bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic evaluation of a reduced dosage of ready‐to‐use therapeutic foods to treat uncomplicated severe acute malnourished children aged 6–59 months in Burkina Faso
Authors: N'Diaye Dieynaba S. , Wassonguema Bibata , Nikièma Victor , Kangas Suvi T. , Salpéteur Cécile
Published: February 2021

Ready‐to‐use therapeutic foods (RUTF) used to treat children with severe acute malnutrition (SAM) are costly, and the prescribed dosage has not been optimized. The MANGO trial, implemented by Action Contre la Faim in Burkina Faso, proved the non‐inferiority of a reduced RUTF dosage in community‐based treatment of uncomplicated SAM. We performed a cost‐minimization analysis to assess the economic impact of transitioning from the standard to the reduced RUTF dose. We used a decision‐analytic model to simulate a cohort of 399 children/arm, aged 6–59 months and receiving SAM treatment. We adopted a societal perspective: direct medical costs (drugs, materials and staff time), non‐medical costs (caregiver expenses) and indirect costs (productivity loss) in 2017 international US dollar were included. Data were collected through interviews with 35 caregivers and 20 informants selected through deliberate sampling and the review trial financial documents. The overall treatment cost for 399 children/arm was $36,550 with the standard and $30,411 with the reduced dose, leading to $6,140 (16.8%) in cost savings ($15.43 saved/child treated). The cost/consultation was $11.6 and $9.6 in the standard and reduced arms, respectively, with RUTF accounting for 56.2% and 47.0% of the total. The savings/child treated was $11.4 in a scenario simulating the Burkinabè routine SAM treatment outside clinical trial settings. The reduced RUTF dose tested in the MANGO trial resulted in significant cost savings for SAM treatment. These results are useful for decision makers to estimate potential economic gains from an optimized SAM treatment protocol in Burkina Faso and similar contexts.
Seascape genomics reveals candidate molecular targets of heat stress adaptation in three coral species
Authors: Selmoni Oliver , Lecellier Gaël , Magalon Hélène , Vigliola Laurent , Oury Nicolas , Benzoni Francesca , Peignon Christophe , Joost Stéphane , Berteaux‐Lecellier Véronique
Published: February 2021

Anomalous heat waves are causing a major decline of hard corals around the world and threatening the persistence of coral reefs. There are, however, reefs that have been exposed to recurrent thermal stress over the years and whose corals appear to have been tolerant against heat. One of the mechanisms that could explain this phenomenon is local adaptation, but the underlying molecular mechanisms are poorly known. In this work, we applied a seascape genomics approach to study heat stress adaptation in three coral species of New Caledonia (southwestern Pacific) and to uncover the molecular actors potentially involved. We used remote sensing data to characterize the environmental trends across the reef system, and sampled corals living at the most contrasted sites. These samples underwent next generation sequencing to reveal single nucleotide polymorphisms (SNPs), frequencies of which were associated with heat stress gradients. As these SNPs might underpin an adaptive role, we characterized the functional roles of the genes located in their genomic region. In each of the studied species, we found heat stress‐associated SNPs located in proximity of genes involved in pathways well known to contribute to the cellular responses against heat, such as protein folding, oxidative stress homeostasis, inflammatory and apoptotic pathways, and DNA damage‐repair. In some cases, the same candidate molecular targets of heat stress adaptation recurred among species. Together, these results underline the relevance and the power of the seascape genomics approach for the discovery of adaptive traits that could allow corals to persist across wider thermal ranges.
Practical guidelines to build Sense of Community in online medical education
Authors: van der Meer Gerben H. , Milota Megan , de Jonge Rosalein R. , Jansen Renée S.
Published: February 2021

Objectives

Sense of Community (SoC) refers to the cognitive or emotional connections established between physically separated learners; it is essential for study success. The recent COVID‐19 pandemic highlighted the need for practical guidelines to facilitate building a SoC in online medical preclerkship education in the Netherlands. Therefore, this qualitative study aims to (a) examine perceptions of SoC from both students’ and teachers’ perspectives in an online elective course during the COVID‐19 pandemic in order to (b) provide a conceptual framework with practical guidelines to medical educators on how to build SoC in online education.

Methods

The study had an exploratory qualitative design. Semi‐structured focus groups with student (n = 15) and teacher (n = 5) volunteers were conducted. Participants discussed their experienced SoC using the storyline method. In addition, course developers (n = 2) were interviewed and lecturers (n = 5) wrote an experience story. Audio‐ and video‐recordings were transcribed verbatim and both the ensuing transcripts and experience stories were analysed using an inductive thematic analysis.

