Medicine, Biological and Life Sciences: Recent submissions
Now showing items 1-20 of 1251
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Gone With the Wind: The Proximate and Ultimate Causes of the Decline and Extinction of the Bahama Nuthatch Sitta insularisNewly elevated to species rank, the Bahama Nuthatch Sitta insularis is or was a bark- and twig-gleaning insectivore only known in life from the pine forests of Grand Bahama in the Bahamas archipelago. It became increasingly difficult to find in the past 50 years, seemingly in part in response to multiple hurricanes in this century. In spring (June–April) 2018, when it was still known to be extant, we divided the island into seven sections and carried out point count transects with playback and measured habitat variables at 464 locations in pine forest across Grand Bahama. We made only six observations at six locations, all in the region of Lucayan North and each involving a single nuthatch (possibly all the same individual). Fourteen count points were within 500 m of the six locations, and tree size at these sites was greater in height and girth than at sites with no observations and indeed than at other sites within Lucayan North. Count points within 500 m of nuthatch records in 2004–2018 had larger trees and more snags than survey points over 500 m away from previous detections, while count points within 500 m of our 2018 nuthatch records tallied more snags than did those within 500 m of the 2004–2007 records. Declines in habitat quality, habitat extent, nesting substrate, and food availability (driven by logging, attritional island development, and the direct and indirect effects of hurricanes), plus speculated increases in populations of invasive predators/competitors and in major mortality events (hurricanes, increasing in force and frequency with climate change), are suspected to be the ultimate causes of the decline of the nuthatch, with Hurricanes Matthew and Dorian the proximate causes of its evident extinction in 2019.
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Habitus, Capital and the Shaping of Sporting Careers: A Qualitative Study of Norwegian YouthPrevious research has established that youngsters’ sporting repertoires become particularly malleable during the early- to mid-teenage years, shifting from formal, organized sports to more informal, recreational activities. This study investigated the processes underlying these changes, using the theoretical framework of social and cultural capital and habitus. Forty-one individual qualitative interviews, with 17–18-year-old middle-class Norwegians, were conducted in order to understand the role of family, friends, and peers in shaping sporting repertoires and careers. Through three analytical themes – ‘Shifting forms, shifting orientations’; ‘Sporting capital and family cultures of sport’; and Sporting repertoires and the growing significance of friends’ – our findings lend support to notions of family cultures as important in initiating young people’s sporting careers by building their sports-related ‘cultural capital’ and establishing sporting routines. However, our findings also indicate that such primary socialization into sport may not be enough for building the sporting repertoires necessary for lifelong engagement. The development of sporting habitus tends to be facilitated by social capital in the form of friendship networks within which friends become increasingly significant in shaping sporting repertoires. Understanding the dynamism and mutability of sporting repertoires during the youth life-stage is crucial for developing sports policies that foster lifelong sports engagement.
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Navigating Food Fraud: A Survey of Nigerian Consumer Knowledge and AttitudesFood fraud presents a growing threat globally, impacting consumer health; food safety; and brand credibility. The key motivation for food fraud is usually an economic or financial advantage. Economically motivated food fraud (EMA) is the illegal deception, deliberate and intentional substitution or addition of a substance in a food product, which may pose a possible health risk to unsuspecting consumers. This study aims to assess the awareness and attitudes of Nigerian consumers towards food authenticity and the regulatory measures in place to combat food adulteration. The study comprised 2160 respondents who were asked about their knowledge of high-profile food fraud incidents, frequently adulterated products, and their opinions of the effects of food fraud and preventative measures. The findings of this study revealed that more than a third of respondents were unfamiliar with the term “food fraud”. However, they were aware of local high-profile cases, such as “plastic rice” and counterfeit dairy products. Most participants relied on point-of-sale information for assessing food authenticity, with street vendors being viewed as potential sources of food adulteration. The study also found that more than half of the respondents were concerned about food fraud regardless of whether it involved local or imported products. A wide variety of food items were identified as prone to adulteration or fraudulent activity. These included alcoholic drinks, dairy products, honey, rice, and tomato paste, amongst others. These findings highlight the need for improved consumer awareness, regulatory effectiveness, and remediation efforts to combat food fraud in Nigeria.
