bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome
Authors: Shukur Hasanain Hamid , de Rijke Yolanda B. , van Rossum Elisabeth F. C. , Hussain-Alkhateeb Laith , Höybye Charlotte 
Published: November 2020

Abstract

Background
Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol.

Methods
Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model.

Results
In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8 ± 25.4 pg/mg compared to 3.8 ± 7.3 pg/mg in controls (p = 0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p = 0.023). Furthermore, hair cortisol increased with BMI (p = 0.012) and reported stress (p = 0.014).

Conclusion
Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.
Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial
Authors: Signori Cácia , Moro Bruna Lorena Pereira , Uehara Juliana Lays Stolfo , Romero Vitor Henrique Digmayer , de Oliveira Elenara Ferreira , Braga Mariana Minatel , Mendes Fausto Medeiros , Cenci Maximiliano Sérgio ,   CaCIA Collaborative Group, de Queiroz Ana Beatriz L. , de Avila Alessandra B. , Souza Bruna O. , Signori Cácia , Dias Camila R. , Becker Camila T. , Chaves Eduardo T. , Malhão Eugênia C. , de Oliveira Elenara F. , Uehara Juliana Lays S. , da Silva Fernanda G. , da Silva Fernanda S. , Kucharski Gabriel V. Lima , dos Santos Gabriele R. , Torres Julia M. , Pinto Karoline V. A. , Morel Laura L. , Weymar Leonardo B. , Brod Marcelo P. , Gamborgi Maria F. , Cenci Maximiliano S. 
Published: November 2020

Abstract
Background
The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults.

Methods
The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%.

Discussion
This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth.
Trial registration NCT03108586 (registered 11 April 2017).
Effects of Er:YAG laser pre-treatment on dentin structure and bonding strength of primary teeth: an in vitro study
Authors: Wang Jun hui , Yang Kuan , Zhang Bai ze , Zhou Zhi fei , Wang Zi rui , Ge Xin , Wang Lu lu , Chen Yu jiang , Wang Xiao jing 
Published: November 2020

Abstract

Background
To investigate the effects of Er:YAG laser pre-treatment on the dentin structure and shear bond strength of primary teeth.

Methods
Dentin specimens were prepared using freshly extracted intact primary molars and divided randomly into four groups based on the surface treatment applied. The control and etchant groups received no treatment and conventional acid etching treatment, respectively, while the energy and frequency groups received laser surface treatment with variable energy (50–300 mJ) and frequency (5–30 Hz) parameters. The morphology was observed using scanning electron microscopy. The surface-treated dentin slices were bonded to resin tablets, followed by thermocycle treatment. The shear strength was determined using a universal testing machine and de-bonded surfaces were observed using a stereomicroscope.

Results
SEM observation showed that the surface morphology of the dentin slices changed after etching as well as after Er:YAG laser pre-treatment with different energy and frequency values. The dentin tubules opened within a specific energy (50–200 mJ) and frequency (5–20 Hz) range. Beyond this range, the intertubular dentin showed cracks and structural disintegration. Shear strength tests showed no significant changes after acid etching. The shear strength increased significantly (P < 0.05) after Er:YAG laser pre-treatment compared with that of the control group. The shear strength increased within the same energy (50–200 mJ) and frequency (5–20 Hz) range as the tubule opening, but not significantly (P > 0.05). The most common mode of interface failure was adhesive (interface) failure, followed by mixed and resin cohesive failure.

Conclusions
Pre-treatment using Er:YAG laser opens the dentinal tubules without the formation of a smear layer and improves the bonding strength between the primary teeth dentin and the resin composites.
Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center
Authors: Fürst Per , Lundström Staffan , Klepstad Pål , Strang Peter 
Published: November 2020

Abstract

Background
Continuous subcutaneous infusion (CSCI) via ambulatory infusion pump (AIP) is a valuable method of pain control in palliative care. When using CSCI, low-dose methadone as add-on to other opioids might be an option in complex pain situations. This study aimed to investigate the effects, and adverse effects, of CSCI for pain control in dying patients, with particular interest in methadone use.

Methods
This was an observational cohort study. Imminently dying patients with pain, admitted to specialized palliative inpatient wards and introduced on CSCI, were monitored daily by staff for symptoms (Integrated Palliative Care Outcome Scale - IPOS), sedation (Richmond Agitation and Sedation Scale – RASS), performance status (Eastern Cooperative Oncology Group - ECOG) and delirium (Confusion Assessment Method - CAM).

