from these novel therapies.
Regulation of kynurenine metabolism by blood donor genetics and biology impacts red cell hemolysis in vitro and in vivo
Authors: Nemkov Travis , Stephenson Daniel , Erickson Christopher , Dzieciatkowska Monika , Key Alicia , Moore Amy , Earley Eric J. , Page Grier P. , Lacroix Ian S. , Stone Mars , Deng Xutao , Raife Thomas , Kleinman Steven , Zimring James C. , Roubinian Nareg , Hansen Kirk C. , Busch Michael P. , Norris Philip J. , D’Alessandro Angelo
Published: November 2023

In the field of transfusion medicine, the clinical relevance of the metabolic markers of the red blood cell (RBC) storage lesion is incompletely understood. Here, we performed metabolomics of RBC units from 643 donors enrolled in the Recipient Epidemiology and Donor Evaluation Study, REDS RBC Omics. These units were tested on storage days 10, 23, and 42 for a total of 1929 samples and also characterized for end-of-storage hemolytic propensity after oxidative and osmotic insults. Our results indicate that the metabolic markers of the storage lesion poorly correlated with hemolytic propensity. In contrast, kynurenine was not affected by storage duration and was identified as the top predictor of osmotic fragility. RBC kynurenine levels were affected by donor age and body mass index and were reproducible within the same donor across multiple donations from 2 to 12 months apart. To delve into the genetic underpinnings of kynurenine levels in stored RBCs, we thus tested kynurenine levels in stored RBCs on day 42 from 13 091 donors from the REDS RBC Omics study, a population that was also genotyped for 879 000 single nucleotide polymorphisms. Through a metabolite quantitative trait loci analysis, we identified polymorphisms in SLC7A5, ATXN2, and a series of rate-limiting enzymes (eg, kynurenine monooxygenase, indoleamine 2,3-dioxygenase, and tryptophan dioxygenase) in the kynurenine pathway as critical factors affecting RBC kynurenine levels. By interrogating a donor-recipient linkage vein-to-vein database, we then report that SLC7A5 polymorphisms are also associated with changes in hemoglobin and bilirubin levels, suggestive of in vivo hemolysis in 4470 individuals who were critically ill and receiving single-unit transfusions.
Pretransfusion hemoglobin level and mortality in adults with transfusion-dependent β-thalassemia
Authors: Musallam Khaled M. , Barella Susanna , Origa Raffaella , Ferrero Giovanni Battista , Lisi Roberto , Pasanisi Annamaria , Longo Filomena , Gianesin Barbara , Forni Gian Luca
Published: November 2023

Regular transfusions have dramatically improved the outcomes for patients with thalassemia major, especially reducing deaths from anemia-related heart failure, but the hemoglobin threshold for maximizing outcomes is the subject of conjecture. Musallam et al report on a retrospective analysis of 10-year survival data in 779 patients, identifying increasing survival to be associated with higher pretransfusion hemoglobin levels, with the highest survival observed when levels were maintained >10.5 g/dL. These data support raising the target threshold for pretransfusion hemoglobin levels in patients with transfusion-dependent thalassemia.
Dynamic Investigations on the Wear Behavior of a 3D Revolute Joint Considering Time-Varying Contact Stiffness: Simulation and Experiment
Authors: Zhang Li , Fang Yining , Bai Guanghan , Tao Junyong
Published: November 2023

The existence of the relative radial and axial movements of a revolute joint’s journal and bearing is widely known. The three-dimensional (3D) revolute joint model considers relative radial and axial clearances; therefore, the freedoms of motion and contact scenarios are more realistic than those of the two-dimensional model. This paper proposes a wear model that integrates the modeling of a 3D revolute clearance joint and the contact force and wear depth calculations. Time-varying contact stiffness is first considered in the contact force model. Also, a cycle-update wear depth calculation strategy is presented. A digital image correlation (DIC) non-contact measurement and a cylindricity test are conducted. The measurement results are compared with the numerical simulation, and the proposed model’s correctness and the wear depth calculation strategy are verified. The results show that the wear amount distribution on the bearing’s inner surface is uneven in the axial and radial directions due to the journal’s stochastic oscillations. The maximum wear depth locates where at the bearing’s edges the motion direction of the follower shifts. These findings help to seek the revolute joints’ wear-prone parts and enhance their durability and reliability through improved design.
Core atoms escape from the shell: reverse segregation of Pb–Al core–shell nanoclusters via nanoscale melting
Authors: Wu Wenkai , Pavloudis Theodoros , Palmer Richard E.
Published: November 2023

