bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV Serodiscordance among Couples in Cameroon: Effects on Sexual and Reproductive Health
Authors: Tchakounté Constantin , Nkenfou Céline N. , Tchouangueu Thibau F. , Ngoufack, Nicole M. , Tchuandom Salomon B. , Ngono Olivier D. , Kuiate Jules-Rogers , Ndjolo Alexis
Published: August 2020

Background and Objectives: One of the main reasons for risky sexual behavior observed in HIV serodiscordant couples despite the knowledge of the partner’s status and counselling is childbearing. In Cameroon, there are few reports on HIV serodiscordant couples. This paper describes the influence of HIV on sexual relationships and decision to procreate.

Methods: This cross-sectional study was conducted in five health centers. Self-administered questionnaire was used to collect social and demographic information, while semi-structured in-depth individual and couple interviews were used to explore sexual relationships and decisions about fatherhood/motherhood. Blood samples were collected from the couples and tested for HIV to confirm serodiscordance. The data were analyzed using the GraphPad Prism Version 6 software.

Results: A total of 53/192 (27.6%) HIV serodiscordant couples participated in the study, and 18/74 (24.32%) HIV positive seroconcordant couples and 32/80 HIV negative seroconcordant couples were used as controls. The majority of HIV-positive partners in serodiscordant couples were women (30/53), of whom 25/30 were on antiretroviral therapy. Nearly half of the respondents (23 /53) reported tensions related to serodiscordance, shown by reduced sex frequency. The use of condoms was not systematically observed among seroconcordant and serodiscordant couples with respective proportions of 55.55% and 20.75% (p = 0.0086). Thirty seven out of 53 HIV serodiscordant couples wanted children, among them, seven couples did not have any and expressed their aspiration for parenthood despite fear of infecting one’s partner.

Conclusion and Global Health Implications: Sexuality of serodiscordant couples as well as of HIV positive seroconcordant couples was affected by the presence of HIV/AIDS. The desire to procreate may lead couples to adopt risky sexual behaviors. It is important to define specific guidelines for serodiscordant couples in order to improve their sexual life and consequently enable them to procreate with minimal risk of infecting their partner and or to transmit the virus to their baby.

Key words: • HIV • Serodiscordance • Sexual health • Childbearing • Cameroon • Reproductive health

 

Copyright © 2020 Tchakounté et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
Mapeando o entorno da escola: Desenvolvendo o raciocínio espacial nos Anos Iniciais do Ensino Fundamental
Authors: Soares de Oliveira Alex , Stefenon Daniel
Published: August 2020

Este plano de aula tem por objetivo fazer uso de materiais didático-cartográficos inovadores para os anos iniciais do Ensino Fundamental, enfatizando a escala local de análise e objetivando que os estudantes percebam os problemas presentes em seu cotidiano e projetem possíveis soluções. Essa etapa de escolarização apresenta carências em relação aos materiais de cunho cartográfico adaptados para problematizar e contextualizar a escala local. Sendo assim, os estudantes com o suporte de um mapa (elaborado a partir de imagens de satélite) do entorno da escola, responderam a três perguntas com base nos níveis dos modos de raciocínio do pensamento espacial. Concluiu-se que os materiais didático-cartográficos, respaldados em diferentes níveis de raciocínio relativos a mecanismos de pensamento espacial, são potencializadores de um ensino de Geografia eficaz nos anos iniciais do Ensino Fundamental e sensibilizam o pensamento crítico acerca da realidade vivida dos estudantes.
Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty
Authors: Wu Su , Yang Yan , Wang Yujiao , Liu Qianqi , Zhu Zi-yang , Gu Wei
Published: August 2020

