bluuebunny/crossref_metadata_2025 huggingface dataset:
A dengue virus infection in Ethiopia: a systematic review and meta-analysis
Authors: Nigussie Eshetu , Atlaw Daniel , Negash Getahun , Gezahegn Habtamu , Baressa Girma , Tasew Alelign , Zembaba Demisu
Published: March 2024

Background

Dengue is caused by a positive-stranded RNA virus called dengue virus, which is spread by Aedes mosquito species. It is a fast-growing acute febrile disease with potentially lethal consequences that is a global public health problem, mostly in tropical and subtropical countries. In Ethiopia, dengue fever is understudied, although the virus is still being transmitted and viral infection rates are rising. This systematic review and meta-analysis was aimed at estimating the pooled prevalence of DENV infection in Ethiopia.

Methods

A literature search was done on the PubMed, Hinari and Google Scholar databases to identify studies published before July, 2023. Random effects and fixed effects models were used to estimate the pooled prevalence of all three markers. The Inconsistency Index was used to assess the level of heterogeneity.

Results

A total of 11 studies conducted on suspected individuals with dengue fever and acutely febrile participants were included in this review. The majority of the studies had a moderate risk of bias and no study had a high risk of bias. A meta-analysis estimated a pooled IgG prevalence of 21% (95% CI: 19–23), a pooled IgM prevalence of 9% (95%CI: 4–13) and a pooled DENV-RNA prevalence of 48% (95% CI: 33–62). There is evidence of possible publication bias in IgG but not in the rest of the markers.

Conclusion

Dengue is prevalent among the dengue fever suspected and febrile population in Ethiopia. Healthcare providers, researchers and policymakers should give more attention to dengue fever.
Analyses of quality of life in cancer drug trials - a review of measurements and analytical choices in post-reimbursement studies
Authors: Svensson Mikael , Strand Gabriella Chauca , Bonander Carl , Johansson Naimi , Jakobsson Niklas
Published: March 2024

Objectives

For drugs reimbursed with limited evidence of patient benefits, confirmatory evidence of overall survival (OS) and quality of life (QoL) benefits is important. For QoL data to serve as valuable input to patients and decision-makers, it must be measured and analyzed using appropriate methods. We aimed to assess the measurement and analyses of post-reimbursement QoL data for cancer drugs introduced in Swedish healthcare with limited evidence at the time of reimbursement.

Methods

We reviewed any published post-reimbursement trial data on QoL for cancer drugs reimbursed in Sweden between 2010 and 2020 with limited evidence of improvement in QoL and OS benefits at the time of reimbursement. We extracted information on the instruments used, frequency of measurement, extent of missing data, statistical approaches, and the use of pre-registration and study protocols.

Results

Out of 22 drugs satisfying our inclusion criteria, we identified published QoL data for 12 drugs in 22 studies covering multiple cancer types. The most frequently used QoL instruments were EORTC QLQ-C30 and EQ-5D-3/5L. We identified three areas needing improvement in QoL measurement and analysis: (i) motivation for the frequency of measurements, (ii) handling of the substantial missing data problem, and (iii) inclusion and adherence to QoL analyses in clinical trial pre-registration and study protocols.

Conclusions

Our review shows that the measurements and analysis of QoL data in our sample of cancer trials covering drugs initially reimbursed without any confirmed QoL or OS evidence have significant room for improvement. The increasing use of QoL assessments must be accompanied by a stricter adherence to best-practice guidelines to provide valuable input to patients and decision-makers.
A clinicopathological study about the epidemiology of granulosa cell tumors in Lebanon
Authors: Yaacoub Sana , Hajj Labib , Khairallah Aya
Published: March 2024

Background

Granulosa Cell Tumors (GCT) are considered the most frequent type of sex-cord stromal tumors. These tumors constitute 3-6% of neoplasms of the ovaries. GCTs are divided into 2 types: Juvenile GCT (JGCT) and Adult GCT (AGCT). Most patients are diagnosed early in the course of the disease and tend to have a favorable prognosis. In the surgical treatment of GCT, two main factors play role in the determination of feasibility of the surgery: age and tumor stage.

Methods

A retrospective study was conducted on 65 consecutive female patients diagnosed with ovarian GCT at different hospitals across Lebanon who were referred to the National Institute of Pathology, Beirut-Lebanon, between January 2000 and January 2020. Then, they were divided according to types: adult versus juvenile type. Statistical analysis was carried out using Stata, version 16.

Results

The incidence of GCT in a Lebanese population was 16.2 per million per year. The mean age of the studied population was 55.6 years. AGCT was the most common with a prevalence of 91% versus 19% for JGCT. Also, inhibine (the most important immunomarker) was found in 77.2% of adult cases. High mitotic index and high tumor size which are predictors for poor prognosis were respectively 20% and 36.9%. Concerning the histopathological features, Grooved nuclei and Exner bodies were less frequently observed in juvenile type (16.7% for both) compared to adult type (36.9%). Most patients with GCT were diagnosed in the early course of disease mainly due to the manifestation of the symptoms as abdominal pain, postmenopausal bleeding or intermenstrual bleeding, and the good diagnosis and screening practices in Lebanon. Regarding the recurrent cases, a significant correlation with high mitotic index (76.9%), high tumor size (92.3%) and advanced stage (46% for stage 3 and 46% for stage 4) was found with a p < 0.05.

