bluuebunny/crossref_metadata_2025 huggingface dataset:
Montelukast as a repurposable additive drug for standard-efficacy multiple sclerosis treatment: Emulating clinical trials with retrospective administrative health claims data
Authors: Manuel Astrid M , Gottlieb Assaf , Freeman Leorah , Zhao Zhongming
Published: April 2024

Background:

Effective and safe treatment options for multiple sclerosis (MS) are still needed. Montelukast, a leukotriene receptor antagonist (LTRA) currently indicated for asthma or allergic rhinitis, may provide an additional therapeutic approach.

Objective:

The study aimed to evaluate the effects of montelukast on the relapses of people with MS (pwMS).

Methods:

In this retrospective case–control study, two independent longitudinal claims datasets were used to emulate randomized clinical trials (RCTs). We identified pwMS aged 18–65 years, on MS disease-modifying therapies concomitantly, in de-identified claims from Optum’s Clinformatics® Data Mart (CDM) and IQVIA PharMetrics® Plus for Academics. Cases included 483 pwMS on montelukast and with medication adherence in CDM and 208 in PharMetrics Plus for Academics. We randomly sampled controls from 35,330 pwMS without montelukast prescriptions in CDM and 10,128 in PharMetrics Plus for Academics. Relapses were measured over a 2-year period through inpatient hospitalization and corticosteroid claims. A doubly robust causal inference model estimated the effects of montelukast, adjusting for confounders and censored patients.

Results:

pwMS treated with montelukast demonstrated a statistically significant 23.6% reduction in relapses compared to non-users in 67.3% of emulated RCTs.

Conclusion:

Real-world evidence suggested that montelukast reduces MS relapses, warranting future clinical trials and further research on LTRAs’ potential mechanism in MS.
What factors are associated with physical education teachers’ (de)motivating teaching style? A circumplex approach
Authors: García-Cazorla Javier , García-González Luis , Burgueño Rafael , Diloy-Peña Sergio , Abós Ángel
Published: April 2024

Building upon the circumplex approach to (de)motivating styles defined by self-determination theory, this research aimed: (a) to analyse the extent to which physical education (PE) teachers’ (de)motivating teaching approaches differ across gender, school level, and years of teaching experience, and (b) to test paths from PE teachers’ need-based experiences to their (de)motivating teaching approaches, via motivation quality. A purposive and cross-sectional sample of 667 Spanish PE teachers (63.7% male; 54.7% primary; mean teaching experience = 10.77 years) participated. The overall results found that male, secondary school, and more experienced teachers scored lower on autonomy-supportive approaches, and higher on controlling and chaotic approaches. The findings also showed that, after controlling for gender, school level, and teaching experience, need satisfaction showed a direct significant effect on autonomous motivation and an indirect effect on participative, attuning, guiding, and clarifying approaches via autonomous motivation. Need frustration showed a direct significant effect on controlled motivation and amotivation and an indirect effect on demanding, domineering, abandoning, and awaiting approaches via controlled motivation and amotivation. Another noteworthy result is the positive relationship between need satisfaction and controlled motivation. Our results underscore the role that PE teachers’ personal traits play in the adaptive motivational mechanisms underlying their variety of (de)motivating approaches to PE teaching.
Heritage tourism and allegiance development: A study of the Korean demilitarized zone
Authors: Lee Sangyung , Kim Taekbin , Kim Young Hoon
Published: April 2024

The Korean Demilitarized Zone (DMZ) stands as a compelling destination for heritage tourism due to its rich historical and sociocultural significance. This study employs the psychological continuum model to explore allegiance development across four dimensions—awareness, attraction, attachment, and allegiance—within the context of DMZ tourism. The investigation delves into how DMZ tourists’ sociocultural motivation shapes their destination engagement, subsequently influencing emotional attachment and ultimately impacting revisit intention. Through a survey of DMZ visitors and the application of structural equation modeling, this study explores the dynamics of DMZ tourists’ allegiance. The findings reveal a positive relationship between sociocultural motivation and destination engagement, emotional attachment, and revisit intention. Destination engagement positively affects emotional attachment, albeit indirectly influencing revisit intention. Emotional attachment positively influences revisit intention. Furthermore, this study identifies notable moderating effects of DMZ tourists’ residency. Specifically, sociocultural motivation more strongly influences revisit intention, and destination engagement has a stronger impact on emotional attachment in international tourists compared to domestic tourists.
Agreement of synchronous remote and in-person application of the Alberta Infant Motor Scale: Cohort study
Authors: Passamani Rafaela S , Shigihara Carolina K , Gomes Paula G , dos Santos Adriana N
Published: April 2024

Introduction

Using standardized scales to assess motor development via telemedicine can increase access for low-income populations. Our aim was to verify the agreement and feasibility between remotely and synchronously applying the Alberta Infant Motor Scale (AIMS) and the in-person format.

