bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Literature Review of Rural Homestays and Sustainability in Tourism
Authors: Janjua Zain ul Abedin , Krishnapillai Gengeswari , Rahman Mobashar
Published: April 2021

This systematic literature review is designed to evaluate the current state of knowledge in rural homestays and tourism academic literature. With reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart, we reviewed 94 studies published in the selected journals from January 1, 2010, to December 31, 2020. Our review explores how sustainable rural homestays have been previously researched in terms of the context, topic, sample, method, geographical location, and theoretical framework. The review provides insights on sustainability and rural homestay tourism from the perspective of co-occurrence beside highlighting the valuable content addressed by authors and suggesting future research directions. In a sustainable rural tourism context, only 51% of the reviewed studies had considered homestay as the core and independent area of inquiry. This review notes an increasing number of researchers from developing countries are working on community-based rural homestays, especially in the Asia-Pacific region. Unfortunately, important topics—like homestay branding, homestay and entrepreneurship, homestays and information and communication technology (ICT) competency, homestay operator’s training and development about sustainability—are rarely addressed in the existing literature.
Do Interlocks Lead to the Convergence of Interfirm Innovation Performance? Evidence From China
Authors: Teng Ying , Gimmon Eli , Lu Wentong
Published: April 2021

We examine how interlocking directorates influence innovation performance differentials between firms. Our study offers a new perspective of the effect of interlocking directorate ties upon innovation performance, focusing on network effects on interfirm performance. Using a sample of China’s listed companies for the period 2012–2016, we empirically examined the relationship between board interlocks and interfirm innovation performance differentials. The results demonstrate that the presence of board interlocks reduces interfirm innovation performance differentials and leads to a convergence of innovation performance between the connected companies. Furthermore, cross-level analysis found that the relationship between board interlocks and interfirm innovation performance differentials is moderated by the interfirm industry attributes and demographic characteristics of the board. This study expands the existing research in explaining the driving mechanism of enterprise innovation performance as affected by interlocking directorate ties.
Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences From the New Impact Program
Authors: Sease Kerry K , Rolke Laura J , Forrester Jacqueline E , Griffin Sarah F
Published: April 2021

Weight management interventions have the potential to reduce body mass index and help families adopt healthier behaviors. This study examined feedback from families to identify central aspects of various intervention strategies based on self-determination theory constructs that have the strongest influence on patient success, with the aim of understanding how best to approach weight management in a clinical pediatric setting. Telephone interviews were conducted with 22 individuals (20 parents/guardians and 2 teenagers) who participated in a multidisciplinary weight management program and data was analyzed using inductive and deductive thematic analysis processes. Participants identified motivational interviewing strategies that were most influential to their success. Parents and patient’s identified barriers and facilitators to success included patient readiness to change, personal logistics, family engagement, and establishing long- and short-term goals. Successful pediatric obesity management requires consideration to both the patient and family’s readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and strategies to ensure families develop self-efficacy toward achievable healthy behaviors.
National Internet-Based Survey of the Use, Barriers, Reasons and Beliefs of Mind-Body Practices During the Early Months of the COVID-19 Pandemic
Authors: Hellem Tracy , Benavides-Vaello Sandra , Taylor-Piliae Ruth
Published: April 2021

The purpose of this study was to learn about the use, barriers, reasons and beliefs regarding mind-body practices among adults living in the United States during the beginning months of the 2019 novel coronavirus disease (COVID-19) pandemic. An on-line survey was developed following the Checklist for Reporting Results of Internet e-Surveys (CHERRIES) guidelines and using the online survey software program, Qualtrics® XM, platform. Pilot testing of the survey was conducted for usability and functionality. The final 24-item survey was distributed via email and social media. A total of 338 adults responded to the survey, with 68.8% indicating that they participated in mind-body activities since the start of the pandemic. Physical activity was the most frequently (61.5%, n = 227) used mind-body practice. Further, 2 of the common barriers to engaging in mind-body practices were lack of motivation and wandering mind. Frequently listed reasons for using mind-body practices were to promote health, reduce stress and relaxation. Respondents believed that mind-body practices resulted in less stress. These findings may be applicable for reducing psychological stress related to the pandemic, as the pandemic continues to impact many areas of the United States.
A Promised Land: Lessons for Community Organising at Multiple Levels
Authors: Pawar Manohar
Published: April 2021