Conclusions

The incidence of GCT in the Lebanese population is 16.2 per million per year. The majority of patients with GCT in Lebanon are of Adult type representing around 90% of cases. Older age, high mitotic index and big tumor size are predictors for poor outcomes.
Epidemiological, clinical, and pathological characteristics of invasive breast cancer in Bedouin and Jewish women in southern Israel: a retrospective comparative study
Authors: Shitrit Itamar Ben , Wang Ao , Ilan Karny , Agassi Ravit , Freih Sofyan Abu , Vaynshtein Julie
Published: March 2024

Background

Invasive breast cancer (IBC) is a leading cause of cancer-related death among women in Israel, regardless of ethnicity. This study compared IBC epidemiological, clinical, and pathological characteristics in Bedouin and Jewish patients in southern Israel.

Methods

Medical records of 1514 Jewish and 191 Bedouin women with IBC treated at Soroka University Medical Center between 2014 and 2021 were analyzed retrospectively. Baseline measures and tumor characteristics were compared between groups. Overall survival (OS) and disease-free survival (DFS) were analyzed using log-rank test. Multivariate analysis was performed using the Cox proportional hazard model.

Results

Bedouin patients exhibited a significantly younger age at diagnosis (median 48 vs. 62 years, p < 0.001), larger tumor size (median 2.5 vs. 2.13 cm, p < 0.001), and higher metastasis rate (18.8% vs. 12.7%, p = 0.03) compared to Jewish patients. In early-stage (non-metastatic) disease, Jewish and Bedouin patients had comparable overall survival (OS) rates (127 vs. 126 months, p = 0.2), consistent across stages 1 to 3. However, among patients with metastatic disease, Bedouins exhibited significantly longer OS (76.6 vs. 37.8 months, p = 0.006). Disease-free survival (DFS) showed no ethnic differences (not reached vs. 122 months, p = 0.31). There were no significant differences in OS between Bedouin and Jewish patients undergoing various treatment modalities for early-stage disease: surgery, adjuvant radiotherapy, chemotherapy, and systemic neoadjuvant therapy.

Conclusion

Breast cancer among Bedouin women in southern Israel manifests at a younger age, with larger tumors and more advanced stages than in Jewish women. However, recent data indicate no differences in OS and DFS between the ethnic groups despite past disparities in prognosis.
Effects of physical fitness on mental health of Chinese college students: across-sectional study
Authors: Ma Shuzhen , Yang Yang , Soh Kim Geok , Tan Hermione
Published: March 2024

Background

The physical and mental health of college students is often mentioned, but there is limited research on a direct relationship between the mental health status of college students and their physical fitness level. This study mainly proves the relationship between Chinese college students’ mental health and physical fitness indicators.

Method

This study collected SCL-90 Scale test results from 5262 students (4012 boys and 1250 girls) through a questionnaire survey and conducted a Sport Quality Test on these students. Statistical software SPSS was applied for differential analysis and logistic regression analysis. Specifically, the differences in sport quality indicators between normal and abnormal mean total scores of psychological tests were analyzed first. Then, the binary logistic regression model was used to explore the impacts of sports quality indicator scores on students’ psychological fitness.

Results

There are differences in the results of physical fitness tests between students with abnormal psychology and students with normal psychology. The four indexes of students’ vital capacity, speed, explosive power of lower limbs, and endurance running are effective in improving students’ psychologically abnormal state, and endurance running and improving vital capacity are the most effective methods to improve students’ psychologically abnormal state. In the physical tests of Chinese college students, the risk of psychological abnormalities was reduced by 9% for every one-point increase in lung capacity and 10.4% for every one-point increase in endurance running performance.

Conclusions

Chinese college students’ physical fitness and mental health are related. The best methods for treating psychological disorders are lung capacity improvement and endurance running. According to the physical test results of Chinese college students, for every 1-point increase in lung capacity and endurance running, the risk of psychological abnormalities decreased by 9% and 10.4%, respectively.
Association of filial attitude, filial behavior and death literacy: implications for development of death system in Guangdong-Hong Kong-Macao Greater Bay Area of China
Authors: Ng Wai I , Che Sok Leng , Li Xiang , Zhu Mingxia
Published: March 2024

Background

Filial piety, as a major traditional norm in Chinese culture and in Chinese families, affects the attitudes and behaviors of adult children toward their parents and impacts their end-of-life decision-making and the quality of death of their parents. Death literacy is a novel concept aimed at promoting palliative care in the context of public health.

