bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients with Combination of Cardiovascular Diseases and Type 2 Diabetes in RECVASA and REGION Registries: Multimorbidity, Outcomes and Potential Effect of Dapagliflozin in the Russian Clinical Practice
Authors: Loukianov M. M. , Kontsevaya A. V. , Myrzamatova A. O. , Khudyakov M. B. , Okshina E. Y. , Kudryashov E. V. 
Published: March 2020

Aim. To evaluate the structure of multimorbidity, outcomes and the potential effect of dapagliflozin in patients with a combination of cardiovascular disease (CVD) and type 2 diabetes in Russian clinical practice.Material and methods. The data of 10 registries with the inclusion of 22957 people, including 4370 with type 2 diabetes in 6 regions of the Russian Federation, were analyzed. Scenarios for reducing mortality from all and cardiovascular causes and hospitalizations for CVD were simulated among groups of patients with diabetes combined with myocardial infarction (MI) and diabetes combined with heart failure with reduced ejection fraction (HFrEF) based on data from the Federal Registry of diabetes, the RECVASA and REGION registries, relative risks associated with analyzed adverse events from the DECLARE study.Results. When analyzing the data of all 22957 patients with CVD included in the registries, it was found that the proportion of patients with comorbid diabetes was on average 19.0%. Of the various diagnoses of CVD, the combination with diabetes was most often recorded in patients that had MI – 2.0%, stroke – 22.5% and heart failure – 24.0%. In the RECVASA registry (Ryazan) for 4 years of follow-up of 699 patients with a combination of CVD and diabetes mortality from all causes was 20.9%, and from cardiovascular causes – 15.6%. The simulated number of potentially prevented cardiovascular deaths with dapagliflozin taking in patients with diabetes combined with MI for 4 years in Russia will be 39124, and 37440 cardiovascular hospitalizations. The number of potentially preventable deaths from all causes among patients with diabetes combined with HFrEF will be 4543, cardiovascular deaths in 1995, and the number of prevented cardiovascular hospitalizations will be 7072.Conclusion. According to data from the registries of CVD patients in 6 regions of the Russian Federation, it was revealed that in real clinical practice the proportion of people with comorbid diabetes averaged 19% both at the outpatient and hospital stages. These subgroups of multimorbid patients have both the highest risk of developing fatal and non-fatal cardiovascular complications, and the largest number of indications for prescribing drugs that affect the prognosis due to effects on both CVD and diabetes.
Detection of Renal Hypoxia Configuration in Patients with Lupus Nephritis: A Primary Study Using Blood Oxygen Level‒Dependent MR Imaging
Authors: Zheng Zhengfeng , Wang Yanyan , Yan Tiekun , Jia Junya , Li Dong , Wei Li , Shang Wenya , shi huilan 
Published: March 2020

Abstract
Background Renal microstructure and function are closely associated with homeostasis of oxygenation. Analyzing renal blood oxygen level‒dependent (BOLD) magnetic resonance imaging (MRI) examination results will provide information on the biological status of the kidneys. The current study was performed to explore the hypoxia mode of the entire renal parenchyma in patients with lupus nephritis (LN). Methods Twenty-three adult patients with LN and eighteen healthy volunteers were recruited. R2* values were acquired through the use of the BOLD MRI analysis technique. The narrow rectangular region of interest was used to explore the hypoxia configuration in entire depths of renal parenchyma. Acquired sequential R2* data were fitted by using four categories of mathematic functions. The tendency of R2* data in both patients with LN and healthy volunteers was also compared through the use of repeated-measures analysis of variance. Results R2* data from the superficial cortex to deep medulla displayed two patterns, called a sharp uptrend style and a flat uptrend style. After sequential R2* data were fitted individually with the use of four mathematic formulas, the multiple-compartment Gaussian function showed the highest goodness of fit. Compared with two categories of R2* value styles, the R2* tendency of entire parenchyma in patients with LN was different from that in healthy volunteers. Conclusions Deep renal medullary oxygenation was not always overtly lower than oxygenation in superficial renal cortical zone. Renal parenchyma oxygenation manifestation could be described through the use of a Gaussian function model. The deoxygenation tolerance capability was damaged in patients with LN.
Insight into Blood Pressure Targets for Universal Coverage of Hypertension Services in Iran: The 2017 ACC/AHA versus JNC 8 Hypertension Guidelines
Authors: Mahdavi Mahdi , Parsaeian Mahboubeh , Mohajer Bahram , Modirian Mitra , Ahmadi Naser , Yoosefi Moein , Mehdipour Parinaz , Djalalinia Shirin , Rezaei Nazila , Haghshenas Rosa , Pazhuheian Forough , Madadi Zahra , Sabooni Mahdi , Razi Farideh , Samiee Siamak Mirab , Farzadfar Farshad 
Published: March 2020

