bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of non-Alcoholic Fatty Liver Disease and Associated Factors in Patients with Moderate or Severe Hemophilia: A Multicenter-Based Study
Authors: Shen Ming-Ching , Chiou Shyh-Shin , Chou Sheng-Chieh , Weng Te-Fu , Lin Ching-Yeh , Wang Jiaan-Der , Lee Shou-Wu , Peng Ching-Tien
Published: September 2022

Introduction

Liver health is essential for persons with hemophilia (PWH) in order to maintain access to new therapies, such as gene therapy. Non-alcoholic fatty liver disease (NAFLD) is seldom reported in the hemophilia population. The study aimed to investigate the prevalence of NAFLD and associated factors in PWH.

Methods

Data of this cross-sectional study were obtained from a multicenter collaborative registry database.

Results

A total of 163 moderate or severe PWH with a complete data of liver examination were analyzed. There were 77 (47.2%) PWH diagnosed with NAFLD. The multivariate analysis showed that overweight/obesity was associated with NAFLD (OR, 4.31, P < .001). In comparison with hemophilia B patients, hemophilia A patients showed a weaker correlation with NAFLD, (OR, 0.30, P = .009). A total of 17 (25.8%) PWH with NAFLD had an elevated level of alanine transaminase (ALT). Both overweight/obesity and presence of inhibitor to clotting factor were independently associated with elevated ALT in PWH with NAFLD.

Conclusions

The study indicated that a high prevalence of NAFLD existed in the hemophilia population. Overweight/obesity was an independent factor for NAFLD and elevated ALT.
Microbiome-Related Indole and Serotonin Metabolites are Linked to Inflammation and Psychiatric Symptoms in People Living with HIV
Authors: Vadaq Nadira , Zhang Yue , Meeder Elise , Van de Wijer Lisa , Gasem Muhammad Hussein , Joosten Leo AB , Netea Mihai G , de Mast Quirijn , Matzaraki Vasiliki , Schellekens Arnt , Fu Jingyuan , van der Ven André JAM
Published: September 2022

Background:

People living with HIV (PLHIV) exhibit dysregulation of tryptophan metabolism. Altered gut microbiome composition in PLHIV might be involved. Mechanistic consequences within the 3 major tryptophan metabolism pathways (serotonin, kynurenine, and indoles), and functional consequences for platelet, immune and behavioral functions are unknown. We investigated plasma tryptophan metabolites, gut microbiome composition, and their association with platelet function, inflammation, and psychiatric symptoms.

Methods:

This study included 211 PLHIV on long-term antiretroviral treatment (ART). Plasma tryptophan pathway metabolites were measured using time-of-flight mass spectrometry. Bacterial composition was profiled using metagenomic sequencing. Platelet reactivity and serotonin levels were quantified by flowcytometry and ELISA, respectively. Circulating inflammatory markers were determined using ELISA. Symptoms of depression and impulsivity were measured by DASS-42 and BIS-11 self-report questionnaires, respectively.

Results:

Plasma serotonin and indole metabolites were associated with gut bacterial composition. Notably, species enriched in PLHIV were associated with 3-methyldioxyindole. Platelet serotonin concentrations were elevated in PLHIV, without effects on platelet reactivity. Plasma serotonin and indole metabolites were positively associated with plasma IL-10 and TNF-α concentrations. Finally, higher tryptophan, serotonin, and indole metabolites were associated with lower depression and anxiety, whereas higher kynurenine metabolites were associated with increased impulsivity.

Conclusion:

Our results suggest that gut bacterial composition and dysbiosis in PLHIV on ART contribute to tryptophan metabolism, which may have clinical consequences for immune function and behavior.
Strategies for capacity building in a low-resource setting: Stakeholders’ voices
Authors: Lee James D , Meadan Hedda , Oyunbaatar Enkhjin , Amar Amarbuyan
Published: September 2022

Although global prevalence of autism has grown substantially, researchers still report inequity in access to evidence-based interventions in many low-resource settings where majority of world’s children live. Capacity building of diverse stakeholders in low-resource settings has been suggested to be a potential way to mitigate low levels of access to resources; however, little is known about what these stakeholders consider as helpful strategies in capacity building. In this qualitative research, we conducted five focus groups with 30 Mongolian caregivers of children with autism and 15 individual interviews with professionals in Mongolia. Three themes emerged from this study, including (a) partnership, (b) advocacy, and (c) empowerment. Each theme also contained several categories. For example, partnerships included enhancing collaboration among stakeholders and collaboration with international development agencies; advocacy included parental and legislative advocacy; and empowerment included training for diverse stakeholders, including caregivers and professionals. Implications and directions for future research are also suggested.

