bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 precautionary behavior: The Israeli case in the initial stage of the outbreak
Authors: Shinan-Altman Shiri , Levkovich Inbar
Published: November 2020

Abstract: OVID-19, play an important role in bringing the outbreak under control, and provide insights into development of risk communication messages to the public. Therefore, this study aimed to explore the association between knowledge about COVID-19, perceived susceptibility, emotional reactions and precautionary behavior among the Israeli lay public at the beginning of the COVID-19 outbreak. Method: A cross-sectional study was conducted among 1,407 participants, aged 18+. Participants completed measures of knowledge about COVID-19, perceived susceptibility, emotional reactions, precautionary behavior, and socio-demographic questionnaires. A hierarchical regression model was calculated with precautionary behavior as the dependent variable.Results: Findings indicated that precautionary behavior was higher for females, older participants, participants with higher levels of knowledge about COVID-19, and participants with greater negative emotional reactions. A negative curvilinear relationship was found between perceived susceptibility and precautionary behavior, so that the latter was highest for participants with moderate perceived susceptibility. All interaction terms were non-significant. Conclusions: Findings suggest that in order to enhance precautionary behavior in the initial stage of a virus outbreak, it is recommended to pay attention to the public’s knowledge about the virus, perceived susceptibility and emotional reactions. Although negative feelings about the virus may motivate preventive behavior, it is important to address these feelings.
An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change
Authors: Leslie Myles , Khayatzadeh-Mahani Akram , Birdsell Judy , Forest PG , Henderson Rita , Gray Robin Patricia , Schraeder Kyleigh , Seidel Judy , Zwicker Jennifer , Green Lee A.
Published: November 2020

Background: Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n=20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses.Results: Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.
Phone-based audience response system as an adjunct in orthodontic teaching of undergraduate dental students: a cross-over randomised controlled trial
Authors: Alharbi Fahad , Alazmi Khulud , Momani Bashar R. El , Al-Muzian Lubna , Wertheimer Mark , Almukhtar Anas , Almuzian Mohammed
Published: November 2020

Background: The advent of electronic teaching facilities improves tutor-student communication. This study aims to explore the effectiveness of Phone-Based Audience Response System (PB-ARS), as an adjunctive pedagogy tool to enhance the retention of orthodontic information by dental students; and to explore the students’ perception of PB-ARS. Methods: This cross-over clustered randomised control trial included 34 males who were in the final year of their undergraduate dental training. Participants were allocated to one of two event groups (G1 and G2) using computer-generated randomisation. Both groups simultaneously attended two different traditional lectures (L 1 and L2) a week apart. During L1, PB-ARS was used as an adjunct to conventional presentation to teach G1 participants, (PB-ARS group) while G2’s participants acted as a control group (CG), and were taught using a traditional presentation. In the second week (L2), the interventions were crossed-over. Participants from both groups completed pre- and post-lecture multiple-choice questionnaires (MCQ) to assess their short-term retention of information. Their performance in the final MCQ exam (10 weeks following L2) was tracked to assess the long-term retention of the information. Participants also completed post-lecture questionnaires to evaluate their perceptions. Results: 29 and 31 participants from the CG and PB-ARS group completed this trial, respectively. Although 87.5% of students in the PB-ARS group showed an improvement in their immediate post-lecture scores compared with 79.3% for the CG, it was statistically insignificant (p= 0.465). Similarly, the intervention showed an insignificant effect on the long-term retention of the knowledge (p=0.560).There was a mildly but favourable attitude of students towards the use of PB-ARS. However, the difference in the overall level of satisfaction between both groups was statistically insignificant (p=0.183).Conclusion: PB-ARS has a minimal and insignificant effect on the short- and long-term retention of orthodontic knowledge by male undergraduate dental students. PB-ARS was the preferred adjunct tool to conventional classroom teaching. Due to the limitations of this trial, a long-term randomised controlled trial with a larger sample size is recommended.
High prevalence of cardiovascular risk factors in adults living in Greece: The EMENO National Health Examination Survey 
Authors: Touloumi Giota , Karakosta Argiro , Kalpourtzi Natasa , Gavana Magda , Vantarakis Apostolos , Kantzanou Maria , Hajichristodoulou Christos , Chlouverakis Grigoris , Trypsianis Grigoris , Voulgari Paraskevi V. , Alamanos Yannis , Makrilakis Konstantinos , Liatis Stavros , Chatzipanagiotou Stylianos , Stergiou George
Published: November 2020

