bluuebunny/crossref_metadata_2025 huggingface dataset:
From Food Gathering to Horticulture: The Food Getting Techniques of Shompen of Great Nicobar Island
Authors: Sasikumar M.
Published: June 2020

Classical social evolutionists generally assumed that the transformation of human societies from one particular mode of production to another is an evolutionary progression. It is a passage from hunting–gathering to herding and cultivation as alternative strategies to exploit a ‘given’ environment. This article portrays the strategies adopted by the Shompen to expand and ensure optimal diet throughout the year. The local environmental conditions and the state of technology the community has achieved had its bearing upon determining the nature of adaptive strategy evolved. The Shompen unlike their counterparts in the Andaman Islands have developed a multipronged strategy to survive at a distant, remote and inaccessible habitat in a largely isolated island that too through independent innovation of certain technologies. In this article, an attempt has been made to establish that the progression of societies was not always linear as assumed by the classical social evolutionists.
Survival, Continuity and Identity Among the Onge of Andaman and Nicobar Islands
Authors: Raviprasad B.V. , Kumar Ghosh Amit , Sasikumar M.
Published: June 2020

The hunter-gatherer tribes of Andaman and Nicobar Islands with negrito physical features had drawn attention of researchers and administrators because of their unique bio-cultural identity and their migration to the present habitat. Until 1950s, the Onge were sparsely distributed and exploited natural biotic resources of whole Little Andaman Island. Population decrease among them was the major factor for resettlement of this tribe at Dugong creek (1976–1977) and at South Bay (1980) of Little Andaman Island. The then Administration’s attempts to protect Onge was in line with the Government of India’s policy towards tribal societies. Often described as ‘Nehru-Elwin’ tribal policy. After resettlement, supply of ‘free ration’ was introduced which is continuing till date. The whole economy of the Onge has undergone a change. Their physical stamina seems to be ‘greatly reduced’ and the incidence of ‘overweight’ has increased in both men and women. ‘Underweight’ is reported more among men (60%) than women (33%). Longevity of male and female Onge is moderate. 10% of Onge male and female are 50 years and above. Four males and two female Onge are aged 60 years and above. 34% of Onge in the age group of 21–40 years are employed in electricity, education and forest department of Andaman and Nicobar administration, Port Blair. The present generation is more interested in ‘cash economy’ and demands facilities such as housing, electricity, piped water, bicycles and medicines. Challenge for administrators and policy makers lies in the changing socio-cultural attitudes of the present day Onge. Skills such as preparation of baskets, boats and paintings over the body are hardly seen among younger generation. Auxiliary Nursing Midwifery (ANMs) at Dugong creek settlement are instructed to visit Onge families daily to distribute allopathic medicines and also observe/wait until medicine are actually consumed. The authors in the paper discuss the present status of the Onge at Little Andaman Island from the point of view of biological attributes such as demography, nutritional status of adults and Growth and development of Onge children, they opine that ‘survival of Onge’ as bio-cultural ethnic group with certain caveats has been achieved. In conclusion we can state that although many National and International critics seem to think that the pristine cultural has been affected, ‘Survival of Onge’ itself has been the biggest success of this resettlement.
Pediatric Residency Obesity and Overweight Training Curricula: A Systematic Review
Authors: Silber Molly , Weiss Lindsay , Sharaf Salma , Wang Yan , Hager Erin , Carter Rebecca
Published: June 2020

Background. Pediatric obesity has become a significant public health concern. Pediatricians are the ideal group to help identify and treat this epidemic, but unfortunately, many pediatricians are not trained to discuss obesity with patients and their families. Standardized training initiatives for pediatric residents on prevention and/or management of obesity are needed to equip emerging pediatricians to combat the obesity epidemic. Objectives. This systematic literature review aims to examine the effectiveness of childhood obesity prevention/counseling resident training interventions. Methods. A comprehensive literature search was performed using preidentified search terms and limited to articles published prior to November 6, 2019. Articles were analyzed by 2 reviewers with a standardized evaluation tool. Results. A total of 698 articles were identified by the search. These were reduced to 111 articles after title review and 11 articles following abstract/full paper review. The 11 articles described 10 different obesity training interventions for residents. The articles varied in their size, length of training session, and study design. Despite these variations, all articles outlined positive outcomes, including an increase in physician confidence, positive changes in behavior, and/or improved electronic medical record documentation. Conclusions. With the continued increase in pediatric obesity, there is a need for practical, easy-to-implement, standardized trainings for pediatric residents on obesity prevention and treatment. More investigation needs to be done to look at long-term results of current interventions as well as other outcomes such as whether physicians are correctly identifying patients who are overweight or obese and whether there is improvement in patient follow-up.
Introduction to the Online Nursing Education Best Practices Guide
Authors: Authement Renae S. , Dormire Sharon L.
Published: June 2020