Results

All students experienced an increase of SoC during the eight‐week course. Five themes were identified: ‘social contacts made possible by a physical campus’, ‘group dynamics’, ‘teacher influence’, ‘education format’ and ‘teachers’ Sense of Community’. The authors formulated challenges and practical guidelines on how to build SoC based on these themes.

Conclusions

This exploratory qualitative study provides a conceptual framework with practical guidelines for medical educators on how to build SoC in online medical preclerkship education. These guidelines provide a valuable starting point to build SoC in online education for medical educators and students alike.
Biomechanical Evaluation of Oblique Lumbar Interbody Fusion with Various Fixation Options: A Finite Element Analysis
Authors: Song Chengjie , Chang Hengrui , Zhang Di , Zhang Yingze , Shi Mingxin , Meng Xianzhong
Published: February 2021

Objective

The aim of the present study was to clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) using different fixation methods in normal and osteoporosis spines.

Methods

Normal and osteoporosis intact finite element models of L1–S1 were established based on CT images of a healthy male volunteer. Group A was the normal models and group B was the osteoporosis model. Each group included four subgroups: (i) intact; (ii) stand‐alone cage (Cage); (iii) cage with lateral plate and two lateral screws (LP); and (iv) cage with bilateral pedicle screws and rods (BPSR). The L3–L4 level was defined as the surgical segment. After validating the normal intact model, compressive load of 400 N and torsional moment of 10 Nm were applied to the superior surface of L2 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. Surgical segmental range of motion (ROM), cage stress, endplate stress, supplemental fixation stress, and stress distribution were analyzed in each group.

Results

Cage provided the minimal reduction of ROM among all motions (normal, 82.30%–98.81%; osteoporosis, 92.04%–97.29% of intact model). BPSR demonstrated the maximum reduction of ROM (normal, 43.94%–61.13%; osteoporosis, 45.61%–62.27% of intact model). The ROM of LP was between that of Cage and BPSR (normal, 63.25%–79.72%; osteoporosis, 70%–87.15% of intact model). Cage had the minimal cage stress and endplate stress. With the help of LP and BPSR fixation, cage stress and endplate stress were significantly reduced in all motions, both in normal and osteoporosis finite element models. However, BPSR had more advantages. For cage stress, BPSR was at least 75.73% less than that of Cage in the normal model, and it was at least 80.10% less than that of Cage in the osteoporosis model. For endplate stress, BPSR was at least 75.98% less than that of Cage in the normal model, and it was at least 78.06% less than that of Cage in the osteoporosis model. For supplemental fixation stress, BPSR and LP were much less than the yield strength in all motions in the two groups. In addition, the comparison between the two groups showed that the ROM, cage stress, endplate stress, and supplemental fixation stress in the normal model were less than in the osteoporosis model when using the same fixation option of OLIF.

Conclusion

Oblique lumbar interbody fusion with BPSR provided the best biomechanical stability both in normal and osteoporosis spines. The biomechanical properties of the normal spine were better than those of the osteoporosis spine when using the same fixation option of OLIF.
Risk Factors of Elbow Stiffness After Open Reduction and Internal Fixation of the Terrible Triad of the Elbow Joint
Authors: He Xiao , Fen Quan , Yang Jiarui , Lei Yutian , Heng Lisong , Zhang Kun
Published: February 2021

Objective

To analyze the risk factors of elbow stiffness following open reduction and internal fixation of the terrible triad of the elbow joint.

Methods

A retrospective study was conducted of 100 patients with the terrible triad of the elbow joint, who had been treated at our hospital from January 2015 to December 2018. All patients were treated with a loop plate to repair the ulnar coronoid process. According to the severity of the injury, the radial head was either fixed or replaced, and the lateral collateral ligament was repaired with an anchor. According to the range of motion of the elbow during the last follow‐up, the patients were divided into two groups. The stiffness group (displayed extension–flexion or pronation–supination <100°) consisted of 30 patients. The second group, named the non‐stiffness group (exhibited extension–flexion and pronation–supination ≥100°), consisted of 70 patients. Related risk factors included age, gender, smoking, diabetes, whether the fracture is on the dominant side, mechanism of injury, fracture classification, time from injury to surgery, configuration of internal fixation of the radial head, postoperative immobilization time, and use of anti‐heterotopic ossification drugs (oral indomethacin). Both t‐test and chi squared test were used to analyze any significant differences. Only the variables with a P < 0.05 in the tests were retested into a logistic multiple regression in order to screen risk factors of elbow stiffness.

Results

All patients were followed up for 12–48 months (average, 25.7 months), and all patients exhibited bone healing. Multivariate regression analysis showed that high‐energy injury (OR = 3.068, 95% CI 1.134–8.295, P = 0.027), time from injury to surgery > 1 week (OR = 2.714, 95% CI 1.029–7.159, P = 0.044), and postoperative immobilization time (OR = 3.237, 95% CI 1.176–8.908, P = 0.023) were independent risk factors of elbow stiffness after surgery for the terrible triad of the elbow.

