bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstacles and facilitators of therapeutic alliance among adolescents with anorexia nervosa, their parents and their psychiatrists: A qualitative study
Authors: Sibeoni Jordan , Verneuil Laurence , Poulmarc’h Léa , Orri Massimiliano , Jean Elise , Podlipski Marc-Antoine , Gérardin Priscille , Révah-Lévy Anne
Published: October 2019

Background:

Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists.

Methods:

This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic.

Results:

Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment – with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization.

Conclusion:

Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent–parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.
Chaos is a ladder: A study of identity, norms, and power transition in the Game of Thrones universe
Authors: Olesker Ronnie
Published: October 2019

This article examines the interplay between identities, norms and power transition in the HBO series Game of Thrones. Using discourse analysis of season 7’s transcripts and viewing the show, I conclude that the most dominant themes to emerge are those related to identity and norms, in the context of hegemonic power transition. The season focuses on the impact of normative and ideational factors on how alliances operate and on the prospects of cooperation between alliances. I find that identity distributions across great powers impact the ability of characters to muster a successful challenge to the existing world order. Furthermore, I find that the survival of actors whose normative commitments are mismatched with their alliance is not guaranteed through the alliance. Thus, the show serves as an effective knowledge production site for exploring the consequences of power transition and alliance theory as power begins to transition in our own universe.
Toward a Visualization of Video Game Cultural History: Grasping the French Touch
Authors: Therrien Carl , Lefebvre Isabelle , Ray Jean-Charles
Published: October 2019

This article introduces a novel methodology to analyze the historical evolution of the adventure game genre. This method involved the development of an analytical system, online database, and data visualization tool designed to help us understand the evolution of gameplay. Following an overview of these methodological considerations, we present the most common gameplay configurations adopted by adventure games over the years with the help of the data visualization interface. This forms the foundation of a comparative study that seeks to highlight the specificity of French production at the turn of the 1990s. The results shed light on gameplay configurations in a way that effectively articulates a synoptic, macrohistorical perspective with deep inspections of specific games.
Efficacy of pre-participation cardiac evaluation recommendations among athletes participating in World Athletics Championships
Authors: Dahlström Örjan , Adami Paolo Emilio , Fagher Kristina , Jacobsson Jenny , Bargoria Victor , Gauffin Håkan , Hansson Per-Olof , Andersson Christer , Bermon Stéphane , Timpka Toomas
Published: October 2019

Background

Athletes competing in athletics (track and field) at international level may be participating with underlying undiagnosed life-threatening cardiovascular conditions. Our objective was to analyse variations in pre-participation cardiac evaluation prevalence among athletes participating in two International Association of Athletics Federations (IAAF) World Athletics Championships, with regard to the human developmental level and global region of their home countries, as well as athletes' age category, gender, event group and medical insurance type.

Design

Cross-sectional web-based survey.

Methods

A total of 1785 athletes competing in the IAAF World Under 18 Championships Nairobi 2017 and World Championships London 2017 were invited to complete a pre-participation health questionnaire investigating the experience of a pre-participation cardiac examination.

Results

A total of 704 (39%) of the athletes participated. Among these, 59% (60% of women; 58% of men) reported that they had been provided at least one type of pre-participation cardiac evaluation. Athletes from very high income countries, Europe and Asia, showed a higher prevalence of at least one pre-participation cardiac evaluation.

Conclusions

The prevalence of pre-participation cardiac evaluation in low to middle income countries, and the African continent in particular, needs urgent attention. Furthermore, increases in evaluation prevalence should be accompanied by the development of cost-effective methods that can be adopted in all global regions.
Antihypertensive drugs and the risks of cancer: More fakes than facts
Authors: Battistoni Allegra , Tocci Giuliano , Presta Vivianne , Volpe Massimo
Published: October 2019

