bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of urination in alleviating man’s urethral pain associated with flexible cystoscopy : a single-center randomized trial
Authors: Xie Yingwei , Wang Wei , Yan Wei , Liu Dan , Liu Yuexin
Published: October 2019

Objective: This study aimed to assess whether urethral pain can be alleviated by urination in male patients undergoing flexible cystoscopy. Patient and Methods: Ninety-six male outpatients undergoing flexible cystoscopy were randomly divided into two groups. Patients in the test group urinated during flexible cystoscopy, whilst patients in the control group received no instructions to do so. All patients received 10mL of 2% lidocaine gel prior to assessment. Using 0 (no-pain) to 10 (unbearable severe pain) pain scores (VAS), we assessed patient discomfort prior to anesthesia gel perfusion (baseline), during gel perfusion, during cystoscope insertion through the urethra, and 15minutes post-examination analysis. The entire protocol was completed by a single doctor in our Department of Urology. Results: The groups showed no statistical differences regarding age or examination time. During cystoscope insertion, the test group recorded significantly lower pain scores 2 (IQR 1-3) - compared to the control group 3 (IQR 2-3) , (P = 0.001). No significant differences between other evaluation points were observed between groups. Conclusion: Urethral pain can be significantly alleviated by urination in male patients undergoing flexible cystoscopy through the urethra.
Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study
Authors: Cui Xueliang , chen Hui , Ma Binbin , Fan Wenbin , Li He
Published: October 2019

Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs.
Methods: We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score.
Result: The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p<0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001).
Conclusion: For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes.
Trial registration: ZDYJLY(2018)New-9.
Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University.
URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17
Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients
Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study In Jos North And Mangu, Plateau State, North - Central Nigeria
Authors: Sariem Comfort Nanbam , Odumosu Patricia , Dapar Maxwell Patrick , Musa Jonah , Ibrahim Luka , Aguiyi John Chinyere
Published: October 2019

Background
Tuberculosis (TB) disease is the leading cause of death from a single infectious agent globally. Medication adherence will be more valuable if it improves clinical/treatment outcomes of the patient because treatment outcomes are major indicators for evaluating TB therapy.
Objective
To examine a fifteen-year record of tuberculosis treatment outcomes in Jos North and Mangu Local Government Areas of Plateau State.
Methods
The retrospective registry based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State, North-Central Nigeria. Data were collected from 10,156 TB patient’s health records from 2001 to 2015. Treatment outcomes were classified as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). Analysis was done descriptively and factors associated with treatment outcomes were determined using multiple logistic regression with the aid of Stata version 11.
Results
Males were 58.1% of the population (10,156). Mean age ±SD was 35.5±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment; sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes from 83.8% to 64.4%, with a corresponding increase in unsuccessful treatment outcomes was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p =0.028) more likely to be associated with treatment success than having an unknown status. TALF/RAD, relapse and MDR-TB were less likely associated with treatment success than newly diagnosed TB patients
Conclusion
Underlying reasons for medication non-adherence and treatment failure identified should be resolved by the patient, treatment supporter and health system through adherence counseling, increased education on voluntary counseling and testing of HIV among TB patients.
Keywords: Tuberculosis, Treatment Outcomes, Retrospective Study, Nigeria
The shape of the glucose response curve during an OGTT heralds β−cell function in a large Chinese population
Authors: Cheng Xinqi , Yang Na , Li Yuxiu , Sun Qi , Qiu Ling , Xu Lingling , Ping Fan , Li Wei , Zhang Huabing
Published: October 2019

Background The shape of the glucose response during an oral glucose tolerance test can detect β-cell function and insulin resistance. But there were few studies in Chinese, so we aimed to verify the utility of these connections in a large Chinese population. Methods A total of 11,866 times of 3-h OGTT were categorized to either a monophasic or a multiphasic group based on the shape of the glucose response. Homeostasis model assessments of fasting insulin resistance, Matsuda index, insulinogenic index and the disposition index were assessed by plasma glucose and serum insulin concentration obtained at fasting or during an OGTT. Results Individuals with a monophasic shape had significantly higher glucose, insulin, and had significantly lower insulin sensitivity and impaired β-cell function than multiphasic group. In addition, Individuals were younger with a multiphasic shape compared to those with a monophasic shape. Conclusion The monophasic OGTT glucose response curve could reflect impaired β-cell function in a large Chinese population.
Phylogenetic signals in pest abundance and distribution range of spider mites
Authors: Jin Peng-Yu , Sun Jing-Tao , Hoffmann Ary , Guo Yan-Fei , Zhou Jin-Cheng , Zhu Yu-Xi , Chen Lei , Hong Xiao-Yue
Published: October 2019

