bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a Physician Survey to Estimate the Economic Burden of Fibromyalgia in China
Authors: Furnback Wesley , Chen Feifei , Li Jim , Wang Bruce CM , Liang Dongfeng 
Published: October 2020

Abstract
Background: Fibromyalgia (FM) is a chronic pain disorder with a global prevalence estimated to be between 2 and 3%. In addition to the chronic pain incurred by patients, FM is commonly associated with comorbidities and complications such as depression, anxiety, and sleep disturbances. This study estimates the economic burden of patients with FM in China using a physician survey. Methods: A burden of illness model was constructed using a micro-costing approach to estimate the direct cost associated with FM patients in China. FM-related comorbidities of anxiety, depression, and sleep disturbance were included in the model. Treatment utilization and costs for FM and FM-related comorbidities were included as well as FM-related healthcare resource utilization (physician visits, hospitalizations, blood tests, and radiologic tests). FM treatments included nonsteroidal anti-inflammatory drugs, pregabalin, duloxetine, amitriptyline, tramadol, Chinese medicine, physiotherapy, and acupuncture. The model leveraged the results of a physician survey, which targeted 6 rheumatologists and pain experts each with 5-10 FM patients per month in China. All costs are presented in Renminbi (¥) using spot exchange rates as of May 1, 2020.Results: From the physician survey, the prevalence rate of FM in China was estimated to be 2.8% with 75.8% as female. The economic model estimated the annual per patient direct medical cost of FM to be ¥17,377. Within these costs, FM-medication and treatment costs (¥11,216), healthcare resource utilization (¥4,297), and costs for medications treating FM-related comorbidities (¥1,863) were the highest contributors. Healthcare resource utilization costs were driven by physician visits (¥2,787) followed by radiographic tests (¥808), blood tests (¥508), and hospitalizations (¥194). Conclusion: The prevalence and gender distribution of FM patients in China is similar to those of other countries. The economic model estimates patients with fibromyalgia in China to incur significant economic costs.
Socio-Economic Related Inequalities in The Utilization of Family Planning Services Among Women in Zambia
Authors: Ndhlovu Simang'aliso , Bulawayo Maio , Mweemba Chris , Hangoma Peter 
Published: October 2020

Abstract
Background: While a large literature documents inequalities in healthcare utilization in Zambia, and the rest of sub-Saharan Africa, there has been limited focus on the examination of inequalities in family planning use and in general has increased, health inequalities persist. Similarly, despite the increase in utilization of family planning services from 15% in 1992 to 48% in 2018, the increase has not been equally shared in the population. We examine drivers of socio-economic related inequalities in utilization of family planning services among women of childbearing age in Zambia. Methods: Using secondary data from the 2014 Zambia Demographic and Health Survey (ZDHS), concentration curves and indices are applied to examine how pro-poor and pro-rich the distribution of family planning is. A Blinder-Oaxaca decomposition analysis is conducted to decompose the rural-urban differences in the utilization of family planning services among women of reproductive age. Results: Our findings show that less than half (45%) of the 12,498 respondents used family planning. Use of family planning services was unequally concentrated on the well-off (CI=0.590, P=0.055). The results are mainly driven by inequalities in rural areas (CI=0.4009, P=0.0730) as the distribution of family planning use in urban areas is more equal (CI=0.049, P=0.159). In addition to family planning use being more unequal in rural areas, the proportion of women who use family planning services is 5.16 percentage points lower than in urban areas. The factors accounting for the gap between rural and urban use of family planning, with a tendency to increase it, include wealth (54.79%), tertiary education (79.46%) and age-group of 45-49 years (53.68%). Some factors act to moderate, or reduce this gap and have negative contribution on family planning use. These include women with 7 and more children (-48.22%), being married (-43.45%), primary education (-33.93%) and middle wealth group (-43.75%). Conclusion: Despite progress in the utilisation of family planning services, socioeconomic inequalities have persisted, primarily in rural areas. Interventions to increase family planning use should aim at addressing rural socioeconomic disadvantage, with programs targeting poor women and those with low levels of education. Narrowing the rural-urban gap in family planning use should focus on improving wealth and education of rural women.
Costing the Outpatient Rehabilitation Services: Time-Driven Activity Based Costing Approach
Authors: Mohammadpour Farzaneh , Basakha Mehdi , Kamal Seyed Hossein Mohaqeqi , Azari Nadia 
Published: October 2020

