Non-intervention Group Research Articles

Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center

ObjectivesTo evaluate the success rate of endoscopic procedures in terms of achieving pregnancy at an interval of three months for 12 months or till achievement of fetal cardiac activity whichever is earlier. MethodsWe prospectively evaluated 157 female patients (age range 19–35 years; mean age 27.75 years), who were diagnosed as infertile. During their diagnostic work, all underwent hysterolaparoscopy. The detected anatomical abnormalities on the hysterolaparoscopy were tackled at the same time during diagnostic work-up if possible. After hysterolaparoscopy, Patients were advised for regular sexual activity. The follow-up of all recruited patients was done at an interval of three months for 12 months or till achievement of fetal cardiac activity. ResultsOf the 157 infertile female patients, 93 (59.2%) were of primary infertility and remaining 64 (41.74%) were secondary infertility patients. Hysterolaparoscopy revealed abnormalities in 125/157 patients. The detected hysterolaparoscopic anatomical abnormalities were distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertility patients. Of the 125 patients with abnormal hysterolaproscopic findings, 121 underwent active therapeutic interventions. All of the secondary infertility patients with hysterolaparoscopic abnormalities experienced active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 patients experienced active intervention. Out of the 125 abnormal hysterolaparoscopic patients, 121 underwent active intervention and 43 patients conceived during next 12 months. Among 32 patients with normal hysterolaparoscopic findings, 7 conceived within 12 months. Significantly higher conception was observed in hysterolaparoscopic intervention patients as compared to normal hysterolaparoscopy patients (p∼0.001). Independently in primary infertility patients, the conception rate in the patient with hysterolaparoscopic intervention was significantly higher than nonintervention group (p<0.0001). Similarly, conception rate was significantly higher in secondary infertility patients (p∼0.004). ConclusionWe concluded that the conception rate was significantly high in infertility patients, who underwent hysterolaproscopic intervention. In short hysterolaparoscopy should be considered as a potential gold standard approach in the evaluation of female infertility.

Brain-computer-interface-based intervention re-normalizes brain functional network topology in children with attention deficit/hyperactivity disorder

A brain-computer-interface (BCI)-based attention training game system has shown promise for treating attention deficit/hyperactivity disorder (ADHD) children with inattentive symptoms. However, little is known about brain network organizational changes underlying behavior improvement following BCI-based training. To cover this gap, we aimed to examine the topological alterations of large-scale brain functional networks induced by the 8-week BCI-based attention intervention in ADHD boys using resting-state functional magnetic resonance imaging method. Compared to the non-intervention (ADHD-NI) group, the intervention group (ADHD-I) showed greater reduction of inattention symptoms accompanied with differential brain network reorganizations after training. Specifically, the ADHD-NI group had increased functional connectivity (FC) within the salience/ventral attention network (SVN) and increased FC between task-positive networks (including the SVN, dorsal attention (DAN), somatomotor, and executive control network) and subcortical regions; in contrast ADHD-I group did not have this pattern. In parallel, ADHD-I group had reduced degree centrality and clustering coefficient as well as increased closeness in task-positive and the default mode networks (prefrontal regions) after the training. More importantly, these reduced local functional processing mainly in the SVN were associated with less inattentive/internalizing problems after 8-week BCI-based intervention across ADHD patients. Our findings suggest that the BCI-based attention training facilitates behavioral improvement in ADHD children by reorganizing brain functional network from more regular to more random configurations, particularly renormalizing salience network processing. Future long-term longitudinal neuroimaging studies are needed to develop the BCI-based intervention approach to promote brain maturation in ADHD.

Effects of behavioural activation on the neural circuit related to intrinsic motivation.