Conclusion

High‐energy injury, the time from injury to surgery > 1 week, and postoperative joint immobilization time > 2 weeks are the independent risk factors of elbow stiffness after surgery of the terrible triad of the elbow, which should be treated carefully in clinical treatment.
Skin eruptions in children: Drug hypersensitivity vs viral exanthema
Authors: Tsabouri Sophia , Atanaskovic‐Markovic Marina
Published: February 2021

Childhood rashes or exanthemas are common and are usually relatively benign. There are many causes of rash in children, including mainly viruses, and less often bacterial toxins, drugs, allergens and other diseases. Viral exanthema often appears while children are taking a medication in the course of a viral infection; it can mimic drug exanthema and is perceived as a drug allergy in 10% of cases. In the vast majority of cases, the distinction between virus‐induced and drug‐induced skin eruption during the acute phase is not possible. The drugs most commonly implicated are beta‐lactams (BL) and non‐steroidal anti‐inflammatory drugs (NSAIDs). Viruses, commonly Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV6) and cytomegalovirus (CMV), and the bacterium,Mycoplasma pneumoniae, may cause exanthema either from the infection itself (active or latent) or because of interaction with drugs that are taken simultaneously. Determination of the exact diagnosis requires a careful clinical history and thorough physical examination. Haematological and biochemical investigations and histology are not always helpful in differentiating between the two types of exanthema. Serological and polymerase chain reaction (PCR) assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity. A drug provocation test (DPT) is although considered the gold standard for the diagnosis and is not preferred by the patients. Skin tests are not well tolerated, and in vitro tests, such as the basophil activation test and lymphocyte transformation, are of low sensitivity and specificity and their relevance is debatable. Based on current evidence, we propose a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous eruption while receiving a drug.
In Defense of Deliberative Indispensability
Authors: Lutz Matt
Published: February 2021

David Enoch has argued that we can be justified in believing in irreducibly normative reasons on the grounds that such reasons are deliberatively indispensable. This deliberative indispensability argument has been attacked from a variety of angles and is generally held to be rather weak. In this paper, I argue that existing criticisms of the deliberative indispensability argument do not touch the core of Enoch's argument. Properly understood, the deliberative indispensability argument is much stronger than its critics allege. It deserves to be taken seriously.
Sodium sequestration confers salinity tolerance in an ancestral wild rice
Authors: Solis Celymar Angela , Yong Miing‐Tiem , Venkataraman Gayatri , Milham Paul , Zhou Meixue , Shabala Lana , Holford Paul , Shabala Sergey , Chen Zhong‐Hua
Published: February 2021

Wild rice Oryza rufipogon, a progenitor of cultivated rice Oryza sativa L., possesses superior salinity tolerance and is a potential donor for breeding salinity tolerance traits in rice. However, a mechanistic basis of salinity tolerance in this donor species has not been established. Here, we examined salinity tolerance from the early vegetative stage to maturity in O. rufipogon in comparison with a salt‐susceptible (Koshihikari) and a salt‐tolerant (Reiziq) variety of O. sativa. We assessed their phylogeny and agronomical traits, photosynthetic performance, ion contents, as well as gene expression in response to salinity stress. Salt‐tolerant O. rufipogon exhibited efficient leaf photosynthesis and less damage to leaf tissues during the course of salinity treatment. In addition, O. rufipogon showed a significantly higher tissue Na+ accumulation that is achieved by vacuolar sequestration compared to the salt tolerant O. sativa indica subspecies. These findings are further supported by the upregulation of genes involved with ion transport and sequestration (e.g. high affinity K+ transporter 1;4 [HKT1;4], Na+/H+ exchanger 1 [NHX1] and vacuolar H+‐ATPase c [VHA‐c]) in salt‐tolerant O. rufipogon as well as by the close phylogenetic relationship of key salt‐responsive genes in O. rufipogon to these in salt‐tolerant wild rice species such as O. coarctata. Thus, the high accumulation of Na+ in the leaves of O. rufipogon acts as a cheap osmoticum to minimize the high energy cost of osmolyte biosynthesis and excessive reactive oxygen species production. These mechanisms demonstrated that O. rufipogon has important traits that can be used for improving salinity tolerance in cultivated rice.
Can proactive fiscal policy achieve the goal of “Beyond Keynesianism”?
Authors: Ke Xiao , Yan Yuanke
Published: February 2021

