bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with complementary feeding practices among children aged 6–23 months in Indonesia
Authors: Yunitasari Esti , Al Faisal Ahmad Hisyam , Efendi Ferry , Kusumaningrum Tiyas , Yunita Fildzah Cindra , Chong Mei Chan
Published: December 2022

Background

Complementary foods with breastfeeding are foods or drinks given to children aged 6–23 months to meet their nutritional needs. The non-optimal provision of complementary feeding influences malnutrition in children of this age.

Aims

To analyze the factors associated with complementary feeding practices among children aged 6–23 months in Indonesia.

Methods

A cross-sectional design was employed using data from the 2017 Indonesia Demographic and Health Survey. A total of 502,800 mothers with children aged 6–23 months were recruited through multistage cluster sampling. Data were analyzed using a logistic regression test to determine the correlation between predisposing, enabling, and reinforcing factors and complementary feeding practices.

Results

A prevalence values of analysis showed that approximately 71.14%, 53.95%, and 28.13% of the children met MMF, MMD, and MAD, respectively. The probability of achieving minimum dietary diversity (MDD) was high in the following: children aged 18–23 months (odds ratio [OR] = 9.58; 95% confidence interval [CI] = 7.29–12.58), children of mothers with higher education (OR = 5.95; 95% CI = 2.17–16.34), children from households with upper wealth index (OR = 2.53; 95% CI = 1.85–3.48), children of mothers who received childbirth assistance by professionals (OR = 1.63; 95% CI = 1.20–2.20), and children of mothers who had access to the Internet (OR = 1.26; 95% CI = 1.06–1.50). Moreover, children from households with the upper wealth index (OR = 1.40; 95% CI = 1.03–1.91), children whose mothers were employed (OR = 1.19; 95% CI = 1.02–1.39) living in urban areas (OR = 1.28; 95% CI = 1.06–1.54) and children of mothers who received childbirth assistance by professionals (OR = 1.33; 95% CI = 0.98–1.82) were more likely to meet Minimum Meal Frequency (MMF). Finally, children aged 18–23 months (OR = 2.40; 95% CI = 1.81–3.17), of mothers with higher education (OR = 3.15; 95% CI = 0.94–10.60), from households with upper wealth index (OR = 1.41; 95% CI = 1.05–2.90) and born with professional childbirth assistance (OR = 1.82; 95% CI = 1.21–2.75) were significantly associated with minimum acceptable diet (MAD).

Conclusions

The findings revealed that the prevalence of MDD and MAD in Indonesia was low. Strategies such as improving health services, economic conditions, and education level of mothers are needed to improve infant and young child feeding in Indonesia.
Prevalence and risk factors for vitamin D insufficiency in 6-12-month-old infants: a cross-sectional study in Southern Thailand
Authors: Kasemsripitak Staporn , Jaruratanasirikul Somchit , Boonrusmee Sasivara , Saengkaew Tansit , Sriplung Hutcha
Published: December 2022

Background

Vitamin D is an essential micronutrient for bone mineralization and bone growth in children. There have been few studies to date of vitamin D status in infants aged 6–12 months in Southeast Asian countries.

Aim

To examine the prevalence of vitamin D insufficiency (VDI, including vitamin D deficiency) in healthy infants and the risk factors for VDI in southern Thailand.

Methods

A cross-sectional study was carried out in 120 healthy infants aged 6–12 months and their mothers. Blood samples were obtained for measurement of serum calcium, phosphate, alkaline phosphatase, albumin, parathyroid hormone and 25-hydroxyvitamin D (25OHD) levels. The mothers were interviewed for their infants feeding intake, sunlight exposure, type of dress, and sunscreen use. Chi-square and t-test were used to compare between groups for categorical and continuous variables, respectively. Pearson correlation was used to identify the relationship between serum levels of 25OHD of the infants and other biochemical variables of the infants and serum levels of maternal 25OHD. Logistic regression analysis was used to identify the factors associated with vitamin D status.

Results

The prevalence of VDI in our study infants was high at 28.3%, all of whom were mainly breastfed infants. Subgroup analysis of the mainly breastfed infants found that the risk factors for VDI were maternal VDI and a short duration of sunlight exposure. The serum 25OHD levels of the mainly breastfed infants were significantly positively correlated with the maternal serum 25OHD levels (r = 0.49, p-value < 0.01) and with sunlight exposure duration (r = 0.40, p-value < 0.01).

