bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Arthroplasty Really Protect the Hindfoot? A 13 year retrospective review of 516 cases for Further Hindfoot Procedures Following Ankle Arthrodesis vs Total Ankle Replacement
Authors: Trew Christopher , Ramaskandhan Jayasree R. , Chambers Simon , Siddique Malik , Qasim Sultan
Published: December 2024

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

Total Ankle Replacement (TAR) have a potential advantage of protecting further degradation of hindfoot joints by maintaining ankle joint motion. However, there is no study to our knowledge that directly compares hindfoot outcomes between TAR and Ankle Arthrodesis (AA) in the long term. Sokolowski et al. found that 68% of TAR patients had no radiological progression of subtalar arthritis after TAR, and 4% went on to fusion. Other studies have looked at 5 year outcomes finding higher hindfoot fusion rates post AA. However, no evaluation of the other hindfoot joints was made and no comparison made to other treatment. This study aimed to analyze the long-term rates of symptomatic hindfoot arthritis resulting in further procedures following TAR versus AA.

Methods:

We performed a retrospective review of all patients at our centre who had a TAR or AA since 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patient were excluded who had no documentation, were followed up at other hospitals, had prior hindfoot fusion, or were having staged surgeries at the time of index treatment. Chi squared analysis was used to compare the cohorts.

Results:

Analysis revealed 428 eligible cases (275 TAR, 153 AA). TAR patients were older (mean age: 62 vs. 52 years, p=0.00001). Average follow up was 12.6 (1 – 21) years for TAR and 12.1 (1-21) years for AA. TAR showed lower rates of overall further hindfoot procedures compared to AA (14% vs. 24%, p=0.01), with significantly fewer hindfoot fusions (4% vs. 14%, p=0.0002). Revision rates were similar between groups (6% TAR vs. 4% AA, p=0.99).

Conclusion:

This study highlights higher rates of symptomatic hindfoot arthritis requiring intervention in AA compared to TAR. TAR appears to offer advantages in hindfoot preservation, with similar revision rates. Prospective studies integrating patient-reported outcomes are warranted to assess TAR versus AA efficacy on hindfoot function and overall well-being. Our findings advocate for TAR as the primary treatment for end-stage ankle arthritis, if appropriate, when considering symptomatic progression in management decisions.
Dorsal Calcaneal Wedge Removal in Zadek Osteotomy: A Cadaveric Study
Authors: Kaplan Jonathan , Hall Sarah , Kumar Padam , DiTommaso Rita , Giles Stephanie , Gonzalez Tyler , Haupt Edward T.
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Insertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO.

Methods:

The ZO was performed on six cadaveric specimens. A 7.5mm and 15mm osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen’s d analysis.

Results:

Maximal DF was 110.87±12.97 deg in the pre-osteotomy state. Removal of a 7.5mm wedge improved DF by 8 deg to a mean 102.93±13.81 deg (p=0.08). Removal of a 15mm wedge improved DF by 16 deg to a mean 95.96±11.41 deg (p=0.003). Cohen’s d and effect size calculation demonstrated a 7.5mm wedge to have a small effect on DF, while a 15mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5mm wedge, or 15mm wedge positions. ICC was 0.96.

Conclusion:

Based on the results presented in this study, removal of a 15mm wedge with ZO yields significant and greater improvement in ROM than a 7.5mm wedge. We hope the current study will better inform preoperative planning for ZO.
Effect of Body Mass Index on Pedobarographic and Patient Reported Outcome Measures in Symptomatic Adolescent Flexible Flat Foot Deformity
Authors: Blackwood Victoria , Jeans Kelly , Coe Kelsie , Capell Will , Riccio Anthony I.
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

The purpose of this study was to use pedobarography and patient reported outcome measures (PROs) to determine if obese adolescents with flexible flatfoot deformity (FFD) have more severe alterations in dynamic plantar pressures than patients with FFD who fall within normal BMI percentiles (wnBMI), and if such alterations affect pain and activity.

Methods:

A retrospective review of patients aged 10 to 18 years with non-syndromic symptomatic FFD enrolled in a prospective IRB approved registry, was performed. Overweight (BMI≥ 85%) patients were compared to wnBMI patients with regard to dynamic plantar pressure measures and PRO scores. Pedobarograph foot data were subdivided into regions: medial/lateral - hindfoot, midfoot and forefoot. Plantar pressure variables were normalized to account for differences in foot size, body weight and walking speed. Contact area was normalized by the total foot (CA%), maximum force by body weight (MF%) and contact time by total time of the roll over process (CT%). Two foot-specific PROs were assessed including the Foot and Ankle Outcome Score (FAOS) and the Oxford Ankle Foot Measure for Children (OxAFQ-C).

