bluuebunny/crossref_metadata_2025 huggingface dataset:
Total Anomalous Pulmonary Venous Connection in Adults: Should We Offer Surgery?
Authors: Bagaria Vivek , Lahari Badragiri , Jagannath B. R. , Hiremath C. S.
Published: April 2024

Background: We aim to determine the surgical outcomes of adult patients with total anomalous pulmonary venous connection (TAPVC) and examine the regression of pulmonary artery (PA) pressures after the procedure. Methods: We reviewed the hospital records from 2003 to 2022 and identified 49 adult patients with TAPVC. We assessed their surgical outcomes and the trend of PA pressures after the procedure. Continuous data are presented as mean ± SD or median (interquartile range) and categorical variables are presented as percentages. Results: The median age of the patients was 23 years (range 18-42) and 31 (63.3%) were male. Thirty-six patients (73.5%) had supracardiac TAPVC. The mean systolic PA pressure was 65.8 ± 16.4 mm Hg and it decreased by 47.9% (34%, 61.8%) after surgery. Moderate or more tricuspid regurgitation was seen in 27 (55.1%) patients before surgery; however, it was present in only 3 (6.1%) patients during early follow-up. There was no intraoperative or 30-day mortality, and the median hospital length of stay was six days. Long-term follow-up data were available for 29 patients with the average duration of follow-up being 5.6 years (range 6 months to 15 years) and the mean systolic PA pressures of this cohort was 29.8±7.9 mm Hg. Forty-six (93.1%) patients were asymptomatic; four women had uneventful pregnancies and delivered healthy children. Conclusion: Surgical repair of the naturally selected group of adult TAPVC patients can be performed safely with good results. Regression in flow-related pulmonary hypertension and an improvement in functional quality of life are seen in nearly all patients.
The Impacts of Water Ecological Carrying Capacity on Green Total Factor Productivity: The Case of Chemical Industry in Jiangsu, China
Authors: Gu Yan , Chen Junfei , Ji Juan , Deng Menghua
Published: April 2024

The chemical industry is not only a crucial sector of national economy, but also a significant consumer of water resources and a major initiator of water pollution. The sustainable development of this sector is intricately linked to the regional water ecological carrying capacity (WECC). Based on SBM-DEA and Global Moran’s I, the green total factor productivity (GTFP) and spatial correlation characteristics of the chemical industry in 13 cities within China’s chemical agglomeration region in Jiangsu Province were estimated from 2015 to 2019. By combining the WECC results, the Tobit model was employed to reveal the driving factors of WECC in optimizing GTFP. The results indicated that the regional WECC in southern Jiangsu was increasing compared with that in northern Jiangsu, which promoted the growth of GTFP. WECC has been a positive radiation-driven effect since 2017, and the optimization of the various subsystems of WECC has had a different impact on GTFP. For the sustainable development of Jiangsu’s chemical industry, effective water resource policies should be formulated by the government, while enterprises need to pursue sustained structural adjustments.
Assessing the Provision of Preconception Care Knowledge, Attitudes, and Practice Among Jordanian Women of Reproductive Age
Authors: Alkhatib Buthaina , Agraib Lana M. , Hourani Huda Al , Hasan Hanan
Published: April 2024

This study aimed to assess the knowledge, attitudes, and practice of preconception care among women of reproductive age in Jordan. A cross-sectional study that included a random sample of 1,368 women of reproductive age (18–44 years) was conducted using an online self-reported questionnaire. Of the total respondents, 48.6% had good knowledge, 48.1% had a positive attitude, and 47.0% had good practice. Participants with poor knowledge were more prevalent in the 35 to 44 age group (37.3%). Participants with good knowledge had a more positive attitude (57.2%) and good practice (63.5%). Married participants had a higher negative attitude (82.9%). Participants with university education had a good practice (44.5%), knowledge (58.5%), and a positive attitude (52.9%). There were positive correlations between knowledge, attitude, and practice. Good preconception care knowledge was higher among participants in the youngest age, while positive attitude was higher in the age group 25 to 29 years.
Treatment Outcome and Associated Factors among Type 1 Diabetic Children Admitted with DKA in Bahir Dar City Public Referral Hospital, Northwest, Ethiopia: A Cross-sectional Study
Authors: Meseret Fentahun , Muluken Silenat , Gebru Gebi Tilaye , Embiale Yigrem Tsegasew
Published: April 2024

