bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey
Authors: Horrill Tara C. , Martin Donna E. , Lavoie Josée G. , Schultz Annette S. H.
Published: August 2021

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.
Separable regulation of POW1 in grain size and leaf angle development in rice
Authors: Zhang Li , Wang Ruci , Xing Yide , Xu Yufang , Xiong Dunping , Wang Yueming , Yao Shanguo
Published: August 2021

Leaf angle is one of the key factors that determines rice plant architecture. However, the improvement of leaf angle erectness is often accompanied by unfavourable changes in other traits, especially grain size reduction. In this study, we identified the pow1 (put on weight 1) mutant that leads to increased grain size and leaf angle, typical brassinosteroid (BR)‐related phenotypes caused by excessive cell proliferation and cell expansion. We show that modulation of the BR biosynthesis genes OsDWARF4 (D4) and D11 and the BR signalling gene D61 could rescue the phenotype of leaf angle but not grain size in the pow1 mutant. We further demonstrated that POW1 functions in grain size regulation by repressing the transactivation activity of the interacting protein TAF2, a highly conserved member of the TFIID transcription initiation complex. Down‐regulation of TAF2 rescued the enlarged grain size of pow1 but had little effect on the increased leaf angle phenotype of the mutant. The separable functions of the POW1‐TAF2 and POW1‐BR modules in grain size and leaf angle control provide a promising strategy for designing varieties with compact plant architecture and increased grain size, thus promoting high‐yield breeding in rice.
Increased bisphenol A levels in Thai children and adolescents with type 1 diabetes mellitus
Authors: Tosirisuk Naruporn , Sakorn Natee , Jantarat Chutima , Nosoongnoen Wichit , Aroonpakmongkol Suphab , Supornsilchai Vichit
Published: August 2021

Background

The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents continues to increase worldwide. The reason for this is unclear. In addition to the role of genetics, bisphenol A (BPA) has been investigated as a possible causal factor for T1DM. This study aimed to determine the correlation between urinary BPA levels and T1DM in Thai children and adolescents.

Methods

A cross‐sectional study was conducted in T1DM patients who were followed at the endocrinology clinic at King Chulalongkorn Memorial Hospital from December 2018 to December 2019 and age‐matched healthy controls. Urinary BPA levels were analyzed by high‐performance liquid chromatography and adjusted by urine creatinine. Anthropometric data were measured in all participants and clinical data were collected for the T1DM patients. All participants completed a questionnaire regarding possible BPA exposures. Multivariate logistic regression analysis was used to estimate the adjusted odds ratio for T1DM.

Results

Seventy‐five T1DM patients and 113 age‐matched controls were included in the study. The mean age for T1DM and control groups were 14.8 ± 5.7 and 14.4 ± 6.2 years, respectively. The T1DM group had a significantly higher median (interquartile range) level of adjusted urinary BPA compared to the control (31.50 [7.87, 69.45] vs 10.1 [0, 54.01] μg/g creatinine, P = 0.02). Urinary BPA of 17 μg/g creatinine or more was significantly associated with TIDM, with adjusted odds ratio (95% Confident interval, CI) of 2.38 (1.27, 4.44), P = 0.006.

Conclusions

Higher urinary BPA level is one of the possible risk factors for T1DM.
Case series of arginase 1 deficiency: Expanding the spectrum in hyperargininemia
Authors: Dorum Sevil , Havalı Cengiz
Published: August 2021

Background

Arginase‐1 deficiency is a rare, autosomal recessively inherited disorder of the urea cycle. In this study, we describe the clinical and molecular details of six patients who were diagnosed with argininemia, and we describe two of the patients with hyperargininemia who carried two novel variations of the Arginase‐1 gene.

Methods

The clinical and demographic characteristics of the patients were retrospectively evaluated.

Results

The ages of the six patients ranged from 1 day to 20 years, and each patient had consanguineous parents. Neuromotor retardation and spastic paraparesis were found in all patients except one, who was diagnosed prenatally. Hyperargininemia was present in all patients. Urinary orotic acid excretion was increased in four of the six patients. The diagnosis was confirmed by genetic analysis in all the patients. Elevated liver enzymes were detected in three patients and blood urea nitrogen levels were normal in each of the six patients.

