bluuebunny/crossref_metadata_2025 huggingface dataset:
Under the influence: The celebrity factor in policy capture
Authors: Dougherty Christopher N. , Phillips Susan D.
Published: March 2023

Celebrity is a form of policy influence that can occur under distinctive circumstances. This paper draws on the regulatory/policy capture literature to develop a model of celebrity capture that explains how interest groups can affect policy in the absence of economic clout or constituency mobilization. We posit that the likelihood of celebrity capture increases when several factors align: (1) a context open to change; (2) reduced oversight in decisionmaking processes; (3) organizations that have credibility and a halo effect due to their celebrity status; and (4) an uncoordinated sector with weak intermediary organizations. The analysis applies process tracing to account for the success of one celebrity‐founded and celebrity‐led organization, WE Charity, in shaping the design and being awarded sole‐source implementation of the CAD $543 million Canada Student Service Grant (CSSG) program during COVID‐19. The CSSG, which proposed to pay up to 100,000 students to “volunteer” in nonprofits over the course of a summer, quickly failed and became a public ethical scandal.
Eliminating Stereotypes: Villages as Desirable Spaces for Partying among Spanish Youth☆
Authors: Pavón‐Benítez Laura , Álvarez‐Montoya José Manuel , Sánchez‐González Penélope , Romo‐Avilés Nuria
Published: March 2023

Most of the research on rural youth has focused on the material conditions that cause their migration to cities, but it has not tended to address sociocultural dimensions, such as those concerning leisure and what might condition the processes of migration among young people. The aim of this study is to contrast the discourse and representations that young people have regarding leisure with the festive practices that they carry out in Spanish villages. The fieldwork consisted of 13 discussion groups and 38 in‐depth interviews (N = 118), with participants aged between 15 and 24 years. The results show that: (1) young people construct their idea of partying through dominant, dichotomous and unequal rural–urban representations, demonstrating the presence of traditional stereotypes around rurality; (2) the village becomes desirable as a place for partying at specific times of the year, such as local festivals; (3) the practices of rural youth call into question this normative imaginary, as is also shown by their adaptation, belonging and agency in the construction and management of leisure. Getting rid of stereotypes about rurality and creating positive thinking about the leisure possibilities in villages can lead young people to see it as a space for opportunities and personal development.
Individual differences and changes in personality during the COVID‐19 pandemic
Authors: Rudolph Cort W. , Zacher Hannes
Published: March 2023

This article reports the results of an eleven‐wave longitudinal study of personality change conducted between December 2019 and December 2022 with 1328 participants in Germany. Based on theories of personality change, we investigated trajectories of big five personality factors (i.e., extraversion, agreeableness, conscientiousness, emotional stability, and openness) across the COVID‐19 pandemic. In addition, we examined whether demographic characteristics (i.e., age, sex), self‐reported health status (i.e., physical, mental), and socioeconomic status (i.e., education, income, industry) moderated these trajectories. There was evidence for increases in extraversion, conscientiousness, and emotional stability and decreases in openness across time. The magnitude of these effects suggests between d = 0.027 to 0.138 standard deviation changes in these personality characteristics across the 3‐year timeframe of this study. Evidence for moderating effects of age, sex, health, and socioeconomic status was mixed, but indicates differential patterns of personality change for certain individuals. Overall, findings suggest that changes in big five personality factors across the COVID‐19 were present, albeit on average relatively weak, but still higher than anticipated given the timeframe. Moreover, certain demographic and health variables were associated with differential trajectories of personality over time.
S‐Nitrosylation of the histone deacetylase HDA19 stimulates its activity to enhance plant stress tolerance in Arabidopsis
Authors: Zheng Yu , Li Zhenting , Cui Xiaoyun , Yang Zheng , Bao Chun , Pan Lei , Liu Xiaoyun , Chatel‐Innocenti Gilles , Vanacker Hélène , Noctor Graham , Dard Avilien , Reichheld Jean‐Philippe , Issakidis‐Bourguet Emmanuelle , Zhou Dao‐Xiu
Published: March 2023

Arabidopsis histone deacetylase HDA19 is required for gene expression programs of a large spectrum of plant developmental and stress‐responsive pathways. How this enzyme senses cellular environment to control its activity remains unclear. In this work, we show that HDA19 is post‐translationally modified by S‐nitrosylation at 4 Cysteine (Cys) residues. HDA19 S‐nitrosylation depends on the cellular nitric oxide level, which is enhanced under oxidative stress. We find that HDA19 is required for cellular redox homeostasis and plant tolerance to oxidative stress, which in turn stimulates its nuclear enrichment, S‐nitrosylation and epigenetic functions including binding to genomic targets, histone deacetylation and gene repression. The Cys137 of the protein is involved in basal and stress‐induced S‐nitrosylation, and is required for HDA19 functions in developmental, stress‐responsive and epigenetic controls. Together, these results indicate that S‐nitrosylation regulates HDA19 activity and is a mechanism of redox‐sensing for chromatin regulation of plant tolerance to stress.
Meta‐learning shows great potential in plant disease recognition under few available samples
Authors: Wu Xue , Deng Hongyu , Wang Qi , Lei Liang , Gao Yangyang , Hao Gefei
Published: March 2023

