bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between hepatitis B or hepatitis C virus infection and risk of pancreatic cancer: a systematic review and meta-analysis of cohort studies
Authors: Zhao Jian-Feng , Teng Qiu-Ping , Lv Yang , Li Xiao-Yi , Ding Yi
Published: November 2023

Background and aim:

With conflicting data from previous observational studies on the relationship between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and pancreatic cancer (PC), we decided to conduct a systematic review and meta-analysis in order to evaluate any potential association.

Design:

This is a systematic review and meta-analysis.

Methods:

We conducted a search of three databases (PubMed, Embase, and Web of Science) from the time of their creation up to June 2023. The summary results, including hazard ratio (HR) with 95% confidence interval (CI), were pooled using a generic inverse variance method and a random-effects model. Furthermore, subgroup and sensitivity analyses were conducted.

Results:

In this meta-analysis, 22 cohort studies with a total of 10,572,865 participants were analyzed. Meta-analysis from 15 cohort studies revealed that HBV infection was correlated with an increased risk of PC (HR = 1.53, 95% CI: 1.40–1.68, p < 0.00001) with no heterogeneity ( I2 = 0%, p = 0.49). Meta-analysis from 14 cohort studies showed that HCV infection was associated with an increased risk of PC (HR = 1.82, 95% CI: 1.51–2.21, p < 0.00001). Most of our subgroup analyses yielded similar results. Meta-analysis from four cohort studies indicated that co-infection with HBV and HCV was linked to an increased risk of PC (HR = 2.32, 95% CI: 1.40–3.85, p = 0.001) with no heterogeneity observed ( I2 = 0%, p = 0.60). The results of sensitivity analyses were robust.

Conclusion:

Our meta-analysis showed that HBV/HCV infection or co-infection with HBV and HCV was associated with an increased risk of PC. Future prospective cohort studies need to take into account various ethnicities and any confounding factors, as well as investigate the potential mechanisms of PC development in those with HBV/HCV.

Trial registration:

Open Science Framework registries (No: osf.io/n64ua).
Blood group-specific apheresis in combination with daratumumab as a rescue therapy of acute antibody-mediated rejection in a case of ABO- and human leukocyte antigen-incompatible kidney transplantation
Authors: Süsal Can C , Kraft Leonie , Ender Andrea , Süsal Caner , Schwenger Amelie , Amann Kerstin , Böhmig Georg A , Schwenger Vedat
Published: November 2023

We report a case of antibody-mediated rejection treated with the human CD38 monoclonal antibody daratumumab in a 58-year-old female patient with end-stage kidney disease due to autosomal dominant polycystic kidney disease who received an ABO- and human leukocyte antigen antibody-incompatible living donor kidney transplant. The patient experienced an episode of severe antibody-mediated rejection within the first week of transplantation. Blood-group-antibody selective immunoadsorption in combination with administration of four doses of daratumumab (each 1800 mg s.c.) led to a persistent decrease of ABO- and more interestingly donor-specific human leukocyte antigen antibody reactivity and resulted in clinical and histopathological remission with full recovery of graft function, which has remained stable until post-transplant day 212. This case illustrates the potential of targeting CD38 in antibody-mediated rejection.
LIME-based ensemble machine for predicting performance status of patients with liver cancer
Authors: Nguyen Hung Viet , Byeon Haewon
Published: November 2023

Objective

The Eastern Cooperative Oncology Group performance status (ECOG PS) is a widely recognized measure used to assess the functional abilities of cancer patients and predict their prognosis. It plays a crucial role in guiding treatment decisions made by physicians. This study aimed to build a stacking ensemble-based prognosis predictor model for predicting the ECOG PS of a liver cancer patient undergoing treatment.

Methods

We used Light Gradient Boosting Machine (LightGBM) as the meta-model, and five base models, including Random Forest (RF), Extra Trees (ET), AdaBoost (Ada), Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost). After preprocessing the data and applying feature selection method, the stacking ensemble model was trained using 1622 liver cancer patients’ data and 46 variables. We also integrated the stacking ensemble model with a LIME-based explainable model to obtain model prediction explainability.

Results

According to the research, the best combination of the stacking ensemble model is ET + XGBoost + RF + GBM + Ada + LightGBM and achieved a ROC AUC of 0.9826 on the training set and 0.9675 on the test set.

Conclusions

This explainable stacking ensemble model can become a helpful tool for objectively predicting ECOG PS in liver cancer patients and aiding healthcare practitioners to adapt their treatment approach more effectively.
Opening the digital front door for individuals using long-term in-home ventilation (LIVE) during a pandemic- implementation, feasibility and acceptability
Authors: Amin Reshma , Qazi Adam M , Ambreen Munazzah , Naushad Naqvi , Pizzuti Regina , Buchanan Francine , Gershon Andrea , Rose Louise ,   on behalf of the TtLIVE Group
Published: November 2023

Background

The COVID-19 pandemic led to an unprecedented need for virtual healthcare that was safe, acceptable and feasible to deliver. In May 2020, we launched the Long-term In-Home Ventilator Engagement (LIVE) program for ventilator assisted individuals using ventilators hosted on an e-platform in Ontario, Canada.

