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AnteayerPLOS ONE Medicine&Health

The COVID-19 pandemic effect on the prehospital Madrid stroke code metrics and diagnostic accuracy

by Nicolás Riera-López, Andrea Gaetano-Gil, José Martínez-Gómez, Nuria Rodríguez-Rodil, Borja M. Fernández-Félix, Jorge Rodríguez-Pardo, Carmen Cuadrado-Hernández, Emmanuel Pelayo Martínez-González, Alicia Villar-Arias, Fátima Gutiérrez-Sánchez, Pablo Busca-Ostolaza, Eduardo Montero-Ruiz, Exuperio Díez-Tejedor, Javier Zamora, Blanca Fuentes-Gimeno, on behalf of the Madrid Stroke Network


Only very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year.


This was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality.


SUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value = Conclusions

During the first wave, a prolongation of the time “on the scene” of the management of the 112 calls, and of the hospital admission was observed. Prehospital diagnostic accuracy and the proportion of patients treated at the hospital level with intravenous thrombolysis or mechanical thrombectomy were not altered with respect to the previous year, showing the resilience of the stroke network and the emergency medical service.

Verbal and psychological violence against women in Turkey and its determinants

by Ömer Alkan, Ceyhun Serçemeli, Kenan Özmen

Verbal and psychological violence against women is considered an important sociological and legal problem and a serious threat within the context of basic human rights. The aim of this study was to detect the factors affecting verbal and psychological violence against women in Turkey, a developing country. The micro data set of the National research on domestic violence against women in Turkey, which was conducted by the Hacettepe University Institute of Population Studies, was employed in this study. The factors affecting women’s exposure to verbal and psychological violence by their husbands or partners in Turkey were determined using binary logistic and binary probit regression analyses. Women whose husbands or partners cheated and used alcohol were more exposed to verbal and psychological violence compared to others. In addition, women who were exposed to physical, economic, and sexual violence were more exposed to verbal and psychological violence compared to others. Exposure to violence by first-degree relatives increases the possibility of exposure to verbal and psychological violence. More effective results can be achieved by prioritizing women likelier to be exposed to violence in policies aimed at preventing acts of verbal violence against women in our country. There are few studies on verbal and psychological violence against women. Therefore, it will be useful to conduct relevant studies from different perspectives.

Impact of the COVID-19 pandemic on changes in temperature-sensitive cardiovascular and respiratory disease mortality in Japan

by Yukitaka Ohashi, Yuya Takane, Ko Nakajima

Some cardiovascular and respiratory diseases are triggered by changes in ambient temperature or extremes of temperature. This study aimed to clarify the changes in mortality associated with temperature-sensitive diseases in Japan during the COVID-19 pandemic. We used data from three major cities (Sapporo City, Tokyo 23 wards, and Osaka City) from 2010 to 2019 to determine disease mortality rates and monthly mean temperatures from April to December. If the pandemic had not occurred in 2020, the results showed that temperature-sensitive disease death counts would have increased from 324 to 980, based on a 95% confidence interval estimated from the past 10 years in Sapporo (19–56% increase in actual deaths from 2020), from 651 to 2,653 in Tokyo (10–39% increase), and from 235 to 1,343 in Osaka (8–48% increase). Analyses of meshed population data during the COVID-19 pandemic indicated that inhibiting people’s behaviour and outdoor mobility, especially in older men, caused a decrease in mortality.

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass

by Naoki Akazawa, Masaki Kishi, Toshikazu Hino, Ryota Tsuji, Kimiyuki Tamura, Akemi Hioka, Hideki Moriyama

Background & aim

A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia.


This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy.


Echo intensity of the quadriceps (β = −0.363, p = 0.012) and FILS at admission (β = 0.556, p 2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = −0.498, p = 0.012] and FILS at admission [β = −0.635, p 2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS.


Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.

Automated multi-class classification for prediction of tympanic membrane changes with deep learning models

by Yeonjoo Choi, Jihye Chae, Keunwoo Park, Jaehee Hur, Jihoon Kweon, Joong Ho Ahn

Backgrounds and objective

Evaluating the tympanic membrane (TM) using an otoendoscope is the first and most important step in various clinical fields. Unfortunately, most lesions of TM have more than one diagnostic name. Therefore, we built a database of otoendoscopic images with multiple diseases and investigated the impact of concurrent diseases on the classification performance of deep learning networks.