Abstract
Background: We assessed and compared the prevalence, awareness, treatment, and control of hypertension in Iran under two hypertension guidelines; the 2017 ACC/AHA with an aggressive blood pressure target 130/80 mm Hg and commonly used guideline JNC8 with 140/90 mm Hg. We shed light on the implications of 2017 ACC/AHA for population subgroups and high-risk individuals eligible for non-pharmacologic and pharmacologic therapies. Methods: Data were obtained from the Iran national STEPS 2016 study. Participants included 27 738 adults ≥25 years as a representative sample of Iranians. The logistic regression models with a survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) by 2017 ACC/AHA. Awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0) respectively by 2017 ACC/AHA. By new guideline, adults 25-34 years had the largest increase in prevalence (from 7.3% to 30.7%). They also had the lowest awareness and treatment rate but the highest control rate (36.5%) among age groups. Compared with JNC8, under 2017 ACC/AHA, 24%, 15%, 17%, and 11% more individuals with dyslipidaemia, high triglyceride, diabetes, and cardiovascular disease (CVD) events respectively fell into the hypertensive category. Yet, based on 2017 ACC/AHA, 68.2% of individuals falling into a hypertensive group were supposed to receive medications (versus 95.7% in JNC8). LDL cholesterol, physical activity, and one unit of Body Mass Index were found to change blood pressure by -3.56 (-4.38, -2.74), -2.04 (-2.58, -1.50), and 0.48 (0.42, 0.53) mm Hg respectively. Conclusions: Switching from JNC8 to 2017 ACC/AHA highlighted sharp increases in prevalence and drastic declines in awareness, treatment, and control in Iran. By the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category, thus might benefit from earlier interventions such as lifestyle modifications. The low control rate among treated individuals calls for a critical review of hypertension services in Iran.
Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal
Authors: Rajan Selina , Rathod Sujit D , Luitel Nagendra P , Murphy Adrianna , Roberts Tessa , Jord Mark JD 
Published: March 2020

Abstract
Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression.Aims: We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.
Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing
Authors: Huang Yifan , Gao Yuhang , Ding Lu , Liu Bo , Liu Jianguo , Qi Xin 
Published: March 2020

Abstract
Background : The incidence of patient dissatisfaction due to multiple factors, especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA), remain a concern. Improvements in the femoral component of the traditional prosthesis could reduce the incidence of these complications in TKA performed with patellar resurfacing. This study aimed to explore whether TKA without patellar resurfacing benefits from this modification in femoral implant design with regard to AKP and patellar crepitus.
Methods : Sixty-two patients (85 knees) who underwent TKA with the modern prosthesis and 62 age- and sex-matched patients (90 knees) fitted with the traditional prosthesis were enrolled in this study. The incidence of AKP and patellar crepitus, and Knee Society Score (KSS) was recorded. Statistical analyses were performed to determine whether there were differences between the groups.
Results: The incidence of AKP was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (4.7% vs. 13.3% [ p =0.048] and 3.5% vs. 13.3% [ p =0.021], respectively). The incidence of patellar crepitus was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (15.3% vs. 34.4% [ p =0.004] and 10.6% vs. 28.9% [ p =0.002], respectively). There was no significant difference in KSS between the groups.
Conclusion : Results revealed that TKA without patellar resurfacing benefited from the femoral implant design modification with regard to AKP and patellar crepitus. These data may be meaningful to surgeons who use the modern prosthesis and omit resurfacing the patella in their patients.
Keywords : total knee arthroplasty, femoral component, prosthesis design, anterior knee pain, patellar crepitus
Measuring the effectiveness of digital nursing technologies: Development of a comprehensive digital nursing technology outcome framework based on a scoping review
Authors: Krick Tobias , Huter Kai , Seibert Kathrin , Domhoff Dominik , Wolf-Ostermann Karin 
Published: March 2020

AbstractBackground:Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done.Methods:We combined an inductive and deductive approach to develop the framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included.Results:The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations.Conclusion:We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment.
A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death
Authors: Scott Hannah Rachel , Pitman Alexandra , Kozhuharova Petya , Lloyd-Evans Brynmor 
Published: March 2020

Abstract
Aims: Whilst any type of bereavement can be traumatic, bereavement through violent or sudden causes is associated with more severe negative health and wellbeing outcomes compared to other types of loss. Social support has been found to have a positive impact on wellbeing after traumatic events in general. However, this association appears to be less consistently demonstrated in studies that focus on bereavement, and the literature in this area has not yet been systematically reviewed. This study aimed to review the international literature to examine systematically whether there is an association between informal social support from family and friends after bereavement through sudden and/or violent causes and post-bereavement wellbeing.Methods: We conducted a systematic search for quantitative studies that tested for an association between social support and any outcome related to wellbeing after a sudden and/or violent loss. Included studies were assessed for quality, and findings were reported using the approach of narrative synthesis. The review was pre-registered on Prospero (registration number CRD42018093704).Results: We identified 16 papers that met inclusion criteria, 11 of which we assessed as being of good or fair quality and 5 as poor quality. 15 different wellbeing outcomes were measured across all studies. We found consistent evidence for an inverse association between social support and symptoms/presence of depression, predominantly consistent evidence for an inverse association between social support and symptoms/presence of post-traumatic stress disorder (PTSD), and conflicting evidence for an inverse association between social support and symptoms/presence of complicated grief.Conclusions: Our systematic review identified evidence to suggest that social support after sudden or violent bereavement is associated with a reduced severity of depressive and PTSD symptoms. Further longitudinal research is needed to explore potential causality in this relationship, widening the focus from common mental disorders to include other mental illnesses, wellbeing outcomes, and suicide-related outcomes after bereavement. There is also a need for consensus on the conceptualisation and measurement of social support. Our findings imply that interventions to improve access to and quality of social support may reduce the burden of mental illness after bereavement, and may therefore be worth investing in.
Physical activity types and risk of dementia in community-dwelling older people: the Three-City cohort.
Authors: Dupré Caroline , Bongue Bienvenue , Helmer Catherine , Dartigues Jean François , Hupin David , Roche Frédéric , Berr Claudine , Carriere Isabelle 
Published: March 2020

