bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in drowning mortality rates and quality of reporting from 2004–2005 to 2014–2015: a comparative study of 61 countries
Authors: Lin Ching-Yi , Wang Liang-Yi , Lu Tsung-Hsueh
Published: October 2019

Background

This study assessed international variations in changes in drowning mortality rates and the quality of reporting specific information in death certificates over the past decade.

Methods

Drowning mortality data of 61 countries were extracted from the World Health Organization Mortality Database. We calculated the percentage change (PC) in age-standardized drowning mortality rates and percentage of drowning deaths reported with unspecified codes between 2004 and 2005 and 2014–2015.

Results

Of the 61 countries studied, 50 exhibited a reduction in drowning mortality rates from 2004 to 2005 to 2014–2015. Additionally, five countries—Lithuania, Moldova, Kyrgyzstan, Romania, and El Salvador—with a high mortality rate in 2004–2005 (> 40 deaths per 100,000) showed improvement (PC < − 32%). By contrast, four countries—South Africa, Guyana, Morocco, and Guatemala—exhibited a more than twofold increase in mortality rates. Regarding the quality of reporting, 34 countries exhibited a decrease in the percentage of unspecified codes. Additionally, three countries—Paraguay, Serbia, and Croatia—with moderate and high percentages of unspecified codes (> 40%) exhibited a marked reduction (PC < − 60%), whereas three countries—Malaysia, Belgium, and Nicaragua—exhibited a notable increase.

Conclusions

Large international variations in the extent of changes in drowning mortality rates and the quality of reporting specific information on the death certificate were observed during the study period.
Risk factors for endometrial carcinoma among postmenopausal women in Sri Lanka: a case control study
Authors: Jayawickcrama Withanage Iresha udayangani , Abeysena Chrishantha
Published: October 2019

Background

Endometrial carcinoma burden is on the rise globally. The objective of this study was to determine the risk factors for endometrial carcinoma among postmenopausal women in Western province in Sri Lanka.

Methods

A case control study was conducted recruiting 83 incident cases of endometrial carcinoma and 332 unmatched hospital controls from all the secondary and tertiary care hospitals in the province using consecutive sampling technique. A case was defined as a postmenopausal woman who had been residing in the province for at least a period of 1 year, diagnosed to have endometrial carcinoma with histological confirmation within 3 months of the initiation of data collection of the study. Data were collected using validated interviewer administered questionnaire. Risk factor were identified through multiple logistic regression and results were expressed as adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results

The independent risk factors of endometrial carcinoma are having family history of any type of cancer among first degree relative (AOR = 12.6; 95% CI:5.14–30.9), generalized obesity (BMI ≥25 kg/m2) (AOR = 11.85; 95% CI:5.12–27.4), never conceived (AOR = 3.84; 95% CI:1.37–10.7), age at menarche ≤11 years (AOR = 4.07; 95% CI:1.16–14.2), age > 55 years (AOR = 4.69; 95% CI:2.16–10.2), monthly family income of ≤20,000 Rupees (AOR = 2.65; 95% CI:1.31–5.39), sub-optimal consumption of deep fried food (AOR = 0.17; 95% CI:0.06–0.46), and low level household activities (AOR = 2.82; 95% CI:1.34–5.92).

Conclusions

There were eight independent risk factors of endometrial carcinoma specific for Sri Lankan postmenopausal women identified. Some modifiable risk factors such as generalized obesity, sub-optimal dietary practices and low level physical activities need to be addressed at primary prevention level.
Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi
Authors: Chirambo Lusungu , Valeta Martha , Banda Kamanga Tifiness Mary , Nyondo-Mipando Alinane Linda
Published: October 2019

Background

Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi.

Methods

We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach.

Results

Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships.

Conclusion

The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.
Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias
Authors: Khaled Islam , Priego Pablo , Faisal Mohammed , Cuadrado Marta , García-Moreno Francisca , Ballestero Araceli , Galindo Julio , Lobo Eduardo
Published: October 2019

Background

Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™).

Methods

A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks.

Results

Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred.

