bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: a meta-analysis
Authors: Qian Jialu , Sun Shiwen , Liu Lu , Yu Xiaoyan
Published: September 2021

Background

Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. This meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae.

Methods

The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until June 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions conducted during 0 ~ 78 weeks postpartum for fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. Cohen’s kappa coefficient was used to measure inter-rater agreement. The meta-analysis was conducted using Review Manager 5.3.

Results

Seventeen published clinical trials matched the eligibility criteria and ten studies involving 1194 participants were included in this meta-analysis. The intervention start time varied from immediately postpartum care to 1 year after delivery, and duration ranged from 1 day to 3 months. The results revealed that exercise (SMD = − 1.74, 95% CI = -2.61 to − 0.88) and drinking tea (MD = − 3.12, 95% CI = -5.44 to − 0.80) resulted in significant improvements in women’s postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD = − 2.89, 95% CI = -4.30 to − 1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed. Physical therapies including mother-infant skin-to-skin contact, taking warm showers and breathing lavender oil aroma were used for reducing postpartum fatigue. No significant risk of publication bias was found. Small number of included studies and sample sizes, not time-matched conditions of control groups, high heterogeneity and the risk of bias within the included studies were the main limitations of our review.

Conclusions

This review provides evidence that exercise and drinking tea may be effective nonpharmacological interventions for relieving postpartum fatigue. More effective and targeted exercise programs need to be further studied. Rigorous RCTs of drinking tea are needed. Caution is required when interpreting the findings due to the limitations of our study. Further studies are still needed to validate our findings and increase confidence in the results.
On the cost-effectiveness of insecticide-treated wall liner and indoor residual spraying as additions to insecticide treated bed nets to prevent malaria: findings from cluster randomized trials in Tanzania
Authors: Mpangala Kihomo Robert , Halasa-Rappel Yara A. , Mohamed Mohamed Seif , Mnzava Ruth C. , Mkuza Kaseem J. , Mangesho Peter E. , Kisinza William N. , Mugasa Joseph P. , Messenger Louisa A. , Mtove George , Kihombo Aggrey R. , Shepard Donald S.
Published: September 2021

Background

Despite widespread use of long-lasting insecticidal nets (LLINs) and other tools, malaria caused 409,000 deaths worldwide in 2019. While indoor residual spraying (IRS) is an effective supplement, IRS is moderately expensive and logistically challenging. In endemic areas, IRS requires yearly application just before the main rainy season and potential interim reapplications. A new technology, insecticide-treated wall liner (ITWL), might overcome these challenges.

Methods

We conducted a 44-cluster two-arm randomized controlled trial in Muheza, Tanzania from 2015 to 2016 to evaluate the cost and efficacy of a non-pyrethroid ITWL to supplement LLINs, analyzing operational changes over three installation phases. The estimated efficacy (with 95% confidence intervals) of IRS as a supplement to LLINs came mainly from a published randomized trial in Muleba, Tanzania. We obtained financial costs of IRS from published reports and conducted a household survey of a similar IRS program near Muleba to determine household costs. The costs of ITWL were amortized over its 4-year expected lifetime and converted to 2019 US dollars using Tanzania’s GDP deflator and market exchange rates.

Results

Operational improvements from phases 1 to 3 raised ITWL coverage from 35.1 to 67.1% of initially targeted households while reducing economic cost from $34.18 to $30.56 per person covered. However, 90 days after installing ITWL in 5666 households, the randomized trial was terminated prematurely because cone bioassay tests showed that ITWL no longer killed mosquitoes and therefore could not prevent malaria. The ITWL cost $10.11 per person per year compared to $5.69 for IRS. With an efficacy of 57% (3–81%), IRS averted 1162 (61–1651) disability-adjusted life years (DALYs) per 100,000 population yearly. Its incremental cost-effectiveness ratio (ICER) per DALY averted was $490 (45% of Tanzania’s per capita gross national income).

Conclusions

These findings provide design specifications for future ITWL development and implementation. It would need to be efficacious and more effective and/or less costly than IRS, so more persons could be protected with a given budget. The durability of a previous ITWL, progress in non-pyrethroid tools, economies of scale and competition (as occurred with LLINs), strengthened community engagement, and more efficient installation and management procedures all offer promise of achieving these goals. Therefore, ITWLs merit ongoing study.

First posted

2015 (NCT02533336).
Spatial and temporal analysis of myocardial infarction incidence in Zanjan province, Iran
Authors: Soleimani Mohsen , Bagheri Nasser
Published: September 2021

Background

Myocardial Infarction (MI) is a major important public health concern and has huge burden on health system across the world. This study aimed to explore the spatial and temporal analysis of the incidence of MI to identify potential clusters of the incidence of MI patterns across rural areas in Zanjan province, Iran.

