bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic sarcoidosis presenting as a rare combination of interstitial nephritis with necrotizing vasculitis and urinary retention due to prostate involvement: a case report
Authors: Osanami Arata , Yamashita Tomohisa , Sakurada Shintaro , Sato Tatsuya , Kyoda Yuki , Shindo Tetsuya , Fujita Hiromi , Ogawa Yayoi , Furuhashi Masato
Published: December 2023

Background

Sarcoidosis affects multiple organs and exhibits diverse clinical manifestations. Although tubulointerstitial nephritis is a known feature of renal involvement, necrotizing vasculitis is rare. Furthermore, prostate involvement with urinary retention is unusual in patients with sarcoidosis. Here, we report a case of systemic sarcoidosis with a rare combination of manifestations and different acute kidney injuries.

Case presentation

A 66-year-old man developed sudden urinary retention and fever. He was diagnosed with prostatitis and admitted to our hospital. An indwelling urethral catheter was inserted, and antimicrobial therapy was initiated; however, the prostatitis was refractory. Computed tomography revealed enlarged mediastinal lymph nodes. Analysis of transbronchoscopic lymph node and prostate biopsies showed epithelioid cell granulomas, suggesting systemic sarcoidosis. During the clinical course, the serum creatinine level rapidly increased to 2.36 mg/dL without oliguria. A kidney biopsy revealed tubulointerstitial injury with moderate lymphohistiocytic infiltration and small-vessel vasculitis in the interstitium. Following oral administration of 60 mg/day prednisolone, the patient’s renal function immediately improved, and urinary retention did not recur.

Conclusions

To the best of our knowledge, this is the first reported case of sarcoidosis with two unusual complications. Given its clinical course and pathology, this case is clinically valuable.
Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda
Authors: Niyigena Anne , Gato Saidath , Alayande Barnabas , Miranda Elizabeth , Hedt-Gauthier Bethany , Goodman Andrea S. , Nkurunziza Theoneste , Mazimpaka Christian , Hakizimana Sadoscar , Ngamije Patient , Kateera Fredrick , Riviello Robert , Boatin Adeline A.
Published: December 2023

Introduction

Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient’s perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30.

Methods

Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression.

Results

Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04).

Conclusion

We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.
“Moderate” adjuvant chemotherapy-induced leukopenia is beneficial for survival of patients with early breast cancer: a retrospective study
Authors: Wang Li , Jiang Chang , Wang Na , Wen Yan-Ling , Wang Si-Fen , Xue Cong , Bi Xi-Wen , Yuan Zhong-Yu
Published: December 2023

Background

The association between chemotherapy-induced leukopenia (CIL) and survival for patients with early breast cancer (EBC) is not known. We investigated the relationship between different grades of CIL and survival in patients with EBC receiving adjuvant chemotherapy.

Methods

A total of 442 patients with EBC receiving a regimen containing an anthracycline (A) and taxane (T) were included into our analysis. Survival analyses were undertaken using Kaplan–Meier curves. The P-value was calculated using the log rank test. Subgroup analysis was conducted to investigate the correlation of CIL grade and survival based on the clinicopathological characteristics of patients. Afterwards, univariate and multivariate analyses screened out independent prognostic factors to construct a prognostic model, the robustness of which was verified.

Results

Patients with EBC who experienced grade 2–4 (“moderate” and “severe”) CIL were associated with longer overall survival (OS) than those with grade 0–1 (mild) CIL (P = 0.021). Compared with patients with mild CIL, OS was longer in patients with severe CIL (P = 0.029). Patients who suffered from moderate CIL tended to have longer OS than those with mild CIL (P = 0.082). Nevertheless, there was no distinguishable difference in OS between moderate- or severe-CIL groups. Subgroup analysis revealed that patients with moderate CIL had longer OS than those with mild CIL among patients who were premenstrual, or with human epidermal growth factor receptor 2-positive (HER2+), > 3 lymph nodes with metastases, a tumor diameter > 5 cm. A prognostic model based on menstrual status, N stage, and CIL grade showed satisfactory robustness.