Conclusions

TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.
Cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town using health belief model, South West Ethiopia
Authors: Nigussie Tadesse , Admassu Bitiya , Nigussie Aderajew
Published: October 2019

Background

Cervical cancer is the second most common gynecologic cancer affecting the lives of women. It causes hundreds of thousands of death among women annually worldwide. When a woman is screened for cervical cancer at least once in her life between the ages of 30 and 40, the risk of getting cervical cancer can be decreased by 25–36%. Despite this advantage, the coverage of cervical cancer screening is limited in low and middle-income countries including Ethiopia.

Objective

To assess cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town, South West Ethiopia, 2017.

Methods

Community based cross-sectional study was used. Seven hundred thirty-seven women were selected using systematic random sampling. Data were collected using a structured interview administered questionnaire. Data were collected on socio-demographic, reproductive factors, knowledge of cervical cancer as well as constructs of Health belief model and practice related variables. Logistic regression analysis was performed, and variables with a p-value of less than 0.05 in the multivariable analysis were taken as statistically significant predictors of cervical cancer screening service utilization.

Results

Of the 737 women, only 15.5% were screened for cervical cancer. The independent predictors of cervical cancer screening utilization were: being government employee [AOR = 3.00, 95% CI: 1.49–6.01], knowing someone who has ever screened [AOR = 3.61, 95% CI: 2.07–6.29], having history of gynecologic examination for any reason (having previous examination that expose women genitalia for physician like examination during child birth, abortion procedure and examination for STI) [AOR =2.84, 95% CI: 1.48–5.45], not preferring gender of physician for gynecological examination [AOR = 3.57, 95% CI: 1.98–6.45], getting advice from health care providers [AOR = 4.45, 95% CI: 2.57–7.70], having good knowledge of cervical cancer screening [AOR = 3.46, 95% CI: 1.47–8.21] and having perceived susceptible for cervical cancer [AOR = 3.03, 95% CI: 1.64–5.56].

Conclusions

The utilization of cervical cancer screening services was low in Jimma town. Strengthening the screening service is important through raising the awareness of the community towards cervical cancer and screening services.
Anti-inflammatory and cytotoxic activities of the extracts, fractions, and chemical constituents isolated from Luehea ochrophylla Mart
Authors: Araújo Clináscia Rodrigues Rocha , de Melo Silva Thiago , dos Santos Michaelle Geralda , Ottoni Marcelo Henrique Fernandes , de Souza Fagundes Elaine Maria , de Sousa Fontoura Humberto , de Melo Gustavo Eustáquio Brito Alvim , de Carvalho Alcântara Antônio Flávio
Published: October 2019

Background

Stem bark ofLuehea ochrophylla(L. ochrophylla) is used by the traditional Brazilian medicine for treatment of rheumatic diseases and tumors. This study aimed to investigate inhibition of acute and chronic inflammations and cytotoxic activity of extracts, fractions, and isolated compounds fromL. ochrophylla.

Methods

Hexane (HE) and ethanol (EE) extracts obtained from stem bark ofL.ochrophyllawere submitted to chromatographic fractionation. In order to test acute inflammation, experimental model of impact injury was used, followed by transdermal application of gels using phonophoresis. Histological analysis was based on scores assigned by the capacity of decreasing the lesion. To evaluate the effect EE and fractions on cell proliferation, human lymphocytes were stimulated with phytohemagglutinin and analyzed using flow cytometry. Proliferation was measured using VPD 450 staining and the calculated proliferative index (PI). The cytotoxic activity was evaluated using MTT colorimetric method against MDA-MB-231, MCF-7, HCT-116, and Vero cells. GraphPad Prism Version 5 was used for statistical analysis.

Results

HE and EE provided friedelin,β-friedelinol, lupeol, mixture of lupeol and pseudotaraxasterol,β-sitosterol, betulinic acid, mixture of lupeol and taraxasterol, (−)-epicatechin,β-sitosterol-3-O-β-D-glucopyranoside, and (+)-epicatechin-(4β-8)-epicatechin. HE, ethyl acetate fraction (AF), betulinic acid, andβ-sitosterol promoted regeneration of muscle fibers caused by muscle injury. AF significantly (p < 0.05) reduced the lymphocyte proliferation index (1.36 for cultures stimulated with PHA, 0.7 for untreated cultures and 0.12 for cultures stimulated with PHA and treated with AF 25 μg/mL and AF 50 μg/mL, respectively).β-Sitosterol-3-O-β-D-glucopyranoside exhibited high cytotoxic activity (IC50 = 1.279 μg/mL) against HCT-116 cell line.

