bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical efficacy and therapeutic mechanism of active ‘five-tone’ speech therapy compared with conventional speech-language therapy for treatment of post-stroke aphasia: protocol for a randomised controlled trial
Authors: Wang Mengxue , Ni Jinglei , Lin Bingbing , Huang Jia 
Published: September 2024

IntroductionAphasia is a common dysfunction among patients with stroke that can severely affect daily life. Listening to the ‘five-tone’ melodies of traditional Chinese medicine can improve some of the language functions of patients with post-stroke aphasia; however, passive listening may limit its clinical efficacy. In this study, we transform the passive listening five-tone melodic therapy of traditional Chinese medicine into an active five-tone speech therapy. This randomised controlled trial aims to investigate the clinical efficacy of active five-tone speech therapy in the treatment of post-stroke aphasia, such as language function, daily communication ability and communication efficiency, as well as investigate the therapeutic mechanism of this innovative therapy by electroencephalogram and MRI.Methods and analysisThe study is a multicentric, randomised, parallel-assignment, single-blind treatment study. 70 participants will be recruited from the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine and the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine and randomly assigned to two groups, the five-tone speech therapy group and the control group, at a 1:1 ratio. The control group will receive 20 sessions of conventional speech-language therapy, while the five-tone speech therapy group will receive 20 sessions of five-tone speech therapy in addition to conventional speech-language therapy. The primary outcome measure for this study will be the score on Western Aphasia Battery. Secondary outcomes include communicative abilities in daily living, percentage of correct information units and correct information units per minute, as well as resting-state electroencephalogram, event-related potentials and MRI data. All outcomes will be evaluated at 0 weeks (before intervention) and at 4 weeks (after 20 intervention sessions).Ethics and disseminationEthical approval of this study was granted by the ethics committees of the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023KY-009-01) and the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023-kl-010). Recruitment commenced on 24 April 2023. Informed consent will be obtained from all participants of the trial (or from their legal guardians, where applicable). The outcomes of the trial will be disseminated through peer-reviewed publications.Trial registration numberChiCTR2300069257.
Suicidal behaviours and associated factors among residents of Jimma Town, Southwest Ethiopia: a community-based cross-sectional study
Authors: Tessema Selamawit Alemayehu , Torba Alemayehu Negash , Tesfaye Elias , Alemu Bezaye , Oblath Rachel 
Published: September 2024

IntroductionSuicidal behaviour is a major public health concern in Africa and a cause of premature mortality. The availability of community epidemiological data in Ethiopia is limited. This study assessed the prevalence of suicidal behaviour and its associated factors in Jimma Town, Southwest Ethiopia.MethodsUsing the Suicide Behaviour Questionnaire-Revised (SBQ-R), a community-based cross-sectional survey was conducted between September and November 2021. Multistage sampling was used to screen 636 participants for suicidal behaviour. The association between suicidal behaviour and other variables was explored using binary and multivariable logistic regression analyses.ResultsThe overall estimated prevalence of suicidal behaviour of the respondents in the study was 7.9% (95% CI 5.9% to 10.3%), using the SBQ-R score (>7). One-third of the individuals with lifetime attempts encountered stigma. Multivariable logistic regression models indicated that being female (AOR 2.81, 95% CI 1.48 to 5.31), having depression (AOR 6.9, 95% CI 1.98 to 24.57), family history of mental illness (AOR 4.11, 95% CI 1.38 to 12.19), poor social support (AOR 3.86, 95% CI 1.23 to 12.15) and good coping efficacy (AOR 0.91, 95% CI 0.88 to 0.94))were significantly associated for suicidal behaviour with p value less than 0.05.ConclusionThe overall prevalence of suicidal behaviour was relatively higher in this population than in other studies done in Ethiopia. In addition, the current study indicates the presence of suicide stigma, which further influences poor health-seeking behaviours. The factors significantly associated with suicidal behaviour in this study included being female, having a family history of mental illness, poor social support, poor coping self-efficacy and depressive symptoms. Findings warrant the attention of policy-makers in early screening of depression, developing preventive measures targeting risk factors and enhancing access to mental healthcare services.
Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care
Authors: Asmamaw Getahun , Minwagaw Tefera , Samuel Mastewal , Ayenew Wondim 
Published: September 2024

ObjectiveThis study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.DesignSecondary data analysis of institution-based cross-sectional national survey data.SettingData were obtained from the 2021–2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia.ParticipantsThis study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021–2022 ESPA survey.Outcome measuresThe service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings.ResultsOnly 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of ‘trained staff and guidelines’ and ‘diagnostics’, but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%.ConclusionsAlthough the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.
Prevention of adverse HIV treatment outcomes: machine learning to enable proactive support of people at risk of HIV care disengagement in Tanzania
Authors: Xie Zhongming , Hu Huiyu , Kadota Jillian L , Packel Laura J , Mlowe Matilda , Kwilasa Sylvester , Maokola Werner , Shabani Siraji , Sabasaba Amon , Njau Prosper F , Wang Jingshen , McCoy Sandra I 
Published: September 2024

