bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative99mTc-albumin colloid nasal mucociliary clearance as an outcome in primary ciliary dyskinesia
Authors: Marthin June K. , Nielsen Kim G. , Mortensen Jann
Published: June 2023

Background

Primary ciliary dyskinesia (PCD) is an inherited disorder in which dyskinetic cilia cause impaired mucociliary clearance of upper and lower airways. Airway ciliary movement can be indirectly testedin vivoafter administration of a radiolabelled tracer to the lower airways for assessment of pulmonary mucociliary clearance or to the nose for assessing nasal mucociliary clearance (NMC). With this study, we investigated NMC as a quantifiable study outcome parameter in patients with PCD.

Material and methods

This single centre proof-of-concept study on NMC velocity investigated patients with PCD across different genotypes and nasal nitric oxide (nasal NO) levels. Healthy controls were used for comparison. NMC was determined as velocity in mm·min−1of a nasally applied99mTc-albumin colloid tracer. Using a gamma camera, repeated dynamic series of images each lasting 30 s were acquired during a 10-minute period and digitally stored.

Results

NMC velocity was investigated in seven patients with PCD (aged 9–31 years) and five adult healthy controls. Mean NMC velocity in healthy controls (8.5 mm·min−1) was significantly higher compared with people with PCD (0.00 mm·min−1, p<0.0001). NMC was completely absent in all included patients with PCD across different PCD genotypes and regardless of nasal NO values. The success rate of the test was 100% in both groups.

Conclusion

NMC velocity discriminated highly significantly between patients with PCD and healthy controls. We suggest here a fast and feasible set up for NMC measurements that is easily applicable for any clinical trial involving PCD medication aimed for the nasal compartment, a step before or parallel to conducting clinical trials investigating whole-lung ciliary function in PCD.
Microstructural characterization of natural fractures and faults in the Opalinus Clay: insights from a deep drilling campaign across central northern Switzerland
Authors: Akker Ismay Vénice , Schneeberger Raphael , Herwegh Marco , Looser Nathan , Aschwanden Lukas , Mazurek Martin , Decker Kurt , Ebert Andreas , Guillong Marcel , Bernasconi Stefano M. , Schrank Christoph , Jones Michael W. M. , Langendam Andrew , Madritsch Herfried
Published: June 2023

The Middle-Jurassic Opalinus Clay is the foreseen host rock for radioactive waste disposal in central northern Switzerland. An extensive drilling campaign aiming to characterize the argillaceous formation resulted in a comprehensive drill core data set. The rheologically weak Opalinus Clay is only mildly deformed compared to the over- and underlying rock units but shows a variety of natural fractures. While these structures are hydraulically indistinguishable from macroscopically non-deformed Opalinus Clay today, their analysis allows for a better understanding of the deformation behaviour in the geological past. Here, we present an overview of the different fracture and fault types recorded in the Opalinus Clay and a detailed microstructural characterization of veins—natural dilational fractures healed by secondary calcite and celestite mineralizations. Macroscopic drill core analysis revealed five different natural fracture types that encompass tension gashes of various orientations with respect to bedding and small-scale faults with displacements typically not exceeding the drill core diameter. The occurrence of different fault types generally fits well with the local tectonic setting of the different drilling sites and with respect to the neighbouring regional fault zones. The microstructural investigations of the various vein types revealed their often polyphase character. Fibrous bedding-parallel veins of presumable early age were found to be overprinted by secondary slickenfibres. The polyphase nature of fibrous bedding parallel veins and slickenfibres is supported by differing elemental compositions, pointing towards repeated fracturing and mineralization events. Direct dating of vein calcites with U–Pb was unsuccessful. Nevertheless, age constraints can be inferred from structural orientations and fault slip kinematics. Accordingly, some of the veins already formed during sediment compaction in Mesozoic times, others possibly relate to Early Cenozoic foreland uplift. The youngest veins are most likely related to Late Cenozoic regional tectonic events, such as the Jura fold-and-thrust belt to the south and the Hegau-Lake Constance Graben to the northeast of the study area. During these latest tectonic events, previously formed veins acted as rheologically stiff discontinuities in the otherwise comparably weak Opalinus Clay along which deformation of the rock formation was re-localized.
Non-coding variants in VAMP2 and SNAP25 affect gene expression: potential implications in migraine susceptibility
Authors: Felício Daniela , Dias Andreia , Martins Sandra , Carvalho Estefânia , Lopes Alexandra M. , Pinto Nádia , Lemos Carolina , Santos Mariana , Alves-Ferreira Miguel
Published: June 2023

Migraine is a common and complex neurological disease potentially caused by a polygenic interaction of multiple gene variants. Many genes associated with migraine are involved in pathways controlling the synaptic function and neurotransmitters release. However, the molecular mechanisms underpinning migraine need to be further explored.

