bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental caries among refugees in Europe: A systematic Literature Review
Authors: Bhusari S , Ilechukwu C , Elwishahy A , Horstick O , Winkler V , Antia K
Published: October 2020

Background

Oral health is one of the most neglected aspects of refugee health. Conflict, violence, loss and unfamiliarity faced by refugees and the reliance on the host country make it difficult to achieve good oral health. The aim of the study was to systematically review the evidence on the prevalence of dental caries among refugees and to evaluate the provided dental care services in the European region.

Methods

Following the PRISMA guidelines, we searched PubMed, Cochrane, WHOLIS, Web of Science, Medline Ovid, and Google Scholar identifying studies on dental caries among refugees in Europe focusing on articles published after 2015 till September 2019. The words caries, decay, DMF, and dental health, refugee and asylum seeker were used.

Results

We obtained 3004 records and included 11 studies in the analysis. The 6 studies primarily focusing on oral health showed a prevalence of caries between 55.8% and 100%, while it ranged from 3% to 65% in the remaining 5 studies investigating the general health of refugees. Caries prevalence was proportional to age and inversely associated with education, whereas gender and country of origin showed no significant association. Oral health is nowhere part of the general health assessment done on arrival and is mainly complain based. Treatment is available at an emergency basis and in equivalence as that of local populations only after the acceptance of refugee status. Lack of orientation, primary focus on resettlement, lack of uniformity, language, cultural and economic barriers emerged as explanatory models for the limited access to oral health care.

Conclusions

Our study identified a high prevalence of caries and limited access to dental health services as the main challenges. The necessity of oral health check-ups will help to shift from curative to preventive oral health care. Further research is urgently needed to better understand the dental health needs of refugees in Europe.

Key messages

Necessity of oral health check-up irrespective of need will help make shift from curative to preventive oral health care. Further research is urgently needed to better understand dental health needs of refugees in Europe.
Association between same-sex marriage introduction and attitudes towards homosexuality in Europe
Authors: Hagen D , Goldmann E
Published: October 2020

Background

Existing research suggests a positive relationship between the introduction of same-sex marriage and country-level acceptance of homosexuality across Europe in the first decade of the 21st century. Between 2010 and 2018, another 8 countries in Europe introduced same-sex marriage. Given the well-established association between greater social acceptance of sexual minorities and LGBT health, it is important to continue to monitor the effect of same-sex marriage policies on public attitudes.

Methods

Using data from waves 1 through 9 of the European Social Survey (ESS), the lagged association between same-sex marriage and acceptance of homosexuality in the subsequent wave was analysed for 12 European countries that introduced same-sex marriage between 2002 and 2018. Acceptance of sexual minorities was assessed using the statement, “Gay men and lesbians should be free to live their own life as they wish”, which was dichotomised into two groups: “agree strongly” or “agree” vs. “neither agree nor disagree”, “disagree”, or “disagree strongly”. The association between same-sex marriage laws and acceptance was analysed in mixed-effects logistic regression models adjusting for country-level and individual-level confounders and survey year.

Results

On the country level, acceptance of homosexuality ranged from 61% in Portugal in 2006 to 96% in Iceland in 2016. Based on the total sample of 171,683 observations, acceptance increased from 77% in 2002 to 88% in 2018. Preliminary analyses indicate that existence of same-sex marriage at the time of data collection was associated with 24% increased odds of acceptance of homosexuality in fully adjusted models (95% CI: 1.05-1.48).

Conclusions

This study provides further evidence of an association between same-sex marriage laws and public acceptance of homosexuality. Additional research will be needed in order to further investigate this relationship beyond Western Europe and in relation to sexual minority health and well-being.

Key messages

For 12 European countries, evidence of an association between the introduction of same-sex marriage between 2002 and 2018, and subsequent accepting public attitudes towards homosexuality was found. Given their role as a key social determinant of health, further research on the association between social norms accepting of sexual minority populations and inclusive social policies is warranted.
How do school nurses promote participation in health visits with children of foreign origin?
Authors: Wahlstrom E , Golsäter M , Granlund M , Holmström I K , Larm P , Harder M
Published: October 2020

Background

All children in Sweden are invited to health visits to the school nurse to talk about their health. However, health visits with children of foreign origin might involve challenges when the child and school nurse do not share language and or culture. Such challenges might hinder the child's participation as e.g. sharing needs and experiences important for their health. Hence, school nurses' promotion of participation for these children need to be clarified to develop knowledge on how to promote health. The aim was to investigate school nurses' descriptions of promoting participation for children of foreign origin in health visits.

Methods

A cross-sectional study was conducted, using a web-based questionnaire distributed to all school nurses in Sweden. It contained eight open-ended questions regarding promotion of participation for children of foreign origin. Answers were provided by 673 Swedish school nurses and analyzed using qualitative content analysis.

Results

The preliminary result shows that school nurses use three approaches to promote participation: 1) adjusting according to the child's proficiency in Swedish and/or cultural or national background, 2) adjusting according to the child's individual needs, and 3) doing the same for all children regardless of their origin. These approaches are used throughout the health visit, although the most commonly was number 1. Such adjustments included the school nurse considering cultural aspects, simplifying their way of talking, or asking the child about their culture or background.

