bluuebunny/crossref_metadata_2025 huggingface dataset:
Uptake of cervical screening and acceptability of HPV self-sampling in Irish Traveller women
Authors: O’Flynn A , Fitzpatrick P , Jalal R , Frazer K , Joye R , Collins M B , Kavanagh L , McCarthy T , McEnery M , Fox P
Published: October 2024

Introduction

Irish Travellers are a minority ethnic group. The 2010 All-Ireland Traveller Health Study noted the life expectancy of Traveller women was 11 years shorter than women in the general population. Coverage of the CervicalCheck, the Irish cervical screening programme, is 78.7% overall, however, there is no recently published data on the attendance of Traveller women. This study sought to determine participation by eligible Traveller women in CervicalCheck and the acceptability of HPV self-sampling.

Methodology

A face-to-face cross-sectional survey, adapted from the National Cancer Control Programme’s 2022 National Survey on Cancer Awareness, was disseminated to Irish Travellers via Primary Health Care Travellers Project peer researchers, following ethical approval, May to December 2023.

Results

451 Travellers participated; 286 (63.4%) were female. Of these, 178 (62.2%) were in the eligible age group for cervical screening. 134 (75.3%) advised they had received an invitation to screening; 121 (68% of all eligible; 90% of all receiving an invitation) advised they had attended at least once (regular attenders 88 (49.4%); 27 (15.2%) irregular attenders). Of all responders in the screening eligible age group, 36 (20.2%) reported HPV self-sampling as acceptable; 18 (50%) of these were non or irregular attenders at screening. Similar proportions of 25-45 year-olds (20.4%) and 46-65 year-olds (20%) reported HPV self-sampling as acceptable.

Conclusions

Irish Traveller women face barriers to accessing mainstream health services. Uptake of cervical screening overall is lower compared to the general population in this study; one issue may be unreliable postal service to Travellers and non-receipt of invitations. While the overall acceptability of HPV self-sampling was low at 20.2%, half of those who would self-sample did not attend or attended irregularly. HPV self-sampling has the potential to improve cervical screening rates among Traveller women.

Key messages

• Irish Traveller women’s uptake of cervical screening is lower than general population.

• HPV self sampling has potential to improve cervical screening rates in Travellers.
Can health communication improve newly settled refugees’ health literacy? A quasi-experimental study
Authors: Al-Adhami M , Durbeej N , Daryani A , Larsson E , Wångdahl J , Salari R
Published: October 2024

Structural and contextual factors such as limited work opportunities, inadequate housing options and discrimination negatively affect the health and well-being of newly settled refugee migrants in European countries. In Sweden, health promotion initiatives aiming at strengthening health, resilience and integration have been tried out within the Introduction Program for refugee migrants. The main component of these interventions has been educational activities in the form of health communication. Generally evaluated from the perspectives of participants and course leaders, longitudinal evaluations remain rare. The current study aimed to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in general self-rated health, psychological well-being or emotional and practical support. The findings indicate that added health communication embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed change in health literacy and its translation into long-term advances in health and integration.

Key messages

• Added health communication provided within the Introduction Program for refugee migrants can increase health literacy.

• Increased health literacy may be beneficial for newly settled refugees as it is linked to improved health-seeking behavior, better health outcomes and empowerment.
Co-creating stigma-prevention strategies for mental health interventions with migrant populations
Authors: Teixeira R , Tol W , Sanna L , Prina E , Thomsen C , Marti Castaner M , de Freitas C
Published: October 2024

Background

The ADVANCE project aims to address mental health disparities among people in a situation of vulnerability in Europe. Through a co-creation approach, workshops were conducted to devise stigma prevention strategies during the implementation of mental health promotion interventions for migrant populations in Italy and Denmark.

Methods

The methodology involved two rounds of scenario-based workshops, a participatory method that elicit expert opinions to solve local problems and anticipate future ones. Round 1 included two separate workshops with (1) end-users and umbrella organizations, and (2) healthcare practitioners and decision-makers, to ensure diverse perspectives and minimize the impact of power imbalances. Participants brainstormed strategies to minimize stigma and optimize the intervention scenario. In Round 2, a mixed-group workshop was held to refine the strategies. Workshops occurred in Copenhagen and Verona in March 2024. Content analysis of the data was carried out.

Results

In Denmark, discussions emphasized tailored presentation of the intervention promoting shared experiences and normalizing mental health challenges, language sensitivity, participation through self-identification, and attention to relational aspects in intervention delivery to combat stigma effectively and enhance acceptability and engagement with the intervention. In Italy, proposed strategies included group exercises to raise awareness and promote open dialogue about cultural differences, language barriers, and discrimination. Discussions also considered the intersectionality of stigma, including factors like gender, socioeconomic status, and sexual orientation. Common themes included language sensitivity, facilitator training, and inclusive and safe spaces.

Conclusions

Scenario-based workshops can be a valuable tool to facilitate the co-creation of stigma-prevention strategies while involving all stakeholders in promoting effective mental health interventions.