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The Role of Antibody Expression and Their Association With Bladder Cancer Recurrence: A Single-Centre Prospective Clinical-Pilot Study in 35 PatientsBladder cancer (BC) is the 10th most common cancer in the UK, with about 10,000 new cases annually. About 75–85% of BC are non-muscle invasive (NMIBC), which is associated with high recurrence and progression rates (50–60% within 7–10 years). There are no routine biomarkers currently available for identifying BC patients at increased risk of developing recurrence. The focus of this research study was to evaluate antibody expression in BC patients and their association with cancer recurrence. Methods: 35 patients scheduled for TURBT were recruited after written informed consent. Ethical approval for the project was granted via IRAS (REC4: 14/WA/0033). Following surgical procedure, tissues were preserved in 10% buffered formalin and processed within 24 h in FFPE blocks. 7 sections (4 µm each) were cut from each block and stained for CD31, Human epidermal growth factor receptor-2 (HER-2), S100P, Cyclooxygenase-2 (COX-2), VEGFR-3 thrombomodulin and CEACAM-1 using immunohistochemistry. Clinical outcome measures (obtained via cystoscopy) were monitored for up to 6 months following surgical procedure. Results: There was significantly increased expression of CD31 (p < 0.001), HER-2 (p = 0.032), S100P (p < 0.001), COX-2 (p < 0.001), VEGFR-3 (p < 0.001) and decreased expression of thrombomodulin (p = 0.010) and CEACAM-1 (p < 0.001) in bladder tumours compared to normal bladder tissues. HER-2 expression was also significantly associated with cancer grade (p = 0.003), especially between grade 1 and grade 2 (p = 0.002) and between grade 1 and grade 3 (p = 0.004). There was also a significant association between cancer stage and HER-2 expression (p < 0.001). Although recurrence was significantly associated with cancer grade, there was no association with antibody expression. Conclusion: Findings from the present study may indicate an alternative approach in the monitoring and management of patients with BC. It is proposed that by allowing urological surgeons access to laboratory markers such as HER-2, Thrombomodulin and CD31 (biomarker profile), potentially, in the future, these biomarkers may be used in addition to, or in combination with, currently used scoring systems to predict cancer recurrence. However, verification and validation of these biomarkers are needed using larger cohorts.
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Identification of Candidate Synovial Fluid Biomarkers for the Prediction of Patient Outcome After Microfracture or OsteotomyBackground: Biomarkers are needed to predict clinical outcomes for microfracture and osteotomy surgeries to ensure patients can be better stratified to receive the most appropriate treatment. Purpose: To identify novel biomarker candidates and to investigate the potential of a panel of protein biomarkers for the prediction of clinical outcome after treatment with microfracture or osteotomy. Study Design: Descriptive laboratory study. Methods: To identify novel candidate biomarker proteins, we used label-free quantitation after liquid chromatography–tandem mass spectrometry of dynamic range-compressed synovial fluids (SFs) from individuals who responded excellently or poorly (based on change in Lysholm score) to microfracture (n = 6) or osteotomy (n = 7). Biomarkers that were identified in this proteomic analysis or that relate to osteoarthritis (OA) severity or have predictive value in another early OA therapy (autologous cell implantation) were measured in the SF of 19 and 13 patients before microfracture or osteotomy, respectively, using commercial immunoassays, and were normalized to urea. These were aggrecanase-1 (ADAMTS-4), cartilage oligomeric matrix protein (COMP), hyaluronan (HA), lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), matrix metalloproteinase 1 and 3, soluble CD14, S100 calcium binding protein A13, and 14-3-3 protein theta (YWHAQ). Levels of COMP and HA were also measured in the plasma of these patients. To find predictors of postoperative function, multivariable regression analyses were performed. Results: Proteomic analyses highlighted YWHAQ and LYVE-1 as being differentially abundant between the clinical responders/improvers and nonresponders after microfracture. A linear regression model after backward variable selection could relate preoperative concentrations of SF proteins (HA, YWHAQ, LYVE-1), activity of ADAMTS-4, and patient demographic characteristics (smoker status and sex) with Lysholm score 12 months after microfracture. Further, a generalized linear model with elastic net penalization indicated that lower preoperative activity of ADAMTS-4 in SF, being a nonsmoker, and being younger at the time of operation were indicative of a higher postoperative Lysholm score (improved joint function) after osteotomy surgery. Conclusion: We have identified biomarkers and generated regression models with the potential to predict clinical outcome in patients treated with microfracture or osteotomy of the knee.
