bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and risk factors of prolonged corrected QT interval in general Chinese population
Authors: Ma Qun , Li Zhao , Guo Xiaofan , Guo Liang , Yu Shasha , Yang Hongmei , Zou Lu , Zheng Liqiang , Pan Guowei , Zhang Yonghong , Sun Yingxian
Published: November 2019

Background

Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community.

Methods

A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders.

Results

The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval.

Conclusions

The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.
Rationale and design of the Henan ST elevation myocardial infarction (STEMI) registry: a regional STEMI project in predominantly rural central China
Authors: Zhang You , Wang Shan , Yang Shuyan , Yin Shanshan , Cheng Qianqian , Li Muwei , Qi Datun , Wang Xianpei , Zhu Zhongyu , Zhao Luosha , Hu Dayi , Gao Chuanyu
Published: November 2019

Background

Cardiovascular disease including ST elevation myocardial infarction (STEMI) is increasing and the leading cause of death in China. There has been limited data available to characterize STEMI management and outcomes in rural areas of China. The Henan STEMI Registry is a regional STEMI project with the objectives to timely obtain real-world knowledge about STEMI patients in secondary and tertiary hospitals and to provide a platform for care quality improvement efforts in predominantly rural central China.

Methods

The Henan STEMI Registry is a multicentre, prospective and observational study for STEMI patients. The registry includes 66 participating hospitals (50 secondary hospitals; 16 tertiary hospitals) that cover 15 prefectures and one city direct-controlled by the province in Henan province. Patients were consecutively enrolled with a primary diagnosis of STEMI within 30 days of symptom onset. Clinical treatments, outcomes and cost are collected by local investigators and captured electronically, with a standardized set of variables and standard definitions, and rigorous data quality control. Post-discharge patient follow-up to 1 year is planned. As of August 2018, the Henan STEMI Registry has enrolled 5479 patients of STEMI.

Discussion

The Henan STEMI Registry represents the largest Chinese regional platform for clinical research and care quality improvement for STEMI. The board inclusion of secondary hospitals in Henan province will allow for the exploration of STEMI in predominantly rural central China.

Trial registration

[NCT02641262] [29 December, 2015].
Comparing Skype (video calling) and in-person qualitative interview modes in a study of people with irritable bowel syndrome – an exploratory comparative analysis
Authors: Krouwel Matthew , Jolly Kate , Greenfield Sheila
Published: November 2019

Background

Within qualitative research in-person interviews have the reputation for being the highest standard of interviewer-participant encounter. However, there are other approaches to interviewing such as telephone and e-mail, which may be appropriate for a variety of reasons such as cost, time and privacy. Although there has been much discussion of the relative values of different interview methods, little research has been conducted to assess what differentiates them using quantifiable measures. None of this research has addressed the video call, which is the interview mode most like the in-person interview. This study uses quantifiable measures generated by the interview to explore the relative value of in-person and video call interview modes.

Methods

Interview data gathered by a qualitative research study exploring the views of people with IBS about hypnotherapy for their condition were used. In-person and video call interviews using the same topic guide were compared on measures of length (time and word count), proportion of time the interviewer was dominant, the number of topics generated (codes) and the number of individual statements on which those topics were based.

Results

Both interview methods produced a similar number of words and a similar number of topics (codes) were discussed, however the number of statements upon which the variety of topics was based was notably larger for the in-person interviews.

Conclusion

These findings suggest that in in-person study interviews were marginally superior to video calls in that interviewees said more, although this was on a similar range of topics. However, the difference is sufficiently modest that time and budget constraints may justify the use of some video call interviews within a qualitative research study.
Spatial distribution and temporal trends of leprosy in Uganda, 2012–2016: a retrospective analysis of public health surveillance data
Authors: Aceng Freda Loy , Kawuma Herman-Joseph , Majwala Robert , Lamunu Maureen , Ario Alex Riolexus , Rwabinumi Frank Mugabe , Harris Julie R. , Zhu Bao-ping
Published: November 2019

Background

Leprosy is a neglected disease that poses a significant challenge to public health in Uganda. The disease is endemic in Uganda, with 40% of the districts in the country affected in 2016, when 42 out of 112 districts notified the National Tuberculosis and Leprosy Program (NTLP) of at least one case of leprosy. We determined the spatial and temporal trends of leprosy in Uganda during 2012–2016 to inform control measures.

