bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Adipose-derived Stromal Vascular Fraction Cells on the Treatment of Knee Osteoarthritis
Authors: Tsubosaka Masanori , Matsumoto Tomoyuki , Sobajima Satoshi , Matsushita Takehiko , Iwaguro Hideki , Kuroda Ryosuke
Published: March 2020

Background Adipose-derived stromal vascular fraction (SVF) cells are a mixed cell population that includes cells with multilineage potential, similar to bone marrow-derived mesenchymal stem cells. Our purpose is to investigate the influence of SVF cells in patients with knee osteoarthritis (OA) and the short-term treatment effects. Methods Fifty-seven patients were enrolled and treated with intra-articular injection of 5.0×10 7 SVF cells into the knee joint between September 2017 and March 2018. All patients were followed up for 12 months or longer. Mean age at treatment and follow-up period were 69.4±6.9 years and 13.7±2.0 months, respectively. The mean preoperative hip-knee-ankle angle was 6.7±3.6°. SVF cells were prepared using the Celution®800/CRS system from the patients’ abdominal or breech subcutaneous fat. The mean SVF cell viability was 90.6±2.7%. Clinical evaluations were performed for range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Imaging evaluations, which included the hip-knee-ankle angle assessed via radiography, and T2 mapping value using a 3.0-T magnetic resonance imaging unit were also assessed. Both clinical and imaging evaluations were performed preoperatively, 1, 3, 6, and 12 months postoperatively, and compared among all timepoints (p<0.05). Results Knee extension angle at 6 and 12 months postoperatively was significantly better than the preoperative angle. Total WOMAC, VAS, and KOOS scores at 1, 3, 6 and 12 months postoperatively were significantly better than preoperative scores. There was no significant difference in hip-knee-ankle angle among the five time periods. T2 mapping values of lateral femur and tibia were significantly higher 12 months postoperatively than preoperatively. Conclusions The short-term clinical effects of intra-articular SVF cell injection on knee OA were excellent. Intra-articular SVF cell injection is a novel and innovative approach for treating patients with knee OA.
HIVFactSheet: A mobile application designed and implemented by youth peer mentors to facilitate HIV and reproductive health care among adolescents and young adults
Authors: Apondi Edith , Bakari Salim , Kwendo Brian , Ingari Jones , McAteer Carole , Scanlon Michael , Aluoch Josephine , Toromo Judith , Chemon Jane , Kimaiyo Sylvester , Nyandiko Winstone , Vreeman Rachel C. , Enane Leslie A.
Published: March 2020

Background:Adolescents and young adults in sub-Saharan Africa face complex challenges in accessing HIV testing, HIV care, and sexual and reproductive health services. We describe and characterize the uptake of a unique mHealth intervention that was designed, led, and implemented by youth peer mentors (YPM) in the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya.Methods: YPM developed a mobile application to address the unmet needs that they identified in youth education around HIV testing, HIV care, and sexual and reproductive health. The application incorporates comprehensive educational materials and information about health services in Kenya. Users can set up reminders for clinic appointments and may call, text, or email a YPM for assistance accessing care or to ask care-related questions. The application has been promoted at AMPATH clinics and on social media. We describe its implementation in this setting.Results: Since launching the application in December 2017, as of April 2019 the application was downloaded 5,800 times, with 4,953 current users. Downloads primarily originated in Kenya (74%) and other African countries, but also globally. Texts to YPM through the application included questions about a broad range of topics on HIV testing, prevention, and care; reproductive and sexual health; substance abuse and addiction; and navigating health care. YPM contacted through the app provided individualized counseling and referred 183 users to health services. YPM utilize the application in large- and small-group and individual peer education sessions, and in trainings for healthcare workers, teachers and new YPM.Conclusions: Adolescents and young adults should be empowered to lead interventions to address the challenges that they face in navigating care. A unique mobile application intervention spearheaded by YPM providing access to comprehensive health education and individualized counseling and referral has great potential to facilitate HIV and sexual and reproductive health care for young people.
Bullying victimization and life satisfaction among rural left-behind children in Central China: a cross-sectional study
Authors: Yang Yide , Zheng Chan-juan , Dong Yanhui , Zhang Ya-qin , Xie Ming , Huang Shu-Zhen , Zhou Mei-ling , Zhu Yu-Lian , Zou Zhi-yong , Ma Jun
Published: March 2020