Conclusion

The grade of CIL was strongly associated with the prognosis among patients with EBC who received a regimen containing both anthracyclines and taxanes. Patients with a “moderate” CIL grade tended to have better survival outcomes.
Willingness to take long-acting injectable pre-exposure prophylaxis among men who have sex with men who participated in the CROPrEP study: a cross-sectional online study
Authors: Liu Yingjie , Chu Zhenxing , Wang Hongyi , Huang XiaoJie , Chen YaoKai , Wang Hui , Zou Dehua , Jiang YongJun , Geng WenQing , Hu Qinghai , Zhou Baosen , Shang Hong
Published: December 2023

Introduction

Evidence on the willingness of men who have sex with men (MSM) with oral pre-exposure prophylaxis (PrEP) experience, especially those with suboptimal adherence, to take long-acting injectable PrEP (LAI-PrEP) is critical to guide future LAI-PrEP implementation.

Objective

The objective was to assess the willingness of MSM with oral PrEP experience to take LAI-PrEP.

Methods

MSM who participated in the China Real-world Study of Oral PrEP (CROPrEP) were enrolled in this study. Information on the willingness of MSM to take LAI-PrEP and potential correlates was collected using a structured online questionnaire. The main outcomes were the willingness of MSM to take LAI-PrEP and its association with HIV-related behaviours, sexually transmitted infections, and oral PrEP history. Logistic regression was used to identify correlates of the willingness of MSM to take LAI-PrEP.

Results

A total of 612 former CROPrEP participants (FCPs) were included in this study. There were 315 (51.5%) daily oral PrEP (D-PrEP) users and 297 (48.5%) event-driven oral PrEP (ED-PrEP) users at the last follow-up. Most FCPs (77.8%) were willing to take free LAI-PrEP. FCPs with no less than two sexual male partners (aOR = 1.54, [95% CI: 1.04, 2.29], P = 0.031), those with male partners with unknown HIV statuses (aOR = 2.04, [95% CI: 1.31, 3.18], P = 0.002), those with recreational drug use (aOR = 1.58, [95% CI: 1.05, 2.40], P = 0.030), and those with HSV-2 positivity (aOR = 2.15, [95% CI: 1.30, 3.57], P = 0.003) were more willing to take LAI-PrEP, while ED-PrEP users (aOR = 0.66, [95% CI: 0.45, 0.98], P = 0.037) and FCPs with suboptimal oral PrEP adherence (aOR = 0.58, [95% CI: 0.36, 0.94], P = 0.026) were less willing to take LAI-PrEP.

Conclusion

LAI-PrEP has good prospects for expanding PrEP coverage. However, FCPs with suboptimal oral PrEP adherence are less likely to take LAI-PrEP. Further intervention and implementation efforts are needed to improve the willingness of MSM to use LAI-PrEP, and sexual health should be considered during the discussion about PrEP initiation.
Socio-demographic predictors of obesity among 12,975 adult ever married Egyptian women of reproductive age group: evidence from nationwide survey
Authors: El-Qushayri Amr Ehab , Hossain Md Anwar , Mahmud Imteaz , Hashan Mohammad Rashidul , Gupta Rajat Das
Published: December 2023

Aim

We aimed to explore the predictors associated with obesity among adult ever-married Egyptian women aged 20–49 years based on the Egyptian Demographic and Health Survey (EDHS).

Method

We included adult ever married women from the EDHS conducted in 2014 that initially recruited 21,903 women. Univariate and multivariable analysis was conducted to identify socio-demographic predictors of women’s obesity.

Result

We included 12,975 Egyptian women. Among them, 76% of the total respondents were obese where as 24% were with normal body mass index (BMI). In multivariable analysis, the results revealed that increasing age, higher wealth index, listening to radio at least once a week and women with primary and secondary education were at significant odds of developing obesity (p < 0.05). However, we found no association between residence of participants and the frequency of watching television upon the development of obesity (p > 0.05).

Conclusion

Appropriate and targeted interventions should be implemented among the Egyptian reproductive age women to reduce the obesity as well as non-communicable diseases load associated with obesity. National Health Service policy makers should take multilevel approach targeting high risk sub-groups to raise awareness and to provide prevention against obesity and the subsequent complications.
Primary school learners’ movement during class time: perceptions of educators in the Western Cape, South Africa
Authors: Fisher Dominic , Louw Quinette
Published: December 2023

Background

Over the last decade, the efficacy of in-classroom movement interventions to reduce sedentary behaviour has been mainly conducted in high-income, developed countries. To date, there have been no published reports on the perceptions of principals and teachers regarding learners’ movement during class time to inform the implementation of classroom-based movement strategies to reduce sedentariness in South Africa.

