bluuebunny/crossref_metadata_2025 huggingface dataset:
Holocene vegetation dynamics of the Eastern Mediterranean region: Old controversies addressed by a new analysis
Authors: Cruz‐Silva Esmeralda , Harrison Sandy P. , Prentice I. Colin , Marinova Elena
Published: October 2023

Aim

We reconstruct vegetation changes since 12 ky in the Eastern Mediterranean to examine four features of the regional vegetation history that are controversial: the extent of non‐analogue vegetation assemblages in the transition from the Late Glacial to the early Holocene, the synchroneity of postglacial forest expansion, the geographical extent of temperate deciduous forest during the mid‐Holocene and the timing and trigger for the re‐establishment of drought‐tolerant vegetation during the late Holocene.

Location

The Eastern Mediterranean–Black Sea Caspian Corridor.

Taxon

Vascular plants.

Methods

We reconstruct vegetation changes for 122 fossil pollen records using a method that accounts for within‐biome variability in pollen taxon abundance to determine the biome with which a sample has greatest affinity. Per‐biome affinity threshold values were used to identify samples that do not belong to any modern biome. We apply time series analysis and mapping to examine space and time changes.

Results

Sites with non‐analogue vegetation were most common between 11.5 and 9.5 ky and mostly in the Carpathians. The transition from open vegetation to forest occurred at 10.64 ± 0.65 ky across the whole region. Temperate deciduous forest was not more extensive at 6 ky; maximum expansion occurred between 5.5 and 5 ky. Expansion of forest occurred between c. 4 and 2.8 k, followed by an abrupt decrease and a subsequent recovery. This pattern is not consistent with a systematic decline of forest towards more drought‐tolerant vegetation in the late Holocene but is consistent with centennial‐scale speleothem patterns linked to variations in moisture availability.

Main Conclusions

We show the occurrence of non‐analogue vegetation types peaked during early Holocene, forest expansion was synchronous across the region and there was an expansion of moisture‐demanding temperate trees around 5.5 to 5 ky. There is no signal of a continuous late Holocene aridification, but changes in forest cover appear to reflect climatic rather than anthropogenic influences.
Functional variants of the chitinase 3‐like 1 gene are associated with clinicopathologic outcomes and progression of prostate cancer
Authors: Wen Yu‐Ching , Lin Chia‐Yen , Ho Kuo‐Hao , Lin Yung‐Wei , Hsiao Chi‐Hao , Wang Shian‐Shiang , Chang Lun‐Ching , Yang Shun‐Fa , Chien Ming‐Hsien
Published: October 2023

Chitinase 3‐like 1 (CHI3L1 or YKL40) is a secreted glycoprotein highly expressed in advanced stages of several cancer types, including prostate cancer (PCa). Impacts of genetic variants of CHI3L1 on PCa development have not yet been investigated. The most common well‐studied genetic variations are single‐nucleotide polymorphisms (SNPs). Therefore, the objective of this study was to explore associations of CHI3L1 SNPs with both the susceptibility to PCa and its clinicopathological development. Three promoter SNPs, rs6691378 (−1371, G>A), rs10399805 (−247, G>A) and rs4950928 (−131, C>G), and one non‐synonymous SNP, rs880633 (+2950, T>C), were analysed using a TaqMan allelic discrimination assay for genotyping in a cohort of 701 PCa patients and 701 healthy controls. Results indicated that there were no significant associations of PCa susceptibility with these four CHI3L1 SNPs. However, among elderly PCa patients (aged >65 years), it was observed that polymorphic variants (GA + AA) of CHI3L1 rs6691378 and 10399805 were significantly linked to reduced risks of several clinicopathological characteristics, including a high Gleason grade, advanced pathologic T stage and tumour cell invasion. Moreover, analyses of The Cancer Genome Atlas database revealed that CHI3L1 expression levels were elevated in PCa tissues compared with normal tissues. Interestingly, higher CHI3L1 expression levels were found to be associated with longer progression‐free survival rates in PCa patients. Our findings indicated that levels of CHI3L1 may influence the progression of PCa, and the rs6691378 and 10399805 SNP genetic variants of CHI3L1 are linked to the clinicopathological development of PCa within a Taiwanese population.
The vanishing of the ACoA syndrome after aneurysmal subarachnoid haemorrhage: New era, different management, fewer problems?
Authors: Buunk A. M. , Spikman J. M. , Wagemakers M. , Jeltema J. R. , de Vries J. , Mazuri A. , Uyttenboogaart M. , Groen R. J. M.
Published: October 2023

