bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of HFE Gene Mutations With Serum Ferritin Level and Heart and Liver Iron Overload in Patients With Transfusion-dependent Beta-Thalassemia
Authors: Zekavat Omid Reza , Zareian Jahromi Mahshid , Haghpanah Sezaneh , Kargar Jahromi Zahra , Cohan Nader 
Published: September 2020

Objective:
This study was performed on patients with transfusion-dependent beta-thalassemia (TDT) to investigate the effect of HFE gene mutations of iron overload in a large group of patients with TDT major and its relationship with heart and liver T2* magnetic resonance imaging (MRI) level.

Materials and Methods:
In a cross-sectional study, a total of 253 patients with TDT who had regular blood transfusion were included in this study. HFE gene mutations including H63D and C282Y were evaluated in all patients through molecular assay. Heart and liver T2* MRI results, types, duration of iron therapy, and the demographic data including age, gender, serum ferritin level, blood transfusion, and splenectomy history of the included participants were also collected, using a questionnaire.

Results:
Homozygous and heterozygous H63D mutation was found in 39.5% of the patients and C282Y mutation was found only in 1 patient. Ferritin level was significantly higher in patients with H63D mutation in comparison with patients without this mutation (P=0.036). Although heart T2* MRI and also the liver T2* MRI in the patients with H63D was slightly higher, the difference was not statistically significant. No significant correlation was observed between serum ferritin level and heart and liver T2* MRI, and iron chelation regimen.

Discussion:
Heart and liver iron overload was not significantly different between patients with and without H63D mutation. As for serum ferritin, it was significantly higher among patients with H63D mutation compared with patients without this mutation. Hence, it is recommended to consider HFE gene mutations among patients with thalassemia to reach a better iron overload evaluation and management.
IAP Chemotherapy Regimen Is a Viable and Cost-effective Option in Children and Adolescents With Osteosarcoma: A Comparative Analysis With MAP Regimen on Toxicity and Survival
Authors: Verma Priyanka , Jain Sandeep , Kapoor Gauri , Tripathi Rupal , Sharma Payal , Doval Dinesh Chandra 
Published: September 2020

Background:
Cisplatin and doxorubicin are integral components of chemotherapy regimens in the treatment of osteosarcoma. Choice of third agent high-dose methotrexate (HDMTX) or an alkylating agent such as ifosfamide is debatable. The present study compared the impact of MAP (HDMTX-doxorubicin-cisplatin) and IAP (ifosfamide-doxorubicin-cisplatin) chemotherapy regimens on toxicity and survival in children and adolescents with osteosarcoma.

Materials and Methods:
This was a retrospective study including patients 18 years and younger with osteosarcoma during the study period. Clinical, demographic, chemotherapy regimen, and surgical details and treatment-related toxicity were retrieved from hospital medical records. Prognostic factors affecting overall survival (OS) and event-free survival (EFS) were analyzed.

Results:
Among 102 patients included in the study, 59 (57.8%) and 43 (42.2%) patients were treated with MAP and IAP regimens, respectively. Two groups were comparable in terms of pretreatment characteristics and surgical treatment. Overall, 95.9% patients underwent limb salvage surgery. There was a statistically increased incidence in supportive care admissions and delay in starting the next cycle of chemotherapy in the MAP group. Among the MAP cohort, the 5-year OS and EFS were 62% and 55% compared with 47% and 44%, respectively, in the IAP cohort (P=0.143 and 0.316, respectively). On univariate and multivariate analyses, statistically significant factors affecting EFS of the whole group included tumor size, stage, site of metastasis, histologic necrosis, and type of surgery.

Conclusions:
OS and EFS with both regimens were similar. However, the MAP regimen was associated with a statistically significant increase in incidence of supportive care admissions, delay in next cycle of chemotherapy, and predicted higher cost of treatment.
Cognitive-Behavioral Therapy to Alleviate Treatment-Induced Menopausal Symptoms in Women With Breast Cancer
Authors: Chang Yun-Chen , Hu Wen-Yu , Chang Yuh-Ming 
Published: September 2020

Background
Numerous women with breast cancer (BC) exhibit early menopausal symptoms after undergoing cancer treatments. Medications that control menopausal symptoms can cause severe side effects and are contraindicated for patients with BC. Therefore, complementary and alternative medicines should be used. This study investigates the use of cognitive-behavioral therapy (CBT) for patients with menopausal symptoms after BC treatment.