Materials & methods

This was a retrospective and geospatial analysis study of the incidence of MI data from nine hospitals during 2014–2018. Three different spatial analysis methods (Spatial autocorrelation, hot spot analysis and cluster and outlier analysis) were used to identify potential clusters and high-risk areas of the incidence of MI at the study area.

Results

Three thousand eight hundred twenty patients were registered at Zanjan hospitals due to MI during 2014–2018. The overall age-adjusted incidence rate of MI was 343 cases per 100,000 person which was raised from 88 cases in 2014 to 114 cases in 2018 per 100,000 person-year (a 30% increase, P < 0.001). Golabar region had the highest age-adjusted incidence rate of MI (515 cases per 100,000 person). Five hot spots and one high-high cluster were detected using spatial analysis methods.

Conclusion

This study showed that there is a great deal of spatial variations in the pattern of the incidence of MI in Zanjan province. The high incidence rate of MI in the study area compared to the national average, is a warning to local health authorities to determine the possible causes of disease incidence and potential drivers of high-risk areas. The spatial cluster analysis provides new evidence for policy-makers to design tailored interventions to reduce the incidence of MI and allocate health resource to unmet need areas.
Association between exposure to ambient air pollution and occurrence of inflammatory acne in the adult population
Authors: El Haddad Claudia , Gerbaka Nour-Estelle , Hallit Souheil , Tabet Carmen
Published: September 2021

Background

Acne vulgaris is one of the most prevalent skin diseases responsible for dermatological consultations. Several internal and external factors can affect acne occurrence and severity. Outdoor air pollution is an external factor discussed to trigger inflammation of the skin. The objective of this study was to find a link between the exposure to ambient air pollution and inflammatory acne occurrence in the Lebanese adult population.

Methods

A cross-sectional study was conducted, using an online questionnaire to collect the required data from different Lebanese regions. The survey covered pollution exposure questions as well as queries on several factors known to have a role on acne occurrence.

Results

A total of 372 participants were included in the study, aged 18 to 55 years old. The results of a logistic regression taking the presence/absence of acne as the dependent variable, showed that female gender (aOR = 4.39), younger age (aOR = 1.05), using hydrating cream (aOR = 4.30), working near a power plant vs not (aOR = 3.07), having a severe NO2 exposure compared to none (aOR = 8.24), a higher number of family members with acne or history of acne (aOR = 1.48) were significantly associated with higher odds of having acne, whereas having a dry skin compared to normal (aOR = 0.20) was significantly associated with lower odds of having acne.

Conclusion

The occurrence of inflammatory acne in Lebanese adults was found to be associated with ambient exposure to high levels of NO2 and employment near a power plant known to emit CO2, CO, SO2, NO2 and PM. Therefore, our findings can serve as a first step towards implementing awareness on a skin care routine suitable for highly polluted areas.
Physical activity in Sami and non-Sami populations in rural Northern Norway, the SAMINOR 2 Clinical Survey
Authors: Borch Kristin Benjaminsen , Eliassen Bent Martin , Melhus Marita , Damsgård Elin , Broderstad Ann Ragnhild
Published: September 2021

Background

The Sami people is an indigenous minority population living in the northern parts of Norway and mainly in rural areas. We lack data of contemporary levels of physical activity (PA) in rural regions of Northern Norway and in the Sami population in particular. We aimed to describe the PA levels and investigate whether PA levels differs between Sami and non-Sami and between coastal and inland areas.

Methods

We used data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations – the SAMINOR 2 Clinical Survey (2012–2014) that includes the adult population in 10 municipalities in the counties Troms, Finnmark and Nordland. Participants self-reported on PA, ethnicity and modifiable lifestyle factors. Twelve thousand four hundred fifty-five individuals were invited with a response rate of 48.2% (n = 6004 participants). We tested differences using chi-square tests, two sample t-tests and linear regression models.

Results

Among 5628 participants, 41.1 and 40.9% of men and women, respectively, were defined as Sami. We found no ethnic differences in PA in men overall. However, Sami men living in Tana, and Nesseby reported higher PA compared to non-Sami men in the same area. For Sami women there was overall lower PA levels compared to non-Sami women, especially pronounced in Kautokeino/ Karasjok.