Behavioural activation is an efficient treatment for depression and can improve intrinsic motivation. Previous studies have revealed that the frontostriatal circuit is involved in intrinsic motivation; however, there are no data on how behavioural activation affects the frontostriatal circuit.AimsWe aimed to investigate behavioural activation-related changes in the frontostriatal circuit. Fifty-nine individuals with subthreshold depression were randomly assigned to either the intervention or non-intervention group. The intervention group received five weekly behavioural activation sessions. The participants underwent functional magnetic resonance imaging scanning on two separate occasions while performing a stopwatch task based on intrinsic motivation. We investigated changes in neural activity and functional connectivity after behavioural activation. After behavioural activation, the intervention group had increased activation and connectivity in the frontostriatal region compared with the non-intervention group. The increased activation in the right middle frontal gyrus was correlated with an improvement of subjective sensitivity to environmental rewards. Behavioural activation-related changes to the frontostriatal circuit advance our understanding of psychotherapy-induced improvements in the neural basis of intrinsic motivation.Declaration of interestNone.

Effect of tele-health care on quality of life in patients with severe COPD: a randomized clinical trial.

Background and objectiveTelemonitoring (TM) of patients with COPD has gained much interest, but studies have produced conflicting results. We aimed to investigate the effect of TM with the option of video consultations on quality of life (QoL) in patients with severe COPD.Patients and methodsCOPD patients at high risk of exacerbations were eligible for the 6-month study and a total of 281 patients were equally randomized to either TM (n=141) or usual care (n=140). TM comprised recording of symptoms, oxygen saturation, spirometry, and video consultations. Algorithms generated alerts if readings breached thresholds. Both groups filled in a health-related QoL questionnaire (15D©) and the COPD Assessment Test (CAT) at baseline and at 6 months. Within-group differences were analyzed by paired t-test.ResultsMost of the enrolled patients had severe COPD (86% with Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 and 45% with admission for COPD within the last year, respectively). No difference in drop-out rate and mortality was found between the groups, and likewise there was no difference in 15D or CAT at baseline. At 6 months, a significant improvement of 0.016 in 15D score (p=0.03; minimal clinically important difference 0.015) was observed in the TM group (compared to baseline), while there was no improvement in the control group −0.003 (p=0.68). After stratifying 15D score at baseline to <0.75 or ≥0.75, respectively, there was a significant difference in the <0.75 TM group of 0.037 (p=0.001), which is a substantial improvement. No statistically significant changes were found in CAT score.ConclusionCompared to the nonintervention group, TM as an add-on to usual care over a 6-month period improved QoL, as assessed by the 15D questionnaire, in patients with severe COPD, whereas no difference between groups was observed in CAT score.

Multikinase inhibitor-associated hand-foot skin reaction as a predictor of outcomes in patients with hepatocellular carcinoma treated with sorafenib

To investigate the relationship between the onsets of multikinase inhibitor (MKI)-associated hand-foot skin reaction (HFSR) and prognosis under intervention by pharmacists after the introduction of sorafenib. We conducted a retrospective study involving 40 patients treated with sorafenib. Intervention by pharmacists began at the time of treatment introduction and continued until the appearance of symptomatic exacerbation or non-permissible adverse reactions. We examined the relationship between MKI-associated HFSR and overall survival (OS) after the initiation of treatment. The median OS was 10.9 mo in the MKI-associated HFSR group and 3.4 mo in the no HFSR group, showing a significant difference in multivariate analysis. A multivariate analysis of the time to treatment failure indicated that the intervention by pharmacists and MKI-associated HFSR were significant factors. The median cumulative dose and the mean medication possession ratio were significantly higher in the intervention group than in the non-intervention group. A borderline significant difference was observed in terms of OS in this group. Intervention by pharmacists increased drug adherence. Under increased adherence, MKI-associated HFSR was an advantageous surrogate marker. Intervention by healthcare providers needs to be performed for adequate sorafenib treatment.