Conclusions

In this study, we describe the two patients with hyperargininemia who carried two novel variations of the ARG1 gene. Also, we present a patient with normal neurodevelopment who was diagnosed prenatally and treated at an early stage of the disease.
Transparency is Surveillance
Authors: Nguyen C. Thi
Published: August 2021

In herBBC Reith Lectures on Trust, Onora O’Neill offers a short, but biting, criticism of transparency. People think that trust and transparency go together but in reality, says O'Neill, they are deeply opposed. Transparency forces people to conceal their actual reasons for action and invent different ones for public consumption. Transparency forces deception. I work out the details of her argument and worsen her conclusion. I focus on public transparency – that is, transparency to the public over expert domains. I offer two versions of the criticism. First, theepistemic intrusionargument: The drive to transparency forces experts to explain their reasoning to non‐experts. But expert reasons are, by their nature, often inaccessible to non‐experts. So the demand for transparency can pressure experts to act only in those ways for which they can offer public justification. Second, theintimate reasonsargument: In many cases of practical deliberation, the relevant reasons are intimate to a community and not easily explicable to those who lack a particular shared background. The demand for transparency, then, pressures community members to abandon the special understanding and sensitivity that arises from their particular experiences. Transparency, it turns out, is a form of surveillance. By forcing reasoning into the explicit and public sphere, transparency roots out corruption — but it also inhibits the full application of expert skill, sensitivity, and subtle shared understandings. The difficulty here arises from the basic fact that human knowledge vastly outstrips any individual’s capacities. We all depend on experts, which makes us vulnerable to their biases and corruption. But if we try to wholly secure our trust — if we leash groups of experts to pursuing only the goals and taking only the actions that can be justified to the non‐expert public — then we will undermine their expertise. We need both trust and transparency, but they are in essential tension. This is a deep practical dilemma; it admits of no neat resolution, but only painful compromise.
Moral Worth and Knowing How to Respond to Reasons
Authors: Cunningham J. J.
Published: August 2021

It's one thing to do the right thing. It's another to be creditable for doing the right thing. Being creditable for doing the right thing requires that one does the right thing out of a morally laudable motive and that there is a non‐accidental fit between those two elements. This paper argues that the two main views of morally creditable action – the Right‐Making Features View and the Rightness Itself View – fail to capture that non‐accidentality constraint: the first because it morally credits agents who make heavy‐duty moral mistakes; the second because it fails to generalise and is too conservative – a point which this paper gives renewed defence. The paper then goes on to defend and develop an alternative according to which moral worth is mediated by the agent's knowing how to respond to the reasons of the type which make acting in that way right. It's argued that this view avoids the problems for the alternatives, and it's shown that in order for the view to avoid collapsing into a problematic form of Reliabilism we'll have to think of states of knowing how as essentially successful in character.
Disruption of AtHAK/KT/KUP9 enhances plant cesium accumulation under low potassium supply
Authors: Genies Laure , Martin Ludovic , Kanno Satomi , Chiarenza Serge , Carasco Loïc , Camilleri Virginie , Vavasseur Alain , Henner Pascale , Leonhardt Nathalie
Published: August 2021

Understanding the molecular mechanisms that underlie cesium (Cs+) transport in plants is important to limit the entry of its radioisotopes from contaminated areas into the food chain. The potentially toxic element Cs+, which is not involved in any biological process, is chemically closed to the macronutrient potassium (K+). Among the multiple K+ carriers, the high‐affinity K+ transporters family HAK/KT/KUP is thought to be relevant in mediating opportunistic Cs+ transport. Of the 13 KUP identified in A. thaliana, only HAK5, the major contributor to root K+ acquisition under low K+ supply, has been functionally demonstrated to be involved in Cs+ uptake in planta. In the present study, we showed that accumulation of Cs+ increased by up to 30% in two A. thaliana mutant lines lacking KUP9 and grown under low K+ supply. Since further experiments revealed that Cs+ release from contaminated plants to the external medium is proportionally lower in the two kup9 mutant alleles, we proposed that KUP9 disruption could impair Cs+ efflux. By contrast, K+ status in kup9 mutants is not affected, suggesting that KUP9 disruption does not alter substantially K+ transport in experimental conditions used. The putative primary role of KUP9 in plants is further discussed.
Visions in stone: Illusion, animation and the devotional gaze in the art of Northern Italy
Authors: Libina Marsha
Published: August 2021

