bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical profile of home-based care patients in a Brazilian cohort
Authors: Botelho A P P P , Netto F C B , Silva R M , Filho C G , Chiesa D , Probo D R G , Santos M C L , Queiroz B L , Sales J M O , Vasconcelos L B 
Published: October 2020

Abstract

Background
The concern with increasing healthcare expenditures and the quality of life of chronically dependent of invasive mechanical ventilation (IMV) patients, led to the emergence of home-based care services (HBCS), which aims the humanization of health services and the reduction of hospital length of stay. Knowledge about the models used in HBCS and the results achieved is essential to identify, plan and execute actions that minimize obstacles to the adequate provision of this service.

Methods
Descriptive, longitudinal and retrospective study, in a HBCS provided by a private hospital in Fortaleza, Brazil. The medical records of 98 adult patients from the HBCS in need of IMV were analyzed.

Results
In 2019, 156 patients went through the HBCS. Of these, 58 were under 18 years-old and not included in the sample. Of the adult patients, 42 (42,8%) were male and 56 (57,1%) female. The age range varied from 28 to 102 years-old and the median age was 85 years. 57 (58,2%) patients were admitted throughout 2019, and 16 (28,1%) of them had, at least, 1 hospital readmission in 2019. 41 (41,8%) patients had been admitted before 2019, and 6 (14,6%) of them had, at least, 1 readmission in 2019. These facts may suggest that the need of hospitalization tend to happen more at the beginning of home-based care. In 2019, 13 (13,3%) patients died. 8 (61,5%) of these were admitted in 2019, and 5 (38,4%) were already in the HBCS before that year. The main diagnosis were: Dementia (21,4%), Chronic Encephalopathy (9,1%) and Multiple Sclerosis (8,2%).

Conclusions
The study shows that, even in an elderly and dependent cohort, the need of re-hospitalization and mortality rates are low, which points to the need of further studies of HBCS in order to reduce hospital stay and expenditures.

Key messages
It is important to deepen studies related to home-based care models, in association with payment expenses inquiries, as this type of assistance seems to develop humanized and safe care. The mortality rate of the HBCS studied was 13% and the overall re-hospitalization rate was 22,4%, which points this as a promising model for IMV dependent patients.
Utility of data-driven clusters for the prevention of type 2 diabetes
Authors: Yacaman-Mendez D , Zhou M , Ponce de leon A , Ebbevi D , Lager A 
Published: October 2020

Abstract

Background
Type 2 diabetes (T2D) is an important cause of mortality, disability and health care expenditures. Prevention is crucial to counter global trends, but individual variability of different risk factors leading to T2D has made prevention difficult to achieve. We aimed to identify clusters of individuals based on individual level characteristics of different risk factors using a data driven approach.

Methods
We used data from the Stockholm Diabetes Prevention Program. A population-based, prospective study. Healthy participants who were born in Sweden and aged 35 to 55 years old were recruited between 1992 and 1998 and followed up after 10 and 20 years. At each visit, participants answered extensive questionnaires, anthropometric measures, laboratory examinations and an oral glucose tolerance test. We used age, sex, family history of diabetes, fasting and two hours glucose and insulin, body mass index (BMI), systolic and diastolic blood pressure, and level of education were at baseline to group participants using the k-prototype algorithm. We then examined the risk of diabetes between clusters using survival analysis.

Results
A total of 7,173 participants representing 138,942 person years of follow-up were included in this study. Among them, 998 (14%) developed T2D. We identified six stable clusters: the group with the lowest cumulative incidence of T2D (2.3%) was used as reference (n = 1,265). In the group with the highest risk, 47% developed T2D (n = 772, HR 26.3, 95%CI 17.9-38.5) followed by 17.1% (n = 1,146, HR 7.6, 95%CI 5.1-11.22), 15.2% (n = 1,453, HR 6.7, 95%CI 4.5-9.8), 9.5% (n = 1,384, HR 4.1, 95%CI 2.8-6.2) and 5.2% (n = 1,157, HR 2.0, 95%CI 1.3-3.1) in the remaining groups.

Conclusions
There is important variability between individuals regarding the effect of different risk factors on the incidence of T2D. Data driven categorization strategies can be useful epidemiological tools to pave the way for more precise T2D intervention programs.

