bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of sociodemographic characteristics of adolescents on E-Health literacy
Authors: Çınar S , Boztepe H , Ozcebe H
Published: October 2020

Background

As a result of having easy access to the internet and mobile devices, a great part of the population uses the internet in order to search for information related to health; therefore, health literacy on the internet has gained importance.

Methods

The study was conducted in three schools from different socioeconomic levels (low, middle, high) affiliated with the Provincial Directorate of Education in the capital city of Turkey, Ankara city. The sample of the study consisted of a total of 1082 adolescents in the age group of 14 and 18 years, who were studying in the 9th, 10th, 11th, and 12th grades in the selected schools. The data were collected using a data collection form consisting of questions related to the adolescents and the sociodemographic characteristics of their parents, as well as E-Health Literacy Scale in Adolescents. The predictors of e-health literacy in adolescents were analyzed through linear regression.

Results

It was found that the e-health literacy mean score of the adolescents was 26.9±7.6 in the study. There was a correlation between e-health literacy and the increase in the age of the adolescent, monthly income of the family, the status of having a computer for the child, the status of reading subjects related to health on the internet, and the status of reading subjects related to their own health on the internet among characteristics of adolescents. In the study, the e-health mean scores of adolescents having high socioeconomic levels were found to be statistically higher (F = 2.153, p < 0.000).

Conclusions

The results revealed the importance of improving the e-health literacy skills of male adolescents, having low socioeconomic levels and using less internet, in order to have access to online health information effectively.

Key messages

Training programs suitable for the developmental period of the adolescents should be organized in the school to increase the e-health literacy of adolescents. The adolescents in high socioeconomic status have higher electronic health literacy than the adolescent in low and middle socioeconomic status.
Relations of self-esteem, obesity and peer bullying among middle school students in Turkey
Authors: Ercan T M F , Özcebe L H
Published: October 2020

Obesity, peer bullying and self-esteem are important public health problems in adolescent age group in Turkey as well as in the world. This study aims to investigate bilateral and tripartite relations of obesity, peer bullying and self-esteem.

The universe of this cross-sectional study was middle school students in Ankara; 1955 student were reached in 42 schools determined by systematic sample method. Data was collected under observation with the questionnaire including anthropometric measurements (BMI-z-score), self-esteem scale and peer bullying. Written permission was given by the Ethical Committee at the University.

We reached 1955 students (975 girls; 877 boys). The average of age was 12.84±0.59. The prevalence of overweight was 15.0% and obesity 7.2%. The percentage of low self-esteem was found as 45.4%. Frequencies of physical bullying-bully subgroup was 36.7%, verbal 51.4% and emotional 35.2%; the percentages of bullying-victim subgroups were found as 41.9%, 49.7% and 19.5%, respectively. A strong relationship was between obesity and physical bullying-victim without grouping for self-esteem (p = 0.03). Obesity was associated with low self-esteem without physical or emotional bullying (p = 0.02; p = 0.03). Low self-esteem was related with all types of bullying (p < 0.001 all subgroups). Obesity was associated with verbal bullying-bully in high self-esteem and without grouping for self-esteem (p = 0.04; p = 0.02). The relationship was between obesity and physical bullying-bully in the low and high self-esteem subgroups (p = 0.02; p = 0.009), but this relation couldn't be demonstrated without grouping for self-esteem.

Prevention of peer bullying, fighting with obesity are important topics to protect adolescent mental health, improve school health. More effective studies should be conducted in this field, intervention programs have holistic approach should be developed at countries levels and global level.

Key messages

The holistic approach always highlighted from Sustainable Development Goals to Astana has a great importance in improving physical, mental and social health of adolescent in schools. Obesity, peer bullying and self-esteem are important issues affecting physical, social and mental health in adolescence in whole world.
Factors associated with Exclusive Breastfeeding in Tunisian population
Authors: Ben Rejeb M , Agina Y , Ben Hmida H , Chelbi S
Published: October 2020

Background

Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. WHO recommend the maintaining the exclusive breastfeeding (EB) up to six months. Unfortunately, its prevalence does not exceed 13% in our country at this age. A better understanding of factors associated with short duration of breastfeeding can allow us to identify the strategies that improve it. This study aimed to determine prevalence of EB and predominant breastfeeding (PB) during the first 2 months and identify their associated factors.

Methods

We conducted an observational prospective study in two centers of maternal and child health of Monastir (Tunisia) during April and May 2019. Data collection was performed after birth using a self-administered questionnaire and at 4th and 8th postpartum week by telephone interviews. We used the BSES-SF scale to identify self-efficacy in BF and the IIFAS-A scale to measure the mother's attitude towards BF. We used Kaplan Meier survival analysis and Cox Proportional Hazard regression to identify independent factors associated with EB and PB.