Plant diseases worsen the threat of food shortage with the growing global population, and disease recognition is the basis for the effective prevention and control of plant diseases. Deep learning has made significant breakthroughs in the field of plant disease recognition. Compared with traditional deep learning, meta‐learning can still maintain more than 90% accuracy in disease recognition with small samples. However, there is no comprehensive review on the application of meta‐learning in plant disease recognition. Here, we mainly summarize the functions, advantages, and limitations of meta‐learning research methods and their applications for plant disease recognition with a few data scenarios. Finally, we outline several research avenues for utilizing current and future meta‐learning in plant science. This review may help plant science researchers obtain faster, more accurate, and more credible solutions through deep learning with fewer labeled samples.
Cultural and Religious Perspectives on Education of Saudi Arabia
Authors: Almalki Afnan Turki
Published: March 2023

In this composition, the intricacies of the relationship between culture and education in Saudi Arabia are analyzed and its implications for students from early education to higher learning are evaluated. The examination delves into the manner in which Islam and the country's customary gender roles shape the syllabus and educational customs. The inculcation of Qur'anic teachings and Hadith, as well as the propagation of Wahhabi principles, are integral facets of religion's influence on the nation's educational structure. The segregation of academic institutions by gender, stringent dress codes, and strict observance of behavioral codes are exemplars of the impact of religion on education. Additionally, the cultural and religious emphasis on gender roles is pronounced through the stringent separation of schools and the reinforcement of cultural and religious norms in society. The religious curriculum and instructional materials are rigorously scrutinized to guarantee their conformity to the government's interpretation of Islam. The report  accentuates both the difficulties and prospects that the cultural and educational landscape presents for students, educators, and education professionals in Saudi Arabia.
Single-cell transcriptomics uncovers the differentiation of a subset of murine esophageal progenitors into taste buds in vivo
Authors: Vercauteren Drubbel Alizée , Beck Benjamin
Published: March 2023

Mouse esophagus is lined with a stratified epithelium, which is maintained by the constant renewal of unipotent progenitors. In this study, we profiled mouse esophagus by single-cell RNA sequencing and found taste buds specifically in the cervical segment of the esophagus. These taste buds have the same cellular composition as the ones from the tongue but express fewer taste receptor types. State-of-the-art transcriptional regulatory network analysis allowed the identification of specific transcription factors associated to the differentiation of immature progenitors into the three different taste bud cell types. Lineage tracing experiments revealed that esophageal taste buds arise from squamous bipotent progenitor, thus demonstrating that all esophageal progenitors are not unipotent. Our cell resolution characterization of cervical esophagus epithelium will enable a better understanding of esophageal progenitor potency and insights into the mechanisms involved in the development of taste buds.
A single-dose F1-based mRNA-LNP vaccine provides protection against the lethal plague bacterium
Authors: Kon Edo , Levy Yinon , Elia Uri , Cohen Hila , Hazan-Halevy Inbal , Aftalion Moshe , Ezra Assaf , Bar-Haim Erez , Naidu Gonna Somu , Diesendruck Yael , Rotem Shahar , Ad-El Nitay , Goldsmith Meir , Mamroud Emanuelle , Peer Dan , Cohen Ofer
Published: March 2023

Messenger RNA (mRNA) lipid nanoparticle (LNP) vaccines have emerged as an effective vaccination strategy. Although currently applied toward viral pathogens, data concerning the platform’s effectiveness against bacterial pathogens are limited. Here, we developed an effective mRNA-LNP vaccine against a lethal bacterial pathogen by optimizing mRNA payload guanine and cytosine content and antigen design. We designed a nucleoside-modified mRNA-LNP vaccine based on the bacterial F1 capsule antigen, a major protective component of
Yersinia pestis
, the etiological agent of plague. Plague is a rapidly deteriorating contagious disease that has killed millions of people during the history of humankind. Now, the disease is treated effectively with antibiotics; however, in the case of a multiple-antibiotic-resistant strain outbreak, alternative countermeasures are required. Our mRNA-LNP vaccine elicited humoral and cellular immunological responses in C57BL/6 mice and conferred rapid, full protection against lethal
Y. pestis
infection after a single dose. These data open avenues for urgently needed effective antibacterial vaccines.
Comparative Efficacy of Mayaro Virus-Like Particle Vaccines Produced in Insect or Mammalian Cells
Authors: Abbo Sandra R. , Nguyen Wilson , Abma-Henkens Marleen H. C. , van de Kamer Denise , Savelkoul Niek H. A. , Geertsema Corinne , Le Thuy T. T. , Tang Bing , Yan Kexin , Dumenil Troy , van Oers Monique M. , Suhrbier Andreas , Pijlman Gorben P.
Published: March 2023

