Applying Essential Public Health Functions in building health systems’ resilience globally

Background

The COVID-19 pandemic has exposed Public Health system weaknesses due to chronic underinvestment in Public Health. In this context, Essential Public Health Functions (EPHFs) have been revitalized as an integrated, cost effective and sustainable approach to operationalising Public Health. The World Health Organization's recent position paper on building health systems resilience towards universal health coverage and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond. There is a need for conceptual and operational clarity of EPHFs to support countries to build back better, fairer and more resilient health systems.

Methods

A rapid review of peer-reviewed and grey literature regarding the EPHFs was conducted to identify different actors’ understandings of EPHFs and key lessons of applying the EPHFs at the global, regional and national levels, in order to identify the added value and key enablers to operationalising EPHFs. A crosswalk analysis of different authoritative lists of EPHFs was conducted to develop a common list of EPHFs as a reference for countries in response to Public Health challenges.

Results

A consolidated list of 12 EPHFs derived from the crosswalk analysis of different authoritative lists is presented, underpinning the consideration of health systems components and pressing health challenges. Six key enablers are identified from evidence and experience. These enablers are fundamental for countries to build holistic and strong Public Health capacities.

Conclusions

The EPHFs provide a clear and integrated framing to operationalise Public Health in countries that can be adapted to country contexts to build resilience. Health authorities and other Public Health stakeholders must seize the opportunity brought by COVID-19 recovery to continue advocating for and strengthening Public Health as a priority in health systems’ reconstruction and reform.

Essential Public Health Functions in Ireland: Perspectives to strengthen capacities and stewardship

Background

COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience.

Methods

A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context.

Results

There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors.

Conclusions

The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.

The effects of caffeine following hypoxic-ischemic encephalopathy: a systematic review of animal studies

BACKGROUND

Caffeine is believed to be neuroprotective in preterm and term infants, despite the conflicting data on its effects on the developing brain in animal models. We aimed to conduct a systematic review with meta-analysis assessing the effects of caffeine on the prevention and treatment of neurological morbidity caused by hypoxic-ischemic encephalopathy (HIE) in preclinical studies.

METHODS

Randomized and non-randomized control studies in animal models of HIE reporting caffeine administration within the first ten days of life were included. Primary outcomes were behavioral tests that served as surrogates for cognition, memory, motor coordination, and gait; secondary outcomes pertained to structural neurologic changes. Screening for inclusion, risk of bias and data extraction were performed independently by two authors.

RESULTS

Seven studies met inclusion: 5 studies were conducted in rats and 2 in mice. All studies were performed in full-term animals, and the majority of studies used animals of both sexes (5/7). In six studies, caffeine was administered intraperitoneally to the pups, while in the remaining study, it was delivered via the drinking water of the lactating dams. The doses of caffeine ranged from 5-20 mg/kg; in one study, caffeine dosage was 0.3 mg/L in the drinking water of lactating dam. The mortality rate was reported only in three studies. Caffeine had a positive effect on overall functional outcome (SDM 0.92(95%CI 0.25 to 1.59)). Animals treated with caffeine performed better on Morris water maze and rotarod tests (SDM -1.39(95%CI -0.36 to -2.41)) and (SDM 1.03(95%CI 0.03 to 2.04)), respectively. Caffeine treated animals performed worse on open field test compared to the controls (SDM -1.11(95%CI -3.01 to 0.80)). The overall quality of the included studies was limited.

CONCLUSIONS

Early caffeine exposure in preclinical rodent models of HIE is associated with improved selective functional and neurological outcomes, although the certainty of the evidence is limited. To validate the therapeutic efficacy of caffeine as a neuroprotective adjuvant, there is a need to explore its effects in larger animal models, which will help guide the design of relevant clinical trials.

Investigation of roost composition of passerine birds in different environmental conditions

Abstract The majority of the birds in different habitats are stressed due to alteration in multiple climate factors contributing to their loss. The present study has been planned to find the roosts composition of passerine birds in different major and sub-habitats of Punjab, Pakistan. In Faisalabad, of the four species, the higher number of exits was almost comparable, while Passer domesticus and Pastor roseus were more abundant than Tachycinet bicolor and Lanius cristatus. For the three remaining birds, total exits and returns were 180 for P. roseus, 181 for T. bicolor, and 179 for L. cristatus, respectively. Considering the exits in morning hours, a total of 314, 256, 246 and 210, were recorded from Sheikhupura. In Khanewal, of the four species, the highest exits and returns were that of P. domesticus (407; 451), followed by that of the P. roseus (273; 336), T. bicolor (242; 319) and L. cristatus (220; 397). The temperature imposed serious effects on roost exits for the four birds. The varied P-values which were higher (< 0.001***, < 0.001***, 0.002 **, <0.001***) appeared to limit the roost exits for them. Nonetheless, the impact of relative humidity exerted a strong influence on the T. bicolor (0.003**). In roosts return, it was seen that roost returns were even likely in warm temperatures and precipitation did not impose seriously on returns, and even in light rainfall. Nonetheless, relative humidity (RH) strongly impacted the sparrow. The T. bicolor and L. cristatus were adversely affected with the slopes (1.37) and (2.06), indicated with each percentage increase of relative humidity, and slope variations became least.