Results:

Of the 48 adolescents studied, 27(56%) were overweight and 21(44%) were wnBMI. After normalization of the data, overweight patients had significantly greater medial midfoot MF%, while CT% was increased across the medial and lateral midfoot and hindfoot regions (Table 1). Significant correlations were made between BMI percentile and MF% in the medial midfoot (r = 0.39, p = 0.006), CT% in the medial (r=0.52, p< 0.001 and CT% lateral (r=0.55, p< 0.001) midfoot. There were no significant differences between the overweight and wnBMI cohorts for CA% or any PRO pain or activity sub-scores. No significant correlations were made between pedobarograph parameters and PRO sub-scores.

Conclusion:

Although obese adolescents with FFD exhibit greater forces and greater time spent during the rollover process in the medial midfoot than patients with wnBMI, they do not report worse pain or disability. While it seems intuitive that increased body weight would be associated with higher levels of pain in adolescents with FFD, this does not seem to be the case. Though significant increases in plantar force and contact time were found in the obese adolescents, this did not result in greater discomfort or functional limitation. It, therefore, cannot be concluded that BMI alone is a differentiating factor in FFD symptomatology.
Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds in Foot and Ankle Ability Measure and Visual Analogue Scale Scores After Hallux Valgus Surgery
Authors: Teplensky Jason , Turan Oguz , Poirier Sarah , Cantrell William A. , Mueller James , Chawla Sagar , Miniaci-Coxhead Sara Lyn
Published: December 2024

Category:

Bunion

Introduction/Purpose:

The purpose of this study was to determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) threshold for the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM) Scores after Hallux Valgus surgery.

Methods:

A retrospective review of prospective collected data was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected pre-operatively and 1 year post-operatively. The specific PROMs utilized were the FAAM- Activities of Daily Living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. The study measured change in PROMs from before surgery to one year after surgery to determine delta. Two methods were used to calculate MCID and PASS thresholds: A distribution-based approach and an anchor-based approach using responses to a one-year postoperative satisfaction question. The analysis identified optimal cut-off points that maximized sensitivity and specificity based on the Youden index. The percentage of patients reaching these optimal MCID and PASS thresholds was also determined.

Results:

Overall, 86% (136/158) completed baseline PROMs, and 72.7% (99/136) completed 1-year PROMs. The distribution-based MCID for FAAM-ADL, FAAM-ADL-SANE, , and VAS were calculated to be 10.8, 14.1, and 1.2 respectively. The rate of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for FAAM-ADL-SANE, and 95.8% for VAS. The PASS threshold for FAAM-ADL, FAAM-ADL-SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The rate of patients who achieved PASS thresholds was 77.5% for FAAM-ADL, 71.4% for FAAM-ADL-SANE, and 68.7% for VAS.

Conclusion:

This study identified useful values for the MCID and PASS thresholds at 1-year follow-up for patient undergoing hallux valgus surgery of FAAM-ADL, FAAM-ADL-SANE, and VAS scores.
The Vacuole Lipid Droplet Contact Site vCLIP
Authors: Diep Duy Trong Vien , Bohnert Maria
Published: December 2024

Lipid droplets frequently form contact sites with the membrane of the vacuole, the lysosome-like organelle in yeast. These vacuole lipid droplet (vCLIP) contact sites respond strongly to metabolic cues: while only a subset of lipid droplets is bound to the vacuole when nutrients are abundant, other metabolic states induce stronger contact site formation. Physical lipid droplet-vacuole binding is related to the process of lipophagy, a lipid droplet-specific form of microautophagy. The molecular basis for the formation and function of vCLIP contact sites remained enigmatic for a long time. This knowledge gap was filled when it was found that vCLIP is formed by the structurally related lipid droplet tether proteins Ldo16 and Ldo45, and the vacuolar surface protein Vac8. Ldo45 additionally recruits the phosphatidylinositol transfer protein Pdr16 to vCLIP. Here, we review the literature on the lipid droplet-vacuole contact site in light of the progress in our understanding of its molecular basis and discuss future directions for the field.
Changes in Local Tumor Immune Microenvironment with Neoadjuvant Cryotherapy and Chemoradiation for Locally Advanced Esophageal Cancer
Authors: Shah Tilak , Koblinski Jennifer , Boothello Rio , Haneefa Shoja M. , Massey Hugh D. , Patel Bhaumik B.
Published: December 2024

Introduction:

We aimed to assess the effect of spray cryotherapy (LNSC) on immune-microenvironment of esophageal cancer (EC).

Methods:

Matched retrospective case-control study of locally advanced EC patients who underwent LNSC plus chemoradiation (CRYOCHEMOXRT) versus chemoradiation alone (CHEMOXRT). A microarray was generated from pre- and post-treatment tissue blocks and subjected to multiplex immunofluorescence.

Results:

Intra-tumor T lymphocytes (IT-TILs) and cytotoxic T-cells increased more frequently with CRYOCHEMOXRT versus CHEMOXRT. Mean survival was 1402 versus 686 days with and without 5× increase in IT-TILs.