Impact of mindfulness based stress reduction on sperm DNA damage

IntroductionSperm DNA damage is the major cause of defective sperm function. Poor social habits take a toll not only on reproductive health of parents but the resultant offspring too. Adopting a holistic integrated approach like mindfulness based stress reduction (MBSR), a yoga based intervention have gained significant impetus in recent years. This study aimed to analyze how mere a simple lifestyle change can bring about balance in seminal oxidative stress parameters and related consequences in next generations. MethodsOut of 126 fathers of children with non-familial sporadic heritable Retinoblastoma (NFSHRb), 102 were randomized into 2 groups i.e. MBSR group and Non-MBSR group. Parameters of seminal oxidative stress (OS) and oxidative DNA damage (ODD) were measured at baseline (0 day) and after 4 weeks in both groups. ResultsThere was significant decrease (p < 0.0001) in mean reactive oxygen species (ROS), DNA fragmentation index (DFI) and 8-hydroxy-2′-deoxyguanosine (8OHdG), increase (p < 0.0001) in mean total antioxidant capacity (TAC) post 4 weeks of MBSR whereas non-intervention group showed opposite trends when compared with baseline. DiscussionA 4-week MBSR resulted in significant improvement in sperm DNA integrity and regulation of OS may affect the sperm epigenome, reduces de novo germline mutation rate and affects lifelong health trajectory of offspring. In the era of limited space, commercial expansion and increased incidence of complex lifestyle diseases, there is a dire need to adopt an integrated system of mind body interventions which aims to achieve physical, mental, spiritual wellbeing and improve quality of life.

\u2018Boost Camp\u2019, a universal school-based transdiagnostic prevention program targeting adolescent emotion regulation; evaluating the effectiveness by a clustered RCT: a protocol paper

BackgroundThe transition from childhood into adolescence can be considered as a critical developmental period. Moreover, adolescence is associated with a decreased use of adaptive emotion regulation strategies and an increased use of maladaptive emotion regulation strategies increasing the risk of emotional problems. Targeting emotion regulation is therefore seen as an innovative prevention approach. The present study aims to evaluate the effectiveness of Boost camp, an innovative school-based prevention program targeting ER, on adolescents’ emotion regulation skills and emotional wellbeing. Also secondary outcomes and possible moderators will be included.MethodsThe aim is to reach 300 adolescents (16 class groups, 6 schools) in their first year of high school. A clustered Randomized Controlled Trial (RCT) with two conditions, intervention (n = 150) and control (n = 150), will be set up. Adolescents in the intervention condition will receive 14 lessons over the course of 2 days, followed by Booster sessions, and will be compared with adolescents in a non-intervention control group. The outcomes will be measured by self-report questionnaires at baseline, immediately after Boost camp, and at three and 6 months follow-up.DiscussionData-collection is planned to be completed in May 2018. Data-analyses will be finished the end of 2018. The presented paper describes the Boost camp program and the clustered RCT design to evaluate its effectiveness. It is expected that Boost camp will have beneficial effects. If found effective, Boost camp will have the potential to increase adolescent’s ER and well-being, and reduce the risk to become adults in need. The trials is registered on the 13th of June 2017 in ISRCTN registry [ISRCTN68235634].

Basic skin surgery interactive simulation: system description and randomised educational trial

BackgroundLearning the skills required for open surgery is essential for trainee progression towards more advanced technical procedures. Simulation supports skill enhancement at a time when exposure to actual surgical procedures and traditional apprentice-based teaching has declined. The proliferation of smartphone and tablet devices with rich, touch sensitive displays and increasing processing power makes a compelling argument for expanding accessibility further by development of mobile virtual simulations for training on demand in any setting, at any time.We present a tablet-based mobile simulation App for educating surgical trainees in the planning and surgical procedures involved in facial lesion resection and local skin flap surgery.MethodsNovel algorithms were developed and modules included in a mobile simulation App to teach concepts required for three defect reconstruction techniques: elliptical closure, bilateral advancement (H flap) and the semi-circular rotation flap, with additional resources such as videos and formal guidelines made available at relevant points in the simulation. A randomised educational trial was conducted using the mobile simulation App with 18 medical students that were divided equally into two groups: the intervention group learning using the new mobile simulation App, and a control group, undergoing traditional text-based self-study. The students were then assessed on knowledge and skills’ acquisition through an MCQ and a task analysis score.ResultsThere was a statistically significant difference between the scores of students in the intervention group and the students in the non-intervention group in both forms of assessment, with an average multiple-choice assessment score of 62.95% points versus 56.73%, respectively (p = 0.0285), and an average task analysis score of 3.53 versus 2.58, respectively (p = 0.0139).ConclusionsTouch-based simulation provided an efficient and superior method of learning three different local flap techniques for facial soft tissue reconstruction, and helped recalling steps involved in the surgery in a fluid manner that also improved task performance.

