Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal

Introduction

Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.

Methods

We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale -8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.

Results

We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.

Discussion

Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

AI-Dentify: deep learning for proximal caries detection on bitewing x-ray - HUNT4 Oral Health Study

BACKGROUND

Dental caries diagnosis requires the manual inspection of diagnostic bitewing images of the patient, followed by a visual inspection and probing of the identified dental pieces with potential lesions. Yet the use of artificial intelligence, and in particular deep-learning, has the potential to aid in the diagnosis by providing a quick and informative analysis of the bitewing images.

METHODS

A dataset of 13,887 bitewings from the HUNT4 Oral Health Study were annotated individually by six different experts, and used to train three different object detection deep-learning architectures: RetinaNet (ResNet50), YOLOv5 (M size), and EfficientDet (D0 and D1 sizes). A consensus dataset of 197 images, annotated jointly by the same six dental clinicians, was used for evaluation. A five-fold cross validation scheme was used to evaluate the performance of the AI models.

RESULTS

The trained models show an increase in average precision and F1-score, and decrease of false negative rate, with respect to the dental clinicians. When compared against the dental clinicians, the YOLOv5 model shows the largest improvement, reporting 0.647 mean average precision, 0.548 mean F1-score, and 0.149 mean false negative rate. Whereas the best annotators on each of these metrics reported 0.299, 0.495, and 0.164 respectively.

CONCLUSION

Deep-learning models have shown the potential to assist dental professionals in the diagnosis of caries. Yet, the task remains challenging due to the artifacts natural to the bitewing images.

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

Serum and salivary inflammatory biomarkers in juvenile idiopathic arthritis-an explorative cross-sectional study

BACKGROUND

Biomarkers may be useful in monitoring disease activity in juvenile idiopathic arthritis (JIA). With new treatment options and treatment goals in JIA, there is an urgent need for more sensitive and responsive biomarkers.

OBJECTIVE

We aimed to investigate the patterns of 92 inflammation-related biomarkers in serum and saliva in a group of Norwegian children and adolescents with JIA and controls and in active and inactive JIA. In addition, we explored whether treatment with tumor necrosis factor inhibitors (TNFi) affected the biomarker levels.

METHODS

This explorative, cross-sectional study comprised a subset of children and adolescents with non-systemic JIA and matched controls from the Norwegian juvenile idiopathic arthritis study (NorJIA Study). The JIA group included individuals with clinically active or inactive JIA. Serum and unstimulated saliva were analyzed using a multiplex assay of 92 inflammation-related biomarkers. Welch's t-test and Mann-Whitney U-test were used to analyze the differences in biomarker levels between JIA and controls and between active and inactive disease.

RESULTS

We included 42 participants with JIA and 30 controls, predominantly females, with a median age of 14 years. Of the 92 biomarkers, 87 were detected in serum, 73 in saliva, and 71 in both biofluids. A pronounced difference between serum and salivary biomarker patterns was found. Most biomarkers had higher levels in serum and lower levels in saliva in JIA versus controls, and in active versus inactive disease. In serum, TNF and S100A12 levels were notably higher in JIA and active disease. The TNF increase was less pronounced when excluding TNFi-treated individuals. In saliva, several biomarkers from the chemokine family were distinctly lower in the JIA group, and levels were even lower in active disease.

CONCLUSION

In this explorative study, the serum and salivary biomarker patterns differed markedly, suggesting that saliva may not be a suitable substitute for serum when assessing systemic inflammation in JIA. Increased TNF levels in serum may not be a reliable biomarker for inflammatory activity in TNFi-treated children and adolescents with JIA. The lower levels of chemokines in saliva in JIA compared to controls and in active compared to inactive disease, warrant further investigation.

Seroepidemological investigation of Toxoplasma gondii and Trichinella spp. in pigs reared by tribal communities and small-holder livestock farmers in Northeastern India

Toxoplasma gondii and Trichinella spp. are critical tissue-dwelling foodborne zoonotic parasites associated with pork consumption and pig rearing. Despite being a major pig-rearing region in the country, Northeastern India has not undergone any investigation regarding the presence of T. gondii and Trichinella spp. in pigs. Therefore, this study aims to determine the seroprevalence of T. gondii and Trichinella spp. and identify associated risk factors in pigs reared by tribal communities and small-holder livestock farmers in the northeastern region of India. In a cross-sectional serological survey, 400 pigs from 400 households across five northeastern states of India underwent testing for the seroprevalence of porcine toxoplasmosis and trichinellosis. Serum samples (80 from each state) were analyzed using commercially available ELISA assays. Data on backyard farm characteristics and various management aspects were collected, and risk factors linked with prevalence were analyzed through univariate and multivariate logistic regression analysis. The findings revealed that the apparent and true prevalence of anti-T. gondii antibodies were 45% (40.12-49.88, 95% CI) and 45.7% (40.7-50.69, 95% CI), respectively. As for anti- Trichinella antibodies, both the apparent and true prevalence were 0.75% (-0.1-1.6, 95% CI). The univariate and multivariate analyses indicated that age above 24 months (OR 7.20, 95% CI 2.45-23.71), exposure to cats (OR = 5.87, 95% CI 2.55-14.05), and farms operating for breeding purposes (OR = 5.60, 95% CI 3.01-11.04) were significant risk factors associated with the seroprevalence of T. gondii. This study marks the initial documentation of the seroprevalence of T. gondii and Trichinella spp. in pigs reared by tribal communities in Northeastern India. The results emphasize the significance of these parasites as foodborne zoonotic threats in the region, potentially posing substantial public health risks, especially within tribal and rural communities. The insights derived from this research could be valuable in formulating targeted preventive and control strategies against T. gondii and Trichinella spp. in pigs, not only in this region but also in areas with similar rearing practices.