Study design

This retrospective study investigated the impact of concurrent diseases in the tympanic membrane on diagnostic performance using multi-class classification. A customized architecture of EfficientNet-B4 was introduced to predict the primary class (otitis media with effusion (OME), chronic otitis media (COM), and ’None’ without OME and COM) and secondary classes (attic cholesteatoma, myringitis, otomycosis, and ventilating tube).


Deep-learning classifications accurately predicted the primary class with dice similarity coefficient (DSC) of 95.19%, while misidentification between COM and OME rarely occurred. Among the secondary classes, the diagnosis of attic cholesteatoma and myringitis achieved a DSC of 88.37% and 88.28%, respectively. Although concurrent diseases hampered the prediction performance, there was only a 0.44% probability of inaccurately predicting two or more secondary classes (29/6,630). The inference time per image was 2.594 ms on average.


Deep-learning classification can be used to support clinical decision-making by accurately and reproducibly predicting tympanic membrane changes in real time, even in the presence of multiple concurrent diseases.

Psychological and behavioral responses to the declaration of COVID-19 as a pandemic: A comparative study of Hong Kong, Singapore, and the U.S.

by Jingshi (Joyce) Liu, Anirban Mukhopadhyay, Catherine Wing-Man Yeung

What is the effect of declaring a pandemic? This research assesses behavioral and psychological responses to the WHO declaration of the COVID-19 pandemic, in Hong Kong, Singapore, and the U.S. We surveyed 3,032 members of the general public in these three regions about the preventative actions they were taking and their worries related to COVID-19. The WHO announcement on March 11th, 2020 created a quasi-experimental test of responses immediately before versus after the announcement. The declaration of the pandemic increased worries about the capacity of the local healthcare system in each region, as well as the proportion of people engaging in preventative actions, including actions not recommended by medical professionals. The number of actions taken correlates positively with anxiety and worries. Declaring the COVID-19 crisis as a pandemic had tangible effects–positive (increased community engagement) and negative (increased generalized anxiety)–which manifested differently across regions in line with expectancy disconfirmation theory.

Comparison of tests done, and tuberculosis cases detected by Xpert® MTB/RIF and Xpert® MTB/RIF-Ultra in Uganda

by Michael Kakinda, Didas Tugumisirize, Abdunoor Nyombi, Marvin Mugisha, Stavia Turyahabwe, Simon Walusimbi, Joseph K. B. Matovu


Uganda introduced Xpert® MTB/RIF assay into its TB diagnostic algorithm in January 2012. In July 2018, this assay was replaced with Xpert® MTB/RIF Ultra assay. We set out to compare the tests done and tuberculosis cases detected by Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assay in Uganda.


This was a before and after study, with the tests done and TB cases detected between Jan-June 2019 when using Xpert® MTB/RIF Ultra assay compared to those done between Jan-June 2018 while using Xpert® MTB/RIF assay. This data was analyzed using Stata version 13, it was summarized into measures of central tendency and the comparison between Xpert® MTB/RIF Ultra and Xpert® MTB/RIF was explored using a two-sided T-test which was considered significant if p Results

One hundred and twelve (112) GeneXpert sites out of a possible 239 were included in the study. 128,476 (M: 1147.11, SD: 842.88) tests were performed with Xpert® MTB/RIF Ultra assay, with 9693 drug-susceptible TB (DS-TB) cases detected (M: 86.54, SD: 62.12) and 144 (M: 1.28, SD: 3.42) Rifampicin Resistant TB cases (RR-TB). Whilst 107, 890 (M: 963.30, SD: 842.88) tests were performed with Xpert® MTB/RIF assay between, 8807 (M: 78.63, SD: 53.29) DS-TB cases were detected, and 147 (M: 1.31, SD: 2.39) RR-TB cases. The Number Need to Test (NNT) to get one TB case was 12 for Xpert® MTB/RIF and 13 for Xpert ®MTB/RIF Ultra. On comparing the two assays in terms of test performance (p = 0.75) and case detection both susceptible TB (p = 0.31) and RR-TB (p = 0.95) were not found statistically significant.


This study found no significant difference in test performance and overall detection of DS-TB and RR-TB when using Xpert® MTB/RIF Ultra and Xpert® MTB/RIF assays. The health systems approach should be used to elucidate all the probable potential of Xpert® MTB/RIF Ultra.