Historically, a specific set of symptoms has been related to the rupture and repair of anterior communicating artery (ACoA) aneurysms. These consequences were defined as the ‘ACoA syndrome’ and included observations of severe memory loss, confabulation and personality or behavioural changes. These observations correspond to neuropsychological impairments in memory, executive functions and social cognition. However, in more recent studies, the existence of such a distinct syndrome has been called into question. We aimed to investigate the existence of the ACoA syndrome, by combining analysis of our own data with a systematic review of the literature. Memory, executive functions and social cognition of subarachnoid haemorrhage patients with ACoA aneurysms (N = 28) were compared to patients with aneurysms in other locations (N = 66). Results showed no significant differences. Subsequently, a systematic review of the existing literature on the ACoA syndrome was performed using Embase and PubMed until October 2022. Studies that investigated cognitive functions after rupture and repair of ACoA aneurysms were included. The search yielded 847 unique entries and after screening titles and abstracts, 648 records were excluded. 199 full‐text articles were assessed for eligibility and 55 articles were included. Evidence was found for the ACoA syndrome in studies between 1960 and 2000, with impairments in memory and executive problems in the majority of studies. However, the majority of studies from 2000 did not demonstrate a distinct ACoA syndrome, although neuropsychological measurements improved. This coincides with the changes in the management of ACoA aneurysms over the past decades, such as the emergence of endovascular treatment and improvement of neurointensive care. Therefore, we hypothesize that the management techniques of ACoA aneurysms until around 2000, i.e. mainly conventional clipping, could be related to the presence of symptoms of the ACoA syndrome.
‘Human rights cities’ in Africa? Rights as resources for urban governance in the Global South
Authors: PIETERSE MARIUS
Published: October 2023

This article considers the use of human rights law as a resource for urban governance by African cities, thereby supplementing the growing literature on ‘human rights cities’ that has thus far focused on the experiences of cities in the Global North. It considers the motivations for and impact of human rights city initiatives, before taking a closer look at reported instances of rights invocation in and by African cities and pointing to factors that explain the seemingly limited traction of human rights law for urban local governments on the continent. The article shows that incomplete and politically contested devolution arrangements across African constitutional systems have combined with pressures pertaining to the domestic enforceability of socio‐economic rights to structure a somewhat cautious and fraught, but nevertheless promising, relationship between local governments in African cities and human rights law.
The Saudi‐UAE Divide over the Yemen Quagmire
Authors: Öztürk Selim
Published: October 2023

The expansion of Iranian influence through the Houthi rebels in Yemen alarmed Saudi Arabia and the United Arab Emirates, leading them to intervene in the civil war. However, this only prolonged the conflict, in part because the two Gulf neighbors failed to coordinate—indeed, they often followed divergent policies. One reason for this was ideological, as the Saudis favored Yemen's al‐Islah party, an offshoot of the Islamist Muslim Brotherhood movement. The Emiratis rejected this group and opposed Saudi‐backed President Abdu Rabbu Mansour Hadi due to his links to it. The other area of dispute was the UAE's support for secessionists seeking an independent South Yemen, largely driven by Emirati economic interests. Saudi Arabia strongly resisted separation and prioritized the fight against the Houthis. The article analyzes the many facets of the divide over Yemen and shows how the rift is affecting other parts of the region.
A resource‐based perspective on the regulatory welfare state: Social security in the United Kingdom
Authors: Horton David P. , Lynch‐Wood Gary
Published: October 2023

The article provides a resource‐based perspective on the polymorphic regulatory welfare state. It shows regulatory and fiscal tools applied in the UK social security sector place demands on claimants' resources (i.e., possessions, labor and data) and simultaneously alter behavior in relation to these resources. The analysis exposes an operation that generates new and increasing resource pressures for claimants, providing a deeper conceptualization of a regulatory welfare state. It offers a new perspective on why regulatory and fiscal arrangements perpetuate existing inequalities and suggests an increase in welfare problems as the regulatory welfare state intensifies resource pressures.
Antimicrobial resistance in Escherichia coli isolated from pigs and associations with aggregated antimicrobial usage in Ireland: A herd‐level exploration
Authors: Byrne Andrew W. , Garvan Caroline , Bolton Julie , Naranjo‐Lucena Amalia , Madigan Gillian , McElroy Máire , Slowey Rosemarie
Published: October 2023

Aims

Antimicrobial resistance (AMR) is of significant global concern and is a major One Health issue. There is evidence to suggest that increased antimicrobial usage (AMU) can be associated with AMR patterns, and therefore, there have been efforts to reduce AMU in anticipation of reducing AMR emergence risk. The aim of this study was to investigate whether there were any associations between AMU and AMR patterns of commensal Escherichia coli isolated from pig herds in Ireland.

