bluuebunny/crossref_metadata_2025 huggingface dataset:
Concerns, Perceived Impact, Preparedness in Coronavirus Disease (COVID-19) Pandemic and Health Outcomes among Italian Physicians: A Cross-Sectional Study
Authors: Portoghese Igor , Meloni Federico , Galletta Maura , Piras Ilenia , D’Aloja Ernesto , Finco Gabriele , Campagna Marcello
Published: March 2021

Background:

Health care workers (HCWs) are among the professionals at serious risk for the impact of the COVID-19 pandemic on their mental health. In this sense, the next public health challenge globally will be to preserving healthy HCWs during this pandemic.

Aim:

The present study has the aim of investigating the relationship among concerns, perceived impact, preparedness for the COVID-19 pandemic and the mental health of Italian physicians.

Methods:

From March 29th to April 15th 2020, we conducted an online survey using snowball sampling techniques through Limesurvey platform. Data were analyzed using descriptive statistics and multiple binary logistic regressions.

Results:

Multivariate analysis showed that the risk factors for perceived job stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] P < .001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] P < .05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] P < .001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P < .05). With respect to the risk factors for rumination about the pandemic emerged concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P < .05), perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P < .05), and impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P < .05). Finally, the risk factors for crying at work were perceived impact on job role (OR = 2.47, [95% CI = 1.20-5.09] P < .05), rumination about the pandemic (OR = 3.027 [95% CI = 1.27-7.19] P < .01), watching colleagues crying at work (OR = 3.82 [95% CI = 1.88-7.77] P < .01), and perceived job stress (OR = 3.53 [95% CI = 1.24-10.07] P < .05).

Conclusion:

In general, our results highlighted that being concerned about being infected/infecting other people, carrying out new and unusual tasks, and witnessing colleagues crying at work were important risk factors for physicians’ well-being. Additional data are necessary to advance understanding of these risk factors in a long-term perspective.
Low-Income Caregivers’ Attitudes and Behaviors on Children’s Diets: Emergent Themes on Cultural Influences and Perceived Value of Nutrition Information from Healthcare Providers
Authors: Yu Kathleen , Wu Fanfan , Eisenberg Colman Miriam H
Published: March 2021

Introduction:

Limited access to affordable, healthy food and identifying as African-American or Hispanic-American are associated with greater risk of childhood obesity, especially for low-income individuals.

Purpose:

To report on (1) the emergent theme of the influence of culture on primary caregivers’ behaviors and motivations when preparing meals for their families; and (2) primary caregivers’ perceptions of the nutritional information they receive from health care providers.

Methods:

Twelve focus groups with low-income, adult primary caregivers of children ages 3 to 6 years were conducted in Texas and the DC-Maryland-Virginia region and were segmented by race/ethnicity and access to grocery stores.

Results:

Culture emerged as an important theme in influencing which foods participants cook at home. In some cases, that influence spilled over into the child’s diet. In other instances, the food that participants reported making for their children varied from the food they make for themselves. Participants reported having high trust in health care providers, but acknowledged that health care providers’ nutritional advice might not always be applicable.

Discussion and Conclusions:

Our findings highlight the importance of considering the role culture might play in influencing and informing caregivers’ decisions regarding children’s diets, and also better understanding caregivers’ perceptions of health care providers as a source of nutrition information for their children.
Evaluating the Appropriateness of Antibiotic Treatment of Tonsillitis during COVID-19 in the North Wale Primary Healthcare Setting
Authors: Li Chunhei , Ong Caitlin , Morris Anna , Woollons Isobel , Ashfaq Ahsan , Jagatia Rikesh
Published: March 2021

Background:

The COVID-19 pandemic has changed the delivery of primary care in the NHS. Consultations have largely moved from face-to-face to remote, forcing practitioners to modify the ways in which they deliver care to patients.

Aim:

In this study, we aim to investigate the appropriateness of antibiotic prescribing in tonsillitis during the COVID-19 pandemic.

Design and Setting:

An observational quantitative analysis in the North Wales primary care setting.

Method:

Retrospective review of computer records across 5 GP centers from March 2020 until the end of October 2020. Data was extracted and analyzed using chi-square or fisher exact rank and Mann–Whitney test.

Results:

Our results have shown no significant difference in antibiotic prescribing behavior comparing face-to-face and remote consultations.

Conclusion:

Remote consultation is as effective as face-to-face consultation with regards to the assessment of tonsillitis and the appropriateness of antibiotic prescription in primary care.
Online Mindfulness May Target Psychological Distress and Mental Health during COVID-19
Authors: Farris Suzan R , Grazzi Licia , Holley Miya , Dorsett Anna , Xing Kelly , Pierce Charles R , Estave Paige M , O’Connell Nathaniel , Wells Rebecca Erwin
Published: March 2021

Background

The COVID-19 pandemic has dramatically affected mental health, creating an urgent need for convenient and safe interventions to improve well-being. Online mindfulness interventions show promise for improving depression, anxiety, and general well-being.