Discussion:

LNSC may stimulate an anti-tumor immune response that enhances effectiveness of neoadjuvant CRT in locally advanced EC.
Things not quite going to plan: The actually existing platformization of the home care sector in Aotearoa New Zealand
Authors: Vonk Lisa , Salter Leon A.
Published: December 2024

This article explores and develops the concept of ‘actually existing platformization’ through a case study of home-based care in Aotearoa New Zealand. We broaden its focus into a typology of four key sources of agency in the platformization process: policy, platform, workers and spatiality. We base our findings on two quite different care platforms: Mycare and My Homecare. Through document analysis, as well as interviews with care workers, we demonstrate how the four agencies shaped the two platforms in distinct and sometimes messy directions. Whilst the platformization process contributed to the rolling back of care worker rights and protections, whilst presenting frustrating barriers and even severe health risks, we also found it presented opportunities for the shared articulation of resistive care ethics, where a workforce comprized predominantly of women worked collectively to shape the path of platformization in their favour.
A computational study on the sensitivity of slip constraints in the blade coating process of an electrically conducting oldroyd 4-constant fluid
Authors: Hasnain Jafar , Ali Zulfiqar , Rafiq Muhammad Yousuf , Abbas Zaheer
Published: December 2024

The blade coating process holds significant importance due to its widespread application in manufacturing products such as newspapers, photographic film, fibers, catalogs, and magnetic storage media. Its economic impact has driven extensive research aimed at deepening the understanding of the underlying physical mechanisms, ultimately leading to improvements in process efficiency and optimization. Therefore, this article investigates the blade coating process of an electrically conducting Oldroyd 4-constant liquid with velocity slippage on the blade surface. The impression of viscous dissipation is also inspected through the energy equation. The mathematical equations are modeled with the use of lubrication approximation theory and the normalized equations of the Oldroyd 4-constant fluid and are numerically solved by the shooting method. To offer valuable insights, the pressure, pressure gradient, velocity, temperature, and load metrics are calculated and displayed in graphs and tables. It is found that liquid velocity and pressure decrease as the Hartmann number increases. As the Brinkman number increases, the temperature distribution increases, with the peak temperature appearing in the narrowest region of the flow.
Uncovering the molecular networks of ferroptosis in the pathogenesis of type 2 diabetes and its complications: a multi-omics investigation
Authors: Dong Changqing , Huoshen Wuda , Bai Yunfeng , Liu Jiaona , Li Bing , Guan Yucan , Luo Ping
Published: December 2024

Background

Diabetes is a multi-factorial disorder and related complications constitute one of the principal causes of global mortality and disability. The role of ferroptosis in diabetes and its complications is intricate and significant. This study endeavors to disclose the role of ferroptosis in the aforementioned diseases from multiple perspectives through multi-omics.

Methods

We performed genetic correlation analyses via the Linkage Disequilibrium Score and High-Definition Likelihood approaches for type 2 diabetes (T2D) and its complications. The data concerning the expression of ferroptosis-related genes (FRGs) were obtained from the meta-analysis of studies on gene expression and protein abundance. Mendelian randomization analyses and cross-validation were implemented using the discovery cohort, replication cohort, and imaging genomics cohort of T2D and its complications. Moreover, we conducted colocalization analyses on T2D and tissue-specific single-cell RNA sequencing investigations on the complications to complement the results.

Results

Genetic association analysis indicated that the selected datasets could be incorporated into a secondary analysis of T2D complications. In the primary analysis, six FRGs (CDKN1A, ENO3, FURIN, RARRES2, TYRO3, and YTHDC2) were found to be positively associated with T2D risk. Conversely, eight FRGs (ARNTL, CAMKK2, CTSB, FADS2, KDM5A, MEG3, SREBF1, and STAT3) were inversely associated with T2D risk. The 14 FRGs were included in the secondary analysis. Within the FRGs, which received full support from both the discovery and replication cohorts, and were further validated by imaging genomics, higher levels of CDKN1A were positively associated with DKD risk. Higher levels of CAMKK2 and KDM5A were associated with a decreased risk of DKD. For DCM, higher levels of CTSB were positively associated with DCM risk. And genetically predicted higher levels of ARNTL and SREBF1 were associated with a decreased risk of NAFLD. Finally, we validated the tissue-specific expression of each complication with scRNA-seq datasets.

Conclusions

This study identified FRGs in relation to T2D and its complications, which may enhance the understanding of the pathogenic mechanisms of their development. Meanwhile, it offers cross-validation for imaging genomics and further indicates the direction for non-invasive diagnosis.

