bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventions co-designed by healthcare providers and clients for improving therapeutic relationships in maternal and child healthcare: a pilot study using human centered design in rural Tanzania
Authors: Isangula Kahabi , Pallangyo Eunice S. , Ndirangu-Mugo Eunice
Published: September 2023

Background

Research shows that poor provider–client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.

Objective

The study’s objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.

Methods

A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt.

Results

According to the community-driven research, poor service, a lack of concern, poor communication, a bad attitude, and unhappiness at work are the nurse factors that affect the relationships between nurses and their patients. Non-compliance with procedures, unfavorable attitudes, poor communication, low education, poverty, and faith in conventional healers were among the client-related factors. Inadequate funding, bad management techniques, improper policy execution, and a lack of an independent institution for handling complaints are the health system factors that affect nurse-client relationships. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i) promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings.

Conclusions

HCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.
Reforming for trust and professionalism in municipal healthcare services: implications for human resource management
Authors: Øygarden Olaug , Nøkleberg Martin , Gressgård Leif Jarle
Published: September 2023

Background

Many countries face an increasing demand for home-based healthcare services, and consequently experience a mismatch between expectations and available financial and human resources. It is therefore important to utilize human resources more efficiently, while at the same time offer jobs that attract the professionals they need. This article reports a study of the development and piloting of a new organizational model for home-based healthcare services in a Norwegian municipality, which addresses the need to provide efficient services and enhance trust and professionalism within healthcare services by improving work autonomy and involvement of employees.

Methods

The research project this article draws its empirical material from was commissioned by the municipality piloting the new organizational model and executed in collaboration with the municipality based on an evaluative trailing research (ETR) design. The data consists of interviews with key personnel and knowledge exchange between researchers and the involved actors in the pilot project. 20 semi-structured interviews involving a total of 34 informants were conducted.

The analysis emphasises how different employee groups and management perceived and experienced various aspects of the work situation, as they were introduced to working and managing within the new organizational model. The aim is to shed light on how these employees and managers feel about it, interpret it, and respond to it.

Results

Overall, the results indicate that the model holds potential for realizing the benefits it aims for. However, there were also challenges that need resolving for the model to fulfil this potential. Central elements include clarification of roles and responsibilities for employees and managers, competence specification and development, and development of structures for inter-professional cross-team collaboration and information provision.

Conclusions

Trust reform initiatives may be a strategy for fostering high-involvement work systems. To achieve this, sufficient attention must be paid to ensuring structures for information exchange and knowledge development in the early phases of implementation, or preferably prior to implementation. The theoretical model applied in this study could potentially be a useful managerial tool in preparing for and implementing trust reforms in healthcare services.
Immuno-reactivity evaluation of Mce-truncated subunit candidate vaccine against Mycobacterium avium subspecies paratuberculosis challenge in the goat models
Authors: Haghkhah Masoud , Hemati Zahra , Derakhshandeh Abdollah , Namazi Fatemeh , Chaubey Kundan Kumar , Singh Shoor Vir
Published: September 2023

Background

Detection of an appropriate antigen with high immunogenicity can be a big step in the production of an effective vaccine for control of Johne’s disease (JD). The aim of this study was to evaluate the efficacy of Mce-truncated protein as a subunit vaccine candidate for the control of JD in experimentally challenged goats.

Materials and methods

Six healthy goat kids were immunized with Mce-truncated protein, and two goats were kept as controls. All kids were twice challenged orally with live Mycobacterium avium subspecies paratuberculosis(MAP) strain and half the goats from both the categories were sacrificed at 7 and 10 months after start of challenge study. Culture of MAP was performed from all the necropsied tissues to determine the true JD infection status.

Results

Mce-truncated protein only reacted with pooled vaccinated goat sera in western-blot. A significant increase in humoral immune response against Mce protein was also observed in vaccinated goats. Compared to the control group, vaccinated goats gained higher body weights and none of them shed MAP or showed histopatological lesions or colonization of MAP in their necropsy tissues.