Conclusion

These results suggest that extracts, fractions, and chemical constituents fromL. ochrophylladecreases inflammatory processes generated by muscle injury. The anti-inflammatory activity may be justified by high inhibition of T cell proliferation. These extracts, fractions, and chemical constituents fromL. ochrophyllamay be useful as a therapeutic agent against rheumatic diseases. Moreover, chemical constituents fromL. ochrophyllashow potent cytotoxic activity against colon and rectal carcinomas.
Factors associated with successful dementia education for practitioners in primary care: an in-depth case study
Authors: Sass Cara , Burnley Natasha , Drury Michelle , Oyebode Jan , Surr Claire
Published: October 2019

Background

With increasing numbers of people in the UK living with dementia, the provision of good quality person-centred care that meets the often complex needs of this population is required. Given the majority of people with dementia live in the community, significant care and support will be provided by primary care services. This means the primary care workforce needs appropriate education to ensure they have the right knowledge, skills and attitudes to meet these care needs. However, little is understood about the most successful approaches to dementia education in this setting.

Methods

An in-depth case study was undertaken in a single primary care organisation with the aim of exploring the impact of a person-centred dementia educational programme, and identify barriers and facilitators to implementation. Data was gathered from a wide range of sources and analysed using Kirkpatrick’s evaluative framework.

Results

Initially, staff learners struggled to incorporate the ‘whole-person’ approach to dementia care, but gained knowledge and confidence through self-directed learning. They reacted positively to the training and appreciated opportunities to learn from peers in other services. They identified improvements in communication and prescribing practices, despite difficulties implementing changes during busy periods. Resultant impact for service users included more timely routine appointments, and positive satisfaction ratings from patients and families.

Conclusions

The findings indicate the perceived value of person-centred dementia education for primary care. Further recommendations for provision in this service setting include tailored programmes designed collaboratively with clinical service providers, and bringing together an interdisciplinary mix of learners to enhance knowledge exchange.
Educational inequalities in all-cause and cause-specific mortality among people with gout: a register-based matched cohort study in southern Sweden
Authors: Kiadaliri Ali , Moreno-Betancur Margarita , Turkiewicz Aleksandra , Englund Martin
Published: October 2019

Background

Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden.

Methods

We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998–2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: “underlying cause”, “any mention”, and “weighted multiple-cause”.

Results

Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach.

Conclusions

Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.
Genetic relevance and determinants of mitral leaflet size in hypertrophic cardiomyopathy
Authors: Chung Hyemoon , Kim Yoonjung , Park Chul-Hwan , Kim Jong-Youn , Min Pil-Ki , Yoon Young Won , Kim Tae Hoon , Lee Byoung Kwon , Hong Bum-Kee , Rim Se-Joong , Kwon Hyuck Moon , Lee Kyung-A , Choi Eui-Young
Published: October 2019

Background

Whether mitral leaflet elongation is a primary phenotype of hypertrophic cardiomyopathy (HCM) is controversial. We investigated the genetic relevance and determinants of mitral leaflet size by performing extensive gene analyses in patients with HCM.

Methods

Anterior mitral leaflet (AML) lengths were measured in HCM patients (n = 211) and age- and sex-matched controls (n = 30) using echocardiography with hemodynamic and chamber geometric assessments. We analyzed 82 nuclear DNA (8 sarcomeric genes, 74 other HCM-associated genes) and mitochondrial DNA. Cardiac magnetic resonance imaging (CMR) was performed in the 132 HCM patients.

Results

Average indexed AML was significantly longer for HCM than for controls (17.2 ± 2.3 vs. 13.3 ± 1.6 mm/m2, P <  0.001). Average AML length correlated with body surface area (BSA), left ventricular (LV) end-systolic volume (P <  0.001) and LV mass by CMR (P < 0.001). Average indexed AML by BSA of pure-apical HCM was significantly shorter than other typed HCM (16.6 ± 2.0 vs. 17.4 ± 2.4 mm/m2, P = 0.025). Indexed AML was independently correlated with left atrial wall stress. The thin filament mutation group showed larger average AML (31.9 ± 3.8 vs. 29.6 ± 3.8 mm, P = 0.045), but this was not significant with the indexed value. No difference in AML size among subgroups was observed based on the presence of sarcomere protein or mitochondria-related gene variants (P > 0.05).

