bluuebunny/crossref_metadata_2025 huggingface dataset:
Theses and Dissertations Completed in Family and Consumer Sciences: 2020
Authors: Wilmarth Melissa J. , Milstead S. Morgan
Published: December 2021

The annual survey of graduate programs in family and consumer sciences at U.S. universities and colleges was conducted during the summer of 2021. The goal was to compile a listing of theses and dissertations completed in 2020 in family and consumer sciences. Representatives at institutions with identified family and consumer sciences programs were e‐mailed requests for information regarding completed theses and dissertations. Twenty‐five institutions reported a total of 137 theses and 174 dissertations completed in 2020. This report includes the submitted information on theses and dissertations separated into 16 subject categories.
A Note of Caution on Quantifying Banks' Recapitalization Effects
Authors: SCHMIDT KIRSTEN , NOTH FELIX , TONZER LENA
Published: December 2021

Unconventional monetary policy measures like asset purchase programs aim to reduce certain securities' yield and alter financial institutions' investment behavior. These measures increase the institutions' market value of securities and add to their equity positions. We show that the extent of this recapitalization effect crucially depends on the securities' accounting and valuation methods, country‐level regulation, and maturity structure. We argue that future research needs to consider these factors when quantifying banks' recapitalization effects and consequent changes in banks' lending decisions to the real sector.
Implications of gnomonic distortion on electron backscatter diffraction and transmission Kikuchi diffraction
Authors: Fancher Chris M. , Burch Matthew J. , Patala Srikanth , Dickey Elizabeth C.
Published: December 2021

The effect of gnomonic distortion on orientation indexing of electron backscatter diffraction patterns is explored through simulation of electron diffraction patterns for sample‐to‐detector geometries associated with transmission Kikuchi diffraction (TKD) and electron backscatter diffraction (EBSD). Simulated data were analysed by computing a similarity index for both Hough transformed data and simulated patterns to determine the sensitivity of each method for detecting subtle differences in the effect of gnomonic distortions on electron diffraction patterns. These results indicate that the increased gnomonic distortions in electron diffraction patterns for a TKD geometry enhance the sensitivity for detecting subtle differences in interband angles. Additionally, the utilisation of a Hough transform‐based indexing approach further enhances the sensitivity.
A Quasi‐experimental study on prevention and reduction of involuntary treatment at home (PRITAH) in people with dementia
Authors: Mengelers Angela M. H. J. , Bleijlevens Michel H. C. , Verbeek Hilde , Capezuti Elizabeth , Hamers Jan P. H.
Published: December 2021

Aim and objectives

To examine the implementation (reach, dose, fidelity, adaptations, satisfaction), mechanisms of impact (attitude, subjective norm, perceived behavioural control and intention) and context of the PRITAH intervention.

Background

Involuntary treatment, defined as care provided against one's will, is highly prevalent in home care. The PRITAH intervention comprises policy, workshops, coaching and alternative measures for professional caregivers to prevent and reduce involuntary treatment in home care.

Design

Quasi‐experimental study.

Methods

Eight home care teams from two care organisations participated in this study. Guided by the Theory of Planned Behavior, the mechanisms of impact were evaluated with questionnaires. Implementation and context were assessed using attendance lists, evaluation questionnaires, focus groups and logbooks. The study adhered to the TREND checklist.

Results

124 of 133 eligible professional caregivers participated (93%). All four components were delivered with minor deviations from protocol. Participants' subjective norms and perceived behavioural control changed over time in favour of the intervention group. No effects were seen for attitude and intention. Barriers included an unclear policy and lack of communication between stakeholders. The multidisciplinary approach and possibility to discuss involuntary treatment with the specialised nurse were described as facilitators.

Conclusions

Prevention and reduction of involuntary treatment at home is feasible in home care practice and contributes to changing professional caregivers' subjective norms and perceived behavioural control, prerequisites for behavioural change in order to prevent and reduce involuntary treatment. A follow‐up study on the effectiveness of PRITAH on actual use, prevention and reduction of involuntary treatment in home care is needed. Future studies should emphasise the role of family caregivers and GPs and actively involve them in the prevention and reduction of involuntary treatment.

