bluuebunny/crossref_metadata_2025 huggingface dataset:
Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease
Authors: Kim Joong-Yub , Kim Na Young , Jung Hee-Won , Yim Jae-Joon , Kwak Nakwon
Published: July 2022

Background

The number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is rapidly increasing globally, especially in the older population. However, there is a dearth of evidence regarding the impact of aging on the treatment outcomes of NTM-PD.

Methods

We analyzed consecutive patients who satisfied the diagnostic criteria for Mycobacterium avium complex (MAC)-PD and received antibiotic treatment between January 2009 and December 2020 at a tertiary referral hospital in Korea. The main outcomes were (1) long-term treatment success, defined by negative culture conversion for more than 12 months; and (2) adverse drug reactions (ADRs). Multivariable logistic regression model was used to evaluate the association between age and main outcomes.

Results

A total of 614 patients (median age, 65 years, interquartile range [IQR] 57–73 years; men, 35.3%) were included. Median treatment duration (530 days, IQR 290–678 days; P for trend < 0.001) and long-term treatment success (P for trend = 0.026) decreased, whereas ADRs (P for trend < 0.001) increased significantly with age. Multivariable analyses demonstrated that age ≥ 80 years was an independent factor associated with ADRs (adjusted odds ratio [aOR] 3.29; 95% confidence interval [CI] 1.05–10.28) and worse treatment outcome (aOR 0.42; 95% CI 0.19–0.91).

Conclusions

Aging is associated with worse treatment outcome and frequent ADRs of patients with MAC-PD. Individualized treatment with reduced-intensity may be a reasonable alternative for older adults.
Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett’s esophagus: case report
Authors: Lange U. G. , Moulla Y. , Mehdorn M. , Tuennemann J. , Zabel-Langhennig A. , Ouaid A. , Dietrich A.
Published: July 2022

Background

The number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett’s metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett’s metaplasia after MGB-OAGB.

Case presentation

We present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m2). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett’s metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett’s epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition.

Conclusions

The rapid progress from inflammatory changes of the distal esophagus towards Barrett’s metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.
Longitudinal determinants of anal intercourse among women with, and without HIV in the United States
Authors: Owen Branwen Nia , Baggaley Rebecca F. , Maheu-Giroux Mathieu , Elmes Jocelyn , Adimora Adaora A. , Ramirez Catalina , Edmonds Andrew , Sosanya Kemi , Taylor Tonya N. , Plankey Michael , Cederbaum Julie A. , Seidman Dominika , Weber Kathleen M. , Golub Elizabeth T. , Wells Jessica , Bolivar Hector , Konkle-Parker Deborah , Pregartner Gudrun , Boily Marie-Claude
Published: July 2022

Background

Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.

Methods

3708 women living with (73%), and without HIV (27%) participating in the Women’s Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994–2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.

Results

AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96–0.98), Hispanic (aOR = 1.88, CI:1.47–2.41) or White (aOR = 1.62, CI:1.15–2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08–1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10–1.62), or both (aOR = 1.77, CI:1.13–2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05–1.66) or any drug use (aOR = 1.34, CI:1.09–1.66), multiple male partners (aOR = 2.64, CI:2.23–3.11), exchange sex (aOR = 3.45, CI:2.53–4.71), one or more female sex partners (aOR = 1.32, CI:1.01–1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53–2.09), and high depressive symptoms (aOR = 1.23, CI:1.08–1.39).

Conclusion

AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.
Self-experienced sexual and reproductive health in young women with Attention Deficit Hyperactivity Disorder: A qualitative interview study
Authors: Wallin Karin , Wallin Lundell Inger , Hanberger Lena , Alehagen Siw , Hultsjö Sally
Published: July 2022

Background

Sexual risk behaviors and struggles in romantic relationships result in higher risk of unplanned pregnancy, sexually transmitted diseases, sexual victimization and lower satisfaction in relationships for young women with Attention Deficit Hyperactivity Disorder (ADHD). There is a need to better understand sexual behaviors and the consequences of relational difficulties to help health professionals promote sexual and reproductive health. To deepen knowledge in this area, this study aimed to identify and describe self-experienced sexual and reproductive health in young women with ADHD.

Methods

A qualitative design was used. Data was collected with individual and focus group interviews with 15 young women, aged 15–29, with an ADHD diagnosis, and analyzed with thematic analysis.