Methods

A sample of primary school principals and grades 5 and 6 teachers from a range of socio-economic categories participated in this exploratory, descriptive qualitative study in the metro central district of the Western Cape Education Department in South Africa. Transcripts of individual depth interviews (IDIs) with principals and focus group discussions (FGDs) with teachers were coded using Atlast ti 9* software for qualitative analysis.

Results

Thirteen principals (13 IDIs) and 24 teachers (6 FGDs) participated in the study. Two main factors influencing in-classroom movement, namely teacher-related and structural factors, were identified. The teacher-related factors pertained to their classroom management practice, knowledge and beliefs about sitting, and management style influenced their role in delivering the curriculum and creating a classroom environment conducive for learning. Classroom factors pertained to classroom size, the number of learners in the class and the ergonomic utility of traditional classroom desks. Institutional expectations and acceptance of learners’ behaviour, and teachers’ practice were also notable contributing factors that influenced learners’ movement during class time.

Conclusion

Emerging evidence about the efficacy of in-classroom movement on sedentary behaviour and learning outcomes challenges traditional teacher practice that sitting is essential for the delivery of the curriculum and for creating an optimal learning environment. Teacher training about the behaviour control utility of in-classroom movement, and school management and policy supportive of in-classroom movement may encourage fidelity to in-classroom movement strategies.
Social epidemiology of early adolescent alcohol expectancies
Authors: Nagata Jason M. , Zamora Gabriel , Smith Natalia , Sajjad Omar M. , Shim Joan , Ganson Kyle T. , Testa Alexander , Jackson Dylan B.
Published: December 2023

Purpose

To determine the sociodemographic correlates of alcohol expectancies (i.e., beliefs regarding positive or negative effects of alcohol) in a national (U.S.) cohort of early adolescents 10–14 years old. A second aim was to determine associations between alcohol sipping and alcohol expectancies.

Methods

We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,868; Year 2). Linear regression analyses were conducted to estimate associations between sociodemographic factors (sex, race/ethnicity, sexual orientation, household income, parental education, parent marital status, religiosity) and positive (e.g., stress reduction) and negative (e.g., loss of motor coordination) alcohol expectancies. Additional linear regression analyses determined associations between alcohol sipping and alcohol expectancies, adjusting for sociodemographic factors.

Results

Overall, 48.8% of the participants were female and 47.6% racial/ethnic minorities, with a mean age of 12.02 (SD 0.67) years. Older age among the early adolescent sample, male sex, and sexual minority identification were associated with more positive and negative alcohol expectancies. Black and Latino/Hispanic adolescents reported less positive and negative alcohol expectancies compared to White non-Latino/Hispanic adolescents. Having parents with a college education or greater and a household income of $200,000 and greater were associated with higher positive and negative alcohol expectancies. Alcohol sipping was associated with higher positive alcohol expectancies.

Conclusions

Older age, White non-Latino/Hispanic race, male sex, sexual minority status, higher parental education, and higher household income were associated with higher positive and negative alcohol expectancies. Future research should examine the mechanisms linking these specific sociodemographic factors to alcohol expectancies to inform future prevention and intervention efforts.
Regular Physical Exercise Adherence Scale (REPEAS): a new instrument to measure environmental and personal barriers to adherence to regular physical exercise
Authors: Pereira Fábio Henrique Ferreira , Santos-de-Araújo Aldair Darlan , Pontes-Silva André , Marinho Renan Shida , Garcia-Araújo Adriana Sanches , Borghi-Silva Audrey , Gonçalves Maria Cláudia , de Cássia Mendonça de Miranda Rita , Protazio Jhonata Botelho , Pinheiro Cezar Augusto Brito , Dibai-Filho Almir Vieira , Bassi-Dibai Daniela
Published: December 2023

Objective

To create, develop, and validate a scale that identifies the environmental and personal barriers that make it difficult to adhere to the practice of physical exercise on a regular basis in a population of Brazilian adults.

