bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare utilisation and out-of-pocket expenditure of type 2 diabetes patients with and without comorbidity: A study in primary care in Bhubaneswar, India.
Authors: Pati Sandipana , Swain Subhashisa , Akker Marjan van den , Schellevis F. (François) G. , Burgers Jako S. 
Published: October 2020

Abstract
Background: Globally, non-communicable diseases (NCD) demand a higher healthcare expenditure. Amongst the NCDs, diabetes mellitus, is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where most of the healthcare expenditure is borne out of pocket, diabetes management may pose a significant financial stress.Methods: A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilisation and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilisation was determined by the number of visits to healthcare facilities in the last six months, and out-of-pocket expenditure was assessed by outpatient consultation fees, medicines, travels to health care facilities and diagnostic tests. Total out-of-pocket expenditure was defined as the sum of these costs.Results: The median number of visits in 6 months for diabetes patients with any comorbidity was 4 and 5 for diabetes patients with more than 4 comorbidities. Among the comorbid conditions, depression, stroke, auditory impairment and acid peptic disease were associated with higher healthcare utilisation. The total out-of-pocket expense was 2.3 times higher among diabetes patients with any comorbid condition compared to patients with diabetes only. The total median expenditure was higher for diabetes patients having stroke, heart diseases, kidney diseases and cancer compared to other comorbid conditions. The association of comorbidity in diabetes patients with health care utilization and out-of-pocket expenditure is statistically significant after adjustment for sociodemographic characteristics and diabetes duration.Conclusion: Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is a significant burden for diabetes patients below the poverty line and with limited or no insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.
Short-Term Changes in the Anterior Segment and Retina after Small Incision Lenticule Extraction
Authors: Chen Yanwei , Liao Huaping , Sun Yue , Shen Xi 
Published: October 2020

Abstract
Background: To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE).Methods: Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density.Results: Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p<0.05), while LT was thickened after surgery (p<0.05). MT at the fovea decreased 1 day and 1 week after surgery (p<0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. 𝜟ACD and 𝜟LT showed no significant correlation 1 day after surgery. 𝜟ACD was negatively correlated with 𝜟LT and sphere 1 week after surgery (r=-0.847, p<0.000; r=-0.398, p=0.002). 𝜟LT was positively correlated with the sphere 1 week after surgery (r=0.256, p=0.048).Conclusion: The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
Atomistic insight into novel co-delivery of doxorubicin and paclitaxel using fullerene modified by dimethyl acrylamide trimethyl chitosan: A computational study
Authors: Alimohammadi Ehsan , Maleki Reza , Akbarialiabad Hossein , Dahri Mohammad 
Published: October 2020

Abstract
Background: The distribution of drugs could not be controlled in the conventional drug delivery system. This has led to the development of a smart nanoparticle-based drug delivery system, known as smart drug delivery systems. In cancer research, novel biocompatible nanocarriers have received much attention for various ranges of anticancer drugs.In the current study, the effect of a novel co-polymer "dimethyl acrylamide-trimethyl chitosan" was investigated on drug delivery of doxorubicin and paclitaxel utilizing modified fullerene nanocarrier. This study was performed via molecular dynamics simulation based on acidic pH sensitivity of the cancer microenvironment. Furthermore, hydrogen bonds, diffusion coefficient, gyration radius, and drug-carrier interaction energies were investigated here. Interestingly, a simultaneous pH and temperature-sensitive system was proposed for paclitaxel and doxorubicin for a co-polymer. A pH-sensitive and temperature-sensitive copolymer was used based on trimethyl chitosan and dimethyl acrylamide, respectively. In such a dualistic approach, co-polymer makes an excellent option to have two properties in one bio-polymer. Results: The results suggest the dramatic and indisputable role of the co-polymer in the release of doxorubicin and paclitaxel in cancerous tissues, as well as an increased biocompatibility and drug uptake in a neutral state. The validation test was performed by repeated simulations of a similar article. The results are very close to those of the reference paper .Conclusions: Overall, conjugated fullerene and dimethyl acrylamide-trimethyl chitosan (DMAA-TMC) as carriers can be a good proposition for loading, delivery, and release of anti-cancer drugs based on a pH/temperature-sensitive smart drug delivery system.
Protocol for a systematic review and network meta-analysis of randomised controlled trials examining the effectiveness of early parenting interventions in preventing internalising problems in children and adolescents.
Authors: Costantini Ilaria , Paul Elise , Caldwell Deborah M , López-López José A , Pearson Rebecca M 
Published: October 2020