Methods

This was a concordance study, with 77 typical infants aged 4–18 months (mean = 13 months). The AIMS was applied remote via video calls and face-to-face. We applied a questionnaire to caregivers to verify feasibility.

Results

There was a high level of agreement between the remote and in-person assessments, with intraclass correlation coefficients above 0.98 and low standard error measure values (<1 item for each posture, <2 items for the total raw score, and =5% for the normative score). The smallest detectable change was between 1.67 and 2.45 for each posture, 3 for the total raw score, and 6% for the normative score. The Bland–Altman analysis showed low bias with the mean difference close to zero (<0.80) and low error with little dispersion of the difference points around the mean. Caregivers’ perspectives on the synchronous remote assessment were positive, with good quality, clear information during the assessment, and comfort with the method.

Discussion

The synchronous remote application of the AIMS may be an alternative for families without access to in-person services that assess motor development.
A model to follow? The EU and global eco-social policy
Authors: Laruffa Francesco , Nullmeier Frank
Published: April 2024

In this article, we study the political project promoted by the European Commission (EC) for tackling simultaneously socioeconomic and environmental issues. Based on a detailed analysis of the most relevant EC policy documents (adopted between 2000 and 2020) that explicitly articulate ecological and socioeconomic questions, we offer two contributions to the literature on eco-social policy. First, we identify the nature of what we call the ‘European Eco-Social Model’. This political project subordinates social-ecological goals to the economic rationality of growth, competitiveness and profits and de-politicizes the efforts to promote more sustainable societies and economies. Second, we show how the Commission is repositioning itself as a global leader in the transformation to sustainability, attempting to extend its particular eco-social model to the whole world. Overall, we argue that this ‘model’ is based on self-contradictory assumptions and cannot demonstrate how it should be able to solve problems of social inequality and climate change on a global level.
Moving Beyond Single Racial Identification: Considering Multiracial and Multiethnic Identification in Public Health
Authors: Pulido Tessa R.
Published: April 2024

As multiracial and multiethnic youth populations are anticipated to be 11.3% of the U.S. population by 2060, it is essential that public health research and practice find ways to effectively capture and reach these diverse groups. Single racial identification has been a norm in public health practice; however, this method has limitations for capturing the health of multiracial and multiethnic individuals. Drawing on personal experience of the author and multidisciplinary scholarship, this research commentary examines the limitations of single race identification and how this influences the processes of racialization. The author provides important implications for public health research by suggesting more complex and effective ways to capture personal racial identification and racial perceptions and addresses how to reach multiracial and multiethnic groups through public health interventions where individuals might identify with multiple cultural identities.
Times They Are A-Changin’? Evolving Representations of Women in the Assassin's Creed Franchise
Authors: Eklund Lina , Zanescu Andrei
Published: April 2024

This study analyzes representations of women—protagonists and NPCs—in Assassińs Creed games between 2007 and 2024, to explore the impact of the last decades’ work for gender rights on the English language AAA game industry. Through close playing, we explore game bodies with attention to the surface level of narrative, graphics, sound, and underlying mechanics of actions and reactions. Through netnography, we add promotional material, retail sites, and social movements of importance to the analysis. Results show four eras for female protagonists: nonexistent, protagonists in side games, defined by their male coprotagonists, and choose your gender. Over the 17 years studied, women are more present, and NPCs are more complex. Though female protagonists remain sidelined or shallow representations as female skins on male characters. We discuss how discrepancies and conflicts between artistic visions, marketing, and brand choices impact how women are represented, and the impact on representation by external cultural events, for example Gamergate/Metoo, during this period.
In-stent restenosis estimation following carotid artery stenting: The robust predictive value of atherogenic index of plasma and other non-traditional lipid profiles
Authors: Yılmaz Cemalettin , Güvendi Şengör Büşra , Zehir Regayip , Kaya Ahmet Ferhat , Özdil Mehmet Hasan , Karaduman Ahmet , Kültürsay Barkın
Published: April 2024

Objective

Atherosclerotic carotid artery stenosis is a significant contributor to ischemic strokes, and carotid artery stenting (CAS) has emerged as a pivotal treatment option. However, in-stent restenosis (ISR) remains a concern, impacting the long-term patency of CAS. This study aimed to investigate the predictive value of non-traditional lipid profiles, including the atherogenic index of plasma (AIP), in ISR development.

Methods

This retrospective single-center study involved patients presenting at a tertiary healthcare facility with severe carotid artery disease between 2016 and 2020 who subsequently underwent CAS. A total of 719 patients were included in the study. The study cohort was divided into ISR and non-ISR groups based on restenosis presence, confirmed by angiography following ultrasonographic follow-up assessments. Non-traditional lipid indices, such as AIP, atherogenic index (AI), and lipoprotein combined index (LCI), were evaluated along with traditional risk factors.

Results

During a 24-month follow-up, ISR occurred in 4.03% of patients. To determine the predictors of restenosis, three different models were constructed in multivariate analysis for non-traditional lipid indices. Multivariate analysis revealed AIP as a robust independent predictor of ISR (OR: 4.83 (CI 95 % 3.05–6.63, p < .001). Notably, AIP demonstrated superior predictive accuracy compared to AI and LCI, with a higher Area Under the Curve (AUC) of 0.971.