Attributes of pest species like host range are frequently reported as being evolutionarily constrained and showing phylogenetic signal. Because these attributes in turn could influence the abundance and impact of species, phylogenetic information could be useful in predicting the likely status of pests. In this study, we used regional (China) and global datasets to investigate phylogenetic patterns in occurrence patterns and host ranges of spider mites, which constitute a pest group of many cropping systems worldwide. We found significant phylogenetic signal in relative abundance and distribution range both at the regional and global scales. Relative abundance and range size of spider mites were positively correlated with host range, although these correlations became weaker after controlling for phylogeny. The results suggest that pest impacts are evolutionarily constrained. Information that is easily obtainable – including the number of known hosts and phylogenetic position of the mites – could therefore be useful in predicting future pest risk of species.
Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up
Authors: McElroy Theresa A , Swartz Erik N. , Hassani Kasra , Waibel Sina , Tuff Yasmin , Marshall Catherine , Chan Richard , Wensley David , O'Donnell Maureen
Published: October 2019

Background: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up.
Methods: We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient charts, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches.
Results: The majority of charts had documented PEWS scores at triage (80%) and first bedside assessment (81.2%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of the PEWS system and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED.

Conclusion: Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.
Development of a high number, high coverage dog rabies vaccination programme in Sri Lanka.
Authors: Soriano Carlos Sánchez , Gibson Andrew D. , Gamble Luke , Bailey Jordana L. Burdon , Green Samantha , Green Mark , Bronsvoort Barend M. deC. , Handel Ian G. , Mellanby Richard J. , Mazeri Stella
Published: October 2019

Background: Rabies is estimated to cause 59,000 deaths and economic losses of 8.6 billion USD every year. Despite several years of rabies surveillance and awareness programmes, increased availability of post-exposure prophylaxis vaccinations and dog population control, the disease still remains prevalent in Sri Lanka. This study reports the development and roll-out of a high number, high coverage canine rabies vaccination campaign in Sri Lanka, providing estimates for the vaccination coverage achieved, analysing the local dog demographics, and identifying barriers of attendance to static vaccination clinics. Methods: A mass dog vaccination campaign was undertaken in Negombo, Sri Lanka. The campaign was composed of static point and door-to-door vaccination stages, with a final survey of vaccination coverage. A large volume of data on the distribution, health, and signalment of vaccinated dogs was collected through a mobile phone application. A logistic regression model was developed to investigate which socio-spatial and dog-related factors influenced attendance of owners to static vaccination points. Results: The campaign vaccinated over 7,800 dogs achieving a vaccination coverage of 75.8%. A dog:human ratio of 1:17 was estimated. Most dogs were owned, and the dog population was mostly male, adult, and non-sterilized. Unawareness, unavailability and handling problems were the most common reasons given by owners to explain failure to attend a static vaccination point. The regression analysis showed that increasing distance to a static point, in addition to young age and poor health of the dog, were associated with a decrease in the likelihood of attendance to a static vaccination points. Conclusion: This study demonstrates the feasibility of high number, high coverage vaccination campaigns in Sri Lanka. The information on dog ecology and barriers of attendance to a static point vaccination clinic will facilitate development of future vaccination campaigns.
Level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia
Authors: DESSIE MESELECH AMBAW , Berihun Ayanaw Worku
Published: October 2019

