bluuebunny/crossref_metadata_2025 huggingface dataset:
Destigmatization Strategies of Serbian Londoners on Social Media
Authors: Vico Sanja
Published: May 2020

This article looks at banal expressions of nationalism and cosmopolitanism among Serbian Londoners on social media. The findings of this ethnographic research and in-depth interviews show that most participants perceive Serbian national identity as stigmatized due to the legacy of the civil war in the 1990s. Most participants hence employ different strategies in coping with the perceived stigma and redefining what it means to be Serbian. These strategies depend on the period of migration, the affordances of social media, and intended publics. Banal nationalism and banal cosmopolitanism are often manifestations of these strategies on platforms such as Facebook, Instagram, and Twitter with an aim to correct national identity, by presenting it either as superior or as cosmopolitan and exotic difference.
Prophylaxis of Radiation-Induced Dermatitis in Patients With Breast Cancer Using Herbal Creams: A Prospective Randomized Controlled Trial
Authors: Thanthong Saengrawee , Nanthong Rattanaporn , Kongwattanakul Sirikorn , Laebua Kanyanee , Trirussapanich Pornwaree , Pitiporn Supaporn , Nantajit Danupon
Published: May 2020

Radiation-induced toxicity is a major limiting factor for prescribing radiation dose in cancer radiotherapy. Skin reaction to radiation is one of the primary concerns, which could affect quality of life of the patients both physically and mentally. Reviews of the literature show limited number of effective reagents for its prophylaxis. In this study, we attempted to determine whether prophylactic treatment of the 3 different herbal creams containing Centella asiatica, Cucumis sativus, and Thunbergia laurifolia extracts as well as a commercial moisturizing cream could reduce acute skin reaction in breast cancer patients undergoing radiotherapy. A total of 153 breast cancer patients undergoing radiotherapy were randomly assigned into 5 different groups with one group receiving no treatment. The patients were instructed to apply their designated creams once daily from their first radiotherapy session until 1-month post-irradiation. Their skins were graded by a radiation oncologist on a weekly basis until 1-month post-irradiation to identify any skin reactions. The results showed that the administration of the herbal creams or the moisturizing cream could neither reduce the severity nor delay the onset of dermatitis compared with the no treatment group. However, despite the limited benefits from the prophylaxis, the Cucumis sativus cream was shown to help with the skin recovery post-irradiation. These results suggested that breast cancer patients undergoing radiotherapy should be advised to apply moisturizing cream to the area of irradiated skin.
Intraoperative Dexmedetomidine in Peripheral or Emergency Neurologic Surgeries of Patients With Mild-to-Moderate Traumatic Brain Injuries: A Retrospective Cohort Study
Authors: Ding Qin , Zhang Xianhe , Chen Peng
Published: May 2020

Background:

Although animal models have demonstrated dexmedetomidine (DEX) as neuroprotective in craniocerebral and subarachnoid injuries, but its role in humans remains to be elucidated. The objectives of the study were to compare plasma brain-derived neurotrophic factor (BDNF), cytokine, and superoxide dismutase levels of patients between those who received intraoperative DEX and those who received intraoperative normal saline (NSE) during peripheral or emergency neurologic surgeries.

Methods:

Intra- and postoperative data of blood biomarkers and surgical outcomes of patients who underwent peripheral or emergency neurologic surgeries with mild-to-moderate traumatic brain injuries were analyzed retrospectively. Patients received intraoperative DEX group (n = 109) or NSE group (n = 116).

Results:

At 15 minutes after intubation and before the operation, in the DEX group, plasma BDNF concentration decreased but remained much higher than the NSE group ( P < .0001, q = 15.82). After 24 hours of surgeries, levels of cytokine were higher in the NSE group than the DEX group ( P < .05 for all). Dexmedetomidine increased malondialdehyde ( P < .0001) and superoxide dismutase ( P < .0001) levels in DEX group.