Objective

To assess: 1) the impact of online mindfulness on psychological distress, 2) altruistic efforts, and 3) the quantity, quality, and availability of online mindfulness resources during the COVID-19 pandemic.

Methods

233 participants (203 U.S.; 20 international; 10 unknown) participated in this prospective, single-arm, non-randomized clinical trial of a single online mindfulness meditation session with pre- and post-surveys.

Main Outcome Measures

(a) Mindfulness session helpfulness, online platform effectiveness, and immediate pre- to post-session changes in momentary stress, anxiety, and COVID-19 concern; (b) qualitative themes representing how people are helping others during the pandemic; (c) absolute changes in quantity of mindfulness-oriented web content and free online mindfulness resource availability from May to August 2020.

Results

Most participants felt the online mindfulness session was helpful and the electronic platform effective for practicing mindfulness (89%, 95% CI: [82 to 93%]), with decreased momentary anxiety (76%; 95% CI: [69 to 83%]), stress (80%; [72 to 86%]), and COVID-19 concern (55%; [46 to 63%]), (p < 0.001 for each measure). Participants reported helping others in a variety of ways during the pandemic, including following public health guidelines, conducting acts of service and connection, and helping oneself in hopes of helping others. “Mindfulness + COVID” search results increased by 52% from May to August 2020. Most (73%) Academic Consortium for Integrative Medicine and Health member websites offer free online mindfulness resources.

Conclusions

Virtual mindfulness is an increasingly accessible intervention available world-wide that may reduce psychological distress during this isolating public health crisis. Kindness and altruism are being demonstrated during the pandemic. The consolidated online mindfulness resources provided may help guide clinicians and patients.
Single-Stage Posterior Approach for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament With K-line (−) Using Thick Cervical Pedicle Screw System: A Technical Note and Preliminary Results
Authors: Zhang Yue-Hui , Liu Hai-Tao , Zhou Fu-Chao , Song Jia , Shao Jiang
Published: March 2021

Study Design:

Technical note, retrospective case series.

Objective:

The optimal surgical strategy for multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with a negative kyphosis line (K-line (−)) remains controversial. We present a novel single-stage posterior approach that converts the K-line from negative to positive in patients with multilevel cervical OPLL, using a posterior thick cervical pedicle screw (CPS) system and report the procedure’s outcomes and feasibility.

Methods:

Twelve consecutive patients with multilevel cervical OPLL and K-line (−) underwent single-stage posterior thick CPS fixation, with laminectomy and foraminal decompression. A pre-bent rod was installed to convert the K-line from negative to positive. Radiographic parameters, including the extent and occupying ratio of OPLL and the C2-C7 angle, were examined. CPS accuracy was assessed using computed tomography. The Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores were analyzed. Quality of life was assessed using the Neck Disability Index (NDI). The mean OPLL extent was 5 vertebral body levels, and posterior decompression was performed on 4.2 segments.

Results:

The average C2-C7 angle and the occupying ratio of OPLL improved from −9.0° to 14.3° and from 63% to 33%, respectively. The preoperative JOA, VAS, and NDI scores significantly improved from 8.4 to 13.3, from 7.1 to 2.2, and from 21.9 to 9.3, respectively. The K-line was converted from negative to positive in all cases. No severe complications were identified.

Conclusion:

Single-stage posterior surgery with a thick CPS system may be a reliable and effective treatment for multilevel cervical OPLL and K-line (−).
Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa
Authors: Gu Lily Y. , Zhang Nanhua , Mayer Kenneth H. , McMahon James M. , Nam Soohyun , Conserve Donaldson F. , Moskow Marian , Brasch Judith , Adu-Sarkodie Yaw , Agyarko-Poku Thomas , Boakye Francis , Nelson LaRon E.
Published: March 2021

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.
The Effects of Ankle Joint Mobilization on Dorsiflexion Range and Gait Parameters in Chronic Stroke Survivors: A Systematic Review and Meta-analysis
Authors: Ravichandran Hariharasudhan , Janakiraman Balamurugan
Published: March 2021

Background:

Ankle dorsiflexion movement restriction is a common presentation in most of the chronic stroke survivors. Spasticity and connective tissue changes around ankle, limits dorsiflexion, and interferes with balance and gait performances. Improving functional range of dorsiflexion is essential in post-stroke rehabilitation.

Objectives:

This meta-analysis analyzed the effects of ankle mobilization techniques in improving dorsiflexion range and gait parameters among chronic stroke survivors.