Background. Outcomes that should be measured during diabetic ketoacidosis management is crucial. However, data associated to this was limited in Ethiopia. Methods. A cross-sectional study was conducted among children with diabetic keto acidosis between 2016 and 2021.Data were stored in Epi-data version 4.6 and exported into STATA 14.0 software for analysis. The association between independent variables and length of hospital stay was assessed using binary logistic regression. Finally, variables with P-value <.05 were considered statistically significant. Result. Median length of hospital stay was 8 ± 6.2 days. Majority of patients (97.5%) improved and discharged. Factors that affected longer hospital stay were Residence(aOR = 4.31;95% CI = 1.25-14.80),family history of diabetes (aOR = 0.12; 95% CI = 0.02-0.64), glycemia at admission (aOR = 1.01; 95% CI = 1.00-1.02),insulin skipping (aOR = 0.08; 95% CI = 0.01-0.98), abdominal pain (aOR = 4.28; 95% CI = 1.11-15.52) and time in which the patient get out of diabetic ketoacidosis(aOR = 6.39; 95% CI = 1.09-37.50). Conclusion. Majority of patients showed improvement and discharged to homes after a long hospital stay. Majority of patients resolved from diabetic ketoacidosis between 24 and 48 hours.
Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?
Authors: Swenson Riley , Paull Thomas , Moua Gaonhia , Weatherby David , Azzam Khalid , Wojahn Robert , Anderson Sarah , Cole Peter A. , Nguyen Mai
Published: April 2024

Background:

Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior.

Methods:

Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey.

Results:

The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was −$204.80 ( P = .68), whereas the mean cost difference for bimalleolar fractures was −$9.82 ( P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 ( P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs ( P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study.

Conclusion:

The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone.

Level of Evidence:

Level III, case control study.
Collateral Damage: Neurological Correlates of Non-Fatal Overdose in the Era of Fentanyl-Xylazine
Authors: Todaro Dustin R , Volkow Nora D , Langleben Daniel D , Shi Zhenhao , Wiers Corinde E
Published: April 2024

Non-fatal opioid overdoses are associated with significant morbidity. Hypoxic brain injury caused by opioid-induced respiratory depression is a key mechanism of such morbidity. For example, reports describe an amnestic syndrome in opioid users associated with acute injury to the hippocampus, a brain region that is highly susceptible to hypoxic injury. In our recent study we investigated the effects of non-fatal opioid overdose on the hippocampal volume in a well-characterized sample of opioid use disorder (OUD) patients with a history of overdose (OD) compared to those with no prior overdose (NOD). Using structural magnetic resonance imaging (MRI) and voxel-based morphometry, we observed lower hippocampal volume in patients with a history OD than in the NOD group. These findings support an association between non-fatal opioid overdose and hippocampal injury, which we hypothesize contributes to recently reported cases of OUD related amnestic syndrome. Here we review our study findings and the potential pathophysiological mechanisms underlying the acute and delayed hippocampal injury in nonfatal opioid overdose. We also discuss the implications for the risk of overdose and brain injury with the increased prevalence of fentanyl and xylazine contamination of the illicit opioid supply. Lastly, we highlight considerations for clinical management of the underappreciated neurological injury and cognitive dysfunction in OUD patients.
Facile preparation of sepiolite-based composites and their antibacterial/rheological properties
Authors: Jiang Yizhi , Peng Zongfan , Yang Yongwen , Li Yuqin , Tang Yufang , Ding Yanhuai
Published: April 2024

Natural sepiolite has great potential for application in wound healing, haemostasis and medicines. This paper introduces a versatile solid-state sintering technique for preparing sepiolite-based nanocomposites with enhanced antibacterial properties, and the physical, structural, rheological and antibacterial properties of which were determined to be enhanced. The incorporation of nanosized Ag and metal oxides into sepiolite composites results in a notable improvement in their antibacterial efficacy against Escherichia coli and Staphylococcus aureus in comparison to the unmodified sepiolite. With a low silver content of just 5%, the sepiolite–Ag composite achieves an antibacterial rate of ~100%. Furthermore, the rheological properties exhibited by the sepiolite composites are noteworthy, suggesting their suitability for use in wound-dressing applications due to their exceptional workability. The methodology employed in this research has the potential to offer a viable substitute for the production of economical and effective natural antibacterial nanocomposites.
The ATF4-RPS19BP1 axis modulates ribosome biogenesis to promote erythropoiesis
Authors: Zheng Zhaofeng , Yang Shangda , Gou Fanglin , Tang Chao , Zhang Zhaoru , Gu Quan , Sun Guohuan , Jiang Penglei , Wang Nini , Zhao Xiangnan , Kang Junnan , Wang Yifei , He Yicheng , Yang Meng , Lu Ting , Lu Shihong , Qian Pengxu , Zhu Ping , Cheng Hui , Cheng Tao
Published: April 2024