Conclusions

The new Mce protein based vaccine provided significant immunity in goats as they could meet the challenge with live MAP bacilli. Although the vaccine used in this study showed the high potential as a new effective vaccine for the control of JD, further validation study is still required to successfully implement the vaccine for JD control program.
Malaria misdiagnosis in the routine health system in Arba Minch area district in southwest Ethiopia: an implication for malaria control and elimination
Authors: Yigezu Engida , Wondale Biniam , Abebe Daniel , Tamiru Girum , Eligo Nigatu , Lindtjørn Bernt , Gadisa Endalamaw , Tadesse Fitsum Girma , Massebo Fekadu
Published: September 2023

Background

Plasmodium falciparum and Plasmodium vivax are coendemic in Ethiopia, with different proportion in different settings. Microscopy is the diagnostic tool in Ethiopian health centres. Accurate species-specific diagnosis is vital for appropriate treatment of cases to interrupt its transmission. Therefore, this study assessed the status of species-specific misdiagnosis by microscope compared with polymerase chain reaction (PCR).

Methods

A health facility based cross-sectional study was conducted from November 2019 to January 2020 in Kolla Shelle Health centre, Arba Minch Zuria district. The study population were suspected malaria cases, who visited the health centre for a diagnosis and treatment. Consecutive microscopy positive cases as well as a sample of microscopically negative cases were included for molecular analysis by polymerase chain reaction (PCR).

Results

254 microscopically negative and 193 microscopically positive malaria suspects were included. Of the 193 malaria positive cases, 46.1% [95% confidence interval (CI) 38.9–53.4] (89/193) were P. falciparum infection, 52.3% (95% CI 45.0–59.5) (101/193) were P. vivax infection, and 1.6% (3/193) had mixed infection of P. falciparum and P. vivax. Of the microscopically positive cases of P. falciparum, 3.4% (3/89) were P. vivax and 11.2% (10/89) were mixed infections with P. falciparum and P. vivax and a single case was negative molecularly. Similarly, of the microscopically positive P. vivax cases, 5.9% (6/101) were P. falciparum and 1% (1/101) was mixed infection. Single case was negative by molecular technique. Of the 254 microscopically negative cases, 0.8% were tested positive for P. falciparum and 2% for P. vivax by PCR. Considering molecular technique as a reference, the sensitivity of microscopy for detecting P. falciparum was 89.2% and for P. vivax, it was 91.2%. The specificity of microscopy for detecting P. falciparum was 96.1% and for P. vivax, it was 97.7%. However, the sensitivity of microscopy in detecting mixed infection of P. falciparum and P. vivax was low (8.3%).

Conclusion

There were cases left untreated or inappropriately treated due to the species misidentification. Therefore, to minimize this problem, the gaps in the microscopic-based malaria diagnosis should be identified. It is recommended to regularly monitor the competency of malaria microscopists in the study area to improve species identification and diagnosis accuracy.
Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis
Authors: Chavula Malizgani Paul , Zulu Joseph Mumba , Goicolea Isabel , Hurtig Anna-Karin
Published: September 2023

Background

Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia.

Methods

We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia.

Results

The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services.

Conclusion

While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework.
Association between life’s essential 8 and biological ageing among US adults
Authors: Zhang Ronghuai , Wu Min , Zhang Wei , Liu Xuna , Pu Jie , Wei Tao , Zhu Zhanfang , Tang Zhiguo , Wei Na , Liu Bo , Cui Qianwei , Wang Junkui , Liu Fuqiang , Lv Ying
Published: September 2023

Background

Biological ageing is tightly linked to cardiovascular disease (CVD). We aimed to investigate the relationship between Life’s Essential 8 (LE8), a currently updated measure of cardiovascular health (CVH), and biological ageing.

Methods

This cross-sectional study selected adults ≥ 20 years of age from the 2005–2010 National Health and Nutrition Examination Survey. LE8 scores (range 0–100) were obtained from measurements based on American Heart Association definitions, divided into health behavior and health factor scores. Biological ageing was assessed by different methods including phenotypic age, phenotypic age acceleration (PhenoAgeAccel), biological age and biological age acceleration (BioAgeAccel). Correlations were analyzed by weighted linear regression and restricted cubic spline models.