Method:

Articles published up to July 2020 were searched in CINAHL, PubMed, Embase, PsyINFO, and OpenGrey. English version of randomized controlled trials (RCTs) assessing the effects of ankle joint mobilization among chronic stroke subjects, with dorsiflexion range of motion (ROM) and gait parameters as outcome, were included. Characteristics of participants, interventions, outcome measure, and measures of variability were extracted. Methodological quality of included trials was assessed using PEDro scale and Cochrane Collaboration tool for the risk of bias. Pooled standardized mean difference was calculated using random effects model for dorsiflexion ROM, gait velocity, step length, cadence, and timed up and go (TUG).

Results:

Eight RCTs including 226 stroke patients, with mean methodological score of 6 out of 10 in PEDro, were eligible for this meta-analysis. Ankle joint mobilization demonstrated statistically significant improvement on passive dorsiflexion ROM, gait velocity, step length (affected side), and cadence outcomes. Nonsignificance was found in step length (unaffected side) and in TUG.

Conclusion:

The ankle mobilization techniques are effective in improving passive dorsiflexion ROM, gait velocity, and cadence in chronic stroke survivors. However, the retention effect of ankle mobilization among stroke subjects is not known.
Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM
Authors: Cohen Flora , Yaeger Lauren
Published: March 2021

Background:

Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context.

Methods:

This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these interventions. Studies included varying interventions and modes of delivery within refugee camp and urban settings. A comprehensive search strategy led to the inclusion and analysis of 11 unique studies.

Results:

While current research documents adaptation strategies, feasibility, and fidelity checks through routine monitoring, there is still a dearth of evidence regarding capacity building of lay providers in humanitarian settings. Barriers to this data collection include a lack of homogeneity in outcomes across studies, and a lack of comprehensive adaptation strategies which account for culture norms in the implementation of interventions. Furthermore, current funding prioritizes short-term solutions for individuals who meet criteria for mental illnesses and therefore leaves gaps in sustainability, and more inclusive programming for psychosocial services for individuals who do not meet threshold criteria.

Conclusion:

Findings contribute to the literature about task-shifting for MHPSS in humanitarian contexts, especially illuminating gaps in knowledge about the lay counselor experiences of these interventions.

Plain language summary:

There is a growing number of refugees forced to make homes in temporary camps or urban centers as they await resettlement, a process that can last decades. These refugees are at risk of serious mental health outcomes due to ongoing stress and trauma. One strategy commonly used in global mental health is the training of lay providers to deliver basic mental health and psychosocial programming to communities. While this tactic is currently being tested in refugee settings, there is limited evidence about the implementation of this strategy. The following scoping review aims to assess the implementation of task-shifting interventions within refugee settings, through the use of a robust implementation science framework.
Gene therapy for hemophilia B using CB 2679d-GT: a novel factor IX variant with higher potency than factor IX Padua
Authors: Nair Nisha , De Wolf Dries , Nguyen Phuong Anh , Pham Quang Hong , Samara-Kuko Ermira , Landau Jeff , Blouse Grant E. , Chuah Marinee K. , VandenDriessche Thierry
Published: March 2021

Sustained expression of therapeutic factor IX (FIX) levels has been achieved after adeno-associated viral (AAV) vector-based gene therapy in patients with hemophilia B. Nevertheless, patients are still at risk of vector dose-limiting toxicity, particularly liver inflammation, justifying the need for more efficient vectors and a lower dosing regimen. A novel increased potency FIX (designated as CB 2679d-GT), containing 3 amino acid substitutions (R318Y, R338E, T343R), significantly outperformed the R338L-Padua variant after gene therapy. CB 2679d-GT demonstrated a statistically significant approximately threefold improvement in clotting activity when compared with R338L-Padua after AAV-based gene therapy in hemophilic mice. Moreover, CB 2679d-GT gene therapy showed significantly reduced bleeding time (approximately fivefold to eightfold) and total blood loss volume (approximately fourfold) compared with mice treated with the R338L-Padua, thus achieving more rapid and robust hemostatic correction. FIX expression was sustained for at least 20 weeks with both CB 2679d-GT and R338L-Padua whereas immunogenicity was not significantly increased. This is a novel gene therapy study demonstrating the superiority of CB 2679d-GT, highlighting its potential to obtain higher FIX activity levels and superior hemostatic efficacy following AAV-directed gene therapy in hemophilia B patients than what is currently achievable with the R338L-Padua variant.
Plasminogen: an enigmatic zymogen
Authors: Keragala Charithani B. , Medcalf Robert L.
Published: March 2021

