bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-derived organoids (PDOs) as a novel in vitro model for neuroblastoma tumours
Authors: Fusco P. , Parisatto B. , Rampazzo E. , Persano L. , Frasson C. , Di Meglio A. , Leslz A. , Santoro L. , Cafferata B. , Zin A. , Cimetta E. , Basso G. , Esposito M. R. , Tonini G. P.
Published: October 2019

Background

Neuroblastoma (NB) is a paediatric tumour of the sympathetic nervous system. Half of all cases are defined high-risk with an overall survival less than 40% at 5 years from diagnosis. The lack of in vitro models able to recapitulate the intrinsic heterogeneity of primary NB tumours has hindered progress in understanding disease pathogenesis and therapy response.

Methods

Here we describe the establishment of 6 patient-derived organoids (PDOs) from cells of NB tumour biopsies capable of self-organising in a structure resembling the tissue of origin.

Results

PDOs recapitulate the histological architecture typical of the NB tumour. Moreover, PDOs expressed NB specific markers such as neural cell adhesion molecules, NB84 antigen, synaptophysin (SYP), chromogranin A (CHGA) and neural cell adhesion molecule NCAM (CD56). Analyses of whole genome genotyping array revealed that PDOs maintained patient-specific chromosomal aberrations such asMYCNamplification, deletion of 1p and gain of chromosome 17q. Furthermore, the PDOs showed stemness features and retained cellular heterogeneity reflecting the high heterogeneity of NB tumours.

Conclusions

We were able to create a novel preclinical model for NB exhibiting self-renewal property and allowing to obtain a reservoir of NB patients’ biological material useful for the study of NB molecular pathogenesis and to test drugs for personalised treatments.
Gender differences in the nonmedical use of psychoactive medications in the school population- national trends and related factors
Authors: Carrasco-Garrido Pilar , Jiménez-Trujillo Isabel , Hernández-Barrera Valentín , Alonso-Fernández Nazaret , García-Gómez-Heras Soledad , Palacios-Ceña Domingo
Published: October 2019

Background

The nonmedical use of prescribed medicines among adolescents has increased significantly in recent years. Our study was designed to describe the prevalence of the nonmedical use of tranquilizers, sedatives, and sleeping pills (TSSp) among the school-age population residing in Spain from a gender perspective, and to identify factors associated with such use.

Methods

Nationwide, epidemiological, cross-sectional study on the nonmedical use during the previous 30 days, of TSSp by the Spanish school population. We used individualized secondary data retrieved from the 2004, 2006, 2008, 2010, 2012 and 2014 Spanish state survey on Drug Use in Secondary Education and a total of 179,114 surveys from respondents aged 14 to 18 years. Using logistic multivariate regression models, we estimated the independent effect of each of these variables on the nonmedical use of medicines. Two models were generated- one for females and one for males.

Results

2.86% (5116) of the Spanish school population of both sexes made nonmedical use of TSSp. Prevalence was greater among girls than among boys for all the study years. Patterns of nonmedical use among female adolescents were related to alcohol, tobacco and marijuana use. Consumption of illegal psychoactive substances, other than marijuana, was the variable showing the greatest value among male teenagers (aOR 6.21 (95% CI 4.97–7.77).

Conclusions

The prevalence of the nonmedical use of TSSp is higher in girls than in boys. The influence of legal and illegal psychoactive substances leads to a higher likelihood of nonmedical use of TSSp in high-school students in Spain.
Evaluation of the safety, tolerance and efficacy of 1-year consumption of infant formula supplemented with Lactobacillus fermentum CECT5716 Lc40 or Bifidobacterium breve CECT7263: a randomized controlled trial
Authors: Maldonado J. , Gil-Campos M. , Maldonado-Lobón J. A. , Benavides M. R. , Flores-Rojas K. , Jaldo R. , Jiménez del Barco I. , Bolívar V. , Valero A. D. , Prados E. , Peñalver I. , Olivares M.
Published: October 2019

Background

The microorganism present in breast milk, added to other factors, determine the colonization of infants. The objective of the present study is to evaluate the safety, tolerance and effects of the consumption of a milk formula during the first year of life that is supplemented withL. fermentumCECT5716 orBifidobacterium breveCECT7263, two strains originally isolated from breast milk.

Methods

A randomized, double blind, controlled, parallel group study including healthy, formula-fed infants was conducted. Two hundred and thirty-six 1-month-old infants were selected and randomly divided into three study groups according to a randomization list. Infants in the control group received a standard powdered infant formula until 12 months of age. Infants in the probiotic groups received the same infant formula but supplemented withL. fermentumCECT5716 Lc40 orB. breveCECT7263. Main outcome was weigh-gain of infants as safety marker.

