bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of alternative consultation forms in Danish general practice in the initial phase of the COVID-19 pandemic – a qualitative study
Authors: Due Tina Drud , Thorsen Thorkil , Andersen Julie Høgsgaard
Published: June 2021

Background

Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs’ choices between telephone, video and face-to-face consultations.

Methods

This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed.

Results

The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue

Conclusion

This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.
Prevalence of stillbirth and its associated factors in East Africa: generalized linear mixed modeling
Authors: Tesema Getayeneh Antehunegn , Tessema Zemenu Tadesse , Tamirat Koku Sisay , Teshale Achamyeleh Birhanu
Published: June 2021

Background

Stillbirth is the most frequently reported adverse pregnancy outcome worldwide, which imposes significant psychological and economic consequences to mothers and affected families. East African countries account for one-third of the 2.6 million stillbirths globally. Though stillbirth is a common public health problem in East African countries, there is limited evidence on the pooled prevalence and associated factors of stillbirth in East Africa. Therefore, this study aimed to investigate the prevalence of stillbirth and its associated factors in East Africa.

Methods

This study was based on the most recent Demographic and Health Surveys (DHSs) of 12 East African countries. A total weighted sample of 138,800 reproductive-age women who gave birth during the study period were included in this study. The prevalence of stillbirth with the 95% Confidence Interval (CI) was reported using a forest plot. A mixed-effect binary logistic regression analysis was done to identify significantly associated factors of stillbirth. Since the DHS data has hierarchical nature, the presence of clustering effect was assessed using the Likelihood Ratio (LR) test, and Intra-cluster Correlation Coefficient (ICC), and deviance were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable mixed-effect binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% CI were reported to declare the strength and significance of the association.

Results

The prevalence of stillbirth in East Africa was 0.86% (95% CI: 0.82, 0.91) ranged from 0.39% in Kenya to 2.28% in Burundi. In the mixed-effect analysis; country, women aged 25–34 years (AOR = 1.27, 95% CI: 1.11, 1.45), women aged ≥ 35 years (AOR = 1.19, 95% CI: 1.01, 1.44), poor household wealth (AOR = 1.07, 95% CI: 1.02, 1.23), women who didn’t have media exposure (AOR = 1.11, 95% CI: 1.01, 1.25), divorced/widowed/separated marital status (AOR = 2.99, 95% CI: 2.04, 4.39), caesarean delivery (AOR = 1.81, 95% CI: 1.52, 2.15), preceding birth interval < 24 months (AOR = 1.15, 95% CI: 1.06, 1.24), women attained secondary education or above (AOR = 0.68, 95% CI: 0.56, 0.81) and preceding birth interval ≥ 49 months (AOR = 1.45, 95% CI: 1.28, 1.65) were significantly associated with stillbirth.

Conclusions

Stillbirth remains a major public health problem in East Africa, which varied significantly across countries. These findings highlight the weak health care system of East African countries. Preceding birth interval, county, maternal education media exposure, household wealth status, marital status, and mode of delivery were significantly associated with stillbirth. Therefore, public health programs enhancing maternal education, media access, and optimizing birth spacing should be designed to reduce the incidence of stillbirth.
Organisation and timeline of measures in French psychiatric establishments during the first wave of the COVID-19 epidemic: EvOlu’Psy study
Authors: Legrand Guillaume , Boisgard Catherine , Canac Bernard , Cardinaud Zuzana , Gorla Michela Giugiario , Gregoire Elisabeth , Jamon Caroline , Oussal Tarik , Vaury Pascal
Published: June 2021

Background

The onset of COVID-19 required rapid organisational changes in the mental health domain. Most mental health-care departments appear to have set up infection control measures and also organised planning, coordination and measures that enabled them to provide psychiatric care in a restrictive environment. Our objective was to assess the organisation by psychiatric facilities in France of their response to COVID-19, during the first wave.

Methods

In June 2020, a cross-sectional study was performed by an audit with 48 items which was proposed to 331 hospitals in metropolitan France with a capacity for full-time, that is, inpatient psychiatric hospitalisation of adults.

Results

Of the 331 establishments contacted, 94 (28.4%) agreed to respond to the survey questionnaire. Full-time inpatient hospitalisation was completely or partially maintained by 94.7% (n = 89) of facilities. Specific measures concerning respect for patients’ rights were reported by 58% (n = 55) of establishments. Overall, 74.5% (n = 70) had set up a dedicated channel of care for patients at risk of severe COVID-19, and 52.1% (n = 49) a system for routine screening at admission for these risk factors. Nearly half the establishments (48.9%, n = 46) reported they had set up specific training programmes for patients about barrier measures and social distancing.