Graphical Abstract
Is functional training functional? a systematic review of its effects in community-dwelling older adults
Authors: Liu Chiung-ju , Chang Wen-Pin , Shin Yun Chan , Hu Yi-Ling , Morgan-Daniel Jane
Published: December 2024

Background

Age-related decline in physical and cognitive capacity increases older adults’ risk of disability, long-term care placement, and mortality rate. Functional training, which uses activities of daily living or simulated movements to complete activities as the intervention medium, could be more effective than rote exercise, which uses repetitive movements without added purpose, in preventing late-life disability in older people. With a growing number of studies in this area, systematically studying the effect of functional training is needed. The purpose of this systematic review was to examine the effects of functional training on the outcomes of activities of daily living, physical functioning, and cognitive function in community-dwelling older adults.

Methods

Literature published between January 2010 and April 2024 in 10 electronic databases were searched and screened. This timeframe was established to include studies published within the last 15 years. Each identified article was screened and reviewed by two authors independently. The methodological quality of the included studies was evaluated using the PEDro Scale. Key findings were synthesized according to participants’ characteristics and intervention types.

Results

The review included 32 studies. In the general community-dwelling older adult population (20 studies), studies that applied functional training as a single-component approach showed a positive effect on activities of daily living. However, the training effect on balance and mobility was not superior to that of other exercise programs. Moreover, the effect was mixed when functional training was combined with other intervention components. In older adults with mild cognitive impairment (5 studies), Simulated Functional Tasks Exercise, a single-component training, consistently demonstrated positive effects on the activities of daily living and cognitive functions. In older adults with dementia (4 studies) or frailty (3 studies), the effect was mixed across the single- and multi-component approaches.

Conclusion

Functional training alone is effective in preventing late-life disability in general community-dwelling older adults. When training activities challenge both motor and cognitive abilities, the effect seems to improve the performance of activities of daily living and cognitive functions in older adults with mild cognitive impairment. Additional studies of functional training in older adults with cognitive impairment or frailty are recommended.
Music medicine and music therapy in neonatal care: a scoping review of passive music listening research applications and findings on infant development and medical practice
Authors: Papatzikis Efthymios , Agapaki Maria , Selvan Rosari Naveena , Hanson-Abromeit Deanna , Gold Christian , Epstein Shulamit , Lok U. Wun Vivian , Barda Evrykleia , Pandey Varun
Published: December 2024

Background

In recent years, the use of music as a therapeutic and developmental tool for infants, especially within neonatal intensive care units (NICUs), has seen a surge in interest. Despite a growing body of research underscoring the potential benefits of music therapy and music medicine in enhancing infant development and aiding medical practices, the specific characteristics of music that maximize these benefits remain poorly understood.

Objectives

This scoping review aims to provide a comprehensive foundation by mapping the existing literature on passive music listening and identifying gaps, trends, and patterns that are crucial precursors to the development of best practices.

Methods

Following the PRISMA guidelines, a comprehensive literature search was conducted, covering studies published up until December 2022. The focus was on passive music listening, with a deliberate exclusion of active music interventions. Out of the initial pool of studies, 56 met the inclusion criteria, determined by the PICO framework, focusing on passive music exposure among full-term and preterm infants. Starting with a descriptive analysis approach, the study employed Non-negative Matrix Factorization (NMF) and Latent Dirichlet Allocation (LDA) to identify key themes, including the physiological impacts of music, its role in pain management, effects on sleep and stress, and influences on feeding and weight gain.

Results

The review revealed a predominance of quantitative research methods, a significant concentration of studies from the United States, suggesting potential geographical bias, and a notable clinical setting bias. These findings indicate a critical need for methodological diversity and a more culturally inclusive and interdisciplinary approach to research. They also point to the necessity for standardized music intervention protocols to optimize therapeutic and developmental outcomes for this vulnerable population. Future research should aim to bridge the methodological gaps identified, integrating both qualitative and quantitative approaches to provide a comprehensive understanding of music’s impact on infant development and medical practices in a global, culturally nuanced context.
Changes in insomnia symptoms among compulsory education students in China after the “Double Reduction” policy: a two-wave longitudinal study
Authors: Zhang Yifan , Ye Haoxian , Huang Meijiao , Li Min , Li Huolian , Zhang Xiangting , Lin Junxu , Liu Hao , Wu Hao , Wang Dongfang , Fan Fang
Published: December 2024

Objective

In July 2021, the “Double Reduction” policy was introduced in China, aiming to alleviate the burden of excessive homework and off-campus tutoring for students in the compulsory education stage. The purpose of this study is to explore the changes in students’ insomnia symptoms and related factors after the policy implementation. Meanwhile, sex differences were further examined.

Methods

The baseline survey (T1) began in April 2021 (pre-policy), with a follow-up (T2) conducted in December 2021 (post-policy). A total of 28,398 students completed both T1 and T2 surveys and were included in this study. Insomnia symptoms were measured at both T1 and T2 using three questions from the Youth Self-Report Insomnia Scale. Demographics and anxiety and depressive symptoms were collected at T1, and policy-related indicators were assessed at T2.