Measurement of energy and directional distribution of neutron ambient dose equivalent for the 7Li(p,n)7Be reaction

Double differential neutron fluence distributions were measured in the 7Li(p,n)7Be reaction for proton beam energies 7, 9 and 12 MeV. Seven liquid scintillator based detectors were employed to measure neutron fluence distributions using the Time of Flight technique. Neutron ambient dose equivalents were determined from the measured fluence distribution using ICRP (International Commission on Radiological Protection) recommended fluence to dose equivalent conversion coefficients. Neutron dose equivalents were also measured using a conventional BF3 detector based REM counter. Ambient dose equivalent measured by the REM counter is found to be in agreement with that determined from the neutron fluence spectra within their uncertainties. Angular distributions of the ambient dose equivalents were also determined from the measured fluence distributions at different angles.

Association between periodontitis stages and self-reported diseases in a Norwegian population: the HUNT study

BACKGROUND

The relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT).

MATERIAL AND METHODS

The fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders.

RESULTS

Compared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema.

CONCLUSION

Periodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis.

First Seroepidemiological Investigation of Hepatitis E Virus Infection in Backyard Pigs from Northeastern India: Prevalence and Associated Risk Factors

Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis globally, with zoonotic potential, and pigs are considered the major reservoir. To determine the seroprevalence of HEV infection in pigs reared in backyard conditions in the northeastern region of India, blood samples were collected from 400 pigs from five northeastern states (80 samples from each state) and tested for IgG antibodies against HEV using an ELISA assay. Questionnaires on farm characteristics and management practices were completed, and risk factors associated with HEV were studied using univariate and multivariate analysis. The apparent seroprevalence of HEV infection was 51% (46.1-55.9, 95% CI), with a true prevalence of 52.98% (47.22-58.75, 95% CI). The risk factors significantly associated with higher HEV seropositivity were as follows: lack of disinfection (OR 4.65), feeding swill (restaurant and bakery waste) (OR 2.55), failure to follow the all-in-all-out production system (OR 3.47), and medium holding size (OR 9.83), which refers to mixed rearing of younger and older age groups. This study demonstrates that HEV is widespread among pigs reared in northeastern India. The risk factor analysis conducted in this study provides valuable insights into the prevalence of HEV in the region.

Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal

Background

Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes.

Method

A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure.

Results

In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI -0.074 to 0.104) between the intervention arm and the control arm, while it was -0.077 (95% CI -0.152 to -0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was -1.6 kg (95% CI -3.1 to -0.1). A significantly lower grain consumption was found in intervention arm (-39 g/day, 95% CI -65 to -14) compared with the control arm at postintervention assessment.

Conclusion

Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention.

Trial registration number

NCT04074148.

Blood pressure, hypertension and the risk of heart failure: A systematic review and meta-analysis of cohort studies

BACKGROUND

Several observational studies have investigated the association between hypertension or elevated systolic blood pressure and diastolic blood pressure and risk of heart failure, but not all the studies have been consistent. This systematic review and meta-analysis aimed to summarize the available data from cohort studies on the association between hypertension, systolic and diastolic blood pressure and the risk of heart failure.

METHODS

PubMed and Embase databases were searched for relevant articles from inception to June 10th 2022. Cohort studies on hypertension or blood pressure and heart failure were included. Random effect models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between hypertension or blood pressure and heart failure.

RESULTS

Forty-seven cohort studies were included. The summary RR was 1.71 (95% Cl: 1.53-1.90, I2 = 98.4%) for hypertension vs. no hypertension (n = 43 studies, 166798 cases, 20359997 participants), 1.28 (95% CI: 1.22-1.35, I2 = 90.3%) per 20 mmHg of systolic blood pressure (24 studies, 31639 cases and 2557975 participants) and 1.12 (95% CI: 1.04-1.21, I2 = 92.6%) per 10 mmHg of diastolic blood pressure (16 studies, 23127 cases and 2419972 participants). There was a steeper increase in heart failure risk at higher blood pressure levels and a 3-5 fold increase in RR at around 180/120 mmHg of systolic and diastolic blood pressure compared to 100/60 mmHg, respectively. There was little indication of publication bias across analyses.

CONCLUSION

This meta-analysis suggest a strong positive association between hypertension and systolic and diastolic blood pressure and the risk of heart failure. These results supports efforts to reduce blood pressure in the general population to reduce the risk of heart failure.

Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey

BACKGROUND

Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population.

METHODS

Participants were adolescents (n = 6351) age 13-17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth - DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test.

RESULTS

Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19-1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02-1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03-1.11). This effect was modified by age (13-15 vs. 16-17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80-3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14-1.50) among 16-17-year-olds.

CONCLUSIONS

Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study

INTRODUCTION

In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal.

METHODS

We used a qualitative methodology informed by Kaufman's socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted.

RESULTS

We found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor's access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure.

CONCLUSION

The study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.

Catalyst Design and Feature Engineering to Improve Selectivity and Reactivity in Two Simultaneous Cross-Coupling Reactions

Highly active catalysts are required in numerous industrial fields; therefore, to minimize costs and development time, catalyst design using machine learning has attracted significant attention. This study focused on a reaction system where two types of cross-coupling reactions, namely, Buchwald-Hartwig type cross-coupling (BHCC) and Suzuki-Miyaura type cross-coupling (SMCC) reactions, occur simultaneously. Constructing a machine-learning model that considers all experimental conditions is essential to accurately predict the product yield for both the BHCC and the SMCC reactions. The objective of this study was to establish explanatory variables x that considered all experimental conditions within the reaction system involving simultaneous cross-couplings and to design catalysts that achieve the target yield and the development of novel reactions. To accomplish this, Bayesian optimization was combined with established variables x to design new catalysts and enhance reaction selectivity. Moreover, the catalyst design in this study successfully pioneered new reactions involving Cu, Rh, and Pt catalysts in a reaction system that did not previously react with transition metals other than Ni or Pd.

