bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traditional medicine use in Timor-Leste
Authors: Grace Robert , Vaz Jacinto , Da Costa Julianti 
Published: June 2020

AbstractBackgroundTraditional medicine use is common amongst peoples in developing nations. Timor-Leste is no exception. However little is known about the prevalence, pattern, satisfaction with, cost or type of traditional medicine used in Timor-Leste. This study aims to describe the prevalence, nature and basic demographic factors associated with contemporary traditional medicine use in Timor-Leste.MethodsA structured interview questionnaire was administered in Tetun to 50 surgical patients, 50 internal medicine patients, 50 hospital staff and 50 hospital visitors at Hospital Nacional Guido Valadares, Timor-Leste’s major referral hospital.Results60% of respondents reported having used traditional medicine; 32% within the last year. The greatest use was amongst surgical patients, the least amongst hospital staff. The frequency of traditional medicine use was comparable amongst all groups regardless of size of community, residence or level of education. Traditional medicine use in Timor-Leste is sufficiently common to represent part of the cultural norm. Factors described as promoting traditional medicine use included cost, limited access to other medical services and a belief that traditional medicine was free of side effects. Approximately half the patients reported using traditional medicine for their current illness and many for chronic illness in conjunction with conventional medicine. Conclusion: Traditional medicine use is common in Timor-Leste. Medical practitioners need to be cognizant of the common and potentially concomitant use of traditional medicine alongside conventional medicine when treating patients in Timor-Leste.
Soyasaponins reduce inflammation by downregulating MyD88 expression and suppressing the recruitments of TLR4 and MyD88 into lipid rafts
Authors: Chen Junbin , Ullah Hidayat , Zheng Zhongdaixi , Gu Xiangfu , Su Chuhong , Xiao Lingyu , Wu Xinglong , Xiong Fei , Li Qing , Zha Longying 
Published: June 2020

Abstract
Background
Previous studies indicate that soyasaponins may reduce inflammation via modulating toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88) signaling. However, its underlying mechanisms are still not fully understood.

Methods
Lipopolysaccharide (LPS)-challenged inflamed male ICR mice were intervened by intragastrical administration with 10 and 20 μmol/kg·BW of soyasaponin A1, A2 or I for 8 weeks. The serum inflammatory markers were determined by commercial kits and the expression of molecules in TLR4/MyD88 signaling pathway in liver by real-time PCR and western blotting. The recruitments of TLR4 and MyD88 into lipid rafts of live tissue lysates were detected by sucrose gradient ultracentrifugation and western blotting. LPS-stimulated RAW264.7 macrophages were treated with 10, 20 and 40 μmol/L of soyasaponin A1, A2 or I for 2 h. MyD88-overexpressed HEK293T cells were treated with 20 and 40 μmol/L of soyasaponins (A1, A2 or I) or 20 μmol/L of ST2825 (a MyD88 inhibitor) for 6 h. The expression of molecules in TLR4/MyD88 signaling pathway were determined by western blotting. Data were analyzed by using one way analysis of variance or t-test by SPSS 20.0 statistical software.

Results
Soyasaponins A1, A2 or I significantly reduced the levels of tumor necrosis factor alpha (TNFα), interleukin (IL)-6 and nitric oxide (NO) in serum (p < 0.05), and decreased the mRNA levels of TNFα, IL-6, IL-1β, cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase (iNOS) (p < 0.05), the protein levels of myeloid differentiation protein 2 (MD-2), TLR4, MyD88, toll-interleukin1 receptor domain containing adaptor protein (TIRAP), phosphorylated interleukin-1 receptor-associated kinase 4 (p-IRAK-4), phosphorylated interleukin-1 receptor-associated kinase 1 (p-IRAK-1) and TNF receptor associated factor 6 (TRAF6) (p < 0.05), and the recruitments of TLR4 and MyD88 into lipid rafts in liver (p < 0.05). In LPS-stimulated macrophages, soyasaponins A2 or I significantly decreased MyD88 (p < 0.05), soyasaponins A1, A2 or I reduced p-IRAK-4 and p-IRAK-1 (p < 0.05), and soyasaponin I decreased TRAF6 (p < 0.05). In MyD88-overexpressed HEK293T cells, soyasaponins (A1, A2 or I) and ST2825 significantly decreased MyD88 and TRAF6 (p < 0.05).