Hematopoietic differentiation is controlled by intrinsic regulators and the extrinsic hematopoietic niche. Activating transcription factor 4 (ATF4) plays a crucial role in the function of fetal and adult hematopoietic stem cell maintenance. However, the precise function of ATF4 in the bone marrow (BM) niche and the mechanism by which ATF4 regulates adult hematopoiesis remain largely unknown. Here, we used 4 cell-type-specific mouse Cre lines to achieve conditional knockout of Atf4 in Cdh5+ endothelial cells, Prx1+ BM stromal cells, Osx+ osteoprogenitor cells, and Mx1+ hematopoietic cells and uncovered the role of Atf4 in niche cells and hematopoiesis. Intriguingly, depletion of Atf4 in niche cells did not affect hematopoiesis; however, Atf4-deficient hematopoietic cells exhibited erythroid differentiation defects, leading to hypoplastic anemia. Mechanistically, ATF4 mediated direct regulation of Rps19bp1 transcription, which is, in turn, involved in 40 S ribosomal subunit assembly to coordinate ribosome biogenesis and promote erythropoiesis. Finally, we demonstrate that under conditions of 5-fluorouracil–induced stress, Atf4 depletion impedes the recovery of hematopoietic lineages, which requires efficient ribosome biogenesis. Taken together, our findings highlight the indispensable role of the ATF4-RPS19BP1 axis in the regulation of erythropoiesis.
Gait differences between COPD and healthy controls: systematic review and meta-analysis
Authors: Buekers Joren , Delgado-Ortiz Laura , Megaritis Dimitrios , Polhemus Ashley , Breuls Sofie , Buttery Sara C. , Chynkiamis Nikolaos , Demeyer Heleen , Gimeno-Santos Elena , Hume Emily , Koch Sarah , Williams Parris , Wuyts Marieke , Hopkinson Nicholas S. , Vogiatzis Ioannis , Troosters Thierry , Frei Anja , Garcia-Aymerich Judith
Published: April 2024

Background

Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls.

Methods

We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias.

Results

Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) −19 cm·s−1, 95% CI −28 to −11 cm·s−1) and at a fast speed (MD −30 cm·s−1, 95% CI −47 to −13 cm·s−1). Alterations in other gait characteristics were not statistically significant.

Conclusion

Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.
Determination of heat wave definition temperatures in Spain at an isoclimatic level: time trend of heat wave duration and intensity across the decade 2009–2018
Authors: López-Bueno J. A. , Alonso P. , Navas-Martín M. Á , Mirón I. J. , Belda F. , Díaz J. , Linares C.
Published: April 2024

Background

In line with WHO guidelines for the implementation of public health prevention plans targeted at the impacts of high temperatures, a heat wave definition temperature (Tthreshold) was calculated for 182 so-called “isoclimatic zones” (IZ) in Spain. As the dependent variable for determining this Tthreshold, we analysed daily all-cause mortality data (ICD-10: A00-R99) for each IZ across the period 2009–2018. The independent variable used was the mean value of the maximum daily temperature of the summer months recorded at meteorological observatories in each IZ. We used Box–Jenkins models to ascertain mortality anomalies, and scatterplots to link these anomalies to the temperatures at which they occurred, thereby determining the Tthreshold for each IZ. We then calculated how many heat waves had occurred in each IZ, as well as their intensity, and analysed their time trend over this period.

Results

The results showed that in 52.5% of the IZ, the percentile of the maximum temperatures series of the summer months to which Tthreshold corresponded was below the 95th percentile of the meteorological heat wave definition in Spain: indeed, it only coincided in 30.7% of cases. The geographical distribution of these percentiles displayed great heterogeneity as a consequence of the local factors that influence the temperature–mortality relationship. The trend in the number of heat waves analysed indicated an overall increase in Spain at a rate of 3.9 heat waves per decade, and a similar rise in mean annual intensity of 9.5 °C/decade. These time-trend values were higher than those yielded by analysing the trend in meteorological heat waves based on the 95th percentile.

Conclusions

The results obtained in this study indicate the need to use a heat wave definition based on epidemiological temperature–mortality studies, rather than on values based on meteorological percentiles. This could be minimising estimated health impacts in analyses of future impacts attributable to heat.
Functional analysis of a wheat class III peroxidase gene, TaPer12-3A, in seed dormancy and germination
Authors: Gao Wei , Jiang Yating , Yang Xiaohu , Li Ting , Zhang Litian , Yan Shengnan , Cao Jiajia , Lu Jie , Ma Chuanxi , Chang Cheng , Zhang Haiping
Published: April 2024

Background

Class III peroxidases (PODs) perform crucial functions in various developmental processes and responses to biotic and abiotic stresses. However, their roles in wheat seed dormancy (SD) and germination remain elusive.