Objective
A systematic review was conducted to determine the efficacy and availability of CBT interventions in reducing treatment-induced menopausal symptoms in female patients with BC.

Methods
Keywords were searched in Medical Subject Headings and 5 databases. The search criteria included randomized controlled trials (RCTs), non-RCTs, and single-group pre- and post-studies. Because of the risk of bias in non-RCTs using Joanna Briggs Institute’s critical appraisal tools and single-group studies, the Critical Appraisal Skills Programme checklist for qualitative studies and RCTs was appraised using the Jadad scale.

Results
After the review, 9 suitable studies were identified. Standard CBT programs lasted for 6 consecutive weeks, with 1 session of 1.5 hours weekly. The follow-up time was approximately 9 to 26 weeks. Women receiving CBT exhibited improvement in physical function and psychological state. This review supported the use of CBT to effectively improve the mental health of and reduce treatment-induced menopausal symptoms in BC survivors.

Conclusions
Cognitive-behavioral therapy interventions yielded positive outcomes in patients with BC, particularly in those experiencing menopausal symptoms.

Implications for Practice
Cancer treatment generated severe menopausal symptoms in patients with BC. However, health professionals may use CBT to alleviate patients’ menopausal symptoms.
A Resilience Model for Patients With Colorectal Cancer
Authors: Chou Yun-Jen , Lin Hsiang-Ying , Cooper Bruce A. , Lin Been-Ren , Jiang Jeng-Kai , Yang Hui-Ying , Miaskowski Christine , Shun Shiow-Ching 
Published: September 2020

Background
Patients with colorectal cancer (CRC) experience multiple symptoms. Resilience is a positive health outcome that can assist patients to face and adapt to their disease.

Objective
The purpose of this study was to evaluate a proposed resilience model for patients with CRC.

Methods
Patients (n = 416), who were given a diagnosis of stage Ι to III CRC within the past 5 years, were recruited from 2 medical centers in Northern Taiwan. Symptom Severity Scale, Fatigue Symptom Inventory, and Center for Epidemiological Studies Depression scale were used to assess the risk factors of symptom severity, fatigue, and depressive symptoms, respectively. Cancer Behavior Inventory and Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale were used to assess the protective factors of self-efficacy for coping with cancer and spiritual well-being, respectively. Resilience was assessed using the Resilience Scale. Structural equation modeling was used to evaluate the proposed resilience model for patients with CRC.

Results
The initial structural equation modeling fit indices did not support the proposed model. In the revised model, depressive symptoms was a partial mediator between protective factors and resilience with an acceptable model fit (comparative fit index, 0.968; root mean square error of approximation, 0.085; standardized root mean square residual, 0.034).

Conclusions
Patients with CRC who had higher levels of protective factors had higher levels of resilience. This study provides new information on the role of depressive symptoms as a partial mediator between protective factors and resilience.

Implications for Practice
Oncology nurses need to evaluate for depressive symptoms as well as protective factors and resilience in patients with CRC.
Dyadic Coping in Couples With Breast Cancer in China
Authors: Cai Tingting , Qian Jianfeng , Yuan Changrong 
Published: September 2020

Background
Dyadic coping may play an important role in promoting marital adjustment in couples with breast cancer. However, few studies have explored dyadic coping and its predictors in couples with breast cancer.

Objective
To assess the dyadic coping level of Chinese couples with breast cancer and identify its predictors and explore the actor and partner effects of marital adjustment on dyadic coping.

Methods
Chinese couples (n = 114) with breast cancer participated in a cross-sectional study and completed the general information questionnaire, the Dyadic Coping Inventory, the Locke-Wallace Marital Adjustment Test, and the Body Image Scale.