Conclusions

French psychiatric establishments on the whole were able to provide a necessary reorganisation of their management of patients and their families, regardless of facility status. Patients’ rights nonetheless seem to have not received the attention they merited during the early pandemic period. Somatic management of patients with mental illness must absolutely be improved.
The effects on self-efficacy, motivation and perceived barriers of an intervention targeting physical activity and sedentary behaviours in office workers: a cluster randomized control trial
Authors: Blom Victoria , Drake Emma , Kallings Lena V. , Ekblom Maria M. , Nooijen Carla F. J.
Published: June 2021

Background

The importance of physical activity on health is clear, but changing behaviour is difficult. Successful interventions aiming to improve physical activity and reduce sedentary behaviour is therefore of importance. The aim of this study was to evaluate effects on motivation, self-efficacy and barriers to change behaviour from two different behavioural intervention focusing either on reducing sedentary behaviour or on increasing physical activity as compared to a waiting list control group.

Methods

The study was designed as a cluster randomized control trial (RCT) within two private companies. Self-efficacy, motivation and perceived barriers were together with demographic variables assessed before and after a 6-month intervention. Participant cluster teams were randomly allocated to either the physical activity intervention (iPA), the sedentary behaviour intervention (iSED), or control group. The intervention was multi componential and included motivational counselling based on Cognitive behaviour therapy and Motivational interviewing, group activities and management involvement. Group differences were determined using Bayesian multilevel modelling (parameter estimate; credible interval (CI)), analysing complete cases and those who adhered to the protocol by adhering to at least 3 out of 5 intervention sessions.

Results

After the intervention, the complete cases analysis showed that the iPA group had significantly higher autonomous motivation (0.33, CI: 0.05–0.61) and controlled motivation (0.27, CI: 0.04–0.51) for physical activity compared with the control group. The iSED group scored less autonomous and controlled motivation compared to the iPA group (0.38, CI: − 0.69- -0.087 respectively − 0.32, CI: − 0.57-0.07) but no significant differences compared with the control group. Among individuals that adhered to the protocol, the results showed higher scores on Exercise (3.03, CI: 0.28–6.02) and Sedentary self-efficacy (3.59, CI: 0.35–7.15) for individuals in the iPA group and on Sedentary self-efficacy (4.77, CI: 0.59–9.44) for the iSED group compared to the control group.

Conclusion

These findings indicate that the interventions were successful in increasing self-efficacy in each intervention group and autonomous motivation for exercise in the iPA group, in particular when actively participating in the motivational counselling sessions.
Comparison of colorectal cancer screening between people with and without disability: a nationwide matched cohort study
Authors: Liao Chun-Ming , Huang Wen-Hao , Kung Pei-Tseng , Chiu Li-Ting , Tsai Wen-Chen
Published: June 2021

Background

The World Health Organization has recognized that people with disability are among the most marginalized in the world. This study’s objective was to investigate the differences in the probability of colorectal cancer (CRC) screening with faecal immunochemical testing (FIT) between people with disability and without disability in Taiwan.

Methods

The study participants included people with and without disability from the Disability Registration Database (2012) and the National Health Insurance Research Database (2009–2012). The study included 50- to 69-year-olds with and without disability who were screened from 2011 to 2012 and were alive in 2012. There were 16 categories of disability. After propensity score matching (PSM) between the two groups, conditional logistic regression analysis with control variables was used to investigate the odds ratio (OR) that people with or without disability would undergo CRC screening.

Results

The percentage of people with disability receiving CRC screening was 21.84%, and the highest rate of those receiving CRC screening (38.72%) was found in people with intractable epilepsy, whose OR was 1.47 times that of people with moving functional limitation (95% confidence interval (CI) = 1.17–1.85). The results showed that the probability of CRC screening in people with disability was lower than that in people without disability (OR = 0.88, 95%CI = 0.87–0.89). The probability of receiving CRC screening differed between people with different categories of disability.

Conclusions

Although the probability of CRC screening in the four categories of disability was higher than that in the general population, overall, people with disability were less likely than people without disability to undergo CRC screening. Health inequalities still exist under National Health Insurance in Taiwan.
Causes of anxiety among teachers giving face-to-face lessons after the reopening of schools during the COVID-19 pandemic: a cross-sectional study
Authors: Wakui Nobuyuki , Abe Shinichiro , Shirozu Shunsuke , Yamamoto Yuuki , Yamamura Miho , Abe Yasuyo , Murata Souichi , Ozawa Mizue , Igarashi Takahiro , Yanagiya Takahiro , Machida Yoshiaki , Kikuchi Mayumi
Published: June 2021

Background

Coronavirus infections are spreading rapidly worldwide, and primary and middle schools are closed in many countries. After the state of emergency was lifted in Japan, schools have reopened, and teachers are conducting face-to-face classes while maintaining safety precautions. This study aimed to assess the factors contributing to infection-related anxiety and educational anxiety among teachers conducting face-to-face classes during the COVID-19 pandemic after schools reopened.

Methods

This questionnaire-based cross-sectional study was conducted with 263 primary and middle school teachers in the Shinagawa area of Tokyo (October 10–30, 2020). The questionnaire assessed the type of school (primary or middle school), sex, age, and factors contributing to infection-related anxiety and educational anxiety that arose from the pandemic. The levels of anxiety and the factors contributing to anxiety were assessed using a 5-point Likert scale ranging from 1 (not at all) to 5 (very anxious).