ObjectivesThis study aimed to develop a machine learning (ML) model to predict disengagement from HIV care, high viral load or death among people living with HIV (PLHIV) with the goal of enabling proactive support interventions in Tanzania. The algorithm addressed common challenges when applying ML to electronic medical record (EMR) data: (1) imbalanced outcome distribution; (2) heterogeneity across multisite EMR data and (3) evolving virological suppression thresholds.DesignObservational study using a national EMR database.SettingConducted in two regions in Tanzania, using data from the National HIV Care database.ParticipantsThe study included over 6 million HIV care visit records from 295 961 PLHIV in two regions in Tanzania’s National HIV Care database from January 2015 to May 2023.ResultsOur ML model effectively identified PLHIV at increased risk of adverse outcomes. Key predictors included past disengagement from care, antiretroviral therapy (ART) status (which tracks a patient’s engagement with ART across visits), age and time on ART. The downsampling approach we implemented effectively managed imbalanced data to reduce prediction bias. Site-specific algorithms performed better compared with a universal approach, highlighting the importance of tailoring ML models to local contexts. A sensitivity analysis confirmed the model’s robustness to changes in viral load suppression thresholds.ConclusionsML models leveraging large-scale databases of patient data offer significant potential to identify PLHIV for interventions to enhance engagement in HIV care in resource-limited settings. Tailoring algorithms to local contexts and flexibility towards evolving clinical guidelines are essential for maximising their impact.
Perceptions of genomic newborn screening: a cross-sectional survey conducted with UK medical students
Authors: Seed Lydia , Scott Anna , Pichini Amanda , Peter Michelle , Tadros Shereen , Sortica da Costa Cristine , Hill Melissa 
Published: September 2024

BackgroundWith the potential to identify a vast number of rare diseases soon after birth, genomic newborn screening (gNBS) could facilitate earlier interventions and improve health outcomes. Designing a gNBS programme will involve balancing stakeholders’ opinions and addressing concerns. The views of medical students—future clinicians who would deliver gNBS—have not yet been explored.MethodsWe conducted a nationwide online survey of UK medical students via the REDCap platform. Perceptions of gNBS, including scope of testing and potential benefits and drawbacks, were explored using a mix of multiple-choice questions, Likert scales, visual analogue scales and free-text questions.ResultsIn total, 116 medical students across 16 universities participated. Overall, 45% supported gNBS, with a positively skewed mean support score of 3.24 (SD 1.26, range: 1.0–5.0), and 55% felt it relevant to their future practice. Almost all agreed that infant-onset and childhood-onset diseases and conditions with effective treatments should be included. Most felt that earlier interventions and personalised care would be the most important benefit of gNBS. Other perceived benefits included earlier diagnoses, diagnosing more patients and enabling research for new treatments. However, several perceived challenges were highlighted: risk of genomic discrimination, incidental or uncertain findings, data security and breaching children’s future autonomy. Students expressed conflicting opinions on the psychological impact on families, but most were concerned about a lack of support due to current resource limitations in health services. Students frequently reported having insufficient knowledge to form an opinion, which may reflect gaps in genomics education at medical school and the current lack of evidence base for gNBS.ConclusionAlthough some support for gNBS was demonstrated, ethicolegal and social challenges were raised, emphasising a need for ongoing discussions about the implications of gNBS.
Comparative effectiveness trial of metformin versus insulin for the treatment of gestational diabetes in the USA: clinical trial protocol for the multicentre DECIDE study
Authors: Venkatesh Kartik K , MacPherson Cora , Clifton Rebecca G , Powe Camille E , Bartholomew Anna , Gregory Donna , Trinh Anne , McAlearney Ann Scheck , Fiechtner Lauren G , Catalano Patrick , Rice Donna , Cross Sharon , Kutay Huban , Gabbe Steven , Grobman William A , Costantine Maged M , Battarbee Ashley N , Boggess Kim , Katukuri Vivek , Eichelberger Kacey , Esakoff Tania , Feghali Maisa N , Harper Lori , Kaimal Anjali , Kole-White Martha , Mendez-Figueroa Hector , Mlynarczyk Malgorzata , Sciscione Anthony , Shook Lydia , Sobhani Nasim C , Stamilio David M , Werner Erika , Wiegand Samantha , Zera Chloe A , Zork Noelia M , Saade George , Landon Mark B 
Published: September 2024

IntroductionGestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the affected pregnant individual and the infant exposed in utero. One in four individuals with GDM will require pharmacotherapy to achieve glycaemic control. Injectable insulin has been the mainstay of pharmacotherapy. Oral metformin is an alternative option increasingly used in clinical practice. Both insulin and metformin reduce the risk of adverse pregnancy outcomes, but comparative effectiveness data from a well-characterised, adequately powered study of a diverse US population remain lacking. Because metformin crosses the placenta, long-term safety data, in particular, the risk of childhood obesity, from exposed children are also needed. In addition, the patient-reported experiences of individuals with GDM requiring pharmacotherapy remain to be characterised, including barriers to and facilitators of metformin versus insulin use.Methods and analysisIn a two-arm open-label, pragmatic comparative effectiveness randomised controlled trial, we will determine if metformin is not inferior to insulin in reducing adverse pregnancy outcomes, is comparably safe for exposed individuals and children, and if patient-reported factors, including facilitators of and barriers to use, differ between metformin and insulin. We plan to recruit 1572 pregnant individuals with GDM who need pharmacotherapy at 20 US sites using consistent diagnostic and treatment criteria for oral metformin versus injectable insulin and follow them and their children through delivery to 2 years post partum. More information is available atwww.decidestudy.org.Ethics and disseminationThe Institutional Review Board at The Ohio State University approved this study (IRB: 2024H0193; date: 7 December 2024). We plan to submit manuscripts describing the results of each study aim, including the pregnancy outcomes, the 2-year follow-up outcomes, and mixed-methods assessment of patient experiences for publication in peer-reviewed journals and presentations at international scientific meetings.Trial registration numberNCT06445946.
Macular exudate in idiopathic intracranial hypertension affects outer retina and visual acuity
Authors: Cao Le , Wang Hang , Kwapong William Robert , Wan Jincheng , Yan Yuying , Liu Guina , Liu Rui , Hu Fayun , Wu Bo 
Published: September 2024

BackgroundOptical coherence tomography (OCT) is suggested as a potential tool for retinal biomarkers in idiopathic intracranial hypertension (IIH). We explored how macular exudate (ME) affects retinal structure in IIH and investigated its relationship with their clinical features.MethodsPatients diagnosed with IIH and matched controls were enrolled. ME detection was done on fundus photography; swept-source OCT was used to image and measure the retinal sublayer thicknesses, including the retinal nerve fibre layer, ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL) and outer retinal layer (ORL). IIH patients underwent lumbar puncture where intracranial pressure (ICP) was assessed.Results195 eyes from 98 IIH patients (42 eyes had ME) and 224 eyes from 112 controls were included. IIH patients had thicker INL and ORL compared with controls (both p<0.001) while IIH eyes with ME had thicker INL and ORL thicknesses compared with eyes without ME (both p<0.05). In IIH patients, the retinal sublayer thicknesses correlated with their ICP levels, and GCIPL thickness correlated with visual acuity (VA). Furthermore, ME was associated with higher ICP, worse papilledema and lower VA (all p<0.001).ConclusionME affects retinal thickness in IIH patients and is associated with more severe clinical features in IIH. OCT may provide biomarkers informative of clinical changes in IIH. Further longitudinal studies are needed to explore the evolution of ME and its relationship to VA and retinal structure.
Evaluation of a training programme on the management of infectious and sharp healthcare waste in Tunisia
Authors: Chelly Souhir , Saffar Sonia , Mabrouk Rihab , ltaif Imen , Ammar Asma , Ezzi Olfa , Njah Mansour , Mahjoub Mohamed 
Published: September 2024

IntroductionThe management of healthcare waste is a crucial issue for public health and the environment. To minimise risks, it is essential to ensure that the management of healthcare waste is meticulously applied. Additionally, among the evaluation methods adopted by the hospital hygiene department to monitor the degree of compliance. The aim of this study was to assess the degree of compliance with healthcare waste management before and after a training and support programme.MethodsThis is a pre-experimental study based on two audits of healthcare waste management at Farhat Hached University Hospital in Sousse, Tunisia. All medical, surgical and laboratory departments were included. The first audit was carried out, followed by training of the responsible staff, which was carried out according to a cycle of training and coaching hygiene technicians, and finally, a second audit was conducted. The compliance rate is compared between 2021 and 2022.ResultsWhen comparing the averages of the compliance percentages for the four audit areas, there was a statistically significant improvement between the years 2021 and 2022 in the availability of equipment and consumables required for the management of infectious and sharp healthcare waste (p=0.029) as well as intramural transport (p=0.014).ConclusionThe study highlights the central role of effective waste management training in promoting compliance, awareness and responsible practices. Constant attention and training are essential to maintain progress at Farhat Hached University Hospital. This helps create safer care environments, better public health outcomes and long-term sustainability.
Factors associated with cost of adverse events in the intensive care unit: an economic evaluation performed in Bogotá, Colombia
Authors: Rincón López Juliana Vanessa , Diaz Rojas Jorge Augusto , Estrada-Orozco Kelly 
Published: September 2024