Results

One hundred and eighty-nine infants completed the eleven months of intervention (61 in control group, 65 in Lf group and 63 in Bb group). The growth of infants in the three groups was consistent with standards. No significant differences were observed in the main outcome, weight-gain (Control group: 5.77 Kg ± 0.95, Lf group: 5.77 Kg ± 1.31, Bb group: 5.58 Kg ± 1.10;p = 0.527). The three milk formulae were well tolerated, and no adverse effects were related to the consumption of any of the formula. Infants receivingB. breveCECT7263 had a 1.7 times lower risk of crying than the control group (OR = 0.569, CI 95% 0.568–0.571;p = 0.001). On the other hand, the incidence of diarrhoea in infants receiving the formula supplemented withL. fermentumCECT5716 was a 44% lower than in infants receiving the control formula (p = 0.014). The consumption of thisLactobacillusstrain also reduced the duration of diarrhoea by 2.5 days versus control group (p = 0.044).

Conclusions

The addition ofL. fermentumCECT5716 Lc40 orB. breveCECT7263, two probiotic strains naturally found in breast milk, to infant formulae is safe and induces beneficial effects on the health of infants.

Trial registration

The trial was retrospectively registered in the US Library of Medicine (www.clinicaltrial.gov) with the numberNCT03204630. Registered 11 August 2016.
Outdoor smoking in Nigeria: prevalence, correlates and predictors
Authors: Lasebikan Victor , Lasebikan Tiwatayo , Adepoju Samson
Published: October 2019

Background

There is a lack of data on smoking in outdoor-open bars in Nigeria that may translate into effective legislation on public smoking.

Method

This study determined the prevalence, demographic and clinical correlates as well as predictors of smoking among a community sample of 1119 patrons of open place bars in Ibadan, Nigeria. Data on current smoking was obtained using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), while smoking intensity was calculated using the Pack-Year. Prevalence of alcohol use was determined using the Alcohol Use Disorders Identification Test (AUDIT), while depression was diagnosed using the Mini International Neuropsychiatry Interview (MINI). Analysis was carried out by SPSS version 20.0 software using Chi square statistics, t test and ANOVA, and was set at 95% confidence interval.

Results

Prevalence of current smoking was 63.8% and the mean pack years of smoking of all respondents was 19.38 ± 17.16 years. Predictors of outdoor smoking were depression OR = 1.41, 95% CI (1.09–1.83) and alcohol use OR = 2.12, 95% CI (1.44–3.13).

Predictors of high pack years were depression OR = 1.47, 95% CI (1.08–2.01), being married, OR = 1.78, 95% CI (1.29–2.45), high income, OR = 1.95, 95% CI (1.42–2.68) and alcohol use OR = 2.82, 95% CI (1.51–5.27). There was no significant relationship between stage of readiness to quit smoking and mean pack years of smoking, F = 0.3, p = 0.5.

Conclusion

The high prevalence of outdoor smoking in the sample calls for urgent public health initiatives for intervention. Thus, outdoor bars are potential tobacco use intervention sites to minimize the health consequences of smoking.
The short-term effects of air pollutants on influenza-like illness in Jinan, China
Authors: Su Wei , Wu Xiuguo , Geng Xingyi , Zhao Xiaodong , Liu Qiang , Liu Ti
Published: October 2019

Background

There is valid evidence that air pollution is associated with respiratory disease. However, few studies have quantified the short-term effects of six air pollutants on influenza-like illness (ILI). This study explores the potential relationship between air pollutants and ILI in Jinan, China.

Methods

Daily data on the concentration of particulate matters < 2.5 μm (PM 2.5), particulate matters < 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) and ILI counts from 2016 to 2017 were retrieved. The wavelet coherence analysis and generalized poisson additive regression model were employed to qualify the relationship between air pollutants and ILI risk. The effects of air pollutants on different age groups were investigated.

Results

A total of 81,459 ILI counts were collected, and the average concentrations of PM2.5, PM10, O3, CO, SO2 and NO2 were 67.8 μg/m3, 131.76 μg/ m3, 109.85 μg/ m3, 1133 μg/ m3, 33.06 μg/ m3 and 44.38 μg/ m3, respectively. A 10 μg/ m3 increase in concentration of PM2.5, PM10, CO at lag0 and SO2 at lag01, was positively associated with a 1.0137 (95% confidence interval (CI): 1.0083–1.0192), 1.0074 (95% CI: 1.0041–1.0107), 1.0288 (95% CI: 1.0127–1.0451), and 1.0008 (95% CI: 1.0003–1.0012) of the relative risk (RR) of ILI, respectively. While, O3 (lag5) was negatively associated with ILI (RR 0.9863; 95%CI: 0.9787–0.9939), and no significant association was observed with NO2, which can increase the incidence of ILI in the two-pollutant model. A short-term delayed impact of PM2.5, PM10, SO2 at lag02 and CO, O3 at lag05 was also observed. People aged 25–59, 5–14 and 0–4 were found to be significantly susceptible to PM2.5, PM10, CO; and all age groups were significantly susceptible to SO2; People aged ≥60 year, 5–14 and 0–4 were found to be significantly negative associations with O3.