Recent studies raised the possibility that migraine may arise from the effect of regulatory non-coding variants. In this study, we explored the effect of candidate non-coding variants potentially associated with migraine and predicted to lie within regulatory elements: VAMP2_rs1150, SNAP25_rs2327264, and STX1A_rs6951030. The involvement of these genes, which are constituents of the SNARE complex involved in membrane fusion and neurotransmitter release, underscores their significance in migraine pathogenesis. Our reporter gene assays confirmed the impact of at least two of these non-coding variants. VAMP2 and SNAP25 risk alleles were associated with a decrease and increase in gene expression, respectively, while STX1A risk allele showed a tendency to reduce luciferase activity in neuronal-like cells. Therefore, the VAMP2_rs1150 and SNAP25_rs2327264 non-coding variants affect gene expression, which may have implications in migraine susceptibility. Based on previous in silico analysis, it is plausible that these variants influence the binding of regulators, such as transcription factors and micro-RNAs. Still, further studies exploring these mechanisms would be important to shed light on the association between SNAREs dysregulation and migraine susceptibility.
Navigated, percutaneous, three-step technique for lumbar and sacral screw placement: a novel, minimally invasive, and maximally safe strategy
Authors: La Rocca Giuseppe , Mazzucchi Edoardo , Pignotti Fabrizio , Nasto Luigi Aurelio , Galieri Gianluca , Rinaldi Pierluigi , De Santis Vincenzo , Pola Enrico , Sabatino Giovanni
Published: June 2023

Background

Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS.

Materials and Methods

An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein–Robbins scale.

Results

A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein–Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E.

Conclusions

The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement.

Level of Evidence Level 3.

Trial registration Not applicable.
Acute acrylamide poisoning with severe symptoms in a short time: a case report
Authors: Yamamoto Rie , Yasuoka Takayuki , Matsushima Junya , Tsubouchi Youhei , Kanazashi Hideaki , Sakurai Keiji , Hanazawa Tomoki , Kamijo Yoshito , Akieda Kazuki
Published: June 2023

Background

Acrylamide poisoning is often reported as chronic poisoning presenting with peripheral neuropathy or carcinogenic action due to long-term exposure to low concentrations. However, there have been few reports of acute poisoning due to oral ingestion of acrylamide, where the symptoms appear a few hours after ingestion. Here, we report a case of acute acrylamide poisoning where a high concentration was ingested in a short time, resulting in a fatal outcome due to the rapid course of events.

Case presentation

The patient was an adolescent female who ingested 150 ml (148 g) of acrylamide with suicidal intent. A disorder of consciousness was observed when the emergency medical team arrived 36 min later. An hour later, tracheal intubation and intravenous access were performed at a hospital, and 2 h after that, she was transported to our hospital. After she arrived at the hospital, circulatory dynamics could not be maintained despite vasopressor and colloid osmotic infusion, and hemodialysis could not be introduced. Subsequently, cardiopulmonary arrest occurred, and the patient passed away 7 h after ingestion.

In the present case, severe symptoms appeared shortly after acrylamide ingestion, unlike other reported cases. In previous report summarizing animal studies, there was a relationship among the symptoms of acute poisoning, the dose, and onset time. The data from this case were compared to those from previous reports, and we were able to predict the early appearance of severe symptoms based on this comparison.

Conclusion

The severity of acute acrylamide poisoning by oral ingestion was primarily dependent on the amount and rate of ingestion.
Multi-locus phylogeny of the catfish genus Ictalurus Rafinesque, 1820 (Actinopterygii, Siluriformes) and its systematic and evolutionary implications
Authors: Pérez-Rodríguez Rodolfo , Domínguez-Domínguez Omar , Pedraza-Lara Carlos , Rosas-Valdez Rogelio , Pérez-Ponce de León Gerardo , García-Andrade Ana Berenice , Doadrio Ignacio
Published: June 2023

Background

Ictalurus is one of the most representative groups of North American freshwater fishes. Although this group has a well-studied fossil record and has been the subject of several morphological and molecular phylogenetic studies, incomplete taxonomic sampling and insufficient taxonomic studies have produced a rather complex classification, along with intricate patterns of evolutionary history in the genus that are considered unresolved and remain under debate.