BackgroundThe costs of adverse health events represent a significant burden of disease. Management of these adverse events also entails high costs to healthcare systems, reaching up to US$110 516.25 in some countries. The intensive care unit is a context where they occur most frequently, with some studies reporting rates as high as 50% of the population. It is of utmost importance to examine which aspects of the care process related to patients or the events themselves have the most significant impact on costs. The objective of this economic evaluation is to establish the clinical and healthcare factors that determine the cost of adverse events in the intensive care units of two university hospitals in Bogotá, Colombia.MethodsWe carried out an economic analysis study evaluating the clinical factors of patient care and institutions that have the most impact on the costs of adverse events. The population consisted of patients treated in the intensive care units of two university hospitals in Bogotá during 2019 and 2022. The outcome variable was the costs of adverse events, measured as direct costs through the perspective of the institutions providing health services. To estimate the direction and degree of association between clinical variables, adverse events and care with the costs of adverse events, a generalised linear regression gamma link function log was performed.ResultsA total of 369 patients were included, 232 men (62.9%) and 137 women (37.1%), with a median age of 63 years. The median APACHE II classification system score was 13 points, and the median Charlson comorbidity index was 5. Of the adverse events, 252 (68.29%) were passively reported, 223 (60.43%) were preventable and 267 events (72.36%) were non-serious. The events had a median cost of US$54.32 per patient, and the variables related to higher cost were overall hospital stay, stay until the event, Charlson comorbidity index, reporting system, severity, overall stay until the event, musculoskeletal major disease categories, and events related to safe care, pharmacovigilance and technovigilance.ConclusionThis study was able to establish that overall hospital stay, Charlson index, reporting system and severity are positively related to the costs of adverse events. The factors that were found to be associated with lower costs were length of stay until the event, admission diagnosis related to the musculoskeletal system, and presenting an event related to safe care, pharmacovigilance and technovigilance.
Exercise training improves cardiovascular fitness in dilated cardiomyopathy caused by truncating titin variants
Authors: Flensted Ida Finsen , Stemmerik Mads Godtfeldt , Skriver Sofie Vinther , Axelsen Kasper Holst , Christensen Alex Hørby , Lundby Carsten , Bundgaard Henning , Vissing John , Vissing Christoffer Rasmus 
Published: September 2024

BackgroundParticipation in regular exercise activities is recommended for patients with chronic heart failure. However, less is known about the effect of exercise in patients with genetic dilated cardiomyopathy (DCM). We sought to examine the effect of vigorousintensity training on physical capacity in patients with DCM caused by truncating titin variants (TTNtv).Trial designNon-randomised clinical pre-post trial of exercise training.MethodsIndividuals with DCM-TTNtv were included from outpatient clinics for inherited cardiac diseases. The trial consisted of 8 weeks of usual care followed by 8 weeks of regular vigorous-intensity cycling exercise, enclosed by three test days. The primary outcome was change in peak oxygen uptake (VO2). Secondary outcomes included change in blood volume, total haemoglobin mass, measures of systolic function and cardiac output/stroke volume during exercise.ResultsThirteen out of 14 included participants (43% women, age 48±11 years, body mass index: 30±6 kg/m2) completed the trial. In the exercise training period, peak VO2increased by +1.9 mL/kg/min (95% CI +0.9 to +2.9, p=0.002). Compared with usual care, exercise training improved peak VO2by +2.9 mL/kg/min (95% CI +1.2 to +4.5, p=0.002), corresponding to a 10% increase. Adaptations to exercise training included an increase in resting cardiac output (+0.8 L/min, p=0.042), total blood volume (+713 mL, p<0.001), total haemoglobin mass (+73 g, p<0.001), and improved left ventricular (LV) systolic function (LV ejection fraction: +3.2% (p=0.053) and global longitudinal strain: −2.0% (p=0.044)). No exercise-related adverse events or change in plasma biomarkers of cardiac or skeletal muscle damage were observed.ConclusionsOur study shows that vigorous intensity exercise training improved peak VO2in patients with DCM-TTNtv. Exercise training was associated with improved LV systolic function and increased blood volume and oxygen carrying capacity. Future research should investigate the effect of long-term exercise in this group.Trial registration numberNCT05180188.