bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes
Authors: Larson Riley J. , Philbrick Ann M. , Carlin Caroline S. , Harris Ila M.
Published: August 2023

Objective: To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). Research Design and Methods: A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An “index date” was identified as the start of CGM. The closest hemoglobin A1c (A1c) 6 months or more after the index date was identified as the “follow-up date.” The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. Results: Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference −1.4%; p < 0.001), with 41.7% of the population meeting goal (mean difference +25%; p < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. Conclusion: A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.
International study of treatment efficacy in SS shows superiority of combination therapy and heterogeneity of treatment strategies
Authors: Campbell Belinda A. , Dobos Gabor , Haider Zahra , Prince H. Miles , Bagot Martine , Evison Felicity , van der Weyden Carrie , McCormack Chris , Ram-Wolff Caroline , Miladi Maryam , Scarisbrick Julia J
Published: August 2023

Despite increasing availability of therapies, patients with Sezary syndrome (SS) commonly endure multi-line treatment journeys, mostly with partial responses of short duration. Measuring clinical benefit is challenging; time-to-next-treatment (TTNT) provides a robust, objective measurement of efficacy. This international observational study examines patterns of clinical care and therapeutic benefit as measured by TTNT. TTNT was calculated for monotherapies and combination therapies, with consideration to treatment line. 178 patients with SS (73% de novo, 27% secondary) were included, receiving 721 lines of systemic therapy, with median follow-up of 56.9 months. Across all lines, 58 different therapeutic regimens were prescribed (54 were systemic therapies) and classified into 17 treatment groups. The most common first-line treatments were extracorporeal photopheresis (ECP)–containing combination therapy (20%) and retinoid monotherapy (19%). Median TTNT for all first-line therapies was short (5.4 months). First-line, combination therapies had longer median TTNT than monotherapies, 10.0 vs 5.0 months (P = .004), respectively. Later delivery of combination therapies was associated with shorter clinical benefit, with median TTNT reduced to 6.2 and 2.2 months for mid-line (2nd-4th line) and late-line (≥5th line), respectively (P < .001). First-line ECP-containing treatments were associated with longer median TTNT than non-ECP–containing treatments, 9.0 vs 4.9 months (P = .007). For both ECP-monotherapy and ECP–containing combination therapy, significant reductions in TTNT were seen in later lines. These data suggest therapeutic benefit from first-line delivery of combination therapy for SS and favor early inclusion of ECP in the treatment algorithm for those who can access it.
Investigation of SNP markers for the melatonin production trait in the Hu sheep with bulked segregant analysis
Authors: Wu Hao , Ma Wenkui , Yan Laiqing , Liu Fenze , Xu Shang , Ji Pengyun , Gao Shuai , Zhang Lu , Liu Guoshi
Published: August 2023

Background

As an important reproductive hormone, melatonin plays an important role in regulating the reproductive activities of sheep and other mammals. Hu sheep is a breed favoring for meat, with prolific traits. In order to explore the relationship between melatonin and reproductive function of Hu sheep, 7,694,759 SNPs were screened out through the whole genome sequencing analysis from high and low melatonin production Hu sheep.

Results

A total of 68,673 SNPs, involving in 1126 genes, were identified by ED association analysis. Correlation analysis of SNPs of AANAT/ASMT gene and MTNR1A/MTNR1B gene were carried out. The melatonin level of CG genotype 7,981,372 of AANAT, GA genotype 7,981,866 of ASMT and GG genotype 17,355,171 of MTNR1A were higher than the average melatonin level of 1.64 ng/mL. High melatonin Hu sheep appear to have better multiple reproductive performance.

Conclusions

By using different methods, three SNPs which are associated with high melatonin production trait have been identified in Hu sheep. These 3 SNPs are located in melatonin synthetase AANAT/ASMT and receptor MTNR1A, respectively. Considering the positive association between melatonin production and reproductive performance in ruminants, these three SNPs can be served as the potential molecular markers for breading Hu sheep with the desirable reproductive traits.
Metagenomic and culture-dependent approaches unveil active microbial community and novel functional genes involved in arsenic mobilization and detoxification in groundwater
Authors: Diba Farzana , Hoque M. Nazmul , Rahman M. Shaminur , Haque Farhana , Rahman Khondaker Md. Jaminur , Moniruzzaman Md. , Khan Mala , Hossain M. Anwar , Sultana Munawar
Published: August 2023

Background

Arsenic (As) and its species are major pollutants in ecological bodied including groundwater in Bangladesh rendering serious public health concern. Bacteria with arsenotrophic genes have been found in the aquifer, converting toxic arsenite [As (III)] to less toxic arsenate [As (V)] that is easily removed using chemical and biological trappers. In this study, genomic and metagenomic approaches parallel to culture-based assay (Graphical abstract) have made it possible to decipher phylogenetic diversity of groundwater arsenotrophic microbiomes along with elucidation of their genetic determinants.