Results

Of the 11,729 participants included, the mean age was 47.41 ± 0.36 years and 5983 (51.01%) were female. The mean phenotypic and biological ages were 42.96 ± 0.41 and 46.75 ± 0.39 years, respectively, and the mean LE8 score was 67.71 ± 0.35. After adjusting for potential confounders, higher LE8 scores were associated with lower phenotypic age, biological age, PhenoAgeAccel, and BioAgeAccel, with nonlinear dose–response relationships. Negative associations were also found between health behavior and health factor scores and biological ageing, and were stronger for health factors. In health factor-specific analyses, the β negativity was greater for blood glucose and blood pressure. The inverse correlations of LE8 scores with phenotypic age and biological age in the stratified analyses remained solid across strata.

Conclusions

LE8 and its subscale scores were strongly negatively related to biological ageing. Encouraging optimal CVH levels may be advantageous in preventing and slowing down ageing.
Study protocol for an individually randomized control trial for India's first roleplay-based mobile game for reproductive health for adolescent girls
Authors: Saha Ananya , Dixit Anvita , Shankar Lalita , Battala Madhusudana , Khan Nizamuddin , Saggurti Niranjan , Ayyagari Kavita , Raj Aparna , Howard Susan
Published: September 2023

Background

Go Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer (DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game’s five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game’s effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT).

Methods

A two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys.

Discussion

Following pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India.

Trial registration number: ctri.nic.in: CTRI/2023/03/050447.
No effect of hydroxyapatite-coated sliding hip screw threads on screw migration in the femoral head/neck of pertrochanteric fractures: a randomized controlled trial using radiostereometric analysis
Authors: Krogh August Christoffer , Thillemann Janni Kjærgaard , Hansen Torben Bæk , Holck Kim , Kristensen Morten Tange , Palm Henrik , Stilling Maiken
Published: September 2023

Introduction

Cut-out is the most frequently reported mechanical failure of internal fixation of pertrochanteric fractures. The purpose of this study was to examine if hydroxyapatite-coated screw thread on a sliding hip screw (SHS) could reduce screw migration within the femoral head in patients with stable pertrochanteric fractures.

Materials and methods

In a double-blinded randomized controlled study, 37 patients at mean age 78 (range 56–96), with pertrochanteric fracture (Evans I, II, IV) received surgery with a SHS with a hydroxyapatite-coated or a non-coated lag screw thread. Radiostereometry and standard radiographs were obtained 1 day, 6 weeks, 3- and 6 months post-operatively to evaluate screw and fracture migration and fracture reposition. The two groups were combined to describe fracture migration.

Results

There was similar and small screw migration in the femoral head between the two groups at 6 weeks, 3- and 6 months (p > 0.12). Fracture migration occurred predominantly in the first 6 weeks, where fracture impaction was 5.95 mm (CI 95% 2.87 to 9.04) and anterior rotation of the femoral head was -2.94° (CI 95% − 5.22 to − 0.66). Migration of the fracture (total translation) correlated to the post-operative fracture reposition (p = 0.002), but not significantly to screw migration (p = 0.09). Neither screw total translation (rho 0.06, p = 0.79) nor fracture total translation (rho 0.04, p = 0.77) correlated with bone mineral density.

Conclusion

There was no clinical benefit of hydroxyapatite coating on lag screw migration in this patient cohort. Migration of the pertrochanteric fractures was higher with poor fracture reposition but fractures generally stabilized after 6 weeks follow-up. The study was registered at ClinicalTrials.gov (NCT05677061).

Level of evidence II

Patient-blinded prospective randomized study.

Trial registration number The study was registered at ClinicalTrials.gov (NCT05677061).
Effect of blastocyst shrinkage on assisted reproductive outcomes: a retrospective cohort study describing a new morphological evaluation of blastocyst pre-vitrification and post-warming
Authors: Ito Ayumu , Katagiri Yukiko , Oigawa Satoko , Amano Kenji , Ichizawa Koichiro , Tokuda Yukiko , Unagami Mami , Yoneyama Masato , Tsuchiya Takahiro , Sekiguchi Mami , Furui Mayuko , Nakaoka Kentaro , Umemura Nahomi , Hayashi Yuko , Tamaki Yuko , Nagao Koichi , Nakata Masahiko
Published: September 2023

Background

The failure of frozen-thawed blastocysts to re-expand adequately within a few hours after warming has been reported to have a negative impact on assisted reproductive technology (ART) outcomes. However, the extent to which this failure truly affects ART outcomes has not yet been presented in a manner that is easily understandable to medical practitioners and patients. This study aimed to assess the effects of blastocyst shrinkage on ART outcomes and determine a more effective morphological evaluation approach for use in clinical settings.