Conclusion

Non-traditional lipid profiles, especially AIP, were found to be associated with an increased risk of ISR and may serve as predictors of ISR in patients undergoing CAS.
Radiofrequency ablation for the treatment of great saphenous venous insufficiency using a newly developed VENISTAR catheter: A preliminary study
Authors: Min Jeeyoung , Hwang Jin Ho , Park Sang Woo , Hwang Jae Joon , Kim Jun Seok , Lee Song Am , Chee Hyun Keun
Published: April 2024

Objectives

This study was aimed to assess the preliminary outcomes of radiofrequency ablation (RFA) using a newly developed catheter (VENISTAR) for the treatment of incompetent great saphenous veins (GSVs).

Methods

In this prospective observational study, endovenous RFA using a VENISTAR catheter was performed on 16 saphenous veins in 12 patients between August and November 2019. Patients’ pre- and post-procedural data were recorded. Doppler ultrasound imaging and clinical evaluation were performed at 1 week and 1, 3, and 6 months to determine the efficacy and safety of the treatment.

Results

Technical success and complete closure of the targeted GSVs immediately after the procedure were observed in all 16 limbs (100%). However, one patient (one limb) was found to have partial occlusion without significant reflux after 1 week of follow-up. Kaplan–Meier analysis yielded a complete occlusion rate of 93% at 6 months of follow-up. The Venous Clinical Severity Scores at the time of all follow-up were significantly lower than those at baseline (3.3 ± 1.1 at baseline to 0.6 ± 0.6, 0.3 ± 0.6, 0.1 ± 0.4, and 0.2 ± 0.4 at 1 week and 1, 3, and 6 months, respectively) ( p < .001). Mild post-procedural pain was noted in 7 and 4 limbs at 1 week and 1 month, respectively. Grade 1 ecchymosis over the ablated segment was noted in 5 (35.7%) of 14 limbs at 1-week follow-up.

Conclusions

Endovenous treatment of GSV insufficiency using a new VENISTAR radiofrequency catheter has been shown to be feasible, effective, and safe throughout the 6-month follow-up.
Development and validation of a pictographic assessment embodiment scale
Authors: Sutil-Jiménez Antonio J. , Alba Guzmán , Muñoz Miguel A.
Published: April 2024

Embodiment is a complex concept related to the subjective perception of an object as it belongs to its own body. In general, this construct has been evaluated by means of questionnaires, but validation studies in other cultures and limitations related with barriers of language received little attention. The purpose of the present investigation was twofold: to validate the factorial structure of embodiment questionnaire (EQ) and to construct a pictographic scale (PAE) to measure embodiment without relapse verbal representations. In the first experiment, 136 participants underwent a Rubber Hand Illusion (RHI) procedure following both congruent and incongruent (control) visuo-tactile stimulations. Then, they evaluated embodiment illusion in EQ using a Likert-type scale to rate their agreement or disagreement with 27 statements and with a pictographic scale designed to assess their subjective experience of the illusion. Principal components analysis in EQ scores identified four components that emerged in both conditions: Embodiment, Disembodiment, Affect and Deafference. PAE scale was highly correlated with embodiment factor and can differentiate between conditions. In a second experiment, 30 participants underwent the RHI procedure, and they were assessed using PAE and proprioceptive drift. Results indicate a high positive correlation between PAE and post-illusion drift score. These results provide evidence about the consistency of the factorial structure of EQ across cultures, and we also provide a new pictographic tool that allows quick measurement of embodiment overcoming language barriers.
Parent–child sensorimotor coordination in toddlers with and without hearing loss
Authors: Monroy Claire , Yu Chen , Houston Derek
Published: April 2024

Infants experience the world through their actions with objects and their interactions with other people, especially their parents. Prior research has shown that school-age children with hearing loss experience poorer quality interactions with typically hearing parents, yet little is known about parent–child interactions between toddlers with hearing loss and their parents early in life. In the current study, we used mobile eye-tracking to investigate parent–child interactions in toddlers with and without hearing loss (mean ages: 19.42 months, SD = 3.41 months). Parents and toddlers engaged in a goal-directed, interactive task that involved inserting coins into a slot and required joint coordination between the parent and the child. Overall, findings revealed that deaf toddlers demonstrate typical action skills in line with their hearing peers and engage in similar interactions with their parents during social interactions. Findings also revealed that deaf toddlers explored objects more and showed more temporal stability in their motor movements (i.e. less variation in their timing across trials) than hearing peers, suggesting further adaptability of the deaf group to their atypical sensory environment rather than poorer coordination. In contrast to previous research, findings suggest an intact ability of deaf toddlers to coordinate their actions with their parents and highlight the adaptability within dyads who have atypical sensory experiences.
Body Mass Index, Sex, and Age Are Predictors of Discharge to a Post-acute Care Facility Following Total Ankle Arthroplasty
Authors: Bakaes Yianni , Gonzalez Tyler , Hardin James W. , Jackson J. Benjamin
Published: April 2024

Background

The utilization of total ankle arthroplasty (TAA) continues to increase. Discharge to a post-acute care (PAC) facility can increase patient morbidity and postoperative costs. The purpose of this study is to investigate the effects of age and body mass index (BMI) on discharge to a PAC facility and hospital length of stay (LOS) following TAA.