Key messages

• Co-creation approach fostered stakeholder collaboration, yielding tailored strategies that promote inclusivity, acceptability and engagement with mental health interventions for migrant populations.

• Context-specific approaches that emphasize trust, confidentiality and cultural sensitivity were prioritised to tackle stigma when implementing interventions and promoting mental health equity.
Socioeconomic inequalities in cervical cancer screening in sub-Saharan Africa: Decomposition analysis
Authors: Ahinkorah B , Aboagye R , Okyere J , Essuman M , Seidu A , Wongnaah A
Published: October 2024

Background

Cervical cancer remains prevalent in sub-Saharan Africa (SSA). Despite global efforts to eliminate this disease, its incidence continues to rise due to barriers in screening, vaccination, and treatment access. While studies address access barriers, little has explored inequality, often limited to single countries. Here, we examine socioeconomic inequalities in cervical cancer screening in SSA.

Methods

Data from the Demographic and Health Surveys of 10 SSA countries was used for the analysis. We stratified the study by wealth index and educational attainment as a measure of socioeconomic status. Socioeconomic status inequalities in cervical cancer screening were constructed using concentration curves. We then computed the concentration index to quantify socioeconomic inequality. To examine the factors associated with high socioeconomic inequality in cervical cancer screening, a decomposition analysis was conducted.

Results

Concentration curves showed screening uptake skewed towards the wealthy and educated across all countries, reflected by positive concentration indices (CIX=0.21; p-value<0.0001) except in Burkina Faso and Mauritius. Decomposition analysis revealed significant positive concentration indices for women with complete secondary (CIX=0.74) and higher education (CIX=0.91), those in the richest wealth index (CIX=0.35), separated women (CIX=0.08), currently working women (CIX=0.02), as well as those who were exposed to reading newspaper/magazine (CIX=0.19), listening to radio (CIX=0.10), and watching TV (CIX=0.44).

Conclusions

Cervical cancer screening in SSA exhibits pro-rich and pro-higher educational inequalities. Urgent interventions are needed to restructure existing screening programs to prioritize accessibility and inclusion, particularly for women from poorer households and with a lower level of education. These findings are vital for policymakers and public health practitioners to address cervical cancer screening disparities in SSA.

Key messages

• Addressing socioeconomic inequalities in cervical cancer screening is crucial for improving public health in sub-Saharan Africa.

• Combatting socioeconomic disparities in cervical cancer screening is critical for achieving health equity in sub-Saharan Africa.
Institutionalising guideline development in a new universal healthcare system: a study in Cyprus
Authors: Kolokotroni O , McGuire H , Kyriakou M , Kouis P , Sioftanos A , Yiallourou A , Achilleos H , Yiallouros P , Nikolopoulos G
Published: October 2024

Issue

Guideline development is a lengthy and diligent process that involves the assessment and interpretation of evidence by a committee. Whilst the implementation of high quality healthcare guidelines ensures consistency and quality in healthcare delivery, many countries worldwide, including Cyprus, lack the capacity and resources to develop de novo guidelines.

Description of the problem

Guidelines developed by internationally recognised organisations, such as NICE, are a valuable resource for countries like Cyprus. The collaboration between NICE and the newly established healthcare system in Cyprus introduced a process for guideline institutionalisation, taking advantage of existing human resources and building guideline development capability in Cyprus.

Results

This process involved recruiting local professionals to form a guideline secretariat. The secretariat, supported by NICE, is responsible for overseeing the guideline development process including technical expert committee (TEC) recruitment and stakeholder consultation. The TEC contextualise an existing NICE guidelines to reflect local considerations. NICE provides quality assurance to ensure changes are contextual in nature and consistent with the underpinning evidence. Despite initial challenges, getting stakeholder buy-in and engaging healthcare professionals in the TEC, one contextualised guideline has been produced and two others are at the final stage.

Lessons

Guideline contextualisation is an efficient and sustainable way of building guideline development capability to institutionalize guidelines in settings with limited capacity.

Key messages

• De-novo guideline development is time consuming and demanding and many countries require an alternative process for producing locally relevant guidelines, capitalising on existing resources.

• Support by an established organisation ensures quality, is less resource intensive, and builds capability for the sustainability of the process.
In at the Deep End: Innovative approaches to engaging underserved communities in Northern England
Authors: Jeffries J , Wearn A , Hassan S , Fryer K , Mitchell C , Sowden S
Published: October 2024

Background

People living in socio-economically deprived communities have greater health needs, but worse access and outcomes from care. A growing international movement of Deep End (DE) general practice networks established to promote health equity, address challenges posed by the inverse care law and advocate for increased research involvement. Researchers, community members and practitioners in the North of England are exploring ways of engaging with underserved communities and addressing low levels of inclusion in research.

Methods

DE research i) co-designing the North East and North Cumbria (NENC) DE network with practitioners to prioritise service investment, research activities and initiatives for local communities; ii) Deep End Research Alliance Yorkshire and Humber (DERA-YH) and Participatory Action Research to increase research capacity and reflect upon the evolution of a novel primary care Community Research Link Worker role (CRLWs).