Results
Ninety-three patients with a median survival of 4 days were included. Of the 47 patients who survived ≥3 days, the proportion of patients with severe/overwhelming pain decreased from 45 to 19% (p < 0.001) after starting CSCI, with only a moderate increase in morphine equivalent daily dose of opioids (MEDD). Alertness was marginally decreased (1 point on the 10-point RASS scale, p = 0.001), whereas performance status and prevalence of delirium, regardless of age, remained unchanged.
Both patients with methadone as add-on (MET, n = 13) and patients with only other opioids (NMET, n = 34), improved in pain control (p < 0.05 and 0.001, respectively), despite that MET patients had higher pain scores at baseline (p < 0.05) and were on a higher MEDD (240 mg vs.133 mg). No serious adverse effects demanding treatment stop were reported.

Conclusions
CSCI via AIP is an effective way to reduce pain in dying patients without increased adverse effects. Add-on methadone may be beneficial in patients with severe complex pain.
Distribution of breast lesions diagnosed by cytology examination in symptomatic patients at Eritrean National Health Laboratory, Asmara, Eritrea: a retrospective study
Authors: Embaye Kidane Siele , Raja Saud Mohammed , Gebreyesus Medhanie Haile , Ghebrehiwet Matiwos Araya 
Published: November 2020

Abstract

Background
Fine needle aspiration cytology is a simple, relatively accurate, non-invasive, and cost-effective method of diagnosing most breast pathologies. To date, there is no sufficient data depicting the distribution of breast lesions detected by fine needle aspiration cytology in our healthcare setting. The aim of this study was to elucidate the general distribution of breast lesions diagnosed by cytology test at Eritrean National Health Laboratory.

Methods
This retrospective study was carried out on 905 symptomatic patients between the years 2013 and 2017 at Eritrean National Health Laboratory. Diagnosis was made by fine needle aspiration cytology in patients with palpable breast lump and in some patients direct smear was prepared from a nipple discharge. Statistical analysis was carried out using Statistical Package for the Social Sciences version 23.

Results
A total of 905 patients were included in the study, of whom 871 (96.24%) were females. The age range of patients was from 13 to 93 years with mean and standard deviation of 33 ± 14.9 years. Breast lump, occurring in 892 (98.56%), was the most frequent presenting symptom. Fibroadenoma and fibrocystic breast lesions were the most prevalent lesions accounting for approximately 40% and 15%, respectively. Malignant breast lesions were seen predominantly in females above the age of 40 years with the highest frequency observed in the age range between 51 and 60 years. Pearson Chi-squared test showed significant association between patients’ age above 40 years and the risk of having a malignant breast lesion (p < 0.001). The highest number of benign and malignant breast lesions was documented in 2014 with little fluctuation elsewhere in the study period.

Conclusion
Fine needle aspiration cytology is a procedure of choice for preoperative diagnosis in breast lesions mainly in a resource-limited settings. Our study identified the occurrence of malignant breast lesions in young women, which is of a paramount public health concern. Of note, significant proportion of patients were late to seek medical attention. Therefore, enhancement of community awareness regarding breast disease and implementation of screening programs are necessary to ameliorate the morbidity and mortality associated with the disease.
Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey
Authors: Rezaei Satar , Ahmadi Sina , Mohamadi-Bolbanabad Amjad , Khanijahani Ahmad 
Published: November 2020

Abstract

Background
Association between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households.

Methods
The data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran.

Results
The overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head.

Conclusions
This study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH.
The effect of supplemental high Fidelity simulation training in medical students
Authors: Meyers Lori , Mahoney Bryan , Schaffernocker Troy , Way David , Winfield Scott , Uribe Alberto , Mavarez-Martinez Ana , Palettas Marilly , Lipps Jonathan 
Published: November 2020

