bluuebunny/crossref_metadata_2025 huggingface dataset:
Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it
Authors: Lim Sandy , Goh E-Yang , Tay Eugene , Tong Yew Kwan , Chung Deborah , Devi Kamala , Tan Chay Hoon , Indran Inthrani Raja
Published: April 2021

Background

Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior.

Purpose

The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system.

Methodology

A nationwide cross-sectional study relying on the Nurse–Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded.

Results

Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants’ open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms.

Practice Implications

Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.
Eflornithine
Authors: Chen Ana Carolina , Luke Janiene D.
Published: April 2021

Drugs are substances that exert effects in the body in order to alter an existing physiological or biochemical process. There are several methods of administering drugs, including the use of creams, ointments, liquids, skin patches, capsules, and injections. This column aims to highlight some of the drugs commonly utilized in dermatology. More precisely, this column hopes to better inform readers about the mechanism of action, administration, dosage, adverse effects, and possible alternatives for each particular drug discussed. This article highlights the use of eflornithine as a topical treatment for hirsutism.
A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia
Authors: Dougherty Gillian , Boccanera Rodrigo , Boyd Mary Adetinuke , Gantt Tracey , Chilungu Kasonka Siphiwe , Kasonde Prisca , Kaetano Nila , Madevu-Matson Caitlin , Milimo Phales , Mwamba Mukuka , Panya Milembe , Senyana Brenda , Tsiouris Fatima , Walker Lauren , Zyongwe Nancy , Zulu Alice , Rabkin Miriam
Published: April 2021

HIV testing with rapid antiretroviral therapy (ART) initiation are life-saving interventions for adolescents living with HIV. However, in Zambia, HIV diagnosis and immediate ART initiation among adolescents living with HIV is lagging. In collaboration with the Zambian Ministry of Health, the U.S. Health Resources and Services Administration, the U.S. Centers for Disease Control and Prevention in Zambia, and ICAP at Columbia University designed and implemented a quality improvement collaborative (QIC) to improve adolescent immediate ART initiation at 25 health facilities in Lusaka. Over the 12-month implementation period, quality improvement teams tested and identified targeted intervention, that significantly improved ART initiation within 14 days of receiving positive test results, from 24% at baseline to more than 93% for the final 6 months of implementation. The quality improvement collaborative approach empowered health care workers to innovate addressing the root causes of suboptimal performance and produced a package of successful interventions that will be shared throughout Zambia.
Factors Associated With the Presenteeism of Single-Person Household Employees in Korea
Authors: Min Deulle , Lee Su Jeong
Published: April 2021

Objective:

The number of single-person households is rapidly increasing worldwide. Many workers from these households have to work even when they are sick, leading to presenteeism. The study aimed to identify factors affecting presenteeism in workers from single-person households.

Methods:

This study is a retrospective survey, a secondary data analysis using data from the 5th Korean Working Conditions Survey of 2017.

Results:

Of 2156 workers, 366 (17%) showed presenteeism and 1790 (83%) did not. Multiple logistic regression analysis showed that being a woman, subjective health status being moderate or good, presence of disease, longer commuting hours, and longer working hours per week are related to presenteeism.

Conclusions:

To reduce the presenteeism of workers from single-person households, specific programs and organizational policies can be developed.
Establishment and assessment of a nomogram model for predicting the risk of fulminant myocarditis
Authors: Xu Guifen , Chen Feizhen , Zhao Wenxiang , Zheng Yong , Zhuang Wei , Yu Fuling
Published: April 2021

We aimed to identify potential clinical predictors associated with the risk of fulminant myocarditis, and further to establish and assess a nomogram model based on significant attributes for clinical practicability.

This is a retrospective, cross-sectional study, involving 28 patients with fulminant myocarditis and 35 age-, and sex-matched patients with non-fulminant myocarditis. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI).

Fifteen factors were primarily identified to be associated with the significant risk of fulminant myocarditis after adjusting for confounders. Due to strong correlation, 6 factors were retained, including mean arterial pressure (OR, 95% CI, P: .82, .72–.94, .005), creatinine (2.15, 1.13–4.10, 0.020), blood urea nitrogen (1.45, 1.04–2.02, 0.028), aspartate aminotransferase (2.62, 1.16–5.91, 0.021), troponin I (1.43, 1.07–1.90, 0.015), and ventricular wall motion abnormality (25.81, 2.52–264.69, 0.006). The contribution of the 6 significant factors to predicting fulminant myocarditis risk was significant from multi-angle analyses, and regressing these factors in a nomogram model exhibited good predictive accuracy, as reflected by both C-index (>90%, P < .001).

We have identified 6 clinical factors in significant association with fulminant myocarditis, and their prediction capability was more obvious in a nomogram model. Further investigations with larger sample sizes and longer follow-up intervals are warranted.
Wild type transthyretin cardiac amyloidosis in a young individual
Authors: Ghosh Shreya , Khanra Dibbendhu , Krishna Vinay , Thakur Ashwani Kumar
Published: April 2021

Rationale:

Senile systemic amyloidosis, a disease of elderly is caused by amyloid deposition of wild-type transthyretin. The symptoms often overlap with other heart diseases. Hence it is either misdiagnosed or considered as a normal aging process in majority of cases.