Aims

To understand attitudes and behaviors related to filial piety and to examine the role of death literacy in filial behaviors toward dying parents among residents in the Guangdong-Hong Kong-Macao Greater Bay Area of China.

Methods

A cross-sectional online survey that employed the convenient and snowball sampling methods was adopted. Filial Piety Representations at Parents’ End of Life Scale and Death Literacy Index were used.

Results

This study identified a significant gap between the filial piety attitudes and behaviors of Chinese adult children. Gender, caregiving experience and death literacy were predictors of filial behaviors in an end-of-life context.

Conclusion

Providing truth disclosure support, offering guidance to young adult children and caregivers of terminally ill fathers, and strengthening factual and community knowledge of death are necessary to enhance the reciprocal comfort of both adult children and dying parents in the context of Chinese filiality.
Will Nigella sativa oil protect parotid glands of rats against cranium gamma irradiation? Histological and immunohistochemical evaluation
Authors: Ahmed Salwa Farid , Bakr Mostafa A.
Published: March 2024

Background

Radiation plays an essential role in treating malignancies. Radiation exposure of salivary glands often results in permanent loss of their functions; therefore, their protection against radiation is crucial. Nigella sativa oil (NSO) is a useful antioxidant against free radicals. The purpose of this study was to investigate the radio-protective effect of NSO on oxidative injury of parotid glands of gamma-irradiated rats. Methods: Twenty-eight male albino rats were divided into four groups (n = 7): Group 1: Neither NSO nor radiation, Group 2: Rats received NSO 400 mg/kg, Group 3: Rats received 15 Gy cranium gamma irradiation & Group 4: Rats received gamma irradiation and NSO. Rats were sacrificed two weeks after the last NSO dose. Histological sections of parotid glands were stained with H&E, Masson’s trichrome and anti-TGF-β antibodies. Area percentage of Masson’s trichrome and TGF-β expression was morphometrically examined. Results: Parotid glands of control and NSO groups revealed normal morphology. Gamma-irradiated glands showed loss of normal acinar architecture and slight acinar shrinkage. NSO treatment of gamma-irradiated glands preserved acinar outline and architecture. Masson’s trichrome stained samples revealed trace amounts of collagen fibers in control and NSO groups, and excessive amounts of collagen fibers in gamma-irradiated group, in addition to few collagen fibers for gamma-irradiated glands treated with NSO. Additionally, control and NSO groups showed negative TGF-β expression. Gamma-irradiated group showed high TGF-β expression, while NSO treated gamma-irradiated group showed moderate TGF-β expression. Conclusions: Gamma-irradiation adversely affected parotid glands, and in contrast, NSO seemed to positively counteract this adverse effect.
Knowledge and associated factors with respect to prevention of post-traumatic compartment syndrome among surgical unit nurses; a multi-center cross-sectional study
Authors: Bazezew Astewil Moges , Getahun Yalemwork , Demlie Tiruye Azene , Ayele Desalegn Getachew , Siyoum Tsehayu Melak , Gedefaw Gezahagn Demsu , Zeleke Kasaye Ahmed , Tekletsadik Esayas Alemshet , Tsega Sintayehu Simie , Dessie Melkamu Tilahun , Getahun Ashenafi Fekad , Woretaw Ashenafi Worku
Published: March 2024

Background

Delayed recognition of compartment syndrome can result in devastating consequences such as the need for amputation or even death. Nurses are at the frontline of patient care and they must have a high index of suspicion for compartment syndrome. Even though nurses’ knowledge about the prevention of compartment syndrome is important, there are no studies in Ethiopia. Therefore this study aims to assess the knowledge and associated factors of nurses towards the prevention of post-traumatic compartment syndrome.

Method

An institutional-based cross-sectional study was conducted among 410 nurses from 26 April to 25 May 2023 at five Comprehensive Specialized Hospital. A stratified sampling technique was employed to recruit the required participants for the study. The data were collected using a structured self-administered questionnaire. The descriptive statistics were presented in text and tables. Analytical analysis schemes including bivariable and multivariable logistic regression were computed considering P-value < 0.05 to identify statistically significant factors.

Result

Nearly three- fifths (61.6%; 95% CI: 56.7 to 66.3) of nurses had adequate knowledge and significantly associated with being male (AOR: 1.615, 95% CI: 1.050–2.485), nurse use of guidelines (AOR: 2.079, 95% CI: 1.307–3.307), nurses they have been trained (AOR = 1.650; 95 CI: 1.063–2.562), and nurses’ who had more than 15 years’ (AOR: 4.207, 95 CI: 1.762–10.045) experience had good knowledge with respect to prevention of compartment syndrome than the counterparts.

