bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating an advanced double intravenous vasopressor automated system to treat hypotension during spinal anesthesia for cesarean delivery: a randomized controlled trial
Authors: Tan Hon Sen , Nagarajan Singaraselvan , Chan Jason Ju In , Tan Chin Wen , Sultana Rehena , Sia Alex Tiong Heng , Sng Ban Leong
Published: January 2023

Background

The optimal treatment of hypotension during spinal anaesthesia is uncertain. A novel double intravenous vasopressor automated (DIVA) system reduces hypotension compared to standard care, and was subsequently modified to an advanced-DIVA (ADIVA) system. The primary objective was to compare ADIVA versus DIVA on incidence of hypotension (systolic BP (SBP) < 80% baseline).

Methods

We conducted a randomized-controlled trial in women undergoing elective cesarean delivery under spinal anesthesia. SBP and heart rate were measured continuously using a Nexfin monitor. ADIVA delivered 25 μg phenylephrine (heart rate > 60 beats.min−1) or 2 mg ephedrine (heart rate < 60 beats.min−1) at SBP 90 to 110% of baseline, 50 μg phenylephrine or 4 mg ephedrine at SBP 80 to 90%, and 75 μg phenylephrine or 6 mg ephedrine at SBP < 80%. ADIVA calculated the trend of SBP; vasopressors were administered rapidly if SBP trended downward, or 30 s if SBP trended upward. In contrast, DIVA delivered 25 μg phenylephrine or 2 mg ephedrine at SBP 90 to 100% of baseline, and 50 μg phenylephrine or 4 mg ephedrine at SBP < 90%. Boluses were followed by a 10-s lockout. Other outcomes included hypertension (SBP > 120% baseline), vasopressor consumption, clinical outcomes, and performance measures from spinal anesthesia to fetal delivery.

Results

We analyzed 94 parturients (ADIVA: n = 46, DIVA: n = 48), with no difference in the incidence of hypotension between ADIVA (78.3%) and DIVA (83.3%, p = 0.677). ADIVA had significantly higher proportion of hypotensive SBP readings, lower phenylephrine consumption and higher umbilical arterial pH. There was no difference in hypertension, bradycardia, ephedrine consumption, intravenous fluid volume, nausea/vomiting, Apgar scores, and umbilical venous pH or lactate. ADIVA maintained SBP higher above baseline with greater fluctuation than DIVA.

Conclusion

ADIVA was associated with a greater proportion of hypotensive SBP readings, reduced phenylephrine consumption, and increased umbilical arterial pH than DIVA. Further research is needed to determine the optimal method of vasopressor delivery in parturients undergoing cesarean delivery.

Trial registration

This study was registered on Clinicaltrials.gov registry (NCT03620942) on 08/08/2018.
Neurological sequelae after encephalitis associated with herpes simplex virus in children: systematic review and meta-analysis
Authors: Rocha Natalie Duran , de Moura Sara Kvitko , da Silva Gabriel Aude Bueno , Mattiello Rita , Sato Douglas Kazutoshi
Published: January 2023

Background

Encephalitis is an inflammation of the cerebral parenchyma manifested by acute symptoms such as fever, headaches, and other neurological disorders. Its etiology is mostly viral, with herpes simplex virus being a frequent etiological agent in children. The development of neurological sequelae is a serious outcome associated with this infection.

Objective

To assess the general prevalence and types of neurological sequelae in children after a case of acute viral encephalitis caused by HSV.

Methods

This systematic review and meta-analysis was developed following the PRISMA guidelines. The literature search was carried out in the MEDLINE, Embase, SciELO, LILACS, Cochrane, CINAHL, PsycINFO, and Web of Science databases. Studies were included of children with confirmed HSV infection and that presented a description of neurological sequelae associated with that infection. For the meta-analysis of general prevalence and of the types of neurological sequelae a random effects model was used.

Results

Of the 2827 articles chosen in the initial search, nine studies were included in the systematic review and meta-analysis. The general prevalence of neurological sequelae was 50.7% (95% CI 39.2–62.2). The most frequent sequelae were related to mental disability, with a 42.1% prevalence (95% CI 30–55.2); on the other hand, the least frequent sequelae were those related with visual impairment, with a 5.9% prevalence (95% CI 2.2–14.6). The included studies presented regular quality and substantial heterogeneity.