Key messages
Prevention strategies for T2D usually follow a one-size fits all approach, ignoring the important variability of risk factors and their consequences among individuals. It is possible to identify subgroups of people with different risk of T2D based on simple clinical and phenotypical characteristics, and could help to improve prevention and treatment of T2D.
Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis
Authors: Mahendran R , Puthussery S , Amalan M 
Published: October 2020

Abstract

Background
Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries.

Methods
We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome.

Results
Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher.

Conclusions
While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment.

Key messages
One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.
Sexual and gender minorities among students in Italy: population estimate and risk behaviours
Authors: Fonzo M , Baldovin T , Bertoncello C , Cappella G , Baldo V , Cocchio S 
Published: October 2020

Abstract

Background
Sexual and gender minorities (SGM) are at higher risk for stigma, discrimination and, ultimately, development of risky health behaviours than heterosexual counterparts. Latest demographic data on SGM population in Italy date back to 2011 census. The prevalence of risk behaviours among SGM university students has not been previously estimated in Italy. We aimed at estimating the population of SGM university students and assessing the prevalence of risk behaviours.

Methods
We conducted a cross-sectional survey involving a sample of 18-25 years old students. Participants were asked to complete an anonymous, self-administrated questionnaire on sexual identity/orientation, smoking, use of condom and sexual partners in the last 24 months. χ2 tests were performed.

Results
We collected 9,988 questionnaires (response rate 91.3%); 1.41% did not disclose sexual orientation. Transgender individuals were 0.12%. Among cisgenders males, 95.39% identified as hetero-, 2.52% as homo- and 2.02% as bisexual; 94.50% of females as hetero-, 1.28% as homo- and 4.21% as bisexual. While among men the proportion of smokers was 30.7% without significant differences among subgroups (p=.219), this proportion was 26.1%, 40,5% and 51.6% among hetero-, homo- and bisexual women (p&lt;.001); 62.4% of all males declared to use the condom without significant differences (p=.089), but 19.0% of homo- and 43.4% of bi- females did compared with 55.5% of heterosexual (p&lt;.001); 18,7% of hetero-, 49.4% of homo- and 32.4% of bisexual men declared to have had three or more partners (p&lt;.001); among hetero- women the proportion was 11.1%, while 12.5% and 26.3% among homo- and bisexuals.

Conclusions
SGMs were 5.26% of university students. Compared with hetero- counterparts, homo- and bisexual women showed a higher prevalence of all risk behaviours investigated. In contrast, homo- and bisexual men showed a similar behaviours compared with heterosexual men, except for a significantly higher number of partners.

Key messages
Sexual and gender minorities (SGMs) account for 5.26% of the investigated university student population; 4.54% of cisgender men and 5.49% of cisgender women are homo- or bisexual; trans are 0.12%. SGMs show unhealthier behaviours compared with heterosexual counterparts; in particular, bisexual women show higher prevalence of smoking and non-use of the condom.
Southwest US Latinas’ Weight Health: A Randomized Controlled Trial to Evaluate the De Las Mías App
Authors: Macario E , Consuelo A 
Published: October 2020

Abstract

Background
Three-quarters of Mexican American women are overweight vs. 64% of white women. Our preliminary 3-year study tested a culturally tailored app to improve weight health among Latinas in Southwest U.S. Phase II randomized controlled trial (RCT) compared experimental group and control group changes in weight health, attitudes, and behaviors at 6 months. The primary outcome was weight loss of &gt; =5% of a participant's body weight at 6 months (weight loss of this amount has shown significant health benefits).

Methods
Phase I evaluated a prototype (n = 54). Phase II RCT tested the app (n = 195). Both included adult Latinas with BMI 25-39 in New Mexico who reported wishing to lose weight. Weight was measured at 0-, 3-, and 6-months; an interview was conducted at 9-months. The experimental group was exposed to the app and the control group was exposed to non-culturally specific government education print materials.

Results
For Phase II participants 35-50 years, 29.4% of those in the experimental group, compared with 12.1% in the control group, had a weight loss of 5% at 6 months (p-value=0.04). Phase II participants &lt;35 years were 3.9X more likely to experience a weight loss of &gt; =5% at 6 months relative to those 50+ years; 9 of 10 participants overall maintained some healthy lifestyle changes at 9 months, with a slightly higher percentage of the experimental than the control group reporting positive changes.