Methods

A retrospective review of patients who underwent TAA from the National Surgical Quality Improvement Program (NSQIP) database was performed. Using overweight patients as the reference BMI group, sex- and age-adjusted log-binomial regression models were utilized to estimate risk ratios of BMI categories for being discharged to a PAC facility. A linear regression was utilized to estimate the effect of BMI category on hospital LOS.

Results

Obese patients had 1.36 times the risk of overweight patients (P = .040), and morbidly obese patients had 2 times risk of overweight patients (P = .001) of being discharged to a PAC facility after TAA. Men had 0.48 times the risk of women (P < .001). Compared with patients aged 18 to 44 years, patients aged ≥65 years had 4.13 times the risk (P = .012) of being discharged to a PAC facility after TAA. Relative to overweight patients, on average there was no difference in hospital LOS for underweight patients, but healthy weight patients stayed an additional 0.30 days (P=.003), obese patients stayed an additional 0.18 days (P = .011), and morbidly obese patients stayed an additional 0.33 days (P = .009). Men stayed 0.29 fewer hospital days than women (P < .001) on average.

Conclusion

Women and patients who are obese or morbidly obese have a longer hospital LOS and an increased chance of being discharged to a PAC facility. Increasing age is also associated with an increased risk of being discharged to a PAC. These may be important factors when developing and discussing the postoperative plan with patients prior to TAA.

Levels of Evidence:

Level III
Trauma, the Holy Spirit, and Spiritual Formation: Facilitating Recovery in the Mind, Spirit, and Body
Authors: Wang David C.
Published: April 2024

The impact of trauma is pervasive, multi-faceted, and longstanding, impacting the mind, body, and spirit. Trauma can unfold with a cascading effect throughout every stage of life, leaving its mark on brain development, stunting social, emotional, and cognitive functioning, promoting risky health behavior, and increasing vulnerability to chronic disease, and ultimately leading to early death. Consistent with this reality, recovery from trauma is a gradual, iterative journey of reshaping or reparenting the brain over time. Trauma is also endemic to the Christian faith and to Christian communities, with its signs and effects persisting after divine and/or conventional healing. This was also the case with Christ, who bore scars and memories of his crucifixion in his post-resurrection body. The substantial though partial and imperfect nature of healing from trauma reflects the dynamics of the already-but-not-yet Kingdom of God in which the world remains in darkness and God’s Kingdom remains incomplete. This reality coexists, however, alongside genuine signs of the eschatological Kingdom that is dawning and an invitation towards Christian community and accompaniment—perhaps the greatest gift of the Holy Spirit for healing and recovery. This paper is part of a special issue on the topic of the Holy Spirit and the healing of the body.
Endoscopic Dacryocystorhinostomy Following Nasolacrimal Drainage System Trauma and Medial Orbital Wall Reconstruction
Authors: Turner Laura Drayer , Gounder Pav A. , Dobson Randolph , Rajak Saul N.
Published: April 2024

Study Design

Case series.

Objective

To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware.

Methods

The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO following medial orbital wall fracture repair treated by nasal endoscopic DCR.

Results

Anatomical and functional success was achieved in both cases at 6 weeks post operatively without disruption of the orbital plate. There was persistent success at 1 and 3 years’ post-operatively.

Conclusions

Endoscopic DCR is a good option for the treatment of NLDO in patients with previous medial orbital wall fracture repair where the location of the plate may complicate the external approach.
A difficult diagnosis of eosinophilic fasciitis: A case report
Authors: Mihailescu Mara , Abbas Mariam
Published: April 2024

Eosinophilic fasciitis can be a debilitating diagnosis and is often delayed given its similarities to other sclerotic conditions including morphea, such as bound-down indurated skin and inflammation and sclerotic thickening of tissue layers on histopathology. Delaying treatment can lead to joint contracture and residual hardness in skin which has both cosmetic and functional implications. Therefore, finding the definitive diagnosis and differentiating from other sclerotic diseases is important early in the disease course. We present a case of a 77-year-old female with a generalized rash on her back and extremities, and progressive symptoms of pain, joint contractures, and limited movement, which highlights the challenges in diagnosis and management given clinical and histological parallels between eosinophilic fasciitis and morphea.
Effect of Dance on Body Type: A Study on Adult Bengalee Female in North 24 Parganas, West Bengal
Authors: Joarder Solanki , Parvin Nagma , Kundu Ramendra Nath , Biswas Subir , Bharati Premananda
Published: April 2024

