bluuebunny/crossref_metadata_2025 huggingface dataset:
Let’s Talk about Sex: Teaching Adolescents with Intellectual Disability about Sexuality Education
Authors: Schaff Anis Raihan Dzeidee , Mohamad Fitri Suraya
Published: October 2020

This qualitative case study explores the experiences of teachers who are responsible for teaching adolescents with intellectual disability about sexuality education at a secondary school in a special education programme in semi-rural Sarawak. The study investigates the teaching approaches to teach cognitive and social-behavioural aspects of sexuality education. It also documents challenges in teaching adolescents with intellectual disability about sexuality education. Findings revealed that cognitively, the adolescents’ comprehension and memory are greatly aided by the use of concrete materials, modelling strategy, and constant repetition; attention and focus in class are obtained by the use of multimedia and storytelling approach; and interestingly, the understanding about sexuality is affected by the language used in content delivery and classroom dialogue.  In the social-behavioural aspect, the findings revealed the importance of teachers and students’ comfort when talking about sexuality, mixed gender classes, peer guidance, and the adolescents’ intrapersonal intelligence. All these aspects are key in ensuring that the adolescents are able to reach an understanding and acceptance towards learning about sexuality education. The study also discovered that limitation of teaching materials, the adolescents’ unsupervised usage of the technology, and the sensitivity of sexuality education within the local home setting are among the main challenges faced by the teachers in teaching about sexuality education. The study also uncovered how the adolescents’ limited mental capabilities particularly in the social-behavioural domain has resulted in the adolescents displaying tendencies toward sexually risky behaviours which in turn, exposed them to sexually risky situations.
The Role of Anemia in Pregnancy in the Incidence of Post Partum Hemorrhage in Maternal Maternity at the Hospital in Sidoarjo, Indonesia
Authors: Khoiroh Mukarromatul , Azizah Nurul
Published: October 2020

Postpartum hemorrhage is bleeding that occurs after the birth of the baby, placenta, and 2 hours after the placenta is born. One of the causes is anemia. Research in 2015, 60% of 100 mothers giving birth at RSIA Kirana Taman Sidoarjo experienced postpartum hemorrhage. The aim of the study was to determine the relationship of anemia in pregnancy with the incidence of postpartum hemorrhage in labor mothers. The study design used an analytical survey with a retrospective method. The population of 206 maternity mothers was taken with simple random sampling technique as many as 136 samples in August 2017. Data were analyzed by Chi Square statistical test with 0.05. The results showed that postpartum hemorrhage was more experienced by mothers with anemia (66.7%) than  those without anemia (26.2%). While those who did not experience postpartum hemorrhage were more experienced by mothers who were not anemic (73.8%) than those who were anemic (33.3%). Chi square test results  (p=0.000  <0.05),  which means there is a relationship  of anemia in pregnancy with the incidence of postpartum hemorrhage in labor mothers. Conclusions of the study were the relationship of anemia in pregnancy with the  incidence  of postpartum hemorrhage in labor mothers. It is expected that midwives and doctors conduct early detection of anemia so that appropriate care can be carried out.
The Role of Religiosity in Happiness of Vocational School Students in Indonesia
Authors: Lestari Putri Dwi , Maryam Effy Wardati
Published: October 2020

This research is quantitative research with a correlational approach. This study aims to determine the relationship between religious and happiness in students class XII SMK 10 Nopember Sidoarjo. This research was conducted at SMK 10 Nopember Sidoarjo with a sample of 220 students who were selected using the cluster random sampling technique. Data  collection technique in  this study used two psychologycalscales with Likert models, namely the scale of religious and  happiness. The hypothesis in this  study is that there   is a  positive relationship between religious and happiness in SMK 10 Nopember Sidoarjo. Data  analysis was carried  out with Spearman Rank correlation  technique using SPSS 22.0 for  Windows program. The results of  the data  analysis showed a correlation coefficient  of 0.863 with significance  of 0.000 < 0.05. this means that is a positive relationship between religious with happiness.
CREACIÓN Y EVALUACIÓN DE PLANTILLAS PARA TRABAJOS FIN DE GRADO COMO BUENA PRÁCTICA DOCENTE
Authors: Redondo López José Manuel
Published: October 2020

Este artículo describe un procedimiento de adaptación de la metodología Métrica 3 a un contexto académico para el desarrollo de trabajos de fin de grado, motivado por una serie de carencias observadas al realizarlos en el Grado en Ingeniería Informática del Software de la Universidad de Oviedo. La metodología de adaptación consistió en la eliminación o simplificación de los procesos de Métrica 3 que se han juzgado menos aplicables al contexto académico y la introducción de elementos y ejemplos que la integran con las asignaturas de la titulación, unificando sus contenidos. Con ello, se ha desarrollado un documento/plantilla que propone una estructura general para un proyecto de desarrollo de software respetando la estructura de Métrica 3. El uso del documento es opcional y flexible: el alumno debe adaptarlo a su trabajo.