Abstract Background: Neural tube defects are congenital anomalies of the brain, spinal cord, and their surrounding structures. Folic acid intake before and during the early weeks of pregnancy could reduce neural tube and other birth defects. Folic acid usage in the protective period of pregnancy against the neural tube defects is related to high level of awareness. This study aimed at evaluating the level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia. Method: A descriptive cross-sectional study design was used. 398 consented pregnant women attending antenatal care in Adama were the participants of the study. The women were selected by using a systematic random sampling method. A structured pre-tested interviewer-administered questionnaire was used to collect the data. The questionnaire was concerned with participants’ demographic information, and their awareness about folic acid, roles of folic acid, and the recommended time of intake. Data were analyzed using SPSS version 20 statical software. Simple and multiple binary logistic regression analyses were conducted. 95% confidence interval and p-value were used to evaluate the association between dependent and independent variables. Results: Of the interviewed women, 20.9% reported having heard or read something about folic acid supplements. But only 1.01% and 6.03% were aware of the recommended time of intake and the role of folic acid in preventing neural tube defects and other congenital anomalies respectively. The healthcare providers were the primary source of information about folic acid, which account 78.3%. Folic acid awareness was associated with age, educational status, household monthly income, week of pregnancy at the first antenatal visit, any complication during current pregnancy, and use of folic acid during current pregnancy. Conclusions: Most of the pregnant women were not aware of folic acid, its importance and the recommended time of intake for preventing neural tube defects. Further effort is required from policymakers, healthcare providers, the media, and community to increase women's awareness about folic acid. Keywords: Folic acid, Awareness, Neural tube defects
Evaluation of Tools to Assess Psychological Distress: How to Measure Psychological Stress Reactions in Citizen Responders– A Systematic Review
Authors: Kragh Astrid Rolin , Folke Fredrik , Andelius Linn , Ries Emma Slebsager , Rasmussen Rasmus Vedby , Hansen Carolina Malta
Published: October 2019

Background Dispatched citizen responders are increasingly involved in out-of-hospital cardiac arrest (OHCA) resuscitation which can lead to severe stress. It is unknown which psychological assessment tools are most appropriate to evaluate psychological distress in this population.
The aim of this systematic review was to identify and evaluate existing assessment tools used to measure psychological distress with emphasis on citizen responders who attempted resuscitation.
Methods A systematic literature search conducted by two reviewers was carried out in March 2018 and revised in July 2018. Four databases were searched: PubMed, PsycInfo, Scopus, and The Social Sciences Citation Index. A total of 504 studies examining assessment tools to measure psychological distress reactions after acute traumatic events were identified, and 9 fulfilled the inclusion criteria for further analysis. The selected studies were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network.
Results The Impact of Event Scale (IES) and The Impact of Event Scale-Revised (IES-R) were the preferred assessment tools, and were used on diverse populations exposed to various traumatic events. One study included lay rescuers performing bystander cardiopulmonary resuscitation and this study used the IES. The IES and the IES-R also have proven a high validity in various other populations. The Clinical administered PTSD scale (CAPS) was applied in two studies. Though the CAPS is comparable to both the IES-R and the IES, the CAPS assess PTSD symptoms in general and not in relation to a specific experienced event, which makes the scale less suitable when measuring stress due to a specific resuscitation attempt.
Conclusions The IES and the IES-R seem to be solid measures for psychological distress among people experiencing an acute psychological traumatic event. However, only one study has assessed psychological distress among citizen responders in OHCA for which the IES-R scale was used, and therefore, further research on this topic is warranted.
Handwriting in Children with Attention Deficient Hyperactive Disorder: Analyzing by graphology
Authors: Cohen Rony , Cohen-Kroitoru Batia , Halevy Ayelet , Aharoni Sharon , Aizenberg Irena , Shuper Avinoam
Published: October 2019