Objectives

To assess the acceptability, appropriateness, feasibility and usability of the LIVE program reported by patients, family caregivers, and healthcare providers (HCP).

Design and Methods

We conducted a cross-sectional study. We provided HCPs participating in the LIVE program anonymized questionnaires (Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), Feasibility of Intervention Measure (FIM), and mHealth App Usability (MAUQ). Patients and family caregivers completed the AIM and MAUQ. Questionnaires were administered via an e-platform.

Results

We recruited 105/251 (42%) patients and family caregivers and 42/48 (87.5%) HCPs. Patients and caregivers rated a mean (SD) overall AIM score of 4.3 (0.7) (maximum score 5; higher scores indicate greater acceptability) and a mean (SD) overall MAUQ score of 5.8 (1.5) (maximum score 7; higher scores indicate greater useability). HCPs rated a mean (SD) overall AIM score of 4.3 (0.7), IAM score of 4.3 (0.8), FIM score of 4.2 (0.7) and overall MAUQ score of 5.6 ± 1.5. There were no differences in AIM ((4.3 (0.7) vs 4.3 (0.8), p = 1) or MAUQ (5.8 (1.5) vs 5.6 (1.5), p = 0.5) scores between patients/ family caregivers and HCPs.

Interpretation

This study suggests that the LIVE program was acceptable, appropriate, feasible, and usable from the perspective of patients, family caregivers and HCPs.
Concussion disrupts brain synchrony: Evidence from interactive metronome on young children with persisting symptoms and prolonged recovery post-concussion
Authors: Bonacina Silvia , Kraus Nina , Krizman Jennifer , Farley Jacob , Nicol Trent , LaBella Cynthia R
Published: November 2023

Objective

Concussions cause microstructural damage, which we hypothesize leads to a lack of synchrony in the brain. Interactive Metronome (IM) behaviorally assesses how well an individual can maintain a steady rhythm under both unsupervised (absence of feedback) and supervised (presence of visual feedback) conditions. If concussion causes dyssynchrony, then we predict that children with concussion do worse on IM than healthy children and that the difficulty should be greatest during the unsupervised condition, when the children must self-regulate their rhythm performance.

Setting and Participants

Seventy-four children and adolescents (age range 8–17 years) were assessed on IM across two different tasks (unsupervised – “no feedback” and supervised – “visual feedback”) during a clinic visit after their concussion injury and diagnosis.

Design and Main Measures

We compared the participants with concussion to a healthy control group (N  =  73, age range 15–19 years) with respect to their ability to clap on time with a steady beat using IM, calculated as ms off the beat, separately for the unsupervised and supervised conditions.

Results

Results reveal participants with concussion struggled to maintain a steady rhythm compared to the control group, particularly during the unsupervised condition.

Conclusion

These results support the hypothesis that concussion can give rise to brain dyssynchrony. IM captures this dysfunction and, we suggest rhythmic training has the potential to re-establish synchronization among neural networks that may be compromised after a concussion. Interventional studies are a necessary next step for testing the efficacy of IM training to accelerate concussion recovery.
Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?
Authors: Tsonis Orestis , Gkrozou Fani , Paschopoulos Minas , Pandey Suruchi , Kopeika Julia
Published: November 2023

Fertility preservation techniques, such as cryopreservation of ovarian tissue, embryos, and oocytes, offer hope for future reproduction to individuals facing conditions like cancer or severe haematologic disorders. While the scientific evidence supporting fertility preservation is limited, it shows promise, and there is a growing trend among fertility experts to extend its application to patients with benign conditions that can cause fertility issues, such as endometriosis. Some forms of endometriosis may have a negative impact on fertility, affecting the ovarian reserve, oocyte quality, and the tubo-ovarian interface. Evaluating fertility preservation in endometriosis patients reveals several key considerations. The diverse nature of endometriosis calls for tailored approaches and distinguishing between the disease and treatment effects on ovarian reserve is crucial. Fertility preservation in endometriosis is complex, demanding consideration of disease variability, treatment effects, accurate assessment, and a clear distinction between ovarian reserve and conception ability. A personalised approach is essential for optimal outcomes in this field.
Comparing Factors Influencing Entrepreneurial Self-Efficacy Between Vocational and Academic Post-secondary Students
Authors: Mack Abede , Honig Benson
Published: November 2023