Introduction

As online nursing education programs continue to increase to meet the demands of the growing market, nursing faculty are challenged to develop and deliver courses based on best practice principles. The Online Nursing Education Best Practices Guide (ONE Guide) builds on and extends the nationally recognized Quality Matters® program and serves as a roadmap guiding course development and delivery. The fundamental principle for success in online teaching is instructor presence; the teacher as a facilitator of learning is illustrated throughout the guide. An Online Instructor Checklist facilitates systematic implementation of best practice principles.

Methods

This article is based on a focused literature review and concept analysis resulting in a comprehensive guide for delivery of effective, quality nursing education through best practices in the online learning environment. A broad search of databases focused on articles during 2014 to 2019 was completed. The literature review included articles that examined over 1200 student perceptions of instructor presence in the online setting.

Conclusion

Nurses carry a direct responsibility for the health and well-being of patients. Nursing quality education proves fundamental to the profession’s long-term outcomes. The ONE Guide and Online Instructor Checklist apply comprehensive, evidence-based teaching strategies to give a roadmap for success in the online teaching environment.
Islamic Feminism: The Challenges and Choices of Reinterpreting Sexual Ethics in Islamic Tradition
Authors: Rehman Talha
Published: June 2020

Despite what the furore over Uniform Civil Code and more recently Triple Talaq might suggest, Muslim women have very little discursive space to voice their concerns in Indian political arena. Dominant discourses on Islam and gender, including those propagated by Muslim male organisations pose Islam as a monolithic entity completely alien to the modern gender-egalitarian ideals. Feminist movements, on the other hand, hold Islam to be irrelevant at best and an obstacle at worst in promotion of gender-egalitarian norms within the community. There are concerns about the extent to which Islamic feminism can go in its demands for egalitarianism while staying within an Islamic paradigm. This paper contests those assumptions about Islam and women that foreclose any dialogue for change by exploring the role of human interpretative choices in formation and development of the Islamic religious tradition. As demonstrated by feminist exegetes, how religious texts are read is shaped deeply by human contingencies and choices. In Indian scenario, such changes are visible in formation of Muslim personal law as well. Post-independence, political contingencies within the subcontinent made it difficult to revisit the laws resulting in the loss of fluidity in the tradition. As formative scholars’ choices became enshrined in the tradition as authentic and canonical, the human element in the canonical became forgotten. The inertia to review the moral choices made by earlier authors became the hallmark of authenticity and therefore authority within the tradition. This paper argues that appreciating the role of human choices and hermeneutical flexibility involved in the formation of gender norms in Muslim societies throughout the history of Islamic legal tradition might prove effective in resolving moral dilemmas faced by modern Muslims while maintaining continuity with the tradition.
‘When We Eat-Out’: Women, Desires and Public Spaces of Food Consumption
Authors: Kalita Pooja
Published: June 2020

Whenever the relationship between women and food is evoked, especially in a South Asian context, the popular imagery is that of the ‘motherly’ women who cooks and feeds her family within the domestic sphere of the household. She is an embodiment of sacrifice and thus perceived as more of a food provider than a consumer. However, contrary to this popular imagery, this article looks at women as consumers of food, more specifically women who desire food and the various constraints she faces while fulfilling them. It attempts to understand why and how do women fulfil or do not fulfil their desires related to food at public spaces of food consumption and what kind of broader understanding of ‘desire’ related to food by women can we derive from a South Asian context.
The spatial structure of US metropolitan employment: New insights from administrative data
Authors: Manduca Robert
Published: June 2020