The main purpose of this article is to review Barack Obama’s memoir, A Promised Land, from the perspective of community organising, racism and social change, and draw implications for social work education and practice. By using the theme and content analysis method, it selects relevant chunks from the memoir and reflects on it. The analysis and reflection bring out Barack Obama’s knowledge, skills and approaches of community organising and social change. It argues that in addition to his own virtues and character, the basic premises and approaches of Obama’s community organising are similar to the values, knowledge and agenda of professional social work. Further, it suggests drawing lessons from Obama’s community organising experiences and exploring the potential for social work to expand at multiple levels of macro practice.
Monitoring of a rehabilitated building in soft soil in Mexico and structural response to the September 2017 earthquakes: Part 1: structural health monitoring system
Authors: Murià-Vila David , Aldama-Sánchez Baruo Daniel , García-Illescas Miguel Ángel , Rodríguez Gutiérrez Gerardo
Published: April 2021

The seismic response of an instrumented 22-story rehabilitated building is presented. The building analyzed is as part of a complex (called CCUT) with three low-rise structures and a common basement founded on soft soil that was built in 1964. Since it was under construction until date, the building tower has experienced differential settlements and tilting. To mitigate such problems, the building has been subjected to several rehabilitations over the years. During the 1985 and 2017 high-intensity earthquakes in Mexico City, the tower suffered some damage. The aim of this article is to discuss the structural health monitoring system implemented for the tower and to describe the structure’s performance since the last rehabilitation in 2009. A monitoring methodology designed and implemented as a structural warning system based on five structural health indicators, two on seismic severity and three on structural performance, to automatically process seismic records, is presented. The results of the seismic response of the CCUT tower between 2011 and 2018 indicate that the structure had suffered moderate damage. Analysis of data, corroborated by building inspection, confirmed that the structure exhibited good performance during the 19 September 2017 Puebla-Morelos earthquake. The importance of the information obtained from the structural warning system is highlighted as a promissory tool for establishing a robust decision framework for occupants’ safety.
KTE-X19 anti-CD19 CAR T-cell therapy in adult relapsed/refractory acute lymphoblastic leukemia: ZUMA-3 phase 1 results
Authors: Shah Bijal D. , Bishop Michael R. , Oluwole Olalekan O. , Logan Aaron C. , Baer Maria R. , Donnellan William B. , O’Dwyer Kristen M. , Holmes Houston , Arellano Martha L. , Ghobadi Armin , Pagel John M. , Lin Yi , Cassaday Ryan D. , Park Jae H. , Abedi Mehrdad , Castro Januario E. , DeAngelo Daniel J. , Malone Adriana K. , Mawad Raya , Schiller Gary J. , Rossi John M. , Bot Adrian , Shen Tong , Goyal Lovely , Jain Rajul K. , Vezan Remus , Wierda William G.
Published: April 2021

ZUMA-3 is a phase 1/2 study evaluating KTE-X19, an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, in adult relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). We report the phase 1 results. After fludarabine-cyclophosphamide lymphodepletion, patients received a single infusion of KTE-X19 at 2 × 106, 1 × 106, or 0.5 × 106 cells per kg. The rate of dose-limiting toxicities (DLTs) within 28 days after KTE-X19 infusion was the primary end point. KTE-X19 was manufactured for 54 enrolled patients and administered to 45 (median age, 46 years; range, 18-77 years). No DLTs occurred in the DLT-evaluable cohort. Grade ≥3 cytokine release syndrome (CRS) and neurologic events (NEs) occurred in 31% and 38% of patients, respectively. To optimize the risk-benefit ratio, revised adverse event (AE) management for CRS and NEs (earlier steroid use for NEs and tocilizumab only for CRS) was evaluated at 1 × 106 cells per kg KTE-X19. In the 9 patients treated under revised AE management, 33% had grade 3 CRS and 11% had grade 3 NEs, with no grade 4 or 5 NEs. The overall complete remission rate correlated with CAR T-cell expansion and was 83% in patients treated with 1 × 106 cells per kg and 69% in all patients. Minimal residual disease was undetectable in all responding patients. At a median follow-up of 22.1 months (range, 7.1-36.1 months), the median duration of remission was 17.6 months (95% confidence interval [CI], 5.8-17.6 months) in patients treated with 1 × 106 cells per kg and 14.5 months (95% CI, 5.8-18.1 months) in all patients. KTE-X19 treatment provided a high response rate and tolerable safety in adults with R/R B-ALL. Phase 2 is ongoing at 1 × 106 cells per kg with revised AE management. This trial is registered at www.clinicaltrials.gov as #NCT02614066.
CD27 is required for protective lytic EBV antigen–specific CD8+ T-cell expansion
Authors: Deng Yun , Chatterjee Bithi , Zens Kyra , Zdimerova Hana , Müller Anne , Schuhmachers Patrick , Ligeon Laure-Anne , Bongiovanni Antonino , Capaul Riccarda , Zbinden Andrea , Holler Angelika , Stauss Hans , Hammerschmidt Wolfgang , Münz Christian
Published: April 2021