Conclusion

This study showed small differences in PA levels between Sami and non-Sami men. Sami women had lower PA levels compared to their non-Sami counterparts. It is important to identify whether there are differences in various ethnic populations, together with other predictors for PA in future planning of public health interventions.
Dysregulation of ribosome-related genes in ankylosing spondylitis: a systems biology approach and experimental method
Authors: Lari Arezou , Pourbadie Hamid Gholami , Sharifi-Zarchi Ali , Akhtari Maryam , Samimi Leila Nejatbakhsh , Jamshidi Ahmadreza , Mahmoudi Mahdi
Published: September 2021

Background

Ankylosing spondylitis (AS) is an autoimmune rheumatic disease. Few candidate gene associations have been reported for AS and the current understanding of its pathogenesis remains still poor. Thus, the exact mechanism of AS is needed to urgently be disclosed. The purpose of this study was to identify candidate genes involving in AS disease.

Methods and results

GSE25101 publicly available microarray and GSE117769 RNA-seq datasets of AS patients were obtained for bioinformatics analyses. Gene set enrichment analysis showed that in the microarray dataset, the ribosome pathway was significantly up-regulated in AS compared with controls. Furthermore, some ribosomal components demonstrated overexpression in patients in the RNA-seq dataset. To confirm the findings, 20 AS patients and 20 matching controls were selected from the Rheumatology Research Center clinic, Shariati Hospital. PBMCs were separated from whole blood and RNA contents were extracted. Following the results of datasets analysis, the expression level of rRNA5.8S pseudogene, rRNA18S pseudogene, RPL23, RPL7, and RPL17 genes were measured through real-time PCR. Our findings showed dysregulation of rRNA5.8S and rRNA18S pseudogenes, and also the RPL17 gene in patients.

Conclusion

Considering that genes involved in ribosome biogenesis contributed to some AS-associated biological processes as well as diseases that have comorbidities with AS, our results might advance our understanding of the pathological mechanisms of ankylosing spondylitis.
Outbreak of oral ulcers (glossitis) among the students of three central schools under Tsirang district Bhutan, 2018
Authors: Gyeltshen Tshewang , Dorji Lham , Dorj Leki , Choden Kuenga
Published: September 2021

Background

Nutritional deficiencies are common worldwide and is most notable in low and middle income countries. In the early weeks of September 2018, oral sores mostly affecting the tongue were reported in three central schools under Tsirang district, Bhutan. A total of 204 students were affected in the three central schools. All the affected students have been assessed on the outbreak and nutritional survey was conducted in the three schools.

Methods

A total of 204 students who complained of different oral lesions in the affected three schools were screened by the dental surgeon for clinical assessment and administered questionnaire for nutritional assessment by the nutritionist. Twenty-one students randomly selected were sent for blood tests for micronutrient assays and complete blood count. 41 students were tested for Exfoliative cell cytology to test for fungal elements. The collected data was double entered and validated using Epi-Data version 3.1 and analysed using Stata 15 IC. The characteristics of the participants are presented as frequencies, percentages, mean and standard deviation (SD).

Results

Almost all the affected students in all the three schools had complaints of Burning Sensation (n = 158) followed by Pain (n = 153), Impaired Taste Sensation (n = 100) and Intolerance to Spicy Food (n = 95). Nutritional assessment analysis suggested schools not meeting the Recommended Dietary Allowance (RDA) for all components of Vitamin B complexes and Iron.

Conclusion

Clinical assessments and nutritional survey analysis found inadequate vitamin rich dietary intakes among all the three schools. Implementation of a strict school feeding program with a balanced diet has been suggested accordingly.
Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact
Authors: Rahimi-Ardabili Hania , Spooner Catherine , Harris Mark F. , Magin Parker , Tam Chun Wah Michael , Liaw Siaw-Teng , Zwar Nicholas
Published: September 2021

Background

Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods).

Methods

Mixed-method data collection was conducted after individual registrars’ completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016–2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews.

Results

The data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen’s d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences.

Conclusions

This study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor’s role on GP registrars’ ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.
Mangroves are an overlooked hotspot of insect diversity despite low plant diversity
Authors: Yeo Darren , Srivathsan Amrita , Puniamoorthy Jayanthi , Maosheng Foo , Grootaert Patrick , Chan Lena , Guénard Benoit , Damken Claas , Wahab Rodzay A. , Yuchen Ang , Meier Rudolf
Published: September 2021

Background

The world’s fast disappearing mangrove forests have low plant diversity and are often assumed to also have a species-poor insect fauna. We here compare the tropical arthropod fauna across a freshwater swamp and six different forest types (rain-, swamp, dry-coastal, urban, freshwater swamp, mangroves) based on 140,000 barcoded specimens belonging to ca. 8500 species.