Conclusion

Air pollutants, especially PM2.5, PM10, CO and SO2, can increase the risk of ILI in Jinan. The government should create regulatory policies to reduce the level of air pollutants and remind people to practice preventative and control measures to decrease the incidence of ILI on pollution days.
Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study
Authors: Lakoh Sulaiman , Jiba Darlinda F. , Kanu Joseph E. , Poveda Eva , Salgado-Barreira Angel , Sahr Foday , Sesay Momodu , Deen Gibrilla F. , Sesay Tom , Gashau Wadzani , Salata Robert A. , Yendewa George A.
Published: October 2019

Background

HIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. The countrywide HIV prevalence was estimated at 1.7% (67,000 people), with less than 30% receiving life-saving ART in 2016. Thus, HIV-infected patients tend to present to health facilities late, with high mortality risk.

Methods

We conducted a prospective study of HIV inpatients aged ≥15 years at Connaught Hospital in Freetown—the main referral hospital in Sierra Leone—from July through September 2017, to assess associated factors and predictors of HIV-related mortality.

Results

One hundred seventy-three HIV inpatients were included, accounting for 14.2% (173/1221) of all hospital admissions during the study period. The majority were female (59.5%, 70/173), median age was 34 years, with 51.4% (89/173) of them diagnosed with HIV infection for the first time during the current hospitalization. The most common admitting diagnoses were anemia (48%, 84/173), tuberculosis (24.3%, 42/173), pneumonia (17.3%, 30/173) and diarrheal illness (15.0%, 26/173). CD4 count was obtained in 64.7% (112/173) of patients, with median value of 87 cells/μL (IQR 25–266), and was further staged as severe immunosuppression: CD4 < 100 cells/μL (50%, 56/112); AIDS: CD4 < 200 cells/μL (69.6%, 78/112); and late-stage HIV disease: CD4 < 350 cells/μL (83%, 93/112). Fifty-two patients (30.1%, 52/173) died during hospitalization, 23% (12/52) of them within the first week. The leading causes of death were anemia (23.1%, 12/52), pneumonia (19.2%, 10/52), diarrheal illness (15.4%, 8/52) and tuberculosis (13.6%, 7/52). Neurological symptoms, i.e., loss of consciousness (p = 0.04) and focal limb weakness (p = 0.04); alcohol use (p = 0.01); jaundice (p = 0.02); cerebral toxoplasmosis (p = 0.01); and tuberculosis (p = 0.04) were significantly associated with mortality; however, only jaundice (AOR 0.11, 95% CI [0.02–0.65]; p = 0.01) emerged as an independent predictor of mortality.

Conclusion

HIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone.
Ethanol extract of Chrysanthemum zawadskii Herbich induces autophagy and apoptosis in mouse colon cancer cells through the regulation of reactive oxygen species
Authors: Kim Kwang-Youn , Oh Tae-Woo , Yang Hye-Jin , Kim Young-Woo , Ma Jin-Yeul , Park Kwang-Il
Published: October 2019

Background

Recent research has suggested that autophagy can provide a better mechanism for inducing cell death than current therapeutic strategies. This study investigated the effects of using an ethanol extract of Chrysanthemum zawadskii Herbich (ECZ) to induce apoptosis and autophagy associated with reliable signal pathways in mouse colon cancer CT-26 cells.

Methods

Using ECZ on mouse colon cancer CT-26 cells, cell viability, annexin V/propidium iodide staining, acridine orange staining, reactive oxygen species (ROS) and western blotting were assayed.

Results

ECZ exhibited cytotoxicity in CT-26 cells in a dose-dependent manner. ECZ induced apoptosis was confirmed by caspase-3 activation, poly (ADP-ribose) polymerase cleavage, and increased production of reactive oxygen species (ROS). Furthermore, it was shown that ECZ induced autophagy via the increased conversion of microtubule-associated protein 1 light chain 3II, the degradation of p62, and the formation of acidic vesicular organelles. The inhibition of ROS production by N-Acetyl-L-cysteine resulted in reduced ECZ-induced apoptosis and autophagy. Furthermore, the inhibition of autophagy by 3-methyladenine resulted in enhanced ECZ-induced apoptosis via increased ROS generation.

Conclusion

These findings confirmed that ECZ induced ROS-mediated autophagy and apoptosis in colon cancer cells. Therefore, ECZ may serve as a novel potential chemotherapeutic candidate for colon cancer.
The protective effect of Phellinus linteus decoction on podocyte injury in the kidney of FSGS rats
Authors: Wan Feng , Yang Ru-chun , Shi Yan-peng , Tang Yue-Wen , Tang Xuan-li , Zhu Xiao-ling , Li You-gui , Wang Yong-jun
Published: October 2019

Background

This study aimed to investigate the effect of the Phellinus linteus (Mesima) decoction on podocyte injury in a rat model of focal and segmental glomerulosclerosis (FSGS) and evaluate the potential mechanisms.