Conclusions

The prevalence of VDI was high in 6–12-month-old infants, particularly those who were mainly breastfed from VDI mothers, and who had short durations of sunlight exposure. As breast milk contains adequate amounts of most important vitamins and growth factors, breastfeeding is still encouraged for infants with 400 IU vitamin D daily supplementation to prevent VDI.
Temporal associations between depressive features and self-stigma in people with substance use disorders related to heroin, amphetamine, and alcohol use: a cross-lagged analysis
Authors: Saffari Mohsen , Chang Kun-Chia , Chen Jung-Sheng , Chang Ching-Wen , Chen I-Hua , Huang Shih-Wei , Liu Chieh-hsiu , Lin Chung-Ying , Potenza Marc N.
Published: December 2022

Background

Depression is a mental health problem and substance use concerns are socially unacceptable behaviors. While depression and substance use may individually impact self-concept and social relationships, their co-occurrence can increase the risk of self-stigmatization. However, there is no evidence regarding how depression and self-stigma may influence each other over time. The aim of the current study was to evaluate the cross-sectional and longitudinal relationships between features of depression and self-stigma in people with substance use disorders.

Methods

Overall, 319 individuals with substance use disorders (273 males) with a mean (± SD) age of 42.2 (± 8.9) years were recruited from a psychiatric center in Taiwan by convenience sampling. They were assessed for features of depression and self-stigma at four times over a period of nine months using the depression subscale of the Depression Anxiety Stress Scales (DASS-21) and Self-Stigma Scale-Short S (SSS-S), respectively. Repeated-measures analyses of variance, Pearson correlations and cross-lagged models using structural equation modeling examined cross-sectional and temporal associations between depression and self-stigma.

Results

Positive cross-sectional associations were found between depressive features and all assessed forms of self-stigma over time (0.13 < r < 0.92). Three models of cross-lagged associations between different forms of self-stigma and depressive features indicated good fit indices (comparative fit index > 0.98). The direction of associations between depressive features towards self-stigma was stronger than the opposite direction.

Conclusion

Positive associations between depressive features and self-stigma were found in people with substance use disorders. Although these associations may be bidirectional longitudinally, the directions from depressive features to self-stigma may be stronger than the reverse directions, suggesting treatment of depression in earlier stages may prevent self-stigmatization and subsequent poor outcomes in people with substance use disorders.
Adverse childhood experiences and deviant behaviors among Chinese rural emerging adults: the role of social support
Authors: Wang Yiqing , Ma Shuang , Jiang Ling , Chen Qinian , Guo Jing , He Huan , Li Pengyang , Gao Tianjiao , Wang Xiaohua
Published: December 2022

Background

ACEs hurt subsequent physical and mental health outcomes. However, still little has been known about the rate of ACEs among rural Chinese emerging adults and the different buffering effects of the three types of social support on different kinds of ACEs. This study described the rate of ACEs among Chinese rural emerging adults, examined the relationship between ACEs and deviant behaviors, and tested the moderating effect of three different sources of perceived social support on this relationship. We hope these results will be helpful in further interventions.

Methods

We used the second wave of a longitudinal survey that included ACEs variables in 2018. A total of 1031 emerging adults aged 18 to 25 participated in the current study.

Results

we found that (1) the rate of abuse, neglect, and household dysfunction was 10.0, 30.0, and 24.9%, respectively among Chinese rural emerging adults; (2) abuse and household dysfunction experience were significantly and positively associated with deviant behaviors; (3) friend support moderated the relationship between three types of ACEs and deviant behaviors. Other support moderated the relationship between abuse/household dysfunction and deviant behaviors.

Conclusions

ACEs could increase the risk of deviant behaviors. Perceived friend support could reduce the negative effect of three types of ACEs. Other support could reduce the negative impact of abuse and household dysfunction. These results suggest that reducing ACEs to make children’s family environments safer and enhancing social support for emerging adults from rural areas are beneficial, which could prevent or reduce their deviant behaviors.
Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study
Authors: Onen Bruno Chan , Semulimi Andrew Weil , Bongomin Felix , Olum Ronald , Kurigamba Gideon , Mbiine Ronald , Kituuka Olivia
Published: December 2022

Background

Postoperative complications and mortality following laparotomy have remained high worldwide. Early postoperative risk stratification is essential to improve outcomes and clinical care. The surgical Apgar score (SAS) is a simple and objective bedside prediction tool that can guide a surgeon’s postoperative decision making. The objective of this study was to evaluate the performance of SAS in predicting outcomes in patients undergoing laparotomy at Mulago hospital.

Method

A prospective observational study was conducted among eligible adult patients undergoing laparotomy at Mulago hospital and followed up for 4 months. We collected data on the patient’s preoperative and intraoperative characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups namely: low (8–10), medium (5–7), and high (0–4). Primary outcomes were in-hospital major complications and mortality. Data was presented as proportions or mean (standard deviation) or median (interquartile range) as appropriate. We used inferential statistics to determine the association between the SAS and the primary outcomes while the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis.

