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This study aimed to evaluate the long-term impact of children's dental care programs on children and adolescents to reduce oral health inequalities. It measured and assessed the improvement effects of children's dental care programs on the oral health of children and adolescents as part of the efforts to decrease oral health disparities in this age group. It included 406 individuals who participated in student and children's dental care program between 2013 and 2019 at screening facilities in Gwangjin-gu, Seoul. A frequency analysis was conducted for demographic characteristics, and a binary logistic regression analysis was performed to identify factors influencing the prevalence of dental caries as the dependent variable. The data were analyzed using PASW Statistics with the statistical significance level set at α = 0.05. Regarding oral health status based on the frequency of participation in children's dental care program for children and adolescents, participants with seven or more sessions had lower prevalence rates of dental caries, malocclusion, and periodontal disease than those with only one session. Second, when comparing oral health status in children's dental care program between primary and adolescent age groups, individuals under continuous oral health care showed a decrease in permanent teeth affected by dental caries, dental caries prevalence, and malocclusion prevalence (excluding primary school age). Third, a binary logistic regression analysis revealed significant influences ( p < 0.05) of the developmental stage and frequency of program participation on dental caries prevalence. Children's dental care programs are essential for alleviating oral health inequalities among children and adolescents and preventing oral diseases. Furthermore, the developmental stage of children and the frequency of program participation are crucial factors in preventing oral conditions, such as dental caries.

Background Depression is a global public health burden, and although it is multifactorial, its development is highly associated with chronic diseases. Thus, physicians' knowledge and attitude toward depression are vital for the recognition and treatment of depression among patients with chronic illnesses. This study aims to examine physicians' knowledge and attitude toward depression in Saudi Arabia and to determine factors that significantly influence them. Methodology An online survey using a 12-item questionnaire was completed by 50 physicians between January and June 2020. Knowledge (K) and attitude (A) scores were calculated and compared nonparametrically based on scores by gender and years of experience. Results Participants' years of clinical experience was found to significantly influence the participants' K scores, with those with fewer than one year of experience having the highest K scores of all participants (p < 0.05). Years of experience had a similar influence on the A scores. Furthermore, gender was an influencing factor as male participants had higher A scores than female participants. Years of experience and gender influenced the A scores independently. Male physicians more commonly referred patients to a mental health specialist than female physicians, and had significantly higher A scores and more years of experience. There was a direct correlation between the K and A score, indicating that participants' knowledge of depression positively influenced their attitude toward depression. Conclusions In this study, participants' gender and years of experience have been identified to have a significant impact on their knowledge and attitude toward comorbid depression when treating patients with chronic illnesses. This identifies an important gap and offers preliminary insight into the readiness and practice of holistic care for patients, particularly for those treated by physicians of differing gender and experience levels. Findings further demonstrate that it is most beneficial to patients with chronic illnesses that physicians utilize a holistic approach and consider depression when developing their treatment plans. This would involve being able to detect and manage depression among their patients properly, as well as referring patients to mental health specialists when needed. Clinical guidelines should be updated to emphasize the use of depression screening tools for patients with chronic diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sayed et al.)

Objectives: The aim of this study was to investigate the seroprevalence of antibodies against scrub typhus, murine typhus and spotted fever groups among North Korean refugees within 1 year of their arrival in South Korea., Methods: We recruited North Korean refugees who had settled in South Korea after a short stay in a third country and did not have any health problems. The antibody titer was measured using a commercial indirect fluorescence assay immunoglobulin G antibody kit., Results: The seroprevalence of antibodies against scrub typhus, murine typhus, and spotted fever groups among the 99 participants was 22.2%, 17.2%, and 10.1%, respectively, with 8.1% of participants testing positive for both spotted fever and murine typhus., Conclusions: Refugees may be exposed to rickettsial infections in North Korea and their journey from North Korea. This study is the first to report the seroprevalence of antibodies against the 3 common rickettsial diseases among North Korean refugees. The findings suggest that rickettsial infections should be added to the list of differential diagnoses for North Koreans with fever after entering South Korea., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Alignment of the inertial navigation system (INS) in the mooring environment should take into account the movements of the waves or wind. The alignment of the INS is performed through an extended Kalman filter (EKF) using zero velocity as a measurement. However, in the mooring condition, this is not perfect stationary, thus the measurement error covariance matrix should be adjusted. In addition, if the measurement error covariance matrix is fixed to one value, the alignment time may take longer or the performance may be reduced depending on the change in mooring conditions. To solve this problem, we propose an alignment method using adaptive Kalman filter and convolution neural network (CNN)-based learning. The proposed method was verified for the superiority of alignment time and accuracy through Monte Carlo simulation in a mooring environment.