Methods

We include adult individuals, aged 18–59 years, practitioners or former practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In the development and validation phases of the process, 6 specialists in the field of the health assessed the content validity: firstly, the specialists were asked to freely list the questions they would ask to investigate the barriers to adherence to regulating physical activity. Secondly, after compiling all the suggestions listed and eliminating suggestions with similar content, the items suggested in the first round were sent to the specialists so that an evaluation of all questions using a 5-point Likert scale and the content validity coefficient was calculated. We then evaluated the structural validity, construct validity, reliability, internal consistency, and ceiling and floor effects of the Regular Physical Exercise Adherence Scale (REPEAS).

Results

Sixteen items were proposed to measure the factors that make it difficult to adhere to the regular practice of physical exercise. The internal structure of the REPEAS initially tested was based on the theoretical proposal of creating the instrument with two domains. After the structural analysis, we used the modification indices to identify the redundant items of the instrument. Consequently, the final version of the REPEAS after factor analysis had 12 items. Thus, the structure with 2 domains and 12 items presented adequate fit indices. With regard to construct validity, the REPEAS scores were compared in two distinct groups: irregular practitioners/ex-practitioners versus regular practitioners of physical exercise, in which a significant difference could be observed between groups (p < 0.001) for both the domains. Acceptable reliability was observed for the environment and personal domains, with ICC values of 0.86 and 0.94, in the same order. For internal consistency, Cronbach's alpha value was 0.908 (environmental domain) and 0.915 (personal domain), these values being adequate for the REPEAS.

Conclusion

The REPEAS is a scale with a valid two-dimensional internal structure, consisting of 12 items, reliable and with a valid construct, which supports its use in the clinical, epidemiological, and research contexts in Brazil.
Knockdown of MRPL35 promotes cell apoptosis and inhibits cell proliferation in non-small-cell lung cancer
Authors: Zhao Chengling , Chen Lei , Jin Zhixin , Liu Haitao , Ma Chao , Zhou Hangtian , Xu Lingling , Zhou Sihui , Shi Yan , Li Wei , Chen Yuqing , Dou Chengli , Wang Xiaojing
Published: December 2023

Background

Non-small cell lung cancer (NSCLC) is a major pathological type of lung cancer. However, its pathogenesis remains largely unclear. MRPL35 is a regulatory subunit of the mitoribosome, which can regulate the assembly of cytochrome c oxidases and plays an important role in the occurrence of NSCLC.

Methods

The expression of MRPL35 in NSCLC was detected by tissue microarray and immunohistochemistry. H1299 cells were infected with lentivirus to knockdown MRPL35, and the cells were subjected to crystal violet staining to assess the results of colony formation assays. A549 cells were infected by lentiviral particles-expressing shMRPL35 or shControl, and then subcutaneously injected into nude mice. Tumorigenesis in mice was detected by in vivo imaging. The potential pathway of MRPL35 in NSCLC was assessed by Western blotting.

Results

MRPL35 was over-expressed in NSCLC tissue compared to para-cancerous and normal tissues. Knockdown of MRPL35 suppressed cell proliferation and decreased NSCLC progression both in vitro and in vivo. The possible molecular mechanisms were also clarified, which indicated that MRPL35 could be involved in cell apoptosis and proliferation by modulating the expression levels of CDK1, BIRC5, CHEK1, STMN1 and MCM2. Knockdown of MRPL35 activated p53 signaling pathway and inhibited cell cycle regulation.

Conclusions

The oncogenic role of MRPL35 in NSCLC was potentially mediated through the cell cycle regulatory genes such as BIRC5, STMN1, CDK1, CHEK1 and MCM2, as well as activation of P53 signaling pathway.
The patient journey in Chronic Obstructive Pulmonary Disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD
Authors: Scichilone Nicola , Whittamore Andrew , White Chris , Nudo Elena , Savella Massimo , Lombardini Marta
Published: December 2023

Background

Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient’s daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance.

The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease.

Methods

Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs.

Results

The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32–70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families.

Conclusions

These results could aid in the creation of new ideas and concepts to improve our patient’s quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.
Inside-out raising mucosal-tympanomeatal flap approach for the repair of large marginal perforations
Authors: Zhang Yanting , Lou Zhengcai
Published: December 2023

Objective

This study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations.

Study design

Prospective case series.