Background: Nationwide data on cardiovascular risk factors prevalence is lacking in Greece. This work presents the findings of the national health examination survey EMENO (2013-2016) regarding the prevalence of hypertension, hypercholesterolemia, diabetes, obesity and smoking.Methods: A random sample of adults (≥18 years) was drawn by multistage stratified random sampling based on 2011 Census. All EMENO participants with ≥1 measurement of interest [blood pressure (BP), fasting glucose, HbA1c, total cholesterol (TC), Body Mass Index (BMI)] were included. Hypertension was defined as BP≥140/90mmHg and/or antihypertensive treatment; diabetes as fasting glucose≥126mg/dL and/or HbA1c≥6.5% or self-reported diabetes; hypercholesterolemia as TC≥190mg/dL. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age and sex distribution to population one. Non-response was adjusted by inverse probability weighting. Results: Of 6,006 EMENO participants, 4,822 were included (51.5% females, median age:47.9 years). The prevalence of hypertension was 39.2%, higher in men (42.4%) than in women (36.1%); of hypercholesterolemia 60.2%, similar in men (59.5%) and women (60.9%); of diabetes 11.6%, similar men (12.4%) and women (10.9%); of obesity 32.1%, higher in women (33.5% vs 30.2%), although in subjects aged 18-40 year it was higher in men; of current smoking 38.2%, higher in men (44.0%) than in women (32.7%). The prevalence of all risk factors increased substantially with age, except smoking, which followed an inverse U shape.Conclusions: The burden of cardiovascular risk factors among Greek adults is alarming. There is considerable preventive potential and actions at health care and societal level are urgently needed.
Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review
Authors: Odejimi Opeyemi , Bagchi Dhruba , Tadros George
Published: November 2020

Background: Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UKMethod: Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 hours. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results: Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion: All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.
Repetitive Transcranial Magnetic Stimulation on Chronic Tinnitus: A Systematic Review and Meta-Analysis
Authors: Liang Zhengrong , Cheng Gui , Huang Lingfei , Zhang Tao , Yang Haidi , Jia Haiying
Published: November 2020

Background: Although the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tinnitus have been frequently examined, the results remain contradictory. Therefore, we performed a systematic review and meta-analysed clinical trials examining the effects of rTMS to evaluate its clinical efficacy and safety.Methods: Studies of rTMS for chronic tinnitus were retrieved from PubMed, Embase, and Cochrane Library through April 2020. Review Manager 5.3 software was employed for data synthesis, and Stata 13.0 software was used for analyses of publication bias and sensitivity.Results: Twenty-nine randomized studies involving 1,228 chronic tinnitus patients were included. Compared with sham-rTMS, rTMS exhibited significant improvements in the tinnitus handicap inventory (THI) scores at 1 week (mean difference [MD]: -7.92, 95% confidence interval [CI]: -14.18, -1.66), 1 month (MD: -8.52, 95% CI: -12.49, -4.55), and 6 months (MD: -6.53, 95% CI: -11.406, -1.66) post intervention; there were significant mean changes in THI scores at 1 month (MD: -14.86, 95% CI: -21.42, -8.29) and 6 months (MD: -16.37, 95% CI: -20.64, -12.11) post intervention, and the tinnitus questionnaire (TQ) score at 1 week post intervention (MD: -8.54, 95% CI: -15.56, -1.52). Nonsignificant efficacy of rTMS was found regarding the THI score 2 weeks post intervention (MD: -1.51, 95% CI: -13.42, -10.40); the mean change in TQ scores 1 month post intervention (MD: -3.67, 95% CI: -8.56, 1.22); TQ scores 1 (MD: -8.97, 95% CI: -20.41, 2.48) and 6 months (MD: -7.02, 95% CI: -18.18, 4.13) post intervention; and adverse events (odds ratios [OR]: 1.11, 95% CI: 0.51, 2.42). Egger's and Begg's tests indicated no publication bias (P = 0.925).Conclusion: This meta-analysis demonstrated that rTMS is effective for chronic tinnitus; however, its safety needs more validation. Restrained by the insufficient number of included studies and the small sample size, more large randomized double-blind multi-centre trials are needed for further verification.
The HIV Epidemic in Colombia: Spatial and Temporal Trends Analysis
Authors: Montana Jhon Freddy , Ferreira Glenda Roberta Oliveira Naiff , Cunha Carlos Leonardo Figueiredo , de Queiroz Ana Angelica Rego , Fernandes Wellington Augusto Andrade , Polaro Sandra Helena Isse , Gonçalves Lucia Hisako Takase , Couto Danielle Costa Carrara , Gir Elucir , Reis Renata Karina , Sorensen Wiliam , Botelho Elia Pinheiro
Published: November 2020