Conclusion

Even with antiviral therapy, half of patients will develop some type of disability.
Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience
Authors: Taher Ameed , Enaya Ahmad , Sarsour Ala , Bahar Sami , Hamayel Dalia , Safarini Omar , Hamdan Zakaria , Nazzal Zaher
Published: January 2023

Introduction

Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them.

Methods

This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes.

Results

A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes.

Conclusion

The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.
A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol
Authors: Mohan Sailesh , Chaudhry Monica , McCarthy Ona , Jarhyan Prashant , Calvert Clara , Jindal Devraj , Shakya Rajani , Radovich Emma , Kondal Dimple , Penn-Kekana Loveday , Basany Kalpana , Roy Ambuj , Tandon Nikhil , Shrestha Abha , Shrestha Abha , Karmacharya Biraj , Cairns John , Perel Pablo , Campbell Oona M. R. , Prabhakaran Dorairaj
Published: January 2023

Background

India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers – Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers).

Methods

This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities—one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist.

Discussion

To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries.

Trial Registration.

ClinicalTrials.gov, NCT03700034, registered 9 Oct 2018,https://www.clinicaltrials.gov/ct2/show/NCT03700034

CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019,http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27
Study protocol for the sheMATTERS study (iMproving cArdiovascular healTh in new moThERS): a randomized behavioral trial assessing the effect of a self-efficacy enhancing breastfeeding intervention on postpartum blood pressure and breastfeeding continuation in women with hypertensive disorders of pregnancy
Authors: Dayan Natalie , Smith Graeme , Nedelchev Atanas , Abenhaim Haim , Brown Richard , Da Costa Deborah , Ali Suhad , Perlman Jesseca , Nguyen Tuong-Vi , Dennis Cindy-Lee , Abdelmageed Wael , Semenic Sonia
Published: January 2023

Background

Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one’s breastfeeding self-efficacy have been shown to improve breastfeeding rates.

Methods

We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months.

Discussion

This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure – an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP.

Trial registration

ClinicalTrials.gov, # NCT04580927, registered on Oct 9, 2020.
Maternal plasma vitamin D levels across pregnancy are not associated with neonatal birthweight: findings from an Australian cohort study of low-risk pregnant women
Authors: van der Pligt Paige F. , Ellery Stacey J. , de Guingand Deborah L. , Abbott Gavin , Della Gatta Paul A. , Daly Robin M.
Published: January 2023

Background

In utero environments can be highly influential in contributing to the development of offspring obesity. Specifically, vitamin D deficiency during pregnancy is associated with adverse maternal and child health outcomes, however its relationship with offspring obesity remains unclear. We assessed maternal vitamin D status across pregnancy, change in plasma vitamin D concentrations and associations with neonatal birthweight, macrosomia and large for gestational age.

Methods

Women (n = 221) aged 18–40 years with singleton (low-risk) pregnancies, attending antenatal clinics at a tertiary-level maternity hospital were recruited at 10–20 weeks gestation. Medical history, maternal weight and blood samples at three antenatal clinic visits were assessed; early (15 ± 3 weeks), mid (27 ± 2 weeks) and late (36 ± 1 weeks) gestation. Maternal 25(OH)D was analysed from stored plasma samples via liquid chromatography-tandem mass spectrometry (LC/MS/MS). Neonatal growth parameters were collected at birth. Unadjusted and adjusted linear and logistic regression assessed associations of maternal vitamin D with birthweight, macrosomia and large for gestational age.

Results

Mean plasma 25(OH)D increased from early (83.8 ± 22.6 nmol/L) to mid (96.5 ± 28.9 nmol/L) and late (100.8 ± 30.8 nmol/L) gestation. Overall 98% of women were taking vitamin D-containing supplements throughout their pregnancy. Prevalence of vitamin D deficiency (25(OH)D < 50 nmol/L) was 6.5%, 6.3% and 6.8% at early, mid and late pregnancy respectively. No statistically significant association was found between 25(OH)D or vitamin D deficiency at any timepoint with neonatal birthweight, macrosomia or large for gestational age.