Study Design: A retrospective study., Objective: The aim of this study was to compare the perioperative outcome of posterior spinal fusion (PSF) between overweight (OW) adolescent idiopathic scoliosis (AIS) patients and the healthy-weight (HW) patients using propensity score matching analysis., Summary of Background Data: Obesity was found to increase postoperative surgical complications compared with the nonobese group. In scoliosis correction surgery, association of OW and perioperative risks had been explored, but most studies were retrospective in nature., Methods: From 374 patients, two comparable groups were matched using propensity score matching analysis with one-to-one nearest neighbor matching and a caliper of 0.2. There were 46 HW and OW patients in each group. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay post-surgery, total patient-controlled analgesia (PCA) morphine usage, perioperative complications, side bending flexibility (SBF), and correction rate (%)., Results: The mean age was 13.3 ± 1.7 and 13.2 ± 1.7 years for HW and OW groups, respectively. The majority of the patients were Lenke 1 curves; 32.6% (HW) and 26.1% (OW) with an average Cobb angle of 69.0 ± 19.1° and 68.8 ± 18.4° for each group, respectively. The two groups were comparable. The operation time was 145.2 ± 42.2 and 154.4 ± 48.3 minutes for HW and OW groups, respectively (P > 0.05). The intraoperative blood loss was almost similar in both groups; 955.1 ± 497.7 mL (HW group) and 1011.8 ± 552.7 mL (OW group) (P > 0.05). Total PCA morphine used was higher in OW group (30.4 ± 22.7 mg) than in the HW group (16.2 ± 11.3 mg). No complication was observed in HW group, while in OW group, one patient (2.2%) developed intraoperative seizure., Conclusion: OW AIS patients (≥85th percentile) had similar mean operative time, intraoperative blood loss, allogeneic transfusion rate, length of stay, and perioperative complications compared with HW AIS patients., Level of Evidence: 3.