Relevance to clinical practice

Involuntary treatment is commonly used in dementia home care and professional and family caregivers need to be supported in prevention and reduction of involuntary treatment in people with dementia.
Examining the development attributed to geographical indications
Authors: Medeiros Mirna de L. , Passador João L.
Published: December 2021

Geographical indications (GIs) are distinctive signs used on goods or services, the reputation or characteristic of which arises from their origin. Examples are Champagne, Darjeeling, Canastra, among others. They were created to prevent fraud, but they can serve and have been used by scholars, governments, and entities as an instrument for development. To discover the components of the development resulting from registration of GI, we conducted an integrative literature review regarding GIs and development. We found 122 articles (ScienceDirect: 38 and ISI Web of Science: 84) which was reduced to 81 following verification by content analysis. The elements constituting this development were understood as consequence of actions and conditions prior and subsequent to recognition of GI. The proposed new synthesis linked these issues with both positive and negative effects. Based on these relationships, it is evident that development is not an immediate consequence of registration, it depends on a series of factors (of which public support, producer engagement, and consumer recognition stand out) and to what extent they are present.
Does aging alter skin vascular function in humans when spatial variation is considered?
Authors: Fujii Naoto , McGarr Gregory W. , Amano Tatsuro , Boulay Pierre , Nishiyasu Takeshi , Kenny Glen P.
Published: December 2021

Objective

Reports evaluating age‐related impairments in cutaneous vascular function assessed by either the venoarteriolar reflex (VAR) induced by venous congestion, or post‐occlusive reactive hyperemia (PORH) activated by arterial occlusion, have yielded mixed findings. This may be due to region‐specific variability that occurs when assessing local cutaneous vascular responses. We evaluated the hypothesis that aging attenuates VAR and PORH responses in forearm skin assessed across four adjacent sites, each separated by ~4 cm to account for inter‐site variability.

Methods

In twenty young (24 ± 4 years, 10 females) and twenty older (60 ± 7 years, 9 females) adults, VAR and PORH were achieved by a 3‐min venous occlusion and 5‐min arterial occlusion, each induced by inflating a pressure cuff to 45 and 240 mmHg, respectively. Cutaneous blood flow at all skin sites was measured by laser‐Doppler flowmetry with the average response from all sites used for between‐group comparisons.

Results

VAR and PORH responses were similar between groups with the exception that the time required to achieve peak PORH was delayed in older adults (mean difference of 5.5 ± 4.4 s,p = 0.003, Cohen'sd = 0.812).

Conclusions

We showed that aging had a negligible influence on VAR and PORH responses in forearm skin even when controlling for region‐specific variability.
Perturbation of ATG16L1 function impairs the biogenesis of Salmonella and Coxiella replication vacuoles
Authors: Lau Nicole , Thomas David R. , Lee Yi Wei , Knodler Leigh A. , Newton Hayley J.
Published: December 2021

Anti‐bacterial autophagy, known as xenophagy, is a host innate immune response that targets invading pathogens for degradation. Some intracellular bacteria, such as the enteric pathogen Salmonella enterica serovar Typhimurium (S. Typhimurium), utilize effector proteins to interfere with autophagy. One such S. Typhimurium effector, SopF, inhibits recruitment of ATG16L1 to damaged Salmonella‐containing vacuoles (SCVs), thereby inhibiting the host xenophagic response. SopF is also required to maintain the integrity of the SCV during the early stages of infection. Here we show disruption of the SopF‐ATG16L1 interaction leads to an increased proportion of cytosolic S. Typhimurium. Furthermore, SopF was utilized as a molecular tool to examine the requirement for ATG16L1 in the intracellular lifestyle of Coxiella burnetii, a bacterium that requires a functional autophagy pathway to replicate efficiently and form a single, spacious vacuole called the Coxiella‐containing vacuole (CCV). ATG16L1 is required for CCV expansion and fusion but does not influence C. burnetii replication. In contrast, SopF did not affect CCV formation or replication, demonstrating that the contribution of ATG16L1 to CCV biogenesis is via its role in autophagy, not xenophagy. This study highlights the diverse capabilities of bacterial effector proteins to dissect the molecular details of host–pathogen interactions.
Psychotropics use and occurrence of falls in hospitalized patients: A matched case‐control study
Authors: Morishita Chihiro , Ichiki Masahiko , Shimura Akiyoshi , Ishibashi Yoshiki , Inubuse Atsuo , Masuya Jiro , Inoue Takeshi
Published: December 2021

Aim

Several studies have suggested the use of psychotropics as a possible risk factor for falling. However, there were several limitations to these previous studies, such as the use of data obtained from administrative databases and the lack of information about the time interval between psychotropics use and falling. Therefore, in this study, we aimed to assess the association between psychotropics use and falling in hospitalized patients, using reliable data collected from medical records.