Lay abstract

Prevalence of autism is increasing all around the globe, but there is still great inequity in accessing evidence-based interventions. Although the field of autism research has made great strides in identifying and establishing evidence-based interventions, dissemination and implementation of these interventions have been reported as inequitable. This inequity is especially highlighted in many low-resource settings, such as Mongolia. As a field, there is still much to be learned about what strategies are used by stakeholders in low-resource settings to build capacity and to mitigate the hardships. To gain a deeper understanding of strategies for capacity building within a low-resource setting, we conducted five focus groups with 30 Mongolian caregivers of children with autism and 15 individual interviews with various professionals who work in Mongolia. These stakeholders reported three main strategies, including (a) partnership, (b) advocacy, and (c) empowerment, which included several strategies and implications on capacity-building practices. Furthermore, the findings from this study may suggest important implications for future intervention research.
Development of a framework for the collaborative adaptation of service models for child and family health in diverse settings (CASCADES)
Authors: Stockton Deborah A , Fowler Cathrine , Debono Deborah , Travaglia Joanne
Published: September 2022

The impact of health service access disparities has significant implications for society. The importance of addressing health and social inequities is never more critical than in the early years of a child’s life. Despite advances in healthcare implementation, there is a lack of an evidence-based framework to specifically guide the adaptation of child and family health (CFH) service models for different community contexts. This paper describes the development of a framework for the adaptation of community-based CFH service models. Drawing on the findings of an integrative review and Delphi study, Participatory Action Research was used to test the framework, resulting in the Framework for Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES). The Framework uses the analogy of a waterfall to represent the iterative process of collecting information to inform each step. The framework supports a collaborative co-design approach to build a comprehensive understanding of the target community to inform the adaptation and evaluation of evidence-based interventions appropriate to the local context. The ultimate aim is to enable the delivery of services that are contextually relevant for local communities and provide greater access to effective, accessible services to support children and their families.
Service, reciprocity, and remedy: From Confucian meritocracy to Confucian democracy
Authors: Kim Sungmoon
Published: September 2022

One of the most notable features in recent Confucian political theory is the advocacy of political meritocracy. Though Confucian meritocrats’ controversial institutional design has been subject to critical scrutiny, less attention has been paid to their underlying normative claims. This paper aims to investigate the two justificatory conditions of Confucian political meritocracy—the service condition and the reciprocity condition—in light of classical Confucianism and with special attention to moral disagreement. Finding the normative argument for Confucian political meritocracy both incomplete (in light of classical Confucianism) and implausible (under the circumstances of moral disagreement), it proposes Confucian constitutional democracy as an alternative that can meet the three conditions of the good Confucian polity—service, reciprocity, and remedy—by reconceiving the people's well-being in terms of their basic rights, as well as by promoting constitutional dialogue among the three branches of the government.
A shape grammar for the spontaneous occupation settled in fishing villages: The case of Garopaba, Brazil
Authors: Correa Sara Dotta , Verzola Vaz Carlos Eduardo
Published: September 2022

This work presents the second stage of a larger study which conducted the elaboration of a shape grammar based on the analysis of the remaining fishing villages in the Santa Catarina State, Southern Brazil. The architectural and formal structure of the villages provide a perspective of the constructive methods and features embedded in the spatial arrangements and represent a local cultural heritage site. The aim of the present work relies on unraveling its spatial resources using a shape grammar approach, in order to contribute to the preservation of a distinct culture, and is intended to be used to safeguard its formal language planning. Also, through the analytical grammar, it would be possible to contribute in framing design guidelines regarding the remaining villages, to keep it steady on the traditional context, safeguarding its peculiar character. As such, the method in this body of work considered the analysis resulting from the first stage, in order to develop an analytical shape grammar using Garopaba village as a case of study. This stage involved the establishment of a formal language for the analytical grammar, consisting of initial form, vocabulary, families, and spatial relations, and thus, a series of rules emerged, decoding the composition arrangements. The results involved the verification of the considered parameters, confirming the existence of spatial patterns. Thus, it was possible to conclude that the grammar contributes to identifying the occupation process occupation and the spatial patterns which underlies an artisanal fishing village. Also, the grammar allowed the creation of urban compositions similar to the structure of traditional fishing communities in Santa Catarina, generating different discussions regarding the analytical approach towards fishing villages arrangements, compared to the examples studied, specifically, in Garopaba city.
Becoming Relationally Spacious: Mental Healthcare Students’ Experiences With the Immunity to Change Workshop
Authors: Sommer Mona , Andvig Ellen , Riis Ragnhild , Bongaardt Rob
Published: September 2022

Students in mental health care are urged to develop professionally as well as personally, according to the Norwegian national state curriculum. The purpose of this study was to describe mental healthcare students’ experiences with the use of Immunity to Change (ITC) workshops and endorse this as a transformative learning approach to personal–professional development. One focus group interview and four in-depth individual interviews were conducted with open-ended questions. These were analyzed with Giorgi’s phenomenological method. Further existential reflections were guided by van Manen’s phenomenological hermeneutics. ITC workshops offered a way to develop the ability to approach various situations and relationships in mental healthcare work flexibly and dynamically. Tolerance for uncertainty and ambiguity enabled students to grow personally and interpersonally. This study highlights the importance of supporting students to structure their transformative journey of becoming relationally spacious, being able to room themselves as well as colleagues and users/patients.
Compassion Fatigue and Spiritual Leaders: A Pilot Study
Authors: Malone Stormy , Lewis Rhonda K.
Published: September 2022

