bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral health care among patients with diabetes in Australia: A snapshot
Authors: Poudel P , Griffiths R , Wong V W , Arora A , Flack J R , George A 
Published: October 2020

Abstract

Background
Diabetes increases the risk of periodontal disease, which in turn negatively impact on diabetes control and complications. Therefore, awareness about the diabetes-oral health link and dental problems is important for people with diabetes. This study aimed to assess self-reported oral health status and knowledge of people living with diabetes.

Methods
A survey was conducted among patients who attended four public diabetes clinics in Sydney, Australia. The questionnaire included 10 knowledge items and a validated Oral Health Impact Profile (OHIP-14) scale. A convenience sample of 200 patients were recruited. The data were analysed using SPSS software with descriptive and Pearson's Chi-Squared tests reported.

Results
The mean age of participants was 62.4(±13.5) years. More than half were males (54.5%), born overseas (64%), not working (73%) and had type 2 diabetes (88%). More than half (55.1%) of the patients reported having one or more dental problems and this was negatively associated with their oral health-related quality of life (p &lt; 0.001). The most common dental problems were: gaps between teeth, pain in teeth and dry mouth. Only 46.2% of the participants had adequate oral health knowledge (&gt; the mean correct score 5.2 (±2.6). The main areas with poor knowledge were around the impact of gum disease on blood glucose levels (29.6%), effects of dry mouth on tooth decay (33.8%) and the link between diabetes and teeth and gums (44.5%). Only 13% of the patients reported receiving oral health information from diabetes care providers (diabetes educator, general practitioner/diabetes specialist and dietitian/nutritionist). Receiving oral health information was found to be significantly associated with higher oral health knowledge scores (p &lt; 0.05).

Conclusions
Considering that a majority of patients with diabetes have dental problems and inadequate oral health knowledge, diabetes care providers should take the opportunity to educate patients about oral health risks.

Key messages
People living with diabetes found to have dental problems and inadequate oral health knowledge. Considering that diabetes and dental problems adversely affect each other, it is crucial to educate patients about good oral hygiene and regular dental visit.
Hospitalization costs related to long-term management of patients undergoing CABG (PRIORITY project)
Authors: Pagano E , Evangelista A , D'Errigo P , Rosato S , Seccareccia F , Biancari F , Badoni G , Forti M , Barili F 
Published: October 2020

Abstract

Background
Identifying potential tools that could help improving the standard of care and lead to a better allocation of economic resources represents a main objective of research in public health. Using data from the PRIORITY cohort, this study aims to describe inpatients costs after a discharge for isolated coronary artery bypass surgery (CABG).

Methods
The PRIORITY project was designed to evaluate the long-term outcomes of 2 large multicenter cohort studies on CABG conducted between 2002-04 and 2007-08. For each patient discharged alive after a CABG intervention, costs of hospitalizations were estimated as the sum of costs of all the admissions occurred during 3 years of follow-up. NHS reimbursement rates were used as standard costs (in Euros). Inpatients costs were analysed according to their baseline risk factors.

Results
Among the 7363 patients included in this analysis, the median 3-year hospitalization costs were 4341€ (IQR: 1865-11699). Median costs were around 4.000€ for subjects alive at the end of follow up but higher for patients dying within 1 (about 8.600€) and 2-3 years of follow up (about 20.000€). The presence of comorbidities (such as diabetes and cancer) lead to higher median hospitalization costs while the on-pump approach was associated to lower median cost. Sixteen per cent of patients were at zero cost having no re-hospitalizations during the 3 years of follow-up (97% alive). Subjects at zero cost received more frequently on-pump approach, had a lower frequency of cancer, arteriopathy and ictus, but a higher frequency of angina and infarction.

Conclusions
Inpatient costs after isolated CABG are affected by preoperative comorbidities and by operative variables that could be removed or managed. Identifying independent risk factors for re-hospitalization will lead to the definition of a preoperative clinical and decision-making path that will bring both a clinical advantage for the patient and an optimization of costs for the NHS.