Clearing the air about airborne transmission of SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has created the current pandemic, has caused a worldwide worry. Different countries have since enforced varying levels of lockdowns and guidelines for their populations to follow in a serious effort to mitigate the spread. Up until recently, the majority of these regulations and policies were established on the assumption that the dominant routes of transmission of this virus are through droplets and fomite contact. However, there is now a substantial amount of research pointing towards the strong possibility that SARS-CoV-2 can spread through airborne means. The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have recently recognized this, which poses the question of whether our collective methods of lessening transmission risk and keeping people safe have been sufficient. This paper is a comprehensive review of the evidence on SARS-CoV-2 being an airborne disease, through different epidemiological, experimental, and animal-model based published research. Studies opposing this evidence have also been discussed. The majority of these studies are favoring the high plausibility of SARS-CoV-2 aerosol transmission, and therefore the many implications of aerosol transmission have been discussed in this paper to suggest effective mitigation and control strategies.

Building resilience through integrated health systems strengthening: policy and planning analysis

 

Health system strengthening towards universal health coverage and health security are key objectives promoted by health policy actors. However, bringing together these agendas has presented challenges. Health investments are often reactive and siloed e.g. emergency and humanitarian response programmes. There has been disinvestment in public health and primary health care (PHC), and limited linkages with allied sectors (e.g. environmental and animal health). There is a need to better understand policies that promote integration and enable effective response to threats such as COVID-19 in tandem with maintaining routine health system functions (e.g. PHC and essential individual and population health services). We conducted document analysis of national health sector, security and public health policies and plans and drew on perspectives of key stakeholders to investigate integration using a health systems resilience framework. We examined the extent and manner in which policies are integrated to enable national and subnational systems to prepare for, prevent and adapt to shocks while maintaining routine and essential functions. While we identified a recognition of the need for better integration to promote health security within health systems strengthening efforts and vice versa including strengthening governance, accountability and capacity for stewardship within national and local health and allied authorities, evidence of such an approach was limited. National laws to support IHR (2005) implementation were often outdated and insufficient to produce the policy environment for multi-sectoral working. In 2020, only 47% of national COVID-19 plans from 106 countries considered the maintenance of non-COVID-19 essential health services - a key component of health systems resilience. Policies which strengthen PHC services and preventative interventions can be cost-effective and efficient whilst bridging pandemic response and other essential functions of the health system.

Key messages

COVID-19 is an opportunity to promote and sustain greater integration and inter- and multisectoral engagement.

Everyone can play a role to foster an integrated approach focussing on preventative, cost-effective health services to ensure health systems resilience.

1677 Integrating Venepuncture Training Within the Curriculum for Oral and Maxillofacial Dental Core Trainees Within A Hospital in South Wales, UK

Aim

The aim of this quality improvement project was to provide a solution to improve the confidence and skill of Oral and Maxillofacial Dental Core Trainees (DCTs) in venepuncture by attending phlebotomy training sessions. DCTs within the hospital where this project was undertaken are dentally qualified and are often not taught the principles of venepuncture during their undergraduate degree. Furthermore, they rarely gain hands-on experience to confidently apply these skills.

Method

Phlebotomy training sessions were held, each an hour and a half long and were completed within the first 4 weeks of the DCTs starting their job. A survey was completed by each of the DCTs prior to the training. The sessions consisted of a short introduction to phlebotomy and the different techniques, observing a phlebotomist taking blood, and then performing venepuncture on live patients attending the clinic who required blood investigations. The Vacutainer eclipse single needle was used with the single-use holder. Following the training, the DCTs completed a second survey.

Results

The mean confidence of the DCTs increased from 2.7 to 8.2 out of 10 following the phlebotomy training. 100% of the DCTs rated the quality of the workshop 10 out of 10, with 10 being excellent. The sessions had minimal disruption to the running of the phlebotomy and maxillofacial clinics.

Conclusions

This quality improvement project will have an overall benefit firstly to patients and also to the Health Board. The success of this programme lead to its permanent implementation within the curriculum for or each intake of new DCTs.

