bluuebunny/crossref_metadata_2025 huggingface dataset:
Corrective treatment for tear trough deformity in a young population utilizing two‐dimensional fat injections
Authors: Su Yongsheng , Zhong Jieguang , Lu Shurong
Published: December 2021

Objectives

Tear trough deformity (TTD) is becoming a growing concern for those seeking facial rejuvenation, and various treatment strategies have been reported. Among treatment options is micro‐autologous fat injection, which appears to be an effective approach to recontour the tear trough in the young. The study we present here investigated the reliability and effectiveness of two‐dimensional fat injections (TDFI) in the treatment of young patients with TTD.

Methods

This study evaluated patients with TTD who underwent TDFI between December 2018 and December 2020. The proposed procedure involved ligament releasing and fat injection into the tear trough in two different directions.

Results

The average age of the 102 enrolled patients was 25.9 ± 3.8 years. Significant improvement and maintenance of TTD were observed during the follow‐up period (13.2 months average) with no major complications being observed. Improvement of dark cycles and enhanced aegyo sal were observed. Patient satisfaction based upon self‐administered post‐procedure questionnaires disclosed that 58.8% were very satisfied, 38.2% were satisfied, and 2.9% neutral with the results.

Conclusions

Two‐dimensional fat injections is an effective and reliable method with high satisfaction and low risk of complication. Long‐term results demonstrated its utility for young‐type TTD.
Analysis of pathogenic factors of Candida albicans and the effect of vaginal immunization on recurrent vulvovaginal candidiasis in mice
Authors: Shao Ming‐Kun , Qi Wen‐Jin , Hou Meng‐Yao , Luo Dan‐Dan
Published: December 2021

Background

The role of fungal pathogenic factors and the immune response of the vaginal epithelium in vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis (RVVC) are still unclear. Our study wants to clarify whether there are differences in pathogenic factors between VVC and RVVC strains, confirm the roles of pathogenic factors in the pathogenesis of RVVC, and analyze the influence of pathogenic factors on vaginal host immunity.

Methods

VVC‐ and RVVC‐causing Candida albicans strains were genotyped with 25S rDNA. Drug susceptibility assays using a modified alamarBlue broth microdilution method were carried out. Milk culture medium and egg yolk culture medium were used to measure the secreted aspartate protease (Sap) and phospholipase (Plb) activity of the samples. We used C. albicans with different Sap activity levels to induce RVVC in mice and measured interleukin 4 (IL4), interleukin 8 (IL8), and interleukin 17 (IL17) in vaginal lavage fluid at different stages of RVVC infection.

Results

There were no significant differences between VVC and RVVC fungi except that the Sap activity was lower for RVVC‐causing C. albicans than for VVC‐causing C. albicans. C. albicans with both strong Sap and weak Sap induced RVVC in mice. C. albicans with strong Sap had a reduced RVVC infection rate. In addition, C. albicans with strong Sap stimulated the vaginal epithelium to secrete more IL4, IL8, and IL17.

Conclusion

Compared with that of VVC‐causing C. albicans, the Sap activity of RVVC‐causing C. albicans was lower. C. albicans with strong Sap was less capable of causing repeated vaginal infections than that with weak Sap and stimulated the vaginal epithelium to produce more cytokines.
Gender behavior and influence in acceptability of beers produced with Rubim and Mastruz
Authors: Lazzari Anderson , Barbosa Heloisa Dias , Filho Evandro Ribeiro Machado , Dada Ana Paula , Saraiva Bianka Rocha , Matumoto‐Pintro Paula Toshimi
Published: December 2021

The consumption of craft and specialized beer across the world has changed, since it passed from something little known to a familiar product among consumers, which has led to brewers incorporating new flavors and ingredients in beer. Regarding this subject, this study aimed to determine physical–chemical properties, acceptability, and gender behavior on beers with Rubim and Mastruz as hops bitterness substitution, following the proportion: 25, 50, 75, and 100%. A consumer trial (n = 84) was conducted to determine acceptability of nine beers. The participants were asked to rate their opinion about the color, aroma, flavor, overall acceptance, and bitterness intensity. Consumers assessed purchase intention. The hops bitterness substitution affected physical–chemical and sensory properties of beers. International bitterness units (IBU) decreased with increased levels of hops substitution, and the sensorially bitterness was felt by men and women. All beers presented purchase intention for men and women. Gender influenced choices and purchase intention of beers, since women usually look for new flavors, as men are mostly influenced by previous experiences and friendship recommendation.