Primary immunodeficiencies in the costimulatory molecule CD27 and its ligand, CD70, predispose for pathologies of uncontrolled Epstein-Barr virus (EBV) infection in nearly all affected patients. We demonstrate that both depletion of CD27+ cells and antibody blocking of CD27 interaction with CD70 cause uncontrolled EBV infection in mice with reconstituted human immune system components. While overall CD8+ T-cell expansion and composition are unaltered after antibody blocking of CD27, only some EBV-specific CD8+ T-cell responses, exemplified by early lytic EBV antigen BMLF1-specific CD8+ T cells, are inhibited in their proliferation and killing of EBV-transformed B cells. This suggests that CD27 is not required for all CD8+ T-cell expansions and cytotoxicity but is required for a subset of CD8+ T-cell responses that protect us from EBV pathology.
Increased complement activation 3 to 6 h after trauma is a predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome: a prospective observational study
Authors: Rognes Ingrid Nygren , Pischke Søren Erik , Ottestad William , Røislien Jo , Berg Jens Petter , Johnson Christina , Eken Torsten , Mollnes Tom Eirik
Published: April 2021

Background

Complement activation is a central mechanism in systemic inflammation and remote organ dysfunction following major trauma. Data on temporal changes of complement activation early after injury is largely missing. We aimed to describe in detail the kinetics of complement activation in individual trauma patients from admission to 10 days after injury, and the association with trauma characteristics and outcome.

Methods

In a prospective cohort of 136 trauma patients, plasma samples obtained with high time resolution (admission, 2, 4, 6, 8 h, and thereafter daily) were assessed for terminal complement complex (TCC). We studied individual TCC concentration curves and calculated a summary measure to obtain the accumulated TCC response 3 to 6 h after injury (TCC-AUC3–6). Correlation analyses and multivariable linear regression analyses were used to explore associations between individual patients’ admission TCC, TCC-AUC3–6, daily TCC during the intensive care unit stay, trauma characteristics, and predefined outcome measures.

Results

TCC concentration curves showed great variability in temporal shapes between individuals. However, the highest values were generally seen within the first 6 h after injury, before they subsided and remained elevated throughout the intensive care unit stay. Both admission TCC and TCC-AUC3–6correlated positively with New Injury Severity Score (Spearman’s rho,p-value 0.31, 0.0003 and 0.21, 0.02) and negatively with admission Base Excess (− 0.21, 0.02 and − 0.30, 0.001). Multivariable analyses confirmed that deranged physiology was an important predictor of complement activation. For patients without major head injury, admission TCC and TCC-AUC3–6were negatively associated with ventilator-free days. TCC-AUC3–6outperformed admission TCC as a predictor of Sequential Organ Failure Assessment score at day 0 and 4.

Conclusions

Complement activation 3 to 6 h after injury was a better predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome than admission TCC. Our data suggest that the greatest surge of complement activation is found within the first 6 h after injury, and we argue that this time period should be in focus in the design of future experimental studies and clinical trials using complement inhibitors.
Identification of prognostic alternative splicing events related to the immune microenvironment of hepatocellular carcinoma
Authors: Yu Shanshan , Cai Luya , Liu Chuan , Gu Ruihong , Cai Lingyi , Zhuo Leying
Published: April 2021

Background

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, and its 5-year survival rate is less than 20%, despite various treatments being available. Increasing evidence indicates that alternative splicing (AS) plays a nonnegligible role in the formation and development of the tumor microenvironment (TME). However, the comprehensive analysis of the impact on prognostic AS events on immune-related perspectives in HCC is lacking but urgently needed.

Methods

The transcriptional data and clinical information of HCC patients were downloaded from TCGA (The Cancer Genome Atlas) database for calculating immune and stromal scores by ESTIMATE algorithm. We then divided patients into high/low score groups and explored their prognostic significance using Kaplan–Meier curves. Based on stromal and immune scores, differentially expressed AS events (DEASs) were screened and evaluated with functional enrichment analysis. Additionally, a risk score model was established by applying univariate and multivariate Cox regression analyses. Finally, gene set variation analysis (GSVA) was adopted to explore differences in biological behaviors between the high- and low-risk subgroups.