This is a pilot study on compassion fatigue experienced by spiritual leaders. The sample consisted of 15 religious affiliations with a total of 41 participants (30 males and 11 females). In this sample, spiritual leaders were not experiencing significant levels of compassion fatigue, and they were satisfied with their work. There was a significant negative correlation between satisfaction and exhaustion, r = −.62, n = 35, p < .01. Additionally, participants reported their coping strategies and support systems.
Model-based design of a novel modular mounting system: Light, compact, and efficient
Authors: Qiu Yuanran , Xu Wei , Hu Zechao , Zhang Shengwu
Published: September 2022

Two-stage mounting systems applied in ships are expected to be light in weight, compact in installation space, and efficient in vibration isolation performance at the same time, which largely increases the engineering complexity. In this paper, analytical models of a two-stage mounting system with flexible and rigid intermediate mass are proposed to compare the vibration isolation effectiveness (VIE) performance and the influences of system parameters with the rigid intermediate mass on VIE are introduced. Based on the analysis results, an integrated adjustable two-stage mounting module is designed. Compared to the traditional floating raft mounting system with flexible intermediate mass, this two-stage mounting module can be arranged in a more compact structure space with greatly reduced size and weight. Furthermore, a novel modular mounting system prototype is proposed and manufactured based on several two-stage mounting modules and real-time behavior monitoring and controlling subsystem. The testing results verify the compatibility of the module design and the behavior monitoring and controlling system. The modular mounting system also exhibits excellent VIE performance combined with the advantage of compact intermediate mass size, lightweight, and automatic behavior monitoring and controlling.
‘He’s got growth’: Coaches understanding and management of the growth spurt in male academy football
Authors: Hill Megan , John Thomas , McGee Darragh , Cumming Sean P.
Published: September 2022

The majority of studies investigating maturation in football have focused on the impact of maturity status or timing upon athletic performance. There is comparatively little research investigating the impact of the adolescent growth spurt, and few research articles that have focussed on injury incidence and burden rather than performance. The aim of this study was to explore and better understand how the adolescent growth spurt impacts youth football players within professional academies. This longitudinal mixed-methods study aimed to understand youth football coaches’ perceptions, experiences, and management of male adolescent football players. Players’ maturity status, growth velocities, and match performance were measured and interviews with coaches were conducted in parallel. The qualitative and quantitative data were combined to generate a deeper contextualised understanding. This study revealed that academy football coaches describe adolescent growth as a ‘condition’; players are diagnosed with growth through perceived signs and symptoms, which coaches must manage and treat. Growth was also seen to impact coaches’ perceptions and therefore had implications for selection and release decisions. The findings from this study emphasise the complexities of experiencing and managing adolescent growth and maturation in the context of elite youth football.
Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries
Authors: Rönkkö Henrikki , Neergård Sletten Ida , Liv Hansen Karina , Ryhänen Jorma , Pietreanu Mihai , Jokihaara Jarkko
Published: September 2022

In this survey, we compared the current postoperative practices in the largest replantation units of four Nordic countries. The topics included were indication for surgery, anaesthesia, postoperative monitoring, use of antibiotics, anticoagulation and postoperative intravenous fluids, change of dressings, duration of bed rest and hospital stay, hand therapy and follow-up after discharge. Although there were many similarities between the units in the postoperative protocols, we found a large variety of practices. There is no robust evidence to assess or support or reject most of the strategies in postoperative care. The differences in practice warrant prospective studies in order to establish an evidence-based postoperative protocol for replantation surgery.
Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective
Authors: Matić Zorana , Sala Maria F. Wong , Tonetto Leandro Miletto , Campiglia Gabrielle Conrad , Morgan Jill , DuBose Jennifer R. , Zimring Craig M. , Kraft Colleen S.
Published: September 2022

Objectives:

This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them.

Background:

The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience.

Method:

A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients’ perception and experience of isolation. The interviews were analyzed using the thematic analysis approach.

Results:

The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness.

Conclusions:

The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients’ experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.
Resilience: Key Factors Associated With Resilience of Older People in Botswana
Authors: Mhaka-Mutepfa Magen , Shaibu Sheila
Published: September 2022

