bluuebunny/crossref_metadata_2025 huggingface dataset:
Ductal Carcinoma in Situ in Ireland, 2008-2020: Screening Data related to Low-Risk Management Trials
Authors: Kelly C , Fitzpatrick P , Quinn C , Flanagan F , Connors A , Larke A , Mooney T , O'Doherty A
Published: October 2021

Background

Four clinical trials are on-going to determine if active surveillance is a feasible management option for patients with low-risk ductal carcinoma in situ (DCIS), in response to concerns that breast cancer screening programmes have increased the incidence of DCIS, some of which may never progress to invasive cancer. This study aimed to describe the epidemiology of screen-detected DCIS in Ireland through the BreastCheck, the national breast screening programme in Ireland (commenced 2000 but fully national since 2008).

Methods

This was a cross-sectional analysis of anonymised BreastCheck data provided by the National Screening Service, including all cases of screen-detected DCIS between 2008 and 2020. Statistical tests included Mann-Whitney U, Chi square, and multivariable logistic regression.

Results

2,240 women were diagnosed with DCIS through BreastCheck between 2008 and 2020 (1353 (60.4%) high-grade and 876 (39.1%) low/intermediate grade). The overall rate of screen-detected DCIS incidence has remained relatively stable during this time. Women with high- grade DCIS were older than women with low/intermediate DCIS (57 (IQR 53-61) years v 56 (IQR 56-61) years; p < 0.001). They were also more likely to have been diagnosed at a subsequent screening episode than at an initial episode (71.0% v 57.5%; p < 0.001). After adjustment (deprivation score, screening unit and year) the odds ratio for high-grade was 1.62 (95% CI 1.30-2.03; p < 0.001) for subsequent compared with initial screening episode.

Conclusions

When trial results are available, these data will assist with service planning should active surveillance be approved as a management option. Based on trial inclusion criteria, up to 40% of women diagnosed with DCIS through BreastCheck may be eligible for consideration for active surveillance. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.

Key messages

Majority of DCIS in national screening programme is high grade. Randomised controlled trial evidence will provide guidance on management of low-risk DCIS.
Prevalence of cognitive impairment before treatments for prostate cancer
Authors: Araujo N , Costa A , Lopes-Conceição L , Ferreira A , Carneiro F , Oliveira J , Morais S , Ruano L , Pereira S , Lunet N
Published: October 2021

Background/Objective

Up to 30% of patients with cancer may present cognitive impairment (CI) before treatment but data are scarce regarding prostate cancer (PCa). We aim to estimate the prevalence of CI in patients with PCa, before cancer treatment.

Methods

Between February 2018 and April 2021, the NEON-PC cohort included 609 patients with a recent PCa diagnosis to be treated at Instituto Português de Oncologia do Porto. Previous history of chemotherapy, radiotherapy, androgen deprivation therapy, and neurologic or psychyatric conditions impairing cognitive performance were exclusion criteria. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance before any treatment for PCa. Participants with a MoCA at least 1.5 SD below age- and education-specific norms were considered to have probable cognitive impairment (PCI) and were proposed for a comprehensive neuropsychological (NP) assessment. Participants scoring <2.0 SD age-corrected norms in at least one cognitive test, or < 1.5 SD age-corrected norms in ≥ 2 cognitive tests were classified as having CI. Data from the population-based cohort EPIPorto (n = 351 men, evaluated in 2013-2015) were used for comparison.

Results/Discussion

Prevalence of PCI was 17.4% in the EPIPorto and 15.1% in the NEON-PC cohort (age- and education-adjusted OR = 1.02,95% confidence interval: 0.70,1.50). NP assessment was performed in 65 patients with PCa: 38.5% had normal cognitive function; 7.7% had a light deficit (<1.0 SD of age-corrected norms in ≥ 1 cognitive tasks); and 53.9% had CI.

Conclusions

PCI was as frequent in patients recently diagnosed with PCa as in the general population. Prevalence of CI was lower than in previous reports, which may be explained by differences in the assessment and definition of CI and of the type of cancer.

Funding

POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017;UIDB/4750/2020; SFRH/BD/119390/2016

Key messages

Patients with prostate cancer and the general population had similar odds of having a score below normative values in the MoCA. Differences in the prevalence of CI between this study and others suggest that the type of cancer may affect patients’ cognitive performance differently, which deserves further confirmation.
Ethnic diversity and mortality in northwestern Burkina Faso: a cohort analysis from 2000 to 2012
Authors: Wasko Z , Dambach P , Kynsat-Wolf G , Steiglbauer G , Zabré P , Bagagnan C H , Schoeps A , Souares A , Winkler V
Published: October 2021

Background

Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established. This study aims to explore the association between ethnic diversity and all-cause mortality.