1662 Closure of Oro-Antral Fistulae in Conjunction with Functional Endoscopic Sinus Surgery: A Retrospective Analysis + Systematic Review

Aim

The aim of this study was to evaluate the surgical closure of OAFs created following dental extractions in conjunction with FESS in adult patients within a hospital in South Wales, UK, during a 5-year period, from 1st January 2014 to 31st December 2018, with a systematic review of the literature to investigate success rates.

Method

A manual search in the hospital’s theatre system for surgery between 2014 and 2018 containing codes for FESS, OAC or OAF was completed. These were screened for joint cases, and the patient’s hospital numbers entered into a Microsoft Excel spreadsheet. A retrospective analysis of their clinical records was performed. Success was measured as total closure and relief of sinusitis after 1 month. The PRISMA format was used to complete the systematic review.

Results

13 patients (mean age 51 ± 12.44, 7:6 male to female) met the inclusion criteria. The most common cause was extraction of the maxillary first molar. A 100% success rate was achieved, with no patients requiring revision surgery. The systematic review highlighted an average success rate of 98.7%. A protocol for the management of OACs was designed in both English and Welsh and distributed to Primary Care Dentists within South Wales.

Conclusions

OAF closure with FESS can be considered as a highly effective approach, leaving patients symptom free. It is important that protocols are in place for dentists suspecting an OAC in order to expedite patient management.

887 Suspected malignancy and unusual pathology in a severe case of Lemierre’s syndrome

Lemierre’s syndrome, although rare, is a potentially fatal condition, usually associated with the anaerobic bacterium, Fusobacterium necrophorum. This case describes a previously healthy 59-year-old female, who had a three-week history of pharyngitis and dysphagia. She presented to the emergency department with a left neck swelling and fever. A CT scan showed a 3 cm left level IV low-density suspected neck mass or necrotic node. There were multiple pulmonary nodules raising suspicion for metastases. Blood cultures were positive for Streptococcus constellatus and Dialister pneumosintes. The scan was further reviewed by a Head and Neck specialist radiologist and an Oral and Maxillofacial consultant, which highlighted a peritonsillar abscess and filling defect in the left internal jugular vein. A conclusive diagnosis of Lemierre’s syndrome with septic pulmonary emboli was established. She improved clinically with IV antibiotics in conjunction with daily enoxaparin injections. We believe that this is the first reported case of Lemierre’s syndrome associated with Dialister pneumosintes. A high index of suspicion is essential in cases of persistent pharyngitis and sepsis in an otherwise healthy individual, in order to promptly diagnose the condition and initiate treatment.

Gastrointestinal parasitic infections of buffaloes (Bubalus bubalis) in Sarawak Borneo: Prevalence, risk factors, and farming practices

The objectives of this study were to investigate the prevalence and associated risk factors for gastrointestinal (GI) parasites in buffaloes from various areas of Sarawak, and to assess current management practices of GI parasites among farmers. Faecal samples were collected from 15 farms and 129 animals, as well as data on farm and animal-based characteristics. A total of 129 faecal samples were examined for GI parasites using a modified McMaster and sedimentation. Association between potential risk factors and the prevalence of GI parasites was investigated using Chi-square statistic. The prevalence of Paramphistomum sp., strongyles, and coccidia were 75.2% (95% CI±7.5), 52.7% (95% CI±8.6) and 48.1% (95% CI±8.6), respectively. Farms which had a grazing area less than 50 acres in size had significantly higher prevalence of strongyles (70.5%, χ² = 8.34, P = 0.004) and paramphistomes (88.6%, χ² = 6.46, P = 0.01) relative to farms with a larger grazing area (43.5% and 68.2%, respectively). Prevalence of strongyles was lower in farms that did not implement a cut- and-carry system (45.6%, χ² = 4.17, P = 0.04) in comparison to those that did (64%). The prevalence of paramphistomes was higher on farms with more than 40 animals (80.6%, χ² = 3.18, P = 0.05) relative to farms with fewer animals. The majority of farmers surveyed (67.9%) showed awareness of GI parasite infection and reported that they recognized the associated symptoms. Most farmers practised deworming, and ivermectin was the most commonly used anthelminthic (60.4%); only 1.9% of farmers used albendazole. Overall this study revealed a high prevalence of GI parasites in buffalo in Sarawak. Although farmers report they are aware of parasitic diseases, further education is still required. This could include how they can successfully implement on-farm changes to reduce the prevalence of GI parasites in their herds.

O-083 Non-invasive, label-free optical analysis to detect aneuploidy within the inner cell mass of the preimplantation embryo

Study question

Can we separate between control and reversine-treated cells within the inner cell mass (ICM) of the mouse preimplantation embryo by using label-free and non-invasive hyperspectral microscopy?

Summary answer

Hyperspectral microscopy is able to discern between control and reversine-treated cells using cellular autofluorescence in the complete absence of fluorescence tags.