Results

Of the 151 participants recruited, 103 (68.2%) were male and the mean age was 40.6 ± 15. Overall postoperative in-hospital major complications and mortality rates were 24.2% and 10.6%, respectively. The participants with a high SAS category had an18.4 times risk (95% CI, 1.9–177, p = 0.012) of developing major complications, while those in medium SAS category had 3.9 times risk (95% CI, 1.01–15.26, p = 0.048) of dying. SAS had a fair discriminatory ability for in-hospital major complications and mortality with the area under the curve of 0.75 and 0.77, respectively. The sensitivity and specificity of SAS ≤ 6 for major complications were 60.5% and 81.14% respectively, and for death 54.8% and 81.3%, respectively.

Conclusion

SAS of ≤ 6 is associated with an increased risk of major complications and/or mortality. SAS has a high specificity with an overall fair discriminatory ability of predicting the risk of developing in-hospital major complications and/or death following laparotomy.
Effect of different axial speed patterns on cyclic fatigue resistance of rotary nickel-titanium instruments
Authors: Thu Myint , Ebihara Arata , Maki Keiichiro , Nishijo Miki , Kimura Shunsuke , Nakatsukasa Taro , Kyaw Moe Sandar , Okiji Takashi
Published: December 2022

Background

To evaluate the effect of pecking motions with faster upward speed on the dynamic cyclic fatigue resistance of nickel-titanium rotary instruments with different metallurgy.

Methods

Forty each of ProTaper Universal F3 (PTU) and ProTaper Gold F3 (PTG) instruments (size #30/.09) were equally divided into four groups. The test was performed using an 18-mm-long stainless steel artificial canal with a 5-mm radius of curvature, a 45° canal curvature and a 2-mm canal diameter. A downward speed of 100 mm/min was employed, while the upward speed was set at 100, 150, 200 or 300 mm/min. Time to failure (Tf), number of cycles to failure (Nf) and number of pecking motions to failure (Np) were recorded. Statistical analysis was performed using Kruskal Wallis and Mann–Whitney U tests for Tf, Nf, and Np (α = 0.05).

Results

The 100/300 mm/min group showed significantly higher Np values than the 100/100 mm/min group (p < 0.05), whereas there were no significant differences in Tf and Nf among the tested speed groups (p < 0.05) in either PTU or PTG. PTG exhibited significantly higher Tf, Nf, and Np than PTU (p < 0.05).

Conclusions

Under the tested conditions, the fastest upward speed group showed significantly higher cyclic fatigue resistance, as demonstrated by larger Np, than the same speed group. PTG had significantly higher cyclic fatigue resistance than PTU in all groups.
Oral Juvenile Xanthogranuloma: a case report of gingival hyperplasia and osteolysis in male adult patient
Authors: Chen Long , Feng Lin , E Lingling
Published: December 2022

Background

Juvenile Xanthogranuloma (JXG) is a non-hereditary, self-limiting disease which is usually presented in infancy or early childhood and in males over females.

Case presentation

We report a rare case of oral Juvenile Xanthogranuloma with recurrent progressive gingival hyperplasia and concomitant presentation of osteolysis in a 21-year-old adult male with no significant medical history. Patient presented with generalized gingival hyperplasia, osteolysis of the maxilla and mandible, and a round, firm, nodular mass with clear circumference on the left shoulder. Results of gingival tissue biopsy, karyotype, bone marrow biopsy and immunohistochemistry were suggestive of a diagnosis of Juvenile Xanthogranuloma with no association to hematologic malignancy. Unfortunately, patient declined treatment and elected to be transferred back to local hospital for future evaluation.

Conclusions

Juvenile Xanthogranuloma in adults can have atypical manifestations including generalized gingival hyperplasia and osteolysis of the maxilla and mandible. It should be differentiated between Langerhans cell histiocytosis, Papillon–Lefevre Syndrome, and Pyogenic Granulomas. Despite uncommon incidence, it should be included in differential diagnoses in cases of similar clinical presentations.
Performance of the London Atlas, Willems, and a new quick method for dental age estimation in Chinese Uyghur children
Authors: Lin Yueting , Maimaitiyiming Nuerbiyamu , Sui Meizhi , Abuduxiku Nuerbiya , Tao Jiang
Published: December 2022

Background

Numerous dental age estimation methods have been devised and practised for decades. Among these, the London Atlas and Willems methods were two of the most frequently adopted, however dependent on atlantes or tables. A new estimation method less reliant on external measurement could be efficient and economical.

Aim

This study aimed to evaluate the utility and applicability of the dental age estimation methods of London Atlas, Willems, and a new quick method that subtracts the number of developing teeth from the universal root mature age of 16 years in one of the lower quadrants reported in this work among Chinese Uyghur children.

Methods

A comparative cross-sectional study was conducted. Subjects enrolled in the study were screened according to preset inclusion and exclusion criteria. The observer then obtained the dental age from the subjects’ panoramic radiographs based on the estimated rules of the London Atlas, Willems, and a new quick method. Paired t-test was used to compare the accuracy and precision of the above three estimation methods. Independent-sample t-test was used to find the difference between gender.