Results
Total scores of the Dyadic Coping Inventory were 114.09 (SD, 18.49) and 114.62 (SD, 17.42) for the patients and partners, respectively. Relationship duration, monthly family income, postoperative time, adjuvant treatments, marital adjustment, body image, and dyadic coping style of the partners predicted dyadic coping among patients with breast cancer. In addition, marital adjustment exhibited both actor and partner effects on dyadic coping in the couples.

Conclusions
Dyadic coping in couples with breast cancer in China was in the reference range. Psychosocial characteristics, marital adjustment, and body image should be considered and evaluated when conducting interventions for couples with breast cancer.

Implications for Practice
When conducting interventions for couples with breast cancer, nurses should identify couples who are likely to adopt negative dyadic coping styles and then conduct targeted interventions that consider psychosocial characteristics, marital adjustment, and body image in couples with breast cancer.
The Pediatric Cancer Survivors' User Experiences With Digital Health Interventions
Authors: Cheng Lei , Liu Fang , Mao Xiaorong , Peng Wentao , Wang Yingwen , Huang Haiying , Duan Mingxia , Wang Yanqing , Yuan Changrong 
Published: September 2020

Background
Evidence suggests that digital health interventions are feasible and acceptable in pediatric cancer survivors. Efforts to synthesize user experiences, however, are limited.

Objective
The aim of this study was to systematically identify, appraise, and synthesize qualitative evidence on the user experiences of pediatric cancer survivors participating in digital health interventions.

Methods
We searched 4 databases to identify studies with qualitative data of the digital health intervention user experiences from childhood, adolescent, and young adult pediatric cancer survivors, published from the databases' inception to January 31, 2020. Studies that met inclusion criteria were selected and reviewed for quality. The extracted data were analyzed by thematic synthesis.

Results
Sixteen articles met the inclusion criteria. Two analytic themes emerged, each with 3 descriptive themes: (1) the favorable experience of using digital health interventions, including “knowing about oneself and one's cancer,” “connecting with others in a trustworthy and safe way,” and “getting empowered and rewarded”; and (2) the challenges of using digital health interventions, including “challenges from the content of the program,” “technology challenges,” and “user challenges.”

Conclusions
This systematic review supports the value of digital health interventions as an acceptable and convenient approach for delivering care to pediatric cancer survivors. It is essential to understand the users' positive experiences and challenges to customize interventions and achieve positive health outcomes.

Implications for Practice
Nurses can contribute to the development and implementation of digital health interventions for pediatric cancer survivors through advocacy, navigation, feedback, and multidisciplinary collaboration. We recommended system-level support in modifying and developing relevant workflows or practice guidelines for implementation.
Moderating Effect of Posttraumatic Growth on the Relationship Between Social Support and Quality of Life in Colorectal Cancer Patients With Ostomies
Authors: Kim Hyerang , Son Heesook 
Published: September 2020

Background
Little research has examined the moderating influence of posttraumatic growth (PTG) on the relationship between social support and quality of life.

Objectives
This study examined the relationship between social support and quality of life by the level of PTG in colorectal cancer patients with ostomies.

Methods
Using a cross-sectional design, colorectal cancer patients with ostomies (n = 140) were recruited using convenience sampling. The City of Hope Quality of Life–Ostomy, the Multidimensional Scale of Social Support, and the Posttraumatic Growth Inventory measured quality of life, social support, and PTG, respectively.

Results
Social support and PTG were positively related to psychological and social well-being. Higher social support was associated with better psychological and social well-being. Posttraumatic growth moderated the relationship between psychological and social well-being. At a low and moderate level of PTG, social support was more strongly associated with psychological and social well-being, whereas at high levels, this association was not significant.

Conclusions
Findings highlight the significance of social support to improve the quality of life for colorectal cancer patients with an ostomy, particularly those with low levels of PTG.

Implications for Practice
Screening for patients’ positive cognitive adaptations while living with an ostomy could identify those who might need further social support to improve their quality of life. Further, intensive social support programs might promote the quality of life for colorectal patients with an ostomy, which was found to be effective for those with low levels of PTG.
Physical Activity Interventions for Colorectal Cancer Survivors
Authors: Jung Youjin , Chung Joohyun , Son Heesook 
Published: September 2020

Background
Physical activity (PA) has been shown to improve total mortality and colorectal-specific mortality risk; however, colorectal cancer (CRC) survivors have lower rates of PA compared with survivors with other types of cancers.