Conclusion

AML elongation was a unique finding of HCM. However, the leaflet size was more related to chamber geometry and hypertrophy pattern rather than genetic factors within overt HCM.
Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes
Authors: Deng Jianwei , Sun Yangyang , Lei Run , Guo Yilun , Liu Jian , Yang Tianan
Published: October 2019

Background

Healthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied.

Methods

This study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing.

Results

We found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process.

Conclusions

Our study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.
Potential therapeutic effects of cyanidin-3-O-glucoside on rheumatoid arthritis by relieving inhibition of CD38+ NK cells on Treg cell differentiation
Authors: Wang Hongxing , Li Shutong , Zhang Guoqing , Wu Hui , Chang Xiaotian
Published: October 2019

Background

CD38+ NK cells are overabundant in rheumatoid arthritis (RA). Cyanidin-3-O-glucoside (C3G) is an inhibitor of CD38. This study investigated the pathogenic role of CD38+ NK cells and the effect of C3G on RA.

Methods

Rats with bovine type II collagen-induced arthritis (CIA) were injected with C3G. RA synovial fibroblasts (RASFs) or mononuclear cells (MNCs) were cultured with C3G. MNCs were also cocultured with CD38+ NK cells following C3G pretreatment.

Results

C3G injection significantly alleviated CIA. C3G also significantly increased the level of interleukin (IL)-10 and the regulatory T (Treg) cell proportion, and it decreased the interleukin (IL)-6 and interferon (IFN)-γ levels and CD38+ NK cell proportion in rat peripheral blood and synovial fluid. Additionally, C3G significantly increased RASF apoptosis and decreased RASF proliferation and IL-6 production in the culture medium. Furthermore, C3G stimulated MNCs to increase IL-2 and IL-10 production and the Treg cell proportion, and it caused MNCs to decrease IL-6 and IFN-γ production and the CD38+ NK cell proportion. Although CD38+ NK cells significantly decreased the Treg cell proportion and IL-10 level in MNCs, CD38+ NK cells that had been pretreated with C3G increased the proportion of Treg cells and IL-10 levels and decreased the IL-6 and IFN-γ levels in the coculture. In CD38+ NK cells, C3G significantly increased Sirtuin 6 (Sirt6) expression and the tumor necrosis factor (TNF)-α level, and it decreased natural killer group 2D (NKG2D) expression and the IFN-γ level. However, when CD38+ NK cells were treated with Sirt6 siRNA, C3G did not change the NKG2D expression, the TNF-α level sharply decreased, and the IFN-γ level increased. When MNCs were cocultured with C3G-pretreated CD38+ NK cells in the presence of TNF-α and an anti-IFN-γ antibody, the IL-10+ Treg cell proportion significantly increased. When MNCs were cocultured with C3G-pretreated CD38+ NK cells in the presence of IFN-γ and an anti-TNF-α antibody, the IL-10+ Treg cell proportion sharply decreased. When CIA rats were injected with both C3G and the Sirt6 inhibitor OSS_128167, the rats exhibited joint inflammation and a low Treg cell proportion, but the CD38+ NK proportion was still low.

Conclusion

C3G has therapeutic effects on CIA and RA. C3G decreased the proportion of CD38+ cells, RASF proliferation, and proinflammatory cytokine secretion, and it increased the Treg cell proportion. C3G also elevated Sirt6 expression to suppress NKG2D expression, increase TNF-α secretion, and decrease IFN-γ secretion in CD38+ NK cells, which stimulates MNCs to differentiate into Treg cells. This study also demonstrates that the inhibition of Treg cell differentiation in MNCs by CD38+ NK cells is a potential cause of the immune imbalance in RA and CIA.
Coronary artery bypass surgery plus medical therapy versus medical therapy alone for ischaemic heart disease: a protocol for a systematic review with meta-analysis and trial sequential analysis
Authors: Lorenzen Ulver Spangsberg , Buggeskov Katrine Bredahl , Nielsen Emil Eik , Sethi Naqash Javaid , Carranza Christian Lildal , Gluud Christian , Jakobsen Janus Christian
Published: October 2019