Devotional images in Renaissance Italy often compare divine visions to an enlivened statue or work of art, thereby heightening the effect of divine immediacy. Yet the early modern period also saw the emergence of another kind of picture that is much less studied. This alternative model favoured the apparent stoniness or emptiness of artistic simulacra – as seen in Cerano’s painted representation of the Virgin in the guise of a marble statue rendered in grisaille. It is a striking departure from Catholic reformers’ insistence on the mimetic naturalism of true images. As this paper shows, Cerano’s work went against the predominant paradigm of imitation, whereby artistic replicas acted as potent transmitters of divine presence inherent in the original cult image. The work presents an alternative to the true ‘living’ image by defending the artistic copy as an efficacious, but also inanimate, substitute for the divine prototype.
Carbon and Hydrocarbon Particle Seeding in Air-Breathing Rotating Detonation Engine
Authors: Burke Robert F. , Rezzag Taha , Ahmed Kareem
Published: August 2021

Within the power generation community, the rotating detonation engine (RDE) is only growing in popularity with its increased performance, simple mechanism, and operation. Although significant testing is underway to characterize the RDE for integration with conventional gas turbines, this entire system is still at a relatively low technology readiness level. In the midst of RDE research, there is an initiative to understand solid particle seeding effects in the detonation performance. Under investigation at the University of Central Florida is a Department of Energy (DOE) 15.24 cm (6 in.) RDE, with a solid particle seeder in parallel with its H2 and air flow lines. Previous work on this system involved carbon particle detonation; however, the tested particles were taken one step further to include more sustainable, greener hydrocarbon particles. Testing of powdered sugar, peanut flour, and cornstarch, along with previous carbon black tests have shown not only successful detonability, but a noticeable effect on the detonation wave dynamics. Side-by-side with a particle burning model being developed, an operational map can be determined for the hydrocarbon particles particularly, which can be tuned with the local flow conditions to achieve peak operability while replacing fuels with sustainable alternatives that could even be grown.
Experimental Investigation on Wear Behavior of Rectangular Labyrinth Fin Against High-Speed Rotor
Authors: Yan Xin , Dai Xinbo
Published: August 2021

The wear behaviors of the rectangular labyrinth seal fin against high-speed rotor were experimentally investigated on the incursion test rig. The material losses, worn geometries, frictional temperature distributions, and contact forces of labyrinth fin in rubbing events were measured at three incursion rates, three final incursion depths and two rotor sliding velocities. The morphologies of the worn labyrinth fin tips were magnified to reveal the wear mechanisms in rubbing events. The transient temperatures and contact forces were detailed to analyze the thermal–mechanical interactions between two contacting parts. The results show that the material loss percentage in the labyrinth fin is higher at the early stage of rubbing process, accounting for 18% mass loss of the worn region, than at final stage. The material loss is decreased with increasing the incursion rate. The incursion rate and final incursion depth have pronounced effects on the mushroom region extensions and curlings. The friction coefficient is fluctuated significantly in the high sliding velocity and low incursion rate conditions, and the averaged value of friction coefficient is about 0.1–0.125 among all experiments. The temperature at labyrinth fin tip is increased with increasing the final incursion depth, incursion rate, and sliding velocity. However, the temperature at fin tip is not increased further as it reaches about 1200 °C. The heat convection from hot fin to ambient plays an important role in worn geometries and transient temperature distributions at fin tip.
Portable rheometer to overcome the challenge of measuring low viscosity solution of acrylamide-based polymers at high temperature with an affordable cost for O&G applications
Authors: Antignard S. , Dupuis G. , Favéro C. , Rodriguez L. , Grassl B.
Published: August 2021