BACKGROUND – Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addressed this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory.METHODS – Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS – While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0–14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65-year-old and above in men, while in women, the incidence was upward among those aged 45 years and above and concerning the AIDS-mortality rate in the 45–64 group. The high–high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions.CONCLUSION – Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0–14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence and AIDS mortality rates in older and younger women, respectively, compared with men may be due to late diagnosis and treatment. The Caribbean and the ‘coffee belt’ regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV.
Epidemiological scenario of leprosy in a province in China: long delay in diagnosis and high rate of deformity.
Authors: Zhang Qing-Ping , Li Ge , Li Chao , Lin Zhao-Xing , Chen Ping
Published: November 2020

Background: This epidemiological study aimed to analyze both the distribution and the characteristics of leprosy in an endemic province in the Chinese Northwest. Methods: The medical records of leprosy in the province of Shaanxi, China, 1998-2018 were collected from the leprosy management information system in China (LEPMIS). Epidemiological variables were analyzed in this study. Results: 477 new cases were diagnosed between 1998-2018 in this area. The average rate of annual detection was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of new patients was 46.7 years, and the ratio of male to female was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) forms. 148 cases (31.0%) had grade 2 disability. The mean delay in diagnosis for new cases was 62.0 months. Conclusion: The epidemiological study showed that the characteristics of the new leprosy cases in our province were still long delay in diagnosis and high rate of deformity, which indicated the need of actions of stimulating early diagnosis and treatment, and strengthening the detection of leprosy in low prevalent areas.
Identifying and Supporting Students at Risk of Failing the National Medical Licensure Examination in Japan Using a Predictive Pass Rate
Authors: Tsunekawa Koji , Suzuki Yasuyuki , Shioiri Toshiki
Published: November 2020

Background Students who fail to pass the National Medical Licensure Examination (NMLE) pose a huge problem from the educational standpoint of healthcare professionals. In the present study, we developed a formula of predictive pass rate (PPR)” which reliably predicts medical students who will fail the NMLE in Japan, and provides an adequate academic support for them. Methods Six consecutive cohorts of 531 medical students between 2012 and 2017, Gifu University Graduate School of Medicine, were investigated. Using 7 variables before the admission to medical school and 10 variables after admission, we developed a prediction formula to obtain the PPR for the NMLE using logistic regression analysis. In a new cohort of 106 medical students in 2018, we applied the formula for PPR to them to confirm the capability of the PPR and predicted students who will have a strong likelihood of failing the NMLE. Results Medical students who passed the NMLE had the following characteristics: younger age at admission, graduates of high schools located in the surrounding area, high scores in the graduation examination and in the comprehensive computer-based test provided by the Common Achievement Test Organization in Japan. However, total score of examination in pre-clinical medical sciences and Pre-CC OSCE score in the 4th year were not correlated with the PPR. Ninety-one out of 531 students had a strong likelihood of failing the NMLE between 2012 and 2017 and 33 of these 91 students failed NMLE. Using the PPR, we predicted 12 out of 106 students will have a strong likelihood of failing the NMLE. Actually, five of these 12 students failed NMLE. Conclusions The PPR can be used to predict medical students who have a higher probability of failing the NMLE. This prediction would enable focused support and guidance by faculty members. Prospective and longitudinal studies for larger and different cohorts would be necessary.
Prevalence and determinants of intimate partner violence against mothers of children under-five years in central Malawi
Authors: Chilanga Emmanuel , Collin-Vezina Delphine , Khan Mohammad Nuruzzaman , Riley Liam
Published: November 2020

