bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health of people with limited access to health services: a retrospective study of patients attending a humanitarian clinic network in Germany in 2021
Authors: Mugambwa Kashung Annie , Lutchmun Wandini , Gach Janina , Bader Carolin , Froeschl Guenter
Published: April 2023

Background

Germany has a statutory health insurance system. However, a substantial part of the population still suffers from limited access to regular health services. While humanitarian organizations are partially filling this gap, people with limited access show a high prevalence of mental disorders. This study investigates the prevalence, and social determinants of mental disorders in patients attending the clinics of a humanitarian health network in three major cities in Germany, as well as perceived barriers to healthcare access in this population.

Methods

We performed a descriptive, retrospective study of individuals attending the outpatient clinics of the humanitarian organization Ärzte der Welt, in Berlin, Hamburg and Munich, in 2021. Medico-administrative data was collected using a digital questionnaire at first presentation to the clinics. We report the prevalence of both perceived altered mental health and diagnosed mental disorders, as well as the perceived barriers to healthcare access in this population. We performed a logistic regression analysis to identify the socio-demographic factors associated with mental disorders.

Results

Our study population consisted of 1,071 first presenters to the clinics in 2021. The median age at presentation was 32 years and 57.2% of the population were male. 81.8% experienced a form of homelessness, 40% originated from non-EU countries and only 12.4% had regular statutory health insurance. 101 (9.4%) patients had a diagnosed mental disorder. In addition, 128 (11.9%) patients reported feeling depressed, 99 (9.2%) reported a lack of interest in daily activities, and 134 (12.5%) lacked emotional support in situations of need on most days. The most reported barrier to accessing health services was high health expenses, reported by 61.3% of patients.In the bivariate logistic regression analysis age, insurance status and region of origin were significantly associated with mental disorders. In the multivariable analysis, only age groups 20–39 and 40–59 years remained significant.

Conclusions

People with limited access to regular health services have a high need for mental health services. As a chronic condition, this is even more difficult to manage outside of regular services, where humanitarian clinics are only filling the gap in serving basic health needs.
A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design
Authors: Berge Jerica M. , Trofholz Amanda C. , Aqeel Marah , Norderud Kristin , Tate Allan , Fertig Angela R. , Loth Katie , Mendenhall Tai , Neumark-Sztainer Dianne
Published: April 2023

Background

Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the “quality” of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan.

Methods/design

The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5–10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference.

Discussion

This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care.

Trial registration

This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.
Global, regional, and national burdens of myocarditis, 1990–2019: systematic analysis from GBD 2019
Authors: Wang Yue-Wen-Ying , Liu Run-Ben , Huang Cheng-Yang , Li Hao-Yang , Zhang Zhi-Xin , Li Xiao-Zheng , Liu Jia-Ling , Zhang Chao , Xiong Xing , Niu Yu-Ming
Published: April 2023

Objectives

Myocarditis, a health-threatening heart disease, is attracting increasing attention. This systematic study was conducted to study the prevalence of disease through the trends of incidence, mortality, disability-adjusted life years (DALYs) over the last 30 years, which would be helpful for the policymakers to better the choices for reasonable decisions.

Methods

The global, regional, and national burdens of myocarditis from 1990–2019 were analyzed by using the 2019 Global Burden of Disease (GBD) database. This study on myocarditis produced new findings according to age, sex, and Social-Demographic Index (SDI) by investigating DALYs, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and corresponding estimated annual percentage change (EAPC).

Results

The number of myocarditis incidence increased by 62.19%, from 780,410 cases in 1990 to 1,265,770 cases in 2019. The ASIR decreased by 4.42% (95%CI, from -0.26% to -0.21%) over the past 30 years. The number of deaths from myocarditis increased by 65.40% from 19,618 in 1990 to 324,490 in 2019, but the ASDR was relatively stable over the investigated period. ASDR increased in low-middle SDI regions (EAPC=0.48; 95%CI, 0.24 to 0.72) and decreased in low SDI regions (EAPC=-0.97; 95%CI, from -1.05 to -0.89). The age-standardized DALY rate decreased by 1.19% (95%CI, from -1.33% to -1.04%) per year.

Conclusions

Globally, the ASIR and DALY for myocarditis decreased and the ASDR was stable over the past 30 years. The risk of incidences and death cases increased with age. Measures should be taken to control the risk of myocarditis in high-burden regions. Medical supplies should be improved in the high-middle SDI regions and middle SDI regions to reduce the deaths from myocarditis in these regions.
“Help Us!”: a content analysis of COVID-19 help-seeking posts on Weibo during the first lockdown
Authors: Guo Yu , Hou Yongkang , Xiang Hongzhe , Chen Liang
Published: April 2023

Background

Social media is playing an increasingly important role in public emergencies for help-seekers, especially during the global COVID-19 pandemic. Wuhan, China, firstly official reported COVID-19 cases and implemented lockdown measures to prevent the spread of the virus. People during the first lockdown were restricted from seeking help face-to-face. Social media is more prominent as an online tool for people seeking help, especially for patients, than in other stages of the COVID-19 pandemic.