AbstractBackgroundSimulation-based education (SBE) with high-fidelity simulation (HFS) offers medical students early exposure to the clinical environment, allowing development of clinical scenarios and management. We hypothesized that supplementation of standard pulmonary physiology curriculum with HFS would improve the performance of first-year medical students on written tests of pulmonary physiology.MethodsThis observational pilot study included SBE with three HFS scenarios of patient care that highlighted basic pulmonary physiology. First-year medical students’ test scores of their cardio-pulmonary curriculum were compared between students who participated in SBE versus only lecture-based education (LBE). A survey was administered to the SBE group to assess their perception of the HFS.ResultsFrom a class of 188 first-year medical students, 89 (47%) participated in the SBE and the remaining 99 were considered as the LBE group. On their cardio-pulmonary curriculum test, the SBE group had a median score of 106 [IQR: 97,110] and LBE group of 99 [IQR: 89,105] (p < 0.001). For the pulmonary physiology subsection, scores were also significantly different between groups (p < 0.001).ConclusionsImplementation of supplemental SBE could be an adequate technique to improve learning enhancement and overall satisfaction in preclinical medical students.
Global scientific output trend for Akkermansia muciniphila research: a bibliometric and scientometric analysis
Authors: Dehghanbanadaki Hojat , Aazami Hossein , Keshavarz Azizi Raftar Shahrbanoo , Ashrafian Fatemeh , Ejtahed Hanieh-Sadat , Hashemi Ehsan , Hoseini Tavassol Zahra , Ahmadi Badi Sara , Siadat Seyed Davar 
Published: November 2020

Abstract

Background
Akkermansia muciniphila is an anaerobic bacterium residing in the healthy intestinal tract of host and its quantity has a negative correlation with various host diseases. This study for the first time provides a holistic bibliometric aspect of Akkermansi muciniphila research in the literature and shows the hot topic terms of these articles in any period of time.

Methods
Scopus database was selected to retrieve documents relevant to Akkermansia muciniphila in any language up to 2019. The bibliometric profile of Akkermansia muciniphila articles including subject area, year distribution, citations, institutions, journals, authors, and countries was systematically characterized and the collaboration networks of authors and countries as well as the burst detection algorithm of the words in the titles, abstracts and keywords were visualized.

Results
There is a progressive growing trend in research on Akkermansia from 2004 to 2019 with a total of 566 articles during this period. Out of 353 original articles, there are 194 animal studies (155 studies on mice) and 112 human studies. Also, 65 various diseases were investigated in these studies. The most focused conditions are obesity (71 articles) and type2 diabetes (39 articles). The United States is the leading country on Akkermansia publications (n = 132), followed by China (n = 95). Frontiers in Microbiology is the most dominant journal with 23 Akkermansia publications. In addition, “cancer” is the hot topic of recent Akkermansia research.

Conclusion
Akkermansia research is of progressive interest during the last decade and the studies on this subject move towards its relationship with cancer and its promising effect on health.
Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions
Authors: Tucker Joshua , Whitehead Lisa , Palamara Peter , Rosman Josephine Xenia , Seaman Karla 
Published: November 2020

Abstract

Background
Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care.

Methods
This study used a descriptive qualitative methodology. Semi-structured focus group interviews were conducted with 20 nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue.

Results
Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care.

Conclusion
The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.
Factors influencing recruitment and retention of male nurses in Macau and mainland China: a collaborative, qualitative study
Authors: Mao Aimei , Wang Jialin , Zhang Yuan , Cheong Pak Leng , Van Iat Kio , Tam Hon Lon 
Published: November 2020

Abstract

Background
Macau and the Mainland China have different political and socio-economic policies but are both influenced by Chinese culture. By comparing the professional development experiences of male nurses from Macau and the Mainland, this study aims to explore factors influencing the recruitment and retention of male nurses.

Methods
A collaborative, qualitative approach was adopted in which researchers from Macau and the Mainland were jointly involved in carrying out interviews and analyzing data. A total of 24 clinical male nurses were invited, with 12 each from Macau the Mainland. Recruitment was based on purposive sampling from various health institutions in the two regions. Semi-structured interviews were conducted in 2017–2018 with similar interview guidelines for both Macau and the Mainland sites. Thematic analysis was used for data analysis, and Nvivo11 Plus software was used to facilitate the analysis.

Results
Key facilitators/barriers to recruitment and retention of male nurses were clustered under the two research questions: 1) What are the factors influencing the recruitment of male nurses? 2) What are the factors influencing the retention of male nurses? Males in Macau and the Mainland experienced pressure while entering nursing because of the stereotype that nursing is a feminine occupation. However, males in Macau chose nursing as a college major under their own volition while males in the Mainland were mostly forced into nursing. The males in Macau hardly thought of leaving nursing while their Mainland counterparts constantly felt uncertain about their professional future. The males on both sides hoped to thrive in career development. While the Macanese tended to pursue advanced programs in specialty nursing for better health care in the frontline, the Mainlanders wanted to get promoted to leave the frontline.

Conclusion
Male nurses in Macau and Mainland share some common experiences in professional development but have different views and values regarding nursing.