Methods and Results

Data on AMR from a panel of antimicrobials (AMDs) were gathered as part of national surveillance activities. These data were associated with reported usage of AMDs, on a year‐quarter basis, measured in mg/kg at a herd‐level using generalized estimating equation regression analysis. Associations were tested with AMR presence or multi‐drug resistance (MDR; ≥3 classes) profiles and total AMU during the contemporaneous quarter and previous quarter, respectively. Furthermore, individual and AMD class‐based associations were tested. The final dataset contained 218 observations (herd‐quarter usage and AMR resistance profile) from 122 herds during 2019–2021. Apparent resistance prevalence varied according to AMD type, with the highest mean prevalence found with tetracycline at 51.57% (95% CI: 45.06%–58.09%). There were significant associations between a herd obtaining a positive AMR result for any AMDs and the overall levels of AMU during the year‐quarter. Furthermore, there were significant positive associations between MDR and total AMU. At the compound level, chloramphenicol resistance was significantly associated with increased usage of trimethoprim/sulfadiazine and chlortetracycline, respectively (p < 0.010). Tetracycline resistance was associated with increased use of chlortetracycline (p = 0.008). At the antimicrobial class level, there was a significant positive relationship between the usage of phenicol and the probability of a resistance for chloramphenicol (p = 0.026) and between the usage of tetracycline and tetracycline resistance probability (p = 0.018).

Conclusions

Our data provide evidence of associations between overall AMU and AMR or MDR risk at the herd‐quarter level. There was also evidence of associations between specific AMDs and patterns of resistance. Associations varied depending on whether time lags in usage were modelled or how usage was modelled (e.g. dichotomized or continuous). Associations with rarely used AMDs (e.g. critically important AMDs) were precluded due to a lack of statistical power. Continued monitoring of both AMU and AMR is crucial to assess the impacts of policy changes aimed at reducing AMU.
New Scheloribates (Topobates) (Acari, Oribatida, Scheloribatidae) from Mexico
Authors: Ermilov Sergey G. , Yurtaev Andrey A.
Published: October 2023

The subgenus Scheloribates (Topobates) (Oribatida, Scheloribatidae) is recorded in Mexico for the first time. Two new species of the subgenus—S. (T.) moskovchenkoi sp. nov. and S. (T.) paramoskovchenkoi sp. nov.—are described, based on adults collected from leaf litter from the karst pits in the secondary semi-evergreen tropical forest. Scheloribates (T.) moskovchenkoi is similar to S. (T.) tibetensis in the presence of heterotridactylous legs and long bothridial seta with elongate, lanceolate head having setiform apex, but it differs from the latter by the number of notogastral setae, the different length of notogastral setae, in having sparse small foveolae in dorsoanterior and dorsocentral parts of notogaster, the position of saccule Sa, the presence of tubercle-like process on the trochanter IV, and the absence of translamella. Scheloribates (T.) paramoskovchenkoi is similar to S. (T.) moskovchenkoi in the presence of bothridial seta with elongate, lanceolate head having setiform apex and 13 pairs of notogastral setae, but it differs from the latter in having monodactylous legs and five pairs of notogastral sacculi, strongly reduced pteromorph, the presence of tooth-like process on the trochanter IV, the presence of two longitudinal dorsodistal carinae and concavity between them on the leg tarsi I, II, and in the absence of foveolae on the notogaster and ventrobasal tooth on the leg tibiae I, II.
Determination of 15 Functional State Biomarkers in Human Urine by High-Performance Liquid Chromatography with Tandem Mass Spectrometric Detection
Authors: Leninskii M. A. , Savel’eva E. I. , Belyakov M. V. , Karakashev G. V. , Samchenko N. A.
Published: October 2023