Methods

A matched (age, sex, and inpatient department) case‐control study of patients hospitalized at Tokyo Medical University Hospital was performed using the new‐user design, based on data extracted from medical records. The outcome was the occurrence of falls. The use of four classes of psychotropics (antipsychotics, antidepressants, anxiolytics, and hypnotics) was compared between 254 cases (patients who experienced falls) and 254 controls (patients without falls). Multivariable logistic regression analysis was performed to clarify the associations between falling and the use of these psychotropics.

Results

Univariable analyses demonstrated that the use of every class of psychotropic was statistically significantly associated with falling. Moreover, the association of the use of hypnotics with falls remained significant in the multivariable logistic regression model built including potential confounding factors, such as age, sex, inpatient department, body mass index, fall risk score measured by a fall risk assessment sheet completed on hospital admission, and the use of other classes of psychotropics.

Conclusions

Our findings suggest that the use of hypnotics may be a risk factor for falling in hospitalized patients.
The interaction between good life conceptions and psychotherapeutic practice – an interpretative phenomenological study of psychologists’ experiences
Authors: Bjerck‐Amundsen Freja , Opsahl Tobias , Emiliussen Jakob
Published: December 2021

Based on qualitative interviews with four Danish psychologists and employing Interpretative Phenomenological Analysis (IPA), this study explored psychologists’ understandings about the good life and how these influence the participants’ clinical practice. The study found that the participants were quite aware of how their conceptions of the good life play a role in their work. Good life understandings that influenced therapeutic practice were quite similar amongst participants and were largely characterized by traits often associated with good mental health. Themes identified were: “Everyday well‐being,” “presence”, and "taking care of oneself and others,” and subthemes were “contact with the self,” “awareness of the good things in life,” “connectedness,” “to mean something to others,” “coping with distress,” and “compassion for oneself and others.” Among participants, these good life conceptions had a similar influence on different areas of their practice in terms of how the participants understand their clients' issues, which impacted what they talk to their clients about, and what they seek to achieve with the clients in therapy. Therefore, the good life conceptions influenced the methods, techniques, personal behaviors, and therapeutic approaches used to provide good and effective therapy. Another finding was that participants’ clinical experiences also seemed to impact their good life conceptions. The interpretation of the participants’ experiences represented a hermeneutic model suggesting that the participants’ good life conceptions and their clinical practice experiences might inform and reinforce each other in a continuously expanding overlap. The actual nature of this interaction and its implications are relevant for future research.
Annotating OGC web feature services automatically for generating geospatial knowledge graphs
Authors: Saquicela Victor , Vilches‐Blázquez Luis M. , Freire Renán , Corcho Oscar
Published: December 2021

The Spatial Data Infrastructure initiatives are now broadly developed and deployed. However, while plenty of tools use them, some tasks are still complex to perform by non‐expert users, such as finding, accessing, and using some of their related OGC Web Services (OWS). One of the main reasons for these challenges is associated with semantic heterogeneity within these services. This entails a lack of proper descriptions and requires knowledge about data structure and domain‐specific query languages to discover and retrieve these services. Semantic annotations of OWS play a crucial role in achieving semantic interoperability and addressing these associated challenges. In this article we describe an approach for enabling the automatic generation of semantic annotations of Web Feature Services (WFS) at their three request levels (GetCapabilities,DescribeFeatureType, andGetFeature), which are used to generate knowledge graphs. This approach uses various external services, ontological resources (POSM, DBpedia, GeoSPARQL, GeoNames, anddatos.ign.esvocabularies), and knowledge bases (DBpedia anddatos.ign.es). Moreover, this approach enables us to validate annotations obtained as a previous step to generating geospatial knowledge graphs. Additionally, we present our proposal through an application case and assess it using a representative set of 21 WFS services, achieving an average of 46.70% annotations, of which 22.29% and 35.52% were validated using DBpedia anddatos.ign.esinitiatives, respectively. This shows the feasibility of our approach to generate knowledge graphs from WFS services in an automatic way.
Back to the Golden Age: Saul Kripke's Naming and Necessity and Twenty‐First Century Philosophy
Authors: Bianchi Andrea
Published: December 2021