Is culturally based prevention effective? Results from a 3-year tribal substance use prevention program

American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased −.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.

Effect of a Good Oral - Dental Care Protocol on Inflammation and Oral Lesions in Renal Transplant Patients

Inflammation plays an important role in causing complications in CKD and transplant patients. C-reactive protein and pro-inflammatory cytokines could predict outcomes in transplant patient. Poor oral health results in inflammation and cytokine production. There is need to evaluate the benefit of good oral hygiene on renal transplant outcome. A randomized controlled trial was carried out amongst CKD patients going for renal transplantation. The randomization was done in 100 CKD patients going for transplantation. All patients had dental and oral examination (Type III clinical examination as per American Dental Association specifications and WHO oral health proforma, 2013) Group I (Non interventional group) 50 patients. Group II (Intervention group) - 50 patients of chronic kidney disease going for transplantation. Group III (Control group) comprised of 50 healthy age, sex matched subjects. Intervention group followed regular tooth brushing, use of dental floss along with use of mouth wash twice every day and counseling sessions for good oral and dental care for a period of 3 months after transplant. Non-intervention group continued usual oral and dental care. Both groups had base line oral examination just before transplantation and at 3 months after transplant. The oral and dental findings specially the periodontitis score was compared between groups I and II and with the healthy controls. CRP (C- reactive protein) values were assayed at baseline and after 3 months. Comparison of CRP values between Interventional and non-interventional groups at baseline and at 3months showed that periodontitis score and CRP significantly came down at 3 months in intervention group as compared to non- intervention group . CRP values in the interventional and non-intervention groups were analyzed in relation to presence of donor specific antibodies (DSA) and HLA mismatch scores in the two groups. Our data shows that after aggressive dental and mouth hygiene routine, intervention group patients showed significant decline in CRP values as compared to the non intervention group. It almost reached close to values in normal controls. This was seen in both patient groups with less than and more than 3-HLA mis-matches. In patients with DSA at time of transplantation, base line CRP values were significantly higher as compared to those with no DSA, but CRP values even in DSA positive group came down significantly with aggressive dental and mouth care routine at 3 months after transplantationThis is a report of results of a randomized control study in transplant recipients showing the benefits of good oral and dental care in relation to inflammation, DSA and HLA mis-matches. The present study concludes that the oral hygiene of the patients with chronic kidney disease going for transplant is deteriorated. Good oral and dental care in transplant recipients can improve inflammation which could have beneficial effect on post transplant outcomes.

Urinary [TIMP-2]·[IGFBP7]-guided randomized controlled intervention trial to prevent acute kidney injury in the emergency department.

Early detection and prevention of acute kidney injury (AKI) is important to reduce morbidity and mortality. Discovery of early-detection biomarkers has enabled early preventive approaches. There are no data on early biomarker-guided intervention with nephrological consultation in emergency departments (EDs). In this prospective randomized controlled intervention trial, patients at high risk for AKI were screened with urinary [TIMP-2]·[IGFBP7] in the ED of Robert-Bosch-Hospital (Stuttgart, Germany). We screened 257 eligible patients of whom 100 met the inclusion criteria, with urinary [TIMP-2]·[IGFBP7] >0.3, and were included. The intervention group received immediate one-time nephrological consultation after randomization, implementing Kidney Disease: Improving Global Outcomes (KDIGO) 2012 recommendations on AKI. The primary outcome was the incidence of moderate to severe AKI within the first day after admission. Secondary outcomes were AKI occurrence within 3 days after admission, need for renal replacement therapy (RRT), length of hospital stay and death. The primary outcome did not differ significantly (P = 0.9) between the groups, neither within the first day nor within the first 3 days after admission. The intervention group had significantly (P < 0.05) lower serum creatinine (SCr) on Day 2 and lower maximum SCr and tended (P = 0.08) to have higher urine output (UOP) at Day 3 than the non-intervention group. No patient in the intervention group needed RRT (0 versus 3) during the hospital stay (P = 0.09). One-time routine nephrologist-guided application of the KDIGO bundle in ED patients with a risk for AKI cannot currently be recommended. However, due to the uniform trend of study endpoints in favour of intervention, further trials to investigate larger cohorts of more severely ill patients are warranted. www.ClinicalTrials.gov, study number NCT02730637.

