bluuebunny/crossref_metadata_2025 huggingface dataset:
Shedding of nontyphoidal
Salmonella
by asymptomatic convalescing children under 5 years as a risk factor for invasive disease in Mukuru informal settlement in Nairobi, Kenya
Authors: Kering Kelvin , Njaanake Kariuki , Wairimu Celestine , Mureithi Marianne , Kebenei Collins , Odityo Georgina , Mugo Michael , Kavai Susan M. , Mbae Cecilia , Weber Kristin , Pietsch Michael , Pilz Tanja , Drechsel Oliver , Thürmer Andrea , Semmler Torsten , Fuchs Stephan , Simon Sandra , Flieger Antje , Wieler Lothar H. , Kariuki Samuel
Published: October 2024

Nontyphoidal
Salmonella
(NTS) is a predominant cause of invasive disease in sub-Saharan Africa especially among children under 5 years. Asymptomatic fecal shedding of NTS is hypothesized to contribute to the human-to-human transmission of NTS especially in low-resource settings. However, the role of pathogen shedding in invasive disease is unknown. This study aimed to investigate the prevalence and duration of fecal shedding of NTS among children under 5 years convalescing from invasive NTS disease and among healthy individuals in the community. Children presenting with fever of ≥38°C with or without diarrhea were recruited at four health facilities in Nairobi, between June 2021 and August 2023. Blood and stool samples collected were subjected to culture for the isolation of NTS (
S
. Enteritidis and
S
. Typhimurium). Children with NTS culture-positive samples (index cases) were followed up post-acute disease where household contacts and controls provided stool samples for isolation of NTS. NTS prevalence among the 3,293 individuals recruited was 1.52%. Asymptomatic shedding post-treatment was observed in almost one-third (31%) of the 42 index cases followed up. Of the 13 with intestinal shedding, 7 were shedding NTS of the same sequence type (ST) as the one recovered during acute disease. The longest duration of intestinal shedding was 3 months post-treatment. Of the 241 healthy individuals recruited, 8 had asymptomatic shedding of NTS, and 2 of these were closely related to those recovered from index cases. These findings support the hypothesis of human-to-human transmission of NTS in sub-Saharan Africa highlighting the possible benefit of vaccine introduction.

IMPORTANCE

Asymptomatic fecal shedding of nontyphoidal
Salmonella
(NTS) is hypothesized to contribute to the human-to-human transmission of NTS especially in low-resource settings which could lead to invasive disease among high-risk populations, especially children. Our findings reiterate the hypothesis that human reservoirs could be important in the transmission of nontyphoidal
Salmonella
in sub-Saharan Africa. This underscores the importance of developing infection prevention measures which could include vaccine deployment and improving water, sanitation and hygiene infrastructure.
Host blood protein biomarkers to screen for tuberculosis disease: a systematic review and meta-analysis
Authors: Gaeddert Mary , Glaser Kerstin , Chendi Bih H. , Sultanli Ayten , Koeppel Lisa , MacLean Emily L. , Broger Tobias , Denkinger Claudia M.
Published: October 2024

Non-sputum tests are needed to improve tuberculosis (TB) diagnosis and close the diagnostic gap. The World Health Organization’s target product profile (TPP) for point-of-care (POC) screening tests requires a minimum sensitivity of 90% and a specificity of 70%. Our objective was to identify host blood protein biomarkers meeting TPP criteria. A systematic review was conducted and reported following PRISMA guidelines. Data extraction and quality assessment with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) were completed for the included studies. Heterogeneity was assessed. For biomarkers reporting sensitivity and specificity in at least four studies, a random-effects meta-analysis was performed for biomarkers with similar cut-offs. We screened 4,651 citations and included 65 studies that enrolled 16,010 participants and evaluated 156 host proteins. Most (47/65) studies enrolled adult pulmonary TB (PTB), with 15 studies in adult extra-pulmonary TB and 5 in children. Small early-stage discovery studies with case-control design were common (24/65) and had a high risk of bias. For adult PTB, CRP, IP-10, NCAM-1, and SAA met TPP criteria in high-quality studies. There was a high degree of heterogeneity in biomarker cut-offs and study design. CRP at 10 mg/L cut-off was meta-analyzed from 10 studies; pooled sensitivity 86% [95% confidence interval (CI): 80–95] and pooled specificity 67% (95% CI: 54–79). In people living with HIV (six studies), CRP pooled sensitivity was 93% (95% CI: 90–95), and pooled specificity was 59% (95% CI: 40–78). We identified promising biomarkers that performed well in high-quality studies. Data overall are limited and highly heterogenous. Further standardized validation across subgroups in prospective studies is needed before translating into POC assays.