The capabilities and limitations of complex procedures for targeted metabolomic analysis using liquid chromatography in combination with tandem mass spectrometry (HPLC-MS/MS) are discussed. An HPLC-MS/MS procedure for the simultaneous determination of the concentrations of 15 biomarkers of the functional state of a human being in urine is presented. The target analytes are biogenic substances of various chemical natures, the basic concentrations of which in biomatrices can vary significantly, up to three orders of magnitude or more. Complex analysis is also difficult to perform due to significant differences in the hydrophilic and hydrophobic properties of the analytes. The testing of the procedure in a bioanalytical experiment made it possible to establish significant differences in the concentrations of a number of biomarkers in the urine of persons with different levels of physical fitness. With a high level of physical fitness, the concentrations of these compounds in urine have lower values in comparison with those in the control group.
Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials
Authors: de Jonge Stijn W , Hulskes Rick H , Zokaei Nikoo Maedeh , Weenink Robert P , Meyhoff Christian S , Leslie Kate , Myles Paul , Forbes Andrew , Greif Robert , Akca Ozan , Kurz Andrea , Sessler Daniel I , Martin Janet , Dijkgraaf Marcel GW , Pryor Kane , Belda F Javier , Ferrando Carlos , Gurman Gabriel M , Scifres Christina M , McKenna David S , Chan Matthew TV , Thibon Pascal , Mellin-Olsen Jannicke , Allegranzi Benedetta , Boermeester Marja , Hollmann Markus W
Published: October 2023

Introduction

The use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO2compared with regular (0.21–0.40) FiO2and its potential effect modifiers.

Methods and analysis

Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO2(0.60–1.00) to regular FiO2(0.21–0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (<15 mL/kg/hour) and procedure duration (>2.5 hour).

Ethics and dissemination

Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal.

PROSPERO registration number

CRD42018090261.
Detecting transthyretin amyloid cardiomyopathy (ATTR-CM) using machine learning: an evaluation of the performance of an algorithm in a UK setting
Authors: Tsang Carmen , Huda Ahsan , Norman Max , Dickerson Carissa , Leo Vincenzo , Brownrigg Jack , Mamas Mamas , Elliott Perry
Published: October 2023

Objective

The aim of this study was to evaluate the potential real-world application of a machine learning (ML) algorithm, developed and trained on heart failure (HF) cohorts in the USA, to detect patients with undiagnosed wild type cardiac amyloidosis (ATTRwt) in the UK.

Design

In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink GOLD and Hospital Episode Statistics, respectively, were used to identify patients diagnosed with HF between 2009 and 2018 in the UK. International Classification of Diseases (ICD)-10 clinical modification codes were matched to equivalent Read (primary care) and ICD-10 WHO (secondary care) diagnosis codes used in the UK. In the absence of specific Read or ICD-10 WHO codes for ATTRwt, two proxy case definitions (definitive and possible cases) based on the degree of confidence that the contributing codes defined true ATTRwt cases were created using ML.

Primary outcome measure

Algorithm performance was evaluated primarily using the area under the receiver operating curve (AUROC) by comparing the actual versus algorithm predicted case definitions at varying sensitivities and specificities.

Results

The algorithm demonstrated strongest predictive ability when a combination of primary care and secondary care data were used (AUROC: 0.84 in definitive cohort and 0.86 in possible cohort). For primary care or secondary care data alone, performance ranged from 0.68 to 0.78.

Conclusion

The ML algorithm, despite being developed in a US population, was effective at identifying patients that may have ATTRwt in a UK setting. Its potential use in research and clinical care to aid identification of patients with undiagnosed ATTRwt, possibly enabling earlier diagnosis in the disease pathway, should be investigated.
Association of fat-to-muscle ratio with non-alcoholic fatty liver disease: a single-centre retrospective study
Authors: Yan Fengqin , Nie Guqiao , Zhou Nianli , Zhang Meng , Peng Wen
Published: October 2023

Objectives

Sarcopenia is a known risk factor for non-alcoholic fatty liver disease (NAFLD). Studies evaluating the association between the fat-to-muscle ratio (FMR) and NAFLD are limited. Therefore, the aim of our study was to investigate the association between FMR and NAFLD.

Design

A retrospective study was conducted on individuals who underwent health examination at Wuhan Union Hospital between January 2020 and November 2021. Clinical data were collected from electronic medical records.

Setting

Wuhan Union Hospital, Wuhan, China.

Participants

1592 participants aged ≥40 years who underwent body composition analysis and liver ultrasonography were retrospectively reviewed.