Plasminogen is an abundant plasma protein that exists in various zymogenic forms. Plasmin, the proteolytically active form of plasminogen, is known for its essential role in fibrinolysis. To date, therapeutic targeting of the fibrinolytic system has been for 2 purposes: to promote plasmin generation for thromboembolic conditions or to stop plasmin to reduce bleeding. However, plasmin and plasminogen serve other important functions, some of which are unrelated to fibrin removal. Indeed, for >40 years, the antifibrinolytic agent tranexamic acid has been administered for its serendipitously discovered skin-whitening properties. Plasmin also plays an important role in the removal of misfolded/aggregated proteins and can trigger other enzymatic cascades, including complement. In addition, plasminogen, via binding to one of its dozen cell surface receptors, can modulate cell behavior and further influence immune and inflammatory processes. Plasminogen administration itself has been reported to improve thrombolysis and to accelerate wound repair. Although many of these more recent findings have been derived from in vitro or animal studies, the use of antifibrinolytic agents to reduce bleeding in humans has revealed additional clinically relevant consequences, particularly in relation to reducing infection risk that is independent of its hemostatic effects. The finding that many viruses harness the host plasminogen to aid infectivity has suggested that antifibrinolytic agents may have antiviral benefits. Here, we review the broadening role of the plasminogen-activating system in physiology and pathophysiology and how manipulation of this system may be harnessed for benefits unrelated to its conventional application in thrombosis and hemostasis.
MARCKS affects cell motility and response to BTK inhibitors in CLL
Authors: Beckmann Laura , Berg Valeska , Dickhut Clarissa , Sun Clare , Merkel Olaf , Bloehdorn Johannes , Robrecht Sandra , Seifert Marc , da Palma Guerreiro Alexandra , Claasen Julia , Loroch Stefan , Oliverio Matteo , Underbayev Chingiz , Vaughn Lauren , Thomalla Daniel , Hülsemann Malte F. , Tausch Eugen , Fischer Kirsten , Fink Anna Maria , Eichhorst Barbara , Sickmann Albert , Wendtner Clemens M. , Stilgenbauer Stephan , Hallek Michael , Wiestner Adrian , Zahedi René P. , Frenzel Lukas P.
Published: March 2021

Bruton tyrosine kinase (BTK) inhibitors are highly active drugs for the treatment of chronic lymphocytic leukemia (CLL). To understand the response to BTK inhibitors on a molecular level, we performed (phospho)proteomic analyses under ibrutinib treatment. We identified 3466 proteins and 9184 phosphopeptides (representing 2854 proteins) in CLL cells exhibiting a physiological ratio of phosphorylated serines (pS), threonines (pT), and tyrosines (pY) (pS:pT:pY). Expression of 83 proteins differed between unmutated immunoglobulin heavy-chain variable region (IGHV) CLL (UM-CLL) and mutated IGHV CLL (M-CLL). Strikingly, UM-CLL cells showed higher basal phosphorylation levels than M-CLL samples. Effects of ibrutinib on protein phosphorylation levels were stronger in UM-CLL, especially on phosphorylated tyrosines. The differentially regulated phosphopeptides and proteins clustered in pathways regulating cell migration, motility, cytoskeleton composition, and survival. One protein, myristoylated alanine-rich C-kinase substrate (MARCKS), showed striking differences in expression and phosphorylation level in UM-CLL vs M-CLL. MARCKS sequesters phosphatidylinositol-4,5-bisphosphate, thereby affecting central signaling pathways and clustering of the B-cell receptor (BCR). Genetically induced loss of MARCKS significantly increased AKT signaling and migratory capacity. CD40L stimulation increased expression of MARCKS. BCR stimulation induced phosphorylation of MARCKS, which was reduced by BTK inhibitors. In line with our in vitro findings, low MARCKS expression is associated with significantly higher treatment-induced leukocytosis and more pronounced decrease of nodal disease in patients with CLL treated with acalabrutinib.
A rapid genotyping panel for detection of primary central nervous system lymphoma
Authors: Gupta Mihir , Burns Evan J. , Georgantas Nicholas Z. , Thierauf Julia , Nayyar Naema , Gordon Amanda , Jones SooAe S. , Pisapia Michelle , Sun Ying , Burns Ryan P. , Velarde Jose , Jordan Justin T. , Frigault Matthew J. , Nahed Brian V. , Jones Pamela S. , Barker Fred G. , Curry William T. , Gupta Rajiv , Batchelor Tracy T. , Romero Javier M. , Brastianos Priscilla K. , Marble Hetal D. , Martinez-Lage Maria , Tateishi Kensuke , Lennerz Jochen K. , Dietrich Jorg , Cahill Daniel P. , Carter Bob S. , Shankar Ganesh M.
Published: March 2021