Due to the economic development in Indian society, most people are experiencing a sedentary lifestyle and least physical exercise, which is responsible for the increase in various health issues. Exercise plays a great role in maintaining our health, and dancing is an enjoyable exercise which involves various body movements to stay fit and maintain the body shape. The present study attempted to find out the differences in body types between female dancers and non-dancers used as a control group. Out of total 140 female participants aged 18–40 years, 70 were dancers and the remaining 70 were age-matched controls. Heath and Carter’s method of somatotyping was used to estimate the somatotypes of dancers and controls. Dancers and controls differed significantly ( t-test, p <.05) in terms of their body types and shapes, with dancers having greater mean values of mesomorphy, while lower mean values of endomorphy and WHR compared to the control group. This study suggests, based on somatotype, that dancers were more muscular and less fatty than the control group. Also, dancers were found to have a lower waist circumference than the hip circumference, resulting in a pear-shaped body. In light of this, the study indicates that dancing is a useful art form and a health-beneficial substitute for other forms of exercise.
Village Formation Among Sumi Naga of Nagaland: A Case Study
Authors: Assumi Inotoli L. , Marak Queenbala
Published: April 2024

The study of space in anthropology provides an outlook on society and culture from the view of the space that people live in. A study on village formation among the Sumi looks at understanding the Sumi culture and society from the socio-cultural perception of their land, that is, the village, which is strongly connected to beliefs, migration rituals, customs and social and cultural perceptions of their village. The research looks at the village formation using genealogy to understand the dynamics of Sumi kinship fabricated in the cultural construction of their space. The study details Sumi space following the Co-production Model of Low (2009) , which looks at the production and construction of space and the concepts of spatial practices and representational spaces of Lefebvre (1991) . The study uses anthropological research methods such as case studies, participant observations, interviews and genealogy of the village founders [village land is an heirloom of the chiefs ( kukami)] among the Sumi for inquiry.
The Functional Integrity of the Anterior Cruciate Ligament Can Be Objectively Assessed With the Use of Stress Radiographs: A Systematic Review
Authors: Schwartz Jake , Rodriguez Ariel N. , Banovetz Mark T. , Braaten Jacob A. , Larson Christopher M. , Wulf Corey A. , Kennedy Nicholas I. , LaPrade Robert F.
Published: April 2024

Background:

Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury. Because conventional radiography is relatively easy, affordable, and available worldwide, the diagnostic efficacy of ACL standing, lateral decubitus, and supine stress radiography should be evaluated.

Purpose:

To examine the existing literature regarding the application of stress radiography in evaluating the integrity of the ACL.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

Using the PubMed and MEDLINE databases for relevant articles published between 1980 and the present, a systematic review was conducted to identify evidence related to the radiographic diagnosis or assessment of ACL tears. The literature search was conducted in September 2022.

Results:

Of 495 studies, 16 (1823 patients) were included. Four studies examined standing stress radiography, and 12 investigated lateral decubitus or supine stress radiography. Significant heterogeneity in imaging technique and recorded anterior tibial translation was identified. Anterior tibial translation for ACL-injured knees ranged from 1.2 to 10.6 mm for standing stress radiographs and 2.7 to 11.2 mm for supine stress radiographs, with high sensitivities and specificities for both.

Conclusion:

Stress radiography was a dependable diagnostic method for identifying ACL rupture. Further research is necessary to determine the ideal anatomic landmarks, optimal patient positioning, and appropriate applied stresses to establish a standardized protocol for both assessing ACL tears and evaluating the postoperative integrity of ACL reconstruction using stress radiography.
Resilience in Relation to Adherence to Antiretroviral Therapy in People Living With HIV: A Qualitative Study
Authors: Zahra Anggri Noorana , Waluyo Agung , Yona Sri , Pakasi Trevino Aristarkus
Published: April 2024

Antiretroviral therapy (ART) adherence significantly impacts the survival and quality of life of people living with HIV (PLWH). Despite the challenges faced by PLWH, adherence remains crucial. Thus, cultivating resilience in ART is essential for optimal treatment outcomes. This qualitative study explored the experience of resilience in relation to ART adherence among PLWH. Semi-structured interviews with 10 participants were conducted and inductively analyzed. Participants’ resilience in ART adherence was reflected in their achievements related to cultivating the habit of taking medication and in their convictions that the medication was a daily necessity. PLWH developed resilience through strategies encompassing finding purpose through faith and motivation, fostering wellness by obtaining adequate information, enjoying life, managing disease therapy, and adopting a healthy lifestyle, and building connections by finding adequate support and involving in the community. Nurses are crucial in HIV management, fostering resilience for successful ART adherence and ensuring effective treatment outcomes.
Modeling and experimental study of surface roughness in smart MR fluid-based finishing process
Authors: Kumar Jayant , Mishra Vinod , Baghel Prabhat K.
Published: April 2024