Results

Seventy-two isolates were retrieved from six As-contaminated (average As concentration of 0.23 mg/L) groundwater samples from Munshiganj and Chandpur districts of Bangladesh. Twenty-three isolates harbored arsenite efflux pump (arsB) gene with high abundance, and ten isolates possessing arsenite oxidase (aioA) gene, with a wide range of minimum inhibitory concentration, MICAs (2 to 32 mM), confirming their role in arsenite metabolism. There was considerable heterogeneity in species richness and microbial community structure. Microbial taxa from Proteobacteria, Firmicutes and Acidobacteria dominated these diversities. Through these combinatorial approaches, we have identified potential candidates such as, Pseudomonas, Acinetobacter, Stenotrophomonas, Achromobacter, Paraburkholderia, Comamonas and Klebsiella and associated functional genes (arsB, acr3, arsD, arsH, arsR) that could significantly contribute to arsenite detoxification, accumulation, and immobilization.

Conclusions

Culture-dependent and -independent shotgun metagenomic investigation elucidated arsenotrophic microbiomes and their functions in As biogeochemical transformation. These findings laid a foundation for further large-scale researches on the arsenotrophic microbiomes and their concurrent functions in As biogeochemical transformation in As-contaminated areas of Bangladesh and beyond.
Psychological distress and health perception in patients with a previous myocardial infarction or stroke: a national cross-sectional study
Authors: Narendrula Aparna , Ajani Kiran , Lang Jacob , Brinza Ellen , Longenecker Chris T
Published: August 2023

Background

While understanding the impact of mental health on health perception improves patient-centered care, this relationship is not well-established in patients with cardiovascular disease (CVD). We examined the relationship between psychological distress and health perception in patients with a previous myocardial infarction (MI) and/or stroke.

Methods

We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported. Presence and severity of anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8). Binary analyses of anxiety/depression, multivariable logistic regressions controlling for confounders, and univariable analyses of confounders and anxiety/depression severity were performed.

Results

Of 31,948 individuals for whom data on MI/stroke was available, 1235 reported a previous MI and 1203 a previous stroke. The odds of positive perceived health status were lower for individuals with anxiety/depression compared to those without anxiety/depression in both post-MI (anxiety OR 0.52, 95% CI = 0.32–0.85, P < 0.001; depression OR 0.45, 95% CI = 0.29–0.7, P < 0.001) and post-stroke groups (anxiety OR 0.61, 95% CI = 0.39–0.97, P < 0.001; depression OR 0.37, 95% CI = 0.25–0.55, P < 0.001) upon multivariable analyses. Increasing severity of anxiety/depression was also associated with worse perception of health status upon univariable analysis.

Conclusion

Among patients with a previous acute CVD event, those with psychological distress have worse perception of their health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care and encourage patient behaviors that may improve both CVD and mental health outcomes.
Designs used in published therapeutic studies of rare superficial vascular anomalies: a systematic literature search
Authors: Allemang-Trivalle Aude , Leducq Sophie , Maruani Annabel , Giraudeau Bruno
Published: August 2023

Background

Rare superficial vascular anomalies represent a wide range of diseases. Their management is difficult given the broad spectrum and the lack of clinical trials assessing treatment efficacy. A randomized clinical trial of vascular anomalies is difficult because of the rarity of the diseases and is enhanced by the population of interest often being children. Therefore, suitable designs are needed. We conducted a methodological systematic literature search to identify designs implemented for investigating the treatment of rare superficial vascular anomalies.

Methods

We conducted a literature search on January 25, 2021, of the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov and European Union Clinical Trials Register databases. This systematic methodological literature search was registered at the Prospective Register of Systematic Reviews (PROSPERO: CRD42021232449). Randomized and non-randomized studies were included if they met the following criteria: were prospective studies of rare superficial vascular anomaly therapies, dealt with humans (adults and children) and were published in English from 2000. We excluded case reports/case series reporting fewer than 10 patients, reviews, retrospective studies, animal studies, studies of systemic or common vascular anomalies and non-therapeutic studies. We did not assess risk of bias in the included studies because our review was a methodological one focused on the design used. The review provided a descriptive analysis of relevant features of eligible research studies.