Conclusions

Adjustment according to the child's proficiency in Swedish and/or cultural or national background are warranted to promote participation in health visits with children of foreign origin. These will strengthen the opportunities for children to share their experiences as well as the encounter between school nurses and children.

Key messages

School nurses adjust promotion of participation when encountering children of foreign origin. Adjusting promotion of participation in health visits will enable children to share their health needs.
Use of healthcare services at time of delivery: a prospective community based study in Madagascar
Authors: Pourette D , Andrianantoandro T V , Rakotoarimanana F M J , Razakamanana M , Rakotomalala O , Ramiaramanana J
Published: October 2020

Background

Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region.

Methods

This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'.

Results

Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family.

Conclusions

Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare.

Key messages

Collaborations between health workers and traditional healers should be formalized. The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.
Using mobile immunization vans to cover under-served populations in hard-to-reach areas
Authors: Siddique M , Abdullah S , Siddiqi D A , Mirza A , Dharma V K , Shah M T , Akhter M A , Khan A J , Chandir S
Published: October 2020

Background

In Pakistan, only 66% of children receive their basic vaccinations. However, the figure masks significant inequalities in vaccine coverage between urban and rural residences, slums and areas distantly located from EPI centers. Frequent outbreaks of vaccine-preventable diseases such as polio and measles, in urban cities like Karachi, signal the need for expanding vaccine services to underserved areas. In Apr'19, we introduced the Mobile Immunization Van initiative in Karachi in collaboration with EPI Sindh. Currently, two vans are deployed in hard-to-reach areas and slums to immunize under-2 children for routine vaccines.

Methods

Before the van visit, mobilization efforts are conducted in targeted areas to encourage caretakers to bring their child for vaccination. On the day of visit, the van is parked at a central location, and announcements are played on a loudspeaker to attract caregivers. All vaccinations are administered in the van, and entries are recorded in Government's Digital Immunization Registry along with GIS coordinates of immunized children. The data is then automatically transferred on to a web-dashboard for analysis and tracking.

Results

From Apr'19 to Jan'20, the vans have vaccinated 2,867 children, out of which 50% had never been immunized prior to the van visit. Of those who received their follow-up vaccines from the van, 80% were at least 4 weeks beyond from their vaccine due date. GIS analysis of van data confirmed that immunizations were conducted in slums, and areas distantly located from EPI centers. Moreover, compared to government outreach activity, proportion of BCG, Penta3 and Measles1 administrations in slums was higher through the vans by 5%, 6%, and 4% respectively.

Conclusions

The vans provide an opportunity for immunizing never-vaccinated children and children defaulting on their vaccine schedule, from the most vulnerable geographies, while simultaneously enrolling them in the Government's EPI Program for effective tracking.

Key messages

The mobile vans help achieve universal immunization coverage through provision of vaccine services in slum and rural hard-to-reach areas with limited access to government-provided services. The mobile vans help vaccinate and capture never-immunized children into the Government’s EPI records, reducing the number of children missed through routine services.
RNA imaging in bacteria
Authors: Rombouts Sara , Nollmann Marcelo
Published: October 2020

The spatiotemporal regulation of gene expression plays an essential role in many biological processes. Recently, several imaging-based RNA labeling and detection methods, both in fixed and live cells, were developed and now enable the study of transcript abundance, localization and dynamics. Here, we review the main single-cell techniques for RNA visualization with fluorescence microscopy and describe their applications in bacteria.
Reasserting hegemonic masculinity: women's leadership within the far right
Authors: Worth Owen
Published: October 2020

The emergence of a global far right has been seen as a significant development in recent years and as a challenge to wider forms of neo-liberal globalization. While much has been written about its significance and representation, little has been written on either the gendered nature of the far right and the role that women have played as actors within it. Though there still remains a gender gap in terms of the support and participation of the far right, there has been an increasing rise of leaders and figureheads within the respective movements themselves. This article argues that despite the emergence of these women, the far right looks to construct an extreme form of masculinity in which anti-feminism appears as a significant part of its overall strategy. By engaging with both the Gramscian understandings of hegemonic construction and subsequent notions of masculinist hegemony, it argues that the appearance of women both as leaders and ‘organic intellectuals’ within respective national movements allows them to gain greater legitimacy. Rather than ‘feminizing’ or indeed moderating the form of far-right narratives, women had looked to re-inforce such extreme masculinity by adding to existing understandings of anti-immigration, nationalism and in particular of the meaning of ‘anti-feminism’. Thus, recent leaders of far-right political parties appear alongside media columnists and ‘celebrities’ in contributing to the construction of extreme masculinity with the far right.
Thoracic endometriosis syndrome in Nigeria: a single-centre experience
Authors: Ezemba Ndubueze , Okafor Okechukwu C , Emeruem Nwadinma U , Adiri Charles O
Published: October 2020

OBJECTIVES

Thoracic endometriosis syndrome (TES) is the presence of functional endometrial tissue in or around the lung. There seem to be differences in the clinical presentation of this condition among Nigerian patients. We aim to study the clinical presentation and management outcome of TES in our centre.