Conclusions:

Intraoperative infusion of DEX may have a neuroprotective, anti-inflammatory, and antioxidant effects during peripheral or emergency neurologic surgeries.

Level of Evidence:

III.
Pharmacology of the lower urinary tract: update on LUTS treatment
Authors: Abreu-Mendes Pedro , Silva João , Cruz Francisco
Published: May 2020

The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-α-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation.
Evaluating Care Partner Preferences for Seating in an Outpatient Surgery Waiting Area Using Virtual Reality
Authors: Jafarifiroozabadi Roxana , Joseph Anjali , Joshi Rutali , Wingler Deborah
Published: May 2020

Objective:

The purpose of this study was to examine the factors impacting seating choices of care partners while conducting common tasks in an outpatient surgical center waiting room.

Background:

Waiting rooms in healthcare environments have been previously studied to understand how factors such as aesthetics, privacy, comfort, and positive distractions impact user perception of quality of care. Although care partners of patients often spend long hours in the surgical waiting rooms, no studies have addressed users’ seat type and location preferences in waiting areas.

Methods:

In this study, 92 participants made seat selections while performing scenario-based tasks in a virtual waiting area. A mixed-methods approach including a survey and semi-structured interviews was utilized to capture participants’ feedback on how certain factors (e.g., visibility, accessibility, privacy, comfort, and aesthetic quality) impacted their choices.

Results:

The optimal seat location and type in the waiting area varied depending on the type of task care partners were engaged in. While being able to sit with their loved one was the most important factor influencing seat selection during patient check-in, seat location was the most important factor in all other scenarios. The importance of factors such as seat comfort, seat type, visual and auditory privacy, and visibility to registration area varied across scenarios. However, the visual appearance of the seating remained equally important across all scenarios.

Conclusions:

The use of different scenarios allowed users to identify their preferences regarding seating within the context of their specific needs at different points in the waiting process.
Computed tomography angiography lightbulb sign: Characteristic enhancement pattern on neck computed tomography angiography in differentiating paraganglioma from schwannoma of the carotid space
Authors: Suthiphosuwan Suradech , Bai Helin D , Yu Eugene , Bharatha Aditya
Published: May 2020

It is important to correctly distinguish paragangliomas from other tumors such as schwannomas in the preoperative assessment of head and neck tumors because paragangliomas have a propensity to bleed profusely during surgery. Therefore, preoperative embolization is often required while with schwannomas preoperative embolization is generally not required. Occasionally, schwannomas can mimic paragangliomas on routine computed tomography and magnetic resonance imaging of the neck. In this study, we retrospectively evaluated the computed tomography angiography of the neck of 10 patients with carotid space tumors. Seven patients had pathologically proven paraganglioma while three patients had schwannomas. We describe the “computed tomography angiography lightbulb sign” as avid homogeneous enhancement in the arterial phase which can accurately distinguish these entities.
Analgesia for extremity fractures in the paediatric emergency department
Authors: Tan Siew Ming , Ong Yong-Kwang Gene , Pek Jen Heng
Published: May 2020

Background:

Extremity fractures are an important and common presentation at the Paediatric Emergency Department (PED). Provision of analgesia is a key management principle, but it is often suboptimal. Although there is an increase in awareness of this issue, the impact on current practice is not known. We aimed to review the current practice of providing analgesia for extremity fractures in the PED.

Objective:

Our objective was to determine the utilisation, adequacy and timeliness of analgesia provided for these patients.

Methods:

A retrospective study was carried out from November to December 2017. Patients with a diagnosis of extremity fracture involving the upper or lower limb were included. Information about patient demographics, diagnosis, pain score, analgesia use and clinical progress were collected for analysis.

Results:

There were 101 cases. The mean age was 8.5±4.2 years old, and 62 (61.4%) patients were male. There were 76 (75.3%) cases of fractures involving the upper limb, and 25 (24.7%) cases of fractures involving the lower limb. The mean pain score at presentation was 3.3±2.3. Analgesia was administered to only 10 (9.9%) patients, with oral paracetamol ( n=5; 5.0%) being the most common medication administered. The median time between arrival in the PED to analgesia administration was 69 minutes (range 25–328 minutes).