Background: Parental migration has many detrimental health impacts on children. This study described the associations between bullying victimization and life satisfaction among left-behind children(LBC), and examined the interactive effects of left behind experience and bullying victimization on life satisfaction. Methods: Students from first to ninth grade in Central China participated in the present study. Life satisfaction were assessed by Chinese version of revised Bully/Victim Questionnaire and Multidimensional students’ life satisfaction scale(MSLSS). Results: A total of 1013 children were investigated, of which 42.5% were left-behind. We found LBC had a significantly 45% higher risk of being teased in a hurtful way than the non-LBC(OR=1.45, 95%CI: 1.10~1.91), and the LBC had lower self-satisfaction than the non-LBC(b=-0.14, P =0.017). Being teased was only associated with self-satisfaction, and other bullying victimization behaviors had significant impact on all dimensions of life satisfaction( P <0.05). We identified an interactive effect between left behind experience and bullying victimization on school satisfaction( P interaction =0.015), bullying was significantly related with lower school satisfaction in the LBC group(b=-0.69, P <0.001), but no association in the non-LBC group. Also, there was a combined effect between left behind experience and bullying victimization on environment satisfaction( P interaction >0.05), bullying was significantly related with lower environment satisfaction in the LBC group(b=-0.31, P =0.033), while no association was observed in the non-LBC group. Conclusion: There is an interaction of left behind experience and bullying victimization on school satisfaction and a combined effect on environment satisfaction. Left behind experience could significantly amplify the associations between bullying victimization and school satisfaction/environment satisfaction.
Factors in multiple behaviour change interventions affecting smoking cessation success: a rapid realist review.
Authors: Minian Nadia , Corrin Tricia , Lingam Mathangee , deRuiter Wayne K , Rodak Terri , Taylor Valerie H. , Manson Heather , Dragonetti Rosa , Zawertailo Laurie , Melamed Osnat C. , Hahn Margaret , Selby Peter
Published: March 2020

Background Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about what components of these interventions help to promote successful smoking cessation . The aim of this rapid realist review was to identify possible mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with effectively changing tobacco use. Methods This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis. Results Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.’s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant’s capability or motivation to make a behaviour change was only successful within certain contexts. Conclusion In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from ‘individualistic epidemiology’ and invest resources into modifying factors that exist outside of the individual (i.e. creating a supportive environment). Study registration PROSPERO registration number: CRD42017064430
Goals of Care or Goals of Life? A qualitative study of clinicians’ and patients’ experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS)
Authors: Hattangadi Nayantara , Kurdyak Paul , Solomon Rachel , Soklaridis Sophie
Published: March 2020

Background : Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of hospital discharge using PODS has not been widely explored. Methods : We used a qualitative research design to explore clinicians’ and patients’ experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews. Data was analyzed using a thematic analysis approach to develop descriptive themes. Results : The themes that emerged based on PODS experience was influenced by the asymmetrical information advantaged that clinicians had with the discharge planning process. Thus, the themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of “goals of care.” They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their “goals of care” for discharge planning. Patients provided more of a “goals of life” perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery. Conclusions : PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the asymmetrical information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. Despite that an asymmetrical relationship exists between clinician and patients, it did not detract from the potential benefits of PODS for the patient. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.
Translation and adaptation of the Learning Organisation Survey for french speaking countries.
Authors: Diez Amalia Giuliani , Amine Souadka , Majbar Mohammed Anass , Benkabbou Amine , Mohsine Raouf , Akhnif El Houcine
Published: March 2020