Key messages
Inpatient costs after isolated CABG are affected by preoperative comorbidities and operative characteristics like the on-pump approach. Appropriate management of operative approaches mainly based on operator preferences can have important implications in terms of healthcare costs.
Overcoming multimorbidity: Chrodis Integrated Multimorbidity Care Model pilot implementation
Authors: Bliek-Bueno K , Gimeno A , Poblador B , Guerrero I , Cano M I , Bestué M , Rodríguez-Blázquez C , Forjaz M J , Prados A 
Published: October 2020

Abstract

Background
Multimorbidity (MM) has become one of the greatest challenges for patients and healthcare providers, calling for the development of care models that offer holistic, patient-centered care plans. Our objective was to assess the applicability and effectiveness of the Chrodis Integrated Multimorbidity Care Model (IMCM) to improve care for patients with MM in the Public Health System of Aragón, a region in northeastern Spain where MM affects 80% of people over 65 years of age.

Methods
We developed and implemented a set of actions (”change package”) to target three main improvement areas (i.e., care fragmentation, training of professionals and community care) covering all five dimensions of the model. We used key process and outcome indicators to evaluate each action, including healthcare service use (hospitalizations, emergency room visits), delivery of care (care plans, case managers), improvement in MM management skills of professionals (online training course), and patient self-perceived quality of care (ad-hoc questionnaire).

Results
291 patients of over 65 years of age with MM were recruited. At the end of the implementation every patient had a designated case manager and an individualized care plan, and 96.7% had their social situation assessed. During the 1-year pilot intervention, patients averaged 0.69 hospitalizations and 1.24 visits to the emergency room; 87.5% reported a self-perceived improvement of received care. 348 community resources were mapped and made available online in an official website. 89% of professionals who were offered to participate in the training programme agreed, reporting 8.3/10 satisfaction with the course, and improved their MM management skills from 7.36 to 9.18/10.

Conclusions
The IMCM is applicable in the context of the Spanish Public Health System and is effective in improving quality of care for patients and professionals alike.

Key messages
Reinforcing the mechanisms that integrate community, primary and hospital care is still necessary if we intend to reduce the negative health outcomes associated to care fragmentation in multimorbidity. The sustainability of the model requires the continued collaboration of key stakeholders and the awareness that multimorbidity is an issue that exceeds purely economic and structural barriers.
Availability of ultra-processed food associated with health outcomes: a systematic review
Authors: Pereira de Araújo T , Moraes M , Magalhães V , Afonso C , Rodrigues S 
Published: October 2020

Abstract

Background
Ultra-processed food (UPF) consumption increases worldwide, which can be harm to population's health. To establish associations between UPF and health outcomes, food consumption can be assessed individually or by using availability data, such as purchase lists or household budget surveys. The aim of this review was to search for studies on the availability of UPF related with mortality and morbidity from noncommunicable diseases or their risk factors.

Methods
PRISMA guideline was used. Searches were performed on PubMED, EBSCO, Scopus and Web of Science on December 2019. Search strategy included terms related with exposure (UPF) and outcomes (mortality or morbidity from noncommunicable diseases and their risk factors). Studies were selected based on the title and abstracts. Full texts were screened for eligibility and the snowballing method was used to find other relevant studies. To be based on UPF availability data and its relation with health outcomes were the inclusion criteria. Studies that assessed only food consumption at an individual level and did not present health outcome were excluded. Selection was conducted by two reviewers and a third helped when disagreement occurred.

Results
After duplicates removal, 560 records were analyzed. From the 11 eligible studies, 55% were conducted in more than one country. Others were performed in Brazil (27%), Guatemala (9%) and Sweden (9%). Studies were ecological (64%), cross-sectional (27%) and longitudinal (9%). All had representative samples, 45.5% were national samples, and the others were from particular population subgroups. In all studies, the only health outcomes that showed positive association with UPF availability were overweight and obesity prevalence.