Background: To date, the gonadotropin-releasing hormone (GnRH) stimulation test is still the gold standard for precocious puberty (PP) diagnosis. However, it has many disadvantages, including low sensitivity, high cost, and invasive operation. This study aims to evaluate whether magnetic resonance imaging (MRI)-derived variables, including pituitary volume (PV), could be used as diagnostic factors for PP in girls, providing a non-invasive diagnostic approach for PP.Methods: A total of 288 young female patients who presented to the Clinic of Pediatric Endocrinology for evaluation of PP from January 2015 to December 2017 were enrolled. The sample included 90 girls diagnosed with premature thelarche (PT), 133 girls determined as idiopathic central precocious puberty (ICPP), 35 early pubertal girls, and 30 normal girls. All patients received pituitary MRI examinations.Results: The largest PV and pituitary height were shown in the ICPP and pubertal groups, followed by the PT group. The receiver operating characteristic (ROC) curve analysis showed that PV is a predictive marker for ICPP, with a sensitivity of 54.10% and a specificity of 72.20% at the cutoff value of 196.01 mm3. By univariate analysis, PV was positively associated with peak luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), age, bone age, and body mass index (BMI) (all P < 0.05). However, bone age and peak LH were the only significant predictors of PV as demonstrated by the stepwise multivariate regression analysis (Model: PV = 9.431 * bone age + 1.230 * peak LH + 92.625 [P = 0.000, R2 = 0.159]).Conclusions: The PV in the ICPP group was significantly higher than in PT and control groups, but there was no reliable cutoff value to distinguish ICPP from PT. Pituitary MRI should be combined with clinical and laboratory tests to improve the diagnostic value of PV for PP.
Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality
Authors: Ohba Tetsuro , Yokomi Hiroshi MD , Koy Kensuke MD , Tanaka Nobuki , Oda Kotaro , H Hirotaka MD
Published: August 2020

Background: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine postoperative mortality.Methods: We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of £ 3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL.Results: The mean follow-up time was 4.1 ±0.8 years. Two years after surgery, percentage of patients who had died was 15%. The VAS scores and modified Frankel classification were significantly improved one year after surgery. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. The univariate analysis showed that male gender, serum albumin <3.5g/dl, creatinine clearance<60mg/dl, and the American Society of Anesthesiologists classificat0ion ≥3 were significant risk factors for postoperative mortality. Multivariate analysis revealed that only serum albumin £3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF.Conclusions: Preoperative hypoalbuminemia was associated with postoperative mortality following surgery for OVF.Level of Evidence: Level 3
District-level strategies to control the HIV epidemic in Zimbabwe: a practical example of precision public health
Authors: Makurumidze Richard , Decroo Tom , Lynen Lutgarde , Chinwadzimba Zororo Kudzaishe , Damme Wim Van , Hakim James , Rusakaniko Simbarashe
Published: August 2020

Objective We conducted a descriptive cross-sectional study using survey and programme data to assess district-level performance along the HIV care cascade (HIV testing target achievement, linkage to ART and ART coverage) in order to formulate district-specific recommendations, taking into consideration prevalence and yield of testing.Results Data from 60 districts were analysed. Forty-eight districts (80.0%) surpassed 90% of their 2018 HIV testing targets. Linkage to ART was less than 90% in 40 districts (83.3%). Thirty districts (50.0%) had ART coverage above 90%. Of the 30 districts with suboptimal (<90%) ART coverage, 18 districts had achieved high HIV testing target but with suboptimal linkage to ART, 6 had achieved high HIV testing targets and high linkage to ART, 4 had both suboptimal HIV testing target achievement and linkage to ART and 2 had suboptimal HIV testing target achievement and high linkage to ART. Priority should be given to districts with suboptimal ART coverage. Remediation strategies should be tailored to address the poorly performing stage of the cascade in each of the districts.
Study of hospitalization and mortality in Korean diabetic patients using the diabetes complications severity index
Authors: Yoo Hyunju , Choo Eunjung , Lee Sukhyang
Published: August 2020