Results

Data analysis identified the themes Acceptance of being different and Feeling sexually secure. The women reveal feelings of being different from others without ADHD as they break norms of sexual behavior, struggle with romantic relationships, and have difficulties concentrating during sex. There is a need to be understood and accepted, to not feel judged, and to manage romantic relationships. Self-knowledge helps them to recognize needs for support and to develop strategies that can improve sexual satisfaction. Feeling sexually secure illustrates the women’s need to feel comfortable with their own sexuality and in control in the sexual situation. Low self-esteem and a negative self-image, described as a consequence of living with ADHD, can compromise communication in sexual situations and increase fear of being rejected. Further, misjudging sexual partners and situations can contribute to sexual victimization.

Conclusions

This study provides knowledge of how ADHD affects emotions and sexual behaviors in young women. The results highlight the need for understanding and acceptance by peers and partners. It accentuates the value of involving the partner in counselling and the importance of self-knowledge. Feeling insecure in sexual relationships further implies the importance of early diagnosis to prevent secondary outcomes of ADHD, and the need for sexual victimization screening in professional settings.
Preliminary application of three-dimensional printing in congenital uterine anomalies based on three-dimensional transvaginal ultrasonographic data
Authors: Wang Li , Chen Xu-Jiao , Liang Jia-He , Zhang Ze-Kai , Cao Tie-Sheng , Zhang Li
Published: July 2022

Background

The three-dimensional (3D) printing technology has remarkable potential as an auxiliary tool for representing anatomical structures, facilitating diagnosis and therapy, and enhancing training and teaching in the medical field. As the most available diagnostic tool and it is routinely used as the first approach in diagnosis of the uterine anomalies, 3D transvaginal ultrasonography (3D-TVS) has been proposed as non-invasive “gold standard” approach for these malformations due to high diagnostic accuracy. Despite holding promise of manufacturing 3D printed models based on 3D-TVS data, relevant reports about 3D-TVS derived gynecological 3D printing haven’t been reported to the best of our knowledge. We found an opportunity to explore the feasibility of building 3D printed models for the abnormal uterus based on the data acquired by 3D-TVS.

Methods

The women suspected with congenital uterine anomalies (CUAs) were enrolled in the study. The diagnose of CUAs were made by 3D-TVS scanning and further confirmed under the hysteroscopy examination. One volunteer with normal uterus was enrolled as control. All subjects underwent 3D-TVS scanning for 3D printing data collection. Acquired images were stored and extracted as DICOM files, then processed by professional software to portray and model the boundary of the uterine inner and outer walls separately. After the computer 3D models were constructed, the data were saved and output as STL files for further surface restoration and smoothing. The colors of endometrium and uterine body were specified, respectively, in the print preview mode. Then the uncured photosensitive resin was cleaned and polished to obtain a smooth and transparent solid model after printed models were cooled down.

Results

3D printing models of normal uterus, incomplete septate uterus, complete septate uterus, uterus didelphys and unicornuate uterus were produced on ultrasonographic data of 3D-TVS.

Conclusions

Our research and practice made the first try in modeling CUAs successfully based on ultrasonographic data entirely, verifying that it’s a feasible way to build 3D printed models of high-quality through 3D-TVS scanning.
The impact of Covid-19 on professional identity formation: an international qualitative study of medical students’ reflective entries in a Global Creative Competition
Authors: Moula Zoe , Horsburgh Jo , Scott Katie , Rozier-Hope Tom , Kumar Sonia
Published: July 2022

Introduction

The Covid-19 pandemic, which affected medical students globally, could be viewed as a disorientating dilemma with the potential to offer opportunities for transformative learning. In 2021 the Medical Education Innovation and Research Centre at Imperial College London launched a Global Creative Competition as a platform for medical students to reflect on their experiences during the pandemic.

Methods

Six hundred forty-eight creative pieces with written reflections were submitted by medical students from 52 countries. 155 students from 28 countries consented for their entries to be included in this study. The reflections were analysed thematically and independently by three reviewers to explore how the pandemic impacted students’ professional identity formation (PIF).

Results

The pandemic increased students’ awareness of the social and global role of doctors in addressing health inequities. Students felt part of a wider healthcare community and showed greater appreciation towards person-centred care. Students also became more aware of their personal needs, priorities, and the importance of self-care.

Discussion

In agreement with Mezirow’s theory of transformative learning (2003), the pandemic led students to re-examine pre-existing epistemic and sociocultural assumptions concerning the role of doctors and explore new perspectives of what it means to be a doctor. In accordance with Cheng’s theory of coping flexibility (2021), students developed both emotion-focused coping strategies (e.g., arts engagement) and problem-solving strategies (e.g., volunteering), suggesting they were able to adjust psychologically and develop agency. However, students experienced tension between their sense of duty and sense of wellbeing, highlighting the need for medical educators to design into programmes formal support systems where medical students have the space and time they need to reflect on their emergent identities as a doctor.