Patient concerns:

We present a young patient of wild-type transthyretin amyloidosis, contradicting its only senile presence. The 34-year-old man presented with dyspnoea on exertion. He was suffering from hypertension for consecutive 3 years.

Diagnosis:

Echocardiography demonstrated left ventricular hypertrophy with reduced global longitudinal strain and apical sparing. Congo red staining and immuno-histochemical staining of the abdominal fat biopsy confirmed transthyretin amyloid deposition. Genetic analysis revealed absence of any mutant variant/s of transthyretin gene, confirming wild-type transthyretin amyloidosis.

Intervention:

A combination of amlodipine 5 mg, telmisartan 40 mg, and chlorthalidone 12.5 mg once daily was given to control the blood pressure of the patient.

Outcome:

Blood pressure was controlled but he continued to have exertional dyspnoea. The patient expired in December 2019.

Lessons:

A systematic diagnosis for wild type transthyretin amyloid cardiomyopathy (ATTR-CM) shall be considered in young cardiac patients suffering from cardiac distress with unknown etiology.
Comparison of opioid local anesthetic combination regimens using the number of self-administrated boluses in patient-controlled epidural analgesia after cesarean section
Authors: Otao Go , Maruta Toyoaki , Tsuneyoshi Isao
Published: April 2021

The aim of this study was to assess the efficacy of combined opioids by comparing four regimens of patient-controlled epidural analgesia (PCEA) after cesarean section.

Parturient patients who underwent elective or emergent cesarean section under combined spinal and epidural anesthesia from April 2013 to March 2016 were retrospectively analyzed. Based on PCEA, they were assigned to one of 4 groups: local anesthetic alone (LA), epidural single morphine administration during surgery followed by local anesthetic alone (M), local anesthetic combined with fentanyl 10 μg/h (F10), or local anesthetic combined with fentanyl 20 μg/h (F20). The primary outcome was the number of PCEA boluses used. Secondary outcomes included the use of rescue analgesia, postoperative nausea and vomiting, and postoperative pruritus.

A total of 250 parturients were analyzed. Whereas the number of PCEA boluses in the LA group was significantly higher than in the other combined opioid groups on the day of surgery and postoperative day 1 (LA: 3 [1–6] and 7 [4–9] vs M: 2 [0–4] and 4 [0–7] vs F10: 1 [0–4] and 3 [0–6] vs F20: 1 [0–3] and 2 [0–8], P = .012 and 0.010, respectively), within the combined opioid groups, the number was not significantly different. Significantly fewer patients in the F20 group required rescue analgesia on postoperative day 1 and 2 (25 and 55%) than those in the M (66 and 81%) and F10 (62 and 66%) groups (P < .001 and P = .007, respectively). Postoperative nausea and vomiting and pruritus were significantly higher in the M group (P < .008 and P = .024, respectively).

The results of the present study suggest that local anesthetic alone after a single administration of morphine, or local anesthetic combined with fentanyl 10 μg/h would generally be adequate for PCEA, whereas local anesthetic combined with fentanyl 20 μg/h would be suitable for conventional epidural analgesia.
Suoquan pill for the treatment of diabetic nephropathy
Authors: Cai Piao , Wu Zhu , Huang Wei , Niu Qian , Zhu Ye , Yin Dehui
Published: April 2021

Background:

Diabetic nephropathy (DN) is one of the most common complications of diabetes and the main cause of kidney failure in developed countries. Clinically, DN is usually treated by controlling blood sugar and blood pressure. According to reports, the application of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist can only target a certain stage of disease development. However, the application of Suoquan Pill (SQP) in traditional Chinese medicine has produced obvious clinical effects and minor side effects. It is used to treat DN and other diseases, but there is no systematic review of SQP in the treatment of diabetic nephropathy. This article reviews the effectiveness and safety of SQP in the treatment of DN.

Methods:

The database sets the registration date for randomized controlled trials (RCT) to March 25, 2021. By searching the following eight Chinese and English electronic databases: Cochrane Library, Embase, PubMed, Science Net, China National Knowledge Infrastructure, China Biomedical Literature Database. Chinese scientific journal database and Wanfang database for analysis. The main results are clinical efficacy, urinary albumin excretion rate, symptom score and quality of life. Finally, Stata 15 was used for meta-analysis.

Results:

This study will provide the latest evidence for SQP in the treatment of DN in the following aspects: clinical efficacy, urinary albumin excretion rate, quality of life, symptom score.

Conclusion:

The results of this study will provide evidence for evaluating the effectiveness of SQP in the treatment of DN.