In the last century, the diffusion of medical news to the public has been profoundly changed by the progressive spread of more pervasive, but at the same time often unreliable, means of communication. The misinterpretation of scientific evidence or fallacious presentation through social media could play as a great drawback to the success in the management of many diseases. This may become particularly alarming when concerning chronic diseases widely affecting the population. Arterial hypertension is still today one of the major causes of mortality and morbidity in most countries, and its management generally requires chronic therapy lasting for decades. Therefore, a recent debate about the potential oncogenic effect of antihypertensive drugs has been made widely available to patients mostly through social media. Since this is a topic of great impact for millions of patients and of main relevance for the scientific community, it must not be contaminated by the spread of fake or twisted news. The objective of this article is to briefly discuss the almost complete lack of hard evidence about the potential oncogenic effect of the major classes of antihypertensive drugs as opposed to the exaggerated mediatic communication and impact of scattered and unconfirmed observations. We believe that it is of key importance to provide authoritative support for patients and clinicians from scientific societies and guidelines to balance an unopposed widespread penetration of twisted or even fake news.
Standard Precautions Among Emergency Medical Services in Urban and Rural Areas
Authors: Alhazmi Riyadh A. , Parker R. David , Wen Sijin
Published: October 2019

Backround: Emergency medical services (EMS) workers are at risk of exposure to bloodborne pathogens and frequently exposed to blood and bodily fluids through percutaneous injuries. This study aimed to assess the consistency with which standard precautions (SPs) among rural and urban EMS providers were used. Methods: This study consisted of a cross-sectional survey conducted with a sample of certified EMS providers in West Virginia in which we ascertained details about sociodemographic characteristics, and the frequency of consistent SP. An email invitation was sent to a comprehensive list of agencies obtained from the Office of West Virginia EMS. Findings: A total of 248 out of 522 (47%) EMS providers completed the survey. The majority of the EMS providers (76%) consistently complied with SPs; however, more than one third (38%) of urban EMS providers indicated inconsistent use compared with 19% of rural EMS providers ( p = .002). Most EMS providers reported low prevention practices to exposure of blood and body fluids in both areas. Conclusion/Application to Practice: The results emphasize the need to enhanced safe work practices among EMS providers in both rural and urban areas through education and increasing self-awareness. Occupational health professional in municipalities that serve these workers are instrumental in ensuring these workers are trained and evaluated for their compliance with SPs while in the field.
Effect of Germanium-Embedded Knee Sleeve on Osteoarthritis of the Knee
Authors: Marino Katherine , Lee Rachel , Lee Paul
Published: October 2019

Background:

Knee osteoarthritis (OA) affects an estimated 1 in 5 individuals older than 45 years of age in the United Kingdom. Previous studies have suggested that germanium-infused garments may provide improved clinical outcomes in OA. Germanium-embedded (GE) knee sleeves embrace this fabric technology.

Purpose:

To assess the outcomes of GE knee sleeves for patients with knee OA.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This study was undertaken at a hospital in the United Kingdom. Patients who had radiographic features of OA, experienced knee pain for at least 6 months, and opted for nonsurgical intervention were included. Patients were recruited over 3 months. The University of California, Los Angeles activity score, Lysholm score, visual analog scale (VAS) score, and Oxford Knee Score (OKS) were collected at monthly intervals for 6 months. Patients were followed to determine their compliance with wearing the knee sleeves at all times, as advised, and whether any adverse effects had occurred.

Results:

A total of 50 participants were recruited for the study; 4 participants were excluded due to pain and were converted to surgical management. Therefore, 46 patients were analyzed and placed into 2 groups according to severity of OA, as classified by the Kellgren-Lawrence system: group A had grade 1 or 2 OA, and group B had grade 3 or 4 OA. There were 25 patients in group A and 21 in group B. Improvements were seen in OKS, VAS, and Lysholm scores in both groups. Clinically significant improvements were seen in group A only for OKS (mean increase, 14), VAS (mean decrease, 4.1), and Lysholm (mean increase, 17.2) scores. These results were also statistically significant (OKS, P = 5.8 × 10-7; VAS, P = 7.7 × 10-12; Lysholm, P = 4.2 × 10-11). The data from this study demonstrated that GE knee sleeves gave better outcomes for patients with grades 1 and 2 OA compared with patients with more advanced disease, which is consistent with previous studies. A total of 3 patients reported skin irritation, which resolved with simple skin ointment application. No patients reported infection, deep vein thrombosis, or circulation problems.