Prevention of caries and obesity in children with immigrant background in Norway- a study protocol for a cluster randomized controlled trial

BACKGROUND

Immigrants are known to experience greater socioeconomic stress and poorer well-being and to suffer more from lifestyle- and diet-related disorders than native populations. There is also evidence that children of immigrant parents are at greater risk of diverse health problems than their host country cohorts. The aim of this study is to apply and evaluate the efficacy of an early life intervention program among parents/children with immigrant background to prevent childhood caries and obesity, thereby improving the children's general health, oral health, and quality of life.

METHODS

This is a study protocol for a cluster randomized controlled intervention follow-up study. In phase I of the study, the primary care health centers in the municipality of Bergen, Norway were randomly allocated to intervention or control groups. The intervention was carried out using the motivational interviewing technique and the common risk factor approach. The intervention group received guidance on diet/oral hygiene and the control group received standard care information. Parental knowledge and children at age 3 and 5 years old will be assessed in a prospective phase II follow-up study compared to native Norwegian controls. The primary outcome will be evaluation of change on parental oral health related knowledge and attitudes. The secondary outcome will assess the impact of the intervention on children's caries -, body mass index- and oral health related quality of life.

DISCUSSION

Collaboration between dental public health and primary health care personnel on the common risk approach motivational intervention offers opportunities to address key dietary behaviors that may prevent obesity and dental caries. Providing sustainable preventive measures decreases the burden of diseases and consequently reduces health inequalities, particularly among at-risk children.

TRIAL REGISTRATION

The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT05758454: 7 March 2023). Ethical approval has already been granted by the Regional Ethical Committee (REK) (2015/ 27,639 /REK vest) and Sikt - Norwegian Agency for Shared Services in Education and Research (Reference number 778825).

Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

The association between body mass index, abdominal fatness, and weight change and the risk of adult asthma: a systematic review and meta-analysis of cohort studies

Obesity has been associated with increased risk of adult asthma, however, not all studies have found a clear association between overweight and the incidence of asthma, and data on other adiposity measures have been limited. Hence, we aimed to summarize evidence on association between adiposity and adult asthma. Relevant studies were retrieved through searches conducted in PubMed, and EMBASE up to March 2021. A total of sixteen studies (63,952 cases and 1,161,169 participants) were included in the quantitative synthesis. The summary RR was 1.32 (95% CI 1.21-1.44, I² = 94.6%, p_{heterogeneity}< 0.0001, n = 13) per 5 kg/m² increase in BMI, 1.26 (95% CI 1.09-1.46, I² = 88.6%, p_{heterogeneity} < 0.0001, n = 5) per 10 cm increase in waist circumference and 1.33 (95% CI 1.22-1.44, I² = 62.3%, p_{heterogeneity}= 0.05, n = 4) per 10 kg increase in weight gain. Although the test for nonlinearity was significant for BMI (p_nonlinearity < 0.00001), weight change (p_nonlinearity = 0.002), and waist circumference (p_nonlinearity = 0.02), there was a clear dose-response relationship between higher levels of adiposity and asthma risk. The magnitude of the associations and the consistency of the results across studies and adiposity measures provide strong evidence that overweight and obesity, waist circumference and weight gain increases asthma risk. These findings support policies to curb the global epidemic of overweight and obesity.

Cluster randomised trial to evaluate comprehensive approach to hypertension management in Nepal: a study protocol

INTRODUCTION

Despite having effective approaches for hypertension management including use of antihypertensive medication, monitoring of blood pressure and lifestyle modification many people with hypertension in Nepal remain undetected and untreated. A comprehensive intervention which provides personalised counselling on lifestyle modification, medication adherence together with support for regular monitoring of blood pressure is expected to achieve well controlled blood pressure.

METHODS AND ANALYSIS

This is a community-based, non-blinded, parallel group, two-arm cluster randomised controlled trial, with an allocation ratio of 1:1, conducted in Budhanilkantha municipality, Nepal. Ten health facilities and their catchment area are randomly allocated to either of the two arms. 1250 individuals aged 18 years and older with an established diagnosis of hypertension will be recruited. The intervention arm receives a comprehensive hypertension management package that includes blood pressure audit by health workers, home-based patient support by community health workers to engage patient and family members in providing tailored educational counselling on behavioural and lifestyle changes in addition to routine care. The control arm includes routine hypertension care. Trained enumerators will ensure consent and collect data. Outcome data on blood pressure, weight, waist and hip circumference will be measured and self-reported data on diet, lifestyle, medication adherence and hypertension knowledge will be registered at 11 months' follow-up. The change in outcome measures will be compared by intention to treat, using a generalised linear mixed model. A formative assessment will be conducted using semistructured interviews and focus group discussions to explore factors affecting hypertension management. A mix-method approach will be applied for process evaluation to explore acceptability, adoption, fidelity, feasibility and coverage.

ETHICS AND DISSEMINATION

Ethics approval was obtained from Nepal Health Research Council (682/2021) and Regional Committee for Medical and Health Research Ethics, Norway (399479). The findings will be disseminated in peer-reviewed journal articles and with decision makers in Nepal.

Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies

PURPOSE

A high fruit and vegetable intake has been associated with reduced risk of hypertension; however, results have been inconsistent and it is unclear whether specific types of fruits and vegetables are particularly beneficial. This systematic review and meta-analysis aimed to summarize the published prospective studies on fruit and vegetable consumption and risk of hypertension.

METHODS

Embase and PubMed databases were searched for relevant prospective studies up to 15th May 2022. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between fruit and vegetable intake and risk of hypertension. Strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria.

