bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study
Authors: Wei Wycliffe E. , De Silva Deirdre A. , Chang Hui Meng , Yao Jiali , Matchar David B. , Young Sherry H. Y. , See Siew Ju , Lim Gek Hsiang , Wong Ting Hway , Venketasubramanian Narayanaswamy 
Published: December 2019

Abstract
Background
Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients.

Methods
This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤ 0.5 m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls.

Results
In all, 2255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died.
After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21–9.65, p = 0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85–7.12, p = 0.098), 2.86 (95%CI:0.95–8.61, p = 0.062) and 1.93 (95%CI:0.44–8.52, p = 0.38) for patients with scores of 3, 4 and 5 respectively.

Conclusions
An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly.
(263 words)
Life expectancy with and without cognitive impairment among Chilean older adults: results of the National Survey of Health (2003, 2009 and 2016)
Authors: Moreno Ximena , Lera Lydia , Moreno Francisco , Albala Cecilia 
Published: December 2019

Abstract
Background
Chile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator.

Methods
We estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method.

Results
At age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively).

Conclusions
Longer life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.
“Being in good hands”: next of kin’s perceptions of continuity of care in patients with heart failure
Authors: Östman Malin , Bäck-Pettersson Siv , Sandvik Ann-Helén , Sundler Annelie J. 
Published: December 2019

Abstract
Background
Heart failure (HF) is a chronic condition with a variety of diverse symptoms. Patients with HF are usually elderly with multimorbidity, which are both multifaceted and challenging. Being a next of kin to patients with HF is described as a complex task consisting of managing care and treatment, monitoring illness and being an emotional support, while also being able to navigate the healthcare system especially in long-term contact. However, few studies have investigated next of kin’s perceptions of continuity of care in connection with HF. The present study aimed to describe continuity of care as perceived by the next of kin who care for patients with HF.

Methods
This study used a qualitative descriptive design. Semi-structured interviews were conducted with the next of kin (n = 15) of patients with HF to obtain their perceptions of continuity of care. A phenomenographic analysis method was used to capture the participants’ perceptions of the phenomenon.

Results
The analysis reveals that the next of kin perceive that support from healthcare professionals was strongly associated with experiences of continuity of care. Four categories reveal the next of kin’s perceptions of continuity of care: Want to be involved without being in charge; A desire to be in control without acting as the driving force in the care situation; A need for sustainability without being overlooked; and Focusing on making life meaningful while being preoccupied with caregiving activities.

Conclusions
Next of kin perceive continuity of care, when they have access to care and treatment and when caregivers collaborate, regardless of healthcare is given by primary care, municipalities or specialist clinics. A sense of “being in good hands” sums up the need for continuous support, shared decision-making and seamless transitions between caregivers. It seems important that healthcare organisations safeguard effective and collaborative models. Moreover, professionals need to plan and perform healthcare in collaboration with patients and next of kin.
1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia – a propensity score analysis of data from a Japanese multicenter registry
Authors:   on behalf of the Adult Pneumonia Study Group-Japan, Hasegawa Shinya , Sada Ryuichi , Yaegashi Makito , Morimoto Konosuke , Mori Takahiro 
Published: December 2019

Abstract
Background
Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO.

Methods
This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects.

Results
Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval − 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result.

Conclusions
The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.
Association between basilar artery configuration and Vessel Wall features: a prospective high-resolution magnetic resonance imaging study
Authors: Xu Ziqi , Li Mingyao , Hou Zhikai , Lyu Jinhao , Zhang Na , Lou Xin , Miao Zhongrong , Ma Ning 
Published: December 2019

Abstract
Background
The relationship between intracranial vessel configuration and wall features remains poorly investigated. Therefore, we aimed to investigate the relationship between the distal and proximal anatomical configuration of basilar artery (BA) and BA vessel wall features on high-resolution magnetic resonance imaging (HRMRI).