Urban researchers have long debated the extent to which metropolitan employment is monocentric, polycentric, or diffuse. In this paper I use high-resolution data based on unemployment insurance records to show that employment in US metropolitan areas is not centralized but is spatially concentrated. Unlike residents, who form a continuous surface covering most parts of each metropolitan area, jobs have a bimodal spatial distribution, with most blocks containing no jobs whatsoever and a small number having extremely high employment densities. Across the 100 largest Metropolitan Statistical Areas, about 75% of jobs are located on the 6.5% of built land in Census blocks with at least twice as many jobs as people. These relative proportions are extremely consistent across cities, even though they vary greatly in the physical density at which they are constructed. Motivated by these empirical regularities, I introduce an algorithm to identify contiguous business districts and classify them into four major types. Based solely on the relative densities of employment and population, this algorithm is both simpler to implement and more flexible than current approaches, requiring no metro-specific tuning parameters and no assumptions about urban spatial layout.
COVID-19 and BAME Group in the United Kingdom
Authors: Bhatia Mrigesh
Published: June 2020

COVID-19 is known to disproportionately affect ethnic minorities in number of settings. This phenomenon has also been reported in the UK where the black, Asian and minority ethnic (BAME) group has adverse health outcomes in terms of number of both cases and mortality rates when compared to the white local population. This trend is also observed among the BAME staff working in the National Health Service. Number of plausible explanations and the importance of various approaches including social-determinants approach is pointed out. This pandemic has re-ignited the debate on social inequalities, issues around social deprivation and health inequalities within the UK. This article concludes with some policy recommendations.
Configuration Synthesis and Performance Analysis of 9-Speed Automatic Transmissions
Authors: Ding Huafeng , Cai Changwang , Chen Ziming , Ke Tao , Mao Bowen
Published: June 2020

Current research of automatic transmission (AT) mainly focuses on the improvement of driving performance, and configuration innovation is one of the main research directions. However, finding new configurations of ATs is one of the main limitations of configuration innovation. In the present study, epicyclic gear trains (EGTs) are applied to investigate mechanisms of 9-speed ATs. Then four kinematic configurations are proposed for automatic transitions. In order to evaluate the performance of proposed mechanisms, the lever analogy method is applied to conduct kinematic and mechanical analyses. The power flow analysis is conducted, and then transmission efficiencies are calculated based on the torque method. The comparative analysis between the proposed and existing mechanisms is carried out where obtained results show that proposed mechanisms have reasonable performance and can be used in ATs. The prototype of an AT is manufactured and the speed test is conducted, which proves the accuracy of analysis and the feasibility of proposed mechanisms.
Emergency department utilization of case-managed patients following benign gynecologic surgery
Authors: Kelly Elizabeth A. , Keller Cara C. , Sax Megan R. , Rossi Rocco A.
Published: June 2020

Background

Case management has been shown to reduce the amount of unnecessary emergency department visits among Medicaid or uninsured patients. This study aims to determine whether case management is associated with decreased unnecessary emergency department visits among benign gynecology surgical patients in the first 30 days following surgery.

Results

Out of 875 patients, there were a total of 58 return visits to the emergency department within 30 days and only 6 readmissions. Twenty-four emergency department visits occurred in the case-managed group, and thirty-eight emergency department visits occurred in the non-case-managed group. The two factors that were statistically significant for increase odds of return to the emergency department were the type of surgery (inpatient versus outpatient) and case management. The odds for returning to the emergency department for those not receiving case management was found to be 4.53 to that of the case-managed group when controlling for BMI, age, marital status, and type of surgery.

Conclusion

In an effort to reduce healthcare costs, case management is a promising intervention to help postoperative patients manage their care while minimizing emergency department visits.
Alterations in the chondrocyte surfaceome in response to pro-inflammatory cytokines
Authors: Jeremiasse Bernadette , Matta Csaba , Fellows Christopher R. , Boocock David J. , Smith Julia R. , Liddell Susan , Lafeber Floris , van Spil Willem E. , Mobasheri Ali
Published: June 2020

Background

Chondrocytes are exposed to an inflammatory micro-environment in the extracellular matrix (ECM) of articular cartilage in joint diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA). In OA, degenerative changes and low-grade inflammation within the joint transform the behaviour and metabolism of chondrocytes, disturb the balance between ECM synthesis and degradation, and alter the osmolality and ionic composition of the micro-environment. We hypothesize that chondrocytes adjust their physiology to the inflammatory microenvironment by modulating the expression of cell surface proteins, collectively referred to as the ‘surfaceome’. Therefore, the aim of this study was to characterize the surfaceome of primary equine chondrocytes isolated from healthy joints following exposure to the pro-inflammatory cytokines interleukin-1-beta (IL-1β) and tumour necrosis factor-alpha (TNF-α). We employed combined methodology that we recently developed for investigating the surfaceome in stem cells. Membrane proteins were isolated using an aminooxy-biotinylation technique and analysed by mass spectrometry using high throughput shotgun proteomics. Selected proteins were validated by western blotting.