Methods

We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths for each village was compared to the expected deaths based on the whole HDSS accounting for sex, age, rainy season, calendar year, and village. SMR were calculated on a village level for ethnic diversity (using the Simpson Index), geographical region, wealth, distance to Healthcare Facility (HCF), and religious diversity (Simpson Index). Also, we modeled SMR with a multilevel random intercept Poisson model considering individual ethnic and religious groups in addition to the above-mentioned village-level information.

Results

Village wealth (poorest quintile: SMR 1.07; 95% CI: 1.02-1.13, richest quintile: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and village geographical region showed significant associations with overall mortality. Villages in the high ethnic diversity tertile had a lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the overall HDSS, while those with low diversity yielded an elevated SMR (1.13; 95% CI: 1.09-1.17). The multivariable model including all co-variables confirmed the association.

Conclusions

This study shows a link between ethnic diversity and health. Historically established ethnic diversity in rural areas of Burkina Faso is associated with lower all-cause mortality. A lack of standardization exists in defining and measuring ethnic diversity. More research is needed to understand this relation and to establish it in different settings.

Key messages

Ethnic diversity is potentially linked to health. Further studies in different settings are needed to fully understand the relation between ethnic diversity and health.
Foodborne outbreaks surveillance in hospitals and nursery homes: investigation on catering data
Authors: Iannetti L , Boone I , D'Errico ML , D'Orsi F , Ricchiuti L , Pomilio F , Cornacchia A , Centorotola G , Tucci P
Published: October 2021

Background

Healthcare associated foodborne outbreaks (HA-FBO) can result from exposure to contaminated food in premises where highly vulnerable patients are cared, including hospitals and nursery homes. The probability of developing severe foodborne diseases such as invasive listeriosis is much higher for susceptible populations. There is limited knowledge on the data on food exposures that could be used to investigate HA-FBOs. There is also lack of data relating to specific policies in the health facilities aimed to prevent the administration of potentially risky foods, possibly bringing them from home.

Methods

This study was in the framework of One Health EJP Project NOVA. A semistructured questionnaire was administered to 4 general hospitals, 1 specialist clinic and 3 nursing homes located in the Abruzzo and Molise regions, Italy. The questionnaire included 25 questions in 3 sections (I. General organization of the catering service; II. Food menu data; III. Food from home).

Results

In most facilities (75%) external catering companies used in-house kitchens. Trace-back of food to individual patients was possible in 5 premises out of 8 (62.5%), but only in 1 nursery home out of 3 (33.3%). Data were collected in electronic format (hospitals) or paper (nursery homes) and stored 1-12 months. Food at risk of Listeria monocytogenes were not excluded from the menus, such as pre-sliced cooked meat products (served in 4 out of 8 premises, 50%), smoked fish (20%), soft cheese (20%). The consumption of food brought from home was possible in “special occasions”, mostly in the nursery homes (66.6%).

Conclusions

In case of HA-FBO it could be difficult to trace back the food particularly in the nursery homes where food data are not individually collected and usually on paper. More studies are needed in order to understand the effective exposure to foodborne pathogens, given that some types of foods considered by EFSA as at high risk of microbial contamination are commonly served.

Key messages

Served food could not be traced back to the patient mostly in nursery homes. Foods at risk of Listeria monocytogenes contamination are commonly served to patients and residents.
Is the hospital Safety Walkround effective to control the risk of contagion during COVID-19 pandemic?
Authors: Gintoli I , Boietti E , Bert F , Barbaro S , Corsi D , Griffa D , Rabacchi G , Scarmozzino A , Siliquini R
Published: October 2021

Background

The Safety Walk Round (SWR) is a risk assessment technique designed to decrease adverse events and improve workers attitudes about safety culture through visits and interviews about safety of care. A new field of application could be the safety requirements that hospitals have to guarantee during the Covid-19 pandemic. Our study aimed to investigate the efficacy of SWR on identifying and solving the critical issues that can increase the risk of SARS-CoV-2 infection in three Italian hospitals.

Materials and Methods

The project was developed during the first wave of SARS-Cov-2 pandemic, from May to July 2020, it involved 3 hospitals in Turin: Traumatology and Orthopaedic Centre, Paediatric Hospital Regina Margherita and Sant'Anna Hospital (obstetric and gynaecological hospital). Pre-triage services and outpatient waiting rooms were identified as areas at higher risk of crowding and potential non-compliance with anti-contagion rules. The first round consisted of observations focused on hands sanitation, safety social distance, PPE correct use. Than the workers of the observed areas were interviewed. Thanks their participation, the critical issues about patient safety and the potential resolutions were identified. A second round was realized to verify the implementation of the planned actions and their effectiveness in solving the issues.

Results

A total of 4907 moments were observed and the 9,1% of them was at risk of contagion. During the interviews 23 critical issues and their possible resolutions were identified. A total of 14 critical issues were solved, 4 partially solved and 5 were build environmental problems and cannot be solved. The 77% of total were completely solved, excluding built environment issues.

