bluuebunny/crossref_metadata_2025_split huggingface dataset:
C-reactive protein mediates the association between leisure-time physical activity and lung function in middle-aged and older adults
Authors: Chen Meng , Huang Chuanying , Feng Wenjing , Li Yujie , Wu Yili 
Published: January 2020

Abstract
Background
Although previous studies have reported the benefits of physical activity (PA) to lung function in middle-aged and older adults, the biological mechanisms are still unclear. This study aimed to assess the extent to which C-reactive protein (CRP) mediates the association between leisure-time PA and lung function.

Methods
A population-based sample was recruited from English Longitudinal Study of Ageing (ELSA), Wave 6 (2012–2013). PA was self-reported by questionnaires. CRP was analyzed from peripheral blood. Lung function parameters including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by using a spirometer. Baron and Kenny’s causal steps method and multiple linear regression models based on the Karlson/Holm/Bree (KHB) method were used to assess the mediating effect.

Results
Among 6875 participants, 28.4% were classified into low PA, 49.8% into moderate PA, and 21.8% into high PA. Multiple linear regression models suggested that higher PA was associated with lower levels of CRP (β = − 0.048, P = 0.002 for moderate PA; β = − 0.108, P < 0.001 for high PA). CRP negatively correlated with FEV1 (β = − 0.180, P < 0.001) and FVC (β = − 0.181, P < 0.001). Higher levels of PA were associated with better FEV1 (β = 0.085, P < 0.001 for moderate PA; β = 0.150, P < 0.001 for high PA) and FVC (β = 0.131, P < 0.001 for moderate PA; β = 0.211, P < 0.001 for high PA). After introducing the CRP into the models, regression coefficients of PA with FEV1 (β = 0.077, P < 0.001 for moderated PA; β = 0.130, P < 0.001 for high PA) and FVC (β = 0.123, P < 0.001 for moderated PA; β = 0.188, P < 0.001 for high PA) decreased. The indirect effect of high PA on lung function via CRP was significant, with 9.42–12.99% of the total effect being mediated.

Conclusions
The association between PA and lung function is mediated by CRP, suggesting that this association may be partially explained by an inflammation-related biological mechanism. This finding highlights the possible importance of PA in systemic inflammation and lung function, thus, middle-aged and older adults should be encouraged to enhance PA levels.
Neonatal mortality and associated factors in the specialized neonatal care unit Asmara, Eritrea
Authors: Andegiorgish Amanuel Kidane , Andemariam Mihreteab , Temesghen Sabela , Ogbai Liya , Ogbe Zemichael , Zeng Lingxia 
Published: January 2020

Abstract
Background
Limited knowledge on the magnitude of neonatal mortality and associated factors is hampering early intervention in African countries.
Objective: To determine neonatal mortality and associated factors in the Specialized Neonatal Care Unit Asmara, Eritrea.

Methods
Medical records of all neonates admitted to the Specialized Neonatal Care Unit in 2016 were reviewed using a cross-sectional study. The most important causes of admission and mortality were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the strength of risk factors associated with neonatal mortality. Variables significant at P < 0.20 level in the univariate analysis were retained in the multivariate model. Model fit was evaluated using Hosmer and Lemeshow test (Chi-square = 12.89, df = 8; P = 0.116), implies the model’s estimates fit the data at an acceptable level. Collinearity was assessed using variance inflation factor (VIF) < 4. P-value < 0.05 was considered statistically significant.

Results
Of the 1204 (59.9% boys and 40.1% girls) neonates admitted in 2016, 79 (65.6/1000 live births) died. The major causes of admission were sepsis (35.5%), respiratory distress syndrome (15.4%) and perinatal asphyxia (10%). Major causes of death were respiratory distress syndrome (48.1%); extremely low birth weight (40.9%) and very low birth weight (30.5%). After adjustment, low birth weight (Adjusted odds ratio (AOR) = 4.55, 95% CI,1.97–10.50), very low birth weight (AOR = 19.24, 95% CI, 5.80–63.78), late admission (24 h after diagnosis) (AOR = 2.96, 95% CI, 1.34–6.52), apgar score (in 1 min AOR = 2.28, 95% CI, 1.09–4.76, in 5 min AOR = 2.07, 95% CI, 1.02–4.22), and congenital abnormalities (AOR = 3.95, 95% CI, 1.59–9.85) were significantly associated with neonatal mortality. Neonates that stayed > 24 h in the Specialized Neonatal Care Unit (AOR = 0.23, 95% CI, 0.11–0.46) had a lower likelihood of death. Overall 95.8% of mothers of neonates attended antenatal care and 96.6% were facility delivered. None of the maternal conditions were associated with neonatal mortality in this study.