RESULTS

Eighteen prospective studies (451 291 participants, 145 492 cases) were included. The summary RR (95% CI) of hypertension per 200 g/day was 0.97 (0.95-0.99, I² = 68%, n = 8) for fruits and vegetables, 0.93 (0.89-0.98, I² = 77%, n = 10) for fruits, and 1.00 (0.98-1.02, I² = 38%, n = 10) for vegetables. Reductions in risk were observed up to 800 g/day for fruits and vegetables, and 550 g/day for fruits, and these two associations were considered probably causal using WCRF criteria. Inverse associations were observed for apples or pears, blueberries, raisins or grapes, avocado, broccoli, carrots and lettuce, while positive associations were observed for cantaloupe, Brussels sprouts, cruciferous vegetables, and total and fried potatoes (n = 2-5).

CONCLUSION

A high intake of fruit and vegetables combined, and total fruit was associated with reduced risk of hypertension, while results for fruit and vegetable subtypes were mixed and need further study.

How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal

Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.

Kelvin-Helmholtz instability in a compressible dust fluid flow

We report the first experimental observations of a single-mode Kelvin-Helmholtz instability in a flowing dusty plasma in which the flow is compressible in nature. The experiments are performed in an inverted [Formula: see text]-shaped dusty plasma experimental device in a DC glow discharge Argon plasma environment. A gas pulse valve is installed in the experimental chamber to initiate directional motion to a particular dust layer. The shear generated at the interface of the moving and stationary layers leads to the excitation of the Kelvin-Helmholtz instability giving rise to a vortex structure at the interface. The growth rate of the instability is seen to decrease with an increase in the gas flow velocity in the valve and the concomitant increase in the compressibility of the dust flow. The shear velocity is further increased by making the stationary layer to flow in an opposite direction. The magnitude of the vorticity is seen to become stronger while the vortex becomes smaller with such an increase of the shear velocity. A molecular dynamics simulation provides good theoretical support to the experimental findings.

Synchronization of dust acoustic waves in a forced Korteweg-de Vries-Burgers model

The synchronization of dust acoustic waves to an external periodic source is studied in the framework of a driven Korteweg-de Vries-Burgers equation that takes into account the appropriate nonlinear and dispersive nature of low-frequency waves in a dusty plasma medium. For a spatiotemporally varying source term, the system is shown to demonstrate harmonic (1:1) and superharmonic (1:2) synchronized states. The existence domains of these states are delineated in the form of Arnold tongue diagrams in the parametric space of the forcing amplitude and forcing frequency and their resemblance to some past experimental results is discussed.

Phase switching phenomenon in a system of three coupled DC glow discharge plasmas

We report the first experimental observations of phase switching in a system of three coupled plasma sources. Two of the plasma sources are inductively coupled to each other while the third one is directly coupled to one of them. The coupled system acquires a frequency pulling synchronized state following which a transition occurs to a frequency entrainment state with an increase in the frequency of the directly coupled system. We also observe a sudden jump from a lower to a higher frequency entrainment state and a concomitant phase switching between the oscillations of the two directly coupled sources while the phase difference between the inductively coupled sources remains constant. These experimental findings are established using various diagnostic tools, such as the Fourier spectra, frequency bifurcation plots, Lissajous plots, and Hilbert transforms of the data. The experimental results are qualitatively modeled using three coupled van der Pol equations, in which two of them are environmentally coupled while the third one is directly coupled with one of them.

Diminishing benefits of urban living for children and adolescents' growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Risk of myocardial infarction after invasive outpatient procedures

OBJECTIVE

To assess the short-term risk of acute myocardial infarction (AMI) associated with procedures performed at outpatient specialised hospital clinics.

METHODS

In this case-crossover, population-based study, we identified first-time AMI cases aged ≥40 years via patient registries and linked them to their surgical intervention in Norway (2008-2016) and Sweden (2001-2014), respectively. The number of individuals with AMI who underwent procedures 0-7 days (hazard period) prior to the AMI diagnosis was compared with cases who were exposed 29-36 days (control period) before the AMI. A total of 6176 patients with AMI who underwent a procedure either during the defined hazard or control period contributed to the analyses. ORs with 95% CIs were computed using conditional logistic regression.

RESULTS

The mean age of the total population was 74.7 years and 64.6% were male. The relative risk was higher following procedures performed under general/regional anaesthesia for gastrointestinal endoscopy (OR_summary, 4.23, 95% CI 1.58 to 11.31), vascular (OR_summary, 3.12, 95% CI 1.10 to 8.90), urological/gynaecological (OR_summary, 2.30, 95% CI 1.50 to 3.53) and orthopaedic (OR_summary,1.78, 95% CI 1.30 to 2.44) procedures, and for ENT (ear, nose and throat) and mouth procedures (OR_summary, 1.53, 95% CI 1.19 to 1.99) performed under local anaesthesia.

CONCLUSION

This large population-based register study from two countries suggests that outpatient procedures are generally safe with regard to the postoperative risk of AMI. However, some procedures, such as gastrointestinal endoscopy, vascular procedures and urological/gynaecological procedures may increase the risk of AMI by twofold or threefold within the first 8 days after the procedures. Further studies are warranted to assess whether the effect is modified by cardiovascular medication or other clinical factors.

Bifurcation behaviour of resonant magnetic perturbation control of edge localized modes in tokamaks: nonlinear simulation results

In this article, some novel results of two fluid nonlinear simulations on the control of edge localized modes (ELMs) in tokamaks by resonant magnetic perturbations (RMPs) are presented. Many experiments around the world have demonstrated that RMPs are effective in possibly mitigating or even completely suppressing strong (type I) ELMs that would seriously degrade confinement and could cause other heat-flux problems in both present (e.g. JET) and planned future tokamaks (ITER). Our simulations demonstrate that non-axisymmetric RMPs with toroidal mode numbers [Formula: see text] and suitable field-strengths (kAturns) at the plasma wall imply significant bifurcations in their ability to mitigate or even suppress type-I ELMs, qualitatively similar to RMP effects on ELMs reported in experiments. This article is part of a discussion meeting issue 'H-mode transition and pedestal studies in fusion plasmas'.