Conclusions

SWR project was effective in involving health workers in safety promotion activities, sharing informations and improving trust between hospital managers and operators and spreading new skills about safety culture in Covid-19 pandemic contest.

Key messages

SWR was effective in a pandemic context. During the emergency, the front line staff were enthusiastic about the method and felt listened and guided.This has contributed to achieving the aim of safety. The study showed that SWR is a useful tool for hospital infection control. It also showed that the SWR method can be used in a time of constant change that requires adaptability like a pandemic.
Predictive utility of the ages and stages questionnaire for below average cognitive ability at age 5
Authors: Bowe A , Staines A , Murray D
Published: October 2021

Background

The first 1000 days of life are a period of unique sensitivity and plasticity during which critical cognitive abilities are formed. For children at risk of later cognitive difficulties, this period is the ideal target for early intervention initiatives. Routine developmental screening tools aim to identify infants who would benefit from early intervention. While these tools have been validated for detecting children with more severe neurodevelopmental disorders, their ability to identify the larger proportion with below average cognitive ability has not been sufficiently explored. The aim of this study was to examine the predictive utility of the Ages and Stages Questionnaire (ASQ), for identifying children with later below average cognitive function.

Methods

The study population (n = 8260) is formed from two national cohort studies, the Growing Up in Ireland Infant cohort (n = 7,444) and the Cork BASELINE cohort (n = 816). The ASQ was completed at 8- and 24-months respectively. Cognitive assessments were performed at age 5. Those scoring <1 standard deviation below the mean were categorised as below average cognitive ability. Applying the currently used onward referral criterion (one fail in any domain) the sensitivity, specificity, positive and negative predictive values of the 8- and 24-month ASQ for detecting children with later below average cognitive function were calculated.

Results

The sensitivities of the 8-month and 24-month ASQ for detecting children with below average cognitive ability were 16.4% (95% CI 14.0-19.0) and 20.8% (95% CI 13.6-30.2) respectively, with specificity of 92.0% (95% CI 91.3-92.6) and 91.1% (95% CI 88.6-93.2).

Conclusions

The ASQ has a low sensitivity for identifying children with below average cognitive ability at age 5. The findings of this study suggest that if we are to intervene early in the developmental trajectory for children with below average cognitive ability alternative methods of identifying high risk infants are needed.

Key messages

The ages and stages questionnaire, a widely used routine infant developmental screening tool, has a low sensitivity between 16%-21% for detecting later below average cognitive ability. To enable intervention in the first 1000 days of life for children at risk of later below average cognitive ability alternative methods of screening and risk identification require investigation.
Exploring young people's perspectives of inequalities in health: a qualitative study
Authors: Fairbrother H , Crowder M , Dodd-Reynolds C , Egan M , Er V , Goyder E , Griffin N , Holding E , Lock K , Scott S , Summerbell C , Woodrow N
Published: October 2021

Background

Reducing inequalities in health is an enduring global public health challenge. Worryingly in England, inequalities across some groups and places are worsening, highlighted and exacerbated by the Covid-19 pandemic. While there has been growing interest in exploring public understandings of health inequalities, few studies have explored the views of young people. Our study seeks to redress this by exploring young people's perspectives of inequalities in health.

Methods

Working with existing youth organisations, we recruited young people (aged 13-21) from six youth groups in areas of high deprivation across three geographical locations in England. Each group took part in three interlinked focus groups (n = 18), the majority of which were run online using video conferencing platforms. Focus groups were co-delivered with partnering youth organisations during 2021. They involved participatory concept mapping activities, and the discussion of health related news articles.

Results

Key themes emerged around young people's perspectives of: i) factors influencing health within their local area; ii) understandings of inequalities in health; and iii) key messages to convey to those with a role in addressing health inequalities at a place level.

Conclusions

Our study highlights the importance of exploring and understanding young people's perspectives of inequalities in order to better shape policies which are supported by the communities and people they impact.

Key messages

Young people have a nuanced, experiential understanding of key factors influencing their health and inequalities in health within their local areas. Building upon young people’s understandings of inequalities in health provides opportunities to mobilise support for policies seeking to change the distribution of key social determinants.
A complexity science perspective on the impact of adverse socioeconomic conditions on chronic stress
Authors: Crielaard L , Sawyer ADM , Quax R , Nicolaou M , Stronks K
Published: October 2021

Chronic stress increases chronic disease risk and may underlie the association between adverse socioeconomic conditions and adverse health outcomes. The relationship between such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined this relationship from a complexity science perspective. We developed a causal loop diagram to interpret available evidence. Literature evidence was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by 8 independent researchers. Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified 5 feedback loops describing these mechanisms: progressive deterioration of access to coping resources because of repeated insolvability of stressors; perception of stressors as uncontrollable due to learned helplessness; tax on cognitive bandwidth caused by stress; stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; susceptibility to appraising stimuli as stressors against a background of stress. The complexity science perspective revealed that adverse socioeconomic conditions imply recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. Therefore, in order for individual-level psychological interventions to be effective, the context of adverse socioeconomic conditions also needs to be addressed.