Performances of rotational shear rheometers are sometimes limited to measuring low viscosity at high temperatures of water-based polymer solutions. These limitations are typically due to the instrument resolution, sample inertia, and volumetric effects. Moreover, such measurements are not possible for temperatures exceeding 80 °C because of evaporation phenomena leading to a distortion of the value. The working principle of rheometers suitable for measuring viscosity above the boiling temperature reduces their sensitivity and limits their use to high-viscosity fluids. Acrylamide-based polymers are viscoelastic complex fluids exhibiting non-Newtonian behavior. Their viscosifying properties are strongly related to their charge density, molar mass, temperature, and salinity. The prediction of their rheological properties at high temperatures is challenging and is often extrapolated with an empiric law, such as Arrhenius equation. To the best of our knowledge, no commercially available rheometers are capable of measuring low viscosity of water-soluble complex fluids at high temperatures. In this work, we investigate a home-made fully automated capillary rheometer that has been developed to give an accurate measurement of viscosity and intrinsic viscosity of polymer solutions. This device is an affordable cost portable apparatus compared with a commercialized rheometer specifically designed for a wide range of viscosities and temperatures for various applications. The intrinsic viscosity has been measured on two acrylamide-based polymers of different chemical compositions using the capillary rheometer at high temperatures. This device has also been explored for measurement of a water-soluble polymer solution viscosity commonly used in enhanced oil recovery applications to limit chemical degradation.
A genome-wide screen uncovers multiple roles for mitochondrial nucleoside diphosphate kinase D in inflammasome activation
Authors: Ernst Orna , Sun Jing , Lin Bin , Banoth Balaji , Dorrington Michael G. , Liang Jonathan , Schwarz Benjamin , Stromberg Kaitlin A. , Katz Samuel , Vayttaden Sharat J. , Bradfield Clinton J. , Slepushkina Nadia , Rice Christopher M. , Buehler Eugen , Khillan Jaspal S. , McVicar Daniel W. , Bosio Catharine M. , Bryant Clare E. , Sutterwala Fayyaz S. , Martin Scott E. , Lal-Nag Madhu , Fraser Iain D. C.
Published: August 2021

The enzyme NDPK-D promotes changes in mitochondrial function that support inflammasome activation.
CsrA Enhances Cyclic-di-GMP Biosynthesis and Yersinia pestis Biofilm Blockage of the Flea Foregut by Alleviating Hfq-Dependent Repression of the
hmsT
mRNA
Authors: Silva-Rohwer Amelia R. , Held Kiara , Sagawa Janelle , Fernandez Nicolas L. , Waters Christopher M. , Vadyvaloo Viveka
Published: August 2021

Yersinia pestis
, the bacterial agent of bubonic plague, produces a c-di-GMP-dependent biofilm-mediated blockage of the flea vector foregut to facilitate its transmission by flea bite. However, the intricate molecular regulatory processes that underlie c-di-GMP-dependent biofilm formation and, thus, biofilm-mediated blockage in response to the nutritional environment of the flea are largely undefined.
Intracellular Localization of the Proteins Encoded by Some Type II Toxin-Antitoxin Systems in Escherichia coli
Authors: Mager Alexander , Safran Tommy , Engelberg-Kulka Hanna
Published: August 2021

Bacterial toxin-antitoxin (TA) systems, which were discovered in 1985, have since been studied extensively. These studies have focused particularly on the distribution of these bacterial TA systems on either plasmids or on bacterial chromosomes, their functionality, their targets, their relation to virulence, and their mechanisms of action.
Orientia tsutsugamushi
Nucleomodulin Ank13 Exploits the RaDAR Nuclear Import Pathway To Modulate Host Cell Transcription
Authors: Adcox Haley E. , Hatke Amanda L. , Andersen Shelby E. , Gupta Sarika , Otto Nathan B. , Weber Mary M. , Marconi Richard T. , Carlyon Jason A.
Published: August 2021

Nucleomodulins are recently defined effectors used by diverse intracellular bacteria to manipulate eukaryotic gene expression and convert host cells into hospitable niches. How nucleomodulins enter the nucleus, their functional domains, and the genes that they modulate are incompletely characterized.
Orientia tsutsugamushi
is an intracellular bacterial pathogen that causes scrub typhus, which can be fatal.
O. tsutsugamushi
Ank13 is the first example of a microbial protein that coopts eukaryotic RaDAR (RanGDP-ankyrin repeats) nuclear import.
Exploring Proteomes of Robust Yarrowia lipolytica Isolates Cultivated in Biomass Hydrolysate Reveals Key Processes Impacting Mixed Sugar Utilization, Lipid Accumulation, and Degradation
Authors: Walker Caleb , Dien Bruce , Giannone Richard J. , Slininger Patricia , Thompson Stephanie R. , Trinh Cong T.
Published: August 2021