Results

Totally, 831 radiographs entered the analyses of this study. Among the three methods evaluated, the Willems method, in particular, showed a distinct underestimated tendency. The mean error of the dental age predicted by the London Atlas, the Willems method, and the quick method was 0.06 ± 1.13 years, 0.44 ± 1.14 years, and 0.30 ± 0.63 years, respectively. The mean absolute error was 0.86 ± 0.75 years according to the London Atlas, 1.17 ± 0.89 years under the Willems method, and 0.70 ± 0.54 years under our quick method. No significant difference was found between the chronological age and dental age using the London Atlas, generally for the 10 to 15 years group (p > 0.05), but our quick method for the 15–16 years children (p < 0.05) and Willems method (p < 0.001).

Conclusion

The London Atlas outperformed the Willems method with better accuracy and precision among 10–15 years Chinese Uyghur children. Our new quick method may be comparable to the London Atlas for children aged 10–14 and potentially become a more straightforward dental age prediction instrument.
Scale-up of the DMPA-SC in Nigeria: Why policy matters
Authors: Akinyemi Oluwaseun , Danfakha Nicole , Adefalu Adewole , Easley Ebony , Afolabi Kayode , Latunji Olajimi
Published: December 2022

Background

Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred means of contraception among women in the country. Enabling policies are required to assure contraceptive access, security, and use. This study aimed to investigate the policy environment and how it supports or limits Nigeria's introduction and scale-up of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC).

Methods

The design of this mixed-methods study was cross-sectional. Desk reviews of policy papers, key informant interviews, and in-depth interviews were used to obtain information from respondents about the introduction of DMPA-SC in Nigeria and how existing policies influenced its scale-up. Data on DMPA-SC and other injectables were gathered from Nigeria's national electronic logistics management information system.

Results

The findings suggest that policies such as task-shifting and task-sharing, cost-free policies, reproductive health policies, and others created an enabling environment for the scale-up of DMPA-SC adoption in Nigeria. The inclusion of DMPA-SC on the essential medicines list and the approved patent medicines list facilitated the scale-up process by ensuring private sector participation, removing economic barriers to access, fostering greater collaboration among health worker cadres, improving intersectoral partnerships, and improving logistics and client access. Despite significant anomalies in some implementing policies, injectable contraceptive consumption data demonstrate a progressive increase in DMPA-SC use during the study period. The results also indicate that policy initiatives have a favorable impact on the use of DMPA-SC throughout the country.

Conclusion

The existence of policies, the active participation of stakeholders, and the political will of the Nigerian health system's leadership have all aided in the scaling-up of the DMPA-SC. Understanding how to build an enabling policy climate is critical for providing women with family planning options. These lessons from Nigeria emphasize the importance of these levers, which should be considered by teams intending to introduce innovative health products, particularly in developing countries.
Prevalence and patterns of premenstrual disorders and possible association with sexual harassment: a cross-sectional study of young Arab women
Authors: AbdelQadir Yossef Hassan , Assar Ahmed , Abdelghafar Yomna Ali , Kamal Manar Ahmed , Zaazouee Mohamed Sayed , Elsayed Sarah Makram , Ragab Khaled Mohamed , Nabhan Ayman Essa , Gamaleldin Nahla Ahmed ,   IMedRA collaborators team, Moris Mariam Salah , AL-Masri Batool Emad , El-Sherif Dina M. , Mohamed Goudy Yomna , Khaled Alsiouty Asmaa , Mahmoud Maysa Madny , Faragalla Hazem Metwally , Abdelazim Ebtehal Ahmed , Mohamed Nadine Abdel-Hamied , Elsayed Sarah Ibrahim , Shehata Hala Hassan , Hasan Sara Mohamed , Mahmoud Rana Hanafy , Fathy Israa Ashraf , Gomaa Eman Mohamed , Ezz Sara Abdallah , Alqatawneh Dana , Hrezat Yasmin Salah , Alhefnawi Kawther Saleem , Hasan Lina Omar , Saleh Hadeel Naem , Abed Ayah AbdElWaley , Rashed Tharwah Mohammad , Ikhlaif Nedaa Yousef Ahmad , Bashir Rand Adnan , Alrosan Sallam Mohammad , Ayyoub Merana khalil , Labeeb Muna Mowafaq , AbuShanab Orjuwan Omar , Fraihat Noor Y. , Al Jabban Haya , Ahdab Amina , Alolabi Homam , Al Khalil Sandy Adel , klib Mohamad , Azzouz Wisam , Allazkani Inas A. Haza’a , Wannes Lana Talal , Naem Maya Abdullah , Al Barudi Nada M. Molham , Alassi Shatha , Tarabishi Joudi Saadeddin , Anadani Rami , Hamoud Hasan M. Masoum
Published: December 2022

Background

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) represent a range of both psychiatric and physical symptoms that impair quality of life and interfere with daily activities in females.