Conclusions
De Las Mías (bilingual healthy lifestyles platform for Latinas) achieved the most impact among women 35-50 years. The primary weight loss drivers were increased efficacy in making changes in healthy eating/physical activity. The food log was difficult to use; thus, new offerings (in-app communications/videos/interactivity) consider literacy. A Healthy Lifestyle Checklist was added to improve usability. New content targets women &lt;35 and 50+ years; builds efficacy to structure habits; and explores in-app peer support and more rewards on weight management.

Key messages
Our preliminary study validates and supports culturally tailored innovation for population health. Valuable lessons learned continue to inform ongoing iterations for an effective De Las Mías platform.
COVID-19 and staff mental health: is there an evidence? An Italian field study
Authors: Magnavita N , Di Prinzio R R , Chirico F , Sacco A , Quintavalle G 
Published: October 2020

Abstract
Since the early months of the COVID-19 epidemic, a large number of scientific papers have considered the possibility that healthcare professionals (HCWs) were affected by depression, anxiety, post-traumatic stress, and psychological distress. The abundance of research has also made it possible to produce several systematic reviews and meta-analyzes. All the studies retrieved in these reviews, however, were cross-sectional. Depressive symptoms and anxiety in HCWs were compared to “normal values”, administrative staff, or external sample; moreover, some studies had no control group. No longitudinal study has been produced so far. Some studies had negative results. Overall, there is still little evidence of an increase in mental health problems and sleep disturbances in HCWs during the outbreak.
To fill this gap, we investigated the mental health of workers who have been monitored for many years in an Italian local health unit. Mental health was investigated with standardized questionnaires. 82 HCWs who tested positive at the COVID-19 nasopharyngeal swab, 152 exposed workers who tested negative and 361 unexposed controls participated in the survey. Anxiety was reported by 16.6% of COVID-19 cases and depression by 20.3%, with a significant increase in the estimated risk (OR = 4.3; CI95%=2.4-7.4 for anxiety, OR = 3.5; CI95% =2.0-6.0 for depression). In test-positive cases, sleep was a significant moderating factor in the relationship between occupational stress or PJ and anxiety. Exposed, negative HCWS also had an increased OR for anxiety (1.84, CI95% 1.1-3.1) and depression (2.2 CI95% 1.4-3.5).
The frequency of anxiety and depression disorders in the population examined was not higher than that recorded in the years preceding the epidemic during periodic occupational health checks in the workplace. Mental health support and organizational interventions must mainly concern workers with positive tests and should also tend to improve sleep quality.

Key messages
Health care workers who have had unprotected exposure to COVID-19 patients, and even more those who have contracted the infection, have sleep problems, anxiety and depression. The psychological support intervention for health care workers should include the promotion of sleep hygiene.
Effects of Covid-19 lockdown on mental health and sleep disturbances, results from an Italian survey
Authors: Voglino G , Gualano M R , Lo Moro G , Bert F , Siliquini R 
Published: October 2020

Abstract

Background
The Covid-19 pandemic is affecting different aspects of our society and brand-new conditions are expected after the lockdown. Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored.

Methods
The COvid COllateral ImpactS (COCOS) project was a national cross-sectional survey performed during the last 14 days of the Italian lockdown. Questionnaires were online and included items on socio-demographics, behaviours, and healthcare access. Depression was assessed through the Patient Health Questionnaire-2, anxiety through the Generalized Anxiety Disorder-2. Participants referring sleep disturbances completed the Insomnia Severity Index. Descriptive analyses, univariable and multivariable logistic regressions were performed (p-value&lt;0.05 significant).

Results
The sample size was 1515. Females were 65.6%, and the median age was 42 years (IQR=23). Depression and anxiety symptoms prevalence were 24.7% and 23.2%. The 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, increased time spent on internet, and avoidance of activities for peer pressure increased the likelihood of at least one of mental health outcomes. Increasing age, not experiencing work-related troubles, being married/cohabitant reduced such probability. Females and participants with chronic conditions resulted positively associated with sleep disturbances.

Conclusions
The results showed a high prevalence of mental health issues. Since the impact might be long-lasting, it is crucial to study effective interventions, specifically planning strategies for more vulnerable groups, e.g. youths, and considering the role of internet.

Key messages
A high prevalence of mental issues and sleep disturbances was recorded during the last week of the lockdown. Age, gender, marital status and the time spent on internet affected mental health while gender and presence of chronic conditions were predictors of sleep disturbances.
Non-nutritive sweeteners in the food supply: changes after the first phase of the Chilean Food Law
Authors: Zancheta Ricardo C , Corvalan C , Tallie L , Quitral V , Reyes M 
Published: October 2020

Abstract

Background
In June 2016, Chile implemented the Food Labeling and Advertising Law, which includes mandatory front-of-package warning labels in products with high content of sugars and other key nutrients. We evaluated whether the non-nutritive sweeteners (NNS) use increased among foods/beverages 7-8 months after implementation of the law.