Methods

FSGS resembling primary FSGS in humans was established in rats by uninephrectomy and the repeated injection of doxorubicin. The FSGS rats were randomly divided into the model group, low-dose group of P. linteus decoction (PLD-LD), medium-dose group of P. linteus decoction (PLD-MD), and high-dose group of P. linteus decoction (PLD-HD). Blood and urine analysis were performed after 12 weeks and the molecular indicators of renal function and the renal pathological changes were examined.

Results

FSGS developed within 12 weeks in the test group and showed progressive proteinuria and segmental glomerular scarring. Urinary protein, serum creatinine, urea nitrogen, triglycerides and cholesterol were significantly reduced following the 12-week intervention with P.linteus decoction, especially in the PLD-LD group. Renal nephrin and podocin were markedly increased. Moreover, the pathological damage in the renal tissue was alleviated by the PLD-LD intervention.

Conclusion

The P. linteus decoction alleviated the podocyte injury in the FSGS rat model, thus minimizing the progression of glomerular sclerosis and improving renal function.
Constructing an experiential education model in undergraduate radiology education by the utilization of the picture archiving and communication system (PACS)
Authors: Chen Yingqian , Zheng Keguo , Ye Shanshan , Wang Jifei , Xu Ling , Li Ziping , Meng Quanfei , Yang Jianyong , Feng Shi-Ting
Published: October 2019

Background

Medical education in China is in a transitional period, from passive learning models to experiential education. We modified an experiential education method for radiology education. The aim of this study is to evaluate the effect of this method on undergraduate radiology education.

Method

With the help of the picture archiving and communication system (PACS) and RadiAnt DICOM Viewer, we modified an experiential education method that simulates similar working conditions for undergraduate medical students to formulate radiology diagnosis similar to clinical radiologists. A total of 101 students were allocated into either the experiential education group or the control group. The final examination scores and a 5-point Likert scale self-assessment questionnaire of radiologic skills were collected from all the students as an objective assessment and a subjective assessment respectively. A questionnaire was also used to assess the satisfaction with the experiential model in the experiential education group. Mann-Whitney U test was used to compare the ranked data, and t-tests were used to compare the numeric data.

Results

The experiential education group demonstrated significantly higher scores (7.4 ± 1.3) compared to the control group (6.7 ± 1.5, p < 0.05) in the question type “description and diagnosis”. The self-assessment questionnaire indicated that the experiential education was related to increased familiarity with the diagnosis thinking principle and the sequences and reconstruction methods of computer tomography (CT) imaging, which also strengthen participants’ self-confidence to perform future clinical work (p < 0.05). The self-assessment questionnaire in the experiential education group showed that the majority of students were satisfied with the organization (82.5%), interactivity (85%) and quality (85%) of the learning activity. Most students found this model of learning to be helpful for studying radiology (85%) and for understanding anatomy (90%).

Conclusion

Compared with the traditional radiology education approach, the experiential education method showed greater efficacy in improving students’ analysis and diagnostic skills and their self-confidence.
Investigating factors affecting on medical sciences students’ intention to adopt mobile learning
Authors: Azizi Seyyed Mohsen , Khatony Alireza
Published: October 2019

Background

Mobile learning (m-learning) provides a good opportunity for students’ lifelong learning. The design and implementation of effective and successful mobile learning requires identification of factors that affect m-learning. The aim of this study was to investigate the factors that affect the intention of students of medical sciences to adopt mobile learning based on theory of planned behavior (TPB).

Methods

In this cross-sectional study, 332 students of medical sciences were randomly selected. The study tool was a based a questionnaire that had been designed based on TPB model. Descriptive statistics (mean, standard deviation, frequency and percentage) were calculated. In order to determine the standardized factor loading and assess the study hypotheses, structural equation modeling was used. Composite reliability, average variance extracted, and standardized factor loading were used to determine the convergent validity.

Results

The mean of mobile learning readiness was 3.59 ± 0.83. Among the TPB structures, the structures of attitude (β = 0.525) and behavioral control (β = 0.318) had positive and significant effect on the intention to adopt m-learning (P ≤ 0.01). However, the structure of subject norm did not have a significant effect on the intention to adopt m-learning. In general, attitude, behavioral control and subject norm structures were 0.675 determinants of the intention to adopt m-learning (r2 = 0.675).