Results

From 2046 articles identified, we included 97 studies (62 reports and 35 ongoing studies): 25 randomized controlled studies, 7 non-randomized comparative studies, 64 prospective cohorts and 1 case series. Among the 32 comparative studies included, 21 used a parallel-group design. The 11 other studies used different designs such as cross-over, randomized placebo phase, delayed-start, within-person, or challenge–dechallenge–rechallenge or used a historical control group or an observational run-in period.

Conclusions

Our systematic literature search highlights the lack of randomized control trials in superficial vascular anomalies due to the rarity of patients and their heterogeneity. New designs are emerging and can overcome the limitations of testing treatments in parallel groups.
Virtual reality exergame in older patients with hypertension: a preliminary study to determine load intensity and blood pressure
Authors: Vorwerg-Gall Susan , Stamm Oskar , Haink Michele
Published: August 2023

Background

Lifestyle changes and physical activity can make an important contribution to reducing the risk factor for high blood pressure (BP). Whether virtual reality (VR) exergames are also appropriate and make a positive contribution to the reduction of BP has not yet been sufficiently investigated. Therefore, the aim of the study was to gain knowledge of the load intensities to be achieved during a VR exergame and to examine the short-term effects on BP.

Methods

For the preliminary study, 22 participants with hypertension over the age of 65 years were analyzed. The study took place in a mobile laboratory truck. All participants visited on two occasions. During visit 1, VR strength endurance training (VR-SET) and during visit 2, VR endurance training (VR-ET) was performed. Each VR session lasted approximately 25 min and was of a moderate intensity. Heart rate (HR) was measured across the entire session, as well as BP before and after the VR exergame. The Rating of Perceived Exertion (RPE) and task load using NASA Task Load Index were determined after each VR session. Included in the statistical analysis were the Shapiro–Wilk test, the paired t-test, the Wilcoxon test and ANOVA for repeated measures.

Results

During the “main part” (p < .001), at the “end” (p = .002) and for the “maximum HR” (p < .001), significant load differences between both VR sessions could be determined. In addition, significantly more participants in the VR-SET group achieved a moderate load intensity of at least 40% of heart rate reserve (p = .014). Regarding RPE, participants rated their subjectively perceived exertion significantly higher in the VR-SET than in the VR-ET (p = .028). Systolic BP decreased significantly in both VR sessions when compared before VR session and 5 min after VR session (p = .015; p = .003), as well as before VR session and 10 min after VR session (p = .018; p < .001).

Conclusions

An individual moderate load intensity of 40% can be reached during VR-SET. In addition, a positive short-term effect of the VR exergame on BP behavior (postexercise hypotension) was observed after both VR sessions. The preliminary results indicate that a VR exergaming could lead to blood pressure lowering effects for older people with hypertension.

Trial registration

The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00022881, 07/09/2020, https://drks.de/search/de/trial/DRKS00022881).
Serologic evolution and follow-up to IgG antibodies of infants born to mothers with gestational COVID
Authors: Vigil-Vázquez Sara , Manzanares Ángela , Hernanz-Lobo Alicia , Carrasco-García Itziar , Zamora del Pozo Clara , Pérez-Pérez Alba , Rincón-López Elena María , Santiago-García Begoña , Pintado-Recarte María del Pilar , Alonso-Fernández Roberto , Sánchez-Luna Manuel , Navarro-Gómez María Luisa
Published: August 2023

Background

It is known that SARS-CoV-2 antibodies from pregnant women with SARS-CoV-2 infection during pregnancy cross the placenta but the duration and the protective effect of these antibodies in infants is scarce.

Methods

This prospective study included mothers with SARS-COV-2 infection during pregnancy and their infants from April 2020 to March 2021. IgG antibodies to SARS-CoV-2 spike protein were performed on women and infants at birth and at two and six months during follow-up. Anthropometrical measures and physical and neurological examinations and a clinical history of symptoms and COVID-19 diagnosis were collected. Simple linear regression was performed to compare categorical and continuous variables. To compare the mother’s and infant’s antibody titers evolution, a mixed linear regression model was used. A predictive model of newborn antibody titers at birth has been established by means of simple stepwise linear regression.