Methods

This retrospective observational cohort study of frozen-thawed blastocyst transfer cycles was conducted from April 2017 to March 2022. Overall, 1,331 cycles were eligible for inclusion, of which 999 were good-quality blastocysts (GQB) and 332 were non-good-quality blastocysts (non-GQB). All frozen-thawed blastocyst transfer cycles performed during the specified study period were included in the study. Exclusion criteria were established to mitigate potential sources of bias as these cycles could impact implantations. We calculated rates and age-adjusted odds ratios of implantation, clinical pregnancy, ongoing pregnancy, and live birth of the re-expansion group, which showed sufficient expansion, and shrinkage group, which showed insufficient expansion. We also calculated the implantation, clinical pregnancy, ongoing pregnancy, and live birth rates of the re-expansion and shrinkage groups for each morphological scoring system parameter.

Results

A reduced ART outcome was observed with use of blastocysts with shrinkage after vitrification/warming. The age-adjusted odds ratios for implantation, clinical pregnancy, ongoing pregnancy, and live birth were lower in the shrinkage group than in the re-expansion group.

Conclusions

This study examined the adverse effect of blastocyst shrinkage after warming and recovery culturing on reproductive outcomes in a clinically useful manner by retrospectively examining a substantial number of frozen-thawed embryo transfer cycles. The study findings can possibly reduce concerns regarding over- or under-estimation of blastocyst implantation by allowing providers and patients to refer to the data.
Ethanol tolerance in engineered strains of Clostridium thermocellum
Authors: Olson Daniel G. , Maloney Marybeth I. , Lanahan Anthony A. , Cervenka Nicholas D. , Xia Ying , Pech-Canul Angel , Hon Shuen , Tian Liang , Ziegler Samantha J. , Bomble Yannick J. , Lynd Lee R.
Published: September 2023

Clostridium thermocellum is a natively cellulolytic bacterium that is promising candidate for cellulosic biofuel production, and can produce ethanol at high yields (75–80% of theoretical) but the ethanol titers produced thus far are too low for commercial application. In several strains of C. thermocellum engineered for increased ethanol yield, ethanol titer seems to be limited by ethanol tolerance. Previous work to improve ethanol tolerance has focused on the WT organism. In this work, we focused on understanding ethanol tolerance in several engineered strains of C. thermocellum. We observed a tradeoff between ethanol tolerance and production. Adaptation for increased ethanol tolerance decreases ethanol production. Second, we observed a consistent genetic response to ethanol stress involving mutations at the AdhE locus. These mutations typically reduced NADH-linked ADH activity. About half of the ethanol tolerance phenotype could be attributed to the elimination of NADH-linked activity based on a targeted deletion of adhE. Finally, we observed that rich growth medium increases ethanol tolerance, but this effect is eliminated in an adhE deletion strain. Together, these suggest that ethanol inhibits growth and metabolism via a redox-imbalance mechanism. The improved understanding of mechanisms of ethanol tolerance described here lays a foundation for developing strains of C. thermocellum with improved ethanol production.
Enhancement of hemostatic properties of Cyclotella cryptica frustule through genetic manipulation
Authors: Wang Lulu , Sun Yan , Zhang Ruihao , Pan Kehou , Li Yuhang , Wang Ruibing , Zhang Lin , Zhou Chengxu , Li Jian , Li Yun , Zhu Baohua , Han Jichang
Published: September 2023

Background

The silicified cell wall of diatoms, also known as frustule, shows huge potential as an outstanding bio-nanomaterial for hemostatic applications due to its high hemostatic efficiency, good biocompatibility, and ready availability. As the architectural features of the frustule determine its hemostatic performance, it is of great interest to develop an effective method to modify the frustule morphology into desired patterns to further improve hemostatic efficiency.