Background The prevalence of type 2 diabetes mellitus (T2DM) is expected to increase from 7.7% in 2017 to 8.4% in 2045 worldwide. Diabetes complications contribute to morbidity and mortality. To evaluate whether the diabetes complications severity index (DCSI) was associated with increased risks of mortality and hospitalization. Methods A retrospective cohort study was conducted using the National Health Insurance Database (NHID) sample cohort of 1,102,047 patients (2002–2015) in Korea. Diabetes complications were evaluated at 2 years after the initial diagnosis and during the subsequent follow-up period (mean duration 6.56±2.81 years). The type and severity of complications were evaluated on the basis of the International Classification of Disease Ninth (ICD-9) codes used in DCSI with 7 categories and 55 subcategories of complications. The Cox proportional hazard and Poisson regression models were used to evaluate the mortality and hospitalization rates. The incidence and relative risk of diabetes complications as well as the risk of mortality and hospitalization were the main outcome measures. Results A total of 27,871 patients were finally included and grouped by the number of complications present at two years. Four hundred ninety patients (5.37%) died without complications, 659 (7.31%) died with one complication and 1,153 (11.85 %) died with two or more complications. As DCSI at index date increased, the risk of additional new diabetes complications increased by 26% [relative risk (RR) 1.26, 95% CI 1.25–1.27]. The risks of mortality and hospitalization were linearly related to DCSI [hazard ratio 1.13 (95% CI 1.11–1.16), relative risk 1.04 (95% CI 1.03–1.06)]. Conclusions Patients with higher incidence and severity of diabetes complications have increased risks of mortality and hospitalization.
Assessing intake and consumption level of spices among urban and rural households of Ludhiana district of Punjab, India
Authors: Bhathal Simranpreet Kaur , Kaur Harpreet , Bains Kiran , Mahal Amrit Kaur
Published: August 2020

Background: Spices are the esoteric food adjuncts that are used for enhancing the sensory quality of the food in Punjabi diets and add many health benefits. Estimating the intake of spices at the individual level is a challenging task as they are consumed in very small quantities as compared to other foods. The present study aimed to assess the intake and spices consumption level of spices among urban and rural households.Methods: A study was carried out among 100 households each from urban and rural areas from Ludhiana district of Punjab, India to collect the information regarding frequency of spice usage and portion sizes using a questionnaire. The information pertaining to sociodemographic characteristics of female respondents from urban and rural households was also collected. The commonly used 25 spices in Punjabi diets were selected to assess their dietary intake at the individual level among households. Results: Spice consumption frequency was more in urban households in comparison to rural households. The maximum mean consumption frequency score among urban and rural households was observed for red chilli powder (5.00) and turmeric powder (5.00). Maximum percentage (76 and 72%) of urban and rural households preferred to use the unroasted form of spices, respectively.The highest mean intake and range was observed for red chilli powder (3.19 g with range 0.35-5.23 g) among urban women and (2.41 g with range 0.25-3.75 g) for rural women. Spice intake from individual dishes showed the maximum number of portion sizes for red chilli powder that were from vegetable>dhal>curry preparations among urban and dhal>vegetable>curry preparation among rural households. Average amount of spices consumed by urban adult women was 10.04 g per day which was higher as compared to spices consumed by rural adult women per day (7.68 g).Conclusions: The study concluded that the urban households showed higher consumption of spices as compared to rural households thus assessing the quantifying intake of spices. Urban adult women consumed more spices per day as compared to rural women. Therefore, more encouragement for increased use of spices is required to reap various health benefits of spices in combating metabolic disorders.
Triglyceride Glucose Index for the Detection of Asymptomatic Coronary Artery Stenosis in Patients With Type 2 Diabetes
Authors: Thai Pham Viet , Tien Hoang Anh , Minh Huynh Van , Valensi Paul
Published: August 2020