Conclusion

Medical educators should encourage students to reflect on their identity formation while encountering disorientating dilemmas. The inclusion of arts and humanities within the medical curriculum is strongly recommended to provide an avenue for students to access and express complex emotions and experiences.
Junior medical doctors’ decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study
Authors: Waller Amy , Bryant Jamie , Bowman Alison , White Ben P. , Willmott Lindy , Pickles Robert , Hullick Carolyn , Price Emma , Knight Anne , Ryall Mary-Ann , Clapham Mathew , Sanson-Fisher Rob
Published: July 2022

Background

Junior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives (ACDs), or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: (1) their legal compliance and decision-making process related to treatment decisions; (2) the factors influencing their clinical decision-making; and (3) the factors associated with accurate responses to one hypothetical vignette.

Method

A cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: (1) bacterial pneumonia; or (2) suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.

Results

Overall, 116 junior doctors responded (35% consent rate). In Vignette 1, 58% of respondents (n = 67/116) selected the legally compliant option (i.e. not commence treatment). Participants who chose the legally compliant option perceived ‘following patient wishes’ (n = 32/67; 48%) and ‘legal requirements to follow ACDs’ (n = 32/67; 48%) as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’ (n = 14/37; 38%). In Vignette 2, 72% of respondents (n = 83/116) indicated they would commence treatment (i.e. not follow the ACD) and 18% (n = 21/116) selected they would not commence treatment. (i.e. follow the ACD). Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.

Conclusions

There are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required.
Combined associations of family history and self-management with age at diagnosis and cardiometabolic risk in 86,931 patients with type 2 diabetes: Joint Asia Diabetes Evaluation (JADE) Register from 11 countries
Authors: Cheung Johnny T. K. , Lau Eric , Tsui Cyrus C. T. , Siu Edmond L. N. , Tse Naomi K. W. , Hui Nicole Y. L. , Ma Ronald C. W. , Kong Alice P. S. , Fu Amy , Lau Vanessa , Jia Weiping , Sheu Wayne H. H. , Sobrepena Leorino , Yoon K. H. , Tan Alexander T. B. , Chia Yook-Chin , Sosale Aravind , Saboo Banshi D. , Kesavadev Jothydev , Goh Su-Yen , Nguyen Thy Khue , Thewjitcharoen Yotsapon , Suwita Raymond , Luk Andrea O. Y. , Yang Aimin , Chow Elaine , Lim Lee Ling , Chan Juliana C. N.
Published: July 2022

Background

Family history (FamH) of type 2 diabetes might indicate shared genotypes, environments, and/or behaviors. We hypothesize that FamH interacts with unhealthy behaviors to increase the risk of early onset of diabetes and poor cardiometabolic control.

Methods

In a cross-sectional analysis of the prospective Joint Asia Diabetes Evaluation Register including patients from 427 clinics in 11 Asian countries/regions in 2007–2021, we defined positive FamH as affected parents/siblings and self-management as (1) healthy lifestyles (balanced diet, non-use of alcohol and tobacco, regular physical activity) and (2) regular self-monitoring of blood glucose (SMBG).

Results

Among 86,931 patients with type 2 diabetes (mean±SD age: 56.6±11.6 years; age at diagnosis of diabetes: 49.8±10.5 years), the prevalence of FamH ranged from 39.1% to 85.3% in different areas with FamH affecting mother being most common (32.5%). The FamH group (n=51,705; 59.5%) was diagnosed 4.6 years earlier than the non-FamH group [mean (95% CI): 47.9 (47.8–48.0) vs. 52.5 (52.4–52.6), logrank p<0.001]. In the FamH group, patients with both parents affected had the earliest age at diagnosis [44.6 (44.5–44.8)], followed by affected single parent [47.7 (47.6–47.8)] and affected siblings only [51.5 (51.3–51.7), logrank p<0.001]. The FamH plus ≥2 healthy lifestyle group had similar age at diagnosis [48.2 (48.1–48.3)] as the non-FamH plus <2 healthy lifestyle group [50.1 (49.8–50.5)]. The FamH group with affected parents had higher odds of hyperglycemia, hypertension, and dyslipidemia than the FamH group with affected siblings, with the lowest odds in the non-FamH group. Self-management (healthy lifestyles plus SMBG) was associated with higher odds of attaining HbA1c<7%, blood pressure<130/80mmHg, and LDL-C<2.6 mmol/L especially in the FamH group (FamH×self-management, pinteraction=0.050–0.001).