Background Learning organizations need a diagnostic tool that allows them to assess how well their team, department, or the entire institution is performing, and help them identify areas of improvement. In turn, having that tool in your own language (in this case, French) and adapted to your own context, gives reliability and ease of application. Health organizations are starting to use more and more tools like this that allow them to improve their learning capabilities and, therefore their performance. The aim of the study was the translation of Garvin's et al. Learning Organization Survey into French to evaluate french-speaking health organizations. Methods the method used to translate the questionnaire was based on Brislin's modified reverse translation technique. Followed by the stage of cross-cultural adaptation through an Atelier of experts, obtaining a pre-final version that was reviewed by a committee of judges with an index of the validity of IVC content ≤ 80%. The French version of the questionnaire proved to be an adequate instrument for the evaluation. The survey was conducted with a sample of 111 workers from the National Oncology Institute of Rabat, who accepted the filling of the survey, ≥ 65%. Results The established validation criteria were exceeded with results > 80% in the assessment of experts. We found a good internal consistency, evidenced by a Cronbach's Alpha of > 0.8 in each block. Conclusion The questionnaire gathers enough psychometric properties to be considered a useful and reliable tool capable of objectively measuring a french speaking Learning Organization.
Exploring the Effectiveness of a P4P Scheme from the Italian General Practitioners’ Perspective: A Replication Study
Authors: GIANCOTTI MONICA , MAURO MARIANNA , RANIA FRANCESCO
Published: March 2020

Background A major problem of the primary healthcare systems is represented by the deficiencies in performance quality. Financial incentives can be used in order to improve the quality of healthcare. According to this, since 1993 many countries have introduced pay for performance reimbursement schemes to encourage practitioner behaviour to align with the specific objectives of the decision maker and to incentivize the provision of targeted services. In this context the study of Krauth et al. (2016) was the first in Europe to determine whether general practitioners would participate in a pay for performance programme and under what conditions. Our research replicates the German survey, adjusting it to the Italian context. This article explores whether financial incentives can improve the quality of healthcare from the perspective of general practitioners. The purposes were as follows: to assess the attitudes of Italian general practitioners towards the current remuneration scheme; to determine if they would participate in a pay for performance programme; and to analyse how such views vary among the groups of respondents. Methods Our tool for data collection was a questionnaire elaborated on the basis of a theoretical framework developed by Krauth et al. The questionnaires were distributed from September to December 2017. Results Results confirm that for a successful implementation of a quality-based compensation scheme, it is crucial to gain the acceptance and support of healthcare providers. Conclusions To ensure that healthcare providers can realistically achieve the programme’s targets, they should be involved in the implementation process. Our study offers useful information for developing an effectiveness remuneration scheme in Italy for general practice.
National data analysis and systematic review for human resources for cervical cancer screening in Japan: Who should take Pap smears for cervical cancer screening?
Authors: Hamashima Chisato , Sasaki Seiju , Hoshi Keika , Hosono Satoyo , Katayama Takafumi , Terasawa Teruhiko
Published: March 2020

Background: Although cervical cancer screening has been performed as a national program since 1983 in Japan, taking Pap smears from the cervix has usually been performed by gynecologists and obstetricians in their offices. Conventionally, general physicians and midwives cannot take Pap smears of cervical cancer screening in Japan. Accessibility is one of the important factors to consider when planning to increase the participation rate in cancer screening programs. Gynecologists also play a primary role in the diagnosis and treatment of cervical cancers. Discussions regarding the needed human resources for cancer screening programs have remained scared in Japan. Methods: We examined the number of gynecologists and obstetricians based on a national survey. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2019. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables.Results: Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. However, 43.6% of municipalities have no gynecologists and obstetricians in 2016. Five articles identified from Ovid-MEDLINE and Ichushi-Web were eligible and assessed. Two Japanese studies showed consistent results regarding the association of resources as gynecologists and obstetricians with participation rates in cervical cancer screening. Another article reported on the national distribution of gynecological oncologists and compared the treatment outcomes between hospitals with and without certified gynecologists. The number of certified gynecological oncologists has remained insufficient with a biased distribution. Thus, the survival rate of cervical cancer patients was different between hospitals with and without accreditation by academic society. Although the perspectives of selected articles were different, the results suggested the burden to access to cervical cancer screening and consequent diagnosis and treatment.Conclusions: The human resources for taking Pap smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. Enabling general physicians to take Pap smears or the introduction of self-sampling HPV testing may be considered to augment the limited access to cervical cancer screening.
Differential breeding practices drive subpopulation differentiation and contribute to the loss of genetic diversity within dog breed lineages
Authors: Lampi Sara , Donner Jonas , Anderson Heidi , Pohjoismäki Jaakko L. O.
Published: March 2020