IMPORTANCE

To our knowledge, this is the first comprehensive systematic review of host blood protein biomarkers for tuberculosis (TB), and we identified promising biomarkers for a TB screening test.
A novel machine-learning aided platform for rapid detection of urine ESBLs and carbapenemases: URECA-LAMP
Authors: Castellanos L. Ricardo , Chaffee Ryan , Kumar Hitendra , Mezgebo Biniyam Kahsay , Kassau Pawulos , Peirano Gisele , Pitout Johann D. D. , Kim Keekyoung , Pillai Dylan R.
Published: October 2024

Pathogenic gram-negative bacteria frequently carry genes encoding extended-spectrum beta-lactamases (ESBL) and/or carbapenemases. Of great concern are carbapenem resistant
Escherichia coli
,
Klebsiella pneumoniae
,
Pseudomonas aeruginosa,
and
Acinetobacter baumannii
. Despite the need for rapid AMR diagnostics globally, current molecular detection methods often require expensive equipment and trained personnel. Here, we present a novel machine-learning-aided platform for the rapid detection of ESBLs and carbapenemases using Loop-mediated isothermal Amplification (LAMP). The platform consists of (i) an affordable device for sample lysis, LAMP amplification, and visual fluorometric detection; (ii) a LAMP screening panel to detect the most common ESBL and carbapenemase genes; and (iii) a smartphone application for automated interpretation of results. Validation studies on clinical isolates and urine samples demonstrated percent positive and negative agreements above 95% for all targets. Accuracy, precision, and recall values of the machine learning model deployed in the smartphone application were all above 92%. Providing a simplified workflow, minimal operation training, and results in less than an hour, this study demonstrated the platform’s feasibility for near-patient testing in resource-limited settings.

IMPORTANCE

Extended-spectrum beta-lactamases (ESBL) and carbapenemases confer resistance to third-generation cephalosporins and carbapenems in pathogenic Gram-negative bacteria such as
Escherichia coli
,
Klebsiella pneumoniae
,
Pseudomonas aeruginosa,
and
Acinetobacter baumannii
. Conventional antimicrobial susceptibility testing is based on phenotypic methods, and results can take several days to be obtained. Current genotypic detection methods can be rapid but require expensive equipment and trained personnel. In this study, we present a novel machine learning-aided platform for the rapid detection of ESBLs and carbapenemases using Loop-mediated isothermal Amplification (LAMP). The validation of the platform demonstrated percent positive and negative agreements above 95% for all targets. The newly developed platform provided a simplified workflow, minimal technical training, and results in less than an hour. This study demonstrated the platform’s feasibility for rapid testing of ESBL and carbapenemases in bacteria and urine specimens.
DCLK1 mediated cooperative acceleration of EMT by avian leukosis virus subgroup J and Marek’s disease virus via the Wnt/β-catenin pathway promotes tumor metastasis
Authors: Zhou Jing , Zhou Defang , Zhang Qian , Zhang Xinyue , Liu Xiaoyang , Ding Longying , Wen Jing , Xu Xiaoyu , Cheng Ziqiang
Published: October 2024

Co-infection with oncogenic retrovirus and herpesvirus significantly facilitates tumor metastasis in human and animals. Co-infection with avian leukosis virus subgroup J (ALV-J) and Marek’s disease virus (MDV), which are typical oncogenic retrovirus and herpesvirus, respectively, leads to enhanced oncogenicity and accelerated tumor formation, resulting in increased mortality of affected chickens. Previously, we found that ALV-J and MDV cooperatively promoted tumor metastasis. However, the molecular mechanism remains elusive. Here, we found that doublecortin-like kinase 1 (DCLK1) mediated cooperative acceleration of epithelial–mesenchymal transition (EMT) by ALV-J and MDV promoted tumor metastasis. Mechanistically, DCLK1 induced EMT via activating Wnt/β-catenin pathway by interacting with β-catenin, thereby cooperatively promoting tumor metastasis. Initially, we screened and found that DCLK1 was a potential mediator for the cooperative activation of EMT by ALV-J and MDV, and enhanced cell proliferation, migration, and invasion. Subsequently, we revealed that DCLK1 physically interacted with β-catenin to promote the formation of the β-catenin–TCF4 complex, inducing transcription of the Wnt target gene, c-Myc, promoting EMT by increasing the expression of N-cadherin, Vimentin, and Snail, and decreasing the expression of E-cadherin. Taken together, we discovered that jointly activated DCLK1 by ALV-J and MDV accelerated cell proliferation, migration and invasion, and ultimately activated EMT, paving the way for tumor metastasis. This study elucidated the molecular mechanism underlying cooperative metastasis induced by co-infection with retrovirus and herpesvirus.

IMPORTANCE

Tumor metastasis, a complex phenomenon in which tumor cells spread to new organs, is one of the greatest challenges in cancer research and is the leading cause of cancer-induced death. Numerous studies have shown that oncoviruses and their encoded proteins significantly affect metastasis, especially the EMT process. ALV-J and MDV are classic tumorigenic retrovirus and herpesvirus, respectively. We found that ALV-J and MDV synergistically promoted EMT. Further, we identified the tumor stem cell marker DCLK1 in ALV-J and MDV co-infected cells. DCLK1 directly interacted with β-catenin, promoting the formation of the β-catenin–TCF4 complex. This interaction activated the Wnt/β-catenin pathway, thereby inducing EMT and paving the way for synergistic tumor metastasis. Exploring the molecular mechanisms by which ALV-J and MDV cooperate during EMT will contribute to our understanding of tumor progression and metastasis. This study provides new insights into the cooperative induced tumor metastasis by retroviruses and herpesviruses.
Genome sequence of the marine alphaproteobacterium
Lentilitoribacter
sp. EG35 isolated from the temperate octocoral
Eunicella gazella
Authors: Keller-Costa Tina , Madureira Selene , Fernandes Ana S. , Kozma Lydia , Gonçalves Jorge M.S. , Barroso Cristina , Egas Conceição , Costa Rodrigo
Published: October 2024