Methods

We analyzed quarterly leprosy case-finding data, reported from districts to the Uganda National Leprosy Surveillance system (managed by NTLP) during 2012–2016. We calculated new case detection by reporting district and administrative regions of treatment during this period. New case detection was defined as new leprosy cases diagnosed by the Uganda health services divided by regional population; population estimates were based on 2014 census data. We used logistic regression analysis in Epi-Info version 7.2.0 to determine temporal trends. Population estimates were based on 2014 census data. We used QGIS software to draw choropleth maps showing leprosy case detection rates, assumed to approximate the new case detection rates, per 100,000 population.

Results

During 2012–2016, there was 7% annual decrease in reported leprosy cases in Uganda each year (p = 0.0001), largely driven by declines in the eastern (14%/year, p = 0.0008) and central (11%/year, p = 0.03) regions. Declines in reported cases in the western (9%/year, p = 0.12) and northern (4%/year, p = 0.16) regions were not significant. The combined new case detection rates from 2012 to 2016 for the ten most-affected districts showed that 70% were from the northern region, 20% from the eastern, 10% from the western and 10% from the central regions.

Conclusion

There was a decreasing trend in leprosy new case detection in Uganda during 2012–2016; however, the declining trends were not consistent in all regions. The Northern region consistently identified more leprosy cases compared to the other regions. We recommend evaluation of the leprosy surveillance system to ascertain the leprosy situation.
A paraneoplastic limbic encephalitis from an anorectal small cell neuroendocrine carcinoma: a case report
Authors: Longo Raffaele , Wagner Marc , Savenkoff Benjamin , de Castaing Mathilde Chastenet , Desiro Guillaume , Tubail Zead , Hennequin Laurent , Mahmoud Sinan Ben , Marcon Nathalie , Quetin Philippe , Campitiello Marco , Plastino Francesca
Published: November 2019

Background

Paraneoplastic limbic encephalitis (PLE) is a rare autoimmune neurological syndrome observed in cancer patients. PLE is difficult to diagnose and presents a variable response to treatment, depending on the characteristics of the tumor and neuronal autoantibodies.

Case presentation

A 64-year-old, Caucasian, non-smoker man presented with a rapidly developing cognitive impairment, personality change, spatial disorientation, and short-term memory loss associated with anorexia and cervical and inguinal lymph nodes. The 18F-FDG PET scan documented intensely hypermetabolic lymph nodes, which histologically corresponded to a metastasis from a small cell neuroendocrine carcinoma. The brain MRI revealed a high T2-weighted FLAIR signal of the hippocamps, consisted with a PLE. The presence of anti-neuronal Hu antibodies confirmed the diagnosis. The patient underwent plasmapheresis, associated to a systemic chemotherapy resulting in a partial and temporary improvement of the neurological symptoms. Four cycles of intravenous immunoglobulins were also necessary. After six cures of chemotherapy, the lymph node metastases regressed. However, a new anorectal lesion was detected and was histologically confirmed as a primary small cell neuroendocrine carcinoma, which was treated with concomitant chemoradiotherapy. At the end of this treatment, the patient showed a rapid tumor progression leading to his death.

Conclusions

This case highlights the rare entity, PLE, which is difficult to diagnose and manage. In addition, this is the first published case of PLE associated with an anorectal small cell neuroendocrine carcinoma, which appeared after completion of systemic chemotherapy.
Prenatal diagnosis of a “living” oropharyngeal fetus in fetu: a case report
Authors: Wang Ling , Long Baiguo , Zhou Qichang , Zeng Shi
Published: November 2019

Backgroud

Fetus in fetu (FIF) is a rare malformation in which a parasitic twin within its more mature twin. Most of the FIF locate in the retroperitoneum and are acardiac and anencephalic.

Case presentation

Here, we describe a unique case of oropharyngeal fetus in fetu with a rudimentary two-chambered heart detected by prenatal ultrasonography. The parents terminated this pregnancy after counseling. Macroscopic examination found a solid mass between the oral and fetal chest, with a rudimentary two-chambered heart at the lowest part of the mass. Microscopic findings showed amniotic membrane, skin, cartilage, gastrointestinal and neural tissue.