Conclusion:

GE knee sleeves could play an important role in optimizing nonsurgical management of patients with knee OA, especially patients with grades 1 and 2 OA, as demonstrated by the clinically significant improvements.
Design Around Bundle Patent Portfolio Based on Technological Evolution
Authors: Li Hui , Yuan Jiefeng , Tan Runhua , Peng Qingjin
Published: October 2019

Product innovation can be achieved by analyzing leading products patents in the market. Different methods have been proposed for design around patent, commonly using the elimination or replacement of a single patent element. However, the existing research fails to restore the position and function of the design around object in the original patent portfolio of enterprises, which often leads to the phenomenon of evading one patent and violating another. This paper proposes a method for design around patent through using the fusion of technologies of the evolution theory and bundle-type patent portfolio analysis in the initial stage of product development. The object system is analyzed to select technical opportunities through the evolutionary path of technologies and functional trimming methods to achieve circumvent barriers of bundle-type patents. The bundle patent portfolio is analyzed for the product evolution with a radar map. The technological evolution path is combined with the TRIZ innovation method to identify and solve the design problem. Patentability of the new design is evaluated using the patent system rules for innovative scheme difference from the original patent portfolio. The method is verified in a case study for the design of a glass-wiping robot. The design solution has been patented.
Finite Element Method on Shape Memory Alloy Structure and Its Applications
Authors: Zhou Bo , Kang Zetian , Wang Zhiyong , Xue Shifeng
Published: October 2019

It is significant to numerically investigate thermo-mechanical behaviors of shape memory alloy (SMA) structures undergoing large and uneven deformation for they are used in many engineering fields to meet special requirements. To solve the problems of convergence in the numerical simulation on thermo-mechanical behaviors of SMA structures by universal finite element software. This work suppose a finite element method to simulate the super-elasticity and shape memory effect in the SMA structure undergoing large and uneven deformation. Two scalars, named by phase-transition modulus and equivalent stiffness, are defined to make it easy to establish and implement the finite element method for a SMA structure. An incremental constitutive equation is developed to formulate the relationship of stress, strain and temperature in a SMA material based on phase-transition modulus and equivalent stiffness. A phase-transition modulus equation is derived to describe the relationship of phase-transition modulus, stress and temperature in a SMA material during the processes of martensitic phase transition and martensitic inverse phase transition. A finite element equation is established to express the incremental relationship of nodal displacement, external force and temperature change in a finite element discrete structure of SMA. The incremental constitutive equation, phase-transition modulus equation and finite element equation compose the supposed finite element method which simulate the thermo-mechanical behaviors of a SMA structure. Two SMA structures, which undergo large and uneven deformation, are numerically simulated by the supposed finite element method. Results of numerical simulation show that the supposed finite element method can effectively simulate the super-elasticity and shape memory effect of a SMA structure undergoing large and uneven deformation, and is suitable to act as an effective computational tool for the wide applications based on the SMA materials.
Accelerated evolution and diversifying selection drove the adaptation of cetacean bone microstructure
Authors: Sun Di , Zhou Xuming , Yu Zhenpeng , Xu Shixia , Seim Inge , Yang Guang
Published: October 2019

Background

The transition from land to sea by the ancestor of cetaceans approximately 50 million years ago was an incredible evolutionary event that led to a series of morphological, physiological, and behavioral adaptations. During this transition, bone microstructure evolved from the typical terrestrial form to the specialized structure found in modern cetaceans. While the bone microstructure of mammals has been documented before, investigations of its genetic basis lag behind. The increasing number of cetaceans with whole-genome sequences available may shed light on the mechanism underlying bone microstructure evolution as a result of land to water transitions.

Results

Cetacean bone microstructure is consistent with their diverse ecological behaviors. Molecular evolution was assessed by correlating bone microstructure and gene substitution rates in terrestrial and aquatic species, and by detecting genes under positive selection along ancestral branches of cetaceans. We found that: 1) Genes involved in osteoclast function are under accelerated evolution in cetaceans, suggestive of important roles in bone remodeling during the adaptation to an aquatic environment; 2) Genes in the Wnt pathway critical for bone development and homeostasis show evidence of divergent evolution in cetaceans; 3) Several genes encoding bone collagens are under selective pressure in cetaceans.