Results

Based on four loci and the most comprehensive taxonomic sampling analyzed to date, including currently recognized species, previously synonymized species, undescribed taxa, and poorly studied populations, this study produced a resolved phylogenetic framework that provided plausible species delimitation and an evolutionary time framework for the genus Ictalurus.

Conclusions

Our phylogenetic hypothesis revealed that Ictalurus comprises at least 13 evolutionary units, partially corroborating the current classification and identifying populations that emerge as putative undescribed taxa. The divergence times of the species indicate that the diversification of Ictalurus dates to the early Oligocene, confirming its status as one of the oldest genera within the family Ictaluridae.
Sequence level genome-wide associations for bull production and fertility traits in tropically adapted bulls
Authors: Tan Wei Liang Andre , Neto Laercio Ribeiro Porto , Reverter Antonio , McGowan Michael , Fortes Marina Rufino Salinas
Published: June 2023

Background

The genetics of male fertility is complex and not fully understood. Male subfertility can adversely affect the economics of livestock production. For example, inadvertently mating bulls with poor fertility can result in reduced annual liveweight production and suboptimal husbandry management. Fertility traits, such as scrotal circumference and semen quality are commonly used to select bulls before mating and can be targeted in genomic studies. In this study, we conducted genome-wide association analyses using sequence-level data targeting seven bull production and fertility traits measured in a multi-breed population of 6,422 tropically adapted bulls. The beef bull production and fertility traits included body weight (Weight), body condition score (CS), scrotal circumference (SC), sheath score (Sheath), percentage of normal spermatozoa (PNS), percentage of spermatozoa with mid-piece abnormalities (MP) and percentage of spermatozoa with proximal droplets (PD).

Results

After quality control, 13,398,171 polymorphisms were tested for their associations with each trait in a mixed-model approach, fitting a multi-breed genomic relationship matrix. A Bonferroni genome-wide significance threshold of 5 × 10− 8 was imposed. This effort led to identifying genetic variants and candidate genes underpinning bull fertility and production traits. Genetic variants in Bos taurus autosome (BTA) 5 were associated with SC, Sheath, PNS, PD and MP. Whereas chromosome X was significant for SC, PNS, and PD. The traits we studied are highly polygenic and had significant results across the genome (BTA 1, 2, 4, 6, 7, 8, 11, 12, 14, 16, 18, 19, 23, 28, and 29). We also highlighted potential high-impact variants and candidate genes associated with Scrotal Circumference (SC) and Sheath Score (Sheath), which warrants further investigation in future studies.

Conclusion

The work presented here is a step closer to identifying molecular mechanisms that underpin bull fertility and production. Our work also emphasises the importance of including the X chromosome in genomic analyses. Future research aims to investigate potential causative variants and genes in downstream analyses.
Sex differences in cardiac rehabilitation barriers among non-enrollees in the context of lower gender equality: a cross-sectional study
Authors: Firoozabadi Mahdieh Ghanbari , Mirzaei Masoud , Grace Sherry L , Vafaeinasab Mohammadreza , Dehghani-Tafti Maryam , Sadeghi Abbas , Asadi Zohre , Basirinezhad Mohammad Hasan
Published: June 2023

Background

Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally.

Methods

In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-attenders from March 2017 to February 2018 with the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). T-tests were used to compare scores, with each of 18 barriers scored out of 5, between men and women.

Results

357 (33.9%) of the sample of 1053 were women, and they were older, less educated and less often employed than men. Total mean CRBS scores were significantly greater in women (2.37 ± 0.37) than men (2.29 ± 0.35; effect size[ES] = 0.08, confidence interval[CI]: 0.03–0.13; p < 0.001). The top CR barriers among women were cost (3.35; ES = 0.40, CI:0.23–0.56; P < 0.001), transportation problems (3.24; ES = 0.41, CI:0.25–0.58; P < 0.001), distance (3.21; ES = 0.31, CI:0.15–0.48; P < 0.001), comorbidities (2.97; ES = 0.49, CI:0.34–0.64; P < 0.001), low energy (2.41; ES = 0.29, CI:0.18–0.41; P < 0.001), finding exercise as tiring or painful (2.22; ES = 0.11, CI:0.02–0.21; P = 0.018), and older age (2.27; ES = 0.18, CI:0.07–0.28; P = 0.001). Men rated “already exercise at home or in community” (2.69; ES = 0.23, CI:0.1–0.36; P = 0.001), time constraints (2.18; ES = 0.15, CI:0.07–0.23; P < 0.001) and work responsibilities (2.24; ES = 0.16, CI:0.07–0.25; P = 0.001) as greater CR barriers than women.