Results

A total of 370 HCC patients with complete and qualified corresponding data were included in the subsequent analysis. According to the results of ESTIMATE analysis, we observed that the high immune/stromal score group had a longer survival probability, which was significantly correlated with prognosis in HCC patients. In addition, 467 stromal/immune score-related DEASs were identified, and enrichment analysis revealed that DEASs were significantly enriched in pathways related to HCC tumorigenesis and the immune microenvironment. More importantly, the final prognostic signature containing 16 DEASs showed powerful predictive ability. Finally, GSVA demonstrated that activation of carcinogenic pathways and immune-related pathways in the high-risk group may lead to poor prognosis.

Conclusions

Collectively, these outcomes revealed prognostic AS events related to carcinogenesis and the immune microenvironment, which may yield new directions for HCC immunotherapy.
Common low complexity regions for SARS-CoV-2 and human proteomes as potential multidirectional risk factor in vaccine development
Authors: Gruca Aleksandra , Ziemska-Legiecka Joanna , Jarnot Patryk , Sarnowska Elzbieta , Sarnowski Tomasz J. , Grynberg Marcin
Published: April 2021

Background

The rapid spread of the COVID-19 demands immediate response from the scientific communities. Appropriate countermeasures mean thoughtful and educated choice of viral targets (epitopes). There are several articles that discuss such choices in the SARS-CoV-2 proteome, other focus on phylogenetic traits and history of the Coronaviridae genome/proteome. However none consider viral protein low complexity regions (LCRs). Recently we created the first methods that are able to compare such fragments.

Results

We show that five low complexity regions (LCRs) in three proteins (nsp3, S and N) encoded by the SARS-CoV-2 genome are highly similar to regions from human proteome. As many as 21 predicted T-cell epitopes and 27 predicted B-cell epitopes overlap with the five SARS-CoV-2 LCRs similar to human proteins. Interestingly, replication proteins encoded in the central part of viral RNA are devoid of LCRs.

Conclusions

Similarity of SARS-CoV-2 LCRs to human proteins may have implications on the ability of the virus to counteract immune defenses. The vaccine targeted LCRs may potentially be ineffective or alternatively lead to autoimmune diseases development. These findings are crucial to the process of selection of new epitopes for drugs or vaccines which should omit such regions.
Low-level variant calling for non-matched samples using a position-based and nucleotide-specific approach
Authors:   NISC Comparative Sequencing Program, Dudley Jeffrey N. , Hong Celine S. , Hawari Marwan A. , Shwetar Jasmine , Sapp Julie C. , Lack Justin , Shiferaw Henoke , Johnston Jennifer J. , Biesecker Leslie G.
Published: April 2021

Background

The widespread use of next-generation sequencing has identified an important role for somatic mosaicism in many diseases. However, detecting low-level mosaic variants from next-generation sequencing data remains challenging.

Results

Here, we present a method for Position-Based Variant Identification (PBVI) that uses empirically-derived distributions of alternate nucleotides from a control dataset. We modeled this approach on 11 segmental overgrowth genes. We show that this method improves detection of single nucleotide mosaic variants of 0.01–0.05 variant allele fraction compared to other low-level variant callers. At depths of 600 × and 1200 ×, we observed > 85% and > 95% sensitivity, respectively. In a cohort of 26 individuals with somatic overgrowth disorders PBVI showed improved signal to noise, identifying pathogenic variants in 17 individuals.

Conclusion

PBVI can facilitate identification of low-level mosaic variants thus increasing the utility of next-generation sequencing data for research and diagnostic purposes.
Correction to: Biochemical metabolism of young plants of Ucuúba (Virola surinamensis) in the presence of cadmium
Authors: Júnior W. V. Andrade , Neto C. F. Oliveira , Filho B. G. Santos , Cruz E. D. , Amarante C. B. , Barbosa A. V. C. , Nogueira G. A. S. , Nascimento V. R. , Sousa D. J. P. , Teixeira J. S. S.
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
The experience of Australian general practice patients at high risk of poor health outcomes with telehealth during the COVID-19 pandemic: a qualitative study
Authors: Javanparast Sara , Roeger Leigh , Kwok Yuen , Reed Richard L
Published: April 2021

Background

The emergence of the COVID-19 pandemic has raised concerns about the potential decrease in access and utilisation of general practice services and its impact on patient care. In March 2020, the Australian Government introduced telehealth services to ensure that people more vulnerable to COVID-19 do not delay routine care from their general practitioners. Evidence about patients’ experience of telehealth and its impact on patient care is scarce. This study aimed to investigate the experience with telehealth by Australian general practice patients at high risk of poor health outcomes during the COVID-19 pandemic.