Conclusions
Studies relating ultra-processed food availability and health outcomes are mainly focused on overweight and obesity. It is thus necessary to further explore the relationship between UPF availability and other health outcomes.

Key messages
It is necessary to further research association between ultra-processed food availability and other health outcomes, such as morbidity and mortality from cardiovascular diseases, diabetes or cancer. Purchase lists or household budget surveys are an important source of food availability data and can be used to relate the consumption of ultra-processed foods to health outcomes.
Barriers and facilitators of adherence for cervical cancer prevention in low-income women in Colombia
Authors: Bermúdez Jaramillo PC , Arrivillaga Quintero M , Torres Poveda K J , Castrillón Libreros D M , Neira Acevedo D , Cuartas Arroyabe D , Castillo Castillo L E 
Published: October 2020

Abstract

Introduction
In Colombian women, cervical cancer screening coverage in 2017, 48.2 % of women were able to pay and 34.3% were not able to.

Objective
To determine the barriers and facilitators of screening adherence to preventive program for cervical cancer prevention, in women were not able to pay affiliated to a public network of primary health care in Cali, Colombia, during the years 2014-2018.

Methods
Sequential mixed study, quantitative initial phase and second qualitative phase. We analyzed information from 32,001 insured women and 7,691 users of the program. The quantitative design was cross-cutting, observational and analytical; we also incorporate a qualitative case study; we conduct focus groups, in-depth interviews with users, health care services and administrative staff.

Results
47.5% of women were adherents to the program; women over 50 (OR = 0,82; 95% CI = 0,73-0,92), who lived further away from the health care site, (OR = 0,78; 95% CI = 0,62-0,97), had worse adherence to the program; women most often from medical consultations had increased adherence (OR = 3; 95% CI = 2,66-3,42). The qualitative case study showed similar barriers to other populations, living conditions, shame and fears of the procedure itself. We found as facilitators, agile attention, the ease of consulting services, and having some social support.

Conclusions
Despite the efforts of the public network of primary health care, the personnel staff consider a great barrier, the lack of updated information of women, which prevents recruitment and monitoring.

Key messages
In low-income women, it is necessary to generate interventions in groups of poor non-adherent women, as well as women with low adherence. Adherence depends on women’s beliefs and knowledge. Lack of interaction with a healthcare provider, increasing age and living far away from the health care site continue to be barriers.
Hospital management of patients with acute coronary syndrome: influence of age and gender
Authors: D'Errigo P , Rosato S , Mureddu G F , Badoni G , Cerza F , Cicala S D , Forti M , Seccareccia F 
Published: October 2020

Abstract

Background
Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered.

Methods
The national administrative hospital discharge record (HDR) system was used. Only data recorded from January 1, 2017 to Dicember 31, 2018 were analyzed. This approach allowed to identify 205775 patients reporting ACS as primary or secondary diagnosis: 122812 with non-ST-elevation ACS (NSTE-ACS) and 82963 with ST-elevation ACS (STEMI). The ACS cohort was stratified by age (&lt;75 and ≥75 years) and gender. The proportion of STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations were analyzed.

Results
Among the 205775 patients hospitalized for ACS, 6% of STEMI and 8.3% of NSTE-ACS patients have been treated only in a general medicine ward and have never passed through a specific cardiology ward. For STEMI patients, the proportion becomes 4% when males are considered, increases up to 10% for females and up to 13% for elderly patients (≥75 years). During the index hospitalization, about 25% of female and more than 30% of elderly patients with STEMI do not undergo a coronary procedure or other extensive investigations; the same happens only in about 10% of male and 6% of younger patients. The proportion of improperly managed patients reaches 35% for women aged ≥75 years.

Conclusions
In-hospital management of women and elderly patients with ST-elevation ACS does not completely comply with the recommended guidelines and exposes them to unfavourable prognosis.