Materials and methods

The study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively.

Results

In total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up.

Conclusions

Endoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications.
Association between periodontitis stages and self-reported diseases in a Norwegian population: the HUNT study
Authors: Stødle Ida Haukåen , Sen Abhijit , Høvik Hedda , Verket Anders , Koldsland Odd Carsten
Published: December 2023

Background

The relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT).

Material and methods

The fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders.

Results

Compared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema.

Conclusion

Periodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis.
Caring for persons with Dementia: a qualitative study of the needs of carers following care recipient discharge from hospital
Authors: Du Preez Janice , Celenza Antonio , Etherton-Beer Christopher , Moffat Paula , Campbell Elissa , Arendts Glenn
Published: December 2023

Background

A randomised clinical trial titled the Carer End of Life Planning Intervention (CELPI) in people dying with dementia evaluated the effect of carer education and support about palliative care on care recipient outcomes. We present a pre-planned qualitative analysis of data collected during the CELPI trial in which needs of carers randomised to the study intervention group were assessed using a novel instrument (Carer Needs Directed Assessment in Dementia (CANDID). This tool aimed to identify carers’ perceptions of their own and their care-recipients’ needs and is an important step in identifying support provision for dementia-specific, palliative cares services upon hospital discharge.

Methods

The CANDID tool was designed to identify the needs and experiences of primary carers and of their care recipients during the last twelve months of the care recipient’s life. The tool consisted of 33 open-ended questions evaluating: symptom management, emergency contacts, advance care planning, carer’s perception of the care recipient’s future needs, carer’s current needs, and a proposed current and future care plan. The researcher’s philosophical assumption of interpretative phenomenology informed the study and approach to data collection and analysis. Qualitative data collected during interviews using this tool were thematically analysed in five steps: compiling, disassembling, reassembling, interpreting and concluding. An interpretation of participants’ reality emerged from their common experiences and the subjective meanings assigned to actions attached to the phenomena studied.

Results

Thirty carer participants were included. Analysis identified three major themes: Carers’ perceived stressors, systemic barriers to care provision, and future planning. Issues identified included barriers to accessing supports, carer health and division between roles, financial burden, familial conflicts, adquate care in hospital and aged care facilities, concern about future needs, and end-of-life discussions.

Conclusion

The CANDID tool enabled an evaluation of carer needs and concerns. Identifying those needs may inform a referral to palliative care services where the level of management required may be benenficial for both the person living with dementia and their primary carer.

Trial Registration

Australian Clinical Trials Registration: (ACTRN12619001187134).
Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping: a prospective, randomized controlled study
Authors: Wang Bingyu , Peng Guanfa , Chen Li , Guo Mingling , Zhou Jianshun , Liu Yingying , Chen Zhen , Wang Lifeng
Published: December 2023

Background

Craniotomy aneurysm clipping is one of the main treatments for intracranial aneurysm (IA). Endotracheal intubation and intraoperative operation may induce dramatic hemodynamic fluctuations and increase the risk of aneurysm rupture. Intraoperative high-dose opioid use is the main measure to reduce the intraoperative stress response, but it increases the incidence of complications such as postoperative vomiting and delayed awakening. Transcutaneous electrical acupoint stimulation (TEAS) stimulates β-endorphin expression levels and reduces opioid requirements. In this study, we aimed to assess the effects of TEAS on remifentanil dosage and oxidative stress (OS) in craniotomy aneurysm clipping.

Method

Forty-two patients with craniotomy aneurysm clipping were randomized into two groups: the TEAS group (T group) and the sham TEAS group (S group). “Hegu” (LI4), “Neiguan” (PC6) and “Zusanli” points (ST36) were selected, and a “HANS” percutaneous acupoint electrical stimulator was used for intervention 30 min before anesthesia induction until the end of the operation. The primary outcome was intraoperative remifentanil dosage. The secondary outcomes were intraoperative propofol dosage, mean arterial pressure (MAP) and heart rate (HR) 5 min before the TEAS intervention (T0), 5 min before head holder pinning (T1), immediately after pinning (T2), 5 min before craniotomy (T3), immediately after craniotomy (T4), at craniotomy (T5), and at the end of surgery (T6), as well as serum β-endorphin levels at T1, T2 and T6 and neuron-specific enolase (NSE), S100β, superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T1, T2 and 24 h after surgery (T7).