Yarrowia lipolytica
is an important industrial oleaginous yeast due to its robust phenotypes for effective conversion of inhibitory lignocellulosic biomass hydrolysates into neutral lipids. While lipid accumulation has been well characterized in this organism, its interconnected lipid degradation phenotype is poorly understood during fermentation of biomass hydrolysates.
Supplemental Material: Patterns of incision and deformation on the southern flank of the Yellowstone hotspot from terraces and topography
Authors: Tuzlak Daphnee , Pederson Joel , al. et
Published: August 2021

Item 1: Surficial map of Alpine Canyon, Item 2: OSL data, Item 3: Bedrock Strength.
Supplemental Material: Three-stage modification of lithospheric mantle: Evidence from petrology, in-situ trace elements, and Sr isotopes of mantle xenoliths in the Cenozoic basalts, northeastern North China Craton
Authors: Xu Xinran , Tang Yanjie , al. et
Published: August 2021

Table S1: Petrological information and equilibrium temperature estimation for the studied samples; Table S2: Major element compositions (wt%) of minerals; Table S3: Trace element concentrations (ppm) of Cpx in xenoliths determined by LA-ICP-MS; Table S4: In situ Sr isotopic compositions of Cpx in the xenoliths.
Fervidicoccus fontis Strain 3639Fd, the First Crenarchaeon Capable of Growth on Lipids
Authors: Karaseva A. I. , Elcheninov A. G. , Perevalova A. A. , Zayulina K. S. , Kochetkova T. V. , Kublanov I. V.
Published: August 2021

Abstract—

Up to now, ability of prokaryotes to grow on lipids has been shown only for bacteria. Thermococcus sibiricus, member of the phylum Euryarchaeota isolated from a high-temperature oil well and capable of growth on olive oil, is the only exception. The present work reports isolation of a pure culture of a strictly anaerobic archaeon, strain 3639Fd (=VKM B-3509, =KCTC 25228) from a Kamchatka thermal spring, capable of growth on various lipids (tributyrin, triolein, and sesame, cottonseed, and sunflower oil) at 70°C and pH 5.5–6.0. Growth on tributyrin resulted in formation of butyrate, CO2, and hydrogen. According to the results of the 16S rRNA gene sequence analysis and in silico DNA–DNA hybridization, the isolate was classified as a strain of Fervidicoccus fontis, an archaeon of the phylum Crenarchaeota. The closest characterized homologs of the α/β-hydrolases, encoded in the genomes of F. fontis 3639Fd and of the type strain of this species, Kam940T, were various carboxyl esterases (EC 3.1.1), the enzymes responsible for lipid hydrolysis. Thus, F. fontis is the first crenarchaeon able to obtain energy by hydrolysis of lipid substrates.
Tylenol or acetaminophen: a recurrent fixed drug eruption perpetuated through the use of inconsistent drug terminology
Authors: Federman Daniel , Gruen Jadry A , Merchant Naseema
Published: August 2021

An 87-year-old man with a history of osteoarthritis presented with worsening knee pain. He was prescribed acetaminophen with codeine. A few days later, he developed a rash on his right buttock and proximal thigh, similar to a rash he experienced in the past when he took over-the-counter (OTC) acetamenophen and an unknown lozenge to treat a presumed viral illness. A fixed drug eruption (FDE) was diagnosed and the patient was asked to avoid Tylenol and other OTC lozenges. Tylenol was entered as an allergy in the electronic medical records. However, since Tylenol, not acetaminophen was listed in the allergy profile, the order for acetaminophen and codeine did not generate an alert for the prescribing physician. Additionally, the dispensing pharmacist did not question the prescribing physician and the patient, unaware that acetaminophen in the pain medication is the same drug as Tylenol, took it and developed recurrent FDE.
Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease
Authors: Sabahat Uzma , Shaikh Niaz Ahmed , Alameen Ali Mohammed Mahmood , Ashfaq Faryal
Published: August 2021

A 42-year-old diabetic man presented to the hospital with severe sepsis and multiorgan dysfunction. A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further management including ventilatory support and renal replacement therapy. He was also found to have marked anaemia requiring multiple blood transfusions with clinical and laboratory evidence pointing towards severe haemolysis. Further workup for the aetiology of pneumonia established a diagnosis of Legionella by confirmatory tests namely legionella antigen in the urine and exponentially rising serum antibody titres. The cause for the severe haemolysis was found to be complement-mediated autoimmune haemolysis as determined by direct antiglobulin test positive for complement components C3 and negative for IgG. Such clinically significant autoimmune haemolysis as a presenting feature, rather than a late complication, has never before been reported in the literature.
Intracerebral haemorrhage and Guillain-Barré syndrome: an exploration of potential pathophysiology
Authors: Connor Sophia , Azzam Omar , Prentice David
Published: August 2021

