bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental health-related stigma and attitudes toward patient care among providers of mental health services in a rural Chinese county
Authors: Deng Yuer , Wang An-Li , Frasso Rosemary , Ran Mao-Sheng , Zhang Tian-Ming , Kong Dexia , Wong Yin-Ling Irene 
Published: February 2021

Background and aims: The increasing prevalence of mental illness and low treatment rate presents a pressing public health issue in China. Pervasive stigma is a significant barrier to mental health recovery and community inclusion. In particular, stigmatizing or supportive attitudes held by healthcare providers could either perpetuate or mitigate self-stigma of people with mental illness. Moreover, mental health resources are unevenly distributed in China, with most of them concentrated in urban centers and provincial capitals. This study explores healthcare providers’ attitudes toward mental illness and the challenges they faced at work in a rural Chinese county. Method: Four focus groups were conducted with 36 healthcare providers from a three-tier mental healthcare system in a rural county in southwestern China. Focus group discussions were recorded and transcribed verbatim. The team employed a conventional content analysis approach for data analysis. All transcripts were double-coded by three bilingual team members who are native Chinese speakers. Coding discrepancies were resolved by consensus. Results: Healthcare providers recruited from the county, township, and village levels varied in educational background, professional qualification, and experience of working with people with mental illness. Five thematic categories identified across four groups include (1) barriers to mental healthcare delivery, (2) keys to mental health recovery, (3) providers’ attitudes toward providing care, (4) providers’ perception toward patients and family members, and (5) providers’ perception of training needs. Conclusions: This is a unique study that included healthcare providers from a three-tier healthcare system. Findings signal the importance of understanding healthcare practitioners’ experiences and views to inform the design of training initiatives in rural or low-resource communities.
Diagnosis, Treatment, and Prevention Practices for Lyme Disease by Clinicians, United States, 2013-2015
Authors: Beck Alyssa R. , Marx Grace E. , Hinckley Alison F. 
Published: February 2021

Objectives Although tick-borne diseases account for a large number of health care visits in the United States, clinical practices for tick bite and Lyme disease treatment and prevention are not well understood. The objective of this study was to better understand factors associated with clinical practices related to tick bites and Lyme disease. Methods In 2013-2015, questions about tick-bite evaluation, Lyme disease diagnosis and treatment, appropriate use of Lyme disease testing, and tick-bite prevention were included in Porter Novelli’s DocStyles survey, a nationally representative annual web-based survey of health care providers. We performed analyses of responses by provider license type and state-level incidence (high or low) of Lyme disease in 2019. Results A total of 4517 providers were surveyed across the 3 study years. Overall, 80.9% of providers reported that they had evaluated at least 1 patient for a tick bite, 47.6% had diagnosed at least 1 patient with Lyme disease, and 61.9% had treated at least 1 patient for Lyme disease in the previous year. Providers from states with a high incidence of Lyme disease saw more patients for tick bites and Lyme disease than providers from states with a low incidence of Lyme disease. Few providers correctly chose Lyme disease testing as clinically useful in the hypothetical case of a patient from a state with a high incidence of Lyme disease with an arthritic knee (36.0%) or with new-onset atrioventricular block (39.5%), and respondents across all provider types incorrectly chose testing when not clinically indicated. Most providers (69.7%) reported routinely recommending tick-bite prevention methods to patients. Conclusions Many providers evaluate patients for tick bites and treat patients for Lyme disease, but knowledge about appropriate testing is low. Providers may benefit from tailored education about appropriate Lyme disease diagnosis, testing, and effective tick-bite prevention.
Evaluation of a New Field Epidemiology Training Program Intermediate Course to Strengthen Public Health Workforce Capacity in Tanzania
Authors: Wilson Kate , Juya Amir , Abade Ahmed , Sembuche Senga , Leonard Devotha , Harris Julie , Perkins Samantha , Chale Stella , Bakari Muhammad , Mghamba Janneth , Kohler Pamela 
Published: February 2021