Abstract
Background

Physical activity may decrease the risk of dementia; however, previous cohort studies seldom investigated the different types of physical activity and household activities. Our objective was to analyze the links between two physical activity types and dementia in older people.

Methods

The study used data from the prospective observational Three-city cohort and included 1550 community-dwelling individuals aged 72 to 87 without dementia at baseline. Physical activity was assessed with the Voorrips questionnaire. Two sub-scores were calculated to assess household/transportation activities and leisure/sport activities. Restricted cubic spline and proportional hazard Cox models were used to estimate the non-linear exposure-response curve for the dementia risk and the appropriate activity level thresholds. Models were adjusted for possible confounders, including socio-demographic variables, comorbidities, depressive symptoms and APOE genotype.

Results

The median age was 80 years, and 63.6% of participants were women. After a median follow-up of 4.6 years, dementia was diagnosed in 117 participants (7.6%). An inverse J-shaped association was found between household/transportation physical activity sub-score and dementia risk, which means that the risk is lowest for the moderately high values and then re-increases slightly for the highest values. The results remained significant when this sub-score was categorized in three classes (low, moderate, and high), with hazard ratios (95% confidence interval) of 0.55 (0.35-0.87) and 0.62 (0.38-1.01) for moderate and high activity levels, respectively. No significant effect was found for leisure/sport activities.

Conclusions

The 5-year risk of dementia was significantly and negatively associated with the household/transportation activity level, but not with the leisure and sport activity sub-score. This highlights the importance of considering all physical activity types in 72 years or older people.
Characterization of the Gh4CL gene family reveals a role of Gh4CL7 in drought tolerance
Authors: Sun Shichao , Xiong Xianpeng , Zhang Xiaoli , Feng Hongjie , Zhu Qianhao , Sun Jie , Li Yanjun 
Published: March 2020

Abstract
Background: The function of 4-coumarate-CoA ligases (4CL) under abiotic stresses has been studied in plants, however, limited is known about the 4CL genes in cotton (G. hirsutum L.) and their roles in response to drought stress.Results: We performed genome-wide identification of the 4CL genes in G. hirsutum and investigated the expression profiles of the identified genes in various cotton tissues and in response to stress conditions with an aim to identify 4CL gene(s) associated with drought tolerance. We identified 34 putative 4CL genes in G. hirsutum that were clustered into three classes. Genes of the same class usually share a similar gene structure and motif composition. Many cis-elements related to stress and phytohormone responses were found in the promoters of the Gh4CL genes. Of the 34 Gh4CL genes, 26 were induced by at least one abiotic stress and 10 (including Gh4CL7) were up-regulated under the polyethylene glycol (PEG) simulated drought stress conditions. Virus-induced gene silencing (VIGS) in cotton and overexpression (OE) in Arabidopsis thaliana were applied to investigate the biological function of Gh4CL7 in drought tolerance. The Gh4CL7-silencing cotton plants showed more sensitive to drought stress, probably due to decreased relative water content (RWC), chlorophyll content and antioxidative enzyme activity, increased stomatal aperture, and the contents of malondialdehyde (MDA) and hydrogen peroxide (H2O2). Arabidopsis lines overexpressing Gh4CL7, however, were more tolerant to drought treatment, which was associated with improved antioxidative enzyme activity, reduced accumulation of MDA and H2O2 and up-regulated stress-related genes under the drought stress conditions. In addition, compared to their respective controls, the Gh4CL7-silencing cotton plants and the Gh4CL7-overexpressing Arabidopsis lines had a ~20% reduction and a ~10% increase in lignin content, respectively. The expression levels of genes related to lignin biosynthesis, including PAL, CCoAOMT, COMT, CCR and CAD, were lower in Gh4CL7-silencing plants than in controls. Taken together, these results demonstrated that Gh4CL7 could positively respond to drought stress and therefore might be a candidate gene for improvement of drought tolerance in cotton.Conclusion: We characterized the 4CL gene family in upland cotton and revealed a role of Gh4CL7 in lignin biosynthesis and drought tolerance.