Abstract
Bachground: Considering the necessity of health services costing, the aim of this study is to calculate the cost of rehabilitation services in an outpatient rehabilitation clinic in Tehran, Iran.Methods: The data for this study were categorized as financial data and information about the process of rehabilitation services. The first category was extracted from the financial documents and the second one is obtained by observation of patient flow and interviewing the clinic staff in 2016. The cost of rehabilitation services has been estimated using the time-driven activity-based costing approach.Results: The findings show that the cost of physical occupational therapy in the Asma rehabilitation center was $18.79 per unit of service. This amount for speech therapy services was $17.23 to $19.40, taking into account the difference in the quality of the service delivered. The cost of mental health occupational therapy service was also between $19.46 and $23.57. Comparing the cost of these services with their government’s tariffs makes it clear that there is a huge gap.Conclusion: The limited number of patients referred to the center has made the cost of one unit of rehabilitation services much higher than their official tariffs. This is true for almost all similar institutions and makes the profitability of small rehabilitation institutions extremely unstable. Therefore, proper marketing for rehabilitation services by promoting patient referral links with larger healthcare centers and the formation of integrated rehabilitation complexes can play a significant role in their profitability.
Assessing the Influence of Parental Anxiety on Child Anxiety During the COVID-19 Pandemic in the United Arab Emirates
Authors: Saddik Basema , Hussein Amal , Albanna Ammar , Elbarazi Iffat , Al-Shujairi Arwa , Sharif-Askari Fatemeh S. , Temsah Mohamad Hani , Stip Emmanuel , Hamid Qutayba , Halwani Rabih 
Published: October 2020

Abstract
Background: Studies have investigated the psychosocial impact of infectious disease outbreaks in adults; however, there is limited information on the mental health impact of the COVID-19 pandemic on children and the general UAE community. The aim of this study was to explore anxiety levels among parents, teachers and the general community amid the COVID-19 pandemic in the UAE, as well as to identify emotional and anxiety disorders in children. Methods: Using a web-based cross-sectional survey we collected data from 2,200 self-selected, assessed volunteers. Demographic information, knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using the (GAD-7) scale , emotional problems in children using the strengths and difficulties questionnaire (SDQ), worry and fear about COVID-19, coping mechanisms and general health information were collected. Results: The overall prevalence of GAD in the general population was 71% with younger people (59.8%) and females (51.7%) reporting highest levels of anxiety. Parents who were teachers reported the highest percentage of emotional problems in children (26.7%). Multivariate logistic regression for GAD-7 scores showed that being female, reporting high levels of worry associated with COVID-19, intention to take the COVID-19 vaccine and smoking were associated with higher levels of anxiety. Multivariate logistic regression for SDQ showed that parents with severe anxiety were seven times more likely to report emotional problems in their children than less anxious parents.Conclusions: This study is among the first to report the psychological impact of COVID-19 among adults and children in the UAE, and to highlight the significant association between parental and child anxiety. Findings suggest the urgency for policy makers to develop effective screening and coping strategies for parents and especially children.
Clinical Features Associated with the Efficacy of Chemotherapy in Patients with Glioblastoma (GBM): A Population-based Study
Authors: Wen Jieqiong , Chen Wanbin , Zhu Yayun , Zhang Pengbo 
Published: October 2020

Abstract
BackgroundGlioblastoma (GBM) is a highly malignant brain tumor with poor survival and prognosis. Randomized trials have demonstrated that chemotherapy improves survival in patients with GBM. This study aims to examine the clinical characteristics that are potentially associated with the efficacy of chemotherapy and the risk factors of GBM.MethodsA total of 25,698 patients diagnosed with GBM were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER). The clinical and demographic variables between groups were examined by Student's t-test and Pearson's chi-squared test. GBM-specific survival (GBMSS) and overall survival (OS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors.ResultsPatients who received chemotherapy had better overall survival (median OS 13 vs. 3 months, HR=1.9224, 95%CI 1.8571-1.9900, p<0.0001) and better GBMSS (median GBMSS of 12 vs. 3 months, HR=1.9379, 95%CI 1.8632-2.0156, p<0.0001) compared with patients who did not. Further subgroup analysis revealed that among patients who underwent chemotherapy, those who were younger, with the well-differentiated tumor, with a supratentorial tumor, received surgery or radiotherapy had both improved OS and GBMSS. Age, race, tumor grade, tumor location, tumor size, and treatments were identified as independent prognostic factors by multivariable analyses for patients with glioblastoma. ConclusionPatients with GBM who were younger (<65 years), with the well-differentiated tumor, underwent surgery or radiotherapy can benefit more from chemotherapeutic regimens. Age, race, tumor size, tumor location, tumor grade, surgery, radiotherapy, and chemotherapy were factors associated with the prognosis of patients with GBM.
Efficacy and Safety of Apatinib in Patients with Recurrent or Refractory Melanoma
Authors: Yuan Shumin , Fu Qiang , Ren Yingkun , Li Zhimeng , Wang Huijuan , Zhang Xiaojie , Huang Hao , Yang Yonghao , Shang Yiman , Gao Quanli , Wang Zibing 
Published: October 2020