Mayaro virus (MAYV) is associated with acute rheumatic disease that can be debilitating and can evolve into months of chronic arthralgia. MAYV is believed to have the potential to emerge as a tropical public health threat, especially if it develops the ability to be efficiently transmitted by urban mosquito vectors, such as
Aedes aegypti
and/or
Aedes albopictus
.
Unusual case of a leiomyoma in the space of Retzius mimicking broad ligament fibroid
Authors: Goyal Lajya Devi , Goyal Suresh , Garg Priyanka , Mahajan Garima
Published: March 2023

This case report will discuss an interesting case of a patient who presented with pain in the lower abdomen of 2-month duration. Clinical examination and imaging findings were suggestive of a broad ligament fibroid. However, intraoperatively, the mass was found to be present in the space of Retzius, which is an extremely rare location for such a pathology. The access to the tumour was very challenging. Successful surgical excision was done with the help of a multidisciplinary team involving a gynaecologist, a urologist and an anaesthetist. Histopathology reported it to be benign leiomyoma. Postoperatively, the patient made an uneventful recovery.
Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis
Authors: Vidhale Tushar Ashok , Bhalde Rucha Prafulla , Pande Minal , Mahure Shital Pradeep
Published: March 2023

A man in his 20s who had previously experienced multiple episodes of transient loss of consciousness, majorly attributable to the seizures, presented with a 1-month history of increased seizure frequency, high-grade fever and weight loss. Clinically, he had postural instability, bradykinesia and symmetrical cogwheel rigidity. His investigations revealed hypocalcaemia, hyperphosphataemia, inappropriately normal intact parathyroid hormone, metabolic alkalosis, normomagnesemic magnesium depletion, and increased plasma renin activity and serum aldosterone concentration. CT scan of the brain revealed symmetrical calcification of the basal ganglia. The patient had primary hypoparathyroidism (HP). A similar presentation of his brother indicated a genetic cause, most likely autosomal dominant hypocalcaemia with Bartter’s syndrome type 5. The patient’s fever was caused by underlying haemophagocytic lymphohistiocytosis secondary to pulmonary tuberculosis, which triggered acute episodes of hypocalcaemia. This case represents a complex interplay of a multifaceted relationship between primary HP, vitamin D deficiency and an acute stressor.
Paraganglioma arising from the liver and abutting the heart
Authors: Kharroubi Hussein , Sawma Tedy , Sfeir Pierre , Khalife Mohammad
Published: March 2023

A paraganglioma is a rare extra-adrenal neuroendocrine tumour with a variable clinical presentation. A paraganglioma can arise anywhere along the sympathetic and parasympathetic chains, but it can occasionally emerge from unusual locations such as the liver and the thoracic cavity. We report a rare case of a woman in her 30s who presented to our emergency department with symptoms of chest discomfort, episodic hypertension, tachycardia and diaphoresis. A diagnostic approach including a chest X-ray, an MRI and a positron emission tomography–CT scan showed a large exophytic liver mass protruding into the thoracic cavity. For further characterisation of the mass, a biopsy of the lesion was performed, demonstrating that the tumour is of neuroendocrine origin. This was supported by a urine metanephrine test showing high levels of catecholamine breakdown products. Treatment consisted of a unique multidisciplinary approach involving hepatobiliary and cardiothoracic surgery allowing a safe and complete extermination of the hepatic tumour and its cardiac extension.
Constipation in transverse myelitis
Authors: Chinnappan Justine , Parajuli Abinash , Marcus Huda , Bachuwa Ghassan
Published: March 2023

Transverse myelitis is an extremely rare neuroinflammatory disorder. About half of the affected patients develop paraplegia associated with urinary and bowel dysfunction. The bowel dysfunction is thought to be benign and is usually managed with dietary management and laxatives. We report a case of a man in his 60s presenting with transverse myelitis and the acute disease course complicated with treatment refractory intestinal dysfunction resulting in intestinal perforation, eventually leading to his death. Thus, this case helps us weigh the fact that intestinal dysfunction in the case of transverse myelitis is not always benign but can lead to deadly outcomes as well.
Age-related experiences of colorectal cancer diagnosis: a secondary analysis of the English National Cancer Patient Experience Survey
Authors: Owais Syeda Somyyah , Arnolda Gaston , Lamprell Klay , Liauw Winston , Delaney Geoff P , Olver Ian , Karnon Jonathan , Braithwaite Jeffrey
Published: March 2023

Objective

The incidence of colorectal cancer (CRC) in people aged <50 years has been increasing dramatically in the past three decades and such patients are known to face difficulties in diagnosis. The objective of this study was to better understand the diagnostic experiences of patients with CRC and explore age-related differences in the proportion with positive experiences.