Diagnosing primary central nervous system lymphoma (PCNSL) frequently requires neurosurgical biopsy due to nonspecific radiologic features and the low yield of cerebrospinal fluid (CSF) studies. We characterized the clinical evaluation of suspected PCNSL (N = 1007 patients) and designed a rapid multiplexed genotyping assay for MYD88, TERT promoter, IDH1/2, H3F3A, and BRAF mutations to facilitate the diagnosis of PCNSL from CSF and detect other neoplasms in the differential diagnosis. Among 159 patients with confirmed PCNSL, the median time to secure a diagnosis of PCNSL was 10 days, with a range of 0 to 617 days. Permanent histopathology confirmed PCNSL in 142 of 152 biopsies (93.4%), whereas CSF analyses were diagnostic in only 15/113 samplings (13.3%). Among 86 archived clinical specimens, our targeted genotyping assay accurately detected hematologic malignancies with 57.6% sensitivity and 100% specificity (95% confidence interval [CI]: 44.1% to 70.4% and 87.2% to 100%, respectively). MYD88 and TERT promoter mutations were prospectively identified in DNA extracts of CSF obtained from patients with PCNSL and glioblastoma, respectively, within 80 minutes. Across 132 specimens, hallmark mutations indicating the presence of malignancy were detected with 65.8% sensitivity and 100% specificity (95% CI: 56.2%-74.5% and 83.9%-100%, respectively). This targeted genotyping approach offers a rapid, scalable adjunct to reduce diagnostic and treatment delays in PCNSL.
The risk of community-acquired pneumonia in children using gastric acid suppressants
Authors: van der Sande Linda J.T.M. , Jöbsis Quirijn , Bannier Michiel A.G.E. , van de Garde Ewoudt M.W. , Coremans Jan J.M. , de Vries Frank , Dompeling Edward , Driessen Johanna H.M.
Published: March 2021

Background

With the increased use of acid suppressants, significant potential complications such as community-acquired pneumonia (CAP) are becoming more apparent. Paradoxically, in spite of an increased focus on potential complications, there is an increased use of acid suppressants in children and a lack of data specifically targeting the association between acid suppressants and CAP. Our main objective was to evaluate the risk of CAP in children using acid suppressants (proton pump inhibitors (PPIs) and/or histamine-2 receptor antagonists (H2RAs)).

Methods

We performed a cohort study using data from the UK Clinical Practice Research Datalink. All patients aged 1 month to 18 years with a prescription of acid suppressants were included and matched to up to four unexposed children. Time-varying Cox proportional hazards models were used to estimate the risk of CAP. The cohort consisted of 84 868 exposed and 325 329 unexposed children.

Results

Current use of PPIs and H2RAs was associated with an increased risk of CAP (adjusted hazard ratio 2.05 (95% CI 1.90–2.22) and 1.80 (95% CI 1.67–1.94), respectively). The risk was even greater in patients with respiratory disease. Long-term use (≥211 days) of PPIs and H2RAs led to a significantly greater risk of CAP compared with short-term use (<31 days). After cessation of therapy, the risk remained increased for the following 7 months.

Conclusion

The use of acid suppressants in children was associated with a doubled risk of CAP. This risk increased with chronic use and respiratory disease, and remained increased after discontinuation of therapy.
Blood eosinophil counts and the development of obstructive lung disease: the Kangbuk Samsung Health Study
Authors: Park Hye Yun , Chang Yoosoo , Kang Danbee , Hong Yun Soo , Zhao Di , Ahn Jiin , Shin Sun Hye , Singh Dave , Guallar Eliseo , Cho Juhee , Ryu Seungho
Published: March 2021

Aim

The impact of blood eosinophil counts on the development of chronic obstructive lung disease (COPD) is unknown. We investigated whether a higher blood eosinophil count was associated with the risk of developing obstructive lung disease (OLD) in a large cohort of men and women free from lung disease at baseline.

Methods

This was a cohort study of 359 456 Korean adults without a history of asthma and without OLD at baseline who participated in health screening examinations including spirometry. OLD was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 and FEV1<80% predicted.

Results

After a median (interquartile range) follow-up of 5.6 (2.9–9.2) years, 5008 participants developed incident OLD (incidence rate 2.1 (95% CI 2.1–2.2) per 1000 person-years). In the fully adjusted model, the hazard ratios for incident OLD comparing eosinophil counts of 100– <200, 200– <300, 300– <500 and ≥500versus<100 cells·μL−1were 1.07 (95% CI 1.00–1.15), 1.30 (95% CI 1.20–1.42), 1.46 (95% CI 1.33–1.60) and 1.72 (95% CI 1.51–1.95), respectively (ptrend<0.001). These associations were consistent in clinically relevant subgroups, including never-, ex- and current smokers.