Background Discrete breed ideals are not restricted to delimiting dog breeds from another, but also are key drivers of subpopulation differentiation. As genetic differentiation due to population fragmentation results in increased rates of inbreeding and loss of genetic diversity, detecting and alleviating the reasons of population fragmentation can provide effective tools for the maintenance of healthy dog breeds. Results Using a genome wide SNP array, we detected genetic differentiation to subpopulations in six breeds, Belgian Shepherd, English Greyhound, Finnish Lapphund, Italian Greyhound, Labrador Retriever and Shetland Sheepdog, either due to geographical isolation or as a result of differential breeding strategies. The subpopulation differentiation was strongest in show dog lineages. Conclusions Besides geographical differentiation caused by founder effect and lack of gene flow, selection on champion looks or restricted pedigrees is a strong driver of population fragmentation. Artificial barriers for gene flow between the different subpopulations should be recognized and abolished for the maintenance of genetic diversity within a breed.
Natural toxic impact and thyroid signaling interplay orchestrates riverine adaptive divergence of Dolly Varden.
Authors: Esin Evgeny V. , Markevich Grigorii N. , Melnik Nikolay O. , Kapitanova Daria V. , Shkil Fedor N.
Published: March 2020

Background Adaptive radiation in fishes has been actively investigated over the last decades. Along with numerous well-studied cases of lotic radiation, some examples of riverine sympatric divergence have been recently discovered. In contrast to the lakes, the riverine conditions do not provide evident stability in the ecological gradients. Consequently, external factors triggering the radiation, as well as developmental mechanisms underpinning it, remain unclear. Herein, we present the comprehensive study of external and internal drivers of the riverine adaptive divergence of the salmonid fish Salvelinus malma. In the Kamchatka River, this species splits in the reproductively isolated morphs that drastically differ in ecology and morphology: the benthivorous Dolly Varden (DV) and the piscivorous Stone charr (SC). To understand why and how these morphs originated, we performed a series of field and experimental work, including common-garden rearing, comparative ontogenetic, physiological and endocrinological analyses, hormonal "engineering" of phenotypes.Results We revealed that the type of spawning ground acts as the main external factor driving the radiation of S. malma . In contrast to DV spawning in the leaf krummholz zone, SC reproduces in the zone of coniferous forest, which litter has a toxic impact on developing fishes. SC enhances resistance to the toxicants via metabolism acceleration provided by the elevated thyroid hormone content. These physiological changes lead to the multiple heterochronies resulting in a specific morphology and SC's expansion into a piscivorous niche.Conclusions S. malma represents a notable example of how the thyroid axis contributes to the generation of diverse phenotypic outcomes underlying the riverine sympatric divergence. Our findings, along with the paleoecology data concerning spruce forest distribution during the Pleistocene, provide an opportunity to reconstruct a scenario of S. malma divergence. Taken together, obtained results with the data of the role of thyroid hormones in the ontogeny and diversification of fishes contribute a resource to consider the thyroid axis as a prime director orchestrating the phenotypic plasticity promoting evolutionary diversification under the changing environmental conditions.
A system-level investigation into the pharmacological mechanisms of flavor compounds in Maotai liquor
Authors: Liu Zhigang , Zhou Wei , Chen Ziyi , Zhang Guohao
Published: March 2020

Maotai-flavor liquor, one of the world’s famous natural fermentation food product plays a significant role in traditional Chinese culture and people’s daily lives for a long time due to its good taste. However, the pharmacological activities of flavor compounds in Maotai liquor has not been fully elucidated. In answering this question, a system-level analysis was developed by combining in silico ADME evaluation, multi-target prediction, GO enrichment analysis, network pharmacology technology, pathway analysis, as well as experimental verification to elucidate the pharmacological effects of flavor compounds in Maotai liquor. Finally, 55 active compounds and 80 targets were identified to interpret the pharmacological effect of the flavor compounds. Moreover, the key active compounds was verified by in vitro experiments to validate the reliability of our approaches. Our study provides a novel integrated strategy to comprehensively understand the pharmacological activities of complex components in Maotai liquor.
Does the addition of concurrent visual feedback increase adherence to a home exercise program in people with stroke: a single-case series?
Authors: Levy Tamina , Crotty Maria , Laver Kate , Lannin Natasha , Killington Maggie
Published: March 2020