Conclusions

Prenatal ultrasound can identify rudimentary organs suspecting FIF from early pregnancy. Detection of fetal heart beat facilitates differential diagnosis with teratomas, providing essential information for parental consulting and management.
Correction to: Plexin-B1 silencing inhibits ovarian cancer cell migration and invasion
Authors: Ye Shuangmei , Hao Xing , Zhou Ting , Wu Mingfu , Wei Juncheng , Wang Yongjun , Zhou Li , Jiang Xuefeng , Ji Li , Chen Yin , You Lanying , Zhang Yiqun , Xu Gang , Zhou Jianfeng , Ma Ding , Wang Shixuan
Published: November 2019

Following publication of the original article [1], the authors reported the following error is the article
Prognostic role of pre-treatment C-reactive protein/albumin ratio in esophageal cancer: a meta-analysis
Authors: Liu Zhenhua , Shi Hongtai , Chen Longyun
Published: November 2019

Background

In recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC.

Methods

Studies assessing the role of pre-treatment CAR in prognosis of EC were searched from PubMed, Embase and the Cochrane Library (last update by April 16, 2019). The hazard ratios (HRs) of CAR and the corresponding 95% CIs for overall survival (OS) or cancer-specific survival (CSS) in EC were extracted for pooled analysis.

Results

A total of eight observational studies including 2255 patients were collected. The pooled analysis showed that high CAR was related to worse OS in EC (pooled HR = 1.81; 95% CI = 1.40–2.35; P < 0.001). Subgroup analyses showed that the negative correlation between the CAR and OS was consistently demonstrated in subgroups stratified by country, pathological type, and cut-off value (P < 0.05). However, there was no relation between CAR and OS in subgroup of patients receiving neoadjuvant chemotherapy at a proportion of 100% (HR = 1.15, 95% CI = 0.56–2.69; P = 0.715). In addition, high CAR was also related to worse CSS in EC (pooled HR = 2.61; 95% CI = 1.67–4.06; P < 0.001).

Conclusions

High pre-treatment CAR was an adverse prognostic factor for EC patients. More large-sample clinical trials are still needed to verify the prognostic value of pre-treatment CAR in EC.
Conventional versus drug-eluting beads chemoembolization for infiltrative hepatocellular carcinoma: a comparison of efficacy and safety
Authors: Zhang Zi-shu , Li Hui-zhou , Ma Cong , Xiao Yu-dong
Published: November 2019

Background

To compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC).

Methods

A total of 89 iHCC patients who were treated with either cTACE (n = 33) or DEB-TACE (n = 56) between April 2013 and September 2017 were included in this retrospective study. Patients with the situations that might have a poor outcome were defined as advanced disease including Child-Pugh class B, bilobar lesions, tumor size greater than 10 cm, ECOG 1–2, tumor burden of 50–70%, and the presence of ascites, arterioportal shunt (APS), and portal venous tumor thrombus (PVTT). The tumor response was measured 1-month and 3-month after the procedure. Progression-free survival (PFS) was calculated. Toxicity was graded by Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0). The differences in tumor response, PFS, and toxicity were compared between the DEB-TACE group and cTACE group.

Results

At 1-month and 3-month after the procedure, the objective response rate (ORR) in the overall study population was similar in DEB-TACE group and cTACE group. The disease control rate (DCR), at 1-month after the procedure, was significantly higher in the patients treated with DEB-TACE relative to those treated with cTACE (P = 0.034), while after 3 months, the difference did not differ between two groups. DEB-TACE showed a higher DCR than cTACE in patients with tumor size greater than 10 cm (P = 0.036) or associated with APS (P = 0.030) at 1-month after the procedure, while after 3 months, the difference was only noted in patients with APS (P = 0.036). The median PFS in DEB-TACE group was 96 days, while in cTACE group was 94 days, and there was no difference in PFS between two groups (P = 0.831). In the side effect analysis, abdominal pain (P = 0.034) and fever (P = 0.009) were more frequently present in the cTACE group than DEB-TACE group, but there was no difference in high grade liver toxicity between the two groups.