METHODS

This is an analysis of consecutive patients with TES treated over a 5-year period and followed up for 6 months to 5 years. Information collected included the gynaecological history, clinical presentation, causes of misdiagnosis, modalities of treatment and outcome.

RESULTS

Twenty-three patients with TES aged between 24 and 45 years (median 32 years) were treated. Severe dysmenorrhoea was a prominent symptom in 91.3% of cases (median dysmenorrhoea score 8) and was uninfluenced by the marital status (P = 0.522). The patients usually presented with massive or recurrent haemothorax associated with massive ascites [16/23 (69.5%) of cases (P = 0.0006)]. The right side alone was involved in 21 cases and 1 patient had catamenial haemoptysis as a part of her symptoms, even though there was bronchial bleed at bronchoscopy in 6 patients. In 40%, tuberculosis was the misdiagnosis. Diagnosis was established histologically in 18/23 (78.3%) of the cases. Treatment was multimodal and multidisciplinary with notable macroscopic lesions in 77.8% of the patients that had surgery.

CONCLUSIONS

TES is not an uncommon lesion. Presentation with massive haemothorax is usually associated with massive ascites. A large percentage of such have pleural and diaphragmatic lesions that require surgical treatment. The ascites may be refractory to treatment requiring repeated paracentesis.
Murmurations: Scale-Free Correlation and Atmospheric Attunement in Families Organizing around Domestic Violence
Authors: Wagner Kirstin
Published: October 2020

This essay seeks to complicate seemingly rigid notions of instinct, agency, and survival for proximate bodies resisting violence through cooperative spatial attunement. I place the behaviors and movements of murmurating starlings (and other nonhuman animal beings in various states of fear/pain) alongside human family members in families organizing around domestic violence in order to theorize predation-evasion-induced scale-free correlation (PEISFC) as a trans-species process of “atmospheric attunement” that resists violence.
Industrious and Imitative Art: Manufacturing Artistic Expertise in Nineteenth-Century Britain
Authors: Rhee Pollyanna
Published: October 2020

In the middle of the nineteenth century, a new material from the British Straits Settlements fascinated botanists, industrialists, journalists and consumers with its almost endless possibilities. For its champions, the gutta percha tree was more than a just a rubber plant. Transported from the colonies to London, gutta percha could be shaped into any form and used to imitate a variety of expensive materials. This article argues that those advancing gutta percha’s applications for decorative and ornamental objects offered a sanitized version of industrial production to the public by portraying artistic skill as central to the transformation of the material from its origins as a colonial raw material. The material’s applications allowed British manufacturers to demonstrate their role in synthetizing scientific knowledge, industrial production and artistic skill. A catalogue of ornamental goods and depictions of the Gutta Percha Factory in London emphasized the skills of workers who crafted artistic objects through industrial processes. Critics decried the influence of industrial manufacturing on workers and industrial production’s detrimental effect on the arts, but others argued that these gutta percha objects highlighted the artistry and ingenuity of factory workers. More significant was the idea that these factory workers with modern industrial techniques supplanted old modes of craft and contributed to a necessary updating of artistic production.
Nonoperative management of gastrointestinal bleeding after a simultaneous pancreas and kidney transplant
Authors: Nawabi Atta , Serwar Sumaiya , Klein Jeffrey , Nawabi Perwaiz , Nawabi Nadia , Cibrik Diane
Published: October 2020

With a shift toward enteric drainage techniques, the complications associated with simultaneous pancreas and kidney (SPK) transplant have also changed. Gastrointestinal (GI) bleeding is one of the most common complications associated with SPK. This case report describes the treatment of a postoperative GI hemorrhage using the push endoscopy technique. A 48-year-old male underwent an uneventful SPK transplant with entero-systemic drainage and developed hematochezia. The push enteroscopy technique was utilized to treat the bleeding ulcer. Historically, the use of the push enteroscopy technique to treat GI bleeding from the small bowel is not described in the literature. One of the limitations of duodenojejunostomy is that standard endoscopy cannot be readily used to visualize the duodenojejunostomy. However, the use of push enteroscopy may prove to be a minimal invasive and cost-effective intervention for GI bleeding after SPK.
Calculating sameness: Identifying early-modern image reuse outside the black box
Authors: Kräutli Florian , Lockhorst Daan , Valleriani Matteo
Published: October 2020

In this article, we present a method for identifying image reuse in a corpus of 358 books printed between the 15th and 17th century. The approach is based on image hashing, an established method for finding near duplicates of images. Our historical interpretation of the method’s result produces two important insights hinting at a radical material and epistemological change taking place around 1530. We then evaluate the image hash approach against a method that employs a neural network for image recognition.
Management of acute stroke within the stroke pathway and stroke clinics
Authors: Birns Jonathan , Bhalla Ajay
Published: October 2020