Melting is a phase transition that profoundly affects the fabrication and diverse applications of metal nanoclusters. Core–shell clusters offer distinctive properties and thus opportunities compared with other classes of nano-alloys. Molecular dynamics simulations have been employed to investigate the melting behaviour of Pb–Al core–shell clusters containing a fixed Pb147 core and varying shell thickness. Our results show that the core and shell melt separately. Surprisingly, core melting always drives the core Pb atoms to break out the shell and coat the nanoclusters in a reversed segregation process at the nanoscale. The melting point of the core increases with the shell thickness to exceed that of the bare core cluster, but the thinnest shell always supresses the core melting point. These results can be a reference for the future fabrication, manipulation, and exploitation of the core–shell nanoalloys chosen. The system chosen is ideally suited for experimental observations.
Turkish translation, cross-cultural adaptation and reliability of the Groningen Frailty Indicator
Authors: Güner Merve , Ceylan Serdar , Okyar Baş Arzu , Koca Meltem , Doğu Burcu Balam , Halil Meltem Gülhan , Cankurtaran Mustafa , Balcı Cafer
Published: November 2023

Background

Frailty is an important geriatric syndrome that can be seen as a way of recognizing and distinguishing the complex health conditions of older people. Due to the time limitation, short and simple instruments are most feasible in clinical practice, and several quick screening tools have been developed and validated, Groningen frailty indicator (GFI) is one of these scales. We aimed to validate and evaluate the reliability of the GFI in outpatient older adults in the Turkish population.

Methods

A total of 101 older patients were enrolled to the study. GFI was scored by a geriatrician for every patient at first admission to the geriatric outpatient clinic. Fried Physical Frailty Phenotype (FPFP) was performed as a reference test.

Results

The median age (IQR) was 72.0 (10.0) and 62.4% of the study population (n = 63) was female. Based on the GFI, 34 patients (33.7%) were defined as robust, and 67 patients (66.3%) were defined as living with frailty. There was a statistically significant concordance between GFI and FPFP (Cohen’s kappa: 0.415 p < 0.001). GFI had excellent consistency in inter-rater reliability (Cronbach’s alpha: 0.99, 95% CI 0.97-1.00) and in intra-rater reliability (Cronbach’s alpha: 0.99, 95% CI 0.96-1.0).

Conclusion

Our study showed that GFI is a valid and reliable scale in the Turkish older population.
Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners’ perceptions and needs
Authors: Diezi Anne-Sylvie , Vanetti Mélanie , Robert Marie , Schaad Béatrice , Baud David , Horsch Antje
Published: November 2023

Background

Complications requiring medical interventions during childbirth are far from rare, even after uncomplicated pregnancies. It is often a challenge for maternity healthcare professionals to know how to prepare future parents for these eventualities without causing unnecessary anxiety. Studies on traumatic birth experiences have shown that feelings of loss of control, insufficient information, and lack of participation in medical decisions during childbirth are factors of difficult experiences. However, little is known about the information and communication needs of expectant parents about childbirth during the prenatal period. To gain a deeper understanding of the information and communication needs of first-time pregnant women and partners, we explored their perceptions and expectations for their upcoming childbirth, and the actions they initiated to prepare for it.

Methods

Semi-structured interviews were conducted individually with first-time pregnant women and partners of pregnant women aged 18 years or older, with an uncomplicated pregnancy. Thematic analysis was used to identify themes and sub-themes.

Results

Twenty expectant parents (15 pregnant women and five partners of pregnant women) were interviewed. Six themes were identified: Childbirth event; Childbirth experience; Childbirth environment; Organisation of care; Participation in decision making; Roles within the couple and transition to parenthood.