Results

During the study, 437 mothers were enrolled. Prevalence at 8th postpartum week was 6.2% with median duration of eight days and 35.6% with median duration of 21 days respectively for EB and PB. Absence of a breastfeeding experience (HR = 1.31 [1.07-1.61], p = 0.008), the first breastfeeding at beyond 12 hours (HR = 1.47 [1.05-2.07], p = 0.023), the intention of mixed breastfeeding (HR = 1.25 [1- 1.55], p = 0.043) were associated with a shorter duration of EB. Absence of breastfeeding experience (HR = 1.47 [1.05-2.07], p = 0.023), the first breastfeeding at beyond 2 hours (HR1 = 1.72 [1.08-2.73]; p = 0.007) and the non-determination of the duration of breastfeeding (HR = 1.54 [1.43-4.51], p = 0.006) were associated with a shorter duration of PB.

Conclusions

This study allowed us to identify mothers likely to stop BF early. They should be the target of specific promotion interventions.

Key messages

Breastfeeding is one of the most effective ways to ensure child health and survival. Information about BF, time of first BF, type and duration of planned BF and self-efficacy deserve a particular attention and constitute key axes of effective promotion interventions of EB and PB.
Breastfeeding self-efficacy and associated factors in the context of primary health care, Brazil
Authors: Souza M H N , Monteiro J S , Rodrigues E C , Peres P L P
Published: October 2020

Introduction

Exclusive breastfeeding is essential to reduce infant morbidity and mortality, as it meets the entire child's nutritional and immunological needs, strengthens the emotional bond between the mother-baby pair and protects against chronic and infectious diseases. Several factors interfere in this practice, among which the woman's self-efficacy stands out because such attitude represents maternal confidence in her ability to breastfeed her child.

Objectives

Evaluating self-efficacy of breastfeeding among women assisted in primary health care units and; verifying the association between socioeconomic and obstetric factors, and between the duration of exclusive breastfeeding and breastfeeding self-efficacy.

Methods

Cross-sectional study carried out with 216 mothers of children under six months, registered in four basic health units in the city of Rio de Janeiro, Brazil. The research was approved by the Ethics and Research Committees of the participating institutions. The Breastfeeding Self-Efficacy Scale - Short Form was used to measure the self-efficacy scores, and the Statistical Package for the Social Science Program was used to analyze such data.

Results

high levels of breastfeeding self-efficacy were associated with six or more prenatal consultations (OR = 0.92, 95% CI 0.84-1.01, p = 0.07), normal birth (OR = 1,25, 95% CI 1.07-1.45, p < 0.001), breastfeeding in the first half hour after delivery (OR = 1,17, 95% CI 1.08 - 1.27, p < 0.001) and the practice of exclusive breastfeeding for 6 months (OR = 1,86, 95% CI 1.27-2.27, p < 0.001).

Conclusions

prenatal care, vaginal delivery, breastfeeding in the first half hour of life and the practice of exclusive breastfeeding were related to the high and medium level of breastfeeding self-efficacy. The knowledge of the self-efficacy degree and the determining factors for the breastfeeding enable health professionals to implement effective interventions for promoting, protecting and supporting breastfeeding

Key messages

Maternal self-efficacy contributes to prevent early weaning and, thus, to reduce infant morbidity and mortality. Awareness of the determining factors of breastfeeding enables the implementation of effective interventions to promote and support breastfeeding.
Estimating infant mortality risk in Uruguay using artificial neural networks
Authors: Alegretti M , Aleman A , Leon I , Cavallieri F , Callero W
Published: October 2020

Background

Uruguay has a national electronic live birth certificate that includes variables of risk factors for infant mortality. Accurate risk stratification of newborns is needed to optimize the use of resources for homes visits. Artificial neural networks are computational tools that have been used successfully in many types of prediction problems.

Objective

To develop a neural network able to estimate the risk of infant mortality using information available in the electronic live birth and mortality certificate in Uruguay.

Methods

A historical cohort of records of newborns in Uruguay from 2014 to 2017 was used. The variables of the electronic live birth certificate were considered for the model. Infant mortality was obtained from the national mortality registry. A multilayer perceptron was trained with a random sample of 70% of the cohort; the remaining 30% was the validation set. The variables included were birth weight, Apgar score at 5 minutes, number of prenatal consultations, maternal educational level, multiple pregnancy and cohabiting father. ROC curve analysis was performed.

Results

The 2014-2017 birth cohort contains 187,388 records. 1,307 children under one year died (IMR 6.97 per 1,000 births). The area under the curve (AUC) was 88.7%, 95% CI [87.6% - 89.8%]. The optimal cut-off point of pseudoprobability of infant mortality was 0.008 (78.9% of sensibility and 82.4% of specificity). The IMR in high-risk newborns identified by the neural network was 32.8 per 1,000 births.

Conclusions

The neural network identifies high-risk newborns at the time of entering the data in the electronic live birth certificate as other models have done. This information could be used to plan and implement preventive actions.

Key messages

In Uruguay, high-risk newborns can be identified by applying artificial intelligence to data collected routinely. The procedure can be applied in other countries with electronic birth certificate.
The use of mindfulness-based intervention to improve bracing compliance for AIS patients
Authors: Li X , Leung C H Y , Gao T , Chung V C H , FWP Yu , Wong S Y S , Lam T P , Cheng J C Y , Yip B H K
Published: October 2020

Introduction

Despite good bracing compliance is crucial to prevent curve progression among braced AIS patients, only few interventions were suggested to improve bracing compliance. This study examined the effect of MBI on bracing compliance for AIS patients.