Results

Here, we identified a wheat class III POD gene, named TaPer12-3A, based on transcriptome data and expression analysis. TaPer12-3A showed decreasing and increasing expression trends with SD acquisition and release, respectively. It was highly expressed in wheat seeds and localized in the endoplasmic reticulum and cytoplasm. Germination tests were performed using the transgenic Arabidopsis and rice lines as well as wheat mutant mutagenized with ethyl methane sulfonate (EMS) in Jing 411 (J411) background. These results indicated that TaPer12-3A negatively regulated SD and positively mediated germination. Further studies showed that TaPer12-3A maintained H2O2 homeostasis by scavenging excess H2O2 and participated in the biosynthesis and catabolism pathways of gibberellic acid and abscisic acid to regulate SD and germination.

Conclusion

These findings not only provide new insights for future functional analysis of TaPer12-3A in regulating wheat SD and germination but also provide a target gene for breeding wheat varieties with high pre-harvest sprouting resistance by gene editing technology.
Factors associated with the level of self-management in elderly patients with chronic diseases: a pathway analysis
Authors: Cong Zhiyang , Huo Mingshu , Jiang Xing , Yu Hongyu
Published: April 2024

Background

To analyze the effects and pathways of factors such as psychological capital, family functioning, and sources of meaning in life on the level of self-management in elderly patients with chronic diseases and to provide a basis for the development of relevant nursing interventions in the future.

Methods

Convenience sampling was used to select elderly patients with chronic diseases who underwent medical checkups and consultations at three community hospitals in Jinzhou city from March 2023 to October 2023, and the self-designed General Information Questionnaire (GIS), Psychological Capital of the Elderly Scale (PCE), Family Functioning Index Questionnaire (APGAR), Sources of Meaning of Life Scale for Older Adults(SMSE), and Self-Management Behavior of Chronic Patients Scale (SMCS) were used. SPSS 26.0 was used for data entry, one-way analysis, Pearson correlation analysis, and multiple linear regression were used to analyze the data, and Amos 17.0 was used to construct the structural equation model.

Results

A total of 355 elderly patients with chronic diseases were included, and their self-management score was 74.75 ± 12.93, which was moderate. The results of the influencing factor analysis showed that the influencing factors of the self-management level of elderly chronic disease patients were age, years of illness, psychological capital, family functioning, and sources of meaning in life (p < 0.05). Path analysis revealed that sources of meaning in life were a partial mediator of the relationship between psychological capital and self-management, with an effect value of 0.166 (95% CI: 0.042,0.391), accounting for 37.6% of the total effect; life meaning was a partial mediator of family functioning and self-management level, with an effect value of 0.231 (95% CI: 0.040,0.452), accounting for 54.0% of the total effect. accounting for 54.0% of the total effect.

Conclusion

The self-management of elderly patients with chronic diseases is intermediate. Healthcare professionals should actively implement holistic healthcare management measures from the family aspect to help patients understand the meaning of life and improve the level of patients’ psychological capital to improve the self-management level of elderly patients with chronic diseases.
Maternal cardiovascular health in early pregnancy and the risk of congenital heart defects in offspring
Authors: Zhang Dan-wei , Zhu Yi-bing , Zhou Si-jia , Chen Xiu-hua , Li Hai-bo , Liu Wen-juan , Wu Zheng-qin , Chen Qiang , Cao Hua
Published: April 2024

Background

Congenital heart disease (CHD) is the predominant birth defect. This study aimed to explore the association between maternal cardiovascular health (CVH) and the CHD risk in offspring.

Methods

We used the prospective data from the Fujian Birth Cohort Study, collected from March 2019 to December 2022 on pregnant women within 14 weeks of gestation. Overall maternal CVH was assessed by seven CVH metrics (including physical activity, smoking, sleep duration, body mass index, blood pressure, total cholesterol, and fasting plasma glucose), with each metric classified as ideal, intermediate or poor with specific points. Participants were further allocated into high, moderate and low CVH categories based on the cumulative CVH score. The association with offspring CHD was determined with log-binominal regression models.

Results

A total of 19810 participants aged 29.7 (SD: 3.9) years were included, with 7846 (39.6%) classified as having high CVH, 10949 (55.3%) as having moderate CVH, and 1015 (5.1%) as having low CVH. The average offspring CHD rate was 2.52%, with rates of 2.35%, 2.52% and 3.84% across the high, moderate and low CVH categories, respectively (P = 0.02). Adjusted relative risks (RRs) of having offspring CHD were 0.64 (95% CI: 0.45-0.90, P = 0.001) for high CVH and 0.67 (95% CI: 0.48-0.93, P = 0.02) for moderate CVH compared to low CVH. For individual metrics, only ideal total cholesterol was significantly associated with lower offspring CHD (RR: 0.73, 95% CI: 0.59-0.83, P = 0.002).