Conclusions

Prevalence of vitamin D deficiency was low in this cohort of pregnant women and likely related to the high proportion of women taking vitamin D supplements during pregnancy. Maternal 25(OH)D did not impact offspring birth weight or birth size. Future studies in high-risk pregnant populations are needed to further assess maternal vitamin D status and factors in utero which promote early life obesity.
The association between healthy beverage index and quality of life among overweight and obese women: a cross-sectional study
Authors: Rasaei Niloufar , Ghaffarian-Ensaf Rasool , Shiraseb Farideh , Fallah Melika , Gholami Fatemeh , Clark Cain C. T. , Mirzaei Khadijeh
Published: January 2023

Background

Although several studies have evaluated the association between patterns of beverage consumption with different components of quality of life separately, the findings are controversial. In addition, none have examined all components of quality of life together in relation to patterns of beverage consumption. Therefore, this study was conducted to identify the association between healthy beverage index (HBI) and quality of life among overweight and obese women.

Methods

For this cross-sectional study, 210 obese and overweight women were recruited from health centers in Tehran, Iran. Using reliable and verified standard protocols, data on beverage intake, socio-demographic, physical activity, and anthropometric variables were assessed. Based on past studies, the predetermined HBI was estimated. Serum samples were used to determine biochemical characteristics, and quality of life was assessed using SF-36 questionnaires.

Results

There was a significant association between total QoL score with T2 tertile of HBI in the adjusted model (β: 13.11, 95% CI: 1.52, 24.69, p-value = 0.027). General health had a significant negative association with T2 (β: -5.83; 95% CI: − 11.48, − 0.18; p-value = 0.043) and T3 (β: -6.20; 95% CI: − 12.37, − 0.03; p-value = 0.049). Women with greater adherence to the HBI had a higher physical functioning score, and there was a significant upward trend from the second to the third tertile (7.74 vs 0.62) (−trend = 0.036). There was a significant positive association between mental health with T3 of HBI (β: 4.26; 95% CI: 1.51, 5.98; p-value = 0.015) and a significant increasing trend was observed with increasing tertiles (P-trend = 0.045).

Conclusion

In conclusion, there is a significant association between total QoL score, and its components, with HBI among overweight and obese women. However, additional well-designed studies are needed to confirm these findings.
Association between choices of transportation means and instrumental activities of daily living: observational cohort study of community-dwelling older adults
Authors: Tamura Motoki , Tomoki Ishikawa , Matsumoto Komaki , Hattori Shinji
Published: January 2023

Introduction

The association between the physical health of older people and the frequency of going out has been reported, and in recent years, local governments have developed transportation support programs for older people. Although previous studies show an association between the frequency of going out and functional health status, little has been reported on the impact of the choice of means of transport on instrumental activities of daily living (IADL).

Objective

To evaluate the association between choice of transportation means and the risk of decline in IADL among older adults.

Methods

We conducted an observational, population (community-dwelling)-based cohort study using data from the Resident Health Status Survey, and longitudinal panel data at 2-time points in 2016 and 2019. In addition, we combined this panel data and a database on people who were certified as requiring long-term care to identify participants’ IADL. The propensity score matching method was used to classify the respondents into two groups, “active means of transportation” and “passive means of transportation,“ and determine the risk of a decline in means-tested independence after 3 years.

Results

Active means were used by 6,280 (76.2%) and passive means were used by 1,865 (22.6%). 999 (12.1%) individuals declined in IADL in 2019. The results of the comparison by balancing the attributes of “active means of transportation” and “passive means of transportation,“ with propensity score matching, showed that “passive means of transportation” were more likely to be “active” than “passive means of transportation,“ and “active” was more likely to be “passive” The risk of IADL decline was significantly higher than that of “active means of transportation” with an RR of 1.93 (95% CI: 1.62–2.30).

Conclusion

Passive means of transportation in older adults could be a possible risk for decreasing IADL 3 years later. Increasing the number of opportunities and places in the community for older adults to use active means of transportation may be effective in encouraging socially independent living among older adults.
Evaluation of national dental curriculum in Iran using senior dental students’ feedback
Authors: Salmani Arvin , Keshavarz Hooman , Akbari Majid , Kharrazifard Mohammad Javad , Varmazyari Shabnam , Khami Mohammad Reza
Published: January 2023

Background

Dental curriculums require regular revision to stay up to date in scientifical and societal fields. Senior dental students are among the main stakeholders of such curriculums. The present study investigated the opinions of Iranian senior dental students regarding the adequacy of their dentistry program and the national dental curriculum in training a competent dentist, the program’s content, and its structure.