Results

Amongst the 431 unique cell surface proteins identified, a high percentage of low-abundance proteins, such as ion channels, receptors and transporter molecules were detected. Data are available via ProteomeXchange with identifier PXD014773. A high number of proteins exhibited different expression patterns following chondrocyte stimulation with pro-inflammatory cytokines. Low density lipoprotein related protein 1 (LPR-1), thrombospondin-1 (TSP-1), voltage dependent anion channel (VDAC) 1–2 and annexin A1 were considered to be of special interest and were analysed further by western blotting.

Conclusions

Our results provide, for the first time, a repository for proteomic data on differentially expressed low-abundance membrane proteins on the surface of chondrocytes in response to pro-inflammatory stimuli.
One species, two developmental modes: a case of geographic poecilogony in marine gastropods
Authors: Wiggering Benedikt , Neiber Marco T. , Gebauer Katharina , Glaubrecht Matthias
Published: June 2020

Background

Poecilogony, the presence of two developmental modes in the same animal species, is a rare phenomenon. Few cases of poecilogony have been suggested for marine invertebrates including molluscs and even less stood extensive testing, mostly revealing a species pair with differing developmental modes. We studied a textbook example of poecilogony in the viviparous snail Planaxis sulcatus (Gastropoda: Planaxidae), for the first time throughout its entire distribution range.

Results

In the Western Indian Ocean and Red Sea this intertidal species is observed to have large, shelled juveniles, whereas in the Indo-West Pacific planktotrophic veliger larvae are released from a subhaemocoelic brood pouch. We uncovered a shift in developmental modes across its range: from west to east successively earlier developmental stages are released. Furthermore, genetic data based on mitochondrial DNA suggests to recognize P. sulcatus as a single species rather than a group of cryptic species. A reconstruction of the ancestral area of P. sulcatus based on molecular data outlines the Western Indian Ocean and the Indo-West Pacific as area of origin.

Conclusion

The findings supporting Planaxis sulcatus as a single widespread species and the geographical shift from one reproductive mode to another suggest for this species to truly represent a case of geographic poecilogony, i.e. differing developmental modes between populations of the same species. Furthermore, the results of our ancestral range estimation imply the release of planktotrophic larvae as the ancestral developmental mode.
Relationship between mucosal healing by tacrolimus and relapse of refractory ulcerative colitis: a retrospective study
Authors: Ito Ayumi , Murasugi Syun , Omori Teppei , Nakamura Shinichi , Tokushige Katsutoshi
Published: June 2020

Background

Tacrolimus (TAC) is a powerful remission-inducing drug for refractory ulcerative colitis (UC). However, it is unclear whether mucosal healing (MH) influences relapse after completion of TAC.We investigated whether MH is related to relapse after TAC.

Patients: Among 109 patients treated with TAC, 86 patients achieved clinical remission and 55 of them underwent colonoscopy at the end of TAC. These 55 patients were investigated.

Methods

Patients with MH at the end of TAC were classified into the MH group (n = 41), while patients without MH were classified into the non-MH group (n = 14). These groups were compared with respect to 1) clinical characteristics before treatment, 2) clinical characteristics on completion of treatment, and 3) the relapse rate and adverse events rates. This is a retrospective study conducted at a single institution.

Results

1) There was a significant difference in baseline age between the two groups before TAC therapy, but there were no significant differences in other clinical characteristics. The NMH group was younger (MH group: 48.1 (23–79) years, NMH group: 36.3 (18–58) years,P = 0.007). Endoscopic scores showed significant differences between the 2 groups at the end of TAC. There were also significant differences in the steroid-free rate after 24 weeks (MH group: 85.3%, NMH group 50%,P = 0.012). There was no significant difference in the relapse rate between the 2 groups at 100 days after remission, but a significant difference was noted at 300 days (17% vs. 43%), 500 days (17% vs. 75%), and 1000 days (17% vs. 81%) (allP < 0.05).