Methods
From September 2014 to January 2017, patients with suspected symptomatic intracranial arterial stenosis underwent HRMRI. Patients with severe BA stenosis were selected for this prospective study and divided into two groups corresponding to complete and incomplete BA configuration based on characteristics of the bilateral vertebral arteries and posterior cerebral arteries. Culprit blood vessel wall features on HRMRI included plaque enhancement, intraplaque hemorrhage, remodeling patterns, and plaque distribution. Culprit vessel wall features were compared between patients in the complete and incomplete BA configuration groups.

Results
Among the 298 consecutively enrolled patients, 34 had severe BA stenosis. Twenty patients had complete anatomical BA configuration and another 14 of them displayed incomplete configuration. There were no significant differences in vessel wall features between the complete and incomplete configuration patient groups. However, the proximal configuration of BA was associated with intraplaque hemorrhage (p = 0.002) while the distal configuration of BA correlated with strong enhancement of BA plaque (p = 0.041).

Conclusions
No association was found between the complete and incomplete BA configuration groups and blood vessel wall features. The proximal configuration of BA was related with intraplaque hemorrhage and the distal configuration of BA was associated with strong plaque enhancement. Further studies are warranted to confirm these findings.

Trial registration
URL: Unique identifier: NCT02705599 (March 10, 2016).
Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS
Authors: Pavisian Bennis , Patel Viral P. , Feinstein Anthony 
Published: December 2019

Abstract
Background
The Symbol Digit Modalities Test (SDMT) is regarded as the cognitive test of choice for people with MS (pwMS). While deficits are linked to impaired processing speed, the mechanisms by which they arise are unclear. Cognitive-mediated eye movements offer one putative explanation. The objective of this study was to determine the association between eye movements and performance on the SDMT.

Methods
Thirty-three people with confirmed MS and 25 matched healthy control subjects (HC) were administered the oral SDMT while eye movements were recorded.

Results
Mean SDMT scores were significantly lower in pwMS (p < 0.038). Shorter mean saccade distance in the key area (p = 0.007), more visits to the key area per response (p = 0.014), and more total number of fixations in the test area (p = 0.045) differentiated pwMS from HCs. A hierarchical regression analysis revealed that the number of visits to the key area per response (p < 0.001; ΔR2 = 0.549) and total number of fixations in the test area (p < 0.001; ΔR2 = 0.782) were the most robust predictors of SDMT scores.

Conclusion
Cognitive-mediated eye movements help elucidate the processing speed challenges confronted by people with MS. Mechanistic insights such as these can potentially help inform new cognitive rehabilitation strategies.
Discrepancy in the perception of symptoms of cognitive decline between older adults and their family members: results of the Toyama dementia survey
Authors: Nakahori Nobue , Sekine Michikazu , Yamada Masaaki , Tatsuse Takashi , Kido Hideki , Suzuki Michio 
Published: December 2019

Abstract
Background
Early consultation is important to delay the onset of dementia. The present study aimed to explore the reasons for delaying a consultation of dementia while focusing on the differences in the perception of cognitive decline between older adults and their family members.

Methods
A group of 663 older adults aged ≥65 years and living with family members in Toyama Prefecture was surveyed. The questionnaires included items that measured changes in cognitive function noticed by older adults and their family members, and the Revised Hasegawa Dementia Scale (HDS-R). The degrees of consistency on the perception of mental changes that accompanied cognitive decline were measured using the Kappa statistic.

Results
Both older adults and their family members were well aware of “forgetfulness” as a symptom of cognitive decline. Only the perception of “loss of appetite” at the late stage of cognitive decline was consistent between older adults and their family (κ = 0.707). When older adults often noticed their own forgetfulness, their mean HDS-R score was 22.7, whereas that of the family members was 14.7. The combinations of perception of forgetfulness by older adults and their family members, and the mean HDS-R scores were unaware/unaware (mean HDS-R score = 27.0), aware/unaware (mean HDS-R score = 24.9), aware/aware (mean HDS-R score = 15.5), and unaware/aware (mean HDS-R score = 13.0).