What is known already

Embryo mosaicism (containing cells that are euploid (46 chromosomes) and aneuploid (deviation from the expected number of chromosomes)) affects up to 17.3% of human blastocyst embryos. Current diagnosis of aneuploidy in the IVF clinic involves a biopsy of trophectoderm (TE) cells or spent media followed by sequencing. In some blastocyst embryos these approaches will fail to diagnose of the proportion of aneuploid cells within the fetal lineage (ICM).

Study design, size, duration

The impact of aneuploidy on cellular metabolism was assessed by using cellular autofluoresence and hyperspectral microscopy (broad spectral profile). Two models were employed: (i) Primary human fibroblast cells with known karyotypes (4-6 independent replicates, euploid n = 467; aneuploid n = 969) and reversine induced aneuploidy in mouse embryos (5-8 independent replicates, 30-44 cells per group). Both models were subjected to hyperspectral imaging to quantify native cell fluorescence.

Participants/materials, setting, methods

The human model is comprised of euploid (male and female) and aneuploid (triploid and trisomies: 13, 18, 21, XXX, and XXY) primary human fibroblast cells. For the mouse model, we treated embryos with reversine, a reversible spindle assembly checkpoint inhibitor, during the 4- to 8-cell division. Individual blastomeres were dissociated from control and reversine treated 8-cell embryos. Blastomeres were either imaged directly or used to generate chimeric blastocysts with differing ratios of control:reversine-treated cells.

Main results and the role of chance

Following unsupervised linear unmixing, the relative abundance of metabolic cofactors was quantified: reduced nicotinamide adenine dinucleotide (NAD(P)H) and flavins with the subsequent calculation of the optical redox ratio (ORR: Flavins/[NAD(P)H + Flavins]). Primary human fibroblast cells displayed an increase in the relative abundance of NAD(P)H with a decrease in flavins, leading to a significant reduction in the ORR for aneuploid cells (P &lt; 0.05). The mouse embryos displayed an identical trend as the human model between control and reversine-treated embryos. Mathematical algorithms were applied and able to distinguish between (i) euploid and aneuploid primary human fibroblast cells, (ii) control and reversine-treated mouse blastomeres and (iii) chimeric blastocysts with differing ratios of control and reversine-treated cells. The accuracy of these separations was supported by receiver operating characteristic curves with areas under the curve. We also showed that hyperspectral imaging of the preimplantation embryo does not impact on embryo developmental competence, pregnancy outcome and offspring health in a mouse model. We believe the role of chance is low as both human somatic cells and mouse embryos showed a consistent shift in cellular metabolism in response to human fibroblast cells that are aneuploid and reversine treated mouse embryos.

Limitations, reasons for caution

Further validation of our approach could include sequencing of the ICM of individual blastocysts to determine the proportion of aneuploid cells in ICM and correlate this with the metabolic profile obtained through hyperspectral imaging.

Wider implications of the findings

With hyperspectral imaging able to discriminate between (i) euploid and aneuploid human fibroblast cells and (ii) control and reversine-treated mouse embryos, this could be an accurate, non-invasive and label-free optical imaging approach to assess mosaicism within the ICM of mouse embryos, potentially leading to a new diagnostic tool for embryos.

Trial registration number

Not applicable

Suicidality measured by PHQ-9 in kosovo during the COVID-19 outbreak

Introduction

As a consequence of the impact of COVID-19 there are suggestions and projections that suicide rates will rise, although this is not inevitable. It is intriguing what impact it will have on Kosovo as a country with the lowest suicide rate in Europe.

Objectives

The objective of this study was to understand the level of suicidal thinking as a result of the COVID-19 situation and possible associations with sociodemographic variables.

Methods

It’s a comparative study. We examined data of two cross-sectional online surveys conducted during the one-month periods 20.03.20 until 23.04.20 and 27.04.2020 until 05.06.2020. The participants were online respondents, N = 194 (first period) and N = 155 (second period); who completed the Albanian version of PHQ-9. We used the statement number 9 of questionnaire indicative of suicide.

Results

Mean score of suicidal thinking resulted 0.58 (SD = .98) in the first period and 0.84 (SD = 1.16) in the second period. 10.1% of participants in March/April and 18.2% in May/June period scored that almost every day thoughts that would be better off dead, or of hurting yourself in some way. Significantly higher suicidal thinking resulted for females and for respondents who had previously had depression in both periods. Compared to two previous studies (2018 and 2019) in different settings only the results of the second period show an increase in suicidal thinking.

Conclusions

Further studies are needed to better scientifically elaborate these findings. It is important enhanced surveillance of COVID-19-related risk factors contributing to suicidal behaviors and timely preventive efforts.

Disclosure

No significant relationships.