Conclusions

Compared to cTACE, DEB-TACE offers slightly better DCR and tolerability for iHCC patients, particularly in patients associated with APS and large tumor size. However, DEB-TACE does not provide higher PFS than cTACE.
Help-seeking behaviors among Chinese people with mental disorders: a cross-sectional study
Authors: Yin Huifang , Wardenaar Klaas J. , Xu Guangming , Tian Hongjun , Schoevers Robert A.
Published: November 2019

Background

Failure to seek treatment for mental health disorders is a serious public health concern. Unfortunately, there is little insight into help-seeking and its associated factors in China which has undergone rapid economic development in the past 30 years and has an increasing prevalence of mental disorder. Therefore, this study aimed to (1) investigate help-seeking rates in healthcare and non-healthcare settings and (2) investigate the correlates of help-seeking behavior in a large Chinese survey.

Methods

Data came from the Tianjin Mental Health Survey (TJMHS), a representative sample of adult community residents in the Chinese municipality of Tianjin (n = 11,748). Of these, 1759 individuals had ≥1 axis-I diagnosis according to the Diagnostic and Statistical manual– fourth edition (DSM-IV) and were administered a Help-Seeking Questionnaire.

Results

15.7% of patients reported that they had ever sought help during their entire lifetime before the interview, with 4.5% seeking help in mental healthcare, 3.2% in other healthcare and 8.1% in non-healthcare settings (e.g., family, friends, and spiritual advisor). Among help-seekers, the first help was mostly sought in non-healthcare settings (58.4%), followed by healthcare (27.5%) and mental healthcare settings (24.5%). Female gender, younger age, having 7–9 years vs 0–6 years of education, a low income, a psychotic disorder and having ≥2 disorders were associated with increased help-seeking. Older age, being married and having a psychotic or organic disorder were associated with increased help-seeking in healthcare vs. non-healthcare settings.

Conclusion

A small percentage of persons with mental disorders in the Tianjin region seek help and among those who do, variations in the types of help-seeking may be partially explained by demographic and clinical characteristics.
Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence
Authors: Sohn Sei Yon , Rees Philippa , Wildridge Bethany , Kalk Nicola J. , Carter Ben
Published: November 2019

Background

Over the past decade, smartphone use has become widespread amongst today’s children and young people (CYP) which parallels increases in poor mental health in this group. Simultaneously, media concern abounds about the existence of ‘smartphone addiction’ or problematic smartphone use. There has been much recent research concerning the prevalence of problematic smartphone use is in children and young people who use smartphones, and how this syndrome relates to mental health outcomes, but this has not been synthesized and critically evaluated.

Aims

To conduct a systematic review and meta-analysis to examine the prevalence of PSU and quantify the association with mental health harms.

Methods

A search strategy using Medical Subject Headings was developed and adapted for eight databases between January 1, 1st 2011 to October 15th 2017. No language restriction was applied. Of 924 studies identified, 41 were included in this review, three of which were cohort studies and 38 were cross sectional studies. The mental health outcomes were self-reported: depression; anxiety; stress; poor sleep quality; and decreased educational attainment, which were synthesized according to an a priori protocol.

Results

The studies included 41,871 CYP, and 55% were female. The median prevalence of PSU amongst CYP was 23.3% (14.0–31.2%). PSU was associated with an increased odds of depression (OR = 3.17;95%CI 2.30–4.37;I2 = 78%); increased anxiety (OR = 3.05 95%CI 2.64–3.53;I2 = 0%); higher perceived stress (OR = 1.86;95%CI 1.24–2.77;I2 = 65%); and poorer sleep quality (OR = 2.60; 95%CI; 1.39–4.85, I2 = 78%).

Conclusions

PSU was reported in approximately one in every four CYP and accompanied by an increased odds of poorer mental health. PSU is an evolving public health concern that requires greater study to determine the boundary between helpful and harmful technology use. Policy guidance is needed to outline harm reduction strategies.
HIV testing experiences in Nairobi slums: the good, the bad and the ugly
Authors: Wekesa Eliud
Published: November 2019

Background

HIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90–90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting.

Methods

The study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N = 41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method.

Results

The respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported.