Conclusion

In this large longitudinal cohort study, blood eosinophil counts were positively associated with the risk of developing of OLD. Our findings indicate a potential role of the eosinophil count as an independent risk factor for developing COPD.
Referral criteria to palliative care for patients with respiratory disease: a systematic review
Authors: Philip Jennifer , Collins Anna , Smallwood Natasha , Chang Yuchieh Kathryn , Mo Li , Yang Ian A. , Corte Tamera , McDonald Christine F. , Hui David
Published: March 2021

Aims

Advanced nonmalignant respiratory diseases are associated with significant patient morbidity, yet access to palliative care occurs late, if at all. Our aim was to examine referral criteria for palliative care among patients with advanced nonmalignant respiratory disease, with a view to developing a standardised set of referral criteria.

Methods

We performed a systematic review of all studies reporting on referral criteria to palliative care in advanced nonmalignant respiratory disease, with a focus on chronic obstructive pulmonary disease and interstitial lung disease. The systematic review was conducted and reported according to the PRISMA guidelines, and was undertaken using electronic databases (Ovid, MEDLINE, Ovid Embase and PubMed).

Results

Searches yielded 2052 unique titles, which were screened for eligibility and resulted in 62 studies addressing referral criteria to palliative care in advanced nonmalignant respiratory disease. Of 18 categories put forward for referral to palliative care, the most commonly discussed factors were hospital use (69% of papers), indicators of poor respiratory status (47%), physical and emotional symptoms (37%), functional decline (29%), need for advanced respiratory therapies (27%), and disease progression (26%).

Conclusion

Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced nonmalignant respiratory illnesses.
The differing physiology of nitrogen and tracer gas multiple-breath washout techniques
Authors: Sandhu Dominic , Ritchie Grant A.D. , Robbins Peter A.
Published: March 2021

Background

Multiple-breath washout techniques are increasingly used to assess lung function. The principal statistic obtained is the lung clearance index (LCI), but values obtained for LCI using the nitrogen (N2)-washout technique are higher than those obtained using an exogenous tracer gas such as sulfur hexafluoride. This study explored whether the pure oxygen (O2) used for the N2washout could underlie these higher values.

Methods

A model of a homogenous, reciprocally ventilated acinus was constructed. Perfusion was kept constant, and ventilation adjusted by varying the swept volume during the breathing cycle. The blood supplying the acinus had a standard mixed-venous composition. Carbon dioxide and O2exchange between the blood and acinar gas proceeded to equilibrium. The model was initialised with either air or air plus tracer gas as the inspirate. Washouts were conducted with pure O2for the N2washout or with air for the tracer gas washout.

Results

At normal ventilation/perfusion (V′/Q′) ratios, the rate of washout of N2and exogenous tracer gas was almost indistinguishable. At lowV′/Q′, the N2washout lagged the tracer gas washout. At very lowV′/Q′, N2became trapped in the acinus. Under lowV′/Q′ conditions, breathing pure O2introduced a marked asymmetry between the inspiratory and expiratory gas flow rates that was not present when breathing air.

Discussion

The use of pure O2to washout N2increases O2uptake in lowV′/Q′ units. This generates a background gas flow into the acinus that opposes flow out of the acinus during expiration, and so delays the washout of N2.
WASP: a versatile, web-accessible single cell RNA-Seq processing platform
Authors: Hoek Andreas , Maibach Katharina , Özmen Ebru , Vazquez-Armendariz Ana Ivonne , Mengel Jan Philipp , Hain Torsten , Herold Susanne , Goesmann Alexander
Published: March 2021

Background

The technology of single cell RNA sequencing (scRNA-seq) has gained massively in popularity as it allows unprecedented insights into cellular heterogeneity as well as identification and characterization of (sub-)cellular populations. Furthermore, scRNA-seq is almost ubiquitously applicable in medical and biological research. However, these new opportunities are accompanied by additional challenges for researchers regarding data analysis, as advanced technical expertise is required in using bioinformatic software.

Results

Here we present WASP, a software for the processing of Drop-Seq-based scRNA-Seq data. Our software facilitates the initial processing of raw reads generated with the ddSEQ or 10x protocol and generates demultiplexed gene expression matrices including quality metrics. The processing pipeline is realized as a Snakemake workflow, while an R Shiny application is provided for interactive result visualization. WASP supports comprehensive analysis of gene expression matrices, including detection of differentially expressed genes, clustering of cellular populations and interactive graphical visualization of the results. The R Shiny application can be used with gene expression matrices generated by the WASP pipeline, as well as with externally provided data from other sources.