Conclusion

Even though nurses’ knowledge regarding the prevention of post-traumatic compartment syndrome was found to be good, Diligent nursing assessment and monitoring of clinical signs should be critically performed. So, it is better to strengthen training, equip wards with standardized guidelines, and create a safe working environment should be routine activities.
Evaluation of antenatal simulation-based learning on satisfaction and self-confidence levels among Thai undergraduate nursing students during the COVID-19 pandemic: a mixed-method study
Authors: Kuesakul Kornkanok , Nuampa Sasitara , Pungbangkadee Rudee , Ramjan Lucie , Ratinthorn Ameporn
Published: March 2024

Background

During the COVID-19 pandemic, simulation-based learning (SBL) serves as an alternative teaching strategy for nursing students facing restricted access to antenatal clinical practicum. However, the factors predicting nursing students’ satisfaction, self-confidence, and their learning experiences remain unclear.

Objective

To identify factors predict satisfaction and self-confidence and explore the learning experiences of antenatal SBL.

Methods

A Mixed methods research of the cross-sectional study design and descriptive qualitative research was conducted. A total of 100 third year nursing students who finished the Maternity-Newborn Nursing and Midwifery Practice course using antenatal simulation-based learning were invited to complete the online questionnaires. A total of seven questionnaires were administered, including a demographic questionnaire, the Attitude Scale toward Simulation-Based Education (SBE), the Professional Identity Scale for Nursing Students, the Perceived Stress Scale, the Evaluation of Teaching Competencies Scale, the Simulation Design Scale: Student Version, and the Student Satisfaction and Self-Confidence in Learning. The 20 nursing students who completed survey were asked to participate a qualitative focus group discussion. Multiple regression analysis was performed to investigate predictors, while qualitative data were analyzed using content analysis.

Results

The quantitative results showed high levels of satisfaction (mean = 20.55, SD = 3.17) and self-confidence (mean = 32.44, SD = 4.76) after completing the antenatal SBL. In regression analysis, attitude toward SBE (Beta = 0.473, t = 5.376, p < 0.001) and attitude toward antenatal care simulation design (Beta = 0.338, t = 2.611, p < 0.011) were significantly associated with a high level of satisfaction with antenatal SBL, which accounted for 44.0% of the variance explained in satisfaction. Only attitude toward SBE was significantly associated with a high level of self-confidence in antenatal SBL (Beta = 0.331, t = 3.773, p < 0.001), which accounted for 45.0% of the variance explained in self-confidence. The qualitative results generated four themes: (1) positive attitude toward antenatal simulation; (2) turning reassurance into confidence; (3) I am really happy to learn; and (4) being a good nurse motivates and stresses me.

Conclusions

Antenatal SBL is an effective teaching strategy that can support nursing students to build clinical confidence. Creating a positive learning environment allows students to have a positive attitude and experience with simulations.
Governance models for historical hospitals: evidence from Italy
Authors: Giusti Martina , Vannini Ilaria Elisa , Persiani Niccolò
Published: March 2024

Many hospitals and health care organizations over the centuries have inherited handcrafts of artistic value, objects of worships, donations from pilgrims, votive offerings, legates as a result of their centuries-old activity in the social and health care of their community. The value of these artistic assets and the role in the territory of these hospitals have transformed them into cultural heritage over time, introducing the issue of the coexistence of cultural and care management. Therefore, the aim of this paper is to identify governance models of what we will call historical hospitals, that is, hospitals that because of their history, their assets, and their artistic heritage, far from being places only dedicated to provision of health care services represent cultural heritage. To pursue this research objective, five Italian historical hospitals were selected and identified as significant case studies for their historic and artistic relevance. Through the analysis of these case studies the paper identifies models of governance of historical hospitals and the reasons of their adoption.
Workforce wellbeing centres and their positive role for wellbeing and presenteeism in healthcare workers during the COVID-19 pandemic: secondary analysis of COVID-Well data
Authors: Blake Holly , Mancini Helen , Coyne Emma , Cooper Joanne , Stanulewicz-Buckley Natalia
Published: March 2024

Background

Supported wellbeing centres established during the COVID-19 pandemic provided high quality rest spaces and access to peer-to-peer psychological first aid for healthcare workers (HCWs). The centres were well accessed and valued by HCWs, but their relationship with wellbeing and job-related factors is not well established. The aim of this study was to explore the relationship between wellbeing centre use, HCWs wellbeing and job-related factors (job stressfulness, job satisfaction, presenteeism, turnover intentions).

Methods

Secondary analysis of data from 819 HCWs from an acute hospital trust who completed an online survey in April-July 2020, as part of the COVID-Well study. Measures included the Warwick Edinburgh Mental Wellbeing Scale, and four single-item global measures of job stressfulness, job satisfaction, presenteeism and turnover intentions. ANCOVA models and regression analyses were conducted on these data.

Results

HCWs who had not accessed the wellbeing centres had lower wellbeing (β = 0.12, p < .001), higher job stressfulness (β = − 0.22, p < .001), lower job satisfaction (β = 0.39, p < .001), higher presenteeism (β = − 0.22, p < .001) and were of younger age (β = 0.09, p = .002). Centre use was associated with wellbeing irrespective of job stressfulness. Those reporting presenteeism and who accessed the centre (M = 3.30, SE = 0.04) had higher wellbeing than those who accessed the centre but did not report presenteeism (M = 3.06, SE = 0.04) (F(1, 791) = 18.65, p < .001, ηp2 = 0.02). Centre use was not significantly associated with turnover intentions (B = − 0.30, p = .13; Wald = 2.26; odds = 0.74), while job stress and job satisfaction showed significant effects.

