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Cell Biology and Toxicology Jul 2024The implementation of Zinc oxide nanoparticles (ZnO NPs) raises concerns regarding their potential toxic effects on human health. Although more and more researches have...
The implementation of Zinc oxide nanoparticles (ZnO NPs) raises concerns regarding their potential toxic effects on human health. Although more and more researches have confirmed the toxic effects of ZnO NPs, limited attention has been given to their impact on the early embryonic nervous system. This study aimed to explore the impact of exposure to ZnO NPs on early neurogenesis and explore its underlying mechanisms. We conducted experiments here to confirm the hypothesis that exposure to ZnO NPs causes neural tube defects in early embryonic development. We first used mouse and chicken embryos to confirm that ZnO NPs and the Zn they release are able to penetrate the placental barrier, influence fetal growth and result in incomplete neural tube closure. Using SH-SY5Y cells, we determined that ZnO NPs-induced incomplete neural tube closure was caused by activation of various cell death modes, including ferroptosis, apoptosis and autophagy. Moreover, dissolved Zn played a role in triggering widespread cell death. ZnO NPs were accumulated within mitochondria after entering cells, damaging mitochondrial function and resulting in the over production of reactive oxygen species, ultimately inducing cellular oxidative stress. The N-acetylcysteine (NAC) exhibits significant efficacy in mitigating cellular oxidative stress, thereby alleviating the cytotoxicity and neurotoxicity brought about by ZnO NPs. These findings indicated that the exposure of ZnO NPs in early embryonic development can induce cell death through oxidative stress, resulting in a reduced number of cells involved in early neural tube closure and ultimately resulting in incomplete neural tube closure during embryo development. The findings of this study could raise public awareness regarding the potential risks associated with the exposure and use of ZnO NPs in early pregnancy.
Topics: Zinc Oxide; Animals; Oxidative Stress; Chick Embryo; Embryonic Development; Mice; Neural Tube; Humans; Neural Tube Defects; Reactive Oxygen Species; Apoptosis; Cell Death; Female; Mitochondria; Metal Nanoparticles; Autophagy; Cell Line, Tumor; Nanoparticles
PubMed: 38958792
DOI: 10.1007/s10565-024-09894-1 -
The Journal of Bone and Joint Surgery.... Jul 2024Type 2 diabetes mellitus (T2DM) and spinal degenerative disorders (SDD) are common diseases that frequently coexist. However, both traditional observational studies and... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Type 2 diabetes mellitus (T2DM) and spinal degenerative disorders (SDD) are common diseases that frequently coexist. However, both traditional observational studies and recent Mendelian randomization (MR) studies have demonstrated conflicting evidence on the association between T2DM and SDD. This comparative study explored and compared the association between T2DM and SDD using observational and MR analyses.
METHODS
For observational analyses, cross-sectional studies (44,972 participants with T2DM and 403,095 participants without T2DM), case-control studies (38,234 participants with SDD and 409,833 participants without SDD), and prospective studies (35,550 participants with T2DM and 392,046 participants without T2DM with follow-up information until 2022) were performed to test the relationship between T2DM and SDD using individual-level data from the U.K. Biobank from 2006 to 2022. For MR analyses, the associations between single-nucleotide polymorphisms with SDD susceptibility obtained using participant data from the U.K. Biobank, which had 407,938 participants from 2006 to 2022, and the FinnGen Consortium, which had 227,388 participants from 2017 to 2022, and genetic predisposition to T2DM obtained using summary statistics from a pooled genome-wide association study involving 1,407,282 individuals were examined. The onset and severity of T2DM are not available in the databases being used.
RESULTS
Participants with T2DM were more likely to have SDD than their counterparts. Logistic regression analysis identified T2DM as an independent risk factor for SDD, which was confirmed by the Cox proportional hazard model results. However, using single-nucleotide polymorphisms as instruments, the MR analyses demonstrated no causal relationship between T2DM and SDD. The lack of such an association was robust in the sensitivity analysis, and no pleiotropy was seen.
CONCLUSIONS
Our results suggest that the association between T2DM and SDD may be method-dependent. Researchers and clinicians should be cautious in interpreting the association, especially the causal association, between T2DM and SDD. Our findings provide fresh insights into the association between T2DM and SDD by various analysis methods and guide future research and clinical efforts in the effective prevention and management of T2DM and SDD.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Diabetes Mellitus, Type 2; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide; Female; Male; Case-Control Studies; Middle Aged; Genetic Predisposition to Disease; Cross-Sectional Studies; Prospective Studies; Observational Studies as Topic; Aged; Genome-Wide Association Study
PubMed: 38958660
DOI: 10.2106/JBJS.23.00984 -
Annals of Surgery Jul 2024A recent study of 21 institutions noted significant differences between number of cases reported during general surgery residency by trainees who are Underrepresented in...
OBJECTIVES
A recent study of 21 institutions noted significant differences between number of cases reported during general surgery residency by trainees who are Underrepresented in Medicine (URiM) versus trainees who are not Underrepresented in Medicine (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time this data has been examined nationally.