Background

Despite increasing survival, cardiovascular disease remains the primary cause of death worldwide with an estimated 7.4 million annual deaths. The main symptom of ischaemic heart disease is chest pain (angina pectoris) most often caused by blockage of a coronary artery. The aim of coronary artery bypass surgery is revascularisation achieved by surgically grafting harvested arteries or veins distal to the coronary lesion restoring blood flow to the heart muscle. Older evidence suggested a clear survival benefit of coronary artery bypass graft surgery, but more recent trials yield less clear evidence. We want to assess the benefits and harms of coronary artery bypass surgery combined with different medical therapies versus medical therapy alone in patients with ischaemic heart disease.

Methods

This protocol for a systematic review follows the recommendations of Cochrane and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all randomised clinical trials assessing coronary artery bypass surgery combined with different medical therapies versus medical therapy alone in patients with ischaemic heart disease. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed as high risk or low risk of bias, and our conclusions will primarily be based on trials at low risk of bias. The analyses of the extracted data will be performed using Review Manager 5, STATA 16 and trial sequential analysis. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table and use GRADE to assess the certainty of the evidence.

Discussion

Coronary artery bypass surgery is invasive and can cause death, which is why its use must be thoroughly studied to determine if it yields a large enough long-term benefit for the thousands of patients receiving it every year.

Systematic review registration

PROSPERO ID 131924
Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania
Authors: Rajaguru Praveen Paul , Jusabani Mubashir Alavi , Massawe Honest , Temu Rogers , Sheth Neil Perry
Published: October 2019

Background

Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.

Methods

The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.

Results

In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).

Conclusion

While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.
The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis
Authors: Peterson Steve , Piercy James , Blackburn Stuart , Sullivan Emma , Karyekar Chetan S. , Li Nan
Published: October 2019

Background

The prevalence of mood disturbances such as anxiety and depression is greater in rheumatoid arthritis (RA) patients than in the general population. Given this association, the primary aim of this study was to assess the incremental impact of anxiety or depression on patients with RA from the United States of America (USA) and Europe, independent of the impact of the underlying RA disease.

Methods

Rheumatologists (n = 408) from the USA and 5 European countries completed patient record forms for a predetermined number of RA patients who consulted consecutively during the study period; these patients completed patient-reported questionnaires. Descriptive statistics and multivariate regression were used to investigate the relationship between anxiety and depression with treatment and economic outcomes in RA patients.

Results

Of 1015 physician and patient pairs who completed all relevant questionnaire sections, 390 (38.4%) patients self-reported anxiety or depression, while 180 (17.7%) patients were reported to have anxiety or depression by their physicians. Controlling for age, gender, body mass index and clinical factors (flaring and severity), multiple regression analyses suggested that patients with anxiety or depression more often experienced treatment dissatisfaction (odds ratio [OR] 2.28; P < .001), had greater impairment in work (coefficient [β] = 11.82; P = .001) and usual activity (β = 14.73; P < .001), greater disability (β = .35; P < .001), and more often reported unemployment (OR 1.74; P = .001). Multinomial logistic regression revealed discordance between physician and patient satisfaction with treatment. For patients reporting anxiety or depression, physicians were more often satisfied with achievement of current disease control than patients (relative risk ratio 2.19; P = .002).

Conclusion

Concomitant anxiety or depression was associated with a significant incremental impact on the health-related quality of life and economic aspects of life of patients with RA. In light of observed differences between physician recognition of patient anxiety and/or depression versus patient reporting of anxiety and/or depression symptoms, further research is warranted to develop optimal screening and management of depression and anxiety in patients with RA.
Improved CNS Control of Childhood Acute Lymphoblastic Leukemia Without Cranial Irradiation: St Jude Total Therapy Study 16
Authors: Jeha Sima , Pei Deqing , Choi John , Cheng Cheng , Sandlund John T. , Coustan-Smith Elaine , Campana Dario , Inaba Hiroto , Rubnitz Jeffrey E. , Ribeiro Raul C. , Gruber Tanja A. , Raimondi Susana C. , Khan Raja B. , Yang Jun J. , Mullighan Charles G. , Downing James R. , Evans William E. , Relling Mary V. , Pui Ching-Hon
Published: October 2019

PURPOSE

Despite contemporary treatment, up to 10% of children with acute lymphoblastic leukemia still experience relapse. We evaluated whether a higher dosage of PEG-asparaginase and early intensification of triple intrathecal therapy would improve systemic and CNS control.