Abstract
Background: Prognosis of patients with metastatic malignant melanoma is very poor and partly due to high resistance to conventional chemotherapies. The study’s objectives were to assess the activity and tolerability of apatinib, an oral small molecule anti-angiogenesis inhibitor, in patients with recurrent advanced melanoma.Methods: This was a single-arm, single-center phase II trial. The primary endpoint was progression-free survival (PFS) and the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and overall survival (OS). Eligible patients received at least one first-line therapy for advanced melanoma and experienced recurrence. Apatinib (500 mg) was orally administered daily. Trail registration: Clinical Trials, ID: NCT03383237. Registered on 24 December 2017. URL of trail registry record: https://register.clinicaltrials.gov. Results: Fifteen patients were included in the analysis. The median PFS was 4.0 months. There were two major objective responses, for a 13.33% response rate. Eleven patients had stable disease, with a DCR of 86.67%.The median OS was 12.0 months. The most common clinically significant grade 3 or 4 toxicities included hypertension and canker sore. No treatment-related deaths occurred.Conclusions: Apatinib showed antitumor activity as a second or first-line therapy in patients with malignant melanoma. The toxicity was manageable.
Obstetric and Neonatal Outcomes in Women with Pregnancy Associated Cancer: A Population-based Study in Lombardy, Northern Italy
Authors: Esposito Giovanna , Franchi Matteo , Dalmartello Michela , Scarfone Giovanna , Negri Eva , Parazzini Fabio , Vecchia Carlo La , Corrao Giovanni 
Published: October 2020

Abstract
Background: Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy. Methods: This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women. Results: Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57-2.07), cesarean section (aPR=1.78, 95% CI: 1.49-2.11) and premature birth (aPR=6.34, 95% CI: 4.59-8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36-1.35 and aPR=1.04, 95% CI: 0.78-1.39, respectively), but newborn among PAC women had a lower birth weight (p-value<0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96-7.33) as compared to cancer-free women. Conclusion: PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.
Acute Kidney Injury in Children with COVID-19
Authors: kari Jameela A , Shalaby Mohamed , Albanna Amr S , Alahmadi Turki , Alherbish Adi , Alhasan Khalid A 
Published: October 2020

Abstract
Background: Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.Methods: This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results: Of 89 children included, 19 (21%) developed AKI (52.6% stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15% vs 1.5%). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32% vs. 2.8%, p< 0.001) and mortality (42% vs. 0%, p< 0.001). However, AKI was not associated with prolonged hospitalization (58% vs. 40%, p=0.163) or development of MIS-C (10.5% vs. 1.4%, p=0.051). Residual renal impairment at discharge occurred in 9% of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.Conclusions: AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.
Trichomonas Vaginalis as A Risk Factor for Human Papillomavirus: A Study With Women Undergoing Cervical Cancer Screening
Authors: Belfort Ilka Kassandra Pereira , Cunha Ana Paula Almeida , Mendes Francisco Pedro Belfort , Galvão-Moreira Leonardo Victor , Lemos Renata Gaspar , Costa Lucas Henrique de Lima , Monteiro Pablo , Ferreira Mariele Borges , Santos Gerusinete Rodrigues Bastos dos , Costa Joyce Leal , Brito Luiz Gustavo Oliveira , Brito Luciane Maria Oliveira , Vidal Flávia Castelo Branco , Monteiro Sally Cristina Moutinho 
Published: October 2020