Do reasons for undergoing bariatric surgery influence weight loss and health-related quality of life?–A Swedish mixed method study

by Maria Jaensson, Emma Josefsson, Erik Stenberg, Karuna Dahlberg


A wish for improved health or avoidance of ill health is often given as reason for wanting to undergo bariatric surgery. How such reasons relate to postoperative outcome is unclear.


The aim was to explore Swedish patients’ reasons for undergoing bariatric surgery. Also, we wanted to analyze if there were sex and age differences and associations with weight loss and health-related quality of life (HRQoL).


This was a single-center study conducted at a university hospital.


Data on 688 patients (528 women and 160 men) including a free text response was analyzed inductively and deductively using predefined statements and was merged with data from the Scandinavian Obesity Surgery Registry. All data was analyzed using descriptive and analytic statistics.


The most common reason for undergoing bariatric surgery was pain in different body parts. A wish for an improved medical condition was reported by most patients (59%, n = 408), followed by physical limitations making daily life difficult (42%, n = 288). Men and women reported similar reasons. Younger patients were more distressed about physical appearance (p = 0.001) and older patients wanted to improve their medical condition (p = 0.013). Health-related quality of life improved irrespective of reasons for undergoing surgery.


The most reported reasons for undergoing bariatric surgery were a wish for improved medical condition and to make daily life easier. Factors associated with the decision for surgery showed that there were few sex differences, but age seemed to be a factor. The HRQoL trajectory showed improvement regardless of reasons for undergoing surgery.

Manipulation of Interleukin-6 (IL-6) and Transforming Growth Factor Beta-1(TGFβ-1) towards viral induced liver cancer pathogenesis

by Yasmin Badshah, Maria Shabbir, Khushbukhat Khan, Maha Fatima, Iqra Majoka, Laiba Aslam, Huda Munawar

Hepatocellular carcinoma (HCC) is the most common liver malignancy. Early diagnosis of HCC has always been challenging. This study aims to assess the pathogenicity and the prevalence of IL-6 -174G/C (rs1800795) and TGFβ-1 +29C/T (rs1800470) polymorphisms in HCV-infected HCC patients. Experimental strategies are integrated with computational approaches to analyse the pathogenicity of the TGFβ-1 +29C/T and IL-6–174 G/C polymorphisms in HCV-induced HCC. AliBaba2 was used to predict the effect of IL-6–174 G/C on transcription factor binding site in IL-6 gene. Structural changes in the mutant TGFβ-1 structure were determined through project HOPE. To assess the polymorphic prevalence of IL-6 -174G/C and TGFβ-1 +29C/T genotypes in HCC and control subjects, amplification refractory mutation system PCR (ARMS-PCR) was performed on 213 HCC and 216 control samples. GraphPad Prism version 8.0 was used for the statistical analysis of the results. In-silico analysis revealed the regulatory nature of both IL-6 -174G/C and TGFβ-1 +29C/T polymorphisms. ARMS-PCR results revealed that the individuals carrying TT genotype for TGFβ-1 gene have an increased risk of developing HCC (p

The efficacy and tolerability of combining pemetrexed-based chemotherapy with gefitinib in the first-line treatment of non-small cell lung cancer with mutated EGFR: A pooled analysis of randomized clinical trials

by Bi-Cheng Wang, Wen-Xuan Zhang, Bo-Hua Kuang, Guo-He Lin


Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) monotherapy is the standard of care in treating advanced non-small cell lung cancer (NSCLC). Nevertheless, whether adding pemetrexed-based chemotherapy to EGFR-TKI targeted therapy furtherly prolongs survival outcomes and improves responses remains controversial. Therefore, we conducted this pooled analysis to compare the efficacy and tolerability between gefitinib plus pemetrexed-based chemotherapy and gefitinib alone in the first-line treatment of advanced NSCLC patients with mutated EGFR.


We systematically searched PubMed, Web of Science, Embase, and Cochrane CENTRAL on June 23, 2022. Eligible studies were registered randomized clinical trials comparing gefitinib plus pemetrexed-based chemotherapy with gefitinib alone. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Objective response rate (ORR), disease control rate (DCR), and discontinuation rate (DR) were explored as secondary outcomes.