Background Intimate partner violence (IPV) against women is a global human rights violation and a public health problem. The phenomenon is linked to adverse health effects for women and children. Mothers of young children in Malawi can be particularly at risk because of gender-based power imbalances. The objectives of this study were to examine the prevalence and the risk factors of IPV against mothers of children under-five years of age in rural Malawi.Methods A multistage, cross-sectional study design was used. A sample of 538 mothers of young children was randomly selected from postnatal clinics in Dowa district. The WHO's Violence against women screening instrument was used to collect data. Logistic regressions were used to determine risk factors that were associated with IPV against mothers. Results Overall prevalence of all four forms of IPV against mothers of under-five children was 60.2%. The prevalence of IPV controlling behavior, psychological, physical, and sexual violence were 74.7%, 49.4%, 43.7% and 73.2% respectively. In multivariate analyses, mothers whose partners had extra marital affairs were more likely to experience controlling behavior (AOR: 4.97, 95% CI: 2.59-8.55, P = 0.001), psychological (AOR: 2.14, 95% CI: 1.486-3.472, P = 0.001) and physical (AOR: 2.29, 95% CI: 1.48-3.94, P = 0.001) violence than mothers whose partners did not have extra marital affairs. Mothers whose partners consume alcohol were more likely to experience sexual violence (AOR: 2.00, 95% CI: 1.17-3.41, P = 0.001) than mothers whose partners did not drink. Finally, mothers who spent more than 30 minutes drawing water were at greater risk of experiencing IPV than mothers who spent less than 30 minutes. Conclusion This study found a significantly higher prevalence of IPV against mothers of under-five children in rural Malawi compared to women in the general population. Micro and macro-level programs aimed at mitigating the partners’ potential risk behaviors identified in this study are suggested. Public health programs that support increased household access to safe water are also recommended to help undermine IPV against mothers.
Umbilical cord-derived Wharton’s Jelly for Regenerative Medicine Applications in Orthopedic Surgery: A Systematic Review Protocol
Authors: Main Benjamin J. , Valk Josiah A. , Maffulli Nicola , Rodriguez Hugo C. , Gupta Manu , Stone Ian W. , III Saadiq F. El-Amin , Gupta Ashim
Published: November 2020

Background: Musculoskeletal injuries and conditions affect millions of individuals. These ailments are typically managed by immobilization, physiotherapy or activity modification. Regenerative medicine has experienced tremendous growth in the past decades, especially in musculoskeletal medicine. Umbilical cord-derived Wharton’s Jelly is an exciting new option for such therapies. Wharton’s jelly is a connective tissue located within the umbilical cord largely composed of mesenchymal stem cells and extracellular matrix components, including collagen, chondroitin sulfate, hyaluronic acid and sulfated proteoglycans. Wharton’s Jelly is a promising and applicable biologic source for orthopedic regenerative application.Methods: A systematic search will be conducted in PubMed, ScienceDirect and Google Scholar databases of English, Italian, French, Spanish and Portuguese language articles published to date. References will be screened and assessed for eligibility by two independent reviewers as per PRISMA guidelines. Articles will be considered without exclusion to sex, activity or age. Studies will be included if they used culture-expanded, mesenchymal stem/stromal cells of mesenchymal stem cells and/or connective tissue obtained from Wharton’s Jelly. Studies will be excluded if Wharton’s Jelly is not the sole experimental examined cell type. Placebos, conventional non-operative therapies including steroids injections, exercise and NSAIDs will be compared. The study selection process will be performed independently by two reviewers using a reference software. Data synthesis and meta-analysis will be performed separately for clinical and pre-clinical studies.Discussion: The results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences.Trial registration: The Protocol was registered on PROSPERO international prospective register of systematic reviews prior to commencement, CRD42020182487.
Global, regional, and national burdens of bladder cancer in 2017: estimates from the 2017 Global Burden of Disease study
Authors: He Hairong , Xie Hongjun , Chen Yule , Li Chengzhuo , Han Didi , Xu Fengshuo , Lyu Jun
Published: November 2020