This study aims to determine key factors that predict resilience in older people. A cross-sectional design and quantitative methods were used for this study. Four districts were selected in Botswana using cluster random sampling. Data on resilience from 378 older adults aged 60 years+ [Mean Age ( SD) = 71.1(9.0)] was collected using snowballing technique. Data on socio-demographics, protective and risk factors were also collected from urban and rural areas. CHAID (Chi-squared Automatic Interaction Detection) analysis was used to predict the strengths of the relationships among resilience and all predictor variables because the data were skewed. Five major predictor variables reached significance to be included in the model: depression, QOL, social impairment, education, and whether participants paid for services or accessed free services, along with high self-esteem ( p < .001), security, and self-efficacy ( p < .05). The presence of depression symptoms (χ2 = 23.7, p = .001, df = 1) and self-esteem (χ2 = 39.6, p < .001) had the greatest influence on resilience. Older people with no depression symptoms but had low QOL still had social impairment (χ2 = 3.9, p < .05). Older people with no depression symptoms had moderate to high QOL but had low resilience as a result of paying for services (χ2 = 7.4, p < .02). Both protective and risk factors had a significant influence on resilience. Knowledge about the predictors of resilience in older people may assist stakeholders devise effective intervention, especially now with COVID-19 ravaging the country. Additionally, policies and programs inclined to assist older people may be established and implemented.
Exploring the Interaction Between Social Strain and Support and its Association with College Students’ Psychological Well-Being
Authors: Hoffman Rebecca K. , Cook Maya N. , Balaguer Matthew T. , Gee Christina B.
Published: September 2022

The current study elucidates the role that close relationships play on emerging adults’ psychological distress. We examined the associations between maternal, paternal, and romantic partner strain and well-being outcomes, as well as the moderating role of overall social support. Data were collected from 469 undergraduates through an online survey. As expected, maternal and paternal strain were negatively associated with satisfaction with life (SWL) and positively associated with loneliness; however, romantic partner strain did not significantly relate to either well-being variable. Additionally, although overall support was associated with the well-being variables, the interactions between overall social support and strain were not significant, suggesting no moderating effect of support. These findings suggest that maternal and paternal strain can contribute negatively to their children’s psychological well-being regardless of emerging adults’ overall perceptions of support from their social networks. Implications for theories of social support and interventions for college students are discussed.
Small Cell Neuroendocrine of the Head and Neck: A Rare Presentation and Review of the Literature
Authors: Niforatos Stephanie , Sandhu Michael , Kallem Mansi , Serinelli Serenella , Curtiss Christopher , Akhtar Komal
Published: September 2022

Head and neck tumors account for roughly 3% of malignancies in the United States and about 90% of these tumors are squamous cell cancers. Neuroendocrine neoplasms arise from neural crest cells and are commonly found in the gastrointestinal tract. Neuroendocrine neoplasms arising from the head and neck tend to be rare. In this article, we present a rare case of human papilloma virus–associated poorly differentiated small cell neuroendocrine carcinoma (NEC). Our patient was a 62-year-old African American man who presented with worsening left-sided neck pain and swelling that started 3 months prior to presentation, associated with an unintentional 20-pound weight loss over 6 months, hoarseness in his voice, in addition to dysphagia and odynophagia. Biopsy of left-sided tongue mass revealed poorly differentiated small cell NEC that was positive for HPV (E6/E7) RNA in situ hybridization. Patient was found to have metastatic disease at the time of diagnosis and given the aggressive nature of small cell NECs and the patient’s symptomatic burden, chemotherapy with cisplatin and etoposide was initiated in the hospital. The patient was subsequently discharged from the hospital and is continuing treatment outpatient with cisplatin, etoposide, and atezolizumab.
Health Utility of Drinkers’ Family Members: A Secondary Analysis of a US Population Data Set
Authors: Thornburg Benjamin , Bray Jeremy W. , Wittenberg Eve
Published: September 2022

Background. Problematic alcohol use is known to harm individuals surrounding the drinker. This study described the health utility of people who reported having a family member(s) whom they perceived as a “problem drinker.”Methods. We conducted a secondary analysis of the US National Epidemiologic Survey of Alcohol and Related Conditions Wave 3 (NESARC-III, 2012–13) data to estimate the independent associations of a family member’s problem drinking on the respondent’s health utility, also known as health-related quality of life, assessed via the SF-6D. Participants included 29,159 noninstitutionalized adults, of whom 21,808 reported perceiving a family member or members as having a drinking problem at any point in that person’s life. Respondent drinking was assessed via self-report and diagnostic interview. We used population-weighted multivariate regression to estimate disutility. Results. After adjusting for the respondent’s own alcohol consumption, alcohol use disorder (AUD), family structure, and sociodemographic characteristics, the mean decrement in SF-6D score associated with perceiving a family member as a problem drinker ranged from 0.033 ( P < 0.001) for a spouse/partner to 0.023 ( P < 0.001) for a grandparent, sibling, aunt, or uncle. The mean decrement in SF-6D score from having AUD oneself was 0.039 ( P < 0.001). Conclusions. Perceived problem drinking within one’s family is associated with statistically significant losses in health utility, the magnitude of which is dependent on relationship type. The adverse consequences associated with problem drinking in the family may rival having AUD oneself. Implications. Family-oriented approaches to AUD interventions may confer outsize benefits, especially if focused on the spouse or partner. Economic evaluation of alcohol misuse could be made more accurate through the inclusion of family spillover effects.