Objective: Handwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD). The aim of our study was to find distinctive characteristics of handwriting in children with ADHD by using graphology to analyze physical characteristics and patterns, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians.
Method: The study group included 21 (43%) males and 28 (57%) females, with 15 (71.4%) males and 7 (25%) females diagnosed with ADHD. A graphologist analyzed handwriting text from 49 patients, 22/49 previously diagnosed with ADHD, aged 13-18 years, in a randomized, single-blinded study. All study participants wrote a story in Hebrew in 10-12 lines, on a blank paper with a blue pen, during a period of twenty minutes. A licensed graphologist was given the papers, without details, for characterization analysis. The graphologist suggested a profile of a person with ADHD based on graphology theory for ADHD, and gave patients one point for each ADHD handwriting characteristic, up to 15 points. Patients with 9-15 points were considered to have ADHD, based on their graphology evaluation.
Results
The mean graphology score in the DSM based ADHD group was significantly higher than in the control group (9.61+3.49 vs. 5.79+4.01, p=0.002, respectfully). Using score of 0 as a cutoff point graphology-based ADHD score had an 80% specificity (95% CIs [59.2-92.8]), and a sensitivity of 71.4%.
Conclusion: Handwriting in ADHD children and adolescence has specific characteristics, thus graphological analysis could be a useful tool to help clinicians in the diagnosis of ADHD.
Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners
Authors: Erisman Jetske Charlotte , de Sabbata Kevin , Zuiderent-Jerak Teun , Syurina Elena V
Published: October 2019

Background

Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse.Methods

A sequential exploratory mixed-methods design. In-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which was followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results

The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support.Conclusion

Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.
Theory of Mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis – a secondary analysis of a randomized-controlled therapy trial.
Authors: Mehl Stephanie , Hesse Klaus , Schmidt Anna-Christine , Landsberg Martin Wilhelm , Soll Daniel , Bechdolf Andreas , Herrlich Jutta , Kircher Tilo , Klingberg Stefan , Mueller Bernhard , Wiedemann Georg , Wittorf Andreas , Woelwer Wolfgang , Wagner Michael
Published: October 2019

Background: Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) - an important precondition to ToM - are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients’ social life: the quality of their therapeutic relationship.Methods: Patients with psychotic disorders and delusions and/or hallucinations (n=185) and healthy controls (n=48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy.Results: In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. Conclusions: Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.
Prevalence of Myopia and Vision Impairment in School Students in Eastern China
Authors: wang jianyong , Ying Gui-shuang , Fu Xiaojin , Zhang Ronghua , Meng Jia , Gu Fang , Li Juanjuan
Published: October 2019

Background : Prevention of myopia has become a public health priority in China. This study is to investigate the prevalence of myopia and vision impairment, and their associated factors in school students in eastern China. Method: In this cross-sectional school-based study of 4804 students from 18 schools ranging from kindergarten to high school, students underwent refraction using non-cycloplegic autorefractor and visual acuity testing using logMAR chart with tumbling E. Myopia was defined as spherical equivalent (SPHE) ≤ -0.5 diopter (D) and uncorrected visual acuity (UCVA) 20/25 or worse. High myopia was defined as SPHE ≤ -6.0 D and UCVA 20/25 or worse. Vision impairment was defined as UCVA 20/40 or worse. Logistic regression models were used to determine factors associated with myopia and vision impairment. Results: Among 4804 children (55% male) with mean age (standard deviation) 12.3 (3.8) years, 3031 (63.1%, 95% CI: 61.7-64.4%) had myopia, 452 (9.4%, 95% CI: 8.6-10.3%) had high myopia, and 2646 (55.1%, 95% CI: 53.7-56.5%) had vision impairment. The prevalence rate of myopia increased with grade in a non-linear manner, 12% in kindergarten, 32% in grade 2, 69% in grade 5, and approximately 90% by grade 10 or above. The prevalence rate of high myopia was relatively low in grade 4 or below (<1.5%), 4-7% in grade 5 to 7, 13-15% in grade 8-9, and >20% in grade 10 to 12. The prevalence rate of vision impairment was 3.7% in kindergarten, 36.6% in elementary school, 76.7% in middle school and 86.5% in high school students. Higher grade (p<0.0001), female (p<0.0001) and higher school workload (p=0.007) were independently associated with higher prevalence rates of myopia and vision impairment, while higher grade (p<0.0001) and higher school workload (p<0.0001) were independently associated with higher prevalence of high myopia. Conclusion: Prevalence of myopia and vision impairment was high among Chinese school students and increased with grade in a non-linear manner, reaching alarming high in high school students accompanied by high prevalence of high myopia. Increasing study burden on school students at younger age plays an important role on the higher prevalence rate of myopia and vision impairment.
Impact of Hemodialysis and Post-Dialysis Period on Granular Activity Levels
Authors: Larkin John W , Han Maggie , Han Hao , Guedes Murilo H , Gonçalves Priscila Bezerra , Poli-de-Figueiredo Carlos Eduardo , Cuvello-Neto Américo Lourenço , Barra Ana Beatriz L , de Moraes Thyago Proença , Usvyat Len A , Kotanko Peter , Canziani Maria Eugenia F , Raimann Jochen G , Pecoits-Filho Roberto
Published: October 2019