This study aims to assess whether counter‐cyclical fiscal policy to release infrastructure bottlenecks achieved the goal of “Beyond Keynesianism,” that is, to stimulate long‐term economic growth. The proactive fiscal policy during the Asian financial crisis dramatically expanded the National Highway System in China. Taking the highway project as an example, we evaluate its impact on per capita output and employment growth and investigate the underlying mechanism. Using provincial panel data from 1995 to 2016, our system generalized method of moments estimation finds that this large‐scale high‐rank road infrastructure project leads to an increase in per capita GDP growth. Automobile‐intensive industries benefit most from it. A channel analysis indicates that the growth effect is driven by structural transformation. Further, the project increases overall employment, mainly in secondary industries. It also creates extra demand for road transportation and longer‐distance road freight transport by facilitating the flow of both commodities and passengers.
How Cultural Environments Shape Online Sentiment Toward Social Movements: Place Character and Support for Feminism*
Authors: Scarborough William J. , Helmuth Allison S.
Published: February 2021

This study explores the relationship between offline and online contexts in social movement discourse. We test whether local place character—the cultural reputations, values, and ideals associated with a particular location—predict support for feminism expressed on Twitter. Applying topic modeling to a unique corpus describing cities’ cultural reputations, we identify five cultural attributes of U.S. cities that constitute their place character. Then, we use these measures to predict the percentage of tweets that are positive toward feminism in each location. The results indicate that while social media may connect people from geographically distant areas, online discourse is still heavily influenced by the local spaces where users reside. Cities with a place character of Revitalization have more positive Twitter sentiment toward feminism, while areas known as Local Hubs for shopping and leisure are more negative. These findings contribute to social movement scholarship by highlighting one way that offline and online contexts are connected. Far from transcending local geographies, social movement discourse taking place online remains shaped by the cultural environment where it originates.
Affects of policy design: The case of young carers in the Care Act 2014 and the Children and Families Act 2014
Authors: Alexander Chloe
Published: February 2021

This article presents an analysis of policies on young carers in England, considering both the design but also the lived experience of policy subjects. Drawing on affect theory we can increase understanding of the reach of these policies into family life and the nature of English policy‐making focussed on this group. This analytic framework presents the opportunity to draw on the use of affect theory developed in other disciplines but less so in the discipline of social policy. The article argues, firstly, that normative messages through policy design are conveyed to families through affects. Secondly, it argues that hierarchies of subject positions established within policy design are reaching and impacting on young carers and their families through affective pressures. This article demonstrates that affect theory contributes to the analysis of social policies on young carers and also illuminates the impacts of policies in the context of limited formal implementation.
Guaranteed Minimization of the Bit Error Ratio for MIMO Systems: A
Mathematical Viewpoint
Authors: Auer Ekaterina , Ahrens Andreas
Published: February 2021

Multiplying the capacity of communication links by using the multiple-input multiple-output (MIMO) mechanism has become an essential part of various wireless standards. In this paper, we focus on the bit error ratio (BER) in such systems and consider its optimization under parameter uncertainty from a formal point of view (including methods with result verification). The theoretical results are demonstrated using a close-to-life application.
Evaluation of Relationship Between Shape of a Rigid Body Unifilar Centrifugal Pendulum Vibration Absorber and Vibration Suppression Performance
Authors: Inoue Tsuyoshi , Okumura Ryota , Yabui Shota , Jiang Xiangyu
Published: February 2021

The torsional vibration hinders the reduction of automobile exhaust gas emitted by using engines with a reduced number of cylinders. Centrifugal pendulum vibration absorbers (CPVA) have been used in engines to suppress torsional vibration. To clarify the dynamics of CPVAs, much analysis has been conducted using the point mass CPVA as the model of rigid body bifilar CPVA. However, few attempts have been made to analyze the rigid body unifilar CPVA on vibration suppression performance in frequency response. In this study, the authors have analyzed the dynamics of the rigid body unifilar CPVA, focusing on the influence of shape parameters. The results verified that the shape parameters, which relating to moment of inertia or radius of gyration of rigid body unifilar CPVA, influence the vibration suppression performance in frequency response. Moreover, the numerical simulation results were confirmed experimentally and showed in good agreement with the experimental results, and both indicated the dependence of the vibration suppression performance on the shape parameters of the rigid body unifilar CPVA.
Cannabidiol Does Not Impair Anabolic Signaling Following Eccentric Contractions in Rats
Authors: Langer Henning T. , Mossakowski Agata A. , Pathak Suraj , Mascal Mark , Baar Keith
Published: February 2021