Conclusions

Accessing wellbeing centres was associated with higher wellbeing of HCWs, particularly for those reporting presenteeism. Therefore, the centres may have provided greatest respite and restoration for those present at work but not in optimal health. Younger workers were disproportionately affected in terms of wellbeing, and targeted support for this population is needed. Strategies to decrease presenteeism and maximise job satisfaction are urgently required. Healthcare organisations should provide rest spaces and psychological support to HCWs for the long-term, as part of a systems-wide approach to improving workforce health and wellbeing.
Adjuvant screening of the Senecavirus A inactivated vaccine in mice and evaluation of its immunogenicity in pigs
Authors: Zhang Jinyong , Wang Peng , Li Zhuoxin , Xie Yubiao , Jin Ningyi , Zhang He , Lu Huijun , Han Jicheng
Published: March 2024

Background

Senecavirus A (SVA) causes an emerging vesicular disease (VD) with clinical symptoms indistinguishable from other vesicular diseases, including vesicular stomatitis (VS), foot-and-mouth disease (FMD), and swine vesicular disease (SVD). Currently, SVA outbreaks have been reported in Canada, the U.S.A, Brazil, Thailand, Vietnam, Colombia, and China. Based on the experience of prevention and control of FMDV, vaccines are the best means to prevent SVA transmission.

Results

After preparing an SVA inactivated vaccine (CH-GX-01-2019), we evaluated the immunogenicity of the SVA inactivated vaccine mixed with Imject® Alum (SVA + AL) or Montanide ISA 201 (SVA + 201) adjuvant in mice, as well as the immunogenicity of the SVA inactivated vaccine combined with Montanide ISA 201 adjuvant in post-weaned pigs. The results of the mouse experiment showed that the immune effects in the SVA + 201 group were superior to that in the SVA + AL group. Results from pigs immunized with SVA inactivated vaccine combined with Montanide ISA 201 showed that the immune effects were largely consistent between the SVA-H group (200 µg) and SVA-L group (50 µg); the viral load in tissues and blood was significantly reduced and no clinical symptoms occurred in the vaccinated pigs.

Conclusions

Montanide ISA 201 is a better adjuvant choice than the Imject® Alum adjuvant in the SVA inactivated vaccine preparation, and the CH-GX-01-2019 SVA inactivated vaccine can provide effective protection for pigs.
Association and mediation between educational attainment and respiratory diseases: a Mendelian randomization study
Authors: Lan Guohui , Xie Mengying , Lan Jieli , Huang Zelin , Xie Xiaowei , Liang Mengdan , Chen Zhehui , Jiang Xiannuan , Lu Xiaoli , Ye Xiaoying , Xu Tingting , Zeng Yiming , Xie Xiaoxu
Published: March 2024

Background

Respiratory diseases are a major health burden, and educational inequalities may influence disease prevalence. We aim to evaluate the causal link between educational attainment and respiratory disease, and to determine the mediating influence of several known modifiable risk factors.

Methods

We conducted a two-step, two-sample Mendelian randomization (MR) analysis using summary statistics from genome-wide association studies (GWAS) and single nucleotide polymorphisms (SNPs) as instrumental variables for educational attainment and respiratory diseases. Additionally, we performed a multivariable MR analysis to estimate the direct causal effect of each exposure variable included in the analysis on the outcome, conditional on the other exposure variables included in the model. The mediating roles of body mass index (BMI), physical activity, and smoking were also assessed.

Findings

MR analyses provide evidence of genetically predicted educational attainment on the risk of FEV1 (β = 0.10, 95% CI 0.06, 0.14), FVC (β = 0.12, 95% CI 0.07, 0.16), FEV1/FVC (β = − 0.005, 95% CI − 0.05, 0.04), lung cancer (OR = 0.54, 95% CI 0.45, 0.65) and asthma (OR = 0.86, 95% CI 0.78, 0.94). Multivariable MR dicated the effect of educational attainment on FEV1 (β = 0.10, 95% CI 0.04, 0.16), FVC (β = 0.07, 95% CI 0.01, 0.12), FEV1/FVC (β = 0.07, 95% CI 0.01, 0.01), lung cancer (OR = 0.55, 95% CI 0.42, 0.71) and asthma (OR = 0.88, 95% CI 0.78, 0.99) persisted after adjusting BMI and cigarettes per day. Of the 23 potential risk factors, BMI, smoking may partially mediate the relationship between education and lung disease.