Methods
We obtained data from packaged foods/beverages available in 6 major supermarkets and 3 candy distributions in Santiago, Chile, in January 2015/16 (T0) and January 2017 (T1). We included products with market share ≥1% of their food groups, with added sugar, salt or fat (i.e. products subject to regulation) and/or with NNS from 7 food groups: beverages, breakfast cereals, candies, sweet spreads, desserts, yogurts, and milk-based drinks, in cross-sectional (T0: N = 1,809; T1: N = 1,478) and longitudinal (i.e. same product collected in both periods; N = 999) samples. We compared the frequencies applying Chi-square and McNemar tests.

Results
In the cross-sectional analysis, there was no significant change in the frequency of NNS use neither considering the overall sample or each food group. Across all groups, about 40% of products presented at least one NNS in both periods, with the highest prevalence among beverages (T0:77%; T1:80%, p = 0.314) and yogurts (T0:63%; T1:68%, p = 0.312). In the longitudinal sample, the frequency of NNS use increased from 38% in T0 to 44% in T1 (p &lt; 0.001). Changes were observed in milk-based drinks (T0:50%; T1:67%, p = 0.008); beverages (T0:72%; T1:83%, p &lt; 0.001); desserts (T0:14%; T1:23%, p &lt; 0.001); and yogurts (T0:60%; T1:63%, p = 0.046).

Conclusions
Our results suggest increased NNS use in the longitudinal subsample after the implementation of the law; however, the overall frequency in the food supply remained the same, which could be explained either by changes in the food supply or sampling differences between the periods. Further analyses must explore the impact of these changes in NNS consumption.

Key messages
Regulations aimed to reduce food sugar content could impact the food NNS content. Monitoring the use of NNS in the food supply and its impact on NNS consumption is important in the current policy scenario.
Prevalence and correlates of elevated HbA1c in rural Zambia: A population-based cross-sectional study
Authors: Tateyama Y , Techasrivichien T , Musumari P M , Macwan’gi M , Zulu R , Dube C , Suguimoto S P , Ono-Kihara M , Kihara M 
Published: October 2020

Abstract

Background
Diabetes mellitus (DM) poses a serious challenge to the health systems in sub-Saharan Africa. In Zambia, the estimated prevalence of DM among adults was 4.2% in 2016. However, little is known about its magnitude among the rural population. To address this gap, we investigated the prevalence of DM and its correlates among rural residents in Zambia.

Methods
In 2016, we recruited 690 rural residents aged 25-64 of Mumbwa district by multistage, clustered, household sampling. Questionnaire survey was conducted along with anthropometric and biological measurements including HbA1c. Data analysis was adjusted for complex sampling.

Results
The prevalence of elevated HbA1c (≥5.7) was 41% (Men 34%, Women 48%). DM, defined as HbA1c ≥ 6.5%, was present in 2.6% of the participants. Sixteen percent of men and 37% of women were overweight or obese (BMI≥25). In multivariable analysis, high cooking oil intake and obesity (BMI≥30) were associated with higher odds of elevated HbA1c (adjusted odds ratio [AOR]=1.76 and 3.30), but the association was inverse for alcohol intake (AOR≈0.55). By gender, obesity was positively associated with an elevated HbA1c in both genders (AOR= men 6.57, women 2.11). Secondary education was inversely (AOR=0.52), and high sugar intake was positively (AOR=1.66) associated with elevated HbA1c in men. Older age and high cooking oil intake were positively associated (AOR=1.89 and 2.14), and alcohol intake (AOR=0.46) was inversely associated with elevated HbA1c in women.

Conclusions
More than 40% of rural residents in Zambia had elevated HbA1c. The risk factor profile was different between genders. Obesity increased the odds of elevated HbA1c in both genders, but the odds was disproportionately higher in men than in women. The reasons for such gender difference remain unknown, but we speculate that it might be explained by the early onset of obesity in women. Such gender difference should be addressed in health interventions in this population.

Key messages
Over 40% of rural residents in Zambia are at risk of prediabetes or diabetes. Health interventions should address the gender difference in the risk of elevated HbA1c.