Conclusion

The 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good – irrespective of whether testing is initiated by the individual or by the health provider.
Knowledge, attitude, and practice towards Hepatitis B infection among nurses and midwives in two maternity hospitals in Khartoum, Sudan
Authors: Mursy Sanaa Mohammed-elbager Mahmoud , Mohamed Sagad Omer Obeid
Published: November 2019

Background

Hepatitis B virus (HBV) infection creates a global health burden with significant morbidity and mortality. Healthcare workers, including nurses and midwives, are at higher risk of acquiring the disease. While health-related behaviours are affected by different aspects of knowledge, attitude, and practices (KAP), there are few studies examining the KAP level of healthcare workers towards HBV infection in Sudan. The purpose of this study was to examine the KAP level of nurses and midwives towards HBV virus infection in Khartoum, Sudan.

Methods

A cross-sectional descriptive hospital-based study was conducted in two public maternity hospitals (Saudi and Saad Abul-Eleella hospitals) in Khartoum state of, Sudan. A pre-tested structured questionnaire was constructed and implemented to examine KAP towards HBV infection. Statistical Package for Social Sciences (SPSS) version of 21 was utilized to conduct statistical analysis and examine the data at hand. Chi-square test was used implemented to determine the relationship between categorical variables.

Results

A total of 110 nurses and midwives from the both hospitals participated in this study. More than half of the respondents (58.2%) had an average level of knowledge, two-third of the respondents had a safe practice, and the majority of the respondents had a favourable attitude towards HBV preventive measures. Approximately half of the participants (51.8%) had a history of needle stick injuries. Half of the participants had inaccurate concepts about post exposure prophylaxis to HBV infection, while more than half of the nurses and midwives didn’t complete the vaccination schedule for HBV.

Conclusion

Most of the nurses and midwives in Saudi and Saad Abul-Eleella hospitals were aware of HBV infection. However, a significant proportion of the participants lack the requisite knowledge about post exposure management. The study revealed a low level of HBV vaccination coverage rate and a high rate of needle stick injuries. Further strategies for preventing workplace exposure, training programs on HBV infection, including post exposure prophylaxis, and increasing vaccination coverage rate of all HCWS are highly recommended.
Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia
Authors: Thompson Genevieve N. , McClement Susan E.
Published: November 2019

Background

With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population.

Methods

A qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors.

Results

Analysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying.

Conclusions

The critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.
Towards a nationwide implementation of a standardized nutrition and dietetics terminology in clinical practice: a pre-implementation focus group study including a pretest and using the consolidated framework for implementation research
Authors: Gäbler Gabriele , Coenen Michaela , Fohringer Katrin , Trauner Michael , Stamm Tanja A.
Published: November 2019

Background & Aims

In order to assure high quality of nutrition and dietetic care as well as research, the implementation of a standardized terminology, such as the World Health Organization (WHO) International Classification of Functioning, Disability and Health for Dietetics (ICF-Dietetics) is indispensable. The aim of this study was to explore the clinical practicability and applicability of the ICF-Dietetics in the field of nutrition and dietetic practice prior to the implementation in order to develop criteria (points to consider) for a targeted implementation strategy.

Methods

A focus group study including a pretest of the ICF-Dietetics was conducted. Subsequently, facilitators and barriers for a nationwide implementation of the ICF-Dietetics in clinical nutrition and dietetic practice were identified and linked to interventions (combining theory-based and group-based approach) using the Consolidated Framework of Implementation Research (CFIR) to organize and represent data and summarized in a logic model.

Results

In the pretest 55 clinical documentations which consisted of 248 different ICF-Dietetics categories were received. In four focus groups with 22 health professionals, 66 relevant higher-level themes and implementation strategy criteria (points to consider) were identified. These themes referred to all five domains of the CFIR, namely intervention characteristics, inner setting, outer setting, characteristics of individuals and implementation process and contained important barriers and facilitators that were linked to six implementation objectives as well as six context requirements and five main actors.