Results

The prevalence of insomnia symptoms showed a slight decrease after the “Double Reduction” policy (9.9% vs. 9.2%). After controlling for demographics and anxiety and depressive symptoms, reduced homework (OR: 0.75 [0.65–0.86]), more family time (OR: 0.50 [0.44–0.57]), and reduced academic pressure (OR: 0.77 [0.71–0.83]) post-policy were related to a lower risk of new-onset insomnia symptoms. Additionally, more family time (OR: 0.59 [0.49–0.72]) and reduced academic pressure (OR:0.70 [0.56–0.86]) were factors against persistent insomnia symptoms. There were no significant sex differences in the associations between policy-related indicators and insomnia symptoms.

Conclusions

The “Double Reduction” policy has somewhat improved the students’ insomnia symptoms. Extending family time, and alleviating homework and academic burden are considered measures for maintaining sleep health in students.
Experiences of policy-advisors in capacity, opportunity and motivation for implementing local tobacco control
Authors: Jooren Sophie J.A. , Geuke Gemma , Willemsen Marc C. , Jansen Maria W. J. , Bommelé Jeroen
Published: December 2024

Introduction

Due to decades of decentralisation of public health policies, local governments have been given increased tobacco control responsibilities across European countries. Previous studies suggest that implementing local tobacco control policies is not without challenges (e.g., lack of resources and enforcement capabilities). This study investigates the policy implementation of both smoke-free environments and smoking cessation support services by local public health professionals in the Netherlands.

Method

We interviewed 24 officials of regional public health departments about the barriers and facilitators of implementing local tobacco control policies. Interviews were transcribed, analysed and classified using the Behaviour Change Wheel model (COM-B) comprising of the three components capability, opportunity, and motivation.

Results

Personal motivation was an important condition for public health professionals to work on specific subtopics within tobacco control. Smoke-free environments were generally considered most motivating to work on, but also involve practical obstacles such as a lack of enforcement capabilities. Smoking cessation support services were reported to be less attractive to work on, as there are no clear guidelines on what public health professionals could and should do regarding smoking cessation support.

Conclusion

Municipalities and local public health departments may contribute to tobacco control by creating smoke-free areas and offering services to help people stop smoking. The national government of the Netherlands could support local governments by providing clearer guidelines on creating smoke-free spaces and on how to improve local smoking cessation support services.
Community readiness to address disparities in access to cancer, palliative and end-of-life care for ethnic minorities
Authors: Wainwright Jodi Emma , Cook Erica Jane , Ali Nasreen , Wilkinson Emma , Randhawa Gurch
Published: December 2024

Background

Inequalities in cancer, palliative, and end-of-life care services remain a significant challenge, particularly for ethnic minorities who face systemic barriers such as limited awareness, cultural stigmas, and language differences. These disparities hinder equitable access to essential services and contribute to poorer health outcomes for affected communities. Addressing these challenges requires targeted, culturally sensitive initiatives that promote both awareness and uptake of care. Community readiness is a critical factor in the success of such interventions, as it reflects the willingness and capacity of a community to engage with and support change.

Methods

A mixed-methods approach was used, combining individual interviews and two focus groups with key informants (N = 14). This study, conducted in the ethnically and geographically diverse region of Bedfordshire, Luton, and Milton Keynes in southeast England, aimed to assess community readiness to embrace initiatives designed to reduce health inequalities in cancer, palliative, and end-of-life care. The key informants, including faith leaders and professional stakeholders, rated community readiness on five anchored scales: Knowledge of efforts, Leadership, Knowledge of the issue, Community Climate, and Resources. The focus groups facilitated a discussion of the ratings, providing deeper insights into community dynamics and barriers.

Results

Overall, the community was identified as being at the pre-planning stage of readiness to address disparities in cancer, palliative, and end-of-life care for ethnic minorities. Quantitatively, faith and religious leaders assessed readiness at the vague awareness stage (mean: 3.88), while professional stakeholders rated it at the pre-planning stage (mean: 4.87). Qualitative findings highlighted limited community knowledge, passive leadership with potential for ‘community champions’ to foster openness, a positive climate influenced by younger generations, widespread misconceptions, language barriers, and resource constraints affecting service accessibility.

Conclusions

The Community Readiness Model provides an insight into the community’s position regarding disparities in access to cancer, palliative and end-of-life services. In order to ensure that continuing efforts are successful in addressing existing inequalities rather than exacerbating them, this study emphasises how critical it is to evaluate the readiness of the community in order to avoid widening inequalities in access and use of services.
Management of Methicillin-Resistant Staphylococcus aureus-infected femoral nonunion during lengthening in achondroplasia using circular external fixator: a case report
Authors: Nozaka Koji , Shirahata Tsuyoshi , Yuasa Yusuke , Miyakoshi Naohisa
Published: December 2024

Background

Achondroplasia, the most common form of rhizomelic dwarfism, occurs in approximately 1 in 25,000 individuals. Clinical features include attenuated growth, rhizomelic limb shortening, and craniofacial abnormalities. Limb-lengthening surgery is widely employed to improve quality of life. However, reports on Methicillin-Resistant Staphylococcus aureus (MRSA) infections in femoral nonunions at lengthening sites are scarce.