Conclusions

In Asia, FamH was common and associated with young age of diagnosis which might be delayed by healthy lifestyle while self management  was associated with better control of  cardiometabolic risk factors especially in those with FamH.
Epidemiological investigation and drug resistance of Eimeria species in Korean chicken farms
Authors: Flores Rochelle A. , Nguyen Binh T. , Cammayo Paula Leona T. , Võ Tuấn Cường , Naw Haung , Kim Suk , Kim Woo H. , Na Byoung-Kuk , Min Wongi
Published: July 2022

Background

Coccidiosis is a poultry disease that occurs worldwide and is caused by Eimeria species. The infection is associated with reduced feed efficiency, body weight gain, and egg production. This study aimed to investigate the current status of coccidiosis and anticoccidial resistance to anticoccidial drugs used as part of control strategies for this disease in Korean chicken farms.

Results

An overall prevalence of 75% (291/388) was found. Positive farms contained several Eimeria species (mean = 4.2). Of the positive samples, E. acervulina (98.6%), E. maxima (84.8%), and E. tenella (82.8%) were the most prevalent species. Compared with cage-fed chickens, broilers and native chickens reared in free-range management were more at risk of acquiring an Eimeria infection. Sensitivities to six anticoccidial drugs (clopidol, diclazuril, maduramycin, monensin, salinomycin, and toltrazuril) were tested using nine field samples. Compared with untreated healthy control chickens, the body weight gains of infected chickens and treated/infected chickens were significantly reduced in all groups. Fecal oocyst shedding was significantly reduced in four clopidol-treated/infected groups, three diclazuril-treated/infected groups, two toltrazuril-treated/infected groups, one monensin-treated/infected group, and one salinomycin-treated/infected group, compared with the respective untreated/infected control groups. Intestinal lesion scores were also reduced in three clopidol-treated/infected groups, one monensin-treated/infected group, and one toltrazuril-treated/infected group. However, an overall assessment using the anticoccidial index, percent optimum anticoccidial activity, relative oocyst production, and reduced lesion score index found that all field samples had strong resistance to all tested anticoccidial drugs.

Conclusion

The results of this large-scale epidemiological investigation and anticoccidial sensitivity testing showed a high prevalence of coccidiosis and the presence of severe drug resistant Eimeria species in the field. These findings will be useful for optimizing the control of coccidiosis in the poultry industry.
A dorsal CA2 to ventral CA1 circuit contributes to oxytocinergic modulation of long-term social recognition memory
Authors: Tsai Tsung-Chih , Fang Yi-Syuan , Hung Yu-Chieh , Hung Ling-Chien , Hsu Kuei-Sen
Published: July 2022

Background

Social recognition memory (SRM) is the ability to distinguish familiar from novel conspecifics and is crucial for survival and reproductive success across social species. We previously reported that oxytocin (OXT) receptor (OXTR) signaling in the CA2/CA3a of dorsal hippocampus is essential to promote the persistence of long-term SRM, yet how the endogenous OXT system influences CA2 outputs to regulate long-term SRM formation remains unclear.

Methods

To achieve a selective deletion of CA2 OXTRs, we crossed Amigo2-Cre mice with Oxtr-floxed mice to generate CA2-specific Oxtr conditional knockout (Oxtr−/−) mice. A three-chamber paradigm test was used for studying SRM in mice. Chemogenetic and optogenetic targeting strategies were employed to manipulate neuronal activity.

Results

We show that selective ablation of Oxtr in the CA2 suffices to impair the persistence of long-term SRM but has no effect on sociability and social novelty preference in the three-chamber paradigm test. We find that cell-type specific activation of OXT neurons within the hypothalamic paraventricular nucleus enhances long-term SRM and this enhancement is blocked by local application of OXTR antagonist L-368,899 into dorsal hippocampal CA2 (dCA2) region. In addition, chemogenetic neuronal silencing in dCA2 demonstrated that neuronal activity is essential for forming long-term SRM. Moreover, chemogenetic terminal-specific inactivation reveals a crucial role for dCA2 outputs to ventral CA1 (vCA1), but not dorsal lateral septum, in long-term SRM. Finally, targeted activation of the dCA2-to-vCA1 circuit effectively ameliorates long-term SRM deficit observed in Oxtr−/− mice.

Conclusions

These findings highlight the importance of hippocampal CA2 OXTR signaling in governing the persistence of long-term SRM and identify a hippocampal circuit linking dCA2 to vCA1 necessary for controlling long-term SRM formation.
Mortality and life expectancy trends in Spain by pension income level for male pensioners in the general regime retiring at the statutory age, 2005–2018
Authors: Pérez-Salamero González Juan M. , Regúlez-Castillo Marta , Ventura-Marco Manuel , Vidal-Meliá Carlos
Published: July 2022

Background

Research has generally found a significant inverse relationship in mortality risk across socioeconomic (SE) groups. This paper focuses on Spain, a country for which there continues to be very little evidence available concerning retirement pensioners. We draw on the Continuous Sample of Working Lives (CSWL) to investigate disparities in SE mortality among retired men aged 65 and above over the longest possible period covered by this data source: 2005–2018. We use the initial pension income (PI) level as our single indicator of the SE status of the retired population.