Conclusion

Women had greater barriers to CR participation than men. CR programs should be modified to address women’s needs. Home-based CR tailored to women’s exercise needs and preferences should be considered.
General health and working conditions of Flemish primary care professionals
Authors: Buffel Veerle , Sirimsi Muhammed Mustafa , De Vriendt Patricia , Van de Velde Dominique , Lahousse Lies
Published: June 2023

Background

The Quintuple aim explicitly includes ‘health and wellbeing of the care team’ as requirement for the care of patients. Therefore, we examined working conditions, work engagement and health status of professionals active in primary care in Belgium (Flanders), and how these are interrelated.

Methods

Data of the cross-sectional ‘Health professionals survey of the Flemish Primary care academy’ of 2020 were examined. We performed logistic regression analyses to study the relationship between working conditions and self-reported dichotomized health of primary care professionals (sample size = 1033).

Results

The majority of respondents (90%) reported having a good to very good general health and has a strong work engagement. Quality of employment was high, in particular regarding job security and supportive relations with colleagues, while less in terms of proper rewards and job career opportunities. Working as self-employee (vs. as salaried employee), and in a multidisciplinary group practice (vs. other organizational settings) were positively related to health. Work engagement and all dimensions of employment quality were related to general health, but work family balance, proper rewards, and perceived employability were independently positively related to self-reported health.

Conclusion

Nine out of 10 Flemish primary care professionals working in diverse conditions, employment arrangements and organizational settings report good health. Work family balance, proper rewards, and perceived employability were important for primary care professionals’ health, and could provide opportunities to further strengthen the job quality and health of primary care professionals.
An adjusted Asia-Pacific colorectal screening score system to predict advanced colorectal neoplasia in asymptomatic Chinese patients
Authors: Zhang Chenchen , Zhang Liting , Zhang Weihao , Guan Bingxin , Li Shuai
Published: June 2023

Purpose

The Asia-Pacific Colorectal Screening (APCS) score and its derivatives have been used to predict advanced colorectal neoplasia (ACN). However, it remains unknown whether they apply to the current Chinese population in general clinical practice. Therefore, we aimed to update the APCS score system by applying data from two independent asymptomatic populations to predict the risk of ACN in China.

Methods

We developed an adjusted APCS (A-APCS) score by using the data of asymptomatic Chinese patients undergoing colonoscopies from January 2014 to December 2018. Furthermore, we validated this system in another cohort of 812 patients who underwent screening colonoscopy between January and December 2021. The discriminative calibration ability of the A-APCS and APCS scores was comparatively evaluated.

Results

Univariate and multivariate logistic regression were applied to assess the risk factors for ACN, and an adjusted scoring system of 0 to 6.5 points was schemed according to the results. Utilizing the developed score, 20.2%, 41.2%, and 38.6% of patients in the validation cohort were classified as average, moderate, and high risk, respectively. The corresponding ACN incidence rates were 1.2%, 6.0%, and 11.1%, respectively. In addition, the A-APCS score (c-statistics: 0.68 for the derivation and 0.80 for the validation cohort) showed better discriminative power than using predictors of APCS alone.

Conclusions

The A-APCS score may be simple and useful in clinical applications for predicting ACN risk in China.
Associations of social interactions during the COVID-19 pandemic with cognitive function among the South Korean older adults
Authors: Yun Il , Park Yu Shin , Park Eun-Cheol , Jung Hee-Won , Shin Jaeyong
Published: June 2023

Background

We aimed to demonstrate the associations between social interactions within social distancing norms during the coronavirus disease 2019 (COVID-19) pandemic and cognitive function among South Korean older adults.

Methods

Data from the 2017 and 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons were used. There were 18,813 participants (7,539 males; 11,274 females). T-test and multiple logistic regression analyses verified whether the mean difference in older adults’ cognitive function before and during the COVID-19 pandemic was statistically significant. We also examined the associations between social interactions and cognitive function. The key results were presented as odds ratios (ORs) and 95% confidence intervals (CI).