Method

A secondary analysis of the English National Cancer Patient Experience Survey (CPES) 2017 was conducted on the responses of patients with CRC, restricted to those likely to have been diagnosed in the preceding 12 months via pathways other than routine screening. Ten diagnosis-related experience questions were identified, with responses to them categorised as positive, negative or uninformative. Age group-related difference in positive experiences were described and ORs estimated, both raw and adjusted for selected characteristics. Sensitivity analysis was performed by weighting survey responses to 2017 cancer registrations by strata defined by age group, sex and cancer site, to assess whether differential response patterns by these characteristics affected the estimated proportion of positive experiences.

Results

The reported experiences of 3889 patients with CRC were analysed. There was a significant linear trend (p<0.0001) for 9 of 10 experience items, with older patients consistently displaying higher rates of positive experiences and patients aged 55–64 showing rates of positive experience intermediate between younger and older age groups. This was unaffected by differences in patient characteristics or CPES response rates.

Conclusion

The highest rates of positive diagnosis-related experiences were reported by patients aged 65–74 or 75 years and older, and this is robust.
Evolution of assisted deliveries at primary healthcare centres in an unstable security context in Mali
Authors: Bonnet Emmanuel , Lerosier Thomas , Touré Laurence , Diarra Yacouba , Diabaté Seydou , Diarra Dansiné , Ridde Valery
Published: March 2023

Introduction

In Mali, healthcare systems are severely affected by conflict. However, several studies suggest a lack of knowledge about its impact on maternal healthcare. Frequent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. The objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis.

Method

This is a mixed sequential and explanatory study. The quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central Mali: Mopti and Bandiagara. The qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres (CsCOM) and two agents of international institutions.

Results

The study reveals an important territorial heterogeneity of assisted deliveries. The primary health centres with high rates of assisted deliveries have mainly high-performance levels. This high level of use can be explained by the movement of the population to areas less exposed to attacks. The centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity.

Conclusion

This study confirms that combining methodological approaches is essential to explain significant use in the local context. The analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes.
Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis
Authors: Ozim Christian Onyedikachi , Mahendran Rahini , Amalan Mahendran , Puthussery Shuby
Published: March 2023

Objective

To estimate prevalence of HIV infection in Nigeria and to examine variations by geopolitical zones and study characteristics to inform policy, practice and research.

Methods

We conducted a comprehensive search of bibliographic databases including PubMed, CINAHL, PsycINFO, Global Health, Academic Search Elite and Allied and Complementary Medicine Database (AMED) and grey sources for studies published between 1 January 2008 and 31 December 2019. Studies reporting prevalence estimates of HIV among pregnant women in Nigeria using a diagnostic test were included. Primary outcome was proportion (%) of pregnant women living with HIV infection. A review protocol was developed and registered (PROSPERO 2019 CRD42019107037).

Results

Twenty-three studies involving 72 728 pregnant women were included. Ten studies were of high quality and the remaining were of moderate quality. Twenty-one studies used two or more diagnostic tests to identify women living with HIV. Overall pooled prevalence of HIV among pregnant women was 7.22% (95% CI 5.64 to 9.21). Studies showed high degree of heterogeneity (I2=97.2%) and evidence of publication bias (p=0.728). Pooled prevalence for most individual geopolitical zones showed substantial variations compared with overall prevalence. North-Central (6.84%, 95% CI 4.73 to 9.79) and South-West zones (6.27%, 95% CI 4.75 to 8.24) had lower prevalence whereas South-East zone (17.04%, 95% CI 9.01 to 29.86) had higher prevalence.

Conclusions

While robust national prevalence studies are sparse in Nigeria, our findings suggest 7 in every 100 pregnant women are likely to have HIV infection. These figures are consistent with reported prevalence rates in sub-Saharan African region. WHO has indicated much higher prevalence in Nigeria compared with our findings. This discrepancy could potentially be attributed to varied methodological approaches and regional focus of studies included in our review. The magnitude of the issue highlights the need for targeted efforts from local, national and international stakeholders for prevention, diagnosis, management and treatment.
All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study
Authors: Farrant Olivia , Baldeh Mamadu , Kamara Joseph Baio , Bailey Emma , Sevalie Stephen , Deen Gibrilla , Russell James Baligeh Walter , Youkee Daniel , Leather Andy JM , Davies Justine , Lakoh Sulaiman
Published: March 2023

Objectives

To study the mortality of patients with COVID-19 in Sierra Leone, to explore the factors associated with mortality during the COVID-19 pandemic and to highlight the complexities of treating patients with a novel epidemic disease in a fragile health system.