Results

In an analysis of the data of 237 participants excluding the missing data, many teachers reported feeling infection- and education-related anxiety. A majority of the participants were women (n = 152, 64.1%), and the mean age of the participants was 39.8 ± 11.3 years. A stepwise multiple regression analysis identified six factors for infection-related anxiety as significant (R2 = 0.61, p < 0.001). Among these variables, the largest partial regression coefficient value was reported for the following reason: “I feel anxious because we cannot ensure the safety of teachers themselves or of their families” (β = 0.37, p < 0.001). For educational anxiety, four of six reasons were identified as significant (R2 = 0.64, p < 0.001). Among these, “anxiety about the students’ home situations” (β = 0.41, p < 0.001) and “delay in education (students’ side)” (β = 0.27, p < 0.001) had stronger associations with anxiety compared to the others.

Conclusion

In-person education during the COVID-19 pandemic has caused teachers to experience anxiety. This report provides useful information by highlighting the reasons for infection-related anxiety and educational anxiety that teachers experience in face-to-face classes during a pandemic. Even if the coverage of a COVID-19 vaccine becomes widespread worldwide, we will still be combating COVID-19 infections for at least a few years. Given concerns regarding such infections, to ensure students’ right to education, it is essential to understand why teachers feel anxious and to determine appropriate measures to decrease such anxiety.
Stuck fragment of totally implantable central venous access ports during removal: risk factor analysis in children
Authors: Jung Hanna , Cho Joon Yong , Seok Yangki , Lee Youngok
Published: June 2021

Background

Totally implantable central venous access ports (TICVAPs) have increasingly been used in pediatric patients because they provide reliable venous access. However, many complications associated with TICVAPs have been reported. Here, we aimed to analyze the risk factors of stuck fragment of TICVAPs during removal in children and recommend the appropriate periods of use or exchange.

Methods

We retrospectively reviewed the medical records of 121 patients, including 147 cases of TICVAP insertion, between January 2010 and July 2020.

Results

Among these, 98 cases in 72 patients involved of TICVAP removal, with 8 patients having had incomplete TICVAP removal resulting in a stuck fragment of the catheter in the central venous system (Group S). All Group S patients were male and had acute leukemia, and their TICVAPs were used for chemotherapy. Compared with the complete removal group (Group N), stuck fragment in Group S were significantly found in patients diagnosed with acute leukemia than those with other diagnoses (p < 0.001). Indwelling duration and body weight change during TICVAP indwelling were significantly longer and larger in Group S, respectively (p < 0.001). In multivariate logistic regression analysis, indwell duration (odds ratio [OR], 1.13; 95% confidence interval [Cl] 1.02–1.37, p = 0.10), body weight change during indwell (OR, 1.00; 95% Cl 0.83–1.18, p = 0.97), and platelet count at TICVAP insertion (OR, 0.98; 95% Cl 0.95–0.99; p = 0.48) showed an increased trend of risk for a stuck catheter.

Conclusions

We suggest prophylactic catheter exchange before indwell duration of 46 months (area under the curve [AUC], 0.949; 95% Cl 0.905–0.993) and body weight change up to 9.9 kg (AUC, 0.903; 95% Cl 0.840–0.966) to prevent a catheter from becoming stuck, especially in children with rapidly growing acute leukemia. Management of a stuck fragment remains controversial in asymptomatic patients, and we suggest careful, close observation rather than aggressive and invasive treatment.
Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015–2019
Authors: Fan Guo Zhen , Li Rui Xue , Jiang Qi , Niu Man Man , Qiu Zhen , Chen Wei Xia , Liu Hui Hui , Ruan Jin Wei , Hu Peng
Published: June 2021

Background

The present study focuses on the associations of streptococcal infection with the clinical phenotypes, relapse/recurrence and renal involvement in Henoch-Schönlein purpura (HSP) children.

Methods

Two thousand seventy-four Chinese children with HSP were recruited from January 2015 to December 2019. Patients’ histories associated with HSP onset were obtained by interviews and questionnaires. Laboratory data of urine tests, blood sample and infectious agents were collected. Renal biopsy was performed by the percutaneous technique.

Results

(1) Streptococcal infection was identified in 393 (18.9%) HSP patients, and served as the most frequent infectious trigger. (2) Among the 393 cases with streptococcal infection, 43.0% of them had arthritis/arthralgia, 32.1% had abdominal pain and 29.3% had renal involvement. (3) 26.1% of HSP patients relapsed or recurred more than 1 time within a 5-year observational period, and the relapse/recurrence rate in streptococcal infectious group was subjected to a 0.4-fold decrease as compared with the non-infectious group. (4) No significant differences in renal pathological damage were identified among the streptococcal infectious group, the other infectious group and the non-infectious group.