Evaluating the Effect of Positive Ideological Intervention on Psychological Flexibility of College Students

Psychological flexibility is a complex dynamic psychological structure, and refers to the dynamic adaptation process which appears repeatedly and matches the situation in the process of interaction between individuals and environment. In the course of their own growth and development, the positive thinking quality of college students means that college students interact with the acquired education environment to form active, positive and upward attitudes, have correct self-cognition ability, can bravely and strongly face setbacks, and have strong sense of identity with the society. It can enable college students to obtain a strong sense of self-efficacy and subjective well-being. Through the positive thinking intervention contrast, this study compares differences in psychological flexibility between the intervention group and the non-intervention group, and obtains the positive effect of the positive thinking intervention on the psychological flexibility of college students.

The use of a disease state simulation assignment increased students’ empathy and comfort with diabetes nutrition counseling

Background and purposeTo determine if a disease state simulation assignment increases empathy, comfort, and knowledge in diabetes nutrition counseling. Educational activity and settingOne-hundred forty students completing ambulatory care experiential rotations over two academic years were invited to participate in the study. Students in the intervention group completed an empathy assignment, which involved developing and following a diet plan appropriate for a patient with diabetes followed by a reflection of their experiences. Students completed a pre- and post-intervention survey assessing empathy, comfort with counseling, and knowledge of diabetes nutrition. FindingsFifty-three students (31 in the intervention, 22 in the non-intervention group) completed the pre- and post-survey and provided informed consent. Empathy scores on the Kiersma Chen Empathy Scale (range 15–105) improved by 6.4 points in students in the intervention group compared to a decline of 1.2 in students in the non-intervention group (p = 0.045). Comfort in counseling on a diabetes diet, measured on a 10-point scale, increased significantly more in students completing the empathy assignment (4.7 vs 3.5; p = 0.044). Knowledge (0–100%) improved by 9.7% and 8.6% in the intervention and non-intervention groups, respectively (p = 0.859). DiscussionSimilar to other studies using disease state simulations, the findings of this study show increased confidence in counseling and empathy. Given that the assignment used in this study is more specific to nutrition counseling, its use may be most helpful in settings where pharmacists are responsible for diabetes nutrition counseling. SummaryImplementation of a similar assignment could be considered for experiential rotations with nutrition counseling.

Accelerate the Self Understanding of Blood Glucose through the Summary Screen (ACCESS STUDY)

We previously assessed the effectiveness of a simple self-monitored blood glucose(SMBG) device with the function to display whether a blood glucose level is high or low in different colors (C device) (REFLECT STUDY, 2012 ADA), which reported that an interventional group using the C device and patient education materials showed a significant decrease in HbA1c compared to a group using a monochrome-display device. In our new ACCESS Study, we evaluated the effectiveness of a new SMBG device with an additional summary screen that shows past blood glucose patterns (device V) and a new educational material that advises on such blood glucose patterns. Outpaitients with diabetes mellitus (N=94, HbA1c 7.41 ± 0.85%) were randomly assigned to either an intervention group (N=50) where patients were switched from device C to device V with the new educational material, or to a non-intervention group (N=44) where patients were just switched from device C to device V and did not receive the new educational material. We evaluated the changes in HbA1c and patient satisfaction survey scores 8 weeks later. There was no significant difference in the change in HbA1c at 8 weeks between the intervention group (-0.06%; -0.165 to 0.045) and non-intervention group (-0.01%; -0.136 to 0.113). According to the results of the satisfaction survey, the intervention group showed a higher satisfaction in "Recognition of patterns/trends in blood glucose levels." There was a tendency in improvement of blood glucose pattern/trend recognition by patients by the intervention, there was no impact on HbA1c improvement. However, the outcomes of this study may have been affected by the short 8-week duration, as well as the fact that it was conducted during the period of seasonal change. Since device V and the new educational material improves blood glucose pattern/trend recognition, the results may have been different if a specific plan for blood glucose improvement tailored to each patient was further conveyed to each patient. Disclosure K. Suzuki: None. K. Hasegawa: None.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers.

BackgroundInfluenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW.MethodsWe conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings.ResultsThirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness.DiscussionOur findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

Hepatitis B Virus Infection among Health Care Workers in Indonesia.

Hepatitis B virus (HBV) infection is a global health problem with an estimated 257 million chronically infected people. Indonesia is a moderately hepatitis B-endemic country with 7.1% prevalence of hepatitis surface antigen (HBsAg). This infection is considered as an important occupational hazard among health care workers (HCWs), who may become further transmitters of this infection. The extent of hepatitis B among HCWs and specific control strategy are not available in Indonesia. A study was done on 644 HCWs, who were categorized into administration, nonintervention, and intervention groups. The prevalence of HBsAg, antibody to HBV core antigen (anti-HBc), and antibody to HBsAg (anti-HBs) was 4.7, 18.5, and 36.7% respectively, while 57.3% were negative for all seromarkers, indicating susceptibility to this infection. Increasing trend with age was observed in the exposure to infection (anti-HBc) (p <0.001) and the marker of resolved infection (HBsAg-, anti-HBc+, anti-HBs+) (p = 0.004), suggesting accumulated exposure to HBV infection by increasing age. Rising trend of exposure rate was also observed across the administration, nonintervention, and intervention groups (p < 0.001). By length of service period, significant escalation of exposure (p = 0.010) and resolved infection (p < 0.001) were also observed, suggesting increasing occupational risk to HBV infection. There is an urgent need to safeguard the HCWs with hepatitis B vaccination and provide continuing education at various health care setups. The establishment of a national policy and a roadmap for effective and efficient intervention is required for the prevention, diagnosis, postexposure management, and treatment of HBV infection in this special population.How to cite this article: Muljono DH, Wijayadi T, Sjahril R. Hepatitis B Virus Infection among Health Care Workers in Indonesia. Euroasian J Hepato-Gastroenterol 2018;8(1):88-92.

THE EFFECT OF BRACING AND BALANCE TRAINING ON ANKLE SPRAIN INCIDENCE AMONG ATHLETES: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Ankle sprains are common musculoskeletal injuries in the athletic population that have been addressed with prevention strategies that include bracing and balance training. Many authors have examined ankle sprain incidence after bracing or balance training in athletes at different levels of competition and in various sports. No systematic review has analyzed the results of both interventions. The purpose of this review was to compare the effect of balance training and bracing in reducing the incidence and relative risk of ankle sprains in competitive athletes, with or without prior injury, across different sports. Systematic review, with meta-analysis. A literature search of four databases was conducted for randomized control trials that reported ankle sprain incidence published from 2005 through 2016. Included articles studied high school, college, or professional level athletes with or without a history of a prior sprain, who received bracing or balance training as an intervention compared to a non-intervention control group. Methodological study quality was assessed by two reviewers using the PEDro scale, with scores ≥5 considered moderate quality. Group incidence and relative risk were determined to assess the preventative effect of bracing or balance training compared to control. From 1832 total citations, 71 full-text articles were reviewed, and eight articles were included in the study. Methodological quality of the available evidence contained in the systematic review was moderate. Five studied the effect of balance training, two studied the effect of bracing, and one studied the effect of bracing and balance training compared to the control condition. In all eight studies, athletes in the control condition did not receive any intervention. Athletes who wore braces had fewer ankle sprains (p=0.0037) and reduced their risk of sprains by 64% (RR=0.36) compared to controls, based on analysis of 3,581 subjects. Athletes performing balance training had fewer ankle sprains (p=0.0057) and reduced their risk by 46% (RR=0.54) compared to controls, based on analysis of 3,577 subjects. The findings of the current systematic review and meta-analysis support the use of bracing and balance training to reduce the incidence and relative risk of ankle sprains in athletic populations. Clinicians can utilize this information to educate their patients on wearing a brace or performing balance training exercises to decrease the risk of an ankle sprain. Level 1a.