Conclusions

In this study Mobile learning readiness of the students was at moderate level. Also the results indicated Positive and significant effect of attitude and behavioral control on the intention of students to accept m-learning. The TPB-based model was a suitable model for identifying psychological factors that affect the intention of students of medical sciences to adopt m-leaning. In order to increase the students’ acceptance of mobile learning, we suggest that, other psychological, behavioral, social, and cultural factors that affect the acceptance of m-learning should be identified. Educational programs are also suggested to be introduced to students to familiarize them with the m-learning and its application in learning process.
A personalized, web-based breast cancer decision making application: a pre-post survey
Authors: Wyatt Kirk D. , Jenkins Sarah M. , Plevak Matthew F. , Venegas Pont Marcia R. , Pruthi Sandhya
Published: October 2019

Background

Every case of breast cancer is unique, and treatment must be personalized to incorporate a woman’s values and preferences. We developed an individually-tailored mobile patient education application for women with breast cancer.

Methods

Pre-post surveys were completed by 255 women who used the tool.

Results

Patients thought the application included helpful information (N = 184, 72%) and was easy to navigate (N = 156, 61%). Most patients thought the amount of information in the tool was “about right” (N = 193, 87%). Decision making confidence increased by an average of 0.8 points (10-point scale) following a consultation and use of the tool (p < 0.001).

Conclusions

Tailored mobile applications may optimize care by facilitating shared decision making and knowledge transfer, and they may also enhance the experience of patients as they navigate through their breast cancer journey.
“I prefer a male nurse to a female nurse”: patients’ preference for, and satisfaction with nursing care provided by male nurses at the Komfo Anokye teaching hospital
Authors: Budu Hayford Isaac , Abalo Emmanuel Mawuli , Bam Victoria Bubunyo , Agyemang Deus Osei , Noi Shirley , Budu Florence A. , Peprah Prince
Published: October 2019

Background

Although most male nurses join the profession for self-actualisation, the cultural and societal stereotyping of male nurses as “He-Man”, “gay” and “troublemakers”, and their marginalisation at the hospital during certain personal and intimate care procedures, tend to deepen the existing gender discrimination prevalent within the nursing profession. This study therefore assessed patients’ preference for, and satisfaction with nursing care provided by male nurses at the medical and surgical wards of Komfo Anokye Teaching Hospital [KATH].

Methods

An inferential cross-sectional study design, in which the prevalence of a condition among an identified population is determined, was used. Using convenience sampling, 150 respondents who meet certain practical criteria and are available and willing to participate were sampled. Data from a context-based research instrument on the opinion, preference and satisfaction of patients with male nursing were analysed using χ2 test, Mann Whitney U test, ordinal logistic regression and logistic regression.

Results

The study indicates that more females than males had ever been attended to by a male nurse for the period considered by the study, and females described male nurses as polite and courteous and were comfortable with their treatment. Being single [OR = 0.111, 95% CI (0.013–0.928)] and professing Islamic faiths [OR = 36.533, 95% CI (2.116–630.597)] were functions of respondents’ preference for a male nurse. Significantly too, affiliating to a religious sect (OR = 2.347, 95% CI [0.076–1.630]) and being educated (OR = 1.387, 95% CI [0.040–0.615]), were associated with higher odds of falling in one of the higher categories of satisfaction with nursing care provided by male nurses as against the lower categories.

Conclusion

Although marital status, religious affiliation and educational level were the significant predictors of patients’ preference for, and satisfaction with care provided by male nurses, the effect of the other variables should not be overlooked. The finding disproves assertions on the negative effect of religion on male nurses. It is recommended that public awareness be created on the role of male nurses in the healthcare delivery system to promote acceptance of gender diversity in the nursing profession.
An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards
Authors: Smith S. J. , Parveen S. , Sass C. , Drury M. , Oyebode J. R. , Surr C. A.
Published: October 2019

Background

Despite people living with dementia representing a significant proportion of health and social care users, until recently in the United Kingdom (UK) there were no prescribed standards for dementia education and training. This audit sought to review the extent and nature of dementia education and training offered to health and social care staff in the UK against the standards described in the 2015 Dementia Training Standards Framework, which describes the knowledge and skills required of the UK dementia workforce.

Methods

This audit presents national data concerning the design, delivery, target audience, length, level, content, format of training, number of staff trained and frequency of delivery within existing dementia training programmes offered to health and social care staff. The Dementia Training Standards Framework was used as a reference for respondents to describe the subjects and learning outcomes associated with their training.

Results

The findings are presented from 614 respondents offering 386 training packages, which indicated variations in the extent and quality of training. Many training packages addressed the subjects of ‘person-centred care’, ‘communication’, ‘interaction and behaviour in dementia care’, and ‘dementia awareness’. Few training packages addressed subjects concerning ‘pharmacological interventions in dementia care’, ‘leadership’ and ‘end of life care’. Fewer than 40% of The Dementia Training Standards Framework learning outcomes targeted to staff with regular contact with people with dementia or in leadership roles were covered by the reported packages. However, for training targeted at increasing dementia awareness more than 70% of the learning outcomes identified in The Dementia Training Standards Framework were addressed. Many training packages are not of sufficient duration to derive impact; although the majority employed delivery methods likely to be effective.