Conclusions:

Despite the increase in awareness, analgesia for these patients remains underutilised, inadequate and delayed. Further efforts at pain assessment, analgesia selection and administration are necessary to improve the provision of analgesia for these patients.
Heparin-induced thrombocytopaenia following abdominal aortic aneurysm repair complicated by treatment failure of rivaroxaban
Authors: Samarakoon Lasitha Bhagya , Chua Felicia , Yap Hao Yun , Choke Edward
Published: May 2020

Heparin-induced thrombocytopaenia (HIT) is a rare life-threatening complication following exposure to heparin. It is mediated by immune-mediated thrombocytopaenia due to antibody against heparin platelet factor 4 complex. Early identification of the condition and the prompt administration of appropriate treatment are important to prevent morbidity and mortality from HIT. We report a case of HIT associated with open abdominal aortic aneurysm repair causing anterior tibial artery and peroneal artery thrombosis following prophylactic use of unfractionated heparin for prophylaxis of venous thromboembolism. Even though enoxaparin was switched to rivaroxaban after HIT was suspected, our patient unfortunately developed a minor cerebrovascular accident during the hospital stay as a consequence of HIT.
The role of thyroid hormone in metabolism and metabolic syndrome
Authors: Teixeira Patrícia de Fátima dos Santos , dos Santos Patrícia Borges , Pazos-Moura Carmen Cabanelas
Published: May 2020

Metabolic syndrome (MetS) and thyroid dysfunction are common in clinical practice. The objectives of this review are to discuss some proposed mechanisms by which thyroid dysfunctions may lead to MetS, to describe the bidirectional relationship between thyroid hormones (THs) and adiposity and finally, to resume a list of recent studies in humans that evaluated possible associations between thyroid hormone status and MetS or its clinical components. Not solely THs, but also its metabolites regulate metabolic rate, influencing adiposity. The mechanisms enrolled are related to its direct effect on adenosine triphosphate (ATP) utilization, uncoupling synthesis of ATP, mitochondrial biogenesis, and its inotropic and chronotropic effects. THs also act controlling core body temperature, appetite, and sympathetic activity. In a bidirectional way, thyroid function is affected by adiposity. Leptin is one of the hallmarks, but the pro-inflammatory cytokines and also insulin resistance impact thyroid function and perhaps its structure. MetS development and weight gain have been positively associated with thyroid-stimulating hormone (TSH) in several studies. Adverse glucose metabolism may be related to hyperthyroidism, but also to reduction of thyroid function or higher serum TSH, as do abnormal serum triglyceride levels. Hypo- and hyperthyroidism have been related to higher blood pressure (BP), that may be consequence of genomic or nongenomic action of THs on the vasculature and in the heart. In summary, the interaction between THs and components of MetS is complex and not fully understood. More longitudinal studies controlling each of all confounding variables that interact with endpoints or exposure factors are still necessary.
What every orthopaedic surgeon should know about COVID-19: A review of the current literature
Authors: Yung Colin Shing-Yat , Fok Kevin Chi Him , Leung Ching Ngai , Wong Yat Wa
Published: May 2020

The coronavirus (COVID-19) pandemic has severely affected the medical community and stopped the world in its tracks. This review aims to provide the basic information necessary for us, orthopaedic surgeons to prepare ourselves to face this pandemic together. Herein, we cover the background of COVID-19, presentation, investigations, transmission, infection control and touch upon emerging treatments. It is of paramount importance that we should stay vigilant for our patients, our families and ourselves. Adequate infection control measures are necessary during day-to-day clinical work.
Tracheobronchopathia Osteochondroplastica—Clinical, Radiological, and Endoscopic Correlation: Case Series and Literature Review
Authors: García Carlos Alejandro , Sangiovanni Saveria , Zúñiga-Restrepo Valeria , Morales Eliana Isabel , Sua Luz Fernanda , Fernández-Trujillo Liliana
Published: May 2020

Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic and benign disease that is often underdiagnosed. TO is characterized by multiple submucosal cartilaginous and osseous tracheobronchial nodules that spare the posterior wall. It usually affects the elderly, developing when the person is around 60 years old without gender preference and has a reported incidence of 0.11%. TO can be symptomatic and should be considered in patients with chronic cough, dyspnea, and recurrent pulmonary infections. Diagnosis is usually incidental by computed tomography or bronchoscopy, the latter being the gold standard diagnostic test for TO. Many thoracic imagers are not well acquainted with TO; thus, these patients are often underdiagnosed or misdiagnosed. We came across 5 patients in our institution who were incidentally diagnosed with TO, inspiring us to review the available literature on this disease. A total of 33 patients diagnosed with TO between 2009 and 2019 were identified by our retrospective review. Clinical and imaging data were collected on these patients. We also included the clinical, radiological, and endoscopic data of our 5 cases. TO should be considered in patients with chronic cough, dyspnea, and recurrent pulmonary infections. Our experience is that both computed tomography and bronchoscopy can be used to make a reliable diagnosis. It is crucial for physicians, especially radiologists and pulmonologists, to be aware of the existence of TO in order to ensure proper diagnosis.
Ready the Canons: The Role of Canonical Stories in Organizational Sensemaking
Authors: Parrish Dan
Published: May 2020

This article examines the role of canonical stories in sensemaking. Canonical stories are known by members of a group; storytellers can refer to the shared narratives as repositories of meaning. While the sensemaking literature includes multiple studies of stories and storytelling, no studies have explicitly examined the role of canonical stories in sensemaking. Interviews with 55 top leaders in U.S. Catholic universities confronting a fraught issue in their institutions (undocumented student access) indicate a variety of ways that canonical stories operate in their sensemaking. Respondents referred to community narratives, canonical stories that hold specific meaning for their university communities. They told generic or stereotypical stories and fragments as shorthand in their communication. They also used counterfactuals as referents for their sensemaking. These findings help us better understand the role and importance of canonical stories in organizational sensemaking.
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot
Authors: Rhee Chanseok , Burgesson Bernard , Orlik Ben , Logan Karl
Published: May 2020

Background:

The Ponseti method has revolutionized the treatment of idiopathic clubfoot, but recurrence remains problematic. Dynamic supination is a common cause of recurrence, and the standard treatment is tibialis anterior tendon transfer using an external button. Although safe and effective, the placement of the button on the sole creates a pressure point, which can lead to skin ulceration. In our institution, a suture button has been used for the tibialis anterior tendon transfer and we report our results here.

Methods:

Two senior authors’ case logs were retrospectively reviewed to identify 23 patients (34 feet) for tibialis anterior tendon transfer using a suture button. Complications and additional operative procedures were assessed by reviewing operative notes, follow-up visit clinic notes, and radiographs. The mean age of the patients was 6 years 2 months (SD 40 months) and the average follow-up duration was 67.1 weeks (SD 72 weeks).

Results:

There were 5 complications (14.7%). Recurrence occurred bilaterally in 1 patient (5.9%) but did not require reoperation. Other complications included a cast-related pressure sore (2.9%) and an infection (2.9%) requiring irrigation with debridement along with hardware removal.

Conclusions:

Tibialis anterior tendon transfer using a suture button was a safe procedure with theoretical advantage of providing stronger fixation and reducing the risk of skin pressure necrosis compared to the standard external button technique. We believe a suture button could allow earlier rehabilitation and may afford stronger ankle eversion. Prospective studies are required to compare the differences in functional outcomes between the procedures.