Methods

116 eligible AIS patients were randomized and 86 participants were enrolled in intervention. Patients in the MBI group joint weekly sessions, which is an adapted version of mindfulness-based stress reduction (MBSR) program, for 8 weeks. Control group consisted of an 8-week PE intervention that is recommended according to the SOSORT 2011 guideline. The primary outcome is the 6-month post-intervention bracing compliance. The secondary outcomes include quality of life and psychosocial measurements. Primary analysis was ANCOVA with treatment as covariate. Trend analysis was conducted using Linear Mixed effect model.

Results

At the end of intervention, intention-to-treat analysis improved bracing compliance by1.24h/day and 0.08h/day for MBI and PE respectively. MBI group presented an increase in emotional regulation than baseline (ERQ-CCA) (1.92, p = 0.01), especially in Cognitive reappraisal sub-scale (1.00, p = 0.05). Bracing Specific Quality of Life (SRS-22) reduced significantly in both groups, but MBI group decreased less (MBI: -3.08, p = 0.00, PE -4.47, p = 0.00). Effect at six months for compliance progressed negatively but favoured MBI group (MBI: -1.16, p = 0.13, PE: -1.84, p = 0.06) although there was no significant difference between groups (p = 0.78). The Perception of stress (PSS) decreased significantly in PE group (-3,53, p = 0.01) rather than MBI (1.53, p = 0.22), however the between-group difference isn't significant (p = 0.62).

Conclusions

It is alarming that patients in both interventions group progressed with poorer compliance and worsen QoL. These progressions were less severe in the MBI group than in the PE group, but the differences did not reach statistical significant.

Key messages

Both groups decreased in compliance and QoL but MBI group reduced less. MBI wasn't more effective in improving participants’ compliance and other measurements.
Birth defects in the Brazilian side of the triple border: a population-based cross-sectional study
Authors: Nampo F K , Souza S , Pestana C R
Published: October 2020

Background

Major birth defects are characterized by its severity and are a public health challenge since it chronically affects the population. Foz do Iguassu is located in Brazili's largest international border and presents a birth defect rate 50% greater than the country's average.

Methods

Identifying factors associated to birth defects is important to guide preventive actions toward modifiable risk factors and target the most susceptible population. In this cross-sectional study we measured the prevalence of major birth defects and associated maternal sociodemographic factors in Foz do Iguassu. Data were collected from a governmental registry and included all births that occurred in the city between 2012 to 2017. The variables measured were maternal education, maternal race, country of residence, maternal parity and onset of prenatal care. Data were analyzed through logistic regression models to verify the maternal sociodemographic factors associated with major birth defects.

Results

26,214 births were analyzed; among the 305 birth defects registered, 140 (46%) corresponded to a major birth defect. Cleft lip and/or palate and gastroschisis were the most prevalent major birth defect (9.5/10,000 live births and 6.83/10,000 live births, respectively). Maternal education up to 7 years was the only variable associated with the major birth defects (ORadj=1.58; CI = 1.07-2.33; p = 0.02). Maternal age was associated with gastroschisis (mean: 21.5 years; p = 0.002) and Down syndrome (mean: 33.5 years; p = 0.007).

Conclusions

In this area, cleft lip and/or palate and gastroschisis are the most common major birth defects, and maternal education is weakly associated with major birth defects.

Key messages

The epidemiology of major birth defects in this area differs from Brazil’s. Future research should focus on inherent risk factors for congenital defects and exposure to teratogens.
Health literacy as a predictor of road traffic injury prevention
Authors: Miskulin M , Simic I , Bilic-Kirin V , Mujkic A , Berlancic T , Miskulin I
Published: October 2020

Background

Road traffic injuries impose a substantial health burden among children. Health literacy is one of the most important determinants of non-communicable disease prevention. Parent health literacy is connected with their knowledge and behaviors regarding children road traffic injuries (CRTI) prevention. The aim of this study was to explore health literacy, knowledge and behaviors of mothers' in Croatia regarding CRTI prevention.

Methods

This population based cross-sectional questionnaire study was done during 2019 in convenient sample of mothers of school aged children. Sociodemographic data and data about knowledge and behaviors of mothers regarding CRTI prevention were collected by the use of specially designed questionnaire. Croatian version of the Newest Vital Sign screening test (NVS-HR) was used for heath literacy determination.

Results

There were 814 mothers' median age 36.0 (interquartile range 32.0. - 39.0). According to NVS-HR there were 17.7%, 26.5% and 55.8% of mothers with low, intermediate and adequate health literacy level, respectively. The higher levels of health literacy were connected with younger age of mothers (37 years old or less) (P = 0.027); urban area of settlement (P < 0.001); living with a partner (P = 0.018); higher educational level of mothers (P < 0.001) and with better self-perceived economic status (P = 0.009). The study revealed poor positive correlation between mothers' health literacy and their knowledge regarding CRTI prevention (rho=0.170; P < 0.001). The study further showed that there was no correlation between mothers' health literacy and their behavior regarding CRTI prevention (rho=0.072; P = 0.041). Finally, the study revealed poor positive correlation between mothers' knowledge and behavior regarding CRTI prevention (rho=0.193; P < 0.001).