There have been considerable advances in stroke research leading to translation of drug therapy for stroke into the clinical arena. Thrombolysis for ischaemic stroke is a key advance that significantly reduces disability. This has revolutionized the manner in which acute stroke is treated as a medical emergency. The use of advanced imaging techniques and adjuncts to thrombolysis could potentially improve selection of patients who may benefit from reperfusion therapy such as mechanical thrombectomy and allow treatment decisions to be based on individual brain pathophysiology, rather than arbitrary time windows. It is likely that reconfiguration of stroke services may be required to accommodate further delivery of hyperacute interventions for acute stroke.
Chronic stable angina
Authors: Lanza Gaetano Antonio , De Vita Antonio
Published: October 2020

Treatment of patients with chronic stable angina has two main objectives: to improve clinical outcome and to reduce angina symptoms. Prognosis is mainly improved by a reduction in cardiovascular risk factor burden, which may be achieved by appropriate lifestyle changes and, for some risk factors (e.g. hypercholesterolaemia, hypertension, diabetes), appropriate pharmacological therapy (including, in particular, statins and renin–angiotensin–aldosterone system inhibitors) and use of antithrombotic agents. Symptoms can be improved by a variable combination of traditional (beta-blockers, calcium channel blockers, nitrates) and novel (e.g. ivabradine, ranolazine) anti-ischaemic drugs, which may act through reduction in myocardial oxygen consumption and/or improvement of myocardial perfusion.
COMPARING HEALTH EFFECTS OF RADON IN MANITOBA AND PRINCE EDWARD ISLAND
Authors: Al-arydah Mo’tassem
Published: October 2020

We compare lung cancer (LC) rates, smoking percentages and radon levels in Manitoba (MN) and Prince Edward Island (PE). Smoking does not explain high LC in MN, but indoor radon does. We show that population attributable risk in PE is only 37% of that in MN. Radon above 200 Bq m −3 increases LC in PE by only 4 cases, but in MN by 195 cases.
RESEARCH ON PASSIVE SOIL DEPRESSURIZATION SYSTEMS: STATE OF THE ART AND LAB TEST ON-GOING
Authors: Fuente Marta , Hung Le Chi , Goggins Jamie , Foley Mark
Published: October 2020

There is strong evidence both internationally and in Ireland that the correct installation of passive prevention systems in new buildings is the most cost-effective way of protecting the population against radon. Previous work considering membranes, granular fill material in the aggregate layer beneath the slab and sump system has been conducted in Ireland to improve the protection of buildings from radon. The implications of research on passive sumps potential to reduce radon concentrations are significant, as if it can be shown that the installation of passive sumps in Irish building is effective; this could constitute a low-cost, passive, sustainable method for minimizing radon levels in buildings. On-going experimental tests investigating the performance of different common cowls used for passive soil depressurization systems are presented, in addition to the impact of different vertical heights and horizontal lengths of pipe with a number of bends investigated.
Doctor, Will You Pray for Me? Responding to Patients’ Religious and Spiritual Concerns
Authors: Klitzman Robert
Published: October 2020

Religion and spirituality in the United States have been shifting, and physicians are treating patients with increasingly diverse beliefs. Physicians’ unfamiliarity with these beliefs poses critical challenges for medical education and practice. Despite efforts to improve medical education in religion/spirituality, most doctors feel their training in these areas is inadequate. This article draws on the author’s conversations with providers and patients over several years in various clinical and research contexts in which religious/spiritual issues have arisen. These conversations provided insights into how patients and their families commonly, and often unexpectedly, make religious/spiritual comments to their providers or question their providers about these topics, directly or indirectly. Comments are of at least 9 types that fall within 4 broad domains: (1) perceiving God’s role in disease and treatment (in causing disease, affecting treatment outcomes, and knowing disease outcomes), (2) making medical decisions (seeking God’s help in making these decisions and determining types/extents of treatment), (3) interacting with providers (ascertaining providers’ beliefs, having preferences regarding providers, and requesting prayer with or by providers), and (4) pondering an afterlife. Because of their beliefs or lack of knowledge, doctors face challenges in responding and often do so in 1 of 4 broad ways: (1) not commenting, (2) asking strictly medical questions, (3) referring the patient to a chaplain, or (4) commenting on the patient’s remark. Medical education should thus encourage providers to recognize the potential significance of patients’ remarks regarding these topics and to be prepared to respond, even if briefly, by developing appropriate responses to each statement type. Becoming aware of potential differences between key aspects of non-Western faiths (e.g., through case vignettes) could be helpful. Further research should examine in greater depth how patients broach these realms, how physicians respond, and how often medical school curricula mention non-Western traditions.
Ketamine Pharmacokinetics
Authors: Kamp Jasper , Olofsen Erik , Henthorn Thomas K. , van Velzen Monique , Niesters Marieke , Dahan Albert ,   for the Ketamine Pharmacokinetic Study Group
Published: October 2020

Background

Several models describing the pharmacokinetics of ketamine are published with differences in model structure and complexity. A systematic review of the literature was performed, as well as a meta-analysis of pharmacokinetic data and construction of a pharmacokinetic model from raw data sets to qualitatively and quantitatively evaluate existing ketamine pharmacokinetic models and construct a general ketamine pharmacokinetic model.