Whole Exome Sequencing Reveals Novel Candidate Genes in Familial Forms of Glaucomatous Neurodegeneration

Glaucoma is the largest cause of irreversible blindness with a multifactorial genetic etiology. This study explores novel genes and gene networks in familial forms of primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) to identify rare mutations with high penetrance. Thirty-one samples from nine MYOC-negative families (five POAG and four PACG) underwent whole-exome sequencing and analysis. A set of prioritized genes and variations were screened in an independent validation cohort of 1536 samples and the whole-exome data from 20 sporadic patients. The expression profiles of the candidate genes were analyzed in 17 publicly available expression datasets from ocular tissues and single cells. Rare, deleterious SNVs in AQP5, SRFBP1, CDH6 and FOXM1 from POAG families and in ACACB, RGL3 and LAMA2 from PACG families were found exclusively in glaucoma cases. AQP5, SRFBP1 and CDH6 also revealed significant altered expression in glaucoma in expression datasets. Single-cell expression analysis revealed enrichment of identified candidate genes in retinal ganglion cells and corneal epithelial cells in POAG; whereas for PACG families, retinal ganglion cells and Schwalbe's Line showed enriched expression. Through an unbiased exome-wide search followed by validation, we identified novel candidate genes for familial cases of POAG and PACG. The SRFBP1 gene found in a POAG family is located within the GLC1M locus on Chr5q. Pathway analysis of candidate genes revealed enrichment of extracellular matrix organization in both POAG and PACG.

Signatures of an energetic charged body streaming in a plasma

A charged body moving in a plasma can excite a variety of linear and nonlinear waves in the form of trailing wakes, fore-wake shocks, and precursor solitons. These structures can further interact with the background plasma to create secondary effects that can serve as signatures of the passage of the charged body. Using particle-in-cell simulations, we carry out a basic investigation of the dynamics of a plasma system that is being traversed by an energetic charged body. Using two different shapes of this charged source, namely, an idealized infinite length planar source and a two-dimensional thin rectangular source, we examine the differences in the nature of the excited wave structures and their consequent impact on the background plasma. Our simulations reveal interesting features such as the dependence of the precursor speeds on the total charge on the driving source, local particle trapping, and energization of the trapped particles in various regions along the traversal path leading to the formation of energetic charged beamlets. Our basic findings could find practical applications such as in analyzing the trajectories of charged objects like space debris orbiting in the ionosphere.

Prevalence of prediabetes and associated factors of prediabetic stages: a cross-sectional study among adults in Nepal

OBJECTIVES

To estimate the prevalence of prediabetes and to assess the association of prediabetic stages with sociodemographic, lifestyle and clinical factors DESIGN: Cross-sectional study at the screening and inclusion stage of a Diabetes Prevention Education Program (DiPEP) trial SETTING: The study was conducted in two urban communities in Nepal (October 2019-March 2020).

PARTICIPANTS

A total of 6222 residents of two study sites, aged 18-64 years and without a history of diabetes, were eligible for prediabetes screening. Exclusion criteria were pregnancy, history of diabetes and critical illness. A total of 291 participants with prediabetes were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of prediabetes based on glycated haemoglobin (HbA1c) criteria (5.7%-6.4%) was the primary outcome of the study. Odds Ratio and 95% CI were estimated to assess the associations between the outcome prediabetic stages (5.7%-5.9% vs 6.0%-6.4%) and sociodemographic, lifestyle and clinical factors in both unadjusted and adjusted models.

RESULTS

Out of 6222 screened participants, 308 (5%, 95% CI: 4.4% to 5.5%) individuals were detected with prediabetes based on HbA1c. The mean age of 291 responded participants was 50.3±7.6 years and 67% were females. Among them, 78% aged 45-64 years, 97% had central obesity, 90% had high waist-hip ratio, 63% were hypertensive and 66% had no family history of diabetes. Approximately, 54% and 46% of individuals with prediabetes had HbA1c of 5.7%-5.9% and 6.0%-6.4%, respectively. Female gender was associated with prediabetes with HbA1c 6.0%-6.4% (OR, 1.98, 95% CI: 1.07 to 3.67) in the adjusted model.

CONCLUSION

The estimated prevalence of prediabetes was 5% among screened participants, and female gender was associated with the prediabetic stage. As a large proportion of the population with prediabetes were not aware of their status, this study demonstrates a need for regular community screening programmes to detect individuals with prediabetes and provide them a comprehensive lifestyle intervention for diabetes prevention.

TRIAL REGISTRATION NUMBER

NCT04074148, 2019/783.

Auto-correlations of microscopic density fluctuations for Yukawa fluids in the generalized hydrodynamics framework with viscoelastic effects

The present work develops a theoretical procedure for obtaining transport coefficients of Yukawa systems from density fluctuations. The dynamics of Yukawa systems are described in the framework of the generalized hydrodynamic (GH) model that incorporates strong coupling and visco-elastic memory effects by using an exponentially decaying memory function in time. A hydrodynamic matrix for such a system is exactly derived and then used to obtain an analytic expression for the density autocorrelation function (DAF)-a marker of the time dynamics of density fluctuations. The present approach is validated against a DAF obtained from numerical data of Molecular Dynamics (MD) simulations of a dusty plasma system that is a practical example of a Yukawa system. The MD results and analytic expressions derived from the model equations are then used to obtain various transport coefficients and the latter are compared with values available in the literature from other models. The influence of strong coupling and visco-elastic effects on the transport parameters are discussed. Finally, the utility of our calculations for obtaining reliable estimates of transport coefficients from experimentally determined DAF is pointed out.

Dental caries at enamel and dentine level among European adolescents - a systematic review and meta-analysis

BACKGROUND

In contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents.

METHOD

Four databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12-19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model.

