bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship between the index of nutritional quality and the risk of colorectal cancer and adenoma : a case-control study
Authors: Bahrami Alireza , Rafiee Pegah , Jafari Nasab Saeede , Hekmatdoost Azita , Sohrab Golbon , Sadeghi Amir , Hejazi Ehsan 
Published: March 2020

Objective:
Colorectal cancer is one of the most common cancers in the world, whereas dietary factors are its most modifiable risk factors. The index of nutritional quality is considered as a general overview of the nutrient content of diet. The aim of this study is to determine the relationship between the index of nutritional quality and the risk of colorectal cancer and adenomas.

Methods:
Overall, 129 colorectal cancer and 130 colorectal adenoma cases and 240 healthy controls were studied in three major general hospitals in Tehran province, Iran. Index of nutritional quality scores were calculated based on information on the usual diet that was assessed by a valid and reliable Food Frequency Questionnaire. Multivariate logistic regression was used to estimate the relationship between the index of nutritional quality scores and the risk of colorectal cancer and adenoma.

Results:
After controlling for several confounding factors, the index of nutritional quality of calcium, vitamin C, riboflavin, folate and fiber were associated with decreased risk of colorectal cancer [ORcalcium: 0.21 (0.08–0.52), ORvitC: 0.16 (0.09–0.28), ORvitB2: 0.35 (0.18–0.65), ORfolate: 0.33 (0.16–0.65), ORfiber: 0.35 (0.21–0.58)]. Also, the inverse association were observed between risk of CRA and the index of nutritional quality of calcium, vitamin C, riboflavin, folate and fiber [OR calcium: 0.32 (0.14–0.74), ORvitC: 0.51 (0.34–0.73), ORvitB2: 0.48 (0.28–0.82), OR folate: 0.44 (0.23–0.81), OR fiber: 0.62 (0.42–0.92)].

Conclusion:
This study showed that individuals who have a healthier diet, high in calcium, vitamin C, riboflavin, folate and fiber and food groups like fruits, vegetables and whole-grain and less in sweets and red or process meats are at a lower risk of colorectal cancer and CRA than those with unhealthy and poor diet.
Assessing the Healthy People 2020 Objective to Expand Early Treatment Receipt Among a National Sample of Children with Autism Spectrum Disorder
Authors: Yingling Marissa E. , Creel Liza M. , Bell Bethany A. 
Published: March 2020

ABSTRACT:

Objective:
To assess the progress of the Healthy People 2020 (HP2020) objective to increase the proportion of children with autism spectrum disorder (ASD) who receive treatment by 48 months old and to examine the relationship between predisposing, enabling, and need factors and age of initial treatment receipt.

Method:
We used data from the National Survey of Children's Health, 2016 to 2017, a nationally representative study of US children. Our sample included children aged 3 to 17 years old with ASD who received treatment (N = 1333). We conducted χ2 goodness of fit tests and logistic regression.

Results:
The HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). Among 3- to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). We detected social inequities and significant differences by provider type and state mandate.

Conclusion:
Research with larger samples is needed to continue tracking progress. If the goal continues not to be met, work will be required to explain stagnation and to inform additional targeted efforts to reduce the age of initial treatment.
Parental Perceptions About Alcohol Use for Their Adolescent with Attention-Deficit/Hyperactivity Disorder
Authors: Harstad Elizabeth , Sideridis Georgios , Kaye Dylan , Wisk Lauren E. , Weitzman Elissa R. , Levy Sharon 
Published: March 2020

ABSTRACT:

Objective:
Alcohol use can worsen attention-deficit/hyperactivity disorder (ADHD) symptoms, interfere with treatment, and worsen outcomes. Our objective was to describe parental perceptions of alcohol use for their adolescents with ADHD.

Methods:
Parents of adolescents with ADHD completed an online survey about perceptions of adolescent alcohol use for adolescents with ADHD. We described the level of parental concern about the impacts of alcohol use on their adolescent's functioning. We assessed whether specific covariates were associated with the level of parental concern.