Study design

A prospective single-centre cohort study. Data were extracted from paper medical records and transferred onto an electronic database. Specific indicators were compared between survivors and non-survivors, using descriptive statistics in Stata V.17.

Study setting

The infectious diseases unit (IDU) at Connaught Hospital in Freetown, Sierra Leone

Participants

Participants were all patients admitted to the IDU between March and July 2020.

Aims of study

The primary outcome of the study was to examine the all-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone and the secondary outcome measures were to examine factors associated with mortality in patients positive for COVID-19.

Results

261 participants were included in the study. Overall, 41.3% of those admitted to the IDU died, compared with prepandemic in-hospital mortality of 23.8%. Factors contributing to the higher mortality were COVID-19 infection (aOR 5.61, 95% CI 1.19 to 26.30, p=0.02) and hypertension (aOR 9.30, 95% CI 1.18 to 73.27, p=0.03)

Conclusions

This study explores the multiple factors underpinning a doubling in facility mortality rate during the COVID-19 pandemic in Sierra Leone . It provides an insight into the realities of providing front-line healthcare during a pandemic in a fragile health system.
Risk factors for incident falls in Singaporean community-dwelling adult men and women: a prospective cohort study
Authors: Yip Wan Fen , Ge Lixia , Heng Bee Hoon , Tan Woan Shin
Published: March 2023

Objectives

Our study aimed to identify the risk factors of incident falls between men and women.

Design

Prospective cohort study.

Setting

The study recruited participants from the Central region of Singapore. Baseline and follow-up data were collected via a face-to-face survey.

Participants

Community-dwelling adults aged 40 years and above from the Population Health Index Survey.

Outcome measure

Incident falls were defined as the experience of a fall between the baseline and 1-year follow-up but having no falls 1 year prior to baseline. Multiple logistic regressions were performed to determine the association of sociodemographic factors, medical history and lifestyle with incident falls. Sex subgroup analyses were conducted to examine sex-specific risk factors for incident falls.

Results

1056 participants were included in the analysis. At 1-year follow-up, 9.6% of the participants experienced an incident fall. Incidence of falls in women was 9.8% compared with 7.4% in men. In the multivariable analysis for the overall sample, older age (OR: 1.88, 95% CI: 1.10 to 2.86), being pre-frail (OR: 2.13, 95% CI: 1.12 to 4.00) and having depression or feeling depressed/anxious (OR: 2.35, 95% CI: 1.10 to 4.99) were associated with higher odds for incident falls. In subgroup analyses, older age was a risk factor for incident falls in men (OR: 2.68, 95% CI: 1.21 to 5.90) and pre-frail was a risk factor for incident falls in women (OR: 2.82, 95% CI: 1.28 to 6.20). There was no significant interaction effect between sex and age group (p value=0.341) and sex and frailty status (p value=0.181).

Conclusion

Older age, presence of pre-frailty and having depression or feeling depressed/anxious were associated with higher odds of incident falls. In our subgroup analyses, older age was a risk factor for incident falls in men and being pre-frail was a risk factor for incident falls in women. These findings provide useful information for community health services in designing falls prevention programmes for community-dwelling adults in a multi-ethnic Asian population.
Time spent on documenting quality indicator data and associations between the perceived burden of documenting these data and joy in work among professionals in intensive care units in the Netherlands: a multicentre cross-sectional survey
Authors: Hesselink Gijs , Verhage Rutger , Hoiting Oscar , Verweij Eva , Janssen Inge , Westerhof Brigitte , Ambaum Gilian , van der Horst Iwan C C , de Jong Paul , Postma Nynke , van der Hoeven Johannes G , Zegers Marieke
Published: March 2023

Objectives

The number of indicators used to monitor and improve the quality of care is debatable and may influence professionals’ joy in work. We aimed to assess intensive care unit (ICU) professionals’ perceived burden of documenting quality indicator data and its association with joy in work.

Design

Cross-sectional survey.

Setting

ICUs of eight hospitals in the Netherlands.

Participants

Health professionals (ie, medical specialists, residents and nurses) working in the ICU.