Conclusions

The level of health literacy affects mothers' knowledge about CRTI prevention. Further studies are needed to better understand the underlying reasons for established association.

Key messages

Low parent health literacy is one of the predictors of poor parent knowledge about children road traffic injuries prevention. It is necessary to identify and to address low parent health literacy in preventive strategies directed towards children road traffic injury prevention.
Effect of stop smoking during the first trimester on Low birth weight: A MCBR Study
Authors: Kharkova O , Odland J
Published: October 2020

Background

Tobacco smoking is a public health problem. Even though this habit is less common among women than men in Russia, it appears to be on the increase among women aged ≥15 years. Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on maternal smoking and birth weight, the influence of stop smoking on low birth weight is not well documented. The aim of the study was to assess an effect of quitting smoking during the first trimester on low birth weight.

Methods

The study is based on the Murmansk County Birth registry. Women who delivered a singleton pregnancy after 37 weeks of gestation were comprised to the study (N = 44,486). Smoking information was assessed at the first antenatal visit during pregnancy and self-reported and. Low birth weight was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions, we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain.

Results

The prevalence of low birth weight was 1.1%. This adverse birth outcome was more prevalent in women who smoked during pregnancy (2.5%) in compared to those who stopped do it during pregnancy (0.8%) or did not smoke before and during pregnancy (0.9%) (p < 0.001). Compared to non-smokers, quitting smoking during the first trimester had no significant impact on the low birth weight, even after adjustment for confounders (ORcrude = 0.97 with 95%CI 0.64-1.47 and ORadj = 0.89 with 95%CI 0.58-1.36).

Conclusions

We observed that women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy.

Key messages

Women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy.
Narrative Case study: The most essential determinants to child and maternal health in Sierra Leone
Authors: Sheriff V , Barzyk G A
Published: October 2020

Background

Sierra Leone is one of the poorest countries in the world, suffering from some of the worst maternal and child health outcomes. In 2013, it had a maternal mortality ratio of 1165/10000 live births and an under-five mortality of 156/1000 live births. The country has introduced a number of policies and interventions to tackle maternal and child health issues but still retains one of the highest global mortality rates. The purpose of this study is to determine the most essential determinants to infant, child and maternal health and recommend some interventions and policy changes to improve their health outcomes.

Methods

A small review of relevant policies and papers and analysis of relevant maternal and child health data and statistics was conducted to inform questions for Key Informant Interviews. Interviews were then conducted with relevant stakeholders to child and maternal health from UN Organisations, international NGOs and the Ministry of Health and Sanitation (MoHS).

Results

Analysis of transcribed Interview data with NVIVO showed that the most essential determinants were the lack of effective coordination between the MoHS and partners due to the emergency mindset, systematic problems with the attitude of the healthcare workforce especially towards women and socio-cultural restriction on women restricting their ability to make choices about their own health and lives

Conclusions

The study found that there was a focus on policies and interventions targeted at improving clinical determinants and health statistics while consideration of socio-cultural context were negligible. An inclusion of interventions focused on women's empowerment and increasing their voices will help to tackle some of these most essential determinants.

Key messages

Sierra Leone has the policy environment, political will, and technical expertise to continue making improvements to their high maternal and child mortality problem. An emergency mindset approach, and interventions targeted only at reducing clinical determinants of maternal mortality are missing out on addressing wider socio-cultural issues to improving health.
Misuse and addiction to mobile phone in a sample of first-grade secondary school students of Palermo
Authors: Pizzo S , Costantino C , Giliberti D , Calò I , Vella C , Conforto A , Sannasardo C , Gambino R , Casuccio A
Published: October 2020

Background

Nowadays, smartphone overuse affects massively teenagers and young adults. From 2014 to 2018 in Italy, for the 11-17 years age group, there has been an increase from 79.9% to 85.8% of daily mobile phone users. This project aims to investigate usage prevalence and misuse/addiction of mobile phones in a representative sample of first-grade secondary school students of the Province of Palermo, Italy, carrying out educational interventions to promote a proper and conscious use of smartphone.

Materials and Methods

An anonymous, standardized and previously validated pre-intervention questionnaire consisting of 39 items on general socio-demographic characteristics, attitudes and habits regarding smartphone usage, was administered online to 10-15 years old students of the Palermo's Province. Moreover, two additional sets of 11 and 15 items contributed to calculate a Misuse and an Addiction Score, respectively. After administration, educational interventions aimed at promoting the correct and conscious use of the smartphone, were carried out.