Objective

This study aimed to explore the urgent needs presented in help-seeking posts in Wuhan during the first COVID-19 lockdown, the content features of these posts, and how they influenced online user engagement.

Methods

This study collected posts from Weibo posted with specific help tags during the first COVID-19 lockdown in Wuhan: from 23 January 2020 to 24 March 2020, and eventually received 2055 data, including textual content, comments, retweets, and publishing location. Content analysis was conducted, and manual coding was performed on help-seeking typology, narrative mode, narrative subject, and emotional valence.

Results

The result showed that help-seeking posts primarily were seeking medical (97.7%). Features of these posts were mainly adopting a mixed narrative mode (46.4%), released by relatives of patients (61.7%), and expressing negative emotions (93.2%). Chi-square tests suggested that help-seeking posts with mixed narrative modes released by relatives express more frequent negative emotions. Results of negative binomial regression indicated posts of seeking information (B = 0.52, p < .001, e0.52 = 1.68), with mixed narrative mode (B = 0.63, p < .001, e0.63 = 1.86), released by themselves (as referential groups) and with neutral emotions increased comments. Posts of seeking medical (B = 0.57, p < .01, e0.57 = 1.77), with mixed narrative mode (B = 1.88, p < .001, e1.88 = 6.53), released by people of unrelated patients (B = 0.47, p < .001, e0.47 = 1.60) and with neutral emotions increased retweets.

Conclusions

This study provides evidence of what actual public demands are to be considered and addressed by governments and public administrators before implementing closure and lockdown policies to limit the spread of the virus. Meanwhile, our findings offer strategies for people help-seeking on social media in similar public health emergencies.
Different associations of occupational and leisure-time physical activity with the prevalence of hypertension among middle-aged community dwellers in rural Khánh Hòa, Vietnam
Authors: Do An Dang , Pham Thuy Thi Phuong , Nguyen Chau Que , Van Hoang Dong , Fukunaga Ami , Yamamoto Shohei , Shrestha Rachana Manandhar , Phan Danh Cong , Hachiya Masahiko , Van Huynh Dong , Le Huy Xuan , Do Hung Thai , Mizoue Tetsuya , Inoue Yosuke
Published: April 2023

Background

In contrast to high-income countries where physical activity (PA), particularly leisure-time PA, has been shown to be protective against hypertension, few studies have been conducted in low- and middle-income countries. We examined the cross-sectional association between PA and hypertension prevalence among rural residents in Vietnam.

Methods

We used data collected in the baseline survey of a prospective cohort study, among 3000 people aged 40–60 years old residing in rural Khánh Hòa, Vietnam. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or the use of antihypertensive medication. We assessed occupational PA and leisure-time PA using the Global Physical Activity Questionnaire. A robust Poisson regression model was used to investigate the associations, with adjustment for covariates.

Results

The prevalence of hypertension was 39.6%. After adjusting for socio-demographic and lifestyle-related variables, leisure-time PA was positively associated with hypertension prevalence (prevalence ratio [PR]: 1.03 per 10 MET-hour/week, 95% confidence interval [CI] 1.01–1.06). Occupational PA was inversely associated with hypertension prevalence (PR: 0.98 per 50 MET-hour/week, 95% CI = 0.96–0.996). After adjusting for BMI and other health-related variables, the association related to occupational PA became statistically non-significant, while the association related to leisure-time PA remained statistically significant.

Conclusion

In contrast to previous studies in high-income countries, we found that leisure-time PA was positively associated with hypertension prevalence and occupational PA was associated with a lower hypertension prevalence. This suggests that the association between PA and hypertension might differ depending on the context.
Assessment of cardiopulmonary manifestations and its correlation with semi-quantitative scoring of high-resolution computed tomography in patients with autoimmune rheumatic diseases
Authors: El-Kalashy Mai M. , Elbeltagy Samah A. , Zahran Enas S. , Salman Maha M. , Elrahman Shrief R. Abd , Abdalraouf Mai M. , El-Koa Amal A.
Published: April 2023

Purpose

Autoimmune rheumatic diseases (ARD) are groups of diseases that are commonly associated with cardiac and pulmonary manifestations and may affect the morbidity and mortality of the patients. The study aimed to the assessment of cardiopulmonary manifestations and their correlation with the semi-quantitative scoring of high-resolution computed tomography (HRCT) in ARD patients.