Interventional study to improve diabetic guidelines adherence using mobile health (m-Health) technology in Lahore, Pakistan

ObjectiveTo check if mobile health (m-Health) short message service (SMS) can improve the knowledge and practice of the American Diabetic Association preventive care guidelines (ADA guidelines) recommendations among physicians.MethodologyQuasi-experimental pre–post...

Impact of pharmacist counseling on reducing instances of adverse events that can affect the quality of life of chemotherapy outpatients with breast Cancer

BackgroundIn recent years, cancer chemotherapy is being conducted at outpatient clinics, wherein pharmacists are involved with patient guidance and management of adverse events as experts in medication therapy. Therefore, we clarified the influence of interventions by pharmacists during counseling of patients with cancer on patients’ quality of life.MethodsTo determine this influence, we conducted a survey to assess the quality of life of 39 patients with breast cancer who underwent their initial course of outpatient cancer chemotherapy at Gifu Municipal Hospital. A quality of life survey was conducted before the 1st, 2nd, and 3rd courses of treatment and was based on a method obtained from a survey paper entitled, “Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs.”ResultsTwenty patients were assigned to the intervention group, which received pharmacist counseling, and nineteen patients were assigned to the non-intervention group, which received no pharmacist counseling. Both groups were compared immediately before the 1st course and 2nd course. Regarding the subscale of social relationships, a significant difference was observed for malaise (p = 0.043), with the non-intervention group experiencing them to a greater degree than the intervention group. Regarding the change between immediately before the 1st course and the 3rd course, a significant difference was observed in the subscale of social relationships for nausea (p = 0.017), with the non-intervention group experiencing it to a greater degree than the intervention group.ConclusionsThe results suggest that receiving pharmacists’ guidance on adverse events and individually adjusted prescriptions tailored to address the occurrence of adverse events improved the treatment environment and enhanced the quality of life in the intervention group. These findings are beneficial in maintaining patients’ quality of life during cancer treatment.Trial registrationNo. UMIN000027171, Registration date: Apr 27, 2017. Retrospectively registered.

The Comorbidity Between Internet Gaming Disorder and Depression: Interrelationship and Neural Mechanisms.

Internet gaming disorder (IGD) is characterized by cognitive and emotional deficits. Previous studies have reported the co-occurrence of IGD and depression. However, extant brain imaging research has largely focused on cognitive deficits in IGD. Few studies have addressed the comorbidity between IGD and depression symptoms and underlying neural mechanisms. Here, we systematically investigated this issue by combining a longitudinal survey study, a cross-sectional resting-state functional connectivity (rsFC) study and an intervention study. Autoregressive cross-lagged modeling on a longitudinal dataset of college students showed that IGD severity and depression are reciprocally predictive. At the neural level, individuals with IGD exhibited enhanced rsFC between the left amygdala and right dorsolateral prefrontal cortex (DLPFC), inferior frontal and precentral gyrus, compared with control participants, and the amygdala-frontoparietal connectivity at the baseline negatively predicted reduction in depression symptoms following a psychotherapy intervention. Further, following the intervention, individuals with IGD showed decreased connectivity between the left amygdala and left middle frontal and precentral gyrus, as compared with the non-intervention group. These findings together suggest that IGD may be closely associated with depression; aberrant rsFC between emotion and executive control networks may underlie depression and represent a therapeutic target in individuals with IGD.Registry name: The behavioral and brain mechanism of IGD;URL: https://www.clinicaltrials.gov/ct2/show/NCT02550405;Registration number: NCT02550405.