Results

A total of 1600 students belonging to 16 schools, responded to the questionnaire. 93% of the sample had a personal smartphone and 84% had a personal profile on at least one social network. About 15% of the sample experienced cyber bullying episodes and 30% accessed to adult content online (38% of parents didn't set parental control on the devices). Overall, 78.3% of the sample showed a moderate to severe misuse and 38.3% a moderate to severe addiction to mobile phones.

Conclusions

The uncontrolled and unconscious use of smartphones among adolescents exposes to different health risks including psycho-social and cognitive-relational problems. Results obtained demonstrate high levels of misuse and addiction to mobile devices in a representative sample of students in a developed Country, suggesting the need to implement educational interventions and the development of guidelines to encourage a responsible use of smartphones.

Key messages

The present study highlights an uncontrolled and unconscious use of mobile phones among 11-15 years old aged students in Southern Italy. The implementation of educational intervention at school and the development of guidelines regulating smartphone usage among adolescents, should represent a future global health priority.
To document Pneumonia case management practices in selected communities of Pakistan
Authors: Mahmood H , Kiani H R , Sheraz S Y , Nair H , Worth A , Campbell H , Sheikh A , Hazir T
Published: October 2020

Introduction

The cornerstone of ARI control programs is standardized case management. According to this strategy thousands of healthcare providers have been trained in Pakistan. Given unchanged mortality statistics, there is a concern that these pieces of training have not been able to deliver the outcome.

Purpose of Study

To document current under-five pneumonia case management practices at the community level, first level care facility (FLCF) and specialist level across Pakistan.

Methodology

32 structured; disguised observations were done using an observation tool based on standard WHO pneumonia case management guidelines from each of four administrative units and the federal capital of Pakistan across the LHW level, FLCF and tertiary level. Thus, a total of 160 observations were made.

Results

At the community level, 100% LHW's did not ask for danger signs & did not expose the chest, 98% misdiagnosed pneumonia and100% prescribed antibiotics to irrespective of diagnosis. At FLCF 0.6% inquired about danger signs, 98% did not expose the chest, 80% did not use WHO classification for diagnosing pneumonia and 100% prescribed antibiotics irrespective of diagnosis. At GP's and specialist level in the private sector, 28 % inquired about at least one danger sign, 82% exposed chest, 58% did not use WHO classification for diagnosis, and 17% wrongly prescribed antibiotics. Whereas in public sector, 7% inquired about at least one danger sign, 78% exposed chest, 64% did not use WHO classification for diagnosis and 28% wrongly prescribed antibiotics.

Acknowledgment of Funding

This research was commissioned by the National Institute of Health Research using Official Development Assistance (ODA) funding. The views expressed in this publication are those of the author(s) and not necessarily those of NHS, the National Institute of Health Research, or the development of Health.

Key messages

Standard pneumonia case management guidelines are not been followed at any level of healthcare systems in Pakistan. Pneumonia case management strategies need to be revised to manage the disease.
Are women satisfied with their experience with breast cancer screening? Systematic review of the literature
Authors: Pagliarin Federica , Pylkkanen Liisa , Salakari Minna , Deandrea Silvia
Published: October 2020

Background

The evaluation of participant experience is an essential part of monitoring the quality of breast cancer screening services. Satisfaction of services can lead to good adherence and hence affect health outcomes.

Methods

We performed a systematic review to assess how satisfied women were with organized breast cancer screening programs. A literature search in Medline, CINAHL, Embase and PsycINFO from 1965 to October 2019 was performed. Articles reporting a quantitative measure of satisfaction collected via questionnaires in programs using mammography as a screening test were selected. We narratively synthesized the data and used tabulated summaries.

Results

Out of 4310 individual citations, 3099 abstracts were reviewed by two independent researchers, and 126 articles were selected for full-text reading. Finally, 48 studies, published between 1990 and 2018, were included in analysis, reporting 54 surveys in the context of an organized screening program, 37 on satisfaction with screening mammography, 14 on satisfaction with further assessments and 3 with counseling. Most studies reported a high level of satisfaction for both mammography and further assessments. Despite commonly reported temporary pain, discomfort and anxiety, the willingness to be re-screened was very high. Effective information transfer, the staff's interpersonal skills and quick delivery of results correlated with high satisfaction. Only 7 out of 54 surveys used recognized satisfaction instruments or their modifications.

Conclusions

In general, satisfaction with breast cancer screening is high, but its evaluation is mainly performed using non-validated instruments. Emphasis should be put on effective communication, the staff´s interpersonal skills and quick delivery of results.
Soil structure, nutrient status and water holding capacity shape Uruguayan grassland prokaryotic communities
Authors: Garaycochea Silvia , Romero Héctor , Beyhaut Elena , Neal Andrew L , Altier Nora
Published: October 2020