Results

We find that the globally imperiled habitat “mangroves” is an overlooked hotspot for insect diversity. Our study reveals a species-rich mangrove insect fauna (>3000 species in Singapore alone) that is distinct (>50% of species are mangrove-specific) and has high species turnover across Southeast and East Asia. For most habitats, plant diversity is a good predictor of insect diversity, but mangroves are an exception and compensate for a comparatively low number of phytophagous and fungivorous insect species by supporting an unusually rich community of predators whose larvae feed in the productive mudflats. For the remaining tropical habitats, the insect communities have diversity patterns that are largely congruent across guilds.

Conclusions

The discovery of such a sizeable and distinct insect fauna in a globally threatened habitat underlines how little is known about global insect biodiversity. We here show how such knowledge gaps can be closed quickly with new cost-effective NGS barcoding techniques.
Rainfall driven and wild-bird mediated avian influenza virus outbreaks in Australian poultry
Authors: Ferenczi Marta , Beckmann Christa , Klaassen Marcel
Published: September 2021

Globally, outbreaks of Avian Influenza Virus (AIV) in poultry continue to burden economies and endanger human, livestock and wildlife health. Wild waterbirds are often identified as possible sources for poultry infection. Therefore, it is important to understand the ecological and environmental factors that directly influence infection dynamics in wild birds, as these factors may thereby indirectly affect outbreaks in poultry. In Australia, where large parts of the country experience erratic rainfall patterns, intense rainfalls lead to wild waterfowl breeding events at temporary wetlands and increased proportions of immunologically naïve juvenile birds. It is hypothesized that after breeding, when the temporary wetlands dry, increasing densities of immunologically naïve waterbirds returning to permanent water bodies might strongly contribute to AIV prevalence in wild waterfowl in Australia. Since rainfall has been implicated as an important environmental driver in AIV dynamics in wild waterbirds in southeast Australia and wild waterbirds are identified globally to have a role in virus spillover into poultry, we hypothesise that rainfall events have an indirect effect on AIV outbreaks in poultry in southeast Australia. In this study we investigated this hypothesis by examining the correlation between the timing of AIV outbreaks in poultry in and near the Murray-Darling basin in relation to temporal patterns in regional rainfall since 1970. Our findings support our hypothesis and suggest that the risk of AIV outbreaks in poultry increases after a period of high rainfall, with peak AIV risk two years after the onset of the high-rainfall period. This is presumably triggered by increased rates of waterbird breeding and consequent higher proportions of immunologically naïve juvenile waterbirds entering the population directly after major rainfall events, which subsequently aggregate near permanent water bodies when the landscape dries out.
Engineered exosomes loaded with miR-449a selectively inhibit the growth of homologous non-small cell lung cancer
Authors: Zhou Wen , Xu Mingming , Wang Zhipeng , Yang Mingjun
Published: September 2021

As an efficient drug carrier, exosome has been widely used in the delivery of genetic drugs, chemotherapeutic drugs, and anti-inflammatory drugs. As a genetic drug carrier, exosomes are beneficial to improve transfection efficiency and weaken side effects at the same time. Here, we use genetic engineering to prepare engineered exosomes (miR-449a Exo) that can actively deliver miR-449a. It was verified that miR-449a Exo had good homology targeting capacity and was specifically taken up by A549 cells. Moreover, miR-449a Exo had high delivery efficiency of miR-449a in vitro and in vivo. We demonstrated that miR-449a Exo effectively inhibited the proliferation of A549 cells and promoted their apoptosis. In addition, miR-449a Exo was found to control the progression of mouse tumors and prolong their survival in vivo. Our research provides new ideas for exosomes to efficiently and actively load gene drugs, and finds promising methods for the treatment of non-small cell lung cancer.
Global accreditation practices for accelerated medically trained clinicians: a view of five countries
Authors: Antwi James , Arkoh Anthony Asare , Choge Joseph Kiprop , Dibo Turi Woticha , Mahmud Alias , Vankhuu Enkhtuya , Wanyama Erick Kizito , McKinley Danette Waller
Published: September 2021

Background

Shortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in five countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia.

Method

Using open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context.

Results

Accreditation practices in the five countries are generally aligned with the WHO indicators with some exceptions. All countries had standards for pre-service and in-service training. It was difficult to determine the extent to which social accountability and social determinants of health were explicitly part of accreditation practices as this cadre of practitioners evolved out of community health needs. Other areas of discrepancy were interprofessional education and continuing professional development.