Entrepreneurship promotion continues to be an important domain for economic policy and growth. Closely related to entrepreneurship promotion are the very individuals engaging with entrepreneurship, whose belief and efforts to succeed are highly correlated with their view that they ‘have what it takes”, measured as entrepreneurial self-efficacy (ESE). ESE has thus become a critical factor toward understanding entrepreneurship support. However, most extant scholarship focuses on formal and university education, while little is said about incorporating entrepreneurship and ESE with technical vocational education and training (TVET) to develop entrepreneurs. This is surprising because so many micro and small businesses, particularly trades, are heavily anchored in TVET. This study compares academic and TVET post-secondary students in Trinidad and Tobago to determine the factors that enhance their ESE. Data emerged from three (3) regression models explaining how academic and TVET students’ ESE are correlated with several factors. Parents with a university degree, friends who are entrepreneurs and an extracurricular focus on entrepreneurship were vital factors that saw a positive correlation with ESE among the TVET population. In contrast, academic students are driven primarily by experiences. Full-time work experience and entrepreneurial experiences were significantly correlated with the ESE of academic students. Our work highlights that academic and TVET students’ ESE have different world views that impact education. This study demonstrates the importance of tailoring entrepreneurial learning for TVET students by linking ESE with cultural capital theory. We found that when teaching academic students entrepreneurship, more emphasis should be placed on experiential learning. Our research provides empirical findings we believe to be both unique and highly relevant to the literature of entrepreneurship education.
Associations Between Epigenetic Age Acceleration and microRNA Expression Among U.S. Firefighters
Authors: Jung Alesia M , Furlong Melissa A , Goodrich Jaclyn M , Cardenas Andres , Beitel Shawn C , Littau Sally R , Caban-Martinez Alberto J , Gulotta John J , Wallentine Darin D , Urwin Derek , Gabriel Jamie , Hughes Jeffrey , Graber Judith M , Grant Casey , Burgess Jefferey L
Published: November 2023

Epigenetic changes may be biomarkers of health. Epigenetic age acceleration (EAA), the discrepancy between epigenetic age measured via epigenetic clocks and chronological age, is associated with morbidity and mortality. However, the intersection of epigenetic clocks with microRNAs (miRNAs) and corresponding miRNA-based health implications have not been evaluated. We analyzed DNA methylation and miRNA profiles from blood sampled among 332 individuals enrolled across 2 U.S.-based firefighter occupational studies (2015-2018 and 2018-2020). We considered 7 measures of EAA in leukocytes (PhenoAge, GrimAge, Horvath, skin-blood, and Hannum epigenetic clocks, and extrinsic and intrinsic epigenetic age acceleration). We identified miRNAs associated with EAA using individual linear regression models, adjusted for sex, race/ethnicity, chronological age, and cell type estimates, and investigated downstream effects of associated miRNAs with miRNA enrichment analyses and genomic annotations. On average, participants were 38 years old, 88% male, and 75% non-Hispanic white. We identified 183 of 798 miRNAs associated with EAA (FDR q < 0.05); 126 with PhenoAge, 59 with GrimAge, 1 with Horvath, and 1 with the skin-blood clock. Among miRNAs associated with Horvath and GrimAge, there were 61 significantly enriched disease annotations including age-related metabolic and cardiovascular conditions and several cancers. Enriched pathways included those related to proteins and protein modification. We identified miRNAs associated with EAA of multiple epigenetic clocks. PhenoAge had more associations with individual miRNAs, but GrimAge and Horvath had greater implications for miRNA-associated pathways. Understanding the relationship between these epigenetic markers could contribute to our understanding of the molecular underpinnings of aging and aging-related diseases.
One-year prospective real-world assessment of effectiveness and safety of erenumab in migraine prevention: results of the French FHU INOVPAIN registry study
Authors: Lanteri-Minet M. , Fabre R. , Martin C. , Pradat K. , Alchaar A. , Bozzolo E. , Duchene M. L. , Van Obberghen E. K. , Donnet A. , Fontaine D.
Published: November 2023

Background

Randomized clinical trials have demonstrated efficacy and safety of erenumab. The aim of this study is to evaluate the effectiveness and safety of erenumab in a real-world setting in French patients with migraine associated with extreme unmet needs.

Methods

This is a one year-prospective real-word study with enrolment of all consecutive adult patients included in the FHU InovPain registry who participated in a compassionate erenumab use program.

Results

Of 144 patients included, 140 patients (82.1% female / mean age of 50.9 ± 11.4) received at least one dose of erenumab and were concerned by effectiveness and safety assessment. All patients had failed 11 oral preventive treatments. Most of them suffered from chronic migraine (88.6%) and presented a medication overuse (90.7%) at baseline. Thirty-eight (27.1%) discontinued treatment during the 12-month follow-up, with 22 (15.7%), 11 (7.9%) and 5 (3.6%) patients before 3, 6 or 9 months of treatment. The proportion of ≥ 50% responders at M3, M6, M9 and M12 was 74/140 (52.9%), 69/118 (58.5%), 61/107 (57.0%) and 60/102 (58.8%) respectively. At M3, the rate of reversion from chronic migraine to episodic migraine was 57.3% and the rate of transition from medication overuse to non-overuse was 46.5%. For monthly migraine days, the median (IQR) was 18.0 (13.0–26.0), 9.0 (5.0–17.0), 7.5 (5.0–14.0), 8.0 (5.0–12.5) and 8.0 (5.0–12.0) at M0, M3, M6, M9 and M12 respectively. For HIT-6 score, the median (IQR) was 68.0 (63.8–73.3), 60.0 (54.0–65.0), 60.0 (50.3–53.0), 59.0 (50.0–63.0) and 58.0 (50.0–62.9) at M0, M3, M6, M9 and M12 respectively. Fifty-three (37.9%) patients reported at least one of the following adverse events: cutaneous erythema and/or pain at the injection site for 42 (30%) patients, constipation for 22 (15.7%) patients, muscle spasm for 2 (1.4%) patients, alopecia for one (0.7%) patient and blood pressure increase in one (0.7%) patient. There was no serious adverse event. One female patient became pregnant after 5 months of exposure to erenumab with a safe evolution after treatment discontinuation.