Methods

Extracted pharmacokinetic parameters from the literature (volume of distribution and clearance) were standardized to allow comparison among studies. A meta-analysis was performed on studies that performed a mixed-effect analysis to calculate weighted mean parameter values and a meta-regression analysis to determine the influence of covariates on parameter values. A pharmacokinetic population model derived from a subset of raw data sets was constructed and compared with the meta-analytical analysis.

Results

The meta-analysis was performed on 18 studies (11 conducted in healthy adults, 3 in adult patients, and 5 in pediatric patients). Weighted mean volume of distribution was 252 l/70 kg (95% CI, 200 to 304 l/70 kg). Weighted mean clearance was 79 l/h (at 70 kg; 95% CI, 69 to 90 l/h at 70 kg). No effect of covariates was observed; simulations showed that models based on venous sampling showed substantially higher context-sensitive half-times than those based on arterial sampling. The pharmacokinetic model created from 14 raw data sets consisted of one central arterial compartment with two peripheral compartments linked to two venous delay compartments. Simulations showed that the output of the raw data pharmacokinetic analysis and the meta-analysis were comparable.

Conclusions

A meta-analytical analysis of ketamine pharmacokinetics was successfully completed despite large heterogeneity in study characteristics. Differences in output of the meta-analytical approach and a combined analysis of 14 raw data sets were small, indicative that the meta-analytical approach gives a clinically applicable approximation of ketamine population parameter estimates and may be used when no raw data sets are available.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Observational Research for Therapies Titrated to Effect and Associated With Severity of Illness: Misleading Results From Commonly Used Statistical Methods*
Authors: de Grooth Harm-Jan , Girbes Armand R. J. , van der Ven Fleur , Oudemans-van Straaten Heleen M. , Tuinman Pieter R. , de Man Angélique M. E.
Published: October 2020

Objectives:

In critically ill patients, treatment dose or intensity is often related to severity of illness and mortality risk, whereas overtreatment or undertreatment (relative to the individual need) may further increase the odds of death. We aimed to investigate how these relationships affect the results of common statistical methods used in observational studies.

Design:

Using Monte Carlo simulation, we generated data for 5,000 patients with a treatment dose related to the pretreatment mortality risk but with randomly distributed overtreatment or undertreatment. Significant overtreatment or undertreatment (relative to the optimal dose) further increased the mortality risk. A prognostic score that reflects the mortality risk and an outcome of death or survival was then generated. The study was analyzed: 1) using logistic regression to estimate the effect of treatment dose on outcome while controlling for prognostic score and 2) using propensity score matching and inverse probability weighting of the effect of high treatment dose on outcome. The data generation and analyses were repeated 1,500 times over sample sizes between 200 and 30,000 patients, with an increasing accuracy of the prognostic score and with different underlying assumptions.

Setting:

Computer-simulated studies.

Measurements and Main Results:

In the simulated 5,000-patient observational study, higher treatment dose was found to be associated with increased odds of death (p = 0.00001) while controlling for the prognostic score with logistic regression. Propensity-matched analysis led to similar results. Larger sample sizes led to equally biased estimates with narrower CIs. A perfect risk predictor negated the bias only under artificially perfect assumptions.

Conclusions:

When a treatment dose is associated with severity of illness and should be dosed “enough,” logistic regression, propensity score matching, and inverse probability weighting to adjust for confounding by severity of illness lead to biased results. Larger sample sizes lead to more precisely wrong estimates.
Use of Stimulants in Patients with Comorbid Anorexia Nervosa and Attention-Deficit/Hyperactivity Disorder in a Structured Inpatient Setting
Authors: Shear Matthew , Deliberto Tara , Kerrigan Sean , Belak Lauren , Attia Evelyn
Published: October 2020

Objective:

Clinicians may be concerned about using psychostimulant medications in patients in whom weight gain is desired because of their potential side effects of appetite suppression and weight loss. This report depicts the successful treatment of 2 adolescent patients with anorexia nervosa (AN) and attention-deficit/hyperactivity disorder (ADHD) in an inpatient eating disorders unit.

Method:

A report of 2 clinical cases (ages 19 and 20 years) was used to describe the management of comorbid AN and ADHD. Tolerance to stimulants, meal completion, and ability to restore weight were assessed over the course of hospitalization.

Results:

Behaviorally focused refeeding combined with psychostimulants notably improved symptoms of AN and comorbid ADHD without adverse effects.