Results

The dosage of remifentanil in the T group was reduced compared to that in the S group (P < 0.05). At T2, T4 and T5, the MAP and HR in the T group were lower than those in the S group (P < 0.05). At T2 and T7, the levels of NSE, S100β and MDA in group T were lower than those in group S (P < 0.05), while the SOD levels in group T were higher than those in group S (P < 0.05).

Conclusions

The use of TEAS can reduce the dosage of remifentanil and reduce hemodynamic fluctuations during craniotomy aneurysm clipping. It reduces the occurrence of OS and central nervous system damage during surgery and has a certain brain protective effect.

Trial registration

ChiCTR2100052353. https://www.chictr.org.cn/about.html.
The effect of mandatory post-call relief on sleep and wellness in ophthalmology residents
Authors: Feng Shu , Davis John A. , Chowdhary Apoorva , Lomazow Whitney , Yi Jonathan S. , Huang Johnson , Ding Leona , Taravati Parisa
Published: December 2023

Background

Multiple duty hour reforms have been implemented to optimize resident wellness through increasing opportunities for sleep recovery, but few studies have recorded objectively measured sleep or shown direct sleep and wellness benefits from such interventions. This study seeks to determine whether mandatory post-call relief policies with a partial night float system improved resident sleep, activity, and burnout among ophthalmology residents taking home call.

Methods

We conducted a two group cohort study of ophthalmology residents at the University Washington comparing post graduate year-2 (PGY-2) resident sleep, activity, and burnout between the optional post-call relief group from July 1, 2017 to June 30, 2019 to the mandatory post-call relief group from July 1, 2019 to June 30, 2021.

Results

Of twenty total residents participating in the survey portion, 18 residents participated in the sleep and activity tracking portion of the study, 9 in in the optional post-call relief cohort, and 9 in the mandatory post-call relief cohort. The mandatory post-call relief group recorded longer total sleep on call than the optional post-call relief group (p < 0.001). There was no difference in overnight sleep recorded on call (median 3.4 h), but residents recorded more time napping in the mandatory post-call relief cohort (p < 0.001). There was no significant difference between cohorts in amount of sleep while not on call. Residents in the mandatory post-call relief cohort recorded higher average daily steps, higher exercise time, and lower sedentary time than residents in the optional post-call relief cohort (p < 0.001). They also recorded lower median emotional exhaustion on the Maslach Burnout Inventory and lower stress in the Depression and Anxiety Stress Scale in the mandatory post-call relief cohort (p = 0.008).

Conclusions

Implementation of mandatory post-call relief policies with a partial night-float system among PGY-2 residents was associated with more post-call naps with more overall physical activity, lower emotional exhaustion scores, and lower stress scores, despite no changes to overnight sleep on call or total sleep. Although sample size limits interpretation of data, implementation of mandatory post call relief could be considered to improve post-call sleep in programs with home call.
Knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population referred to the health centers: a cross-sectional study
Authors: Kordi Fatemeh , Lakeh Nasrin Mokhtari , Pouralizadeh Moluk , Maroufizadeh Saman
Published: December 2023

Background and objective

Observance of preventive behaviors is one of the main ways to break the coronavirus disease 2019 (COVID-19) chain of transmission. Therefore, the present study was conducted to determine the knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population of Rasht city.

Methods

In this cross-sectional study, 344 people of the population referred to health centers in Rasht city were included through multi-stage cluster random sampling. The data were collected using a three-part researcher-made questionnaire including individual-social factors, knowledge about the prevention of COVID-19, and the preventive behaviors against COVID-19. Data analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk tests, Spearman’s correlation coefficient, and multiple logistic regression analysis, by SPSS software version 16 at a significance level < 0.05.

Results

The mean total score of knowledge about COVID-19 was at a moderate level, and the preventive behaviors of COVID-19 were at a good level. There was no significant relationship between the scores of awareness and preventive behaviors of COVID-19 (rs=0.001, P = 0.998). Awareness of COVID-19 was higher in university-educated individuals and women. Also, women, individuals who had access to the Internet, those trained by health centers, and those who were visited by health workers at home had more preventive behaviors.