Results

51 mother-infant couples were included. 45 (90%) of the mothers and 44 (86.3%) of the newborns had a positive serology al birth. These antibodies were progressively decreasing and were positive in 34 (66.7%) and 7 (13.7%) of infants at 2 and 6 months, respectively. IgG titers of newborns at birth were related to mothers’ titers, with a positive moderate correlation (Pearson’s correlation coefficient: 0.82, p < 0,001). Fetal/maternal antibodies placental transference rate was 1.3 (IQR: 0.7–2.2). The maternal IgG titers at delivery and the type of maternal infection (acute, recent, or past infection) was significantly related with infants’ antibody titers at birth. No other epidemiological or clinical factors were related to antibodies titers. Neurodevelopment, psychomotor development, and growth were normal in 94.2% of infants in the third follow-up visit. No infants had a COVID-19 diagnosis during the follow-up period.

Conclusions

Transplacental transfer of maternal antibodies is high in newborns from mothers with recent or past infection at delivery, but these antibodies decrease after the first months of life. Infant’s IgG titers were related to maternal IgG titers at delivery. Further studies are needed to learn about the protective role of maternal antibodies in infants.
Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 – an analysis of Tamil Nadu and Chhattisgarh
Authors: Neethi Mohan Varshini , Shirisha P , Vaidyanathan Girija , Muraleedharan V R
Published: August 2023

Background

The prevalence of C-sections in India increased from 17.2% in 2016 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG).

Methods

Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions.

Results

The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95–2.29; NFHS-5) those for underweight women. Women aged 35–49 were also twice (OR = 2.10; 95% CI 1.92–2.29; NFHS-5) as likely as those aged 15–24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74–4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor.

Conclusion

The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.
Association of TP53 rs1042522 G > C, MDM2 rs2279744 T > G, and miR-34b/c rs4938723 T > C polymorphisms with aneuploidy pregnancy susceptibility
Authors: Chan Ying , Xu Weiming , Feng Yan , Zhang Yan , Li Suyun , Geng Zibiao , Liu Zhijiao , Zhao Qingfen , Zhang Jinman , Zhu Baosheng
Published: August 2023

Background

Aneuploidy pregnancy is a severe major birth defect and causes about 50% spontaneous miscarriages with unknown etiology. To date, only a few epidemiological studies with small sample sizes have investigated the risk factors for aneuploidy pregnancy. TP53, MDM2, and miR-34b/c genes are implicated in tumorigenesis with aneuploidy, yet the function of their polymorphisms in aneuploidy pregnancy susceptibility needs to be clarified.

Objective

To elucidate the association of TP53 rs1042522 G > C, MDM2 rs2279744 309 T > G, and miR-34b/c rs4938723 T > C specific polymorphisms with aneuploidy pregnancy.

Methods

In the retrospective case-control study, 330 aneuploidies pregnancy women and 813 normal pregnancy controls were recruited between January 2018 and April 2022 at the First People’s Hospital of Yunnan Province, Kunming, China. Three functional polymorphisms, the TP53 rs1042522 G > C (Arg72Pro), MDM2 rs2279744 309 T > G, and miR-34b/c rs4938723 T > C, were genotyped using the snapshot method.

Results

The frequency distribution of three genotypic variants was not different between case and control pregnant women and was similar to with Hardy-Weinberg Equilibrium (HWE). However, in the younger subgroup (less than 35 years old), a significant difference was detected in allele and recessive model (p = 0.01). In the advanced age subgroup (more than or equal to 35 years old), G of MDM2 rs2279744 T > G revealed a significantly higher frequency in cases than controls (p = 0.045), and miR-34b/c rs4938723 T > C revealed a significant difference under the dominant model (p = 0.03), but no significant differences were observed in other models and in both younger and older subgroup (p > 0.05, respectively). These results suggest that individual polymorphisms were not associated with aneuploidy pregnancy, combined with age, they may serve as a risk factor for aneuploidy pregnancy.