Conclusions

TAC is effective for refractory ulcerative colitis. However, even if clinical remission is achieved, relapse is frequent when colonoscopy shows that MH has not been achieved. It is important to evaluate the mucosal response by colonoscopy on completion of TAC.
Complementary alternative medicine use among postpartum mothers in a primary care setting: a cross-sectional study in Malaysia
Authors: Nik Yusof Fuad Nik Farah , Ching Siew Mooi , Awg Dzulkarnain Dayangku Hayaty , Cheong Ai Theng , Zakaria Zainul Amiruddin
Published: June 2020

Background

Complementary alternative medicine (CAM) is widely used among postpartum mothers to maintain their well-being. This study aims to determine the prevalence and factors associated with CAM use among postpartum mothers in a primary-care clinic in Malaysia.

Methods

This is a cross-sectional study of 725 postpartum mothers, aged 18 and above, attending a primary-care clinic. The systematic sampling method was used to recruit patients through a structured, self-administered questionnaire. Data analysis was conducted using SPSS version 23. Multiple logistic regression was used to identify the predictors of CAM use among postpartum mothers.

Results

The prevalence of CAM use among postpartum mothers was 85.5%. Manipulative body therapies, including massage, reflexology, hot stone compression and body wrapping were the most widely used methods of CAM (84.1%) among postpartum mothers, followed by biological-based therapies (33.1%). More than half of the respondents (52.1%) opted to use CAM, as they had observed good results from other CAM users. However, our study showed that 57.1% of mothers who consumed herbal medicine reported neonatal jaundice in their newborn. The median of the expenditure on CAM usage was 250 Malaysian Ringgits, or USD 61.3 per month. According to multiple logistic regression analyses, being Muslim (OR = 5.258, 95% CI: 2.952–9.368), being Malay (OR = 4.414, 95% CI: 1.18–16.56), having a higher educational level (OR = 2.561, 95% CI: 1.587–4.133) and having delivered via spontaneous vaginal delivery (OR: 5.660, 95% CI: 3.454–9.276) had a significantly positive association with CAM use among postpartum mothers.

Conclusions

The prevalence of CAM use was high (8 out of 10) among postpartum mothers. Postpartum mothers who are Malay, Muslim, have a higher educational level and who have had spontaneous vaginal delivery tended to use CAM more. Manipulative body therapies, including massage, reflexology, hot stone compression and body wrapping, were the most widely used forms of CAM, followed by biological-based therapies. More than half of the mothers who consumed herbal medicine reported neonatal jaundice in their newborn. Thus, education to increase awareness regarding the consumption of herbs is urgently required in this country.
Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study
Authors: Mutabazi Jean Claude , Gray Corie , Muhwava Lorrein , Trottier Helen , Ware Lisa Jayne , Norris Shane , Murphy Katherine , Levitt Naomi , Zarowsky Christina
Published: June 2020

Background

Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework.

Methods

A total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis.

Results

Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation.

Conclusions

Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.
Whole genome sequencing of familial isolated oesophagus atresia uncover shared structural variants
Authors: Klar Joakim , Engstrand-Lilja Helene , Maqbool Khurram , Mattisson Jonas , Feuk Lars , Dahl Niklas
Published: June 2020

Background

Oesophageal atresia (OA) is a life-threatening developmental defect characterized by a lost continuity between the upper and lower oesophagus. The most common form is a distal connection between the trachea and the oesophagus, i.e. a tracheoesophageal fistula (TEF). The condition may be part of a syndrome or occurs as an isolated feature. The recurrence risk in affected families is increased compared to the population-based incidence suggesting contributing genetic factors.

Methods

To gain insight into gene variants and genes associated with isolated OA we conducted whole genome sequencing on samples from three families with recurrent cases affected by congenital and isolated TEF.

Results

We identified a combination of single nucleotide variants (SNVs), splice site variants (SSV) and structural variants (SV) annotated to altogether 100 coding genes in the six affected individuals.

Conclusion

This study highlights rare SVs among candidate gene variants in our individuals with OA and provides a gene framework for further investigations of genetic factors behind this malformation.
Cardiac biomarkers of prognostic importance in chronic obstructive pulmonary disease
Authors: Nilsson Ulf , Mills Nicholas L. , McAllister David A. , Backman Helena , Stridsman Caroline , Hedman Linnea , Rönmark Eva , Fujisawa Takeshi , Blomberg Anders , Lindberg Anne
Published: June 2020

Background

Ischemic heart disease is common in COPD and associated with worse prognosis. This study aimed to investigate the presence and prognostic impact of biomarkers of myocardial injury and ischemia among individuals with COPD and normal lung function, respectively.