Practical applications

This study brings significant information about the factors considered by consumers when they purchase and consume craft beer, aiming the influence by gender. The results were obtained by simple sensory methodologies, such as hedonic scales values, which took into consideration the consumers' appraisal and evaluated it by multivariate approaches, as Principal component analysis (PCA). With the emergence of craft beers, the results of this study emphasize consumer characteristics that can describe the relationship between perceived sensory complexity and appraisal, as well as evaluate how beer knowledge and familiarity with beer impact their decisions, which will help craft brewers market their beers effectively.
Constraints on the formation of carbonates and low‐grade metamorphic phases in the Martian crust as a function of H2O‐CO2 fluids
Authors: Semprich Julia , Filiberto Justin , Treiman Allan H. , Schwenzer Susanne P.
Published: December 2021

Low‐grade metamorphic hydrous minerals and carbonates occur in various settings on Mars and in Martian meteorites. We present constraints on the stability of prehnite, zeolites, serpentine, and carbonates by modeling the influence of H2O‐CO2 fluids during low‐grade metamorphism in the Martian crust using compositions of a Martian basalt and an ultramafic cumulate. In basaltic compositions with 5 wt% fluid, our models predict prehnite in less oxidized, CO2‐poor conditions (≤0.44 mol kg−1 CO2) on warmer geotherms of 20 °C km−1. At fluid‐saturated conditions, epidote and laumontite are replaced by quartz, calcite, chlorite, and muscovite. In ultramafic compositions with 5 wt% fluid, antigorite (serpentine) is stable at CO2‐poor conditions of ≤0.33 mol kg−1, while talc forms at 0.05–0.56 mol kg−1 CO2. At fluid‐saturated conditions, antigorite is replaced by talc and chlorite, and at higher X(CO2) by magnesite and quartz. Our models therefore suggest that prehnite, zeolites, and serpentine have formed in a CO2‐poor environment on Mars implying that fluids during their formation either did not contain high amounts of CO2 or had degassed CO2. Carbonates and potentially talc would have formed in the presence of a CO2‐bearing fluid and therefore at different alteration stages than for prehnite, zeolites, and serpentine either in the same hydrothermal event during which the fluid composition changed gradually due to cooling and precipitation or by separate and successive alteration events with fluids of different compositions.
Multigenerational transmission of obesity: A systematic review and meta‐analysis
Authors: Kanmiki Edmund W. , Fatima Yaqoot , Mamun Abdullah A.
Published: December 2021

There is a strong link between parental and offspring obesity status. However, the state of epidemiological evidence on multigenerational transmission of overweight/obesity, such as from grandparents to grandchildren, is relatively unknown. This systematic review collates and appraises existing evidence on multigenerational transmission of overweight/obesity and uses meta‐analytic estimates for quantitative synthesis. Six electronic databases were searched for publications reporting the relationship between grandparents and their grandchildren overweight/obesity status. A total of 25 studies from 17 countries with a combined population of 238,771 study participants met the inclusion criteria. About 60% (15) of the reviewed studies reported a positive association between grandparent–grandchild (GP‐GC) overweight/obesity, out of which 11 were statistically significant. Seven studies reported odds ratios of GP‐GC overweight/obesity associations and were included in the meta‐analysis. The pooled estimates showed a significant GP‐GC association in overweight/obesity status (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.01–2.57). Thus, the current research evidence shows that grandchildren's overweight/obesity status is associated with their grandparents' overweight/obesity status, indicating a multigenerational transmission of obesity. However, more studies, especially from developing countries, are required to assess the robustness of these findings. Future studies should also focus on the mechanisms through which this transmission occurs.
Propofol context‐sensitive decrement times in children
Authors: Morse James D. , Cortinez Luis Ignacio , Meneely Stephen , Anderson Brian J.
Published: December 2021