Background: Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. Methods: We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over one week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 hours after start HD), first non-HD days (0 to ≤24 hours after start HD) and second non-HD day (>24 to ≤48 hours after start HD). PA was recorded in blocks/slices: 4 hours during HD, 0 to ≤2 hours post-HD (30 minute slices), and >2 to ≤20 hours post-HD (4.5 hour slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. Results: Among 195 patients (mean age 53±15 years, 71% male), step counts per 24-hours were 3919±2899 on HD days, 5308±3131 on first non-HD days (p<0.001), and 4926±3413 on second non-HD days (p=0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p<0.001). Patients took 276 more steps and had highest rates of steps/hour 2-hours post-HD versus same times on first non-HD days (all p<0.05). Consistent findings were observed on second non-HD days. Conclusions: PA was higher within 2-hours of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments. Trial Registration: HDFIT was registered 20 April 2016 on ClinicalTrials.gov (NCT02787161) https://clinicaltrials.gov/ct2/show/NCT02787161.
Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity.
Authors: Elnady Basant , Rageh Elsayed M , Ekhouly Tohamy H. , Fathy Sabry M. , Alshaar Mohamed , Fouda El Saeed , Attar Mohammed , Abdelaal Ahmed M. , Tantawi Ahmed El , Algethami Mohammed M , Bong David Andrew
Published: October 2019

Background: Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population. Methods: Sixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitis or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group . High resolution ultrasound (US) was performed to assess cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd) . Results: There was a significant difference between both groups regarding mean ±SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with the severity neurophysiological CTS (P=0.001). A ∆CSA threshold of 2.5 mm 2 showed the highest sensitivity and specificity to diagnose CTS in Saudis. Conclusion High resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm 2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.
Association of Dietary Inflammatory Index with Cardiovascular Disease in Kurdish Adults: Results of a Prospective Study on Ravansar Non-Communicable Diseases
Authors: Ayenehpour Azad , Nazar Mehdi Moradi , Samadi Mehnoosh , Hamzeh Behrooz , Najafi Farid , Karimi Sheno , Faraji Fakhereh , Darbandi Mitra , Pasdar Yahya
Published: October 2019

Background and aim Various diets and dietary compounds, through their inflammatory properties, are involved in the pathogenesis of chronic diseases including cardiovascular diseases (CVDs). Dietary Inflammatory Index (DII) can evaluate the inflammatory properties of diet. The purpose of this study was to determine the association between DII and CVDs in participants of the Ravansar non-communicable diseases (RaNCD)cohort study, Kermsnahsh, Iran.Materials and methods The present cross-sectional study was conducted using the recruitment phase data of the RaNCD cohort study on 6369 participants aged 35 to 65 years. The Food frequency questionnaire (FFQ) was used to assess diet. The DII scores were calculated using FFQ data. Participants with a history of myocardial infarction, stroke and coronary artery disease, and/or taking medications for the CVDs were considered as the CVDs patients.Results Of the 6369 studied participants, 9% (n=579) had CVDs history. The mean DII score in this study was -0.84±1.6. Odds ratio (OR) of CVDs in female was 1.6 times higher than in male (CI 95%=1.3-1.9), which this association was remained after adjusting for confounding variables (OR=1.5, CI%=1.2-1.9). The risk of CVDs in the fourth quartile of DII was 1.4 times higher than the first quartile of DII (OR: 1.4, CI 95%=1.1-1.8). We found that higher adhere to DII was associated with risk of CVDs.Conclusion Given the role of diet through inflammatory properties on the risk of CVDs, it is highly recommended to use DII as an appropriate index to measure the effect of diet on CVDs. In addition, a diet with lower DII is more healthy diet for cardiovascular health.
The interaction between serum uric acid and triglycerides level on blood pressure for middle-aged and elderly individuals in China
Authors: Zhang Lin , Li Jin-long , Guo Lei-lei , Li Hong , Li Dan , xu guang
Published: October 2019