La plantilla es pública e integra una serie de estilos y formatos predeterminados, así como explicaciones o ejemplos adicionales que facilitan su uso. El uso de esta plantilla a lo largo de más de 10 años ha sido un éxito, facilitando lograr trabajos con una mejor estructuración. También ha decrementado el número de defectos, problemas generales de desarrollo y dificultades planteadas por los alumnos.
Gamificando un aula virtual en Moodle
Authors: Martín Vílchez Celia
Published: October 2020

El presente trabajo pretende contribuir a la incorporación de metodologías educativas motivadoras e innovadoras, como es el caso de la gamificación o ludificación, en el ámbito de la Formación Profesional. Con dicho objetivo, se lleva a cabo una propuesta de intervención basada en la incorporación de elementos propios de la gamificación en un aula virtual creada en la plataforma Moodle como recurso complementario a las clases presenciales del módulo profesional Asistencia Sanitaria Inicial en Situaciones de Emergencia perteneciente al Ciclo Formativo de Grado Medio de Emergencias Sanitarias. En dicha propuesta se incluye de forma pormenorizada los pasos a seguir para la creación de un sistema de insignias, un conjunto de niveles diseñados con la extensión Level Up! para la mejora de la competencia digital y una colección de objetos ocultos que pueden ser canjeados, todo ello destinado a fomentar la motivación e implicación de los estudiantes. En la configuración de dichos elementos se ha tenido en cuenta la atención al alumnado con necesidades específicas de apoyo educativo.

En definitiva, este trabajo pretende constituir un ejemplo o herramienta de consulta para la creación de entornos de aprendizaje basados en la gamificación que fomenten la motivación, participación, implicación e interacción del alumnado.
Aprendizaje-Servicio y Mujeres de cine: el Making of en innovación docente
Authors: Jiménez Millán Azahara , García-Cano Torrico María , Hinojosa Pareja Eva F.
Published: October 2020

El artículo se enmarca en un proyecto de innovación docente (2019-3-4005) desarrollado en el curso académico 2019/2020 en 2.º curso en los Grados de Educación Infantil y Educación Primaria en la asignatura Convivencia en la Escuela y Cultura de Paz. Se propuso utilizar el cine como texto cultural para el análisis y crítica de los sesgos de género y de los modelos patriarcales en las sociedades actuales; del mismo modo, como vehículo de acción transformadora en los espacios educativos. Mediante la metodología de Aprendizaje-Servicio (ApS) los y las estudiantes utilizaron el cine para analizar los sesgos de género y para hacer propuestas de acción socioeducativa, relacionando de esta manera aprendizajes académicos con experiencias más prácticas y vivenciales que se desarrollan fuera de las aulas. Las actividades realizadas han consistido en: selección de la temática, documentación, realización de entrevistas con expertas en materia de cine y educación, visualización de documental relacionado con la desigualdad de género, análisis reflexivo de los datos producidos y, por último, elaboración de un servicio para movilizar recursos y aprendizajes que propongan acciones alternativas a los modelos patriarcales en distintos espacios, formales y no formales. Además, el trabajo de visualización y diálogo con mujeres directoras de trabajos fílmicos ha permitido la visibilización de éstas y la interacción dentro del aula sobre la acción coeducativa.
Relação entre o desempenho de gestão e as variáveis que influenciaram a eficiência e a efetividade do programa Bolsa Família
Authors: Alves Simone Tiessa de Jesus , Leite Filho Geraldo Alemandro , Bezerra George Eduardo
Published: October 2020

Neste estudo visou-se investigar a relação entre o desempenho de gestão e as variáveis que influenciaram a eficiência e efetividade do programa Bolsa Família (comunicação interorganizacional, condições socioeconômicas, esforço administrativo dos órgãos executores, recursos destinados).  Os dados foram anuais e secundários dos municípios de Minas Gerais no período de 2011 a 2017. A análise se baseou no índice de Gestão Descentralizada, indicador de monitoramento e incentivo financeiro à gestão municipal do programa. Utilizou-se estatística descritiva e regressão de dados em painel. O estudo sugeriu a rejeição da hipótese de que a eficiência (esforço) de execução dos implementadores estaria associada de forma positiva com o desempenho de gestão. As disparidades entre os municípios foram observadas, ressaltando a relevância de estudos comparativos dos desempenhos nas regiões do Estado. Como principal conclusão, os dados apontam que o desempenho de gestão está associado à eficácia e não à efetividade da política pública.
Rede de combate à escravidão contemporânea: De Jure ou De Facto?
Authors: Moura Paula Renata Castro Fonseca de , Cavalcante Pedro Luiz Costa , Arcanjo Cecília Braz
Published: October 2020