Background: Linezolid improves the treatment outcomes of multidrug-resistant tuberculosis substantially. We investigated whether use of linezolid instead of ethambutol increases the proportion of sputum culture conversion at 8 weeks of treatment in patients with pulmonary tuberculosis., Methods: We did a phase 2, multicentre, randomised, open-label trial for patients with pulmonary tuberculosis at the three affiliated hospitals to Seoul National University and National Medical Center (Seoul-Seongnam, South Korea). Patients, aged 20-80 years, with a positive sputum for pulmonary tuberculosis, but without resistance to rifampicin, and current treatment administered for 7 days or fewer, were randomly assigned at a 1:1:1 ratio into three groups. The control group received ethambutol (2 months) with isoniazid, rifampicin, and pyrazinamide. The second group used linezolid (600 mg/day) for 2 weeks and the third group for 4 weeks instead of ethambutol for 2 months. We used a minimisation method to randomise, and stratified according to institution, cavitation on chest radiographs, and diabetes. The primary endpoint was the proportion of patients with negative culture conversion of sputum in liquid media after 8 weeks of treatment. The results of this trial were analysed primarily in the modified intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01994460., Findings: Between Feb 19, 2014, and Jan 13, 2017, a total of 429 patients were enrolled and 428 were randomly assigned into either the control group (142 patients), the linezolid 2 weeks group (143 patients), or the linezolid 4 weeks group (143 patients). Among them, 401 were eligible for primary efficacy analyses. In the modified intention-to-treat analyses, negative cultures in liquid media at 8 weeks of treatment were observed in 103 (76·9%) of 134 control patients, 111 (82·2%) of 135 in the linezolid 2 weeks group, and 100 (75·8%) of 132 in the linezolid 4 weeks groups. The difference from the control group was 5.4% (95% CI -4·3 to 15·0, p=0·28) for the linezolid 2 weeks group and -1·1% (-11·3 to 9·1, p=0·83) for the linezolid 4 weeks group. Numbers of patients who experienced at least one adverse event were similar across the groups (86 [62·8%] of 137 in control, 79 [57·2%] of 138 in the linezolid 2 weeks group, and 75 [62·0%] of 121 in the linezolid 4 weeks group). Resistance to linezolid was not identified in any patient., Interpretation: Higher rates of culture conversion at 8 weeks of treatment with short-term use of linezolid were not observed. However, safety analyses and the resistance profile suggested the potential role of linezolid in shortening of treatment for drug-susceptible tuberculosis., Funding: Ministry of Health and Welfare, South Korea., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The aim of the study was to investigate the practice and pattern of smokeless tobacco (SLT) use as well as the knowledge and perception about its ill effects among rural Bangladeshi adolescents., Methods: A cross-sectional survey was conducted among students aged 13-18 years in two rural secondary schools in Bangladesh in August 2015. Data were collected through a self-administered questionnaire which consists of topics derived from the Social Cognitive Theory and Health Belief Model (personal characteristics, environmental factors, self-efficacy, outcome expectancies, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action). Data analysis was performed using SPSS version 24. A descriptive analysis was conducted to determine the current pattern of SLT use and knowledge about its ill effects. A chi-square test and Fisher exact test were conducted to explore associations between variables. Lastly, a logistic regression model was used to locate the predictors for current SLT use., Results: A total of 790 students participated in the study. Among them, 9.5% (75) had used SLT at least once and 3.7% (29) were current SLT users. Males had a higher incidence of SLT use compared with females. The majority of students (77.3%) initiated SLT use between 10-13 years of age. 'Zarda' was the most common type of SLT used and most of the current users (86%) were able to buy SLT without age restrictions. Most of the current users (90%) wanted to quit SLT immediately; however, professional help was not available in schools. Overall, students had a good knowledge about the harmful effects of SLT with 54.8% (428) of respondents scoring in the good knowledge category. However, the majority of never SLT users (55.4%; 396) had a good knowledge compared to ever SLT users (42.7%; 32). Significant predictors of current SLT use included being a student aged 14 years and above (OR = 6.58, 95% CI [2.23-28.31]) as well as the variables of self-efficacy (OR = 5.78, 95% CI [1.46-19.65]), perceived barriers (OR = 0.30, 95% CI [0.10-0.74]), perceived benefit (OR = 0.21, 95% CI [0.05-1.03]) and perceived severity (OR = 0.36, 95% CI [0.16-0.91])., Discussion: This study demonstrates the need for comprehensive prevention and control programme in rural schools targeting young adolescents. Effective measure should be taken to reshape the attitude of rural adolescents towards self-confidence and competence, as to prevent SLT use., Competing Interests: The authors declare there are no competing interests.

The prevalence of neuropathic low back pain differs in different ethnic populations. The aims of the study are to determine its frequency and associations in a multi-ethnic cohort of Asian low back pain patients. This was a cross-sectional study of low back patients seen at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Neuropathic low back pain patients were identified using the painDETECT questionnaire and compared with non-neuropathic (unclear or nociceptive) low back pain patients, in terms of socio-demographic and clinical factors, pain severity (numerical pain rating scale, NPRS), disability (Roland Morris Disability Questionnaire, RMDQ), as well as anxiety and depression (Hospital Anxiety and Depression Scale, HADS). Of 210 patients, 26 (12.4%) have neuropathic low back pain. Neuropathic pain is associated with non-Chinese ethnicity, higher body mass index and pain radiation below the knee. Patients with neuropathic pain have significantly higher NPRS and RMDQ scores, and there are more subjects with anxiety on HADS. However, there are no differences between the groups in age, gender, pain duration or underlying diagnosis of low back pain. The prevalence of neuropathic low back pain in a multi-ethnic Malaysian cohort is lower than previously reported in other populations with possible differences between ethnic groups. It is associated with greater pain severity, disability and anxiety.

Background: Cervical cancer is the commonest cause of cancer-related death in Sub Sahara Africa (SSA). Both primary and secondary preventive services are available but utilisation remain low. This systematic review aims to summarise reported barriers preventing women from utilising cervical cancer screening services in SSA., Method: Electronic searches on MEDLINE, EMBASE, PsycINFO, BIOSIS preview, Global Health, PubMed, Cochrane library, CINAHL, ISI Web of Knowledge and Google scholar and quality assessment of the included studies were performed. A meta-analysis was applied to identify major themes., Results: Eight studies exploring reasons women did not utilise cervical cancer screening were included. Women in SSA reported similar barriers despite cultural and language diversity in the region. Women reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude., Conclusion: Strategies for improving uptake and utilisation of cervical screening in SSA should focus on improving cervical health education, addressing cultural beliefs and practices and improving spousal support and empowering women, as well as addressing physical access problem, costs and improving staff attitude., (© 2016 John Wiley & Sons Ltd.)