Conclusion

This first French real-world study related to migraine prevention with CGRP-mAbs confirms effectiveness and safety of erenumab in patients with extreme unmet needs.
Management of links of interest in European Union expertise authorities dealing with plant protection products: comparative analysis and recommendations
Authors: Karr Guillaume , Prete Giovanni , Duboc Soraya , Zmirou-Navier Denis
Published: November 2023

Background

To ensure a high level of public health and environmental protection, authorities that deliver scientific expertise to inform decision-makers and the public at large need to be independent from external stakeholders and free of conflicts of interest. This independence requires effective rules for managing links of interest (LoIs) and a high level of transparency, including publication of declarations of interest (DoIs) where appropriate. In the particular case of plant protection products (PPPs) within the European Union, these requirements should apply to all Competent Authorities contributing to the marketing authorization processes.

Methods

A comparative analysis of LoIs management procedures was performed on a selection of ten National Competent Authorities from different member states (NCAs). This analysis was based on (i) the identification of 17 criteria aiming at characterizing good practices for LoIs management; (ii) a survey of ten NCAs, based on an analysis of their institutional websites and their responses to official mail requests.

Results

The comparative analysis showed: (i) a frequent lack of transparency of NCAs regarding their procedures for managing LoIs; (ii) a significant heterogeneity between the NCAs’ LoIs management rules, even though they are in charge of comparable missions regarding the marketing of PPPs; (iii) substantial gaps between the LoIs management procedures adopted by several NCAs and the good practices that are promoted by EFSA.

Current limits on their practices regarding LoIs management might open ways for undue external influences on scientific expertise, and ultimately impact negatively the risk management options adopted by national or European authorities. Limitations of this study and its extension for a more thorough overview of the current LoIs management practices are also discussed.

Conclusions

LoIs management and transparency rules need to be improved across NCAs, given their contribution as (co-)rapporteurs or peer reviews participants to the health and environmental risk assessment steps of the EFSA processes. To this end, a common minimum set of rules should be defined by EFSA; recommendations are proposed, based on the best practices implemented by the investigated NCAs. Such progress would contribute promoting high-quality unbiased scientific expertise and enhance EU citizens’ trust.
Emerin deficiency does not exacerbate cardiomyopathy in a murine model of Emery–Dreifuss muscular dystrophy caused by an LMNA gene mutation
Authors: Wada Eiji , Matsumoto Kohei , Susumu Nao , Kato Megumi , Hayashi Yukiko K.
Published: November 2023

Emery–Dreifuss muscular dystrophy (EDMD), caused by mutations in genes encoding nuclear envelope proteins, is clinically characterized by muscular dystrophy, early joint contracture, and life-threatening cardiac abnormalities. To elucidate the pathophysiological mechanisms underlying striated muscle involvement in EDMD, we previously established a murine model with mutations in Emd and Lmna (Emd−/−/LmnaH222P/H222P; EH), and reported exacerbated skeletal muscle phenotypes and no notable cardiac phenotypes at 12 weeks of age. We predicted that lack of emerin in LmnaH222P/H222P mice causes an earlier onset and more pronounced cardiac dysfunction at later stages. In this study, cardiac abnormalities of EDMD mice were compared at 18 and 30 weeks of age. Contrary to our expectations, physiological and histological analyses indicated that emerin deficiency causes no prominent differences of cardiac involvement in LmnaH222P/H222P mice. These results suggest that emerin does not contribute to cardiomyopathy progression in LmnaH222P/H222P mice.
Molecular characterization and phylogenetic analysis of the first Corynebacterium rouxii strains isolated in Brazil: a recent member of Corynebacterium diphtheriae complex
Authors: Ramos Juliana Nunes , Araújo Max Roberto Batista , Baio Paulo Victor Pereira , Sant’Anna Lincoln Oliveira , Veras João Flávio Carneiro , Vieira Érica Miranda Damásio , Sousa Mireille Ângela Bernardes , Camargo Carlos Henrique , Sacchi Cláudio Tavares , Campos Karoline Rodrigues , Santos Marlon Benedito Nascimento , Bokermann Sérgio , Alvim Luige Biciati , Sanches dos Santos Louisy , de Mattos-Guaraldi Ana Luiza , Vieira Verônica Viana
Published: November 2023

Background

Corynebacterium diphtheriae complex was formed by the species C. diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis in the recent past. In addition to C. diphtheriae, C. ulcerans and C. pseudotuberculosis species can carry the tox gene, which encodes diphtheria toxin. Currently, three new species have been included in the complex: Corynebacterium rouxii, Corynebacterium silvaticum, and Corynebacterium belfantii. C. rouxii is derived from the ancient Belfanti biovar of C. diptheriae. We provide the complete genome sequences of two non-toxigenic strains C. rouxii isolated from a cat with a purulent infection in Brazil. The taxonomic status and sequence type, as well as the presence of resistance and virulence genes, and CRISPR-Cas system were additionally defined.