Methods

A previously designed and validated questionnaire on the opinion of senior dental students regarding curriculum adequacy was sent to a representative in each of the country’s dental schools. Before the COVID pandemic terminated data collection, a total of 16 schools (438 students) managed to respond (37%). The questionnaire asked the students to assess the adequacy of the training received in curriculum’s theoretical and practical competencies with the help of a five-point Likert scale that ranged from “Completely inadequate” to “Completely adequate”. It also questioned them on its teaching methods and intensity. SPSS software version 24 and Chi-square test served for statistical analysis.

Results

In total, the study has 438 participants, 245 female and 193 male. Significant sex differences were spotted in the responses concerning both theoretical and practical training. Regarding general training adequacy, 50 (22.6%) female students and 50 male ones (30.7%), P = 0.08 agreed that the program was acceptable. The numbers for students of old (more than 15 years of activity) and new schools were 47 (21.7%) and 53 (31.7%), respectively (P = 0.03). Nearly one-third deemed the teaching methods appropriate. Regarding the duration of curriculum phases, 33 students (8.3%) believed that basic science required extension, while 108 (28.6%) and 266 (69.1%) reported such need for pre-clinical and clinical phases. The school’s years of activity emerged as significant, as 38.1% of students from new schools versus 21.7% of those from old ones deemed the extension of pre-clinical phase necessary (P < 0.001).

Conclusion

A significant number of Iranian senior dental students found the undergraduate dental curriculum inadequate regarding competencies, content, and teaching. Further investigations will determine whether it’s the curriculum or its implementation that warrants revision.
Endometriosis of the skeletal muscular system (ESMS): a systematic review
Authors: Ye Hui , Shen Chongyang , Quan Qingli , Xi Mingrong , Li Lin
Published: January 2023

Background

Extrapelvic endometriosis occurring at skeletal muscle and joint sites is not rare and is prone to delayed diagnosis and inappropriate treatment. Herein, endometriosis of the skeletal muscular system (ESMS) is systematically reviewed to facilitate early diagnosis and treatment.

Methods

Literature on ESMS published before March 2022 was retrieved from the Ovid Medline and Web of Science databases, and the major clinical data were extracted for descriptive analysis.

Results

A total of 62 studies (78 ESMS cases) met these requirements. The ESMS included the abdominal muscles (50.7%), pelvic floor muscles (11.6%), lower limb muscles (11.6%), hip muscles (8.7%), lumbar muscles (7.2%), joints (5.8%), upper limb muscles (2.9%), and shoulder–neck muscles (1.4%). The age was 34.0 ± 7.2 years (range 17–49 years). Approximately 63.8% of patients had at least one previous pelvic surgery, and 76.8% of local symptoms were related to the menstrual cycle. The course of disease was 29.6 ± 25.4 months (range 0.5–96 months). Only 30.3% of the patients sought initial medical advice from gynecologists, while 69.7% sought initial medical advice from a nongynecological physician. Twenty-seven patients underwent fine-needle aspiration (FNA) under ultrasound or CT monitoring, and only 44.4% (12/27) were confirmed to have endometriosis by FNA tissue pathology. Approximately 47.4% (37/78) of the patients had a normal pelvic cavity appearance. Surgical resection was performed in 92.3% (72/78) of the patients, of whom 88.9% (64/72) underwent complete resection of the lesion (negative surgical margin) and 20.8% (15/72) received postoperative hormone therapy. At 16.7 months of follow-up, 83.3%, 13.8%, 2.9%, and four patients had complete response, partial response, recurrence, and permanent function impairment, respectively.