Objective
To examine the effect of PA interventions on CRC survivors.

Methods
A systematic review and meta-analysis were conducted to identify randomized controlled trials that met the inclusion criteria, which included an intervention designed to increase PA and more than 1 outcome of interest. Random effects of the meta-analyses were performed using Review Manager 5.3.

Results
Eight publications representing 7 randomized controlled trials of 803 participants were identified. All studies used a combination of behavioral change methods. Physical activity interventions significantly improved disease-specific quality of life, PA level, and maximum amount of oxygen and did not show significant improvements for fatigue and body mass index among CRC survivors.

Conclusions
We provided evidence that PA interventions were effective in improving disease-specific quality of life, PA level, and maximum amount of oxygen; however, they did not improve fatigue and body mass index. Further randomized controlled trials are needed to determine the optimal mode of delivering PA intervention for CRC survivors.

Implications for Practice
As the survival rate of patients with CRC increases, survivors of CRC need to increase PA in a community setting after completing primary treatments. Effective and efficient modes of PA intervention delivery could improve health-related outcomes and address specific barriers for CRC survivors.
Short-term Effects of Randomized Mindfulness-Based Intervention in Female Breast Cancer Survivors
Authors: Chang Yun-Chen , Yeh Tzu-Lin , Chang Yuh-Ming , Hu Wen-Yu 
Published: September 2020

Background
Patients with breast cancer usually experience depression, anxiety, stress, fatigue, pain, poor sleep quality, and low quality of life after their cancer treatment. Some studies used mindfulness-based stress reduction (MBSR) interventions for reducing these symptoms; however, the results are conflicting.

Objective
This study evaluated the clinical efficacy of MBSR interventions in the short term.

Methods
Five databases were searched from their inception to April 2020. We included only randomized controlled trials (RCTs) comparing MBSR intervention and control groups for symptom reduction in women with breast cancer. Pooled mean difference (MD), standardized MD, and 95% confidence intervals (CIs) were calculated using random-effects models. We used the Cochrane risk-of-bias assessment tool to assess the included RCTs.

Results
Nineteen RCTs with 36 to 336 participants were included, of which 11 studies with a total of 1687 participants (mean age, 53.3 years) were eligible for the meta-analysis. The pooled meta-analysis results indicated that, at the end of the MBSR interventions, participants' depression (standardized MD, −1.32; 95% CI, −2.18 to −0.46; I
2 = 97%) and fatigue (MD, −0.47; 95% CI, −0.59 to −0.34; I
2 = 0%) levels had significantly decreased; moreover, up to 3 months after baseline, their stress levels had significantly decreased (MD, −0.79; 95% CI, −1.34 to −0.24; I
2 = 0%).

Conclusion
Mindfulness-based stress reduction interventions are highly beneficial for reducing depression, fatigue, and stress in the short term.

Implications for Practice
Mindfulness-based stress reduction interventions are cost-effective and practical. Breast cancer survivors are recommended to practice MBSR as part of their daily care routine.
Mycoplasma genitalium and Bacterial Vaginosis–Associated Bacteria in a Non–Clinic-Based Sample of African American Women
Authors: Moore Kristen R. , Tomar Meena , Taylor Brandie D. , Gygax Scott E. , Hilbert David W. , Baird Donna D. 
Published: September 2020

Background

Mycoplasma genitalium is associated with adverse reproductive problems. However, prevalence estimates from studies that screen women not seeking care are rare. Studies have reported co-occurrence of M. genitalium with bacterial vaginosis (BV), but no prior study of specific BV-associated bacteria has been conducted in African Americans whose reproductive tract infection burden is high.

Methods
Using quantitative polymerase chain reaction, we screened vaginal swabs for M. genitalium, 9 BV-associated bacteria, and 4 Lactobacillus species from 200 participants drawn from a cohort of African Americans 23 to 35 years old. Sexual history, herpes serostatus, and Nugent score had been assessed. Prevalence of M. genitalium was computed. The associations of other vaginal bacteria with M. genitalium were examined with binomial regression.