Ball-end magnetorheological finishing (BEMRF) is a high-efficiency nano-finishing technology based on smart magnetorheological fluid to polish complex materials precisely. The surface roughness can be linked with the experimental data to understand the finishing mechanism based on advancements in manufacturing automation and the prediction of material removal. This study proposes a mathematical model to predict surface roughness, helping to understand the effects of various process parameters on surface quality during the BEMRF process. This study adds value to practitioners by providing a mathematical model to predict the optimum parameters for attaining the desired surface finish in BEMRF polishing.
Clinical implications of innate immune exhaustion in cystic fibrosis
Authors: Møller Rikke , Uhre Nielsen Bibi , Rossi Elio , Lausen Mads , Skov Marianne , Pressler Tacjana , Ostrowski Sisse Rye , Johansen Helle Krogh
Published: April 2024

Objectives

Lung disease progression in people with cystic fibrosis (pwCF) varies from one individual to another. Different immunological characteristics have been suggested to explain this variation, and we hypothesised that lung capacity may be associated with the innate immune response in pwCF. In an exploratory study, we aimed to investigate potential links between the innate immune response and lung function in pwCF using the standardised immune function assay TruCulture.

Methods

In a single-centre study with combined cross-sectional and longitudinal data before and after intravenous antibiotics, blood was sampled fromPseudomonas aeruginosa-infected pwCF. Whole blood was analysed by TruCulture to reveal the unstimulated and stimulated cytokine release. Tobit regressions and Spearman's correlations were used to estimate the associations between lung function and cytokine release.

Results

We included 52 pwCF in the cross-sectional study and 24 in the longitudinal study. In the cross-sectional study, we found that compared to a healthy population, the release of toll-like receptor (TLR)3, TLR4- and TLR7/8-stimulated interferon-γ, and interleukin (IL)-12p40 was reduced. Although TLR3-stimulated IL-1β and IL-6 release increased with lung function, overall, cytokine release did not correlate well with lung function. In the longitudinal study, the cytokine release was modified by antibiotic treatment, but the cytokine release before antibiotic treatment did not associate with changes in lung function after treatment.

Conclusion

The stimulated cytokine release could not predict lung function levels or changes in pwCF, but our data indicate that pwCF experience exhaustion in the innate immune response after years of chronic bacterial infection.
How family physicians in Singapore recognise complexity during consultations: a qualitative study
Authors: Quek Jing Sheng , Lee Eng Sing , Low Lian Leng , Wong Sabrina Kay Wye
Published: April 2024

Background

The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians’ (FP) perspectives.

Methods

Focus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators.

Results

Five FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy.

Conclusion

Recognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.
Clinical variables influencing the perception of fatigue in people with multiple sclerosis: a cross-sectional study using FSIQ-RMS
Authors: Sellitto Giovanni , Ruotolo Ilaria , Ianniello Antonio , Felicetti Federica , D’Ambrosi Giorgia , Berardi Anna , Galeoto Giovanni , Conte Antonella , Pozzilli Carlo
Published: April 2024

Background

Physical fatigue is one of the most disabling symptoms in people with Multiple Sclerosis (PwMS). Several factors might influence the development of fatigue, such as gender, education, body mass index (BMI), Expanded Disability Status Scale (EDSS), disease duration, working status (Ws), physiotherapy (Ph), and disease-modifying therapies (DMTs). Fatigue Symptoms and Impacts Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS) is a patient-reported outcome (PRO) that allows one to define the impact of fatigue in PwMS clearly. This study aimed to assess fatigue impact on PwMS by using FSIQ-RMS.

Methods

The participants were enrolled from May to July 2021 in MS Centers of Sant’Andrea Hospital and Policlinico Umberto I Hospital in Rome. Fatigue was evaluated using the FSIQ-RMS, validated, and culturally adapted in Italian. Clinical and demographic data were collected at the same time.

Results

We enrolled 178 PwMS [Female 74.16%; RMS 82.58%, SPMS 17.52%]. FSIQ-RMS scores were significantly correlated with EDSS (p-value < 0.01). Analysis of variance between means showed a statistically significant difference between the BMI groups at the 24hours_FSIQ-RMS score and the 7days_FSIQ-RMS score (p < 0.01), with the lower BMI group having the highest scores. Furthermore, perceived fatigue significantly improved both in subjects performing Ph (p < 0.05) and in those who actively work (p < 0.01).

Conclusions

The use of FSIQ-RMS in a real-world setting confirmed that underweight and high levels of disability are closely related to fatigue. In addition, Ph and active Ws are strongly correlated with fatigue in PwMS.
Preconception underweight impact on postnatal osteoporotic fracture: a retrospective cohort study using Japanese claims data
Authors: Kaneko Kayoko , Suto Maiko , Miyagawa Eiko , Mikami Masashi , Nakamura Yukio , Murashima Atsuko , Takehara Kenji
Published: April 2024

Background

Undernutrition and underweight are osteoporosis risk factors. Therefore, improving the health of underweight young women in Japan is an important medical issue. However, few studies have evaluated the association between being preconception underweight and postnatal osteoporotic fractures in young women.