Background: Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the prevalence of coronary stenoses (CS) in patients with type 2 diabetes and no history or symptom of cardiovascular disease and to investigate the association between TyG index and cardiovascular risk factors and both the presence and severity of CS. Futhermore, we assessed the value of TyG index in predicting subclinical CS. Methods: This was a cross-sectional observational study. We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG index and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed.Results: The population was classified according to tertiles of TyG index. The highest TyG values were associated with higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose, HbA1c levels and HOMA-IR, lower HDL-cholesterol, a higher incidence of metabolic syndrome and less frequent physical activity (p<0.05 to <0.0001). TyG index correlated with logHOMA-IR (p<0.0001). CS ≥50% were present in 60 participants and 32 had coronary artery stenosis ≥70%. TyG index and HOMA-IR were significantly higher in patients with CS ≥70%. The number of narrowed coronary arteries and the degree of stenosis were associated with higher TyG index levels (p=0.04 and <0.005 respectively). A TyG index ≥ 10 was significantly associated with an increased risk of multiple coronary artery disease and of more severe CS. After adjusting for confounding factors, including logHOMA-IR, these risks remained mostly significant. A TyG index threshold at 10 resulted in 57% sensitivity and 75% specificity for predicting the presence of CS ≥ 70%. In subgroup analysis TyG index ≥ 10 was associated with an increased risk in CS ≥ 70% in patients treated with statin or antiplatelet therapy.Conclusion: More than one third of asymptomatic patients with type 2 diabetes had significant CS on CCTA. TyG index may be considered as a marker for insulin resistance and increased TyG index could identify patients with high risk of coronary artery stenoses and is associated with the number and the severity of artery stenoses.
Ancestral origin, antigenic resemblance and epidemiological insights of novel coronavirus (SARS-CoV-2): Global burden and Bangladesh perspective
Authors: Uddin Md Bashir , Hasan Mahmudul , Harun-Al-Rashid Ahmed , Ahsan Md. Irtija , Imran Md. Abdus Shukur , Ahmed Syed Sayeem Uddin
Published: August 2020

Recently a new coronavirus strain, COVID-19 has emerged in Wuhan City, China which cause disease and in many cases deaths to humans. Considering its severity a number of works are working on it and full genomic sequences has already released in the last few weeks to understand the evolutionary origin and molecular characteristics of this virus. Based on currently available genomic information a phylogenetic tree was constructed from four types of representative viral proteins (Spike, Membrane, Envelope and Nucleoproetin) of COVID-19, HCoV-229E, HCoV-OC43, SARS-CoV, HCoV-NL63, HKU1, MERS-CoV, HKU4, HKU5 and BufCoV-HKU26 clearly demonstrated that the ancestral origin and distant evolutionary relation of newly epidemic novel coronavirus (COVID-19). It had been found that COVID-19 was evolutionary related to SARS-CoV. It was also found that COVID-19 proteins were almost more than ninety (90%) similar and identical with SARS-CoV proteins. The cross-checked conservancy analysis of COVID-19 antigenic epitopes showed significant conservancy with SARS-CoV proteins. VaxiJen server reveal almost 100% immunogenic potential of four viral proteins with COVID-19. In this article, we present an effort on molecular evolutionary analysis, temperature comparison and compile and analyze epidemiological outbreak information on the 2019 novel coronavirus based on the several open datasets on COVID-19 (SARS-COV-2) and possible threat to Bangladesh.Authors Md Bashir Uddin and Mahmudul Hasan contributed equally to this work
A geospatial analysis of two-hour surgical access to district hospitals in South Africa
Authors: Chu Kathryn , Dell Angela J , Moultrie Harry , Day Candy , Naidoo Megan , Straten Stephanie van , Rayne Sarah
Published: August 2020

Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.
Influence of culture conditions on the production of extracellular polymeric substances (EPS) by Arthrospira platensis
Authors: Silva Mariana Barbalho , Azero Edwin G. , Teixeira Cláudia M. L. L. , Andrade Cristina T.
Published: August 2020