O artigo analisa o funcionamento da rede de atores que desenvolvem ações no âmbito do II Plano Nacional para a Erradicação do Trabalho Escravo (II PNETE), mais especificamente aquelas direcionadas a fomentar a reforma agrária como forma de enfrentamento do problema. O objetivo foi explorar se a rede formalmente estabelecida pelo plano (de jure) atua efetivamente (de facto) na política de combate e prevenção ao trabalho escravo no país. Foi realizada pesquisa qualitativa, com utilização da técnica de grupo focal com atores relevantes para a execução da política. Os resultados indicam a carência de vínculos entre os atores indicados no Plano, revelando uma dissociação entre a formalização da política e sua dinâmica. Conclui-se que o foco das análises de redes deve atentar também para as práticas cotidianas das organizações, para assim avaliar os reais resultados e dificuldades do policymaking.
Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis
Authors: Bi Yonghua , Li Jindong , Bai Liangliang , Han Xinwei , Ren Jianzhuang
Published: October 2020

Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.
Mental health consequences of long-term stays in refugee camps: Preliminary evidence from Moria
Authors: Wiel willemine van de , Castillo-Laborde Carla , I. Francisco Urzúa , Fish Michelle , Scholte Willem F.
Published: October 2020

Background Ever since the implementation of the EU-Turkey deal, most refugees that enter Greece via sea are confined to the island on which they arrive until their asylum claims are adjudicated, where they generally reside camps. Some of these camps have detention-like characteristics and dire living conditions, such as Moria camp on the island of Lesbos, Greece. Aid-organizations have stated that the situation in camp Moria deteriorates the mental health of its inhabitants and there is qualitative evidence to support this. This study explores the quantitative relationship between the incidence of acute mental health crises and the length of stay in the camp. Methods A cross-sectional study was conducted using routinely collected data on 856 consultations of 634 different patients during 90 nights at an emergency clinic in Moria camp. Logistic regression analysis was used to explore whether the length of stay in the camp was predictive of the occurrence of an acute mental health crisis. Results Of the 634 patients, the majority were men (59·3%), the average age was 23·2 years [0–71], and 24·3% was <18 years. 25·5% (n=218) of consultations were related to mental health problems; 17·0% (n=37) of these met the study’s case definition of an acute mental health crisis. Such crises were positively associated with the length of stay in the camp (p=0011); the odds ratio of a mental health crisis increases with 1·03 for every 10% increase in days of residence in the camp. This is notable when considering the average length of stay in the camp is 71 days. Conclusion This study offers quantitative support for the notion that the adverse conditions in Moria camp deteriorate the mental health of its inhabitants as suggested in qualitative research. Although this study does not provide evidence of causality, it is likely that the poor and unsafe living conditions, challenging refugee determination procedures, and a lack of mental health services in the camp are significant contributing factors. We urgently call for Europe’s policymakers to honor the ‘51 Geneva refugee convention and terminate the neglectful situation on the Greek archipelago.
Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study
Authors: Chen Yen-Chih , CHEN Pei-Yun , WANG Yu-Chen , WANG Tyng-Guey , HAN Der-Sheng
Published: October 2020

Background: Sarcopenia and dysphagia are prevalent health issues as the elderly population continues to grow. However, whether sarcopenia, defined by either reduced handgrip strength or gait speed, would lead to pathological effects on swallowing function is still a matter of debate. Studies focusing on subclinical changes in the swallowing function in the sarcopenic elderly are lacking. This study evaluates the swallowing function in the sarcopenic elderly without dysphagia.Methods: A cross-sectional study was conducted including subjects recruited from the community. Ninety-four individuals aged 65 and older without dysphagia were divided into two groups: sarcopenia and nonsarcopenia. The swallowing assessment included tongue pressure measurement, hyoid displacement (HD), hyoid velocity (HV) measurement with submental ultrasonography, 100-ml water-swallowing test, and the 10-item Eating Assessment Tool (EAT-10).Results: The average tongue pressure was 47.0 ± 13.7 and 48.6 ± 11.5 kPa in the sarcopenia and nonsarcopenia groups, respectively (p = 0.55), whereas the average HD during swallowing was 15.3 ± 4.4 and 13.0 ± 4.2 mm in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of HV during swallowing was 19.5 (6.41–45.86) and 15.9 (3.7–39.7) mm/s in the sarcopenia and nonsarcopenia group (p < 0.05). The median of time needed for consuming 100 ml water was 12.43 (3.56–49.34) and 5.66 (2.07–19.13) seconds in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of the EAT-10 score was 0 (0–2) and 0 (0–1) in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05).Conclusions: In elderly individuals, swallowing function was significantly impaired with sarcopenia before clinical symptoms become clear. However, tongue muscles exhibited resistance to sarcopenia. We observed compensative strategies in patients with sarcopenia, such as reduced swallowing speed and increased hyoid bone movement.
Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: A national survey
Authors: Kazzaz Yasser , Da'ar Omar
Published: October 2020