Abstract
Background: Internalising problems, such as depression and anxiety, are common and represent an important economical and societal burden. The effectiveness of parenting interventions in reducing risk of internalising problems in children and adolescents has not yet been summarised. The aims of this review are to assess the effectiveness of parenting interventions in the primary, secondary and tertiary prevention of internalising problems in children and adolescents and to determine which intervention components and which intervention aspects are most effective for reducing risk of internalising problems in children and adolescents. Methods: Electronic searches in OVID SP versions of Medline, EMBASE and PsycINFO; Cochrane Central Register of Controlled Trials; EBSCO version of ERIC and clinicaltrials.gov have been performed to identify randomised controlled trials or quasi-randomised controlled trials of parenting interventions. At least two independent researchers will assess studies for inclusion and extract data from each paper. The risk of bias assessment will be conducted independently by two reviewers using the Cochrane Collaboration’s Risk of Bias Assessment Tool. Statistical heterogeneity is anticipated given potential variation in participant characteristics, intervention type and mode of delivery, and outcome measures. Random effects models, assuming a common between-study variability, will be used to account for statistical heterogeneity. Results will be analysed using a network meta-analysis (NMA). If appropriate, we will also conduct a component-level NMA, where the ‘active ingredients’ of interventions are modelled using a network meta-regression approach.Discussion: Preventing and reducing internalising problems could have major beneficial effects at the economic and societal level. Informing policy makers on the effectiveness of parenting interventions and on which intervention’s component is driving the effect is important for the development of treatment strategies. Systematic review registration: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020172251
The Association Between Alcohol Consumption and Dysmenorrhea in University Students in North China
Authors: Yang Zhuo , Guo Jia , Sun Ming-li , He Qin-cheng , Ma Ya-Nan 
Published: October 2020

Abstract
Background: Dysmenorrhea is common gynecological disease in the whole world. Unfortunately, only a few studies have estimated the relationship between alcohol consumption and dysmenorrhea among women. In particular, there are fewer studies to explore the association between alcohol consumption, dysmenorrhea, and age at menarche.Objective: This study aimed to evaluate whether and what extent alcohol consumption is related to dysmenorrhea and age at menarche.Methods: This is a cross-sectional, observational study conducted among college students. A total of 3,837 participants (age ≥18 years) volunteered to participate in the study and completed the questionnaire. Moreover, 145 were excluded from the study owing to exclusion criteria. Finally, a total of 3692 female college students were enrolled in this study using the following criteria. We divided female college students into two groups stratified by age at menarche 13 years. The logical regression model was performed to evaluate the association between alcohol use and primary dysmenorrhea. The model adjusted for confounding factors and estimated the odds ratio and 95% confidence interval.Results: A total of 3692 female college students completed the survey, including 409(11.08%) students with alcohol use and 3283 (88.92%) participants without alcohol use. We founded that alcohol use and alcohol consumption were not related to dysmenorrhea. However, stratified by age at menarche, we found that there was a negative association between alcohol consumption and dysmenorrhea among participants with AAM ≥13 years (OR,1.41; 95% CI, 1.06, 1.88). Compared with participants without alcohol consumption, participants with alcohol consumption at least once a month (OR,1.29; 95% CI, 0.94, 1.78) and alcohol consumption at least once a week (OR,1.92; 95% CI, 1.07, 3.45) were more likely to have dysmenorrhea adjusted for other confounding factors.Conclusion: Our findings showed there was a negative association between alcohol consumption and dysmenorrhea stratified by age at menarche (13 years).
Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: A high-density MEG case study
Authors: D'Arcy Ryan C.N. , Greene Trevor , Greene Debbie , Frehlick Zack , Fickling Shaun D. , Campbell Natasha KJ , Etheridge Tori , Smith Christopher , Bollinger Fabio , Danilov Yuri , Livingstone Ashley , Tannouri Pamela , Martin Pauline , Lakhani Bimal 
Published: October 2020

Abstract
Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits.Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program.Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes.Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.
Pharmacokinetic herb-drug interactions between Aidi injection and Doxorubicin in rats with diethylnitrosamine-induced hepatocellular carcinoma
Authors: Lu Yuan , Pan Jie , Zhu Xiaoqing , Zhang Shuai , Chunhua Liu , Sun Jia , Li Yueting , Chen Siying , Huang Jing , Cao Chuang , Wang Yonglin , Li Yongjun , Liu Ting 
Published: October 2020

Abstract
Background: Aidi Injection (ADI), a Chinese herbal preparation with anti-cancer activity, is used for the treatment of hepatocellular carcinoma (HCC). Several clinical studies have shown that co-administration of ADI with doxorubicin (DOX) is associated with reduced toxicity of chemotherapy, enhanced clinical efficacy and improved quality of life for patients. However, limited information is available about the herb-drug interactions between ADI and DOX. The study aimed to investigate the pharmacokinetic mechanism of herb-drug interactions between ADI and DOX in a rat model of HCC. Methods: Experimental HCC was induced in rats by oral administration of diethylnitrosamine. The HCC rats were pretreated with ADI (10 mL/kg, intraperitoneal injection) for 14 consecutive days prior to administration of DOX (7 mg/kg, intravenous injection) to investigate pharmacokinetic interactions. Plasma concentrations of DOX and its major metabolite, doxorubicinol (DOXol), were determined using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Results: Preadministration of ADI significantly altered the pharmacokinetics of DOX in HCC rats, leading to increased plasma concentrations of both DOX and DOXol. The area under the plasma drug concentration-time curve (AUCs) of DOX and DOXol in rats pretreated with ADI were 3.79-fold and 2.92-fold higher, respectively, than those in control rats that did not receive ADI. Conclusions: Increased levels of DOX and DOXol were found in the plasma of HCC rats pretreated with ADI.
Extensively drug-resistant Alcaligenes faecalis infection
Authors: Huang Chienhsiu 
Published: October 2020