Key messages

We examined the mechanisms underlying the relationship between adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops. The complexity science perspective illustrates that interventions are unlikely to be successful if they focus only on individual-level psychological factors.
Mental Health in times of COVID-19: Policy Brief
Authors: Almeida T , Heitor MJ , Santos O , Costa A , Rasga C , Martiniano H , Virgolino A , Fialho M , Vicente AM
Published: October 2021

Issue

The COVID-19 pandemic caused profound disruptive changes worldwide. Mental health (MH) and wellbeing (WB) have been particularly affected, namely with increased levels of anxiety, depression, post-traumatic stress disorder and burnout symptoms. Several factors can have contributed to individuals' vulnerability, including perceived uncertainty, the strict measures adopted, the socioeconomic hardship and the direct effects of the virus. Although the pandemic is primarily a public health and a socioeconomic crisis, it could turn into a serious MH crisis with all the associated implications.

Description

As a Health Observatory, National Institute of Health Doutor Ricardo Jorge, in collaboration with Institute of Environmental Health of Lisbon School of Medicine, and Portuguese Society of Psychiatry and Mental Health, coordinated an observational study to characterize the MH and WB of general population and health professionals residing in Portugal, during pandemic's first wave. Anxiety, depression, post-traumatic stress disorder, burnout and resilience were selected as main outcomes, measured using validated instruments with sound psychometric properties.

Results

High levels of psychological distress were observed among general population and health professionals. Women, younger, individuals with lower income or unemployed, lower educational level and frontline health professionals were most susceptible to psychological suffering. The research team produced a Policy Brief with a set of 14 recommendations for immediate action to ensure equal access to psychological and emotional support for all citizens, to reduce the impact of mental disorders and to promote MH.

Lessons

The mitigation of psychological suffering is of paramount importance, from an equitable perspective focus on identified vulnerable sub-groups. Particular attention should also be given to citizens infected with SARS-CoV-2 and patients with COVID-19, who faced direct consequences of the disease.

Key messages

In a pandemic context, monitorization of population’s mental health is of paramount importance. Health Observatories should have an active and reinforced role in this public health area to mitigate potential negative impacts of pandemics.
Patient-level costs in intensive care: a case report of a standardized and scalable approach
Authors: Bezerra I , Rodrigues M , Sousa EM , Malicia J , Prestes R , Rêgo RC , Mendes A , Sousa A , Nassar Junior AP , Pereira AJ
Published: October 2021

Background

Intensive care units (ICU) costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs (Value-Based Healthcare).

Methods

Case report of a costing methodology implementation, in a 15-bed ICU, in a public, teaching hospital at Teresina/Piauí-Brazil (as part of a broader initiative, with 10 hospitals from all Brazilian regions). All costs incurred during ICU stay were measured from the hospital perspective, applying absorption costing method, by using a standardized approach and a specific central IT system. The study was carried out from Oct/19-Sep/20, including 613 patients, and a team of 10 researchers working with 4 teams of the local hospital (costs, IT, ICU and managers).

Results

ICU fixed costs (personnel, overheads, energy/water, depreciation, non-tracked drugs/medical materials), were divided by service capacity (total bed-hours) for calculation of the costs/minute. Costs were then allocated in the patient level multiplying costs/minute by the ICU length of stay. Variable costs (lab/image tests, transfusions, hemodialysis, and traceable medical materials/drugs) were directly allocated, multiplying the unit cost by the volume consumed per patient. A mini-survey applied 1-year after showed that both cost researchers and hospital staff agreed on the main challenges in measuring patient-level costs (fragmented process; fixed costs available only at the hospital level; lack of control on cost-drivers; indirect costs not considered; any reference for lab/image costs) and that the approach was sufficient to overcome them. The local team also reported increased awareness about the importance of patient-level costs after the experience.

Conclusions

The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.

Key messages

ICU costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs. The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
Klebsiella pneumoniae in vegetable products: antimicrobial resistance and consumer health risk
Authors: Centorotola G , Cornacchia A , Marfoglia C , Saletti MA , Ciarrocchi A , Del Matto I , Galante D , Rodrigues C , Brisse S , Pomilio F
Published: October 2021

Background

Klebsiella pneumoniae (Kp) is considered one of the major causes of human hospital infections. Moreover, Kp is often present in several food products and it could be a potential health hazard for the consumers through the increase of Kp antimicrobial resistance (AMR) to the main routinely used antibiotics classes. The aim of this study was to evaluate the AMR profile of Kp strains isolated from vegetable food products.