Conclusions

Streptococcal infection is the most frequent trigger for childhood HSP and does not aggravate renal pathological damage; the possible elimination of streptococcal infection helps relieve the relapse/recurrence of HSP.
How mathematical modeling could contribute to the quantification of metastatic tumor burden under therapy: insights in immunotherapeutic treatment of non-small cell lung cancer
Authors: Schlicke Pirmin , Kuttler Christina , Schumann Christian
Published: June 2021

Background

Cancer is one of the leading death causes globally with about 8.2 million deaths per year and an increase in numbers in recent years. About 90% of cancer deaths do not occur due to primary tumors but due to metastases, of which most are not clinically identifiable because of their relatively small size at primary diagnosis and limited technical possibilities. However, therapeutic decisions are formed depending on the existence of metastases and their properties. Therefore non-identified metastases might have huge influence in the treatment outcome. The quantification of clinically visible and invisible metastases is important for the choice of an optimal treatment of the individual patient as it could clarify the burden of non-identifiable tumors as well as the future behavior of the cancerous disease.

Results

The mathematical model presented in this study gives insights in how this could be achieved, taking into account different treatment possibilities and therefore being able to compare therapy schedules for individual patients with different clinical parameters. The framework was tested on three patients with non-small cell lung cancer, one of the deadliest types of cancer worldwide, and clinical history including platinum-based chemotherapy and PD-L1-targeted immunotherapy. Results yield promising insights into the framework to establish methods to quantify effects of different therapy methods and prognostic features for individual patients already at stage of primary diagnosis.
Planned early delivery for late preterm pre-eclampsia in a low- and middle-income setting: a feasibility study
Authors: Beardmore-Gray Alice , Vousden Nicola , Silverio Sergio A. , Charantimath Umesh , Katageri Geetanjali , Bellad Mrutyunjaya , Chinkoyo Sebastian , Vwalika Bellington , Goudar Shivaprasad , Sandall Jane , Chappell Lucy C. , Shennan Andrew H.
Published: June 2021

Background

Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity globally. Planned delivery between 34+0 and 36+6 weeks may reduce adverse pregnancy outcomes but is yet to be evaluated in a low and middle-income setting. Prior to designing a randomised controlled trial to evaluate this in India and Zambia, we carried out a 6-month feasibility study in order to better understand the proposed trial environment and guide development of our intervention.

Methods

We used mixed methods to understand the disease burden and current management of pre-eclampsia at our proposed trial sites and explore the acceptability of the intervention. We undertook a case notes review of women with pre-eclampsia who delivered at the proposed trial sites over a 3-month period, alongside facilitating focus group discussions with women and partners and conducting semi-structured interviews with healthcare providers. Descriptive statistics were used to analyse audit data. A thematic framework analysis was used for qualitative data.

Results

Case notes data (n = 326) showed that in our settings, 19.5% (n = 44) of women with pre-eclampsia delivering beyond 34 weeks experienced an adverse outcome. In women delivering between 34+0 and 36+6 weeks, there were similar numbers of antenatal stillbirths [n = 3 (3.3%)] and neonatal deaths [n = 3 (3.4%)]; median infant birthweight was 2.2 kg and 1.9 kg in Zambia and India respectively. Lived experience of women and healthcare providers was an important facilitator to the proposed intervention, highlighting the serious consequences of pre-eclampsia. A preference for spontaneous labour and limited neonatal resources were identified as potential barriers.

Conclusions

This study demonstrated a clear need to evaluate the intervention and highlighted several challenges relating to trial context that enabled us to adapt our protocol and design an acceptable intervention. Our study demonstrates the importance of assessing feasibility when developing complex interventions, particularly in a low-resource setting. Additionally, it provides a unique insight into the management of pre-eclampsia at our trial settings and an understanding of the knowledge, attitudes and beliefs underpinning the acceptability of planned early delivery.
Resource-efficient internally controlled in-house real-time PCR detection of SARS-CoV-2
Authors: Michel Janine , Neumann Markus , Krause Eva , Rinner Thomas , Muzeniek Therese , Grossegesse Marica , Hille Georg , Schwarz Franziska , Puyskens Andreas , Förster Sophie , Biere Barbara , Bourquain Daniel , Domingo Cristina , Brinkmann Annika , Schaade Lars , Schrick Livia , Nitsche Andreas
Published: June 2021

Background

The reliable detection of SARS-CoV-2 has become one of the most important contributions to COVID-19 crisis management. With the publication of the first sequences of SARS-CoV-2, several diagnostic PCR assays have been developed and published. In addition to in-house assays the market was flooded with numerous commercially available ready-to-use PCR kits, with both approaches showing alarming shortages in reagent supply.

Aim

Here we present a resource-efficient in-house protocol for the PCR detection of SARS-CoV-2 RNA in patient specimens (RKI/ZBS1 SARS-CoV-2 protocol).

Methods

Two duplex one-step real-time RT-PCR assays are run simultaneously and provide information on two different SARS-CoV-2 genomic regions. Each one is duplexed with a control that either indicates potential PCR inhibition or proves the successful extraction of nucleic acid from the clinical specimen.