Objectives Sub-Saharan Africa faces a shortage of skilled epidemiologists to prevent, detect, and respond to health threats. Tanzania has implemented one of the first Centers for Disease Control and Prevention Field Epidemiology Training Program (FETP) Intermediate courses in Africa. This course aims to strengthen health workforce capacity in surveillance system assessment, outbreak investigation, and evaluation, prioritizing HIV control. We conducted an outcome evaluation of this new course. Methods We used a pre/post evaluation design using data from 4 cohorts of trainees who took the FETP Intermediate course from 2017 to 2020. We conducted knowledge assessments before and after each cohort and combined those results. Outcomes included knowledge and self-rated competency and trends in integrated disease surveillance and response (IDSR) data. We collected data through tests, field assignments, exit interviews, and data audits. We compared the mean change in pre-/posttest scores using linear regression and 95% CIs. We used content analysis to summarize exit interviews. Results Fifty-three FETP trainees from 10 regions enrolled in the FETP Intermediate course, and 52 (99.0%) completed the course. We found substantial increases in mean knowledge (44.0 to 68.0 points) and self-rated competency (4.14 to 4.43) scores before and after the course. Trainees evaluated 52 surveillance systems and 52 district HIV care programs, and 39 (75.0%) trainees participated in outbreak investigations. From before to after cohort 1, timeliness and completeness of IDSR reports increased from 4.2% to 52.1% and from 27.4% to 76.5%, respectively. Course strengths were quality of instruction, individualized mentoring, and practical skills gained. Challenges were mentor availability, limited time for data analysis practice, and balancing work and field assignments. Conclusions The Tanzania FETP Intermediate course substantially improved trainee knowledge and helped to improve local data quality and reporting. This course is a promising model to strengthen subnational capacity to prevent, detect, and respond to public health threats in Africa.
Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study
Authors: Huh Hyub , Go Doo Yeon , Cho Jang Eun , Park Jihoon , Lee Jiwon , Kim Hyun-Chang 
Published: February 2021

Objective General anaesthesia with tracheal intubation results in sore throat. We evaluated the influence of the two-handed jaw thrust on postoperative sore throat in patients who require tracheal intubation. Methods In this prospective, double-blind, single-centre, parallel-arm, and randomised trial, 92 patients who were scheduled for general anaesthesia for total hip arthroplasty were allocated to one of two groups. In the jaw thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at intubation. In the control group (n = 46), conventional intubation with sham jaw thrust was performed. Incidences of airway morbidities including sore throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were compared. Results During the postoperative 24 hours, the incidence of sore throat (8 [17%] vs. 20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18 [39%]) compared with the control group. The incidence of cough during the postoperative 24 hours was similar between the groups. Conclusions The jaw thrust manoeuvre significantly reduced sore throat and hoarseness in patients after general anaesthesia using tracheal intubation. Clinical trial registration: NCT 03568279.
Senescence associated long non-coding RNA 1 regulates cigarette smoke-induced senescence of type II alveolar epithelial cells through sirtuin-1 signaling
Authors: Yuan Dong , Liu Yuanshun , Li Mengyu , Zhou Hongbin , Cao Liming , Zhang Xiaoqin , Li Yaqing 
Published: February 2021

Objective The primary aim of our study was to explore the mechanisms through which long non-coding RNA (lncRNA)-mediated sirtuin-1 (SIRT1) signaling regulates type II alveolar epithelial cell (AECII) senescence induced by a cigarette smoke-media suspension (CSM). Methods Pharmacological SIRT1 activation was induced using SRT2104 and senescence-associated lncRNA 1 (SAL-RNA1) was overexpressed. The expression of SIRT1, FOXO3a, p53, p21, MMP-9, and TIMP-1 in different groups was detected by qRT-PCR and Western blotting; the activity of SA-β gal was detected by staining; the binding of SIRT1 to FOXO3a and p53 gene transcription promoters was detected by Chip. Results We found that CSM increased AECII senescence, while SAL-RNA1 overexpression and SIRT1 activation significantly decreased levels of AECII senescence induced by CSM. Using chromatin immunoprecipitation, we found that SIRT1 bound differentially to transcriptional complexes on the FOXO3a and p53 promoters. Conclusion Our results suggested that lncRNA-SAL1-mediated SIRT1 signaling reduces senescence of AECIIs induced by CSM. These findings suggest a new therapeutic target to limit the irreversible apoptosis of lung epithelial cells in COPD patients.
SIRT5 regulates autophagy and apoptosis in gastric cancer cells
Authors: Gu Wen , Qian Qinyi , Xu Yinkai , Xu Xiaolan , Zhang Liping , He Songbing , Li Dechun 
Published: February 2021