Methods and patients

30 patients with ARD were included in the study (mean age 42.2 ± 9.76 years) [10 patients were scleroderma (SSc), 10 patients were rheumatoid arthritis (RA), and 10 patients were systemic lupus erythematosus (SLE)]. They all met the diagnostic criteria of the American College of Rheumatology and underwent spirometry, echocardiography, and chest HRCT. The HRCT was assessed by a semi-quantitative score for parenchymal abnormalities. Correlation between HRCT lung scores and: inflammatory markers, lung volumes in spirometry, and echocardiographic indices has been performed.

Results

The total lung score (TLS) by HRCT was 14.8 ± 8.78 (mean ± SD), ground glass opacity score (GGO) was 7.20 ± 5.79 (mean ± SD) and fibrosis lung score (F) was 7.63 ± 6.05 (mean ± SD). TLS correlated significantly with ESR (r 0.528, p 0.003), CRP (r 0.439, p 0.015), PaO2 (r -0.395, P 0.031) FVC% (r -0.687, p 0.001), and echocardiographic Tricuspid E (r -0.370, p 0.044), Tricuspid E/è (r -0.397,p 0.03), ESPAP (r 0.459,p 0.011), TAPSE (r -0.405, p 0.027), MPI-TDI (r -0.428, p 0.018) and RV Global strain(r -0.567, p 0.001). GGO score correlated significantly with ESR (r 0.597, p 0.001), CRP (r 0.473, p 0.008), FVC% (r -0.558, p 0.001), and RV Global strain(r -0.496, p 0.005). F score correlated significantly with FVC% (r -0.397, p 0.030), Tricuspid E/è (r -0.445, p 0.014), ESPAP (r 0.402, p 0.028), and MPI-TDI (r -0.448, p 0.013).

Conclusion

The total lung score and GGO score in ARD were found to be consistently significantly correlated with FVC% predicted, PaO2, inflammatory markers, and RV functions. Fibrotic score correlated with ESPAP. Therefore, in a clinical setting, most clinicians who monitor patients suffering from ARD should concern with the applicability of semiquantitative HRCT scoring in clinical practice.
Long-term survivorship and results in lower limb arthroplasty: a registry-based comparison study
Authors: Ho Kevin Ki-Wai , Chau Wai-Wang , Lau Lawrence Chun-Man , Ng Jonathan Patrick , Chiu Kwok-Hing , Ong Michael Tim-Yun
Published: April 2023

Introduction

Popularity of joint replacement surgery due to ever aging population surges the demand for a proper national joint registry. Our Chinese University of Hong Kong – Prince of Wales Hospital (CUHK-PWH) joint registry has passed the 30th year. The aims of this study are 1) summarize our territory-wide joint registry which has passed the 30th year since establishment and 2) compare our statistics with other major joint registries.

Methods

Part 1 was to review the CUHK-PWH registry. Demographic characteristics of our patients who underwent knee and hip replacements had been summarized. Part 2 was a series of comparisons with registries from Sweden, UK, Australia and New Zealand.

Results

CUHK-PWH registry captured 2889 primary total knee replacements (TKR) (110 (3.81%) revision) and 879 primary total hip replacements (THR) (107 (12.17%) revision). Median Surgery time of TKR was shorter than THR. Clinical outcome scores were much improved after surgery in both. Uncemented of hybrid in TKR were most popular in Australia (33.4%) and 40% in Sweden and UK. More than half of TKR and THR patients showed the highest percentage with ASA grade 2. New Zealand reflected the best cumulative percentage survival 20 years after surgery of 92.2%, 76.0%, 84.2% survivorship 20 years after TKR, unicompartmental knee replacement (UKR) and Hip.

Conclusion

A worldwide accepted patient-reported outcome measure (PROM) is recommended to develop to make comparisons among registries and studies feasible. Completeness of registry data is important and useful to improve surgical performance through data comparisons from different regions. Funding from government on sustaining registries is reflected. Registries from Asian countries have yet to be grown and reported.
Association of Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet and metabolically unhealthy overweight/obesity phenotypes among Iranian women: a cross sectional study
Authors: Khadem Alireza , Shiraseb Farideh , Mirzababaei Atieh , Noori Sahar , Mirzaei Khadijeh
Published: April 2023

Purpose

Paradoxes have been found in obesity, including individuals with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO), and diet may be one of the reasons for the creation of these metabolic phenotypes. Hence, the purpose of the present study was to investigate the association of the Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet with metabolically unhealthy overweight/obesity (MUHOW/O) phenotypes.