Results:
Of 290 parents who completed the survey, 96.5% were women, and 66.1% had an educational attainment of college degree or higher. Most adolescents (75.4%) took ADHD medication, and 59.9% had comorbid anxiety or depression. Almost one-third (30.3%) of parents perceived that their adolescent was more likely to use alcohol because of ADHD, whereas 34.8% of parents disagreed with this and 34.8% of parents were neutral. Parents who suspected their adolescent regularly used alcohol were less likely to report concern about the impact of alcohol on their adolescent's school performance or ADHD medication effectiveness compared with parents who did not suspect regular adolescent alcohol use. Almost half of the parents (48.5%) did not report discussing the impact of alcohol use on ADHD with their adolescent.

Conclusion:
Many parents of adolescents with ADHD do not understand the unique risks of alcohol use for their adolescents. In addition, if alcohol use harm is not obvious, parents may not perceive there to be concerns about alcohol use on functioning. Parental education about alcohol use and ADHD is needed.
Assessment of the Accuracy of Identification of Selected Disabilities and Conditions in Hospital Discharge Data for Pregnant Women
Authors: Schwartz Naomi R. M. , Crane Deborah A. , Doody David R. , Schiff Melissa A. , Mueller Beth A. 
Published: March 2020

Background:
Linked birth certificate–hospital discharge records are a valuable resource for examining pregnancy outcomes among women with disability conditions. Few studies relying on these data have been able to assess the accuracy of identification of preexisting disability conditions. We assessed the accuracy of International Classification of Diseases version 9 (ICD9) codes for identifying selected physical, sensory, and intellectual conditions that may result in disability. As ICD9 codes were utilized until recently in most states, this information is useful to inform analyses with these records.

Methods:
We reviewed 280 of 311 (90%) medical records of pregnant women with disabilities based on ICD9 codes and 390 of 8,337 (5%) records of pregnant women without disabilities who had deliveries at a large university medical center. We estimated sensitivity, specificity, and positive predictive values (PPV) using the medical record as gold standard. We adjusted for verification bias using inverse probability weighting and imputation.

Results:
The estimated sensitivity of ICD9 codes to identify women with disabilities with deliveries 2009–2012 was 44%; PPV was 98%, improving over time. Although sensitivity was <50% for some conditions, PPVs were 87%–100% for all conditions except intellectual disability (67%). Many physical conditions had complete verification and no underreporting.

Conclusions:
These results are helpful for new studies using historical data comparing outcomes among women with and without these conditions and to inform interpretation of results from earlier studies. Assessment of the accuracy of disabilities as identified by ICD version 10 codes is warranted.
Superthin Thoracodorsal Artery Perforator Flap for the Reconstruction of Palmar Burn Contracture
Authors: Hattori Yoshitsugu , Harima Mitsunobu , Yamashita Shuji , Iida Takuya , Niu Atsushi 
Published: March 2020

Summary:
Treating burn scar contractures is challenging. Although free flap transfer is an effective tool for hand reconstruction, free flaps are often bulky, causing functional disturbance and poor cosmetic appearance. Secondary debulking operations are required, resulting in a prolonged total treatment period and delayed return to daily life and work for the patient. Therefore, 1-stage reconstruction using a thin and pliable flap is ideal. In this report, we present the superthin TDAP flap as an option for the reconstruction of postburn palmar contracture. During TDAP flap elevation, the thoracodorsal artery perforator was identified and traced distally until its penetration into the dermis. Subsequently, the subdermal tissue was removed and a uniformly superthin TDAP flap was elevated. Postoperatively, early functional recovery was achieved with excellent palmar contour and texture. No revision surgery was required and no recurrence of contractures occurred during the 6-month follow-up. This procedure is useful in elevating a superthin TDAP flap and is a feasible option for the reconstruction of working surfaces, such as the palm.
Designing Occupational Safety and Health Training Materials for Clear Communication
Authors: Sinyai Clayton , Barlet Grace 
Published: March 2020

Introduction:Printed materials are an essential part of occupational safety and health programs. Public health professionals at the Centers for Disease Control and Prevention (CDC) have created a Clear Communication Index (CCI) to guide design of health education materials for the general public.Methods:We revised an existing handout on heat exposure hazards in construction using the CCI and tested the old and new versions of the handout with an audience of 425 construction apprentices and journey-level workers.Results:Some features recommended by the CCI—such as the use of subheadings, numbering, and other visual cues—strongly conditioned the readers’ understanding of the main message.Conclusions:Design and layout have a significant impact on the delivery of messages in written materials. A communications-based rubric such as the CCI can help writers preparing written occupational safety and health materials for workers and general audiences.
Improvement in Bone Mineral Density after a Distal Weight-Bearing Implant in a Series of 13 Cases
Authors: Guirao Cano Lluis , Samitier Pastor Beatriz , Maldonado Garrido Dolores , Rodriguez-Piñero Duran Manuel , Exposito Tirado Jose , Peraita-Costa Isabel , Morales-Suarez-Varela Maria 
Published: March 2020