Objective Accumulating evidence illustrates that sirtuins (SIRTs) regulate autophagy and apoptosis in cancer cells; however, the role of SIRT5 in gastric cancer (GC) cells remains unknown. In this study, we examined the role of SIRT5 in GC cells. Methods We detected SIRT5 protein levels in freshly collected samples from patients with GC. Next, we studied the function of SIRT5 in autophagy. Furthermore, the signaling pathway through which SIRT5 enhanced autophagy in GC cells was detected. In addition, we established a GC cell apoptosis model to analyze the role of SIRT5 in apoptosis. Results SIRT5 expression was downregulated in GC tissues. We discovered that SIRT5 promoted autophagy in GC cells. We demonstrated that SIRT5 enhanced autophagy in GC cells via the AMP-activated protein kinase–mammalian target of rapamycin signaling pathway. In addition, SIRT5 was degraded during apoptosis in GC cells. Meanwhile, we observed that calpains and caspase-related proteins were associated with SIRT5-related GC cell apoptosis. Conclusions SIRT5 is a crucial regulator of autophagy and apoptosis in GC cell lines that can maintain the balance of autophagy and apoptosis.
Decreased serum bilirubin levels in children with lead poisoning
Authors: Ye Mengsi , Zhang Tingting , Chen Zhibo , Chen Shuo , Chen Huale 
Published: February 2021

Objective Lead is a toxic heavy metal, which causes irreversible damage in children. Oxidative stress is the underlying mechanism of lead toxicity, and monitoring oxidative stress of lead poisoning children in vivo is important. Our study aimed to investigate blood serum levels of biochemical parameters, including albumin, bilirubin, creatinine, and uric acid, which are regarded as non-enzymatic antioxidants, in children with lead poisoning. Methods We studied 355 children with lead poisoning and 355 age- and sex-matched controls. We analyzed clinical characteristics and measured serum levels of total protein, globulin, albumin, bilirubin, aspartate aminotransferase (AST), alanine aminotransferase, urea, and creatinine. Results We found that albumin, bilirubin, urea, and creatinine levels were significantly lower and AST, total protein, and globulin levels were higher in children with lead poisoning than in controls. Direct bilirubin, albumin, total protein, urea, creatinine, and AST levels were associated with lead poisoning after adjustment for other covariates. Spearman analysis showed that direct bilirubin, albumin, and urea levels were independent indicators (i.e., not related to hemoglobin or weight), while creatinine levels showed a moderate correlation with weight. Conclusion Lead interferes with the non-enzymatic antioxidant system in children, and lead poisoning results in a decrease in serum bilirubin levels.
Deep exploration of PARP inhibitors in breast cancer: monotherapy and combination therapy
Authors: Chen Zheling , Wang Xiao , Li Xiao , Zhou Yucheng , Chen Ke 
Published: February 2021

Objective Nearly 5% of patients with breast cancer carry germline BRCA mutations, which are more common in triple-negative breast cancer (TNBC). Previous clinical trials demonstrated the therapeutic efficacy of poly (ADP-ribose) polymerase inhibitors (PARPis) against BRCA-mutated metastatic breast cancer. The current study conducted a systemic review and meta-analysis of the clinical efficiency and safety of PARPis, either alone or combined with chemotherapy, in patients with TNBC. Methods We searched PubMed, EMBASE, and ClinicalTrials.gov to identify randomized controlled trials comparing PARPi therapy with chemotherapy, and comparisons of chemotherapy plus PARPis with chemotherapy alone were included. The study endpoints included the clinical response, progression-free survival, and adverse event rates. Results PARPi therapy was revealed to improve progression-free survival in patients with advanced breast cancer, either alone or in combination with chemotherapy. Subgroup analysis illustrated that patients with mutant BRCA1 and mutant BRCA2 and those who had not been treated with platinum-based agents could specifically benefit from PARPis. Conclusion PARPi monotherapy can significantly improve clinical outcomes in patients with advanced breast cancer, especially those with TNBC, those who had not previously received platinum therapy, and those with mutant BRCA1/2. PARPis combined with chemotherapy represent new treatment options for patients with advanced cancer.
Patterns of Brain Injury in Perinatal Arterial Ischemic Stroke and the Development of Infantile Spasms
Authors: Srivastava Ratika , Shaw Oriana E. F. , Armstrong Edward , Morneau-Jacob Francois-Dominique , Yager Jerome Y. 
Published: February 2021