Results

M. genitalium prevalence was 18%. Detection and quantity of 2 BV-associated bacteria were significantly associated with a higher prevalence of M. genitalium (Leptotrichia/Sneathia: detection prevalence ratio (PR) of 2.9 [95% confidence interval {CI}, 1.1–7.7] and quantity PR of 1.2 [95% CI, 1.0–1.3]; Megasphaera phylotype 1: detection PR of 2.2 [95% CI, 1.2–4.2] and quantity PR of 1.1 [95% CI, 1.0–1.2]). Increased quantity of L. iners was also positively associated with M. genitalium (PR, 1.3 [95% CI, 1.0–1.8]). Nugent ≥7, herpes serostatus, and lifetime number of sex partners were not associated with M. genitalium.

Conclusions
Specific BV-associated microbes and L. iners were associated with M. genitalium, but Nugent ≥7 was not. Studies are needed to confirm a high prevalence of M. genitalium in African Americans and to understand its interactions with other vaginal bacteria.
A Narrative Review of the Epidemiology of Congenital Syphilis in the United States From 1980 to 2019
Authors: Smullin Carolyn , Wagman Jennifer , Mehta Shivani , Klausner Jeffrey D. 
Published: September 2020

Objectives
Congenital syphilis (CS) is the result of antepartum transmission from mother to fetus of the spirochete Treponema pallidum. Although preventable through timely screening and treatment, the incidence of CS in the United States is increasing. This review describes the epidemiological trends in CS in the United States from 1980 to 2019 and characteristics of mothers of infants with CS.

Methods
We performed a narrative review of epidemiological studies of CS following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting of observational studies in epidemiology. Quality and bias of included studies were assessed using the Newcastle-Ottawa Scale. Studies that described the demographics and characteristics of pregnant women with syphilis or who delivered an infant with CS in the United States were identified from PubMed and Embase.

Results
We identified a total of 2771 studies, of which 309 were selected for further review and 27 were included in the final analysis. Substance use during pregnancy was a risk factor for CS in 16 studies. Maternal cocaine use was described in 11 of the 16 studies, 10 of which were published between the years 1980 and 1999. No prenatal care was a risk factor for CS in 17 studies. Evidence of inadequate syphilis testing (i.e., no maternal screen, first screen after the first trimester, or no repeat screen in third trimester) or treatment (i.e., no treatment, treatment <30 days before delivery, or nonpenicillin treatment) was significantly associated with CS in 13 studies. Finally, higher rates of CS were reported among African American women in 11 studies.

Conclusions
Infection with and antepartum transmission of syphilis disproportionately affect certain subgroups of women. Women who report substance use during pregnancy are more likely to give birth to an infant with CS. No prenatal care and evidence of inadequate syphilis testing and treatment during pregnancy are also significantly associated with giving birth to an infant with CS. Finally, cases of CS disproportionately affect African American women. Addressing the CS epidemic will require identification and targeted allocation of resources to communities at elevated risk for syphilis, removal of barriers to prenatal care, and ensuring timely treatment and adequate partner notification of identified cases.
Syndromes Associated with Sexually Transmitted Infections in Lilongwe, Malawi: Burden and Trends, 2006 to 2015
Authors: Matoga Mitch , Chen Jane S. , Kudowa Evaristar , Kamanga Gift , Mapanje Clement , Massa Cecilia , Ndalama Beatrice , Bonongwe Naomi , Nyirenda Naomi , Mathiya Esther , Jere Edward , Ngoma Edith , Chagomerana Maganizo , Phiri Sam , Powers Kimberly A. , Miller William C. , Cohen Myron S. , Hoffman Irving F. 
Published: September 2020

Abstract
Monitoring the burden of and trends in sexually transmitted infection syndromes is useful in informing syndromic management guidelines. Among sexually transmitted infection clinic patients in Lilongwe, Malawi, between 2006 and 2015, genital discharge, lower abdominal pain, and genital ulcer syndromes were common. Prevalence of most syndromes remained stable during the 10-year period.