Cannabidiol (CBD) has proven clinical benefits in the treatment of seizures, inflammation, and pain. The recent legalization of CBD in many countries has caused increased interest in the drug as an over-the-counter treatment for athletes looking to improve recovery. However, no data on the effects of CBD on the adaptive response to exercise in muscle are available. To address this gap, we eccentrically loaded the tibialis anterior muscle of 14 rats, injected them with a vehicle (n = 7) or 100 mg/kg CBD (n = 7), and measured markers of injury, inflammation, anabolic signaling, and autophagy 18 hr later. Pro-inflammatory signaling through nuclear factor kappa B (NF-kB) (Ser536) increased with loading in both groups; however, the effect was significantly greater (36%) in the vehicle group (p < .05). Simultaneously, anabolic signaling through ribosomal protein S6 kinase beta-1 (S6K1) (Thr389) increased after eccentric contractions in both groups with no difference between vehicle and CBD (p = .66). The ribosomal protein S6 phosphorylation (240/244) increased with stimulation (p < .001) and tended to be higher in the CBD group (p = .09). The ubiquitin-binding protein p62 levels were not modulated by stimulation (p = .6), but they were 46% greater in the CBD compared with the vehicle group (p = .01). Although liver weight did not differ between the groups (p = .99) and levels of proteins associated with stress were similar, we did observe serious side effects in one animal. In conclusion, an acute dose of CBD decreased pro-inflammatory signaling in the tibialis anterior without blunting the anabolic response to exercise in rats. Future research should determine whether these effects translate to improved recovery without altering adaptation in humans.
Role of the N- and C-Terminal Regions of FliF, the MS Ring Component in the
Vibrio
Flagellar Basal Body
Authors: Kojima Seiji , Kajino Hiroki , Hirano Keiichi , Inoue Yuna , Terashima Hiroyuki , Homma Michio
Published: February 2021

The bacterial flagellum is a supramolecular architecture involved in cell motility. At the base of the flagella, a rotary motor that begins to construct an MS ring in the cytoplasmic membrane comprises 34 transmembrane proteins (FliF).
Tuberculosis under the Influence of COVID-19 Lockdowns: Lessons from Tehran, Iran
Authors: Kargarpour Kamakoli Mansour , Hadifar Shima , Khanipour Sharareh , Farmanfarmaei Ghazaleh , Fateh Abolfazl , Mostafaei Shayan , Siadat Seyed Davar , Vaziri Farzam
Published: February 2021

This study investigates the short-term effects of the coronavirus disease 2019 (COVID-19) pandemic lockdown on tracing and detection of tuberculosis (TB) patients in Tehran, Iran. Results of this study have demonstrated that due to the significant decrease in the identification of patients with suspected TB during the COVID-19 outbreak in Tehran, it is imperative that patients with suspected TB be tracked and diagnosed more quickly to make up for some of the decline in TB diagnosis in recent months and to recover lost cases.
Data Analysis Strategies for Microbiome Studies in Human Populations—a Systematic Review of Current Practice
Authors: Kleine Bardenhorst Sven , Berger Tom , Klawonn Frank , Vital Marius , Karch André , Rübsamen Nicole
Published: February 2021

The human microbiome has emerged as an important factor in the development of health and disease. Growing interest in this topic has led to an increasing number of studies investigating the human microbiome using high-throughput sequencing methods.
Supplemental Material: Prehistoric earthquakes on the Banning strand of the San Andreas fault, North Palm Springs, California
Authors: Castillo B.A. , al. et
Published: February 2021

Plate 1. Plate provides photomosaics and mapping interpretations of excavations completed at 18th Avenue trench, including sample locations and interpreted event horizons. Annotations can be turned off through Layers function.
Austerity, resilience and the management of actors in public hospitals: a qualitative study from South Africa
Authors: Fana Thanduxolo , Goudge Jane
Published: February 2021

Background

Global economic recession coupled with internal inefficiencies and corruption has led to a period of austerity in the South African healthcare system.

This paper examines the strategies used by management in response to austerity in the three public hospitals and their effect on organisational functioning.

Methods

We used a comparative qualitative case study approach, collecting data using a combination of in-depth interviews with managers, and focus group discussion and interviews with shop stewards and staff.

Results

Austerity, imposed by the introduction of a provincial cost containment committee, has led to a reduction in staff, benefits, shortages of equipment and delayed procurement and recruitment processes. Managers in the first hospital maintained training on labour relations for staff and managers, they jointly planned how to cope with reduced staff and initiated a new forum for HR and finance staff. These strategies improved the way actors engaged, enabling them to resolve problems. Good communication ensured that staff understood what was within the hospitals control and what was not. A second hospital relied on absorptive strategies, such as asking staff to do more with less. The result was resistance, and greater use of sick leave. Some staff gave their own money to help feed patients but were angry at management for putting them in this difficult position. Leadership in the third hospital did not manage actors well either; help from the Government’s Expanded Public Works Programme was rejected by the unions, managers did not attend meetings as they felt their contributions were not listened to. Poor communication meant that the managers and staff did not understand what was within the hospital’s control and what was not; a misunderstanding led to a physical fight between managers.