Results

All participants were more likely to experience cognitive impairment during the COVID-19 pandemic than before (males: OR 1.56, 95% CI 1.3–1.78; females: OR 1.26, 95% CI: 1.14–1.40). Cognitive impairment increased linearly with the decreased frequency of face-to-face contact with non-cohabiting children. Possible cognitive impairment was greater for females who had not visited senior welfare centers for the past year (OR 1.43, 95% CI 1.21–1.69).

Conclusion

Korean older adults’ cognitive function declined during the COVID-19 pandemic and was associated with reduced social interactions because of social distancing measures. Alternative interventions should be promoted for safely restoring social networks, considering the adverse effects of long-term social distancing on older adults’ mental health and cognitive function.
Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: the multiple sclerosis online course (MSOC)
Authors: Reece Jeanette C , Yu Maggie , Bevens William , Simpson-Yap Steve , Jelinek George , Jelinek Pia , Davenport Rebekah , Nag Nupur , Gray Kathleen , Neate Sandra
Published: June 2023

Background

People living with multiple sclerosis (plwMS) seek access to information on evidence-based lifestyle-related risk factors associated with multiple sclerosis (MS). As the internet has made delivery of lifestyle information increasingly accessible and cost-effective, we designed the Multiple Sclerosis Online Course (MSOC) to deliver a multimodal lifestyle modification program for plwMS. Two MS online courses were developed: the intervention course based on lifestyle recommendations of the Overcoming Multiple Sclerosis (OMS) program and the standard-care course representing standard lifestyle recommendations from other MS websites. We examined for feasibility in a pilot randomised controlled trial (RCT), where satisfactory completion and accessibility were achieved across both study arms. From this success, a protocol for a larger RCT was developed to examine the effectiveness of MSOC in improving health-related quality of life (HRQoL) and other health outcomes in plwMS.

Methods/design

This single-blinded RCT will recruit n = 1,054 plwMS. Participants in the intervention arm will receive access to a MSOC with seven modules providing evidence-based information on the OMS program. Participants in the control group will receive access to a MSOC of identical format, with seven modules providing general MS-related information and lifestyle recommendations sourced from popular MS websites, e.g. MS societies. Participants will complete questionnaires at baseline and at 6, 12, and 30 months after course completion. The primary endpoint is HRQoL, as measured by MSQOL-54 (both physical and mental health domains) at 12 months following course completion. Secondary outcomes are changes to depression, anxiety, fatigue, disability, and self-efficacy as measured by Hospital Anxiety and Depression Scale, Patient-Determined Disease Steps and University of Washington Self-Efficacy Scale, respectively, assessed at each timepoint. Further assessments will include quantitative post-course evaluation, adoption and maintenance of behaviour change from follow-up survey data, and qualitative analysis of participants’ outcomes and reasons for course completion or non-completion.

Discussion

This RCT aims to determine whether an online intervention course delivering evidence-based lifestyle modification recommendations based on the Overcoming Multiple Sclerosis program to plwMS is more effective at improving HRQoL, and other health outcomes post-intervention, compared with an online standard-care course.

Trial registration

This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, identifier ACTRN12621001605886.

Date of registration

25 November 2021.
The new future perspective in corneal tissue utilisation – methods of preparation and preservation
Authors: Polachova Martina , Netukova Magdalena , Benada Oldrich , Kucera Tomas , Kolin Vojtech , Baxant Alina-Dana , Sirolova Zuzana , Studeny Pavel
Published: June 2023

Purpose

The goal of our study is to find an optimal approach to the preparation and preservation of corneal stromal tissue. We want to compare different methods of corneal stromal tissue creation and storage to optimize the efficacy of this process under the conditions of an eye bank. After we find the most suitable method to create a safe high quality product, we want to prove the possibility of using a single donor cornea for more than one patient. We would also like to verify the feasibility of making more corneal lenticules after the removal of a corneal endothelium for DMEK transplantation.

Methods

We provided morphological (histology, scanning electron microscope) and microbiological analysis in order to compare different methods of corneal lenticule and corneal stromal lamellae preparation and preservation. We also tested the surgical handling of the tissue to secure a safe manipulation of the tissue for clinical use. We compared two methods of corneal lenticule preparation: microkeratome dissection and femtosecond laser. As methods of preservation, we tested hypothermia, cryopreservation at -80 degrees Celsius in DMSO (dimethyl sulfoxide) and storage at room temperature with glycerol. Some intrastromal lenticules and lamellae in each group were previously irradiated with gamma radiation of 25 kGy (KiloGray).