Plasma drug concentration is the variable linking dose to effect. The decrement time required for plasma concentration of anesthetic agents to decrease by 50% (context‐sensitive half‐time) correlates with the time taken to regain consciousness. However, the decrement time to consciousness may not be 50%. An effect compartment concentration is associated more closely with return of consciousness than plasma concentration. An alternative decrement time, the time required for propofol to decrease to a predetermined effect compartment concentration associated with movement (eg, 2 µg.ml−1), was used to simulate time for the concentration to decrease from steady state at a typical targeted effect compartment concentration 3.5 µg.ml−1 in children. These times were short and reflected a decrement time to consciousness (CSTAWAKE) increase that was small with longer infusion time. CSTAWAKE ranged from 7.5 min in 1‐year‐old infant given propofol for 15 min to 13.5 min in a 15‐year‐old adolescent given a 2‐hour infusion. Changes in decrement time with age reflect maturation of drug clearance. Neonates had prolonged increment times, 10 min after 15 min infusion and 18 min after 120 min infusion using a target concentration of 3.5 µg.ml−1. Decrement times to a targeted arousal concentration are context‐sensitive. Use of a higher target concentration of 6 µg.ml−1 doubled decrement times. Decrement times are associated with variability: delayed recovery beyond these simulated times is likely more attributable to the use of adjuvant drugs or the child's clinical status. An understanding of propofol decrement times can be used to guide recovery after anesthesia.
Finding a breather for Oryza sativa: Understanding hormone signalling pathways involved in rice plants to submergence stress
Authors: Mittal Lavanya , Tayyeba Sumaira , Sinha Alok K.
Published: December 2021

During the course of evolution, different ecotypes of rice (Oryza sativa L.) have evolved distinct strategies to cope with submergence stress. Such contrasting responses are mediated by plant hormones that are principle regulators of growth, development and responses to various biotic and abiotic stresses. These hormones act cooperatively and show extensive crosstalk which is mediated by key regulatory genes that serve as nodes of molecular communication. The presence or absence of such genes leads to significant changes in hormone signalling pathways and hence, governs the type of response that the plant will exhibit. As flooding is one of the leading causes of crop loss across all the major rice‐producing countries, it is crucial to deeply understand the molecular nexus governing the response to submergence to produce flood resilient varieties. This review focuses on the hormonal signalling pathways that mediate two contrasting responses of the rice plant to submergence stress namely, rapid internode elongation to escape flood waters and quiescence response that enables the plant to survive under complete submergence. The significance of several key genes such as Sub1A‐1, SLR1, SD1 and SK1/SK2, in defining the ultimate response to submergence has also been discussed.
Peen forming and stress peen forming of rectangular 2024–T3 aluminium sheets: Curvatures, natural curvatures and residual stresses
Authors: Faucheux Pierre A. , Miao Hong Yan , Lévesque Martin , Gosselin Frédérick P.
Published: December 2021

Aluminium skins on the lower wings of most commercial aircraft are shaped using shot peen forming. This process, which involves bombarding the skins with hard shot, uses nonuniform plastic flow to induce curvatures—in the same way that differential expansion makes metal bilayers bend when heated. Here, we investigate experimentally how constraining conditions affect the final shape of peen formed parts. We report peen forming experiments for 4.9‐mm‐thick rectangular 2024–T3 aluminium sheets of different aspect ratios uniformly shot peened on one face with a low intensity saturation treatment. Some specimens were free to deform during peening while others were elastically prestressed in a four‐point bending jig. For each aspect ratio and prestress condition, residual stresses were measured near the peened surface with the hole drilling method. Additional residual stress profiles were also obtained with the slitting method. The residual stress measurements show that the progressive deformation of unconstrained specimens had the same effect as an externally applied prestress. For the peening conditions investigated, this progressive deformation caused unconstrained strips to exhibit curvatures 33% larger than identical strips held flat during peening. Furthermore, we found that the relative importance of material anisotropy and geometric effects did determine the bending direction of unconstrained specimens.
Canine endotheliitis: Clinical characteristics, advanced imaging features, and treatment
Authors: Mayes Melaney A. , Casanova Maria Isabel , Park Sangwan , Steele Kirsten , Linton Lana , Kim Soohyun , Good Kathryn L. , Moore Bret A. , Newbold Georgina M. , Leonard Brian C. , Li Jennifer Y. , Thomasy Sara M.
Published: December 2021

Objective

To describe the clinical findings, multimodal corneal imaging features and treatment in canine patients diagnosed with endotheliitis.