Conclusions

Pregnant women of high or moderate CVH categories in early pregnancy had reduced risks of CHD in offspring, compared to those of low CVH. It is important to monitor and improve CVH during pre-pregnancy counseling and early prenatal care.
Parenting style and child mental health at preschool age: evidence from rural China
Authors: Wang Lei , Tian Jing , Rozelle Scott
Published: April 2024

Background

Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver’s parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver’s parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.

Methods

Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.

Results

The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver’s authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.

Conclusion

Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.
Sleep disturbance and internalizing symptoms in adolescents: a moderated mediation model of self-control and mindfulness
Authors: Ye Haoxian , Jiang Nan , He Sisi , Fan Fang
Published: April 2024

Objectives

Despite accumulating evidence regarding the impact of sleep disturbance on internalizing symptoms among adolescents, the underlying psychological mechanisms remain inadequately explored. This study aimed to investigate a conceptual framework elucidating how sleep disturbance influences internalizing symptoms in adolescents through the mediating role of self-control, with mindfulness as a moderator.

Methods

In this cross-sectional study, 1876 Chinese adolescents (Mage = 14.88 years, SD = 1.47 years, range = 12–19 years, 44.7% boys) completed the Youth Self-Rating Insomnia Scale (YSIS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Self-control Scale (BSCS), and Mindful Attention Awareness Scale-Children (MAAS-C) to provide data on sleep-related variables, internalizing symptoms (anxiety and depression), self-control, and mindfulness, respectively. The PROCESS macro for SPSS was applied to perform moderated mediation analysis.

Results

Sleep disturbance demonstrated a significant positive correlation with internalizing symptoms in adolescents, including anxiety (β = 0.481, p < 0.001) and depression (β = 0.543, p < 0.001). Self-control served as a mediator between sleep disturbance and two forms of internalizing symptoms. Moreover, mindfulness moderated the pathways from self-control to internalizing symptoms (for anxiety symptoms: β = 0.007, p < 0.001; for depression symptoms: β = 0.006, p < 0.001), and the mediating relationships were weaker for adolescents exhibiting higher levels of mindfulness.

Conclusions

Our findings enhance understanding of the impact, pathways, and influencing factors of sleep disturbance on adolescent internalizing symptoms, suggesting the importance of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.
Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities?
Authors: Owusu Bernard Afriyie , Doku David Teye
Published: April 2024

Introduction

Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals’ health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality.

Methods

Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes.

Results

Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients’ limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression.

Conclusion

T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.
Bayesian modeling of quantiles of body mass index among under-five children in Ethiopia
Authors: Mekuriaw Daniel M. , Mitku Aweke A. , Zeru Melkamu A.
Published: April 2024

Background

Body Mass Index (BMI) is a measurement of nutritional status, which is a vital pre-condition for good health. The prevalence of childhood malnutrition and the potential long-term health risks associated with obesity in Ethiopia have recently increased globally. The main objective of this study was to investigate the factors associated with the quantiles of under-five children’s BMI in Ethiopia.

Methods

Data on 5,323 children, aged between 0-59 months from March 21, 2019, to June 28, 2019, were obtained from the Ethiopian Mini Demographic Health Survey (EMDHS, 2019), based on the standards set by the World Health Organization. The study used a Bayesian quantile regression model to investigate the association of factors with the quantiles of under-five children’s body mass index. Markov Chain Monte Carlo (MCMC) with Gibbs sampling was used to estimate the country-specific marginal posterior distribution estimates of model parameters, using the Brq R package.