Conclusion
Soyasaponins can reduce inflammation by downregulating MyD88 expression and suppressing the recruitments of TLR4 and MyD88 into lipid rafts. This study provides novel understanding about the anti-inflammatory mechanism of soyasaponins.
Impact of take-home messages written into slide presentations delivered during lectures on the retention of messages and the residents’ knowledge: a randomized controlled study
Authors: Lautrette Alexandre , Boyer Alexandre , Gruson Didier , Argaud Laurent , Schwebel Carole , Tardy Bernard , Vignon Philippe , Megarbane Bruno , Schoeffler Pierre , Chabrot Pascal , Schmidt Jeannot , Boirie Yves , Guerin Claude , Darmon Michaël , Klouche Kada , Souweine Bertrand , Dellamonica Jean , Pereira Bruno ,   for the TREX group, Timsit Jean-François , Terzi Nicolas , Papazian Laurent , Gainnier Marc , Roch Antoine , Forel Jean-Marie , Hraiech Sami , Eisenmann Nathanaël , Bohe Julien , Richard Jean-Christophe , Cour Martin , Zeni Fabrice , Thiery Guillaume , Perinel Sophie , Bernardin Gilles , Jung Boris , Jonquet Olivier , Silva Stein 
Published: June 2020

Abstract
Background
Lectures with slide presentations are widely used to teach evidence-based medicine to large groups. Take-home messages (THMs) are poorly identified and recollected by students. We investigated whether an instruction to list THMs in written form on slides would improve the retention thereof by residents, and the residents’ level of knowledge, 1 month after lectures.

Methods
Prospective blinded randomized controlled study was conducted. Twelve lectures (6 control and 6 intervention lectures) were delivered to 73 residents. For the intervention lectures, the lecturers were instructed to incorporate clear written THMs into their slide presentations. The outcomes were ability of resident to recollect THMs delivered during a lecture (as assessed by accordance rate between the lecturers’ and residents’ THMs) and knowledge (as assessed by multiple choice questions (MCQs)).

Results
Data for 3738 residents’ THMs and 3410 MCQs were analyzed. The intervention did not significantly increase the number of THMs written on slides (77% (n = 20/26), 95% CI 56–91 vs 64% (n = 18/28), 95% CI 44–81, p = 0.31) nor THMs retention (13% (n = 238/1791), 95% CI 12–15 vs 17% (n = 326/1947), 95% 15–18, p = 0.40) nor knowledge (63.8 ± 26.2 vs 61.1 ± 31.4 /100 points, p = 0.75). In multivariable analyses performed with all THMs written on slides from the two groups, a superior knowledge was associated with notetaking during lectures (OR 1.88, 95% CI 1.41–2.51) and THMs retention (OR 2.17, 95% CI 1.54–3.04); and THMs retention was associated with written THMs (OR 2.94, 95% CI 2.20–3.93).

Conclusions
In lectures delivered to residents, a third of the THMs were not in written form. An intervention based on an explicit instruction to lecturers to provide THMs in written form in their slide presentations did not result in increased use of written THMs into the slide presentation or improvement of the THMs retention or level of knowledge. However, we showed that there was a strong positive association between writing THMs on a slide, retention of THMs and residents’ knowledge. Further researches are needed to assess interventions to increase written THMs in lectures by faculty.

Trial registration
ClinicalTrials.gov NCT01795651 (Fev 21, 2013).
Medical students as health coaches: adding value for patients and students
Authors: Maini Arti , Fyfe Molly , Kumar Sonia 
Published: June 2020

Abstract
Background
Underlying the global burden of chronic disease are common and modifiable risk factors such as unhealthy diet, physical inactivity and tobacco use. Health coaching is being introduced into healthcare as an effective tool in facilitating behaviour change and addressing lifestyle risk factors in patients. Although some medical schools are training students in health coaching, there is little research on this emerging practice. This qualitative study explores the experience and application of health coaching approaches by third year medical students that have been trained in health coaching.