Conclusions

Our results suggest that evolutionary pressures have shaped the bone microstructure of cetaceans, to facilitate life in diverse aquatic environments.
Foxp3+Helios+ regulatory T cells are associated with monocyte subsets and their PD-1 expression during acute HIV-1 infection
Authors: Liu Lifeng , Zhang Qiuyue , Chen Peng , Guo Na , Song Aixin , Huang Xiaojie , Xia Wei , Li Li , Moog Christiane , Wu Hao , Su Bin , Zhang Tong
Published: October 2019

Background

Helios has been reported to stabilize regulatory T (Treg) suppressive function. Programmed cell death protein 1 (PD-1) expression in three human monocyte subsets modulates immune responses. Recently, our team reported that three monocyte subsets are associated with T helper cell differentiation in HIV-1-infected patients. Until now, the effects of monocyte subsets and their PD-1 expression on Foxp3+Helios+ Treg cells have not been fully characterized, especially during acute HIV-1 infection.

Results

The frequency of Foxp3+Helios+CD45RA+ Treg cells is significantly higher in patients with acute HIV-1 infection than those of healthy controls and chronic HIV-1-infected patients undergoing combined antiretroviral therapy. The frequency of Foxp3+Helios+CD45RA+ Treg cells is inversely correlated with CD4 T-cell counts and the CD4/CD8 ratio in chronic HIV-1-infected patients. During acute HIV-1 infection, the frequency of Foxp3+Helios+CD45RA+ Treg cells is inversely correlated with the frequency of the intermediate CD14++CD16+ monocyte subset, but positively correlated with PD-1 expression in both intermediate CD14++CD16+ and non-classical CD14+CD16++ monocyte subsets.

Conclusions

In this study, the perturbations of Foxp3+Helios+ Treg cells were characterized, and the association between monocyte subsets and their PD-1 expression and Foxp3+Helios+ Treg cells was evaluated during HIV-1 infection. Our observations provide new evidence of the roles for Foxp3+Helios+ Treg cells and PD-1 expression on monocyte subsets in HIV pathogenesis.
Chronic stress, work-related daily challenges and medicolegal investigations: a cross-sectional study among German general practitioners
Authors: Kersting Christine , Zimmer Lena , Thielmann Anika , Weltermann Birgitta
Published: October 2019

Background

The prevalence of chronic stress among German general practitioners (GPs) was shown to be twice as high as in the general population. Because chronic stress negatively influences well-being and poor physician well-being is associated with poor patient outcomes, targeted strategies are needed. This analysis focuses on work-related factors associated with high chronic stress in GPs.

Methods

This cross-sectional study measured chronic stress among German GPs using the validated and standardized Trier Inventory for the Assessment of Chronic Stress (TICS-SSCS). Based on the TICS, GPs were categorized as either having low strain (≤ 25th percentile) or high strain (≥ 75th percentile) due to chronic stress. Questions on work-related challenges assessed the frequency and the subjectively perceived strain of single challenges. For exploratory analyses, these items were combined to dichotomous variables reflecting challenges that are common and that cause high strain. Variables significant in bivariate analyses were included in a multivariate logistic regression model analyzing their association with high chronic stress.

Results

Data of 109 GPs categorized as having low strain (n = 53) or high strain (n = 56) due to chronic stress were analyzed. Based on bivariate analyses, challenges regarding personnel matters, practice software, complexity of patients, difficult patients, care facilities, scheduling of appointments, keeping medical records up-to-date, fee structures, and expectations versus reality of care were included in the regression model. Keeping medical records up-to-date had the strongest association with high chronic stress (odds ratio 4.95, 95% confidence interval 1.29–19.06). A non-significant trend showed that medicolegal investigations were more common among GPs with high chronic stress.