Background: The aim of this study is to describe the prevalence and mortality of bladder cancer (BCa) using data obtained in the Global Burden of Disease study performed in 2017 (GBD 2017).Methods: Data on BCa for 2017, including prevalence, mortality, and disability-adjusted life years (DALYs), were obtained from GBD 2017 at the global, regional, and national levels. We also analyzed the association of BCa burden with the country development level.Results: There were 2.63 million BCa cases estimated from the GBD 2017 data, with 200,000 persons dying of BCa, resulting in 3.60 million DALYs in 2017. The age-standardized prevalence (ASP) of BCa was 32.91/100,000 persons, and age-standardized death rate (ASDR) was 2.57/100,000 persons. The ASP and ASDR of BCa were higher in males than in females, and higher in people older than 60 years. The ASP and ASDR of BCa were higher in Western Europe and Central Europe than in South Asia, Andean Latin America, and Central Latin America, and higher in countries with a higher sociodemographic index (SDI). Correlation analysis identified that the ASP and ASDR of BCa were positively correlated with the country SDI (P<0.0001 and ρ=0.68 for ASP, and P=0.0048 and ρ=0.20 for ASDR). In addition, 33.72% deaths and 36.80% DALYs caused by BCa could be attributed to smoking globally.Conclusion: The prevalence and mortality of BCa were very high in 2017, especially in high-SDI countries. Smoking-cessation strategies should be strengthened to control the burden associated with BCa.
Quality of life during the epidemic of COVID-19 and its associated factors among enterprise workers in East China
Authors: Chen Xiaoxiao , Xu Qian , Lin Haijiang , Zhu Jianfu , Chen Yue , Zhao QI , Fu Chaowei , Wang Na
Published: November 2020

Background: The COVID-19 related lockdown and home confinement might have an important impact on the quality of life in enterprise workers. We investigated the quality of life during the epidemic in enterprise workers who just returned to work, and assessed its potential influencing factors to have a better understanding of the impact of COVID-19 epidemic lockdown and home confinement.Methods: This was a cross-sectional study of enterprise workers conducted in Deqing and Taizhou, Zhejiang Province, China. The Chinese version of EQ5D was used to assess life quality, and information about general characteristics and COVID-19 related factors was collected by a structured questionnaire, which was distributed through the social application “WeChat”.Results: A total of 2,435 participants were enrolled, 59.5% of which worked in Deqing. About 50% of the participants reported worries about the COVID-2019 epidemic and 40.1% had a centralized or home quarantine during the epidemic. The mean EQ-5D score and VAS were 0.990 and 93.5. Multiple logistic regression showed that the quality of life measures was related to physical activities (ORad=0.46) and keeping home ventilation (ORad=0.04) in Deqing, and were related to wearing a mask when going out (ORad=0.35), keeping home ventilation (ORad=0.16), unmarried status (ORad=2.38) and having a centralized or home quarantine (ORad=1.64) in Taizhou,Conclusions: The quality of life for returning enterprise workers in areas with different risks of COVID-19 was affected by different factors. Associated factors identified from this study would help develop proper intervention measures for enterprise workers to reduce the impact of large-scale public health events like the COVID-19 on their quality of life.
Interpersonal Relationships and Drug Use Over Time Among Homeless People: a Qualitative Study.
Authors: de Espíndola Marília Ignácio , Bedendo André , Silva Eroy Aparecida da , Noto Ana Regina
Published: November 2020

BACKGROUND: Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users.METHOD: We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis.RESULTS: Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use.CONCLUSION: The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.
Spatiotemporal Variations in Ischemic Heart Disease Mortality and related risk factors in China between 2010 and 2015: A Multilevel Analysis
Authors: Wang Baohua , Li Peiyao , He Fengdie , Sha Yuting , Wan Xia , Wang Lijun
Published: November 2020

Background: To explore the relationship between geographical differences of mortality and related risk factors in ischemic heart disease (IHD) in China.Methods: We used data from the nationally representative China Mortality Surveillance System to calculate annual IHD mortality counts (2010-2015) stratified by 5-year age groups (aged > 40), gender and time for 161 counties and districts (Disease Surveillance Points, or DSP). Descriptive analysis was used to analyze the IHD mortality in Chinese population from 2010 to 2015. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region.Results: The overall IHD mortality was 221.17/100,000, accounting for 1.51 million deaths in 2015. The standardized IHD mortality rate increased by 5.51% from 2010 to 2015 among people aged 40 years and older. Multilevel analysis indicated significant differences in gender, regional effects, and age. High urbanization rate (risk ratio [RR] = 0.728, 95% confidence interval [CI] = (0.631, 0.840)) and average high-density lipoprotein (HDL) (RR=0.741, 95%CI: 0.616,0.891) were negatively associated with IHD mortality. IHD mortality was significantly higher in populations with a low rate of medical insurance coverage (RR= 1.218, 95%CI: 1.007, 1.473), as well as the average body mass index (BMI) (RR= 1.436, 95%CI: 1.135, 1.817) and systolic blood pressure (SBP) (RR= 1.310, 95%CI: 1.019, 1.684). While the relationship with current smoking rate, excessive intake of red meat, insufficient vegetable or fruits intake didn’t show the statistical significance. The negative correlation between the average sedentary time and IHD mortality was not conclusive due to the possible deviation of the data.Conclusions: The mortality of IHD showed an upward trend for people aged 40 years and older in China during 2010-2015, which should be paid attention to. Therefore, some risk factors should be controlled, that are SBP, overweight/obesity. HDL is a protective factor, as well as higher urbanization rate, family income level, and medical insurance coverage.
Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for high astigmatism
Authors: Kim Bu Ki , Chung Young Taek
Published: November 2020