Background: As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists’ comfort and importance levels of organ donation competencies.Methods: We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians’ characteristics.Results: With a response rate of 76%, we found that 40%–60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists’ rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.Conclusions: Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.
Metagenomic insights into the diversity of carbohydrate-degrading enzymes in the yak fecal microbial community
Authors: Gong Ga , Zhou Saisai , Luo Runbo , Gesang Zhuoma , Suolang Sizhu
Published: October 2020

Background: Yaks are able to utilize the gastrointestinal microbiota to digest plant materials. Although the cellulolytic bacteria in the yak rumen have been reported, there is still limited information on the diversity of the major microorganisms and putative carbohydrate-metabolizing enzymes for the degradation of complex lignocellulosic biomass in its gut ecosystem. Results: Here, this study aimed to decode biomass-degrading genes and genomes in the yak fecal microbiota using deep metagenome sequencing. A comprehensive catalog comprising 4.5 million microbial genes from the yak feces were established based on metagenomic assemblies from 92 Gb sequencing data. We identified a full spectrum of genes encoding carbohydrate-active enzymes, three-quarters of which were assigned to highly diversified enzyme families involved in the breakdown of complex dietary carbohydrates, including 120 families of glycoside hydrolases, 25 families of polysaccharide lyases, and 15 families of carbohydrate esterases. Inference of taxonomic assignments to the carbohydrate-degrading genes revealed the major microbial contributors were Bacteroidaceae, Ruminococcaceae, Rikenellaceae, Clostridiaceae, and Prevotellaceae. Furthermore, 68 prokaryotic genomes were reconstructed and the genes encoding glycoside hydrolases involved in plant-derived polysaccharide degradation were identified in these uncultured genomes, many of which were novel species with lignocellulolytic capability. Conclusions: Our findings shed light on a great diversity of carbohydrate-degrading enzymes in the yak gut microbial community and uncultured species, which provides a useful genetic resource for future studies on the discovery of novel enzymes for industrial applications.
Uncovering fungal community composition in natural habitat of Ophiocordyceps sinensis using high-throughput sequencing and culture-dependent approaches
Authors: Zhang Chuanbo , Ren Chao-Hui , Wang Yan-Li , Wang Qi-Qi , Wang Yun-Sheng , Weng Qing-Bei
Published: October 2020

Background: The fungal communities inhabiting natural Ophiocordyceps sinensis play critical ecological roles in alpine meadow ecosystem, contribute to infect host insect, influence the occurrence of O. sinensis, and are repertoire of potential novel metabolites discovery. However, a comprehensive understanding of fungal communities of O. sinensis remain elusive. Therefore, the present study aimed to unravel fungal communities of natural O. sinensis using combination of high-throughput sequencing and culture-dependent approaches. Results: A total of 280,519 high-quality sequences, belonging to 5 fungal phyla, 15 classes, 41 orders, 79 families, 112 genera, and 352 putative operational taxonomic units (OTUs) were obtained from natural O. sinensis using high-throughput sequencing. Among of which, 43 genera were identified in external mycelial cortices, Ophiocordyceps, Sebacinia, Archaeorhizomyces were predominant genera with the abundance of 95.86%, 1.14%, 0.85%, respectively. A total of 66 genera were identified from soil microhabitat, Inocybe, Archaeorhizomyces, unclassified Thelephoraceae, Tomentella, Thelephora, Sebacina, unclassified Ascomycota, unclassified Fungi were predominant genera with an average abundance of 53.32%, 8.69%, 8.12%, 8.12%, 7.21%, 4.6%, 3.08% and 3.05%, respectively. The fungal communities in external mycelial cortices were significantly distinct from the soil microhabitat. Meanwhile, seven types of culture media were used to isolate culturable fungi at 16°C, resulted in 77 fungal strains isolated by rDNA ITS sequence analysis, belonging to 33 genera, including Ophiocordyceps, Trichoderma, Cytospora, Truncatella, Dactylonectria, Isaria, Cephalosporium, Fusarium, Cosmospora and Paecilomyces, etc.. Among all culturable fungi, Mortierella and Trichoderma were predominant genera. Conclusions: The significantly differences and overlap in fungal community structure between two approaches highlight that the integration of high-throughput sequencing and culture-dependent approaches would generate more information. Our result reveal a comprehensive understanding of fungal community structure of natural O. sinensis, provide new insight into O. sinensis associated fungi, and support that microbiota of natural O. sinensis is an untapped source for novel bioactive metabolites discovery.
The usefulness of melatonin supplementation in postmenopausal women with Helicobacter pylori-associated dyspepsia
Authors: Chojnacki Cezary , Mędrek-Socha Marta , Konrad Paulina , Chojnacki Jan , Błońska Aleksandra
Published: October 2020