Arthrospira platensis is a cyanobacterium that is of great biotechnological interest, particularly for the food industry, as it possesses a high content of proteins, pigments, lipids and carbohydrates. Cyanobacteria produce extracellular polymeric substances (EPS), which are co-products of secondary metabolism that present thickening or gelling properties. A 3-level factorial design was used to study the combined effect of different nitrate concentrations and photon flux density (PFD) values to evaluate the biomass and EPS production of A. platensis. The best result in terms of biomass production was obtained under condition 6 (2 g.L-1 NaNO3 and 600 μE.m-2.s-1) yielding a concentration of 1.292 g.L-1. However, condition 1 (0.25 g.L-1 NaNO3 and 200 μE.m-2.s-1) produced the greatest EPS yield (111 mg.g-1), followed by condition 9 (2 g.L-1 NaNO3 and 1000 μE.m-2.s-1). FTIR analyses of EPS samples indicated the presence of carboxylate and sulfate functional groups, and rheological studies of the EPS at 5 and 10 g.L-1 revealed a dilute solution behavior.
A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices
Authors: Schop Annemarie , Stouten K. , Riedl J.A. , Houten R.J. van , Leening M.J.G. , Rosmalen J. van , Bindels P.J.E. , Levin M-D.
Published: August 2020

Background.
To study etiologies of anemia using an extensive laboratory analysis in general practices.
Method.
An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥ 50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results.

Results.
Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA.

Conclusion.
Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.
Early L-T4 intervention improves fetal heart development in pregnant rats with subclinical hypothyroidism rats by activating BMP4/Smad4 signaling pathway
Authors: Xue D , Sun JL , Yang J
Published: August 2020

Background: It is unclear whether the offspring of subclinical hypothyroidism (SCH) pregnant rats have abnormal cardiac development, and whether early intervention with L-T4 can improve the abnormality of these offspring. Therefore, the aim of this study was to investigate the effect of early L-T4 intervention on the heart development of offspring of SCH pregnant rats and its possible molecular mechanism. Methods: Eighty female Wistar rats were randomly divided into Sham group (placebo control), SCH group, LT4-E10 group (L-T4 treatment started on the 10th day of gestation), and LT4-E13 group (L-T4 treatment started on the 13th day of gestation). Each group was further divided into E16, E18, P5 (postnatal day 5 rats), and P10 (postnatal day 10 rats) subgroups. The levels of serum TT4 and TSH, the ratio of heart weight to body weight of offspring rats, the expression of metabolic enzymes, and the histopathology of cardiomyocytes were determined. To elucidate the effects of L-T4 on cardiac development of offspring of SCH pregnant rats, the expression levels of GATA4, Nkx2-5 and proteins involved in BMP4/Smad4 signaling pathway were detected by immunohistochemistry, real time quantitative polymerase chain reaction and Western blotting to elucidate the molecular mechanism of L-T4 regulating the heart development of the offspring of SCH pregnant rats. Results: Compared with Sham group, serum TSH was significantly increased in SCH pregnant rats. Moreover, early L-T4 intervention significantly reduced the levels of serum TSH. Compared with the offspring in the SCH group, early L-T4 intervention significantly increased the heart weight, heart weight to body weight ratio, the activities of succinate dehydrogenase (SDH), Na + /K + -ATPase and Ca 2+ -ATPase, but reduced myocardial cell shrinkage and nuclear staining, hyperemia/congestion and vacuolar degeneration. In addition, early L-T4 intervention not only significantly increased the mRNA and protein expression of Gata4 and Nkx2-5, but also increased the protein expression involved in BMP4/Smad4 signal pathway in myocardium of the offspring of SCH pregnant rats. Conclusions : Early L-T4 intervention can regulate the cardiac development of the offspring of SCH pregnant rats by activating BMP4/Smad4 signaling pathway and increasing the expression of Gata4 and Nkx2-5 proteins.
Knowledge and Attitudes about Transcranial Magnetic Stimulation Among Psychiatrists in China
Authors: Deng Jiahui , Gong Yimiao , Lin Xiao , Bao Yanping , Sun Hongqiang , Lu Lin
Published: August 2020

Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive form of brain stimulation. It has been used in many mental health institutions to treat mental disorders worldwide. However, comprehensive knowledge about rTMS is not yet widespread among psychiatrists. The present study assessed psychiatrists’ knowledge and attitudes about rTMS in China and investigated related factors.Methods: A quantitative observational cross-sectional study was conducted using an online survey. The sample consisted of 522 psychiatrists. Multinomial logistic regression and multiple linear regression analyses were used to explore factors that contributed to psychiatrists’ knowledge about rTMS. We also ascertained psychiatrists’ attitudes about rTMS and provide recommendations for the more widespread use of rTMS.Results: The majority of respondents (86.4%) reported having access to rTMS at their institution. A total of 379 psychiatrists (72.6%) knew that rTMS is approved by the United States Food and Drug Administration for treatment-resistant depression. Univariate logistic regression indicated that psychiatrists who were older, had a senior professional title, worked more years, had an onsite clinical rTMS program in their hospital, and received formal training in theory and application (all p < 0.05) were more likely to know that rTMS is approved by the Food and Drug Administration for the treatment of depression. The percentages of respondents who knew most or all indications, the mechanism of action, parameter settings, adverse reactions were 51.9%, 40.2%, 27.4%, and 41.4%. Linear regression showed that formal training in rTMS theory and practice were associated with higher knowledge scores (all p < 0.05). Most of the subjects had negative attitudes about using rTMS to treat mental disorders. When asked about their attitudes about continuing rTMS education, nearly all of the respondents indicated that they were willing to pursue continuing training in rTMS in the future.Conclusions: Many psychiatrists had an insufficient level of knowledge about rTMS and negative attitudes about rTMS. Psychiatrists who had formal rTMS training experience had higher levels of rTMS knowledge. rTMS training and relevant policy making should be strengthened.
Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians
Authors: Flenady Tracy , Dwyer Trudy , Sobolewska Agnieszka , Lagadec Danielle Le , Connor Justine , Kahl Julie , Signal Tania , Browne Matthew
Published: August 2020

Background: Early warning systems (EWS) are most effective when clinicians monitor patients’ vital signs and comply with the recommended escalation of care protocols once deterioration is recognised. Objectives: To explore sociocultural factors influencing acute care clinicians’ compliance with an early warning system commonly used in Queensland public hospitals in Australia. Methods: This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia. Results: This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication. Conclusions: The overarching organisational context including the hospital’s embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians’ and teams’ compliance or non-compliance with early warning system’s monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.
A description of the influenza vaccination program for health care workers in Vietnam
Authors: Ha Nga , Nguyen Thoa Thi Minh , Nguyen Tung Xuan , Tran Phu Dac , Nguyen Hang Minh , Ha Van Thi Cam , Lafond Kathryn E. , Seward Jane F. , McFarland Jeffrey W. , Chu Susan Y.
Published: August 2020

Background In 2017, the Vietnam Ministry of Health conducted a demonstration project to introduce seasonal influenza vaccination to health care workers (HCWs). A total of 11,000 doses of influenza vaccine, single-dose prefilled syringes, were provided free to HCWs at 29 selected hospitals, clinics, and research institutes in four provinces: Hanoi, Khanh Hoa, Dak Lak and Ho Chi Minh City. Methods Before the campaign, a workshop was organized to discuss an implementation plan including technical requirements, cold chain, uptake reporting, and surveillance for adverse events following immunization (AEFIs). All sites distributed communication materials and encouraged their staff to register for vaccination. Following immunization sessions, sites sent reports on uptake and AEFI cases. Left-over vaccine was transferred to other sites to maximize vaccine use. Results The average uptake was 57% for all HCWs, with 11 sites achieving 90% and above. These 11 sites were small with less than 500 staff, including 5 primary hospitals, 3 preventive medicine units, and 2 referral hospitals. Among the six biggest sites with over 1,000 staff, four sites had the lowest uptake (14%-47%). Most of the high-uptake sites were from the central to the south; only one site, a referral hospital, was from the north. After redistribution of left-over vaccine, only 130 vaccine doses (1.2%) were not used and destroyed. Based on factors that affected uptake, including registration levels, differing communication strategies, availability of vaccination, and commitment by health facility leaders, we recommended ways to increase HCW coverage; recommendations to improve AEFI reporting also were made. Conclusions The project demonstrated that it was feasible to conduct influenza vaccination campaigns among HCWs in Vietnam. Improvements in promotion of registration, more intense pre-planning, especially at larger facilities, and wider, more consistent availability of communication materials will result in increased efficiency and coverage in this program’s future expansion.
The Effect of Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes Mellitus, Pilot RCT Part II: Diabetes Health Outcomes
Authors: Alshehri Mohammed , Alothman Shaima A. , Alenazi Aqeel M. , Rucker Jason L. , Phadnis Milind A. , Miles John M. , Siengsukon Catherine F. , Kluding Patricia M.
Published: August 2020