Discussion

While it is possible to use NHWA module 3 indicators there are disadvantages as well, at least for accelerated medically trained clinicians. There are aspects of accreditation practices that are not readily coded in the standard definitions used for the indicators. While the indicators provide detailed definitions, some invite social desirability bias and others are not as easily understood by practitioners whose roles continue to evolve and adapt to their health systems.

Conclusion

Regular review and revision of indicators are essential to facilitate uptake of the NHWA for planning and monitoring healthcare providers.
Projecting health labor market dynamics for a health system in transition: planning for a resilient health workforce in Saudi Arabia
Authors: Lin Tracy Kuo , Bruckner Tim A. , Alghaith Taghred , Hamza Mariam M. , Alluhidan Mohammed , Herbst Christopher H. , Alghodaier Hussah , Alamri Adwa , Saber Rana , Alazemi Nahar , Liu Jenny X.
Published: September 2021

Background

Health workforce planning is critical for health systems to safeguard the ability to afford, train, recruit, and retain the appropriate number and mix of health workers. This balance is especially important when macroeconomic structures are also reforming. The Kingdom of Saudi Arabia is moving toward greater diversification, privatization, and resiliency; health sector reform is a key pillar of this transition.

Methods

We used the Ministry of Health Yearbook data on the number of workers and health expenditures from 2007 to 2018 and projected health labor market supply and demand of workers through 2030, evaluated the potential shortages and surpluses, and simulated different policy scenarios to identify relevant interventions. We further focused on projections for health workers who are Saudi nationals and health worker demand within the public sector (versus the private sector) to inform national objectives of reducing dependency on foreign workers and better deploying public sector resources.

Results

We projected the overall health labor market to demand 9.07 physicians and nurses per 1,000 population (356,514) in 2030; the public sector will account for approximately 67% of this overall demand. Compared to a projected supply of 10.16 physicians and nurses per 1,000 population (399,354), we estimated an overall modest surplus of about 42,840 physicians and nurses in 2030. However, only about 17% of these workers are estimated to be Saudi nationals, for whom there will be a demand shortage of 287,895 workers. Among policy scenarios considered, increasing work hours had the largest effect on reducing shortages of Saudi workers, followed by bridge programs for training more nurses. Government resources can also be redirected to supporting more Saudi nurses while still ensuring adequate numbers of physicians to meet service delivery goals in 2030.

Conclusion

Despite projected overall balance in the labor market for health workers in 2030, without policy interventions, severe gaps in the Saudi workforce will persist and limit progress toward health system resiliency in Saudi Arabia. Both supply- and demand-side policy interventions should be considered, prioritizing those that increase productivity among Saudi health workers, enhance training for nurses, and strategically redeploy financial resources toward employing these workers.
Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: characterizing an era of intensive rise and fall
Authors: Jones Wayne , Kaoser Ridhwana , Fischer Benedikt
Published: September 2021

Background

Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020.

Methods

Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing.

Results

All provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control.

Conclusions

We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.
Validity of self-reported substance use: research setting versus primary health care setting
Authors: Khalili Parvin , Nadimi Ali Esmaeili , Baradaran Hamid Reza , Janani Leila , Rahimi-Movaghar Afarin , Rajabi Zohre , Rahmani Abdollah , Hojati Zahra , Khalagi Kazem , Motevalian Seyed Abbas
Published: September 2021

Background

Self-reported substance use is more likely to be influenced by underreporting bias compared to the biological markers. Underreporting bias or validity of self-reported substance use depends on the study population and cannot be generalized to the entire population. This study aimed to compare the validity of self-reported substance use between research setting and primary health care setting from the same source population.

Methods and materials

The population in this study included from Rafsanjan Youth Cohort Study (RYCS) and from primary care health centers. The sample from RYCS is made up 607 participants, 113 (18.62%) women and 494 (81.38%) men and sample from PHC centers is made up 522 individuals including 252 (48.28%) women and 270 (51.72%) men. We compared two groups in respect of prevalence estimates based on self-reported substance use and urine test. Then for evaluating validity of self-reported substance use in both group, the results of reference standard, urine tests, were compared with the results of self-reported drug use using measures of concordance.

Results

The prevalence of substance use based on urine test was significantly higher in both settings compared to self-reported substance use over the past 72 h. The sensitivity of self-report substance use over the past 72 h in research setting was 39.4, 20, 10% and zero for opium, methadone, cannabis and amphetamine, respectively and in primary health care setting was 50, 20.7, 12.5% and zero for opium, methadone, cannabis and amphetamine, respectively. The level of agreement between self-reported substance use over the past 72 h and urine test indicated fair and moderate agreement for opium in both research and primary health care settings, respectively and also slight agreement for methadone and cannabis in both settings were reported. There was no significant difference between the two groups in terms of self-reported substance use. For all substances, the level of agreement increased with longer recall periods. The specificity of self-report for all substances in both groups was more than 99%.