Objective Evidence is accumulating for the potential benefits of technology use in stroke rehabilitation. However, few studies have examined ways in which technology can be used to increase adherence to programs after discharge from rehabilitation. The aim of this study was to determine if the addition of concurrent visual feedback, via a tablet computer, increased adherence to an exercise program following stroke. Ten participants were provided with a self-administered exercise program and were asked to perform 60 minutes of the exercises daily. After a baseline phase (one week), participants were given a tablet computer (two weeks) and were asked to video record each exercise session. The tablet computer was removed during the fourth week of the program. Results Exercise duration over the four weeks was investigated using the two-standard deviation (2 SD) band method. A statistically significant effect was observed in four out of ten cases, demonstrated by two successive data points occurring outside the 2 SD band during the intervention phase, suggesting that adherence was increased in response to the tablet computer use. This preliminary study indicates that the use of visual feedback, via a tablet computer, may increase adherence to an exercise program in people with stroke.
Association between sleep quality and central obesity among southern Chinese reproductive-aged women
Authors: Li Bingbing , Liu Nan , Guo Donghui , Li Bo , Liang Yan , Huang Lingling , Wang Xiaoxiao , Su Zhenzhen , Zhang Guozeng , Wang Peixi
Published: March 2020

Background Females are more prone to complain about sleep problems. Poor sleep quality in this group may make them more vulnerable to suffering obesity and other diseases, which can seriously affect their fitness and quality of life. Nevertheless, the connections between sleep quality and central obesity among reproductive-aged women are not clear. The aims of this study were to explore the association between sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and central obesity among Chinese reproductive-aged women and to identify the independent contributions of sociodemographic characteristics, health-related factors, and sleep quality to central obesity. Methods In this cross-sectional survey, 2449 Chinese reproductive-aged women aged 18-49 years were studied. Sleep quality was assessed using the Chinese version of the PSQI. Central obesity as the outcome of interest was a binary variable; women were categorized as with versus without central obesity. Clustered logistic regression was used to analyze the independent contribution of sleep quality to central obesity. Results The risk of central obesity increased significantly with poor sleep quality (assessed by global PSQI score) (adjusted OR(Odds Ratio)=2.20 per SD increase; P=0.004), increased sleep disturbance score (adjusted OR=1.11 per SD increase; P=0.042) and decreased subjective sleep quality score (adjusted OR=0.81 per SD increase; P<0.001). The independent contribution of sleep quality was 9.9%, less than those of sociodemographic (73.3%) and health-related (16.8%) variables. Among complaints related to sleep disturbance, the inability to breathe comfortably and having bad dreams showed significant associations with central obesity. Conclusions There exists some degree of correlation between sleep quality and central obesity among Chinese reproductive-aged women. Understanding this link has public health relevance because of the important role sleep plays in health. It also has some implications for the discovery of novel strategies to prevent central obesity and the implementation of weight maintenance programs in this population group.
Association between maternal high-risk fertility behavior and anemia among reproductive age women in Ethiopia
Authors: Fadl Noha , Haile Zelalem T. , Ice Gillian H.
Published: March 2020

Objectives Anemia constitutes a major public health problem in low- and middle-income countries. The purpose of this study was to examine the individual and combined influence of high-risk fertility behavior on anemia among reproductive age women in Ethiopia.Methods Secondary data analysis was conducted using a nationally representative sample of women aged 15-49 years from the 2016 Ethiopia Demographic and Health Survey (n=5799). Anemia status was the outcome of interest. Maternal high-risk fertility behaviors were measured using maternal age at delivery, birth order and birth interval. Descriptive statistics and multivariable regression models were performed.Results Overall, 28.7% of women had anemia and 71.4% experienced at least one high-risk fertility behavior. In the multivariable model, there was a significant interaction between high-risk fertility behavior and place of residence on anemia. Women with any high-risk fertility behavior were more likely to have anemia than women without any high-risk fertility behavior. However, the strength of association differed by place of residence (AOR: 2.68; 95% CI, 1.26-5.67 for urban and AOR: 1.27; 95% CI, 1.01-1.61 for rural residents). Single high-risk fertility behavior was significantly associated with anemia only among urban residents (AOR: 2.65; 95% CI, 1.20-5.83). Multiple high-risk fertility behavior significantly increased the odds of anemia, with stronger association among urban residents (AOR: 2.82; 95% CI, 1.14-6.95) than rural residents (AOR: 1.56; 95% CI, 1.11-2.19).Conclusions Place of residence moderated the relationship between high-risk fertility behaviors and anemia. Our findings suggest the need for context-specific strategies and interventions to prevent anemia.
Audit Feedback Interventions to Address High-Risk Prescriptions in Long-Term Care Homes: A Costing Study and Return on Investment Analysis
Authors: Thavorn Kednapa , Kumar Srishti , Reis Catherine , Lam Jonathan , Dobell Gail , Mulhall Cara , Grimshaw Jeremy M. , Ivers Noah
Published: March 2020