Conclusion

Combination of TP53 rs1042522 G > C, MDM2 rs2279744 T > G, and miR-34b/c rs4938723 T > C polymorphisms with maternal age may be related to aneuploidy pregnancy susceptibility. These findings might elaborate on the genetic etiology of aneuploidy pregnancy.
Impact of childhood maltreatment on adult resilience
Authors: Li Chao , Lv Guanyi , Liu Bangshan , Ju Yumeng , Wang Mi , Dong Qiangli , Sun Jinrong , Lu Xiaowen , Zhang Liang , Wan Ping , Guo Hua , Zhao Futao , Liao Mei , Zhang Yan , Li Lingjiang , Liu Jin
Published: August 2023

Background

Previous studies suggested that childhood maltreatment is associated with poor health outcomes. While not everyone who experiences abuse as a child goes on to experience poor mental health, some traumatized people are grown to be more resilient than others. Few studies have examined the association between childhood maltreatment and adult resilience. This study aimed to determine different relationships between specific types and features of childhood maltreatment with adult resilience among Chinese with Major Depressive Disorder (MDD) and healthy controls (HCs).

Methods

A total of 101 patients with MDD and 116 participants in the healthy control (HC) group from Zhumadian Psychiatric Hospital and its nearby communities were included in this analysis. Childhood maltreatment was assessed retrospectively using Childhood Trauma Questionnaire (CTQ). Adults’ resilience was assessed by the Connor-Davidson Resilience Scale (CD-RISC). Generalized linear models were applied between childhood maltreatment (specific types and features) and resilience adjusting for covariates.

Results

The total score of CD-RISC and factor scores of strength, optimism, and tenacity in the HC group were higher than those in the MDD group. CTQ total score had a negative association with optimism score among participants in MDD (β=-0.087, P < 0.001) and HC (β=-0.074, P = 0.023) groups. Higher emotional neglect (EN) score (β=-0.169, P = 0.001) and physical neglect (PN) score (β=-0.153, P = 0.043) were related to a worse optimism score in MDD group. Emotional abuse (EA) score was associated with a worse tenacity score (β=-0.674, P = 0.031) in MDD group. For participants in HC group, higher EN and PN scores were related to worse resilience scores (tenacity, strength, and optimism).

Conclusions

Patients with MDD showed lower optimism than HCs. Childhood maltreatment, especially childhood negect, independently contributed to optimism, with more severe childhood maltreatment predictive of worse performance of optimism. EA in childhood was also linked to worse tenacity in adult patients with MDD.
Fighting the infodemic: the 4 i Framework for Advancing Communication and Trust
Authors: Sundelson Anne E. , Jamison Amelia M. , Huhn Noelle , Pasquino Sarah-Louise , Sell Tara Kirk
Published: August 2023

Background

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

Methods

A multi-pronged search strategy was used to identify tools and approaches for combatting health-related misinformation and disinformation. The search strategy included a scoping review of academic literature; a review of gray literature from organizations involved in public health communications and misinformation/disinformation management; and a review of policies and infodemic management approaches from all U.S. state health departments and select local health departments. A team of annotators labelled the main feature(s) of each tool or approach using an iteratively developed list of tags.

Results

We identified over 350 infodemic management tools and approaches. We introduce the 4 i Framework for Advancing Communication and Trust (4 i FACT), a modified social-ecological model, to characterize different levels of infodemic intervention: informational, individual, interpersonal, and institutional. Information-level strategies included those designed to amplify factual information, fill information voids, debunk false information, track circulating information, and verify, detect, or rate the credibility of information. Individual-level strategies included those designed to enhance information literacy and prebunking/inoculation tools. Strategies at the interpersonal/community level included resources for public health communicators and community engagement approaches. Institutional and structural approaches included resources for journalists and fact checkers, tools for managing academic/scientific literature, resources for infodemic researchers/research, resources for infodemic managers, social media regulation, and policy/legislation.

Conclusions

The 4 i FACT provides a useful way to characterize the current ecosystem of infodemic management strategies. Recognizing the complex and multifaceted nature of the ongoing infodemic, efforts should be taken to utilize and integrate strategies across all four levels of the modified social-ecological model.
Association between serum uric acid, hyperuricemia and periodontitis: a cross-sectional study using NHANES data
Authors: Xu Jing , Jia Yifan , Mao Zhi , Wei Xiaoxi , Qiu Tianyuan , Hu Min
Published: August 2023

Objectives

Diabetes and other metabolic diseases have been linked to the development of periodontitis, but little research has been done to determine whether serum uric acid (SUA) levels and hyperuricemia play a role. This study aimed to investigate the relationship between SUA, hyperuricemia, and periodontitis.

Methods

Using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014, we created a nationally representative data set. We used multivariable logistic regression models to assess the relationship between SUA, hyperuricemia, and periodontitis and presented odds ratios (OR) in women and men, respectively.