Methods

In this cross-sectional study, 229 overweight and obese women (body mass index (BMI) ≥ 25 kg/m2) aged 18–48 years were examined. Anthropometric measures and biochemical parameters were collected from all participants. The body composition of each participant was assessed using a bioelectrical impedance analyzer (BIA). The MIND diet score was determined based on 15 components using a valid and reliable food frequency questionnaire (FFQ) containing 147 items. Karelis criteria was used to determine metabolically healthy/unhealthy phenotype (MH/MUH).

Results

Among the participants, 72.5% of individuals were identified as MUH and 27.5% as MH, with a mean ± standard deviation (SD) age of 36.16 (8.33) years. The results of our analysis showed that after controlling for age, energy intake, BMI, and physical activity, there was no significant association observed between overweight/obesity phenotypes with tertile 2 (T2) (OR: 2.01, 95% CI: 0.86–4.17, P-value = 0.10), T3 (OR: 1.89, 95% CI: 0.86–4.17, P-value = 0.11) of MIND score, and only the odds of MUH relative to MH with a marginal significant decreasing trend was observed from the second to the third tertile (1.89 vs. 2.01) (P − trend = 0.06). Also, after additional adjustment for marital status, the nonsignificant association between overweight/obesity phenotypes with tertile 2 (T2) (OR: 2.13, 95% CI: 0.89−5.10, P-value = 0.08), T3 (OR: 1.87, 95% CI: 0.83−4.23, P-value = 0.12) of MIND score remained, and the odds of MUH relative to MH with a significant decreasing trend was observed with increasing tertiles (P-trend = 0.04).

Conclusions

In conclusion, no significant associations were found between adherence to MIND diet with MUH, and only a significant downward trend in the odds of MUH was observed with increasing tertiles. We suggest further studies in this field.
Organizational resilience in healthcare: a review and descriptive narrative synthesis of approaches to resilience measurement and assessment in empirical studies
Authors: Ignatowicz Agnieszka , Tarrant Carolyn , Mannion Russell , El-Sawy Dena , Conroy Simon , Lasserson Daniel
Published: April 2023

Background

The coronavirus pandemic has had a profound impact on organization and delivery of care. The challenges faced by healthcare organizations in dealing with the pandemic have intensified interest in the concept of resilience. While effort has gone into conceptualising resilience, there has been relatively little work on how to evaluate organizational resilience. This paper reports on an extensive review of approaches to resilience measurement and assessment in empirical healthcare studies, and examines their usefulness for researchers, policymakers and healthcare managers.

Methods

Various databases (MEDLINE, EMBASE, PsycINFO, CINAHL (EBSCO host), Cochrane CENTRAL (Wiley), CDSR, Science Citation Index, and Social Science Citation Index) were searched from January 2000 to September 2021. We included quantitative, qualitative and modelling studies that focused on measuring or qualitatively assessing organizational resilience in a healthcare context. All studies were screened based on titles, abstracts and full text. For each approach, information on the format of measurement or assessment, method of data collection and analysis, and other relevant information were extracted. We classified the approaches to organizational resilience into five thematic areas of contrast: (1) type of shock; (2) stage of resilience; (3) included characteristics or indicators; (4) nature of output; and (5) purpose. The approaches were summarised narratively within these thematic areas.

Results

Thirty-five studies met the inclusion criteria. We identified a lack of consensus on how to evaluate organizational resilience in healthcare, what should be measured or assessed and when, and using what resilience characteristic and indicators. The measurement and assessment approaches varied in scope, format, content and purpose. Approaches varied in terms of whether they were prospective (resilience pre-shock) or retrospective (during or post-shock), and the extent to which they addressed a pre-defined and shock-specific set of characteristics and indicators.

Conclusion

A range of approaches with differing characteristics and indicators has been developed to evaluate organizational resilience in healthcare, and may be of value to researchers, policymakers and healthcare managers. The choice of an approach to use in practice should be determined by the type of shock, the purpose of the evaluation, the intended use of results, and the availability of data and resources.
Development and initial validation of the addressing client needs with social determinants of health scale (ACN: SDH)
Authors: Johnson Kaprea F.
Published: April 2023

Background

The purpose of this study was to validate a scale that can be used by healthcare service professionals, healthcare systems, educators, and researchers to assess health service professionals’ social determinants of health (SDOH) competency; with competency defined as their knowledge, awareness-biases, skills, and actual preparedness to address SDOH challenges.

Methods

An Exploratory Factor Analysis (EFA) was conducted with a sample of 220 health service professionals, and 6 factors were identified. A Confirmatory Factor Analysis (CFA) was conducted with 303 health service professionals and the 6-factor solution was supported, with 22 items.