Measurements

The survey included reported time spent on documenting quality indicator data and validated measures for documentation burden (ie, such documentation being unreasonable and unnecessary) and elements of joy in work (ie, intrinsic and extrinsic motivation, autonomy, relatedness and competence). Multivariable regression analysis was performed for each element of joy in work as a separate outcome.

Results

In total, 448 ICU professionals responded to the survey (65% response rate). The overall median time spent on documenting quality data per working day is 60 min (IQR 30–90). Nurses spend more time documenting these data than physicians (medians of 60 min vs 35 min, p<0.01). Most professionals (n=259, 66%) often perceive such documentation tasks as unnecessary and a minority (n=71, 18%) perceive them as unreasonable. No associations between documentation burden and measures of joy in work were found, except for the negative association between unnecessary documentations and sense of autonomy (β=−0.11, 95% CI −0.21 to −0.01, p=0.03).

Conclusions

Dutch ICU professionals spend substantial time on documenting quality indicator data they often regard as unnecessary. Despite the lacking necessity, documentation burden had limited impact on joy in work. Future research should focus on which aspects of work are affected by documentation burden and whether diminishing the burden improves joy in work.
Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada
Authors: Movahedi Mohammad , Choquette Denis , Coupal Louis , Cesta Angela , Li Xiuying , Keystone Edward C , Bombardier Claire , Investigators OBRI
Published: March 2023

Objectives

The similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries.

Design

Retrospective cohort study.

Setting

Pooled data from two rheumatoid arthritis (RA) registries in Canada.

Participants

Patients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493).

Outcome measures

Time to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects.

Results

The mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.

Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).

TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users.

Conclusions

In this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users.
Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study)
Authors: Zee Masha S , Bagchus Lotje , Becqué Yvonne N , Witkamp Erica , van der Heide Agnes , van Lent Liza G G , Goossensen Anne , Korfage Ida J , Onwuteaka-Philipsen Bregje D , Pasman H Roeline
Published: March 2023

Objectives

The objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.

Methods

An in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.

Results

Several aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.

Conclusion

The palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.
Incidence and influencing factors of occupational pneumoconiosis: a systematic review and meta-analysis
Authors: Su Xuesen , Kong Xiaomei , Yu Xiao , Zhang Xinri
Published: March 2023

Objectives

To determine the incidence of pneumoconiosis worldwide and its influencing factors.

Design

Systematic review and meta-analysis.

Setting

Cohort studies on occupational pneumoconiosis.

Participants

PubMed, Embase, the Cochrane Library and Web of Science were searched until November 2021. Studies were selected for meta-analysis if they involved at least one variable investigated as an influencing factor for the incidence of pneumoconiosis and reported either the parameters and 95% CIs of the risk fit to the data, or sufficient information to allow for the calculation of those values.

Primary outcome measures

The pooled incidence of pneumoconiosis and risk ratio (RR) and 95% CIs of influencing factors.

Results

Our meta-analysis included 19 studies with a total of 335 424 participants, of whom 29 972 developed pneumoconiosis. The pooled incidence of pneumoconiosis was 0.093 (95% CI 0.085 to 0.135). We identified the following influencing factors: (1) male (RR 3.74; 95% CI 1.31 to 10.64; p=0.01), (2) smoking (RR 1.80; 95% CI 1.34 to 2.43; p=0.0001), (3) tunnelling category (RR 4.75; 95% CI 1.96 to 11.53; p<0.0001), (4) helping category (RR 0.07; 95% CI 0.13 to 0.16; p<0.0001), (5) age (the highest incidence occurs between the ages of 50 and 60), (6) duration of dust exposure (RR 4.59, 95% CI 2.41 to 8.74, p<0.01) and (7) cumulative total dust exposure (CTD) (RR 34.14, 95% CI 17.50 to 66.63, p<0.01). A dose–response analysis revealed a significant positive linear dose–response association between the risk of pneumoconiosis and duration of exposure and CTD (P-non-linearity=0.10, P-non-linearity=0.16; respectively). The Pearson correlation analysis revealed that silicosis incidence was highly correlated with cumulative silica exposure (r=0.794, p<0.001).

Conclusion

The incidence of pneumoconiosis in occupational workers was 0.093 and seven factors were found to be associated with the incidence, providing some insight into the prevention of pneumoconiosis.

PROSPERO registration number

CRD42022323233.
Key lessons learnt from COVID-19 intra-action reviews in the Republic of Moldova, Montenegro, Kosovo and North Macedonia 2020–2021: a qualitative study
Authors: Sane Jussi , Schmidt Tanja , Isla Nicolas , Ibrahim Rawi , Boshevska Golubinka , Mayigane Landry Ndriko , Perriat Delphine , Stauke Janina , Esquevin Sarah , Fehr Angela , Brajovic Mina , Bajić Borko , Galic Igor , Humolli Isme , Bunjaku Dafina Gexha , Gheorghita Stela , Kuli Arta , Manevska Suzana , Stavridis Kristina , Demiscan Daniela , Capmari Dumitru , Mengistu Abebayehu Assefa
Published: March 2023

Objectives

Our study described how the WHO intra-action review (IAR) methodology was operationalised and customised in three Western Balkan countries and territories and the Republic of Moldova and analysed the common key findings to inform analyses of the lessons learnt from the pandemic response.