In this paper, I try to outline what I take to be Naming and Necessity's fundamental legacy to my generation and those that follow, and the new perspectives it has opened up for twenty‐first century philosophy. The discussion is subdivided into three sections, concerning respectively philosophy of language, metaphysics, and metaphilosophy. The general unifying theme is that Naming and Necessity is helping philosophy to recover a Golden Age, by freeing it from the strictures coming from the empiricist and Kantian traditions and reconnecting it to the world and the objects that populate it. Because of this, in the concluding paragraph I tentatively suggest that Kripke's philosophy may be seen as a sui generis form of naturalism.
Sexual risk behavior questions: Understanding and mitigating donor discomfort
Authors: Haw Jennie , Woo Hyunjin , Kohut Taylor , Fisher William
Published: December 2021

Background

Blood operators are working to improve donor screening and eligibility for gay, bisexual and other men who have sex with men (gbMSM), and trans and nonbinary donors. Many consider screening all donors for specific sexual risk behaviors to be a more equitable approach that maintains the safety of the blood supply. Feasibility considerations with this change include ensuring donor understanding of additional sexual behavior questions and minimizing donor loss due to discomfort.

Study design and methods

Qualitative one‐on‐one interviews were conducted with Canadian whole blood and plasma donors (N = 40). A thematic analysis was conducted to assess participants' understandings of the questions, examine their comfort/discomfort, and identify strategies to mitigate donor discomfort.

Results

All participants understood what the sexual behavior questions were asking and thought the questions were appropriate. Themes related to comfort/discomfort include: their expectations of donor screening, social norms that they bring to donation, whether their answer felt like personal disclosure, knowing the reasons for the question, trusting confidentiality, confidence in knowing their sexual partner's behavior, and potential for the question to be discriminatory. Strategies to mitigate discomfort include: providing an explanation for the questions, forewarning donors of these questions, reducing ambiguity, and using a self‐administered questionnaire.

Conclusion

While many blood operators and regulators view the move to sexual behavior–based screening for all donors as a significant paradigmatic shift, donors may not perceive additional sexual behavior questions as a significant change to their donation experience. Further research is needed to evaluate the effectiveness of strategies to mitigate donor discomfort.
STAT3-YAP/TAZ signaling in endothelial cells promotes tumor angiogenesis
Authors: Shen Ying , Wang Xiaohong , Liu Yi , Singhal Mahak , Gürkaşlar Can , Valls Aida Freire , Lei Yi , Hu Wenjie , Schermann Géza , Adler Heike , Yu Fa-Xing , Fischer Tamás , Zhu Yi , Augustin Hellmut G. , Schmidt Thomas , de Almodóvar Carmen Ruiz
Published: December 2021

Nuclear cotranslocation with STAT3 enables YAP/TAZ to activate genes involved in tumor vascularization.
Putative Familial Transmissible Bacteria of Various Body Niches Link with Home Environment and Children’s Immune Health
Authors: Zhao Lu , Chen Wanning , Ge Yongsheng , Lv Xin , Wang Ying , Yu Han , Liu Yi , Wu Dingfeng , Jiao Na , Wu Yuanqi , Lv Daqing , Zhang Guoqing , Xue Fuzhong , Xu Xiaohong , Gai Zhongtao , Zhu Ruixin , Zhang Lei , Zhao Guoping
Published: December 2021

Our study revealed that the children’s microbiota was partially transmitted from their family members and specific putative transmissible ASVs were associated with the immune system of children. These findings suggest that home life plays a key role in the shaping of young children’s microbiomes and has long-term health benefits.
Fourier Transform Infrared Spectroscopy for Typing Burkholderia cenocepacia ET12 Isolates
Authors: Barker Kevin R. , Santino Michael , LiPuma John J. , Tullis Elizabeth , Muller Matthew P. , Matukas Larissa M. , Tadros Manal
Published: December 2021