Results

Limit of RNA detection for both SARS-CoV-2 assays is below 10 genomes per reaction. The protocol enables testing specimens in duplicate across the two different SARS-CoV-2 PCR assays, saving reagents by increasing testing capacity. The protocol can be run on various PCR cyclers with several PCR master mix kits.

Conclusion

The presented RKI/ZBS1 SARS-CoV-2 protocol represents a cost-effective alternative in times of shortages when commercially available ready-to-use kits may not be available or affordable.
Parasitic fauna of Eurasian beavers (Castor fiber) in Sweden (1997–1998)
Authors: Åhlen Per-Arne , Sjöberg Göran , Stéen Margareta
Published: June 2021

Background

The parasitic fauna of beavers (Castor fiberandC. canadensis) has been well studied in many parts of their respective areas of distribution. In Scandinavia there have, however, been limited investigations conducted on the parasites of beavers in recent times. The present study is the first quantitative survey of parasites on beavers living in Sweden and elsewhere in Scandinavia. We investigated the parasitic fauna of the Eurasian beaver (C. fiber) in a North–South gradient in Sweden. The aim of the study was to investigate parasite distribution and prevalence in particular, related to average yearly air temperature and different age groups of beavers. A total of 30 beavers were sampled at eight localities, spanning a 720 km North–South gradient during the springs of 1997 and 1998.

Results

Five parasite taxa were identified. Four of these were present in all of the examined beavers,Stichorchis subtriquetrus(trematode),Travassosius rufus(nematode),Platypsyllus castoris(coleopteran), andSchizocarpusspp.(arachnid). A higher number of new infections ofS. subtriquetrus,and more adults ofT. rufus,were seen in beavers in southern Sweden where temperatures are higher. One-year old beavers had a higher infestation ofS. subtriquetrus,but not ofT. rufus, than older individuals.

Conclusions

The parasite fauna of Swedish beavers mirrored the impoverished parasite fauna of the original Norwegian population, and the high prevalence of parasites could be due to low major histocompatibility complex (MHC) polymorphism. Young beavers had a higher load of trematodes, probably depending on behavioural and ecological factors. Warmer temperatures in southern localities likely contributed to increased endoparasite loads.
Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature
Authors: Siracusa L. , Cascio A. , Giordano S. , Medaglia A. A. , Restivo G. A. , Pirrone I. , Saia G. F. , Collura F. , Colomba C.
Published: June 2021

Objectives

To describe clinical characteristics, laboratory tests, radiological data and outcome of pediatric cases with SARS-CoV-2 infection complicated by neurological involvement.

Study design

A computerized search was conducted using PubMed. An article was considered eligible if it reported data on pediatric patient(s) with neurological involvement related to SARS-CoV-2 infection. We also described a case of an acute disseminated encephalomyelitis (ADEM) in a 5-year-old girl with SARS-CoV-2 infection: this case was also included in the systematic review.

Results

Forty-four articles reporting 59 cases of neurological manifestations in pediatric patients were included in our review. Most (32/59) cases occurred in the course of a multisystem inflammatory syndrome in children (MIS-C). Neurological disorders secondary to cerebrovascular involvement were reported in 10 cases: 4 children with an ischemic stroke, 3 with intracerebral hemorrhage, 1 with a cerebral sinus venous thrombosis, 1 with a subarachnoid hemorrhage, 1 with multiple diffuse microhemorrhages. Reversible splenial lesions were recognized in 9 cases, benign intracranial hypertension in 4 patients, meningoencephalitis in 4 cases, autoimmune encephalitis in 1 girl, cranial nerves impairment in 2 patients and transverse myelitis in 1 case. Five cases had Guillain-Barré syndrome (GBS) and two, including ours, had ADEM. Radiological investigations were performed in almost all cases (45/60): the most recurrent radiological finding was a signal change in the splenium of the corpus callosum. The presence of SARS-CoV-2 viral nucleic acid in the cerebrospinal fluid was proved only in 2 cases. The outcome was favorable in almost all, except in 5 cases.

Conclusions

Our research highlights the large range of neurological manifestations and their presumed pathogenic pathways associated with SARS-CoV-2 infection in children. Nervous system involvement could be isolated, developing during COVID-19 or after its recovery, or arise in the context of a MIS-C. The most reported neurological manifestations are cerebrovascular accidents, reversible splenial lesions, GBS, benign intracranial hypertension, meningoencephalitis; ADEM is also a possible complication, as we observed in our patient. Further studies are required to investigate all the neurological complications of SARS-CoV-2 infection and their underlying pathogenic mechanism.
Symptom measures in pediatric narcolepsy patients: a review
Authors: Ouyang Hui , Gao Xuguang , Zhang Jun
Published: June 2021

Purpose

This study aimed to provide a summary of the measures to assess narcoleptic symptoms or complications in pediatric narcolepsy patients.

Methods

We searched in the National Center for Biotechnology Information (NCBI) for measures of narcoleptic symptoms for pediatric patients. Further review was conducted if relevant questionnaires or information were mentioned.