Methods

This retrospective cohort study used a Japanese nationwide claims database (JMDC Inc.) to evaluate the effect of preconception underweight on the incidence of osteoporotic fracture within two years after delivery. Data from 16,684 mothers who delivered their first singleton babies between January 2006 and December 2020 were analysed. The combination of disease codes of fractures at sites associated with osteoporosis and medical procedures for fractures was defined as the incidence of osteoporotic fractures, whereas the body mass index (BMI) recorded 12–36 months before delivery was used as the exposure. We estimated the incidence of osteoporotic fractures by BMI category using a Kaplan–Meier curve and examined the fracture risk using Cox hazard regression analyses.

Results

Fifty-one women (0.31%) were affected by osteoporotic fractures within two years of delivery. More than 80% of these were rib fractures, and approximately 65% of fractures occurred after the first year postpartum. Preconception underweight (BMI < 18.5 kg/m2) was significantly associated with the incidence of postpartum osteoporotic fractures. There was no significant association between low BMI and postnatal fractures, as analysed via multiple categorical logistic regression analysis.

Conclusion

Appropriate control of preconception weight might be critical to improving the postpartum quality of life, subsequent bone health, and neonatal care environment.
Placental inflammation in a fetal demise of a SARS-CoV-2-asymptomatic, COVID-19-unvaccinated pregnant woman: a case-report
Authors: Abrego-Navarro Maricarmen , Villalobos Rodrigo , Sanchez Jaime , Lamela Deisa , Fu Cindy , Guerrero Erika , Gracia Paulino Vigil-De , López-Vergès Sandra , Solis Mairim A.
Published: April 2024

Background

Intrauterine fetal demise is a recognized complication of coronavirus disease 2019 in pregnant women and is associated with histopathological placental lesions. The pathological mechanism and virus-induced immune response in the placenta are not fully understood. A detailed description of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced inflammation in the placenta during fetal demise is crucial for improved clinical management.

Case presentation

We report the case of a 27-week gestation SARS-CoV-2-asymptomatic unvaccinated pregnant woman without comorbidities or other risk factors for negative pregnancy outcomes with a diagnosis of intrauterine fetal demise. Histopathological findings corresponded to patterns of subacute inflammation throughout the anatomic compartments of the placenta, showing severe chorioamnionitis, chronic villitis and deciduitis, accompanied by maternal and fetal vascular malperfusion. Our immunohistochemistry results revealed infiltration of CD68+ macrophages, CD56+ Natural Killer cells and scarce CD8+ T cytotoxic lymphocytes at the site of placental inflammation, with the SARS-CoV-2 nucleocapsid located in stromal cells of the chorion and chorionic villi, and in decidual cells.

Conclusion

This case describes novel histopathological lesions of inflammation with infiltration of plasma cells, neutrophils, macrophages, and natural killer cells associated with malperfusion in the placenta of a SARS-CoV-2-infected asymptomatic woman with intrauterine fetal demise. A better understanding of the inflammatory effects exerted by SARS-CoV-2 in the placenta will enable strategies for better clinical management of pregnant women unvaccinated for SARS-CoV-2 to avoid fatal fetal outcomes during future transmission waves.
Clinical impact of panel gene sequencing on therapy of advanced cancers of the digestive system: a retrospective, single center study
Authors: Dreikhausen Lena , Klupsch Anna , Wiest Isabella , Xiao Qiyun , Schulte Nadine , Betge Johannes , Boch Tobias , Brochhausen Christoph , Gaiser Timo , Hofheinz Ralf-Dieter , Ebert Matthias , Zhan Tianzuo
Published: April 2024

Background

Panel gene sequencing is an established diagnostic tool for precision oncology of solid tumors, but its utility for the treatment of cancers of the digestive system in clinical routine is less well documented.

Methods

We retrospectively identified patients with advanced or metastatic gastrointestinal, pancreaticobiliary or hepatic cancers who received panel gene sequencing at a tertiary university hospital from 2015 to 2022. For these cases, we determined the spectrum of genetic alterations, clinicopathological parameters and treatment courses. Assessment of actionability of genetic alterations was based on the OncoKB database, cancer-specific ESMO treatment guidelines, and recommendations of the local molecular tumor board.

Results

In total, 155 patients received panel gene sequencing using either the Oncomine Focus (62 cases), Comprehensive (91 cases) or Childhood Cancer Research Assay (2 cases). The mean age of patients was 61 years (range 24–90) and 37% were female. Most patients suffered from either colorectal cancer (53%) or cholangiocellular carcinoma (19%). 327 genetic alterations were discovered in 123 tumor samples, with an average number of 2.1 alterations per tumor. The most frequently altered genes were TP53, KRAS and PIK3CA. Actionable gene alterations were detected in 13.5–56.8% of tumors, according to ESMO guidelines or the OncoKB database, respectively. Thirteen patients were treated with targeted therapies based on identified molecular alterations, with a median progression-free survival of 8.8 months.