Background Dyspeptic syndrome in the form of epigastric pain are particularly frequent in postmenopausal women. The aim of the study was to assess the role of melatonin in chronic dyspepsia in this group of women, with consideration of Helicobacter infection.Methods The study comprised 152 subjects including 30 healthy women (group I), 60 women with asymptomatic H.pylori infection (group II), and 64 women H. pylori infected with chronic dyspepsia (group III). Endoscopic examination, histological assessment of gastric end duodenal mucosa, urease breath test (UBT-13C), and serum levels of 17-β-estradiol, follicle stimulating hormone, melatonin and urinary concentration of 6-sulfatoxymelatonin were determined by immunoenzymatic method. In group III – 14-day antibacterial treatment was introduced with pantoprazole, amoxicillin and levofloxacin. Afterward, in 32 women was administered placebo (group IIIa), and in 32 women (group IIIb) melatonin at a dose 1 mg/morning and 3 mg/at bedtime, for six months.Results No significant differences were assessed between serum level of female hormone. Serum level of melatonin in group I and in group II was similar – 12,5 ± 2,72pg/ml and 10,5±3,73 pg/ml (p>0,05), whereas in group III it was lesser – 5,72±1,42 pg/ml (p<0,001). Eradication of H.pylori was obtained in 75,0% women in group IIIa, and in 84,3% in group IIIb (p>0,05). After 6 months dyspeptic symptoms resolved in 43,7% patients in group IIIa and in 84,3% in group IIIb (p<0,001).Conclusion Melatonin supplementation is useful to complex therapy of H. pylori-associated dyspepsia, particularly in postmenopausal women at whom secretion of this hormone is decreased.Trial registration: NCT04352062, date of registration: 15.04.2020.
Treatment of insertional Achilles tendinopathy with ultrasound-guided intrabursal retrocalcaneal hyaluronic acid injection - a prospective study
Authors: Slevin Omer , Segal David , Ohana Nissim , Kots Eugene , Feldman Viktor , Nyska Meir , Palmanovich Ezequiel
Published: October 2020

Background﻿Insertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy involving fibrocartilage changes that resemble osteoarthritic changes in articular cartilage. Thus, our primary goal was to evaluate the effect of hyaluronic acid (HA) injections on IAT. MethodsFifteen IAT ankles (14 patients) were treated with three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of hylan G-F 20 (Synvisc®). Patients answered the "Victorian Institute of Sport Assessment – Achilles" (VISA-A) questionnaire before every injection and on 1 month and 6 months follow-up visits. Univariate analysis was performed to identify differences in functional scores. ResultsThe mean (VISA-A) score improved significantly following HA injections from 34.8 ± 15.2 (range, 11-63) points before the first injection to 53.6 ± 20.9 (range, 15-77) points after 1 month, and 50.7 ± 18.6 (20-75) points after 6 months. No adverse drug reactions were noted.ConclusionsThree consecutive ultrasound-guided intrabursal retrocalcaneal HA injections were found in our cohort to be beneficial in treating IAT.Trial registrationNCT02368561. Registered 23 February 2015. https://clinicaltrials.gov/ct2/show/NCT02368561?term=insertional+achilles&draw=2&rank=2
Additive interaction of mid- to late-life depression and cerebrovascular disease on the risk of dementia: A nationwide population-based cohort study
Authors: Jang Yoo Jin , Kang Cinoo , Myung Woojae , Lim Shinn-Won , Moon Young Kyung , Kim Ho , Kim Doh Kwan
Published: October 2020