Conclusion

Endometriosis can occur at almost any site in the musculoskeletal system. For women of reproductive age with catamenial pain or a mass in the musculoskeletal system, endometriosis should be suspected. Fine-needle aspiration can easily lead to missed diagnoses. Surgical resection for negative margins is the main treatment, and permanent impairment of function may occur in a few patients due to delayed diagnosis. Vascular lymphatic metastasis is the most likely mechanism of pathogenesis.
Implementation and evaluation of an elective quality improvement curriculum for preclinical students: a prospective controlled study
Authors: Aredo Jacqueline V. , Ding Jack B. , Lai Cara H. , Trimble Richard , Bromley-Dulfano Rebecca A. , Popat Rita A. , Shieh Lisa
Published: January 2023

Background

Quality improvement (QI) is a systematic approach to improving healthcare delivery with applications across all fields of medicine. However, exposure to QI is minimal in early medical education. We evaluated the effectiveness of an elective QI curriculum in teaching preclinical health professional students foundational QI concepts.

Methods

This prospective controlled cohort study was conducted at a single academic institution. The elective QI curriculum consisted of web-based video didactics and exercises, supplemented with in-person classroom discussions. An optional hospital-based QI project was offered. Assessments included pre- and post-intervention surveys evaluating QI skills and beliefs and attitudes, quizzes, and Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) cases. Within-group pre-post and between-group comparisons were performed using descriptive statistics.

Results

Overall, 57 preclinical medical or physician assistant students participated under the QI curriculum group (N = 27) or control group (N = 30). Twenty-three (85%) curriculum students completed a QI project. Mean quiz scores were significantly improved in the curriculum group from pre- to post-assessment (Quiz 1: 2.0, P < 0.001; Quiz 2: 1.7, P = 0.002), and the mean differences significantly differed from those in the control group (Quiz 1: P < 0.001; Quiz 2: P = 0.010). QIKAT-R scores also significantly differed among the curriculum group versus controls (P = 0.012). In the curriculum group, students had improvements in their confidence with all 10 QI skills assessed, including 8 that were significantly improved from pre- to post-assessment, and 4 with significant between-group differences compared with controls. Students in both groups agreed that their medical education would be incomplete without a QI component and that they are likely to be involved in QI projects throughout their medical training and practice.

Conclusions

The elective QI curriculum was effective in guiding preclinical students to develop their QI knowledge base and skillset. Preclinical students value QI as an integral component of their medical training. Future directions involve evaluating the impact of this curriculum on clinical clerkship performance and across other academic institutions.
Big data- and artificial intelligence-based hot-spot analysis of COVID-19: Gauteng, South Africa, as a case study
Authors: Lieberman Benjamin , Kong Jude Dzevela , Gusinow Roy , Asgary Ali , Bragazzi Nicola Luigi , Choma Joshua , Dahbi Salah-Eddine , Hayashi Kentaro , Kar Deepak , Kawonga Mary , Mbada Mduduzi , Monnakgotla Kgomotso , Orbinski James , Ruan Xifeng , Stevenson Finn , Wu Jianhong , Mellado Bruce
Published: January 2023

The coronavirus disease 2019 (COVID-19) has developed into a pandemic. Data-driven techniques can be used to inform and guide public health decision- and policy-makers. In generalizing the spread of a virus over a large area, such as a province, it must be assumed that the transmission occurs as a stochastic process. It is therefore very difficult for policy and decision makers to understand and visualize the location specific dynamics of the virus on a more granular level. A primary concern is exposing local virus hot-spots, in order to inform and implement non-pharmaceutical interventions. A hot-spot is defined as an area experiencing exponential growth relative to the generalised growth of the pandemic. This paper uses the first and second waves of the COVID-19 epidemic in Gauteng Province, South Africa, as a case study. The study aims provide a data-driven methodology and comprehensive case study to expose location specific virus dynamics within a given area. The methodology uses an unsupervised Gaussian Mixture model to cluster cases at a desired granularity. This is combined with an epidemiological analysis to quantify each cluster’s severity, progression and whether it can be defined as a hot-spot.
Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study
Authors: Sheikhan Natasha Y. , Henderson Jo L. , Halsall Tanya , Daley Mardi , Brownell Samantha , Shah Jai , Iyer Srividya N. , Hawke Lisa D.
Published: January 2023

Background

Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.

Objective

This study aims to understand how stigma influences service seeking among youth with mental health challenges.

Methods

Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.

Results

Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling ‘sick enough’ and ‘not sick enough’ to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma’s effects on seeking and obtaining services.