Methods

The whole genome sequences of 10 Kp strains, previously isolated from carrots (n. 4), salads (n. 3), tomatoes (n. 2) and pumpkin (n. 1) samples, were obtained by next generation sequencing technique, using Illumina platform. Phenotypic and genotypic AMR profiles, with particular attention to β-lactams, quinolones and aminoglycosides resistances, were acquired by both agar diffusion and micro-dilution susceptibility testing and uploading the Kp sequences to Institut Pasteur platform (https://bigsdb.pasteur.fr/), respectively.

Results

Most of Kp strains (9 of 10) resulted susceptible to the main antibiotics tested and few AMR genes were detected in silico besides the native blaSHV, blaOKP and blaLEN. Only one Kp harboured blaAMPC and blaCMY, showing resistance to 5 β-lactams (amoxicillin/clavulanate, cefoxitin, cefpodoxime, cefpodoxime/clavulanate, ceftobiprole). Regarding the quinolone resistances, all the Kp strains carried gyr and par genes. No aminoglycoside resistance genes were highlighted in the 10 Kp strains studied.

Conclusions

These preliminary results showed the presence, in vegetable foods, mainly in ready to eat raw products, of Kp strains, harbouring no or few AMR genes. Good hygiene practices should be properly applied during the entire food processing chain, to avoid hazardous implications for the consumer. Further studies are needed in order to: analyse more vegetable samples, deeply evaluate the phenotypic and genotypic AMR profile of the Kp strains and their possible transmission from food products to consumer.

Key messages

Klebsiella pneumoniae is often isolated in food, as ready to eat vegetables, and it could be a potential public health risk due to the antimicrobial resistance increase to main antibiotics. The presence of Klebsiella pneumoniae in food implies the correct application of good hygiene practices in the entire food processing chain, in order to avoid dangerous effects for consumers.
Occupational exposure to formaldehyde and oxidative stress in Italian workers
Authors: Squillacioti G , Bellisario V , Ghelli F , Bono R
Published: October 2021

Background

Formaldehyde (FA) is an environmental pollutant widely used in several occupational settings. Beyond its carcinogenic effect, FA can trigger inflammation by promoting reactive oxygen species formation in exposed subjects. The current study aims to investigate the association between air-FA exposure and systemic oxidative stress induction in specific working environments.

Methods

We accounted for three different scenarios of air-FA exposure by including a sample of pathologists and nurses from operating theatres (n = 185), traffic police officers (n = 154) and wood-workers (n = 127), who participated as volunteers. Exposure to air-FA was assessed by passive air-samplers (Radiello®) and oxidative stress was quantified by 15-F2t-IsoP urinary biomarker (ELISA). A piecewise linear regression model was performed to analyse oxidative stress variation in response to air-FA exposure.

Results

Overall, 466 subjects (45 ± 9 years) were included in the study, 53% were females. None significant changes of ln(15-F2t-IsoP) were observed before a specific exposure breakpoint of 4.729 (air-FA = 113 µg/m3). Beyond the breakpoint, ln(15-F2t-IsoP) showed a 1.5 increase (p < 0.0001), independently from age and sex. Interestingly, while age did not affect oxidative stress levels nor before neither beyond the breakpoint, sex determined an increase of ln(15-F2t-IsoP) only before the breakpoint (+0.62, p < 0.0001).

Conclusions

Currently, the most precautionary regulatory limit of air-FA exposure in occupational settings is 0.1 ppm (TLW-TVA, i.e. 120 µg/m3). This limit is recommended to protect for eyes and upper respiratory tract irritation. However, our results highlighted that slightly lower exposures can induce a biological effect, which should deserve consideration from Primary Prevention perspective. Since oxidative stress may evolve in future diseases, it would be advisable considering to tailor the regulatory limits to such a pre-pathological condition rather symptoms onset.

Key messages

Occupational exposure to air-FA is able to induce systemic oxidative stress even below the regulatory limit, independently from age and sex. Future updates of the regulatory limits in force may consider pre-pathological conditions, such as oxidative stress, rather symptoms onset.
Risk Management Assessments of Adverse Drug Reactions: A Systematic Review of the Literature
Authors: Traore B , Tsoumbou-Bakana G , Nani S , Hassoune S
Published: October 2021

Background

Improving the quality of life of patients is a key concern in public health. In the context of improving therapeutic compliance, quality of life of patients undergoing anti-tuberculosis treatment, and prevention of antibiotic resistance, we conducted this systematic review to support risk minimization actions.

Methods

A literature review of risk management strategies targeting adverse drug reactions to anti-tuberculosis drugs was conducted, including published observational studies. Two independent reviewers identified studies through Medline, Scopus, and Web of Science. The methodological quality of the included studies was assessed using criteria defined by the Newcastle Ottawa Scale.

Results

Seven studies were included in this review, which identified four risk management strategies (psychological intervention, reduction of drug dose with or without prescription of adjunctive medications, change of medication, permanent or temporary discontinuation of medication). The strategies adopted were dependent on the nature and severity of the adverse events. All drugs responsible for serious adverse events were changed or discontinued. Three studies had a moderate risk of methodological bias.