Animals studied

Four canine patients met inclusion criteria for bilateral corneal disease with endothelial inflammation and secondary corneal edema that responded to topical anti‐inflammatory treatment.

Methods

The patients selected underwent a complete ophthalmic examination with emphasis on the cornea including ultrasound pachymetry (USP), Fourier‐domain optical coherence tomography (FD‐OCT), in vivo confocal microscopy (IVCM), and digital slit lamp photography.

Results

All patients in this study demonstrated thickened corneas due to edema with USP and FD‐OCT. With IVCM, mild to severe polymegathism and pleomorphism of corneal endothelial cells, reduced endothelial cell density, hyperreflective keratic precipitates (KPs), and extracellular debris as well as hyporeflective pseudoguttata were observed. With FD‐OCT, hyperreflective KPs were commonly observed on the inferior cornea. Clinical examination and advanced imaging results were consistent with a diagnosis of endotheliitis. All patients initially responded to topical anti‐inflammatory treatment and required continued therapy; two patients also received topical netarsudil, a rho‐associated coiled‐coil kinase inhibitor.

Conclusion

Endotheliitis should be considered for canine patients with bilateral edema that is most severe in the inferior cornea. Careful inspection of Descemet's membrane–endothelial complex should be performed for KPs or inflammatory debris. Chronic administration of topical anti‐inflammatories may be necessary to prevent flare‐ups of endotheliitis.
Suspensory ligament size does not change after plantar fasciotomy and neurectomy of the deep branch of the lateral plantar nerve by ultrasonographic assessment
Authors: Scharf Alexandra , de Solis Cristobal Navas , Sampson Sarah N. , Glass Kati , Watts Ashlee E.
Published: December 2021

Objective

To determine the short‐term effect of plantar fasciotomy and neurectomy (PFN) of the deep branch of the lateral plantar nerve on the proximal suspensory ligament (PSL) cross‐sectional area (CSA) in horses with hindlimb proximal suspensory desmopathy (PSD).

Study design

Analytical, observational, cohort study.

Sample population

Twenty‐one horses.

Methods

Records of horses with chronic PSD treated by PFN were included if a preoperative ultrasonographic examination was available and at least one postoperative ultrasonographic examination. One masked observer measured the ultrasonographic cross‐sectional area (CSA) of the PSL. Intraobserver reliability was determined by repeatedly measuring a subset of ultrasonographic images (n = 127). Two masked observers measured the cross‐sectional area of the proximal suspensory ligament (PSL‐CSA) on preoperative proton density (PD)‐weighted transverse high field magnetic resonance images (n = 19 horses) . Agreements for PSL‐CSA between preoperative ultrasonographic and MRI measures and between the two magnetic resonance imaging (MRI) observers were assessed. Follow up considered the horses’ ability to return to exercise and their owners’ satisfaction.

Results

The reliability of the ultrasonographic measurement of the PSL‐CSA was excellent. Agreement between ultrasonographic assessment and MRI assessment of PSL‐CSA was good. No difference was detected between preoperative (median, interquartile range; oblique‐incidence, 2.07, 1.72‐2.55; on‐incidence, 2.23, 1.98‐2.65) and postoperative (oblique‐incidence, 2.08, 1.80‐2.74; on‐incidence, 2.28, 2.01‐2.74) PSL‐CSAs. At a median of 12 months (4‐33 months), 16/20 (80%) owners reported the horse was “better” and 15/20 (75%) functioned at or above preoperative levels.

Conclusion

Ultrasonographic measurement of the PSL‐CSA was reproducible and in good agreement with MRI measurement. The PSL‐CSA was not influenced by PFN.

Clinical significance

The PSL‐CSA cannot be used to guide return to function.
Abdominal hereditary angio-oedema caught on magnetic resonance imaging
Authors: Siow Mayven Tien Li , Robertson Alexander Myles , Ghurye Rohit R , Blaker Paul A
Published: December 2021