Conclusions

Actionable genetic alterations are frequently detected by panel gene sequencing in patients with advanced cancers of the digestive tract, providing clinical benefit in selected cases. However, for the majority of identified actionable alterations, sufficient clinical evidence for targeted treatments is still lacking.
An evaluation of nutritional impact symptoms and their association with reduced dietary intake in patients with solid tumors at tertiary care hospitals: a multicenter, cross-sectional study from Palestine
Authors: Shakhshir Muna H. , Salameh Husam T. , Amer Riad , Zyoud Sa’ed H.
Published: April 2024

Background

Nutritional impact symptoms (NISs) are proposed to be a key indicator of decreased dietary intake in patients with solid cancer. Cancer patients frequently experience NIS from the disease itself and from disease treatment side effects that impact oral and gastrointestinal health. Thus, this study aimed to investigate the association between NIS and dietary intake among cancer patients in the Nablus district, one of the largest districts in Palestine. This study also sought to identify the types of treatment and other factors related to dietary intake for solid cancer patients.

Methods

A cross-sectional study was conducted between October 15, 2021, and October 15, 2022. The convenience sampling technique was used to recruit participants from two primary hospital campuses for cancer treatment in the entire region of Nablus Governorate in northern Palestine. To assess the patients, structured questionnaires completed by interviewers during face-to-face interviews with patients were used. The NIS was assessed using a checklist developed based on a literature review and clinical experience. Univariate and multivariate analyses were used to evaluate the correlations between sociodemographic variables and clinical variables and between the NIS and dietary intake. Multiple binary logistic regression analyses were also performed to determine the most influential variables, sociodemographic, clinical, and NIS, on dietary intake.

Results

Data were collected from 290 patients with solid malignancies. The mean age of the participants was 55.04 ± 12.76 years. Multiple binary logistic regressions revealed that dry mouth (odds ratio (OR) = 3.742; 95% confidence interval (CI) = 1.800–7.780; p < 0.001), constipation (OR = 2.707; 95% CI = 1.113–6.581; p = 0.028), taste alteration (OR = 3.620; 95% CI = 1.752–7.481; p = 0.001), and feeling fullness (OR = 8.879; 95% CI = 2.982–26.441; p < 0.001) were significantly related to decreased dietary intake. Biological and hormonal treatments had an inverse association with dietary intake (OR = 0.372; 95% CI = 0.177–0.782; p = 0.009 and OR = 0.383; 95% CI = 0.168–0.874; p = 0.023, respectively).

Conclusions

This study revealed that many solid cancer patients have reduced food intake due to NIS, such as dry mouth and taste changes. These patients may be at risk of malnutrition. Healthcare professionals should consider these NISs to improve dietary plans and decide whether extra feeding support is needed. The results obtained indicate the need for further research focused on removing limitations in food consumption as an effect of treatment and appropriate nutritional strategies to prevent patient malnutrition.
Financial scarcity, psychological well-being and perceptions: an evaluation of the Nigerian currency redesign policy outcomes
Authors: Ani Judith Ifunanya , Ajayi-Ojo Vincent O. , Batisai Kezia
Published: April 2024

Background

The relationship between insufficient financial resources and psychological health has been extensively studied and established in various contexts. However, there remains uncertainty regarding the potential impact of the Nigerian naira currency redesign policy on the psychological well-being of Nigerians. This policy, which aimed to demonetize the economy and promote economic stability, involved changes to the physical appearance of some naira denominations (200, 500 and 1000). Understanding the effects of this policy on psychological health is essential for evaluating its overall societal impact and identifying potential areas for improvement in future currency redesign initiatives.

Methods

The study is a cross-sectional mixed-methods study involving 2237 respondents across the six geopolitical zones of Nigeria. Utilizing the simple random, snowball and convenience sampling technique, social media platforms (Facebook and WhatsApp) were used to recruit respondents. Variables were analyzed at descriptive and inferential levels. The qualitative component comprised seven (7) in-depth interviews with participants across the geo-political zones.

Results

The perceptions of respondents towards the policy were diverse across different demographic groups. It was widely perceived that the timing of the policy was inappropriate, considering the challenges faced in utilizing online payment platforms and the significant inaccessibility of cash. Furthermore, the analysis revealed that demographic variables played a role in explaining systematic variations in the experience of financial scarcity and its effect on psychological health during the cash crunch that ensued as a result of the Nigerian naira currency redesign policy.

Conclusions

This study identified a significant association between the psychological inventory of financial scarcity and psychological well-being among residents in Nigeria during the cash crunch resulting from the Naira redesign policy. The findings suggest that the financial scarcity experienced by Nigerians due to the policy had a substantial impact on individuals’ psychological well-being. We recommend that a holistic approach be undertaken by policymakers to ensure that policy actions not only address economic objectives but also safeguard the mental health and overall well-being of the population.