Conclusions

This exploratory research shows that chronic stress is predominantly associated with administrative challenges. Treatment documentation, which represents a legal safeguard and is closely linked to existential concerns, has the strongest influence.
Prevalence of active trachoma and associated factors among children aged 1 to 9 years in rural communities of Lemo district, southern Ethiopia: community based cross sectional study
Authors: WoldeKidan Endale , Daka Deresse , Legesse Deresse , Laelago Tariku , Betebo Bealu
Published: October 2019

Background

Trachoma, caused by Chlamydia trachomatis is the leading infectious cause of blindness. It is transmitted via personal contact with infected ocular and nasal secretions by hands, fomites and eye- seeking flies. Active trachoma is more common among children aged 1 to 9 years. The objective of this study was determining the prevalence of active trachoma and associated factors among children aged 1 to 9 years in rural community of Lemo district.

Methods

Community-based cross-sectional study was conducted from March to April, 2018 in rural community of Lemo district. Multistage sampling technique was used to select 589 study participants. Data were collected by using structured pre-tested questionnaire, physical examination and observation. Binocular loupe was used to identify active trachoma cases. The data were entered by using EPi-data version 3.1 and analyzed by SPSS. Binary logistic regression was used to assess factors associated with active trachoma. Variables with p-value < 0.05 in the multivariable analysis were used to declare significance of association.

Result

Eighty seven (15.2%) children were positive for active trachoma. Absence of solid waste disposal pit (AOR = 2.20, 95% CI (1.12-4.37), do not use latrine as reported by respondent (AOR = 7.53, 95% CI (2.86-19.84), do not use soap for face washing as reported by respondent (AOR =2.3, 95% CI (1.32–4.12), washing face frequency as reported by respondent (AOR = 1.86, 95% CI (1.06–3.26), and family size greater than five (AOR = 1.96, 95% CI (1.06–3.67) were significantly associated with active trachoma.

Conclusion

Active trachoma among children aged 1 to 9 years is high. Do not use latrine, do not use soap for face washing, and face washing frequency in a day as reported by respondents and family size were associated with active trachoma. Access to adequate water and sanitation can be important components in working towards eliminating trachoma as a public health problem. Therefore, prompt measures must be taken by concerned bodies to increase access to adequate water and sanitation facilities.
Identifying high risk areas of Zika virus infection by meteorological factors in Colombia
Authors: Chien Lung-Chang , Sy Francisco , Pérez Adriana
Published: October 2019

Background

Several Zika virus (ZIKV) outbreaks have occurred since October 2015. Because there is no effective treatment for ZIKV infection, developing an effective surveillance and warning system is currently a high priority to prevent ZIKV infection. Despite Aedes mosquitos having been known to spread ZIKV, the calculation approach is diverse, and only applied to local areas. This study used meteorological measurements to monitor ZIKV infection due to the high correlation between climate change and Aedes mosquitos and the convenience to obtain meteorological data from weather monitoring stations.

Methods

This study applied the Bayesian structured additive regression modeling approach to include spatial interactive terms with meteorological factors and a geospatial function in a zero-inflated Poisson model. The study area contained 32 administrative departments in Colombia from October 2015 to December 2017. Weekly ZIKV infection cases and daily meteorological measurements were collected. Mapping techniques were adopted to visualize spatial findings. A series of model selections determined the best combinations of meteorological factors in the same model.

Results

When multiple meteorological factors are considered in the same model, both total rainfall and average temperature can best assess the geographic disparities of ZIKV infection. Meanwhile, a 1-in. increase in rainfall is associated with an increase in the logarithm of relative risk (logRR) of ZIKV infection of at most 1.66 (95% credible interval [CI] = 1.09, 2.15) as well as a 1 °F increase in average temperature is significantly associated with at most 0.79 (95% CI = 0.12, 1.22) increase in the logRR of ZIKV. Moreover, after controlling rainfall and average temperature, an independent geospatial function in the model results in two departments with an excessive ZIKV risk which may be explained by unobserved factors other than total rainfall and average temperature.