Aims

To assess the prevalence of PMS and PMDD in Egypt, Jordan and Syria, its demographic associations and the potential link to sexual harassment (SH).

Methods

We used an Arabic version of the premenstrual symptoms screening tool (PSST) to assess the prevalence of PMS and PMDD. Another two-part questionnaire was used to assess the harassment experience.

Results

22,021 women agreed to fill the questionnaire; the majority (65%) aged 18–25 years old. PMS was more prevalent in Egyptian women 77.7% followed by women from Jordan 72.9% then Syria 66.3%. PMDD prevalence followed the same order (40%, 34.7% and 28.2%). Both conditions were significantly associated with obesity and working in medical careers (P = .001). 5733 women agreed to share their sexual harassment experience. Results showed a significant association between the diversity and frequency of sexual harassment and the frequency of the pre-menstrual conditions, PMS Frequency was 87.6%, 80.7% and 78% in participants who were harassed on daily basis Vs. once weekly or monthly vs. few times in their lifetime (p = .04). A similar statistically significant difference was noticed regarding having PMDD (66.4% vs. 47.6% vs. 42.5%).

Conclusion

The study showed high levels of both PMS and PMDD. The data provided by this study also sheds light on a potential link between SH and developing Pre-menstrual disorders.
Effect of medical researchers’ creative performance on scientific misconduct: a moral psychology perspective
Authors: Zhang Na , Guo Mingxuan , Jin Chunhua , Xu Zhen
Published: December 2022

Background

In recent years, some researchers have engaged in scientific misconduct such as fabrication, falsification, and plagiarism to achieve higher research performance. Considering their detrimental effects on individuals’ health status (e.g., patients, etc.) and extensive financial costs levied upon healthcare systems, such wrongdoings have even more salience in medical sciences. However, there has been little discussion on the possible influence of medical researchers’ existing creative performance on scientific misconduct, and the moral psychological mechanisms underlying those effects are still poorly understood.

Methods

We build a moderated mediation model to test how medical researchers’ creative performance affects their scientific misconduct and explore the role of moral licensing and moral identity in this process. Based on situational experiments and projection techniques, 287 medical researchers in China participated in a survey.

Results

Medical researchers’ creative performance positively relates to scientific misconduct, and moral licensing plays a mediating role in the relationship between them. In addition, moral identity has a negative moderating effect on the mediating effect of moral licensing on creative performance and scientific misconduct.

Conclusion

Moral licensing plays a fully mediating role in the relationship between creative performance and scientific misconduct. And moral identity negatively moderates the indirect effect of creative performance on scientific misconduct through moral licensing. The findings provide theoretical and practical implications for the prevention of medical researchers’ scientific misconduct.
An international survey of the structure and process of care for traumatic spinal cord injury in acute and rehabilitation facilities: lessons learned from a pilot study
Authors: Abedi Aidin , Biering-Sørensen Fin , Chhabra Harvinder S. , D’Andréa Greve Julia Maria , Khan Nasser M. , Koskinen Eerika , Kwan Kenny Yat Hong , Liu Nan , Middleton James W. , Moslavac Sasa , Rahimi-Movaghar Vafa , O’Connell Colleen , Previnaire Jean G. , Patel Alpesh , Scivoletto Giorgio , Sharwood Lisa N. , Townson Andrea , Urquhart Susan , Vainionpää Aki , Zaman Atiq Uz , Noonan Vanessa K. , Cheng Christiana L.
Published: December 2022

Background

To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care.

Methods

An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify “hard to meet” indicators defined as those met by less than two-thirds of facilities and to describe performance level.

Results

A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59–100%; rehabilitation 36–100%) and among LMIC facilities (acute: 41–82%; rehabilitation: 36–93%) was reported.

Conclusions

Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.
A doctor-nurse-patient mobile health management system effectively controls blood glucose in chinese patients with type 2 diabetes mellitus: a prospective study
Authors: Tan Xiaoqing , Qi Zonghai , Chen Ling , Li Dongmin , Cai Xiangyin , Song Yi , Liu Yajie
Published: December 2022

Background

Coronavirus-2019 pandemic in China aroused increasing interest in telemedicine-supported glycaemic control. We hypothesize that age might influence usage and efficacy of telemedicine-supported glycaemic control. This study aims to measure the effects of a doctor-nurse-patient Mobile Health Management System (MHMS) for fasting plasma glucose (FPG) control in patients with type 2 diabetes mellitus (T2DM).

Methods

Four hundred sixty four patients with T2DM were recruited. A one-hour diabetes education provided to each patient and subsequent follow-ups arranged in the 1st, 2nd, 4th, 8th, and 12th week after enrollment were recorded in MHMS. The effectiveness of MHMS was defined as the proportion of patients achieving FPG target (below 126 mg/dL or 7.0mml/L).