Intravenous glycoprotein IIbIIIa inhibitor bridging for urgent coronary artery bypass graft after acute coronary syndrome

Background

Previous studies have shown the safety of intravenous glycoprotein (GP) IIbIIIa inhibitors used as a bridging after ADP receptor blocker withdrawal in patients with stable coronary artery disease and previous percutaneous coronary interventions (PCI) undergoing cardiac or non-cardiac surgeries. However, there are few data analyzing GP IIbIIIa inhibitor bridging among patients with acute coronary syndromes (ACS) scheduled for coronary artery bypass graft (CABG) during the same hospitalization.

Purpose

To evaluate the safety of tirofiban bridging after clopidogrel withdraw in post-ACS patients schedule for CABG during the same hospitalization.

Methods

Fifty-six patients who underwent CABG after tirofiban bridging post-ACS (bridge group - BG) were compared to 56 sex and age-matched controls also submitted to same-hospitalization CABG post-ACS without bridging (control group - CG). All patients received aspirin plus clopidogrel for ACS; clopidogrel was withdrawn 5 to 7 days before CABG and aspirin was maintained during the whole perioperative period. The primary endpoint was chest tube output in the first 24h after CABG (CTO24h). We hypothesized that BG would be non-inferior to CG, with a non-inferiority margin of 25% in excess of CTO24h in the BG compared to the CG, based on prior literature data. Other exploratory analyses were: blood transfusions, number of red blood cells/patient and re-thoracotomy 24h after surgery. A multivariable linear regression model was developed considering CTO24h as dependent variable and adjusted for other eight co-variates, described in the figure.

Results

From the 112 patients included (75% men; mean age 60.2±9.3 years), in comparison with CG, BG had higher proportion of STEMI (80.0% vs. 28.6%, p&lt;0.01), fibrinolytic utilization (25% vs. 7.1%, p&lt;0.05), PCI in the acute phase (92.9% vs. 0%, p&lt;0.01) and LMCA stenosis (30.4% vs. 7.1% p&lt;0.01). Tirofiban was utilized by clinician discretion due to PCI in the same hospitalization previously to CABG (n=52), previous PCI up to 3 months before index event (n=3) or severe LMCA stenosis (n=1). BG patients received tirofiban for a mean of 4.3±2.1 days and it was withdrawn at a mean of 6.6±4.3 hours before CABG. After adjustments, BG was non-inferior to CG regarding CTO24h (figure) There were no significant differences between BG and CG regarding need for blood transfusion (26.8% vs. 26.8%, p&gt;0.99), mean number of red blood cells/patient (0.3±0.8 vs 0.5±1.2, p=0.35) or re-thoracotomy due to bleeding (5.4% vs 0%, p=0.24).

Conclusion

Among ACS patients submitted to urgent CABG after clopidogrel withdrawal, tirofiban bridging, compared to no bridging, was not associated with higher risk of bleeding in the first 24 hours after surgery. Our study suggests that tirofiban may be a safe therapy to patients with high risk of thrombotic complication (such as stent thrombosis or re-infarction) after clopidogrel withdraw.

Figure 1

Funding Acknowledgement

Type of funding source: None

Effects of mesenchymal stromal cell-conditioned media on measures of lung structure and function: a systematic review and meta-analysis of preclinical studies

BACKGROUND

Lung disease is a leading cause of morbidity and mortality. A breach in the lung alveolar-epithelial barrier and impairment in lung function are hallmarks of acute and chronic pulmonary illness. This review is part two of our previous work. In part 1, we demonstrated that CdM is as effective as MSCs in modulating inflammation. Herein, we investigated the effects of mesenchymal stromal cell (MSC)-conditioned media (CdM) on (i) lung architecture/function in animal models mimicking human lung disease, and (ii) performed a head-to-head comparison of CdM to MSCs.

METHODS

Adhering to the animal Systematic Review Centre for Laboratory animal Experimentation protocol, we conducted a search of English articles in five medical databases. Two independent investigators collected information regarding lung: alveolarization, vasculogenesis, permeability, histologic injury, compliance, and measures of right ventricular hypertrophy and right pulmonary pressure. Meta-analysis was performed to generate random effect size using standardized mean difference with 95% confidence interval.

RESULTS

A total of 29 studies met inclusion. Lung diseases included bronchopulmonary dysplasia, asthma, pulmonary hypertension, acute respiratory distress syndrome, chronic obstructive pulmonary disease, and pulmonary fibrosis. CdM improved all measures of lung structure and function. Moreover, no statistical difference was observed in any of the lung measures between MSCs and CdM.

CONCLUSIONS

In this meta-analysis of animal models recapitulating human lung disease, CdM improved lung structure and function and had an effect size comparable to MSCs.