Results

In this study, the gene encoding Silicalemma Associated Protein 2 (a silicalemma-spanning protein) of Cyclotella cryptica (CcSAP2) was identified as a key gene in frustule morphogenesis. Thus, it was overexpressed and knocked down, respectively. The frustule of the overexpress lines showed no obvious alteration in morphology compared to the wild type (WT), while the size, specific surface area (BET), pore volume, and pore diameter of the knockdown strains changed greatly. Particularly, the knockdown frustules achieved a more pronounced coagulation effect and in vivo hemostatic performance than the WT strains. Such observations suggested that silicalemma proteins are ideal genetic encoding targets for manipulating frustule morphology associated hemostatic properties. Furthermore, the Mantel test was adopted to identify the key morphologies associated with C. cryptica bleeding control. Finally, based on our results and recent advances, the mechanism of frustule morphogenesis was discussed.

Conclusion

This study explores a new strategy for enhancing the hemostatic efficiency of the frustule based on genetic morphology modification and may provide insights into a better understanding of the frustule morphogenesis mechanism.
Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study
Authors: Kiryowa Haruna Muhmood , Munabi Ian Guyton , Buwembo William , Rwenyonyi Charles Mugisha , Mwaka Erisa Sabakaki , Kaddumukasa Mark
Published: September 2023

Introduction

Evidence suggests that majority of patients with diabetes mellitus in Uganda have poor glycaemic control as well as periodontal disease. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the triglyceride glucose index.

Methods

Two hundred and twenty-three adult study participants with confirmed diabetes mellitus were enrolled in a cross-sectional study. Oral examination was carried with the aid of a periodontal probe to determine the periodontal status and findings recorded using the WHO Oral Health Assessment Tool for Adults, 2013. We recorded clinical details for body mass index (BMI in kg/m2) and laboratory parameters including fasting blood sugar (mmol/L), glycated hemoglobin levels (HbA1c, %) and serum triglycerides (mmol/L) using a study questionnaire. Data were analyzed using R version 4.10. The glucose triglyceride index was used as a measure of insulin resistance. Logistic regression analysis carried out to determine the factors associated insulin resistance.

Results

The majority of the study participants was female (70%) with an average age of 48.5 years (SD+/- 11.1). The mean body mass index was 29.6 kg/m2 (SD+/- 5.82). The mean serum triglyceride index was 9.48 (SD+/- 0.675). Eighty-six-point 1% of the participants had periodontal disease. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44–4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79–26.15, p = 0.13) but low odds for a high BMI (OR = 0.45. 95% C.I = 0.07–1.67, p = 0.30). Multivariate regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19–1.83, p = 0.03).

Conclusion

Insulin resistance is highly prevalent in patients with diabetes mellitus in Uganda and is associated with periodontitis and low body weight.
Improving investment in chronic disease care in Sub-Saharan Africa is crucial for the achievement of SDG 3.4: application of the chronic care model
Authors: Amu Hubert , Brinsley Theodora Yayra , Kwafo Frank Oppong , Amu Selasi , Bain Luchuo Engelbert
Published: September 2023

Over 41 million people die of chronic non-communicable diseases (CNCDs) each year, accounting for 71% of all global deaths. The burden of CNCD is specifically a problem in sub-Saharan Africa (SSA) since CNCDs are largely a leading major cause of mortality in the sub-region. While the disease burden and mortality from chronic non-communicable diseases (CNCDs) have reached an epidemic threshold in sub-Saharan Africa (SSA), health systems, policy-makers and individuals still consider CNCDs to be uncommon and, therefore, do not give its management the required attention. In sub-Saharan Africa (SSA), effectively addressing the growing burden of CNCDs will require comprehensive measures that incorporate both curative and preventive interventions, towards achieving the Sustainable Development Goal (SDG) 3.4 target of reducing by one-third premature mortality from CNCDs through prevention and treatment and the promotion of mental health and well-being by the year 2030. In this commentary, we adopt the Chronic Care Model (CCM) to discuss how improved investment in Chronic Disease Care is crucial in achieving the SDG target in SSA. At the health systems level of the CCM, we propose that countries in SSA should increase the proportion of their annual budgets allocated to health in line with the Abuja Declaration of 2001. Social health insurance should also be adopted by all countries and effectively implemented. At the community level, we propose intensified community-based health education, the formation of peer support groups and the implementation of community-based policies that promote healthy eating and physical activity.
Hexarelin alleviates apoptosis on ischemic acute kidney injury via MDM2/p53 pathway
Authors: Guan Chen , Li Chenyu , Shen Xuefei , Yang Chengyu , Liu Zengying , Zhang Ningxin , Xu Lingyu , Zhao Long , Zhou Bin , Man Xiaofei , Luo Congjuan , Luan Hong , Che Lin , Wang Yanfei , Xu Yan
Published: September 2023

Introduction

Hexarelin exhibits significant protection against organ injury in models of ischemia/reperfusion (I/R)-induced injury (IRI). Nevertheless, the impact of Hexarelin on acute kidney injury (AKI) and its underlying mechanism remains unclear. In this study, we investigated the therapeutic potential of Hexarelin in I/R-induced AKI and elucidated its molecular mechanisms.