Background: To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism.Methods: This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method.Results: Twenty-four months after the combined procedure, the average spherical equivalent was reduced from -6.56 ± 2.38 D to -0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to -0.02 ± 0.09 and from -0.03 ± 0.07 D to -0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was -5.48 ± 1.17 D, which was reduced to -2.27 ± 0.97 D and -0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p <0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion: Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.
The relationship between seasonality, latitude and tuberculosis notifications in Pakistan.
Authors: Butt Mohsin F. , Younis Sidra , Wu Zhenqiang , Hadi Syed H. , Latif Abdullah , Martineau Adrian R.
Published: November 2020

BackgroundPakistan is amongst the top 20 highest burden tuberculosis (TB) countries in the world. Approximately 369,548 cases of TB (all forms) were notified in 2018, with an estimated incidence of 265 per 100,000 people per year. In other settings, TB has been shown to demonstrate seasonal variation, with higher incidence in the spring/summer months and lower incidence in the autumn/winter; the amplitude of seasonal variation has also been reported to be higher with increasing distance from the equator.MethodsNotifications of newly-diagnosed pulmonary and extrapulmonary TB cases were obtained for 139 districts in Pakistan from 2011-2017. Data were provided by the Pakistan National TB Control Programme, Islamabad, Pakistan. Statistical analyses were performed to determine whether there was seasonal variation in TB notifications in Pakistan; whether the amplitude of seasonal variation in TB notifications varied according to latitude; whether the amplitude of seasonal variation of TB in Pakistan differed between extrapulmonary TB vs. pulmonary TB. To assess the quarterly seasonality of TB, we used the X-13-ARIMA-SEATS seasonal adjustment programme from the United States Census Bureau. The mean difference and corresponding 95% confidence intervals of seasonal amplitudes between different latitudes and type of TB were estimated using linear regression.ResultsTB notifications were highest in quarter 2, and lowest in quarter 4. The mean amplitude of seasonal variation was 25.5% (95% CI 25.0% to 25.9%). The mean seasonal amplitude of TB notifications from latitude 24.5ºN-<26.5ºN was 29.5% (95% CI 29.3% to 29.7%) whilst the mean seasonal amplitude of TB notifications from latitude 34.5ºN -<36.5ºN was 21.7% (95% CI 19.6% to 23.9%). The mean seasonal amplitude of TB notifications across Pakistan between latitudes 24.5ºN to 36.5ºN reached statistically significant difference (p<0.001). The amplitude of seasonal variation was greater for extrapulmonary TB (mean seasonal amplitude: 32.6%, 95% CI 21.4% to 21.8%) vs. smear positive pulmonary TB mean seasonal amplitude: 21.6%, 95% CI 32.1% to 33.1%), p<0.001.ConclusionTB notifications in Pakistan exhibit seasonal variation with a peak in quarter 2 (April-June) and trough in quarter 4 (October-December). The amplitude of seasonality decreases with increasing latitude, and is more pronounced for extrapulmonary TB than for pulmonary TB.
Health Care Provider's Support from Mothers in NICU: A Focused Ethnography Study
Authors: Negarandeh Reza , Hassankhani Hadi , jabraeili mahnaz , Abbaszadeh mohammaf , Best Amy
Published: November 2020