Highlights

Spillover effects from problem drinking in the family vary by relationship type. One’s perception of their spouse or child as having a drinking problem is associated with a utility decrement of equal magnitude to having alcohol use disorder oneself. Medical decision makers should consider the outsize effects of family spillovers in treatment decisions in the context of alcohol consumption, particularly among spouses and children of problem drinkers. Economic evaluation should consider how to incorporate family spillover effects from problem drinking in alcohol-related models.
Reflections on the in-prison recruitment and participation of men with a history of injecting drug use, in a longitudinal cohort study in Australia
Authors: Walker Shelley , Curtis Michael , Woods Emma , Pierce Lyn , Kirwan Amy , Stewart Ashleigh C , Cossar Reece , Winter Rebecca , Dietze Paul , Kinner Stuart A , Ogloff James RP , Butler Tony , Stoové Mark
Published: September 2022

Studies aimed at improving the health and well-being needs of people in prison are increasing in number. The ethical and logistical challenges of conducting this research, however, pose challenges for researchers which can limit its scope. Emerging literature provides insights into these challenges, but little is focused on the Australian perspective, and most are based on the experiences of recruiting and collecting data for ethnographic and qualitative research. Literature describing the challenges of conducting quantitative prospective studies in prisons is limited. Furthermore, despite the fact that people who inject drugs are overrepresented amongst prison populations, and experience higher levels of socioeconomic disadvantage and poorer health than the general prison population, we are unaware of literature describing the particular sensitivities associated with their recruitment and participation in research in prisons. We intend to address these gaps by drawing on our experience and reflecting on learnings that emerged from longitudinal research we conducted with 400 incarcerated males with recent histories of injecting drug use, in Victoria, Australia. Our aim is to provide guidance and lessons for future research.
circGPA: circRNA functional annotation based on probability-generating functions
Authors: Ryšavý Petr , Kléma Jiří , Merkerová Michaela Dostálová
Published: September 2022

Recent research has already shown that circular RNAs (circRNAs) are functional in gene expression regulation and potentially related to diseases. Due to their stability, circRNAs can also be used as biomarkers for diagnosis. However, the function of most circRNAs remains unknown, and it is expensive and time-consuming to discover it through biological experiments. In this paper, we predict circRNA annotations from the knowledge of their interaction with miRNAs and subsequent miRNA–mRNA interactions. First, we construct an interaction network for a target circRNA and secondly spread the information from the network nodes with the known function to the root circRNA node. This idea itself is not new; our main contribution lies in proposing an efficient and exact deterministic procedure based on the principle of probability-generating functions to calculate thep-value of association test between a circRNA and an annotation term. We show that our publicly available algorithm is both more effective and efficient than the commonly used Monte-Carlo sampling approach that may suffer from difficult quantification of sampling convergence and subsequent sampling inefficiency. We experimentally demonstrate that the new approach is two orders of magnitude faster than the Monte-Carlo sampling, which makes summary annotation of large circRNA files feasible; this includes their reannotation after periodical interaction network updates, for example. We provide a summary annotation of a current circRNA database as one of our outputs. The proposed algorithm could be generalized towards other types of RNA in way that is straightforward.
Facilitators and barriers to COVID-19 vaccination among healthcare workers and the general population in Guinea
Authors: Toure Almamy Amara , Traore Fodé Amara , Camara Gnoume , Magassouba Aboubacar Sidiki , Barry Ibrahima , Kourouma Mohamed Lamine , Sylla Younoussa , Conte Naby Yaya , Cisse Diao , Dioubaté Nafissatou , Sidibe Sidikiba , Beavogui Abdoul Habib , Delamou Alexandre
Published: September 2022

Introduction

The advent of the effective COVID-19 vaccine was the most eagerly expected worldwide. However, this hope quickly became hesitation and denial in many countries, including Guinea. Understanding the reasons for low vaccine coverage is essential to achieving herd immunity leading to disease control. This study aimed to comprehend the facilitators and barriers to the acceptance COVID-19 vaccine in Guinea.

Methods

The survey focused on healthcare workers (HCWs) and the general population (GP) in 4 natural regions in Guinea from 23 March 2021 to 25 August 2021. We used the Fishbein integration model to study the behaviours of HWCs and GP regarding vaccination. A mixed cross-sectional study collected knowledge, attitudes, norms, and perceptions. Regression and thematic content analysis identified the main facilitators and barriers to vaccination.

Results

We surveyed 3547 HCWs and 3663 GP. The proportion of people vaccinated was 65% among HCWs and 31% among the GP. For HCWs: the main factors associated with vaccination against COVID-19 were as follows: absence of pregnancy AOR = 4.65 [3.23–6.78], being supportive of vaccination AOR = 1.94 [1.66–2.27] and being an adult AOR = 1.64 [1.26–2.16]. Regarding the GP, the following factors increased the odds of vaccination: absence of pregnancy AOR = 1.93 [CI 1.01–3.91], being favourable for vaccination AOR = 3.48 [CI 2.91–4.17], being an adult AOR = 1.72 [CI 1.38–2.14] and being able to get the vaccine AOR = 4.67 [CI 3.76–5.84]. Semi-interviews revealed fear, lack of trust, and hesitant perception of the government as potential barriers to vaccination.