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy classically thought to be caused by infections through the process of molecular mimicry. We report a case of GBS caused by intracerebral haemorrhage and postulate potential theories for the development of GBS following intracerebral haemorrhage and other non-infectious aetiologies by association. We highlight that GBS is an important differential diagnosis in patients developing generalised paresis following intracerebral haemorrhage.
Tooth autotransplantation in a patient with rapidly progressing periodontitis aided by 3D printing
Authors: Shi Hongyi Adrian , Siow Shu Fen Dawn , Phua Zong You Jonathan
Published: August 2021

Patients with rapidly progressing periodontitis may require extractions of teeth with poor periodontal prognosis. Although replacement with a dental implant is a popular choice, teeth autotransplantation remains a viable option. Herein, we report a case of a 23-year-old patient with rapidly progressing periodontitis resulting in severe clinical attachment loss on the left maxillary first molar, which required extraction. The tooth was replaced by tooth autotransplantation of the unerupted immature left mandibular third molar, which was delivered carefully without compromising the periodontal ligament. Cone beam computed tomography and three-dimensional printing of the third molar donor tooth significantly aided the tooth autotransplantation procedure. Recovery was uneventful. At the 1-year follow-up, healthy periodontal parameters and radiographic features were noted, and the autotransplanted tooth remained vital. This case showed that tooth autotransplantation is a viable option for replacing tooth loss due to rapidly progressing periodontitis.
The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review
Authors: Regan Lydia , Wilson David , Chalkidou Kalipso , Chi Y-Ling
Published: August 2021

Background

Countries are recommended to progressively work towards universal health coverage (UHC), and to make explicit choices regarding the expansion of priority services. However, there is little guidance on how to manage the inclusion of vertical programmes, funded by external partners, in health benefits packages (HBP) in low and middle-income countries (LMICs).

Objective

We conducted a scoping review to map the inclusion of six vertical programmes (HIV, tuberculosis, malaria, maternal and child health, contraceptives, immunisation) in 26 LMICs.

Methods

We identified 26 LMICs with an HBP that was not aspirational (eg, with evidence of implementation or funding). For each HBP, we collected information on the corresponding UHC scheme, health financing at the time of establishment, revisions since inception and entitlements. For each vertical programme, we developed a list of tracer interventions based on the Disease Control Priorities 3 and the 100 Core Health Indicators List. We then used this list of tracer interventions to map the coverage of the six vertical programmes.

Results

The review shows that there is no common starting point for countries embarking into UHC. Some HBPs were almost three decades old. Whole package revisions are rare. The inclusion of vertical programme does not follow a given pattern based on health financing indicators or country’s income group. Maternal child health services are the most often included and family planning the least. Six countries in our sample covered all vertical programmes, while one covered only one of six.

Conclusions

This review has shown that there has been a long history of countries facing this question and we have provided the first mapping of inclusion of vertical programmes in UHC. The results of the mapping can inform decisions in countries embarking in UHC.
Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study
Authors: Zhang Tianhang , Yan Lijing L , Chen Hua-Shuai , Jin Hai-Yu , Wu Chenkai
Published: August 2021

Background

Allostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world.

Objective

This study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years.

Design

Population-based prospective cohort study.

Setting

In 2011–2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey.

Participants

The final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women).

Primary outcome measure

Cox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise.

Results

Male with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden.

Conclusion

Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.
Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial
Authors: Dieris-Hirche Jan , Bottel Laura , Pape Magdalena , te Wildt Bert Theodor , Wölfling Klaus , Henningsen Peter , Timmesfeld Nina , Neumann Anja , Neusser Silke , Beckers Rainer , Herpertz Stephan
Published: August 2021

Introduction

In May 2019, the WHO classified internet gaming disorder (IGD) as a mental disorder in the upcoming International Classification of Diseases 11th Revision. However, individuals affected by IGD or internet use disorders (IUDs) are often not provided with adequate therapy due to a lack of motivation or absence of adequate local treatment options. To close the gap between individuals with IUDs and the care system, we conduct an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS).