We report the genome sequence of
Lentilitoribacter
sp. strain EG35 isolated from the octocoral
Eunicella gazella
sampled off the coast of Portugal. We reveal the coding potential for the biosynthesis of polyhydroxyalkanoates — biodegradable polyesters that may serve bioplastics production, diverse homoserine lactone-like communication signals, and four putatively novel natural products.
Whole-genome sequence of
Bacillus paralicheniformis
strain R243 isolated from rice (
Oryza sativa
L.) roots
Authors: Chebotar Vladimir K. , Gancheva Maria S. , Keleinikova Oksana V. , Baganova Maria E. , Zaplatkin Alexander N. , Pishchik Veronika N. , Chizhevskaya Elena P.
Published: October 2024

We isolated an endophytic strain R243 and sequenced its genome using the NextSeq 1000 (Illumina) sequencing platform. The sequenced genome contains 4,478 protein-coding genes with a mean GC content of 45.56%. The strain R243 was identified as
Bacillus paralicheniformis
. Gene clusters involved in the synthesis of biocontrol substances were identified.
The
Plasmodium falciparum
histone methyltransferase SET10 participates in a chromatin modulation network crucial for intraerythrocytic development
Authors: Musabyimana Jean-Pierre , Musa Sherihan , Manti Janice , Distler Ute , Tenzer Stefan , Ngwa Che Julius , Pradel Gabriele
Published: October 2024

The lifecycle progression of the malaria parasite
Plasmodium falciparum
requires precise tuning of gene expression including histone methylation. The histone methyltransferase
Pf
SET10 was previously described as an H3K4 methyltransferase involved in
var
gene regulation, making it a prominent antimalarial target. In this study, we investigated the role of
Pf
SET10 in the blood stages of
P. falciparum
in more detail, using tagged
Pf
SET10-knockout (KO) and -knockdown (KD) lines. We demonstrate a nuclear localization of
Pf
SET10 with peak protein levels in schizonts.
Pf
SET10 deficiency reduces intraerythrocytic growth but has no effect on gametocyte commitment and maturation. Screening of the
Pf
SET10-KO line for histone methylation variations reveals that lack of
Pf
SET10 renders the parasites unable to mark H3K18me1, while no reduction in the H3K4 methylation status could be observed. Comparative transcriptomic profiling of
Pf
SET10-KO schizonts shows an upregulation of transcripts particularly encoding proteins linked to red blood cell remodeling and antigenic variation, suggesting a repressive function of the histone methylation mark. TurboID coupled with mass spectrometry further highlights an extensive nuclear
Pf
SET10 interaction network with roles in transcriptional regulation and mRNA processing, DNA replication and repair, and chromatin remodeling. The main interactors of
Pf
SET10 include ApiAP2 transcription factors, epigenetic regulators like
Pf
HDAC1, chromatin modulators like
Pf
MORC and
Pf
ISWI, mediators of RNA polymerase II, and DNA replication licensing factors. The combined data pinpoint
Pf
SET10 as a histone methyltransferase essential for H3K18 methylation that regulates nucleic acid metabolic processes in the
P. falciparum
blood stages as part of a comprehensive chromatin modulation network.

IMPORTANCE

The fine-tuned regulation of DNA replication and transcription is particularly crucial for the rapidly multiplying blood stages of malaria parasites and proteins involved in these processes represent important drug targets. This study demonstrates that contrary to previous reports the histone methyltransferase
Pf
SET10 of the malaria parasite
Plasmodium falciparum
promotes the methylation of histone 3 at lysine K18, a histone mark to date not well understood. Deficiency of
Pf
SET10 due to genetic knockout affects genes involved in intraerythrocytic development. Furthermore, in the nuclei of blood-stage parasites,
Pf
SET10 interacts with various protein complexes crucial for DNA replication, remodeling, and repair, as well as for transcriptional regulation and mRNA processing. In summary, this study highlights
Pf
SET10 as a methyltransferase affecting H3K18 methylation with critical functions in chromatin maintenance during the development of
P. falciparum
in red blood cells.
Pooled analysis of oral microbiome profiles defines robust signatures associated with periodontitis
Authors: Soueidan Assem , Idiri Katia , Becchina Camille , Esparbès Pauline , Legrand Arnaud , Le Bastard Quentin , Montassier Emmanuel
Published: October 2024

Oral microbial dysbiosis has been associated with periodontitis in studies using 16S rRNA gene sequencing analysis. However, this technology is not sufficient to consistently separate the bacterial species to species level, and reproducible oral microbiome signatures are scarce. Obtaining these signatures would significantly enhance our understanding of the underlying pathophysiological processes of this condition and foster the development of improved therapeutic strategies, potentially personalized to individual patients. Here, we sequenced newly collected samples from 24 patients with periodontitis, and we collected available oral microbiome data from 24 samples in patients with periodontitis and from 214 samples in healthy individuals (
n
= 262). Data were harmonized, and we performed a pooled analysis of individual patient data. By metagenomic sequencing of the plaque microbiome, we found microbial signatures for periodontitis and defined a periodontitis-related complex, composed by the most discriminative bacteria. A simple two-factor decision tree, based on
Tannerella forsythia
and
Fretibacterium fastidiosum
, was associated with periodontitis with high accuracy (area under the curve: 0.94). Altogether, we defined robust oral microbiome signatures relevant to the pathophysiology of periodontitis that can help define promising targets for microbiome therapeutic modulation when caring for patients with periodontitis.