Background The purpose of the research is to explore the extent of interaction between triglycerides (TG) and serum uric acid (SUA) level with blood pressure (BP) in middle-aged and elderly individuals in China.Methods Data were selected from the CHARLS, a cross-sectional study. A total of 7119 individuals aged 45 to 96 in our study was included. Differences between gender, or between categories of blood pressure levels were evaluated by t-test or chi-square test. The adjusted associations between various characteristics and BP status were first compared using linear regression models, as appropriate. Then, general linear models adjusting for related potential confounders were used to examine the synergistic effect of SUA and TG level on blood pressure (BP) for middle-aged and elderly individuals in China.Results Age-adjusted partial Pearson’s correlation coefficient showed that SUA and TG level positively correlated with both SBP and DBP in men and women. Multiple linear regression analysis showedTG levels were significantly and positively associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both males (SBP: β =0.068, P =0.001; DBP: β =0.064, P =0.002) and females (SBP: β =0.061, P =0.002; DBP: β =0.084, P =0.000), but serum uric acid (SUA) were significantly and positively associated with systolic blood pressure (SBP) in both males (SBP: β =0.047, P =0.013) and females (SBP: β =0.040, P =0.028), regardless of other confounding factors. A general linear model adjusted for confounding factors was used to assessed the statistical significance of the synergistic relationship between serum uric acid (SUA) and triglycerides (TG) level. Evidence of interaction between serum uric acid (SUA) and triglycerides (TG) level on SBP (men: β =-1.090, P =0.726; women: β =-0.692, P =0.861) and DBP (men: β=-1.026, P =0.572; women: β =-0.794, P =0.842) was not observed.Conclusion The interaction effect of serum uric acid (SUA) and triglycerides (TG) level on blood pressure (BP) was not observed in our study.
Alterations in gut microbiota of abdominal aortic aneurysm mice
Authors: Xie Jiahe , Lu Weiling , Zhong Lintao , Hu Yuhua , Li Qingrui , Ding Rongming , Zhong Zhonggao , Liu Ziyou , Xiao Hai , Xie Dongming , Zheng Guofu , Ye Bo , Zhong Yiming , Liu Zuheng
Published: October 2019

Background：The gut microbiome plays an important role in various cardiovascular diseases, such as atherosclerosis and hypertension, which are associated with abdominal aortic aneurysms (AAAs). Methods: Here, we used 16S rRNA sequencing to explore gut microbiota in mice with AAAs. A mouse model of abdominal aortic aneurysms was induced with angiotensin II (1000 ng/min per kg). On day 28 after the operation, fecal samples were collected and stored at −80 °C until DNA extraction. We determined the relative abundances of bacterial taxonomic groups using 16S rRNA amplicon metabarcoding, and sequences were analyzed using a combination of mother software and UPARSE. Results: We found that the gut microbiome was different between control and AAA mice. The results of correlation analysis between AAA diameter and the gut microbiome as well as LEfSe of the genera Akkermansia, Odoribacter, Helicobacter and Ruminococcus might be important in the progression of AAAs. Conclusions: AAA mice is subjected to gut microbial dysbiosis, and Akkermansia might be a potential therapeutic target.
Lycopene improves on basic hematological and immunological parameters in diabetes
Authors: Eze Ejeike Daniel , Afodun Adam Moyosore , Kasolo Josephine , Kasozi Keneth Iceland
Published: October 2019

Objective Diabetes is associated with an upset of hematological and immunological parameters in humans, however information on the effects of Lycopene is scarce. The aim of the study was to gain information on basic changes in hematological parameters as markers for safety since anemia as a complication in diabetic chemotherapy has been reported.Results Lycopene had anti-anemic effects and improved on the immune status of diabetic rats and these observations were dose independent. There was a decrease in neutrophil, low neutrophil-lymphocyte ratio and platelet counts and stable albumin, globulin levels.
Food insecurity and lipid profile abnormalities are associated with an increased risk of non-alcoholic fatty liver disease (NAFLD): a case-control study
Authors: Tutunchi Helda , Saghafi-Asl Maryam , Asghari-Jafarabadi Mohammad , Ostadrahimi Alireza
Published: October 2019