RESULTS

Overall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16-19 years, and in studies where caries examinations were done before 2010. The overall mean DMFT score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12-15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age.

CONCLUSIONS

Although studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting

Quadriceps tendon (QT) graft is a versatile graft for anterior and posterior cruciate ligament reconstruction. Advantages of quadriceps tendon autograft are the superior quality of graft, customization of graft size, reduced anterior knee pain, reduced risk of neurovascular injury, reduced incidence of arthrofibrosis compared to BPTB graft, preservation of ACL agonists, i.e., hamstrings, implantation of thicker graft and better patella mobility. Considering its advantages over other available autografts, its popularity is now increasing among surgeons. Conventionally, quadriceps tendon graft is harvested by an open technique, which produces an ugly scar and delays rehabilitation. In this article, we describe a minimally invasive technique of quadriceps tendon graft harvesting with a 2-2.5-cm vertical skin incision. Our technique does not require any specialized instrumentation, unlike other reported minimally invasive QT graft harvesting techniques, as we harvest the graft with a close tendon stripper.

Square Lattice Formation in a Monodisperse Complex Plasma

We present the first observations of a square lattice formation in a monodisperse complex plasma system, a configurational transition phenomenon that has long been an experimental challenge in the field. The experiments are conducted in a tabletop L-shaped dusty plasma experimental device in a dc glow discharge Argon plasma environment. By a careful control of the vertical potential confining the charged particles as well as the strength of the ion wake charge interactions with the dust particles, we are able to steer the system toward a crystalline phase that exhibits a square lattice configuration. The transition occurs when the vertical confinement strength is slightly reduced below a critical value leading to a buckling of the monodisperse hexagonal 2D dust crystal to form a narrowly separated bilayer state (a quasi-2D state). Some theoretical insights into the transition process are provided through molecular dynamics simulations carried out for the parameters relevant to our experiment.

Association between socioeconomic positions and overweight/obesity in rural Nepal

Introduction

Obesity and its association with socioeconomic factors are well-established. However, the gradient of this relationship among rural populations in low- and middle-income countries such as Nepal is not fully understood. We sought to assess the association of socioeconomic factors (education, income, and employment status) with overweight/obesity.

Methods

This cross-sectional study analyzed data from 260 participants aged ≥18 years and attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors was collected, and weight and height were measured for all the study participants. Those with a body mass index of &lt;25 kg/m2 were regarded as non-overweight/obese and those with ≥25 kg/m2 were regarded as overweight/obese. Poisson regression models were used to estimate prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and overweight/obesity. In addition, we assessed the effect of modification by age and gender to study the effect of socioeconomic factors on overweight/obesity.

Results

The age-standardized prevalence of overweight/obesity was higher for individuals with higher education (23%) and high-income (32%) and those who were unemployed (42%). Compared to the low-income and no formal education groups, the prevalence ratio of overweight/ obesity was 1.69 and 2.27 times more for those belonging to the high-income and high school and above groups, respectively. No evidence of effect modification by gender and age was observed.

Conclusions

Socioeconomic factors, education, and income were positively associated with overweight/obesity prevalence in rural Nepal. Further large studies using longitudinal settings are necessary to replicate our findings.

Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study

Background

Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics.

Methods

This multi-center, cross-sectional study, included individuals with JIA aged 4–16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education.

Results

Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43–5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10–5.01). No associations were found with active JIA disease or more severe disease characteristics.

Conclusion

In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02349-1.

Phenylboronic Ester-Activated Aryl Iodide-Selective Buchwald-Hartwig-Type Amination toward Bioactivity Assay

In this study, a phenylboronic ester-activated aryl iodide-selective Buchwald-Hartwig-type amination was developed. When the reaction of aryl iodides and aryl/aliphatic amines using Ni(acac)₂ is carried out in the presence of phenylboronic ester, the Buchwald-Hartwig-type amination proceeds smoothly to afford the corresponding amines in high yields. This reaction does not proceed in the absence of phenylboronic ester. A wide variety of aryl iodides can be applied in the presence of aryl chlorides and bromides, which remain intact during the reaction. The mechanistic studies of this reaction suggest that the phenylboronic ester acts as an activator for the amines to form the ″ate complex″. Chemical kinetics studies show that the reaction of aryl iodides, base, and Ni(acac)₂ follows first-order kinetics, while that of amines and phenylboronic ester follows zero-order kinetics. The bioactivity screening of the corresponding products showed that some amination products exhibit antifungal activity.

Systematic assessment of salivary inflammatory markers and dental caries in children: an exploratory study

OBJECTIVE

To investigate associations between a wide panel of salivary inflammatory markers and the presence of dental caries among children.

MATERIAL AND METHODS

In this exploratory, cross-sectional study, 176 children, aged 7-9, underwent a dental examination. Information on the children's oral health habits and lifestyles was collected from their mothers. In addition, saliva samples were collected and analyzed using a multiplex immunoassay. Of 92 inflammatory markers measured, 56 were included in the statistical analyses. To identify potential inflammatory markers associated with caries, we applied low to advanced statistical analyses. First, we performed traditional logistic regression analysis followed by Bonferroni corrections. Thereafter, a more robust and less conservative statistical approach, i.e. Least Absolute Shrinkage and Selection Operator (LASSO), was applied. The models were adjusted for potential confounders.

RESULTS

Of the 176 children in the study, 22.2% were affected by caries. Among the 56 salivary inflammatory markers, only macrophage colony-stimulating factor 1 (CSF1) was selected by the LASSO and found to be positively associated with the presence of caries.

CONCLUSIONS

The observed association between CSF1 and the presence of caries may be of clinical value in caries risk management and early diagnosis. Larger studies are warranted to assess the replicability of our findings.

Oral health-related quality of life following peri-implantitis surgery; a prospective study

AIM

The aim of this prospective study was to describe long-term patient-reported outcomes following surgical treatment of peri-implantitis.