Conclusion

Organisational resilience in the face of austerity requires leaders to manage different stakeholders well. Hospital managers who promote democratic or participatory leadership and management, open communication, teamwork and trust among all stakeholders will lead better functioning organisations. A special focus should be placed on such practices to develop the resilience of health systems’ organisations.
Learning-by-doing: the importance of experiential knowledge sharing for meeting the information needs of people with colorectal cancer in Germany—a qualitative study
Authors: Kaiser Maleen , Adami Sandra , Lucius-Hoene Gabriele , Muller-Nordhorn Jacqueline , Goerling Ute , Breuning Martina , Holmberg Christine
Published: February 2021

Objective

The aim of this article is to understand how, when and why the topics of information and information needs arise when people diagnosed with colorectal cancer (CRC) narrate their illness experiences.

Methods

Guided by principles of grounded theory, a qualitative interview study was conducted that collected a wide variety of illness experiences with CRC in Germany using maximum variation sampling. Sampling criteria included place of residence, age at interview, age at diagnosis, treatment, disease course and sociodemographic factors such as varying family backgrounds and professions.

Setting and participants

Men and women diagnosed with CRC in different parts of Germany were sought via physicians, social workers and psychologists in hospital settings, organisations offering psychosocial support for patients with cancer, self-help groups, rehabilitation centres, newspapers and personal contacts. The interviewees in the final sample (n=41) had been diagnosed with CRC between 4 weeks and 36 years prior to the interview.

Results

Three inter-related categories of information needs emerged from the analysis: the need for non-medical information for daily life; the challenge of integrating the bodily changes that accompany CRC in everyday life; and sources of non-medical information concerning handling daily life. Learning to live with the bodily changes of CRC in everyday life was described as a long process of learning-by-doing. While sources for medical information were clear, finding practical information was often a challenge. The best source of such information was often seen to be other people living with the disease, who shared their experiential knowledge, as well as stoma and nutritional therapists.

Conclusion

Information needs are part of the process and struggle to normalise everyday life after a disruptive diagnosis and treatment. Providing access to practical knowledge and information from others with CRC experience may be an important resource for patient support.
Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England
Authors: Sutton-Klein Joanna , Moody Alison , Hamilton Ian , Mindell Jennifer S
Published: February 2021

Objective

Excess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter is associated with reporting poor general health; cold and damp homes have greater prevalence in lower socioeconomic groups. Overheating in the summer also has adverse health consequences. This study evaluates the association between indoor temperature and general health and the extent to which this is affected by socioeconomic and household factors.

Design

Cross-sectional study.

Setting

England.

Participants

Secondary data of 74 736 individuals living in England that took part in the Health Survey for England (HSE) between 2003 and 2014. The HSE is an annual household survey which uses multilevel stratification to select a new, nationally representative sample each year. The study sample comprised adults who had a nurse visit; the analytical sample was adults who had observations for indoor temperature and self-rated health.

Results

Using both logistic and linear regression models to examine indoor temperature and health status, adjusting for socioeconomic and housing factors, the study found an association between poor health and higher indoor temperatures. Each one degree increase in indoor temperature was associated with a 1.4% (95% CI 0.5% to 2.3%) increase in the odds of poor health. After adjusting for income, education, employment type, household size and home ownership, the OR of poor health for each degree temperature rise increased by 19%, to a 1.7% (95% CI 0.7% to 2.6%) increase in odds of poor health with each degree temperature rise.

Conclusion

People with worse self-reported health had higher indoor temperatures after adjusting for household factors. People with worse health may have chosen to maintain warmer environments or been advised to. However, other latent factors, such as housing type and energy performance could have an effect.
What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons for the Best
Authors: Ramanathan Shanthi Ann , Larkins Sarah , Carlisle Karen , Turner Nalita , Bailie Ross Stewart , Thompson Sandra , Bainbridge Roxanne , Deeming Simon , Searles Andrew
Published: February 2021

Objectives

To (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.

Setting

Three Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia.

Participants

LFTB research team and one representative from each PHC centre.

Primary and secondary outcome measures

Impact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites.

Results

LFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres.

Conclusion

Retrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.
Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya
Authors: Amisi James A , Carter E Jane , Masini Enos , Szkwarko Daria
Published: February 2021

Setting

Children especially those <5 years of age exposed to pulmonary tuberculosis (TB) are at a high risk of severe TB disease and death. Isoniazid preventive therapy (IPT) has been shown to decrease disease progression by up to 90%. Kenya, a high TB burden country experiences numerous operational challenges that limit implementation of TB preventive services. IPT completion in child contacts is not routinely reported in Kenya.

Objective

This study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya.

Design

A retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy.