Background Non-alcoholic fatty liver disease (NAFLD) is an important public health problem and a significant cause of morbidity and mortality. Little is known about the relation between food insecurity and NAFLD. This study aimed to assess the relationship between food insecurity, risk factors associated with food insecurity, and NAFLD prevalence in a sample of Iranian adults.Methods In this age-matched and gender-matched case–control study, 210 subjects were recruited. NAFLD diagnosis was performed by a single expert radiologist using ultrasonography. The demographic and socioeconomic characteristics, anthropometric indices, body composition, along with food insecurity and depression status were assessed. Blood samples were collected to determine the lipid profile parameters. Chi-square, independent samples t-test, and uni-and multi-variate logistic regression tests were used. Data were analysed using SPSS V.23.0.Results The prevalence of food insecurity was 56.8% and 26.1% in cases and controls ( P<0.001 ), respectively. According to final analysis model, food insecurity, depression, number of children≥4, overweight, and obesity were identified as significant independent risk factors for NAFLD. The chance of NAFLD in the food insecure, depressed, overweight, and obese subjects was 2.2 (95%CI:1.12-3.43), 1.9 (95%CI:1.02-3.62), 2.6 (95% CI:1.81-3.92), and 2.9 (95%CI:2.02- 5.34) times higher, respectively. Additionally, a higher waist circumference (men, OR = 2.9, P<0.001 ; women, OR= 2.6, P<0.001 ), an elevated waist-to-hip ratio (men, OR = 2.3, P<0.001 ; women, OR= 2.7, P<0.001 ), an increased waist-to-height ratio (OR = 2.9, P<0.001 ), and a higher body fat percentage (men, OR = 3.0, P<0.001 ; women, OR= 3.3, P<0.001 ) were independently associated with an increased risk of NAFLD. The odds of NAFLD increased by increment in serum triglyceride (TG) levels (OR = 2.6, P<0.001 ) and decreased by increase in serum high-density lipoprotein cholesterol (HDL-C) (OR = 0.34, P<0.001 ). Compared to controls, NAFLD patients were more likely to have higher TG/HDL-C ratio (OR = 3.3, P<0.001 ).Conclusions The prevalence of food insecurity in patients with NAFLD was significantly higher compared to controls. Food insecurity was associated with an increased risk of NAFLD, even after adjusting for potential confounding factors. Additionally, NAFLD was significantly related to some indicators of dyslipidemia.
A Translation and Cross-Cultural Adaptation to a North American Context of the 51-Item Swedish Flodén Attitudes Toward Organ Donor Advocacy Instrument (Flodén ATODAI)
Authors: Flodén Anne , Stadtler Maria , Collazo Stephanie E Jones , Mone Tom , Ash Rick , Fridlund Bengt
Published: October 2019

Background: Intensive and critical-care nurses are the key to successful donor management in the critical-care setting. No studies measuring attitudes toward organ donor advocacy existed before 2011, when the 51-item Swedish “Attitudes Toward Organ Donor Advocacy Scale” was developed. The aim of this study was to translate, adapt and establish the psychometric properties of the North American version of the Flodén ATODAI (Attitudes Toward Organ Donor Advocacy Instrument) in terms of validity and reliability. Methods: A multi-step approach was used: Initial translation; Back-translation; Review and synthesis of these translations; Expert panel (N=7) rated the prefinal version of the instrument for content validity index (CVI); International panel made adjustments guided by the expert panel . Reliability testing with test and retest of the adjusted 46-item version was conducted using intraclass correlation coefficient (ICC), weighted kappa ( ҡ Weight ), sign test, and Cronbach’s alpha coefficient (α), (N=50); and finally Delphi technique procedure with a preselected Delphi panel (N=15). Results: The CVI was determined to be greater than the 0.05 significance level. Item level (I-CVI) ranged 0.82-1.0, with a mean of 0.97. Scale level (S-CVI) on the entire instrument was 0.97. Test-retest procedure was performed to estimate stability. In total, 34 of the items had good-to-high ICC. Accepting an ICC of > 0.70 resulted in a total of 24 items. Homogeneity reliability was estimated by α and was calculated for these items where α=0.90. In total, 20 of the items had a substantial or almost perfect ҡ Weight and 23 showed a moderate ҡ Weight . None of the items showed systematical differences. The Delphi technique procedure was used on the 22 items with ICC <0.70 resulted in adjustments establishing that consensus was achieved. Conclusions: Undertaking this multi-step, cross-cultural adaptation procedure has effectively ensured that the 46-item Flodén ATODAI [North America version] produces valid and reliable measurements.
Advanced practice nurses in primary care in Switzerland: an analysis of interprofessional collaboration
Authors: Josi Renata , Bianchi Monica , Brandt Sophie
Published: October 2019