Background: Mothers of premature infants in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers support needs in the NICU. The aim of study was to explore mothers and health staff experiences and care practices meeting support needs of the mothers in the NICU. Methods: A focused ethnographic approach was adopted. Observation and interviews with 21 mothers, 18 nurses and 5 physicians were undertaken over a seven month period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework. Result: Two main themes of “failure to meet the support needs of mothers” (Subthemes: failure to accompany the mother in care, assigning monitoring and care to the mother, inadequate sharing of medical information) and “supporting the mothers in certain circumstances” (Subthemes: reassuring the mother, supporting mothers with reduced functional capacity, providing information) were obtained. Conclusion: This study showed that the mothers were supported by the staff, particularly while mothers were in serious need of support. However, the staff considered the treatment and care of the infant as their main professional duty and mothers support was provided when they had the opportunity to support.
Obesity And Severity In Patients With COVID-19: A Scoping Review Protocol
Authors: Costa Marcela Larissa , Souza Carlos Adriano Santos , Silva Ana Caroline Cardoso , Santos Dayane Franciely Conceição , Nonato Edilene Fernandes , Santana Francismayne Batista , Dias Giselle dos Santos , Barreto Jessyca Teles , Costa Laís Santos , Costa Maria Carolina Barros , Ferreira Tamila das Neves , Santana Jeniffer Santos , Netto Raquel Simões Mendes , Nascimento Tereza Virgínia Silva Bezerra do , Nunes Marco Antônio Prado , de Souza Márcia Ferreira Cândido
Published: November 2020

Background: Coronavirus disease (COVID-19), caused by the SARS-CoV-2 strain, was first identified in late 2019, in China. A greater number of countries were affected in 2020, with a consequent increase in the disease's epidemiological curve. The outcomes of patients affected by the virus can worsen, developing acute respiratory failure and other serious complications, especially when related to older individuals and people of all ages with obesity and comorbidities. Some studies have shown that obese infected with COVID-19 had a high frequency risk of hospitalization in the Intensive Care Unit and the need to use Invasive Mechanical Ventilation, in addition to the association between a higher death rate. Thus, obese patients tend to have a more severe course of COVID-19. In this sense, this review aims to synthesize the evidence in the literature that associates COVID-19 and the severity of clinical outcomes in infected obese patients. Methods: This protocol will include all study articles that can be used as instruments to assess the severity of clinical outcomes in obese patients infected by 2019-nCoV. There will be no time limitation when searching for articles. Studies in any environment or country for inclusion will be considered. Discussion: There are still not enough studies to characterize the evidence and its strength in the severity of clinical outcomes of the disease. Therefore, given the need for early detection of the possible implications and treatment for patients with obesity, the evidence will be useful for directing the conduct and optimization of therapies in these patients by the multiprofessional teams.Scoping review registration: Open Science Framework: https://osf.io/xrkec
COPD patients prescribed inhaled corticosteroid in primary care – Time for re-assessment based on exacerbation rate and blood eosinophils?
Authors: Savran Osman , Godtfredsen Nina Skavlan , Sørensen Torben , Jensen Christian , Ulrik Charlotte
Published: November 2020

Background and objective: Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood-eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice.Methods: The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using two-sample t-tests.Results: The study cohort comprised 1,567 COPD patients (44% males and mean age 72 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥2 exacerbations (21%) per year reported more dyspnea (p<0.001) and had higher degree of airflow obstruction (p<0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 26%, respectively, had a blood-eosinophil count ≥ 0.3 x 109/L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 x 109/L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 x 109/L.Conclusion: This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggests the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.
Metabolic syndrome Amongst Adults in Jordan: Prevalence, Trend, and its Association with Socio-demographic Characteristics
Authors: Ajlouni Kamel , Khader Yousef , Alyousfi Mohamad , Nsour Mohannad Al , Batieha Anwar , Jaddou Hashem
Published: November 2020