Eight studies within five randomized clinical trials were eligible. Gefitinib combined with pemetrexed-based chemotherapy significantly prolonged OS (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.37–0.89, p = 0.0125) and PFS (HR 0.52, 95% CI 0.39–0.70, p Conclusion

Compared with gefitinib alone, combining pemetrexed-based chemotherapy with gefitinib significantly improved OS and PFS in advanced EGFR-mutant NSCLC patients with acceptable tolerability. However, the accurate sub-population who could have OS benefits requires further validation.

Immunomodulatory effects of chicken cathelicidin-2 on a primary hepatic cell co-culture model

by Csilla Sebők, Stephanie Walmsley, Patrik Tráj, Máté Mackei, Júlia Vörösházi, Janka Petrilla, László Kovács, Ágnes Kemény, Zsuzsanna Neogrády, Gábor Mátis

Cathelicidin-2 is an antimicrobial peptide (AMP) produced as part of the innate immune system of chickens and might be a new candidate to combat infection and inflammation within the gut-liver axis. Studying the hepatic immune response is of high importance as the liver is primarily exposed to gut-derived pathogen-associated molecular patterns. The aim of the present study was to assess the effects of chicken cathelicidin-2 alone or combined with lipoteichoic acid (LTA) or phorbol myristate acetate (PMA) on cell viability, immune response and redox homeostasis in a primary hepatocyte—non-parenchymal cell co-culture of chicken origin. Both concentrations of cathelicidin-2 decreased the cellular metabolic activity and increased the extracellular lactate dehydrogenase (LDH) activity reflecting reduced membrane integrity. Neither LTA nor PMA affected these parameters, and when combined with LTA, cathelicidin-2 could not influence the LDH activity. Cathelicidin-2 had an increasing effect on the concentration of the proinflammatory CXCLi2 and interferon- (IFN-)γ, and on that of the anti-inflammatory IL-10. Meanwhile, macrophage colony stimulating factor (M-CSF), playing a complex role in inflammation, was diminished by the AMP. LTA elevated IFN-γ and decreased M-CSF levels, while PMA only increased the concentration of M-CSF. Both concentrations of cathelicidin-2 increased the H2O2 release of the cells, but the concentration of malondialdehyde as a lipid peroxidation marker was not affected. Our findings give evidence that cathelicidin-2 can also possess anti-inflammatory effects, reflected by the alleviation of the LTA-triggered IFN-γ elevation, and by reducing the M-CSF production induced by PMA. Based on the present results, cathelicidin-2 plays a substantial role in modulating the hepatic immune response with a multifaceted mode of action. It was found to have dose-dependent effects on metabolic activity, membrane integrity, and reactive oxygen species production, indicating that using it in excessively high concentrations can contribute to cell damage. In conclusion, cathelicidin-2 seems to be a promising candidate for future immunomodulating drug development with an attempt to reduce the application of antibiotics.

Explicit and implicit attitudes toward smoking: Dissociation of attitudes and different characteristics for an implicit attitude in smokers and nonsmokers

by Xinyue Gao, Daisuke Sawamura, Ryuji Saito, Yui Murakami, Rika Yano, Satoshi Sakuraba, Susumu Yoshida, Shinya Sakai, Kazuki Yoshida

Smoking is a global health risk for premature death and disease. Recently, addictive behaviors, like smoking, were considered to be guided by explicit and implicit processes. The existence of a dissociation between the two attitudes in nonsmokers and the causes of the differences in implicit attitudes toward smoking have not been fully investigated. We investigated the explicit and implicit attitudes toward smoking via a self-reported scale and the single category implicit association test (SC-IAT), respectively, among undergraduate and graduate health sciences students. In addition, we applied the drift-diffusion model (DDM) on the SC-IAT and examined the behavioral characteristics that caused differences in implicit attitude toward smoking between smokers and nonsmokers. The results showed the existence of a dissociation between explicit and implicit attitudes toward smoking among nonsmokers. In addition, nonsmokers had a higher decision threshold than smokers and a higher drift rate in the condition where negative words were associated with smoking. Nonsmokers engaged in SC-IAT with more cautious attitudes and responded more easily in a negative condition since it was consistent with their true attitudes. Conversely, smokers did not show a significant difference in the drift rate between the conditions. These results suggested that the differences in an implicit attitude between smokers and nonsmokers were caused by differences in evidence accumulation speed between the positive and negative conditions. The existence of dissociation between implicit and explicit attitudes toward smoking may indicate the difficulty of measuring true attitude in nonsmokers in a questionnaire survey. Additionally, the DDM results explained the difference of implicit attitude between smokers and nonsmokers; it may provide information on the mechanisms of addictive behaviors and a basis for therapy. However, whether these results are affected by cultural differences requires further investigation.