METHODS

Oral health related quality of life (OHRQoL) of 43 patients diagnosed with peri-implantitis was recorded using the short form of the Oral Health Impact Profile (OHIP-14), where low scores indicate low impact. A Norwegian version of the OHIP-14 form was filled out 1 week before and 6-, 18- and 36 months after the peri-implant surgery. The mean and median OHIP-14 scores were calculated for its seven domains (i.e Functional limitation, Physical pain, Psychological discomfort, Physical disability, Psychological disability, Sosial disability and Handicap) across four different time-points. The dataset was analyzed to find correlations between independent variables and the OHIP-scores.

RESULTS

The OHIP-14 scores were at a low level from baseline to 36 months post-surgery. The mean scores at specific timepoints were at baseline 7.2 (SD 7.3), 6 months post-surgery 6.0 (SD 6.9), 18 months post-surgery 6.8 (SD 9.7) and 3 years post-surgery 7.0 (SD 9.4). None of these changes were statistically significant. Specific domains of OHRQoL did not significantly differ across different time-points (pre- and post-surgery) in males (except for domain 'handicap') or females (except for domain 'functional limitation').

CONCLUSIONS

The reported OHIP-14 measures were initially low and stayed low up to three years after peri-implant surgery. This may indicate that neither the disease nor the treatment deteriorated or improved the OHRQoL.

Inter-cluster competition and resource partitioning may govern the ecology of Frankia

Microbes live in a complex communal ecosystem. The structural complexity of microbial community reflects diversity, functionality, as well as habitat type. Delineation of ecologically important microbial populations along with exploration of their roles in environmental adaptation or host-microbe interaction has a crucial role in modern microbiology. In this scenario, reverse ecology (the use of genomics to study ecology) plays a pivotal role. Since the co-existence of two different genera in one small niche should maintain a strict direct interaction, it will be interesting to utilize the concept of reverse ecology in this scenario. Here, we exploited an 'R' package, the RevEcoR, to resolve the issue of co-existing microbes which are proven to be a crucial tool for identifying the nature of their relationship (competition or complementation) persisting among them. Our target organism here is Frankia, a nitrogen-fixing actinobacterium popular for its genetic and host-specific nature. According to their plant host, Frankia has already been sub-divided into four clusters C-I, C-II, C-III, and C-IV. Our results revealed a strong competing nature of CI Frankia. Among the clusters of Frankia studied, the competition index between C-I and C-III was the largest. The other interesting result was the co-occurrence of C-II and C-IV groups. It was revealed that these two groups follow the theory of resource partitioning in their lifestyle. Metabolic analysis along with their differential transporter machinery validated our hypothesis of resource partitioning among C-II and C-IV groups.

Risk for Acute Myocardial Infarction After Ophthalmologic Procedures

BACKGROUND

Preoperative cardiovascular evaluations are frequently done before ambulatory ophthalmologic procedures. However, whether these procedures can trigger an acute myocardial infarction (AMI) is unknown.

OBJECTIVE

To assess the short-term risk for AMI associated with ophthalmologic procedures.

DESIGN

Case-crossover design.

SETTING

Population-based nationwide study from Norway and Sweden.

PARTICIPANTS

First-time patients with AMI, aged 40 years and older, identified via inpatient registries and linked to outpatient surgical procedures in Norway (2008 to 2014) and Sweden (2001 to 2014), respectively.

MEASUREMENTS

Using self-matching, for each participant, exposure to ophthalmologic procedures in the 0 to 7 days before AMI diagnosis (hazard period) was compared with an 8-day period 30 days earlier, that is, days 29 to 36 before AMI (control period) to estimate the relative risk for an AMI the week after an ophthalmologic procedure. The odds ratios (ORs) with 95% CIs were calculated, using conditional logistic regression. Only patients who had a procedure of interest during either the hazard or control period were included.

RESULTS

For the 806 patients with AMI included in this study, there was a lower likelihood of AMI in the week after an ophthalmologic procedure than during the control week (OR_, 0.83; 95% CI, 0.75 to 0.91). Furthermore, there was no evidence of increased risk for AMI when analyses were stratified by surgery subtype, anesthesia (local or general), duration, invasiveness (low, intermediate, or high), patient's age (<65 years or ≥65 years), or comorbidity (none vs. any).

LIMITATION

Potential bias from time-varying confounders between the hazard and the control periods.

CONCLUSION

Ophthalmologic procedures done in an outpatient setting did not seem to be associated with an increased risk for AMI.

PRIMARY FUNDING SOURCE

Central Norway Regional Health Authority and the Swedish Research Council.

Diabetes Prevention Education Program in a population with pre-diabetes in Nepal: a study protocol of a cluster randomised controlled trial (DiPEP)

INTRODUCTION

Evidence suggests that diabetes burden can be reduced by implementing early lifestyle intervention programmes in population with pre-diabetes in high-income countries. However, little is known in developing nations like Nepal. This study aims to assess effectiveness of community-based Diabetes Prevention Education Program (DiPEP) on haemoglobin A1c (HbA1c) level, proportion of pre-diabetes reverting to normoglycaemia, diet, physical activity, weight reduction, diabetes knowledge and health literacy after 6 months of follow-up. Furthermore, we will also conduct qualitative studies to explore experiences of participants of intervention sessions and perception of healthcare workers/volunteers about DiPEP.

METHODS AND ANALYSES

This is a community-based two-arm, open-label, cluster randomised controlled trial. We will randomise 14 clusters into intervention arm and control arm. Estimated total sample size is 448. We will screen individuals without diabetes, aged 18-64 years, and permanent residents of study sites. HbA1c test will be only performed if both Indian Diabetes Risk Score and random blood sugar value are ≥60 and 140-250 mg/dL, respectively. At baseline, participants in intervention arm will receive DiPEP package (including intensive intervention classes, diabetes prevention brochure, exercise calendar and food record booklet), and participants in control arm will be provided only with diabetes prevention brochure. The change in outcome measures will be compared between intervention to control arm after 6 months of follow-up by linear mixed models. Also, we will conduct individual interviews among participants and healthcare workers as part of a qualitative study. We will use thematic analysis to analyse qualitative data.