Conclusion

Despite the lack of connection between knowledge and preventive behaviors, the villagers living in the suburbs of Rasht had a moderate level of knowledge and a good level of preventive behaviors of COVID-19. Appropriate educational interventions should be carried out to increase the awareness and performance of the rural residents.
Social disparities and inequalities in healthcare access and expenditures among Iranians exposed to sulfur mustard: a national study using spatio-temporal analysis
Authors: Hosseini-Shokouh Seyed-Morteza , Ghanei Mostafa , Mousavi Batool , Bagheri Hassan , Bahadori Mohammadkarim , Meskarpour-Amiri Mohammad , Mehdizadeh Parisa
Published: December 2023

Background

Sulfur Mustard (SM) is a chemical warfare agent that has serious short-term and long-term effects on health. Thousands of Iranians were exposed to SM during the eight-year Iran-Iraq conflict and permanently injured while the socioeconomic imbalance in their healthcare utilization (HCU) and health expenditures remains. This study aims to describe the HCU of SM-exposed survivors in Iran from 2018 to 2021; identify high-risk areas; and apply an inequality analysis of utilization regarding the socioeconomic groups to reduce the gap by controlling crucial determinants.

Methods

From Oct 2018 to June 2021, the Veterans and Martyrs Affairs Foundation (VMAF) recorded 58,888 living war survivors with eye, lung, and skin ailments. After cleaning the dataset and removing junk codes, we defined 11 HCU-related variables and predicted the HCU for the upcoming years using Bayesian spatio-temporal models. We explored the association of individual-level HCU and determinants using a Zero-inflated Poisson (ZIP) model and also investigated the provincial hotspots using Local Moran’s I.

Results

With ≥ 90% confidence, we discovered eleven HCU clusters in Iran. We discovered that the expected number of HCU 1) rises with increasing age, severity of complications in survivors' eyes and lungs, wealth index (WI), life expectancy (LE), and hospital beds ratio; and 2) decreases with growing skin complications, years of schooling (YOS), urbanization, number of hospital beds, length of stay (LOS) in bed, and bed occupancy rate (BOR). The concentration index (CInd) of HCU and associated costs in age and wealth groups were all positive, however, the signs of CInd values for HCU and total cost in YOS, urbanization, LOS, and Hospital beds ratio groups were not identical.

Conclusions

We observed a tendency of pro-rich inequity and also higher HCU and expenditures for the elderly population. Finally, health policies should tackle potential socioeconomic inequities to reduce HCU gaps in the SM-exposed population. Also, policymakers should allocate the resources according to the hotspots of HCU.
Risk factors for preterm birth: an umbrella review of meta-analyses of observational studies
Authors: Mitrogiannis Ioannis , Evangelou Evangelos , Efthymiou Athina , Kanavos Theofilos , Birbas Effrosyni , Makrydimas George , Papatheodorou Stefania
Published: December 2023

Background

Preterm birth defined as delivery before 37 gestational weeks is a leading cause of neonatal and infant morbidity and mortality. The aim of this study is to summarize the evidence from meta-analyses of observational studies on risk factors associated with PTB, evaluate whether there are indications of biases in this literature, and identify which of the previously reported associations are supported by robust evidence.

Methods

We searched PubMed and Scopus until February 2021, in order to identify meta-analyses examining associations between risk factors and PTB. For each meta-analysis, we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. Evidence was graded as robust, highly suggestive, suggestive, and weak.

Results

Eighty-five eligible meta-analyses were identified, which included 1480 primary studies providing data on 166 associations, covering a wide range of comorbid diseases, obstetric and medical history, drugs, exposure to environmental agents, infections, and vaccines. Ninety-nine (59.3%) associations were significant atP < 0.05, while 41 (24.7%) were significant atP < 10−6. Ninety-one (54.8%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 37 (22.3%) and 12 (7.2%) associations, respectively. We evaluated all associations according to prespecified criteria. Seven risk factors provided robust evidence: amphetamine exposure, isolated single umbilical artery, maternal personality disorder, sleep-disordered breathing (SDB), prior induced termination of pregnancy with vacuum aspiration (I-TOP with VA), low gestational weight gain (GWG), and interpregnancy interval (IPI) following miscarriage < 6 months.