Introduction: Perinatal arterial ischemic stroke (PAIS) underlies approximately 10% of infantile spasms (IS). We aim to identify patterns of brain injury in ischemic stroke that may predispose infants to infantile spasms. Methods: Sixty-four perinatal arterial ischemic stroke patients were identified meeting the following inclusion criteria: term birth, magnetic resonance imaging (MRI) showing ischemic stroke or encephalomalacia in an arterial distribution, and follow-up records. Patients who developed infantile spasms (PAIS-IS) were analyzed descriptively for ischemic stroke injury patterns and were compared to a seizure-free control group (PAIS-only). Stroke injury was scored using the modified pediatric ASPECTS (modASPECTS). Results: The PAIS-IS (n = 9) group had significantly higher modASPECTS than the PAIS-only (n = 16) group ( P = .002, Mann-Whitney). A greater proportion of PAIS-IS patients had injury to deep cerebral structures (67%) than PAIS-only (25%). Conclusion: Infarct size was significantly associated with infantile spasms development. Results support theories implicating deep cerebral structures in infantile spasms pathogenesis. This may help identify perinatal arterial ischemic stroke patients at risk of infantile spasms, facilitating more timely diagnosis.
Evaluation of Discipline-Specific Outcomes Through a Multidisciplinary Team Clinic for Patients With Isolated Cleft Palate
Authors: Trivedi Prerak B. , Padovano William M. , Skolnick Gary B. , Menezes Maithilee D. , Grames Lynn M. , Cheung Susan , Kim Andrew M. , Cradock Mary M. , Naidoo Sybill D. , Snyder-Warwick Alison K. , Patel Kamlesh B. 
Published: February 2021

Objective: To describe the incidence and timing of provider-specific interventions for children with isolated cleft palate. Design: This was a retrospective cohort study involving review of medical records. Setting: Multidisciplinary team care clinic at a tertiary academic children’s hospital between January 2000 and July 2019. Patients: Patients with isolated nonsyndromic cleft palate seen by an American Cleft Palate-Craniofacial Association-approved team; 138 children were included. Main Outcome Measures: Study outcomes included incidence of secondary velopharyngeal management, tympanostomy tube insertion, speech therapy, hearing loss, dental/orthodontic treatment, and psychology interventions. Provider-specific outcomes were calculated for patients at ages 0 to 3, 3 to 5, and >5 years. Results: Median follow-up time was 7.0 years (interquartile range: 3.3-11.8 years). At their last team assessment, 42% of patients still had conductive hearing loss. The rate of tympanostomy tube insertions not done alongside a palatoplasty was highest for ages 3 to 5 and dropped after new American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines in 2013 ( P = .015); 54% of patients received speech-language therapy during follow-up. Palatoplasty, psychology, and dental/orthodontic treatment were all less common than speech or ENT treatment ( P < .01). Secondary palatoplasty was performed in 31 patients (22%). Patients who received speech, dental/orthodontic, or psychology intervention followed up longer than those who did not (9.8 vs 2.1 years, P < .001). Conclusion: Half of the patients terminated team follow-up by age 7, suggesting that burden of care outweighed perceived benefits of continued follow-up for many families. These results can be used to adjust protocols for children with isolated cleft palate.
Dental Age Estimation According to European Formula and Willems Method: Comparison Between Children With and Without Cleft Lip and Palate
Authors: Markovic Evgenija , Marinkovic Nemanja , Zelic Ksenija , Milovanovic Petar , Djuric Marija , Nedeljkovic Nenad 
Published: February 2021