A 17-year-old woman presented with a 3-year history of recurrent, severe abdominal pain with spontaneous resolution within a few days. An ultrasound revealed nothing more than free fluid within the pelvis. An MRI of the small bowel was done within 24 hours of abdominal pain onset, which revealed extensive submucosal oedema associated with moderate volume ascites. A repeat MRI of the small bowel after 72 hours showed near-complete resolution of these changes. Checking C1 inhibitor levels confirmed a diagnosis of hereditary angio-oedema with an abdominal presentation. This is a rare cause of recurrent abdominal pain and, to our knowledge, the first case in which MR images have been obtained during and after an acute attack.
Dose–response relationships between polycyclic aromatic hydrocarbon exposure and blood cell counts among coke oven workers: a sex-stratified analysis
Authors: Liu Chengjuan , Wu Min , Fu Mengmeng , Wang Huimin , Nie Jisheng
Published: December 2021

Objectives

To explore sex differences and dose–response relationships between nine urinary polycyclic aromatic hydrocarbon (PAH) metabolites and neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and complete blood counts among coke oven workers.

Design and setting

A cross-sectional study with stratified sex was conducted in Shanxi, China.

Participants

A total of 458 male workers and 226 female workers were selected.

Primary and secondary outcome measures

General linear models, p values for trend tests and natural cubic spline models were used to explore the dose–response relationships between nine urinary PAH metabolites and NLR, PLR and complete blood counts.

Result

Compared with male workers, female workers had lower exposure level of PAH (0.95 ng/mL vs 1.38 ng/mL). Only among female workers did we observe that a 1-unit increase in lg(1-OHPyr) was related to a 0.149 (95% CI: 0.055 to 0.242; p for trend=0.041) and 0.103 (95% CI: 0.025 to 0.181; p for trend=0.007) increase in lg(NLR) and lg(PLR), and a 0.116 (95% CI: −0.179 to –0.054; p for trend=0.007) decrease in lg(lymphocyte counts (LYMs)). A 1-unit increase in lg(2-OHNap) was related to a 0.045 (95% CI: 0.003 to 0.086; p for trend=0.037) increase in lg(PLR) and a 0.029 (95% CI: −0.056 to –0.002; p for trend=0.030) and 0.016 (95% CI: −0.029 to –0.003; p for trend=0.010) decrease in lg(white blood cell counts (WBCs)) and lg(haemoglobin (HGB)).

Conclusion

Female workers’ NLR, PLR, WBCs, HGB and LYMs may be more susceptible than those of male workers when affected by PAH.
Reducing missed opportunities for vaccination in Mozambique: findings from a cross-sectional assessment conducted in 2017
Authors: Magadzire Bvudzai Priscilla , Joao Gabriel , Bechtel Ruth , Matsinhe Graça , Nic Lochlainn Laura , Ogbuanu Ikechukwu Udo
Published: December 2021

Objective

Missed opportunities for vaccination (MOV) are a significant contributor to low vaccination coverage. To better understand the magnitude and underlying causes of MOV among children aged 0–23 months in Mozambique, we conducted an assessment and developed a roadmap for strengthening the country’s childhood immunisation programme.

Setting

Three provinces in North, South and Central Mozambique.

Methods

The assessment applied a mixed-method approach. From a sample of 41 health facilities, we conducted exit interviews with caregivers of children aged 0–23 months (n=546), surveys with health workers (n=223), focus group discussions with caregivers (n=6) and health workers (n=5), and in-depth interviews with health facility managers (n=9). We analysed the data to assess the magnitude of MOV and to identify causes of MOV and ways of preventing them.

Results

Vaccination records were available for 538 children. Sixty per cent (n=324) were eligible for vaccination on arriving for their health facility visit. Of these, 76% (n=245) were not fully vaccinated, constituting MOV. Our analysis shows that these MOV were most frequently attributable to practices of caregivers and health workers and also to health systems reasons. Inadequate information about vaccination among both caregivers and health workers, poor or poorly understood health facility practices, inadequate integration of curative and preventative services, inadequate tracking systems to identify children due for vaccination and, less often, limited supply of vaccines, syringes and other related supplies at service points resulted in MOV.

Conclusions

The results of the assessment informed the development of roadmaps for reducing MOV that may be applicable to other settings. The global immunisation community should continue to invest in efforts to reduce MOV and thereby make health service visits more effective and efficient for vaccination.
Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study
Authors: Jessup Rebecca Leigh , Bramston C , Beauchamp A , Gust A , Cvetanovska N , Cao Y , Haywood C , Conilione P , Tacey Mark , Copnell Beverley , Mehdi H , Alnasralah Dialla , Kirk M , Zucchi Emilliano , Campbell D , Trezona A , Haregu T , Oldenburg Brian , Stockman K , Semciw Adam Ivan
Published: December 2021

Objectives

The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance.