Methods
Six focus groups were conducted with medical students (n = 39) who had participated in an experiential health coaching training module and practiced their health coaching skills in primary care settings. Interactive facilitated discussions between students aimed to explore experiences of health coaching, how this related to their ongoing practice, and their perceived impacts of engagement with patients. Data was thematically analysed.

Results
Themes emerged around ‘mindset’, ‘skills’, ‘application of skills’, ‘perceived value’ and ‘context’. Training in health coaching prompted a shift towards a non-judgemental, solution-oriented mindset in which students increasingly accepted the ability of each person to define their needs and identify individually appropriate solutions. Mindset change supported skill development in person-centred communication, active listening, and self-refection. Mindset and skills related to changes in how students conducted patient consultations, their practice of self-refection, and their personal relationships. Perceived value of coaching approaches reinforced mindset. Students described facilitators to their coaching practice, and also tensions due to misalignment between their coaching mindset and ongoing practices in medical education and service delivery.

Conclusions
Training medical students in health coaching and supporting them to contribute meaningfully through empowering patients in real-world settings can help develop students’ professional identity and a non-judgemental, solution-oriented mindset and skills in self-reflection, person-centred care and facilitating health behaviour change.
Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries
Authors: Van Bulck Liesbet , Goossens Eva , Luyckx Koen , Apers Silke , Oechslin Erwin , Thomet Corina , Budts Werner , Enomoto Junko , Sluman Maayke A. , Lu Chun-Wei , Jackson Jamie L. , Khairy Paul , Cook Stephen C. , Chidambarathanu Shanthi , Alday Luis , Eriksen Katrine , Dellborg Mikael , Berghammer Malin , Johansson Bengt , Mackie Andrew S. , Menahem Samuel , Caruana Maryanne , Veldtman Gruschen , Soufi Alexandra , Fernandes Susan M. , White Kamila , Callus Edward , Kutty Shelby , Moons Philip ,   on behalf of the APPROACH-IS consortium and the International Society for Adult Congenital Heart Disease (ISACHD)
Published: June 2020

Abstract
Background
The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries’ healthcare system on patient-reported outcomes in adults with congenital heart disease.

Methods
This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.

Results
Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.

Conclusions
This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.

Trial registration
ClinicalTrials.gov: NCT02150603. Registered 30 May 2014,
‘There is no such thing as getting sick justly or unjustly’ – a qualitative study of clinicians’ beliefs on the relevance of personal responsibility as a basis for health prioritisation
Authors: Traina Gloria , Feiring Eli 
Published: June 2020

Abstract
Background
Concerns have been raised regarding the reasonableness of using personal health responsibility as a principle or criterion for setting priorities in healthcare. While this debate continues, little is known about clinicians’ views on the role of patient responsibility in clinical contexts. This paper contributes to the knowledge on the empirical relevance of personal responsibility for priority setting at the clinical level.

Methods
A qualitative study of Norwegian clinicians (n = 15) was designed, using semi-structured interviews with vignettes to elicit beliefs on the relevance of personal responsibility as a basis for health prioritisation. Sampling was undertaken purposefully. The interviews were conducted in three hospital trusts in South-Eastern Norway between May 2018 and February 2019 and were analysed with conceptually driven thematic analysis.

Results
The findings suggest that clinicians endorsed a general principle of personal health responsibility but were reluctant to introduce personal health responsibility as a formal priority setting criterion. Five main objections were cited, relating to avoidability, causality, harshness, intrusiveness, and inequity. Still, both retrospective and prospective attributions of personal responsibility were perceived as relevant in specific clinical settings. The most prominent argument in favour of personal health responsibility was grounded in the idea that holding patients responsible for their conduct would contribute to the efficient use of healthcare resources. Other arguments included fairness to others, desert and autonomy, but such standpoints were controversial and held only marginal relevance.

Conclusions
Our study provides important novel insights into the clinicians’ beliefs about personal health responsibility improving the empirical knowledge concerning its fairness and potential applications to healthcare prioritisation. These findings suggest that although personal health responsibility would be difficult to implement as a steering criterion within the main priority setting framework, there might be clinical contexts where it could figure in prioritisation practices. Additional research on personal health responsibility would benefit from considering the multiple clinical encounters that shape doctor-patient relationships and that create the information basis for eligibility and prioritisation for treatment.
Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study
Authors: Hammervold Unn Elisabeth , Norvoll Reidun , Vevatne Kari , Sagvaag Hildegunn 
Published: June 2020

Abstract
Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context.