Level of Evidence:

Level IV, case series, therapeutic study.
ICEKAT: an interactive online tool for calculating initial rates from continuous enzyme kinetic traces
Authors: Olp Michael D. , Kalous Kelsey S. , Smith Brian C.
Published: May 2020

Background

Continuous enzyme kinetic assays are often used in high-throughput applications, as they allow rapid acquisition of large amounts of kinetic data and increased confidence compared to discontinuous assays. However, data analysis is often rate-limiting in high-throughput enzyme assays, as manual inspection and selection of a linear range from individual kinetic traces is cumbersome and prone to user error and bias. Currently available software programs are specialized and designed for the analysis of complex enzymatic models. Despite the widespread use of initial rate determination for processing kinetic data sets, no simple and automated program existed for rapid analysis of initial rates from continuous enzyme kinetic traces.

Results

An Interactive Continuous Enzyme Kinetics Analysis Tool (ICEKAT) was developed for semi-automated calculation of initial rates from continuous enzyme kinetic traces with particular application to the evaluation of Michaelis-Menten and EC50/IC50 kinetic parameters, as well as the results of high-throughput screening assays. ICEKAT allows users to interactively fit kinetic traces using convenient browser-based selection tools, ameliorating tedious steps involved in defining ranges to fit in general purpose programs like Microsoft Excel and Graphpad Prism, while still maintaining simplicity in determining initial rates. As a test case, we quickly analyzed over 500 continuous enzyme kinetic traces resulting from experimental data on the response of the protein lysine deacetylase SIRT1 to small-molecule activators.

Conclusions

ICEKAT allows simultaneous visualization of individual initial rate fits and the resulting Michaelis-Menten or EC50/IC50 kinetic model fits, as well as hits from high-throughput screening assays. In addition to serving as a convenient program for practicing enzymologists, ICEKAT is also a useful teaching aid to visually demonstrate in real-time how incorrect initial rate fits can affect calculated Michaelis-Menten or EC50/IC50 kinetic parameters. For the convenience of the research community, we have made ICEKAT freely available online at https://icekat.herokuapp.com/icekat.
Decoupling behavioral and transcriptional responses to color in an eyeless cnidarian
Authors: Leach Whitney B. , Reitzel Adam M.
Published: May 2020

Background

Animals have specific molecular, physiological, and behavioral responses to light that are influenced by wavelength and intensity. Predictable environmental changes – predominantly solar and lunar cycles – drive endogenous daily oscillations by setting internal pacemakers, otherwise known as the circadian clock. Cnidarians have been a focal group to discern the evolution of light responsiveness due to their phylogenetic position as a sister phylum to bilaterians and broad range of light-responsive behaviors and physiology. Marine species that occupy a range of depths will experience different ranges of wavelengths and light intensities, which may result in variable phenotypic responses. Here, we utilize the eyeless sea anemoneNematostella vectensis, an estuarine anemone that typically resides in shallow water habitats, to compare behavioral and molecular responses when exposed to different light conditions.

Results

Quantitative measures of locomotion clearly showed that this species responds to light in the blue and green spectral range with a circadian activity profile, in contrast to a circatidal activity profile in the red spectral range and in constant darkness. Differences in average day/night locomotion was significant in each condition, with overall peak activity during the dark period. Comparative analyses of 96 transcriptomes from individuals sampled every 4 h in each lighting treatment revealed complex differences in gene expression between colors, including in many of the genes likely involved in the cnidarian circadian clock. Transcriptional profiling showed the majority of genes are differentially expressed when comparing mid-day with mid-night, and mostly in red light. Gene expression profiles were largely unique in each color, although animals in blue and green were overall more similar to each other than to red light.