Conclusions

This study contributes to a better understanding of the information needs of future parents expecting their first child. Results highlighted that the notion of “childbirth risks” went beyond the prospect of complications during birth, but also encompassed concerns related to a feeling of loss of control over the event. Expectant parents showed an ambivalent attitude towards consulting risk information, believing it important to prepare for the unpredictability of childbirth, while avoiding information they considered too worrying. They expressed a desire to receive concrete, practical information, and needed to familiarise themselves in advance with the birth environment. Establishing a respectful relationship with the healthcare teams was also considered important. The findings suggest that information on childbirth should not be limited to the transmission of knowledge, but should primarily be based on the establishment of a relationship of trust with healthcare professionals, taking into account each person’s individual values and expectations.
HPV testing in Polish population-based cervical cancer screening programme (HIPPO project)—study protocol of a randomised healthcare policy trial
Authors: Glinska Patrycja , Komerska Katarzyna , Janik Beata , Olkowicz Julia , Jedrzejewska Ilona , Macios Anna , Wieszczy Paulina , Kaminski Michal F. , Arbyn Marc , Nowakowski Andrzej
Published: November 2023

Background

An Organised Cervical Cancer Screening Programme (OCCSP) was started in Poland in 2006/2007. Each woman aged 25 to 59 is eligible for a free Pap test every 3 years in OCCSP. Despite implementation of the OCCSP, the age-standardised cervical cancer (CC) incidence and mortality rates in 2019 were 7.3/100 000 and 3.9/100 000 respectively and were still higher than those in Western European countries with well-organised screening programmes. Apart from low coverage of the OCCSP, suboptimal performance of the screening test (conventional cytology) may be partially responsible for this situation. Several countries have already incorporated high risk Human Papillomavirus (hrHPV) testing in CC screening as a more sensitive tool reducing the risk of missing precancerous lesions and allowing for extension of screening intervals. The European Guidelines for Quality Assurance in Cervical Cancer Screening recommend pilot evaluation of a new screening test in country-specific conditions before its implementation.

Methods

The HIPPO project (HPV testing In Polish POpulation-based cervical cancer screening program) is a randomised health services study nested in the OCCSP in Poland. The project will randomise 33 000 women aged 30–59 years to cytology or hrHPV testing (ratio: 1:1) with age stratification. In the cytology arm women with repeated Atypical Squamous Cells of Undetermined Significance (ASC-US) or ≥ Low–Grade Squamous Intraepithelial Lesions (LSIL) are referred for colposcopy. In the other arm, hrHPV ( +) women with ≥ ASC-US reflex Liquid-Based Cytology (LBC) are referred for colposcopy. Primary endpoints include detection rates of histologically confirmed high grade intraepithelial lesions or worse (CIN2 +) in each arm.

Discussion

This pilot randomised healthcare study nested in the OCCSP in Poland will assess and compare the performance of hrHPV testing to current standard—cytology in order to make decisions on implementation of HPV-based screening in the country.

Trial registration

This randomised healthcare service study was prospectively registered at https://clinicaltrials.gov/ (identifier: NCT04111835, protocol ID 28/2019) on 19th of September 2019.
Neonatal near-miss audits: a systematic review and a call to action
Authors: Medeiros P.B. , Bailey C. , Pollock D. , Liley H. , Gordon A. , Andrews C. , Flenady V.
Published: November 2023

Background

Neonatal near-miss (NNM) can be considered as an end of a spectrum that includes stillbirths and neonatal deaths. Clinical audits of NNM might reduce perinatal adverse outcomes. The aim of this review is to evaluate the effectiveness of NNM audits for reducing perinatal mortality and morbidity and explore related contextual factors.

Methods

PubMed, Embase, Scopus, CINAHL, LILACS and SciELO were searched in February/2023. Randomized and observational studies of NNM clinical audits were included without restrictions on setting, publication date or language. Primary outcomes: perinatal mortality, morbidity and NNM. Secondary outcomes: factors contributing to NNM and measures of quality of care. Study characteristics, methodological quality and outcome were extracted and assessed by two independent reviewers. Narrative synthesis was performed.

Results

Of 3081 titles and abstracts screened, 36 articles had full-text review. Two studies identified, rated, and classified contributing care factors and generated recommendations to improve the quality of care. No study reported the primary outcomes for the review (change in perinatal mortality, morbidity and NNM rates resulting from an audit process), thus precluding meta-analysis. Three studies were multidisciplinary NNM audits and were assessed for additional contextual factors.