Results

Among the enrolled 464 patients (age: 55.0 ± 13.7 years) who were divided into three groups: young (18–40 years), middle-aged (41–65 years) and elderly (> 65 years), 424 ones completed all follow-ups of 12 weeks. FPG decreased from 178.38 ± 95.04 to 117.90 ± 14.22 mg/dL in the young group, from 180.00 ± 91.08 to 122.94 ± 37.95 mg/dL in the middle-aged group, and from 174.24 ± 80.64 to 128.88 ± 23.4 mg/dL in the elderly group. The proportion of FPG-target-achieved patients increased from 46.2 to 90.4% in the young group, from 32.6 to 82.8% in the middle-aged group, and from 29.5 to 73.3% in the elderly group. The proportion of FPG-target-achieved patients between three age groups were statistically significant (P < 0.001). And the changes of proportion of FPG-target-achieved patients at different follow-up times were statistically significant (P = 0.037). Compared with the young group, the elderly group achieved poorer FPG level (P = 0.032).

Conclusion

MHMS can help patients with T2DM lower FPG and improve proportion of FPG-target-achieved patients. Younger patients may achieve better glycaemic control than older patients. MHMS may serve multitudinous patients with T2DM to achieve adequate FPG self-management.
COVID-19 and the forgone health benefits of elective operations
Authors: Gandjour Afschin
Published: December 2022

Background and aim

The first SARS-CoV-2 pandemic wave in Germany involved a tradeoff between saving the lives of COVID-19 patients by providing sufficient intensive care unit (ICU) capacity and foregoing the health benefits of elective procedures. This study aims to quantify this tradeoff.

Methods

The analysis is conducted at both the individual and population levels. The analysis calculates quality-adjusted life years (QALYs) to facilitate a comparison between the health gains from saving the lives of COVID-19 patients in the ICU and the health losses associated with postponing operative procedures. The QALYs gained from saving the lives of COVID-19 patients are calculated based on both the real-world ICU admissions and deaths averted from flattening the first wave. Scenario analysis was used to account for variation in input factors.

Results

At the individual level, the resource-adjusted QALY gain of saving one COVID-19 life is predicted to be 3 to 15 times larger than the QALY loss of deferring one operation (the average multiplier is 9). The real-world QALY gain at the population level is estimated to fall within the range of the QALY loss due to delayed procedures. The modeled QALY gain by flattening the first wave is 3 to 31 times larger than the QALY loss due to delayed procedures (the average multiplier is 17).

Conclusion

During the first wave of the pandemic, the resource-adjusted health gain from treating one COVID-19 patient in the ICU was found to be much larger than the health loss from deferring one operation. At the population level, flattening the first wave led to a much larger health gain than the health loss from delaying operative procedures.
miR194 hypomethylation regulates coronary artery disease pathogenesis
Authors: Duan Lian , Liu Yongmei , Li Jun , Zhang Yun , Liao Jiangquan , Dong Yan , Jie Wang
Published: December 2022

Coronary artery disease (CAD) is one of the most common heart diseases, characterized by the hardening and narrowing of arteries, resisting blood supply to cardiac muscle. Despite extensive research, the pathogenesis and therapeutic options for CAD remain limited. Epigenetic regulation plays a critical role in CAD progression. Here, we report a unique DNA methylation-miRNA-mRNA regulatory network for CAD, delineated through DNA methylation assays, miRNA and mRNA sequencing, bioinformatics analyses. We also identified key signaling pathways in this network, including the miR194 promoter-miR194-MAPK signaling pathway by pyrosequencing, methylation PCR, qRT-PCR. This pathway could play a role in CAD by apoptosis. Our findings suggested that this signaling pathway may be a potential therapeutic target for CAD. We believe that our study significantly contributes to an improved understanding of the role of specific miRNAs methylation, miRNA, and mRNAs in CAD pathogenesis.
Ultrasound-assessed lung aeration correlates with respiratory system compliance in adults and neonates with acute hypoxemic restrictive respiratory failure: an observational prospective study
Authors: Biasucci Daniele Guerino , Loi Barbara , Centorrino Roberta , Raschetti Roberto , Piastra Marco , Pisapia Luca , Consalvo Ludovica Maria , Caricato Anselmo , Grieco Domenico Luca , Conti Giorgio , Antonelli Massimo , De Luca Daniele
Published: December 2022

Background

Lung ultrasound allows lung aeration to be assessed through dedicated lung ultrasound scores (LUS). Despite LUS have been validated using several techniques, scanty data exist about the relationships between LUS and compliance of the respiratory system (Crs) in restrictive respiratory failure. Aim of this study was to investigate the relationship between LUS and Crs in neonates and adults affected by acute hypoxemic restrictive respiratory failure, as well as the effect of patients’ age on this relationship.