Results

In women, adjusted multivariable regression models showed that SUA (4.1–4.3mg/dl) was associated with higher odds of periodontitis (OR = 1.43; 95% confidence interval (CI):1.0 ~ 2.03, p = 0.047) with SUA (≤ 3.3mg/dl) as reference. The risk of periodontitis tended to increase slightly but insignificantly with increasing SUA levels, and the adverse effects occurred only when SUA increased to a certain level, and then reached a plateau. In men, the adjusted OR values for SUA (4.9–5.2mg/dl), SUA (5.3–5.5mg/dl), SUA (5.9–6.2mg/dl), and SUA (6.3–6.5mg/dl) were 0.66 (95% CI: 0.45 ~ 0.96, p = 0.029), 0.58 (95% CI: 0.40 ~ 0.85, p = 0.006), 0.67(95% CI: 0.47 ~ 0.97, p = 0.035), and 0.67 (95% CI: 0.45 ~ 0.99, p = 0.043), respectively, with SUA (≤ 4.3mg/dl) as reference. The elevated SUA levels are protective against periodontitis, but there is a range within which the risk of periodontitis decreases, followed by a non-significant tendency to increase.

Conclusions

The levels of SUA that are linked to the risk of periodontitis. Future prospective longitudinal studies and strategies are required to further confirm whether controlled SUA treatment is an effective adjunct to systematic periodontal therapy and whether SUA can be used as a diagnostic biomarker to assess the risk or progression of periodontitis.
Updating mortality risk estimation in intensive care units from high-dimensional electronic health records with incomplete data
Authors: Bouvarel Bertrand , Carrat Fabrice , Lapidus Nathanael
Published: August 2023

Background

The risk of mortality in intensive care units (ICUs) is currently addressed by the implementation of scores using admission data. Their performances are satisfactory when complications occur early after admission; however, they may become irrelevant in the case of long hospital stays. In this study, we developed predictive models of short-term mortality in the ICU from longitudinal data.

Methods

Using data collected throughout patients’ stays of at least 48 h from the MIMIC-III database, several statistical learning approaches were compared, including deep neural networks and penalized regression. Missing data were handled using complete-case analysis or multiple imputation.

Results

Complete-case analyses from 19 predictors showed good discrimination (AUC > 0.77 for several approaches) to predict death between 12 and 24 h onward, yet excluded 75% of patients from the initial target cohort, as data was missing for some of the predictors. Multiple imputation allowed us to include 70 predictors and keep 95% of patients, with similar performances.

Conclusion

This proof-of-concept study supports that automated analysis of electronic health records can be of great interest throughout patients’ stays as a surveillance tool. Although this framework relies on a large set of predictors, it is robust to data imputation and may be effective early after admission, when data are still scarce.
Reasons for non-disclosure of HIV-Positive status to healthcare providers: a mixed methods study in Mozambique
Authors: Fuente-Soro Laura , Figueroa-Romero Antía , Fernández-Luis Sheila , Augusto Orvalho , López-Varela Elisa , Bernardo Edson , Saura-Lázaro Anna , Vaz Paula , Wei Stanley C. , Kerndt Peter R. , Nhampossa Tacilta , Naniche Denise
Published: August 2023

Background

Non-disclosure of known HIV status by people living with HIV but undergoing HIV testing leads to waste of HIV testing resources and distortion of estimates of HIV indicators. In Mozambique, an estimated one-third of persons who tested positive already knew their HIV-positive status. To our knowledge, this study is the first to assess the factors that prevent people living with HIV (PLHIV) from disclosing their HIV-positive status to healthcare providers during a provider-initiated counseling and testing (PICT) campaign.

Methods

This analysis was nested in a larger PICT cross-sectional study performed in the Manhiça District, Southern Mozambique from January to July 2019, in which healthcare providers actively asked patients about their HIV-status. Patients who tested positive for HIV were crosschecked with the hospital database to identify those who had previously tested positive and were currently or previously enrolled in care. PLHIV who did not disclose their HIV-positive status were invited to participate and provide consent, and were interviewed using a questionnaire designed to explore barriers, patterns of community/family disclosure, and stigma and discrimination.

Results

We found that 16.1% of participants who tested positive during a PICT session already knew their HIV-positive status but did not disclose it to the healthcare provider. All the participants reported previous mistreatment by general healthcare providers as a reason for nondisclosure during PICT. Other reasons included the desire to know if they were cured (33.3%) or to re-engage in care (23.5%). Among respondents, 83.9% reported having disclosed their HIV-status within their close community, 48.1% reported being victims of verbal or physical discrimination following their HIV diagnosis, and 46.7% reported that their HIV status affected their daily activities.