Key messages
Women and elderly STEMI patients are markedly less intensively investigated and treated in cardiologic departments. This medical policy could lead to unfavourable prognosis.
Trajectories of cognitive performance over 5 years in a cohort of breast cancer patients (NEON-BC)
Authors: Araujo N , Lopes-Conceição L , Fontes F , Severo M , Dias T , Tedim-Cruz V , Ruano L , Pereira S , Lunet N 
Published: October 2020

Abstract

Purpose
Cancer-related cognitive impairment may affect 30-70% of cancer patients, either at baseline or during and after treatment. We aimed to identify trajectories of cognitive performance, from before any treatment to 5 years later, in a cohort of breast cancer (BCa) patients.

Methods
BCa women admitted to the Portuguese Institute of Oncology, Porto, were included in the NEON-BC study during 2012. They were evaluated with the Montreal Cognitive Assessment (MoCA) before any treatment, and after 1, 3 and 5 years (N = 506, 503, 475 and 466, respectively). Nlme R package was used to fit a mixed-effect model of the trends in MoCA scores over time, with age and education as fixed effect. Coefficients of this model were retrieved to calculate an age- and education-modified MoCA score (mMoCA). Mclust was used to obtain clusters of trajectories of mMoCA.

Results
Two trajectories were identified, one with higher scores and increasing over time, and the other showing a continuous decline (25.9% of the participants and 84% of the women with cognitive impairment confirmed by neuropsychological tests and clinical examination by neurologist at the 5 year follow-up). Each trajectory was split into 2, according to scoring above or below to the median value of mMoCA at baseline to account for the possibility of patients being in a declining pathway before treatment. In addition to trajectories characterized by the highest and lowest scores, respectively, relatively stable over time, two trajectories with middle-range scores were observed, one increasing over time and the other decreasing (12.7% of the participants); being older than 65 years, suffering from anxiety, depression or poor sleep after treatment were more frequent among the latter.

Conclusions
One quarter of the 5-year breast cancer survivors had a declining trajectory in cognitive performance. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.

Key messages
Cognitive decline occurs during breast cancer care, affecting one quarter of the patients. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.
Multimorbidities associated with bruxism: a population-based study. Campinas- Brazil
Authors: Kelly Fehlberg B , Guimarães Lima M , Alvarenga Santini P , Berti de Azevedo Barros M 
Published: October 2020

Abstract

Background
Bruxism is a relevant topic in public health, as it represents an increasingly frequent parafunctional activity and also for presenting musculoskeletal and dental effects affecting the health and well-being of the affected population. The reviewed literature shows that bruxism is associated with some health problems, but with multimorbidities has not yet been investigated.

Objective
To identify the association of bruxism with a multimorbidity pattern.

Methods
A population-based cross-sectional study was conducted with a sample composed of 1986 adults (≥20 years of age). This study used data from the Third Health Survey of the City of Campinas conducted in 2014 and 2015 (ISACamp 2014/15). A principal component analysis was performed to identify in which multimorbidity pattern, present in the population, bruxism is included. From this pattern, the variable number of diseases was created (0; 1; 2 to 4; 5 or more). The prevalence of bruxism was established according to this variable and associations were tested using the Rao-Scott chi-square test and Poisson regression.

Results
The factor analysis revealed three relevant patterns of multimorbidity in the population of Campinas. Bruxism was part of the pattern also composed of: asthma, rhinitis, sinusitis, allergy, migraine/headache, emotional/mental problem, dizziness/vertigo and back pain. The prevalence of bruxism increased more than fivefold in the concomitant presence of five or more of these conditions (PR = 5.35;95%CI:3.35 to 8.45).

Conclusions
Knowledge about the association of bruxism with a pattern of multimorbidities can show the direction of health actions in multidisciplinary teamwork, prioritizing the reduction in harm caused by the simultaneous presence of health problems associated with bruxism. We also emphasize the possible role of bruxism as an indicator of multimorbidities, especially those associated with the pattern found.