Methods

We assessed the protective effects of Hexarelin through both in vivo and in vitro experiments. In the I/R-induced AKI model, rats were pretreated with Hexarelin at 100 μg/kg/d for 7 days before being sacrificed 24 h post-IRI. Subsequently, kidney function, histology, and apoptosis were assessed. In vitro, hypoxia/reoxygenation (H/R)-induced HK-2 cell model was used to investigate the impact of Hexarelin on apoptosis in HK-2 cells. Then, we employed molecular docking using a pharmmapper server and autodock software to identify potential target proteins of Hexarelin.

Results

In this study, rats subjected to I/R developed severe kidney injury characterized by tubular necrosis, tubular dilatation, increased serum creatinine levels, and cell apoptosis. However, pretreatment with Hexarelin exhibited a protective effect by mitigating post-ischemic kidney pathological changes, improving renal function, and inhibiting apoptosis. This was achieved through the downregulation of conventional apoptosis-related genes, such as Caspase-3, Bax and Bad, and the upregulation of the anti-apoptotic protein Bcl-2. Consistent with the in vivo results, Hexarelin also reduced cell apoptosis in post-H/R HK-2 cells. Furthermore, our analysis using GSEA confirmed the essential role of the apoptosis pathway in I/R-induced AKI. Molecular docking revealed a strong binding affinity between Hexarelin and MDM2, suggesting the potential mechanism of Hexarelin’s anti-apoptosis effect at least partially through its interaction with MDM2, a well-known negative regulator of apoptosis-related protein that of p53. To validate these findings, we evaluated the relative expression of MDM2 and p53 in I/R-induced AKI with or without Hexarelin pre-administration and observed a significant suppression of MDM2 and p53 by Hexarelin in both in vivo and in vitro experiments.

Conclusion

Collectively, Hexarelin was identified as a promising medication in protecting apoptosis against I/R-induced AKI.
Plastics shape the black soldier fly larvae gut microbiome and select for biodegrading functions
Authors: De Filippis Francesca , Bonelli Marco , Bruno Daniele , Sequino Giuseppina , Montali Aurora , Reguzzoni Marcella , Pasolli Edoardo , Savy Davide , Cangemi Silvana , Cozzolino Vincenza , Tettamanti Gianluca , Ercolini Danilo , Casartelli Morena , Caccia Silvia
Published: September 2023

Background

In the last few years, considerable attention has been focused on the plastic-degrading capability of insects and their gut microbiota in order to develop novel, effective, and green strategies for plastic waste management. Although many analyses based on 16S rRNA gene sequencing are available, an in-depth analysis of the insect gut microbiome to identify genes with plastic-degrading potential is still lacking.

Results

In the present work, we aim to fill this gap using Black Soldier Fly (BSF) as insect model. BSF larvae have proven capability to efficiently bioconvert a wide variety of organic wastes but, surprisingly, have never been considered for plastic degradation. BSF larvae were reared on two widely used plastic polymers and shotgun metagenomics was exploited to evaluate if and how plastic-containing diets affect composition and functions of the gut microbial community. The high-definition picture of the BSF gut microbiome gave access for the first time to the genomes of culturable and unculturable microorganisms in the gut of insects reared on plastics and revealed that (i) plastics significantly shaped bacterial composition at species and strain level, and (ii) functions that trigger the degradation of the polymer chains, i.e., DyP-type peroxidases, multicopper oxidases, and alkane monooxygenases, were highly enriched in the metagenomes upon exposure to plastics, consistently with the evidences obtained by scanning electron microscopy and 1H nuclear magnetic resonance analyses on plastics.