Conclusion:

Psychostimulant medications may be used successfully in patients with AN and ADHD in the context of structured behavioral treatment designed for weight restoration.
Insights from Behavioral Economics: A Case of Delayed Diagnosis of Autism Spectrum Disorder
Authors: Wallis Kate E. , Buttenheim Alison M. , Mandell David S.
Published: October 2020

We present the case of a child of color diagnosed with autism spectrum disorder (ASD) at 67 months of age. Drawing from behavioral economics, we used this case to explore errors in decision-making by clinicians and family members and structural factors that may have delayed ASD diagnosis well beyond the national average.
Gene expression in urinary incontinence and pelvic organ prolapse: a review of literature
Authors: Isali Ilaha , Abdeldayem Jasmin , El-Nashar Sherif
Published: October 2020

Purpose of review

To review current evidence on gene expression in women with urinary incontinence and pelvic organ prolapse (POP).

Recent findings

Our literature review revealed numerous genes that are associated with urinary incontinence and POP. For overactive bladder and urge urinary incontinence, four genes were highlighted: adrenergic receptor β3, Rho guanine nucleotide exchange factor 10, Rho-associated coiled-coil containing protein kinase 2, and potassium two pore domain channel subfamily K member-1. For Stress Urinary incontinence (SUI), 13 genes were included: skin-derived antileukoproteinase, collagen type XVII alpha 1 chain, plakophilin 1, keratin 16, decorin, biglycan, protein bicaudal D homolog 2, growth factor receptor-bound protein 2, signal transducer and activator of transcription 3, apolipoprotein E, Golgi SNAP receptor complex member 1, fibromodulin, and glucocerebrosidase. For POP seven genes were identified: homeobox A13, matrix metallopeptidase 9, estrogen receptor 2, collagen type XIV alpha 1 chain, collagen type V alpha 1 chain, collagen type IV alpha 2 chain, and catenin beta 1.

The current review highlights many genes which are potential biomarkers and targets for drug development.
Presence and Duration of Symptoms in Febrile Infants With and Without SARS-CoV-2 Infection
Authors: McLaren Son H. , Dayan Peter S. , Zachariah Philip , McCann Teresa A. , Lubell Tamar R.
Published: October 2020

The clinical course of SARS-CoV-2 infection in young infants is not well understood. In this prospective cohort study, we compared the presence and duration of symptoms in febrile infants ≤60 days with (n = 7) and without (n = 16) SARS-CoV-2 infection. Overall, we observed overlapping symptoms and duration of illness, with longer length of cough and nasal congestion among the SARS-CoV-2-positive infants.
Diagnosis of Community-acquired Pneumonia in Hospitalized Children: A Multicenter Experience in Bolivia
Authors: Gareca Perales José , Soleto Ortiz Lorena , Loayza Mafayle Roxana , Machuca Soto Blanca , Hidalgo Flores Lucia , López Montaño Javier , Zuna Calle Neida , Jarovsky Daniel , Naaman Berezin Eitan
Published: October 2020

Background:

Community-acquired pneumonia (CAP) represents a major cause of hospitalization, especially among young children. In the third world countries, information about CAP etiology is scarce. Therefore, rapid and highly sensitive diagnostic methods are crucial to determine etiologic agents.

Methods:

Between March 2016 and March 2017, we have prospectively studied the clinical, radiologic, laboratory, and molecular aspects of patients with CAP at 2 tertiary-level hospitals in Santa Cruz de la Sierra, using a multiplex real-time polymerase chain reaction (RT-PCR).

Results:

A total of 274 children were evaluated, with a median age of 13 months. An etiologic agent was identified in 187 patients (68.2%): 54% (n = 148) were viruses and 14.2% (n = 39) were bacteria. CAP prevalence was highest among children under 2 years (71%; 195/274); respiratory syncytial virus (RSV) was the most frequent cause in 22% (60/274), especially among infants, followed by influenza (14.5%; 40/274). Streptococcus pneumoniae accounted for 7% of the total (19/274), followed by Staphylococcus aureus (3%;8/274) and Haemophilus influenzae (1.4%;4/274). Together, these cases accounted for 79.5% (31/39) of all bacterial CAP. Pleural effusion (PE) complicated CAP in 13.8% (38/274), of which 29 were of bacterial etiology. RT-PCR increased the detection rate of pneumococcus by 47%. Coinfection occurred in 28 patients (10%); 26 (9.5%) required intensive care and 9 patients (3%) died.

Conclusions:

RT-PCR provided additional diagnostic value to conventional, clinical, and laboratory methods. The higher prevalence of RSV, influenza, and Streptococcus pneumoniae reveals the need for preventive measures with better vaccine uptake and future research for RSV vaccines.
Self-Report Measures of Presenteeism Are Not Strongly Correlated With Health Workers’ Logged Activity
Authors: Thompson Angus H. , Waye Arianna , Jacobs Philip , Dewa Carolyn S.
Published: October 2020

Objective:

Low productivity while at work (presenteeism) has been reported to produce significant cost excesses for organizations and economies. However, many of these reports have been based on estimates drawn from self-report instruments that are not supported by evidence showing their efficacy. Thus, the aim of this study was to assess associations between responses to leading self-report tests of presenteeism and self-recorded on-the-job productivity.

Methods:

Health care worker self-ratings of productivity were taken from a questionnaire that contained the key item from each presenteeism instrument. Productivity levels were drawn from employee reported daily work activity logs.