A survey on smartphone dependence and psychological effects among undergraduate students in a Malaysian University

OBJECTIVE

Problematic smartphone use (PSU) is the development of pathological dependence at the expense of performing activities of daily living, thus having negative health and psychological impact on the users. Previous PSU studies focused on medical students and little is known regarding its effect on students undergoing other courses. The objective of this study is to identify the pattern of smartphone usage and determine the psychological factors affecting PSU among undergraduate students in Malaysia and compare the pattern among students from different fields of study.

METHOD

A prospective cross-sectional study was conducted using the validated Smartphone Addiction Scale-Malay version (SAS-M) questionnaire. One-way ANOVA was used to determine the correlation between the PSU among the students categorised by their ethnicity, hand dominance and by their field of study. MLR analysis was applied to predict PSU based on socio-demographic data, usage patterns, psychological factors and fields of study.

RESULTS

A total of 1060 students completed the questionnaire. Most students had some degree of problematic usage of the smartphone. Students used smartphones predominantly to access SNAs, namely Instagram. Longer duration on the smartphone per day, younger age at first using a smartphone and underlying depression carried higher risk of developing PSU, whereas the field of study (science vs. humanities based) did not contribute to an increased risk of developing PSU.

CONCLUSION

Findings from this study can help better inform university administrators about at- risk groups of undergraduate students who may benefit from targeted intervention designed to reduce their addictive behaviour patterns.

Intranasal delivery of human umbilical cord Wharton's jelly mesenchymal stromal cells restores lung alveolarization and vascularization in experimental bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a devastating lung condition that develops in premature newborns exposed to prolonged mechanical ventilation and supplemental oxygen. Significant morbidity and mortality are associated with this costly disease and effective therapies are limited. Mesenchymal stem/stromal cells (MSCs) are multipotent cells that can repair injured tissue by secreting paracrine factors known to restore the function and integrity of injured lung epithelium and endothelium. Most preclinical studies showing therapeutic efficacy of MSCs for BPD are administered either intratracheally or intravenously. The purpose of this study was to examine the feasibility and effectiveness of human cord tissue-derived MSC administration given via the intranasal route. Human umbilical cord tissue MSCs were isolated, characterized, and given intranasally (500 000 cells per 20 μL) to a hyperoxia-induced rat model of BPD. Lung alveolarization, vascularization, and pulmonary vascular remodeling were restored in animals receiving MSC treatment. Gene and protein analysis suggest the beneficial effects of MSCs were attributed, in part, to a concerted effort targeting angiogenesis, immunomodulation, wound healing, and cell survival. These findings are clinically significant, as neonates who develop BPD have altered alveolar development, decreased pulmonary vascularization and chronic inflammation, all resulting in impaired tissue healing. Our study is the first to report the intranasal delivery of umbilical cord Wharton's jelly MSCs in experimental BPD is feasible, noninvasive, and an effective route that may bear clinical applicability.

[Zinc induces normoxic accumulation of transcriptionally active hypoxia-inducible factor 1-alpha in mammary epithelial cells]

Both zinc and the α-subunit of hypoxia-inducible factor (HIF-1α) play important roles in the remodelling of mammary gland tissues. In the present study, we examined the level and the transcriptional activity of HIF-1α in mammary cells upon zinc treatment. In MCF-7 mammary adenocarcinoma and MCF-10A mammary epithelial cell lines, the toxicity levels of zinc differ. Interestingly, both cell lines overexpress HIF-1α following zinc treatment. As it was evident from an up-regulation of its specific target gene CA9 that encodes carbonic anhydrase IX, the stabilized HIF-1α translocated to the nucleus and was transcriptionally active. Hence, we conclude that zinc causes normoxic accumulation of transcriptionally active HIF-1α by interfering with its post-translational regulation.

Upcycling umbilical cords: bridging regenerative medicine with neonatology

Preterm birth is a major health concern that affects 10% of all worldwide deliveries. Many preterm infants are discharged from the hospital with morbidities that lead to an increased risk for neurodevelopmental impairment, recurrent hospitalizations, and life-long conditions. Unfortunately, the treatment of these conditions is palliative rather than curative, which calls for novel and innovative strategies. Progress in regenerative medicine has offered therapeutic options for many of these conditions. Specifically, human umbilical cord mesenchymal stem cells (MSCs) and cord blood (UCB) cells have shown promise in treating adult-onset diseases. Unlike bone-marrow and embryonic derived stem cells, umbilical cord-derived cells are easily and humanely obtained, have low immunogenicity, and offer the potential of autologous therapy. While there are several studies to uphold the efficacy of umbilical cord MSCs in adult therapies, there remains an unmet need for the investigation of its use in treating neonates. The purpose of this review is to provide a summary of current information on the potential therapeutic benefits and clinical applicability of umbilical cord MSCs and UCB cells. Promising preclinical studies have now led to a research movement that is focusing on cell-based therapies for preterm infants.