In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women., (© 2016 John Wiley & Sons Ltd.)

Direct influences of dietary trans -11 18:1 vaccenic acid (TVA) at physiological concentrations of 50-200 μM were evaluated for cell growth, cytotoxic activity, and cytokine production in leukocytes isolated from the mouse spleen. TVA supplementation for 24 h induced growth of splenocytes at concentrations of 50-200 μM, except for 100 μM. The cytokines TNFα, IFNγ, and IL-10 of splenocytes were stimulated by 100 μM TVA. Induced production of TNFα in splenocytes challenged with lipopolisaccharides was suppressed by 100 μM TVA. Physiological levels of TVA had direct effects on growth and cytokine production in splenocytes. Further in vivo studies are needed to improve understanding of the precise influence of trans fatty acids on production of pro-inflammatory markers under acute inflammation conditions.

Objective: To explore and compare barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia., Design: A qualitative interview study with thematic analysis of transcripts., Participants: 67 patients with self-discovered breast symptoms were included in the analysis. Of these, 36% were of Malay ethnicity, 39% were Chinese and 25% Indian, with an average age of 58 years (range 24-82 years). The number of women diagnosed at early stages of cancer almost equalled those at advanced stages. Approximately three-quarters presented with a painless lump, one-quarter experienced a painful lump and 10% had atypical symptoms., Setting: University hospital setting in Singapore and Malaysia., Results: Patients revealed barriers to early presentation not previously reported: the poor quality of online website information about breast symptoms, financial issues and the negative influence of relatives in both countries, while perceived poor quality of care and services in state-run hospitals and misdiagnosis by healthcare professionals were reported in Malaysia. The pattern of presentation by ethnicity remained unchanged where more Malay delayed help-seeking and had more advanced cancer compared to Chinese and Indian patients., Conclusions: There are few differences in the pattern of presentation and in the reported barriers to seek medical care after symptom discovery between Singapore and Malaysia despite their differing economic status. Strategies to reduce delayed presentation are: a need to improve knowledge of disease, symptoms and causes, quality of care and services, and quality of online information; and addressing fear of diagnosis, treatment and hospitalisation, with more effort focused on the Malay ethnic group. Training is needed to avoid missed diagnoses and other factors contributing to delay among health professionals., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The aim of the present study was to investigate the effects of dietary trans fatty acids in mice. Following the administration of a 0.5/100 g diet of trans-9 octadecenoic acid (EA), trans-11 vaccenic acid (TVA) or cis-9, trans-11 conjugated linoleic acid (CLA) for 4 weeks, the body weights and the weights of the liver, testis and mediastinal adipose tissue (MAT) of the animals gradually decreased (P<0.05). The EA group exhibited the lowest levels of magnesium and triglycerides (P<0.05). CLA increased villus length (P<0.05), while EA and TVA decreased villus length (P<0.05). The TVA group exhibited the lowest levels of low-density lipoprotein and tumor necrosis factor-α (P<0.05). Taken together, EA, TVA and CLA affected the physiological conditions of mice differently. The potential effects of three well-known fatty acids, including trans-9 octadecenoic acid (EA), trans-11 vaccenic acid (TVA) and cis-9, trans-11 conjugated linoleic acid (CLA), in animals or humans remain to be elucidated. Therefore, in the present study, 32 animals were randomly divided into four groups and administered a 0.5/100 g diet of EA, TVA or CLA for 4 weeks. The results demonstrated that the body weights and the weights of the liver, testis and mediastinal adipose tissue (MAT) of the animals gradually decreased (P<0.05). Blood was collected individually via the external jugular veins and the EA group exhibited the lowest levels of magnesium and triglycerides (P<0.05). CLA increased villus length (P<0.05), while EA and TVA decreased villus length (P<0.05). The TVA group exhibited the lowest levels of low-density lipoprotein and tumor necrosis factor-α (P<0.05). Taken together, EA, TVA and CLA affected the physiological conditions of mice differently and these may further our understanding of the various effects of these fatty acids on animals and humans.