Conclusions

In addition to highlighting that the astonishing plasticity of the microbiota composition of BSF larvae is associated with functional shifts in the insect microbiome, the present work sets the stage for exploiting BSF larvae as “bioincubators” to isolate microbial strains and enzymes for the development of innovative plastic biodegradation strategies. However, most importantly, the larvae constitute a source of enzymes to be evolved and valorized by pioneering synthetic biology approaches.
Correlates of disordered eating and insulin restriction behavior and its association with psychological health in Taiwanese youths with diabetes mellitus
Authors: Chou Wei-Chih , Chou Yen-Yin , Pan Yu-Wen , Ou Tsung-Ying , Tsai Meng-Che
Published: September 2023

Background

Adolescents and young adults (AYAs) with diabetes mellitus (DM) are prone to eating disorders that may worsen metabolic control. This study investigated the clinical and behavioral correlates of disordered eating and insulin restriction (DE/IR) behavior and its association with psychological health among AYAs with DM.

Methods

We enrolled patients with DM aged 10–30 years receiving insulin treatment in a tertiary medical center from 2019 to 2021. After obtaining informed consent, we assessed various visit-to-visit HbA1c measures indicating glycemic control, DE/IR behavior using the modified SCOFF questionnaire, weight-control practices (e.g., self-medication, induced vomiting, and over-exercising), and anxious and depressive symptoms using the Hospital Anxiety and Depression Scale. Correlation and hierarchical regression analyses were applied to understand the clinical and behavioral correlates of DE/IR behavior and its association with anxiety and depression.

Results

Among the 110 patients with type 1 and type 2 DM recruited, we found 17.6% restricting insulin use and 6.3% self-medicating for weight control (higher in type 2 DM than type 1 DM). Hierarchical regression analyses showed HbA1c standard deviation (odds ratio = 2.18, [95% confidence interval 1.07–4.42]), body image (1.83, [1.05–3.20]), and dieting (4.74, [1.70–13.23]) associated with DE/IR behavior. Moreover, DE/IR behavior was further associated with anxiety (1.17 [1.08–1.27]) and depression (1.12 [1.03–1.22]).

Conclusion

DE/IR behavior is not uncommon among AYAs with DM, particularly those with type 2 DM, and may be associated with anxiety and depressive symptoms. In addition, HbA1c variability is correlated with DE/IR behavior, and the clinical implications need further exploration.
2‐year results of middle‐aged patients with two‐compartment cartilage lesions in one knee treated with two patient specific metal implants
Authors: Toom Daniel Aaron den , Rieke Markus , Elbadawi Allaeldin , Kösters Clemens ,   Maria‐Josef‐Hospital Greven
Published: September 2023

Purpose

Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient‐specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient‐specific implants.

Methods

This prospective, non‐randomized, non‐comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden).

A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D‐printed surgical instruments to provide exact placement of the implant.

The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow‐up.

Results

The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months.

Conclusion

Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further.

Level of Evidence

IV
A whole-body diffusion MRI normal atlas: development, evaluation and initial use
Authors: Sjöholm Therese , Tarai Sambit , Malmberg Filip , Strand Robin , Korenyushkin Alexander , Enblad Gunilla , Ahlström Håkan , Kullberg Joel
Published: September 2023

Background

Statistical atlases can provide population-based descriptions of healthy volunteers and/or patients and can be used for region- and voxel-based analysis. This work aims to develop whole-body diffusion atlases of healthy volunteers scanned at 1.5T and 3T. Further aims include evaluating the atlases by establishing whole-body Apparent Diffusion Coefficient (ADC) values of healthy tissues and including healthy tissue deviations in an automated tumour segmentation task.

Methods

Multi-station whole-body Diffusion Weighted Imaging (DWI) and water-fat Magnetic Resonance Imaging (MRI) of healthy volunteers (n = 45) were acquired at 1.5T (n = 38) and/or 3T (n = 29), with test-retest imaging for five subjects per scanner. Using deformable image registration, whole-body MRI data was registered and composed into normal atlases. Healthy tissue ADCmean was manually measured for ten tissues, with test-retest percentage Repeatability Coefficient (%RC), and effect of age, sex and scanner assessed. Voxel-wise whole-body analyses using the normal atlases were studied with ADC correlation analyses and an automated tumour segmentation task. For the latter, lymphoma patient MRI scans (n = 40) with and without information about healthy tissue deviations were entered into a 3D U-Net architecture.