Conclusions

Together, these analyses support the hypothesis that cnidarians are sensitive to red light, and this perception results in a rich transcriptional and divergent behavioral response. Future work determining the specific molecular mechanisms driving the circadian and potential circatidal rhythms measured here would be impactful to connect gene expression variation with behavioral variation in this eyeless species.
Readmission rates following heart failure: a scoping review of sex and gender based considerations
Authors: Hoang-Kim Amy , Parpia Camilla , Freitas Cassandra , Austin Peter C. , Ross Heather J. , Wijeysundera Harindra C. , Tu Karen , Mak Susanna , Farkouh Michael E. , Sun Louise Y. , Schull Michael J. , Mason Robin , Lee Douglas S. , Rochon Paula A.
Published: May 2020

Background

Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender.

Methods

We conducted a scoping review using the Arksey and O’Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis.

Results

The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53–0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year.

Conclusions

Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.
Psychometric testing of the support and control in birth scale
Authors: Liu Shu-Yu , Lu Yu-Ying , Gau Meei-Ling , Liu Chieh-Yu
Published: May 2020

Background

The Support and Control in Birth (SCIB) scale primarily measures the perceived support and control of expectant mothers during childbirth, thereby obtaining an understanding of their birth experiences. The advantages of this scale are its good reliability and validity and that it consolidates birth support and control. However, a Chinese version of the scale has yet to be developed. Therefore, this study sought to evaluate the validity and reliability of a Chinese version of the Support and Control in Birth Scale (C-SCIB).

Methods

A total of 228 postpartum women participated in this study. The C-SCIB scale was developed through a translation and back translation, followed by an evaluation of its content validity by a group of experts. Cronbach’s α internal consistency and test-retest reliability were used to test the reliability of the scale. In addition, criterion-related validity (predictive validity and concurrent validity) and construct validity were used to test the validity of the scale.

Results

The C-SCIB scale showed good results in terms of the item-level and scale-level content validity indices. The Cronbach’s α internal consistency was 0.81, and its test-retest reliability was 0.96. The confirmatory factor analysis results showed the overall goodness-of-fit was parsimony fit indices. The predictive validity analysis showed a significant positive correlation between the C-SCIB scale and the Questionnaire Measuring Attitudes About Labor and Delivery (r = 0.31, p < 0.01). Furthermore, the concurrent validity analysis showed a significant and moderate correlation between the C-SCIB and the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (r = 0.49, p < 0.01) as well as the Labor Agentry Scale (r = 0.51, p < 0.01).

Conclusion

The C-SCIB scale was proven to have good reliability and validity, and thus can be used to measure the degree of support and the locus of control perceived by expectant women during labor.
Risk factors for postpartum sepsis: a nested case-control study
Authors: Bakhtawar Samina , Sheikh Sana , Qureshi Rahat , Hoodbhoy Zahra , Payne Beth , Azam Iqbal , von Dadelszen Peter , Magee Laura
Published: May 2020

Background

The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.

Methods

A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).

Results

Multivariable analysis revealed that 1–4 antenatal visits (95% CI 0.01–0.62).

, 3 or more vaginal examinations (95% CI 1.21–3.65), home delivery (95% CI 1.72–50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93–20.23), lower abdominal pain (95% CI 1.15–3.42)) vaginal discharge (95% CI 2.97–20.21), SpO2 < 93% (95% CI 4.80–37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80–0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis.

Conclusion

This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK
Authors: Kim Jaeryung , Choi Sung-Ho , Lim Dong Hui , Yoon Gil-Joong , Chung Tae-Young
Published: May 2020

Background

To compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK).

Methods

This observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit.

Results

Three months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups.

Conclusions

Although these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.
Trajectories of maternal depressive symptoms from the antenatal period to 24-months postnatal follow-up: findings from the 2015 Pelotas birth cohort
Authors: Jacques Nadège , Mesenburg Marilia Arndt , Matijasevich Alicia , Domingues Marlos Rodrigues , Bertoldi Andréa Dâmaso , Stein Alan , Silveira Mariangela Freitas
Published: May 2020

Background

Maternal depression may be chronic and recurrent, with negative effects both on the health of mothers and children. Many studies have shown trajectories of postnatal depressive symptoms but few studies in low- and middle-income countries have evaluated the trajectories of depressive symptoms starting during pregnancy. This study aims to identify the different trajectories of depressive symptoms among mothers in the Pelotas 2015 birth cohort, from pregnancy to the second year of the child’s life.