Design

This convergent parallel mixed methods study comprised two parts.

Setting

An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting.

Participants

A total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23–99).

Results

Interrupted time-series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 67% across emergency triage categories. 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health-seeking behaviour: fear and/or avoidance of hospital care; use of telehealth for remote assessment; no fear or avoidance of hospital care; not leaving the house for any reason.

Conclusions

This study demonstrated reduced ED use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth.
Malnutrition assessment methods in adult patients with tuberculosis: a systematic review
Authors: ter Beek Lies , Bolhuis Mathieu S , Jager-Wittenaar Harriët , Brijan René X D , Sturkenboom Marieke G G , Kerstjens Huib A M , de Lange Wiel C M , Tiberi Simon , van der Werf Tjip S , Alffenaar Jan-Willem C , Akkerman Onno W
Published: December 2021

Objectives

Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.

Design

Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.

Results

Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.

Conclusions

Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.

PROSPERO registration number

CRD42019122832.
Association of the patterns of use of medications with mortality of COVID-19 infection: a hospital-based observational study
Authors: Wallace Arthur W , Cirillo Piera M , Ryan James C , Krigbaum Nickilou Y , Badathala Anusha , Cohn Barbara A
Published: December 2021

Objectives

SARS-CoV-2 enters cells using the ACE2 receptor. Medications that affect ACE2 expression or function such as angiotensin receptor blockers (ARBs) and ACE inhibitors (ACE-I) and metformin have the potential to counter the dysregulation of ACE2 by the virus and protect against viral injury. Here, we describe COVID-19 survival associated with ACE-I, ARB and metformin use.

Design

This is a hospital-based observational study of patients with COVID-19 infection using logistic regression with correction for pre-existing conditions and propensity score weighted Cox proportional hazards models to estimate associations between medication use and mortality.

Setting

Medical record data from the US Veterans Affairs (VA) were used to identify patients with a reverse transcription PCR diagnosis of COVID-19 infection, to classify patterns of ACE inhibitors (ACE-I), ARB, beta blockers, metformin, famotidine and remdesivir use, and, to capture mortality.

Participants

9532 hospitalised patients with COVID-19 infection followed for 60 days were analysed.

Outcome measure

Death from any cause within 60 days of COVID-19 diagnosis was examined.

Results

Discontinuation of ACE-I was associated with increased risk of death (OR: 1.4; 95% CI 1.2–1.7). Initiating (OR: 0.3; 95% CI 0.2–0.5) or continuous (OR: 0.6; 95% CI 0.5–0.7) ACE-I was associated with reduced risk of death. ARB and metformin associations were similar in direction and magnitude and also statistically significant. Results were unchanged when accounting for pre-existing morbidity and propensity score adjustment.

Conclusions

Recent randomised clinical trials support the safety of continuing ACE-I and ARB treatment in patients with COVID-19 where indicated. Our study extends these findings to suggest a possible COVID-19 survival benefit for continuing or initiating ACE-I, ARB and metformin medications. Randomised trials are appropriate to confirm or refute the therapeutic potential for ACE-I, ARBs and metformin.
Cost-effectiveness of paediatric surgery: an economic evaluation of World Paediatric Project surgical interventions in St. Vincent and the Grenadines (2002–2019)
Authors: Dolan Carrie B , Agyemang Samuel A , Clare Brian , Coleman Charles , Richter Bill , Robertson Emily , Nonvignon Justice
Published: December 2021

Objectives

The purpose of this study is to examine the cost-effectiveness of six types of surgical interventions as part of a sustained paediatric surgical programme in St.Vincent and the Grenadines from 2002 to 2019.

Design

In this economic model, six paediatric surgical interventions (ophthalmic, orthopaedic, plastic, general, urology, neurosurgery) were compared with no surgery in a deterministic cost-effectiveness model. We assessed health benefits as averted disability-adjusted life-years (DALYs). Costs were included from the programme perspective and measured using standard micro-costing methods. Incremental cost-effectiveness ratios (ICERs) were calculated for each type of surgical intervention. Interventions with ICERs of <50% of gross domestic product (GDP) per capita were considered cost-effective. Costs are reported in 2019 US$. Univariate sensitivity analyses were conducted to assess the effect of uncertainty.