OSF registration number:

10.17605/OSF.IO/KZ9RA
Can YKL-40 be used as a biomarker for interstitial lung disease?
Authors: Tong Xiang , Ma Yao , Liu Tao , Li Zhenzhen , Liu Sitong , Wu Guihui , Fan Hong
Published: April 2021

Background:

Interstitial lung disease (ILD) has a poor prognosis and lacks specific biomarkers for early diagnosis, assessment of disease severity, and prognosis. YKL-40 levels were found to be elevated in patients with ILD, but these results are inconsistent. Therefore, we conducted a systematic review and meta-analysis to accurately study the relation between YKL-40 and ILD.

Methods:

We performed a systematic literature search in many databases (PubMed, Embase, the China National Knowledge Infrastructure, and Wanfang databases) and commercial Internet search engines to identify studies involving the role of YKL-40 in patients with ILD. The weighted mean difference with its 95% confidence interval were used to investigate the effect sizes. If obvious heterogeneity was found in the meta-analysis, the level of YKL-40 was directly compared by the Mann-Whitney test.

Results:

Sixteen eligible articles were finally identified. The results showed that the serum YKL-40 levels of patients with idiopathic pulmonary fibrosis, connective tissue-related ILD, sarcoidosis, cryptogenic tissue pneumonia, asbestosis-ILD, and idiopathic nonspecific interstitial pneumonia were higher than those in controls, but there was no increase in patients with pulmonary alveolar proteinosis. We also found that there are certain differences in the serum YKL-40 levels in patients with different types of ILD. The results showed that the bronchoalveolar lavage fluid YKL-40 levels of patients with idiopathic pulmonary fibrosis were significantly higher than that in controls. A systematic review indicated that there were correlations between the serum YKL-40 levels and lung function in patients with different ILD. In addition, YKL-40 may be used as a valuable biomarker for survival, with risk ratios ranging from 1.006 to 10.9.

Conclusions:

This study suggests that YKL-40 may be a useful biomarker for the diagnosis and prognosis of ILD.
Efficacy and safety of pediatric massage in the treatment of anorexia
Authors: Yi Baoxiu , Chen Wenguang , Deng Gen , Wang Yiyi , Wang Jinfeng , Chi Zhenhai
Published: April 2021

Background:

Anorexia is a common and frequent disease in clinical pediatrics. It refers to a chronic digestive disorder syndrome with loss of appetite or disappearance and reduced food intake. The incidence of anorexia in children is very high, if not timely, safe and effective treatment, will have a huge impact on the growth and development of children. The toxic side effects of related treatment drugs often worry clinicians. Pediatric massage is external therapy, with green, safe and effective characteristics, lack of evidence-based medicine evidence support. A systematic evaluation and meta-analysis of the safety and efficacy of pediatric massage in the treatment of anorexia will be carried out in this paper to provide a powerful evidence.

Methods:

We’ll retrieve 8 electronic databases, including the PubMed, Embase, Cochrane Library, Web Of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), China Science Journal Database (VIP), the retrieval date was established from the database to March 2021. The authors will screen the study independently, Extracting data, and through Coch bias tools to assess the quality hazards of methods. RevmanV.5.3 software will be used for statistical analysis.

Results:

The results of this study need to be obtained after the completion of this program.

Conclusions:

The conclusion of this study will confirm the efficacy and safety of pediatric massage in the treatment of anorexia, and provide reliable evidence for clinical selection of pediatric massage in the treatment of anorexia.

Ethics and dissemination:

This study does not need to be reviewed by the Ethics Committee, because this paper is not a clinical study or a related experimental study, and this paper is only a literature study.

INPLASY Registration number:

INPLASY202130050.
Immune activation and chronic inflammation
Authors: Sauce Delphine , Pourcher Valérie , Ferry Tristan , Boddaert Jacques , Slama Laurence , Allavena Clotilde
Published: April 2021

HIV infection has become a chronic disease, with a lower mortality, but a consequent increase in age-related noninfectious comorbidities. Metabolic disorders have been linked to the effect of cART as well to the effects of immune activation and chronic inflammation. Whereas it is known that aging is intrinsically associated with hyperinflammation and immune system deterioration, the relative impact of chronic HIV infection on such inflammatory and immune activation has not yet been studied focusing on an elderly HIV-infected population.

The objectives of the study were to assess 29 blood markers of immune activation and inflammation using an ultrasensitive technique, in HIV-infected patients aged ≥75 years with no or 1 comorbidity (among hypertension, renal disease, neoplasia, diabetes mellitus, cardiovascular disease, stroke, dyslipidemia, and osteoporosis), in comparison with age-adjusted HIV-uninfected individuals to identify whether biomarkers were associated with comorbidities. Wilcoxon nonparametric tests were used to compare the levels of each marker between control and HIV groups; logistic regression to identify biomarkers associated to comorbidity in the HIV group and principal component analysis (PCA) to determine clusters associated with a group or a specific comorbidity.