Conclusion

High levels of educational attainment have a potential causal protective effect on respiratory diseases. Reducing smoking and adiposity may be a target for the prevention of respiratory diseases attributable to low educational attainment.
Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review
Authors: Farabaugh Ronald , Hawk Cheryl , Taylor Dave , Daniels Clinton , Noll Claire , Schneider Mike , McGowan John , Whalen Wayne , Wilcox Ron , Sarnat Richard , Suiter Leonard , Whedon James
Published: March 2024

Background

The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

Methods

A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

Results

The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

Conclusion

Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted.
Repeatability quantification of brain diffusion-weighted imaging for future clinical implementation at a low-field MR-linac
Authors: Rabe Moritz , Dietrich Olaf , Forbrig Robert , Niyazi Maximilian , Belka Claus , Corradini Stefanie , Landry Guillaume , Kurz Christopher
Published: March 2024

Background

Longitudinal assessments of apparent diffusion coefficients (ADCs) derived from diffusion-weighted imaging (DWI) during intracranial radiotherapy at magnetic resonance imaging-guided linear accelerators (MR-linacs) could enable early response assessment by tracking tumor diffusivity changes. However, DWI pulse sequences are currently unavailable in clinical practice at low-field MR-linacs. Quantifying the in vivo repeatability of ADC measurements is a crucial step towards clinical implementation of DWI sequences but has not yet been reported on for low-field MR-linacs. This study assessed ADC measurement repeatability in a phantom and in vivo at a 0.35 T MR-linac.

Methods

Eleven volunteers and a diffusion phantom were imaged on a 0.35 T MR-linac. Two echo-planar imaging DWI sequence variants, emphasizing high spatial resolution (“highRes”) and signal-to-noise ratio (“highSNR”), were investigated. A test–retest study with an intermediate outside-scanner-break was performed to assess repeatability in the phantom and volunteers’ brains. Mean ADCs within phantom vials, cerebrospinal fluid (CSF), and four brain tissue regions were compared to literature values. Absolute relative differences of mean ADCs in pre- and post-break scans were calculated for the diffusion phantom, and repeatability coefficients (RC) and relative RC (relRC) with 95% confidence intervals were determined for each region-of-interest (ROI) in volunteers.

Results

Both DWI sequence variants demonstrated high repeatability, with absolute relative deviations below 1% for water, dimethyl sulfoxide, and polyethylene glycol in the diffusion phantom. RelRCs were 7% [5%, 12%] (CSF; highRes), 12% [9%, 22%] (CSF; highSNR), 9% [8%, 12%] (brain tissue ROIs; highRes), and 6% [5%, 7%] (brain tissue ROIs; highSNR), respectively. ADCs measured with the highSNR variant were consistent with literature values for volunteers, while smaller mean values were measured for the diffusion phantom. Conversely, the highRes variant underestimated ADCs compared to literature values, indicating systematic deviations.

Conclusions

High repeatability of ADC measurements in a diffusion phantom and volunteers’ brains were measured at a low-field MR-linac. The highSNR variant outperformed the highRes variant in accuracy and repeatability, at the expense of an approximately doubled voxel volume. The observed high in vivo repeatability confirms the potential utility of DWI at low-field MR-linacs for early treatment response assessment.
Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study
Authors: Wang Tianyu , Wu Dongwei , Li Chengsi , Cheng Xinqun , Yang Zhenbang , Zhang Yingze , Zhu Yanbin
Published: March 2024

Background

No large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH.

Method

From our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis.

Result

There were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031).

Conclusion

Although ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.
Investigating the in vitro antibacterial efficacy of composite bone cement incorporating natural product-based monomers and gentamicin
Authors: Kan Yu-Chen , Guo Rui , Xu Yang , Han Lu-Yang , Bu Wen-Han , Han Long-Xu , Chu Jian-Jun
Published: March 2024

Objective

The objective of this study is to investigate the impact of four natural product extracts, namely, aloe-emodin, quercetin, curcumin, and tannic acid, on the in vitro bacteriostatic properties and biocompatibility of gentamicin-loaded bone cement and to establish an experimental groundwork supporting the clinical utility of antibiotic-loaded bone cements (ALBC).

Methods

Based on the components, the bone cement samples were categorized as follows: the gentamicin combined with aloe-emodin group, the gentamicin combined with quercetin group, the gentamicin combined with curcumin group, the gentamicin combined with tannic acid group, the gentamicin group, the aloe-emodin group, the quercetin group, the curcumin group, and the tannic acid group. Using the disk diffusion test, we investigated the antibacterial properties of the bone cement material against Staphylococcus aureus (n = 4). We tested cell toxicity and proliferation using the cell counting kit-8 (CCK-8) and examined the biocompatibility of bone cement materials.

Results

The combination of gentamicin with the four natural product extracts resulted in significantly larger diameters of inhibition zones compared to gentamicin alone, and the difference was statistically significant (P < 0.05). Except for the groups containing tannic acid, cells in all other groups showed good proliferation across varying time intervals without displaying significant cytotoxicity (P < 0.05).