Background: Audit and feedback is a common implementation strategy, but little literature describes its costs. ‘MyPractice’ is an audit and feedback initiative produced by Ontario Health, the provincial agency tasked with supporting quality of care. This study sought to estimate the costs of ‘MyPractice’ and assess whether the financial benefit of ‘MyPractice’ offsets those costs. Methods: We conducted a costing study from the perspective of the government of Ontario, which funds both Ontario Health and necessary healthcare costs for people living in long-term care (LTC) homes in the province. Total cost of ‘MyPractice’ was calculated as the sum of the costs of producing and disseminating the reports (covering three report releases) which were obtained from Ontario Health staff interviews and document reviews. Return on investment (ROI) was calculated as the ratio of net cost-savings and the intervention cost. Net cost-savings were estimated as the reduction in the costs of antipsychotics incurred by LTC home residents attributable to ‘MyPractice’ reports. Results: Total intervention costs were C$223,691 (C$838 per physician and C$74,564 per release). Costs incurred during the development phase accounted for 74% of the total cost (C$166,117), while implementation costs for three report releases were responsible for 26% of the total costs (C$57,575). The ROI for every C$1 spent on the ‘MyPractice’ intervention was 1.22 (95% CI: 0.82, 1.61) for three report releases. Conclusion: ‘My Practice’ report offers a good return on investment and the value for money increases if physicians sign up and view the reports.
Lung MRI to predict lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 mismatch
Authors: Paula Wagner Diniz de , Rodrigues Marcelo Palmeira , Ferreira Nathali Mireise Costa , Passini Viviane Vieira , Silva César Augusto Melo e
Published: March 2020

BackgroundHigh-resolution chest computed tomography (HRCT) signs of interstitial lung disease (ILD) are varied, some corresponding to irreparable parenchymal destruction and fibrosis, others representing potentially reversible changes, such as fine reticulation and ground-glass opacities (GGO). GGO frequently correspond to sites of active inflammation that may be responsive to steroids or immunosuppressive agents, but they might also represent intralobular interstitial fibrosis not resolved by current HRCT technique. Our aim was to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO.MethodsIn this prospective cohort, 15 participants (4 male and 11 female) aged 38–84 years, presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI with breath-hold (SSFSE) and respiratory-gated (PROPELLER) T2-weighted pulse sequences, and with dynamic contrast-enhanced fat-suppressed T1-weighted pulse sequence (LAVA). Relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response in a dichotomous fashion (response versus non-response) with t test for independent samples. SSFSE/PROPELLER T2 mismatch was compared to response with Fisher’s exact test. Inter-rater agreement was evaluated with Cohen’s kappa coefficient. The primary endpoint for response was a greater than 10% increase in forced vital capacity in 10 weeks.ResultsResponders (4/15, 27%) and non-responders (11/15, 73%) showed similar relative signal intensity on T2-weighted images and relative enhancement measurements. SSFSE/PROPELLER T2 mismatch was able to discriminate responders from non-responders in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with inter-rater agreement of 87% between readers 1 and 2 (Cohen’s kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen’s kappa coefficient of 0.865).ConclusionsSSFSE-PROPELLER T2 mismatch was predictive of lack of response to treatment in this small group of ILD patients presenting with predominant GGO at HRCT.Key PointSSFSE/PROPELLER T2 mismatch may help predict lack of response to anti-inflammatory/immunosuppressive treatment in interstitial lung disease, with high accuracy and high inter-rater agreement.
Twinning partnership helps to accelerate the performance of district health systems towards achieving Universal Health Coverage
Authors: Argaw Mesele Damte , Desta Binyam Fekadu , Kibret Mengistu Asnake , Abebe Melkamu Getu , Heyi Wubishet Kebede , Mamo Elias , Gebru Tesfaye , Gela Chala , Tefera Bekele Belayhun , Bele Temesgen Ayehu
Published: March 2020