A total of 111 HIV-infected subjects were included from the Dat’AIDS cohort and compared to 63 HIV-uninfected controls. In the HIV-infected group, 4 biomarkers were associated with the risk of developing a comorbidity: monocyte chemoattractant protein-1 (MCP-1), neurofilament light chain (NF-L), neopterin, and soluble CD14. Six biomarkers (interleukin [IL]-1B, IL-7, IL-18, neopterin, sCD14, and fatty acid-binding protein) were significantly higher in the HIV-infected group compared to the control group, 11 biomarkers (myeloperoxydase, interleukin-1 receptor antagonist, tumor necrosis factor receptor 1, interferon-gamma, MCP-1, tumor necrosis factor receptor 2, IL-22, ultra sensitivity C-reactive protein, fibrinogen, IL-6, and NF-L) were lower. Despite those differences, PCA to determine clusters associated with a group or a specific comorbidity did not reveal clustering nor between healthy control and HIV-infected patients neither between the presence of comorbidity within HIV-infected group.

In this highly selected geriatric HIV population, HIV infection does not seem to have an additional impact on age-related inflammation and immune disorder. Close monitoring could have led to optimize prevention and treatment of comorbidities, and have limited both immune activation and inflammation in the aging HIV population.
Effectiveness of acupuncture for asthenozoospermia
Authors: Zhou Yuliang , Yao Wenliang , Zhang Duanjun , Yu Yinglv , Chen Shenghui , Lu Huiyu , Jiang Wanxue , Jiang Chaoren
Published: April 2021

Background:

According to the World Health Organization, the global incidence of infertility is about 15%, and more than 50% of infertility cases are caused by male infertility. Asthenozoospermia is caused by male fertility decline and male infertility. Due to work pressure, environmental pollution, sexual diseases, and other factors, the number of patients with asthenozoospermia has increased in recent years. It has been confirmed that acupuncture has a certain effect on patients with asthenozoospermia. Acupuncture and moxibustion can be an adjuvant treatment plan for the treatment of asthenozoospermia in addition to drug treatment.

Methods:

Randomized controlled trials of acupuncture for asthenozoospermia will be searched in the relevant database, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). The studies of electronic searches will be exported to EndNote V.9.1 software. We will run meta-analyses using the Review Manager (RevMan) V.5.3 software. Any disagreements will be solved in consultation with a third reviewer.

Results:

Our study aims to explore the efficacy of acupuncture for asthenozoospermia and to provide up-to-date evidence for clinical of asthenozoospermia.

Conclusion:

This study will perform a comprehensive systematic review and meta-analysis on the efficacy of acupuncture for asthenozoospermia, making up for the lack of relevant evidence of the clinical use of acupuncture.

INPLASY registration number:

INPLASY 202140032.
Comparison of the efficacy and safety of subthreshold micropulse laser with photodynamic therapy for the treatment of chronic central serous chorioretinopathy
Authors: Wu Zhizhong , Wang Huixing , An Junsheng
Published: April 2021

Background:

This meta-analysis was conducted to compare the therapeutic effect and safety of subthreshold micropulse laser (SML) vs photodynamic therapy (PDT) in treatment of chronic central serous chorioretinopathy (cCSC).

Methods:

PubMed, EMBASE, and the Cochrane Library were searched for all relevant studies published up to August 17, 2020. Data of interest were analyzed by STATA (version 14.0) software.

Results:

Four randomized clinical trials (RCTs) and 5 retrospective studies with 790 eyes were included in this meta-analysis after study selection. The results showed that SML significantly improved the best-corrected visual acuity (BCVA) compared with PDT at 6 to 8 weeks, 6 months, and 7 to 8 months in patients with cCSC (weighted mean difference (WMD) = −0.15, 95% confidence intervals (CI): −0.23 to −0.07, P < .01; WMD = −2.83, 95% CI: −4.79 to −0.87, P < .01; and WMD = −2.61, 95% CI: −4.23 to −1.24, P = .026, respectively). There was also a statistically significant difference between SML and PDT groups in the differences in the complete resolution of subretinal fluid (SRF) (risk radios = 0.388, 95% CI: 0.307 to 0.491, P < .01). There were no significant differences between the SML and PDT in the overall effect with central macular thickness (CMT), adverse events, complete resolution of SRF and treatment response.

Conclusions:

Based on the available evidence, this meta-analysis demonstrated that SML may be considered as a competitive alternative to PDT for treating cCSC, and as the first-line treatment of cCSC.
Effects of aromatherapy on sleep disorders
Authors: Song Xin , Peng Jiahua , Jiang Weiyu , Ye Minghua , Jiang Lisheng
Published: April 2021

Background:

The progress of modern society and changes in lifestyle have not only increased the proportion of sub-healthy people, but also caused many people to suffer from sleep disorders and mental anxiety. Long-term lack of high-quality sleep will not only cause psychological problems such as anxiety and fatigue, but also cause physical abnormalities, such as abnormal hormone secretion, weakened immunity, neuroendocrine disorders, and high blood pressure. Therefore, the purpose of this study is to systematically evaluate the effectiveness of aromatherapy in improving sleep quality in people with sleep disorders.

Methods:

Computer search CNKI, SinoMed, Wanfang, PubMed, Web of science, and EMbase collect randomized controlled trials on aromatherapy to improve sleep quality of people with sleep disorders. The search time limit is to build the database until April 5, 2021. RevMan5.3 software is used for meta-analysis.