Methods

Semi-structured telephone interviews were conducted with 30 patients from nine general practices in metropolitan Adelaide (May–June 2020). Participants were identified by their regular doctor as being at high risk of poor health outcomes. Interviews sought participants’ perspectives and experiences about telehealth services in the general practice setting during COVID-19, and the value of offering continued telehealth services post pandemic. Interviews were recorded and transcribed verbatim. Data were analysed using a coding structure developed based on deductive codes derived from the research questions and any additional concepts that emerged inductively from interviews.

Results

Participants expressed satisfaction with telehealth including convenient and timely access to general practice services. Yet, participants identified challenges including difficulties in expressing themselves and accessing physical exams. Prescription renewal, discussing test results and simple follow-ups were the most common reasons that telehealth was used. Telehealth was mainly via phone that better suited those with low digital literacy. Participants indicated that an existing doctor-patient relationship was important for telehealth services to be effective. Subjects believed that telehealth services should be continued but needed to be combined with opportunities for face-to-face consultations after the COVID-19 pandemic was over.

Conclusions

The expansion of telehealth supported access to general practice including chronic disease management during the COVID-19 pandemic. In the future, telehealth in Australia is likely to have a stronger place in primary healthcare policy and practice and an increased acceptance amongst patients.
Gastrointestinal symptoms as first remarkable signs of ANCA-associated granulomatosis with polyangiitis: a case report and reviews
Authors: Ledó Nóra , Pethő Ákos Géza
Published: April 2021

Background

Systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA) have an extremely wide variety of symptoms, therefore the fast and proper diagnosis is difficult to establish even for experienced physicians. Gastrointestinal manifestations in ANCA-associated granulomatosis with polyangiitis (GPA) may be present, however, severe, life-threatening complications (such as perforations) are rare.

Case presentation

A case of an 18-year-old male patient is presented, where gastrointestinal symptoms (abdominal pain, vomiting, diarrhoea) were the first remarkable signs of GPA. The initial diagnosis of inflammatory bowel disease delayed the administration of proper immunosuppressive therapy, which might have contributed to the rare and life-threatening complication of arterial duodenal bleeding with perforation. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often.

Conclusions

Gastrointestinal bleeding is a rare but potential lethal complication of vasculitis. Consequently, we recommend investigating the patients diagnosed with GPA for gastrointestinal bleeding during the treatment.
Effect of hookworm infection and anthelmintic treatment on naturally acquired antibody responses against the GMZ2 malaria vaccine candidate and constituent antigens
Authors: Amoani Benjamin , Gyan Ben , Sakyi Samuel Asamoah , Abu Emmanuel Kwasi , Nuvor Samuel Victor , Barnes Precious , Sarkodie-Addo Tracy , Ahenkorah Benjamin , Sewor Christian , Dwomoh Duah , Theisen Michael , Cappello Michael , Wilson Michael D. , Adu Bright
Published: April 2021

Background

Malaria and helminths diseases are co-endemic in most parts of sub-Saharan Africa. Immune responses from each of these pathogens interact, and these interactions may have implications on vaccines. The GMZ2 malaria vaccine candidate is a fusion protein of Plasmodium falciparum merozoite surface protein 3 (MSP3) and glutamate rich protein (GLURP R0). GMZ2 has recently showed modest efficacy in a phase IIb multicenter trial. Here, we assessed the effect of hookworm (Necator americanus) infection and anthelmintic treatment on naturally acquired antibody responses against GMZ2 and constituent antigens.

Methods

This longitudinal cross-sectional study was conducted in the Kintampo North Municipality of Ghana. Blood and stool samples were taken from 158 individuals (4–88 years old) infected with either P. falciparum alone (n = 59) or both hookworm and P. falciparum (n = 63) and uninfected endemic controls (n = 36). Stool hookworm infection was detected by the Kato-Katz method and PCR. Malaria parasitaemia was detected by RDT, light microscopy and P. falciparum-specific 18S rRNA gene PCR. Serum samples were obtained prior to hookworm treatment with a single dose of albendazole (400 mg) and 3 weeks (21 days) after treatment. Levels of IgG1, IgG3 and IgM against GMZ2, MSP3 and GLURP R0 were measured by ELISA and compared among the groups, before and after treatment.

Results

Participants with P. falciparum and hookworm co-infection had significantly higher IgG3 levels to GMZ2 than those with only P. falciparum infection and negative control (p < 0.05) at baseline. Treatment with albendazole led to a significant reduction in IgG3 levels against both GMZ2 and GLURP R0. Similarly, IgM and IgG1 levels against MSP3 also decreased following deworming treatment.