Outcome measures

Liver ultrasonography was used to assess liver steatosis, and the fibrosis-4 index was used to calculate the risk scores for liver fibrosis. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction model was used to calculate ASCVD risk scores.

Results

The FMR was significantly higher in individuals with NAFLD than in those without NAFLD (p<0.001). The prevalence of NAFLD gradually increased from FMR tertile 1 (reference) to tertile 2 (OR=1.49, 95% CI 1.13 to 1.97) and tertile 3 (OR=2.85, 95% CI 2.08 to 3.90). In addition, patients with NAFLD in FMR tertile 3 had a significantly higher risk of liver fibrosis (OR=4.48, 95% CI 2.12 to 9.50) and ASCVD (OR=4.63, 95% CI 2.62 to 8.19) than those in FMR tertile 1 after adjustment for multiple confounders.

Conclusion

In this study, we found a significant association between FMR and NAFLD. A higher FMR indicates a higher risk of NAFLD in the study population and a higher risk of liver fibrosis and ASCVD in NAFLD patients.
SMS text intervention for uncontrolled hypertension among hypertensive homeless adults in shelter clinics of New York City: protocol for a pragmatic randomised trial study
Authors: Asgary Ramin , Bauder Leah , Naderi Rosanna , Ogedegbe Gbenga
Published: October 2023

Introduction

Uncontrolled hypertension (HTN) is prevalent in persons experiencing homelessness (PEH) and contributes to significant suffering and financial cost. Mobile health approaches such as short messaging service (SMS) texting have led to better control of HTN in the general population. Despite the high utilisation of mobile phones by PEH, SMS texting to support HTN control has not been evaluated among this population. We hypothesise that an SMS testing programme will enhance health communication, information management, outreach and care coordination, and provide behavioural support to address some barriers to HTN management in PEH.

Methods and analysis

This study will use a mixed-methods study design to address two objectives: First, it will evaluate, in a randomised controlled trial, the efficacy of a 6-month SMS texting strategy vs an attention control on blood pressure reduction and adherence to medications and clinical appointments in 120 adults PEH with uncontrolled HTN. Outcomes will be measured at 0, 2, 4 and 6 months. Second, it will assess patients’ and providers’ acceptability and experience of SMS texting using semistructured interviews with PEH (n=30) and providers (n=10). The study will be conducted in shelter clinics in New York City in collaboration with community organisations. The primary statistical analysis will be on an intention-to-treat basis. The trial results will be reported as comparative summary statistics (difference in response rate or means) with 95% CIs and in accordance with the Consolidated Standards of Reporting Trials (CONSORT). Interviews will be transcribed, coded and analysed using an inductive grounded theory analysis.

Ethics and dissemination

This study has been approved by the Institutional Review Board (IRB) at George Washington University. Written consent will be obtained from participants. The findings will be disseminated in peer-reviewed journals.

Trial registration number

NCT05187013.
Addressing self-criticism in depression using CBT-based emotion-focused chairwork: study protocol of a randomised controlled trial
Authors: Kroener Julia , Mahler Jacqueline , Sosic-Vasic Zrinka
Published: October 2023

Introduction

Self-criticism is a key feature in people diagnosed with depression, resulting in significant psychological distress. Despite the fact that cognitive–behavioural treatments are readily available, a significant number of patients report experiencing cognitive, but not emotional, change following therapy, resulting in the maintenance of psychological symptoms. Additionally, interventions targeting emotional experiencing, such as chairwork, are generally implemented within large-scale therapeutic treatments. Therefore, within the present study, we aim to evaluate the efficacy and safety of a short intervention using emotion-focused chairwork to target self-criticism in patients diagnosed with depression.

Methods and analysis

The study is designed as a randomised controlled trial with two parallel arms. 62 patients diagnosed with depression will be randomised to the intervention group or the waiting-list control group receiving treatment as usual. The intervention comprises of three treatment sessions using the chairwork technique over the course of 3 weeks. Outcome assessments will take place 1 week before the first treatment session, as well as 1 week and 3 months after the last treatment session. The primary outcomes are self-criticism and self-compassion. Secondary outcomes assess depressive symptoms, emotion regulation and overall self-esteem. Statistical analysis will be performed using intention-to-treat analysis, as well as per-protocol analysis implementing linear-mixed models.