METHODS
We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t- tests for female versus male and URiM versus non- URiM overall case numbers.
RESULTS
A total of 6,458 residents submitted case logs from 319 accredited programs. Eight-hundred and fifty-four (13%) were URiM and 5,604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD +/- 160.57) major cases versus 1115.96 (+/- 160.53) for non-URiM residents (difference =19 cases, P=0.001). Case logs were submitted by 3,833 (60.1%) male residents and 2,625 (39.9%) female residents over the five-year study period. Male residents reported 1128.56 (SD +/- 168.32) cases versus 1091.38 (+/- 145.98) cases reported by females (difference=37.18, P<0.001). When looking at Surgeon Chief and Teaching Assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers (P<0.001).
CONCLUSIONS
Overall, URiM residents submitted fewer cases in the five- year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30-40 cases can amount to 1-3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.
PubMed: 38957982
DOI: 10.1097/SLA.0000000000006373 -
British Journal of Clinical Pharmacology Jul 2024This systematic review aimed to investigate the occurrence of moderate and severe adverse drug reactions (ADRs) to antimicrobials among hospitalized children. (Review)
Review
AIMS
This systematic review aimed to investigate the occurrence of moderate and severe adverse drug reactions (ADRs) to antimicrobials among hospitalized children.
METHODS
The PubMed/Medline, Cochrane Library, Embase, Web of Science, Scopus, Lilacs and CINAHL databases were searched in April 2023 to systematically review the published data describing the characteristics of moderate and severe ADRs to antimicrobials among hospitalized children. The search was carried out without date restrictions, up to the search date (April, 2023).
RESULTS
At the end of the selection process, 30 articles met the inclusion criteria. Cutaneous reactions were the primary serious clinical manifestations in most articles (19/30), followed by erythema multiforme (71 cases), Stevens-Johnson syndrome (72 cases), and toxic epidermal necrolysis (22 cases). The main antimicrobials involved in moderate and severe ADRs were penicillins, cephalosporins and sulfonamides. Regarding the primary outcomes, 30% (9/30) of the articles reported deaths, and 46.7% (14/30) of studies reported increased lengths of hospital stay, need for intensive care, and transfer to another hospital. Regarding the main interventions, 10% (3/30) of the articles mentioned greater monitoring, suspension, medication substitution or prescription of specific medications for the symptomatology.
CONCLUSIONS
The findings of this review could be used to identify areas for improvement and help health professionals and policymakers develop strategies. In addition, we emphasize the importance of knowing about ADRs so that there is adequate management to avoid undesirable consequences.
PubMed: 38957966
DOI: 10.1111/bcp.16153 -
MedEdPORTAL : the Journal of Teaching... 2024Community partnership is a key strategy for addressing the social determinants of health and achieving health equity. There are few examples of curricula for...
INTRODUCTION
Community partnership is a key strategy for addressing the social determinants of health and achieving health equity. There are few examples of curricula for undergraduate medical education that teach all, rather than self-selected, medical students to collaborate with community members to improve health. We describe the design and implementation of the Community Health Advocacy Initiative (CHAI) curriculum, a new yearlong educational program for medical students at Northwestern University's Feinberg School of Medicine.
METHODS
CHAI aimed to fill the curricular gap in social determinants of health education by providing medical students with the knowledge and skills to improve the health of patients through collaborations with community partners. This longitudinal curriculum included structured faculty mentorship and an applied community experience.
RESULTS
The CHAI curriculum was delivered to 164 second-year medical students in academic year 2021-2022. Faculty mentors rated most students as meeting expectations for application of community partnership principles and demonstration of professionalism. Qualitative analysis of faculty mentor comments demonstrated that medical students exhibited positive outcomes in engaging with community organizations, overcoming barriers, developing feasible and impactful goals, and advancing their own knowledge and skills.
DISCUSSION
Implementing a community health curriculum for all medical students is feasible and represents an important model for teaching about the importance of community partnerships in addressing the social determinants of health.
Topics: Humans; Curriculum; Students, Medical; Education, Medical, Undergraduate; Problem-Based Learning; Social Determinants of Health; Longitudinal Studies; Mentors
PubMed: 38957527
DOI: 10.15766/mep_2374-8265.11415 -
Public Health Action Jun 2024Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital...
INTRODUCTION
Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs).
METHODS
The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25.
RESULTS
Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network ( = 9, 37.5%) and ( = 1, 4.2%) power failure.
CONCLUSION
DATs help HCWs provide better support and care regarding real-time tracking of their patients' adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.
PubMed: 38957501
DOI: 10.5588/pha.24.0008 -
Public Health Action Jun 2024Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned...
INTRODUCTION
Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB.
METHODS
This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB.
RESULT
A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs.
CONCLUSION
DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients.
PubMed: 38957499
DOI: 10.5588/pha.24.0009 -
Ghana Medical Journal Mar 2024To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana.
OBJECTIVES
To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana.
DESIGN
We employed a cross-sectional design using a quantitative approach.