Conclusion

A constant negotiation between being ‘sick enough’ or ‘not sick enough’ is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma’s impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.
UK government’s new placement legislation is a ‘good first step’: a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives
Authors: Muir Sarah , Dhuria Preeti , Roe Emma , Lawrence Wendy , Baird Janis , Vogel Christina
Published: January 2023

Background

The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders.

Methods

A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders.

Results

Stakeholders perceived the legislation to be a ‘good first step’ towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health.

Conclusions

This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20–30 years.
Simultaneous enzyme production, Levan-type FOS synthesis and sugar by-products elimination using a recombinant Pichia pastoris strain expressing a levansucrase-endolevanase fusion enzyme
Authors: Ávila-Fernández Ángela , Montiel Silvia , Rodríguez-Alegría María Elena , Caspeta Luis , López Munguía Agustín
Published: January 2023

Background

Although Levan-type fructooligosaccharides (L-FOS) have been shown to exhibit prebiotic properties, no efficient methods for their large-scale production have been proposed. One alternative relies on the simultaneous levan synthesis from sucrose, followed by endolevanase hydrolysis. For this purpose, several options have been described, particularly through the synthesis of the corresponding enzymes in recombinant Escherichia coli. Major drawbacks still consist in the requirement of GRAS microorganisms for enzyme production, but mainly, the elimination of glucose and fructose, the reaction by-products.

Results

The expression of a fusion enzyme between Bacillus licheniformis endolevanase (LevB1) and B. subtilis levansucrase (SacB) in Pichia pastoris cultures, coupled with the simultaneous synthesis of L-FOS from sucrose and the elimination of the residual monosaccharides, in a single one-pot process was developed. The proof of concept at 250 mL flask-level, resulted in 8.62 g of monosaccharide-free L-FOS and 12.83 gDCW of biomass, after 3 successive sucrose additions (30 g in total), that is a 28.7% yield (w L-FOS/w sucrose) over a period of 288 h.

At a 1.5 L bioreactor-level, growth considerably increased and, after 59 h and two sucrose additions, 72.9 g of monosaccharide-free L-FOS and 22.77 gDCW of biomass were obtained from a total of 160 g of sucrose fed, corresponding to a 45.5% yield (w L-FOS/w sucrose), 1.6 higher than the flask system. The L-FOS obtained at flask-level had a DP lower than 20 fructose units, while at bioreactor-level smaller oligosaccharides were obtained, with a DP lower than 10, as a consequence of the lower endolevanase activity in the flask-level.

Conclusion

We demonstrate here in a novel system, that P. pastoris cultures can simultaneously be used as comprehensive system to produce the enzyme and the enzymatic L-FOS synthesis with growth sustained by sucrose by-products. This system may be now the center of an optimization strategy for an efficient production of glucose and fructose free L-FOS, to make them available for their application as prebiotics. Besides, P. pastoris biomass also constitutes an interesting source of unicellular protein.
Factors associated with the ownership and use of insecticide-treated nets in Guinea: an analysis of the 2018 Demographic and Health Survey
Authors: Diallo Ousmane Oumou , Ozodiegwu Ifeoma D. , Camara Alioune , Galatas Beatriz , Gerardin Jaline
Published: January 2023

Background

Malaria is a leading cause of outpatient visits and deaths among children in Guinea. Despite several mass distribution campaigns of insecticide-treated nets (ITNs) in Guinea, ITN ownership and use remain low. Identifying the underlying factors affecting household ITN ownership and ITN usage among those with access will allow the Guinea National Malaria Control Programme to develop targeted initiatives to improve bed net ownership and usage.

Methods

To understand national and regional drivers of ITN ownership and use, multivariable binary logistic regression models were applied to data from the 2018 Demographic and Health Survey to identify risk factors of household ITN ownership and risk factors of ITN use among individuals with access. Akaike Information Criterion (AIC) was used for model parameter selection. Odds ratios were estimated with corresponding 95% confidence intervals.