Soil microbial communities play critical roles in maintaining natural ecosystems such as the Campos biome grasslands of southern South America. These grasslands are characterized by a high diversity of soils, low available phosphorus (P) and limited water holding capacity. This work aimed to describe prokaryotic communities associated with different soil types and to examine the relationship among these soil communities, the parent material and the soil nutrient status. Five Uruguayan soils with different parent material and nutrient status, under natural grasslands, were compared. The structure and diversity of prokaryotic communities were characterized by sequencing 16S rRNA gene amplicons. Proteobacteria, Actinobacteria, Firmicutes,Verrucomicrobia, Acidobacteria, Planctomycetes and Chloroflexi were the predominant phyla. Ordination based on several distance measures was able to discriminate clearly between communities associated with different soil types. Edge-PCA phylogeny-sensitive ordination and differential relative abundance analyses identified Archaea and the bacterial phyla Firmicutes, Acidobacteria, Actinobacteria and Verrucomicrobia as those with significant differences among soil types. Canonical analysis of principal coordinates identified porosity, clay content, available P, soil organic carbon and water holding capacity as the main variables contributing to determine the characteristic prokaryotic communities of each soil type.
Teachers’ professional identities in the context of school-based sexuality education in Uganda—a qualitative study
Authors: de Haas Billie , Hutter Inge
Published: October 2020

School-based sexuality education makes teachers important gatekeepers of students’ access to information about sexual and reproductive health and rights. The school setting has the potential to reach large numbers of students. However, teachers’ professional identities may go beyond, differ from or even conflict with the qualities required of sexuality educators. To gain a better understanding of the role of professional identity in the delivery of school-based sexuality education, this study used cultural schema theory to study teachers’ professional identities, and how these motivate them to provide sexuality education. In-depth interviews were conducted with 40 sexuality education teachers at secondary schools in Kampala, the capital of Uganda. Sexuality education lessons were observed to validate the findings from the interviews. Results identified five cultural schemas of professional identity: (i) upholder of ethics and regulations; (ii) authority figure; (iii) counsellor and guide; (iv) role model; and (v) guardian. The study concludes that teachers’ cultural schemas of professional identity motivate them to adhere to moral discourses of abstinence and sexual innocence. To support teachers in taking more comprehensive approaches to sexuality education, it is important that they receive adequate teacher training and support from the Ugandan government, the school administration and the wider community.
Public procurement in Big Science: politics or technology? The case of CERN
Authors: Bastianin Andrea , Del Bo Chiara F
Published: October 2020

Public procurement from Big Science Centers (BSCs) yields a variety of spillover effects that can ultimately have growth enhancing consequences for their Member States (MS). We study the determinants of procurement for the biggest research infrastructure ever built: the Large Hadron Collider (LHC) at CERN. A unique database of firms that have registered to become industrial partners of the LHC program allows us to estimate the determinants for potential suppliers of receiving an order from CERN. We compare the relative weight of firms’ technological features and CERN’s procurement rules aimed at securing a juste retour for its MS. Although in accordance to CERN’s procurement rules our results highlight the role of both technological factors and political constraints, we also show the existence of a premium toward Swiss and French firms. We document that the constraints related with the achievement of a juste retour affect—directly or indirectly—the procurement policy of many European BSCs and international bodies whose budget is financed by the public funds of their MS. Therefore, our results have policy implications that go beyond our empirical application.
Estimating the lifetime risk of dementia using nationwide individually linked cause-of-death and health register data
Authors: Klijs Bart , Mitratza Marianna , Harteloh Peter PM , Moll van Charante Eric P , Richard Edo , Nielen Markus MJ , Kunst Anton E
Published: October 2020

Background

Previous estimates of the lifetime risk of dementia are restricted to older age groups and may suffer from selection bias. In this study, we estimated the lifetime risk of dementia starting at birth using nationwide integral linked health register data.

Methods

We studied all deaths in The Netherlands in 2017 (n = 147 866). Dementia was assessed using the cause-of-death registration, individually linked with registers covering long-term care, specialized mental care, dispensed medicines, hospital discharges and claims, and primary care. The proportion of deaths with dementia was calculated for the total population and according to age at death and sex.

Results

According to all data sources combined, 24.0% of the population dies in the presence of dementia. This proportion is higher for females (29.4%) than for males (18.3%). Using multiple causes of death only, the proportion with dementia is 17.9%. Sequential addition of long-term care and hospital discharge data increased the estimate by 4.0 and 1.5%-points, respectively. Further addition of dispensed medicines, hospital claims and specialized mental care data added another 0.6%-points. Among persons who die at age ≤65–70 years, the proportion with dementia is ≤6.2%. After age 70, the proportion rises sharply, with a peak of 43.9% for females and 33.1% for males at age 90–95 years.