Abstract
BackgroundHuman papillomavirus (HPV) and Trichomonas vaginalis (TV) infections are the most common STIs. The latter has contributed to a variety of adverse outcomes for both sexes. Moreover, in Brazil, epidemiological studies on patients with STIs are limited. Therefore, this study aimed to determine the prevalence of TV and its association with HPV in women undergoing cervical cancer screening. MethodsWomen with a normal cervix were recruited from a community-based cervical cancer screening program. Gynecological examinations were conducted and questionnaires were provided. Vaginal canal and uterine cervix samples were collected and tested for the presence of TV and HPV DNA. ResultsThe overall prevalence of HPV DNA was 45.68%; among these, 27.1% had a co-infection with TV (p = 0.001). The presence of TV was associated with an increased risk of HPV (p = 0.0001) and previously identified cytological changes (p = 0.0001). ConclusionsWe concluded that a TV infection is associated with an HPV infection of the cervix as well as with the cervical cytological abnormalities. Further studies could reveal the mechanisms by which these two organisms interact at the cellular level, with control for shared behavioral risk factors. This research is in agreement with Resolution No. 466/2012 of the National Health Council and has the Research Ethics Committee of the Hospital Universitário Presidente Dutra, from Universidade Federal do Maranhão, under opinion number 76328917.5.0000.5086.
Low pH alleviated salinity stress in ginger seedlings by enhancing light efficiency and equilibrium of mineral elements
Authors: Yin Fengman , Zhang Shanying , Cao Bili , Xu Kun 
Published: October 2020

Abstract
BackgroundSalt stress is one of the abiotic stresses that affect plant growth, and it mainly reduces the biomass of plants by affecting their photosynthesis. However, little is known about the mechanisms by which low pH improves plant growth under salt stress. The effects of low pH on photosynthesis, chlorophyll fluorescence and mineral content in ginger (Zingiber officinale Roscoe) leaves under salt stress were investigated.ResultsIn this study, we found that the plant height and fresh weight, photosynthesis parameter (Pn, Gs, WUE and Tr), pigment concentration, fluorescence (qP, ΦPSII, Fv/Fm), Photosynthetic enzyme (fructose 1,6-diphosphatase (FBPase), ribulose-1,5-bisphosphate carboxylase (Rubisco), fructose 1,6-bisphosphate aldolase (FBA)), sugar metabolism and mineral content were significantly decreased under salt stress, but these parameters were all recovered by low pH. Meanwhile, low pH reduced the content of Na, while enhanced the content of K, Mg, Fe, Ca and Zn in ginger seedling leaves under salt stress. The observation of the ultrastructure of ginger seedlings under salt stress also showed that low pH can alleviate the damage of ginger seedlings to the complete structure and chloroplast.ConclusionsOur results suggested that low pH could enhance salt tolerance by improving photosynthetic efficiency and promoting absorption mineral.
Analysis of the Mixed Effects Regression Model for Clustered Count Response Data
Authors: Aguade Aragaw Eshetie , Begari Muniswamy 
Published: October 2020

Abstract
Background

The Poisson regression model is useful to analyze count data, but, when the observations are correlated the Poisson estimate will be biased. Whereas, when the over-dispersion and heterogeneity problems occur the imposition of the Poisson model underestimate the standard error and overestimate the significance of the regression parameters. Therefore, the objective of this paper was to develop a test statistic to model and predict clustered count response data via application and simulation data.
Methods

This paper concentrated on the clustered count data model to take into account heterogeneity. Accordingly, we developed a score test based on the multilevel Poisson model for testing heterogeneity with the alternative Poisson regression model. In addition, for the model application, we used the EDHS children`s data. Therefore, to evaluate the proposed model, we used both simulation and application data.
Results

Simulation results showed that the proposed score test has high power to predict and used to control heterogeneity between groups. Oromia, Amhara, and SNNPR are among the regions with the highest child mortality rates (Table 1). The results indicated that women who made marriage a mean age of 16 years and gave birth for the first child a mean age of 18 years and 8 months. Table 1 showed that 81% of all child deaths have recorded in rural areas. 78% of child families were illiterate, as a result, 75% of children don't have access to latrines and drinking water. Rivers and open-sources waters are the common sources of drinking water which comprised 79% of the total water supply. Therefore, from the research finding, it is possible to conclude that most child mortality is due to scarcity of water.
Conclusion

The Power of test estimates indicated that the proposed method was better than the existing models. All covariant and dummy explanatory variables have a significant effect on the deaths of children. Hence, the multilevel Poisson model results indicated that there exist high variability among regions for the deaths of children. Therefore, this work suggested that the applications of the random-effects model provided a simple and robust means to predict the count response data model.