Objective: To assess dental age and deviations of dental from chronological age according to the Willems and Cameriere methods (European formula) in patients with cleft lip and/or cleft palate (CL/P) and compare it with control group. Design: Retrospective cross-sectional study. Setting: Clinic of Orthodontics. Participants: Sixty-nine patients with CL/P between 6 and 15 years of age (55 with unilateral and 14 with bilateral CL/P) with 148 panoramic radiographs. The same number of radiographs was examined in the age-matched control group. Main Outcome Measures: Estimation and comparison of dental age and differences of dental from chronological age in relation to the type of cleft, sex, and age in the group of patients with and without CL/P according to Willems and Cameriere method. Results: No significant intersex and intergroup differences were found in deviations of dental from chronological age according to Cameriere method ( P > .05). Significant difference in deviation of dental from chronological age was found between the patients with and without CL/P according to Willems method ( P < .001). Conclusion: Cameriere European formula for dental age estimation, which is not influenced by sex and tooth morphology, showed similar dental development of children with and without CL/P. However, Willems method detected that deviation of dental from chronological age significantly differed between children with and without clefts.
Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors
Authors: Ettinger Sarah , Altemeier Anna , Stukenborg-Colsman Christina , Yao Daiwei , Plaass Christian , Lerch Matthias , Claassen Leif 
Published: February 2021

Background: The common treatment for end-stage tarsometatarsal (TMT) arthritis is an arthrodesis of the affected joints. This study was performed to examine the clinical and radiographic outcome after TMT arthrodesis and to identify risk factors for postoperative complications. Methods: A total of 101 patients with tarsometatarsal arthritis of at least 2 joints were retrospectively examined. Data were acquired using clinical and radiographic examination, pedobarographic analysis, and standardized questionnaires, including the European Foot and Ankle Society Score, the Foot and Ankle Outcome Score, a pain numeric rating scale (NRS), the 36-Item Short Form Health Survey, and the University of California at Los Angeles Activity (UCLA) Score. The fixation technique, any complications, and revision surgery were recorded. Results: All scores improved significantly, except for the UCLA Score. The mean pain NRS score was significantly reduced from 7.7 preoperative to 3.0 postoperative ( P < .05). The overall nonunion rate was 12.6%. Compared with 2 crossed-screw fixation, locking plate plus compression screw fixation was associated with a decreased nonunion rate (odds ratio [OR] 0.165, 95% confidence interval [CI] 0.032-0.854; P = .017). A body mass index >27 was significantly associated with a higher nonunion rate and wound healing problems (OR 12.05, 95% CI 1.430-101.468; P = .006; OR 5.03, 95% CI 1.273-19.871; P = .013). The overall reoperation rate was 25.2%. Conclusion: TMT arthrodesis of the medial and central column resulted in significant improvement in foot function and pain. A major complication was nonunion. Locking plate plus compression screw fixation was associated with a lower nonunion rate. Level of Evidence: Level III, comparative series.
Femoral Head Allografts for Talar Body Defects
Authors: Coetzee J. Chris , Den Hartog Bryan D. , Stone McGaver Rebecca , Seiffert Kayla J. , Giveans M. Russell 
Published: February 2021

Background: Large structural bone deficits after a failed ankle arthroplasty or avascular necrosis (AVN) of the talus present a complex reconstruction challenge. The aim of this study was to report the results of patients undergoing an ankle arthrodesis or tibiotalocalcaneal fusion using a femoral head allograft (FHA). Methods: All ankle and tibiotalocalcaneal fusions using FHA between February 2006 and January 2019 were included. Forty-four patients (45 ankles) with a mean follow-up of 42.8 months were studied. Males accounted for 58.1% (25/43 patients). All patients had either failure of primary or revision total ankle arthroplasty (TAA) or AVN of the talus. Pre- and postoperative Veterans RAND Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Ankle Osteoarthritis Scale (AOS) and visual analog scale (VAS) for pain scores were obtained. A patient satisfaction survey was distributed postoperatively and results were tabulated. Results: Preoperatively to postoperatively, the VR-12 Mental score remained essentially unchanged ( P = .752) and the VR-12 Physical score improved ( P = .007); the FAAM Activities of Daily Living (ADL) and Sport scores improved ( P < .001); the AOS Pain and Disability scores improved ( P < .001); and the man VAS score improved ( P < .001). The overall satisfaction rate was 78.6 on a 100-point scale. At an average of 18.7 weeks, 90.7% of the ankles were substantially fused. Five patients went on to nonunions and revision surgery. Conclusion: The use of FHA to treat talar defects was a viable option. In this complex patient population, the arthrodesis rate was high at 89% with very positive patient-reported outcome scores. Level of Evidence: Level IV, case series.