Conclusions

Around one-fourth of the Dutch population is diagnosed with dementia at some point in life and dies in the presence of dementia. It is a major challenge to arrange optimal care for this group.
Dynamics of Extensive Drug Resistance Evolution of Mycobacterium tuberculosis in a Single Patient During 9 Years of Disease and Treatment
Authors: Hjort Karin , Jurén Pontus , Toro Juan Carlos , Hoffner Sven , Andersson Dan I , Sandegren Linus
Published: October 2020

Mycobacterium tuberculosis is one of the hardest to treat bacterial pathogens with a high capacity to develop antibiotic resistance by mutations. Here we have performed whole-genome sequencing of consecutive M. tuberculosis isolates obtained during 9 years from a patient with pulmonary tuberculosis. The infecting strain was isoniazid resistant and during treatment it stepwise accumulated resistance mutations to 8 additional antibiotics. Heteroresistance was common and subpopulations with up to 3 different resistance mutations to the same drug coexisted. Sweeps of different resistant clones dominated the population at different time points, always coupled to resistance mutations coinciding with changes in the treatment regimens. Resistance mutations were predominant and no hitch-hiking, compensatory, or virulence-increasing mutations were detected, showing that the dominant selection pressure was antibiotic treatment. The results highlight the dynamic nature of M. tuberculosis infection, population structure, and resistance evolution and the importance of rapid antibiotic susceptibility tests to battle this pathogen.
Selective expression of claudin-5 in thymic endothelial cells regulates the blood–thymus barrier and T-cell export
Authors: Nagatake Takahiro , Zhao Yan-Chun , Ito Takeshi , Itoh Masahiko , Kometani Kohei , Furuse Mikio , Saika Azusa , Node Eri , Kunisawa Jun , Minato Nagahiro , Hamazaki Yoko
Published: October 2020

T-cell development depends on the thymic microenvironment, in which endothelial cells (ECs) play a vital role. Interestingly, vascular permeability of the thymic cortex is lower than in other organs, suggesting the existence of a blood–thymus barrier (BTB). On the other hand, blood-borne molecules and dendritic cells bearing self-antigens are accessible to the medulla, facilitating central tolerance induction, and continuous T-precursor immigration and mature thymocyte egress occur through the vessels at the cortico-medullary junction (CMJ). We found that claudin-5 (Cld5), a membrane protein of tight junctions, was expressed in essentially all ECs of the cortical vasculatures, whereas approximately half of the ECs of the medulla and CMJ lacked Cld5 expression. An intravenously (i.v.) injected biotin tracer hardly penetrated cortical Cld5+ vessels, but it leaked into the medullary parenchyma through Cld5– vessels. Cld5 expression in an EC cell line caused a remarkable increase in trans-endothelial resistance in vitro, and the biotin tracer leaked from the cortical vasculatures in Cldn5–/– mice. Furthermore, i.v.-injected sphingosine-1 phosphate distributed selectively into the medulla through the Cld5– vessels, probably ensuring the egress of CD3high mature thymocytes from Cld5– vessels at the CMJ. These results suggest that distinct Cld5 expression profiles in the cortex and medulla may control the BTB and the T-cell gateway to blood circulation, respectively.
IS26-mediated amplification of blaOXA-1 and blaCTX-M-15 with concurrent outer membrane porin disruption associated with de novo carbapenem resistance in a recurrent bacteraemia cohort
Authors: Shropshire William C , Aitken Samuel L , Pifer Reed , Kim Jiwoong , Bhatti Micah M , Li Xiqi , Kalia Awdhesh , Galloway-Peña Jessica , Sahasrabhojane Pranoti , Arias Cesar A , Greenberg David E , Hanson Blake M , Shelburne Samuel A
Published: October 2020

Background

Approximately half of clinical carbapenem-resistant Enterobacterales (CRE) isolates lack carbapenem-hydrolysing enzymes and develop carbapenem resistance through alternative mechanisms.

Objectives

To elucidate development of carbapenem resistance mechanisms from clonal, recurrent ESBL-positive Enterobacterales (ESBL-E) bacteraemia isolates in a vulnerable patient population.

Methods

This study investigated a cohort of ESBL-E bacteraemia cases in Houston, TX, USA. Oxford Nanopore Technologies long-read and Illumina short-read sequencing data were used for comparative genomic analysis. Serial passaging experiments were performed on a set of clinical ST131 Escherichia coli isolates to recapitulate in vivo observations. Quantitative PCR (qPCR) and qRT–PCR were used to determine copy number and transcript levels of β-lactamase genes, respectively.

Results

Non-carbapenemase-producing CRE (non-CP-CRE) clinical isolates emerged from an ESBL-E background through a concurrence of primarily IS26-mediated amplifications of blaOXA-1 and blaCTX-M-1 group genes coupled with porin inactivation. The discrete, modular translocatable units (TUs) that carried and amplified β-lactamase genes mobilized intracellularly from a chromosomal, IS26-bound transposon and inserted within porin genes, thereby increasing β-lactamase gene copy number and inactivating porins concurrently. The carbapenem resistance phenotype and TU-mediated β-lactamase gene amplification were recapitulated by passaging a clinical ESBL-E isolate in the presence of ertapenem. Clinical non-CP-CRE isolates had stable carbapenem resistance phenotypes in the absence of ertapenem exposure.