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Spatio-Temporal Dynamics of Wolves in the Italian AlpsThe recolonization of wolves (Canis lupus) in Europe has become a notable ecological and conservation success in recent decades, though it presents various legislative and management challenges. These challenges are heightened by the wolves' wide-ranging distribution, which often crosses administrative boundaries. Effective management of wolves depends on robust data from well-designed monitoring programs, which are difficult to implement in fragmented regions. Italy has taken significant steps to address these issues, conducting the first national scale monitoring of wolf abundance and distribution in 2020-2021 using non-invasive genetic sampling (NGS) combined with Spatial Capture-Recapture (SCR) modelling. This thesis explores a variety of ways to implement and optimise the current monitoring strategies by focusing on the Italian Alpine region. This area, in particular, can rely on historical information on wolves since the first surveys in the 90’s and on a highly trained network of personnel dedicated to their monitoring that has been implemented over the years. The year of national monitoring has been a great success in coordination and results, but it opens the question of the feasibility of maintaining such high quality in the long term and with possible reductions in economic funds. In fact, with both European and national management of the species expected in the next future, constantly updated abundance estimates will be essential to ensure the conservation of the species. In this thesis I investigated how the combination of NGS and SCR to obtain population size estimates can be optimised by identifying reduction limits for the number of search transects and also for their repetitions within the sampling season. This will allow to reduce both effort and costs for the next years of population size monitoring while maintaining accuracy and precision. Additionally, I explored the feasibility of extending large-scale monitoring of wolf abundance in the Italian Alps using more cost-effective tools, such as camera traps. I demonstrated the unsuitability of a group of statistical models, Spatial Counts or unmarked SCR, which are often used when individuals in the population are not distinguishable from each other. After identifying the limitations of the current modelling framework, I proposed a solution to address some of these issues by incorporating the group-living nature of wolves into the existing model through an extension of the Spatial Counts approach. Finally, I tested whether the drivers of the latest phase of wolf expansion throughout the Italian Alpine region have changed over time. I used a Dynamic Occupancy model to analyse wolf presence-absence data from 2014 to 2021. This analysis revealed the increasing importance of prey richness in colonization and persistence dynamics together with the smoothed effect over time of human densities. Additionally, I identified key areas where new potential conflicts could arise in human-dominated landscapes. Addressing these challenges is crucial for the continued recovery and sustainable coexistence of wolves with human communities in Italy and all Europe. Finally, I discussed all the findings in light of future population management of wolves.
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Relative Age Effect in Male and Female Elite International Amateur BoxingThis study aimed to determine whether the Relative Age Effect (RAE) was present in different sexes and age categories in 12 elite-level international amateur boxing competitions. A total of 4813 athletes competing between 2013 and 2022 were analysed. Athletes were split into four quartiles according to their birth date and compared to the expected (equal) birth date distribution using chi-squared goodness of fit. The results revealed greater RAE prevalence in youth compared to the senior group. RAE was more prominent in males compared to females, with the female group showing an inverse RAE trend. Odds ratio (OR) showed an overrepresentation of male boxers born in Q1 compared to Q4 (OR > 1.19-1.33), while senior female boxers presented an inverse trend (OR < 0.95). Odds Ratios for medallists within the youth group were greater than 1.07 (except Q3 × Q4 = 0.93) highlighting an overrepresentation of boxers born earlier in the year. A shift in strategy to reduce the RAE in young boxers whereby coaches focus less on the short-term pursuit of sporting success is encouraged. Organisations and coaches should increase awareness and provide systematic education around RAE, whilst creating equal competitive opportunities for all young boxers to reduce the extent of RAE in boxing.
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Sweet Mama: Affiliative Interactions are Related to the Reproductive Success of Dominant Female Alpine Marmots (Marmota marmota)Sociality is a complex phenomenon, able to influence multiple traits of an individual life history. In group-living mammals, sociality is likely to play a major role in the reproductive success of individuals. Here we investigate how sociality traits are associated to reproductive success in female Alpine marmots (Marmota marmota), a highly social and cooperative breeding ground squirrel distributed in the European Alps. We used social network analysis to calculate sociality metrics and hurdle generalized linear mixed models (hurdle GLMMs) to model the relationship between sociality metrics and reproductive success of individually tagged female Alpine marmots. Our results showed that centrality of a reproductive female within her social group and the number of social partners are positively related to reproductive success, while agonistic behavior was not related with reproduction. Our results highlight the importance of affiliative interactions with other group members in cooperative breeders, suggesting that in such systems female fitness could be more related to social cohesion than to costs of agonistic behaviors to maintain dominance status.