cis-9, trans-11 Conjugated linoleic acid (CLA) is one of the most extensively studied CLA isomers due to its multiple isomer-specific effects. However, the molecular mechanisms of cis-9,trans-11 CLA synthesis in ruminant mammary gland are still not clearly understood. This process may be mediated, to a certain extent, by trans-11 C18:1 regulated by stearoyl-CoA desaturase-1 (SCD1) and/or its syntrophic proteins. This study aimed to investigate the effects of TVA on SCD1-mediated cis-9,trans-11 CLA synthesis in MAC-T cells and its potential molecular mechanism. Results showed that trans-11 C18:1 was continually taken up and converted into cis-9,trans-11 CLA in MAC-T cells during the 4-h incubation of 50 μM trans-11 C18:1. SCD1 protein expression increased more than twofold at 2 h (P < 0.01) and 2.5 h (P < 0.05) before decreasing to less than half of the normal level at 4 h (P < 0.05). One up-regulated (RAS guanyl releasing protein 4 isoform 1 [RASGRP4]) and six down-regulated proteins (glucosamine-6-phosphate deaminase 1 [GNPDA1], triosephosphate isomerase [TPI1], phosphoglycerate mutase 1 [PGAM1], heat shock protein beta-1 [HSPB1], annexin A3 [ANXA3], thiopurine S-methyltransferase [TPMT]) were found in MAC-T cells treated with trans-11 C18:1. Of these seven identified proteins, the presence of GNPDA1 and PGAM1 was verified in several models. More trans-11 C18:1 was taken up after PGAM1 knockdown by small interfering RNA (siRNA). In conclusion, our data suggested that PGAM1 may have a negative relationship with SCD1 and seemed to be involved in cis-9, trans-11 CLA synthesis by facilitating the absorption of trans-11 C18:1 in the bovine mammary gland.

Current use of microbes for metabolic engineering suffers from loss of metabolic output due to natural selection. Rather than combat the evolution of bacterial populations, we chose to embrace what makes biological engineering unique among engineering fields - evolving materials. We harnessed bacteria to compute solutions to the biological problem of metabolic pathway optimization. Our approach is called Programmed Evolution to capture two concepts. First, a population of cells is programmed with DNA code to enable it to compute solutions to a chosen optimization problem. As analog computers, bacteria process known and unknown inputs and direct the output of their biochemical hardware. Second, the system employs the evolution of bacteria toward an optimal metabolic solution by imposing fitness defined by metabolic output. The current study is a proof-of-concept for Programmed Evolution applied to the optimization of a metabolic pathway for the conversion of caffeine to theophylline in E. coli. Introduced genotype variations included strength of the promoter and ribosome binding site, plasmid copy number, and chaperone proteins. We constructed 24 strains using all combinations of the genetic variables. We used a theophylline riboswitch and a tetracycline resistance gene to link theophylline production to fitness. After subjecting the mixed population to selection, we measured a change in the distribution of genotypes in the population and an increased conversion of caffeine to theophylline among the most fit strains, demonstrating Programmed Evolution. Programmed Evolution inverts the standard paradigm in metabolic engineering by harnessing evolution instead of fighting it. Our modular system enables researchers to program bacteria and use evolution to determine the combination of genetic control elements that optimizes catabolic or anabolic output and to maintain it in a population of cells. Programmed Evolution could be used for applications in energy, pharmaceuticals, chemical commodities, biomining, and bioremediation.

Background: Family history is often referred to as a family tree in casual everyday conservations, but it carries a different connotation in medicine. This study is the first to investigate people's understanding of 'family medical history' and the concept of 'family' in the context of inherited cancer., Methods: Three hundred and nine staff at the Faculty of Medicine and Health, University of Leeds completed an online web survey., Results: Not all respondents understood or knew what makes a family history of cancer. Only 54% knew exactly the type of information required to make a family history. Apart from blood relatives, adopted and step-siblings, step parents, in-laws, spouses, friends and colleagues were also named as 'family' for family history taking. Personal experience of living with cancer and academic qualification were not significant in influencing knowledge of family history., Conclusions: There is misunderstanding and poor knowledge of family history of cancer and the type of information required to make a family history even in a sample of people teaching and researching medicine and health issues. Public understanding of the value of family medical history in cancer prevention and management is important if informed clinical decisions and appropriate health care are to be delivered., (© 2012 John Wiley & Sons Ltd.)