Conclusion

Individuals in primary health care setting were more likely to self-reported substance use than in research setting, but setting did not have a statistically significant effect in terms of self-reported substance use. Programs that rely on self-reported substance use may not estimate the exact prevalence of substance use in both research and primary health care settings, especially for substances that have a higher social stigma. Therefore, it is recommended that self-report and biological indicators be used for more accurate evaluation in substance use studies. It is also suggested that future epidemiological studies be performed to reduce bias of social desirability and find a method providing the highest level of privacy.
Predilection for developing a hematogenous orthopaedic implant-associated infection in older versus younger mice
Authors: Thompson John M. , Ashbaugh Alyssa G. , Wang Yu , Miller Robert J. , Pickett Julie E. , Thorek Daniel L. J. , Sterling Robert S. , Miller Lloyd S.
Published: September 2021

Background

The pathogenesis of hematogenous orthopaedic implant-associated infections (HOIAI) remains largely unknown, with little understanding of the influence of the physis on bacterial seeding. Since the growth velocity in the physis of long bones decreases during aging, we sought to evaluate the role of the physis on influencing the development of Staphylococcus aureus HOIAI in a mouse model comparing younger versus older mice.

Methods

In a mouse model of HOIAI, a sterile Kirschner wire was inserted retrograde into the distal femur of younger (5–8-week-old) and older (14–21-week-old) mice. After a 3-week convalescent period, a bioluminescent Staphylococcus aureus strain was inoculated intravenously. Bacterial dissemination to operative and non-operative legs was monitored longitudinally in vivo for 4 weeks, followed by ex vivo bacterial enumeration and X-ray analysis.

Results

In vivo bioluminescence imaging and ex vivo CFU enumeration of the bone/joint tissue demonstrated that older mice had a strong predilection for developing a hematogenous infection in the operative legs but not the non-operative legs. In contrast, this predilection was less apparent in younger mice as the infection occurred at a similar rate in both the operative and non-operative legs. X-ray imaging revealed that the operative legs of younger mice had decreased femoral length, likely due to the surgical and/or infectious insult to the more active physis, which was not observed in older mice. Both age groups demonstrated substantial reactive bone changes in the operative leg due to infection.

Conclusions

The presence of an implant was an important determinant for developing a hematogenous orthopaedic infection in older but not younger mice, whereas younger mice had a similar predilection for developing periarticular infection whether or not an implant was present. On a clinical scale, diagnosing HOIAI may be difficult particularly in at-risk patients with limited examination or other data points. Understanding the influence of age on developing HOIAI may guide clinical surveillance and decision-making in at-risk patients.
Is laminoplasty or laminectomy the best strategy for C3 segment in French-door laminoplasty? A systematic review and meta-analysis
Authors: Chen Tiantian , Zhang Xun , Meng Fanchao , Yan Jinglong , Xu Gongping , Zhao Wei
Published: September 2021

Background

To compare the clinical outcomes of C3 laminectomy and C3 laminoplasty at the C3 segment during French-door laminoplasty.

Methods

The Cochrane Library, PubMed, Embase, and Web of Science databases were searched from inception to November 10, 2020 for studies comparing the clinical outcomes of two types of French-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Review Manager 5.3 was used to analyze the following outcomes: operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, recovery rate, cervical curvature, cervical range of motion (ROM), incidence of axial symptoms (AS), and C2-3 bony fusion rate.

Results

A total of eight studies involving 776 patients were included; there were 424 patients in the C3 laminectomy group and 352 patients in the C3 laminoplasty group. The results of the meta-analysis showed that the C3 laminectomy group was superior to the C3 laminoplasty group in terms of operative time (P < 0.00001), cervical ROM (P = 0.04), and incidence of AS (P < 0.0001). However, no statistically significant differences between the two groups were noted regarding intraoperative bleeding (P = 0.44), preoperative JOA score (P = 0.57), postoperative JOA score (P = 0.09), recovery rate (P = 0.25), cervical curvature (P = 0.22), and C2-3 bony fusion rate (P = 0.06).

Conclusion

This meta-analysis demonstrated that both C3 laminoplasty and C3 laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C3 laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS.

Trial registration

PROSPERO registration number is CRD42021230798.