Conclusions

The development of new and existing training and education should take account of subjects that are currently underrepresented and ensure that training reflects the Training Standard Framework and evidence regarding best practice for delivery. Lessons regarding the limitations of training in the UK serve as a useful illustration of the challenge of implementing national dementia training standards; particularly for countries who are developing or have recently implemented national dementia strategies.
Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study
Authors: Basharat Sarah , Shaikh Babar Tasneem , Rashid Haroon Ur , Rashid Mamoon
Published: October 2019

Background

Delayed diagnosis of Oral Cancer (OC) can mean a difference in quality and expectancy of life for the patient. This delay could be from the healthcare side, or more importantly from the patient’s side. Globally, there are studies enumerating the causes for delays from the patients’ side in seeking healthcare for Oral Cancer; however, no similar research is found in the context of Pakistan. This study endeavoured to understand the health seeking behaviour, reasons for delay in consultation and the impact on OC patients’ lives.

Methods

In-depth interviews were conducted with randomly selected OC patients at a private sector tertiary care facility in Islamabad (who met the inclusion criteria of having successfully been treated for Oral Cancer) which caters to the most diverse population for the treatment of Oral Cancer. Theoretical saturation was achieved at 14 interviews. All participants gave verbal consent for participation, which was recorded prior to the interviews.

Results

Patients (age range 43–68 years) had received the surgical treatment and radiation. The reported delay before seeking a proper medical advice ranged from 1 month to 2 years. Lack of awareness about OC risk factors, symptoms, and whom to approach for treatment were the main reasons. Most respondents relied on self-treatment considering the non-healing wound/ulcer to be a minor issue until they were advised a consultation with a specialist. Treatment started within 1–3 months after a confirmed diagnosis on biopsy. The reported average expenditure on treatment was US$5000-10,000, mostly covered through a private health insurance and others borrowed the money.

Conclusion

A socio-behavioural change campaign for the general population can result in earlier presentation of the OC, minimizing the financial burden on the patient as well as the health system, and improving the quality of life of the patients.
Accessing public healthcare in Oslo, Norway: the experiences of Thai immigrant masseuses
Authors: Tschirhart Naomi , Diaz Esperanza , Ottersen Trygve
Published: October 2019

Background

Thai massage is a highly gendered and culturally specific occupation. Many female Thai masseuses migrate to Norway as marriage migrants and as such are entitled to the same public healthcare as Norwegian citizens. Additionally, anyone who is not fluent in Norwegian is entitled to have an interpreter provided by the public healthcare system. Norway and most other countries aspire to universal health coverage, but certain immigrant populations continue to experience difficulties accessing appropriate healthcare. This study examined healthcare access among Thai migrant masseuses in Oslo.

Methods

Guided by access to healthcare theory, we conducted a qualitative exploratory study in 2018 with Thai women working as masseuses in Oslo, Norway. Through semi-structured in-depth interviews with 14 Thai women, we explored access to healthcare, health system navigation and care experiences. We analyzed the data using thematic analysis and grouped the information into themes relevant to healthcare access.

Results

Participants did not perceive that their occupation limited their access to healthcare. Most of the barriers participants experienced when accessing care were related to persistent language challenges. Women who presented at healthcare facilities with their Norwegian spouse were rarely offered interpreters, despite their husband’s limited capacity to translate effectively. Cultural values inhibit women from demanding the interpretation services to which they are entitled. In seeking healthcare, women sought information about health services from their Thai network and relied on family members, friends and contacts to act as informal interpreters. Some addressed their healthcare needs through self-treatment using imported medication or sought healthcare abroad.

Conclusions

Despite having the same entitlements to public healthcare as Norwegian citizens, Thai migrants experience difficulties accessing healthcare due to pervasive language barriers. A significant gap exists between the official policy that professional interpreters should be provided and the reality experienced by study participants. To improve communication and equitable access to healthcare for Thai immigrant women in Norway, health personnel should offer professional interpreters and not rely on Norwegian spouses to translate. Use of community health workers and outreach through Thai networks, may also improve Thai immigrants’ knowledge and ability to navigate the Norwegian healthcare system.
Development and evaluation of a patient passport to promote self-management in patients with heart diseases
Authors: Stamm-Balderjahn Sabine , Faliniski Rebecca , Rossek Susanne , Spyra Karla
Published: October 2019

Background

Patients with cardiovascular diseases (CVD) are treated over a long period of time by physicians and therapists from various institutions collaborating within a multidisciplinary team. Usually, medical records detailing the diagnoses and treatment regimens are long and extensive. Brief overviews of relevant diagnostic and treatment data in the form of a patient passport are currently missing in routine care for patients with CVD. This study aimed to develop and evaluate a patient passport (the Kardio-Pass) based on the needs of patients who had undergone cardiac rehabilitation, and of healthcare professionals.

Methods

A mixed method design was adopted consisting of an explorative qualitative phase followed by a quantitative evaluation phase. Interviews with patients and experts were conducted to develop the Kardio-Pass. CVD rehabilitees (N = 150) were asked to evaluate the passport using a semi-standardized written questionnaire.