Conclusions

The results from the synthesis of observational studies suggest that seven risk factors for PTB are supported by robust evidence. Routine screening for sleep quality and mental health is currently lacking from prenatal visits and should be introduced. This assessment can promote the development and training of prediction models using robust risk factors that could improve risk stratification and guide cost-effective preventive strategies.

Trial registration

PROSPERO 2021 CRD42021227296.
Status, evaluation, and influencing factors of biosecurity levels in pig farms in China
Authors: Wang Jiamei , Shi Zizhong , Hu Xiangdong
Published: December 2023

Background

Animal diseases have always been a serious threat to livestock breeding, and the establishment of a biosecurity barrier is important for disease prevention and control. Based on the investigations conducted in seven provinces located farms, this study aimed to explore the current biosecurity levels of farms in China, construct a biosecurity evaluation system, calculate the biosecurity levels of farms using the rank sum ratio comprehensive evaluation method, and develop an empirical analysis of the factors influencing biosecurity levels.

Results

The results show that the greater the cost of biosecurity invested, the greater the level of biosecurity. Male farmers, educational attainment and participation in technical training had a significant positive effect on biosecurity levels. In addition, biosecurity levels first decreased and then increased as the scale of farming increased. The study also found that the more people in the household engaged in farming, the higher the biosecurity level of the farm. And farms that joined cooperatives had higher levels of biosecurity.

Conclusion

The rank sum ratio method can evaluate the index system, so as to obtain a comprehensive index RSR value that can be compared, and the operation steps are simple and effective. By taking measures such as improving the comprehensive quality of farmers and increasing the investment in human, material and financial resources for biosecurity, the biosecurity level of farms can be effectively improved and animal diseases can be effectively prevented and controlled.
Incident cardiac arrhythmias associated with metabolic dysfunction-associated steatotic liver disease: a nationwide histology cohort study
Authors: Simon Tracey G. , Ebrahimi Fahim , Roelstraete Bjorn , Hagström Hannes , Sundström Johan , Ludvigsson Jonas F.
Published: December 2023

Background

Prior studies suggest a link between metabolic dysfunction-associated steatotic liver disease (MASLD) and incident arrhythmias, including atrial fibrillation (AF). However, robust data are lacking from cohorts with liver histology, which remains the gold standard for staging MASLD severity.

Methods

This population-based cohort included all Swedish adults with histologically-confirmed MASLD and without prior cardiac arrhythmias (1966–2016; n = 11,206). MASLD was defined from prospectively-recorded histopathology, and characterized as simple steatosis, non-fibrotic steatohepatitis (MASH), non-cirrhotic fibrosis, or cirrhosis. MASLD patients were matched to ≤ 5 controls without MASLD or arrhythmias, by age, sex, calendar year and county (n = 51,856). Using Cox proportional hazards modeling, we calculated multivariable-adjusted hazard ratios (aHRs) for incident arrhythmias (including AF, bradyarrhythmias, other supraventricular arrhythmias, ventricular arrhythmias/cardiac arrest).

Results

Over a median follow-up of 10.8 years, incident arrhythmias were confirmed in 1351 MASLD patients (10.3/1000 person-years [PY]) and 6493 controls (8.7/1000PY; difference = 1.7/1000PY; aHR = 1.30, 95%CI 1.22–1.38), and MASLD patients had significantly higher rates of incident AF (difference = 0.9/1000PY; aHR = 1.26, 95%CI 1.18–1.35). Rates of both overall arrhythmias and AF were significantly elevated across all MASLD histological groups, particularly cirrhosis (differences, 8.5/1000PY and 5.3/1000PY, respectively). In secondary analyses, MASLD patients also had significantly higher rates of incident ventricular arrhythmias/cardiac arrest (aHR = 1.53, 95%CI 1.30–1.80), bradyarrhythmias (aHR = 1.26, 95%CI 1.06–1.48), and other supraventricular arrhythmias (aHR = 1.27, 95%CI 1.00–1.62), compared to controls.

Conclusions

Compared to matched controls, patients with biopsy-confirmed MASLD had modest but significantly higher incidence of cardiac arrhythmias, including AF, bradyarrhythmias, other supraventricular arrhythmias and ventricular arrhythmias/cardiac arrest. Excess risk was observed across all stages of MASLD and was highest with cirrhosis.