Background: Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes’ health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. Methods: Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n=14) or Health Education (HE; n=14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. Results: The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B=-0.56, p=.009) and after awakening in the morning (B=-0.57, p=.007). Conclusions: This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements.Trial registration: Clinical Trials Registry (NCT03713996). Registered 22 October 2018, https://clinicaltrials.gov/ct2/show/NCT03713996
Proteomic analysis of banana xylem sap provides insight into resistant mechanisms to Fusarium oxysporum f. sp. cubense Tropical Race 4
Authors: Zhang Lei , Liu Lina , Li Shu , Bai Tingting , Xu Shengtao , Fan Huacai , Yin Kesuo , He Ping , Wang Yunyue , Tang Weihua , Zheng Sijun
Published: August 2020

Background

Fusarium wilt is a destructive soilborne disease of banana caused by Fusarium oxysporum f. sp. cubense ( Foc ), especially Tropical Race 4 (TR4), which is a xylem-invading fungus. It was evident that xylem sap contained macromolecules, such as proteins, involved in disease-resistance processes. However, there is no research to analyze changes in banana xylem sap proteins response to TR4 to date.

Methods

To gain an integrated understanding of differential protein expression in banana xylem sap during TR4 infection, we performed a comparative proteomic analysis of xylem sap in resistant ‘Pahang’ and susceptible ‘Brazilian’ bananas inoculated with TR4.

Results

A total of 1036 proteins were detected in xylem sap of both bananas, among which some proteins are involved in ‘signal transduction’, ‘environmental adaptation’, ‘biosynthesis of secondary metabolites’ and ‘lipid metabolism’, indicating that xylem sap contained defense-related proteins. A number of 129 differential expression proteins (DEPs) were identified in 4 possible pairs between resistant and susceptible tested combinations. Of these DEPs, hypersensitive-induced response protein 1 (HIR1), E3 ubiquitin ligase (E3) might play negative roles in ‘Pahang’ response to TR4 attack, whereas chalcone isomerase (CHI), glycine-rich RNA-binding protein (GRP), carboxylesterase (CXE) and GDSL lipase (GLIP) might play positive roles in ‘Pahang’ defense against TR4 infection.

Conclusions

Banana xylem sap contained defense-related proteins, among which HIRP1, E3, CHI, GRP, CXE and GLIP involved in banana defense against TR4. To our knowledge, this is first report to analyze changes in banana xylem sap proteins response to TR4, which help us to explore molecular mechanisms of banana resistant to Fusarium wilt.
The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study
Authors: Tan Lei , Wen Bingtao , Guo Zhaoqing , Chen Zhongqiang
Published: August 2020

Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared. Results: 24 hours post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6-24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR. Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.
Risk factors associated with renal crescentic formation in pediatric Henoch–Schönlein purpura nephritis: a retrospective cohort study
Authors: Song Yong-rui , Guo Wan-liang , Sheng Mao , Lin Qiang , Zhu Xue-ming , Li Xiao-Zhong
Published: August 2020