Results

Patients and experts who were interviewed in the qualitative study phase considered the following passport contents to be particularly important: documentation of findings and diagnoses, cardiac diagnostics and intervention, medication plan, risk factors for heart disease, signs of a heart attack and what to do in an emergency. During the evaluation phase, 93 rehabilitees (response rate: 62%) completed the questionnaire. The Kardio-Pass achieved high overall approval: All respondents considered the information contained in the passport to be trustworthy. The professionalism and the design of the passport were rated very highly by 93 and 92% of participants, respectively. Use of the Kardio-Pass prompted 53% of participants to regularly attend follow-up appointments. The most common reasons for non-use were a lack of support from the attending doctor, failure by the patient to make entries in the passport, and loss of the passport.

Conclusions

By documenting the course of cardiac diseases, the patient passport pools all medical data–from diagnosis to treatment and aftercare–in a concise manner. Rehabilitees who used the cardiac passport rated it as a helpful tool for documenting follow-up data. However, with regard to this explorative study there is a need for further research, particularly on whether the patient passport can improve heart patient care.
Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
Authors: Bergen Nicole , Hudani Alzahra , Asfaw Shifera , Mamo Abebe , Kiros Getachew , Kurji Jaameeta , Morankar Sudhakar , Abebe Lakew , Kulkarni Manisha A. , Labonté Ronald
Published: October 2019

Background

Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes.

Methods

We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives’ perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach.

Results

Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives’ ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives’ working relationships with HEWs.

Conclusion

Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.
Ubiquitin-mediated regulation of autophagy
Authors: Chen Ruey-Hwa , Chen Yu-Hsuan , Huang Tzu-Yu
Published: October 2019

Autophagy is a major degradation pathway that utilizes lysosome hydrolases to degrade cellular constituents and is often induced under cellular stress conditions to restore cell homeostasis. Another prime degradation pathway in the cells is ubiquitin-proteasome system (UPS), in which proteins tagged by certain types of polyubiquitin chains are selectively recognized and removed by proteasome. Although the two degradation pathways are operated independently with different sets of players, recent studies have revealed reciprocal cross talks between UPS and autophagy at multiple layers. In this review, we summarize the roles of protein ubiquitination and deubiquitination in controlling the initiation, execution, and termination of bulk autophagy as well as the role of ubiquitination in signaling certain types of selective autophagy. We also highlight how dysregulation of ubiquitin-mediated autophagy pathways is associated with a number of human diseases and the potential of targeting these pathways for disease intervention.
Residential relocation trajectories and neighborhood density, mixed land use and access networks as predictors of walking and bicycling in the Northern Finland Birth Cohort 1966
Authors: Kärmeniemi Mikko , Lankila Tiina , Ikäheimo Tiina , Puhakka Soile , Niemelä Maisa , Jämsä Timo , Koivumaa-Honkanen Heli , Korpelainen Raija
Published: October 2019

Background

Given the high global prevalence of physical inactivity, there is a need to design cities that support active modes of transportation. High density diverse neighborhoods with good access networks have been associated with enhanced walking and cycling, but there is a lack of large-scale longitudinal studies utilizing a life course perspective to model residential relocation trajectories. The objectives of the present longitudinal study were to model and visualize residential relocation trajectories between 31 and 46 years of age based on neighborhood density, mixed land use and access networks (DMA), and to assess neighborhood DMA as a predictor of self-reported regular walking and cycling and objectively measured physical activity.

Methods

Based on data from the Northern Finland Birth Cohort 1966 (N = 5947), we used self-reported regular walking and cycling and objectively measured physical activity as outcome variables and objectively assessed neighborhood DMA as the main explanatory variable. We conducted sequence analysis to model residential relocation trajectories, and generalized linear mixed models and Fisher’s exact test were used to explore longitudinal associations between neighborhood DMA and physical activity.

Results

Over 80% of the participants lived in a neighborhood with the same level of neighborhood DMA during the follow-up. Relocation occurred more often from higher to lower DMA neighborhoods than reverse. Increased neighborhood DMA was associated with increased regular walking (OR 1.03; 95% CI: 1.00, 1.05;p = 0.023) and cycling (OR 1.17; 95% CI: 1.12, 1.23;p <  0.001). Residential relocation trajectory from lower to highest neighborhood DMA increased the odds of starting regular walking (OR 3.15; 95% CI: 1.50, 7.14;p = 0.001) and cycling (OR 2.63; 95% CI: 1.23, 5.79;p = 0.009) as compared to higher to lower neighborhood DMA trajectory.