Conclusions
Low birth weight, late admission, low apgar scores and congenital abnormalities were significantly associated with neonatal mortality in the Specialized Neonatal Care Unit. Early management of low birth weight, preterm births, and neonatal complications should be the priority issues for controlling local neonatal deaths.
Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community
Authors: Chamberlain Alanna M. , Finney Rutten Lila J. , Wilson Patrick M. , Fan Chun , Boyd Cynthia M. , Jacobson Debra J. , Rocca Walter A. , St. Sauver Jennifer L. 
Published: January 2020

AbstractBackgroundPersons with low socioeconomic status may be disproportionately at risk for multimorbidity.MethodsAdults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR).ResultsAmong 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39–1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51–1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62–1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72–2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group.ConclusionsHigher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.
Cross-sectional study of associations between normal body weight with central obesity and hyperuricemia in Japan
Authors: Shirasawa Takako , Ochiai Hirotaka , Yoshimoto Takahiko , Nagahama Satsue , Watanabe Akihiro , Yoshida Reika , Kokaze Akatsuki 
Published: January 2020

Abstract
Background
Several studies have shown that normal weight with central obesity (NWCO) is associated with cardiovascular disease risk factors such as hypertension, dyslipidemia and diabetes. However, the relationship between NWCO and hyperuricemia has not been studied in detail.

Methods
We investigated the association between NWCO and hyperuricemia among Japanese adults aged 40–64 years who had undergone periodic health examinations between April 2013 and March 2014. Obesity was defined as a body mass index (BMI) ≥25 kg/m2 and central obesity was determined as a waist-to-height ratio (WHtR) ≥0.5. We classified the participants into the following groups based according to having obesity and central obesity: normal weight (BMI 18.5–24.9 kg/m2) without (NW; WHtR < 0.5) and with (NWCO) central obesity, and obesity without (OB) and with (OBCO) central obesity. Hyperuricemia was defined as serum uric acid > 7.0 and ≥ 6.0 mg/dL in men and women, respectively, or under medical treatment for hyperuricemia. Alcohol intake was classified as yes (daily and occasional consumption) and none (no alcohol consumption). Odds ratios (OR) and 95% confidence intervals (CI) for hyperuricemia were calculated using a logistic regression model.

Results
We analyzed data derived from 96,863 participants (69,241 men and 27,622 women). The prevalences of hyperuricemia in men and women were respectively, 21.4 and 11.0%, and of participants with NWCO respectively 15.6 and 30.0%. The adjusted OR for hyperuricemia was significantly increased in OBCO compared with NW, regardless of sex (men: OR, 2.12; 95%CI; 2.03–2.21; women: OR, 3.54; 95%CI, 3.21–3.90) and were statistically significant in NWCO compared with NW (men: OR, 1.44; 95%CI, 1.36–1.52; women: OR, 1.41; 95%CI, 1.27–1.57). The results were similar regardless of alcohol consumption.

Conclusions
We found that NWCO and OBCO were associated with hyperuricemia in middle-aged Japanese men and women. Middle-aged Japanese adults with normal weight but having central obesity should be screened using a combination of BMI and WHtR and educated about how to prevent hyperuricemia.
Association between early childhood caries and poverty in low and middle income countries
Authors:   the ECCAG, Folayan Morenike Oluwatoyin , El Tantawi Maha , Aly Nourhan M. , Al-Batayneh Ola B. , Schroth Robert J. , Castillo Jorge L. , Virtanen Jorma I. , Gaffar Balgis O. , Amalia Rosa , Kemoli Arthur , Vulkovic Ana , Feldens Carlos A. 
Published: January 2020

AbstractBackgroundThe aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).MethodsThis ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R2measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.ResultsSignificantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.ConclusionThe use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.
Evaluation of apoptosis and angiogenesis in ectopic and eutopic stromal cells of patients with endometriosis compared to non-endometriotic controls
Authors: Delbandi Ali-Akbar , Mahmoudi Mahmoud , Shervin Adel , Heidari Sahel , Kolahdouz-Mohammadi Roya , Zarnani Amir-Hassan 
Published: January 2020

Abstract
Background
Endometriosis is a chronic, painful, and inflammatory disease characterized by extra-uterine growth of endometrial tissues. Increased angiogenesis and resistance to apoptosis have been suggested to be involved in pathogenesis and development of endometriosis. The objective of this study was to examine apoptosis potential and angiogenesis contribution of eutopic (EuESCs) and ectopic (EESCs) endometrial stromal cells in patients with endometriosis compared to endometrial stromal cells from non-endometriotic controls (CESCs).

Methods
Stromal cells were isolated by enzymatic digestion of ectopic (n = 11) and eutopic (n = 17) endometrial tissues from laparoscopically-confirmed endometriotic patients. Endometrial stromal cells of 15 non-endometriotic patients served as control. Following cell characterization by immunofluorescent staining and flow cytometry using a panel of antibodies, the total RNA was isolated from the cultured cells, and analyzed for the expression of genes involved in apoptosis (Bcl-2, Bcl-xL, Bax, and caspase-3) and angiogenesis [vascular endothelial growth factor-A (VEGF-A) and hepatocyte growth factor (HGF)] by Real-time PCR.