Methods

The mortality gradient by income is quantified in two ways: via an indicator referred to as “relative mortality”, and by estimating changes in total life expectancy (LE) by PI level at ages 65 and 75 over time. We show that, should the information provided by the relative mortality ratio not be completely clear, a second indicator needs to be introduced to give a broad picture of the true extent of inequality in mortality.

Results

The first indicator reveals that, for the period covered and for all age groups, the differences in death rates across PI levels widens over time. At older age groups, these differences across PI levels diminish. The second indicator shows that disparities in LE at ages 65 and 75 between pensioners in the lowest and highest income groups are relatively small, although slightly higher than previously reported for Spain. This gap in LE widens over time, from 1.49 to 2.54 years and from 0.71 to 1.40 years respectively for pensioners aged 65 and 75. These differences are statistically significant.

Conclusions

Along with other behavioral and structural aspects, a combination of factors such as the design of the pension system, the universality and quality of the health system, and high levels of family support could explain why LE inequalities for retired Spanish men are relatively small. To establish the reasons for this increased inequality in LE, more research needs to be carried out. An analysis of all Spanish social security records instead of just a sample would provide us with more information.
Cadmium exposures and deteriorations of cognitive abilities: estimation of a reference dose for mixture risk assessments based on a systematic review and confidence rating
Authors: Chatterjee Mousumi , Kortenkamp Andreas
Published: July 2022

To support a mixture risk assessment with a focus on developmental neurotoxicity we evaluated the strength of evidence for associations of cadmium exposures with declines in IQ by conducting a systematic review and confidence rating. We searched peer-reviewed studies published in English between 2012 and July 2021 and identified 15 eligible studies (11 prospective cohort studies, and 4 cross-sectional studies). Of the 10 studies that observed associations of cadmium exposure with child IQ declines, two achieved an overall “High (H)” confidence rating, five a “Medium to High (M/H)”, one a “Medium (M)” and two a “Low (L)” confidence rating. Five studies did not detect significant associations between cadmium exposure and reduced cognitive ability; of these, two received a “High (H)” confidence rating, two an overall rating of “Medium to High (M/H)” and one a “Medium (M)” rating. The null findings reported by the “High (H)” and Medium to High (M/H)” studies could partly be explained by low exposures to cadmium or confounding with high levels of lead. By using a one-compartment toxicokinetic model in a reverse dosimetry approach, we estimated that a daily intake of 0.2 μg/kg body weight/day corresponds to urinary cadmium levels no longer associated with cognitive declines observed in a “High (H)”-confidence study. This estimate is 1.8-fold lower than the current health-based guidance value (HBGV) for kidney toxicity of 0.36 μg/kg bodyweight/day established by the European Food Safety Authority (EFSA). Our value does not have the normative character associated with health-based guidance values and is intended only as a reasonable estimate for the purpose of mixture risk assessments. However, with cadmium exposures in Europe between 0.28 (middle bound) and up to 0.52 μg/kg bodyweight/day (95th percentile), our review suggests that pregnant women and children are poorly protected against neurodevelopmental effects. This warrants a revision of the current HBGV.
The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19
Authors: McCrae Karen , Glegg Stephanie , Goyer Marie-Éve , Le Foll Bernard , Brar Rupi , Sutherland Christy , Fairbairn Nadia
Published: July 2022

Background

The dual COVID-19 and overdose emergencies amplified strain on healthcare systems tasked with responding to both. One downstream consequence of the pandemic in the USA and Canada was a surge in drug overdoses resulting from public health-restricted access to services and an increasingly toxic unregulated drug supply. This study aimed to describe changes implemented by programs prescribing pharmaceutical alternatives to the drug supply during the early stages of the COVID-19 pandemic.

Methods

An environmental scan used surveys and qualitative interviews with service providers across Canada to examine pharmaceutical alternative prescribing practices and programs before and during the pandemic. This study summarized the nature, frequency, and reasons for pandemic-driven service delivery changes using directed content analysis, counts, and thematic analysis.

Results

Eighty-two of the 103 participating sites reported 1193 unique changes in physical space (368), client protocols (347), program operations (342), ancillary services (127), and staffing (90). Four qualitative themes describing the reasons for these changes emerged, namely (1) decreasing risk of COVID-19 infection; (2) decreasing risk of overdose; (3) prioritizing acute care of COVID-19 patients; and (4) improving client access to treatment.