Results:

This systematic review will provide an assessment of the current state of sleep disorders, aiming to assess the efficacy of aromatherapy for patients with sleep disorders.

Conclusion:

This systematic review will provide a credible evidence-based for the clinical treatment of sleep disorders with aromatherapy.
Exercise intervention for sleep disorders after stroke
Authors: Zhang Qin , Liu Yi , Liang Yin , Yang Dan , Zhang Wei , Zou Liqun , Wan Zhi
Published: April 2021

Background:

Sleep disorders after stroke is one of the most common neuropsychiatric complications and is associated with increased risk of death and poor functional outcomes. Some evidence shows that patients with sleep disorders after stroke benefit from exercise intervention. However, this result is still conflicting. This study aims to explore the effects of exercise on sleep disorders after stroke and to establish safe and effective exercise prescriptions.

Methods and analysis:

The databases including Google Scholar, Pubmed, Embase, and Cochrane library will be searched using pre-specified search strategies. Randomized controlled trials and non-randomized prospective controlled cohort studies regarding exercise for sleep disorders after stroke will be included. The primary outcome is the Pittsburgh Sleep Quality Index (PSQI) scale. The secondary outcomes are adverse events associated with exercise and all deaths. The methodological quality of each study will be evaluated by the physiotherapy evidence database scale. The heterogeneity will be evaluated using the I
2 test. If I
2 > 50%, random effects models will be used in the analysis; otherwise, fixed effects models will be used to pool the data.

Results:

This study will assess the efficacy and safety of exercise for sleep disorders after stroke.

Conclusions:

Our findings will be helpful for clinicians to examine the clinical decision-making in the treatment of sleep disorders after stroke using exercise intervention.

Ethics and dissemination:

Ethical approval is not required because this study is a secondary analysis. The results of this study will be disseminated through journals and academic exchanges.

Systematic review registration number:

INPLASY202130106.
Association between serum uric acid and bone mineral density in patients with type 2 diabetes
Authors: Yang Kun , Miao Huilei , Zhao Ruijie , Wu Xiling , Liu Bo , Zheng Shuiqiao , Huang Dan , Ping Zhao
Published: April 2021

The relationship between serum uric acid (UA) and bone mineral density (BMD) has been proposed by several researchers. However, there has been no consensus regarding the relationships among serum UA, diabetes, and BMD. The aim of this study is to investigate the association between UA, BMD, and at least osteopenia in type 2 diabetes patients.

This research was a longitudinal study performed at Xiao-Tang-Shan Hospital in Beijing. Type 2 diabetes diagnosis was consistent with the WHO standard classification. Participants with osteopenia or osteoporosis documented by dual-energy X-ray absorptiometry were defined as having “at least osteopenia.” A generalized additive model and multivariable logistic regressions were performed to explore the relationship between serum UA and at least osteopenia. Receiver operating characteristic analysis was conducted. Propensity score matching was used to verify the correctness of the cutoff point.

In total, 3476 type 2 diabetes patients free of any osteopenia-related diseases were recruited in 2012 and followed up to 2018. The general proportions of patients with at least osteopenia in 2018 was 16.46% (572/3476). Serum UA was negatively associated with BMD stratified by sex, age group, and BMI level. Setting the first quartile as the reference, the risk of at least osteopenia in the fourth quartile was significant among all patients (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57, 0.98) and specifically in females (OR: 0.79; 95% CI: 0.43, 0.97), patients aged over 50 years (OR: 0.79; 95% CI: 0.60, 0.97) and patients with a BMI greater than 25 (OR: 0.74; 95% CI: 0.47, 0.97). The optimal cutoff point for the serum UA level to distinguish at least osteopenia in diabetic patients was 395 μmol/L.

Serum UA concentration is negatively associated with the occurrence of at least osteopenia in Chinese patients with type 2 diabetes.
The relationship between non-alcoholic fatty liver disease and hypothyroidism
Authors: Zeng Xiaoxu , Li Bin , Zou Yang
Published: April 2021

Background:

Whether hypothyroidism is related to non-alcoholic fatty liver disease (NAFLD) is controversial. Our aim was to investigate the relationship between NAFLD and hypothyroidism that may predict the NAFLD potential of these lesions and new prevention strategies in hypothyroidism patients.

Methods:

Totally 51,407 hypothyroidism patients with average 28.23% NAFLD were analyzed by Revman 5.3 and Stata 15.1 softwares in the present study. The PubMed and Embase databases were systematically searched for works published through May 9, 2020.

Results:

The blow variables were associated with an increased risk of NAFLD in hypothyroidism patients as following: increased of thyroid stimulating hormone (TSH) levels (odds ratio [OR] = 1.23, 1.07–1.39, P = .0001); old age (mean difference [MD] = 3.18, 1.57–4.78, P = .0001); increased of body mass index (BMI) (MD = 3.39, 2.79–3.99, P < .000001); decreased of free thyroxine 4 (FT4) levels (MD = –0.28, –0.53 to –0.03, P = .03). In addition, FT3 (MD = 0.11, –0.09–0.3, P = .29) had no association with the risk of NAFLD in hypothyroidism patients.