Conclusions

These data demonstrate IS26-mediated mechanisms underlying β-lactamase gene amplification with concurrent outer membrane porin disruption driving emergence of clinical non-CP-CRE. Furthermore, these amplifications were stable in the absence of antimicrobial pressure. Long-read sequencing can be utilized to identify unique mobile genetic element mechanisms that drive antimicrobial resistance.
Characterizing the Transport of Aluminum-, Silicon- and Titanium-Containing Particles and Nanoparticles in Mainstream Tobacco Smoke
Authors: Fresquez Mark R , Watson Clifford H , Valentin-Blasini Liza , Steven Pappas R
Published: October 2020

The most commonly observed forms of aluminum, silicon and titanium in tobacco products are aluminum silicates (e.g., kaolin), silica and titanium(IV) oxide. These compounds are neither water soluble nor volatile at cigarette combustion temperatures. Rather, they are transported in mainstream tobacco smoke as particles after being freed by combustion from the tobacco filler and can induce pulmonary inflammation when inhaled. Aluminum silicate particles are the most frequently observed particles in the pulmonary macrophages of smokers and have become known as ‘smokers’ inclusions’. A relatively new technique, single particle triple quadrupole inductively coupled plasma-mass spectrometry was used to analyze aluminum-, silicon- and titanium-containing particle deliveries in cigarette and little cigar mainstream tobacco smoke, and to collect information on solid inorganic particles. The mass concentration of aluminum-containing particles transmitted in mainstream smoke was low (0.89–0.56 ng/cigarette), which was not surprising because aluminum silicates are not volatile. Although the collective masses (ng/cigarette) of aluminum-, silicon- and titanium-containing particles under 100 nm diameter transported in mainstream smoke were low, an abundance of ‘ultrafine’ particles (particles < 100 nm or nanoparticles) was observed. Limitations of the particle background equivalent diameter (the smallest detectable particle size (MassHunter 4.5 Software) due to the environmentally ubiquitous silicon background restricted the determination of silica nanoparticles, but silica particles slightly below 200 nm diameter were consistently detected. Aluminum- and titanium-containing nanoparticles were observed in all cigarette and little cigar samples, with titanium(IV) oxide particle deliveries consistently fewer in number and smaller in diameter than the other two types of particles. The highest concentrations of aluminum-containing particles (as kaolin) were in the nanoparticle range with much lower concentrations extending to the larger particle sizes (>100 nm). The number and range of particle sizes determined in mainstream smoke is consistent with pulmonary deposition of aluminum silicates described by other researchers as contributing to the ‘smokers’ inclusions’ observed in pulmonary macrophages.
Exotic Haemaphysalis longicornis (Acari: Ixodidae) in the United States: Biology, Ecology, and Strategies for Management
Authors: Schappach Brittany L , Krell Rayda K , Hornbostel Victoria L , Connally Neeta P
Published: October 2020

The Asian longhorned tick (ALT), Haemaphysalis longicornis Neumann (Acari: Ixodidae), is a three-host tick that was first detected outside of United States Department of Agriculture (USDA) quarantine in Hunterdon County, New Jersey, in 2017 and subsequently found in another 14 states. In its native Asia, and where it has become established in Australia and New Zealand, ALTs feed on a variety of hosts and are economically important livestock pests and competent vectors of multiple pathogens to humans and other animals. The degree to which ALT will become a persistent livestock pest or competent vector for introduced or existing pathogens in the United States is yet unclear. Because of its vast host availability, ability to reproduce asexually, known vector competence, and the presence of multiple life stages on hosts, the expansion of ALT establishment in the United States is expected, and is a significant public health and veterinary concern. In this paper, we discuss the biology, geographical distribution, life cycle and seasonal activity, reproduction, identification, medical and veterinary implications, management options, and future concerns in the United States.
Improving the depth resolution of STEM-ADF sectioning by 3D deconvolution
Authors: Ishizuka A , Ishizuka K , Ishikawa R , Shibata N , Ikuhara Y , Hashiguchi H , Sagawa R
Published: October 2020

Although the possibility of locating single atom in three dimensions using the scanning transmission electron microscope (STEM) has been discussed with the advent of aberration correction technology, it is still a big challenge. In this report we have developed deconvolution routines based on maximum entropy method (MEM) and Richardson–Lucy algorithm (RLA), which are applicable to the STEM-annular dark-field (ADF) though-focus images to improve the depth resolution. The new three-dimensional (3D) deconvolution routines require a limited defocus-range of STEM-ADF images that covers a whole sample and some vacuum regions. Since the STEM-ADF probe is infinitely elongated along the optical axis, a 3D convolution is performed with a two-dimensional (2D) convolution over xy-plane using the 2D fast Fourier transform in reciprocal space, and a one-dimensional convolution along the z-direction in real space.

Using our new deconvolution routines, we have processed simulated focal series of STEM-ADF images for single Ce dopants embedded in wurtzite-type AlN. Applying the MEM, the Ce peaks are clearly localized along the depth, and the peak width is reduced down to almost one half. We also applied the new deconvolution routines to experimental focal series of STEM-ADF images of a monolayer graphene. The RLA gives smooth and high-P/B ratio scattering distribution, and the graphene layer can be easily detected. Using our deconvolution algorithms, we can determine the depth locations of the heavy dopants and the graphene layer within the precision of 0.1 and 0.2 nm, respectively. Thus, the deconvolution must be extremely useful for the optical sectioning with 3D STEM-ADF images.