Methods

In 2002–04, all individuals with airway obstruction (FEV1/VC < 0.70, n = 993) were identified from population-based cohorts, together with age and sex-matched non-obstructive referents. At re-examination in 2005, spirometry, Minnesota-coded ECG and analyses of high-sensitivity cardiac troponin I (hs-cTnI) were performed in individuals with COPD (n = 601) and those with normal lung function (n = 755). Deaths were recorded until December 31st, 2010.

Results

Hs-cTnI concentrations were above the risk stratification threshold of ≥5 ng/L in 31.1 and 24.9% of those with COPD and normal lung function, respectively. Ischemic ECG abnormalities were present in 14.8 and 13.4%, while 7.7 and 6.6% had both elevated hs-cTnI concentrations and ischemic ECG abnormalities. The 5-year cumulative mortality was higher in those with COPD than those with normal lung function (13.6% vs. 7.7%, p < 0.001). Among individuals with COPD, elevated hs-cTnI both independently and in combination with ischemic ECG abnormalities were associated with an increased risk for death (adjusted hazard ratio [HR]; 95% confidence interval [CI] 2.72; 1.46–5.07 and 4.54; 2.25–9.13, respectively). Similar associations were observed also among individuals with COPD without reported ischemic heart disease.

Conclusions

In this study, elevated hs-cTnI concentrations in combination with myocardial ischemia on the electrocardiogram were associated with a more than four-fold increased risk for death in a population-based COPD-cohort, independent of disease severity.
“Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?
Authors: George Mathew Sunil , Davey Rachel , Mohanty Itismita , Upton Penney
Published: June 2020

Background

Inequity in access to healthcare services is a constant concern. While advances in healthcare have progressed in the last several decades, thereby significantly improving the prevention and treatment of disease, these benefits have not been shared equally. Excluded communities such as Indigenous communities typically face a lack of access to healthcare services that others do not. This study seeks to understand why the indigenous communities inAttapadicontinue to experience poor access to healthcare in spite of both financial protection and adequate coverage of health services.

Methods

Ethnographic fieldwork was carried out among the various stakeholders living inAttapadi. A total of 47 in-depth interviews and 6 focus group discussions were conducted amongst the indigenous community, the healthcare providers and key informants. The data was coded utilising a reflexive and inductive approach leading to the development of the key categories and themes.

Results

The health system provided a comprehensive financial protection package in addition to a host of healthcare facilities for the indigenous communities to avail services. In spite of this, they resisted attempts by the health system to improve their access. The failure to provide culturally respectful care, the discrimination of the community at healthcare facilities, the centralisation of the delivery of services as well as the lack of power on the part of the indigenous community to negotiate with the health system for services that were less disruptive for their lives were identified as the barriers to improving healthcare access. The existing power differentials between the community and the health system stakeholders also ensured that meaningful involvement of the community in the local health system did not occur.

Conclusion

Improving access to health care for indigenous communities would require UHC interventions to be culturally safe, locally relevant and promote active involvement of the community at all stages of the intervention. Continuing structural power imbalances that affect access to resources and prevent meaningful involvement of indigenous communities also need to be addressed.
Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor
Authors: Maeda Naoaki , Shirakawa Yasuhiro , Tanabe Shunsuke , Sakurama Kazufumi , Noma Kazuhiro , Fujiwara Toshiyoshi
Published: June 2020

Background

The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.

Methods

The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and February 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and 3 days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.

Results

There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The 3-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.

Conclusion

Skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.
Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce
Authors: Ingram Maia , Sabo Samantha , Redondo Floribella , Soto Yanitza , Russell Kim , Carter Heather , Bender Brook , de Zapien Jill Guernsey
Published: June 2020

Background

Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort.

Case presentation

In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally.