Conclusion

Our study found that meteorological factors are significantly associated with ZIKV infection across departments. The study determined both total rainfall and average temperature as the best meteorological factors to identify high risk departments of ZIKV infection. These findings can help governmental agencies monitor at risk areas according to meteorological measurements, and develop preventions in those at risk areas in priority.
Interventions to treat methicillin-susceptible Staphylococcus aureus bacteremia: many methodological concerns
Authors: García-Perdomo Herney Andrés , Toro Maldonado Jessica Fernanda
Published: October 2019

The aim of this letter was to point out some methodological concerns about an article written by Shi et al. and published in the journal. There is an increasing trend in the isolation of Methicillin-susceptible Staphylococcus aureus bacteremia and a variety of questions regarding the best therapy to treat this condition. These concerns might lead to selection, publication and information bias that prevent the generalization and application of these results in our clinical practice.
Increase of CSF inflammatory profile in a case of highly active multiple sclerosis
Authors: Magliozzi R. , Marastoni D. , Rossi S. , Castellaro M. , Mazziotti V. , Pitteri M. , Gajofatto A. , Monaco S. , Benedetti M. D. , Calabrese M.
Published: October 2019

Background

Clinical and imaging follow-up coupled with cerebrospinal fluid (CSF) and possibly serum profiling could provide information on disease activity and disability evolution in multiple sclerosis patients.

Case presentation

We describe the case of a relapsing-remitting MS patient whose history was characterized by failure of several therapeutic approaches and sustained disease activity. By using a highly sensitive immunoassay methodology, we examined protein expression of 70 inflammatory/cytotoxic molecules in two consecutive paired CSF and serum samples, obtained respectively in 2006 and 2013. At disease diagnosis, elevated CSF protein levels of an inflammatory pattern, including CXCL13, CXCL12, IFNγ, TNF, sTNFR1, IL8, sCD163, APRIL, BAFF, pentraxin III and MMP2 were found compared with a group of controls. At the second lumbar puncture, sustained disease activity was accompanied by considerable (more than 2 fold changes) increase expression of most of these inflammatory molecules while no significant changes in serum inflammatory markers were detected in the two consecutive serum samples.

Conclusions

Elevated CSF protein expression of pro-inflammatory mediators, possibly specifically associated to GM demyelination, could remain stable or increase over time in patients with active multiple sclerosis. We underline the role of fluid analysis in understanding the pathophysiology of the disease and providing information on possible markers of disease activity and evolution.
A double dilemma: treatment of stage IV fetal twin-twin transfusion syndrome in the setting of maternal recurrent venous thromoembolism: a case report
Authors: McCarthy Claire M. , al-Madhani Alya , Smyth Suzanne , Russell Nóirín E. , Wimalasundera Ruwan , O’Donoghue Keelin
Published: October 2019

Background

Fetal conditions can pose significant challenges in the management of pregnancies complicated by pre-existing maternal medical conditions.

Case presentation

We report a case of a 34-year-old woman with Stage IV Twin Twin Transfusion syndrome in the presence of maternal recurrent complex venous thromboembolic disease. Following a previous pregnancy loss, complicated by a third episode of thromboembolic disease, an inferior vena cava filter was placed. One month later, a pregnancy was confirmed and subsequently identified as a monochorionic twin pregnancy. Twin-Twin Transfusion syndrome was identified at 18 weeks’ gestation and progressed rapidly to Quintero Stage IV. In consultation with a multi-disciplinary international team, fetoscopic laser photocoagulation was performed. The pregnancy progressed to delivery of female infants at 33 weeks gestation, who have achieved all developmental milestones at 2 years of age.

Conclusions

We describe the multi-disciplinary effort to optimise the maternal condition to allow fetoscopic laser photocoagulation and continued management of the maternal and fetal conditions to a successful pregnancy outcome.
Sociodemographic characteristics associated with alcohol consumption and alcohol-related consequences, a latent class analysis of The Norwegian WIRUS screening study
Authors: Skogen Jens Christoffer , Bøe Tormod , Thørrisen Mikkel Magnus , Riper Heleen , Aas Randi Wågø
Published: October 2019

Background

For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges – the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to vary across SES. This observation is called the ‘alcohol harm paradox’. This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, full-time employment, occupational level and income is analysed.

Methods

Employing data from the ongoing cross-sectional WIRUS-study, N = 4311 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors were analysed and presented.