Ethics and dissemination

The study was approved by the Ethics Committee of the State Chamber of Physicians in Baden-Wuerttemberg, Germany (approval number: F-2023-12). Scientific findings shall be published in peer-reviewed journals to inform prospective clinical studies focusing on the implementation of chairwork within clinical practice.

Trial registration number

German Clinical Trials Register (DRKS00031307;https://drks.de/search/de/trial/DRKS00031307).
Direct impact of 2 years of COVID-19 on chronic disease patients: a population-based study in a large hard-hit Italian region
Authors: Fortuna Daniela , Caselli Luana , Berti Elena , Moro Maria Luisa
Published: October 2023

Objectives

We aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic period (2020–2021).

Design

Population-based retrospective study.

Setting/participants

Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%).

Results

COVID-19 incidence among chronic disease patients was 4.1% (74 067 cases) in 2020 and 7.3% (126 556 cases) in 2021, varying across pathologies, with obesity and dementia showing the highest incidence. Hospitalisation rate for pneumonia or acute respiratory distress syndrome among SARS-CoV-2-positive patients was 15.4%. COVID-19-related excess mortality, that is, deaths from COVID-19 as either main or contributing (1.5% of the total) cause of death, was observed during the three pandemic waves, with observed/expected death ratios ranging from +38% (March 2020) to +11% (December 2021). Increased risks of both COVID-19-related hospitalisation and death were associated with male gender, elderly age and many pre-existing pathologies, including cardiovascular, cerebrovascular and respiratory diseases, neurological and psychiatric disorders, and metabolic dysfunctions. The higher the number of concomitant pathologies, the greater the risk of COVID-19-related adverse outcomes: the likelihood of hospitalisation and death more than doubled for people with more than two comorbidities, compared with those with one underlying condition.

Conclusions

This study presents a thorough and up-to-date quantification of the direct impact of COVID-19 on chronic disease patients. The results obtained are particularly relevant considering that people with pre-existing chronic conditions accounted for almost all cases of COVID-19-related hospitalisation (82.6%) and death (91.5%) in a vast region of Italy, among the hardest hit by the pandemic.
Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol
Authors: Zilezinski Max , Denninger Natascha-Elisabeth , Tannen Antje , Kottner Jan
Published: October 2023

Introduction

Delirium is one of the most common forms of acute cerebral dysfunction in critically ill children leading to increased morbidity and mortality. Prevention, identification and management of delirium is an important part of paediatric and neonatological intensive care. This scoping review aims to identify and map evidence on non-pharmacological interventions for paediatric delirium prevention and management in paediatric and neonatal intensive care settings.

Methods and analysis

This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches will be performed in the databases Medline (via PubMed), CINAHL, Cochrane Library, Ovid (Journals), EMBASE and Web of Science (01/2000–current). Two reviewers will independently review retrieved studies, and relevant information will be extracted using data extraction forms. The results will be presented in tabular format and accompanied by a narrative summary.

Inclusion criteria

The review will include references that describe or evaluate non-pharmacological interventions to prevent or manage paediatric delirium. Conference abstracts, editorials, opinion papers and grey literature will be excluded.

Ethics and dissemination

Due to the nature of research involving humans or unpublished secondary data, approval of an ethics committee are not required. The dissemination of findings is planned via professional networks and publication in an open-access scientific journal.
Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study
Authors: Thuo Nicholas , Martins Tanimola , Manley, Eugene , Standifer Maisha , Sultan Dawood H , Faris Nicholas R , Hill Angela , Thompson Matthew , Jeremiah Rohan , Al Achkar Morhaf
Published: October 2023

Objective

This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients.

Methods

We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model.

Results

From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure.

Conclusions

BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.
Association between atherogenic coefficient and depression in US adults: a cross-sectional study with data from National Health and Nutrition Examination Survey 2005–2018
Authors: Zhang Lu , Yin Jiahui , Sun Haiyang , Yang Jiguo , Liu Yuanxiang
Published: October 2023

Objective

The pathogenesis of depression is related to immune inflammatory response. Atherogenic coefficient (AC) is an important indicator of lipid abnormalities, which can lead to immune inflammatory responses. However, no study has investigated the relationship between AC and depression in adult Americans. Therefore, we investigated this relationship.

Design

This study used a cross-sectional design.

Setting

The National Health and Nutrition Examination Survey (2005–2018) data were used for this study.

Participants

A total of 32 502 participants aged 20 years or older who had complete information for AC and depression were included in this study.