Conclusions

Strategies to minimize the risk of adverse drug reactions and improve adherence to therapy have a strong potential to improve adherence to therapy, improve patient quality of life, and reduce antibiotic resistance. However, high-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.

Key messages

Strategies to manage the risk of adverse drug reactions have a strong potential benefit for TB patients on treatment; and improve adherence to treatment. High-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.
How the health-related quality of life in geriatric patients is influenced?
Authors: Nante N , Rivieri C , Cuccaro C , Diodati D , Abinova A , Gentile G
Published: October 2021

Background

Health requires a multi-dimensional approach and not just a cure for illness. Health can be assessed from the point of view of the objective state, but also from its perception which influences the quality of life (QoL). Several tools have been used to measure QoL in many clinical contexts such as five-level EuroQol-5 dimension questionnaire (EQ-5D-5L). The aim of the study is to evaluate the perceived QoL in geriatric patients.

Methods

We conducted a cross-sectional study, using EQ-5D-5L from January to December 2019. EQ-5D-5L was self-administered to a sample of 187 geriatric patients from a private clinical (100 beds). We performed a descriptive and statistical analyses using the five dimensions: mobility (M), self-care (SC), usual activities (UA), pain/discomfort (PD), anxiety/depression (AD) in association with BMI, age, sex, length of stay (LoS). The analyses (Spearman correlation coefficient) was carried out with STATA software.

Results

In our sample the 66,8% was female, the mean age was 78,35 ±10,9, the LoS had an average of 22,37 ± 37,72. Only 170 patients responded to EQ-5D-5L. The mean score of the five dimension of EQ-5D-5L was 3 excepted for the AD that was 2. The mean of EQ index was 0.44 ± 0.29, and it is realted to LoS (p = 0,01; Rho=-0,18). Only UA was associated to BMI (p < 0.05; Rho= -0,21). The age and LoS were associated to M, SC and UA (p < 0,03 Rho<0,25). The gender appeared related to the M (p < 0,02) with a worse perception in the female.

Conclusions

Our sample perceived a low quality of life that appeared to be related to the length of stay. Among the 5 dimensions mobility, self-care and usual activities were more influenced by our variables. A higher BMI doesn't appear as a limit to the habitual daily activities.

Key messages

Health requires a multi-dimensional approach and not just a cure for illness beacause it could influence the quality of life. The length of the stay seems to condition the quality of life of patiens and also a higher BMI seems not impacted the habitual daily activities.
BSAC Vanguard Series: the future of ADVOCACY on AMR
Authors: Osterholm Michael T
Published: October 2021

The COVID public health emergency has brought home how vulnerable we are to forces beyond our control. We are losing our ability to treat infectious diseases for a number of reasons, including antimicrobial resistance (AMR). AMR is a ‘slow-moving’ threat, which makes it harder to recognize and address. The situation has not been helped by the difficulty we have had in seeing the actions and health of everyone on this planet as interconnected. The COVID pandemic has changed this. Despite the dire predictions of the effect of AMR in the future, we still have time to change course. Advocacy by scientists and health professionals is a powerful tool in this process, but there are pitfalls and it must be used wisely. In this article I suggest a number of ways in which this can be achieved.
Predictors of Incident Severe Acute Respiratory Syndrome Coronavirus 2 Positivity in a Veteran Population
Authors: Smith Jeremy , Aboumrad Maya , Reyes Carolina , Satram Sacha , Young-Xu Yinong
Published: October 2021

Objectives

We explored factors related to testing positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) to identify populations most at risk for this airborne pathogen.

Methods

Data were abstracted from the medical record database of the U.S. Department of Veterans Affairs and from public sources. Veterans testing positive were matched in a 1:4 ratio to those at a similar timepoint and local disease burden who remained negative between March 1, 2020, and December 31, 2020. Multivariable logistic regression was used to calculate odds ratios for the association of each potential risk factor with a positive test result.

Results

A total of 24,843 veterans who tested positive for SARS-CoV-2 were matched with 99,324 controls. Cases and controls were similar in age, sex, ethnicity, and rurality, but cases were more likely to be Black, reside in low-income counties, and suffer from dementia. Multivariable analysis demonstrated highest risk for Black veterans, those with dementia or diabetes, and those living in nursing homes or high-poverty areas. Veterans living in counties likely to be more adherent to public health guidelines were at the lowest risk.

Conclusions

Our results are similar to those from studies of other populations and add to that work by accounting for several important proxies for risk. In particular, this work has implications for the value of infection control measures at the population level in helping to stem widespread outbreaks of this type.
Community Benefit Programs
Authors: Seegert Liz
Published: October 2021

Opportunities for nurses to spearhead these initiatives.
EUA for Regen-Cov Now Includes COVID-19 Postexposure Prophylaxis
Authors: Aschenbrenner Diane S.
Published: October 2021

The emergency use authorization for REGEN-COV (a combination of two monoclonal antibodies, casirivimab and imdevimab) has been revised to include postexposure prophylaxis of COVID-19 in adults and children 12 years of age and older who, if they become COVID-19 positive, are at high risk for severe disease.