Background: Dementia is a progressive neurocognitive disease with a substantial social burden. No apparent breakthroughs in treatment options have emerged so far; thus, disease prevention is essential for at-risk populations. Depression and cerebrovascular disease (CVD) are independent risk factors for dementia, but no studies have examined their interaction effect on dementia risk. This study aimed to identify the association of depression and CVD with the risk of dementia and evaluate whether dementia risk among patients with comorbid depression and CVD is higher than the sum of the individual risk due to each condition.Methods: A population-based cohort study was conducted to analyze the Korean National Health Insurance Service-National Sample Cohort data of all individuals over 50 years of age. Individuals who had not been diagnosed with dementia at baseline were included and followed up from January 1, 2005 to December 31, 2013. A time-varying Cox proportional hazard regression model adjusted for potential confounding factors was used for the analysis. The interaction between depression and CVD was estimated based on attributable proportion (AP), relative excess risk due to interaction (RERI), synergy index (SI), and multiplicative-scale interaction.Results: A total of 242,237 participants were included in the analytical sample, of which 12,735 (5.3%) developed dementia. Compared to that for participants without depression or CVD, the adjusted hazard ratio for the incidence of dementia for those with depression alone was 2.35 (95% confidence interval [CI]: 2.21-2.49), CVD alone was 3.25 (95% CI: 3.11-3.39), and comorbid depression and CVD was 5.02 (95% CI: 4.66-5.42). The additive interaction between depression and CVD was statistically significant (AP: 0.08, 95% CI: 0.01-0.16; RERI: 0.42, 95% CI: 0.03-0.82; SI: 1.12, 95% CI: 1.01-1.24). The multiplicative interaction was significant too, but effect was negative (0.66, 95% CI: 0.60-0.73).Conclusions: In this population-based nationwide cohort with long-term follow-up, depression and CVD were associated with an increased risk of dementia, and their coexistence additively increased dementia risk more than the sum of the individual risks.
Coagulation parameters are associated with the prognosis of immunoglobulin A nephropathy: a retrospective study
Authors: Xia Ming , Liu Di , Peng Liang , Li Yan , Liu Haiyang , Wu Lingzhi , Chen Guochun , Liu Yu , Liu Hong
Published: October 2020

Background: Interstitial fibrosis/tubular atrophy (T) score is a known determinant of the progression of immunoglobulin A nephropathy (IgAN). Strong evidence indicates that the components of the coagulation system closely linked with fibrotic events have been highlighted in the kidney. However, whether the coagulation system can affect the renal outcome of IgAN remains unclear. Herein, we investigated the association of coagulation parameters and pathological phenotype of IgAN and their combined effects on the deterioration of renal function. Methods: This retrospective study included N=291 patients with biopsy-proven IgAN from May 2009 to April 2013 in the Second Xiangya Hospital. Clinical data, pathological features were collected, and the associations of coagulation parameters at biopsy, T score, and renal outcome were evaluated. T score indicated the degree of tubular atrophy or interstitial fibrosis. The renal outcome was defined as an end-stage renal disease (ESRD) or an irreversible 50% estimated glomerular filtration rate (eGFR) reduction. Results: Shorter prothrombin time (PT) and the activated partial thromboplastin time (APTT) were significantly associated with T (both p<0.001). PT (<11.15s) or APTT (<29.65s) had worse cumulative survival rate (p=0.008, p=0.027 respectively) and were significantly but not independently associated with a higher risk of renal outcome (p=0.012, p=0.032 respectively). In the combined analyses of PT, APTT, and T lesions, the odd ratios for the outcome were significantly higher in the presence of T with PT (<11.15s) or APTT (<29.65s). Conclusion: Shorter PT and APTT are associated with an increased incidence of the T lesion and are additional factors that portend a poorer prognosis in IgAN. Monitoring coagulation function might be important when assessing the risk of progression. Additional studies exploring the molecular mechanism between coagulation and IgAN pathology are needed.
Education of Pharmacists in Ghana: evolving curriculum, context and practice in the journey from Dispensing Certificate to Doctor of Pharmacy Certificate.
Authors: Koduah Augustina , Kretchy Irene , Sekyi-Brown Reginald , Asiedu-Danso Michelle , Ohene-Agyei Thelma , Duwiejua Mahama
Published: October 2020

Background

Understanding the origin and evolution of education of pharmacists is important for practice and health system reforms. In Ghana, education of pharmacists started in the 1880s with the training of dispensers in a government hospital. Over the years, the curriculum and institutional arrangements changed and currently pharmacists are trained in universities. In this study we explored how and why education of pharmacists evolved in Ghana.

Methods

We used a case study design to systematically describe education of pharmacists reforms. Data was collected from October 2018 and December 2019 through document review and in-depth interviews. The data was analysed based on institutional arrangements and contextual factors influencing reforms from the 1880s through 2012, when the Doctor of pharmacy programme was initiated in Ghana.

Results

Reforms occurred around four main periods when institutional arrangements including the certificate awarded and expected roles were modified by educators and government. These are: (1) the Certificate of dispensing with dispenser-in-training and nurse-dispenser schemes (1880s to 1942), when dispensers were trained to assist doctors in dispensing or directly diagnosing and treating specific disease conditions. (2) the Diploma and Certificate of competency with the dispenser-in-training and pupil pharmacist schemes (1943 to 1960), where in addition to existing roles, pharmacists operated village dispensers. (3) the Bachelor of pharmacy degree (1961 to 2017), when pharmacists were trained mainly as medicines experts with a strong science base on all aspects of medicines from production, distribution and use; and over time with a gradual move to patient-oriented practice. (4) the Doctor of pharmacy degree (2012 to date), where in addition to existing roles, trainees are exposed to advance professional practice experiences. Important factors influencing the reforms included, health systems demands for village dispensaries and clinically oriented pharmacists, and harmonization with regional and international training and practice.