Conclusion

In this study, aloe-emodin, quercetin, curcumin, and tannic acid were capable of enhancing the in vitro antibacterial performance of gentamicin-loaded bone cement against S. aureus. While the groups containing tannic acid displayed moderate cytotoxicity in in vitro cell culture, all other groups showed no discernible cytotoxic effects.
Metabolic, cognitive and neuromuscular responses to different multidirectional agility-like sprint protocols in elite female soccer players – a randomised crossover study
Authors: Raeder Christian , Kämper Meike , Praetorius Arthur , Tennler Janina-Sophie , Schoepp Christian
Published: March 2024

Purpose

Resistance to fatigue is a key factor in injury prevention that needs to be considered in return-to-sport (RTS) scenarios, especially after severe knee ligament injuries. Fatigue should be induced under game-like conditions. The SpeedCourt (SC) is a movement platform for assessing multidirectional sprint performance, typical of game-sports, due to change-of-direction movements in response to a visual stimulus. Designing adequate fatigue protocols requires the suitable arrangement of several loading variables such as number of intervals, sprint distance or work/relief ratio (W:R). Therefore, this study analysed the acute fatigue effects of different SC protocols on metabolic load, cognitive function and neuromuscular performance.

Methods

Eighteen female soccer players (mean ± SD; age: 23.1 ± 4.6 years) of the 1st German Division participated in this randomised, crossover study. Using a random allocation sequence, players completed four volume-equated protocols differing in W:R and sprint distance per interval (P1:12 × 30 m, W:R = 1:2 s; P2:12 × 30 m, W:R = 1:3 s; P3:18 × 20 m, W:R = 1:2 s; P4:18 × 20 m, W:R = 1:3 s). Pre- and post-exercise, metabolic load was measured per blood lactate concentration (BLaC), cognitive function per reaction time (RT), and neuromuscular performance including multiple rebound jumps (MRJ height, primary outcome variable; Reactive Strength Index, RSI) and 5 m sprint times (SP5).

Results

Repeated-measures ANOVA revealed significant main time effects (p < .05) with improved performance post-exercise in RT (504 vs. 482 ms, d = 1.95), MRJ height (24.0 vs. 24.8 cm, d = 0.77), RSI (1.39 vs. 1.43, d = 0.52), and SP5 (1.19 vs. 1.17 s, d = 0.56). There was significant main time (p < .001) and time x protocol interaction effects in BLaC (p < .001). P1 induced higher BLaC values (4.52 ± 1.83 mmol/L) compared to P2 (3.79 ± 1.83 mmol/L; d = 0.74) and P4 (3.12 ± 1.83 mmol/L; d = 1.06), whereas P3 (4.23 ± 1.69 mmol/L) elicited higher BLaC values compared to P4 (d = 0.74).

Conclusion

All protocols caused an improved cognitive function and neuromuscular performance. The former may be related to enhanced noradrenergic activation or exercise specificity which induced an improved stimulus processing. The latter may be explained by a possible post-activation performance enhancement effect on jump and sprint performance. A shorter relief duration in W:R as opposed to sprint distance per interval produced higher BLaC values. The protocols may serve as reference data for improved RTS decision-making in elite female soccer players.

Trial registration

Deutsches Register Klinischer Studien (DRKS), No.: DRKS00033496, Registered 19. Februar 2024, Retrospectively Registered.
Transient binocular vision loss and pain insensitivity in Klippel–Feil syndrome: a case report
Authors: Ullah Zeeshan , Zafar Ayesha , Ishaq Hira , Umar Zainab , Khan Amir , Badar Yaseen , Din Nizamud , Khan Muhammad Fawad , McCombe Pamela , Khan Nemat
Published: March 2024

Background

Klippel–Feil syndrome is a rare congenital bone disorder characterized by an abnormal fusion of two or more cervical spine vertebrae. Individuals with Klippel–Feil syndrome exhibit diverse clinical manifestations, including skeletal irregularities, visual and hearing impairments, orofacial anomalies, and anomalies in various internal organs, such as the heart, kidneys, genitourinary system, and nervous system.

Case presentation

This case report describes a 12-year-old Pashtun female patient who presented with acute bilateral visual loss. The patient had Klippel–Feil syndrome, with the typical clinical triad symptoms of Klippel–Feil syndrome, along with Sprengel’s deformity. She also exhibited generalized hypoalgesia, which had previously resulted in widespread burn-related injuries. Upon examination, bilateral optic disc swelling was observed, but intracranial pressure was found to be normal. Extensive investigations yielded normal results, except for hypocalcemia and low vitamin D levels, while parathyroid function remained within the normal range. Visual acuity improved following 2 months of calcium and vitamin D supplementation, suggesting that the visual loss and optic nerve swelling were attributed to hypocalcemia. Given the normal parathyroid function, it is possible that hypocalcemia resulted from low vitamin D levels, which can occur after severe burn scarring. Furthermore, the patient received a provisional diagnosis of congenital insensitivity to pain on the basis of the detailed medical history and the findings of severe and widespread loss of the ability to perceive painful stimuli, as well as impaired temperature sensation. However, due to limitations in genetic testing, confirmation of the congenital insensitivity to pain diagnosis could not be obtained.