Conclusion

There was little data available to determine the effectiveness of clinical audits of NNM. While trials randomised at patient level to test our research question would be difficult or unethical for both NNM and perinatal death audits, other strategies such as large, well-designed before-and-after studies within services or comparisons between services could contribute evidence. This review supports a Call to Action for NNM audits. Adoption of formal audit methodology, standardised NNM definitions, evaluation of parent’s engagement and measurement of the effectiveness of quality improvement cycles for improving outcomes are needed.
Intricate role of intestinal microbe and metabolite in schizophrenia
Authors: Shi Li , Ju Peijun , Meng Xiaojing , Wang Zhongxian , Yao Lihui , Zheng Mingming , Cheng Xialong , Li Jingwei , Yu Tao , Xia Qingrong , Yan Junwei , Zhu Cuizhen , Zhang Xulai
Published: November 2023

Background

The brain-gut axis has gained increasing attention due to its contribution to the etiology of various central nervous system disorders. This study aims to elucidate the hypothesis that schizophrenia is associated with disturbances in intestinal microflora and imbalance in intestinal metabolites. By exploring the intricate relationship between the gut and the brain, with the goal of offering fresh perspectives and valuable insights into the potential contribution of intestinal microbial and metabolites dysbiosis to the etiology of schizophrenia.

Methods

In this study, we used a 16S ribosomal RNA (16S rRNA) gene sequence–based approach and an untargeted liquid chromatography-mass spectrometry-based metabolic profiling approach to measure the gut microbiome and microbial metabolites from 44 healthy controls, 41 acute patients, and 39 remission patients, to evaluate whether microbial dysbiosis and microbial metabolite biomarkers were linked with the severity of schizophrenic symptoms.

Results

Here, we identified 20 dominant disturbances in the gut microbial composition of patients compared with healthy controls, with 3 orders, 4 families, 9 genera, and 4 species. Several unique bacterial taxa associated with schizophrenia severity. Compared with healthy controls, 145 unusual microflora metabolites were detected in the acute and remission groups, which were mainly involved in environmental information processing, metabolism, organismal systems, and human diseases in the Kyoto encyclopedia of genes and genomes pathway. The Sankey diagram showed that 4 abnormal intestinal and 4 anomalous intestinal microbial metabolites were associated with psychiatric clinical symptoms.

Conclusions

These findings suggest a possible interactive influence of the gut microbiota and their metabolites on the pathophysiology of schizophrenia.
Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study
Authors: Zheng Guangjun , Zhou Biying , Fang Zhenger , Jing Chunxia , Zhu Sui , Liu Mingliang , Chen Xia , Zuo Lei , Chen Haiyan , Hao Guang
Published: November 2023

Background

There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population.

Methods

The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms.

Results

There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41).

Conclusion

Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.
Spatial and temporal analysis of road traffic crashes and ambulance responses in Lagos state, Nigeria
Authors: Odusola Aina Olufemi , Jeong Dohyo , Malolan Chenchita , Kim Dohyeong , Venkatraman Chinmayee , Kola-Korolo Olusegun , Idris Olajide , Olaomi Oluwole Olayemi , Nwariaku Fiemu E.
Published: November 2023

Background

Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic approaches that explore spatial and temporal trends of past road crashes can inform novel interventions. To improve access to PTCS and reduce burden of road traffic injuries we explored geospatial trends of past emergency responses to road traffic crashes (RTCs) by Lagos State Ambulance Service (LASAMBUS), assessed efficiency of responses, and outcomes of interventions by local government areas (LGAs) of crash.

Methods

Using descriptive cross-sectional design and REDcap we explored pre-hospital care data of 1220 crash victims documented on LASAMBUS intervention forms from December 2017 to May 2018. We analyzed trends in days and times of calls, demographics of victims, locations of crashes and causes of delayed emergency responses. Assisted with STATA 16 and ArcGIS pro we conducted descriptive statistics and mapping of crash metrics including spatial and temporal relationships between times of the day, seasons of year, and crash LGA population density versus RTCs incidence. Descriptive analysis and mapping were used to assess relationships between ‘Causes of Delayed response’ and respective crash LGAs, and between Response Times and crash LGAs.