Methods

Observational, cross-sectional, international, patho-physiology, bi-center study recruiting invasively ventilated, adults and neonates with acute respiratory distress syndrome (ARDS), neonatal ARDS (NARDS) or respiratory distress syndrome (RDS) due to primary surfactant deficiency. Subjects without lung disease (NLD) and ventilated for extra-pulmonary conditions were recruited as controls. LUS, Crs and resistances (Rrs) of the respiratory system were measured within 1 h from each other.

Results

Forty adults and fifty-six neonates were recruited. LUS was higher in ARDS, NARDS and RDS and lower in control subjects (overall p < 0.001), while Crs was lower in ARDS, NARDS and RDS and higher in control subjects (overall p < 0.001), without differences between adults and neonates. LUS and Crs were correlated in adults [r = − 0.86 (95% CI − 0.93; − 0.76), p < 0.001] and neonates [r = − 0.76 (95% CI − 0.85; − 0.62), p < 0.001]. Correlations remained significant among subgroups with different causes of respiratory failure; LUS and Rrs were not correlated. Multivariate analyses confirmed the association between LUS and Crs both in adults [B = − 2.8 (95% CI − 4.9; − 0.6), p = 0.012] and neonates [B = − 0.045 (95% CI − 0.07; − 0.02), p = 0.001].

Conclusions

Lung aeration and compliance of the respiratory system are significantly and inversely correlated irrespective of patients’ age. A restrictive respiratory failure has the same ultrasound appearance and mechanical characteristics in adults and neonates.
Effect of exoskeleton-assisted Body Weight-Supported Treadmill Training on gait function for patients with chronic stroke: a scoping review
Authors: Yamamoto Rieko , Sasaki Shun , Kuwahara Wataru , Kawakami Michiyuki , Kaneko Fuminari
Published: December 2022

Background

Therapeutic exercise for gait function using an exoskeleton-assisted Body Weight Supported Treadmill Training (BWSTT) has been identified as a potential intervention that allows for task-based repetitive training with appropriate kinematics while adjusting the amount of body weight support (BWS). Nonetheless, its effect on gait in patients with stroke in the chronic phase are yet to be clarified. The primary aim of this scoping review was to present the status of effectiveness of exoskeleton-assisted BWSTT in patients with chronic stroke. The secondary aims were to summarise intervention protocols, types and functions of BWSTT exoskeletal robotic devices currently used clinically.

Method and results

Articles were accessed and collected from PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases, which were completed in October 2020. Articles were included if the subjects were adults with stroke in the chronic phase (onset ≥ 6 months) and if they utilised a robotic exoskeleton with treadmill and body weight support and investigated the efficacy of gait exercise. A total of 721 studies were identified, of which 11 randomised controlled trials were selected. All included studies were published from 2008 to 2020. Overall, 309 subjects were enrolled; of these, 241 (156 males, 85 females) participated. Walking outcome measures were used more often to evaluate the functional aspects of gait than to evaluate gait independence. In 10 of 11 studies, showed the effectiveness of exoskeleton robot-assisted BWSTT in terms of outcomes contributing to improved gait function. Two studies reported that exoskeleton-assisted BWSTT with combination therapy was significantly more effective in improving than exoskeleton-assisted BWSTT alone. However, no significant difference was identified between the groups; compared with therapist-assisted BWSTT groups, exoskeleton-assisted BWSTT groups did not exhibit significant change.

Conclusion

This review suggests that exoskeleton-assisted BWSTT for patients with chronic stroke may be effective in improving walking function. However, the potential may be “to assist” and not because of using the robot. Further studies are required to verify its efficacy and strengthen evidence on intervention protocols.
Patterns associated with hunting with dogs in a semiarid region of northeastern Brazil
Authors: Santos Sebastiana Lima , De la Fuente María Fernanda , Alves Rômulo Romeu Nóbrega
Published: December 2022

Background

Hunting has been an important cultural and subsistence activity for the survival of the human population. In the Brazilian semiarid region (Caatinga), the extreme seasonal changes and socioeconomic conditions have made local people dependent on the natural resources available, including wildlife. Although hunting with dogs can result in higher efficiency for hunters, it can also have implications for game species conservation.

Methods

Using an ethnozoological approach (semi-structured questionnaires, free interviews, informal conversations, and free listing technique), this study aimed to analyze the patterns of hunting with dogs activities in a semiarid region of northeastern Brazil by characterizing hunters’ and hunting dogs’ profiles, investigating target and nontarget prey species, hunters’ practices, motivations, and perceptions regarding the efficiency of hunting with dogs.