Methods and analysis

Within the randomised controlled trial, a total of n=162 participants will be allocated by sequential balancing randomisation to the OMPRIS intervention or a waitlist control group. The study includes an extensive diagnostic, followed by a 4-week psychological intervention based on motivational interviewing, (internet-related) addiction therapy, behavioural therapy techniques and additional social counselling. The primary outcome is the reduction of problematic internet use measured by the Assessment of Internet and Computer Game Addiction Scale. Secondary outcomes include time spent on the internet, motivation for change (Stages of Change Readiness and Treatment Eagerness Scale for Internet Use Disorder), comorbid mental symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder Screener-7), quality of life (EuroQoL Standardised Measure of Health-related Quality of Life–5 Dimensions, General Life Satisfaction-1), self-efficacy (General Self-Efficacy Scale), personality traits (Big Five Inventory-10), therapeutic alliance (Helping Alliance Questionnaire) and health economic costs. The diagnosis of (comorbid) mental disorders is carried out with standardised clinical interviews. The measurement will be assessed before (T0), at midpoint (T1) and after the OMPRIS intervention (T2), representing the primary endpoint. Two follow-up assessments will be conducted after 6 weeks (T3) and 6 months (T4) after the intervention. The outcomes will be analysed primarily via analysis of covariance. Both intention-to-treat and per-protocol analyses will be conducted.

Ethics and dissemination

Participants will provide written informed consent. The trial has been approved by the Ethics Committee of the Faculty of Medicine, Ruhr University Bochum (approval number 19-6779). Findings will be disseminated through presentations, peer-reviewed journals and conferences.

Trial registration number

DRKS00019925.
Sociodemographic disparity in health-related behaviours and dietary habits among public workers in China: a cross-sectional study
Authors: Li Ling , He Jun , Ouyang Feiyun , Qiu Dan , Li Yilu , Luo Dan , Yu Yu , Xiao Shuiyuan
Published: August 2021

Objective

We aimed to estimate the distribution of health-related behaviours and dietary habits by sociodemographics among public workers in China.

Design

Cross-sectional study.

Setting

A representative sample was obtained from 10 government-run institutions in Hunan province of China.

Participants

A total of 5029 public workers were included in this study.

Primary and secondary outcome measures

Prevalence on their sociodemographic characteristics, health-related behaviours and dietary habits. Socioeconomic status (SES) scores were calculated by multiplying ordinal numerical values assigned to consecutive categories of education level and annual household income. Multivariate logistic regression analysis and categorical principal component analysis were used to estimate differences in health-related behaviours and dietary habits by sociodemographics.

Results

The distribution of health-related behaviours and dietary habits was varied by sociodemographic groups. Middle-aged groups (41–60 years) were more likely to smoke (for men, 34.5%), use alcohol (for men, 22.5%), and have short sleep duration (for men, 36.3%; for women, 39.6%). Young participants (≤30 years) were more likely to have multiple unhealthy behaviours and dietary habits. Those in low-SES have a significant higher rate of smoking (ORadj=1.46, 95% CI: 1.15 to 1.85) and leisure-time physical inactivity (ORadj=1.18, 95% CI: 1.02 to 1.37), but a lower rate of late sleeping (ORadj=0.69, 95% CI: 0.57 to 0.83) than those in high-SES. Notably, older men (≥51 years) with low-SES preferred the ‘smoked and pickled foods and dessert’ and ‘fish and nut’ pattern. In high-SES groups, 41–50 year old people preferred the ‘traditional foods’ and ‘cereals and dairy product’ pattern. No difference in dietary patterns by sociodemographics was found among women (p<0.05).

Conclusions

Our findings of the disparity distribution of health-related behaviours and dietary habits by specific gender, age and SES among Chinese public workers have important policy implications for developing targeted health interventions to facilitate health-related behaviours and dietary habits in this population.
Study protocol:Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia
Authors: Whop Lisa J , Butler Tamara L , Brotherton Julia M L , Anderson Kate , Cunningham Joan , Tong Allison , Garvey Gail
Published: August 2021

Introduction

Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia.

Methods and analysis

The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced.