Prophylaxis with REGEN-COV is not a substitute for vaccination against COVID-19.
New Type 2 Diabetes Drug Aims to Reduce Risk of Diminished Kidney Function and Cardiovascular Complications
Authors: Aschenbrenner Diane S.
Published: October 2021

Finerenone (Kerendia) has been approved to reduce the risk of sustained estimated glomerular filtration rate decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes.
The Flu Pandemic of 1918: A Nurse's Story
Authors: Johnson Deborah
Published: October 2021

In the spring of 1918, a virus swept across the world, killing approximately 50 million people by the summer of 1919. My grandmother, Kathryn (“Katie”) Ann Darmody—an Irish immigrant who settled in New York State in 1904—was among the nurses who responded to this pandemic, which became known as the 1918 influenza pandemic (or, erroneously, the Spanish flu). Today, as the world contends with the COVID-19 pandemic, my grandmother's experiences resonate with new meaning—a reminder of how, then as now, nurses have been at the forefront of public health. Her story, transmitted across generations, is one I now share with a new generation of nurses.
Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review
Authors: Albuquerque Andreia , Stockdale Colleen K. , Heller Debra , Bornstein Jacob , Roberts Jennifer M. , Preti Mario , Poynten I. Mary , Vieira-Baptista Pedro
Published: October 2021

Objectives

Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women.

Materials and Methods

A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC.

Results

The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method.

Conclusions

Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.
Clinical Application of the Musculoperiosteal Iliac Flap for Osteonecrosis of the Femoral Head
Authors: Li Bo-Rui , Qin Kai-Rong , Liu Bao-Yi , Wang Ben-Jie , Qiu Xing , Li Zhi-Gang , Lineaweaver William C. , Zhang Feng , Zhao Dewei
Published: October 2021

Background

Osteonecrosis of the femoral head (ONFH) often affects young, active patients, and the femoral head’s preservation is the primary goal of treatment for this disease. Vascularized iliac crest bone grafting is one of the many vascularized procedures used in treating ONHF. In some cases, we selectively performed this procedure using the musculoperiosteal iliac flap with the ascending branch of the lateral femoral circumflex artery for ONFH treatment.

Methods

Twelve patients (12 hips) with nontraumatic femoral head necrosis underwent musculoperiosteal iliac flap transfer with the ascending branch of the lateral femoral circumflex artery. The Harris Hip Score (HHS), visual analog scale score, and double-hip X-ray findings were used to analyze hip function changes within 10 days preoperatively and 6 and 12 months postoperatively.

Results

The mean HHS increased from 52.33 ± 3.34 preoperatively to 65.92 ± 5.04 6 months postoperatively and 79.75 ± 3.84 12 months postoperatively, and the data showed a statistical significance difference between preoperative and postoperative (F = 131.90, P < 0.01). The HHS at 6 and 12 months after surgery were significantly different (P < 0.01). The visual analog scale score showed the same trend. The x-ray of hip joints at 6 and 12 months after surgery showed that the femoral heads' shape and contour were good, femoral heads did not collapse, and the transferred bone flaps healed well.

Conclusions

Musculoperiosteal iliac flap transfer with the ascending branch of the lateral femoral circumflex artery may be an effective method with a high clinical success rate for treating young patients with early to midstage ONFH.
A Systematic Stepwise Method to Perform a Supermicrosurgical Lymphovenous Anastomosis
Authors: Rodriguez Jose R. , Yamamoto Takumi
Published: October 2021

Background

Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with extremity lymphedema. In this article, we present our current strategy for patient selection, preoperative planning, and a series of intraoperative clues that may help to perform a supermicrosurgical LVA. Technical considerations are presented using a systematic step-by-step method to make this procedure more reproducible and straightforward.

Patients and Methods

We conducted a review of patients operated between January 2015 and June 2018 using the aforementioned approach. Data were collected prospectively, and all procedures were performed by the senior author. Preoperative assessment included lymphoscintigraphy, indocyanine green lymphography, noncontrast magnetic resonance lymphography and high-frequency ultrasonography. Lymphovenous anastomosis was decomposed into a sequential 6-step approach considering the main aspects that determine a successful anastomosis.