Respiratory infections due to
Burkholderia cenocepacia
, particularly the ET12 epidemic strain, are considered sentinel events for persons with cystic fibrosis, as they are often associated with person-to-person transmission and accelerated decline in lung function and early mortality. Current typing methods are generally only available at reference centers, with long turn-around-times, which can affect the identification of outbreaks and critical patient triage.
Supplemental Material: Experimental evidence on the origin of Ca-rich carbonated melts formed by interaction between sedimentary limestones and mantle-derived ultrabasic magmas
Authors: Lustrino Michele , al. et
Published: December 2021

Experimental and analytical procedures, including SEM images of the experimental runs, and a data set containing the entire set of EMP analyses of glass and quenched minerals, as well as the original composition of the starting materials and additional plots.
Supplemental Material: Proterozoic–Phanerozoic tectonic evolution of the Qilian Shan and Eastern Kunlun Range, northern Tibet
Authors: Wu Chen , al. et
Published: December 2021

Table S1: Summary of Geochronology Results of Intrusive rocks in the Qilian Shan; Table S2: Summary of Geochronology Results of Intrusive rocks in the East Kunlun Range; Table S3: LA-ICP-MS results for zircons U-Pb ages of igneous, sandstone, and metamorphic sedimentary samples in this study; Table S4: Geochemistry Data for Plots of age against crustal thickness of the Qilian Shan; Table S5: Geochemistry Data for Plots of age against crustal thickness of the Eastern Kunlun Range.
Supplemental Material: Earthquake weather and climate change: Should we stress about the forecast?
Authors: Wilson Miles P. , al. et
Published: December 2021

Table S1. Onshore UK earthquake catalogue for 1980–2012 with local magnitudes ≥1.5
Effect of milk protein content in Toddler formula on later BMI and obesity risk: protocol of the multicentre randomised controlled Toddler Milk Intervention (ToMI) trial
Authors: Grote Veit , Jaeger Vanessa , Escribano Joaquin , Zaragoza Marta , Gispert Mariona , Grathwohl Dominik , Koletzko Berthold
Published: December 2021

Introduction

Reduction of milk protein content in infant formula provided during the first year of life has been shown to reduce early weight gain and obesity later in life. While rapid weight gain during the first 2 years of life is one of the strongest early predictors of obesity, the role of animal protein intake beyond the first year of life is unclear. The aim of this study is to examine the role of milk protein during the second year of life in healthy children on weight gain and obesity risk in preschool age.

Methods and analysis

This randomised, double-blinded study enrolled 1618 children aged 11.5–13.5 months in Spain and Germany into two groups receiving isocaloric toddler milk with differing protein content during the second year of life. The experimental formula contains 1.5 g/100 kcal and the control formula 6.15 g/100 kcal protein and otherwise equal formula composition, except for modified fat content to achieve equal energy density. The primary endpoint is body mass index (BMI)-for-age z-score at the age of 24 months adjusted for BMI at 12 months of age. The children are followed until 6 years of age.

Ethics and dissemination

Ethics approval was obtained from the ethical committees of the LMU University Hospital Munich, Germany (Nr. 555-15) and at Institut d’Investigació Sanitaria Pere Virgili, Reus, Spain (Ref. CEIm IISPV 013/2016). We aim at publishing results in peer-reviewed journals and sharing of results with study participants.

Trial registration number

NCT02907502.
Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures
Authors: Geurten Rose J , Elissen Arianne M J , Bilo Henk J G , Struijs Jeroen N , van Tilburg Chantal , Ruwaard Dirk
Published: December 2021

Objectives

We aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database.

Design

Retrospective observational cohort study based on an all-payer claims database of the Dutch population.

Setting

The Netherlands.

Participants

The whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes.

Outcome measures

Annual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively.

Results

In 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%).

Conclusions

All-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.
Ratio of asymptomatic COVID-19 cases among ascertained SARS-CoV-2 infections in different regions and population groups in 2020: a systematic review and meta-analysis including 130 123 infections from 241 studies
Authors: Chen Xiao , Huang Ziyue , Wang Jingxuan , Zhao Shi , Wong Martin Chi-Sang , Chong Ka Chun , He Daihai , Li Jinhui
Published: December 2021

Introduction

Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.

Methods

In this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command ‘metaprop’ was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).

Results

A total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%–29.1%) and 21.7% (16.8%–27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%–68.9%), children (32.1%, 24.2%–40.5%), and studies reporting screening programmes (36.0%, 24.6%–48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%–51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%–71.6%), followed by America (40.0%, 27.4%–53.3%), Europe (28.1%, 19.0%–38.1%) and Asia (18.1%, 13.2%–23.5%).