Key messages
Bruxism was more associated with multimorbidities of the pattern composed of asthma, rhinitis, sinusitis, dizziness/vertigo, migraine/headache, emotional/mental problem, back pain and allergy. The concomitant presence these conditions increased the prevalence of bruxism up to fivefold.
Burden of cardiovascular diseases in the region of Monastir (Tunisia)
Authors: Abroug H , Kacem M , Ben fredj M , Zemni I , Bennasrallah C , Dhouib W , Sriha A 
Published: October 2020

Abstract

Background
Cardiovascular disease (CVD) is the leading cause of death in Tunisia. The aim of this study was to analyze CVD burden from 2002 to 2013 in the region of Monastir.

Methods
Using the Global Burden of Disease methodology, cardiovascular disease mortality and disability-adjusted life years (DALYs) were analyzed by age group and sex for all admissions at the university hospital of Monastir, using standardized approaches for data processing and statistical modeling. Data were retrieved from the regional register of hospital morbidity in Monastir and were analyzed from January 2002 to December 2013.

Results
CVDs caused 519 in-hospital deaths during the study period, accounting for 43.3 % (CI 95%: 40.6-46.1%) of all in-hospital non-communicable diseases-related mortality (n = 1197). The crude mortality rate of CVDs was 8.81 per 100,000 inh. The highest rate was recorded among patients aged ≥ 60 years-old. The age-standardized mortality rate was 11/100,000 PY (14 in men and 8 in women). CVD DALY per 100,000 was 176.4 (199.4 in men and 152.7 in women). The highest CVD DALY was in the age groupe of 60 years and older (929.7/100,000). The leading causes of DALYs for both sexes are coronary heart diseases and stroke with DALY rate of 112.6 and 47.4 per 100,000 inh, respectively.

Conclusions
The CVD burden was heavy in the study population, in particular in the elderly and in men. Prevention and control of modifiable risk factors should be taken actively to improve health for Tunisian adults.

Key messages
CVD burden was heavy in the region of Monastir. More efforts are needed to improve cardiovascular health in Tunisian adults.
Diabetes and education: analysis of the consequences on the school and academic careers of diabetics
Authors: Matchika Megaptché M , Wamba A 
Published: October 2020

Abstract

Background
Diabetes management is a very critical time for many people as they have to make a new life with the disease on a daily basis. However, the effect of the school environment on this management remains poorly understood, and most existing studies neglect the role of teachers and students in preventing or triggering a possible diabetic crisis.

Objective/Methods
Based on the ethnography of the subjective experience of 6 young diabetics aged 15 to 20 years attending school in Yaoundé, the study combines life stories examining how teachers and students modify the markers of preventive management of diabetes in the classroom, and observations analysing how these markers vary according to the level of their knowledge of the constraints related to the disease and the consequences it generates in the young diabetic's school and social life.

Results
Managing diabetes in the school setting results in a double handicap. Firstly relational: it creates latent or open conflicts between the diabetic and his peers and with certain teachers, due to the constraints of treatment and the social perceptions/representations they send back to the young diabetic. Second, pedagogical: some young diabetics are denied access to PSE courses, for example, while others choose to drop out of certain courses because of conflicts with the teacher or drop out of school permanently. Finally, others are denied access to certain training schools of their choice, which limits their possibilities of developing a socio-professional project compatible with their real aspirations and adapted to their state of health.

Conclusions
The study suggests the need to develop a school diabetes support programme that takes into account this dual educational and relational handicap; and that educates teachers and peers about the medical constraints and socio-educational consequences of the disease.

Key messages
The management of diabetes in the school and academic environment produces in young diabetics a double relational and pedagogical handicap. The study suggests developing a school-based diabetes support program that takes into account this double handicap and educates teachers and peers about the constraints and consequences of the disease.