Conclusions

Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.
Nutritional management of lactose intolerance: the importance of diet and food labelling
Authors: Facioni Maria Sole , Raspini Benedetta , Pivari Francesca , Dogliotti Elena , Cena Hellas
Published: June 2020

Worldwide, 70% of the adult population has limited expression of lactase enzyme with a wide variation among different regions and countries. Lactase deficiency may lead to lactose intolerance (LI). Depending both on the amount of lactose ingested and on the lactase activity, people who suffer from lactose malabsorption might experience numerous gastrointestinal and extra-intestinal symptoms and manifestations. Treatment of LI mainly consists of reducing or eliminating lactose from the diet until the symptoms disappear as well as supplementing lactase, and inducing colon microbiome adaptation by probiotics. Cow’s milk is one of the major source of calcium and several other vitamins and minerals. Thus, a complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. Therefore, the dietetic approach has a crucial role in the management of LI patients. Additionally, the use of lactose and milk-derived products in non-dairy products (e.g., baked goods, breakfast cereals, drinks, and processed meat) has become widespread in the modern industry (the so-called “hidden lactose”). In this regard, a strict adherence to the lactose-free diet becomes challenging for LI patients, forced to continuous check of all products and food labels. In fact, lactose-free product labeling is still controversial. Considering that nowadays a specific cut-off value establishing “lactose-free” labeling policy is lacking and that there is no universal law regulating the production and commercialization of “delactosed” products, identification of specific safe and suitable products with a well-recognized lactose-free logo might help consumers. This narrative review aims to identify the dietary management for lactose intolerant people, avoiding symptoms and nutrients deficiencies, helped by the use of specific labelling to guide them to choose the safer product on the market.
Participation in the “nutrition at the Centre” project through women’s group improved exclusive breastfeeding practices, as measured by the deuterium oxide dose-to-mother technique
Authors: Lokonon Jaures H. F. , Hounkpatin Waliou Amoussa , Idohou-Dossou Nicole
Published: June 2020

Background

Evidence of interventions that are effective in improving exclusive breastfeeding (EBF) practices is needed to help countries revise their strategies. To assess whether mothers who had participated in the Nutrition at the Centre (N@C) project effectively demonstrated better EBF practices than did those who did not participate, we documented the processes of this nutritional intervention in Benin.

Methods

This study was a cross-sectional design comparing the intervention group, namely, the Village Saving and Loan Association (VSLA-N@C), to the control group. The N@C project was an educational intervention based on behavioural and social changes related to nutrition. Through VSLA groups installed in communities, mothers were connected to the project; had weekly discussions around the process, benefits and challenges linked to EBF, and advocated during Breastfeeding Week celebrations. The study participants were mothers with children aged 4–5.5 months from the VSLA-N@C group (n = 53) and mothers (n = 50) from non-intervention areas who served as controls. With the deuterium oxide dose-to-mother technique, we quantified human milk intake (HMI) and non-milk oral intake (NMOI) and compared both groups using Student’s t-test. A child is considered to be exclusively breastfed if the NMOI is less than 86.6 g/day. Multivariate regression logistics adjusted for VSLA membership, mothers’ body mass index, and children’s age, weight-for-age and weight-for-length, thus enabling us to measure differences in EBF rates.

Results

Children of mothers from the VSLA-N@C group consumed significantly more human milk than those of mothers in the control group (900.2 ± 152.5 g/day vs 842.2 ± 188.6 g/day, P = 0.044). Children in the VSLA-N@C group had significantly less non-milk oral intake than did those in the control group (difference: 148.2 g/day, P = 0.000). Therefore, the EBF rate was significantly higher in the VSLA group (38% vs 8%, P < 0.0001), and mothers in VSLAs were 14 times more likely to practise EBF than were those in the control group (adjusted odds ratio [AOR] = 13.9, 95% CI 1.9–116.5, P = 0.015).

Conclusion

The EBF rate was significantly higher in the group of mothers who participated in the VSLA-N@C project than in those who did not receive the intervention. The N@C model could be promoted as a strategy for increasing EBF practices in poor and rural contexts, where it is possible to organize mothers into VSLA groups to discuss the process, benefits and challenges of EBF.
Root causes of extended length of stay and unplanned readmissions after orthopedic surgery and hand surgery: a retrospective observational cohort study
Authors: Tolvi Morag , Tuominen-Salo Hanna , Paavola Mika , Mattila Kimmo , Aaltonen Leena-Maija , Lehtonen Lasse
Published: June 2020

Background

While previous studies have evaluated the effect of some patient characteristics (e.g. gender, American Society of Anesthesiologists (ASA) class and comorbidity) on outcome in orthopedic and hand day surgery, more detailed information on anesthesia related factors has previously been lacking. Our goal was to investigate the perioperative factors that affect overstay, readmission and contact after day surgery in order to find certain patient profiles more prone to problemed outcomes after day surgery.