Design

We extracted data from the respective IAR reports and performed a qualitative thematic content analysis to identify common (between countries and territories) and cross-cutting (across the response pillars) themes on best practices, challenges and priority actions. The analysis involved three stages, namely: extraction of data, initial identification of emerging themes and review and definition of the themes.

Setting

IARs were conducted in the Republic of Moldova, Montenegro, Kosovo and the Republic of North Macedonia between December 2020 and November 2021. The IARs were conducted at different time points relative to the respective pandemic trajectories (14-day incidence rate ranging from 23 to 495 per 100 000).

Results

Case management was reviewed in all the IARs, while the infection prevention and control, surveillance and country-level coordination pillars were reviewed in three countries. The thematic content analysis identified four common and cross-cutting best practices, seven challenges and six priority recommendations. Recommendations included investing in sustainable human resources and technical capacities developed during the pandemic, providing continuous capacity-building and training (with regular simulation exercises), updating legislation, improving communication between healthcare providers at all levels of healthcare and enhancing digitalisation of health information systems.

Conclusions

The IARs provided an opportunity for continuous collective reflection and learning with multisectoral engagement. They also offered an opportunity to review public health emergency preparedness and response functions in general, thereby contributing to generic health systems strengthening and resilience beyond COVID-19. However, success in strengthening the response and preparedness requires leadership and resource allocation, prioritisation and commitment by the countries and territories themselves.
Association of poor perceived work ability and psychosocial work-related factors in health and social service worker age groups: a cross-sectional study
Authors: Selander Kirsikka , Nikunlaakso Risto , Korkiakangas Eveliina , Sinervo Timo , Laitinen Jaana
Published: March 2023

Objective

Previous work ability studies have primarily focused on old workers and physical health. This study investigated how poor perceived work ability (PPWA) is associated with work-related factors in different health and social service (HSS) worker age groups.

Design

Cross-sectional survey in 2020.

Setting

HSS employees (general HSS and eldercare) in nine Finnish public sector organisations.

Participants

All employees who were employed in the organisation completed self-reported questionnaires. Of the original sample (N=24 459, response rate 67%), 22 528 gave consent for research use.

Primary and secondary outcome measures

Participants evaluated their psychosocial work environment and work ability. Lowest decile of work ability was categorised as poor. The association between psychosocial work-related factors and PPWA in different age-groups of HSS workers, adjusting for perceived health, was analysed with logistic regression.

Results

The proportion of PPWA was highest in shift workers, eldercare employees, practical nurses and registered nurses. Considerable variation between age groups exists in the work-related psychosocial factors associated with PPWA. Among young employees engaging leadership and working time and work task autonomy were statistically significant, whereas in middle-aged and old employees procedural justice and ethical strain were highlighted. The strength of the association with perceived health also differs in age groups (young: OR=3.77, 95% CI 3.30 to 4.30; middle-aged: OR=4.66, 95% CI 4.22 to 5.14; old: OR=6.16, 95% CI 5.20 to 7.18).

Conclusions

Young employees would benefit from engaging leadership and mentoring, and from more working time and work task autonomy. As employees get older they would benefit more from job modification and from ethical and just organisation culture.
Effectiveness and cost-effectiveness of a digital health intervention to support patients with colorectal cancer prepare for and recover from surgery: study protocol of the RecoverEsupport randomised controlled trial
Authors: Wyse Rebecca , Smith Stephen , Zucca Alison , Fakes Kristy , Mansfield Elise , Johnston Sally-Ann , Robinson Sancha , Oldmeadow Christopher , Reeves Penny , Carey Mariko L , Norton Grace , Sanson-Fisher Rob W
Published: March 2023

Introduction

Surgery is the most common treatment for colorectal cancer (CRC) and can cause relative long average length of stay (LOS) and high risks of unplanned readmissions and complications. Enhanced Recovery After Surgery (ERAS) pathways can reduce the LOS and postsurgical complications. Digital health interventions provide a flexible and low-cost way of supporting patients to achieve this. This protocol describes a trial aiming to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention in decreasing the hospital LOS in patients undergoing CRC surgery.