Results

The average cost per procedure was US$16 685 (range: US$9791.78–US$72 845.76). The cumulative discounted 18-year health impact was 5815 DALYs averted with a cost per DALY averted of US$2622. Most paediatric surgical interventions were cost-effective, yielding cost per DALY estimates less than 50% of GDP per capita of St. Vincent and the Grenadines. When undiscounted, only orthopaedic surgeries had cost per DALY more than 50% GDP per capita. When considering discounting, orthopaedic and urology surgeries exceeded the adopted threshold for cost-effectiveness.

Conclusions

We found that short-term, recurrent surgical interventions could yield substantial economic benefits in this limited resource setting. This research indicates that investment in paediatric surgical interventions is cost-effective for the majority of specialties. These findings are of clinical significance given the large burden of disease attributable to surgically treatable diseases. This work demonstrates that scaling up dedicated surgical programmes for children is a cost-effective and essential component to improve paediatric health.
Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring
Authors: DeLacey Emily , Hilberg Evan , Allen Elizabeth , Quiring Michael , Tann Cally J , Groce Nora Ellen , Vilus James , Bergman Ethan , Demasu-Ay Merzel , Dam Hang T , Kerac Marko
Published: December 2021

Objectives

The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.

Design

A retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status.

Setting

We conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines.

Participants

Deidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information.

Results

At initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits.

Conclusions

Malnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared.
Role of maintenance strategies in advanced epithelial ovarian cancer: a systematic review, network meta-analysis and cost-effectiveness analysis protocol
Authors: Hu Qiancheng , Kang Wenli , Wu Qiuji , Wang Xin , Wang Qingfeng , Luo Ting
Published: December 2021

Introduction

Different maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and cost-effectiveness analysis to investigate maintenance strategies containing chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenesis therapy for patients with advanced ovarian cancer.

Methods and analysis

The search strategy to identify potentially relevant studies will include hand searches in EMBASE, PubMed, Cochrane library and Web of science. The primary outcome is progression-free survival, defined as the date of randomisation to the date of progression or death. The secondary outcome is overall survival (calculated from the time from randomisation to death from any cause), grade 3–4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. Two steps of meta-analysis will be carried out, traditional pair-wise meta-analysis and network meta-analysis. Methodological quality, risk of bias and the strength of evidence from randomised controlled trials (RCTs) will be proposed to assess the quality of RCTs. Heterogeneity, publication bias, subgroup analysis and sensitivity analysis will be explored.

Ethics and dissemination

The purpose of our study is to perform a comprehensive efficacy, safety and cost-effectiveness analysis of all maintenance strategies in patients with advanced ovarian cancer. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics approval is not required for network meta-analysis and cost-effectiveness analysis.

PROSPERO registration number

CRD42021231814.
Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for theBuddyrandomised factorial trial
Authors: Åsberg Katarina , Lundgren Oskar , Henriksson Hanna , Henriksson Pontus , Bendtsen Preben , Löf Marie , Bendtsen Marcus
Published: December 2021

Introduction

The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions.

Methods and analysis

A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation.

Ethics and dissemination

The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study.

Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023.

Trial registration number

ISRCTN23310640; Pre-results.
Age-specific correlation between thyroid hormone concentrations and ultrasound thyroid volume for diagnosing thyroid dysfunction in preterm infants: a single-centre, prospective, observational study protocol
Authors: Mikołajczak Aleksandra , Kufel Katarzyna , Bokiniec Renata
Published: December 2021

Introduction

Thyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to lack of gestational age-specific reference ranges and thyroid ultrasound nomograms. We aim to evaluate the age-specific correlation between circulating free thyroxine (FT4) and thyrotropin stimulating hormone (TSH) levels and ultrasound thyroid volume to assist identify infants requiring thyroid hormone replacement therapy.

Methods and analysis

This is an observational, prospective, single-centre study that will include 200 preterm infants born between 24 and 32 weeks of gestational age, without any congenital diseases or malformation that may affect thyroid function. Venous blood will be obtained in infants at 14–21 days of life, and at 32 and 36 weeks of postconceptional age (PCA) to measure FT4 and TSH concentrations. Thyroid ultrasound will be performed at 32 and 36 weeks of PCA. Relevant outcomes will include determination of FT4 and TSH values and ultrasound thyroid volume for preterm infants born at 24–28 weeks of gestation and 29–32 weeks of gestation. Correlations among circulating hormone concentrations and thyroid volumes with the head circumference and body mass will also be determined.