Date of registration: February 11, 2021.
Pandora: nucleotide-resolution bacterial pan-genomics with reference graphs
Authors: Colquhoun Rachel M. , Hall Michael B. , Lima Leandro , Roberts Leah W. , Malone Kerri M. , Hunt Martin , Letcher Brice , Hawkey Jane , George Sophie , Pankhurst Louise , Iqbal Zamin
Published: September 2021

We present pandora, a novel pan-genome graph structure and algorithms for identifying variants across the full bacterial pan-genome. As much bacterial adaptability hinges on the accessory genome, methods which analyze SNPs in just the core genome have unsatisfactory limitations. Pandora approximates a sequenced genome as a recombinant of references, detects novel variation and pan-genotypes multiple samples. Using a reference graph of 578 Escherichia coli genomes, we compare 20 diverse isolates. Pandora recovers more rare SNPs than single-reference-based tools, is significantly better than picking the closest RefSeq reference, and provides a stable framework for analyzing diverse samples without reference bias.
Effect of Lycium barbarum polysaccharide supplementation in non-alcoholic fatty liver disease patients: study protocol for a randomized controlled trial
Authors: Gao Lu-Lu , Li Yu-Xiang , Ma Jia-Min , Guo Yi-Qiong , Li Lin , Gao Qing-Han , Fan Yan-Na , Zhang Meng-Wei , Tao Xiu-Juan , Yu Jian-Qiang , Yang Jian-Jun
Published: September 2021

Background

Non-alcohol fatty liver disease (NAFLD) is the most common chronic liver disease in the world, with a high incidence and no effective treatment. At present, the targeted therapy of intestinal microbes for NAFLD is highly valued. Lycium barbarum polysaccharide (LBP), as the main active ingredient of Lycium barbarum, is considered to be a new type of prebiotic substance, which can improve NAFLD by regulating the gut microbiota. The purpose of this study is to evaluate the safety and efficacy of LBP supplementation in modulating gut microbiota for NAFLD patients.

Methods

This randomized, double-blind, placebo-control study will be conducted in the physical examination center of the Ningxia Hui Autonomous Region People’s Hospital. A total of 50 patients with NAFLD confirmed by abdominal ultrasound, laboratory tests, and questionnaire surveys will be recruited and randomly assigned into the control group (maltodextrin placebo capsules) and the intervention group (LBP supplementation capsules) for 3 months. Neither patients, nor investigators, nor data collectors will know the contents in each capsule and the randomization list. The primary outcome measure is the level of ALT concentration relief after the intervention. Secondary outcomes include gut microbiota abundance and diversity, intestinal permeability, patient’s characteristic demographic data and body composition, adverse effects, and compliance from patients.

Discussion

LBPs are potential prebiotics with the property of regulating host gut microbiota. Our previous studies have documented that LBP supplement can improve the liver damage and the gut microflora dysbiosis in NAFLD rats. This treatment would provide a more in-depth understanding of the effect of this LBP supplementation.

Trial registration

Chinese Clinical Trial Register, ChiCTR2000034740. Registered on 17 July 2020.
Seroprevalence and prevalence of Babesia vogeli in clinically healthy dogs and their ticks in Costa Rica
Authors: García-Quesada Andrea , Jiménez-Rocha Ana , Romero-Zuñiga Juan José , Dolz Gaby
Published: September 2021

Canine babesiosis is a disease caused by a parasite of the genus Babesia which destroys red blood cells. Previous studies have shown the presence of Babesia vogeli in rural areas in Costa Rica using molecular techniques. The objective of the present study was to determine the seroprevalence and prevalence of B. vogeli in clinically healthy dogs and their ticks at the national level, both within and outside the Central Valley. Blood samples and ticks from 482 dogs were collected between June 2011 and May 2014, and analyzed by immunofluorescence assay (IFA) and real-time polymerase chain reaction (qPCR); two protocols of endpoint PCR and sequencing were used to confirm qPCR-positive samples. Seroprevalence of canine babesiosis of 5.3% (24/453) was determined at the national level, specifically 2.0% (5/253) within and 9.5% (19/200) outside the Central Valley, respectively. Real-time PCR determined a global prevalence of B. vogeli of 31.3% (125/400): 21.4% (47/220) within the Central Valley and 43.3% (78/180) outside the Central Valley. The endpoint PCR amplified only 10 of the 125 blood samples identified as positive in qPCR. One sample amplified by endpoint PCR was sequenced and identified as B. vogeli. Twelve canines were identified with past infections, seven canines with active infection, and 111 canines with early infection. Two species of ticks were found with B. vogeli: Rhipicephalus sanguineus sensu lato (n = 40) and Amblyomma ovale (n = 1). The prevalence of canine babesiosis at the national level, both within and outside the Central Valley, is reported here for the first time, determining the presence of the piroplasmid throughout the country, with a higher circulation of the agent outside the Central Valley. Only one species, B. vogeli, was detected in the blood of dogs and their ticks. Therefore, veterinarians should consider using qPCR to determine the presence of the parasite in blood donors and before starting treatment of vector-borne disease in dogs.
Hyalomma spp. ticks and associated Anaplasma spp. and Ehrlichia spp. on the Iran-Pakistan border
Authors: Choubdar Nayyereh , Karimian Fateh , Koosha Mona , Nejati Jalil , Oshaghi Mohammad Ali
Published: September 2021