Conclusion

This study suggests that beliefs and negative perceptions are potential barriers to vaccination against COVID-19 among HCWs and the GP. Policies should emphasise practical strategies to mitigate these barriers among young people and pregnant women. Lastly, there is a need to improve access to vaccines in the GP.
Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis
Authors: Murea Mariana , Highland Benjamin R. , Yang Wesley , Dressler Emily , Russell Gregory B.
Published: September 2022

Background

Physical and emotional symptoms are prevalent in patients with kidney-dysfunction requiring dialysis (KDRD) and the rigors of thrice-weekly hemodialysis (HD) may contribute to deteriorated health-related quality of life. Less intensive HD schedules might be associated with lower symptom and/or emotional burden.

Methods

The TWOPLUS Pilot study was an individually-randomized trial conducted at 14 dialysis units, with the primary goal to assess feasibility and safety. Patients with incident KDRD and residual kidney function were assigned to incremental HD start (twice-weekly HD for 6 weeks followed by thrice-weekly HD) vs conventional HD (thrice-weekly HD). In exploratory analyses, we compared the two treatment groups with respect to three patient-reported outcomes measures. We analyzed the change from baseline in the score on Dialysis Symptom Index (DSI, range 0–150), Generalized Anxiety Disorder-7 (GAD-7, range 0–21), and Patient Health Questionnaire-9 (PHQ-9, range 0–27) at 6 (n = 20 in each treatment group) and 12 weeks (n = 21); with lower scores denoting lower symptom burden. Analyses were adjusted for age, race, gender, baseline urine volume, diabetes mellitus, and malignancy. Participants’ views on the intervention were sought using a Patient Feedback Questionnaire (n = 14 in incremental and n = 15 in conventional group).

Results

The change from baseline to week 6 in estimated mean score (standard error; P value) in the incremental and conventional group was − 9.7 (4.8; P = 0.05) and − 13.8 (5.0; P = 0.009) for DSI; − 1.9 (1.0; P = 0.07) and − 1.5 (1.4; P = 0.31) for GAD-7; and − 2.5 (1.1; P = 0.03) and − 3.5 (1.5; P = 0.02) for PHQ-9, respectively. Corresponding changes from week 6 to week 12 were − 3.1 (3.2; P = 0.34) and − 2.4 (5.5; P = 0.67) in DSI score; 0.5 (0.6; P = 0.46) and 0.1 (0.6; P = 0.87) in GAD-7 score; and − 0.3 (0.6; P = 0.70) and − 0.5 (0.6; P = 0.47) in PHQ-9 score, respectively. Majority of respondents felt their healthcare was not jeopardized and expressed their motivation for study participation was to help advance the care of patients with KDRD.

Conclusions

This study suggests a possible mitigating effect of twice-weekly HD start on symptoms of anxiety and depression at transition from pre-dialysis to KDRD. Larger clinical trials are required to rigorously test clinically-matched incrementally-prescribed HD across diverse organizations and patient populations.

Trial registration

Registered at ClinicalTrials.gov with study identifier NCT03740048, registration date 14/11/2018.
Roles of alpha-7 nicotinic acetylcholine receptors and spleen in the lung injury induced by a repeated saline lavage in rat
Authors: Fatemikia Hossein , Dehghanian Amirreza , Ziaian Bizhan , Farokhipour Maryam , Ketabchi Farzaneh
Published: September 2022

Background

The study aimed to determine whether or notα7 nicotinic acetylcholine receptors (α7nAChR) induce anti-inflammatory effects directly in the lung or through the spleen pathway in a sterile model of lung injury by saline lavage.

Methods

Male Sprague Dawley rats were divided into seven groups; Sham, splenectomy (SPX), saline lavage (LAV), LAV treated with α7nAChR agonist nicotine (LAV + NIC), and LAV treated with NIC and a selective α7nAChR antagonist MLA (LAV+MLA+NIC), LAV and splenectomy (LAV+SPX), and LAV+SPX treated with nicotine (LAV+SPX+NIC). Tracheostomy and catheterization of the femoral artery were performed under deep anesthesia. Animals were subjected to volume-controlled ventilation and lung injury by 10 repeated saline lavages. Splenectomy was achieved one week before the induction of lung injury. The recovery phase lasted for 3 h, and drugs were injected 1 h after the last lavage.