Methods

We examined orthopedic and hand day surgery at an orthopedic day surgery unit of Helsinki University Hospital. Patient data of all adult orthopedic and hand day surgery patients (n = 542) over a 3-month period (January 1 – March 31, 2015) operated on at the unit were collected retrospectively using the hospital’s surgery database. These data comprised anesthesia and patient records with a follow-up period of 30 days post-operation. Patients under the age of 16 and patients not eligible for day surgery were excluded. Patient records were searched for an outcome of overstay, readmission or contact with the emergency room or policlinic. Pearson chi-square test, Fischer’s exact test and multivariable logistic regression were used to analyze the effect of various perioperative factors on postoperative outcome.

Results

Various patient and anesthesia related factors were examined for their significance in the outcomes of overstay, readmission or contact. Female gender (p = 0.043), total amount of fentanyl (p = 0.00), use of remifentanil (p = 0.036), other pain medication during procedure (p = 0.005) and administration of antiemetic medication (p = 0.048) emerged as statistically significant on outcome after day surgery.

Conclusions

Overstay and readmission in orthopedic and hand day surgery were clearly connected with female patients undergoing general anesthesia and needing larger amounts of intraoperative opioids. By favoring local and regional anesthesia, side effects of general anesthesia, as well as recovery time, will decrease.
Effects of interferon-alpha on hippocampal neurogenesis and behavior in common marmosets
Authors: Kaneko Naoko , Nakamura Sayuri , Sawamoto Kazunobu
Published: June 2020

In many mammalian species, the production of new neurons in the hippocampal dentate gyrus continues throughout life. Previous studies using rodents suggest that adult-born neurons are involved in memory and cognition tasks and mood regulation. Interferon-alpha (IFNα), a proinflammatory cytokine used for the treatment of chronic viral hepatitis and malignancies, frequently causes depressive symptoms in patients and animals, including non-human primates. We have previously demonstrated that chronic IFNα treatment decreases hippocampal neurogenesis in mice. Here, we investigated the effects of four-week human pegylated IFNα treatment on hippocampal neurogenesis and behavior in common marmosets. Continuous monitoring of voluntary activity levels using an actigraphy device suggested that adaptive ability is impaired in IFNα-treated animals. Analyses of BrdU-labeled cells expressing a marker for immature or mature neurons revealed a significant reduction in the number of new neurons in the hippocampus of IFNα-treated animals. These data indicate that chronic human IFNα treatment causes behavioral changes and a decrease in hippocampal neurogenesis in common marmosets.
Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India
Authors: Pathare Soumitra , Shields-Zeeman Laura , Vijayakumar Lakshmi , Pandit Deepa , Nardodkar Renuka , Chatterjee Susmita , Kalha Jasmine , Krishnamoorthy Sadhvi , Jain Nikhil , Kapoor Arjun , Shahjahan Mohammad , Chauhan Ajay , Smit Filip
Published: June 2020

Background

Suicide is a major public health challenge globally and specifically in India where 36.6% and 24.3% of all suicides worldwide occur in women and men, respectively. The United Nations Sustainable Development Goals uses suicide rate as one of two indicators for Target 3.4, aimed at reducing these deaths by one third by 2030. India has no examples of large-scale implementation of evidence-based interventions to prevent suicide; however, there is a sizeable evidence base to draw on for suicide prevention strategies that have been piloted in India or proven to be effective regionally or internationally.

Method

The SPIRIT study is designed as a cluster-randomized superiority trial and uses mixed methods to evaluate the implementation, effectiveness and costs of an integrated suicide prevention programme consisting of three integrated interventions including (1) a secondary-school-based intervention to reduce suicidal ideation among adolescents, (2) a community storage facility intervention to reduce access to pesticides and (3) training for community health workers in recognition, management, and appropriate referral of people identified with high suicidal risk.

Discussion

Combining three evidence-based interventions that tackle suicide among high-risk groups may generate a synergistic impact in reducing suicides at the community level in rural areas in India. Examination of implementation processes throughout the trial will also help to prepare a roadmap for policymakers and researchers looking to implement suicide prevention interventions in other countries and at scale.

Trial registration

Clinical Trial Registry of Indian Council of Medical Research, India: CTRI/2017/04/008313. Registered on 7 April 2017.

http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=18256&EncHid=&userName=SPIRIT

Trial registry was last modified on 28 June 2019.