Background: Multiple epidemiological studies were conducted amongst a variety of ethnic groups and showed discrepancies in the prevalence of metabolic syndrome (MeS) and its individual components. This study aimed to determine the prevalence of MeS in Jordan using both the Adult Treatment Panel Guidelines (ATP III) and the International Diabetes Federation (IDF) criteria. The study also aimed to assess the changes in the prevalence of MeS over time and determine its association with sociodemographic variables. Methods: Data from the 2017 Cardiovascular Disease Risk Factors Survey were used for this study. Socio-demographic and clinical data were collected using a structured questionnaire. Blood samples were taken for biochemical measurements. Furthermore, anthropometric characteristics were measured by the same team of trained field researchers. A sample of 4,056 individuals aged between 18 and 90 years was included in this study. The findings from the 2017 survey were compared with the findings of a 2009 survey that adopted the same methods and procedures. Results: According to the IDF criteria, the crude prevalence of Metabolic syndrome was 48.2% (52.9% among men and 46.2% among women; p<0.001). Using the ATP III criteria, the prevalence was 44.1% (51.4% among men and 41% among women, p<0.001). The age-standardized prevalence rate of metabolic syndrome was 44% (95% CI: 42.7, 45.4) and 39.9% (95% CI: 39.6, 41.2), according to both the IDF definition and ATP III criteria, respectively. The Kappa measure of agreement showed excellent agreement between the two definitions (k= 81.9%, p<0.001). Of all participants, 41.7% met both the IDF and ATP III diagnostic criteria, 6.6% met the IDF criteria only, and 2.5% met the ATP III criteria only. The age-standardized prevalence rate of metabolic syndrome was significantly higher in 2017 (45.7% in men and 44.5% in women) than that in 2009 survey (34.6% in men and 39.8% in women). Gender, age, occupation, region, and marital status were significantly associated with metabolic syndrome. Conclusion: The prevalence of metabolic syndrome in Jordan is considerably high and it is increasing. Healthy lifestyle programs encouraging appropriate dietary habits and physical activity are strongly recommended in Jordan.
SiFBA5, a cold-responsive factor from Saussurea involucrate promotes cold resilience and biomass increase in transgenic tomato plants under cold stress
Authors: Mu Jianqiang , Fu Yajuan , Liu Bucang , Zhang Yao , Wang Aiying , Li Yuxia , Zhu Jianbo
Published: November 2020

Background
Saussurea involucrate survives in extreme arctic conditions with strong cold resistant ability. The species occurs in rocky, mountainous habitats at elevations of approximately 2400-4100m with year-round snowfall and freezing temperatures providing a magnificent model and abundant gene pool for dissecting plant stress responses. Fructose-1,6-Bisphosphate Aldolase (FBA) mediates the reverse conversion of fructose 1,6-bisphosphate (FBP) into dihydroxyacetone phosphate (DHAP) and glycerol triphosphate (GAP) during glycolysis or gluconeogenesis, which is the key enzyme in this reaction. Saussurea involucrate can survive in extremely low temperature environment, which shows that it has extremely high photosynthesis efficiency. Significantly, the underlying mechanism of its cold tolerance is yet to be unveiled. Therefore, our work aims to explore potential molecular mechanisms.
Results
In this study, we identified a cold-responsive gene SiFBA5 that based on a preliminary low-temperature genome-wide transcriptional profiling in S. involucrata. Expression analysis showed that cold temperature rapidly induced transcriptional expression of SiFBA5, suggesting that SiFBA5 participates in initial stress responses. Subcellular localization showed that SiFBA5 is localized to the chloroplast. We then generated transgenic tomato plants overexpressing SiFBA5 derived by a CaMV 35S promoter. Phenotypic observation suggested that the transgenic overexpress plants displayed increased cold tolerance, photosynthesis efficiency, and carbohydrate accumulation in comparison with wild-type plants.
Conclusion
Collectively, our results demonstrated that SiFBA5 positively regulates plant response to cold stress, making it a promising candidate for improving cold tolerance in crops.
An ultra-low magnetic field thermal demagnetizer for high-precision paleomagnetism
Authors: Qin Huafeng , Zhao Xiang , Liu Shuangchi , Paterson Greig , Jiang Zhaoxia , Cai Shuhui , Li Jinhua , Liu Qingsong , Zhu Rixiang
Published: November 2020

Thermal demagnetization furnaces are widely used paleomagnetic facilities for progressive removal of naturally acquired magnetic remanence or the imparting of well controlled laboratory magnetization. An ideal thermal demagnetizer should maintain “zero” magnetic field in the sample chamber during thermal treatments. However, magnetic field noises, including the residual magnetic fields of the construction material and the induced fields caused by the alternating current (AC) in the heating element are always present, which can contaminate the paleoamgnetic results at the elevated temperatures or especially for the magnetically weak samples. Here, we designed a new structure of heating wire named “straight core solenoid” to develop a new demagnetization furnace with ultra-low magnetic field noise. Simulation and practical measurements show that the heating current magnetic field can be greatly reduced by using the new technology. Thermal demagnetization experiments demonstrate that the new demagnetizer can yield low noise results even for weakly magnetic samples.