Conclusion

We approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic.
Neonatal morbidity among African refugee women in Israel: a case–control study
Authors: Ovental Amit , Doyev Reut , Mangel Laurence , Herzlich Jacky , Hadanny Amir , Marom Ronella
Published: December 2021

Objectives

Reports on neonatal morbidity (NM) among refugees in developed countries remain inconsistent. We aimed to compare NM among infants of African refugees in Israel to the native population based on a large population sample.

Design

A case–control study.

Setting

A tertiary hospital in Israel.

Participants

Data on hospital-based live births of refugee women and their newborns who were born in 2014 and 2017 were retrieved from medical records. Perinatal and neonatal data were compared between the refugee group and the native residents matched for gestational age and year of birth as well as within the refugee group.

Primary outcome

Prevalence of NM among African refugees in Israel.

Results

Newborns delivered by 357 refugee women (mean age 30.2 years) and 357 controls (mean age 32.2 years) were analysed. Both groups were similar for the newborns’ weight and gestational age. There were no significant differences in NM between the groups. A within-refugee comparison conducted between 2014 and 2017 yielded significant differences in birth weight (3051.4 vs 3373.6 gr, p<0.001, 95% CI (198.3 to 446.2), d=0.56), the number of twin deliveries (10 vs 4, p=0.002, Φ=0.173), the number of neonates evaluated as small for gestational age (15 vs 10, p=0.003, Φ=0.167) and the use of human milk (71% vs 93%, p<0.001, Φ=−0.298).

Conclusions

We conclude that NM among neonates born to refugee mothers was not higher than that of neonates born to native Israeli mothers. We suggest that successful implementation of health policies for refugees has improved their accessibility to mother–child health services.
Spectrum of COVID-19 clinical characteristics among patients presenting to the primary healthcare in Qatar during the early stages of the pandemic: a retrospective multicentre cross-sectional study
Authors: Ismail Mansoura , Joudeh Anwar , Al-Dahshan Ayman , Alsaadi Muna Mehdar , Al Abdulla Samya , Selim Nagah Abdel Aziz
Published: December 2021

Objectives

To describe clinical characteristics and laboratory investigations of patients with COVID-19 diagnosed in primary care in Qatar and to assess predictors of hospitalisation.

Design

A retrospective cross-sectional study.

Setting and participants

3515 confirmed patients with COVID-19 diagnosed in any of the 27 primary healthcare centres in Qatar between 9 April 2020 and 30 June 2020.

Main outcome measures

Demographic characteristics, comorbidities, contact tracing, clinical and laboratory data, in addition to patient disposition at the time of diagnosis

Results

Mean age of patients was 35.5 years (±14.7). 2285 patients (65.0%) were males, 961 patients (27.3%) had a history of concomitant comorbidity and 640 patients (18.2%) were asymptomatic. Adult patients (19–64 years old) were more likely to report symptoms than children or elderly. Fever and cough were the most frequently documented symptoms affecting 1874 patients (46.7%) and 1318 patients (37.5%), respectively. Most patients had normal vital signs at presentation; however, patients who were subsequently hospitalised had higher median temperature than non-hospitalised patients (37.7°C, IQR: 37.0°C–38.4°C, and 37.2°C, IQR: 36.8°C–37.8°C, respectively). Hospitalised patients had significantly higher C reactive protein (CRP) (median CRP: 20 mg/L, IQR: 5.0–61.2 mg/L) than non-hospitalised patients (median CRP: 4.6 mg/L, IQR: 1.7–11.50 mg/L), and lower median absolute lymphocyte count (1.5×103/µL, IQR: 1.1×103/µL–2.1×103/µL, and 1.8×103/µL, IQR: 1.3×103/µL–2.4×103/µL, respectively). Predictors of hospitalisation were increasing age (adjusted OR (AOR): 2.614, 95% CI 1.281 to 5.332 for age between 50 years and 64 years, and AOR: 3.892, 95% CI 1.646 to 9.204 for age ≥65 years), presence of two or more comorbidities (AOR: 2.628; 95% CI 1.802 to 3.832) and presence of symptoms (AOR: 1.982: 95% CI 1.342 to 2.928).