Conclusion:

Our systematic review identified results are as following: hypothyroidism was positively associated with the risk of NAFLD. The increased concentration of TSH levels maybe a risk factor that increased incidence of NAFLD. The BMI of NAFLD patients was significantly higher than that of non-NAFLD patients. Old age was significantly associated with the incidence of NAFLD. FT4 was significantly associated with the risk of NAFLD due to its negatively effect while FT3 was not significantly related to the risk of NAFLD. Taken together, the present meta-analysis provides strong evidence that hypothyroidism may play a vital role in the progression and the development of NAFLD.
The association between white matter changes and development of malignant middle cerebral artery infarction
Authors: Wu Meng-Ni , Fang Pen-Tzu , Hung Chih-Hsien , Hsu Chung-Yao , Chou Ping-Song , Yang Yuan-Han
Published: April 2021

Disrupted blood–brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.

Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.

In this case–control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.

Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444–28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107–28.399, P = .0372) were significantly associated with MMI development.

MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.
Analysis of risk factors for cesarean scar diverticulum
Authors: Liu Songjun , Chen Linlin , Zhu Guang , Shao Yupei , Yu Shuqian , Li Wu , Lv Wen
Published: April 2021

The purpose of this study was to explore the relevant factors that affect the risk of cesarean scar diverticulum (CSD).

A retrospective, case-control study was designed among women with a history of cesarean section (CS) who were admitted in Zhejiang Tongde Hospital from January 2017 to December 2019. Women with missing information were excluded. The basic clinical characteristics and the risk factors for CSD were assessed using univariate analysis and multivariate logistic regression analysis.

A total of 216 women were analyzed, including 87 patients with CSD and 129 cases without CSD as control. Significant differences in number of CS, trial of labor (elective or urgent CS), CS interval, uterine position, intraoperative hemorrhage, and dysmenorrhea between CSD group and control group (P < .05). Multivariate logistic regression analysis showed that number of CS, trial of labor, interval of CS, and uterine position were independent risk factors of CSD.

In women with a history of CS, multiple cesarean deliveries, elective CS, cesarean interval of less than 5 years, and retroflexed position of the uterus may be associated with an elevated risk of CSD.
Baseline Characteristics, Evaluation, and Management of Women With Complaints of Recurrent Urinary Tract Infections
Authors: Dieter Alexis A. , Mueller Margaret G. , Andy Uduak U. , Kirby Anna C. , Dwarica Denicia S. , Amundsen Cindy L. , Gregory W. Thomas , Desai Shivani , Clayton Laura , Squires Natalie A. , Allen Antoinette , Casper Kaitlyn P. , Murphy Mary J. , Shepherd Jonathan P.
Published: April 2021

Objective

The aims of this study were to determine the proportion of women presenting for recurrent urinary tract infections (UTIs) who met the diagnostic criteria (culture-proven UTI ≥3 in 1 year or ≥2 in 6 months) and to assess advanced testing utilization, preventive therapy use, and risk factors.

Methods

This is a retrospective chart review of women seen as new urogynecology consults for recurrent UTI (rUTI) between April 1, 2017, and April 1, 2018, followed through April 1, 2019. Exclusion criteria included catheter use, cancer treatment within 2 years, and prior organ transplant, urinary diversion, conduit, or bladder augmentation.

Results

Of 600 women, 71% had follow-up with a median of 179 days. Urinary tract infection symptoms included frequency (50%), dysuria (46%), urgency (43%), and malodorous urine (7%). One third met the rUTI diagnostic criteria. Two hundred thirty-four (39%) underwent advanced testing, and 9% (21/234) of women who underwent advanced testing had a change in clinical care. Preventive therapy use increased after consultation (P < 0.001), with vaginal estrogen (47%) being most common. Compared with women not meeting the rUTI criteria, women meeting the rUTI criteria were more likely to be older (adjusted odds ratio [aOR], 1.03/year; 95% confidence interval [CI], 1.02–1.04), have a prior history of gynecologic cancer (aOR, 4.07; 95% CI, 1.02–16.25), or report UTI symptoms of dysuria (aOR, 2.27; 95% CI, 1.57–3.27), or malodorous urine (aOR, 2.96; 95% CI, 1.47–5.94) and, while equally likely to be receiving preventive treatment prior to consultation, were more likely after consultation (OR, 3.06; 95% CI, 2.05–4.55).