Conclusion

Reasons influencing education of pharmacists reforms are context specific and are driven by historical experiences, national and international expectations as well as educators and regulators abilities to influence change. These reforms call for direct corresponding change in professional practice laws and regulation to enable pharmacists contribute fully to health care delivery in Ghana.
Exploiting an early warning nomogram for predicting the risk of ICU admission in COVID-19 patients: A multi-center study in China
Authors: Zhou Yiwu , He Yanqi , Yang Huan , Yu He , Wang Ting , Chen Zhu , Yao Rong , Liang Zongan
Published: October 2020

Background Novel coronavirus disease 2019 (COVID-19) is a global public health emergency. Here, we developed and validated a practical model based on the data from a multi-center cohort in China for early identification and prediction of which patients will be admitted to the intensive care unit (ICU).Methods Data of 1087 patients with laboratory-confirmed COVID-19 were collected from 49 sites between January 2 and February 28, 2020, in Sichuan and Wuhan. Patients were randomly categorized into the training and validation cohorts (7:3). The least absolute shrinkage and selection operator and logistic regression analyzes were used to develop the nomogram. The performance of the nomogram was evaluated for the C-index, calibration, discrimination, and clinical usefulness. Further, the nomogram was externally validated in a different cohort.Results The individualized prediction nomogram included 6 predictors: age, respiratory rate, systolic blood pressure, smoking status, fever, and chronic kidney disease. The model demonstrated a high discriminative ability in the training cohort (C-index = 0.829), which was confirmed in the external validation cohort (C-index = 0.776). In addition, the calibration plots confirmed good concordance for predicting the risk of ICU admission. Decision curve analysis revealed that the prediction nomogram was clinically useful.Conclusion We established an early prediction model incorporating clinical characteristics that could be quickly obtained on hospital admission, even in community health centers. This model can be conveniently used to predict the individual risk for ICU admission of patients with COVID-19 and optimize the use of limited resources.
A Multi-Method Exploratory Study of Health Professional Students’ Experiences with Compliance Behaviours
Authors: Violato Efrem , King Sharla , Bulut Okan
Published: October 2020

Background: Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students’ perceptions. Methods: To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions. Results: The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings. Conclusions: The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional’s education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.
Nerve growth factor is closely related to glucose metabolism, insulin sensitivity and insulin secretion in the second trimester:a case-control study in Chinese
Authors: Tang Mengyang , Luo Mingjuan , Lu Wenqian , Zhang Rong , Liang Wei , Gu Jianfen , Yu Xuemei , Zhang Xueli , Hu Cheng
Published: October 2020

Objective

Inflammation-related factors have been shown to play a significant role throughout pregnancy. In this study, we aimed to explore the relationships between selected inflammatory cytokines and gestational diabetes (GDM) in Chinese pregnant women.

Design and Methods

This was a 1:1 matched case-control study that included 200 pairs of subjects in the second trimester and 130 pairs of subjects in the third trimester. Serum levels of nerve growth factor (NGF), Interleukin-6 (IL-6), leptin, Interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α) and Interleukin-1beta (IL-1β) were measured by enzyme immunoassay. The associations of these inflammatory factors with metabolic parameters were analysed.

Results

In the second trimester, GDM patients had higher NGF levels and lower IL-8 levels than did normal controls ( P <0.001 and P =0.015, respectively). However, in the third trimester, only lower leptin levels were observed in the GDM group ( P =0.031). Additionally, in the second trimester, NGF levels were not only positively associated with fasting, 1-h and 2-h glucose levels and the area under curve of glucose (AUCG), but also positively related to insulin sensitivity and secretion, as suggested by fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment index of β-cell secretion (HOMA-β) (all P <0.05). Moreover, IL-6 and leptin levels were positively correlated with HOMA-IR and HOMA-β, and TNF-α levels were positively related to HOMA-IR (all P <0.05). Except for the relationships between NGF and HOMA-β and TNF-α and HOMA-IR, the other correlations still existed even after adjusting for confounding factors (all P < 0.05).