Results

We found that hunters that use dog assistance were mostly men, of different ages, with an occupation in agriculture, receiving less than a minimum wage, and with a low level of formal education. Hunters use two or more mixed-breed dogs with no clear preference regarding dogs’ sex. The motivations for hunting with dogs included mainly food, sport, and trade. Hunters cited twenty species captured by dogs without distinction between prey’s sex and age (14 mammals, 4 birds, and 2 reptiles). Only six of these were mentioned as being target prey when hunting with dogs. From nontarget species, eight carnivores are usually left at the site of kill, as they have no use to the hunters. Hunters perceived that hunting with dogs could be three times more efficient than hunting without dogs.

Conclusion

Overall, hunting with dogs represents a complex set of local variables, including characteristics of dogs and prey species, hunters’ motivations, and practices that should be considered according to each particular situation. Considering the human dependence on natural resources in the semiarid region, hunters should be included in wildlife management debates to mitigate the threat to game species while allowing sustainable hunting practices.
Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction
Authors: Jalava Maina P. , Savontaus Mikko , Ahvenvaara Tuomas , Laakso Teemu , Virtanen Marko , Niemelä Matti , Tauriainen Tuomas , Maaranen Pasi , Husso Annastiina , Kinnunen Eve , Dahlbacka Sebastian , Jaakkola Jussi , Rosato Stefano , D’Errigo Paola , Laine Mika , Mäkikallio Timo , Raivio Peter , Eskola Markku , Valtola Antti , Juvonen Tatu , Biancari Fausto , Airaksinen Juhani , Anttila Vesa
Published: December 2022

Background

Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.

Methods

The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.

Results

Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively.

Conclusions

Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention.

Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.
The DEVA trial: protocol for a randomised controlled trial of dequalinium chloride versus usual care antibiotics for the treatment of bacterial vaginosis
Authors: Haydock Rebecca , Hepburn Trish , Ross Jonathan , Daniels Jane , Brittain Clare , Jackson Louise , Ozolins Mara , Wilson Janet
Published: December 2022

Background

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of reproductive age, and it is estimated that up to a third of women will experience it at some point in their lives. BV produces an offensive vaginal odour and it is associated with serious sequelae. The most frequently prescribed treatment for BV in the UK is 7-day oral metronidazole but recurrences are common following it. Dequalinium chloride (Fluomizin©) is an anti-infective, antiseptic agent administered as a vaginal tablet. Small studies have shown this to be an effective alternative to antibiotics as a BV treatment. This trial aims to investigate whether dequalinium is as effective as current antibiotic treatments for the treatment of BV 1 month after treatment start.

Methods

DEVA is a multi-centre, randomised, open-label, parallel group, non-inferiority trial of dequalinium chloride versus usual care antibiotics for the treatment of BV. Recruitment will take place in 15 GUM clinics in the UK with Leeds Sexual Health also managing remote recruitment via the trial website. Women will be randomised 1:1 to receive dequalinium or usual care antibiotics. The primary outcome is to determine if the proportion of women reporting resolution of BV symptoms 4 weeks after treatment (without the need for additional treatment) is not worse in women treated with dequalinium chloride compared to usual care antibiotics. Questionnaire follow-up will take place 4 and 12 weeks after starting treatment, and remotely recruited patients will also provide a week 4 BV vaginal smear. The sample size is 904.

Discussion

This trial will provide high-quality evidence on the use of dequalinium chloride as a BV treatment, which could result in patients reducing the number of antibiotics they take.

Trial registration

ISRCTN ISRCTN91800263. Prospectively registered on 20 January 2020.
Establishing a Core Domain Set for early-phase clinical trials of electrical stimulation interventions for tinnitus in adults: protocol for an online Delphi study
Authors: Labree Bas , Hoare Derek J. , Fackrell Kathryn , Hall Deborah A. , Gascoyne Lauren E. , Sereda Magdalena
Published: December 2022

Background

Tinnitus is the awareness of a sound in the ear or head in the absence of an external source. It affects around 10–15% of people and current treatment options are limited. Experimental treatments include various forms of electrical stimulation of the brain. Currently, there is no consensus on the outcomes that should be measured when investigating the efficacy of this type of intervention for tinnitus. This study seeks to address this by establishing a Core Domain Set: a common standard of what specific tinnitus-related complaints are critical and important to assess in all clinical trials of electrical stimulation-based interventions for tinnitus.

Methods

A two-round online survey will be conducted, followed by a stakeholder consensus meeting to identify a Core Domain Set. Participants will belong to one of two stakeholder groups: healthcare users with lived experience of tinnitus, and professionals with relevant clinical, commercial, or research experience.

Discussion

This study will establish a Core Domain Set for the evaluation of electrical stimulation-based interventions for tinnitus via an e-Delphi study. The resulting Core Domain Set will act as a minimum standard for reporting in future clinical trials of electrical stimulation interventions for tinnitus. Standardisation will facilitate comparability of research findings.