Conclusion

This case highlights a rare presentation of transient binocular vision loss and pain insensitivity in a patient with Klippel–Feil syndrome, emphasizing the importance of considering unusual associations in symptom interpretation.
Automated surveillance of non-ventilator-associated hospital-acquired pneumonia (nvHAP): a systematic literature review
Authors: Wolfensberger Aline , Scherrer Alexandra U. , Sax Hugo
Published: March 2024

Background

Hospital-acquired pneumonia (HAP) and its specific subset, non-ventilator hospital-acquired pneumonia (nvHAP) are significant contributors to patient morbidity and mortality. Automated surveillance systems for these healthcare-associated infections have emerged as a potentially beneficial replacement for manual surveillance. This systematic review aims to synthesise the existing literature on the characteristics and performance of automated nvHAP and HAP surveillance systems.

Methods

We conducted a systematic search of publications describing automated surveillance of nvHAP and HAP. Our inclusion criteria covered articles that described fully and semi-automated systems without limitations on patient demographics or healthcare settings. We detailed the algorithms in each study and reported the performance characteristics of automated systems that were validated against specific reference methods. Two published metrics were employed to assess the quality of the included studies.

Results

Our review identified 12 eligible studies that collectively describe 24 distinct candidate definitions, 23 for fully automated systems and one for a semi-automated system. These systems were employed exclusively in high-income countries and the majority were published after 2018. The algorithms commonly included radiology, leukocyte counts, temperature, antibiotic administration, and microbiology results. Validated surveillance systems' performance varied, with sensitivities for fully automated systems ranging from 40 to 99%, specificities from 58 and 98%, and positive predictive values from 8 to 71%. Validation was often carried out on small, pre-selected patient populations.

Conclusions

Recent years have seen a steep increase in publications on automated surveillance systems for nvHAP and HAP, which increase efficiency and reduce manual workload. However, the performance of fully automated surveillance remains moderate when compared to manual surveillance. The considerable heterogeneity in candidate surveillance definitions and reference standards, as well as validation on small or pre-selected samples, limits the generalisability of the findings. Further research, involving larger and broader patient populations is required to better understand the performance and applicability of automated nvHAP surveillance.
A randomized trial of the Caregiver Interaction Profile (CIP) training with childcare providers: the Copenhagen Daycare Project study protocol
Authors: Reijman Sophie , Christensen Vieira Clara , Wahl Haase Tina , Helmerhorst Katrien O. W. , Pontoppidan Maiken , Grosen Sofie Amalie , Egmose Ida , Røhder Katrine , Skovgaard Vaever Mette
Published: March 2024

Background

Most young children (0–3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0–3 years) are of “insufficient” quality, which constitutes a risk for affected children’s well-being and development. Effective interventions to improve childcare providers’ interactive skills are necessary.

Methods

In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children’s autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers’ six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children’s social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers’ nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers.

Discussion

If the training is effective at improving childcare providers’ interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3–5 years) in Danish kindergartens.

Trial registration

This trial is registered at clinicaltrials.gov as “Testing the Effects of the Caregiver Interaction Profile Training on the Interactive Skills of Daycare Providers (CDP)” with registry ID NCT05654116. Registration date: 12/01/2022.
Epidemiologic analysis of antimicrobial resistance in hospital departments in China from 2022 to 2023
Authors: Bai Hui-Jun , Geng Qing-Feng , Jin Fang , Yang Yong-Li
Published: March 2024

Bacterial drug resistance monitoring in hospitals is a crucial aspect of healthcare management and a growing concern worldwide. In this study, we analysed the bacterial drug resistance surveillance in our hospital from 2022 Q1 to 2023 Q2. The main sampling sources were respiratory, blood, and urine-based, and the main clinical infections were respiratory and genitourinary in nature. Specimens were inoculated and cultured; bacterial strains were isolated using a VITEK® 2 Compact 60-card automatic microorganism identifier (bioMerieux, Paris, France) and their matching identification cards were identified, and manual tests were supplemented for strain identification. The most common Gram-positive bacteria detected were Staphylococcus aureus, followed by Enterococcus faecalis (E. faecalis), Staphylococcus epidermidis (S. epidermidis), and Staphylococcus haemolyticus (S. haemolyticus). The most common Gram-negative bacteria detected were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The most prevalent multidrug-resistant bacteria were those producing extended-spectrum beta-lactamases, followed by methicillin-resistant Staphylococcus aureus, followed by carbapenem-resistant Enterobacterales. This study suggests that the prevention and control of infections in the respiratory and genitourinary systems should be the focus of anti-infective work and that the use of antimicrobials should be reduced and regulated to prevent the emergence and spread of resistant bacteria.