Results

Out of a total of 5323 children included in this study, 5.09% were underweight (less than 12.92 BMI), 10.05% were overweight (BMI: 17.06 – 18.27), and 5.02% were obese (greater than or equal to 18.27 BMI) children’s. The result of the Bayesian quantile regression model, including marginal posterior credible intervals (CIs), showed that for the prediction of the 0.05 quantile of BMI, the current age of children [$$\upbeta$$
β
= -0.007, 95% CI :(-0.01, -0.004)], the region Afar [$$\upbeta$$
β
= - 0.32, 95% CI: (-0.57, -0.08)] and Somalia[$$\upbeta$$
β
= -0.72, 95% CI: (-0.96, -0.49)] were negatively associated with body mass index while maternal age [$$\upbeta$$
β
= 0.01, 95% CI: (0.005, 0.02)], mothers primary education [$$\upbeta$$
β
= 0.19, 95% CI: (0.08, 0.29)], secondary and above [$$\upbeta$$
β
= 0.44, 95% CI: (0.29, 0.58)], and family follows protestant [$$\upbeta$$
β
= 0.22, 95% CI: (0.07, 0.37)] were positively associated with body mass index. In the prediction of the 0.95 (or 0.85?) quantile of BMI, in the upper quantile, still breastfeeding [$$\upbeta$$
β
= -0.25, 95% CI: (-0.41, -0.10)], being female [$$\upbeta$$
β
= -0.13, 95% CI: (-0.23, -0.03)] were negatively related while wealth index [$$\upbeta$$
β
= 0.436, 95% CI: (0.25, 0.62)] was positively associated with under-five children’s BMI.

Conclusions

In conclusion, the research findings indicate that the percentage of lower and higher BMI for under-five children in Ethiopia is high. Factors such as the current age of children, sex of children, maternal age, religion of the family, region and wealth index were found to have a significant impact on the BMI of under-five children both at lower and upper quantile levels. Thus, these findings highlight the need for administrators and policymakers to devise and implement strategies aimed at enhancing the normal or healthy weight status among under-five children in Ethiopia.
Incidence of deep venous thrombosis in patients with hemophilia undergoing bilateral simultaneous total knee arthroplasty: a retrospective cohort study
Authors: Zhang Qian , Zhao Lingying , Riva Nicoletta , Yu Ziqiang , Jiang Miao , Gatt Alexander , Guo Jiong Jiong
Published: April 2024

Background

Hemophilic arthropathy usually affects the knees bilaterally. In order to reduce costs and improve rehabilitation, bilateral simultaneous total knee arthroplasty (TKA) can be performed. However, pharmacological prophylaxis for deep venous thrombosis (DVT) remains controversial in patients with severe hemophilia. The purpose of this study was to establish the incidence of DVT in severe hemophilia A patients undergoing bilateral simultaneous TKA without pharmacological thromboprophylaxis.

Methods

Consecutive patients with severe hemophilia A undergoing bilateral simultaneous TKA at a single center between January 2015 and December 2020 were retrospectively reviewed. All patients received a modified coagulation factor substitution regimen. Tranexamic acid (TXA) was used for hemostasis in all patients during surgery. All patients followed a standardized postoperative protocol with routine mechanical thromboprophylaxis, and none received anticoagulation. D-dimer was measured preoperatively, on the day of the operation and on postoperative days 1, 7 and 14. Ultrasound (US) of the lower extremities was performed before (within 3 days of hospitalization) and after surgery (days 3 and 14) to detect asymptomatic DVT. Patients were followed up until 2 years after surgery for the development of symptomatic DVT or pulmonary embolism (PE).

Results

38 male patients with severe hemophilia A underwent 76 simultaneous TKAs. Mean (± standard deviation) age at the time of operation was 41.7 (± 17.1) years. Overall, 47.3% of patients had D-dimer concentrations above the threshold 10 µg/mL on day 7 and 39.5% on day 14. However, none of the patients had DVT detected on postoperative US, nor developed symptomatic DVT or PE during the 2-year follow-up.

Conclusions

The risk of DVT in patients with severe hemophilia A after bilateral simultaneous TKA is relatively low, and routine pharmacological thromboprophylaxis may not be needed.
Development of nursing handoff competency scale: a methodological study
Authors: Do Jiyoung , Shin Sujin
Published: April 2024

Background

Nursing handoff competency is the ability of the nurse performing the handoff to select and interpret the necessary information for patient care and to convey it efficiently to the nurse accepting the handoff. Nursing handoff is an important nursing task that ensures nursing care continuity, quality and patient safety. This study aimed to develop a scale to measure nursing handoff competency and verify its validity and reliability.

Methods

This study adopted a methodological design. A research process included three phases: (1) scale development (literature review and interviews); (2) scale validation (validity and reliability); (3) standard setting. Data were collected from 496 clinical nurses currently working in hospital wards, intensive care units, and emergency rooms, and who independently perform a handoff in South Korea.

Results

The final scale comprises a self-reported 4-points Ilert scale with 25 items based on four factors: knowledge on handoff methods, identification of patient information, judgment and transfer of nursing situation, and “formation of supportive relationships. Construct validity, criterion-related validity, and discrimination validities were verified and the fitness of the scale revealed good results in confirmatory factor analysis. The Cronbach’s α of the whole tool was.912 and the cut-off score for satisfied/unsatisfied was.72.