Results

The reliability estimates for the 6 factors are as follows: Factor 1,Action Toward Addressing SDOH(a = .85); Factor 2,SDOH Knowledge (a = .94);Factor 3,Negative Attitude toward Addressing SDOH(a = .79); Factor 4,Systemic Accountability(a = .81); Factor 5,School Preparation(a = .86); and Factor 6,Perception of the Cause of SDOH(a = .94).

Conclusion

The ACN:SDH scale is the first validated measure that can be used to systematically appraise health service professionals’ SDOH competency.
Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study
Authors: Nguyen Anh Le Tuan , Si Lei , Lubel John S , Shackel Nicholas , Yee Kwang Chien , Wilson Mark , Bradshaw Jane , Hardy Kerry , Palmer Andrew John , Blizzard Christopher Leigh , de Graaff Barbara
Published: April 2023

Background

Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia.

Methods

A microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort’s ranges of ages.

Results

Sixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective.

Conclusions

HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.
Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada
Authors: Hudon Catherine , Bisson Mathieu , Chouinard Maud-Christine , Delahunty-Pike Alannah , Lambert Mireille , Howse Dana , Schwarz Charlotte , Dumont-Samson Olivier , Aubrey-Bassler Kris , Burge Fred , Doucet Shelley , Ramsden Vivian R. , Luke Alison , Macdonald Marilyn , Gaudreau André , Porter Judy , Rubenstein Donna , Scott Cathy , Warren Mike , Wilhelm Linda
Published: April 2023

Background

Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services.

Methods

A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out.

Results

Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an “individualized services plan” with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers’ concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care.

Conclusion

Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.
Genome-wide association analyses identified novel susceptibility loci for pulmonary embolism among Han Chinese population
Authors: Zhang Zhu , Li Haobo , Weng Haoyi , Zhou Geyu , Chen Hong , Yang Guoru , Zhang Ping , Zhang Xiangyan , Ji Yingqun , Ying Kejing , Liu Bo , Xu Qixia , Tang Yongjun , Zhu Guangfa , Liu Zhihong , Xia Shuyue , Yang Xiaohong , Dong Lixia , Zhu Ling , Zeng Mian , Yuan Yadong , Yang Yuanhua , Zhang Nuofu , Xu Xiaomao , Pang Wenyi , Zhang Meng , Zhang Yu , Zhen Kaiyuan , Wang Dingyi , Lei Jieping , Wu Sinan , Shu Shi , Zhang Yunxia , Zhang Shuai , Gao Qian , Huang Qiang , Deng Chao , Fu Xi , Chen Gang , Duan Wenxin , Wan Jun , Xie Wanmu , Zhang Peng , Wang Shengfeng , Yang Peiran , Zuo Xianbo , Zhai Zhenguo , Wang Chen ,   on behalf of the China pUlmonary Thromboembolism REgistry Study (CURES) investigators
Published: April 2023

Background

A large proportion of pulmonary embolism (PE) heritability remains unexplained, particularly among the East Asian (EAS) population. Our study aims to expand the genetic architecture of PE and reveal more genetic determinants in Han Chinese.

Methods

We conducted the first genome-wide association study (GWAS) of PE in Han Chinese, then performed the GWAS meta-analysis based on the discovery and replication stages. To validate the effect of the risk allele, qPCR and Western blotting experiments were used to investigate possible changes in gene expression. Mendelian randomization (MR) analysis was employed to implicate pathogenic mechanisms, and a polygenic risk score (PRS) for PE risk prediction was generated.

Results

After meta-analysis of the discovery dataset (622 cases, 8853 controls) and replication dataset (646 cases, 8810 controls), GWAS identified 3 independent loci associated with PE, including the reported lociFGGrs2066865 (p-value = 3.81 × 10−14),ABOrs582094 (p-value = 1.16 × 10−10) and newly reported locusFABP2rs1799883 (p-value = 7.59 × 10−17). Previously reported 10 variants were successfully replicated in our cohort. Functional experiments confirmed thatFABP2-A163G(rs1799883) promoted the transcription and protein expression ofFABP2. Meanwhile, MR analysis revealed that high LDL-C and TC levels were associated with an increased risk of PE. Individuals with the top 10% of PRS had over a fivefold increased risk for PE compared to the general population.

Conclusions

We identifiedFABP2, related to the transport of long-chain fatty acids, contributing to the risk of PE and provided more evidence for the essential role of metabolic pathways in PE development.
Heterozygous variant in FGFR3 underlying severe phenotypes in the second trimester: a case report
Authors: Chen Shujun , Dong Hongmei , Luo Yong , Zhang Yingpin , Li Pan
Published: April 2023

Background

Achondroplasia is a congenital skeletal system malformation caused by missense variant of FGFR3 gene with an incidence of 1 per 20,000–30,000 newborns, which is an autosomal dominant inheritance disease. Despite similar imaging features, the homozygous achondroplasia is absolutely lethal due to thoracic stenosis, whereas heterozygous achondroplasia does not lead to fetal death.