Conclusions

This study provides facilitators and barriers to be addressed when implementing the ICF-Dietetics in clinical practice and shows potential interventions based on this analysis. A nationwide implementation was mainly seen as a great advantage for enhancing quality and continuity of care and for providing comparable data. However, it requires further refinements and a multifaceted implementation strategy where the engagement of leadership of institutions plays a crucial role. These results have provided a foundation for a targeted implementation strategy to increase the success, reproducibility and comparability.
Exploring strategies to promote influenza vaccination of children with medical comorbidities: the perceptions and practices of hospital healthcare workers
Authors: Ma Vanessa , Palasanthiran Pamela , Seale Holly
Published: November 2019

Background

To explore how the influenza vaccine is promoted and delivered to children with medical comorbidities in the hospital setting, as well as the facilitators of and barriers to vaccination from the healthcare worker perspective.

Methods

Semi-structured interviews were conducted with staff members (n = 17) at a paediatric hospital in Sydney, Australia between April and July 2018. This included nurses, clinical nurse consultants, pediatricians and department heads. The interviews were transcribed and analysed iteratively to generate the major themes.

Results

Approaches used to promote and/or deliver the influenza vaccine varied among the participants. Some described the vaccine as an ingrained component of their clinical consultation. Others acknowledged that there was missed opportunities to discuss or provide the vaccine, citing competing priorities as well as a lack of awareness, time and resources. Participants perceived that some parents had concerns about safety and appropriateness of the vaccine for their child. While there was some support for sending reminders and/or educating patients through the hospital, there were differing perspectives on whether tertiary centres should be delivering the vaccine.

Conclusion

Hospital-based interventions to increase vaccine uptake must consider the needs of staff. Easily accessible information and increased awareness of the recommendations among staff may lead to improved uptake in this hospital. Additional resources would be required to increase on-site delivery of the vaccine.
Healthcare workers’ clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment
Authors: Zemedu Theodros Getachew , Teshome Aster , Tadesse Yared , Bekele Abebe , Keyes Emily , Bailey Patricia , Ruano Ana Lorena
Published: November 2019

Background

Improving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers’ knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge.

Methods

This study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score.

Results

A total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants.

Conclusion

With regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.
Expanding access to maternal, newborn and primary healthcare services through private-community-government partnership clinic models in rural Kenya: the Ubuntu-Afya kiosk model
Authors: Gatakaa Hellen , Ombech Elizabeth , Omondi Rogers , Otiato James , Waringa Vincent , Okomo Gordon , Muga Richard , Ndiritu Moses , Gwer Samson
Published: November 2019

Background

Fifteen counties contribute 98.7% of the maternal and newborn morbidity and mortality in Kenya. The dismal maternal and newborn (MNH) outcomes in these settings are mostly attributable to limited access to skilled MNH services. Public health services are stretched and limited in reach, and many social programmes are not sustainably designed. We implemented a network of 16 self-sustaining community medical centres (Ubuntu-Afya Kiosks) in Homa Bay County, to facilitate access to MNH and other primary health services. We investigated the effect of these centres on MNH access indicators over a 2-year period of initial implementation.

Methods

We conducted a baseline and end-line survey in June 2016 and May 2018 respectively, in 10 community health units (CHU) served by Ubuntu-Afya Kiosks. We targeted women of child bearing age, ensuring equal sample across the 10 CHUs. The surveys were powered to detect a 10% increase in the proportion of women who deliver under a skilled birth attendant from a perceived baseline of 55%. Background characteristics of the respondents were compared using Fisher’s exact test for the categorical data. STATA ‘svy’ commands were used to calculate confidence intervals for the proportions taking into account the clustering within CHU.

Results

The coverage of antenatal care during previous pregnancy was 99% at end-line compared to 81% at baseline. Seventy one percent of mothers attended at least four antenatal care visits, compared to 64% at baseline. The proportion of women who delivered under a skilled birth attendant during previous pregnancy was higher at end-line (90%) compared to baseline (85%). There was an increase in the proportion of women who had their newborns examined within 2 day of delivery from 74 to 92% at end-line. A considerable proportion of the respondents visited private clinics at end-line (31%) compared to 3% at baseline.

Conclusions

Ubuntu-Afya Kiosks were associated with enhanced access to MNH care, with significant improvements observed in newborn examination within 2 days after delivery. More women sought care from private clinics at end-line compared to baseline, indicating potential for private sector in supporting health service delivery gaps in under-served settings.
Determinants and supporting factors for rebuilding nursing workforce in a post-disaster setting
Authors: Hirohara Moe , Ozaki Akihiko , Tsubokura Masaharu
Published: November 2019

Background

The workforce shortage is one of the major issues associated with the recovery of Minamisoma City in Fukushima Prefecture, after the Great East Japan Earthquake and the subsequent accidents at the Fukushima Daiichi Nuclear Power Plants in March 2011. While the radiation risks are often discussed as a major factor of evacuation, little is known about the actual reasons why the residents chose to evacuate, and what enables them to return.