Conclusion

The majority of COVID-19 cases diagnosed in primary healthcare in Qatar were symptomatic. Most cases had normal vital signs and laboratory results at presentation. Predictors of hospitalisation were increasing age, the presence of symptoms and having two or more comorbidities.
Mobile app for prolonged grief among bereaved parents: study protocol for a randomised controlled trial
Authors: Eklund Rakel , Eisma Maarten C , Boelen Paul A , Arnberg Filip K , Sveen Josefin
Published: December 2021

Introduction

Bereaved parents, who have lost a child, have an elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive–behavioural therapy (CBT), both face to face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, calledMy Grief,in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users’ experiences and adverse events ofMy Grief.

Methods and analysis

We will conduct a two-armed randomised waitlist-controlled trial. Parents living in Sweden, who lost a child between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content ofMy Griefcovers four main domains (Learn; Self-monitoring; Exercises; Get support) and builds on principles of CBT and the proven-effectivePTSD Coachapp. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12 months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are post-traumatic stress and depression symptoms, quality of life and cognitive behavioural variables (ie, avoidance, rumination, negative cognitions).

Ethics and dissemination

Ethical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents.

Trial registration number

NCT04552717.
Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study
Authors: Lasater Karen B , Aiken Linda H , Sloane Douglas , French Rachel , Martin Brendan , Alexander Maryann , McHugh Matthew D
Published: December 2021

Objective

To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.

Design

Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.

Setting: 87 acute care hospitals in Illinois.

Participants

210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital.

Main outcome measures

Primary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.

Results

Patient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse’s workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse’s workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.

Conclusions

Patient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical–surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.
Awareness of obstetric fistula and its associated factors among reproductive-age women in Ethiopia: a multilevel analysis of Ethiopian Demographic and Health Survey data: a cross-sectional study
Authors: Aleminew Wallelign , Mulat Bezawit , Shitu Kegnie
Published: December 2021

Objective

This study aimed to determine the magnitude and associated factors of obstetric fistula (OF) awareness among reproductive-age women in Ethiopia.

Methods

This community-based cross-sectional study was conducted among 15 683 reproductive-aged women in Ethiopia. Following the presentation of a case vignette, women’s OF awareness was measured by asking if they had ever heard of OF. A multilevel multivariable logistic regression analysis was employed. A 95% CI and p<0.05 were used to declare statistical significance.

Result

The magnitude of women’s awareness of OF was 38% (95% CI 0.37 to 0.39). Individual level variables including being in the age group of 20–25 (adjusted OR, AOR 1.17; 95% CI 1.02 to 1.35), 26–30 (AOR 1.50; 95% CI 1.27 to 1.76) and >30 (AOR 1.76; 95% CI 1.50 to 2.07), being Muslim (AOR 0.83; 95% CI 0.73 to 0.94), having primary (AOR 1.70; 95% CI 1.53 to 1.89), secondary (AOR 3.43; 95% CI 2.95 to 3.99) and tertiary education (AOR 5.88; 95% CI 4.66 to 7.42), history of pregnancy termination (AOR 1.31; 95% CI 1.13 to 1.51), media exposure (AOR 1.33; 95% CI 1.2 to 1.49), internet use (AOR 2.25; 95% CI 1.84 to 2.75), medium (AOR 1.17; 95% CI 1.02 to 1.34) and rich house hold wealth (AOR 1.50; 95% CI 1.31 to 1.72) and community level factors including high community media exposure (AOR 1.30; 95% CI 1.05 to 1.61), high community antenatal care rate (AOR 1.66; 95% CI 1.37 to 2.02) and low health facility distance problem (AOR 1.49; 95% CI 1.23 to 1.81) were significantly associated with women’s awareness of OF.

Conclusions and recommendations

The magnitude of women’s awareness of OF was very low in Ethiopia. Awareness of OF was influenced by sociodemographic, economic, obstetric and community-related factors. Thus, tailored public health education is required at the national level to enhance women’s awareness of OF.
Preferences for healthcare services among hypertension patients in China: a discrete choice experiment
Authors: Yu Xiaolan , Bao Haini , Shi Jianwei , Yuan Xiaoyu , Qian Liangliang , Feng Zhe , Geng Jinsong
Published: December 2021

Objectives

Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.