Methods
Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process.

Results
Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions.

Conclusion
Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
Infectious disease specialist consultations in a Japanese cancer center: a retrospective review of 776 cases
Authors: Itoh Naoya , Hadano Yoshiro , Yamamoto Yasumasa , Terada Norihiko , Kurai Hanako 
Published: June 2020

Abstract
Background
Little is known about the impact of infectious disease (ID) consultations on the management of patients with cancer. This study aimed to describe the consultation services provided by ID specialists to all departments in a comprehensive cancer center in Japan.

Methods
We conducted a retrospective review of ID consultations with adult patients at a comprehensive cancer center in Japan from April 2017 to March 2018.

Results
During the study period, 776 patients with cancer had an ID consultation. Of these, 414 (53.4%) were hospital inpatients. Reasons for the ID consultation comprised clinical management (n = 481, 62.0%), immunization (n = 272, 35.1%), and infection control (n = 23, 3.0%). Of the 474 ID consultations for diagnostic purposes, the most frequent condition was fever or elevated inflammatory markers of unknown origin (n = 125, 26.4%). The most frequent diagnoses after the diagnostic ID consultation were hepatobiliary infections (n = 97, 22.4%), respiratory infections (n = 89, 20.618.8%), and intra-abdominal infections (n = 71, 16.4%). The commonest reasons for immunization consultations were to prevent seasonal influenza (n = 193, 71.0%) and post-splenectomy vaccination (n = 58, 21.3%). The commonest reasons for infection control consultations were suspected tuberculosis or contact with tuberculosis (n = 11, 47.8%) and herpes zoster infection (shingles) (n = 7, 30.4%).

Conclusions
ID specialists play an important role in the clinical management of patients with cancer. ID physicians who work in cancer centers need to be specialized in treating IDs, diagnosing the causes of fevers of unknown origin, and controlling infection.
A tissue level atlas of the healthy human virome
Authors: Kumata Ryuichi , Ito Jumpei , Takahashi Kenta , Suzuki Tadaki , Sato Kei 
Published: June 2020

AbstractBackgroundHuman-resident microbes can influence both health and disease. Investigating the microbiome using next-generation sequencing technology has revealed examples of mutualism and conflict between microbes and humans. Comparing to bacteria, the viral component of the microbiome (i.e., the “virome”) is understudied. Somatic tissues of healthy individuals are usually inaccessible for the virome sampling; therefore, there is limited understanding of the presence and distribution of viruses in tissues in healthy individuals and how virus infection associates with human gene expression and perturbs immunological homeostasis.ResultsTo characterize the human virome in a tissue-specific manner, here we performed meta-transcriptomic analysis using the RNA-sequencing dataset from the Genotype-Tissue Expression (GTEx) Project. We analyzed the 8991 RNA-sequencing data obtained from 51 somatic tissues from 547 individuals and successfully detected 39 viral species in at least one tissue. We then investigated associations between virus infection and human gene expression and human disease onset. We detected some expected relationships; for instance, hepatitis C virus infection in the liver was strongly associated with interferon-stimulated gene upregulation and pathological findings of chronic hepatitis. The presence of herpes simplex virus type 1 in one subject’s brain strongly associated with immune gene expression. While torque teno virus was detected in a broad range of human tissues, it was not associated with interferon responses. Being notable in light of its association with lymphoproliferative disorders, Epstein-Barr virus infection in the spleen and blood was associated with an increase in plasma cells in healthy subjects. Human herpesvirus 7 was often detected in the stomach; intriguingly, it associated with the proportion of human leukocytes in the stomach as well as digestive gene expression. Moreover, virus infections in the local tissues associated with systemic immune responses in circulating blood.ConclusionsTo our knowledge, this study is the first comprehensive investigation of the human virome in a variety of tissues in healthy individuals through meta-transcriptomic analysis. Further investigation of the associations described here, and application of this analytical pipeline to additional datasets, will be useful to reveal the impact of viral infections on human health.