Methods and analysis

The two-arm randomised controlled trial will assess the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention compared with usual care (control) in patients with CRC. The intervention consists of a website and a series of automatic prompts and alerts to support patients to adhere to the patient-led ERAS recommendations. The primary trial outcome is the length of hospital stay. Secondary outcomes include days alive and out of hospital; emergency department presentations; quality of life; patient knowledge and behaviours related to the ERAS recommendations; health service utilisation; and intervention acceptability and use.

Ethics and dissemination

The trial has been approved by the Hunter New England Research Ethics Committee (2019/ETH00869) and the University of Newcastle Ethics Committee (H-2015-0364). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team will facilitate its adoption within the Local Health District for widespread adaptation and implementation.

Trial registration number

ACTRN12621001533886.
Study design and rationale for the PAASIM project: a matched cohort study on urban water supply improvements and infant enteric pathogen infection, gut microbiome development and health in Mozambique
Authors: Levy Karen , Garn Joshua V , Cumbe Zaida Adriano , Muneme Bacelar , Fagnant-Sperati Christine S , Hubbard Sydney , Júnior Antonio , Manuel João Luís , Mangamela Magalhães , McGunegill Sandy , Miller-Petrie Molly K , Snyder Jedidiah S , Victor Courtney , Waller Lance A , Konstantinidis Konstantinos T , Clasen Thomas F , Brown Joe , Nalá Rassul , Freeman Matthew C
Published: March 2023

Introduction

Despite clear linkages between provision of clean water and improvements in child health, limited information exists about the health impacts of large water infrastructure improvements in low-income settings. Billions of dollars are spent annually to improve urban water supply, and rigorous evaluation of these improvements, especially targeting informal settlements, is critical to guide policy and investment strategies. Objective measures of infection and exposure to pathogens, and measures of gut function, are needed to understand the effectiveness and impact of water supply improvements.

Methods and analysis

In the PAASIM study, we examine the impact of water system improvements on acute and chronic health outcomes in children in a low-income urban area of Beira, Mozambique, comprising 62 sub-neighbourhoods and ~26 300 households. This prospective matched cohort study follows 548 mother–child dyads from late pregnancy through 12 months of age. Primary outcomes include measures of enteric pathogen infections, gut microbiome composition and source drinking water microbiological quality, measured at the child’s 12-month visit. Additional outcomes include diarrhoea prevalence, child growth, previous enteric pathogen exposure, child mortality and various measures of water access and quality. Our analyses will compare (1) subjects living in sub-neighbourhoods with the improved water to those living in sub-neighbourhoods without these improvements; and (2) subjects with household water connections on their premises to those without such a connection. This study will provide critical information to understand how to optimise investments for improving child health, filling the information gap about the impact of piped water provision to low-income urban households, using novel gastrointestinal disease outcomes.

Ethics and dissemination

This study was approved by the Emory University Institutional Review Board and the National Bio-Ethics Committee for Health in Mozambique. The pre-analysis plan is published on the Open Science Framework platform (https://osf.io/4rkn6/). Results will be shared with relevant stakeholders locally, and through publications.
Local anaesthetic infiltration in rubber band ligation of rectal haemorrhoids: study protocol for a three-arm, double-blind randomised controlled trial (PLATIPUS trial)
Authors: Watson Eleanor G R , Qin Kirby R , Smart Philip J , Burgess Adele N , Mohan Helen M , Proud David M
Published: March 2023

Introduction

Rubber band ligation (‘banding’) is a common approach for the management of symptomatic haemorrhoids. However, up to 90% of patients experience postprocedural pain, and there is no consensus regarding the optimal analgesic strategy. In practice, patients may receive submucosal local anaesthetic, pudendal nerve block or routine periprocedural analgesia. The aim of this study is to compare the efficacy of submucosal local anaesthetic, pudendal nerve block and routine analgesia for postprocedural pain in patients undergoing haemorrhoid banding.

Methods and analysis

This is a multicentre, prospective, three-arm, double-blind randomised controlled trial of adults booked for haemorrhoid banding. Participants will be randomised to one of three groups in a 1:1:1 ratio: (1)submucosal bupivacaine injection; (2) pudendal nerve ropivacaine injection and (3) no local anaesthetic. The primary outcome is patient reported postprocedural pain (scored 0–10) from 30 min to 2 weeks. Secondary outcomes include postprocedural analgesia use, time to discharge, patient satisfaction, time to return to work and complications. A sample size of 120 patients is required to achieve statistical significance.

Ethics and dissemination

This study received Human Research Ethics Approval from the Austin Health Human Research Ethics Committee (March 2022). Trial results will be submitted to a peer-reviewed journal, and presented at academic meetings. A summary of the trial results will be made available to study participants on request.

Trial registration number

ACTRN12622000006741p.