Results

Of 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children).

Conclusion

Our evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes.
Examining Australian’s beliefs, misconceptions and sources of information for COVID-19: a national online survey
Authors: Thomas Rae , Greenwood Hannah , Michaleff Zoe A , Abukmail Eman , Hoffmann Tammy C , McCaffery Kirsten , Hardiman Leah , Glasziou Paul
Published: February 2021

Objective

Public cooperation to practise preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies.

Design

An online cross-sectional survey.

Participants

A national sample of 1500 Australian adults with representative quotas for age and gender provided by an online panel provider.

Main outcome measure

Proportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions.

Results

Of the 1802 potential participants contacted, 289 did not qualify, 13 declined and 1500 participated in the survey (response rate 83%). Most participants correctly identified ‘washing your hands regularly with soap and water’ (92%) and ‘staying at least 1.5 m away from others’ (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them from contracting COVID-19. Views about face masks were divided. Only 66% of participants correctly identified that ‘regular use of antibiotics’ would not prevent COVID-19.

Most participants (90%) identified ‘fever, fatigue and cough’ as indicators of COVID-19. However, 42% of participants thought that being unable to ‘hold your breath for 10 s without coughing’ was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%) and the Australian Government COVID-19 information app (31%).

Conclusions

Public messaging about hand hygiene and physical distancing to prevent transmission appears to have been effective. However, there are clear, identified barriers for many individuals that have the potential to impede uptake or maintenance of these behaviours in the long term. We need to develop public health messages that harness these barriers to improve future cooperation. Ensuring adherence to these interventions is critical.
Impact of levothyroxine in women with positive thyroid antibodies on pregnancy outcomes: a systematic review and meta-analysis of randomised controlled trials
Authors: Lau Lorraine , Benham Jamie L , Lemieux Patricia , Yamamoto Jennifer , Donovan Lois E
Published: February 2021

Objective

To evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism with presence of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).

Design

Systematic review and meta-analysis of randomised controlled trials

Study eligibility criteria

Prespecified criteria for inclusion were: randomised trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception.

Data sources

Ovid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched from 1980 to 5 November 2020.

Outcome measures

Prespecified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth.

Risk of bias assessment

Cochrane Risk of Bias Tool for Quality Assessment of Randomised Controlled Trials.

Results

From 3023 citations, 79 citations were identified for full-text review. Of these, six trials (total of 2263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93 to 1.13), miscarriage (RR 0.93; 95% CI 0.76 to 1.14), preterm delivery (RR 0.66; 95% CI 0.39 to 1.10) or live births (RR 1.01; 95% CI 0.89 to 1.16) in thyroid autoimmune women treated with levothyroxine compared with controls. Sensitivity analyses of preterm birth identified study quality and timing of levothyroxine initiation as sources of heterogeneity.

Conclusions

Among pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use (moderate to high Grading of Recommendations, Assessment, Development and Evaluations). Recommendations to use levothyroxine in this setting need to be reconsidered.

PROSPERO registration number

CRD42019130459.
KAP-COVIDGLOBAL: a multinational survey of the levels and determinants of public knowledge, attitudes and practices towards COVID-19
Authors: Masoud Ahmed Taher , Zaazouee Mohamed Sayed , Elsayed Sarah Makram , Ragab Khaled Mohamed , Kamal Esraa M , Alnasser Yusra T , Assar Ahmed , Nourelden Anas Z , Istatiah Loai J , Abd-Elgawad Mohamed M , Abdelsattar Ahmed T , Sofy Ahmed A , Hegazy Doaa G , Femía Victor Z , Mendonça Adriana R , Sayed Fatma M , Elmoursi Ahmed , Alareidi Alaa , Abd-Eltawab Ahmed K , Abdelmonem Mohamed , Mohammed Omar M , Derballa EzzEldeen A , El-Fas Kareem A , Abdel-Daim Mohamed M. , Abushouk Abdelrahman I.
Published: February 2021

Objective

The adherence to public health recommendations to control COVID-19 spread is influenced by public knowledge, attitudes and practices (KAP). We performed this cross-sectional study to assess the levels and determinants of public KAP towards COVID-19 in a large, multinational sample.

Design

Cross-sectional study (survey).

Setting

The questionnaire was distributed to potential respondents via online platforms.

Participants

71 890 individuals from 22 countries.

Methods

We formulated a four-section questionnaire in English, followed by validation and translation into seven languages. The questionnaire was distributed (May to June 2020) and each participant received a score for each KAP section.