Results

There were only two narcolepsy-specific questionnaires, the narcolepsy severity scale and Ullanlinna Narcolepsy Scale, neither of them was developed or validated in the pediatric population. For cataplexy, all the measures were study-specific diaries and were not validated questionnaires. For excessive daytime sleepiness, the Epworth Sleepiness Scale was most frequently used to measure excessive daytime sleepiness in children. For nighttime sleep, the Children’s Sleep Habits Questionnaire was most frequently used. For depression, the Children Depression Inventory was the most frequently used. For attention-deficit/hyperactivity disorder, the Child Behavior Checklist was the most frequently used. For quality of life, KIDSCREEN was most frequently used.

Conclusions

At present, there is a lack of disease-specific and validated questionnaires for pediatric narcoleptic patients. This need can be met by modifying and adjusting the existing adult questionnaires and developing new questionnaires for pediatric narcoleptic patients.
Report of two siblings with APECED in Serbia: is there a founder effect of c.769C>T AIRE genotype?
Authors: Fierabracci Alessandra , Lanzillotta Mariafrancesca , Vorgučin Ivana , Palma Alessia , Katanić Dragan , Betterle Corrado
Published: June 2021

Background

Autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy (APECED) or autoimmune polyglandular syndrome Type 1 is a rare autosomal recessive syndrome. The disorder is caused by mutations in the AIRE (AutoImmune Regulator) gene. According to the classic criteria, clinical diagnosis requires the presence of at least two of three main components: chronic mucocutaneous candidiasis, hypoparathyroidism and primary adrenal insufficiency. Furthermore, patients are often affected by other endocrine or non-endocrine associated autoimmune conditions. The enrichment of the non-classical triad seems to occur differently in different cohorts. Screenings of the population revealed that homozygous AIRE mutations c.769C > T, c.415C > T and c.254A > G have a founder effect in Finnish, Sardinian and Iranian Jew populations respectively.

Case presentation

We report here the clinical and genetic characteristics of two new Serbian APECED siblings, one male and one female, actual age of 27 and 24 respectively, born from non-consanguineous parents. Addison’s disease was diagnosed in the male at the age of 3.5 and hypoparathyroidism at the age of 4. The female developed hypoparathyroidism at 4 years of age. She presented diffuse alopecia, madarosis, onychomycosis, teeth enamel dysplasia. She further developed Addison’s disease at the age of 11 and Hashimoto’s thyroiditis at the age of 13.5. She had menarche at the age of 14 but developed autoimmune oophoritis and premature ovarian failure at the age of 16. A treatment with hydrocortisone, fludrocortisone and alfacalcidiol was established for both siblings; L-T4 (levo-thyroxine) for thyroid dysfunction and levonorgestrel and etinilestradiol for POF were also administered to the female.

Genetic screening revealed a homozygous c.769C > T (R257X (p.Arg257X)) AIRE mutation. We additionally reviewed the literature on 11 previously published Serbian patients and evaluated the frequency of their main diseases in comparison to Finnish, Sardinian, Turkish, Indian and North/South American cohorts.

Conclusion

A founder effect was discovered for the R257X genotype detected in the DNA of 10 homozygous and 2 heterozygous patients. Of note, all Serbian APECED patients were affected by adrenal insufficiency and 10 out of 13 patients presented CMC.
Prognostic value of baseline interleukin 6 levels in liver decompensation and survival in HCC patients undergoing radioembolization
Authors: Öcal Osman , Kupčinskas Juozas , Morkunas Egidijus , Amthauer Holger , Schütte Kerstin , Malfertheiner Peter , Klümpen Heinz Josef , Sengel Christian , Benckert Julia , Seidensticker Ricarda , Sangro Bruno , Wildgruber Moritz , Pech Maciej , Bartenstein Peter , Ricke Jens , Seidensticker Max
Published: June 2021

Background

To confirm the prognostic value of previously published baseline interleukin 6 (IL6) and IL8 cutoff values in survival and liver dysfunction in patients with advanced HCC undergoing 90Y radioembolization.

Methods

A total of 83 patients (77 male) represented a subset of HCC patients undergoing 90Y radioembolization combined with sorafenib as part of the prospective multicenter phase II trial SORAMIC. IL6 and IL8 levels were determined in serum samples collected at baseline. In this post hoc analysis, we sought to confirm the prognostic value of baseline cutoff values of 6.53 pg/mL and 60.8 pg/mL for IL6 and IL8, respectively, in overall survival (OS) or liver dysfunction (grade 2 bilirubin increase) after treatment.

Results

Median OS was 12.0 months. While low baseline albumin and high bilirubin values were associated with high IL6, liver cirrhosis, alcoholic liver disease, and portal vein infiltration were associated with high IL8.

In univariate analysis, high baseline IL6 and IL8 were associated with significantly shorter overall survival (7.8 vs. 19.0 months for IL6 and 8.4 vs. 16.0 months for IL8). In addition to IL values, liver cirrhosis, Child–Pugh grade, baseline albumin (< 36 g/dL), and total bilirubin (≥ 17 µmol/L), and higher mALBI grade (2b &3) values were associated with OS. At multivariate analysis, high baseline IL6 was the only independent prognostic factor for OS (HR 2.35 [1.35–4.1], p = 0.002).