Abstract
Background: Alcaligenes faecalis is usually causes opportunistic infections in humans. Alcaligenes faecalis infection is often difficult to treat due to its increased resistance to several antibiotics. The results from a clinical study of patients with Alcaligenes faecalis infection may help improve patients’ clinical care. Methods: We conducted a retrospective analysis of all patients presenting with Alcaligenes faecalis infection from January 2014 to December 2019. The medical records of all patients were reviewed for demographic information, clinical symptoms and signs, comorbidities, use of intravenous antibiotics within the past three months, bacterial culture, antibiotics sensitivity test, and clinical outcomes. Results: Sixty-one cases of Alcaligenes faecalis infection were seen during the study period, including 25 cases of cystitis, nine cases of diabetic foot infection, eight cases of pneumonia, seven cases of acute pyelonephritis, three cases of bacteremia, and nine cases of infection at specific sites. Thirty-seven patients (60.7%) had a history of receiving intravenous antibiotics within three months of the diagnosis. Fifty-one (83.6%) cases were mixed with other bacterial infections. Extensively drug-resistant infections have been reported since 2018. The best sensitivity rate to A. faecalis was 66.7% for three antibiotics (imipenem, meropenem, and ceftazidime) in 2019. Two antibiotics (ciprofloxacin and piperacillin/tazobactam) sensitivity rates to A. faecalis were less than 50%. Conclusions: The most frequent Alcaligenes faecalis infection sites, in order, are the bloodstream, urinary tract, skin and soft tissue, and middle ear. The susceptibility rate of Alcaligenes faecalis to commonly used antibiotics is decreasing. Extensively drug-resistant Alcaligenes faecalis infections have emerged.
Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.
Authors: Billings Jenny , de Bruin Simone R. , Baan Caroline , Nijpels Giel 
Published: October 2020

Abstract
BackgroundDespite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015-2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators.ConclusionsLessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysis.
Partograph utilization as a decision making tool and associated factors among obstetric care providers in Ethiopia: A systematic review and Meta-analysis
Authors: Ayenew Asteray , Zewdu Biruk Ferede 
Published: October 2020

Abstract
Background Globally, a total of 13.6 million women have died due to maternal causes from 1990 to 2015. Majority of these deaths occurred in resource-limited countries. Among the causes of these deaths, obstructed and prolonged labor covers the highest percentage, which could be prevented by cost-effective and affordable health interventions like partograph use. Therefore, this systematic review and meta-analysis aimed to assess the level of partograph utilization among obstetric care providers and its associated factors in Ethiopia. Method for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed/Medline, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. Microsoft Excel was used for data entrance and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) for data analysis.Result Nineteen studies were included in this systematic review and meta-analysis with a total of 6237 obstetric care providers. The overall pooled prevalence of partograph utilization was 59.95% (95%CI: 46.8–73.09, I2 =99.4%, P <0.001). Being midwifery profession (adjusted odds ratio (AOR):3.97; 95% confidence interval (CI):95%CI:2.63–5.99, I2 =28.8%, P=0.198), presence of supervision (AOR = 3.21; 95%CI: 2.22–4.66, I2=0.0%, p=0.742), Basic Emergency Obstetric and Newborn Care (BEmONC) training (AOR  = 2.90; 95% CI: 2.19–3.84, I2=36.9%, P=0.13), Knowledge of partograph (AOR=2.5; 95%CI: 1.6–3.8, I2=64.58%, P=0.024), on-the-job refresher training on partograph (AOR =5.7; 95%CI:2.5–12.9, I2=87.8%, P<0.001), favorable attitude (AOR=2.12; 95%CI: 1.48–3.04, I2=0.0%, P=0.58), and working at health center (AOR=3.50; 95%CI: 2.49–4.92, I2=49.1%, P=0.08) were the determinant factors for partograph use among obstetric acre providers in Ethiopia.Conclusion The overall pooled prevalence of partograph utilization among obstetric care providers was low. Therefore, supportive supervision, providing Basic Emergency Obstetric and Newborn Care training, on-the-job refresher training on partograph, and promoting midwifery profession are strongly recommended to increase the use of partograph.