Effects of assisted reproductive technology on severe maternal morbidity risk in both singleton and multiple births in Korea: A nationwide population-based cohort study

by Jin Young Nam, Seoyeon Hwang, Sung-In Jang, Eun-Cheol Park


Whether infertility treatment predicts severe maternal morbidity in both singleton and twin pregnancies is controversial. We conducted this nationwide population-based cohort study to compare pregnancies conceived through assisted reproductive technology treatments, such as intrauterine insemination or in vitro fertilization, with unassisted pregnancies.


This study included 269,930 women who experienced childbirth in 2018, using data of the National Health Insurance Service National Delivery Cohort in Korea. The primary outcome was assessed using a severe maternal morbidity algorithm developed by the Centers for Disease Control and Prevention in the United States. A modified Poisson regression was used to estimate the adjusted risk ratio of severe maternal morbidity.


Severe maternal morbidity occurred in 6,333 (2.3%) of 280,612 deliveries investigated. The risk of severe maternal morbidity was approximately 1.5-fold higher among women who received in vitro fertilization (risk ratio: 1.51, 95% confidence interval: 1.36–1.68) than among fertile women. However, no significant association between intrauterine insemination and maternal morbidity was identified. Via subgroup analysis, in vitro fertilization increased the risk of severe maternal morbidity by 1.6- and 1.3-fold in singleton and multiple births, respectively (singleton: risk ratio: 1.62, 95% confidence interval: 1.43–1.83; multiple birth: risk ratio: 1.31, 95% confidence interval: 1.07–1.60).


This study suggested that in vitro fertilization was associated with the risk of severe maternal morbidity in both singleton and multiple births. Further research should identify patient- and treatment-specific factors that may mitigate or prevent adverse maternal health risks.

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia

by Yikeber Abebaw Moyehodie, Solomon Sisay Mulugeta, Seyifemickael Amare Yilema


Community-based health insurance (CBHI) is a type of volunteer health insurance that has been adopted all over the world in which people of the community pool funds to protect themselves from the high costs of seeking medical care and treatment for the disease. In Ethiopia, healthcare services are underutilized due to a lack of resources in the healthcare system. The study aims to identify the individual and community level factors associated with community-based health insurance enrollment of households in Ethiopia.


Data from the Ethiopian mini demographic and health survey 2019 were used to identify factors associated with community-based health insurance enrollment of households in Ethiopia. Multilevel logistic regression analysis was used on a nationally representative sample of 8,663 households nested within 305 communities, considering the data’s layered structure. We used a p-value Result

The prevalence of community-based health insurance enrollment in Ethiopia was 20.2%. The enrollment rate of households in the scheme was high in both Amhara (57.9), and Tigray (57.9%) regions and low (3.0%) in the Afar region. At the individual level; the age of household heads, number of children 5 and under, number of household members, has land for agriculture, has a mobile telephone, receiving cash of food from the safety Net Program, Owning livestock, and herds of farm animals, wealth index, and at the community level; the region had a significant association with community-based health insurance enrollment.


Both individual and community-level characteristics were significant predictors of community-based health insurance enrollment in households. Furthermore, the ministry of health, health bureaus, and other concerning bodies prioritize clusters with low health insurance coverage to strengthen health system financing and intervene in factors that negatively affect the CBHI enrollment of households.

The protein phosphatase 2A catalytic subunit StPP2Ac2b enhances susceptibility to <i>Phytophthora infestans</i> and senescence in potato

by María N. Muñiz García, Cecilia Grossi, Rita M. Ulloa, Daniela A. Capiati

The serine/threonine protein phosphatases type 2A (PP2A) are involved in several physiological responses in plants, playing important roles in developmental programs, stress responses and hormone signaling. Six PP2A catalytic subunits (StPP2Ac) were identified in cultivated potato. Transgenic potato plants constitutively overexpressing the catalytic subunit StPP2Ac2b (StPP2Ac2b-OE) were developed to determine its physiological roles. The response of StPP2Ac2b-OE plants to the oomycete Phytophthora infestans, the causal agent of late blight, was evaluated. We found that overexpression of StPP2Ac2b enhances susceptibility to the pathogen. Further bioinformatics, biochemical, and molecular analyses revealed that StPP2Ac2b positively regulates developmental and pathogen-induced senescence, and that P. infestans infection promotes senescence, most likely through induction of StPP2Ac2b expression.