Results

The genomes showed an average size of 2.4 Mb and 53.2% GC content, similar to the type strain of the species deposited in Genbank/NCBI. Strains were identified as C. rouxii by the rMLST database, with 95% identity. ANI and DDH in silico were consistent with values above the proposed cut-off points for species limit, corroborating the identification of the strains as C. rouxii. MLST analyses revealed a new ST, which differs from ST-537 only by the fusA allele. No horizontal transfer resistance gene was predicted in both genomes and no mutation was detected in the constitutive genes gyrA and rpoB. Some mutations were found in the seven penicillin-binding proteins (PBPs) detected. The tox gene was not found, but its regulatory gene dtxR was present. Among the predicted virulence genes are those involved in iron uptake and adherence, in addition to the DIP0733 protein involved in epithelial cell adhesion and invasion. The CRISPR-Cas type I-E system was detected in both genomes, with 16 spacer sequences each. Of them, half are unknown according to the databases used, indicating that there is an unexplored reservoir of corynebacteriophages and plasmids.

Conclusions

This is the first genomic study of C. rouxii reported in Brazil. Here we performed taxonomic analysis and the prediction of virulence factors. The genomic analyses performed in this study may help to understand the potential pathogenesis of non-toxigenic C. rouxii strains.
Effect of SGLT-2 inhibitor, dapagliflozin, on left ventricular remodeling in patients with type 2 diabetes and HFrEF
Authors: Fu Qianyu , Zhou Longhua , Fan Yuqin , Liu Fenfen , Fan Yuanyuan , Zhang Xin , Wang Li , Cheng Lan
Published: November 2023

The current study evaluated the effect of SGLT-2 inhibitor, dapagliflozin, on left ventricular remodeling in patients with type 2 diabetes and HFrEF. 60 patients were randomized (1:1) to receive dapagliflozin 10 mg once daily, or placebo double blind for 1 year. Patients underwent transthoracic echocardiography and doppler evaluation prior to dapagliflozin initiation and at 1 year. At 1year, adjusted mean difference versus placebo in change from baseline in LVEF was 2.5% (95% CI: 1.00–4.06, P = 0.002). Adjusted mean difference versus placebo in change from baseline in LVED volume was − 6.0ml (95% CI: -8.07 -−3.87, P<0.001). Adjusted mean difference versus placebo in change from baseline in LVES volume was − 8.1ml (95% CI: -11.07 -−5.14, P<0.001). Similarly, adjusted mean difference versus placebo in change from baseline in LVED diameter was − 1.6 mm (95% CI: -2.67 -−0.62, P = 0.002). Adjusted mean difference versus placebo in change from baseline in VTI was 0.20 cm (95% CI: 0.01–0.38, P = 0.036). Dapagliflozin was well tolerated. Dapagliflozin was associated with significant and clinically meaningful improvement in echocardiographic parameters versus placebo in patients with type 2 diabetes and HFrEF.

Registration number and date: ChiCTR2300072707, 21/06/2023.
Pertrochanteric hip fracture is associated with mobility decline and poorer physical performance 4 to 6 months post-hip fracture
Authors: Kujala Minna A. , Hongisto Markus T. , Luukkaala Tiina , Stenholm Sari , Nuotio Maria S.
Published: November 2023

Background

To study the effect of hip fracture type on physical performance, functional ability and change in mobility four to six months after the injury.

Methods

A total of 1331 patients out of consecutive 2052 patients aged ≥ 65 years who underwent hip fracture surgery were included in the study. Patient information was collected on admission, during hospitalization, by phone interview and at the geriatric outpatient clinic 4 to 6 months after the fracture. Of the 1331 eligible patients, Grip strength, Timed Up and Go -test (TUG), Elderly Mobility Scale (EMS), mobility change compared to pre-fracture mobility level, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) were used to determine physical performance and functional ability. Logistic regression was used for the analyses which was adjusted for gender, age, American Society of Anesthesiologists score, diagnosis of cognitive disorder, pre-fracture living arrangements, mobility and need of mobility aid.

Results

Patients with pertrochanteric hip fracture had an EMS lower than 14 (Odds Ratio (OR) 1.38, 95% confidence intervals (CI) 1.00–1.90), TUG time ≥ 20 s (OR 1.69, 95% CI 1.22–2.33) and they had declined in mobility (OR 1.58, 95% CI 1.20–2.09) compared to femoral neck fracture patients 4 to 6 months post-hip fracture in multivariable-adjusted logistic regression analyses. Grip strength and functional ability (IADL, BADL) 4 to 6 months after hip fracture did not differ between fracture types. There were no statistically significant differences in physical performance in patients with a subtrochanteric fracture compared to patients with a femoral neck fracture.

Conclusions

Pertrochanteric hip fracture independently associated with poorer physical performance 4 to 6 months post hip fracture compared to other hip fracture types. Pertrochanteric hip fracture patients should be given special attention in terms of regaining their previous level of mobility.
Biomarkers for distinguishing tuberculous pleural effusion from non-tuberculosis effusion: a retrospective study
Authors: Fei Guo , Yijun Mo , Weijiang Jin , Huimin Chen , Fang Liu
Published: November 2023

Background

Pleural effusion (PE) is a common clinical feature that presents a diagnostic challenge for clinicians. In this retrospective study, we aimed to assess the biomarkers, ratios, and multiple indicators in serum and Pleural effusion for the differential diagnosis of tuberculous pleural effusion (TPE) from non-tuberculosis effusion (non-TPE).