Conclusion

Previous mistreatment by healthcare workers was the main barrier to disclosing HIV-positive status. The high proportion of those disclosing their HIV status to their community but not to healthcare providers suggests that challenges with patient-provider relationships affect this care behavior rather than social stigma and discrimination. Improving patient-provider relationships could increase trust in healthcare providers, reduce non-disclosures, and help optimize resources and provide accurate estimates of the UNAIDS first 95 goal.
The Dutch Solid Start program: describing the implementation and experiences of the program's first thousand days
Authors: Molenaar Joyce M. , Boesveld Inge C. , Struijs Jeroen N. , Kiefte- de Jong Jessica C.
Published: August 2023

Background

In 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span from preconception to a child’s second birthday, and has a specific focus towards (future) parents and young children in vulnerable situations. A key program element is improving collaboration between the medical and social sector by creating Solid Start coalitions. This study aimed to describe the implementation of the Dutch Solid Start program, in order to learn for future practice and policy. Specifically, this paper describes to what extent Solid Start is implemented within municipalities and outlines stakeholders’ experiences with the implementation of Solid Start and the associated cross-sectoral collaboration.

Methods

Quantitative and qualitative data were collected from 2019 until 2021. Questionnaires were sent to all 352 Dutch municipalities and analyzed using descriptive statistics. Qualitative data were obtained through focus group discussions(n = 6) and semi-structured interviews(n = 19) with representatives of care and support organizations, knowledge institutes and professional associations, Solid Start project leaders, advisors, municipal officials, researchers, clients and experts-by-experience. Qualitative data were analyzed using the Rainbow Model of Integrated Care.

Results

Findings indicated progress in the development of Solid Start coalitions(n = 40 in 2019, n = 140 in 2021), and an increase in cross-sectoral collaboration. According to the stakeholders, initiating Solid Start increased the sense of urgency concerning the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on cross-sectoral care provision. Important elements mentioned for effective collaboration within coalitions were an active coordinator as driving force, and a shared societal goal. However, stakeholders experienced that Solid Start is not yet fully incorporated into all professionals’ everyday practice. Most common barriers for collaboration related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of ensuring Solid Start and mentioned various needs, including sustainable funding, supportive regulations, responsiveness to stakeholders’ needs, ongoing knowledge development, and client involvement.

Conclusion

Solid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration to improve care during the first thousand days, without major transformations of systemic structures. However, to ensure the program’s sustainability, needs such as sustainable funding should be addressed.
Cochlear implantation impact on health service utilisation and social outcomes: a systematic review
Authors: Bekele Okuba Tolesa , Lystad Reidar P. , Boisvert Isabelle , McMaugh Anne , Moore Robyn Cantle , Walsan Ramya , Mitchell Rebecca J.
Published: August 2023

Background

Hearing loss can have a negative impact on individuals’ health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults’ health service utilisation and social outcomes.

Methods

Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised.

Results

There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults’ health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias.

Conclusions

This review identified beneficial impacts of CI in improving adults’ health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.
Professional quality of life and its associated factors among Vietnamese doctors and nurses
Authors: Tran Anh N. P. , To Quyen G. , Huynh Van-Anh N. , Le Khoi M. , To Kien G.
Published: August 2023

Background

Prevalence of health workers with occupational health issues ranked fourth among all careers resulting in a reduction in quality of life. However, tools to measure professional quality of life (ProQoL) are unavailable in Vietnamese. This study aims to develop a Vietnamese version of the ProQoL, and examine ProQoL and its associated factors among doctors and nurses.

Methods

The ProQoL is comprised of 30 items measures compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). The tool was translated into Vietnamese following the Guideline by Guillemin et. al (1993), reviewed by expert panels, and validated for internal consistency and test-retest reliability among 38 health workers working at hospitals in HCMC. The validated tool was then used in a cross-sectional study to measure the ProQoL of full-time doctors and nurses working in clinical departments at the University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. In addition to the ProQoL, self-reported data about demographic and occupational characteristics were collected.