Case presentation

A fetus with progressive rhizomelic short limbs and overt narrow chest was detected by prenatal ultrasound in the second trimester. Gene sequencing results of amniotic fluid sample indicated a rare missense variant NM_000142.4: c.1123G > T(p.Gly375Cys), leading to a glycine to cysteine substitution. Re-sequencing confirmed that it was a heterozygous variant, and thoracic stenosis was then confirmed in the corpse by radiological examination.

Conclusions

We identified a heterozygous variant of the FGFR3 gene as the rare pathogenic variant of severe achondroplasia in a fetus. Heterozygous variants of p.Gly375Cys may have a severe phenotype similar to homozygote. It’s crucial to combine prenatal ultrasound with genetic examination to differentiate heterozygous from homozygous achondroplasia. The p.Gly375Cys variant of FGFR3 gene may serve as a vital target for the diagnosis of severe achondroplasia.
MiRNA-93: a novel signature in human disorders and drug resistance
Authors: Hussen Bashdar Mahmud , Abdullah Snur Rasool , Rasul Mohammed Fatih , Jawhar Zanko Hassan , Faraj Goran Sedeeq Hama , Kiani Arda , Taheri Mohammad
Published: April 2023

miRNA-93 is a member of the miR-106b-25 family and is encoded by a gene on chromosome 7q22.1. They play a role in the etiology of various diseases, including cancer, Parkinson’s disease, hepatic injury, osteoarthritis, acute myocardial infarction, atherosclerosis, rheumatoid arthritis, and chronic kidney disease. Different studies have found that this miRNA has opposing roles in the context of cancer. Recently, miRNA-93 has been downregulated in breast cancer, gastric cancer, colorectal cancer, pancreatic cancer, bladder cancer, cervical cancer, and renal cancer. However, miRNA-93 is up-regulated in a wide variety of malignancies, such as lung, colorectal, glioma, prostate, osteosarcoma, and hepatocellular carcinoma. The aim of the current review is to provide an overview of miRNA-93's function in cancer disorder progression and non-cancer disorders, with a focus on dysregulated signaling pathways. We also give an overview of this miRNA's function as a biomarker of prognosis in cancer and emphasize how it contributes to drug resistance based on in vivo, in vitro, and human studies.
Molecular characterization of coxsackievirus B5 from the sputum of pneumonia children patients of Kunming, Southwest China
Authors: Tan Miao , Suo Jiale , Zhang Zhilei , He Wenji , Tan Li , Jiang Haiyan , Li Ming , He Juan , Pan Yue , Xu Bin , Yan Lingmei , Bin Songtao , Gan Zhengyan , Sun Yuxing , Jiang Hongchao , Sun Qiangming , Zhang Zhen
Published: April 2023

Background

CVB5 can cause respiratory infections. However, the molecular epidemiological information about CVB5 in respiratory tract samples is still limited. Here, we report five cases in which CVB5 was detected in sputum sample of pneumonia children patients from Kunming, Southwest China.

Methods

CVB5 isolates were obtained from sputum samples of patients with pneumonia. Whole-genome sequencing of CVB5 isolates was performed using segmented PCR, and phylogenetic, mutation and recombination analysis. The effect of mutations in the VP1 protein on hydration were analyzed by Protscale. The tertiary models of VP1 proteins were established by Colabfold, and the effect of mutations in VP1 protein on volume modifications and binding affinity were analyzed by Pymol software and PROVEAN.

Results

A total of five CVB5 complete genome sequences were obtained. No obvious homologous recombination signals comparing with other coxsackie B viruses were observed in the five isolates. Phylogenetic analysis showed that the five CVB5 sputum isolates were from an independent branch in genogroup E. Due to the mutation, the structure and spatial of the VP1 protein N-terminus have changed significantly. Comparing to the Faulkner (CVB5 prototype strain), PROVEAN revealed three deleterious substitutions: Y75F, N166T (KM35), T140I (KM41). The last two of the three deleterious substitutions significantly increased the hydrophobicity of the residues.