Case presentation

A 15-year-old boy with achondroplasia presented with MRSA-infected femoral nonunion. Bilateral femoral lengthening had been performed at age 13 using unilateral external fixators. Following a 7 cm lengthening of the right femur, surgical site infection occurred, with MRSA detected on postoperative day 127. Despite debridement and autologous iliac bone graft with non-locking screws, nonunion persisted. Referred to our hospital at age 15, the patient underwent radical debridement until punctate bleeding appeared, and vancomycin-loaded cement beads were implanted. A circular external fixator, effective even with bone weakened by prolonged non-weight bearing, was applied. Six weeks later, further debridement and vancomycin bead replacement were performed. Final fixation included refreshing the nonunion site and placing a cancellous bone graft from the contralateral iliac bone. Bone fusion progressed, and the ring was removed 9 months post-surgery. After seven years, no recurrence of infection was noted. Although slight knee flexion limitation persisted, the patient experiences no pain while walking and has become a healthy working adult.

Conclusion

This case highlights the effectiveness of radical debridement, antibiotic-loaded cement beads, autologous bone grafting, and circular external fixation in treating MRSA-induced nonunion at femoral lengthening sites in achondroplasia. Circular external fixators provide stable fixation even in cases of prolonged bone weakness.
A meta-analysis comparing open and minimally invasive cervical tumor surgery wound infection and postoperative complications
Authors: Song Ran , Ma Mingming , Yang Nana , Chen Chunfang , Wang Huan , Li Juan
Published: December 2024

To evaluate the impact of open surgical care (OSC) compared to minimally invasive surgery (MIS) on the occurrence of wound infection (WI) and overall postoperative aggregate complications (POACs) in female cervical cancer (CC) patients, we conducted this meta-analysis study. A thorough examination of the literature up to March 2024 was conducted, and 1849 related studies were examined. The 44 studies that were selected included 11,631 females who had CC. The odds ratio (ORs) and the estimation using 95% confidence intervals (CIs) were used to calculate the impact of open surgical management and MIS on WI and POACs in females with CC, using dichotomous methodologies and a random or fixed model. When comparing MIS to open surgical care, there was a substantial decrease in WI (OR, 0.19; 95% CI, 0.13–0.29, p < 0.001) and POACs (OR, 0.49; 95% CI, 0.38–0.62, p < 0.001) in females with CC. On the other hand, among female patients with CC, MIS did not differ significantly from open surgical care in pelvic infection and abscess (PI&A) incidence (OR, 0.59; 95% CI, 0.31–1.16, p = 0.13). When compared to OSC, women with CC who underwent MIS experienced considerably fewer WI and POACs; however, there was no discernible difference in PI&A rates. However, given several of the designated examinations for the meta-analysis had relatively small sample sizes, caution must be used while handling its values.
Associations between mental health conditions in pregnancy and maternal socioeconomic status: a population-based retrospective cohort study in Ontario, Canada
Authors: Miao Qun , Zai Gwyneth , Joiner Ian , Burnside Jessica , Walker Mark
Published: December 2024

Background

The World Health Organization has recognized maternal mental illness as an emerging issue. Previous studies have indicated that maternal mental illness is associated with socioeconomic status (SES). However, there is a lack of research concerning the mental health of pregnant people with low SES in Ontario, Canada. In this study, we examined associations between mental health conditions during pregnancy and two SES indicators: the pregnant person’s residential neighbourhood income and education level.

Methods

A population-based retrospective cohort study was conducted, consisting of all singleton pregnancies resulting in stillbirths or live births in Ontario hospitals from April 1, 2012, to March 31, 2021. Data were linked from the BORN Information System database, Canadian Institute for Health Information Discharge Abstract Database, and Canadian Census. Poisson regression with robust error variance models was performed to estimate the relative risks of anxiety, depression, anxiety and/or depression, or any mental health condition during pregnancy, by SES indicator. We adjusted for maternal age, obesity status in pre-pregnancy, certain pre-existing maternal health conditions, substance use during pregnancy, race, and rural or urban residence.

Results

Within the cohort (n = 1,202,292), 10.5% (126,076) and 8.1% (97,135) of pregnant individuals experienced anxiety and depression, respectively, and 15.8% (189,616) had at least one mental health condition during pregnancy. The trend test (p < 0.0001) showed a significant downward trend in the total rates of mental health conditions by increasing SES quintiles. Pregnant individuals in the lowest neighbourhood income quintile tended to have a higher risk of anxiety (aRR: 1.24, 95%CI: 1.22–1.27), depression (aRR: 1.56, 95%CI: 1.52–1.59), anxiety and/or depression (aRR: 1.13, 95%CI: 1.11–1.15), or any mental health condition (aRR: 1.18, 95%CI: 1.16–1.19). Similarly, pregnant people living in the lowest education level neighbourhoods had higher likelihoods of anxiety (aRR: 1.66, 95%CI: 1.62–1.69), depression (aRR: 2.09, 95%CI: 2.04–2.14), anxiety and/or depression (aRR: 1.42, 95%CI: 1.39–1.44), and any mental health condition (aRR: 1.41, 95%CI: 1.38–1.43).