Results

Corneal stromal lamellae prepared with a microkeratome have a smoother cut – side surface compared to lamellae prepared with a femtosecond laser. Femtosecond laser preparation caused more irregularities on the surface and we detected more conglomerates of the fibrils, while lamellae made with microkeratome had more sparse network. Using femtosecond laser, we were able to make more than five lenticules from a single donor cornea.

Gamma irradiation led to damage of collagen fibrils in corneal stroma and a loss of their regular arrangement. Corneal tissue stored in glycerol showed collagen fibril aggregates and empty spaces between fibrils caused by dehydration. Cryopreserved tissue without previous gamma irradiation showed the most regular structure of the fibrils comparable to storage in hypothermia.

Conclusion

Our results suggest that formation of a corneal lenticule lamellae by microkeratome results in smoother corneal lenticules, while being much cheaper than formation by femtosecond laser.

Gamma irradiation of 25 kGy caused damage of the collagen fibres as well as their network arrangement, which correlated with loss of transparency and stiffer structure. These changes impair possible surgical utilisation of gamma irradiated corneas.

Storage in glycerol at room temperature and cryopreservation had similar outcomes and we believe that both methods are appropriate and safe for further clinical use .
Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial—a stepped wedge cluster randomized trial protocol
Authors: Zhu Yunying , Li Sisi , Zhang Ruotong , Bao Lei , Zhang Jin , Xiao Xiaohua , Jiang Dongdong , Chen Wenxiao , Hu Chenying , Zou Changli , Zhang Jingna , Zhu Yong , Wang Jianqiu , Liang Jinchun , Yang Qian
Published: June 2023

Background

The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.

Methods

A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of “usual care” as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.

Discussion

Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.

Trial registration

AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW
Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study
Authors: Vold Jørn Henrik , Halmøy Anne , Chalabianloo Fatemeh , Pierron Marianne Cook , Løberg Else-Marie , Johansson Kjell Arne , Fadnes Lars Thore
Published: June 2023

Background

Attention-deficit/hyperactivity disorder (ADHD) symptoms may challenge sufficient treatment of substance use and mental disorders. The literature on the extent of such symptoms among patients receiving opioid agonist therapy (OAT) is scarce. This study examined ADHD symptoms using the ADHD self-report scale (ASRS) and the association between the ‘ASRS–memory’ and ‘ASRS–attention’ scores and substance use and sociodemographic characteristics among patients receiving OAT.

Methods

We used data from assessment visits of a cohort of patients in Norway. In total, 701 patients were included from May 2017 to March 2022. All patients responded at least once to two ASRS questions assessing memory and attention, respectively. Ordinal regression analyses were performed to investigate whether the two obtained scores were associated with age, sex, frequent substance use, injecting use, housing status, and educational attainment at baseline, i.e., the first assessment, and over time. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). Additionally, a subsample of 225 patients completed an extended interview, including the ASRS–screener and collection of registered mental disorder diagnoses from the medical records. Standard cutoffs were used to define the presence of each ASRS symptom or a positive ASRS–screener (‘ASRS–positive’).

Results

At baseline, 428 (61%) and 307 (53%) patients scored over the cutoffs on the ‘ASRS–memory’ and ‘ASRS–attention,’ respectively. Frequent cannabis use was associated with higher ‘ASRS–memory’ (OR: 1.7, 95% CI: 1.1–2.6) and ‘ASRS–attention’ (1.7, 1.1–2.5) scores compared with less or no use at baseline, though reduced score on the ‘ASRS–memory’ over time (0.7, 0.6–1.0). At baseline, frequent stimulant use (1.8, 1.0–3.2) and low educational attainment (0.1, 0.0–0.8) were associated with higher ‘ASRS–memory’ scores. In the subsample fulfilling the ASRS–screener, 45% of the patients were ‘ASRS–positive,’ of whom 13% with a registered ADHD diagnosis.

Conclusions

Our findings illustrate a relationship between the ASRS–memory and –attention scores and frequent cannabis and stimulant use. Furthermore, nearly half of the subsample was ‘ASRS–positive.’ Patients receiving OAT might benefit from being further assessed for ADHD, but improved diagnostic methods are required.
Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial
Authors: Stabell L.A , Johnsen E. , Kroken R. A , Løberg E.M. , Blindheim A. , Joa I. , Reitan S.K. , Rettenbacher M. , Munk-Jørgensen P. , Gjestad R.
Published: June 2023

Background

Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement.