Conclusion

Individuals with co-infection had higher antibody responses to GMZ2 antigen. Treatment of hookworm/malaria co-infection resulted in a reduction in antibody responses against GMZ2 and constituent antigens after albendazole treatment. Thus, hookworm infection and treatment could have a potential implication on malaria vaccine efficacy.
Factors determining ultra-short-term survival and the commencement of active treatment in high-grade serous ovarian cancer: a case comparison study
Authors: Hawarden Amy , Russell Bryn , Gee Mary Ellen , Kayali Fatima , Clamp Andrew , Crosbie Emma Jayne , Edmondson Richard John
Published: April 2021

Background

Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood.

Here we investigate if ultra short-term survival can be explained by patient characteristics or treatment pathways.

Methods

A nested case comparison study was used to examine differences between patients with high grade serous ovarian/fallopian tube cancer who died within 100 days (n = 28) compared to a comparison group of patients matched for histology and including any survival greater than 100 days (n = 134).

Results

Cases and comparison patients had similar ages, BMI, ACE-27, deprivation indices, and distribution of disease on CT. There were no significant delays in time to diagnosis or treatment (p = 0.68) between the groups.

However, cases had lower serum albumin, haemoglobin and higher platelet counts than matched comparison patients (p < 0.0001) and a worse performance score (P = 0.006).

Conclusion

Patients who die rapidly after a diagnosis of ovarian cancer are only slightly older and have similar pre treatment frailty compared to patients whose survival approaches the median. However they do appear to undergo greater physiological compromise as a result of their disease.
Combining tissue and circulating tumor DNA increases the detection rate of a CTNNB1 mutation in hepatocellular carcinoma
Authors: Oversoe Stine Karlsen , Clement Michelle Simone , Weber Britta , Grønbæk Henning , Hamilton-Dutoit Stephen Jacques , Sorensen Boe Sandahl , Kelsen Jens
Published: April 2021

Background and aims

Studies suggest that mutations in the CTNNB1 gene are predictive of response to immunotherapy, an emerging therapy for advanced hepatocellular carcinoma (HCC). Analysis of circulating tumor DNA (ctDNA) offers the possibility of serial non-invasive mutational profiling of tumors. Combining tumor tissue and ctDNA analysis may increase the detection rate of mutations.

This study aimed to evaluate the frequency of the CTNNB1 p.T41A mutation in ctDNA and tumor samples from HCC patients and to evaluate the concordance rates between plasma and tissue. We further evaluated changes in ctDNA after various HCC treatment modalities and the impact of the CTNNB1 p.T41A mutation on the clinical course of HCC.

Methods

We used droplet digital PCR to analyze plasma from 95 patients and the corresponding tumor samples from 37 patients during 3 years follow up.

Results

In tumor tissue samples, the mutation rate was 8.1% (3/37). In ctDNA from HCC patients, the CTNNB1 mutation rate was 9.5% (9/95) in the pre-treatment samples. Adding results from plasma analysis to the subgroup of patients with available tissue samples, the mutation detection rate increased to 13.5% (5/37). There was no difference in overall survival according to CTNNB1 mutational status. Serial testing of ctDNA suggested a possible clonal evolution of HCC or arising multicentric tumors with separate genetic profiles in individual patients.

Conclusion

Combining analysis of ctDNA and tumor tissue increased the detection rate of CTNNB1 mutation in HCC patients. A liquid biopsy approach may be useful in a tailored therapy of HCC.
Treatment administered to newborns with congenital syphilis during a penicillin shortage in 2015, Fortaleza, Brazil
Authors: Rocha Ana Fátima Braga , Araújo Maria Alix Leite , Taylor Melanie M. , Kara Edna O. , Broutet Nathalie Jeanne Nicole
Published: April 2021

Background

Between 2014 and 2016, Brazil experienced a severe shortage in penicillin supply, resulting in a lack of treatment among some pregnant women and newborns with syphilis and the use of non-evidence-based regimens. This study evaluated all live births in Fortaleza reported with CS in 2015 in order to identify the different therapeutic regimens used in newborns during this period of penicillin shortage.

Methods

A retrospective cross-sectional study design was conducted using manually extracted data from medical chart review of maternal and infant cases delivered in 2015 from all public maternity hospitals in the city of Fortaleza. Data collection occurred from June 2017 to July 2018.