Hearing loss and physical function in the general population: A cross-sectional study

by Kaori Daimaru, Yukiko Wagatsuma


Hearing loss is a major public health concern. Higher physical function may be related to the maintenance of hearing acuity. Therefore, this study examined the association between hearing loss and physical function in the general population.


This cross-sectional study was conducted with health checkup participants who underwent pure-tone audiometry at a regional health care center in Japan. Information for physical function included handgrip strength, vital capacity (VC), and forced expiratory volume in one second (FEV1). A hearing threshold of >30 dB at 1 kHz and/or >40 dB at 4 kHz in either ear was identified as hearing loss. The characteristics of the subjects were examined with stratification by sex and age group. Multivariable logistic regression analysis was performed to examine the association between hearing loss and physical function with adjustments for age, body mass index and current smoking.


Among the 4766 study subjects, 56.5% were male. The mean age was 47.7 years (SD: 13.8 years; range: 20–86 years), and the prevalence of hearing loss was 12.8% based on the definition stated above. For females, handgrip strength, VC, and FEV1 showed significant negative associations with hearing loss (multivariable-adjusted OR [95% CI] = 0.691 [0.560–0.852], 0.542 [0.307–0.959], and 0.370 [0.183–0.747], respectively). These associations were not found in males.


Higher physical function was associated with a lower prevalence of hearing loss among females. This study suggests that it is important to maintain physical function for hearing loss in females. Further studies are required to investigate sex differences in the relationship between physical function and hearing loss in the general population.

Exploring the feasibility of technological visuo-cognitive training in Parkinson’s: Study protocol for a pilot randomised controlled trial

by Julia Das, Rosie Morris, Gill Barry, Rodrigo Vitorio, Paul Oman, Claire McDonald, Richard Walker, Samuel Stuart

Visual and cognitive dysfunction are common in Parkinson’s disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson’s (PwP). Non-pharmacological interventions for visuo-cognitive deficits are possible with modern technology, such as combined mobile applications and stroboscopic glasses, but evidence for their effectiveness in PwP is lacking. We aim to investigate whether technological visuo-cognitive training (TVT) can improve visuo-cognitive function in PwP. We will use a parallel group randomised controlled trial to evaluate the feasibility and acceptability of TVT versus standard care in PwP. Forty PwP who meet our inclusion criteria will be randomly assigned to one of two visuo-cognitive training interventions. Both interventions will be carried out by a qualified physiotherapist in participants own homes (1-hour sessions, twice a week, for 4 weeks). Outcome measures will be assessed on anti-parkinsonian medication at baseline and at the end of the 4-week intervention. Feasibility of the TVT intervention will be assessed in relation to safety and acceptability of the technological intervention, compliance and adherence to the intervention and usability of equipment in participants homes. Additionally, semi structured interviews will be conducted to explore participants’ experience of the technology. Exploratory efficacy outcomes will include change in visual attention measured using the Trail Making Test as well as changes in balance, gait, quality of life, fear of falling and levels of activity. This pilot study will focus on the feasibility and acceptability of TVT in PwP and provide preliminary data to support the design of a larger, multi-centre randomised controlled trial. This trial is registered at (ISRCTN46164906).

Medieval and early modern diets in the Polack region of Belarus: A stable isotope perspective

by Vera Haponava, Aliaksei Kots, Mary Lucas, Max Both, Patrick Roberts

In western and north-western Europe there has been a growing focus on exploring how major economic, political, and social changes during the Medieval period impacted the lived experience of different populations and sectors of society. Stable isotope analysis has proven particularly powerful in this regard, providing direct insights into the long-term diets of individuals and communities. Despite experiencing similarly dramatic social reconfigurations and changes, eastern Europe has, however, received far less attention in this regard. The territory of Belarus has, especially, so far remained a relative blank spot on the bioarchaeological map of Europe, though cities such as Polack emerged rapidly as key nodes within a growing economic and religious network. To gain direct insight into the diets of inhabitants of the Polack region of Belarus in the 11-18th centuries, we applied stable carbon and nitrogen isotope analysis to bone and dentine collagen from human (n = 143) and animal (n = 105) individuals from the city of Polack and surrounding rural sites. Results indicate a diet based on C3 terrestrial resources, which did not differ between sexes and showed limited variation over time. Contrary to expectations, it appears that animal products were commonly consumed by rural dwellers, but no significant reliance on fish resources or millet consumption is found. In contrast to examples from western Europe, we argue that the diets in the city and the surrounding villages remained broadly similar for the majority of the population, and similar to commoners analysed in Poland and Lithuania, perhaps suggestive of slightly different economic changes operating in this part of the Medieval world.