Conclusions

The results strongly support the hypothesis that increasing urban DMA can enhance regular walking and cycling at population level and so improve public health. The findings have implications for zoning and transportation policies, favoring the creation of dense and diverse neighborhoods with good access networks to support regular walking and cycling.
Treg/Th17 imbalance and its clinical significance in patients with hepatitis B-associated liver cirrhosis
Authors: Lan Yong-Ting , Wang Zhen-li , Tian Peng , Gong Xiao-Na , Fan Yu-Chen , Wang Kai
Published: October 2019

Background

Recent studies have shown that T cell-mediated cellular immune mechanisms play important roles in the progression of hepatitis B to liver cirrhosis, but the underlying mechanisms remain unclear. This present study was aimed to determine the relationship between Treg/Th17 and hepatitis B-associated liver cirrhosis.

Methods

The Treg and Th17 cell frequencies in the peripheral blood of all participants, including 93 patients with hepatitis B-associated liver cirrhosis and 40 healthy subjects, were measured by flow cytometer. Cox regression model and receiver operating characteristic(ROC) curves were applied to investigate the prognostic significance of Treg/Th17 ratio in decompensated liver cirrhosis.

Results

We observed the Treg/Th17 imbalance was present in patients with hepatitis B-associated liver cirrhosis, with reduced Treg cells in their peripheral blood, increased Th17 cells and decreased Treg/Th17 ratio. Treg and Th17 cells were negatively correlated. Treg/Th17 imbalance was closely related to the clinical stage of hepatitis B-associated liver cirrhosis. The Virus load, Treg frequencies and the Treg/Th17 ratio were independent factors predicting decompensated liver cirrhosis from a Cox regression model. The ROC analysis showed that the Treg/Th17 ratio was the best marker for predicting decompensated liver cirrhosis.

Conclusions

Treg/Th17 imbalance is involved in the pathogenesis of hepatitis B-associated liver cirrhosis and the Treg/Th17 ratio can be used as a potential marker for predicting decompensated liver cirrhosis.
The urinary levels of CTX-II, C2C, PYD, and Helix-II increased among adults with KBD: a cross-sectional study
Authors: Song Quan Quan , Sun Li Yan , Li Chun Hui , Liu Yu Jiao , Cui Si Lu , Liu Yun Qi , Cao Yan Hong , Pei Jun Rui , Wang Yue , Lian Wei , Jiao Zhe , Deng Qing , Yu Jun
Published: October 2019

Background

Kashin-Beck disease (KBD) is an endemic osteoarthropathy, and its pathogenesis is still not entirely clear. Pathologically, many KBD changes are similar to those of osteoarthritis (OA). Therefore, this study aimed to identify changes in the levels of potential urinary biomarkers for OA, including C-telopeptide of type II collagen (uCTX-II), type II collagen cleavage neoepitope (uC2C), pyridinoline (uPYD), and uHelix-II, among adults with KBD.

Methods

Urinary samples of 83 external control (EC) subjects, 91 KBD patients, and 86 internal control (IC) subjects were tested by ELISA after the subjects completed a questionnaire and X-ray examination.

Results

The medians of the four markers in the KBD group were higher than those in the EC group and those in the IC group. The medians in the grade II KBD group were higher than those in the grade I group but were not statistically significant (P = 0.301, P = 0.408, P = 0.204, and P = 0.898 for uCTX-II, uC2C, uPYD, and uHelix-II, respectively). The area under the curve (AUC) of uCTX-II (0.775) was higher than that of the others (0.672, 0.639, and 0.628 for uC2C, uPYD, and uHelix-II, respectively).

Conclusion

The levels of uCTX-II, uC2C, uPYD, and uHelix-II were elevated in adults with KBD and showed an increasing trend as the severity of KBD increased. The prediction accuracy of uCTX-II was more useful than that of the others for assisting in the diagnosis of KBD.
The effectiveness of intervention with board games: a systematic review
Authors: Noda Shota , Shirotsuki Kentaro , Nakao Mutsuhiro
Published: October 2019

To examine the effectiveness of board games and programs that use board games, the present study conducted a systematic review using the PsycINFO and PubMed databases with the keywords “board game” AND “trial;” in total, 71 studies were identified. Of these 71 studies, 27 satisfied the inclusion criteria in terms of program content, intervention style, and pre–post comparisons and were subsequently reviewed. These 27 studies were divided into the following three categories regarding the effects of board games and programs that use board games: educational knowledge (11 articles), cognitive functions (11 articles), and other conditions (five articles). The effect sizes between pre- and post-tests or pre-tests and follow-up tests were 0.12–1.81 for educational knowledge, 0.04–2.60 and − 1.14 – − 0.02 for cognitive functions, 0.06–0.65 for physical activity, and − 0.87 – − 0.61 for symptoms of attention-deficit hyperactivity disorder (ADHD). The present findings showed that, as a tool, board games can be expected to improve the understanding of knowledge, enhance interpersonal interactions among participants, and increase the motivation of participants. However, because the number of published studies in this area remains limited, the possibility of using board games as treatment for clinical symptoms requires further discussion.