Conclusion

In addition to the positive associations of IL-6 and leptin with insulin resistance and secretion, NGF was higher in the GDM patients and strongly linked to glucose metabolism, insulin resistance and pancreatic β cell function in Chinese pregnant women in the second trimester.
A systematically collated library of prescribing safety indicators for people with chronic kidney disease
Authors: Smith Fiona , Hayward Samantha , Hole Barnaby , Kimpton George , Sluman Christine , Whiting Penny , Caskey Fergus
Published: October 2020

Background: People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. Methods: A systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. Results: 9,852 papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%). Conclusion: CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.
Magnetic Resonance Imaging and Dynamic X-ray's correlations with Dynamic Electrophysiological Findings in Cervical Spondylotic Myelopathy: a retrospective cohort study.
Authors: Yu Zhengran , Lin Kaiyuan , Chen Jiacheng , Chen Kuan-Hung , Chen Yuguang , Guo Wei , Dai Yuhu , Zou Xuenong , Peng Xinsheng
Published: October 2020

Background: Dynamic somatosensory evoked potentials (DSSEP) can be used to disclose abnormalities of ascending sensory pathways at dynamic positions and diagnose cervical spondylotic myelopathy (CSM). However, radiographic tests including magnetic resonance imaging (MRI) and dynamic X-ray are used much more widely in the management of CSM. Our study aims to clarify the correlations between several radiographic parameters and the DSSEP results, and further determine their reliability with clinical data.Methods: We retrospectively enrolled 38 CSM patients with surgical intervention. DSSEP tests were performed before surgery. Amplitude ratios of DSSEP N13 and N20 waves at extension and flexion were calculated and recorded as N13_E, N20_E, N13_F, N20_F, respectively. Baseline severity was evaluated with the modified Japanese Orthopedic Association (mJOA) score and the Nurick grades. Prognosis was evaluated based on the 2-year recovery rate. Sagittal diameter and transverse areas of the cord and canal were measured and the the compressive ratios at the compressed site (Compression_Ratio), central (Central_Ratio), and 1/4-lateral points (1/4-Lateral_Compression_Ratio), and spinal cord/Canal Area Ratio were calculated. The intramedullary T2 hyperintensity patterns (Ax-CCM types) were also collected from MRI axial images. Dynamic X-rays were used to test for segmental instability of the cervical spine. The correlations between radiologic findings, DSSEP data, and clinical assessments were investigated.Results: We found that DSSEP N13_E and N13_F correlated with the Compression_Ratio, Central_Ratio, 1/4-Lateral_Compression_Ratio (Pearson, p<0.05) and Ax-CCM types (ANOVA, p<0.05) in MRI axial images and cervical segmental instability in dynamic X-ray (t-test, p<0.05). Apart from the 1/4-Lateral_Compression_Ratio, these radiographic parameters above also correlated with the baseline clinical assessments (Spearman or ANOVA or t-test, p<0.05) and postoperative recovery rate (Pearson or ANOVA or t-test, p<0.05).Conclusions: We found that the preoperative Compression_Ratio, Central_Ratio and 1/4-Lateral_Compression_Ratio in MRI and cervical segmental instability in dynamic X-ray could reflect the dynamic neural dysfunction of the spinal cord. Different Ax-CCM types corresponded to different DSSEP results at extension and flexion, suggesting divergent pathophysiology. These radiographic parameters could help evaluate disease severity and predict postoperative prognosis.
Dietary Fructose and Risk of Metabolic Syndrome in Chinese Residents Aged 45 and above: Results from the China National Nutrition and Health Survey
Authors: pang shaojie , Song Pengkun , Qi Wentao , Yang Chun , Song Ge , Wang Yong , Zhang Jian
Published: October 2020

Background: A growing number of researches supported that dietary fructose was associated with all the key features of metabolic syndrome (MetS). However, there was no related epidemiological studies among Chinese population despite that cases of MetS increased sharply. This study explores the relationship between dietary fructose and MetS among Chinese residents aged 45 and above. Methods: A total of 25528 participants (11574 males and 13954 females) were included in this nationwide representative cross-sectional study of China National Nutrition and Health Survey. Dietary fructose intake was assessed by 3-day 24-h dietary records. MetS was defined by the International Diabetes Federation and Chinese Diabetes Society criteria. Results: The consumption of dietary fructose was 11.6g/day for urban residents and 7.6g/day for rural residents. Fruits and vegetables as well as their products were the main food sources. There was no association between dietary fructose intake and the risk of MetS in both urban (P = 0.315) and rural residents (P = 0.230) after adjustment for confounding factors. Moreover, for urban residents participating physical activities, the risk of MetS in the fourth quartiles (OR: 0.67; 95%CI: 0.52-0.86) was reduced compared with the first quartile. In the sensitivity analysis, a significant reduction in the risk of MetS was also found in the fourth quartiles (OR, 95%CI: 0.67, 0.51-0.89; 0.63, 0.46-0.85; 0.74, 0.56-0.98) compared with the first quartile when excluding smokers, alcohol users, and underweight/obesity, respectively. And there was no association between dietary fructose intake and the risk of MetS after multivariate adjustment stratified by gender, smoking and alcohol use. Conclusions: Under the current dietary fructose intake status, there was no association between dietary fructose intake and the risk of MetS among Chinese residents aged 45 and above. Physical activity and relatively low fructose intake may have a beneficial synergistic effect on MetS.