Conclusions

The developed scale can evaluate the nurse’s handoff competencies and determine whether training is necessary. The measurement results of the scale can be used to select training subjects and compose the contents of the education program.
Factors influencing the development of nursing professionalism: a descriptive qualitative study
Authors: He Xingyue , Mao Ya , Cao Huili , Li Linbo , Wu Yanming , Yang Hui
Published: April 2024

Background

The shortage of nurses threatens the entire healthcare system, and nursing professionalism can improve nurse retention and enhance the quality of care. However, nursing professionalism is dynamic, and the factors influencing its development are not fully understood.

Methods

A qualitative descriptive study was conducted. Using maximum variation and purposive sampling, 14 southern and northern China participants were recruited. Semi-structured interviews were conducted from May 2022 to August 2023 in face-to-face conversations in offices in the workplace or via voice calls. The interviews were transcribed verbatim and analyzed via thematic analysis.

Results

Three main themes emerged: (1) nourishment factors: promoting early sprouting; (2) growth factors: the power of self-activation and overcoming challenges; and (3) rootedness factors: stability and upward momentum. Participants described the early acquisition of nursing professionalism as derived from personality traits, family upbringing, and school professional education, promoting the growth of nursing professionalism through self-activation and overcoming challenges, and maintaining the stable and upward development of nursing professionalism through an upward atmosphere and external motivation.

Conclusion

We revealed the dynamic factors that influence the development of nursing professionalism, including “nourishment factors”, “growth factors”, and “rootedness factors”. Our findings provide a foundation for future development of nursing professionalism cultivation strategies. Nursing administrators can guide the development of nurses’ professionalism from many angles according to the stage they are in, and the development of professionalism deserves more attention. In the future, we can no longer consider the development of nursing professionalism solely as the responsibility of individual nurses; the power of families, organizations, and society is indispensable to jointly promoting nursing professionalism among nurses.
Temporomandibular disorders in individuals with Marfan syndrome: an exploratory analysis
Authors: Jenabzadeh Termeh , Bohner Lauren , Köppe Jeanette , Kleinheinz Johannes , Hanisch Marcel , Oelerich Ole
Published: April 2024

Background

This study aims to analyze to what extent patients with Marfan syndrome (MFS) are affected by temporomandibular disorders (TMD) and its impact on oral health-related quality of life (OHRQoL). To collect data, an online questionnaire was created to recruit participants from Germany, Austria, and Switzerland through social media and support groups. The questionnaire consists of free-text questions, the German versions of the Oral Health Impact Profile (OHIP-G14), the Depression Anxiety Stress Scale (DASS), and the Graded Chronic Pain Status (GCPS).

Results

A total of 76 participants with diagnosed MFS were included. Of these, 65.8% showed TMD symptoms, the most common being pain or stiffness of the masticatory muscles in the jaw angle (50.0%). Only 14.5% of the participants were already diagnosed with TMD. Of the participants with an increased likelihood of a depression disorder, 76.9% showed TMD symptoms. Of those with a critical score for an anxiety disorder, 90.9% showed TMD symptoms. 73.3% of participants with TMD symptoms reached the critical score for a stress disorder. TMD symptoms were associated with a higher risk for chronic pain. In the median, participants with TMD showed statistically notably higher OHIP-G14 scores than participants without TMD (11.5 [IQR 17] vs. 1 [IQR 3] points, p ≤ 0.001).

Conclusion

TMD symptoms had a noticeable impact on OHRQoL in patients with MFS, i.e., chronic pain and psychological impairment. TMD seems underdiagnosed, and more research is needed to prevent the associated chronification of pain and psychological burden to improve the OHRQoL.
Posterior pericardiotomy and the prevention of post-operative atrial fibrillation and cardiac tamponade in isolated coronary artery bypass grafting – A retrospective analysis
Authors: Rathnayake Ayeshmanthe , Goh Siew SC , Fenton Carmel , Hardikar Ashutosh
Published: April 2024

Background

Post-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accidents, heart failure, renal dysfunction, infection, length of stay and hospital costs. Cardiac tamponade although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a posterior pericardiotomy (PP) aims to shunt blood from pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade.

Methods

2168 patients had undergone isolated Coronary Artery Bypass Grafting at Royal Hobart Hospital from 2008 to 2022. They were divided into PP group vs. control group. Patient baseline demographics, intraoperative data and post-operative outcomes were reviewed retrospectively.

Results

Total incidence of new POAF and cardiac tamponade was 24% and 0.74% respectively. Primary outcome of both the incidence of POAF (20.2% vs. 26.3%, p < 0.05) and Cardiac Tamponade (0% vs. 1.1%, p < 0.05) were less in the pericardiotomy group. A subgroup analysis of patients with recent myocardial infarction showed reduced incidence of POAF in the PP group (p < 0.05). Increasing age, Body Mass Index, poor left ventricular ejection fraction (EF < 30%) and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal.