Risk factors for liver dysfunction were high baseline IL6, albumin, and total bilirubin, and mALBI grade as found in univariate analysis. High baseline IL6 (HR 2.67 [1.21–5.94], p = 0.016) and total bilirubin ≥ 17 µmol/L (HR 3.73 [1.72–8.06], p < 0.001) were independently associated with liver dysfunction.

Conclusion

In advanced HCC patients receiving 90Y radioembolization combined with sorafenib, baseline IL6 values proved to be prognostic, confirming previous findings in patients undergoing 90Yradioembolization. IL6 might be useful for patient selection or stratification in future trials.
Heat stroke: knowledge and practices of medical professionals in pediatric emergency medicine departments – a survey study
Authors: Cohen-Ronen Noy , Rimon Ayelet , Cohen Neta , Capua Tali
Published: June 2021

Background and importance

Heat stroke is a life-threatening condition affecting children worldwide. Rapid cooling remains the most important feature of emergency management. The accepted preferred method of evaporative cooling in the ED as listed by the reference text book endorsed by the Israeli Society of Pediatric Emergency Medicine (PEMI), is actively cooling the patient by spraying him with water and positioning fans to blow air across the body.

Objective

This study aimed to assess Israeli health care workers (HCWs) medical professionals’ knowledge and preparedness of treating heat stroke and recommend policy changes to ensure better treatment based on survey results.

Design, settings and participants

A cross-sectional survey of all HCWs working in an ED that accepts children was conducted. An online questionnaire was utilized to assess heat stroke management practices and available resources in all Israeli pediatric emergency departments (PEDs).

Main results

Data from 208 health care workers was analyzed. Only 30% of the participants reported ever treating a patient with exertional heat stroke. Two scenarios were presented to the participants: motor vehicle-related child hyperthermia (MVRCH) in an infant and an adolescent with exertional heat stroke. One hundred twenty-five (60%) and 83 (40%) participants, respectively, listed cool water with a fan as the primary mode of cooling, which is considered the appropriate preferred method of evaporative cooling in the PED. Certificated pediatric emergency medicine (PEM) physicians answered significantly more correctly regarding both scenarios’ management (P < 0.001). Participants who were trained via simulation in the past, answered significantly more correctly regarding the exertional heat stroke scenario (P < 0.01), however no difference was found regarding the MVRCH case.

Conclusions: The present study exposes weaknesses in HCW knowledge, PED resources, and published PED policies for appropriate management of children following heat stroke. Our finding emphasizes the importance of both certificated PEM physicians attendance and simulation performance for implementing proper management of patients with heat stroke. A policy change should be performed among the Israeli PED community, with respect to establishing and implementing guidelines for treatment of exertional heat stroke. A future study, following an interventional simulation program is planned to be performed.
Measurement properties of patient-reported outcome measures (PROMs) in patients with hyperhidrosis: protocol for a systematic review
Authors: Gabes Michaela , Knüttel Helge , Apfelbacher Christian J.
Published: June 2021

Background

Hyperhidrosis is a chronic skin condition that impairs the patient’s quality of life (QoL). There are several patient-reported outcome measures (PROMs) for patients affected by hyperhidrosis available; however an evidence-based assessment of their quality has not been undertaken so far.

Objective

In our systematic review, we aim to identify all existing PROMs that were developed and/or validated for measuring patient-reported outcomes in patients with hyperhidrosis and assess their measurement properties in a transparent and structured way to give a recommendation for future clinical research.

Methods/design

Our systematic review aims to contain all PROMs developed and/or validated for patients with hyperhidrosis. We will perform a highly sensitive, systematic literature search including the databases MEDLINE (Ovid), EMBASE (Ovid), and Science Citation Index Expanded and Social Sciences Citation Index (Web of Science). Especially studies which evaluate, describe, or compare measurement properties of PROMs for patients with hyperhidrosis will be considered as eligible. Two independent reviewers will judge the eligibility of the studies found in the literature search. The study and PROM characteristics will be summarized in evidence tables. The methodological quality of each study will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. We will apply predefined and consensus-based quality criteria for good measurement properties. Subsequently, the quality of the evidence will be graded. Furthermore, aspects on interpretability and feasibility will be described. A final recommendation will be given.

Discussion

In our systematic review, we aim to provide a comprehensive description of the quality of all existing PROMs for patients with hyperhidrosis. The assessment of measurement properties, interpretability, and feasibility will serve as a guidance regarding the selection of PROMs for future clinical hyperhidrosis trials.