Conclusions

While most changes were aimed at decreasing risk of COVID-19 infection, some were found to be at odds with the measures needed to combat the overdose crisis; others met dual objectives of decreased risk of both overdose and infection. Further research should examine which changes should be kept or reversed once COVID-19-related public health measures are lifted.
Impact of physical activity programs and services for older adults: a rapid review
Authors: Pinheiro Marina B. , Oliveira Juliana S. , Baldwin Jennifer N. , Hassett Leanne , Costa Nathalia , Gilchrist Heidi , Wang Belinda , Kwok Wing , Albuquerque Bruna S. , Pivotto Luiza R. , Carvalho-Silva Ana Paula M. C. , Sharma Sweekriti , Gilbert Steven , Bauman Adrian , Bull Fiona C. , Willumsen Juana , Sherrington Catherine , Tiedemann Anne
Published: July 2022

Background

Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life.

Methods

We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2.

Results

Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented.

Conclusion

Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.
The association between the built environment and intervention-facilitated physical activity: a narrative systematic review
Authors: McCormack Gavin R. , Patterson Michelle , Frehlich Levi , Lorenzetti Diane L.
Published: July 2022

Background

A diverse range of interventions increase physical activity (PA) but few studies have explored the contextual factors that may be associated with intervention effectiveness. The built environment (BE) may enhance or reduce the effectiveness of PA interventions, especially interventions that encourage PA in neighbourhood settings. Several studies have investigated the effects of the neighbourhood BE on intervention-facilitated PA, however, a comprehensive review of evidence has yet to be conducted. In our systematic review, we synthesize evidence from quantitative studies that have examined the relationships between objectively-measured neighbourhood BE and intervention-facilitated PA in adults.

Method

In October 2021, we searched 7 databases (Medline, CINAHL, Embase, Web of Science, SPORTDiscus, Environment Complete, and Cochrane Central Register of Controlled Trials) for English-language studies reporting on randomized and non-randomized experiments of physical activity interventions involving adults (≥18 years) and that estimated the association between objectively-measured BE and intervention-facilitated physical activity.

Results

Twenty articles, published between 2009 and 2021, were eligible for inclusion in the review.

Among the 20 articles in this review, 13 included multi-arm experiments and 7 included single-arm experiments. Three studies examined PA interventions delivered at the population level and 17 examined interventions delivered at the individual level. PA intervention characteristics were heterogeneous and one-half of the interventions were implemented for at least 12-months (n = 10). Most studies were undertaken in North America (n = 11) and most studies (n = 14) included samples from populations identified as at risk of poor health (i.e., metabolic disorders, coronary heart disease, overweight, cancer, high blood pressure, and inactivity). Fourteen studies found evidence of a neighbourhood BE variable being negatively or positively associated with intervention-facilitated PA.

Conclusion

Approximately 70% of all studies reviewed found evidence for an association between a BE variable and intervention-facilitated PA. The BE’s potential to enhance or constrain the effectiveness of PA interventions should be considered in their design and implementation.
Spotlight on pyroptosis: role in pathogenesis and therapeutic potential of ocular diseases
Authors: Chen Meini , Rong Rong , Xia Xiaobo
Published: July 2022

Pyroptosis is a programmed cell death characterized by swift plasma membrane disruption and subsequent release of cellular contents and pro-inflammatory mediators (cytokines), including IL‐1β and IL‐18. It differs from other types of programmed cell death such as apoptosis, autophagy, necroptosis, ferroptosis, and NETosis in terms of its morphology and mechanism. As a recently discovered form of cell death, pyroptosis has been demonstrated to be involved in the progression of multiple diseases. Recent studies have also suggested that pyroptosis is linked to various ocular diseases. In this review, we systematically summarized and discussed recent scientific discoveries of the involvement of pyroptosis in common ocular diseases, including diabetic retinopathy, age-related macular degeneration, AIDS-related human cytomegalovirus retinitis, glaucoma, dry eye disease, keratitis, uveitis, and cataract. We also organized new and emerging evidence suggesting that pyroptosis signaling pathways may be potential therapeutic targets in ocular diseases, hoping to provide a summary of overall intervention strategies and relevant multi-dimensional evaluations for various ocular diseases, as well as offer valuable ideas for further research and development from the perspective of pyroptosis.
Mesenchymal stromal cell treatment attenuates repetitive mild traumatic brain injury-induced persistent cognitive deficits via suppressing ferroptosis
Authors: Wang Dong , Zhang Shishuang , Ge Xintong , Yin Zhenyu , Li Meimei , Guo Mengtian , Hu Tianpeng , Han Zhaoli , Kong Xiaodong , Li Dai , Zhao Jing , Wang Lu , Liu Qiang , Chen Fanglian , Lei Ping
Published: July 2022