This study aims to find the essential factors for rebuilding the workforce in a post-disaster setting by analysing the residents’ decisions about evacuation and the return to Minamisoma. In particular, we focus on the experiences of nurses as an example of healthcare workers, who play an important role in the disaster recovery.

Methods

The data were obtained through qualitative interviews in a semi-structured form with 25 nurses from four hospitals in Minamisoma City. The interview questions focused on the reasons of their decisions on evacuation and return. The data were analysed by a thematic approach to investigate the major factors which led them to evacuate and enabled them to return afterwards, as well as the support they needed to resettle.

Results

Nearly two-thirds of the interviewees chose to evacuate from Minamisoma with their family. Family conditions seem to be the predominant factor that influenced their decisions. In particular, having small children was a strong cause for evacuation. After a certain period of time, the nurses that evacuated were then faced with another decision about returning to the area; once again, having children, as well as other life factors, such as livelihoods, job opportunities and emotional attachment to the work, influenced this decision. On the other hand, radiation risk was a minor factor. Therefore, we analyse that improved support considering their life situations would contribute to the better retention of the nurses.

Conclusions

We suggest measures such as parenting supports, ensuring job opportunities after return, and psychological support in the workplace as possible solutions for higher job retention.
Fhl1p protein, a positive transcription factor in Pichia pastoris, enhances the expression of recombinant proteins
Authors: Zheng Xueyun , Zhang Yimin , Zhang Xinying , Li Cheng , Liu Xiaoxiao , Lin Ying , Liang Shuli
Published: November 2019

Background

The methylotrophic yeast Pichia pastoris is well-known for the production of a broad spectrum of functional types of heterologous proteins including enzymes, antigens, engineered antibody fragments, and next gen protein scaffolds and many transcription factors are utilized to address the burden caused by the high expression of heterologous proteins. In this article, a novel P. pastoris transcription factor currently annotated as Fhl1p, an activator of ribosome biosynthesis processing, was investigated for promoting the expression of the recombinant proteins.

Results

The function of Fhl1p of P. pastoris for improving the expression of recombinant proteins was verified in strains expressing phytase, pectinase and mRFP, showing that the productivity was increased by 20–35%. RNA-Seq was used to study the Fhl1p regulation mechanism in detail, confirming Fhl1p involved in the regulation of rRNA processing genes, ribosomal small/large subunit biogenesis genes, Golgi vesicle transport genes, etc., which contributed to boosting the expression of foreign proteins. The overexpressed Fhl1p strain exhibited increases in the polysome and monosome levels, showing improved translation activities.

Conclusion

This study illustrated that the transcription factor Fhl1p could effectively enhance recombinant protein expression in P. pastoris. Furthermore, we provided the evidence that overexpressed Fhl1p was related to more active translation state.
Long noncoding RNA LCAT1 functions as a ceRNA to regulate RAC1 function by sponging miR-4715-5p in lung cancer
Authors: Yang Juze , Qiu Qiongzi , Qian Xinyi , Yi Jiani , Jiao Yiling , Yu Mengqian , Li Xufan , Li Jia , Mi Chunyi , Zhang Jisong , Lu Bingjian , Chen Enguo , Liu Pengyuan , Lu Yan
Published: November 2019

Introduction

Long noncoding RNAs (lncRNAs) are emerging as key players in the development and progression of cancer. However, the biological role and clinical significance of most lncRNAs in lung carcinogenesis remain unclear. In this study, we identified and explored the role of a novel lncRNA, lung cancer associated transcript 1 (LCAT1), in lung cancer.

Methods

We predicted and validated LCAT1 from RNA-sequencing (RNA-seq) data of lung cancer tissues. The LCAT1–miR-4715-5p–RAC1 axis was assessed by dual-luciferase reporter and RNA immunoprecipitation (RIP) assays. Signaling pathways altered by LCAT1 knockdown were identified using RNA-seq. Furthermore, the mechanism of LCAT1 was investigated using loss-of-function and gain-of-function assays in vivo and in vitro.