Results:

Test-based productivity estimates did not show strong associations with daily recordings of work activity.

Conclusions:

Associations were too low to recommend any test as a proxy measure for reported productivity. It is suggested that objective measures of work output be explored.
Proton‐pump Inhibitor Response Prediction Using Esophageal microRNAs in Children With Eosinophilic Esophagitis
Authors: Cañas José Antonio , Tabares Ana , Barbero Claudia , García‐Sánchez Daniel , Sastre Beatriz , Rodrigo‐Muñoz José Manuel , Mahíllo‐Fernández Ignacio , Rayo Ana , Borrell Belén , Cilleruelo Mª Luz , Román Enriqueta , Fernandez‐Fernandez Sonia , Gutiérrez‐Junquera Carolina , del Pozo Victoria
Published: October 2020

Objectives:

Eosinophilic esophagitis (EoE) is a chronic esophageal disease characterized by eosinophilic inflammation. Proton‐pump inhibitors (PPI) induce disease remission but no predictive factors of PPI‐responsiveness have been identified yet. So, a biomarker must be found to differentiate between responders (PPI‐R) and nonresponder patients (PPI‐NR) to PPI. Aims were to identify any molecular biomarker that could predict PPI responsiveness and to study molecular remission after PPI therapy.

Methods:

This prospective study enrolled 39 controls and 43 pediatric children with EoE from 2 hospitals, and they were treated with esomeprazole for 8 to 12 weeks. After therapy, patients were classified as either PPI‐R or PPI‐NR. Biopsies were collected and RNA, microRNAs, and proteins were isolated from them, measuring levels by qPCR and Western blot (WB). Also, miRNAs were evaluated in serum.

Results:

We found several esophageal miRNAs with different expression values between PPI‐R and PPI‐NR children, which can be used to discriminate them (area under curve = 0.90). No useful serum miRNAs were, however, identified. Also, these miRNAs were dysregulated in responder patients before and after PPI therapy. Moreover, we corroborated in this child population, that PPI‐R displayed a significant decrease in eotaxin‐3, IL‐5, IL‐13, periostin, and major basic protein (P < 0.05) and a significant increase in filaggrin levels after PPI treatment (P < 0.01).

Conclusions:

Esophageal miRNA levels found are able to discriminate between both PPI‐R and PPI‐NR at baseline, and before and after treatment in PPI‐R, so they could be used as biomarkers. Furthermore, we observed clinical and esophageal molecular restoration in PPI‐R patients after PPI therapy.
Establishing a National Rate of Rectal Biopsy Positivity in the Diagnosis of Hirschsprung Disease
Authors: Maassel Nathan L. , Ozgediz Doruk E. , Solomon Daniel G.
Published: October 2020

Objectives:

Although rectal biopsy has long been established as the criterion standard for the diagnosis of Hirschsprung disease, little to no information exists regarding nationwide rates of rectal biopsy positivity or interinstitutional variability. We sought to determine the national rate of rectal biopsy positivity and factors contributing to institutional variability.

Methods:

A retrospective review of the Children's Hospital Association's (CHA) Pediatric Health Information System from 2009 to 2018 identified infants <100 days old with ICD‐9/ICD‐10 procedural codes for rectal biopsy in addition to codes for pull‐through procedures within 500 days of life as a proxy for positive biopsy. A subgroup analysis of only patients biopsied at institutions with positive biopsy rates 1 standard deviation above or below the mean positive biopsy rate (deemed high and low outliers) was performed to better delineate these populations.

Results:

A total of 7225 children underwent rectal biopsies between 2009 and 2018 at 52 Children's Hospital Association Hospitals. Mean positive biopsy rate for individual institutions was 21.5% (standard deviation ± 6.4%). Linear regression to predict the effect of hospital surgical volume on positive biopsy rate demonstrated no volume outcome relationship (R2 = 0.049). Patients at high outlier hospitals for biopsy positivity were found to travel significantly further to the hospital (232.5 vs 123.1 miles, P < 0.0001) when compared to patients presenting at low outlier hospitals.

Conclusions:

There appears to be little interinstitutional variability in the rate of surgery following rectal biopsy for presumed Hirschsprung and no significant relationship to surgical volume. About 1 in every 4 infants undergoing biopsy proceeds to surgery.
Mean arterial pressure maintenance following spinal cord injury: Does meeting the target matter?
Authors: Weinberg Jordan A. , Farber S. Harrison , Kalamchi Louay D. , Brigeman Scott T. , Bohl Michael A. , Varda Bianca M. , Sioda Natasha A. , Radosevich John J. , Chapple Kristina M. , Snyder Laura A.
Published: October 2020

INTRODUCTION

Neurosurgical guidelines recommend maintaining mean arterial pressure (MAP) between 85 and 90 mm Hg following acute spinal cord injury (SCI). In our hospital, SCI patients receive orders for MAP targeting for 72 hours following admission, but it is unclear how often the patient’s MAP meets the target and whether or not this affects outcome. We hypothesized that the proportion of MAP measurements ≥85 mm Hg would be associated with neurologic recovery.