Conclusions
There were discrepancies in the perception of cognitive decline between older adults and their family members. Cognitive decline had progressed by the time that family members had noticed the symptom of forgetfulness in their older adult relatives. The perception gap regarding cognitive decline deters consultation of dementia.
The study of Wilson disease in pregnancy management
Authors: Yu Xu-En , Pan Min , Han Yong-Zhu , Yang Ren-Min , Wang Juan , Gao Shan 
Published: December 2019

Abstract
Introduction
Pregnancy management in women with Wilson disease (WD) remains an important clinical problem. This research was conducted to investigate how to avoid worsening of WD symptoms during pregnancy and increase pregnancy success in women with WD by identifying the best pregnancy management approaches in these patients.

Patients and methods
The clinical data of 117 pregnancies among 75 women with WD were retrospectively analyzed. Related information of the fetus was also recorded and analyzed. At the same time, regression analysis was performed for data of 22 pregnant women without WD, as normal controls.

Results
Of a total of 117 pregnancies among the 75 women with WD and 31 pregnancies among the 22 control womenincluded in this study, there were 108 successful pregnancies and 9 spontaneous abortions. Among the 108 successful pregnancies, 97 women a history of copper chelation therapy before pregnancy; all 97 women stopped anti-copper therapy during pregnancy. The nine women with spontaneous abortion had no pre-pregnancy history of copper displacement therapy. The incidence of lower limb edema was higher in the WD group than in normal controls (P = 0.036). Compared with the control group, there was a higher proportion in the WD group of male infants (P = 0.022) and lower average infant birth weight (t = 3.514, P = 0.001).

Conclusion
It is relatively safe for women with WD patients to become pregnant. The best management method for pregnancy in women with WD may be intensive pre-pregnancy copper chelation therapy and no anti-copper treatment during pregnancy.
Combined surgical and medical treatment in an adolescent with severe gynecomastia due to excessive estradiol secretion: a case report
Authors: Moon Jung-Eun , Ko Cheol Woo , Yang Jung Dug , Lee Joon Seok 
Published: December 2019

Abstract
Background
Gynecomastia develops due to the reversed estradiol-to-Testosterone ratio in adolescence, and symptoms typically improve within 2 years. The causes vary widely, including estrogen excess and tumors, and surgical treatment is usually given in late adolescence because postoperative symptoms may recur in adolescents. This study reports a case of a pediatric patient with severe gynecomastia due to excessive estradiol secretion who showed a positive outcome after receiving surgical treatment combined with aromatase inhibitor administration.

Case presentation
A 9-year old boy visited to the Department of Pediatric Endocrinology for breast budding. At that time, the patient showed breasts at Tanner stage II and no abnormality on hormone tests. During a follow-up, both gynecomastia had progressed to Tanner stage III–IV at age 13. Tamoxifen 10 mg bid was administered; however, the condition rapidly progressed to Tanner stage V at 13.5 years. The evaluation of pathologic gynecomastia showed an increase of estradiol to 296 pg/mL with normal range 10 ~ 36 pg/mL and microlithiasis in both testes. As the condition worsened, total mastectomy was performed at the age of 13.5 years. Based on the assessment that elevated aromatase activity had induced breast budding, we changed the medication to anastrozole (Arimidex) 1 mg once a day, after which the estradiol level improved to 38.5 pg/mL and was maintained well in the two-year postoperative follow-up.

Conclusions
This case report shows a combined plastic surgery and appropriate medical management bring a positive outcome in severe gynecomastia patient.
Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis
Authors: Bose Montu , Banerjee Somdutta 
Published: December 2019

Abstract
Background
Rapid ageing of the population and increasing non-communicable diseases (NCDs) among the elderly is one of the major public health challenges in India. To achieve the Universal Health Coverage, ever-growing elderly population should have access to needed healthcare, and they should not face any affordability related challenge. As most of the elderly suffers from NCDs and achieving health-equity is a priority, this paper aims to - study the utilization pattern of healthcare services for treatment of NCDs among the elderly; estimate the burden of out-of-pocket expenditure for the treatment of NCDs among the elderly and analyze the extent of equity in distribution of public subsidy for the NCDs among the elderly.

Methods
National Sample Survey data (71st round) has been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, out-of-pocket expenditure and distribution of public subsidy among economic classes. Concentration curves and indices are also estimated.