Systematic review registration

PROSPERO CRD42020170247
Intent-driven cloud resource design framework to meet cloud performance requirements and its application to a cloud-sensor system
Authors: Wu Chao , Horiuchi Shingo , Murase Kenji , Kikushima Hiroaki , Tayama Kenichi
Published: June 2021

In cloud service delivery, the cloud user is concerned about “what” function and performance the cloud service could provide, while the cloud provider is concerned about “how” to design proper underlying cloud resources to meet the cloud user’s requirements. We take the cloud user’s requirement as intent and aim to translate the intent autonomously into cloud resource decisions. In recent years, intent-driven management has been a widely spread management concept which aims to close the gap between the operator’s high-level requirements and the underlying infrastructure configuration complexity. Intent-driven management has drawn attention from telecommunication industries, standards organizations, the open source software community and academic research. There are various application of intent-driven management which are being studied and implemented, including intent-driven Software Defined Network (SDN), intent-driven wireless network configuration, etc. However, application of intent-driven management into the cloud domain, especially the translation of cloud performance-related intent into the amount of cloud resource, has not been addressed by existing studies. In this work, we have proposed an Intent-based Cloud Service Management (ICSM) framework, and focused on realizing the RDF (Resource Design Function) to translate cloud performance-related intent into concrete cloud computation resource amount settings that are able  to meet the intended performance requirement. Furthermore, we have also proposed an intent breach prevention mechanism, P-mode, which is essential for commercial cloud service delivery. We have validated the proposals in a sensor-cloud system, designed to meet the user’s intent to process a large quantity of images collected by the sensors in a restricted time interval. The validation results show that the framework achieved 88.93 ~ 90.63% precision for performance inference, and exceeds the conventional resource approach in the aspects of human cost, time cost and design results. Furthermore, the intent breach prevention mechanism P-mode significantly reduced the breach risk, at the same time keeping a high level of precision.
Exploring a core psychopathology in disordered eating: the feelings of fat scale
Authors: Zhang Yichelle Y. , Burns Bruce D. , Touyz Stephen
Published: June 2021

Background

Feelings of fat are common for people with eating disorders, but ways of measuring its intensity are needed. Therefore, our goal was to develop a self-report feelings of fat scale that asked participants to indicate how intensely they currently felt statements such as “I feel fat”. With such a scale we can determine how strongly feelings of fat relate to evidence of disordered eating.

Methods

We conducted three studies of eating disorders with undergraduate women taking introductory psychology classes. The combined sample was 472 participants. A previous eating disorder diagnosis was self-reported by 33 participants and a current diagnosis by 11. All participants completed the EDE-Q and the seven (Study 1) or nine item (Studies 2 and 3) “State Feelings of Fat” (SFF) scales we developed. Each item asked them to rate the intensity with which they felt statements such “I feel fat” on a seven-point scale from “not at all” to “the most I have ever felt”.

Results

Both the seven and nine item SFF scales were highly coherent (Cronbach’s α were .94, .95 and .94), but factor analysis supported the seven-item version. We found high correlations between SFF and EDE-Q scores (Study 1: .816; Study 2: .808; Study 3: .841). SFF scores distinguished participants self-reporting no eating disorder diagnosis from those with a former diagnosis,t(361) = 2.33,p = .021, who in turn were distinguished from those with a current diagnosis,t(42) = 2.09,p = .043. Due to the high coherence of the scale, the single item “I feel fat” captured most of the variance in EDE-Q scores (r[472] = .793).

Conclusions

We have constructed an eating disorders relevant feelings of fat scale. Given that the EDE-Q is considered a valid questionnaire for measuring severity of eating disorders, our findings suggests that feelings of fat are core to the psychopathology of eating disorders. To the extent that EDE-Q scores are stable it also suggests that feelings of fat are surprisingly stable. Furthermore, the single item “I feel fat” alone may capture most of what the EDE-Q measures.
Micro-CT imaging of Thiel-embalmed and iodine-stained human temporal bone for 3D modeling
Authors: Halm Sebastian , Haberthür David , Eppler Elisabeth , Djonov Valentin , Arnold Andreas
Published: June 2021

Introduction

This pilot study explores whether a human Thiel-embalmed temporal bone is suitable for generating an accurate and complete data set with micro-computed tomography (micro-CT) and whether solid iodine-staining improves visualization and facilitates segmentation of middle ear structures.

Methods

A temporal bone was used to verify the accuracy of the imaging by first digitally measuring the stapes on the tomography images and then physically under the microscope after removal from the temporal bone. All measurements were compared with literature values. The contralateral temporal bone was used to evaluate segmentation and three-dimensional (3D) modeling after iodine staining and micro-CT scanning.

Results

The digital and physical stapes measurements differed by 0.01–0.17 mm or 1–19%, respectively, but correlated well with the literature values. Soft tissue structures were visible in the unstained scan. However, iodine staining increased the contrast-to-noise ratio by a factor of 3.7 on average. The 3D model depicts all ossicles and soft tissue structures in detail, including the chorda tympani, which was not visible in the unstained scan.

Conclusions

Micro-CT imaging of a Thiel-embalmed temporal bone accurately represented the entire anatomy. Iodine staining considerably increased the contrast of soft tissues, simplified segmentation and enabled detailed 3D modeling of the middle ear.