Perceptions and Attitudes Towards HIV/AIDS Patients among General Public in Bahrain

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Genetische Veränderungen des Protein-C-Systems

Das Protein-C-System umfaßt neben dem Protein C (PC) das Protein S (PS) sowie Thrombomodulin (TM). Obwohl das PC bereits im Jahr 1976 isoliert und charakterisiert wurde, wurde familiärer PC-Mangel erst im Jahr 1981 mit familiärer Thrombophilie in Zusammenhang gebracht. Heute wissen wir, daß PC einen der wichtigsten Inhibitoren der Gerinnung repräsentiert. Zur Umwandlung des Zymogens PC durch Thrombin in aktiviertes PC (APC) ist das TM von essentieller Bedeutung. Dieses Protein wurde 1981 entdeckt und danach intensiv in seiner biochemischen Funktion studiert. Die klinische Relevanz von TM-Defekten ist allerdings bis heute unklar. APC inaktiviert proteolytisch die aktivierten Gerinnungsfaktoren Faktor V (FVa) und Faktor VIII (FVIIIa). Zur Entfaltung der vollen Aktivität benötigt PC einen Kofaktor, das PS. Ein Mangel von PS führt zu erhöhter Thromboseneigung. Eine häufig vorkommende Mutante des Faktor V (FV), der FV-Leiden, kann durch APC nur unzureichend inaktiviert werden und ist ebenfalls mit erhöhter Thromboseneigung assoziiert. Der genaue Mechanismus über den FV-Leiden zu einem erhöhten Thromboserisiko beiträgt wird derzeit noch kontrovers diskutiert. Heute sind die biochemischen Interaktionen der Komponenten des PC-Systems recht genau untersucht und viele zugrundeliegende Mutationen aufgeklärt. Darüber hinaus gibt es recht umfangreiche Studien an großen Patientenkollektiven, in denen die Auswirkungen der Mutationen in den einzelnen Komponenten des PC-Systems auf das Thromboserisiko analysiert wurden. Die Ergebnisse mehrerer Evaluierungen werden in diesem Artikel zusammengefaßt.

Self-esteem links with anxiety and depression at one community adolescent sample

Introduction

Anxiety and depression is becoming an increasingly important public health issue. The adolescents’ population is among affected seriously.

Objectives

The objectives of the study was to investigate the level of anxiety, depression and self-esteem among adolescents and explore links between.

Methodology

Participants were 99 adolescents randomly selected in school, aged between 12 to 19 years (M = 14.88; SD = 2.09); in terms of gender composition, there were girls 41.1% and boys 58.9%. The measures used included the Albanian versions of depression self-rating scale for children, the revised children's manifest anxiety scale, and the rosenberg self-esteem scale. All data has been analysed by SPSS 21 and Excel 2007.

Results

Results showed that clinical significant levels reported 10.3% of participants for anxiety and 22.4% for depression. With low self-esteem scored 16.3% of participants. Self-esteem is significantly negatively correlated only with depression (r = -.433, P < .00). Mann-Whitney Test didn’t found significant differences in anxiety based on self-esteem levels. Mann-Whitney Test found significant differences in depression levels based on levels of self-esteem (Mdlowself-esteem = 15; n = 16; Mdnormalself-esteem = 10; n = 81) as adolescents with low self-esteem had significantly higher depression as compared to adolescents with normal self-esteem (z = -2.876, P < .004).

Conclusions

Findings suggested that self-esteem and depression links are present but not links self-esteem and anxiety. It is important to investigate these relationships in future research aimed identification/interventions programs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cation-Exchange Properties of Aluminium(III) Phosphate

Potentiometric titrations of aluminium(III) phosphate have been performed in the presence of aqueous electrolyte solutions containing Cu2+, Zn2+, Ni2+ and K+ ions as a function of the concentration of the latter, the pH and the temperature. The sorption of Zn2+ ions has also been studied and the data for metal ion sorption shown to correlate with the Potentiometric titration data, indicating that the process responsible for metal ion uptake is ion exchange. The pKa value of the exchanger and its thermodynamic parameters have been evaluated.

Exchange of Some Divalent Metal Cations and Their Effect on the Dissociation of Iron(III) Phosphate

Potentiometric titrations of iron(III) phosphate have shown an apparently weak monobasic acid behaviour towards alkali, alkaline earth and divalent transition metal ions. The selectivity sequence and dissociation of the exchanger was found to increase in the order Cu2+ > Zn2+ > Ni2+ > Ca2+ > K+. The dissociation constants of iron(III) phosphate have been determined from Potentiometric titration data in the temperature range 303–323 K. In addition, the exchange of Cu2+, Zn2+ and Co2+ on iron(III) phosphate and the effect of these ions on dissociation were also studied as a function of concentration, temperature and solution pH value. The thermodynamic parameters ΔH0, ΔS0 and ΔG0 for the dissociation of iron(III) phosphate are also presented.