Results

We identified three classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES, with class 3 characterised by younger age, more males and lower educational attainment.

Conclusions

Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Furthermore, the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.
Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis
Authors: Buruck Gabriele , Tomaschek Anne , Wendsche Johannes , Ochsmann Elke , Dörfel Denise
Published: October 2019

Background

The aim of this review was to synthesize the evidence on the potential relationship between psychosocial work factors from the Areas of Worklife (AW) model (workload, job control, social support, reward, fairness, and values) and chronic low back pain (CLBP; unspecific pain in the lumbar region lasting 3 months or longer).

Methods

We conducted a systematic literature search of studies in Medline, PsycINFO, Web of Science, and CINAHL (1987 to 2018). Three authors independently assessed eligibility and quality of studies. In this meta-analysis, we pooled studies’ effect sizes using a random-effects model approach and report sample size weighted mean Odds Ratios (ORs).

Results

Data from 18 studies (N = 19,572) was included in the analyses. We found no studies investigating associations between fairness or values and CLBP. CLBP was significantly positively related to workload (OR = 1.32) and significantly negatively related to overall job control (OR = 0.81), decision authority (OR = 0.72), and two measures of social support (ORs = 0.75 to 0.78), even in prospective studies. Skill discretion and reward did not significantly relate to CLBP. Moderation analyses revealed several variables (e.g., exposure time, mean age and sex) affecting these relationships.

Conclusions

Our results support employees’ workload, job control, and social support as predictors of CLBP. In this line, these work factors should be considered when developing programs to prevent chronic low back pain. Future studies should apply measures of CLBP that are more precise, and investigate the full areas of work life (AW) factors in combination.
Protein hydrolysate from potato confers hepatic-protection in hamsters against high fat diet induced apoptosis and fibrosis by suppressing Caspase-3 and MMP2/9 and by enhancing Akt-survival pathway
Authors: Asokan Shibu Marthandam , Hung Tsu-Han , Li Zong-Yan , Chiang Wen-Dee , Lin Wan-Teng
Published: October 2019

Background

A potato protein hydrolysate, APPH is a potential anti-obesity diet ingredient. Since, obesity leads to deterioration of liver function and associated liver diseases, in this study the effect of APPH on high fat diet (HFD) associated liver damages was investigated.

Methods

Six week old male hamsters were randomly separated to six groups (n = 8) as control, HFD (HFD fed obese), L-APPH (HFD + 15 mg/kg/day of APPH), M-APPH (HFD + 30 mg/kg/day), H-APPH (HFD + 75 mg/kg/day of APPH) and PB (HFD + 500 mg/kg/day of probucol). HFD fed hamsters were administered with APPH 50 days through oral gavage. The animals were euthanized and the number of apoptotic nuclei in liver tissue was determined by TUNEL staining and the extent of interstitial fibrosis was determined by Masson’s trichrome staining. Modulation in the molecular events associated with apoptosis and fibrosis were elucidated from the western blotting analysis of the total protein extracts.

Results

Hamsters fed with high fat diet showed symptoms of liver damage as measured from serum markers like alanine aminotransferase and aspartate aminotransferase levels. However a 50 day long supplementation of APPH effectively ameliorated the effects of HFD. HFD also modulated the expression of survival and apoptosis proteins in the hamster liver. Further the HFD groups showed elevated levels of fibrosis markers in liver. The increase in fibrosis and apoptosis was correlated with the increase in the levels of phosphorylated extracellular signal-regulated kinases (pERK1/2) revealing a potential role of ERK in the HFD mediated liver damage. However APPH treatment reduced the effect of HFD on the apoptosis and fibrosis markers considerably and provided hepato-protection.

Conclusion

APPH can therefore be considered as an efficient therapeutic agent to ameliorate high fat diet related liver damages.
Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers
Authors: Meijer E. , Van der Kleij R. M. J. J. , Chavannes N. H.
Published: October 2019

Background

Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer.

Methods

Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses.

Results

The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes.

Conclusions

There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.
The role of health and advocacy organisations in assisting female sex workers to gain access to health care in South Africa
Authors: Makhakhe Nosipho Faith , Meyer-Weitz Anna , Struthers Helen , McIntyre James
Published: October 2019

Background

Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services.