Methods

The participants, who were divided into two groups: TPE and non-TPE (MPE and PPE), from Ningbo First Hospital, were incorporated in this study. The clinical and laboratory features were collected and analyzed using logistic regression analysis. Twelve biomarkers and their ratios in serum and PE were investigated for TPE versus non-TPE. Additionally, the value of multiple indicators for joint diagnosis was estimated.

Results

Biomarkers and ratios showed good diagnostic performance. The five variables including Serum ADA, IGRA, Effusion ADA, Effusion ADA/Serum ADA and Effusion LDH/Effusion ADA were identified as valuable parameters for differential diagnosis of TPE from non-TPE. The combined diagnosis of the five indexes yielded the highest diagnostic accuracy for TPE with an AUC (0.919), sensitivity (90.30%), and specificity (94.50%).

Conclusions

The biomarkers and ratios demonstrated strong diagnostic performance, and the utilization of multiple indicators for joint diagnosis can improve the diagnostic efficacy of tuberculous pleurisy.
The impact of anxiety, depression, and social support on the relationship between HIV-related stigma and mental health-related quality of life among Chinese patients: a cross-sectional, moderate-mediation study
Authors: Zhang Yushu , Chai Chengliang , Xiong Jianjing , Zhang Lin , Zheng Jinlei , Ning Zhen , Wang Ying
Published: November 2023

Background/objective

People living with HIV (PLWH) are prone to mental health problems and evidence indicates that HIV-related stigma can negatively impact mental health-related quality of life. This study explored potential mechanisms between HIV-related stigma and mental health-related quality of life, specifically whether anxiety or depression mediates, and whether social support moderates, the relationship.

Method

A total of 1197 Chinese PLWH participated in the study. The Berger HIV Stigma Scale, the Hospital Anxiety and Depression Scale (HADS), the 12-item Brief Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) were employed.

Results

HIV-related stigma was negatively associated with mental health-related quality of life. Anxiety and depression partially mediated the relationship between HIV-related stigma and mental health-related quality of life; social support played a moderating role.

Conclusions

The mental health-related quality of life in PLWH was shown to be indirectly affected by HIV-related stigma through anxiety and depression in China. The negative impact of HIV-related stigma decreased with increased social support.
Diagnostic value of niacin skin blunting response in adolescent patients with depression
Authors: Nianhong Shen , Pan Liu , Caijun Li , Hongying Ye , You Sun , Jie Chang , Jinquan Zhou , Yunshan Zhou , Donghu Wang , Mingchao Yu , Chengbing Huang , Xueyuan Hou
Published: November 2023

Objective

To investigate the differences in the niacin skin flushing response of adolescent depressed patients and healthy adolescents and its diagnostic value in adolescent depression.

Methods

Thirty-eight cases of acute episodes of depression in unmedicated adolescents and 47 age- and sex-matched healthy controls were included as study subjects, and sociodemographic and clinical data were collected, all of which were stimulated with six concentration gradients (up to 60 mmol/L, followed by sequential 3-fold gradient dilution to a minimum of 0.25 mmol/L) of niacin solution on the forearm skin, and the skin flushing area was applied as an assessment index.

Results

The total area of redness of the skin in response to niacin was significantly lower in the adolescent depression group than in the healthy adolescent group (Z=-3.36, p = 0.001) and was able to distinguish the adolescent depression group from the healthy adolescent group (area under curve = 0.713, sensitivity 51.1%, specificity 83.2%).

Conclusions

Niacin sensitivity is reduced in adolescent depressed patients, and the niacin skin flush response has potential clinical value as a diagnostic biomarker for adolescent depression.
Disease awareness and healthcare utilization in rural South Africa: a comparative analysis of HIV and diabetes in the HAALSI cohort
Authors: Beidelman Erika T. , Bärnighausen Till , Wing Coady , Tollman Stephen , Phillips Meredith L. , Rosenberg Molly
Published: November 2023

Background

Studies from rural South Africa indicate that people living with HIV (PLHIV) may have better health outcomes than those without, potentially due to the frequent healthcare visits necessitated by infection. Here, we examined the association between HIV status and healthcare utilization, using diabetes as an illustrative comparator of another high-burden, healthcare-intensive disease.

Methods

Our exposure of interest was awareness of positive disease status for both HIV and diabetes. We identified 742 individuals who were HIV-positive and aware of their status and 305 who had diabetes and were aware of their status. HIV-positive status was further grouped by viral suppression. For each disease, we estimated the association with (1) other comorbid, chronic conditions, (2) health facility visits, (3) household-level healthcare expenditure, and (4) per-visit healthcare expenditure. We used log-binomial regression models to estimate prevalence ratios for co-morbid chronic conditions. Linear regression models were used for all other outcomes.