Background: The twinning partnership is a formal and substantive collaboration between two districts to improve their performance in providing primary healthcare services. The ‘win-win’ twinning partnership pairs relatively high and low performing districts. The purpose of this formative evaluation is to use the empirically derived systems model as an analytical framework to systematically document the inputs, throughputs and outputs of the twinning partnership strategy.Methods: This evaluation employed a case study research design and was conducted from October 2018 to September 2019, in Amhara, Oromia, Southern, Nations, Nationalities and Peoples’ (SNNP) and Tigray Regions. Qualitative data was collected using interviewer-guided semi-structured interview tools. The data were transcribed verbatim, translated into English and analyzed through the theoretical framework called Bergen Model of Collaborative Functioning (BMCF). Quantitative data were extracted from Routine Health Management Information System. Results were presented using average, percentages and graphs.Result: The result of this case study revealed that scanning the mission of the twinning partnership and focusing on a shared vision coupled with mobilizing internal and external resources were the fundamental input element for successful twinning partnership at the district level. In addition, the context of pursuing Universal Health Coverage (UHC) through achieving transformed districts can be enhanced through deploying skilled and knowledgeable leadership, defining clear roles and responsibilities for all stakeholders, forming agreed detailed action plans and effective communication that leads to additive results and synergy. The twinning partnership implementing districts benefit from the formal relationship and accelerate their performances towards meeting criteria of transformed districts in Ethiopia. At the baseline measurement stage, only two out of eight districts achieved a medium performance status; at mid-term, two districts achieved high performance status and during the end-line results out of eight twinning targeted districts, three districts fulfilled the transformation criteria, three districts were categorized as medium performers and the remaining two districts fell into the low performing districts category.Conclusions: The implemented twinning partnership helped to accelerate the health system’s performance in achieving the district transformation criteria. Therefore, scaling up the implementation of the twinning partnership strategy is recommended.
GLP-1-induced AMPK activation inhibits PARP-1 and promotes LXR-mediated ABCA1 expression to protect pancreatic β-cells against cholesterol-induced toxicity through cholesterol efflux
Authors: Li Rao , Sun Xulong , Li Pengzhou , Li Weizheng , Zhao Lei , Zhu Liyong , Zhu Shaihong
Published: March 2020

Background: T2DM (Type 2 diabetes) is a complex, chronic disease characterized as insulin resistance and islet β-cell dysfunction. Bariatric surgeries, mainly Roux-en-Y gastric bypass (RYGB) surgery and laparoscopic sleeve gastrectomy (LSG), have become an important method for treating obesity and T2DM, and GLP-1 increase after bariatric surgery has been regarded as a central event in bariatric surgery-induced remission of T2DM.Methods: The cell viability was examined using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT). Cell apoptosis was determined by Flow cytometry. The cellular contents of cholesterol in INS-1 cells were measured using cholesterol assay kits. The BODIPY-cholesterol assay was performed to monitor the cholesterol efflux.Results: High concentration cholesterol-induced lipotoxicity was observed in INS-1 cells, including inhibited cell viability, enhanced cell apoptosis, and inhibited cholesterol efflux from INS-1 cells; in the meantime, ABCA1 protein level was decreased by cholesterol stimulation. Cholesterol-induced toxicity and ABCA1 downregulation was attenuated by GLP-1 agonist EX-4. GLP-1 induced AMPK phosphorylation during the protection against cholesterol-induced toxicity. Under cholesterol stimulation, GLP-1-induced AMPK activation inhibited PARP-1 activity, therefore attenuating cholesterol-induced toxicity in INS-1 cells. In INS-1 cells, PARP-1 directly interacted with LXR, leading to the poly(ADP-ribosyl)ation of LXRα and downregulation of LXR-mediated ABCA1 expression. In STZ-induced T2DM model in rats, RYGB surgery or EX-4 treatment improved the glucose metabolism and lipid metabolism in rats through GLP-1 inhibition of PARP-1 activity. According to clinical data, GLP-1 was significantly increased after LSG surgery on T2DM patients, and the increase in GLP-1 was closely related to the improvement of islet function.Conclusions: GLP-1 inhibits PARP-1 to protect islet β cell function against cholesterol-induced toxicity in vitro and in vivo through enhancing cholesterol efflux. GLP-1-induced AMPK and LXR-mediated ABCA1 expression are involved in GLP-1 protective effects.
Clinical and cost effectiveness of staff training in the delivery of positive behaviour support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial
Authors: Strydom André , Bosco Alessandro , Vickerstaff Victoria , Hunter Rachael , Hassiotis Angela
Published: March 2020

Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n=11 clusters) or to treatment as usual (TAU; n=12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = -2.10, 95% CI: -11.3 7.13, p =0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.Trial registrationClinicalTrials.gov: NCT01680276
Functional analysis of haplotypes and promoter activity at the 5' region of the DRD2 gene and associations with schizophrenia.
Authors: Zhang Xicen , Ding Mei , Liu Yi , Liu Yongping , Xing Jiaxin , Xuan Jinfeng , Xia Xi , Yao Jun , Wang Baojie
Published: March 2020

Background: In previous studies, we researched the association of the DRD2 gene promoter region SNP loci rs7116768, rs1047479195, rs1799732, rs1799978 and schizophrenia using Sanger sequencing. rs7116768 and rs1799978 were found to be slightly associated with schizophrenia. This study investigated the effects of haplotypes consisted of the four SNPs on protein expression level in vitro and identified the functional sequence in the 5’ regulatory region of DRD2 gene which has a potential link with schizophrenia.Methods: Recombinant plasmids with haplotypes, SNPs and 13 recombinant vectors containing deletion fragments from the DRD2 gene 5' regulatory region were transfected into HEK293 and SK-N-SH cell lines. Relative luciferase activity of the haplotypes, SNPs and different sequences was compared using a dual luciferase reporter assay system.Results: Haplotype H4(G-C-InsC-G) could significantly increase the gene expression in SK-N-SH cell lines. Allele C of rs7116768, allele A of rs1047479195 and allele del C of rs1799732 could up-regulate the gene expression. There were 5~7 functional regions in the promoter region of DRD2 gene that could affect the level of gene expression.Conclusion: We cannot rule out the possibility that different haplotypes may influence DRD2 gene expression in vivo. We observed that allele C of rs7116768, allele A of rs1047479195 and allele del C of rs1799732 could up-regulate gene expression. The truncation results confirmed the existence of functional regions in the promoter region of DRD2 gene that could affect the level of gene expression.
Psychometric of Iranian version of Mental Health Literacy Scale(MHLS)
Authors: Nejatian Mahboobeh , Tehrani Hadi , Momenian Hanieh , Jafari Alireza
Published: March 2020

Background: The risk rate for the incidence of any mental disorder is 50%, and the prevalence of mental disorders is increasing. This study aimed to evaluate the psychometric of the Iranian Version of Mental Health Literacy Scale(MHLS).Methods: This cross-sectional study was conducted with a multi-stage sampling method with the participation of 1363 individuals in the general population. The formal, content and construct validity were used for validation of MHLS. Cronbach’s alpha coefficient was used for the reliability of MHLS. Confirmatory factor analysis(CFA) was performed using AMOS software Version 24.Results: After performing the CFA, the final version of the MHLS included a total of 29 items, which consisted knowledge of where to seek information (4 item), Ability to recognize disorders (8 item), knowledge of self-treatment (2 item), knowledge of risk factors and causes (2 item), Attitudes that promote recognition or appropriate help-seeking behavior (10 item), and knowledge of professional help available (3 item). In the CFA test, the six items were deleted.Conclusion: Due to the lack of appropriate tools for measuring health literacy in the Iranian population, the 29-item MHLS with six subscales is a valid and reliable tool for measuring mental health literacy in the population.
The introduction of mindfulness groups to a Psychiatric Rehabilitation in-patient setting: a feasibility study
Authors: Millar Audrey , Tip Liesbeth , Lennon Ruth , Macinnes Marlene , Michalska Beata , Lawrie Stephen , Schwannauer Matthias
Published: March 2020

Background Patients within Psychiatric Rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as ‘treatment resistant’. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated. Methods Mindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over five months, and weekly in a second ward over an 18 month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention. Results In both wards around two thirds (65%, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards. Conclusions Clinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.