Results

Prioritisation activities in the NENC DE network, uncovered the volume and complexity of clinical and social need, leading to the co-design and evaluation of initiatives to improve mental health care, increase childhood immunisations, tailor deprescribing, support training, and increase patient inclusion in research. In the DERA-YH, the CRLW model increased participation in research from ethnic minority communities regarding prostate cancer, lung health, dementia, and contraceptive services. Community leaders stated that sharing resources and power in the research process builds trust and interest in research in their communities.

Conclusions

DE networks in Northern England have driven innovative approaches to engage underserved communities in research, fostering empowering and enduring relationships to address health and care inequalities. Co-design methodologies and CRLWs integration into research teams had a transformative impact on the accessibility of research for communities and for the researchers’ positionality.

Key messages

• Deep End networks are advancing approaches to meaningful engagement and partnership working with underserved communities, to address health, care and research participation inequalities.

• We recommend co-design by default and CRLW models to build capacity and embed reflective practice, mutual respect, and power sharing across the research team.
Unmet health needs during COVID-19 pandemic in Serbia
Authors: Jakovljevic M , Matejic B , Cirkovic A , Mladenovic Jankovic S
Published: October 2024

Background

The COVID-19 pandemic made health care access more difficult. This study provides insight into significant individual factors associated with unmet needs in 2021 in Serbia.

Methods

The study is a secondary analysis of SILC data, conducted on a sample of 13,855 respondents aged 16 + (source: Statistical Office of the Republic of Serbia). The outcome variable is self-reported unmet need for physician service in last 12 months (yes/no). Multivariate logistic regression is used to identify factors significantly related to unmet needs. Demographic, socioeconomic factors and health needs, which have been found to be significant for outcome in univariate logistic regression, are entered in final analysis.

Results

It was shown that age, marital, employment status, income and health needs were significant factors for unmet needs. Compared to 16-24 age group, aged 65+ were more likely to report unmet needs, OR = 3.5(CI = 2.1-5.6); for 45-64 years old OR = 3.4(CI = 2.1-5.3); for 25-44 OR = 2.0(CI = 1.3-3.1). Separated/divorced had higher odds for unmet needs than married ones, OR = 1.4(CI = 1.2-1.8); as well as unemployed, OR = 1.4(CI = 1.2-1.6), and retired, OR = 1.2(CI = 1.0-1.5), than employed. Those from the 1st quintile, based on equalized disposable household income, were more likely to report unmet need compared to the 5th quintile, OR = 1.8(CI = 1.5-2.1). A gradient across all quintiles was proven (for 2nd quintile OR = 1.6(CI = 1.3-1.9), for 3rd OR = 1.4(CI = 1.1-1.7), for 4th OR = 1.3(CI = 1.1-1.5)). Compared to participants with very good/good health, those who perceive own health as very poor/poor had 3 times higher odds (CI = 2.5-3.5) to report unmet need; for those with average health OR = 1.7(CI = 1.5-1.9). Suffering from chronic illness increases odds 2.2 times (CI = 1.9-2.5).

Conclusions

The highest probability for unmet needs was established across most vulnerable groups, which is significant for preparing for future public health crises and preventing increase in health inequalities during them.

Key messages

• During the pandemic,there was a higher probability of unmet health needs among the most vulnerable groups.

• Strategies need to be put in place to prevent health inequalities deepening in a future crisis.
Association of CETP gene polymorphisms and haplotypes with acute heart rate response to exercise
Authors: Pikó P , Al Ashkar H , Kovács N , Veres-Balajti I , Ádány R
Published: October 2024

Background

Polymorphisms in the cholesteryl ester transfer protein (CETP) gene are known to be strongly associated with increased cardiovascular risk, primarily through their effects on the lipid profile, and consequently on atherosclerotic risk. The acute heart rate response (AHRR) to physical activity is closely related to individual cardiovascular fitness. This study aimed to investigate the effect of CETP gene polymorphisms on AHRR.

Methods

Our analysis examines the association of five single nucleotide polymorphisms (SNPs; rs1532624, rs5882, rs708272, rs7499892 and rs9989419) and their haplotypes (H) known to be associated with cardiovascular risk in the CETP gene with AHRR in 607 individuals from the Hungarian population. Individual AHRR in the present study was assessed using the YMCA 3-minute step test and was measured as the difference between resting and post-exercise heart rate, i.e. delta heart rate (ΔHR). To exclude the direct confounding effect of the CETP gene on the lipid profile, adjustments for TG and HDL-C levels were applied in the statistical analyses.

Results

Among the five SNPs examined, two showed a significant association with lower ΔHR (rs1532624-Cdom: B = -8.15, p < 0.001; rs708272-Gdom: B = -8.09, p < 0.001) and reduced the risk of adverse AHRR (rs1532624-A: OR = 2.26, p < 0.001; rs708272-A: OR = 2.17, p < 0.001). Among the ten haplotypes, two showed significant association with lower ΔHR (H3 - CAGCA: B = -6.79, p = 0.003; H9 - CGGCG: B = -14.79, p = 0.014) and lower risk of adverse AHRR (H3 - CAGCA: OR = 0.58, p = 0.038; H9 - CGGCG: OR = 0.05, p = 0.008) compared to the reference haplotype (H1 - AGACG).