IMPORTANCE

Oral microbial dysbiosis has been associated with periodontitis in studies using 16S rRNA gene sequencing analysis. However, this technology is not sufficient to consistently separate the bacterial species to species level, and reproducible oral microbiome signatures are scarce. Here, using ultra-deep metagenomic sequencing and machine learning tools, we defined a simple two-factor decision tree, based on
Tannerella forsythia
and
Fretibacterium fastidiosum
, that was highly associated with periodontitis. Altogether, we defined robust oral microbiome signatures relevant to the pathophysiology of periodontitis that can help define promising targets for microbiome therapeutic modulation when caring for patients with periodontitis.
Hyperintense vessel sign in vertebrobasilar dolichoectasia
Authors: Bhatele Prashant , Pai Aparna Ramakrishna
Published: October 2024

Vertebrobasilar dolichoectasia (VBD) is a rare condition characterised by ectasia, elongation and tortuosity in the vertebrobasilar arteries. VBD prevalence ranges from 0.05% to 18%. A possible interplay between vascular risk factors and a predisposing genotype could alter the balance between tunica media matrix metalloproteinases and antiprotease activity. VBD is characterised by the disruption of smooth muscle atrophy, reticular fibre degeneration and multiple gaps in the inner elastic lamina, causing thinning of the tunica media and arterial wall weakening and deformation. VBD can be asymptomatic. VBD is often characterised by ischaemic stroke, intracerebral haemorrhage, brainstem/cranial nerve compression and subarachnoid haemorrhage. Vascular events are the most common clinical manifestation. Slow arterial blood flow results in hyperintense vascular signals, which are linked with a larger infarct and a higher risk of cerebral bleeding. Treatment for VBD is difficult. Currently, there are no specific treatments for VBD, and the available treatments focus on the consequences.
Detection of hypertension from pharyngeal images using deep learning algorithm in primary care settings in Japan
Authors: Yoshihara Hiroshi , Tsugawa Yusuke , Fukuda Memori , Okiyama Sho , Nakayama Takeo
Published: October 2024

Background

The early detection of hypertension using simple visual images in a way that does not require physical interaction or additional devices may improve quality of care in the era of telemedicine. Pharyngeal images include vascular morphological information and may therefore be useful for identifying hypertension.

Objectives

This study sought to develop a deep learning-based artificial intelligence algorithm for identifying hypertension from pharyngeal images.

Methods

We conducted a secondary analysis of data from a clinical trial, in which demographic information, vital signs and pharyngeal images were obtained from patients with influenza-like symptoms in multiple primary care clinics in Japan. A deep learning-based algorithm that included a multi-instance convolutional neural network was trained to detect hypertension from pharyngeal images and demographic information. The classification performance was measured by area under the receiver operating characteristic curve. Importance heatmaps of the convolutional neural network were also examined to interpret the algorithm.

Results

This study included 7710 patients from 64 clinics. The training dataset comprised 6171 patients from 51 clinics (460 positive cases), and the test dataset comprised 1539 patients from 13 clinics (130 positive cases). Our algorithm achieved an area under the receiver operating characteristic curve of 0.922 (95% CI, 0.904 to 0.940), significantly improving over the baseline prediction model incorporating only demographic information, which scored 0.887 (95% CI, 0.862 to 0.911). Our algorithm had consistent classification performance across all age and sex subgroups. Importance heatmaps revealed that the algorithm focused on the posterior pharyngeal wall area, where blood vessels are mainly located.

Conclusions

The results indicate that a deep learning-based algorithm can detect hypertension with high accuracy using pharyngeal images.
Breast and endometrial safety of micronised progesterone versus norethisterone acetate in menopausal hormone therapy (PROBES): study protocol of a double-blind randomised controlled trial
Authors: Lundell Christina , Stergiopoulos Nikolaos , Blomberg Liselott , Ujvari Dorina , Schuppe-Koistinen Ina , Kopp-Kallner Helena , Iliadis Stavros I , Skalkidou Alkistis , Hirschberg Angelica Linden
Published: October 2024

Introduction

Data suggest that micronised progesterone (mP) in menopausal hormone therapy is safer for the breast than synthetic progestins, while protection of the endometrium appears to be less effective. However, comparative randomised trial data are lacking. The objective of the Progesterone Breast Endometrial Safety Study is to investigate breast and endometrial safety of mP versus norethisterone acetate (NETA) in continuous combination with oral oestrogen.

Methods and analysis

This multicentre trial, conducted at three University Hospitals in Stockholm and Uppsala, Sweden, consists of two phases: part 1 focuses on breast safety and is designed as a double-blind, randomised controlled trial. 260 postmenopausal women will be randomised to 100 mg mP or 0.5 mg NETA per day in continuous combination with 1 mg oestradiol. The primary objective is to compare the treatments with respect to percentage change in mammographic breast density after 12-month treatment. Secondary outcomes are breast proliferation, endometrial histology and proliferation, bleeding pattern, gut and vaginal microbiome, hormone levels and coagulation and metabolic factors, mood, and health-related quality of life. Part 2 features an open, single-arm design to study endometrial safety of 1-year treatment with mP in continuous combination with oestradiol on endometrial pathology (hyperplasia and cancer). We will treat 260 additional women with 100 mg mP/1 mg oestradiol resulting in an endometrial safety population of 390 women. The total number of participants in part 1 and part 2 will be 520.