Temperature and pH Effect on the Sorption of Divalent Metal Ions by Silica Gel

The sorption of Zn2+, Ni2+ and Cd2+ ions by silica gel was studied as a function of ion concentration, pH and temperature. An increase in all three parameters led to an increase in the extent of sorption for all the metal cations studied. The selectivity of the solid was observed to be in the order Zn2+ > Ni2+ > Cd2+. Sorption of the metal cations was accompanied by the release of H+ ions into the bulk phase. On average two moles of H+ ions were released per mole of metal cation sorbed. The sorption data fitted the linear forms of both the Kurbatov and Langmuir adsorption equations. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS, for the adsorption process. FT-IR spectroscopic studies also showed that the uptake of metal cations by the silica gel occurred via a cation-exchange process.

Sorption of Metal Ions on a Mixed Oxide [0.5 M SiO2:0.5 M Fe(OH)3]

The sorption of Zn2+, Ni2+, Cd2+, Ca2+ and Mg2+ ions on to a mixed oxide of iron and silicon was found to increase with increasing temperature, concentration and pH of the system. The selectivity of this mixed oxide was Cd2+ ≥ Zn2+ ≥ Ni2+ > Ca2+ > Mg2+, indicating that the mixed oxide was more selective as an exchanger towards Cd2+ ions relative to its components, SiO2 and Fe(OH)3. The sorption data fitted the linear forms of the Kurbatov and Langmuir adsorption equations. The sorption of metal cations was accompanied by the release of H+ ions to the bulk phase. On average 1 mol H+ was released for every cation sorbed. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS. The phenomenon of enthalpy/entropy compensation showed that the adsorption of metal ions by the mixed oxide occurred typically through a cation-exchange mechanism.

Cation-Exchange Properties of CrPO4

Alkali metal ion exchange (Li+, Na+ and K+) on chromium phosphate (CrPO4) was studied potentiometrically as a function of temperature and metal ion concentration. The shift in the potentiometric titration curves corresponding to the exchange of alkali metal cations increased with increasing pH and concentration of the metal ions, while the opposite results were obtained by increasing the temperature of the system. The affinity of the exchanger for alkali metal ions was also found to be in the order Li+ > Na+ > K+. The data were employed to evaluate the apparent deprotonation constants of CrPO4 and the corresponding thermodynamic parameters ΔH0, ΔS0 and ΔG0.

Temperature Effect on the Surface Properties of ZnO(am)

The point of zero charge and surface acidity constants of zinc oxide were determined over the temperature range 293–323 K. Both the point of zero charge (pzc) and the surface acidity constants (pKa1 and pKa2) were found to decrease with increasing temperature. The values of the dissociation constants (pKa1 and pKa2) determined from the Henderson-Hasselbach equation agreed very well with those determined using the Gaines-Thomas equation. The thermodynamic parameters ΔH0 and ΔS0 for the processes were also evaluated.

The role of TWEAK/Fn14 signaling in the MPTP-model of Parkinson's disease

The tumor necrosis factor like weak inducer of apoptosis (TWEAK) and its receptor, fibroblast growth factor-inducible 14 (Fn14), mediate inflammation and neuronal apoptosis in cerebral edema, ischemic stroke and multiple sclerosis. The downstream effectors and pathways linked to TWEAK-Fn14 signaling are strongly implicated in the pathology of Parkinson's disease (PD), thus indicating a putative role for TWEAK/Fn14 signaling in PD neurodegeneration. Using the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model, we aimed to determine whether genetic ablation or pharmacologic mitigation of the TWEAK protein and its Fn14 receptor affected substantia nigra and striatum Parkinsonian pathology. Changes in endogenous TWEAK protein expression were also quantified in tissue from both MPTP-treated mice and PD human samples. TWEAK protein expression was transiently increased in the striatal tissue but remained unaltered in substantia nigra tissue of MPTP-treated mice. There was also no change of TWEAK protein levels in the substantia nigra or the striatum of human PD patients as compared to matched control subjects. Mitigating the effects of endogenous TWEAK protein using neutralizing antibody did affect MPTP-mediated neurotoxicity in the substantia nigra using the sub-acute model of MPTP (30mg/kg i.p. over five consecutive days). Neither TWEAK nor Fn14 genetic ablation led to attenuation of MPTP-toxicity in the acute model. These findings suggest that TWEAK signaling might be an aspect of MPTP-mediated neuropathology and be involved in the overall neurodegenerative pathology of PD.