PATIENTS AND METHODS

Between 2007 and 2017, 598 consecutive patients age 0 to 18 years received risk-directed chemotherapy without prophylactic cranial irradiation in the St Jude Total Therapy Study 16. Patients were randomly assigned to receive PEG-asparaginase 3,500 U/m2 versus the conventional 2,500 U/m2. Patients presenting features that were associated with increased risk of CNS relapse received two extra doses of intrathecal therapy during the first 2 weeks of remission induction.

RESULTS

The 5-year event-free survival and overall survival rates for the 598 patients were 88.2% (95% CI, 84.9% to 91.5%) and 94.1% (95% CI, 91.7% to 96.5%), respectively. Cumulative risk of any—isolated or combined—CNS relapse was 1.5% (95% CI, 0.5% to 2.5%). Higher doses of PEG-asparaginase did not affect treatment outcome. T-cell phenotype was the only independent risk factor for any CNS relapse (hazard ratio, 5.15; 95% CI, 1.3 to 20.6; P = . 021). Among 359 patients with features that were associated with increased risk for CNS relapse, the 5-year rate of any CNS relapse was significantly lower than that among 248 patients with the same features treated in the previous Total Therapy Study 15 (1.8% [95% CI, 0.4% to 3.3%] v 5.7% [95% CI, 2.8% to 8.6%]; P = .008). There were no significant differences in the cumulative risk of seizure or infection during induction between patients who did or did not receive the two extra doses of intrathecal treatment.

CONCLUSION

Higher doses of PEG-asparaginase failed to improve outcome, but additional intrathecal therapy during early induction seemed to contribute to improved CNS control without excessive toxicity for high-risk patients.
African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa
Authors: Hessissen Laila , Patte Catherine , Martelli Helene , Coze Carole , Howard Scott C. , Kili Amina , Gagnepain-Lacheteau Anne , Harif Mhamed
Published: October 2019

PURPOSE

In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries.

METHODS

A 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training.

RESULTS

The first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site.

CONCLUSION

This training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.
When Demand Increases Cause Shakeouts
Authors: Hubbard Thomas N. , Mazzeo Michael J.
Published: October 2019

Standard models that guide competition policy imply that demand increases should lead to more, not fewer firms. However, Sutton’s (1991) model shows that demand increases instead can lead to shakeouts if non-price competition takes the form of fixed investments. We investigate this effect in the 1960s–1980s hotel and motel industry, where quality competition arose through investments in swimming pools. We show that demand increases associated with highway openings led to fewer firms, particularly in warm places. We do not find this effect in other industries that serve travelers, gasoline retailing, and restaurants, where quality competition does not involve fixed investments. (JEL G34, K21, L13, L15, L40, L83)
Children and young people's experiences of living with developmental coordination disorder/dyspraxia: study protocol for a qualitative evidence synthesis
Authors: O'Dea Áine , Coote Susan , Robinson Katie
Published: October 2019

Children with developmental coordination disorder (DCD) face significant challenges to deal with everyday activities due to underlying motor proficiency difficulties. These challenges affect children and young people’s participation; that is, involvement in daily life situations. In the past, limited consideration was given to personal experience of events, relationships and everyday life in children and young people with DCD; as a result, understanding what it is like to live with DCD is not well conceptualised in the literature. There is a pressing need to synthesise the findings of discrete qualitative studies to advance the conceptual understanding of living with DCD, to inform health service delivery and the development and implementation of complex interventions. This study aims to systematically review and synthesise qualitative literature regarding children and young people’s experiences and views of everyday life and living with DCD. The method of qualitative evidence synthesis that will be followed in this review is a meta-ethnography. The eMERGe and PRISMA reporting guidelines will be used in the development, design and reporting of this review. Nine databases will be searched; Academic Search Complete, AMED, CINAHL, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science. Two independent reviewers will use the Joanna Briggs Institute Checklist to appraise all included papers. The findings of this meta-ethnography will endeavour to inform future research, policy and practice. In particular, the results will help to inform the design of future complex interventions to meet the needs of children and young people with DCD. Dissemination will involve the publication of the results in a peer-reviewed journal. Increasingly researchers and policymakers are calling for services to be informed by the perspective and voice of children with DCD; therefore, a policy brief will be published so that the findings are widely available.