Conclusions

We unexpectedly found five cases of CVB5 infection instead of rhinoviruses infection during our routine surveillance of rhinoviruses in respiratory tract samples. All five patients were hospitalized with pneumonia symptoms and were not tested for enterovirus during their hospitalization. This report suggests that enterovirus surveillance in patients with respiratory symptoms should be strengthened.
Central nervous system insulin signaling can influence the rate of insulin influx into brain
Authors: Nguyen Van , Thomas Peter , Pemberton Sarah , Babin Alice , Noonan Cassidy , Weaver Riley , Banks William A. , Rhea Elizabeth M.
Published: April 2023

Background

Insulin transport across the blood-brain barrier (BBB) is a highly regulated, saturable process, known to be affected by many peripheral substrates including insulin itself and triglycerides. This is in contrast to insulin leakage into peripheral tissues. Whether the central nervous system (CNS) can control the rate of insulin uptake by brain remains to be determined. Insulin BBB interactions are impaired in Alzheimer’s disease (AD) and CNS insulin resistance is widely prevalent in AD. Therefore, if CNS insulin controls the rate of insulin transport across the BBB, then the defective transport of insulin seen in AD could be one manifestation of the resistance to CNS insulin observed in AD.

Methods

We investigated whether enhancing CNS insulin levels or induction of CNS insulin resistance using an inhibitor of the insulin receptor altered the blood-to-brain transport of radioactively labeled insulin in young, healthy mice.

Results

We found that insulin injected directly into the brain decreased insulin transport across the BBB for whole brain and the olfactory bulb in male mice, whereas insulin receptor blockade decreased transport in female mice for whole brain and hypothalamus. Intranasal insulin, currently being investigated as a treatment in AD patients, decreased transport across the BBB of the hypothalamus.

Conclusions

These results suggest CNS insulin can control the rate of insulin brain uptake, connecting CNS insulin resistance to the rate of insulin transport across the BBB.
Urate-lowering therapy following a treat-to-target continuation strategy compared to a treat-to-avoid-symptoms discontinuation strategy in gout patients in remission (GO TEST Finale): study protocol of a multicentre pragmatic randomized superiority trial
Authors: Peeters Iris Rose , den Broeder Alfons A. , Taylor William J , den Broeder Nathan , Flendrie Marcel , van Herwaarden Noortje
Published: April 2023

Background

Long-term gout treatment is based on reducing serum urate levels using urate-lowering therapy (ULT). Most guidelines recommend using a lifelong continuation treat-to-target (T2T) strategy, in which ULT is dosed or combined until a serum urate target has been reached and maintained. However, a frequently used alternative strategy in clinical practice is a treat-to-avoid-symptoms (T2S) ULT discontinuation strategy, with the possibility of restarting the medication. This latter strategy aims at an acceptable symptom state, regardless of serum urate levels. High-quality evidence to support either strategy for patients in prolonged remission while using ULT is lacking.

Methods

We developed an investigator-driven pragmatic, open-label, multicentre, randomized, superiority treatment strategy trial (GO TEST Finale). At least 278 gout patients using ULT who are in remission (>12 months, preliminary gout remission criteria) will be randomized 1:1 to a continued T2T strategy (treatment target serum urate < 0.36 mmol/l) or switched to a T2S discontinuation strategy in which ULT is tapered to stop and restarted in case of (persistent or recurrent) flaring. The primary outcome is the between-group difference in the proportion of patients not in remission during the last 6 months of 24 months follow-up and will be analyzed using a two proportion z test. Secondary outcomes are group differences in gout flare incidence, reintroduction or adaptation of ULT, use of anti-inflammatory drugs, serum urate changes, occurrence of adverse events (with a special interest in cardiovascular and renal events), and cost-effectiveness.

Discussion

This study will be the first clinical trial comparing two ULT treatment strategies in patients with gout in remission. It will contribute to more specific and unambiguous guideline recommendations and improved cost-effectiveness of long-term gout treatment. It also paves the way (exploratory) to individualized long-term ULT treatment. In this article, we elaborate on some of our trial design choices and their clinical and methodological consequences.

Trial registration

International Clinical Trial Registry Platform (ICTRP) NL9245. Registered on 2 February 2021 (METC Oost-Nederland NL74350.091.20); EudraCT EUCTR2020-005730-15-NL. Registered on 11 January 2021.
Safety and effectiveness of standardized exercise training in patients with pulmonary hypertension associated with heart failure with preserved ejection fraction (TRAIN-HFpEF-PH): study protocol for a randomized controlled multicenter trial
Authors: Palevičiūtė Eglė , Čelutkienė Jelena , Šimbelytė Toma , Gumbienė Lina , Jurevičienė Elena , Zakarkaitė Diana , Čėsna Sigitas , Eichstaedt Christina A. , Benjamin Nicola , Grünig Ekkehard
Published: April 2023