ABSTRACT

Introduction
The amputation of lower limbs and the subsequent use of a prosthesis require the adoption of new biomechanical patterns of load and gait by the patient, which may favor the onset of local or generalized bone mineral density loss. Osseo-anchored implants that allow distal weight bearing of the residuum may be able to mitigate bone mineral density loss related to amputation. The objective of this study is to determine the effect of the use of a distal weight-bearing implant on the bone mineral density of the amputated limb in relation to the nonamputated limb.

Materials and Methods
An interrupted time series clinical trial carried out in the Outpatient Department of Rehabilitation of the five participant hospitals. Thirteen patients with previous transfemoral amputations of traumatic, oncologic, and vascular etiology were enrolled. These patients underwent surgical implantation of an osseo-anchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using dual-energy x-ray absorptiometry of the femur neck.

Results
The mean increase in bone mineral density for the amputated limb was 0.020 g/cm2, which represented a mean percentage increase of 3.0%. For the nonamputated limb, the mean increase in bone mineral density was 0.005 g/cm2 and the mean percentage increase was 0.5%, with eight patients showing improvements in bone mineral density. The mean percentage of bone mineral density of the amputated limb in comparison with the nonamputated limb was 70.6% preimplantation and 73.2% postimplantation, with an average increase of 2.6%.

Conclusions
The results of this study show an improvement in bone mineral density in individuals with transfemoral amputation 14 months after having received a distal weight-bearing implant.
Prognostic implications of coronary artery stenosis and coronary spasm in patients with stable angina: 5-year follow-up of the Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries (ACOVA) study
Authors: Seitz Andreas , Morár Nathalie , Pirozzolo Giancarlo , Athanasiadis Anastasios , Bekeredjian Raffi , Sechtem Udo , Ong Peter 
Published: March 2020

Background
In the Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries study, we showed that 62% of patients with stable angina and unobstructed coronary arteries had coronary spasm. In this study, we sought to assess the 5-year prognosis in these patients.

Methods
Data regarding the following endpoints were obtained: death, non-fatal myocardial infarction, coronary event (=cardiac death or non-fatal myocardial infarction), persistent angina and repeated coronary angiography. Quality of life was assessed using the Seattle Angina Questionnaire.

Results
Among patients with unobstructed coronary arteries there were three deaths (2.9%) and no non-fatal myocardial infarction. Among those with obstructive CAD 15 died (13.8%) and three had a non-fatal myocardial infarction (2.8%). Patients with obstructive CAD had a higher rate of all-cause death and coronary events compared to those without (P = 0.004). Persistent angina was more prevalent in patients with unobstructed coronaries (P = 0.042). Prognosis of patients with unobstructed coronaries regarding hard clinical events, persistent angina and repeated coronary angiography was independent of the presence of coronary spasm (all P > 0.05). However, spasm patients were more likely to take nitrate medication at follow-up (P = 0.029).

Conclusion
Patients with stable angina and unobstructed coronary arteries have a favorable prognosis regarding mortality and non-fatal myocardial infarction after 5 years compared to patients with obstructive CAD irrespective of the presence of coronary artery spasm. However, persistent angina remains a common issue in patients with unobstructed coronary arteries leading to a similar frequency of repeated invasive procedures as in patients with obstructive CAD.
Instantaneous wave-free ratio cutoff values for nonculprit stenosis classification in patients with ST-segment elevation myocardial infarction (an iSTEMI substudy)
Authors: Thim Troels , Götberg Matthias , Fröbert Ole , Nijveldt Robin , van Royen Niels , Baptista Sergio Bravo , Koul Sasha , Kellerth Thomas , Bøtker Hans Erik , Terkelsen Christian Juhl , Christiansen Evald Høj , Jakobsen Lars , Kristensen Steen Dalby , Maeng Michael 
Published: March 2020

Objectives
The instantaneous wave-free ratio cutoff value of <0.90 for hemodynamic significance of coronary stenoses has been validated in stable patients. We examined different cutoff values in the evaluation of nonculprit stenoses in patients with ST-segment elevation myocardial infarction.