Methods

Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically.

Results

The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours.

Conclusion

This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs’ engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.
Implementing integrated services in routine behavioral health care: primary outcomes from a cluster randomized controlled trial
Authors: Assefa Mehret T. , Ford James H. , Osborne Eric , McIlvaine Amy , King Ahney , Campbell Kevin , Jo Booil , McGovern Mark P.
Published: October 2019

Background

An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders.

Methods

This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not?

Results

From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen’s d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen’s d = 0.91) and Continuity of Care (p = 0.026, Cohen’s d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen’s d = 0.51) were found.

Conclusions

Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders.

Trail registration

ClinicalTrials.gov, NCT03007940. Retrospectively registered January 2017
Morbidity burden of respiratory diseases attributable to ambient temperature: a case study in a subtropical city in China
Authors: Zhao Yiju , Huang Zhao , Wang Shengyong , Hu Jianxiong , Xiao Jianpeng , Li Xing , Liu Tao , Zeng Weilin , Guo Lingchuan , Du Qingfeng , Ma Wenjun
Published: October 2019

Background

There are significant associations between ambient temperature and respiratory disease mortality. However, few studies have assessed the morbidity burdens of various respiratory diseases that are attributable to different temperature ranges in subtropical regions.

Methods

Daily outpatient visits, weather variables, and air pollution data were collected from January 2013 to August 2017 in a hospital in Dongguan city. A standard time series quasi-Poisson regression with a distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for total respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. Attributable fractions were then calculated to quantify disease burden relative to different temperature components. Finally, we conducted stratified analysis by age group.

Results

Both low and high temperatures were associated with an increased risk of morbidity secondary to respiratory diseases. Compared with the optimum temperature, the accumulated relative risk (RR) during the seven lag days was 1.13 with a 95% confidence interval (CI) of 1.01–1.26 for extreme heat and 1.02 (95% CI: 0.99–1.05) for extreme cold. Heat-related respiratory morbidity risk was higher than cold-related risk for the total population, but an opposite result was observed for the elderly. About 8.4% (95% CI: 2.8–13.3%) of respiratory morbidity was attributable to non-optimal temperatures, and moderate heat was responsible for most of the excess respiratory morbidity (7.5, 95% CI: 2.4–12.2%).

Conclusions

We found that exposure to non-optimal temperatures increased the risk of respiratory morbidity in subtropical region, and moderate heat contributed to most of the temperature-related respiratory morbidities. This indicates a need for further examination of moderate, rather than extreme, heat in subtropical region.
Genotypic and phenotypic character of Chinese neonates with congenital protein C deficiency: a case report and literature review
Authors: Li Xiaoying , Li Xiaoyan , Li Xiao , Zhuang Yuanhua , Kang Lili , Ju Xiuli
Published: October 2019

Background

Our objective was to study the phenotype of and molecular genetic mechanisms underlying congenital protein C (PC) deficiency in Chinese neonates. We report the case of a neonate who presented 4 h after birth with purpura fulminans of the skin and thrombosis in the kidney. We also carried out a through literature review to study the genotype and phenotype, relevance, diagnosis, management, and prognosis of neonates with congenital PC deficiency in China.

Case presentation and literature review

Following a septic work-up and check of PC and protein S (PS) levels that showed PC deficiency, we investigated the patient’s and her parents’ genotypes. Our patient was found to have a plasma PC level of 0.8%. Molecular testing revealed a compound heterozygous mutation of the PROC gene: From the father, a c._262 G > T p. ASP88Tyr mutation in exon 4; from the mother, a C. 400 + 5G mutation in intron 5 that had been previously reported as likely pathogenic. Both parents were found to have heterozygous mutations for PC deficiency. In China, 5 other cases of congenital PC deficiency in the neonatal period were reported in the literature. In those cases, purpura fulminans and thrombosis were the main symptoms, and homozygous or compound heterozygous mutations of the PROC gene were identified.

Conclusion

Congenital PC deficiency should be ruled out for neonates presenting with purpura fulminans and thrombosis.