Results

Virally suppressed PLHIV had decreased prevalence of chronic conditions, increased public clinic visits [β = 0.59, 95% CI: 0.5, 0.7], and reduced per-visit private clinic spending [β = -60, 95% CI: -83, -6] compared to those without HIV. No differences were observed in hospitalizations and per-visit spending at hospitals and public clinics between virally suppressed PLHIV and non-PLHIV. Conversely, diabetic individuals had increased prevalence of chronic conditions, increased visits across facility types, increased household-level expenditures (β = 88 R, 95% CI: 29, 154), per-visit hospital spending (β = 54 R, 95% CI: 7, 155), and per-visit public clinic spending (β = 31 R, 95% CI: 2, 74) compared to those without diabetes.

Conclusions

Our results suggest that older adult PLHIV may visit public clinics more often than their HIV-negative counterparts but spend similarly on a per-visit basis. This provides preliminary evidence that the positive health outcomes observed among PLHIV in rural South Africa may be explained by different healthcare engagement patterns. Through our illustrative comparison between PLHIV and diabetics, we show that shifting disease burdens towards chronic and historically underfunded diseases, like diabetes, may be changing the landscape of health expenditure inequities.
Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample
Authors: Virtanen Lotta , Kaihlanen Anu-Marja , Saukkonen Petra , Reponen Jarmo , Lääveri Tinja , Vehko Tuulikki , Saastamoinen Peppiina , Viitanen Johanna , Heponiemi Tarja
Published: November 2023

Background

Physicians’ work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations.

Methods

We used representative survey data on Finnish physicians’ (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions.

Results

Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1–5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16–.30]), facilitates access to patient information (b = .15 [.07–.23]), and supports decision-making (b = .11 [.05–.18]). Disagreement with accelerated clinical encounters (b = .12 [.04–.20]), and agreements with patients’ more active role in care (b = .11 [.04–.19]) and interprofessional collaboration (b = .10 [.02–.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06–1.48]) and agreeing with patients’ active role (OR = 1.19 [1.02–1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure.

Conclusions

Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians’ satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.
Defining the content of a website on advance care planning in dementia: a focus group study with family and health professionals
Authors: Dupont Charlèss , Smets Tinne , Monnet Fanny , Pivodic Lara , De Vleminck Aline , Van Audenhove Chantal , Van den Block Lieve
Published: November 2023

Background

Advance care planning (ACP) is a process that enables individuals to define goals and preferences for their future care. It is particularly relevant for people with dementia and their family. Interactive tools, such as websites, that encourage reflection, communication and/or documentation, may support this group in the ACP process. However, considering the specific needs of people with dementia, it is important to develop adapted tools for this population. This study was conducted to define the content of an interactive website for people with dementia and their family caregivers to support them in ACP and to assess the barriers and facilitators for potential users in finding and using such a website from the perspective of family caregivers and healthcare professionals.

Methods

Online focus groups with family caregivers (serving both as potential users and proxies for people with dementia) and healthcare professionals caring for people with dementia, using a semi-structured topic guide. To analyse the data, we used thematic framework analysis with a combination of deductive and inductive approaches to coding.

Results

We conducted 4 focus groups with family caregivers of people with dementia (n = 18) and 3 with healthcare professionals (n = 17). Regarding the content of the website, participants highlighted that information on ACP (what and why) and guidance on how to start talking about ACP throughout the dementia trajectory should be included on the website. To increase the usability of the website, most participants considered a text-to-speech and a print option as important functionalities. A lack of computer literacy was found to be the most significant barrier to finding and using the website.

Conclusion

A website for people with dementia and their family caregivers to support them in ACP should focus on comprehensive content on ACP, peer testimonials, and interactive communication tools. Moreover, there should be certain flexibility in navigating through the website so people with dementia and their family caregivers can use it at their own pace. As the next step, we will include people with dementia in developing the website.
Bullying behaviors and intention to drop-out among nursing students: the mediation roles of sense of belonging and major satisfaction
Authors: Sharif-Nia Hamid , Marôco João , Rahmatpour Pardis , Allen Kelly A. , Kaveh Omolhoda , Hoseinzadeh Esmaeil
Published: November 2023

Bullying in academic settings has long-lasting implications on students’ well-being and career prospects, particularly in fields like nursing that require a high level of interpersonal skills and emotional resilience. This study explored the relationships between experiences of bullying and intentions to drop out among Iranian nursing students, with major satisfaction and a sense of belonging serving as mediating factors. A cross-sectional research design was employed from April to June 2023. Undergraduate nursing students (n = 386) filled out a five-part questionnaire namely demographic and educational information, bullying behaviors in nursing education environments, the Belongingness scale, intention to drop out, and academic major satisfaction scale. The study confirmed that experiences of bullying positively correlated with intentions to drop out, negatively affected students’ sense of belonging and major satisfaction, and established that course satisfaction and a sense of belonging acted as mediators between bullying and intentions to drop out. The findings show the urgent need for anti-bullying interventions targeting faculty behavior and educational strategies aimed at fostering a sense of belonging and course satisfaction among nursing students.
Team experiences of the root cause analysis process after a sentinel event: a qualitative case study
Authors: Liepelt Silje , Sundal Hildegunn , Kirchhoff Ralf
Published: November 2023

Background

Root cause analysis (RCA) is a systematic approach, typically involving several stages, used in healthcare to identify the underlying causes of a medical error or sentinel event. This study focuses on how members of a Norwegian RCA team experience aspects of an RCA process and whether it complies with the Norwegian RCA method.