Results

LCAT1 is an oncogene that is significantly upregulated in lung cancer tissues and associated with poor prognosis. LCAT1 knockdown caused growth arrest and cell invasion in lung cancer cells in vitro, and inhibited tumorigenesis and metastasis in the mouse xenografts. Mechanistically, LCAT1 functions as a competing endogenous RNA for miR-4715-5p, thereby leading to the upregulation of the activity of its endogenous target, Rac family small GTPase 1 (RAC1). Moreover, EHop-016, a small molecule inhibitor of RAC1, as an adjuvant could improve the Taxol monotherapy against lung cancer cells in vitro.

Conclusions

LCAT1–miR-4715-5p–RAC1/PAK1 axis plays an important role in the progression of lung cancer. Our findings may provide valuable drug targets for treating lung cancer. The novel combination therapy of Taxol and EHop-016 for lung cancer warrants further investigation, especially in lung cancer patients with high LCAT1 expression.
WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours
Authors: Picetti Edoardo , Rossi Sandra , Abu-Zidan Fikri M. , Ansaloni Luca , Armonda Rocco , Baiocchi Gian Luca , Bala Miklosh , Balogh Zsolt J. , Berardino Maurizio , Biffl Walter L. , Bouzat Pierre , Buki Andras , Ceresoli Marco , Chesnut Randall M. , Chiara Osvaldo , Citerio Giuseppe , Coccolini Federico , Coimbra Raul , Di Saverio Salomone , Fraga Gustavo P. , Gupta Deepak , Helbok Raimund , Hutchinson Peter J. , Kirkpatrick Andrew W. , Kinoshita Takahiro , Kluger Yoram , Leppaniemi Ari , Maas Andrew I. R. , Maier Ronald V. , Minardi Francesco , Moore Ernest E. , Myburgh John A. , Okonkwo David O. , Otomo Yasuhiro , Rizoli Sandro , Rubiano Andres M. , Sahuquillo Juan , Sartelli Massimo , Scalea Thomas M. , Servadei Franco , Stahel Philip F. , Stocchetti Nino , Taccone Fabio S. , Tonetti Tommaso , Velmahos George , Weber Dieter , Catena Fausto
Published: November 2019

The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.
The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort
Authors: Karakike Eleni , Kyriazopoulou Evdoxia , Tsangaris Iraklis , Routsi Christina , Vincent Jean-Louis , Giamarellos-Bourboulis Evangelos J.
Published: November 2019

Background

Since the Sepsis-3 criteria, change in Sequential Organ Failure Assessment (SOFA) score has become a key component of sepsis identification. Thus, it could be argued that reversal of this change (ΔSOFA) may reflect sepsis response and could be used as measure of efficacy in interventional trials. We aimed to assess the predictive performance of ΔSOFA for 28-day mortality.

Methods

Data from two previously published randomized controlled trials were studied: the first reporting on patients with severe Gram-negative infections as a derivation cohort and the second reporting on patients with ventilator-associated pneumonia as a validation cohort. Only patients with sepsis according to the Sepsis-3 definition were included in this analysis. SOFA scores were calculated on days 1, 2, 3, 5, 7, 14, and 28.

Results

We included 448 patients within the derivation cohort and 199 within the validation cohort. Mean SOFA scores on day 1 were 6.06 ± 4.07 and 7.84 ± 3.39, and 28 day mortality 22.8% and 29.6%, respectively. In the derivation cohort, the earliest time point where ΔSOFA score predicted mortality was day 7 (AUROC (95% CI) 0.84 (0.80–0.89); p < 0.001). The best tradeoff for prediction was found with 25% changes (78% sensitivity, 80% specificity); less than 25% decrease of admission SOFA was associated with increased mortality (odds ratio for death 14.87). This finding was confirmed in the validation cohort.

Conclusions

ΔSOFA on day 7 is a useful early prognostic marker of 28-day mortality and could serve as an endpoint in future sepsis trials alongside mortality.

Trial registration

ClinicalTrials.gov numbers NCT01223690 and NCT00297674