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iCan, Empowering Recovery: Evaluating a Patient-Centred Cancer Rehabilitation Programme across the Cancer Care ContinuumBackground/Objectives: The adverse effects of cancer and the long-term sequelae of associated treatments result in reduced quality of life and increased mortality for patients. Supporting patients with cancer to mitigate adverse outcomes is an important aspect of oncology care and the primary purpose of cancer rehabilitation. A retrospective service evaluation was conducted to evaluate the effectiveness of the core iCan patient-centred cancer rehabilitation service. Methods: At the beginning and end of a five-week programme, a series of questionnaires evaluating changes in mental health and wellbeing, and physical activity performance/attitudes, and functional capacity were administered to participants. Results: Following iCan, we found that functional capacity was improved (30 s sit-to-stand: +6.3 repetition; d = −1.00, p < 0.001) and that self-reported physical activity was increased (~1173 MET-mins/wk; d = −0.76, p < 0.001); participants also perceived greater capability, opportunity, and motivation to be active. Mental wellbeing was also improved (SWEMWBS: d = −0.69, p < 0.001), whilst fatigue was reduced (FACIT: d = −0.77, p < 0.001). Conclusion: It appears that iCan has beneficial effects upon the physical/functional and psychological health of its participants. Where data are available, there appear to be clinically significant improvements across the range of measured functional, wellbeing, and activity/sedentariness outcomes, which suggest that participation in iCan is instrumental in adding value to the health and wellbeing of patients.
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“Some People Sit, Some People Stand, That’s Just What We Do ”: a Qualitative Exploration of Sit-Stand Desk Use in Naturalistic SettingsProlonged sedentary behaviour is associated with poor health. Office-based workers spend much of the working day sitting. Sit-stand desks have become a popular intervention, but real-life experiences of the value of sit-stand desks remain relatively unexplored outside of research-led interventions. A qualitative study was therefore undertaken to explore real-life experiences, including perceived barriers, and facilitators of using sit-stand desks. Six focus-group interviews were undertaken with a total of 34 desk-based employees in North-West England. Interviews were transcribed and analysed using thematic analysis. Three main themes emerged: The Sedentary Office, Motivators, and The Active Office. The Sedentary Office highlighted participants’ frustration with an increasingly sedentary office environment. Motivators to reducing sitting time were knowledge of the health consequences of prolonged sitting, previous (ill) health, and the potential benefits expected. The Active Office highlighted the importance of control, choice, enhanced interaction with colleagues, and the benefits associated with moving more and enhancing an overall sense of workplace wellbeing. Perceived benefits, facilitators, and barriers - experienced and observed – from sit-stand desk use in the real world were examined, thus contributing to important discussions of transferability. Overall, the study shed light on the perceived facilitators, benefits, and drawbacks of sit-stand desk work whilst also giving evidence of the real-world acceptability and research translation of sit-stand desk use. Future research should examine this in multiple contexts and should explore implications of an increasing prevalence in home working.
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Redox, Cysteines, and Kinases - A Triad Sustaining Myeloid LeukemiaReactive oxygen species (ROS) work as a second messenger, modulating cell response and establishing homeostasis. Abrupt changes in ROS are used to modulate transient cell response to different stimuli, from viral infection to inflammation. Chronic exposure to high ROS concentration can cause cellular damage and promote the development of diseases. Leukemogenesis is adapted to high concentrations of ROS, hijacking the ROS system, and uses kinase cascades to promote survival advantages. The oxidation-reduction (redox) machinery is composed of enzymes that orchestrate all classes of protein and use available Cys as transmitters and sensors, to disseminate stress signals through cells via kinase cascades. Myeloid leukemias (MLs) are known for being a heterogeneous disease, and clonal diversity is remarkably characterized by differences in the activation of kinase-regulated signaling cascades to provide survival advantage. Stress-activated kinase cascades and other cascades are regulated by the ROS system. Several studies present nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2) and the ER-resident NOX4 as key elements of ROS activity in healthy myeloid cells and myeloid leukemia. Targeting ROS presents an attractive therapeutic strategy for (MLs) patients, but the boundaries between pro-apoptotic and anti-apoptotic ROS concentrations are not well established. Detailed understanding of the signaling switches that determine cell fate needs to be well understood. This work explores several aspects of the redox system and thiol-mediated reactions with focus on kinase signaling in myeloid cancers and highlights some of the challenges.