Primary and secondary outcome measures

Depressive symptoms were assessed using the nine-item version of the Patient Health Questionnaire (PHQ-9), with a cut-off point of 9/10 indicating likely depression cases. Weighted logistic regression analyses and the smooth curve fittings were performed to explore the association between AC and depression.

Results

After adjusting for potential confounders, a single unit increase in AC was associated with a 3% increase in the prevalence of depression (HR=1.03, 95% CI=1.00 to 1.06, p=0.039). The relationship between AC and depression was more obvious in females.

Conclusions

The AC is positively associated with depression.
General practitioners’ decision-making process to prescribe pain medicines for low back pain: a qualitative study
Authors: Ferreira Giovanni E , Zadro Joshua , Jones Caitlin , Ayre Julie , Lin Christine , Richards Bethan , Needs Christopher , Abdel Shaheed Christina , McLachlan Andrew , Day Richard O , Maher Christopher
Published: October 2023

Background

Pain medicines are widely prescribed by general practitioners (GPs) when managing people with low back pain (LBP), but little is known about what drives decisions to prescribe these medicines.

Objectives

The aim of this study was to investigate what influences GPs’ decision to prescribe pain medicines for LBP.

Design

Qualitative study with in-depth interviews.

Setting

Australian primary care.

Participants

We interviewed 25 GPs practising in Australia experienced in managing LBP (mean (SD) age 53.4 (9.1) years, mean (SD) years of experience: 24.6 (9.3), 36% female). GPs were provided three vignettes describing common LBP presentations (acute exacerbation of chronic LBP, subacute sciatica and chronic LBP) and were asked to think aloud how they would manage the cases described in the vignettes.

Data analysis

We summarised GP’s choices of pain medicines for each vignette using content analysis and used framework analysis to investigate factors that affected GP’s decision-making.

Results

GPs more commonly prescribed opioid analgesics. Anticonvulsants and antidepressants were also commonly prescribed depending on the presentation described in the vignette. GP participants made decisions about what pain medicines to prescribe for LBP largely based on previous experiences, including their own personal experiences of LBP, rather than guidelines. The choice of pain medicine was influenced by a range of clinical factors, more commonly the patient’s pathoanatomical diagnosis. While many adhered to principles of judicious use of pain medicines, polypharmacy scenarios were also common. Concerns about drug-seeking behaviour, adverse effects, stigma around opioid analgesics and pressure from regulators also shaped their decision-making process.

Conclusions

We identified several aspects of decision-making that help explain the current profile of pain medicines prescribed for LBP by GPs. Themes identified by our study could inform future implementation strategies to improve the quality use of medicines for LBP.
Added value of electrical impedance spectroscopy in adjunction of colposcopy: a prospective cohort study
Authors: Bergqvist Laura , Heinonen Annu , Carcopino Xavier , Redman Charles , Aro Karoliina , Kiviharju Mari , Virtanen Seppo , Omar Pirjo-Liisa , Kotaniemi-Talonen Laura , Louvanto Karolina , Nieminen Pekka , Kalliala Ilkka
Published: October 2023

Objective

To assess whether electrical impedance spectroscopy (EIS) as an adjunctive technology enhances the performance of colposcopy.

Design

Prospective cohort study.

Setting

University Hospital colposcopy clinic.

Participants

Colposcopy with EIS for 647 women and conventional colposcopy for 962 women.

Interventions

Comparison of the performance of colposcopy by referral cervical cytology in two cohorts, with and without EIS as an adjunctive technology.

Outcome measures

Prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), diagnostic testing accuracy to detect CIN2+ with and without EIS and their relative differences between cohorts.

Results

The prevalence of CIN2+ varied between the cohorts according to referral cytology: 17.0% after abnormal squamous cells of unknown significance referral cytology in EIS cohort and 9.1% in the reference cohort, 16.5% and 18.9% after low-grade squamous intraepithelial lesion (LSIL), 44.3% and 58.2% after atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (HSIL) (atypical squamous cells that cannot exclude HSIL), and 81.9% and 77.0% after HSIL cytology, respectively. Sensitivity to detect CIN2+ was higher in the EIS cohort, varying from 1.79 (95% CI 1.30 to 2.45) after LSIL referral cytology to 1.16 (95% CI 1.09 to 1.23) after HSIL referral cytology, with correspondingly lower specificity after any referral cytology.