Conclusions

Our study is the first to report a significant association between polymorphisms and their haplotypes in the CETP gene and AHRR. It also confirms that the effect of the CETP gene on cardiovascular risk is expressed through the acute heart rate response to physical activity, in addition to its effect on the lipid profile.

Key messages

• Certain polymorphisms and haplotypes in the CETP gene show a significant association with AHRR.

• The CETP gene polymorphisms exert their effect on cardiovascular risk not only by altering the lipid profile, but also by modifying the heart rate response to physical activity.
Family function, psychological distress and burden in informal caregivers of people with dementia
Authors: Nemcikova M , Katreniakova Z , Timkova V , Nagyova I
Published: October 2024

Background

Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables.

Methods

We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data.

Results

The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for >40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p < 0.001), anxiety (β = 0.52; p < 0.001), family dysfunction (β = 0.36; p < 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p < 0.001). This association weakened (0.47; p < 0.01) when family function was added to the final model (β=-0.22; p < 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified.

Conclusions

Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587].

Key messages

• Dementia caregiving is a global public health priority.

• The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.
Cadmium exposure and hypertension: a systematic review and a dose-response meta-analysis
Authors: Giuliano V , Verzelloni P , Vinceti M , Filippini T
Published: October 2024

Background

Since the shape of the relation between Cd exposure and risk of HTN has not been previously investigated, we aimed to perform a systematic review with dose-response meta-analysis in epidemiological studies.

Methods

After registration of the review in PROSPERO database (ID: CRD42022382030), we searched for eligible articles in online databases using Mesh-terms/keywords related to Cd, HTN, and BP. Eligible criteria were: adult population, assessment of exposure through Cd concentrations in blood or urine, risk estimates for HTN, observational design. Whenever possible, we computed summary odds ratio (OR) with 95% confidence interval (CI) and performed a dose-response meta-analysis on overall studies and subgroups.

Results

We eventually included 8 articles for both the qualitative and quantitative analysis published between 2006-2023 almost of cross-sectional design, 7 and 4 assessing blood and urine Cd concentrations, respectively. Comparing the highest versus lowest exposure, we found increased risk of HTN for both blood (OR = 1.12, 95% CI 0.92-1.36) and urine assessment (OR = 1.09, 95% CI 0.94-1.28). Dose-response meta-analysis showed an almost linear increased risk for blood Cd concentrations until 1.5 µg/L above with it plateaued. In contrast when using urine concentrations for exposure assessment, risk started to increase above 0.5 µg/g creatinine.

Conclusions

Our results confirm the recent findings of non-linear relation between Cd exposure and risk of both CVD and diabetes and the subsequent need to lower Cd exposure on a public health perspective.

Key messages

• Cadmium exposure showed positive association with risk of hypertension.

• Public health efforts should be implemented to lowed cadmium exposure to decrease CVD risk.
Patterns of overeating in middle-aged Chinese from Hong Kong
Authors: Kim J , Sze K , Poon P , Qi F , Wong A
Published: October 2024

Background

Obesity is one of the most important risk factors for non-communicable diseases worldwide. Overweightness may be attributable to a wide spectrum of overeating behaviours. However, the various types of overeating behaviors are under-studied in Asia, particularly in non-adolescent age groups. This study aims to estimate the prevalence and factors associated with various overeating patterns among middle-aged Chinese adults.

Methods

A random telephone survey was conducted in 2023 on Hong Kong Chinese adults between 35 and 59 years or age (n = 785). An instrument composed of modified Positive-Negative Emotional Eating (EE) Scale, Night Eating Questionnaire-Chinese (NEQ), Binge Eating Disorder Screener (BED-7), Depression Anxiety and Stress Scales (DASS-21), demographic factors, BMI and number of reported gastrointestinal (GI) conditions was used. Multiple regression analyses were conducted to test the association of demographic factors, BMI, GI conditions as well as dysphoric mood with overeating behaviors.

Results

Hong Kong Chinese middle-aged adults reported the following past-month prevalence of overeating behaviors: positive EE (26.1%), general overeating (12.4%), negative EE (9.2%), binge eating (6.0%) and night eating behavior (1.8%). Nightshift work, mental stress, being single and younger age were common risk factors for the various overeating patterns among middle-aged men. Anxiety, high/low educational levels and younger age were common risk factors among middle-aged women. Obesity was associated with binge eating and positive EE in men (OR: 1.7-4.0) and associated with negative EE and general overeating (OR:2.3-2.7) in women.

Conclusions

This study noted that binge eating, night eating, positive/negative EE, and GOB were distinct eating patterns requiring different clinical approaches. The significant association between various overeating behaviors with BMI, indicates that these individuals should be prioritized to receive healthy eating interventions.