Background

Anaplasmosis and ehrlichiosis are tick-borne diseases affecting humans and livestock, particularly in tropical and subtropical regions. Animal husbandry is the main activity of people on the borders of Iran and Pakistan, with thousands of cattle crossing the border each week.

Methods

PCR and sequencing of the 16S rRNA gene was used to determine the percentage and geographical distribution of the pathogens carried by Hyalomma spp. (n = 306) collected from 126 goats, cattle and camels in the region between November 2017 and late March 2018.

Results

In total, 1124 hard ticks including 1020 Hyalomma spp. ticks belonging to six species (Hyalomma anatolicum, Hyalomma asiaticum, Hyalomma marginatum, Hyalomma dromedarii, Hyalomma schulzei, and Hyalomma detritum) were found on the borders of Iran and Pakistan, with H. anatolicum being the most prevalent tick species. Anaplasma spp. and/or Ehrlichia spp. DNA was found in 68.3% of the engorged tick specimens (n = 256). Sequencing of a subset (12.6%) of PCR-positive samples revealed Anaplasma ovis, Anaplasma marginale, and Ehrlichia ewingii DNA in 81.8%, 9.1%, and 9.1% of the ticks, respectively. To our knowledge, this is the first report of E. ewingii, an important human pathogen, in Iran.

Conclusions

Based on molecular analysis, three pathogenic Anaplasmataceae were detected in six Hyalomma spp. parasitizing cattle, goats and camels, confirming the presence of these pathogens along the Iran-Pakistan border.

Graphical Abstract
High levels of pyrethroid resistance and super-kdr mutations in the populations of tropical bed bug, Cimex hemipterus, in Iran
Authors: Ghavami Mohammad Bagher , Ghahremani Zarafat , Raeisi Narges , Taghiloo Behrooz
Published: September 2021

Background

The tropical bed bug,Cimex hemipterus, is an important ectoparasite causing various health problems. This species is mainly confined to tropical regions; however, insecticide resistance, global warming, and globalization have changed its distribution map. Molecular information on pyrethroid resistance, which is essential for the development of control programs, is unknown forC. hemipterusin expanded areas. The present study was designed to determine the permethrin resistance status, characterize the pyrethroid receptor sites in voltage-gated sodium channel (vgsc) gene, and identify the resistance-related mutations in the populations of tropical bed bug in Iran.

Methods

Live bed bugs were collected, and adults ofC. hemipteruswere selected for bioassay and molecular surveys. Bioassay was performed by tarsal contact with permethrin 0.75% in mixed-sex of samples. Conventional and quantitative TaqMan and SYBR Green real-time PCR assays were conducted to characterize thevgscgene and genotypes of studied populations.

Results

In the bioassay tests, the mortality rates were in the range of 30.7–38.7% and 56.2–77.4% in 24 and 48 h, respectively. The knockdown rates of studied populations were in the range of 32.2–46.6% and 61.5–83.8% in the first and second days, respectively. The KT50and KT90values in theCimex lectulariusKh1 strain were presented as 5.39 and 15.55 h, respectively. These values in the selected populations ofC. hemipterusvaried from 27.9 to 29.5 and from 82.8 to 104.4 h, respectively. Knockdown time ratios (KR50and KR90) in these populations varied from 5.17 to 6.17-fold compared with those of theC. lectulariusKh1 strain. Fragments ofvgscgene with 355 bp and 812 bp were amplified. Analysis of sequences revealed the A468T substitution,kdr-associated D953G, andsuper-kdrM918I and L1014F mutations in all populations.

Conclusions

The specific/sensitive, safe, and rapid diagnostic assays developed in this study are recommended for detection ofkdr/super-kdrmutations and frequency of mutant alleles. The presence ofsuper-kdrmutations and high resistance to permethrin in all the populations necessitate the reconsideration of control approaches againstC. hemipterus.

Graphical Abstract