Conclusions

Colposcopy with EIS had overall higher sensitivity but lower specificity to detect CIN2+ than conventional colposcopy. CIN2+ prevalence rates were, however, not consistently higher in the EIS cohort, suggesting innate differences between the cohorts or truly lower detection rates of CIN2+ for EIS, highlighting the need for randomised controlled trials on the effectiveness of EIS.
Associations between spirometric impairments and microvascular complications in type 2 diabetes: a cross-sectional study
Authors: Hayfron-Benjamin Charles F , Agyemang Charles , van den Born Bert-Jan H , Amoah Albert G B , Amissah-Arthur Kwesi Nyan , Musah Latif , Abaidoo Benjamin , Awula Pelagia , Awuviri Henry Wedoi , Abbey Joseph Agyapong , Fummey Deladem A , Ackam Joana N , Asante Gloria Odom , Hashimoto Simone , Maitland-van der Zee Anke H
Published: October 2023

Objective

Evidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D.

Design

Cross-sectional study.

Setting

National Diabetes Management and Research Centre in Ghana.

Participants

The study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease.

Primary and secondary outcome measures

The associations of spirometric measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥30 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index.

Results

In age and sex-adjusted models, lower Z-score FEV1was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19–2.02, p=0.001) and neuropathy (1.27 (1.01–1.65), 0.038) but not retinopathy (1.22 (0.87–1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19–2.01), 0.001), neuropathy (1.25 (1.01–1.54), 0.037) and retinopathy (1.19 (0.85–1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1with nephropathy (1.43 (1.09–1.87), 0.011) and neuropathy (1.34 (1.04–1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11–1.91), 0.007) and neuropathy (1.32 (1.03–1.69), 0.029). Lower Z-score FEV1/FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models.

Conclusion

Our study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.
‘Children awaken by playing’: a qualitative exploration of caregivers’ norms, beliefs and practices related to young children’s learning and early childhood development in rural Burkina Faso
Authors: Dumbaugh Mari , Belem Mireille , Kousse Sylvain , Ouoba Patricia , Sankoudouma Adama , Tchibozo Achille Mignondo , Fearon Pasco , Hollowell Jennifer , Hill Z
Published: October 2023

Introduction

Evidence suggests that responsive caregiving and early learning activities positively impact developmental outcomes, with positive effects throughout the life course. Early childhood development interventions should align with local values, beliefs and resources but there has been little research of caregiver beliefs and perspectives on development and learning, especially in sub-Saharan Africa. This qualitative study explored norms, beliefs, practices and aspirations around child development of caregivers of young children in rural Burkina Faso.

Methods

We conducted 32 in-depth interviews with mothers and fathers of young children and 24 focus group discussions with mothers, fathers and grandmothers, which included trying behaviours and reporting on experiences. The research informed the development of Scaling Up Nurturing Care, a Radio Intervention to Stimulate Early Childhood Development (SUNRISE), an early child development radio intervention.

Results

Caregivers described a process of ‘awakening’, through which children become aware of themselves and the world around them.Perceptions of the timing of awakening varied, but the ability to learn was thought to increase as children became older and more awake. Consequently, talking and playing with babies and younger children were perceived to have little developmental impact. Caregivers said children’s interactions with them, alongside God-given intelligence, was believed to impact later behaviour and development. Caregivers felt their role in helping their children achieve later in life was to pay for education, save money, provide advice and be good role models. Interaction and learning activities were not specifically mentioned. Caregivers who trialled interaction and learning activities reported positive experiences for themselves and their child, but interactions were often caregiver led and directive and play was often physical. Key barriers to carrying out the behaviours were poverty and a lack of time.

Conclusions

Exploring early childhood beliefs and practices can reveal important sociocultural beliefs which, if incorporated into programme planning and implementation, could help achieve more impactful, acceptable and equitable programmes.

Trial registration number

NCT05335395.
Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites
Authors: Schram Anders , Jensen Hanne Irene , Gamborg Maria , Lindhard Morten , Rölfing Jan , Kjaergaard-Andersen Gunhild , Bie Magnus , Jensen Rune Dall
Published: October 2023

Objective

Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave.

Design

Cohort study.

Setting and intervention

Five Danish hospitals.

Participants

A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study.

Intervention

From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group.

Outcome measures

Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention).

Results

Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was −0.3% (95% CI −0.6% to −0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by −0.7% (95% CI −1.3% to −0.1%) in the intervention group.

Conclusion

The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.