Results

The proportion of households in Guinea with at least one ITN was 44%, ranging from a low of 25% in Conakry to a high of 54% in Labé. Use of ITNs among those with access was 66.1% nationally, ranging from 35.2% in Labé to 89.7% in N'zérékoré. Risk factors for household ITN ownership were household size, marital status of the household head, education level of the household head, and region. For ITN use among those with access, risk factors were age, wealth quintile, marital status, and region. In the seven regions of Guinea and capital of Conakry, risk factors for household ITN ownership were household size in Boké, Faranah, and Kankan; education level of the household head in Boké, Faranah, and N’zérékoré; age of the household head in Conakry and Labé; children under five in the household in Kankan; and wealth quintile in Mamou. For ITN use among those with access, risk factors were marital status in Conakry, Faranah, Kindia, Labé, Mamou, and N’zérékoré; place of residence in Labé; children under five in the household in Labé; wealth quintile in Mamou; and age in Faranah and N’zérékoré.

Conclusions

This analysis identified national and region-specific factors that affect ownership and use among those with access in Guinea. Future ITN and social-behavioural change campaigns in Guinea may particularly want to target larger households, households without children, and areas with lower perceived risk of malaria if universal coverage and usage are to be achieved for optimal malaria prevention.
Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials
Authors: Greff Dorina , Juhász Anna E. , Váncsa Szilárd , Váradi Alex , Sipos Zoltán , Szinte Julia , Park Sunjune , Hegyi Péter , Nyirády Péter , Ács Nándor , Várbíró Szabolcs , Horváth Eszter M.
Published: January 2023

Background

Metformin is the gold standard insulin sensitizer, which is widely used to treat insulin resistance in polycystic ovary syndrome (PCOS). However, metformin may induce gastrointestinal side effects.

Objective

Inositols have long been debated as a potential alternative for metformin in treating PCOS. Therefore, the present systematic review aimed to evaluate the efficacy and safety of inositols in treating PCOS.

Methods

The present systematic search was performed in CENTRAL, MEDLINE, and Embase from the inception until October 20th, 2021. Eligible randomized controlled trials (RCTs) included women diagnosed with PCOS and compared any inositols with metformin or placebo. Our primary outcome was cycle normalization, whereas secondary outcomes were body mass index (BMI), parameters of carbohydrate metabolism and clinical and laboratory hyperandrogenism. Results are reported as risk ratios or mean differences (MDs) with 95% confidence intervals (CIs).

Results

Twenty-six RCTs were identified, including data of 1691 patients (806 inositol, 311 with placebo, and 509 metformin groups). In patients treated with inositols, the risk (CI: 1.13; 2.85) of having a regular menstrual cycle was found by 1.79 higher than in the case of placebo. Moreover, the inositols showed non-inferiority compared to metformin in this outcome. In the case of BMI (MD = -0.45; CI: -0.89; -0.02), free testosterone (MD = -0,41, CI: -0.69; -0.13), total testosterone (MD = -20.39, CI: -40.12; -0.66), androstenedione (MD = -0.69, CI: -1,16; -0.22), glucose (MD = -3.14; CI: -5.75; -0.54) levels and AUC insulin (MD = -2081.05, CI: -2745.32; -1416.78) inositol treatment induced greater decrease compared to placebo. Inositol increased sex-hormone-binding globulin significantly compared to placebo (MD = 32.06, CI:1.27; 62.85).

Conclusion

Inositol is an effective and safe treatment in PCOS. Moreover, inositols showed non-inferiority in most outcomes compared to the gold standard treatment; metformin.

Trial registration

PROSPERO registration number: CRD42021283275.
Current and future strategies to monitor and manage coagulation in ECMO patients
Authors: Zeibi Shirejini Saeedreza , Carberry Josie , McQuilten Zoe K. , Burrell Aidan J. C. , Gregory Shaun D. , Hagemeyer Christoph E.
Published: January 2023

Extracorporeal membrane oxygenation (ECMO) can provide life-saving support for critically ill patients suffering severe respiratory and/or cardiac failure. However, thrombosis and bleeding remain common and complex problems to manage. Key causes of thrombosis in ECMO patients include blood contact to pro-thrombotic and non-physiological surfaces, as well as high shearing forces in the pump and membrane oxygenator. On the other hand, adverse effects of anticoagulant, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis are all established as causes of bleeding. Finding safe and effective anticoagulants that balance thrombosis and bleeding risk remains challenging. This review highlights commonly used anticoagulants in ECMO, including their mechanism of action, monitoring methods, strengths and limitations. It further elaborates on existing anticoagulant monitoring strategies, indicating their target range, benefits and drawbacks. Finally, it introduces several highly novel approaches to real-time anticoagulation monitoring methods including sound, optical, fluorescent, and electrical measurement as well as their working principles and future directions for research.
Traffic-light front-of-pack environmental labelling across food categories triggers more environmentally friendly food choices: a randomised controlled trial in virtual reality supermarket
Authors: Arrazat Laura , Chambaron Stéphanie , Arvisenet Gaëlle , Goisbault Isabelle , Charrier Jean-Christophe , Nicklaus Sophie , Marty Lucile
Published: January 2023