Results
Results show that public-sector hospitalization for NCDs among the elderly has a pro-rich trend in rural India. However, in urban sector, for both inpatient and outpatient care the poorest class has substantial share in utilization of public facilities. Same result is also observed for rural outpatient care. Analysis shows that out-of-pocket expenditure is very high for both medicine and medical care even in public facilities for all economic groups. It is also observed that medicine has the highest share in total medical expenses during treatment of NCDs among the elderly in both the region. Benefit incidence analysis shows that the public subsidy has a pro-rich distribution for inpatient care treatment in both the sectors. In case of outpatient care, subsidy share is the maximum among the richest in the urban sector and in the rural region the poorest class gets the maximum subsidy benefit.

Conclusions
It is evident that a substantial share of the public subsidies is still going to the richer sections for the treatment of NCDs among the elderly. Evidences also suggest that procuring medicines and targeted policies for the elderly are needed to improve utilization and equity in the public healthcare system.
Sun exposure and health safety practices of high school students in an urban population of Iran
Authors: Janjani Hosna , Nedjat Saharnaz , MasoudYunesian  , Nasseri Simin , Haghighat Doost Fatemeh , Nabizadeh Ramin 
Published: December 2019

Abstract
Background
Skin cancer attributed to sunlight exposure has an increasing trend worldwide, resulting in increased problems for healthcare services. This study aimed to evaluate the health safety practices of high school students in Saveh, Iran according to a sun protection guideline produced locally for Iran.

Method
This cross-sectional study was done in 31 government and private high schools of Saveh, a central city of Iran. A sun protection questionnaire was designed in accordance with Iran sun protection guideline which has been developed based on the World Health Organization and US Environmental Protection Agency guidelines. The questionnaire consists of four sections of demographic information, knowledge, attitude, and protection behavior. A total of 504 students were selected by simple random sampling method. Pearson correlation coefficient and multiple linear regression analysis were used to assess the correlation between knowledge, attitude and behavior of the participants.

Results
The mean score of the students’ knowledge, attitude, and behavior regarding harmfulness of ultraviolet radiation was 50.79 ± 14.64, 60.41 ± 15.04, and 45 ± 11.59, respectively. A significant association was observed between attitude and knowledge, behavior and knowledge as well as attitude. There was a significant correlation between sex and protective behaviors, sex and knowledge (p ≤ 0.001), and education level and knowledge (p = 0.002).

Conclusion
students who protected themselves from sunlight less than others believed that their protection level was adequate. Health concerns related to sun exposure suggest the need for increasing the student’s awareness in sun protection area. As behavior is influenced by cultural aspects, implementation of the current guideline can be effective in reducing the health effects of sun exposure.
Predicting the evolution of neck pain episodes in routine clinical practice
Authors: Kovacs Francisco M. , Seco-Calvo Jesús , Fernández-Félix Borja M. , Zamora Javier , Royuela Ana , Muriel Alfonso 
Published: December 2019

Abstract
Background
The objective of this study was to develop models for predicting the evolution of a neck pain (NP) episode.

Methods
Three thousand two hundred twenty-five acute and chronic patients seeking care for NP, were recruited consecutively in 47 health care centers. Data on 37 variables were gathered, including gender, age, employment status, duration of pain, intensity of NP and pain referred down to the arm (AP), disability, history of neck surgery, diagnostic procedures undertaken, imaging findings, clinical diagnosis, and treatments used. Three separate multivariable logistic regression models were developed for predicting a clinically relevant improvement in NP, AP and disability at 3 months.

Results
Three thousand one (93.5%%) patients attended follow-up. For all the models calibration was good. The area under the ROC curve was ≥0.717 for pain and 0.664 for disability. Factors associated with a better prognosis were: a) For all the outcomes: pain being acute (vs. chronic) and having received neuro-reflexotherapy. b) For NP: nonspecific pain (vs. pain caused by disc herniation or spinal stenosis), no signs of disc degeneration on imaging, staying at work, and being female. c) For AP: nonspecific NP and no signs of disc degeneration on imaging. d) For disability: staying at work and no signs of facet joint degeneration on imaging.

Conclusions
A prospective registry can be used for developing valid predictive models to quantify the odds that a given patient with NP will experience a clinically relevant improvement.