Results

Incidences of RTCs were highest across peak commuting hours (07:00-12:59 and 13:00-18:59), rainy season and harmattan (foggy) months, and densely populated LGAs. Five urban LGAs accounted for over half of RTCs distributions: Eti-Osa (14.7%), Ikeja (14.4%), Kosofe (9.9%), Ikorodu (9.7%), and Alimosho (6.6%). On intervention forms with a Cause of Delay, Traffic Congestion (60%), and Poor Description (17.8%), had associations with LGA distribution. Two densely populated urban LGAs, Agege and Apapa were significantly associated with Traffic Congestion as a Cause of Delay. LASAMBUS was able to address crash in only 502 (36.8%) of the 1220 interventions. Other notable outcomes include: No Crash (false calls) (26.6%), and Crash Already Addressed (22.17%).

Conclusions

Geospatial analysis of past road crashes in Lagos state offered key insights into spatial and temporal trends of RTCs across LGAs, and identified operational constraints of state-organized PTCS and factors associated with delayed emergency responses. Findings can inform programmatic interventions to improve trauma care outcomes.
Assessing the impact of COVID-19 passes and mandates on disease transmission, vaccination intention, and uptake: a scoping review
Authors: Natalia Yessika Adelwin , Delporte Margaux , De Witte Dries , Beutels Philippe , Dewatripont Mathias , Molenberghs Geert
Published: November 2023

Purpose

Policymakers have struggled to maintain SARS-CoV-2 transmission at levels that are manageable to contain the COVID-19 disease burden while enabling a maximum of societal and economic activities. One of the tools that have been used to facilitate this is the so-called “COVID-19 pass”. We aimed to document current evidence on the effectiveness of COVID-19 passes, distinguishing their indirect effects by improving vaccination intention and uptake from their direct effects on COVID-19 transmission measured by the incidence of cases, hospitalizations, and deaths.

Methods

We performed a scoping review on the scientific literature of the proposed topic covering the period January 2021 to September 2022, in accordance with the PRISMA-ScR guidelines for scoping reviews.

Results

Out of a yield of 4,693 publications, 45 studies from multiple countries were retained for full-text review. The results suggest that implementing COVID-19 passes tends to reduce the incidence of cases, hospitalizations, and deaths due to COVID-19. The use of COVID-19 passes was also shown to improve overall vaccination uptake and intention, but not in people who hold strong anti-COVID-19 vaccine beliefs.

Conclusion

The evidence from the literature we reviewed tends to indicate positive direct and indirect effects from the use of COVID-19 passes. A major limitation to establishing this firmly is the entanglement of individual effects of multiple measures being implemented simultaneously.
Assessing parents’ and children’s psychological well-being and its associated factors during the COVID-19 lockdown in a Tunisian-North African population
Authors: Guedria Asma , Slama Hela , Fredj Manel Ben , Miladi Shayma , Kefi Hamdi El , Gatti Syrine , Oumaya Abdelaziz
Published: November 2023

Background

The rapidly emerging Coronavirus infectious disease 2019 (COVID-19) has spread around the world yielding in significant changes in almost every aspect of daily life. While primary research of the epidemic COVID-19 has focused on the psychological impact on the general population and health professionals, no survey of the pandemic-resulting containment on parents and their children has been yet addressed in the Tunisian-North African population. This study aimed to assess the psychological profile of parents and youth in Tunisia during a period of COVID 19 lockdown, and to identify associated factors to parental anxiety symptoms.

Methods

This is an analytical cross-sectional study composed of a total of 538 adults including 464 mothers and 74 fathers. Parents of children aged less than 18 years completed an online survey (Google Forms) on the Psychological Impact of Confinement which includes the Generalized Anxiety Scale (GAD-7), the Parental Burnout Assessment (PBA), and the infantile trait-anxiety scale. The survey was initiated in May 2020 on a population of the Tunisian-North African citizens and lasted for more than 6 weeks.

Results

The median GAD-7 score was 11 corresponding to a moderate anxiety with 27.8% reporting severe anxiety. The median PBA score was 31 corresponding to a moderate risk of burnout, with 19.5% being affected. The children's anxiety scores were associated with their parents' anxiety ratings with 24% of the children reported signs of moderate anxiety.

Conclusions

The COVID-19 pandemic affected parental and their children’ psychological behavior due to a direct social isolation and distancing. Pediatricians need to be alerted on this issue and future measures are essential to avoid parental emotional burnout and anxiety disorder in similar situations.