Ethics and dissemination

The study protocol was approved by the Swedish Ethical Review Authority (2021-03033) on 29 June 2021 with amendment (2023-01480-02, protocol version 3.1) on 14 March 2023. Results of the study will be published in peer-reviewed journals and presented at scientific meetings.

Trial registration number

NCT05586724.
Effect of high-flow nasal cannula oxygen versus standard oxygen on mortality in patients with acute hypoxaemic respiratory failure: protocol for a multicentre, randomised controlled trial (SOHO)
Authors: Frat Jean-Pierre , Coudroy Remi , Quenot Jean-Pierre , Guitton Christophe , Badie Julio , Gacouin Arnaud , Ehrmann Stephan , Demoule Alexandre , Jarousseau Fabien , Carteaux Guillaume , Rigaud Jean Philippe , Reignier Jean , Sedillot Nicholas , Contou Damien , Beloncle François , Daubin Cédric , Dureau Anne-Florence , Fatah Abdelhamid , Besse Marie-Catherine , Ferre Alexis , Turbil Emanuele , Merdji Hamid , Galerneau Louis-Marie , Lacombe Béatrice , Richard Jean-Christophe , Romen Antoine , Delbove Agathe , Prat Gwenael , Lautrette Alexandre , Colin Gwenhaël , Soum Edouard , Bourdin Gaël , Hernández Gonzalo , Ragot Stéphanie , Thille Arnaud W
Published: October 2024

Introduction

First-line oxygenation strategy in patients with acute hypoxaemic respiratory failure consists in standard oxygen or high-flow nasal oxygen therapy. Clinical practice guidelines suggest the use of high-flow nasal oxygen rather than standard oxygen. However, findings remain contradictory with a low level of certainty. We hypothesise that compared with standard oxygen, high-flow nasal oxygen may reduce mortality in patients with acute hypoxaemic respiratory failure.

Method and analysis

The Standard Oxygen versus High-flow nasal Oxygen-trial is an investigator-initiated, multicentre, open-label, randomised controlled trial comparing high-flow nasal oxygen versus standard oxygen in patients admitted to an intensive care unit (ICU) for acute respiratory failure with moderate-to-severe hypoxaemia. 1110 patients will be randomly assigned to one of the two groups with a ratio of 1:1. The primary outcome is the number of patients who died 28 days after randomisation. Secondary outcomes include comfort, dyspnoea and oxygenation 1 hour after treatment initiation, the number of patients intubated at day 28, mortality in ICU, in hospital and until day 90, and complications during ICU stay.

Ethics and dissemination

The study has been approved by the central Ethics Committee ‘Sud Méditerranée III’ (2020-07-05) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT04468126.
A digital health-supported and community pharmacy-based lifestyle intervention program for adults with pre-diabetes: a study protocol for a cluster randomised controlled trial
Authors: Teoh Kah Woon , Ng Choon Ming , Chong Chun Wie , Cheong Wing Loong , Ng Yi Ling , Bell J Simon , Lee Shaun Wen Huey
Published: October 2024

Introduction

Pre-diabetes indicates an elevated risk of developing type-2 diabetes and presents a window for preventive actions. The Pre-diabetes Intervention, Management and Evaluation (PRIME) programme is a community pharmacy-based pre-diabetes management programme that uses a mobile application for self-monitoring and pre-diabetes education, aiming to promote lifestyle changes among participants with pre-diabetes.

Methods and analysis

This is a protocol for a cluster randomised controlled trial that aims to evaluate the impact of the PRIME programme on participants’ clinical outcomes and explore participants’ and pharmacists’ views towards its implementation. This protocol describes the development of the PRIME programme and mobile app, its feasibility and implementation in community pharmacy settings. 16 pharmacies from two states in Malaysia will be randomised to the intervention arm or standard care. The study will include overweight or obese adults with pre-diabetes. During each follow-up visit at the pharmacy, intervention participants will receive in-depth counselling from pharmacists after reviewing their self-monitoring data recorded in the PRIME app. They will also receive pre-diabetes education through the app and join a peer support chatgroup. The primary clinical outcome includes changes in body weight at 6 months, while the secondary clinical outcomes include changes in blood glucose profile, lipid profile, blood pressure and adiposity measures. The sustainability of the PRIME programme will be accessed using a follow-up questionnaire, while participants’ engagement with the intervention will be evaluated using attendance rate and the app data. Focus group discussions and one-to-one interviews will be conducted for process evaluation. This study will inform the impact of community pharmacists-led digital health intervention in pre-diabetes management.

Ethics and dissemination

This study has been registered with clinicaltrials.gov (NCT04832984) and approved by the Monash University Human Research Ethics Committee (Project ID: 27512).

Trial registration number

clinicaltrials.gov (NCT04832984).
Traditional Chinese Medicine treatment for postoperative axial symptoms of cervical spondylotic myelopathy: a systematic review
Authors: Liu Xuhao , Yang Xiaolong , Dong Yuanwei , Liao Tiannan , Gou Xin , Zou Jinwen , Ren Liangjuan , Li Ling
Published: October 2024

Background

Axial symptoms (AS) represent one of the primary complications after cervical spondylotic myelopathy (CSM) surgery. Traditional Chinese Medicine (TCM), as a complementary and alternative therapy, is widely used in the treatment of postoperative AS in CSM. However, it lacks standardised treatment protocols, uniform therapeutic criteria, assessment methods and a sufficiently in-depth understanding of its mechanisms of action. These shortcomings impact the credibility of TCM treatment in clinical practice.