Conclusions

With WASP we provide an intuitive and easy-to-use tool to process and explore scRNA-seq data. To the best of our knowledge, it is currently the only freely available software package that combines pre- and post-processing of ddSEQ- and 10x-based data. Due to its modular design, it is possible to use any gene expression matrix with WASP’s post-processing R Shiny application. To simplify usage, WASP is provided as a Docker container. Alternatively, pre-processing can be accomplished via Conda, and a standalone version for Windows is available for post-processing, requiring only a web browser.
Sex differences in the association between latent class of lifestyle and disability among older adults in China
Authors: Shi Zaixing , Lin Jianlin , Xiao Jian , Fang Ya
Published: March 2021

Background

A healthy lifestyle may prevent disability for older adults. But research to date is limited to a single lifestyle behavior and ignore sex difference in the lifestyle-disability association. This study aimed at identifying sex-specific latent classes of lifestyle and their relationship with disability among older Chinese adults.

Methods

Data were obtained from adults aged 65 years or above in the 2018 Chinese Longitudinal Healthy Longevity Survey, a nationally representative sample of older adults in China. We used latent class analysis to categorize participants into subgroups based on three dimensions of lifestyle factors: health behaviors, psychological wellbeing, and social engagement. Disability was assessed by the activities of daily living (ADL). Multivariable logistic regression was used to evaluate the associations between the latent lifestyle classes and disability.

Results

A total of 15,771 older adults were included in this analysis, of whom 56% were women and 66% aged 80 years or above. We identified four latent lifestyle classes among older women: “Health Promoting” (28%), “Isolated and Health Harming” (34%), “Restless and Dismal” (21%), and “Restless” (17%). A different set of four lifestyle classes were identified in older men: “Health Promoting” (21%), “Isolated and Health Harming” (26%), “Restless and Dismal” (20%), and “Discordant” (33%). Compared with the “Health Promoting” class, the “Isolated and Health Harming” class (OR = 1.88, 95% CI: 1.46–2.43) and the “Restless and Dismal” class (OR = 1.67, 95% CI: 1.27–2.20) had higher risk of disability in women. The “Discordant” class had lower risk of disability in men (OR = 0.52, 95% CI: 0.37–0.72).

Conclusions

Our analyses revealed different lifestyle patterns for older women and men in China. Sex differences in the associations between lifestyle and disability need to be considered when formulating interventions to prevent disability.
Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China
Authors: Xiao Wenhui , Huang Dajiang , Li Saiqiong , Zhou Shangcheng , Wei Xiaolin , Chen Bin , Zou Guanyang
Published: March 2021

Background

Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay.

Methods

Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM.

Results

Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%,p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627,p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626,p < 0.05) were more likely to have a total diagnostic delay of> 14 days.

Conclusions

Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.
Close contact infection dynamics over time: insights from a second large-scale social contact survey in Flanders, Belgium, in 2010-2011
Authors: Hoang Thang Van , Coletti Pietro , Kifle Yimer Wasihun , Kerckhove Kim Van , Vercruysse Sarah , Willem Lander , Beutels Philippe , Hens Niel
Published: March 2021

Background

In 2010-2011, we conducted a social contact survey in Flanders, Belgium, aimed at improving and extending the design of the first social contact survey conducted in Belgium in 2006. This second social contact survey aimed to enable, for the first time, the estimation of social mixing patterns for an age range of 0 to 99 years and the investigation of whether contact rates remain stable over this 5-year time period.

Methods

Different data mining techniques are used to explore the data, and the age-specific number of social contacts and the age-specific contact rates are modelled using a generalized additive models for location, scale and shape (GAMLSS) model. We compare different matrices using assortativeness measures. The relative change in the basic reproduction number (R0) and the ratio of relative incidences with 95% bootstrap confidence intervals (BCI) are employed to investigate and quantify the impact on epidemic spread due to differences in sex, day of the week, holiday vs. regular periods and changes in mixing patterns over the 5-year time gap between the 2006 and 2010-2011 surveys. Finally, we compare the fit of the contact matrices in 2006 and 2010-2011 to Varicella serological data.

Results

All estimated contact patterns featured strong homophily in age and sex, especially for small children and adolescents. A 30% (95% BCI [17%; 37%]) and 29% (95% BCI [14%; 40%]) reduction in R0 was observed for weekend versus weekdays and for holiday versus regular periods, respectively. Significantly more interactions between people aged 60+ years and their grandchildren were observed on holiday and weekend days than on regular weekdays. Comparing contact patterns using different methods did not show any substantial differences over the 5-year time period under study.