SETTING
The Radiotherapy, Oncology and Surgery Departments of the Korle Bu Teaching Hospital, Accra.
PARTICIPANTS
Inpatient and outpatient breast cancer patients.
MAIN OUTCOME MEASURES
The level of inpatient and outpatient satisfaction was measured using descriptive and inferential statistical analyses. The Shapiro-Wilk test was employed to assess normality, while the Heckman selection model assessed significance with outcomes of interest.
RESULTS
A total of 636 participants, with a mean age of 52.64±14.07 years, were recruited. The measured inpatient and outpatient levels of satisfaction out of 100 were 74.06±7.41 and 49.99±1.00 respectively, while the self-reported satisfaction levels out of 5 were 4.22±0.63 and 4.11±0.85 respectively. The level of inpatient satisfaction was significantly influenced by age, marital status, income level, and number of previous facilities visited (p<0.05). Outpatient satisfaction level was significantly associated with place of residence and income level (p<0.05).
CONCLUSIONS
The study offers insight into the satisfaction levels of breast cancer patients receiving inpatient and outpatient services at the largest tertiary referral centre and teaching hospital in Ghana, as well as the factors influencing attendance and satisfaction levels. Understanding and improving breast cancer patients' levels of satisfaction is a way that providers can safeguard their emotional well-being. Improvement in patient satisfaction at our institution among outpatients is an area for future growth.
FUNDING
Gardner-Holt Women's Health Grant program, Centre for Global Surgery 2021.
Topics: Humans; Ghana; Female; Breast Neoplasms; Middle Aged; Cross-Sectional Studies; Adult; Patient Satisfaction; Aged; Tertiary Care Centers; Outpatients; Inpatients
PubMed: 38957283
DOI: 10.4314/gmj.v58i1.3 -
Taiwanese nurse educators' behaviour or intention to teach LGBT health content: A qualitative study.International Nursing Review Jul 2024To explore factors associated with Taiwanese nurse educators' behaviour or intention to teach lesbian, gay, bisexual and transgender (LGBT) health content.
AIM
To explore factors associated with Taiwanese nurse educators' behaviour or intention to teach lesbian, gay, bisexual and transgender (LGBT) health content.
BACKGROUND
Nurse educators were found to have limited experiences and readiness to teach LGBT health content. However, limited evidence exists to comprehensively understand factors associated with nurse educators' behaviour and intentions to teach LGBT health content.
METHODS
A qualitative descriptive study design was adopted. A total of 24 nurse educators were interviewed. One-on-one interviews were conducted employing a semi-structured topic guide and were audio-recorded. Interview data were analysed using the socio-ecological model and constant comparative technique. This article was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.
FINDINGS
Most nurse educators had no experience of teaching LGBT health content and expressed their low or no intention to teach it. Factors associated with nurse educators' behaviour and intention to teach LGBT content were categorised by the socio-ecological model level: intrapersonal factors, interpersonal factors, community factors and societal and policy factors.
CONCLUSION
This study identified multilevel factors associated with Taiwanese nurse educators' behaviour and intention to teach LGBT health content. Recommendations were provided to address multilevel barriers to diminish nurse educators' challenges in teaching LGBT health content.
IMPLICATIONS FOR NURSING AND NURSING POLICY
Supervisors of nurse educators should assess and discuss nurse educators' concerns and competencies regarding teaching LGBT health content. To address schools' or organisations' adverse climates and conventional societal atmosphere, related policies and regulations should be developed and implemented.
PubMed: 38957098
DOI: 10.1111/inr.13014 -
Teaching and Learning in Medicine Jul 2024Clinical medicine's complexities and demands often surpass the scope of formal ethics and leadership training that medical schools and residency programs provide. The...
Clinical medicine's complexities and demands often surpass the scope of formal ethics and leadership training that medical schools and residency programs provide. The discrepancy between medical education and the realities of clinical work may contribute to ethical erosion among learners, namely, medical students and residents. Unlike traditional approaches to teaching professional ethics and leadership in medicine, rights-based (aspirational) pedagogies approach trainees as , whose work has moral value to themselves and others, who live with the ethical consequences of their professional choices, and whose work shapes their individual moral character. By incorporating teaching strategies that intentionally build learners' rights-based leadership through the development of moral courage, medical educators may counter important aspects of ethical erosion while promoting learner preparedness, outcomes, and well-being. Military teaching approaches offer a valuable example to medical educators seeking to create structured curricula that foster moral courage to promote rights-based leadership, given the high level of moral and managerial complexity present in both medicine and the military. Through a comparative analysis of professional ethics in the medical and military disciplines, this article explores the validity of applying precedents from military ethics and leadership education to medical training. Through arguments rooted in moral philosophy, military history, and military organizational research, we explore the expansion of rights-based teaching methods within the predominantly traditional and rules-based norms of medical education. In relating these findings to real-life clinical scenarios, we offer six specific, rights-based modifications to medical ethics curricula that have potential to promote morally courageous leadership and counteract the ethical erosion medical students and residents face.
PubMed: 38956858
DOI: 10.1080/10401334.2024.2369611