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Mediating Kinase Activity in Ras-Mutant Cancer: Potential for an Individualised Approach?It is widely acknowledged that there is a considerable number of oncogenic mutations within the Ras superfamily of small GTPases which are the driving force behind a multitude of cancers. Ras proteins mediate a plethora of kinase pathways, including the MAPK, PI3K, and Ral pathways. Since Ras was considered undruggable until recently, pharmacological targeting of pathways downstream of Ras has been attempted to varying success, though drug resistance has often proven an issue. Nuances between kinase pathway activation in the presence of various Ras mutants are thought to contribute to the resistance, however, the reasoning behind activation of different pathways in different Ras mutational contexts is yet to be fully elucidated. Indeed, such disparities often depend on cancer type and disease progression. However, we are in a revolutionary age of Ras mutant targeted therapy, with direct-targeting KRAS-G12C inhibitors revolutionising the field and achieving FDA-approval in recent years. However, these are only beneficial in a subset of patients. Approximately 90% of Ras-mutant cancers are not KRAS-G12C mutant, and therefore raises the question as to whether other distinct amino acid substitutions within Ras may one day be targetable in a similar manner, and indeed whether better understanding of the downstream pathways these various mutants activate could further improve therapy. Here, we discuss the favouring of kinase pathways across an array of Ras-mutant oncogenic contexts and assess recent advances in pharmacological targeting of various Ras mutants. Ultimately, we will examine the utility of individualised pharmacological approaches to Ras-mediated cancer.
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Exploring Puffed Rice as a Novel Ink for 3D Food Printing: Rheological Characterization and Printability AnalysisThis study introduces a novel approach by using puffed rice (PR) as a sustainable and innovative ink for 3D food printing. Due to gelatinization and dextrinization, PR saw notable water absorption and solubility gains, with a modest viscosity uptick from 39.2 to 49.9 RVU, sharply contrasting Native rice (NR)'s jump from 128.9 to 167.8 RVU, emphasizing PR's minimal retrogradation. Gelatinized rice (GR) demonstrates similar stability in viscosity changes as PR, yet it requires more water and extended processing times for gelatinization. Conversely, PR's puffing process, which eliminates the need for water, offers quicker preparation and notable environmental benefits. Rheological analysis at 25% PR concentration reveals an optimal balance of viscosity (η, 897.4 Pa s), yield stress (τy, 2471.3 Pa), and flow stress (τf, 1509.2 Pa), demonstrating superior viscoelastic properties that facilitate enhanced printability and shape fidelity. Texture Profile Analysis outcomes reveals that PR significantly enhances key textural properties including hardness, adhesiveness, and springiness at this specific concentration. These findings highlight PR's potential as an eco-friendly and efficient ink choice for 3D-printed food products, providing enhanced performance and sustainability compared to GR and NR.
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A Multi-Dimensional Sustainable Diet Index (SDI) for Ghanaian Adults Under Transition: The RODAM StudyThe sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. Methods: We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. Results: The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. Conclusion: The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.
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The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic reviewInsulin resistance (IR) is a common pathology in women with polycystic ovarian syndrome (PCOS) involved in increased rates of cardiometabolic disease such as diabetes and cardiovascular disease. Low serum vitamin D is often associated with insulin resistance but there is no consensus on whether vitamin D supplementation can ameliorate markers of IR in PCOS. We assessed evidence on the effects of vitamin D supplementation (≥ 1000 IU/day), without the use of additional supplements or other pharmacological treatments known to affect IR, on markers of IR and glycemic control in women with PCOS. A systematic search was conducted using PubMed, Medline and Web of Science databases from January 2000 up to November 2023. Randomized controlled trials that assessed the effects of vitamin D supplementation in women with PCOS, on fasting glucose, fasting insulin, glycated haemoglobin (HbA1c) or homeostatic model assessment for insulin resistance (HOMA-IR) were included. 9 studies were identified. Study populations ranged from 28 to 180 participants, with mean ages ranging from 22 to 30 years. Daily vitamin D doses ranged from 1714-12,000 IU. Of the included studies, 3 reported statistically significant reductions in fasting glucose, 2 reported reductions in fasting insulin, 2 reported reductions in HOMA-IR, none reported reductions in HbA1c and 5 reported no differences in any of the relevant outcomes. In conclusion, in RCTs of vitamin D supplementation in women with PCOS, the majority of studies do not report statistically significant improvements in fasting glucose, fasting insulin, HbA1c or HOMA-IR. However, as a minority of studies report some statistically significant results, further investigation may be warranted. PROSPERO ID: CRD42023486144. [Abstract copyright: © 2024. The Author(s).]