Ethics and dissemination

The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.
Exposure to low-dose ionising radiation from cardiac catheterisation and risk of cancer: the COCCINELLE study cohort profile
Authors: Abalo Kossi Dovene , Malekzadeh-Milani Sophie , Hascoët Sébastien , Dreuil Serge , Feuillet Tiphaine , Cohen Sarah , Dauphin Claire , Filippo Sylvie Di , Douchin Stéphanie , Godart François , Guérin Patrice , Helms Pauline , Karsenty Clement , Lefort Bruno , Mauran Pierre , Ovaert Caroline , Piéchaud Jean-François , Thambo Jean-Benoît , Leuraud Klervi , Bonnet Damien , Bernier Marie-Odile , Rage Estelle
Published: August 2021

Purpose

The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood.

Participants

Children who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients’ vital status.

Findings to date

A total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population.

Future plans

Dose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose–response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation.
Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg
Authors: Moran Valerie , Suhrcke Marc , Ruiz-Castell Maria , Barré Jessica , Huiart Laetitia
Published: August 2021

Objectives

We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need.

Design

Cross-sectional survey conducted between February and December 2014.

Setting and participants

4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.

Outcome measures

Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.

Results

The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.

Conclusions

Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.
International survey on fear and childbirth experience in pregnancy and the postpartum period during the COVID-19 pandemic: study protocol
Authors: Lok Kris Yuet-Wan , Ko Rachel Wai Tung , Fan Heidi Sze Lok , Wong Janet YH , Choi Edmond PH , Shek Noel Wan Man , NGAN Hextan Y S , Tarrant Marie , Li Junyan , Huang Yi-yan , Ouyang Yan-Qiong , Fong Daniel Yee Tak
Published: August 2021

Introduction

The COVID-19 pandemic has caused unprecedented disruptions around the world. Adding to the existing stress surrounding pregnancy and childbirth, the threat of infection and social isolation policies may negatively impact pregnant women and new mothers. Literature on the effect of COVID-19 on fear during pregnancy and childbirth experience is limited. As the COVID-19 pandemic continues to affect the global population, it is important to understand how it has impacted pregnant women and new mothers’ experiences worldwide to inform perinatal care and interventions.

Methods and analysis

This multicountry study involving China and Canada targets to recruit 1000 pregnant women and new mothers who gave birth since 2020 in each participating country. Participants will be recruited online in the local language through mothers’ groups, antenatal and postnatal clinics and hospital wards. All questionnaires will be completed online. Participants’ level of fear, depression and childbirth experience will be assessed along with other sociodemographic, medical and COVID-related measures. Regression models will be used to compare the outcomes among the participating countries.

Ethics and dissemination

The study has been reviewed and approved by the institutional review boards of the participating countries. Findings will be disseminated in peer-reviewed journals and academic conferences. Results from this study may guide the formulation of future health guidelines and policies in the face of a pandemic.
Access to essential medicines for children: a cross-sectional survey measuring medicine prices, availability and affordability in Hanam province, Vietnam
Authors: Dinh Dai Xuan , Nguyen Huong Thi Thanh , Nguyen Van Minh
Published: August 2021

Objective

To identify the availability, prices and affordability of essential medicines for children (cEMs) in Hanam province, Vietnam.

Design

Cross-sectional study.

Setting

One city and five districts of Hanam province.

Participants

66 public health facilities and 66 private drugstores.

Primary and secondary outcome measures

The standardised methodology of the WHO and Health Action International was used to investigate 30 paediatric essential medicines. For each medicine, data were collected for two products: the lowest-priced medicine (LPM) and the highest-priced medicine (HPM). The availability of medicine was computed as the percentage of facilities in which this medicine was found on the day of data collection. Median prices of individual medicines were reported in local currency. Affordability was calculated as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common diseases. Data were analysed using R software V.4.1.0.

Results

The mean availability of LPMs in the private sector (33.2%, SD=38.0%) was higher than that in the public sector (24.9%, SD=39.4%) (p<0.05). The mean availability of HPMs was extremely low in both sectors (11.3% and 5.8%, respectively). The mean availability of cEMs in urban areas was significantly higher than that in rural areas (36.5% and 31.6%, respectively, p<0.05). In the public sector, the prices of LPMs were nearly equal to the international reference prices (IRPs). In the private sector, LPMs were generally sold at 4.06 times their IRPs. However, in both sectors, the affordability of LPMs was reasonable for most conditions as standard treatments only cost a day’s wage or less.

Conclusion

The low availability was the main reason hindering access to cEMs in Hanam, especially in the countryside. A national study on cEMs should be conducted, and some practical policies should be promulgated to enhance access to cEMs.