Methods

Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight.

Results

Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0–6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6–52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics.

Conclusions

Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain.

Trial registration

ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
Adolescent determinants of life-course leisure-time vigorous physical activity trajectories: a 27-Year longitudinal study
Authors: Mathisen Frida Kathrine Sofie , Kristensen Sara Madeleine , Falco Coral , Wold Bente
Published: June 2023

Background

Adolescence is regarded as formative years for building the foundations for life-long health and well-being, and adolescent determinants of physical activity (PA) development is particularly interesting. Novel approaches for the study of PA development, such as group-based trajectory modelling, opens for the possibility of identifying different patterns in the relationship among several known determinants of PA. This study aimed to explore how demographic, psychological and social factors in early adolescence determine membership in four distinct leisure-time vigorous physical activity (LVPA) trajectories from 13 to 40 years.

Methods

This study is based on data from the Norwegian Longitudinal Health Behaviour Study, following a cohort born in 1977 from Western Norway. Four trajectories identified using latent class growth analysis, based on self-reposted LVPA (n = 1103, 45.5% women) measured ten times from age 13 to age 40 and 17 different adolescent determinants, were used in a multivariate multinomial logistic regression.

Results

We found that gender (male), VPA intentions the next year and athletic identity associated with belonging to the two trajectories reporting the highest levels of LVPA in adolescence, while VPA intentions in ten years were associated with belonging to the active trajectory compared to the decreasingly active and low active trajectories Enjoyment increased the odds of belonging to the increasingly and decreasingly active trajectories compared to the low active trajectory. In addition, two of the social determinants, mother’s PA and emotional support from father, were associated with belonging to the increasingly active trajectory when compared to the low active trajectory. Higher family income increased the odds of belonging to the increasingly active compared to the decreasingly active trajectory.

Conclusions

Both demographic, psychological, and social factors were identified as determinants of LVPA trajectory membership, and the findings support previous research related to the importance of intentions, but also indicate that enjoyment, role modelling and emotional support in PA can be of great importance to LVPA promotion among adolescents.
Does the implementation of an incentive scheme increase adherence to diabetes guidelines? A retrospective cohort study of managed care enrollees
Authors: Farcher Renato , Graber Sereina M. , Thüring Nicole , Blozik Eva , Huber Carola A.
Published: June 2023

Background

A novel incentive scheme based on a joint agreement of a large Swiss health insurance with 56 physician networks was implemented in 2018. This study evaluated the effect of its implementation on adherence to evidence-based guidelines among patients with diabetes in managed care models.

Methods

We performed a retrospective cohort study, using health care claims data from patients with diabetes enrolled in a managed care plan (2016–2019). Guideline adherence was assessed by four evidence-based performance measures and four hierarchically constructed adherence levels. Generalized multilevel models were used to examine the effect of the incentive scheme on guideline adherence.

Results

A total of 6′273 patients with diabetes were included in this study. The raw descriptive statistics showed minor improvements in guideline adherence after the implementation. After adjusting for underlying patient characteristics and potential differences between physician networks, the likelihood of receiving a test was moderately but consistently higher after the implementation of the incentive scheme for most performance measures, ranging from 18% (albuminuria: OR, 1.18; 95%-CI, 1.05–1.33) to 58% (HDL cholesterol: OR, 1.58; 95%-CI, 1.40–1.78). Full adherence was more likely after implementation of the incentive scheme (OR, 1.37; 95%-CI, 1.20–1.55), whereas level 1 significantly decreased (OR, 0.74; 95%-CI, 0.65 – 0.85). The proportions of the other adherence levels were stable.

Conclusion

Incentive schemes including transparency of the achieved performance may be able to improve guideline adherence in patients with diabetes and are promising to increase quality of care in this patient population.
Disparities in the level of COVID-19 health literacy and the associated factors among employees in long-term care facilities in Taiwan
Authors: Lin Lan-Ping , Yu Jia-Rong , Lin Jin-Ding
Published: June 2023

Background

Coronavirus disease 2019 (COVID-19) poses a significant threat to the safety of residents in long-term care facilities, and the staff of long-term care facilities are essential in the care and prevention of major infectious diseases and therefore require good health literacy to ensure the health of residents. The main objective of this study was to examine the health literacy of staff in long-term care facilities and analyze the factors associated with their COVID-19 health literacy in Taiwan to provide a basis for the response mechanism to emerging infectious diseases.