Results

A total of 575 congenital syphilis cases were reported to the municipality of Fortaleza during 2015 and 469 (81.5%) were analyzed. Of these, only 210 (44.8%) were treated with a nationally-recommended treatment. As alternative therapeutic options, ceftriaxone was used in 65 (13.8%), Cefazolin in 15 (3.2%) and the combination of more than one drug in 179 (38.2%). Newborns with serum VDRL titers ≥1:16 (p = 0.021), who had some clinical manifestation at birth (p = 0.003), who were born premature (p <  0.001), with low birth weight (p = 0.010), with jaundice indicative of the need for phototherapy (p = 0.019) and with hepatomegaly (p = 0.045) were more likely to be treated with penicillin according to national treatment guidelines compared to newborns treated with other regimens.

Conclusion

During the period of shortage of penicillin in Fortaleza, less than half of the infants reported with CS were treated with a nationally-recommended regimen, the remaining received treatment with medications available in the hospital of birth including drugs that are not part of nationally or internationally-recommended treatment recommendations.
Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria
Authors: Duke Roseline E. , Torty Chimaeze , Okorie Uche , Kim Min J. , Eneli Nnena , Edadi Ukam , Burton Kathryn , Tann Cally , Bowman Richard
Published: April 2021

Background

To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance.

A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included.

Results

Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6–28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5–5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2–4.3) manual ability classification scale 4–5 (OR 4.7,p = 0.049; CI:1.0–22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0–24.0.) were seen as increasing the likelihood of poor school attendance.

Conclusion

Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.
From income inequality to social inequity: impact on health levels in an international efficiency comparison panel
Authors: Schenkman Simone , Bousquat Aylene
Published: April 2021

Background

Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems.

Method

Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks.

Results

Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV.

Conclusion

The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.
Correction to: Questionnaire choice affects the prevalence of recommended physical activity: an online survey comparing four measuring instruments within the same sample
Authors: Stassen Gerrit , Rudolf Kevin , Gernert Madeleine , Thiel Ansgar , Schaller Andrea
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Reduction of chronic malnutrition for infants in Bogotá, Colombia
Authors: Castro Prieto Paula Andrea , Trujillo Ramírez Kenny Margarita , Moreno Sergio , Holguín Juan Sebastián , Pineda Diana María , Tomasi Simón , Ramirez Varela Andrea
Published: April 2021

Background

According to the 2015 National Survey of the Nutritional Situation in Colombia the prevalence of stunting in children under 5 years of age was 10.8%. In terms of region, Bogotá, presented the highest prevalence rate (13%), a figure that exceeded national records. With the collaboration of local and national government, and nongovernmental it was decided to develop a pilot study involving a public health intervention with residents of Bogotá under 1 year of age with nutritional classification by anthropometry compatible with stunting risk or stunting.

Methods

Pre-experimental, before and after study that sought to determine the magnitude of the change in nutritional status through a 10 months public health nutrition intervention in children under one-year-old residing in 3 prioritized territories of Bogotá.

Results

The intervention comprised 1126 children living in the following territories in Bogotá: Kennedy, San Cristóbal, and Engativá. A total of 43.3% children presented delay in height for age, and 56.7% presented risk of short stature. In the final measurement, data were obtained from 686 children, identifying that 17% of the children progressed from stunting to a stunting risk and that 4.5% recovered their growth trajectory, achieving an adequate length for their age.

Conclusion

That children classified as at risk or stunting at the beginning of the intervention showed an increased probability of approaching or being in the appropriate growth trajectory according to the length-for-age indicator after the intervention.
Unwillingness to engage in behaviors that protect against COVID-19: the role of conspiracy beliefs, trust, and endorsement of complementary and alternative medicine
Authors: Soveri Anna , Karlsson Linda C. , Antfolk Jan , Lindfelt Mikael , Lewandowsky Stephan
Published: April 2021

Background

We investigated if people’s response to the official recommendations during the COVID-19 pandemic is associated with conspiracy beliefs related to COVID-19, a distrust in the sources providing information on COVID-19, and an endorsement of complementary and alternative medicine (CAM).

Methods

The sample consisted of 1325 Finnish adults who filled out an online survey marketed on Facebook. Structural regression analysis was used to investigate whether: 1) conspiracy beliefs, a distrust in information sources, and endorsement of CAM predict people’s response to the non-pharmaceutical interventions (NPIs) implemented by the government during the COVID-19 pandemic, and 2) conspiracy beliefs, a distrust in information sources, and endorsement of CAM are related to people’s willingness to take a COVID-19 vaccine.