Translation and validation of the Arabic version of the Morisky, Green and Levine (MGL) adherence scale

by Oriana Awwad, Suha AlMuhaissen, Ayat Al-Nashwan, Salahdein AbuRuz

The Morisky Green Levine (MGL) adherence scale is a 4-item tool used for the detection of medication nonadherence among patients with chronic health conditions. Despite being widely used in Arabic-speaking research contexts, it has never been validated in Arabic language. The aim of this study was to translate and validate the MGL tool into Arabic. A standard forward-backward process was used to translate the questionnaire. Cronbach’s alpha coefficient was measured to assess internal consistency of the scale. The test-retest reliability measured the consistency of participants’ responses over time. Construct validity was evaluated by Explanatory factor analysis (EFA); Kaiser-Meyer-Olkin value and Bartlett’s test of sphericity were determined. Convergent validity was assessed using a preexisting medications Arabic Adherence Assessment Tool (AAAT). The model fit was evaluated using confirmatory factor analysis (CFA). Associations between the MGL scale scores and the patient demographic/clinical characteristics were tested by linear regressions. A total of 201 participants were included into the study. The MGL scale categorization revealed that 20.9%, 59.2% and 19.9% of the participants had high, moderate and low levels of adherence respectively. Adequate internal consistency (alpha = 0.593) was observed. A significant strong ICC and Pearson’s correlations were generated between responses at time 1 and time 2. EFA results elucidated the suitability of the data for factor analysis. Pearson’s coefficient (r) revealed a significant strong correlation between MGL scale and AAAT. CFA results confirmed a good fit for the suggested model. Linear regression revealed higher number of medications, more frequent outpatient clinic visits and not experiencing medication adverse effect factors significantly associated with better adherence. The Arabic version of MLG scale is a reliable valid tool to assess adherence among Arabic-speaking communities. Implementing interventions targeting patients not compliant to regular clinic visits and those at higher risk of experiencing medication side effects can greatly enhance medication adherence.

Maturation-based Corrective Adjustment Procedures (Mat-CAPs) in youth swimming: Evidence for restricted age-group application in females

by Clorinda Hogan, Shaun Abbott, Mark Halaki, Marcela Torres Castiglioni, Goshi Yamauchi, Lachlan Mitchell, James Salter, Michael Romann, Stephen Cobley

Inter-individual differences in maturation-associated development can lead to variations in physical performance, resulting in performance (dis)advantages and maturation selection bias within youth sport systems. To address such bias and account for maturational differences, Maturation-based Corrective Adjustment Procedures (Mat-CAPs) could be beneficial. The present study aimed to: (1) determine maturity timing distributions in youth female swimming; (2) quantify the relationship between maturation status and 100-m front-crawl (FC) performance; (3) implement Mat-CAPs to remove maturational influences upon swimming performance. For Aim 1 and 2, participants were 663 female (10–15 years) swimmers who participated in 100-m FC events at Australian regional, state, and national-level competitions between 2016–2020 and underwent anthropometric assessment (mass, height and sitting height) to estimate maturity timing and offset. For Aim 3, participants aged 10–13 years were categorised into maturity timing categories. Maturity timing distributions for Raw (‘All’, ‘Top 50%’ and ‘Top 25%’) and Correctively Adjusted swim times were examined. Chi-square, Cramer’s V and Odds Ratios determined the presence of maturation biases, while Mat-CAPs identified whether such biases were removed in targeted age and selection-groups. Results identified that between 10–13 years, a significantly higher frequency of ‘early’ maturers was apparent, although tapered toward higher frequencies of ‘Late-normative’ maturers by 14–15 years. A curvilinear relationship between maturity-offset and swim performance was identified (R2= 0.51, p