Results

Lymphovenous anastomosis was performed in 229 patients, including 677 anastomoses. Median follow-up was 33 months (range, 13–51 months). A median of 3.1 (range, 1–7) LVA were performed on 2.7 (range, 1–6) incision sites per patient. Median time for dissection of lymphatic(s) and vein(s) was 8.7 minutes (1–18 minutes) with a median time of 27.2 minutes (range, 13–51 minutes) for a complete LVA. Lymphatic detection rate was 100% (677 of 677) and vein detection rate was 99.7% (675 of 677), with 31.0% (210 of 677) of reflux-free veins. For upper-extremity lymphedema (47 of 229; 20.6%), volume reduction was achieved in 100% (47 of 47) of the cases, with a median volume reduction rate of 67% (range, 7–93%). In lower-extremity lymphedema (182 of 229; 79.4%), volume reduction was achieved in 86.8% (158 of 182) of the cases, with a median volume reduction rate of 41% (range, 7–81%). Cellulitis episodes decreased from 2.1 to 0.2 episodes/year after LVA (P < 0.05).

Conclusions

Acceptable success rates were obtained using a sequential strategy for planning and execution of supermicrosurgical LVA for secondary extremity lymphedema. We believe including a stepwise approach may help to simplify this procedure, especially for surgeons in their early practice.
Nutritional dependence of sperm mitochondrial metabolism and small RNA biogenesis
Authors: Ramesh Rashmi , Skog Signe , Nätt Daniel , Kugelberg Unn , Örkenby Lovisa , Öst Anita
Published: October 2021

A wide spectrum of exogenous factors, including diet, environmental pollutants, stress, and seasonal changes have major impact on sperm quality and function. The molecular basis, however, that explains this susceptibility remains largely unknown. Using a combination of proteomics and small RNA (sRNA) sequencing, we show thatDrosophilasperm display rapid molecular changes in response to dietary sugar, both in terms of metabolic/redox proteins and sRNA content, particularly miRNA and mitochondria derived sRNA (mt-sRNA). Thus, results from two independent omics point at the dynamics of mitochondria as the central aspect in rapid metabolic adjustments in sperm. Using specific stains andin vivoredox reporter flies, we show that diet indeed rapidly alters the production of mitochondrial derived reactive oxygen species (ROS). Quenching ROS via supplementation of N acetyl cysteine reduces diet-upregulated miRNA, but not mitochondrial-sRNA. Together, these results open new territories in our search for the mechanistic understanding of sperm health and disease.

Highlights

Diet rapidly changes the proteomic and sRNA profiles in sperm

Diet sensitive sperm proteins are found in human infertility studies

Sperm mitochondrial ROS levels are modulated by diet

dme-miR-10 regulation is secondary to diet-induced ROS

Diet, but not diet-induced ROS, alters the expression of mitochondrial small RNA, especially tsRNA
Pre-neoplastic stromal cells drive BRCA1-mediated breast tumorigenesis
Authors: Nee Kevin , Ma Dennis , Nguyen Quy H. , Pervolarakis Nicholas , Insua-Rodríguez Jacob , Pein Maren , Gong Yanwen , Hernandez Grace , Alshetaiwi Hamad , Williams Justice , Rauf Maha , Dave Kushal Rajiv , Boyapati Keerti , Calderon Christian , Markaryan Anush , Edwards Robert , Lin Erin , Parajuli Ritesh , Zhou Peijie , Nie Qing , Shalabi Sundus , LaBarge Mark A. , Kessenbrock Kai
Published: October 2021

Women with germline mutations in BRCA1 (BRCA1+/mut) have increased risk for developing hereditary breast cancer1, 2. Cancer initiation in BRCA1+/mut is associated with pre-malignant changes in the breast epithelium including altered differentiation3–5, proliferative stress6 and genomic instability7. However, the role of the epithelium- associated stromal niche during BRCA1-driven tumor initiation remains unclear. Here, we show that the pre-malignant stromal niche promotes epithelial proliferation and BRCA1- driven cancer initiation in trans. Using single-cell RNAseq (scRNAseq) analysis of human pre-neoplastic BRCA1+/mut and control breast tissues, we show that stromal cells provide numerous pro-proliferative paracrine signals inducing epithelial proliferation. We identify a subpopulation of pre-cancer associated fibroblasts (pre-CAFs) that produces copious amounts of pro-tumorigenic factors including matrix metalloproteinase 3 (MMP3)8, 9, and promotes BRCA1-driven tumorigenesis in vivo. Our gene-signature analysis and mathematical modeling of epithelial differentiation reveals that stromal-induced proliferation leads to the accumulation of luminal progenitor cells with altered differentiation, and thus contributes to increased breast cancer risk in BRCA1+/mut. Our results demonstrate how alterations in cell-cell communication can induce imbalances in epithelial homeostasis ultimately leading to cancer initiation. We anticipate our results to form the foundation for novel disease monitoring and therapeutic strategies to improve patient management in hereditary breast cancer. For example, pre-CAF specific proteins may serve as biomarkers for pre-cancerous disease initiation to inform whether radical bilateral mastectomy is needed. In addition, MMP inhibitors could be re-indicated for primary cancer prevention treatment in women with high-risk BRCA1 mutations.