Background: The increase in the number of chronically ill patients due to ageing is calling existing models of primary care into question. New care models have recently been implemented in Swiss primary care and involve interprofessional teams. This paper aimed to analyze the practice of interprofessional collaboration between advanced practice nurses, registered nurses, and medical practice assistants within new models of primary care in Switzerland using the National Interprofessional Competency Framework (NICF). Methods: An ethnographic design comprising semi-structured interviews and non-participant observations was conducted. Sixteen interviews were conducted with care providers at their primary care practice. Interviewees included four advanced practice nurses, two registered nurses, six medical practice assistants, and four general practitioners. Nine other health professionals were subsequently observed in their practice. Interviews and observations were conducted by the first author from February to April 2019. Results: Our analysis confirmed that role clarification, team functioning, collaborative leadership, interprofessional conflict resolution, patient-centered care, and interprofessional communication have a significant influence on the interprofessional collaboration among health professionals in Swiss primary care. Among these domains, role clarification and team functioning were the most frequently raised issues. Both were found to have the potential to negatively influence and, therefore, hinder efficient interprofessional collaboration within primary care. The observation of APNs and MPAs working in practice confirmed these results. Conclusion: From the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss primary care context. Our study results may inform international health policymakers and practitioners about six important domains of interprofessional care when implementing new care models. Practical experience with new models of care involving advanced practice nurses and medical practice assistants may also influence the regulation of the scope of practice of these health professionals in Switzerland.
Clinical Academic Careers for General Practice Nurses: A qualitative exploration of associated barriers and enablers
Authors: Jones Sarahjane , Bradbury Andrew , Shortland Sue , Hewett Fraser , Storey Karen
Published: October 2019

Background: The delivery of research in healthcare is dependent on a sub-group of clinicians – clinical academics – who concurrently engage in clinical practice and academic activities. The need to increase access to such roles for general practice nurses (GPNs) has been identified, though the need for a robust career framework remains. In order to generate evidence needed to contribute to the development of a career framework, this study aimed to explore the concept of clinical academic careers for GPNs by identifying barriers and enablers associated with pursuing and performing such roles. Methods: GPNs ( n =18) and general practitioners (GPs) ( n =5) engaged in either an audio recorded interview or focus group. Recordings were transcribed verbatim, with transcripts subject to a process of thematic analysis.Results: Four main themes were identified: awareness and understanding; career pathway; personal and professional attributes; and organisational factors. Awareness and understanding of clinical academic careers for GPNs was generally poor. Participants suggested that the career pathway for GPN clinical academics was unclear, though it was generally assumed that such roles were “out of reach” and would require a minimum of Master’s level education. Personal and professional attributes were reported as an interest in research and the confidence to perform such activities, though it was noted these elements should be encouraged during pre-registration training. Organisational factors included the needed for GPN employers to understand the value and benefit of GPN clinical academic roles, along with ensuring that the inevitable competing demands of such a role were appropriately managed. Conclusions: This study highlights the difficulties faced by GPNs wishing to pursue a clinical academic career. Academia is seemingly placed upon a pedestal, emphasising the need to embed research training early on in nursing education in order to alter GPN perceptions that clinical academic roles are unobtainable. Moreover, the development of a robust career pathway for GPN clinical academic roles may have a positive impact on the retention of experienced GPNs and attract newly qualified nurses.