Results

The Vietnamese version of ProQoL achieved high internal consistency (alphas between 0.85 and 0.91) and Intra-class Correlation Coefficients (ICCs between 0.71 and 0.89) for all subscales. Among 316 health workers, mean scores of CS, BO, STS were 36.4 (SD = 5.4), 24.9 (SD = 5.1), 25.9 (SD = 5.3), respectively, indicating moderate levels of CS, BO and STS. Participants who were older (b = 0.17, 95%CI = 0.08, 0.26), had sufficient perceived income (b = 2.59, 95%CI = 0.93, 4.24), and > 10 years of working experience (b = 2.15, 95%CI = 0.68, 3.62), had higher CS scores. Those who were older (b=-0.15, 95%CI=-0.23, -0.07), had sufficient perceived income (b=-2.64, 95%CI=-4.18, -1.09), > 10 years of experience (b=-1.38, 95%CI=-2.76, -0.01), worked in surgical department (b=-1.46, 95%CI=-2.54, -0.38) and 8 hours/day (b=-1.52, 95%CI=-2.61, -0.44), had lower BO scores. Moreover, those in a relationship (b=-2.27, 95%CI=-3.53, -1.01) and had sufficient perceived income (b=-1.98, 95%CI=-3.64, -0.32) had lower STS scores.

Conclusions

The Vietnamese version of ProQoL is valid and reliable for use among Vietnamese health workers. Age, marital status, perceived income status, years of working experience, daily working hours, and specialty was associated with at least one component of ProQoL but gender, religion, education level, and monthly income were not.
Agent-Based Modeling and Simulation (ABMS)on the influence of adjusting medical service fees on patients' choice of medical treatment
Authors: Li Danhui , Yang Jia , Li Jin , Zhao Ning , Ju Wensheng , Guo Moning
Published: August 2023

Background

We explored the impact of medical service fee adjustments on the choice of medical treatment for hypertensive patients in Beijing. We hope to provide decision-making reference to promote the realization of hierarchical diagnosis and treatment in Beijing.

Methods

According to the framework of modeling simulation research and based on the data of residents and medical institutions in Beijing, we designed three models of residents model, disease model and hospital model respectively. We then constructed a state map of patients’ selection of medical treatment and adjusted the medical service fee to observe outpatient selection behaviors of hypertensive patients at different levels of hospitals and to find the optimal decision-making plan.

Results

The simulation results show that the adjustment of medical service fees can affect the proportion of patients seeking medical treatment in primary and tertiary hospitals to a certain extent, but has little effect on the proportion of patients receiving medical treatment in secondary hospitals.

Conclusions

Beijing can make adjustments of the current medical service fees by reducing fees in primary hospitals and slightly increasing fees in tertiary hospitals, and in this way could increase the number of patients with hypertension in the primary hospitals.
A primary multiple pleomorphic rhabdomyosarcoma of the heart in an adult dog
Authors: Szaluś-Jordanow Olga , Czopowicz Michał , Moroz-Fik Agata , Mickiewicz Marcin , Łobaczewski Andrzej , Tarka Sylwia , Koperski Łukasz , Sapierzyński Rafał
Published: August 2023

Background

Heart tumors are rare in dogs. They can be benign or malignant. Clinical signs depend primarily on the location of the tumor and its effect on blood flow.

Case presentation

An eleven-year-old crossbreed male dog lethargic and anorectic for previous 3 days was presented to the veterinary clinic. The focused ultrasound assessment with sonograms in trauma (FAST) revealed multiple tumors in the heart which were then confirmed in echocardiographic examination performed by a veterinary cardiologist. Due to the poor general condition and grave prognosis, the dog was humanely euthanized. The autopsy revealed numerous intracardiac tumors in all four heart chambers. No proliferative changes were found in other organs either in thoracic or abdominal cavity. Immunohistochemical examination was performed using formalin-fixed, paraffin-embedded tissue from heart masses. The antibodies against myoglobin, desmin, smooth muscle actin, vimentin, CD34, S100, and pan-cytokeratin (AE1/AE3) were used. Microscopically, the tumor was composed of fascicles of spindle-shaped cells with pale eosinophilic cytoplasm with round, oval, and focally elongated nuclei and one or two prominent nucleoli. The tumor cells showed strong diffuse cytoplasmic immunopositivity for myoglobin and vimentin and focal staining for desmin. Immunostainings for smooth muscle actin-SMA, CD34, pan-cytokeratin, S-100 protein were negative. The immunohistochemical staining pattern confirmed rhabdomyosarcoma.

Conclusions

This is the first description of the primary multiple heart rhabdomyosarcoma in a dog.