METHODS

Spinal cord injury patients with blunt mechanism of injury admitted between 2014 and 2019 were identified from the registry of a level 1 trauma center. Proportion of MAP values ≥85 mm Hg was calculated for each patient. Neurologic improvement, as measured by positive change in American Spinal Injury Association (ASIA) impairment scale by ≥1 level from admission to discharge was evaluated with respect to proportion of elevated MAP values.

RESULTS

A total of 136 SCI patients were evaluated. Average proportion of elevated MAP values was 75%. Admission ASIA grades were as follows: A, 30 (22.1%); B, 20 (14.7%); C, 28 (20.6%); and D, 58 (42.6%). One hundred six patients (77.9%) required vasopressors to elevate MAP (ASIA A, 86.7%; B, 95.0%; C, 92.9%; D, 60.3%). Forty patients (29.4%) were observed to have improvement in ASIA grade by discharge (admission ASIA A, 15%; B, 33%; C, 40%; D, 13%). The proportion of elevated MAP values was higher for patients with neurologic improvement (0.81 ± 0.15 vs. 0.72 ± 0.25, p = 0.014). Multivariate modeling demonstrated a significant association between proportion of elevated MAP values and neurologic improvement (p = 0.028). An interaction revealed this association to be moderated by vasopressor dose (p = 0.032).

CONCLUSION

The proportion of MAP measurements ≥85 mm Hg was determined to be an independent predictor of neurologic improvement. Increased vigilance regarding MAP maintenance above 85 mm Hg is warranted to optimize neurologic recovery following SCI.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.
Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine
Authors: Seale Holly , Heywood Anita E , Leask Julie , Sheel Meru , Durrheim David N , Bolsewicz Katarzyna , Kaur Rajneesh
Published: October 2020

Background

There is an indication that vaccine(s) for COVID-19 could be available by early 2021. As immunisation program launches have previously demonstrated, it is essential that careful planning occurs now to ensure the readiness of the public for a COVID-19 vaccine. As part of that process, this study aimed to understand the public perceptions regarding a future COVID-19 vaccine in Australia.

Methods

A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis.

Results

Participants generally held positive views towards vaccination. Eighty percent (n=1143) agreed with the statement that getting myself vaccinated for COVID-19 would be a good way to protect myself against infection. Females (614, 83%) were more likely to agree with the statement than males (529, 78%) (aOR=1.4 (95% CI: 1.1-1.8); P=0.029), while 90.9% aged 70 and above agreed compared to 76.6% aged 18-29 year old (aOR=2.3 (95% CI:1.2-4.1); 0.008). Agreement was also higher for those with a self-reported chronic disease (aOR=1.4 (95% CI: 1.1-2.0); P=0.043) and among those who held private health insurance (aOR=1.7 (95% CI: 1.3-2.3); P<0.001). Beyond individual perceptions, 78% stated that their decision to vaccinate would be supported by family and friends

Conclusion

This study presents an early indication of public perceptions towards a future COVID-19 vaccine and represents a starting point for mapping vaccine perceptions. To support an effective launch of these new vaccines, governments need to use this time to understand the communities concerns and to identify the strategies that will support engagement.
On Mendelian Randomisation Mixed-Scale Treatment Effect Robust Identification (MR MiSTERI) and Estimation for Causal Inference
Authors: Liu Zhonghua , Ye Ting , Sun Baoluo , Schooling Mary , Tchetgen Eric Tchetgen
Published: October 2020

Standard Mendelian randomization analysis can produce biased results if the genetic variant defining instrumental variable (IV) is confounded and/or has a horizontal pleiotropic effect on the outcome of interest not mediated by the treatment. We provide novel identification conditions for the causal effect of a treatment in the presence of unmeasured confounding by leveraging an invalid IV for which both the IV independence and exclusion restriction assumptions may be violated. The proposed Mendelian Randomization Mixed-Scale Treatment Effect Robust Identification (MR MiSTERI) approach relies on (i) an assumption that the treatment effect does not vary with the invalid IV on the additive scale; and (ii) that the selection bias due to confounding does not vary with the invalid IV on the odds ratio scale; and (iii) that the residual variance for the outcome is heteroscedastic and thus varies with the invalid IV. Although assumptions (i) and (ii) have, respectively appeared in the IV literature, assumption (iii) has not; we formally establish that their conjunction can identify a causal effect even with an invalid IV subject to pleiotropy. MR MiSTERI is shown to be particularly advantageous in the presence of pervasive heterogeneity of pleiotropic effects on the additive scale. For estimation, we propose a simple and consistent three-stage estimator that can be used as preliminary estimator to a carefully constructed one-step-update estimator, which is guaranteed to be more efficient under the assumed model. In order to incorporate multiple, possibly correlated and weak IVs, a common challenge in MR studies, we develop a MAny Weak Invalid Instruments (MR MaWII MiSTERI) approach for strengthened identification and improved estimation accuracy. Both simulation studies and UK Biobank data analysis results demonstrate the robustness of the proposed MR MiSTERI method.