Discussion

Thirty-seven percent of women seen for rUTI met the diagnostic criteria. Advanced imaging rarely changed care. Education about diagnostic criteria and preventive therapy is warranted.
Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management
Authors: Myint Thida Maung , Chong Chanel H. Y. , Wyld Melanie , Nankivell Brian , Kable Kathy , Wong Germaine
Published: April 2021

Polyomavirus BK virus (BKPyV) infection is an important complication of kidney transplantation and allograft failure. The prevalence of viremia is 10%–15%, compared with BK-associated nephropathy (BKPyVAN) at 3%–5%. Given that there are no effective antiviral prophylaxis or treatment strategies for BKPyVAN, active screening to detect BKPyV viremia is recommended, particularly during the early posttransplant period. Immunosuppression reduction to allow viral clearance may avoid progression to severe and irreversible allograft damage. The frequency and duration of screening are highly variable between transplant centers because the evidence is reliant largely on observational data. While the primary treatment goals center on achieving viral clearance through immunosuppression reduction, prevention of subsequent acute rejection, premature graft loss, and return to dialysis remain as major challenges. Treatment strategies for BKPyV infection should be individualized to the recipient’s underlying immunological risk and severity of the allograft infection. Efficacy data for adjuvant therapies including intravenous immunoglobulin and cidofovir are sparse. Future well-powered and high-quality randomized controlled trials are needed to inform evidence-based clinical practice for the management of BKPy infection.
Benefits of water-related ecological infrastructure investments to support sustainable land-use: a review of evidence from critically water-stressed catchments in South Africa
Authors: Rebelo Alanna J. , Holden Petra B. , Esler Karen , New Mark G.
Published: April 2021

Investments to promote sustainable land-use within critical river catchment areas are often undertaken to provide benefits to society. Investments generally aim to protect or restore ecological infrastructure—the underlying framework of ecosystems, functions and processes that supply ecosystem services—for multiple benefits to society. However, the empirical evidence base from studies across the world on both mechanisms and outcomes to support these assumptions is limited. We collate evidence on the benefits of ecological infrastructure interventions, in terms of ecosystem services provided to society, from three major South African water-providing catchments using a novel framework. In these catchments, millions of US Dollars' worth of investments have been made into ecological infrastructure since 1996. We ask the question: is there evidence that ecological infrastructure interventions are delivering the proposed benefits? Results show that even in catchments with substantial, long-term financial investment into ecological infrastructure, research has not empirically confirmed the benefits. Better baseline data collection is required, and monitoring during and after ecological infrastructure interventions, to quantify benefits to society. This evidence is needed to leverage investment into ecological infrastructure interventions at scale. Investment at scale is needed to transition to more sustainable land-use to unlock greater benefits to nature and people.
Anticipating trajectories of exponential growth
Authors: Hutzler Florian , Richlan Fabio , Leitner Michael Christian , Schuster Sarah , Braun Mario , Hawelka Stefan
Published: April 2021

Humans grossly underestimate exponential growth, but are at the same time overconfident in their (poor) judgement. The so-called ‘exponential growth bias' is of new relevance in the context of COVID-19, because it explains why humans have fundamental difficulties to grasp the magnitude of a spreading epidemic. Here, we addressed the question, whether logarithmic scaling and contextual framing of epidemiological data affect the anticipation of exponential growth. Our findings show that underestimations were most pronounced when growth curves were linearly scaledandframed in the context of a more advanced epidemic progression. For logarithmic scaling, estimates were much more accurate, on target for growth rates around 31%, and not affected by contextual framing. We conclude that the logarithmic depiction is conducive for detecting exponential growth during an early phase as well as resurgences of exponential growth.
COVID-19 vaccine acceptance in older Syrian refugees: preliminary findings from an ongoing study
Authors: Salibi Noura , Abdulrahim Sawsan , Haddad Maria El , Bassil Stephanie , Khoury Zeina El , Ghattas Hala , McCall Stephen J.
Published: April 2021

This study assesses COVID-19 vaccine intentions among a sample of Syrian refugees (≥50 years) beneficiaries of a humanitarian organization in Lebanon, and explores factors associated with vaccine refusal. The findings are part of an ongoing rotating 4-wave panel study. The sample was limited to participants from the first panel who completed a phone interview between January-February, 2021. Out 1,037 beneficiaries, almost a third (29%) reported no intention to vaccinate. Reasons for refusal were: newness of the vaccine (35%); preference to maintain precaution measures (21%); belief that COVID-19 vaccine is not essential (21%); and other reasons (23%). COVID-19 vaccine refusal was significantly associated with perceptions regarding vaccine safety (OR: 5.97; 95%CI: 4.03-8.84) and effectiveness (OR: 6.80; 95%CI:4.44-10.42) but did not differ by age, presence of chronic conditions, self-reported adherence to COVID-19 measures, and perceptions of susceptibility to and severity of COVID-19. Addressing vaccine hesitancy among Syrian refugees in Lebanon necessitates disseminating accurate, accessible, and culturally appropriate information about vaccine safety and effectiveness.
The initial impact of a national BNT162b2 mRNA COVID-19 vaccine rollout
Authors: Zaqout Ahmed , Daghfal Joanne , Alaqad Israa , Hussein Saleh A.N. , Aldushain Abdullah , Almaslamani Muna A. , Abukhattab Mohammed , Omrani Ali S.
Published: April 2021

Objective

We herein report the initial impact of a national BNT162b2 rollout on SARS-CoV-2 infections in Qatar.