Background: The long-term prognosis of Henoch-Schönlein purpura (HSP) depends on the severity of renal involvement, and crescent formation is considered an important risk factor for poor prognosis of Henoch-Schönlein purpura nephritis (HSPN). The objective of this study was to evaluate factors affecting crescent formation in children with HSPN.Methods: Demographic factors, clinical characteristics, and laboratory data of children with HSPN with or without crescents were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of crescent formation in HSPN.Results: A total of 191 children with HSPN were enrolled in the study. There were 107 (56%) males and 84 (44%) females, with a median age of 7 years (range: 2 years–15 years). International Study of Kidney Disease in Children (ISKDC) grading was used to divide subjects into two groups: those without glomerular crescent formation (ISKDC grades I–II, n = 146 cases) and those with glomerular crescent formation (ISKDC grades III–V, n = 45 cases). Logistic regression analysis showed that higher urinary white blood cell (WBC) count (OR = 3.300; 95% CI, 1.119–9.739; P = 0.0306) and higher urinary microalbumin/creatinine ratio (ACR) (OR = 25.053; 95% CI, 1.354–463.708; P = 0.0305) were independent risk factors for the formation of crescents in HSPN. The area under the receiver operating characteristic curve of urinary WBC and ACR were 0.753 and 0.698 respectively, with the Hosmer and Lemeshow goodness-of-fit test (P = 0.0669, P > 0.05).Conclusion: These results suggest that higher urinary WBC count and ACR should be strictly monitored for children with HSPN. Adequate clinical intervention for these risk factors may limit or prevent renal crescent formation.
Teladorsagia circumcincta beta tubulin: the presence of the E198L polymorphism on its own is associated with benzimidazole resistance
Authors: Valladares Maria Martinez , Valderas-García Elora , Gandasegui Javier , Skuce Philip , Morrison Alison , de Agüero Verónica Castilla Gómez , Cambra-Pellejà Maria , Balaña-Fouce Rafael , Vázquez Francisco A. Rojo
Published: August 2020

Background: Benzimidazole resistance is associated with isotype-1 β-tubulin gene F200Y, E198A and F167Y SNPs. In this study, the recently described polymorphism E198L was reported and analysed in Teladorsagia circumcincta.Methods: The benzimidazole phenotypic resistance was measured by the Faecal Egg Count Reduction Test (FECRT) and the Egg Hatch Test (EHT) using a discriminating dose (DD) in 39 sheep flocks. Around 1,000 larvae collected before and after treatment were used for DNA extraction. The resistant species identified in all flocks was T. circumcincta. The resistance alleles frequencies were measured for F200Y and E198A. A 371 bp fragment of the isotype-1 β-tubulin gene was analysed, including the three codons of interest, and a new pyrosequencing assay was designed for testing E198L.Results: The percentage of resistant flocks was 35% by FECRT or 26% by EHT, however F200Y and E198A SNPs were absent in T. circumcincta. The amplification of a 371 bp fragment confirmed the absence of F167Y and F200Y in 6 resistant flocks. Regarding codon 198, all samples after treatment carried a leucine (CTA). A pyrosequencing assay analysed the allele frequencies for the first two bases at codon 198 independently, G/C and A/T. The correlation between C and T frequencies was almost 1 (r = 0.929; p < 0.0001) and the mean value of both was calculated to measure the leucine frequency; this value ranged between 10.4 and 80.7% before treatment, and from 82.3 to 92.8% after treatment. High and similar correlations were reported between the genotypic variables (C frequency, T frequency or mean of both frequencies) and phenotypic resistance (r > 0.720; p < 0.0001), although negatively associated with the FECRT and positively with the EHT. According to multivariate linear regression analysis, the T frequency was the most significant variable influencing the phenotypic resistance (FECRT or EHT; p < 0.0001). In the EHT, 67.1% of the phenotypic variability is associated with the T frequency but in the FECRT only 33.4%; therefore, the EHT using a DD seems to detect the genotypic resistance more accurately than the FECRT.Conclusions: The E198L polymorphism can confer BZ resistance on its own in T. circumcincta.
Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer
Authors: Wu Yixuan , Liu Haiying
Published: August 2020

Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. Live birth rates were higher in the <38 years of age group as compared those > 38 years (19.0% vs.16.6%; P=0.045). ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.