Results

Individuals with more conspiracy beliefs and a lower trust in information sources were less likely to have a positive response to the NPIs. Individuals with less trust in information sources and more endorsement of CAM were more unwilling to take a COVID-19 vaccine. Distrust in information sources was the strongest and most consistent predictor in all models. Our analyses also revealed that some of the people who respond negatively to the NPIs also have a lower likelihood to take the vaccine. This association was partly related to a lower trust in information sources.

Conclusions

Distrusting the establishment to provide accurate information, believing in conspiracy theories, and endorsing treatments and substances that are not part of conventional medicine, are all associated with a more negative response to the official guidelines during COVID-19. How people respond to the guidelines, however, is more strongly and consistently related to the degree of trust they feel in the information sources, than to their tendency to hold conspiracy beliefs or endorse CAM. These findings highlight the need for governments and health authorities to create communication strategies that build public trust.
Health literacy and health outcomes in China’s floating population: mediating effects of health service
Authors: Hai-YanYu  , Wu Wei-Ling , Yu Lin-Wei , Wu Lei
Published: April 2021

Background

The floating population in China consists primarily of internal immigrants and represents a typical health vulnerable group. Poor health literacy has recently become an obstacle in the accessibility and utilization of health services for the vulnerable population, leading to adverse health outcomes. This study aimed to examine whether health literacy affected health outcomes in China’s floating population and whether health service utilization had a mediating effect between health literacy and health outcomes.

Method

The current study utilized a cross-sectional stratified, multistage, proportional to scale (PPS) study in Zhejiang Province, China, in November and December 2019. In total, 657 valid self-reported questionnaires were recovered and used for data collection. Questionnaires included questions regarding sociodemographic characteristics, health literacy, health outcomes, and health service utilization. Confirmatory factor analysis was used to test questionnaire validity; descriptive statistics were used to understand the demographic characteristics of the floating population; and structural equation modeling was used to determine whether health service utilization mediated health literacy and health outcomes.

Results

We report positive correlations between health literacy, health service utilization, and health outcomes. Mediation analysis demonstrated that health service utilization had partial mediating effects between health literacy and health outcomes. In the relationship between health literacy and health outcomes, the indirect effects of health service utilization accounted for 6.6–8.7% of the total effects.

Conclusion

Complete health literacy, through health care literacy and health promotion literacy, affects the mobile population’s initiative to use health services, which, in turn, affects health outcomes. Thus, improving the health literacy of the floating population will help to improve health outcomes. Furthermore, health service providers should enhance the diversity of health service supply to ensure that the floating population has the external resources to improve personal health literacy.
What do the general public believe about the causes, prognosis and best management strategies for low back pain? A cross-sectional study
Authors: Hall Amanda , Coombs Danielle , Richmond Helen , Bursey Krystal , Furlong Brad , Lawrence Rebecca , Kamper Steven J.
Published: April 2021

Background

Low back pain (LBP) is one of the most common reasons for seeking health care and is costly to the health care system. Recent evidence has shown that LBP care provided by many providers is divergent from guidelines and one reason may be patient’s beliefs and expectations about treatment. Thus, examining the nature of patient beliefs and expectations regarding low back pain treatment will help coordinate efforts to improve consistency and quality of care.

Methods

This study was a cross-sectional population-based survey of adults living in Newfoundland, Canada. The survey included demographic information (e.g. age, gender, back pain status and care seeking behaviors) and assessed outcomes related to beliefs about the inevitable consequences of back pain with the validated back beliefs questionnaire as well as six additional questions relating beliefs about imaging, physical activity and medication. Surveys were mailed to 3000 households in July–August 2018 and responses collected until September 30th, 2018.

Results

Fout hundred twenty-eight surveys were returned (mean age 55 years (SD 14.6), 66% female, 90% had experienced an episode of LBP). The mean Back Beliefs Questionnaire score was 27.3 (SD 7.2), suggesting that people perceive back pain to have inevitable negative consequences. Large proportions of respondents held the following beliefs that are contrary to best available evidence: (i) having back pain means you will always have weakness in your back (49.3%), (ii) it will get progressively worse (48.0%), (iii) resting is good (41.4%) and (iv) x-rays or scans are necessary to get the best medical care for LBP (54.2%).

Conclusions

A high proportion of the public believe LBP to have inevitable negative consequences and hold incorrect beliefs about diagnosis and management options, which is similar to findings from other countries. This presents challenges for clinicians and suggests that considering how to influence beliefs about LBP in the broader community could have value. Given the high prevalence of LBP and that many will consult a range of healthcare professionals, future efforts could consider using broad reaching public health campaigns that target patients, policy makers and all relevant health providers with specific content to change commonly held unhelpful beliefs.