Methods

We included all individuals who by 16 March 2021 had completed ≥14 days of follow up after the receipt of BNT162b2. We calculated incidence rates (IR) and their 95% confidence intervals (CI), during days 1–7, 8–14, 15–21, 22–28, and >28 days post-vaccination. Poisson regression was used to calculate incidence rate ratios (IRR) relative to the first 7-day post-vaccination period.

Results

We included 199,219 individuals with 6,521,124 person-days of follow up. SARS-CoV-2 infection was confirmed in 1,877 (0.9%), of which 489 (26.1%) were asymptomatic and 123 (6.6%) required oxygen support. The median time from first vaccination to SARS-CoV-2 confirmation was 11.9 days (IQR 7.7–18.2). Compared with the first 7-day post-vaccination period, SARS-CoV-2 infections were lower by 65.8–84.7% during days 15–21, days 22–28, and >28 days (P <0.001 for each). For severe COVID-19, the incidence rates were 75.7– 93.3% lower (P <0.001 for each) during the corresponding time periods.

Conclusion

Our results are consistent with an early protective effect of BNT162b2 against all degrees of SARS-CoV-2 severity.
Physician Perceptions of Surveillance: Wearables, Apps, and Bots for COVID-19
Authors: Linares Alexandra R. , Bramstedt Katrina A. , Chilukuri Mohan M. , Doraiswamy P. Murali
Published: April 2021

Objective

To characterize the global physician community’s opinions on the use of digital tools for COVID-19 public health surveillance and self-surveillance.

Methods

Cross-sectional, random, stratified survey done on Sermo, a physician networking platform, between September 9-15, 2020. We aimed to sample 1,000 physicians divided among the USA, EU, and rest of the world. The survey questioned physicians on the risk-benefit ratio of digital tools, as well as matters of data privacy and trust.

Results

The survey was completed by 1004 physicians with a mean (SD) age of 49.14 (12) years. Enthusiasm was highest for self-monitoring smart watches (66%) and contact tracing apps (66%) and slightly lower (48-56%) for other tools. Trust was highest for health providers (68%) and lowest for technology companies (30%). Most respondents (69.8%) felt that loosening privacy standards to fight the pandemic would lead to misuse of privacy in the future.

Conclusion

The survey provides foundational insights about how physicians think of surveillance. Collaborations between public health and technology researchers to strengthen evidence of effectiveness and build public trust may be useful.
SARS-CoV-2 subgenomic RNA kinetics in longitudinal clinical samples
Authors: Verma Renu , Kim Eugene , Martinez-Colón Giovanny Joel , Jagannathan Prasanna , Rustagi Arjun , Parsonnet Julie , Bonilla Hector , Khosla Chaitan , Holubar Marisa , Subramanian Aruna , Singh Upinder , Maldonado Yvonne , Blish Catherine A. , Andrews Jason R.
Published: April 2021

Background

Given the persistence of viral RNA in clinically recovered COVID-19 patients, subgenomic RNAs (sgRNA) have been reported as potential molecular viability markers for SARS-CoV-2. However, few data are available on their longitudinal kinetics, compared with genomic RNA (gRNA), in clinical samples.

Methods

We analyzed 536 samples from 205 patients with COVID-19 from placebo-controlled, outpatient trials of Peginterferon Lambda-1a (Lambda; n=177) and favipiravir (n=359). Nasal swabs were collected at three time points in the Lambda (Day 1, 4 and 6) and favipiravir (Day 1, 5, and 10) trials. N-gene gRNA and sgRNA were quantified by RT-qPCR. To investigate the decay kinetics in vitro, we measured gRNA and sgRNA in A549ACE2+ cells infected with SARS-CoV-2, following treatment with remdesivir or DMSO control.

Results

At six days in the Lambda trial and ten days in the favipiravir trial, sgRNA remained detectable in 51.6% (32/62) and 49.5% (51/106) of the samples, respectively. Cycle threshold (Ct) values for gRNA and sgRNA were highly linearly correlated (Pearson’s r=0.87) and the rate of increase did not differ significantly in Lambda (1.36 cycles/day vs 1.36 cycles/day; p = 0.97) or favipiravir (1.03 cycles/day vs 0.94 cycles/day; p=0.26) trials. From samples collected 15-21 days after symptom onset, sgRNA was detectable in 48.1% (40/83) of participants. In SARS-CoV-2 infected A549ACE2+ cells treated with remdesivir, the rate of Ct increase did not differ between gRNA and sgRNA.

Conclusions

In clinical samples and in vitro, sgRNA was highly correlated with gRNA and did not demonstrate different decay patterns to support its application as a viability marker.

We observed prolonged detection of subgenomic RNA in nasal swabs and equivalent decay rates to genomic RNA in both longitudinal nasal swabs and in remdesivir-treated A549ACE2+ cells infected with SARS-CoV-2. Taken together, these findings suggest that subgenomic RNA from SARS-CoV-2 is comparably stable to genomic RNA and that its detection is therefore not a more reliable indicator of replicating virus.