Registration: PROSPERO registration number CRD42019129178; registered on 09 July 2019.
Beside and within the walls of Reccopolis: social dynamics and landscape transformations of a new Visigothic urban foundation
Authors: Lauro Olmo-Enciso  , Manuel Castro  , Pilar Diarte
Published: October 2019

Reccopolis is the sole archaeologically-attested Visigothic city foundation in the Iberian Peninsula. Created under King Leovigild in A.D. 576, the city played a notable role in the landscape, persisting as the focal point of the territory through to the 8th century AD. This paper offers an overview of the most recent results from the project undertaken in and around Reccopolis, which in the last two decades has drawn much from the discipline of Landscape Archeology, enabling fuller understanding of the agrosystem, the character and structure of rural occupation and exploitation, and a developed awareness of environmental conditions across the Early Middle Ages in the territory of the Central Plateau of the Iberian Peninsula.
The Urban Archaeology Project in Asculum: the case of Piazza Arringo
Authors: Francesco Pizzimenti
Published: October 2019

The work presented here is a brief summary of part of my post-graduate dissertation and falls within the Urban Archaeology Project of University of Bologna in Asculum in agreement with Archeological Superintendency of Marche Region and Municipality of Ascoli Piceno. During 2013’s campaign a non-intrusive survey has been carried out in Piazza Arringo: the field data, after their collection and process, have been compared to previous archaeological knowledge coming from bibliographical and archive’s data in order to add them to the archaeological reconstruction of the city.
Communication of the absence: possible instruments. On-site communication project for the archaeological area ‘La Cuma’ of Monte Rinaldo
Authors: Irina Ivanova
Published: October 2019

The term ‘communication of the absence’ concerns the problem of reconfiguration of the lost architectural volume. The issue regards the archaeological monuments that had mostly reached our days only at the foundations level. On the example of the archaeological area ‘La Cuma’ of Monte Rinaldo the development of the on-site communication project based on a certain methodology is showed. It provides the complex analysis of the monument, the research of study cases, the definition of project vision and the choice of the most effective solutions aimed at giving back a disappeared image of the ancient complex.
Phronesis y complejidad
Authors: Burbules Nicholas C.
Published: October 2019

Este ensayo explora dos aspectos del concepto griego de phrónesis. Por un lado, el que está estrechamente relacionado con el concepto aristotélico de «virtud» y es que, en efecto, es un tipo de «meta-virtud». Por otro lado, el concepto se aborda también desde las teorías de la práctica y del razonamiento práctico de un modo más general. Argumento que estos dos aspectos están estrechamente relacionados, y que pueden ser entendidos como dos versiones de la misma cosa. Esta relación llega a ser especialmente clara cuando exploramos la pregunta de cómo la phrónesis se aprende. Para terminar, se expone cómo nuestro entendimiento de la phrónesis se amplía cuando tenemos en cuenta cómo se aplica en contextos complejos.
Controlling Death. Highlights from Harvard Medical School Annual Bioethics Conference
Authors: Gomes Rodrigues Rosamaria , Silva dos Santos Carlos Adriano
Published: October 2019

En 2019, la Conferencia Anual de Bioética de la Facultad de Medicina de Harvard se cuestionó si estamos controlando la muerte eligiendo cuándo y cómo morimos. Este artículo compara las investigaciones publicadas con el tema de la conferencia. Los participantes en la conferencia discutieron sobre la comodidad y la dignidad en el final de la vida, los aspectos legales y éticos de los cuidados paliativos, pero otras opciones de salida deben ser discutidas, como los cuidados paliativos, la suspensión voluntaria de comer y beber, la muerte asistida por un médico y la eutanasia activa voluntaria, así como el documento de voluntades anticipadas o el equipo de cuidados paliativos. Concluimos discutiendo qué otras condiciones de salud (psiquiátricas, cardiovasculares o respiratorias) podrían beneficiarse de las opciones de salida.
Ante la muerte ¿cómo cuidar a las personas?
Authors: Bátiz Cantera Jacinto
Published: October 2019