Ethics and dissemination

The Ethics Committee of the Medical University of Warsaw has approved the study protocol prior to recruitment (KB44/2019). Informed consent will be obtained from caretakers of preterm infants at the time of enrolment. Consent for participation in the study can be withdrawn at any time, without consequences and without obligation to justify the decision. All data will be stored in a secure, password-protected Excel file that is only accessible to researchers involved in the study. Findings will be published in a peer-reviewed journal and disseminated at relevant national and international conferences.

Trial registration number

NCT04208503.
Inequities in childhood anaemia at provincial borders in Mozambique: cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey
Authors: Muhajarine Nazeem , Adeyinka Daniel A , Matandalasse Mbate , Chicumbe Sergio
Published: December 2021

Objectives

This study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique.

Design

Cross-sectional study.

Setting

Mozambique.

Participants

This study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey.

Primary outcome measure

Child’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L); the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks.

Results

The mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-Nampula triprovincial border, Gaza-Inhambane border, Zambezia-Nampula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia.

Conclusion

Findings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for example, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study
Authors: Kristensen Pia Kjær , Falstie-Jensen Anne Mette , Madsen Morten , Johnsen Søren Paaske
Published: December 2021

Objectives

To characterise and quantify possible patient-related disparities in hip fracture care including temporal changes.

Design

Population-based cohort study.

Setting

All Danish hospitals treating patients with hip fracture.

Participants

60 275 hip fracture patients from 2007 to 2016.

Interventions

Quality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient’s probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients.

Primary and secondary outcome measures

The primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme.

Results

The proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment.

Conclusions

Disparity of care between best-off and worst-off patients remained substantial over time.
Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study
Authors: Shah Rahul , Raji Mukaila A , Westra Jordan , Kuo Yong-Fang
Published: December 2021

Objective

Examine the association between the co-prescribing of opioids, benzodiazepines, gabapentinoids (pregabalin and gabapentin) and selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs) in different combinations and the risk of falls and fractures.

Design

Retrospective cohort study from 2015 to 2018.

Setting

Medicare enrolment and claims data.

Participants

Medicare beneficiaries with both chronic pain and anxiety disorders in 2016 with continuous enrolments in Parts A and B from 2015 to 2016 who were prescribed any combination of opioid, benzodiazepine, gabapentinoid and SSRI/SNRI in 2017 for ≥7 days, as documented in their Medicare Part D coverage.

Interventions

Any combination of use of seven drug regimens (benzodiazepine +opioid; benzodiazepine +gabapentinoid; benzodiazepine +SSRI/SNRI; opioid +gabapentinoid; opioid +SSRI/SNRI; gabapentinoid +SSRI/SNRI; ≥3 drug classes).

Main outcomes

First event of fall and the first event of fracture after the index date, which was the first day of combination drug use that lasted ≥7 days in 2017.

Results

A total of 47 964 patients (mean [SD] age, 75.9 [7.1]; 78.0% woman) with diagnoses of both chronic pain and anxiety were studied. The median (Q1–Q3) duration of drug combination use was 26 (14-30) days. After adjusting for demographic characteristics, chronic conditions and history of hospitalisation and fall or fracture, the co-prescribing of ≥3 drugs (adjusted HR [aHR], 1.38; 95% CI 1.14 to 1.67) and opioid plus gabapentinoid (aHR, 1.18; 95% CI 1.02 to 1.37) were associated with a high fall risk, compared with benzodiazepineplus opioid co-prescribing, findings consistent with the secondary analysis using inverse probability of treatment weighting with propensity scores. The co-prescribing of benzodiazepine plus gabapentinoid (aHR, 0.76; 95% CI 0.59 to 0.98) was associated with lower fracture risk compared with the co-prescribing of benzodiazepine plus opioid, though this finding was not robust.

Conclusions

Our findings add to comparative toxicity research on different combinations of gabapentinoids and serotonergic agents commonly prescribed with or as substitutes for opioids and benzodiazepines in patients with co-occurring chronic pain and anxiety.