Method

Based on a sentinel event in which a child died unexpectedly during childbirth in a Norwegian hospital in 2021, the following research questions are addressed: 1. What was the RCA team’s experience of the RCA process? 2. Was there compliance with the Norwegian RCA method in this case? A case study was chosen out of the desire to understand complex social phenomena and to allow in-depth focus on a case.

Results

The result covered three main themes. The first theme related to the hospital’s management system and aspects of the case that made it challenging to follow all recommendations in the Norwegian RCA guidelines. The second theme encompassed external and internal assessment. The RCA team was composed of members with methodological and medical expertise. However, the police’s involvement in the case made it complex for the team to carry out the process. The third and final theme covered intrapersonal challenges RCA team members faced. Team members experienced various challenges during the RCA process, including being neutral, dealing with role-related challenges, grappling with ambivalence, and managing the additional time burden and resource constraints. As anticipated in the RCA guidelines, the team’s ability to remain neutral was tested.

Conclusion

The findings of this study can help stakeholders better comprehend how an inter-professional RCA teamwork intervention can affect a healthcare organization and enhance the teamwork experience of healthcare staff while facilitating improvements in work processes and patient safety. Additionally, these results can guide stakeholders in creating, executing, utilizing, and educating others about RCA processes.
Impact of vaccination against severe COVID-19 in the French population aged 50 years and above: a retrospective population-based study
Authors: Tan-Lhernould Laetitia , Tamandjou Cynthia , Deschamps Guilhem , Platon Johnny , Sommen Cécile , Chereau Fanny , Parent du Châtelet Isabelle , Cauchemez Simon , Vaux Sophie , Paireau Juliette
Published: November 2023

Background

Given the widespread implementation of COVID-19 vaccination to mitigate the pandemic from the end of 2020, it is important to retrospectively evaluate its impact, in particular by quantifying the number of severe outcomes prevented through vaccination.

Methods

We estimated the number of hospitalizations, intensive care unit (ICU) admissions and deaths directly averted by vaccination in France, in people aged ≥ 50 years, from December 2020 to March 2022, based on (1) the number of observed events, (2) vaccination coverage, and (3) vaccine effectiveness. We accounted for the effect of primary vaccination and the first booster dose, the circulating variants, the age groups, and the waning of vaccine-induced protection over time.

Results

An estimated 480,150 (95% CI: 260,072–582,516) hospitalizations, 132,156 (50,409–157,767) ICU admissions and 125,376 (53,792–152,037) deaths were directly averted by vaccination in people aged ≥ 50 years, which corresponds to a reduction of 63.2% (48.2–67.6), 68.7% (45.6–72.4) and 62.7% (41.9–67.1) respectively, compared to what would have been expected without vaccination over the study period. An estimated 5852 (2285–6853) deaths were directly averted among the 50–59 years old, 16,837 (6568–19,473) among the 60–69 years old, 32,136 (13,651–36,758) among the 70–79 years old and 70,551 (31,288–88,953) among the ≥ 80 years old.

Conclusions

The vaccination campaign in France considerably reduced COVID-19 morbidity and mortality, as well as stress on the healthcare system.
Association between triglyceride-glucose index and in-hospital mortality in critically ill patients with sepsis: analysis of the MIMIC-IV database
Authors: Zheng Rui , Qian Songzan , Shi Yiyi , Lou Chen , Xu Honglei , Pan Jingye
Published: November 2023

Background

This study aimed to explore the association between the triglyceride-glucose (TyG) index and the risk of in-hospital mortality in critically ill patients with sepsis.

Methods

This was a retrospective observational cohort study and data were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC IV2.2) database. The participants were grouped into three groups according to the TyG index tertiles. The primary outcome was in-hospital all-cause mortality. Multivariable logistics proportional regression analysis and restricted cubic spline regression was used to evaluate the association between the TyG index and in-hospital mortality in patients with sepsis. In sensitivity analysis, the feature importance of the TyG index was initially determined using machine learning algorithms and subgroup analysis based on different subgroups was also performed.

Results

1,257 patients (56.88% men) were included in the study. The in-hospital, 28-day and intensive care unit (ICU) mortality were 21.40%, 26.17%, and 15.43% respectively. Multivariate logistics regression analysis showed that the TyG index was independently associated with an elevated risk of in-hospital mortality (OR 1.440 [95% CI 1.106–1.875]; P = 0.00673), 28-day mortality (OR 1.391; [95% CI 1.52–1.678]; P = 0.01414) and ICU mortality (OR 1.597; [95% CI 1.188–2.147]; P = 0.00266). The restricted cubic spline regression model revealed that the risks of in-hospital, 28-day, and ICU mortality increased linearly with increasing TyG index. Sensitivity analysis indicate that the effect size and direction in different subgroups are consistent, the results is stability. Additionally, the machine learning results suggest that TyG index is an important feature for the outcomes of sepsis.

Conclusion

Our study indicates that a high TyG index is associated with an increased in-hospital mortality in critically ill sepsis patients. Larger prospective studies are required to confirm these findings.