Methods and analysis

We will conduct comprehensive searches, both manual and electronic, on literature published up to 31 July 2024, and database searches will commence after the publication of this agreement, with an estimated commencement date of 1 October 2024 and the end date of 31 March 2025, without language restrictions. Key databases such as MEDLINE, PubMed, Embase, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Network, China Biomedical Literature Database, China Scientific Journal Database and Wanfang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. After identifying and screening all randomised controlled trials focused on TCM for postoperative AS of CSM, the two investigators will conduct a meta-analysis of the included studies. The results will be summarised as the risk ratio for binary data and the standardised or weighted average difference for continuous data.

Ethics and dissemination

Ethical approval is not required since this review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using TCM treatment for AS post-CSM surgery, disseminated through peer-reviewed publications or conferences.

PROSPERO registration number

CRD42024505160.
Fathers’ knowledge of neonatal danger signs and its associated factors in Northwest Ethiopia: a community-based cross-sectional study
Authors: Kebie Adugnaw Bantie , Abitie Tilksew Ayalew , Mequanint Fikir Tadesse , Emrie Ambaw Abebaw , Nega Selamsew Kindie , Tilahun Werkneh Melkie
Published: October 2024

Objective

This study aimed to assess fathers’ knowledge of neonatal danger signs and their associated factors in Northwest Ethiopia.

Design

Community-based cross-sectional study.

Setting

Enarji and Enawga Woreda, Northwest Ethiopia.

Participants

The study was conducted on 613 participants in Enarji and Enawga Woreda from 13 May to 13 June 2022. Participants were selected using stratified simple random sampling. Participants with serious illnesses who were unable to respond to the questions were excluded from the study. A total of 602 participants completed the questionnaire. Data were collected through face-to-face interviews conducted by four well-trained data collectors. To assess participants’ knowledge, 10 structured and standardised questions were adopted from WHO and the Ethiopian Federal Ministry of Health. The data were analysed using SPSS V.26. A logistic regression model was fitted to identify factors associated with knowledge about neonatal danger signs. An adjusted OR (AOR) with a 95% CI and a p value <0.05 was used to declare factors as significantly associated.

Result

Less than a quarter (23.26%) of fathers had good knowledge of neonatal danger signs (95% CI 19.9, 26.8). The study also found that several factors were significant predictors of good knowledge, including: secondary education (AOR 2.98, 95% CI 1.08, 8.24), college education or higher (AOR 3.45, 95% CI 1.09, 10.85), number of children (AOR 3.68, 95% CI 1.62, 8.34), history of sickness in the index baby (AOR 2.18, 95% CI 1.18, 4.01), fathers’ attendance on postnatal care visits (AOR 4.32, 95% CI 2.06, 9.08), history of neonatal death (AOR 3.94, 95% CI 1.80, 8.64), receiving information on neonatal danger signs (AOR 2.71, 95% CI 1.30, 5.64) and health professionals as a source of information (AOR 3.27, 95% CI 1.52, 7.04). These factors were all significantly associated with good knowledge of neonatal danger signs.

Conclusion

Fathers’ knowledge of neonatal danger signs was found to be low. Therefore, substantial efforts are needed to enhance their knowledge. It is essential to develop strategies that actively involve fathers in the continuum of postnatal care for both mothers and newborns. Additionally, providing targeted information on neonatal danger signs through health professionals can significantly improve fathers’ knowledge.
The Understanding America Study (UAS)
Authors: Kapteyn Arie , Angrisani Marco , Darling Jill , Gutsche Tania
Published: October 2024

Purpose

The Understanding America Study (UAS) is a probability-based Internet panel housed at the Center for Economic and Social Research at the University of Southern California (USC). The UAS serves as a social and health sciences infrastructure for collecting data on the daily lives of US families and individuals. The collected information includes survey data, DNA from saliva samples, information from wearables, contextual and administrative linkages, ecological momentary assessments, self-recorded narratives and electronic records of financial transactions. The information collected focuses on a defining challenge of our time—identifying factors explaining racial, ethnic, geographic and socioeconomic disparities over the life course, including racial discrimination, inequalities in access to education and healthcare, differences in physical, economic and social environments, and, more generally, the various opportunities and obstacles one encounters over the life course. The UAS infrastructure aims to optimise engagement with the wider research community both in data dissemination and in soliciting input on content and methods. To encourage input from the research community, we have reserved 100 000 min of survey time per year for outside researchers, who can propose to add survey questions four times a year.

Participants

The UAS currently comprises about 15 000 US residents (including a 3500-person California oversample) recruited by Address-Based Sampling and provided with Internet-enabled tablets if needed. Surveys are conducted in English and Spanish.