Results

Overall, the participants had fair knowledge (mean score: 19.24±3.59) and attitudes (3.72±2.31) and good practices (12.12±1.83) regarding COVID-19. About 92% reported moderate to high compliance with national lockdown. However, significant gaps were observed: only 68.2% knew that infected individuals may be asymptomatic; 45.4% believed that antibiotics are an effective treatment; and 55.4% stated that a vaccine has been developed (at the time of data collection). 71.9% believed or were uncertain that COVID-19 is a global conspiracy; 36.8% and 51% were afraid of contacting doctors and Chinese people, respectively. Further, 66.4% reported the pandemic had moderate to high negative effects on their mental health. Female gender, higher education and urban residents had significantly (p≤0.001) higher knowledge and practice scores. Further, we observed significant correlations between all KAP scores.

Conclusions

Although the public have fair/good knowledge and practices regarding COVID-19, significant gaps should be addressed. Future awareness efforts should target less advantaged groups and future studies should develop new strategies to tackle COVID-19 negative mental health effects.
Relationships between social spending and childhood obesity in OECD countries: an ecological study
Authors: Miyawaki Atsushi , Evans Charlotte Elizabeth Louise , Lucas Patricia Jane , Kobayashi Yasuki
Published: February 2021

Objectives

The burden of childhood obesity is clustered among children in low-socioeconomic groups. Social spending on children—public welfare expenditure on families and education—may curb childhood obesity by reducing socioeconomic disadvantages. The objective of this study was to examine the relationship between social spending on children and childhood obesity across the Organisation for Economic Cooperation and Development (OECD) countries.

Design

Ecological study.

Setting

Data on social spending on children were obtained from the OECD Social Expenditure Database and the OECD educational finance indicators dataset during 2000–2015. Data on childhood obesity were obtained from the NCD Risk Factor Collaboration database.

Participants

Aggregated statistics on obesity among children aged 5–19 years, estimated for OECD 35 countries based on the measured height and weight on 31.5 million children.

Outcome measures

Country-level prevalence of obesity among children aged 5–19 years.

Results

In cross-sectional analyses in 2015, social spending on children was inversely associated with the prevalence of childhood obesity after adjusting for potential confounders (the gross domestic product per capita, unemployment rate, poverty rate, percentage of children aged <20 years and prevalence of childhood obesity in 2000). In addition, when we focused on changes from 2000 to 2015, an average annual increase of US$100 in social spending per child was associated with a decrease in childhood obesity by 0.6 percentage points for girls (p=0.007) and 0.7 percentage points for boys (p=0.04) between 2000 and 2015, after adjusting for the potential confounders. The dimensions of social spending that contributed to these associations between the changes in social spending on children and childhood obesity were early childhood education and care (ECEC) and school education for girls and ECEC for boys.

Conclusion

Countries that increase social spending on children tend to experience smaller increases in childhood obesity.
Relationships between changes due to COVID-19 pandemic and the depressive and anxiety symptoms among mothers of infants and/or preschoolers: a prospective follow-up study from pre-COVID-19 Japan
Authors: Kimura Miyako , Kimura Kazuki , Ojima Toshiyuki
Published: February 2021

Objectives

Mothers with young children are particularly vulnerable to the impacts of the lifestyle changes brought about by the COVID-19 pandemic. However, the association between such changes and maternal mental health has not been examined, and comparable pre-COVID-19 baseline data were lacking. Thus, we aimed to examine the relationships between changes due to COVID-19 pandemic and the development of depressive and anxiety symptoms among mothers of infants and/or preschoolers in Japan.

Design

Prospective follow-up study. The baseline survey was conducted in February 2020, and the follow-up survey was conducted in June 2020.

Setting

All 47 prefectures in Japan.

Participants

At the baseline, 4700 mothers of infants and/or preschoolers (0–6 years) participated in the online survey (100 respondents per prefecture); 2489 of them also participated in the follow-up survey. After excluding 203 participants with a higher risk of severe mental illness at the baseline, 2286 were included in the analysis.

Outcome measures

The Kessler Psychological Distress Scale was used to measure depressive and anxiety symptoms, with a cut-off point of 13 or more. We estimated the adjusted OR (AOR) using multiple logistic regression analysis.

Results

During the follow-up period, 151 (6.6%) of respondents newly developed depressive and anxiety symptoms. Participants who experienced a shortage of relaxation time (AOR 1.61, 95% CI 1.06 to 2.47), increased difficulty in child rearing (AOR 1.89, 95% CI 1.32 to 2.70), increased partner aggression (AOR 2.93, 95% CI 1.42 to 6.05) and an increased sense of unfairness (AOR 1.74, 95% CI 1.10 to 2.73) were more likely to develop these symptoms.

Conclusions

Changes in circumstances and perceptions during COVID-19 outbreak were significantly related to the development of depressive and anxiety symptoms among mothers of young children. Strategies to reduce solo parenting and increase social awareness related to domestic violence are needed.