Key messages

• Adult overeating is not a singular behavior but represents an array of different eating patterns with different risk factors.

•  Like their Western counterparts, overeating behaviors in Chinese adults are often linked to dysphoric mood, therefore treatment of obesity may require psychological counseling.
Gene Expression Changes in CAD Patients Due to Smoking Using Matched Samples
Authors: Merzah M , Póliska S , Balogh L , Sándor J , Szász I , Natae S , Fiatal S
Published: October 2024

Background

Smoking is a well-known risk factor for coronary artery disease (CAD). However, the effects of smoking on gene expression in the blood of CAD patients in Hungary have not been extensively studied.

Aim

To identify differentially expressed genes associated with smoking in CAD patients.

Methods

Eleven matched samples, based on age and gender, were selected for analysis in this study. All patients were non-obese, non-alcoholic, non-diabetic, and non-hypertensive and had moderate to severe stenosis of one or more coronary arteries, confirmed by coronary angiography. Whole blood samples were collected using PAXgene tubes. Next-generation sequencing was employed using the NextSeq 500 system to generate high-throughput sequencing data for transcriptome profiling. The differentially expressed genes were analyzed using the R programming language.

Results

The median age of patients was 67 years (range: 54-75). RNA sequencing was performed on two groups: smokers and non-smokers. After quality control and filtering, gene expression data were obtained for all samples. Using DESeq2, we identified 279 differentially expressed genes with a p-value ≤ 0.05 and a log2 fold change ≥1. Of these genes, 160 were upregulated in the smokers, and 119 were downregulated compared to non-smokers. Gene ontology analysis revealed that the upregulated genes were enriched for pathways related to immune responses and activities (FDR< 0.03). Specifically, upregulated genes were involved in keratinocyte differentiation, cornification, and epidermis development. The downregulated genes were enriched for cell-cardiac muscle cell adhesion (FDR= 0.004) and epithelium development (FDR= 0.001) pathways.

Conclusions

This research illuminates smoking’s biological effects, aiding personalized medicine for predicting and treating smoking-related diseases.

Key messages

• Smoking alters gene expression in CAD patients’ blood, identifying 279 differentially expressed genes, revealing smoking’s biological effects.

• The study underscores gene expression profiles’ role in personalized medicine, predicting smoking-related disease risks and tailoring CAD patient treatments.
A Bundle of the “Top 10” Outpatient Parenteral Antimicrobial Therapy Publications in 2023
Authors: Childs-Kean Lindsey M , Beieler Alison M , Cortés-Penfield Nicolás , Keller Sara C , Rivera Christina G , Ryan Keenan L , Yoke Leah H , Mahoney Monica V
Published: October 2024

Outpatient parenteral antimicrobial therapy (OPAT) has become more common in infectious diseases practice settings. Similarly, OPAT-related publications have also increased. The objective of this article was to summarize clinically important OPAT-related publications from 2023. Eighty-one articles were found on initial search, with 52 meeting inclusion criteria. A survey containing the 19 articles that had at least 1 citation was sent to an email listserv of multidisciplinary clinicians with OPAT experience. This article summarizes the “top 10” 2023 OPAT articles from the survey results.
Debtor (Non-)Participation in Sovereign Debt Relief: A Real Option Approach
Authors: Cassimon Danny , Essers Dennis , Presbitero Andrea F
Published: October 2024

Developing countries have recently proved reluctant to participate in sovereign debt moratoria and debt relief initiatives. This paper argues that debtors’ (non-)participation decisions can be understood through the lens of real options. Eligible countries compare the net benefits of participating in a debt relief initiative now with the value of waiting to potentially execute their participation option later, when they may have more information on benefits and costs. The analysis corroborates the real option framing with anecdotal evidence and through a survival analysis showing that debtor countries with larger expected debt service savings or higher pre-existing risks of debt distress were quicker to apply for the Debt Service Suspension Initiative, which provided temporary debt moratoria during the COVID-19 pandemic. The paper discusses policies that can make participation in debt relief initiatives more attractive to debtor countries.
CircPCNXL2 promotes preeclampsia progression by suppressing trophoblast cell proliferation and invasion via miR-487a-3p/interferon regulatory factor 2 axis
Authors: Xu Hua , Qu Xin , Wang Xiaoli
Published: October 2024

Background:

Preeclampsia (PE) has culminated in maternal and perinatal sickness and death across the world, affecting approximately 4.6% of pregnancies. Circular RNAs (circRNAs) have been linked to the biology of numerous pathologies, including PE. Here, we investigated the functional role of circPCNXL2 in the progression of PE.

Methods:

We employed the GEO database to get the expression profile of circPCNXL2 in patients with PE. This was followed by the detection of the expression of circPCNXL2 and miR-326 by qRT-PCR. The role of circPCNXL2 on trophoblast cell proliferation, migration, and invasion was confirmed with cell viability assays, the transwell assay, and the colony formation assay. Further, we employed dual luciferase, FISH, RNA pull-down assay and Western blot analysis to determine the interaction between the expression of circPCNXL2, miR-487a-3p, and IRF2.