Conclusions

Despite a universal healthcare system, the variations in mental health prevalence and risk during pregnancy based on SES suggest health inequity in Ontario, Canada. Future studies are needed to examine the mechanisms of this health inequity to guide policy makers in reducing disparities in Ontario.
From decision to destination: factors influencing healthcare students’ career paths in Qatar
Authors: Yasin Yasin M. , Alomari Albara , MacNevin Shannan , Kmainasi Baysan , Abdulla Mohammad , Hassanin Sondos
Published: December 2024

Background

Healthcare education is crucial for building a workforce in Qatar that is in line with Vision 2030. Although various factors influence career choices, little research exists on their impact on healthcare students in Qatar. This study explores the factors influencing healthcare students in Qatar to pursue healthcare careers, as well as the facilitators and challenges they face during their education.

Methods

A cross-sectional survey was conducted among 364 healthcare students in Qatar. Quantitative data was analyzed to identify key factors influencing career choice, while qualitative data provided deeper insights into challenges and support systems.

Results

Quantitative findings identified “contribution to society” and “quality” as key factors shaping career choices. Demographic variables such as gender, income, and birthplace influenced these decisions. Qualitative analysis revealed that students face numerous challenges, such as academic demands, financial pressures, and logistical difficulties, but these were mitigated by support from family, peers, and institutional resources.

Conclusion

This study underscores the importance of tailored support systems to foster student retention and success in healthcare education, particularly for students from diverse cultural backgrounds. Policymakers and educators should develop strategies that support a sustainable, culturally competent healthcare workforce in Qatar that meets the nation’s evolving healthcare needs.

Clinical trial number

Not applicable.
‘Death on an industrial scale’- general practice trainees’ perceptions and experiences of dying and death during covid-19: an interpretative phenomenological analysis
Authors: Holdsworth Rebecca , Alberti Hugh , Burford Bryan , Farrington Emma , Vance Gillian
Published: December 2024

Context

The COVID-19 pandemic led to an increase in numbers of patients dying at home in the UK, meaning that general practitioners (GPs) were exposed to more patient death than would be pre-COVID. This project aimed to gain insight into GP trainees’ experiences of patient death between March and July 2020. This insight can inform support for GPs, leading to improved wellbeing, workforce retention and ultimately, better patient-centred care.

Methods

Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to explore GP trainees’ experiences of patient death in one region of England.

Results

Seven trainees, two male and five female, participated. They were working in both rural and urban community settings and were at different stages of GP training. Group experiential themes related to heightened emotional responses to patient death, managing uncertainty and the increased salience of relationships. Most appreciated positive teamworking and solidarity, though some had felt isolated within their surgery and wider community. There were some unforeseen positive experiences of individual and organisational healthcare changes, including a perceived new appreciation for the NHS workforce equality, diversity and inclusion (EDI) by actions to identify and reduce occupational hazards to at-risk healthcare staff. There were potential effects on career choice with participants feeling that changes during COVID-19 offered new flexibility in working arrangements and opportunity to sub-specialise within GP.

Conclusion

More support to help navigate the amplified emotional responses to managing dying and death in the community is needed. Some experiences, particularly around managing uncertainty, can cause moral injury if not managed in a safe and supportive environment.
Social interaction of people living with dementia in residential long-term care: an ecological momentary assessment study
Authors: Gebhard Doris , Lang Leonie , Maier Marco J. , Dichter Martin N.
Published: December 2024

Background

The importance of social health is increasingly recognized in dementia research. For most people living with dementia, their social environment changes as the disease progresses, especially when they move into a long-term care facility. However, maintaining social interactions in the new living environment contributes significantly to health and quality of life. Staff and other residents are the most readily available interaction partners to provide this. The aim of this study is to investigate the frequency, contexts, partners and influencing factors (personal and contextual) of social interactions of people living with dementia in residential long-term care.

Methods

Participants were observed for two days in 20-min slots (from 7 am to 7 pm) in 12 long-term care facilities in Germany. The Maastricht Electronic Daily Live Observation Tool (MEDLO-tool) was used for ecological momentary assessment. Age, gender, functional status, cognitive status and length of stay at the facility were recorded. Generalized linear mixed-effect models were used for the data analysis.

Results

In all, 106 people living with dementia (average age: 85.16 ± 7.42 years, 82.9% female) were observed at 6134 time points. No social interaction take place in 71.9% of the observations. The place where the participants spend their time influences the occurrence of social interaction (p < 0.001), with a significantly higher probability of social interaction in communal spaces. Most frequently, interaction takes place with staff (43.4%), closely followed by other residents (40.9%), with the context (location, p < 0.001; time of day, p < 0.001) and functional status (care level, p < 0.001) influencing which of the two groups people living with dementia interact with.