Findings to date

Since the founding of the UAS in 2014, we have conducted more than 600 surveys, including a sequence of surveys collecting biennial information on health and retirement (the complete Health and Retirement Study instrument), 11 cognitive assessments, personality, knowledge and use of information on Social Security programme rules, work disability and subjective well-being. Several hundreds of papers have been published based on the collected data in the UAS. Studies include documentations of the mental health effects of the COVID-19 pandemic and how this varied across socioeconomic groups; comparisons of physical activity measured with accelerometers and by self-reports showing the dramatic biases in the latter; extensive studies have shown the power of using paradata in gauging cognitive change over time; several messaging experiments have shown the effectiveness of information provision on the quality of decision-making affecting well-being at older ages.

Future plans

The UAS national sample is planned to grow to 20 000 respondents by 2025, with subsamples of about 2500 African American, 2000 Asian and 3000 Hispanic participants and an oversample of rural areas. An increasing amount of non-interview data (contextual information, data from a suite of wearables and administrative linkages) is continually being added to the data files.
Comorbid ADHD and schizophrenia and the use of psychostimulants: a scoping review protocol
Authors: Bamford Jordan , Qurashi I , Axiaq Ariana , Marwaha Steven , Husain Nusrat
Published: October 2024

Introduction

Schizophrenia and attention deficit hyperactivity disorder (ADHD) are psychiatric disorders that have a profound impact on patients and healthcare systems globally. There is preliminary evidence suggesting a potential association between the two in terms of symptomatology and genetic underpinning. There is a paucity of guidance regarding pharmacological approaches for patients with comorbid ADHD and schizophrenia. There is a concern that psychostimulants may be more harmful than therapeutic. This scoping review protocol aims to systematically review the evidence for potential harm and benefit of psychostimulants among patients with comorbid ADHD and schizophrenia and identify research gaps.

Methods and analysis

This scoping review will employ a systematic and iterative approach to identify and synthesise the literature on the topic of psychostimulant use among patients with comorbid schizophrenia and ADHD, based on Arksey and O’Malley’s framework. A search will be conducted in relevant databases, including MEDLINE (Ovid), Embase (Ovid), PsycINFO and ISI Web of Science. Additionally, grey literature will be sought. The scoping review will involve two independent reviewers screening the search results. The initial screen will be of title and abstract, and the subsequent full-text review will determine eligibility. A descriptive overview of the eligible studies will be provided. This scoping review has been registered athttps://osf.io/cmn5s.

Ethics and dissemination

There is a paucity of high-quality evidence available to clinicians when making decisions regarding the prescription of psychostimulants to patients with comorbid schizophrenia and ADHD. To the best of our knowledge, this will be the first scoping review to examine the evidence addressing this clinical scenario. This review, therefore, has the potential to contribute to decision-making processes for this patient group, thereby improving patient outcomes. Furthermore, as this review is designed to identify research gaps, we aim to contribute to the development of a research agenda that will benefit patients, clinicians and healthcare systems. The dissemination strategy will involve open access peer review publication and scientific presentations.
Effects of myopia on health-related quality of life in adolescents: a population-based cross-sectional causal empirical survey
Authors: Lu Liyong , Zheng Yu , Xu Yanjiao , Feng Junchao , Li Shunping
Published: October 2024

Objective

Myopia is a prevalent disease affecting adolescent vision and harms various health outcomes. However, the evidence about the effects of myopia on adolescents’ overall health status is limited. Using health-related quality of life (HRQoL), a comprehensive health measurement indicator, this study aims to evaluate the effects of myopia on adolescents’ HRQoL.

Methods and analysis

Adolescents’ HRQoL was measured by the Child Health Utility 9D instrument. Data were collected from a population-based cross-sectional survey conducted in Shandong province of China. To mitigate the potential endogeneity bias, parents’ myopia degree was used as the instrumental variable for adolescents’ myopia status. The causal model was built to explore the effects and potential mediators of myopia on the HRQoL of adolescents. Heterogeneity analysis was used to identify susceptible groups.

Results

108 657 adolescents with an average age of 12 were included in the analysis. Compared with adolescents without myopia, the health utility value of individuals with low, moderate and high decreases by 0.5%, 1.1% and 2.2%, respectively. The reduction of outdoor activity time and increase in electronic device usage time play the mediator role. Myopia leads to a greater decrease in the health utility value of adolescents in higher grades, boarding schools and low-income households compared with their counterparts.

Conclusion

Myopia impairs adolescents’ HRQoL and damages the overall health level of adolescents. The frequency of outdoor activity and electronic device usage could be the potential mediators. The susceptibility of adolescents in higher grades, boarding schools and low-income households would be exacerbated.
Improving the efficiency and person-centredness of occupational therapy input into care-plans in a forensic mental health and rehabilitation service
Authors: Ige Joshua Jesudunsin Ige , Alston Amanda , Boreland Velmer , Caudwell Megan , Ashbourne Rhiannon , Ford Bronwen , Katsere Fortunate , Banham Georgia
Published: October 2024

Care-planning is vital to the delivery of timely, person-centred, safe and effective care. Despite the understanding of the benefits of person-centred care-plan in both services, occupational therapists (OTs) within our forensic and rehabilitation services had difficulties in inputting into patient care-plan an efficient and person-centred manner.

The OT team developed a Quality Improvement (QI) project to improve the efficiency of the OT process to create more time for care-planning and improve person-centredness of OT input into care-plans to 82% in the forensic services and rehabilitation services by December 2023.

The results indicated an increase in the person-centredness of care-plans from 63.64% to 84.34% within the rehabilitation service and an increase from 65.15% to 95.45% in the forensic service. This project used feedback from patients to develop our input into care-plans. The project also increased the efficiency of the admission process and released time to be spent on care-planning and treatment.