Results
Significantly higher gene expression levels of Bcl-2 and Bcl-xL were found in EESCs compared with EuESCs and CESCs (p < 0.01). The gene expression of Bax in EESCs, EuESCs, and CESCs was not statistically significant. Furthermore, EuESCs exhibited a significantly lower caspase-3 gene expression compared with CESCs (p < 0.01) or EESCs (p < 0.05). Regarding angiogenesis, VEGF-A gene expression in EESCs (p < 0.001) and EuESCs (p < 0.05) were significantly higher compared with those of CESCs. EESCs exhibited a significantly higher HGF gene expression compared with EuESCs (p < 0.05).

Conclusions
These findings suggest reduced propensity to apoptosis and increased angiogenesis potential of EESCs, which may be involved in pathogenesis of endometriosis.
A new concordant partial AUC and partial c statistic for imbalanced data in the evaluation of machine learning algorithms
Authors: Carrington André M. , Fieguth Paul W. , Qazi Hammad , Holzinger Andreas , Chen Helen H. , Mayr Franz , Manuel Douglas G. 
Published: January 2020

AbstractBackgroundIn classification and diagnostic testing, the receiver-operator characteristic (ROC) plot and the area under the ROC curve (AUC) describe how an adjustable threshold causes changes in two types of error: false positives and false negatives. Only part of the ROC curve and AUC are informative however when they are used with imbalanced data. Hence, alternatives to the AUC have been proposed, such as the partial AUC and the area under the precision-recall curve. However, these alternatives cannot be as fully interpreted as the AUC, in part because they ignore some information about actual negatives.MethodsWe derive and propose a new concordant partial AUC and a new partialcstatistic for ROC data—as foundational measures and methods to help understand and explain parts of the ROC plot and AUC. Our partial measures are continuous and discrete versions of the same measure, are derived from the AUC and c statistic respectively, are validated as equal to each other, and validated as equal in summation to whole measures where expected. Our partial measures are tested for validity on a classic ROC example from Fawcett, a variation thereof, and two real-life benchmark data sets in breast cancer: the Wisconsin and Ljubljana data sets. Interpretation of an example is then provided.ResultsResults show the expected equalities between our new partial measures and the existing whole measures. The example interpretation illustrates the need for our newly derived partial measures.ConclusionsThe concordant partial area under the ROC curve was proposed and unlike previous partial measure alternatives, it maintains the characteristics of the AUC. The first partial c statistic for ROC plots was also proposed as an unbiased interpretation for part of an ROC curve. The expected equalities among and between our newly derived partial measures and their existing full measure counterparts are confirmed. These measures may be used with any data set but this paper focuses on imbalanced data with low prevalence.Future workFuture work with our proposed measures may: demonstrate their value for imbalanced data with high prevalence, compare them to other measures not based on areas; and combine them with other ROC measures and techniques.
Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey
Authors: Rutebemberwa Elizeus , Ssemugabo Charles , Tweheyo Raymond , Turyagaruka John , Pariyo George William 
Published: January 2020

Abstract
Background
Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received.

Methods
A cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed.

Results
A total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009).

Conclusion
Patients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.
Experience gained from the implementation of the Saudi TraumA Registry (STAR)
Authors: FORD Jane E. , ALQAHTANI Abdulrahman S. , ABUZINADA Shatha A. A. , CAMERON Peter A. , FITZGERALD Mark C. , ALENIZI Ahmed S. , FARJOU Dina 
Published: January 2020

Abstract
Background
Trauma registries are essential to trauma systems, to enable collection of the data needed to enhance clinical knowledge and monitor system performance. The King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi Arabia (KSA) is aiming to become a Level 1 Trauma Centre, and required a trauma registry in order to do so. Our objective was to establish the Saudi TraumA Registry (STAR) at the (KSMC) and ready it for national deployment. The challenge was that no formal trauma data collection had occurred previously and clinicians had no prior experience of trauma registries.

Methods
To develop the registry, a novel 12 step implementation plan was created and followed at the KSMC. Registry criteria and a Minimum Dataset were selected; training was delivered; database specifications were written; operating procedures were developed and regular reporting was initiated.

Results
Data collection commenced on August 1st 2017. The registry was fully operational by April 2018, eight months ahead of schedule. During the first year of data collection an average of 216 records per month were entered into the database. An inaugural report was presented at the Saudi Trauma Conference in February 2019.

Conclusions
The strategy deployed at the KSMC has successfully established the STAR. In the short term, process indicators will track the development of the hospital into a Level 1 Trauma Centre. In the medium to long term the STAR will be rolled out nationally to capture the impact of public health initiatives aimed at reducing injury in the KSA. The effect of the STAR will be that the country is better equipped to deliver continuous improvements in trauma systems and quality of care.