The incidence of repetitive mild traumatic brain injury (rmTBI), one of the main risk factors for predicting neurodegenerative disorders, is increasing; however, its underlying mechanism remains unclear. As suggested by several studies, ferroptosis is possibly related to TBI pathophysiology, but its effect on rmTBI is rarely studied. Mesenchymal stromal cells (MSCs), the most studied experimental cells in stem cell therapy, exert many beneficial effects on diseases of the central nervous system, yet evidence regarding the role of MSCs in ferroptosis and post-rmTBI neurodegeneration is unavailable. Our study showed that rmTBI resulted in time-dependent alterations in ferroptosis-related biomarker levels, such as abnormal iron metabolism, glutathione peroxidase (GPx) inactivation, decrease in GPx4 levels, and increase in lipid peroxidation. Furthermore, MSC treatment markedly decreased the aforementioned rmTBI-mediated alterations, neuronal damage, pathological protein deposition, and improved cognitive function compared with vehicle control. Similarly, liproxstatin-1, a ferroptosis inhibitor, showed similar effects. Collectively, based on the above observations, MSCs ameliorate cognitive impairment following rmTBI, partially via suppressing ferroptosis, which could be a therapeutic target for rmTBI.
Transmission networks of hepatitis C virus among HIV/HCV-coinfected patients in Guangdong, China
Authors: Deng Xizi , Liang Zhiwei , Cai Weiping , Li Feng , Li Junbin , Hu Fengyu , Lan Yun
Published: July 2022

Background

Coinfection with hepatitis C virus (HCV) is common in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients due to shared routes of transmission. We aimed to investigate the characteristics of HCV subgenotypes among HIV/HCV-coinfected patients in Guangdong and explore the molecular transmission networks and related risk factors for HCV strains.

Methods

Plasma samples were obtained from 356 HIV/HCV-coinfected patients for HCV NS5B region sequencing. A neighbor-joining phylogenetic tree was constructed to affirm HCV subgenotypes. The transmission networks based on maximum likelihood phylogenetic tree were determined by Cluster Picker, and visualized using Cytoscape 3.2.1.

Results

A total of 302 HCV NS5B sequences were successfully amplified and sequenced from the 356 plasma samples. A neighbor-joining phylogenetic tree based on the 302 NS5B sequences revealed the profile of HCV subgenotypes circulating among HIV/HCV coinfection patients in Guangdong. Two predominant strains were found to be 6a (58.28%, 176/302) and 1b (18.54%, 56/302), followed by 3a (10.93%, 33/302), 3b (6.95%, 21/302), 1a (3.64%, 11/302), 2a (0.99%, 3/302) and 6n (0.66%, 2/302). A molecular transmission network of five major HCV genotypes was constructed, with a clustering rate of 44.04%. The clustering rates of subgenotypes 1a, 3a, 3b, 1b, and 6a were 18.18% (2/11), 42.42%, 52.38%, 48.21%, and 44.89%, respectively. Multivariate logistic regression analysis showed no significant effects from sex, age, transmission route, geographical region, baseline CD4 + T cell count or subgenotype (P > 0.05), except marital status. Married or cohabiting people (compared with unmarried people) had more difficulty forming transmission networks.

Conclusions

In summary, this study, based on HCV NS5B subgenotypes, revealed the HCV subtype diversity and distribution among HIV/HCV-coinfected patients in Guangdong. Marital status inclined to be the factor influencing HCV transmission networks formation.
Developing mental health services during and in the aftermath of the Ebola virus disease outbreak in armed conflict settings: a scoping review
Authors: Vivalya Bives Mutume Nzanzu , Vagheni Martial Mumbere , Kitoko Germain Manzekele Bin , Vutegha Jeremie Muhindo , Kalume Augustin Kensale , Piripiri Astride Lina , Masika Yvonne Duagani , Mbeva Jean-Bosco Kahindo
Published: July 2022

Background

Mental health is mostly affected by numerous socioeconomic factors that need to be addressed through comprehensive strategies. The aftermath of armed conflict and natural disasters such as Ebola disease virus (EVD) outbreaks is frequently associated with poor access to mental healthcare. To design the basis of improving mental health services via the integration of mental health into primary health care in the Democratic Republic of Congo (DRC), we conducted a scoping review of available literature regarding mental illness in armed conflict and EVD outbreak settings.

Methods

This scoping review of studies conducted in armed conflict and EVD outbreak of DRC settings synthesize the findings and suggestions related to improve the provision of mental health services. We sued the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to scoping studies. A mapping of evidence related to mental disorders in the eastern part of DRC from studies identified through searches of electronic databases (MEDLINE, Scopus, Psych Info, Google Scholar, and CINAHL). Screening and extraction of data were conducted by two reviewers independently.