Results

Mean arterial blood pressure (MBP), heart rate (HR), PaO2, PaO2/FiO2 ratio, and pH decreased, whereas, maximal inspiratory (MIP) and expiratory (MEP) pressures, and PaCO2 increased 1 h after the saline lavage. Nicotine corrected entirely all the above parameters in the LAV + NIC group. MLA or SPX prevented the effects of nicotine on the above parameters, except that MLA had no extra effect on MIP or MEP. In addition, nicotine improved lung compliance in the LAV + NIC and LAV + SPX + NIC groups, though it was inhibited by MLA in the LAV + MLA + NIC group. The increases of plasma and lung tissue malondialdehyde (MDA) in the LAV group were diminished by nicotine, whereas, MLA and SPX prevented these reductions. Besides, nicotine could reduce plasma MDA in the LAV + SPX + NIC group. Total BAL cell count, protein BAL/protein plasma ratio, and lung histological scores were attenuated by nicotine in the LAV + NIC group, whereas, MLA reversed the mentioned alterations in the LAV + MLA + NIC group. However, splenectomy could not stop the decreasing effect of nicotine on the total BAL cell in the LAV + SPX + NIC group.

Conclusions

In this study, we indicated that α7nAChR and spleen play roles in cholinergic anti-inflammatory pathways in saline lavage-induced lung injury. However, our results are in favor of at least some direct effects of α 7nAChR in the lung.
Correlates of work productivity and maternal competence after having a baby: the roles of mother-infant bonding and maternal subjective experiences
Authors: Tohme Pia , Abi-Habib Rudy
Published: September 2022

Background

The law in Lebanon allows new mothers to take up to 10 weeks paid maternity leave, and some private organizations choose to give fathers 2 days of paternity leave in the absence of clear legislation. This falls short of the 6 months recommended for mothers in the literature.

Methods

The sample consisted of 97 Lebanese mothers with children between 6 and 24 months of age. First, we examined correlations between the length of maternity leave and measures of work productivity and maternal sense of competence in their new role as a parent. Second, we explored correlations between the length of maternity leave and mother–child adjustment measures (mother-infant bonding, maternal stress, and parenting guilt). Finally, we looked for predictors of work productivity and maternal sense of competence in demographic variables, mother–child adjustment measures, and partner attachment scores.

Results

Results showed significant correlations between work productivity and maternal sense of competence, irrespective of the length of maternity leave. Regression analyses showed that working for pleasure, mother-infant healthy bonding, and positive subjective experience of being back to work were significant predictors of work productivity, and that maternal stress predicted maternal competence.

Conclusion

These findings are discussed within the framework of providing suggestions facilitating mothers’ transition back to work and increasing work productivity after having a baby.
Continuity of care for older adults in a Canadian long-term care setting: a qualitative study
Authors: King Madeline , Steele Gray Carolyn , Kobewka Daniel , Grudniewicz Agnes
Published: September 2022

Background

Continuity of care has been shown to improve health outcomes and increase patient satisfaction. Goal-oriented care, a person-centered approach to care, has the potential to positively impact continuity of care. This study sought to examine how a goal-oriented approach impacts continuity of care in a long-term care setting.

Methods

Using a case study approach, we examined what aspects of goal-oriented care facilitate or inhibit continuity of care from the perspectives of administrators, care providers, and residents in a long-term care centre in Ontario, Canada. Data was collected through documentary evidence and semi-structured interviews.

Results

We analyzed six internal documents (e.g., strategic plan, client information package, staff presentations, evaluation framework, program logic model), and conducted 13 interviews. The findings indicated that the care provided through the goal-oriented approach program had elements that both facilitated and inhibited continuity of care. These factors are outlined according to the three types of continuity, including aspects of the program that influence informational, relational, and management continuity.

Conclusions

Aspects of the goal-oriented care approach that facilitate continuity can be targeted when designing person-centered care approaches. More research is needed on goal-oriented care approaches that have been implemented in other long-term care settings to determine if the factors identified here as influencing continuity are confirmed.
A multicenter, double-blind, randomized, parallel-group, placebo-controlled study to evaluate the efficacy and safety of camostat mesilate in patients with COVID-19 (CANDLE study)
Authors: Kinoshita Taku , Shinoda Masahiro , Nishizaki Yasuhiro , Shiraki Katsuya , Hirai Yuji , Kichikawa Yoshiko , Tsushima Kenji , Shinkai Masaharu , Komura Naoyuki , Yoshida Kazuo , Kido Yasutoshi , Kakeya Hiroshi , Uemura Naoto , Kadota Junichi
Published: September 2022

Background

In vitro drug screening studies have indicated that camostat mesilate (FOY-305) may prevent SARS-CoV-2 infection into human airway epithelial cells. This study was conducted to investigate whether camostat mesilate is an effective treatment for SARS-CoV-2 infection (COVID-19).

Methods

This was a multicenter, double-blind, randomized, parallel-group, placebo-controlled study. Patients were enrolled if they were admitted to a hospital within 5 days of onset of COVID-19 symptoms or within 5 days of a positive test for asymptomatic patients. Severe cases (e.g., those requiring oxygenation/ventilation) were excluded. Patients were enrolled, randomized, and allocated to each group using an interactive web response system. Randomization was performed using a minimization method with the factors medical institution, age, and underlying diseases (chronic respiratory disease, chronic kidney disease, diabetes mellitus, hypertension, cardiovascular diseases, and obesity). The patients, investigators/subinvestigators, study coordinators, and other study personnel were blinded throughout the study. Patients were administered camostat mesilate (600 mg qid; four to eight times higher than the clinical doses in Japan) or placebo for up to 14 days. The primary efficacy endpoint was the time to the first two consecutive negative tests for SARS-CoV-2.