Conclusions

The second social contact survey in Flanders, Belgium, endorses the findings of its 2006 predecessor and adds important information on the social mixing patterns of people older than 60 years of age. Based on this analysis, the mixing patterns of people older than 60 years exhibit considerable heterogeneity, and overall, the comparison of the two surveys shows that social contact rates can be assumed stable in Flanders over a time span of 5 years.
Home-based exercise and bone mineral density in peritoneal dialysis patients: a randomized pilot study
Authors: Watanabe Kumi , Kamijo Yuka , Yanagi Mai , Ishibashi Yoshitaka , Harada Taku , Kohzuki Masahiro
Published: March 2021

Background

The prevalence of osteopenia and osteoporosis is higher in patients with chronic kidney disease than that in the general population. Although physical exercise prevents bone loss in hemodialysis (HD) patients, previous studies have not focused on peritoneal dialysis (PD) patients. Therefore, we aimed to evaluate the effects of home-based exercise on bone mineral density (BMD) in patients with PD.

Methods

Stable outpatients undergoing PD were randomly assigned to the intervention group (n = 26; male, 20; median age, 66 years) or usual-care group (n = 27; male, 21; median age, 64 years). Patients in the intervention group performed home-based exercises (resistance exercise, stretching, and aerobic exercise such as walking) for 6 months, whereas those in the usual-care group performed stretching and their usual physical activity. Based on dual X-ray absorptiometry, the primary outcomes were the BMD data of the lumbar spine and proximal femoral neck. Secondary outcomes included physical function and physical activity. Pre- and post-intervention values were compared.

Results

There was no significant within-group change in the BMD of the lumbar spine, femoral neck, and hip after 6 months of the exercise program. The intervention group had significantly improved 30-s chair-stand test, 6-min walk test, and physical activity results.

Conclusions

Home-based exercises in patients with PD did not improve BMD at any of the sites evaluated. Improvement in physical function and physical activity may reduce the risk of falls in patients with PD.

Trial registration

UMIN Clinical Trials Registry, UMIN000041678. Registered September 4, 2020; retrospectively registered.
Psychometric properties of a Persian version of respectful maternity care questionnaire
Authors: Esmkhani Mina , Namadian Masoumeh , Nooroozy Ali , Korte Jeffrey E.
Published: March 2021

Background

Providing high quality and respectful care during pregnancy and birth is one of the ways to reduce complications in women. Respectful care is a type of care that requires a valid instrument to measure. This study was conducted to determine the validity and reliability of the Persian version of the Respectful Maternity Care (RMC) questionnaire in 2018.

Methods

This study was performed with 150 women (in the first 48 h after birth), who were admitted in the postpartum wards of public hospitals from 1st January until 6th April 2018 in Zanjan city in Iran. Participants were selected randomly using the Poisson distribution (Time) sampling method. After receiving permission from the questionnaire’s author, the internal consistency of the tool was measured by Cronbach’s alpha coefficient after the Forward translation of the Persian version of the tool under expert supervision. The reliability of the modified questionnaire was assessed using a test-retest method in 10 eligible postpartum women, who completed the same questionnaire again after 72 h. The validity of the tool was confirmed by exploratory and confirmatory factor analysis using LISREL and SPSS software.

Results

The original RMC tool achieved an overall high internal reliability (α = 0.839). Confirmatory factor analysis of original RMC scores demonstrated poor fit indices. In LISREL proposed paths for the model, one item was excluded and a re-exploratory factor analysis was performed with the remaining 14 items. Four new subscales were defined for the revised tool including Abusive Care, Effective Care, Friendly Care, and Respectful Communication, which explained 60% of the variance.

Conclusions

The revised tool included four subscales of Abusive Care, Effective Care, Friendly Care, and Respectful Communication in 14 items which explained 60% of the variance. Given the importance of providing high quality maternity care, and the variety of cultures and birth services across different countries, further research is needed on this RMC tool to evaluate its use in other countries and regions.
What explains the inequalities in health care utilization between immigrants and non-migrants in Switzerland?
Authors: Tzogiou Christina , Boes Stefan , Brunner Beatrice
Published: March 2021

Background

Inequalities in health care use between immigrants and non-migrants are an important issue in many countries, with potentially negative effects on population health and welfare. The aim of this study is to understand the factors that explain these inequalities in Switzerland, a country with one of the highest percentages of foreign-born population.

Methods

Using health survey data, we compare non-migrants to four immigrant groups, differentiating between first- and second-generation immigrants, and culturally different and similar immigrants. To retrieve the relative contribution of each inequality-associated factor, we apply a non-linear decomposition method and categorize the factors into demographic, socio-economic, health insurance and health status factors.

Results

We find that non-migrants are more likely to visit a doctor compared to first-generation and culturally different immigrants and are less likely to visit the emergency department. Inequalities in doctor visits are mainly attributed to the explained component, namely to socio-economic factors (such as occupation and income), while inequalities in emergency visits are mainly attributed to the unexplained component. We also find that despite the universal health care coverage in Switzerland systemic barriers might exist.

Conclusions

Our results indicate that immigrant-specific policies should be developed in order to improve access to care and efficiently manage patients in the health system.