Los cuidados a las personas que se encuentran en el final de sus vidas necesitan de unas características humanas, técnicas y éticas. La persona que se enfrenta a su muerte necesita el acercamiento humano de quienes le cuidan además de su competencia profesional. En este artículo abordaré cómo poder cuidar a las personas para que salir de esta vida no sea una experiencia traumática para quien se muere y para sus seres queridos que le acompañan en el proceso de morir y para que quien se muere perciba que le cuidan personas solícitas, sensibles y entendidas, intentando comprender sus necesidades.
¿Es necesaria una ley nacional sobre la eutanasia en España? Análisis de la legislación autonómica de Madrid
Authors: Junquera de Estéfani Rafael
Published: October 2019

Hoy, el debate público sobre la eutanasia en España se centra en la presentación de un proyecto de ley a nivel nacional. Cuando se echa una mirada al entorno autonómico español, comprobamos que la mayoría de las autonomías ya disponen de normativas reguladoras de la muerte digna, derechos de los pacientes en el proceso de la muerte, etc. Ahora es momento de plantearnos la pregunta que figura como título de este artículo: ¿es necesaria una ley que regule la eutanasia cuando contamos con una multiplicidad de normas autonómicas que ya están regulando los derechos de las personas al final de la vida? Nos vamos a centrar en la normativa de una sola de estas comunidades autónomas: la Comunidad de Madrid.
El régimen jurídico de las comunidades autónomas respecto al proceso de muerte: un análisis comparado
Authors: Ruiz Martínez-Cañavate Manuel
Published: October 2019

El régimen jurídico aplicable en España al proceso de muerte o final de la vida viene determinado por las normas aprobadas en las diversas comunidades autónomas. Un estudio comparado de las normas respectivas permitirá comprobar la coherencia interna del sistema y su adecuación a las directrices de la Guía para el Proceso de Toma de Decisiones relativas al Tratamiento Médico en situaciones del Final de la Vida, aprobada en 2014 por el Consejo de Europa.
Edición genética en humanos y su relación con la biopolítica como dispositivo de control
Authors: Morales García Miguel Ángel
Published: October 2019

La biopolítica entendida como la incidencia del poder sobre la vida por parte del Estado sobre una población es un concepto que se desarrolló desde el siglo pasado y que se mantiene hasta nuestros días por medio de distintos dispositivos de poder que han ido cambiando a lo largo de la historia. En el presente trabajo se hace una relación entre las técnicas de edición genética en humanos y su uso como dispositivo de poder, y a partir del cual se analizan las consecuencias del uso de estas tecnologías en la sociedad.
Use of Social Media as a Virtual Community and Support Group by Left Ventricular Assist Device (LVAD) Patients
Authors: Boling Brian , Hart Amanda , Okoli Chizimuzo T. C. , Halcomb Tamra , El-Mallakh Peggy
Published: October 2019

Background

Left ventricular assist device (LVAD) patients may benefit from participating in a social support group; however, several factors may limit the availability of these communities. Alternatively, online social support communities may be more accessible for LVAD patients. No studies have examined patterns and reasons for health-related social media use among people with LVADs

Methods

An online survey of patients actively participating in LVAD social media groups was conducted using both multiple choice and open-ended questions.

Results

Thirty-nine participants (65% male) completed the survey. Participants’ reasons for weekly engagement in online communities were to seek (69.2%) and offer (66.7%) advice, seek (43.6%) and share (71.8%) coping strategies, seek help (48.7%) or help others (64.1%) solve LVAD problems, and offer general social/emotional support (74.4%). Negative aspects from involvement in a virtual community included an excessive focus on fear/negativity (26.3%) and confusing or misleading information (21%). Most felt supported (100%) from involvement in the virtual community and believed that the information/advice received was helpful (94.6%) and accurate (100%). A significant minority (41.7%) reported that it was easier to get medical advice from Facebook groups than from their health care providers.

Conclusions

LVAD patients use social media to exchange information/advice, share coping strategies, and work with others to solve LVAD problems. Benefits to participating in these groups exist; however, the degree to which they are utilized for medical advice, instead of consulting a health care professional, highlights the importance of a trusting relationship between practitioners and LVAD patients.