Results

One-hundred fifty-five patients were randomized to receive camostat mesilate (n = 78) or placebo (n = 77). The median time to the first test was 11.0 days (95% confidence interval [CI]: 9.0–12.0) in the camostat mesilate group and 11.0 days (95% CI: 10.0–13.0) in the placebo group. Conversion to negative viral status by day 14 was observed in 45 of 74 patients (60.8%) in the camostat mesilate group and 47 of 74 patients (63.5%) in the placebo group. The primary (Bayesian) and secondary (frequentist) analyses found no significant differences in the primary endpoint between the two groups. No additional safety concerns beyond those already known for camostat mesilate were identified.

Conclusions

Camostat mesilate did not substantially reduce the time to viral clearance, based on upper airway viral loads, compared with placebo for treating patients with mild to moderate SARS-CoV-2 infection with or without symptoms.

Trial registration

ClinicalTrials.gov, NCT04657497. Japan Registry for Clinical Trials, jRCT2031200198.
Comorbidities and mortality risk in adults younger than 50 years of age with chronic obstructive pulmonary disease
Authors: Divo Miguel J. , Marin José M. , Casanova Ciro , Cabrera Lopez Carlos , Pinto-Plata Victor M. , Marin-Oto Marta , Polverino Francesca , de-Torres Juan P. , Billheimer Dean , Celli Bartolome R. ,   The BODE Collaborative Group, Celli Bartolome R. , Marin José M. , Macario Ciro Casanova , Pinto-Plata Victor , de-Torres Juan Pablo , Divo Miguel J. , Lopez Carlos Cabrera , Polverino Francesca , Oto Marta Marin
Published: September 2022

Rationale and objective

Patients with chronic obstructive pulmonary disease (COPD), usually diagnosed after the 6th decade, frequently suffer from comorbidities. Whether COPD patients 50 years or younger (Young COPD) have similar comorbidities with the same frequency and mortality impact as aged-matched controls or older COPD patients is unknown.

Methods

We compared comorbidity number, prevalence and type in 3 groups of individuals with ≥ 10 pack-years of smoking: A Young (≤ 50 years) COPD group (n = 160), an age-balanced control group without airflow obstruction (n = 125), and Old (> 50 years) COPD group (n = 1860). We also compared survival between the young COPD and control subjects. Using Cox proportional model, we determined the comorbidities associated with mortality risk and generated Comorbidomes for the “Young” and “Old” COPD groups.

Results

The severity distribution by GOLD spirometric stages and BODE quartiles were similar between Young and Old COPD groups. After adjusting for age, sex, and pack-years, the prevalence of subjects with at least one comorbidity was 31% for controls, 77% for the Young, and 86% for older COPD patients. Compared to controls, “Young” COPDs’ had a nine-fold increased mortality risk (p < 0.0001). “Comorbidomes” differed between Young and Old COPD groups, with tuberculosis, substance use, and bipolar disorders being distinct comorbidities associated with increased mortality risk in the Young COPD group.

Conclusions

Young COPD patients carry a higher comorbidity prevalence and mortality risk compared to non-obstructed control subjects. Young COPD differed from older COPD patients by the behavioral-related comorbidities that increase their risk of premature death.
Validation of retail food outlet data from a Danish government inspection database
Authors: Bernsdorf Kamille Almer , Bøggild Henrik , Aadahl Mette , Toft Ulla
Published: September 2022

Background

Globally, unhealthy diet is one of the leading global risks to health, thus it is central to consider aspects of the food environment that are modifiable and may enable healthy eating. Food retail data can be used to present and facilitate analyses of food environments that in turn may direct strategies towards improving dietary patterns among populations. Though food retail data are available in many countries, their completeness and accuracy differ.

Methods

We applied a systematically name-based procedure combined with a manual procedure on Danish administrative food retailer data (i.e. the Smiley register) to identify, locate and classify food outlets. Food outlets were classified into the most commonly used classifications (i.e. fast food, restaurants, convenience stores, supermarkets, fruit and vegetable stores and miscellaneous) each divided into three commonly used definitions; narrow, moderate and broad. Classifications were based on branch code, name, and/or information on the internal and external appearance of the food outlet. From ground-truthing we validated the information in the register for its sensitivity and positive predictive value.

Results

In 361 randomly selected areas of the Capital region of Denmark we identified a total of 1887 food outlets compared with 1861 identified in the register. We obtained a sensitivity of 0.75 and a positive predictive value of 0.76. Across classifications, the positive predictive values varied with highest values for the moderate and broad definitions of fast food, convenience stores and supermarkets (ranging from 0.89 to 0.97).

Conclusion

Information from the Smiley Register is considered to be representative to the Danish food environment and may be used for future research.