ETHICS AND DISSEMINATION

Regional Committee for Medical and Health Research Ethics, Norway; Nepal Health Research Council, Nepal and Institutional Review Committee, Kathmandu University School of Medical Sciences have approved the study. The DiPEP package can be implemented in other communities of Nepal if it is effective in preventing diabetes.

TRIAL REGISTRATION NUMBER

NCT04074148, 2019/783.

Effects of an individualized training course on technical quality and periapical status of teeth treated endodontically by dentists in the Public Dental Service in Norway: An observational intervention study

AIM

To investigate the effect of a continuing education course on technical quality and treatment outcome for root filled permanent teeth in Møre and Romsdal County, Norway.

METHODOLOGY

Fifty-two dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, completed a two-day continuing education course in root canal treatment. Periapical radiographs of root filled teeth treated before and after the course, with at least one-year follow-up were identified and scored for technical quality and periapical status. Technical root filling quality was assessed by density and length and the treatment outcome by PAI scores. Treatment information was achieved from the county's electronic dental record system. Information regarding the dental practitioners' background and treatment procedure routines was collected by a questionnaire. Descriptive statistics analyses and mixed-effect logistic regression analyses were performed to evaluate the effect of the course.

RESULTS

Radiographs were available for 224 teeth root filled before and for 221 teeth after the course. The proportion of teeth with adequate root filling quality was significantly lower after the course (p = .006), associated mainly with short root fillings (p < .001). No significant differences were observed in treatment outcome. There were, however, large differences in treatment outcome amongst subgroups of dentists. Further, there was evidence of effect modification by the continuing education course on periapical outcome by patient's age (p_interaction  = .0023) suggesting that teeth in patients ≤18 years healed relatively better post-course compared to patients >18 years.

CONCLUSIONS

A two-day continuing education course in root canal treatment attended by Public Dental Service dentists in Norway did not improve the technical quality of root fillings or periapical status associated with root filled teeth.

Polymer-Supported-Cobalt-Catalyzed Regioselective Cyclotrimerization of Aryl Alkynes

A convoluted poly(4-vinylpyridine) cobalt(II) (P4VP-CoCl₂) system was developed as a stable and reusable heterogeneous catalyst. The local structure near the Co atom was determined on the basis of experimental data and theoretical calculations. This immobilized cobalt catalyst showed high selectivity and catalytic activity in the [2 + 2 + 2] cyclotrimerization of terminal aryl alkynes. With 0.033 mol % P4VP-CoCl₂, the regioselective formation of 1,3,5-triarylbenzene was realized without 1,2,4-triarylbenzene formation. Further, a multigram-scale (11 g) reaction proceeded efficiently. In addition, the polymer-supported catalyst was successfully recovered and used three times. X-ray photoelectron spectroscopy analysis of the recovered catalyst suggested that cobalt was in the +2 oxidation state. The 1,3,5-triarylbenzene derivatives were applied to the synthesis of a molecular beam electron resist and a polycyclic aromatic hydrocarbon.

Short-term and long-term outcome of manipulation under anesthesia in primary frozen shoulder

Background: Painful restriction of active and passive shoulder range of motion which cannot be attributed to any internal shoulder pathology is termed as primary frozen shoulder. It has three stages – freezing stage, frozen stage, and thawing stage. Nonsteroidal anti-inflammatory drugs, physiotherapy, intra-articular corticosteroid injection, hydrodilatation, arthroscopic capsular release, and manipulation under anesthesia (MUA) are different modalities of treatment. Aims and Objectives: The main objective of our study was to assess the short-term and long-term outcome of MUA in frozen shoulder once it did not respond to 3 months course of physiotherapy. Materials and Methods: Fifty patients of primary frozen shoulder fulfilling inclusion criteria were manipulated under general anesthesia, and intra-articular Depo-Medrol and bupivacaine were administered. Functional status of the shoulder was assessed using the adjusted Constant-Murley (CM) score preoperatively and in subsequent follow-ups. Results: There was a significant improvement of mean adjusted CM score in short- and long-term follow-ups compared to pre-manipulation value. A significant negative correlation was found between the age of the patient and the final outcome. Conclusion: MUA is an effective modality of treatment in primary frozen shoulder with good short- and long-term outcomes.

The impact of COVID-19 on epilepsy care: Perspectives from UK healthcare workers

•

We surveyed UK healthcare workers (HCWs) involved in the care of people with epilepsy.

•

During the pandemic, 70% of respondents held most consultations remotely.

•

HCWs experienced increased mental strain and concern for colleagues/family members.

•

HCWs reported being less confident in diagnosing epilepsy remotely.

•

Clinicians were more reluctant to withdraw seizure medications during the pandemic.

The COVID-19 pandemic has created an immense pressure on healthcare providers, resulting in a shift to remote consultations and the redeployment of healthcare workers (HCWs). We present survey data from the United Kingdom (UK) HCWs to outline how changes in healthcare provision impact clinicians' wellbeing and ability to provide adequate care. We designed an online survey to gather the experiences of HCWs providing care to people with epilepsy. We received seventy-nine responses from UK-based HCWs, of whom 43% reported an impact on their mental health. Changes to service delivery have resulted in 71% of clinicians performing > 75% of their consultations remotely. Diagnosing and treating epilepsy has changed, with a fifth of respondents being significantly less confident in diagnosing epilepsy. Ultimately, these results show that COVID-19 has had an overall negative impact on HCWs and their ability to provide epilepsy care. These results must be considered when reorganizing health services to ensure optimal outcomes for people with epilepsy.