Background

Left heart failure (HF) is characterized by an elevation in left-sided filling pressures, causing symptoms of dyspnea, impairing exercise capacity, and leading to pulmonary venous congestion and secondary pulmonary hypertension (PH). There is an increased incidence of PH associated with left heart disease, particularly with heart failure with preserved ejection fraction (HFpEF-PH). Treatment possibilities in HFpEF-PH are non-specific and very limited, thus additional pharmacological and non-pharmacological therapeutic strategies are needed. Various types of exercise-based rehabilitation programs have been shown to improve exercise capacity and quality of life (QoL) of HF and PH patients. However, no study focused on exercise training in the population of HFpEF-PH. This study is designed to investigate whether a standardized low-intensity exercise and respiratory training program is safe and may improve exercise capacity, QoL, hemodynamics, diastolic function, and biomarkers in patients with HFpEF-PH.

Methods

A total of 90 stable patients with HFpEF-PH (World Health Organization functional class II–IV) will be randomized (1:1) to receive a 15-week specialized low-intensity rehabilitation program, including exercise and respiratory therapy and mental gait training, with an in-hospital start, or standard care alone. The primary endpoint of the study is a change in 6-min walk test distance; secondary endpoints are changes in peak exercise oxygen uptake, QoL, echocardiographic parameters, prognostic biomarkers, and safety parameters.

Discussion

To date, no study has investigated the safety and efficacy of exercising specifically in the HFpEF-PH population. We believe that a randomized controlled multicenter trial, which protocol we are sharing in this article, will add important knowledge about the potential utility of a specialized low-intensity exercise and respiratory training program for HFpEF-PH and will be valuable in finding optimal treatment strategies for these patients.

Trial registration

ClinicalTrials.gov NCT05464238. July 19, 2022.
Assessment of binding interaction to salmon sperm DNA of two antiviral agents and ecofriendly nanoparticles: comprehensive spectroscopic study
Authors: Abdel Hakiem Ahmed Faried , El-Sagheir Ahmed Mohsen Kamal , Draz Mohammed E. , Mohamed Niveen A. , Aboraia Ahmed Safwat
Published: April 2023

The direct binding of antiviral agents; Daclatasvir and valacyclovir and green synthesized nanoparticles to salmon sperm DNA have been assessed in a comparative study. The nanoparticles were synthesized by the hydrothermal autoclave method and have been fully characterized. The interactive behavior and competitive binding of the analytes to DNA in addition to the thermodynamic properties were deeply investigated by the UV–visible spectroscopy. The binding constants were monitored in the physiological pH conditions to be 1.65 × 106, 4.92 × 105 and 3.12 × 105 for daclatasvir,valacyclovir and quantum dots, respectively. The significant changes in the spectral features of all analytes have proven intercalative binding. The competitive study has confirmed that, daclatasvir, valacyclovir, and the quantum dots have exhibited groove binding. All analytes have shown good entropy and enthalpy values indicating stable interactions. The electrostatic and non-electrostatic kinetic parameters have been determined through studying the binding interactions at different concentrations of KCl solutions. A molecular modelling study has been applied to demonstrate the binding interactions and their mechanisms. The obtained results were complementary and afforded new eras for the therapeutic applications.
Ovulatory signal-triggered chromatin remodeling in ovarian granulosa cells by HDAC2 phosphorylation activation-mediated histone deacetylation
Authors: Jin Jiamin , Ren Peipei , Li Xiang , Zhang Yinyi , Yang Weijie , Ma Yerong , Lai Mengru , Yu Chao , Zhang Songying , Zhang Yin-Li
Published: April 2023

Background

Epigenetic reprogramming is involved in luteinizing hormone (LH)-induced ovulation; however, the underlying mechanisms are largely unknown.

Results

We here observed a rapid histone deacetylation process between two waves of active transcription mediated by the follicle-stimulating hormone (FSH) and the LH congener human chorionic gonadotropin (hCG), respectively. Analysis of the genome-wide H3K27Ac distribution in hCG-treated granulosa cells revealed that a rapid wave of genome-wide histone deacetylation remodels the chromatin, followed by the establishment of specific histone acetylation for ovulation. HDAC2 phosphorylation activation coincides with histone deacetylation in mouse preovulatory follicles. When HDAC2 was silenced or inhibited, histone acetylation was retained, leading to reduced gene transcription, retarded cumulus expansion, and ovulation defect. HDAC2 phosphorylation was associated with CK2α nuclear translocation, and inhibition of CK2α attenuated HDAC2 phosphorylation, retarded H3K27 deacetylation, and inactivated the ERK1/2 signaling cascade.

Conclusions

This study demonstrates that the ovulatory signal erases histone acetylation through activation of CK2α-mediated HDAC2 phosphorylation in granulosa cells, which is an essential prerequisite for subsequent successful ovulation.