Result:

Findings from this study revealed that proliferation and migration of trophoblast cells were significantly increased in the HTR-8/SVneo cells after silencing circPCNXL2. Additionally, knockdown of circPCNXL2 remarkably increased miR-487a-3p expression, while IRF2 expression was remarkably reduced (P < 0.05), indicating the presence of complementary binding sequence on miR-487a-3p with which they sequester circPCNXL2. Rescue experiments revealed that interaction occurs between circPCNXL2, miR-487a-3p, and the IRF2 protein, indicating that circPCNXL2 expression elicits suppression of migration and proliferation of trophoblast cells via the miR-487a-3p/IRF2 pathway.

Conclusions:

We demonstrated that circPCNXL2 upregulation promotes pre-eclampsia by inhibiting proliferation and migration of trophoblast cells via the miR-487a-3p/IRF2 pathway or axis.
Visual exposure to green light therapy reduces knee joint pain and alters the lipidome in osteoarthritic rats
Authors: O'Brien Melissa S. , Richter Emily , Woodward Taylor , Bradshaw Heather B. , McDougall Jason J.
Published: October 2024

Visual exposure to dim, green, light has been found to reduce pain levels in patients living with migraine, low back pain, and fibromyalgia. Preclinical studies discovered that the analgesic effect of green light was due to the central release of endogenous opioids and a reduction in inflammatory cytokines in the cerebrospinal fluid. The present study assessed the effect of green light therapy (GLT) on joint pain in a rat model of osteoarthritis (OA) and investigated the role of endolipids. Male and female Wistar rats (207-318 g) received an intra-articular injection of sodium monoiodoacetate (3 mg in 50 μL saline) into the knee to induce OA. On day 9, animals were placed in a room illuminated by either white (neutral-white 4000K; 20 lux) or green (wavelength: 525 nm; luminance: 20 lux) light for 5 days (8 hours per day). Joint nociception was assessed by von Frey hair algesiometry, dynamic weight bearing, and in vivo single unit extracellular recordings from knee joint mechanonociceptors. Compared to white light, GLT significantly reduced secondary mechanical hypersensitivity in both sexes and improved hindlimb weight bearing in females only. There was no effect of GLT on joint nociceptor activity in either sex. Serum lipidomics indicated an increase in circulating analgesic endolipids in response to GLT, particularly the N-acyl-glycines. Partial blockade of the endocannabinoid system with the G protein receptor-18/cannabinoid-1 receptor antagonist AM281 (500 μg/kg i.p.) attenuated GLT-induced analgesia. These data show for the first time that GLT acts to reduce OA pain by upregulating circulating analgesic endolipids, which then engage the endocannabinoid system.
Investigating the genetic causal relationship between breast cancer and endometrial cancer: A two-sample Mendelian randomization study
Authors: Wu Jian-Cong , Huang Xiao-Bi , Lin Yan-Ming , Zhang Qi , Chen Xiao-Rao , Huang Zhong , Ye Hai-Yin , Xie Yu-Liu , Yang Zhi-Xiong , Su Wen-Mei , Wu Qi-Biao
Published: October 2024

Observational studies have consistently shown a correlation between breast cancer (BC) and endometrial cancer (EC). Despite these findings, the causal relationship between these cancers has not been clearly defined. This research employed a bidirectional two-sample Mendelian randomization to explore the genetic causality between BC and EC. Genetic instruments for BC were derived from the Breast Cancer Association Consortium genome-wide association studies summary statistics, while for EC, data were sourced from the Endometrial Cancer Association Consortium, the Epidemiology of Endometrial Cancer Consortium, and the UK Biobank. The primary analytical method was inverse-variance weighted. Additional analyses, such as MR-Egger and weighted median, were conducted to validate the robustness of our findings from multiple perspectives. The MR-Egger intercept test was conducted to examine potential pleiotropy, whereas Cochrane Q test was implemented to assess heterogeneity. A leave-one-out analysis was conducted to assess the sensitivity of the observed association. Our analysis identified a bidirectional genetic causal relationship between estrogen receptor-positive breast cancer (ER+BC) and EC. Inverse-variance weighted analysis indicated an odds ratio of 1.0686 (95% confidence interval: 1.0029–1.1386, P = .0403) from ER+BC to EC and an odds ratio of 1.0692 (95% confidence interval: 1.0183–1.1225, P = .0071) from EC to ER+BC. No significant horizontal pleiotropy was detected. This study confirms a bidirectional genetic link between ER+BC and EC, suggesting shared genetic etiologies and possibly linked pathophysiological pathways. Understanding the genetic interplay between ER+BC and EC can enhance strategies for the precise prevention and screening of these prevalent cancers, potentially leading to improved clinical outcomes and management of secondary primary malignancies.
Evaluating the diagnostic accuracy of microRNA-494 as a biomarker in cancers: A systematic review and meta-analysis
Authors: Liu Yuhan , Yu Libo , Mei Hongbing
Published: October 2024