Results

This review identified seven papers and described the findings in a narrative approach. It reveals that the burden of mental illness is consistent, although mental healthcare is not integrated into primary health care. Access to mental healthcare requires the involvement of affected communities in their problem-solving process. This review highlights the basis of the implementation of a comprehensive mental health care, through the application of mental health Gap Action Program (mhGAP) at community level. Lastly, it calls for further implementation research perspectives on the integration of mental healthcare into the health system of areas affecting by civil instability and natural disasters.

Conclusion

This paper acknowledges poor implementation of community mental health services into primary health care in regions affected by armed conflict and natural disasters. All relevant stakeholders involved in the provision of mental health services should need to rethink to implementation of mhGAP into the emergency response against outbreaks and natural disasters.
Sonographic features differentiating early-stage ovarian clear cell carcinoma from endometrioma with atypical features
Authors: Huang Kuan-Ju , Li Ying-Xuan , Wu Chin-Jui , Chang Wen-Chun , Wei Lin-Hung , Sheu Bor-Ching
Published: July 2022

Background

Ovarian clear cell carcinoma (OCCC) is the most common endometriosis-associated ovarian cancer. Ovarian endometriosis may present with atypical or malignant sonographic features and interfere with clinical judgment about whether definitive surgical intervention is required.

Objective

To compare the characteristics of endometrioma with atypical features and OCCC.

Methods

This study enrolled patients with pathologic diagnoses of either endometrioma or OCCC. For patients with endometrioma, only those with atypical features, defined as the presence of at least one of the following sonographic characteristics: cyst diameter of 10 ± 1 cm, multi-cystic lesions, any solid component or papillary structure, and blood flow of any degree, were included.

Results

Sixty-three patients had endometriomas with atypical features, while 57 patients had OCCC. Patients with endometriomas were younger (39.33 ± 7.04 years vs. 53.11 ± 9.28 years, P < 0.01), had smaller cysts (7.81 ± 2.81 cm vs. 12.68 ± 4.60 cm, P < 0.01), and had smaller solid components (0.93 ± 1.74 cm vs. 4.82 ± 3.53 cm, P < 0.01). In contrast, OCCCs were associated with loss of ground-glass echogenicity (6.3% vs 68.4%, P < 0.01). In multivariate analysis, advanced age (> 47.5 years), large cysts (> 11.55 cm), large solid components (size > 1.37 cm), and loss of ground-glass echogenicity were independent factors suggestive of malignancy.

Conclusion

Advanced age, larger cyst sizes, larger solid component sizes, and loss of ground-glass echogenicity are major factors differentiating endometriomas from malignancies. For women in menopausal transition who have finished childbearing who present with endometrioma with atypical features, removal of the adnexa intact could be considered.
External validation of a machine learning model to predict hemodynamic instability in intensive care unit
Authors: Dung-Hung Chiang , Cong Tian , Zeyu Jiang , Yu-Shan Ou-Yang , Yung-Yan Lin
Published: July 2022

Background

Early prediction model of hemodynamic instability has the potential to improve the critical care, whereas limited external validation on the generalizability. We aimed to independently validate the Hemodynamic Stability Index (HSI), a multi-parameter machine learning model, in predicting hemodynamic instability in Asian patients.

Method

Hemodynamic instability was marked by using inotropic, vasopressor, significant fluid therapy, and/or blood transfusions. This retrospective study included among 15,967 ICU patients who aged 20 years or older (not included 20 years) and stayed in ICU for more than 6 h admitted to Taipei Veteran General Hospital (TPEVGH) between January 1, 2010, and March 31, 2020, of whom hemodynamic instability occurred in 3053 patients (prevalence = 19%). These patients in unstable group received at least one intervention during their ICU stays, and the HSI score of both stable and unstable group was calculated in every hour before intervention. The model performance was assessed using the area under the receiver operating characteristic curve (AUROC) and was compared to single indicators like systolic blood pressure (SBP) and shock index. The hemodynamic instability alarm was set by selecting optimal threshold with high sensitivity, acceptable specificity, and lead time before intervention was calculated to indicate when patients were firstly identified as high risk of hemodynamic instability.

Results

The AUROC of HSI was 0.76 (95% CI, 0.75–0.77), which performed significantly better than shock Index (0.7; 95% CI, 0.69–0.71) and SBP (0.69; 95% CI, 0.68–0.70). By selecting 0.7 as a threshold, HSI predicted 72% of all 3053 patients who received hemodynamic interventions with 67% in specificity. Time-varying results also showed that HSI score significantly outperformed single indicators even up to 24 h before intervention. And 95% unstable patients can be identified more than 5 h in advance.

Conclusions

The HSI has acceptable discrimination but underestimates the risk of stable patients in predicting the onset of hemodynamic instability in an external cohort.