Results

Sex- and Body Mass Index (BMI)-stratified whole-body high b-value DWI and ADC normal atlases were created at 1.5T and 3T. %RC of healthy tissue ADCmean varied depending on tissue assessed (4–48% at 1.5T, 6–70% at 3T). Scanner differences in ADCmean were visualised in Bland-Altman analyses of dually scanned subjects. Sex differences were measurable for liver, muscle and bone at 1.5T, and muscle at 3T. Volume of Interest (VOI)-based multiple linear regression, and voxel-based correlations in normal atlas space, showed that age and ADC were negatively associated for liver and bone at 1.5T, and positively associated with brain tissue at 1.5T and 3T. Adding voxel-wise information about healthy tissue deviations in an automated tumour segmentation task gave numerical improvements in the segmentation metrics Dice score, sensitivity and precision.

Conclusions

Whole-body DWI and ADC normal atlases were created at 1.5T and 3T, and applied in whole-body voxel-wise analyses.
Localizability estimation using correlation on occupancy grid maps
Authors: Kondo Maiku , Hoshi Masahiko , Hara Yoshitaka , Nakamura Sousuke
Published: September 2023

In the field of autonomous mobile robotics, reliable localization is important. However, there are real environments where localization fails. In this paper, we propose a method to estimate localizability based on occupancy grid maps. The localizability indicates the reliability of localization. There are several approaches to estimate localizability, we propose a method to estimate localizability as a covariance matrix of the Gaussian distribution using local map correlation. Our method can estimate the magnitude of the localization error and the characteristics of the error. To confirm the effectiveness of the proposed method, we constructed simulation environments that include representative shapes of indoor environments. We conducted an experiment to investigate the characteristics of the distribution of local map correlation. Furthermore, we also conducted an experiment of our method to estimate localizability on occupancy grid maps. The simulation experiment results showed that the proposed method could estimate the magnitude of the localization error and the characteristics of the error on occupancy grid maps. The proposed method was confirmed to be effective in estimating localizability.
Prevalence of hypertension among travelers and stability of blood pressure control during travel: a cross-sectional descriptive study and prospective cohort study
Authors: Gultawatvichai Watsapol , Matsee Wasin , Pisutsan Phimphan , Kusolsuk Teera , Silachamroon Udomsak , Mansanguan Chayasin , Lawpoolsri Saranath , Flaherty Gerard T. , Piyaphanee Watcharapong
Published: September 2023

Background

Hypertension is a common and important risk factor for cardiovascular disease which is the leading cause of death among the general population and travelers. Data on hypertension among travelers are very limited due to the scarcity of research reports in this specific population. Therefore, this study aimed to determine the prevalence of hypertension among adult travelers and the stability of blood pressure control during international trips using a mobile automated blood pressure device.

Methods

This was a cross-sectional descriptive study conducted at the Thai travel clinic, Hospital for Tropical Diseases in Bangkok, Thailand. All adult travelers completed a questionnaire which included demographic data, medical history, medication use, trip characteristics and hypertension awareness and knowledge. Standard two time blood pressure measurements were performed at the clinic to detect possible undiagnosed hypertension. Travelers with pre-existing hypertension were also invited to monitor their blood pressure level before and during their trip for a total of 14 days by using an automated blood pressure device and reporting the readings back to the study team.

Result

During July and October 2022, a total of 1,359 adult travelers visited the Thai Travel Clinic before their international trip. The overall prevalence of hypertension was 28.8%, including those with pre-existing hypertension (6.7%) and those with newly diagnosed hypertension (22.2%). Travelers with newly diagnosed hypertension were significantly younger than travelers with pre-existing hypertension (38.5 years vs. 55.6 years, p < 0.001). Eleven travelers agreed to monitor their blood pressure, Most (90.9%, 10/11) had stable blood pressure control during their trip. One participant had > 10 mmHg higher blood pressure during the trip, however this was not clinically significant. All participants remained well, and acute symptoms secondary to hypertension were not reported.

Conclusion

Up to 28.8% of adult travelers seen in pre-travel consultations had hypertension. Most of them were unaware of their blood pressure condition. Vital signs including blood pressure should be evaluated in all pre-travel visits in order to prevent undiagnosed severe hypertension that might lead to hypertensive crisis.