Design

We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients’ preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.

Setting

The DCE was conducted in Jiangsu province and Shanghai municipality in China.

Participants

Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.

Results

Patients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician–patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients’ choice (β=−0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.

Conclusions

Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients’ preferences.
Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study
Authors: Lee Peter , Brennan Angela L , Stub Dion , Dinh Diem T , Lefkovits Jeffrey , Reid Christopher M , Zomer Ella , Liew Danny
Published: December 2021

Objectives

In this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers.

Design

A cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective.

Setting

A linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR.

Primary outcome measures

Direct healthcare costs attributed to PCI, estimated using a casemix funding method.

Results

Key cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors.

Conclusions

The overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.
Retrospective case–control study to evaluate hypocalcaemia as a distinguishing feature of COVID-19 compared with other infective pneumonias and its association with disease severity
Authors: Mehta Meera , Ghani Hakim , Chua Felix , Draper Adrian , Calmonson Sam , Prabhakar Meghna , Shah Rijul , Navarra Alessio , Vaghela Tejal , Barlow Andrew , Vancheeswaran Rama
Published: December 2021

Objectives

To investigate whether calcium derangement was a specific feature of COVID-19 that distinguishes it from other infective pneumonias, and its association with disease severity.

Design

A retrospective observational case–control study looking at serum calcium on adult patients with COVID-19, and community-acquired pneumonia (CAP) or viral pneumonia (VP).

Setting

A district general hospital on the outskirts of London, UK.

Participants

506 patients with COVID-19, 95 patients with CAP and 152 patients with VP.

Outcome measures

Baseline characteristics including hypocalcaemia in patients with COVID-19, CAP and VP were detailed. For patients with COVID-19, the impact of an abnormally low calcium level on the maximum level of hospital care, as a surrogate of COVID-19 severity, was evaluated. The primary outcome of maximal level of care was based on the WHO Clinical Progression Scale for COVID-19.

Results

Hypocalcaemia was a specific and common clinical finding in patients with COVID-19 that distinguished it from other respiratory infections. Calcium levels were significantly lower in those with severe disease. Ordinal regression of risk estimates for categorised care levels showed that baseline hypocalcaemia was incrementally associated with OR of 2.33 (95% CI 1.5 to 3.61) for higher level of care, superior to other variables that have previously been shown to predict worse COVID-19 outcome. Serial calcium levels showed improvement by days 7–9 of admission, only in survivors of COVID-19.

Conclusion

Hypocalcaemia is specific to COVID-19 and may help distinguish it from other infective pneumonias. Hypocalcaemia may independently predict severe disease and warrants detailed prognostic investigation. The fact that decreased serum calcium is observed at the time of clinical presentation in COVID-19, but not other infective pneumonias, suggests that its early derangement is pathophysiological and may influence the deleterious evolution of this disease.

Trial registration number

20/HRA/2344.
Exploring healthcare providers’ perceptions of mental health amid COVID-19 pandemic in obstetrics and gynaecology department of a tertiary care public sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol
Authors: Yasmin Haleema , Sadia Afreen , Qamar Areesha , Shahil Feroz Anam
Published: December 2021

Introduction

In the wake of the unprecedented public health challenge of the COVID-19 pandemic, it is highly significant to recognise the mental health impact of this mounting threat on healthcare providers (HCPs) working in the obstetrics and gynaecology department. Experience from epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that HCPs are dealing with is linked with the increased burden of mental health conditions. We aim to conduct an exploratory qualitative descriptive study to assess HCPs’ perceptions of mental health amid the COVID-19 pandemic in the obstetrics and gynaecology department of a public sector tertiary care hospital of Karachi, Pakistan.

Methods and analysis

This study will use a qualitative descriptive approach where approximately 20–25 HCPs from the obstetrics and gynaecology department will be recruited using a purposive sampling approach. Data will be collected through semistructured interviews and it will be analysed thematically using NVivo V.12 Plus software.

Ethics and dissemination

Ethical approval for this study has been obtained from the Institutional Review Board Committee of Jinnah Postgraduate Medical Center hospital. The study results will be disseminated to the scientific community and the HCPs participating in the study. The findings will help us to explore the doctor’s perceptions of mental health during the current pandemic of COVID-19 and its impact on their daily lives and mental well-being.