Methods

This study used data from the 2015 Pelotas Birth Cohort, a longitudinal study of all live births occurred in 2015 in Pelotas, Brazil. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers who completed the EPDS on at least three follow-up visits beginning to the antenatal follow-up visit were included in the analyses. The trajectory of maternal depressive symptoms was estimated through group-based trajectory modeling.

Results

A total of 3040 women were included in the present analysis. We identified five groups of maternal depressive symptoms trajectories, with 23.4% of the mothers presenting persistent depressive symptoms and 3.9% showing chronic high depressive symptoms throughout the study period. The probability of having persistent depressive symptoms increased among mothers with greater socioeconomic vulnerability.

Conclusions

This study shown the persistence of maternal depressive symptoms since pregnancy until 2 years postnatal. Additionally, alongside the known risk factors, pre-gestational depression and antenatal depressive symptoms are important risk factors for the persistence and severity of depressive symptoms. These findings support the need to provide mental health evaluation and care for women from pregnancy to the late postnatal period.
Association between health behaviours and depression: findings from a national cross-sectional study in South Korea
Authors: Jang Bich Na , Lee Hyeon Ji , Joo Jae Hong , Park Eun-Cheol , Jang Sung-In
Published: May 2020

Background

Depression is a leading cause of disability, and it has been reported that more than 264 million people worldwide have depression. The causes of depression may be numerous, and physical health has also been linked to depression. Therefore, the aim of this study was to determine the effect of health behaviours on depression.

Methods

This study used the data of 224,868 participants from the Community Health Survey, conducted in 2017. We defined health behaviours by combining three variables: no smoking, not belonging to high-risk drinking group, and walking frequently. Depression was measured using the Patient Health Questionnaire-9. Logistic regression was used to examine the association between health behaviours and depression.

Results

Both men and women who did not practise health behaviours were more likely to experience depressive symptoms than those who did (men, odds ratio (OR): 1.48, 95% confidence interval (CI): 1.31–1.68; women, OR: 1.42, 95% CI: 1.32–1.53). Not walking frequently had the strongest association with depression in men and the risk of depression was the highest in women who smoked. Participants who did not practise any health behaviours were the most likely to have depressive symptoms (men, OR: 1.69, 95% CI: 1.38–2.07; women, OR: 3.08, 95% CI: 2.27–4.19).

Conclusion

Our study found that lack of health behaviours is significantly associated with depression. Furthermore, the most influential factor of health behaviours in depression was different for men and women. It is necessary to manage depression through interventional methods customised to gender characteristics. Additionally, national-level policies are needed to encourage steps to improve personal lifestyles, including practising health behaviours.
Interpretation of within-group change in randomised trials
Authors: Kypri Kypros
Published: May 2020

In medicine, it is common to observe improvement after intervention, at least partly because patients present for care in extremis and would have improved without intervention. Controlling for this counterfactual explanation for improvement is the principle reason to conduct a trial in which patients are randomised to treatment or a control group. Accordingly, it is not reasonable to infer that both interventions are effective when the groups show similar improvements in outcome.
Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study
Authors: Sande Odala , Burtscher Doris , Kathumba Daneck , Tweya Hannock , Phiri Sam , Gugsa Salem
Published: May 2020

Background

Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients.

Methods

To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis.

Results

Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule).

Patients’ nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles.

Conclusions

The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factors – including staff transportation and workload – must be taken into consideration and purposefully planned.
Health literacy and its effect on chronic disease prevention: evidence from China’s data
Authors: Liu Lefan , Qian Xujun , Chen Zhuo , He Tianfeng
Published: May 2020

Background

Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, confounding factors are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention.

Methods

A population-based sample of 8194 participants aged 15–69 years old in Ningbo were used from China’s 2017 National Health Literacy Surveillance Data. We use multivariate regression analysis to disentangle the relationship between health literacy and chronic disease prevention.