Background

Food systems highly contribute to anthropogenic greenhouse gas emissions and shifting towards more environmentally friendly diets is urgently needed. Enabling consumers to compare the environmental impact of food products at point-of-purchase with front-of-pack labelling could be a promising strategy to trigger more environmentally friendly food choices. This strategy remained to be tested.

Methods

The effect of a new traffic-light front-of-pack environmental label on food choices was tested in a 2-arm randomised controlled trial in a virtual reality supermarket. Participants (n = 132) chose food products to compose two main meals for an everyday meal scenario and for an environmentally friendly meal scenario with or without the label. The environmental label (ranging from A: green/lowest impact, to E: red/highest impact) was based on the Environmental Footprint (EF) single score calculation across food categories. The effect of the label on the environmental impact of food choices in each scenario was tested using linear mixed models.

Results

In the everyday meal scenario, the environmental impact of meals was lower in the label condition than in the no label condition (-0.17 ± 0.07 mPt/kg, p = 0.012). This reduction was observed at no nutritional, financial nor hedonic cost. The effectiveness of the label can be attributed to a change in the food categories chosen: less meat-based and more vegetarian meals were chosen with the label. In the environmentally friendly meal scenario, we demonstrated that the label provided new information to the participants as they were able to further reduce the environmental impact of their food choices with the label (-0.19 ± 0.07 mPt/kg, p = 0.005).

Conclusions

Implementing a front-of-pack environmental label on food products in real supermarkets could increase awareness of the environmental impact of food and contribute to drive more environmentally friendly food choices.

Trial registration

The study protocol was pre-registered prior to data collection at Clinicaltrials.gov (NCT04909372).
β-catenin-IRP2-primed iron availability to mitochondrial metabolism is druggable for active β-catenin-mediated cancer
Authors: Wu Yuting , Yang Shuhui , Han Luyang , Shang Kezhuo , Zhang Baohui , Gai Xiaochen , Deng Weiwei , Liu Fangming , Zhang Hongbing
Published: January 2023

Background

Although β-catenin signaling cascade is frequently altered in human cancers, targeting this pathway has not been approved for cancer treatment.

Methods

High-throughput screening of an FDA-approved drug library was conducted to identify therapeutics that selectively inhibited the cells with activated β-catenin. Efficacy of iron chelator and mitochondrial inhibitor was evaluated for suppression of cell proliferation and tumorigenesis. Cellular chelatable iron levels were measured to gain insight into the potential vulnerability of β-catenin-activated cells to iron deprivation. Extracellular flux analysis of mitochondrial function was conducted to evaluate the downstream events of iron deprivation. Chromatin immunoprecipitation, real-time quantitative PCR and immunoblotting were performed to identify β-catenin targets. Depletion of iron-regulatory protein 2 (IRP2), a key regulator of cellular iron homeostasis, was carried out to elucidate its significance in β-catenin-activated cells. Online databases were analyzed for correlation between β-catenin activity and IRP2-TfR1 axis in human cancers.

Results

Iron chelators were identified as selective inhibitors against β-catenin-activated cells. Deferoxamine mesylate, an iron chelator, preferentially repressed β-catenin-activated cell proliferation and tumor formation in mice. Mechanically, β-catenin stimulated the transcription of IRP2 to increase labile iron level. Depletion of IRP2-sequered iron impaired β-catenin-invigorated mitochondrial function. Moreover, mitochondrial inhibitor S-Gboxin selectively reduced β-catenin-associated cell viability and tumor formation.

Conclusions

β-catenin/IRP2/iron stimulation of mitochondrial energetics is targetable vulnerability of β-catenin-potentiated cancer.