Methods

A cross-sectional survey with a structured questionnaire by a convenience sample method and to assess the COVID-19 health literacy of caregivers working in long-term care facilities in this study. The COVID-19 health literacy scale was a self-administered scale designed to combine the concept of “health literacy” with the 3 levels and 5 stages of preventive medicine. A total of 385 workers from 10 long-term care facilities were surveyed as the study sample, and the validated questionnaires were statistically analyzed using SPSS version 22.0 statistical software. A multivariate logistic regression model was used to establish the associated factors of the COVID-19 health literacy level.

Results

Overall, the mean COVID-19 health literacy score was 88.7 ± 10.4 (range: 58–105). Using a quartile scale, 92 (23.9%) of the study participants had low health literacy (health literacy score < 82), 190 (49.3%) had average health literacy (health literacy score 82–98), and the remaining 103 (26.8%) had good health literacy (health literacy score 99–105). Statistical analysis revealed significant differences (p < 0.05) in the COVID-19 health literacy score by demographic variables (education, job category, number of daily service users, and training related to infectious disease prevention and control) of the study population. The logistic regression analysis of the COVID-19 health literacy level (> 82 vs. ≤82) showed a significant difference in the study sample by gender (male vs. female, OR = 2.46, 95% CI = 1.15–5.26), job category (nurse practitioner vs. caregiver, OR = 7.25, 95% CI = 2.46–21.44), monthly service hours (> 160 h vs. 40–79 h, OR = 0.044, 95% CI = 0.07–0.97), experience caring for confirmed COVID-19 patients (yes vs. no, OR = 0.13, 95% CI = 0.02–0.98), and training related to infectious disease prevention and control (yes vs. no, OR = 2.8, 95% CI = 1.52–5.15).

Conclusions

This study recommends that facilities provide immediate updated COVID-19 information to staff, especially frontline caregivers, and specifically enhance COVID-19 infection control education training for all facility staff to eliminate health literacy disparities.
Impact of Watson’s human caring-based health promotion program on caregivers of individuals with schizophrenia
Authors: Bagheri Shahpar , Zarshenas Ladan , Rakhshan Mahnaz , Sharif Farkhondeh , Sarani Ebrahim Moghimi , Shirazi Zahra Hadian , Sitzman Kathleen
Published: June 2023

Background

Caring for people with schizophrenia is accompanied by challenges that impact caregiver health. We conducted this study to explore the effect of a Caring Science-Based health promotion program on the sense of coherence and well-being among caregivers of persons with schizophrenia.

Methods

This randomized clinical trial with the Solomon four-group design was conducted on 72 caregivers randomly allocated into two intervention and two control groups. A health promotion program based on Watson’s theory was performed individually through five face-to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected using a demographic information form, the Sense of Coherence Scale, and the Caregiver Well-Being Scale. One-way ANOVA, chi-square, Kruskal–Wallis, and independent t-test were used to determine the homogeneity at baseline. In the post-test, multiple between-groups and pairwise comparisons were assessed by One-way ANOVA and Tukey’s post-hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed, and the statistical level was considered 0.05.

Results

Data analysis showed that the mean scores of caregiver sense of coherence and well-being from pre-intervention to post-intervention were significantly increased in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups.

Conclusion

The health promotion program based on Watson’s human caring theory facilitated ongoing intrapersonal, and holistic caring and improved the sense of coherence and well-being in caregivers of persons with schizophrenia. Hence, this intervention is recommended for developing healing care programs.

Trial registration

https://www.irct.ir/trial/55040: IRCT20111105008011N2 (11/04/2021).
The effects of digitalisation on health and social care work: a qualitative descriptive study of the perceptions of professionals and managers
Authors: Kaihlanen Anu-Marja , Laukka Elina , Nadav Janna , Närvänen Johanna , Saukkonen Petra , Koivisto Juha , Heponiemi Tarja
Published: June 2023

Background

Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work.

Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals.

Methods

We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach.

Results

Digitalisation was perceived to have changed professionals’ 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems.

Conclusions

The findings suggest that some of the effects of digitalisation on professionals’ work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals’ well-being and adaptation to changes, as well as the provision of quality health and social services.