MicroRNA-494 (miR-494) has emerged as a potential diagnostic biomarker for cancer detection, but conflicting reports have led to uncertainty regarding its clinical utility. This study aims to address these discrepancies by conducting a comprehensive meta-analysis of miR-494 diagnostic performance across various cancer types. A comprehensive literature search was performed across multiple databases, including PubMed, Web of Science, Wanfang databases, and CNKI (China National Knowledge Infrastructure), with a cutoff date of April 23, 2024. Eligible studies were identified using predefined inclusion criteria and various search strategies to ensure a thorough coverage of the available evidence. To evaluate the diagnostic performance of miR-494 in cancer detection, relevant measures such as sensitivity, specificity, and other diagnostic accuracy indicators were extracted from the included studies. These data were synthesized using bivariate meta-analysis models to generate pooled estimates of miR-494 diagnostic performance. All statistical analyses were conducted using the STATA 16.0 software. This meta-analysis pooled data from 8 studies, comprising a total of 647 cancer cases and 407 healthy controls. The aggregated diagnostic performance of miR-494 was as follows: a sensitivity of 0.67 (95% confidence interval [CI], 0.52–0.80), a specificity of 0.85 (95% CI, 0.77–0.91), and an area under the curve of 0.86 (95% CI, 0.82–0.88), indicating good overall diagnostic accuracy. The diagnostic odds ratio (DOR) was 12.11 (95% CI, 7–21), suggesting that miR-494 has strong discriminatory power in distinguishing cancer patients from healthy individuals. The positive likelihood ratio of 4.62 (95% CI, 3.1–6.8) and negative likelihood ratio of 0.38 (95% CI, 0.26–0.56) further support the diagnostic utility of miR-494. Deeks’ funnel plot asymmetry test was employed to assess potential publication bias, yielding a P value of 0.50, which suggests the absence of significant bias in the included studies. The meta-analysis results suggest that miR-494 exhibits promising diagnostic performance in detecting cancer, with moderate accuracy. The pooled sensitivity, specificity, and high area under the receiver operating characteristic curve highlight its potential as a cancer biomarker, indicating its utility in early detection and accurate diagnosis.
Advances in treatment strategies for non–clear cell renal cell carcinoma
Authors: Li Shangwei , Gu Liangyou , Ma Xin , Zhang Xu
Published: October 2024

Renal cell carcinoma is the sixth most commonly diagnosed cancer in men and the tenth in women, with clear cell renal cell carcinoma accounting for nearly 75% of cases. The remaining 25% consists of non–clear cell renal cell carcinoma, a diverse and less prevalent group. Although current treatments for clear cell types are well-defined, progress in treating non–clear cell renal cell carcinoma has been limited owing to its heterogeneity and rarity, relying primarily on findings from small-scale phase II clinical trials. This review examined recent advancements in the treatment of non–clear cell renal cell carcinoma, particularly in the areas of immunotherapy and targeted therapy.
Clinical Practice Patterns and Evidence-Based Medicine in Blepharoplasty: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery
Authors: Stein Michael J. , Stoehr Jenna R. , Harrast John , Zins James E. , Matarasso Alan , Gosain Arun K.
Published: October 2024

Introduction:

The American Board of Plastic Surgery (ABPS) Continuous Certification tracer data on blepharoplasty offers valuable information on national trends in clinical practice. The present study was performed to analyze evolving trends in blepharoplasty and compare practice patterns to Evidence-Based Medicine (EBM) publications within the same timeframe.

Methods:

Tracer data for blepharoplasty procedures performed by ABPS-certified surgeons between 2005 and 2020 was analyzed. Data between two timeframes, 2005-2014 (early cohort, EC) and 2015-2020 (recent cohort, RC), were compared to identify evolving trends in blepharoplasty over time. Results were then compared to EBM-based publications.

Results:

Of 3,050 blepharoplasties (1,510 EC; 1,540 RC), 82% were performed in female patients and the average age was 56 years. Blepharoplasty was most frequently performed in an ambulatory setting (56%) compared to in hospital (25%); significantly more cases are being performed in the office (p< 0.001) in the RC compared to the EC. Mean surgical duration has decreased by 13 minutes (p< 0.001), and fewer surgeries are being performed with concomitant procedures (p< 0.001). Fewer surgeons use antibiotics (p< 0.001), and fewer surgeons use DVT prophylaxis in the form of sequential compression devices after anesthesia (p< 0.001). More skin resections were performed for upper blepharoplasties (p=0.016), while fewer cases of lower lid blepharoplasty involved either skin-muscle flaps (p=0.038) or transcutaneous fat removal (p=0.004). Most surgeons did not perform canthal tightening during their blepharoplasty (82%).