We improved the quality of our input to care-plans in a sustainable way by using the Royal Academy of Improvement sustainability measure and taking actions which included training our band 6 and 7 OTs to complete their monthly audit and reporting this as part of the head of nursing report for assurance in our monthly Clinical and Operational Assurance Team meetings. These actions ensured that our project fitted with the organisation’s strategic aims and values. We also used low carbon alternatives by holding most of our improvement meetings online and eliminating the use of paper.

Lastly, we improved the generalisability of this project by using the Goal Directed Care Plan audit tool, which is a well-researched, evidence-based tool created by service-users, carers and members of staff. This was used to train members of staff and develop an example of a person-centred input into care-plans to improve their practice.
Prevalence of unplanned first pregnancy and socioeconomic factors in Benin: a cross-sectional and analytical study
Authors: Mintogbe Mahouli Mireille-Marie , Adje Elihou , Dougnon Victorien Tamègnon , Ahoussinou Clément , Sanni Mouftaou Amadou
Published: October 2024

Background

Early or unplanned pregnancy is an obstacle to the well-being of adolescent girls, especially as early motherhood has health and social consequences on the young mother and the newborn. This also negatively impacts maternal and infant morbidity and mortality. The aim of this study is to determine the prevalence of unplanned first pregnancies and the explanatory factors among adolescent girls.

Methods

Data were collected from a sample of 738 adolescent girls aged 15–19 years in the 12 departments of Benin. Analyses focused on teenagers who were pregnant for the first time or had at least one child at the time of the survey (337 individuals). Descriptive and bivariate analyses and logistic regression were used.

Results

The prevalence of unplanned first pregnancies was 80.1% (n=270). The frequency of unplanned first pregnancies was higher among adolescents who had reached secondary school or higher (85.7%, p=0.027), those who had spent their socialisation period in big cities (88.5%, p=0.018) and those whose financial needs were not met (84.8%, p=0.014). The main explanatory factor identified was unmet financial needs. Indeed, adolescents with unmet financial needs were 1.7 times (p=0.041) more likely to have an unplanned first pregnancy than those whose needs were met.

Conclusion

Multisectoral interventions are needed to reduce the prevalence of unplanned first pregnancies, which can compromise adolescent girls’ academic and career plans. These interventions could focus on sexual and reproductive health education, girl empowerment, improvement of households’ socioeconomic conditions, etc.
Variation in the use of primary care-led investigations prior to a cancer diagnosis: analysis of the National Cancer Diagnosis Audit
Authors: Akter Nurunnahar , Lyratzopoulos Georgios , Swann Ruth , Rubin Greg , McPhail Sean , Rafiq Meena , Aminu Abodunrin , Zakkak Nadine , Abel Gary
Published: October 2024

Introduction

Use of investigations can help support the diagnostic process of patients with cancer in primary care, but the size of variation between patient group and between practices is unclear.

Methods

We analysed data on 53 252 patients from 1868 general practices included in the National Cancer Diagnosis Audit 2018 using a sequence of logistic regression models to quantify and explain practice-level variation in investigation use, accounting for patient-level case-mix and practice characteristics. Four types of investigations were considered: any investigation, blood tests, imaging and endoscopy.

Results

Large variation in practice use was observed (OR for 97.5th to 2.5th centile being 4.02, 4.33 and 3.12, respectively for any investigation, blood test and imaging). After accounting for patient case-mix, the spread of practice variation increased further to 5.61, 6.30 and 3.60 denoting that patients with characteristics associated with higher use (ie, certain cancer sites) are over-represented among practices with lower than the national average use of such investigation. Practice characteristics explained very little of observed variation, except for rurality (rural practices having lower use of any investigation) and concentration of older age patients (practices with older patients being more likely to use all types of investigations).

Conclusion

There is very large variation between practices in use of investigation in patients with cancer as part of the diagnostic process. It is conceivable that the diagnostic process can be improved if investigation use was to be increased in lower use practices, although it is also possible that there is overtesting in practices with very high use of investigations, and in fact both undertesting and overtesting may co-exist.
It’s about timing: how density can benefit future research on the optimal dosage of acute physical exercise breaks in esports
Authors: Manci Egemen , Theobald Paula , Toth Adam , Campbell Mark , DiFrancisco-Donoghue Joanne , Gebel Arnd , Müller Notger G , Gronwald Thomas , Herold Fabian
Published: October 2024

In recent years, organised and competitive video gaming, esports, has gained enormous popularity in many parts of the world, contributing to the growing professionalisation of this sports branch. To become or remain a professional esports player, individuals practice video gaming for several hours a day while remaining in a sitting posture which may not only lead to a decrease in training quality in the short term (eg, due to cognitive fatigue) but also put them at a higher risk for negative health events in the long-term (eg, overuse injuries). Thus, interrupting periods of prolonged video gaming in a sitting posture with acute physical exercise is strongly recommended for esports players even though the optimal dosage of acute physical exercise breaks remains unclear. To address this gap, we propose in this viewpoint that traditional concepts of exercise prescription and dosage determination using the variables frequency, intensity, time (also referred to as duration) and type of physical exercise (ie, abbreviated with the acronym FITT) should be complemented by the variable density which characterises the timing of consecutive bouts of acute physical exercise during an esports session.