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Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary CareNudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care. Objective: To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers. Evidence Review: On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias. Findings: Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (e.g., documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7). Conclusions and Relevance: This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.
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The ARRIVE guidelines 2.0 author checklistThe ARRIVE guidelines 2.0 - full author checklist
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Mental Health and Public Health: Improving Mental Health and Well-being of Communities in the Modern World: A Pragmatic Approach Using the Global Mental Health Assessment Tool/PCThe World Health Organization report of 2022 on mental health highlights the slow progress in reducing the treatment gap for people with mental illness worldwide. It emphasizes that everyone should participate in improving the mental health and well-being of the communities. The governments should put their act together and all agencies should work in coordination to address the mental health needs of their population. They should also focus on mental health promotion, early intervention, and prevention of suicide. The Mental Health Action Plan 2013–2030 outlines the importance of leadership and governance for mental health in providing comprehensive, integrated, and responsive mental health and social care services in community-based settings. Stigma, human resource shortages, fragmented service delivery models, and poor commitment of authorities for mental health are some of the factors for the ongoing service gap in mental health. Providing mental health knowledge and assessment skills to frontline workers, supporting frontline workers by mental health specialists using their leadership skills, and fully utilizing mobile and Internet technology in providing education and training as well as providing services could bring down the treatment gap of mental disorders worldwide. The Global Mental Health Assessment Tool for Primary Care and General Health Setting (GMHAT/PC)-based training package has been developed and successfully implemented in training frontline health workers in different parts of the word. The authors propose that this may be a pragmatic way to integrate mental health in public health by skilling frontline workers in assessing mental health along with physical health and by providing holistic care.
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Co-presence of Epstein-Barr Virus and Human Papillomavirus is associated with a high frequency of p53 gene mutation in cervical cancer diagnosed in southern NigeriaBackground: Evidence shows that the co-existence of Human papillomavirus (HPV) and Epstein-Barr virus (EBV) is associated with aggressive and poorly differentiated cervical squamous cell carcinomas (CSCC) phenotype. Aim: This study aimed to determine the frequency of mutant p53 (mtp53) gene in single and co-existence of HPV and oncogenic EBV latent membrane protein 1 (E-LMP1) among women diagnosed with CSCC in Southern Nigeria. Methods: This retrospective cohort study included 105 cervical cancer tissues, diagnosed between January 2016 and December 2018. The tissue sections were immunohistochemically stained for mtp53, E-LMP1, and HPV proteins and scored accordingly. Descriptive, Chi- square test and Pearson’s correlation were performed, and statistical significance was set at p≤0.05. Result: Among the stained sections, the frequency of HPV, E-LMP1, and E-LMP1/HPV detection was 8.6%, 20.0%, and 42.9%, respectively. The mtp53 detection was higher in ELMP1/HPV co-presence (86.7%) compared with HPV and ELMP1 mono-presence (55.6%, and 14.3%, respectively), and this was statistically significant (p< 0.0001). The prevalence of invasive and non-invasive cases of CSCC were 62.9% and 37.1%, respectively. E-LMP1 and HPV co-presence were significantly higher in invasive cervical cancer (48.5%) compared to non-invasive cervical cancer cases (33.3%) at p= 0.156. The E-LMP1 presence was significantly higher in poorly differentiated CSCC (50.0%) compared to the moderately and well- differentiated CSCC (25.0% and 10.5%, respectively) at p= 0.011. Conclusion: This study revealed a higher frequency of EBV/HPV co- infection in CSCC. It also shown- that a higher frequency of mtp53 in E-LMP1 and HPV co-presence, suggesting that E-LMP1 could be responsible for the high CSCC lethality in West Africa.