Results

We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. This might arise because having one or more chronic conditions is associated with better knowledge about chronic diseases, thus improve their health literacy. More importantly, we find health literacy is associated with a reduction in the likelihood of having a comorbid condition. However, this protective effect is only found among urban residents, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes.

Conclusion

Our findings highlight the important role of health literacy in preventing comorbidities instead of preventing the first chronic condition. Moreover, family support could help improve health literacy and result in beneficial effects on health.
Factors associated with quality of life of postmenopausal women living in Iran
Authors: Nazarpour Soheila , Simbar Masoumeh , Ramezani Tehrani Fahimeh , Alavi Majd Hamid
Published: May 2020

Background

Quality of life (QoL) after menopause could be influenced by a host of personal and social factors. This study aimed to determine the factors associated with quality of life among postmenopausal women.

Methods

This cross-sectional study was conducted among 405 postmenopausal women selected using a multi-stage randomized sampling. The data-collection tools were the WHO Quality of Life-BREF (WHOQOL-BREF), the Menopause Rating Scale (MRS), and a researcher-designed questionnaire. The relationship between QoL and its potentially correlated factors was examined usingt-test, ANOVA, Pearson’s correlation, Spearman’s correlation coefficient, and multiple linear regression.

Results

A negative correlation was found between the scores of QoL (total and all subscales) and the MRS total scores. The total scores of QoL were negatively correlated with duration of menopause (r = − 0.127,P = 0.010), gravida (r = − 0.177,P < 0.001), parity (r = − 0.165,P = 0.001), frequency of stillbirth (r = − 0.104,P = 0.037), vaginal delivery (r = − 0.161,P = 0.001), and waist-to-hip ratio (r = − 0.195,P < 0.001). The QoL total scores were positively correlated with the educational level of the participants (r = 0.207,P < 0.001) and that of their spouses (r = 0.160,P = 0.001) along with their level of monthly family income (r = 0.218,P < 0.001). Multiple-linear-regression analysis showed that the total score of QoL decreased with inadequate income, waist-to-hip ratio, and the total score of MRS.

Conclusions

Personal and social factors along with the severity of menopausal symptoms affect QoL post-menopause. These factors need to have a bearing on any effort to improve QoL among postmenopausal women.
The relationship between clinical dishonesty and perceived clinical stress among nursing students in southeast of Iran
Authors: Rafati Foozieh , Bagherian Behnaz , Mangolian shahrbabaki Parvin , Imani Goghary Zahra
Published: May 2020

Background

Clinical dishonesty is a complex problem that threatens the health and safety of patients. This study aimed to investigate the relationship between clinical dishonesty and perceived clinical stress in nursing students.

Method

This cross-sectional correlational study was conducted on 395 nursing students from 4 nursing colleges. The data were collected using a demographic information questionnaire, Nursing Student’s Perception of Clinical Stressors, and a 12-item researcher-made questionnaire to evaluate the frequency of clinical dishonesty in the previous semester, the frequency of witnessing dishonest behavior among peers, and the perceived severity of unethical behavior.

Results

In this study, 89.1% of the students stated that they had committed at least one dishonest clinical behavior in the previous semester. The frequency of clinical dishonesty was significantly correlated with the frequency of observing dishonesty among peers (r = 0.053, p<0.01), perceived severity of unethical behavior (r = − 0.4, p<0.01), and perceived stress of students in the clinical setting (r = 0.28, p<0.01). Moreover, there were significant differences in the frequency of clinical dishonesty by gender (p = 0.006), the interest in the field of study (p = 0.004), and academic year (p = 0.002).

Conclusion

The frequency of clinical dishonesty among nursing students is high and needs attention. Furthermore, considering the positive relationship between dishonesty and perceived clinical stress, it is essential to teach effective strategies to nursing students to empower them to cope with clinical stress.