Conclusion

Posterior pericardiotomy is associated with a significant reduction in the incidence of POAF and cardiac tamponade which is safe and efficient.
The efficacy and safety of GLP-1 receptor agonists in youth with type 2 diabetes: a meta-analysis
Authors: Yugar Louise Buonalumi Tacito , Sedenho-Prado Luis Gustavo , da Silva Ferreira Isadora Maria Castilho , Silva Cleide Aparecida Moreira , Sposito Andrei C. , Cercato Cintia
Published: April 2024

Background

Glucagon-like peptide 1 receptor agonists have been proven to be effective in adults with diabetes and children with obesity. However, children with type 2 diabetes constitute an underrepresented subpopulation with limited treatment options. This meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric type 2 diabetes mellitus.

Methods

Three databases were searched (PubMed, Embase, and Cochrane Central Register of Controlled Trials) for trials published until the end of March 2024. The search indexing terms included 3 categories: [1] type 2 diabetes mellitus [2], youth, and [3] glucagon-like peptide-1 receptor agonist (GLP-1 RA). Randomized controlled trials in youth with type 2 diabetes (age ≤ 18 years) that assessed anthropometric and metabolic parameters were included. A total of 1119 nonduplicate studies were retrieved, and 137 full-text articles were screened. The data were analyzed using mean differences (MDs) with 95% CIs and odds ratios (ORs) with 95% CIs. For outcomes with low heterogeneity, a fixed-effects model was used. Otherwise, we applied a random effects model. Our outcomes were Hb1Ac, fasting blood glucose (FBG), blood pressure, weight, and side effects.

Results

Five studies comprehending 415 children and adolescents were included. On average, GLP-1 RA reduced HbA1c levels (-1.01%; 95% CI, -1.26 to -0.76), fasting blood glucose levels (-1.88 mmol/L; 95% CI, -2.51 to -1.26), and body weight (-1.6 kg; 95% CI, -2.83 to -0.36). No significant reductions in systolic blood pressure (MD -0.19 mmHg; 95% CI, -3.9 to 3.52 mmHg) or diastolic blood pressure (MD 0.3 mmHg; 95% CI, -2.33 to 2.93 mmHg) were observed. Despite a higher incidence of side effects, withdrawal rates from the studies remained low.

Conclusions

Within this specific population, GLP-1 RAs exhibit a notable association with substantial reductions in HbA1c, FBG, and body weight. The administration of these medications is concurrent with an elevated incidence of side effects, which are predominantly gastrointestinal and tolerable.

Trial registration

PROSPERO identifier: CRD42023393020.
Simple modeling of familial Alzheimer’s disease using human pluripotent stem cell-derived cerebral organoid technology
Authors: Choe Mu Seog , Yeo Han Cheol , Kim Joong Sun , Lee Jean , Lee Hae Jun , Kim Hyung-Ryong , Baek Kyung Min , Jung Na-Yeon , Choi Murim , Lee Min Young
Published: April 2024

Background

Cerebral organoids (COs) are the most advanced in vitro models that resemble the human brain. The use of COs as a model for Alzheimer’s disease (AD), as well as other brain diseases, has recently gained attention. This study aimed to develop a human AD CO model using normal human pluripotent stem cells (hPSCs) that recapitulates the pathological phenotypes of AD and to determine the usefulness of this model for drug screening.

Methods

We established AD hPSC lines from normal hPSCs by introducing genes that harbor familial AD mutations, and the COs were generated using these hPSC lines. The pathological features of AD, including extensive amyloid-β (Aβ) accumulation, tauopathy, and neurodegeneration, were analyzed using enzyme-linked immunosorbent assay, Amylo-Glo staining, thioflavin-S staining, immunohistochemistry, Bielschowsky’s staining, and western blot analysis.

Results

The AD COs exhibited extensive Aβ accumulation. The levels of paired helical filament tau and neurofibrillary tangle-like silver deposits were highly increased in the AD COs. The number of cells immunoreactive for cleaved caspase-3 was significantly increased in the AD COs. In addition, treatment of AD COs with BACE1 inhibitor IV, a β-secretase inhibitor, and compound E, a γ-secretase inhibitor, significantly attenuated the AD pathological features.

Conclusion

Our model effectively recapitulates AD pathology. Hence, it is a valuable platform for understanding the mechanisms underlying AD pathogenesis and can be used to test the efficacy of anti-AD drugs.