Conclusion

A better understanding of the context of social interactions and its influencing factors provide a basis for more targeted interventions. As the increasing staff shortage will further limit the opportunities for social interaction with staff, future concepts should focus on other residents. Meaningful activities that enable people living with dementia to co-operate and share responsibility can provide a stimulating framework for this. In addition, social assistance robots and the application of peer-mentoring/leading represent promising approaches for creating a socially interactive environment.
Infection survey, molecular, pathogenicity, and morphological characteristics of Sarcocystis species naturally infected water buffaloes (Bubalus bubalis) in Egypt
Authors: Elsharkawy Lamiaa K. , Barghash Safaa M. , El-Nour Basma M. Abou , Labib Wafaa , Sadek Al-Shaimaa M.
Published: December 2024

Background

Sarcocystosis is a parasitic disease found worldwide, resulting from various Sarcocystis species. The current research was carried out in three significant economic areas in Egypt: Greater Cairo, the Nile Delta, and Upper Egypt. It aimed to investigate the occurrence of Sarcocystis spp. in locally bred water buffaloes Bubalus bubalis.

Methods

To achieve this objective, 317 buffalos were slaughtered in different slaughterhouses in various regions of Egypt. Samples of heart, skeletal muscle, esophagus, and tongue were assessed using macroscopic and microscopic tests. Examination methods included direct optical observation of tissues as well as digestion and examination of the sediment obtained from the tissues. Additionally, ultrastructural features were analyzed using scanning and transmission electron microscopy. Molecular characterization was conducted through PCR, followed by nucleotide sequencing and phylogenetic analysis.

Results

A total of 317 slaughtered buffaloes were examined for Sarcocystis during the period from September 2021 to October 2023. The prevalence of infection was recorded with 229 out of 317 (72.2%) infected with Sarcocystis spp. The results also showed that the prevalence of Sarcocystis species in females was higher than males. Based on the age of carcasses, adults (> 2 years) had a higher infection rate compared to young ones (< 2 years). Regarding seasonal variation, the highest prevalence of infection was recorded during the summer followed by spring, and then autumn, while winter had the lowest prevalence of infection. Additionally, the skeletal muscle was the most susceptible organ to sarcocystosis (87.3%) followed by the esophageal muscle (8.3%), the tongue (4.4%), and no infection in the heart muscle. The use of scanning and transmission electron microscopy allowed the identification of S. fusiformis and S. cruzi in buffaloes in Egypt. Furthermore, the Sarcocystis 18 S rRNA genes from skeletal tissue samples were cloned and sequenced under accession numbers OQ507387, OQ507388, and OQ507389 for S. fusiforms, and one OQ507391 for S. cruzi.

Conclusion

The findings revealed a notably high prevalence of Sarcocystis infection (72.2%) in buffaloes from Egypt, with skeletal muscle identified as the organ most susceptible to the parasite. Two Sarcocystis species were detected: S. fusiformis and S. cruzi.
Spatial distribution of Q fever in sheep and goats of selective villages of Punjab Province, Pakistan
Authors: Amin Freeha , Ali Shahzad , Hassan Ahmad , Rashid Imran , Neubauer Heinrich , Mertens-Scholz Katja
Published: December 2024

This study aimed to assess the geographical distribution of Q fever in sheep and goats in different areas of Punjab, Pakistan. Three hundred blood samples of small ruminants including sheep and goats were collected from 60 villages of three districts (Okara, Kasur, and Pakpattan) of Punjab Province Pakistan and tested for the detection of anti-Coxiella burnetii antibodies using a commercial Indirect ELISA kit. Data related to sampling location, host species, gender, age, and GPS coordinates were collected for spatial analysis. A surface plot was created using inverse distance weight (IDW) by interpolation of the Aeronautical Reconnaissance Coverage Geographic Information system (Arc GIS). The district Kasur (14%) and the tehsil Chunian (24%) had the most prominent Q fever prevalence in both species. No ovine males were seropositive but 19.2% of male goats were seropositive. No samples of sheep younger than 1 year were found seropositive. Gender in sheep and age in goats have to be considered as significant risk factors based on multiple logistic regression analysis. Based on spatial analysis, seropositivity for C. burnetii antibodies was more likely observed in villages of tehsil Kasur, Pattoki, Okara, Depalpur, and Renala Khurd in the case of goats while in case of sheep villages of tehsil Chunian, Renala Khurd and Pakpattan. The main outcome of this study is that Q fever-specific antibodies of C. burnetii are prevalent in the goat and sheep populations of the study area and we have identified potential risk zones. The findings of this study can be used for the control of Q fever in small ruminants of the study area to minimize the risk of this zoonosis in other animals and the associated human population.