Conclusions:

A review of over 15-years of ABPS blepharoplasty tracer data allows surgeons to compare their practice with national trends and EBM. The tracer data illustrates a shift in technique towards shorter and simpler procedures in the office setting.
The Evolution of Unicoronal Synostosis Correction: Long-Term Aesthetic Outcomes of Fronto-Orbital Distraction Versus Traditional Advancement
Authors: Wu Meagan , Massenburg Benjamin B , Villavisanis Dillan F , Chang Ashley E , Romeo Dominic J , Ng Jinggang J , Napoli Joseph A , Bartlett Scott P , Swanson Jordan W , Taylor Jesse A
Published: October 2024

Introduction:

This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR).

Methods:

Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative and complication characteristics were compared between all patients who underwent FOAR, open FODO, and endoscopic-assisted FODO (“endo-FODO”). Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated, with positive differences representing postoperative improvement.

Results:

Forty-one patients were treated at a median age of 9.7, 5.4, and 5.4 months in the FOAR, open FODO, and endo-FODO groups, respectively. Among 28 patients photographed at a median of 6.3 years postoperatively, the FODO cohort demonstrated greater margin-to-reflex distance 1 symmetry (6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5], p=0.010) and canthal tilt symmetry (0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°], p=0.004) postoperatively as well as ODA correction (5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°], p=0.027) compared to the FOAR cohort. Fewer patients in the FODO cohort exhibited temporal hollowing postoperatively compared to the FOAR cohort (14% vs. 71%, p=0.002).

Conclusions:

Compared to FOAR, FODO was associated with greater periorbital symmetry, greater orbital dystopia correction, and reduced temporal hollowing in the long-term. Follow-up to cranial maturity is needed to adequately compare the two techniques.
Factors Associated With Acceptance of an Optional Diagnosis
Authors: Matthews Cortney , Ring David , Teunis Teun , Ramtin Sina
Published: October 2024

Background:

A sensation becomes a symptom (a concern) when a person associates it with potential illness. In the absence of objective evidence of a pathophysiological process that has important health consequences without treatment, assigning a diagnosis to the sensation is optional. This is important because labeling of benign bodily sensations as pathophysiology has potential advantages and disadvantages.

Question:

We asked what patient and clinician factors are associated with willingness to accept an optional diagnosis.

Methods:

In a survey administered using Amazon M-Turk, 536 people anonymously completed validated measures for symptoms of anxiety and depression, intolerance of uncertainty, and skepticism regarding the healthcare system. They then viewed fictional personal medical scenarios in which they were asked to imagine they experienced certain symptoms, and were offered an optional diagnosis of a nerve problem, muscle pain syndrome, or fatigue syndrome, and were asked to rate their willingness to accept the diagnosis on an 12-point ordinal scale from 0 indicating “I do not accept it at all” to 11 indicating “I accept it with enthusiasm.” The language of the scenarios was varied to attempt to reflect critical thinking, denigration of other doctors, an alternative mental health focus, or a hopeful outlook. Multilevel linear regression was used to identify factors associated with likelihood of accepting an optional diagnosis.

Results:

Threshold likelihood of accepting an optional diagnosis greater than 5.5 on a 0 to 11 ordinal scale was independently associated with greater symptoms of anxiety (regression coefficient [RC] = 0.38, 95% confidence interval [95% CI] = 0.30-0.47, P < .001), greater skepticism regarding the healthcare system (RC = 0.11, 95% CI = 0.076-0.13, P < .001), and delivery tones characterized by either denigration of other doctors (RC = 0.39, 95% CI = 0.19-0.60, P < .001) or a hopeful outlook (RC = 0.50, 95% CI = 0.26-0.73, P < .001).

Conclusion:

Likelihood of accepting an optional diagnosis may be a sign of relative vulnerability from feelings of distress or distrust of medical evidence. Given this potential vulnerability, clinicians can take care to limit persuasive communication styles that can influence acceptance of optional diagnoses.

Level of Evidence:

III prognostic.
The concept of critical age group for density dependence: bridging the gap between demographers, evolutionary biologists and behavioural ecologists
Authors: Gamelon Marlène , Araya-Ajoy Yimen G. , Sæther Bernt-Erik
Published: October 2024

Density dependence plays an important role in population regulation in the wild. It involves a decrease in population growth rate when the population size increases. Fifty years ago, Charlesworth introduced the concept of ‘critical age group’, denoting the age classes in which variation in the number of individuals most strongly contributes to density regulation. Since this pioneering work, this concept has rarely been used. In light of Charlesworth’s concept, we discuss the need to develop work between behavioural ecology, demography and evolutionary biology to better understand the mechanisms acting in density-regulated age-structured populations. We highlight demographic studies that explored age-specific contributions to density dependence and discuss the underlying evolutionary processes. Understanding competitive interactions among individuals is pivotal to identify the ages contributing most strongly to density regulation, highlighting the need to move towards behavioural ecology to decipher mechanisms acting in density-regulated age-structured populations. Because individual characteristics other than age can be linked to competitive abilities, expanding the concept of critical age to other structures (e.g. sex, dominance rank) offers interesting perspectives. Linking research fields based on the concept of the critical age group is key to move from a pattern-oriented view of density regulation to a process-oriented approach.

This article is part of the discussion meeting issue ‘Understanding age and society using natural populations’.