Methods
We measured instantaneous wave-free ratio across nonculprit stenoses in the acute setting and at follow-up in 120 patients with ST-segment elevation myocardial infarction and 157 nonculprit stenoses, of which, 113 patients with 147 nonculprit stenoses completed follow-up.

Methods
The prevalence of nonculprit stenosis hemodynamic significance was 52% in the acute setting and 41% at follow-up. With follow-up, instantaneous wave-free ratio as reference, acute instantaneous wave-free ratio >0.90 had a negative predictive value of 89%. Acute instantaneous wave-free ratio <0.90 had a positive predictive value of 68%. Acute instantaneous wave-free ratio >0.93 had a negative predictive value of 100%. Acute instantaneous wave-free ratio <0.86 and <0.83 had positive predictive values of 71 and 77%. Using acute instantaneous wave-free ratio <0.90 as cutoff for hemodynamic significance yielded the highest degree of classification agreement between acute and follow-up instantaneous wave-free ratio.

Conclusions
In patients with ST-segment elevation myocardial infarction, acute instantaneous wave-free ratio with the cutoff values <0.90 for hemodynamic significance appears optimal in the evaluation of nonculprit stenoses and has a high negative predictive value and a moderate positive predictive value.
Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series
Authors: Peters Sue , Ivanova Tanya D. , Lakhani Bimal , Boyd Lara A. , Garland S. Jayne 
Published: March 2020

Background and Purpose:
Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping.

Case Description:
Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor.

Intervention:
Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training).

Outcomes:
All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude.

Discussion:
Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.
This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).
A 12-month Prospective Study of Tear Osmolarity in Contact Lens Wearers Refitted with Daily Disposable Soft Contact Lenses
Authors: Garaszczuk Izabela Katarzyna , Mousavi Maryam , Szczesna-Iskander Dorota H. , Cerviño Alejandro , Iskander D. Robert 
Published: March 2020

SIGNIFICANCETear osmolarity has been reported as one of the best diagnostic tests for dry eye disease and its management. Contact lens wear is thought to influence tear homeostasis. Understanding how regular wear of contact lenses and their type affect tear osmolarity is important.PURPOSEThe purpose of this study was to assess changes in tear osmolarity and ocular symptoms over a period of 12 months following refitting contact lens wearers with daily disposable contact lenses.METHODSFifty subjects aged (mean ± SD) 26 ± 4 years were refitted with either silicone-hydrogel (delefilcon A, SiHy, n = 34) or hydrogel (omafilcon A, Hy, n = 16) daily disposable soft contact lenses. Study included seven visits: baseline measurements without contact lenses; two visits for contact lens fit and selection; follow-up measurements after 3, 6, and 12 months of contact lens wear; and a post-study visit without contact lenses. Lens type selection was based on a set of objective measurements. Subjects were instructed to follow strict wearing rules. Impedance-based osmometer was used to collect samples from the lower tear meniscuses. The Ocular Surface Disease Index (OSDI) and the eight-item Contact Lens Dry Eye Questionnaire were used to assess subject-reported ocular symptoms and contact lens discomfort, respectively.RESULTSDownward trend of tear osmolarity was noted over the time course of study. Statistically significant differences were noted in tear osmolarity (Friedman test, χ2= 21.91 [P< .001], and χ2= 13.89 [P= .003]) for the right and left eyes, respectively. A statistically significant decrease in tear osmolarity was apparent only for initially symptomatic subjects (for OSDI ≥13: χ2= 26.25,P< .001; for OSDI <13: χ2= 5.65,P= .13). Statistically significant differences were not noted in OSDI and the eight-item Contact Lens Dry Eye Questionnaire between the baseline and 12-month visit (χ2= 5.92 [P= .12] andR= 0.015 [P= .87], respectively). There was a difference between baseline and post-study visits (P= .002) in OSDI, showing lower score at the latter visit.CONCLUSIONSRefitting with daily disposable contact lenses was demonstrated to lower tear osmolarity.
Evaluation Using Spectral-Domain Optical Coherence Tomography of the Effects of Malnutrition on Ocular Parameters in Pediatric Patients
Authors: Tekin Mehmet , Simsek Ali , Bilak Semsettin , Konca Capan , Almis Habip , Bilen Abdurrahman 
Published: March 2020

SIGNIFICANCE
We determined decreases in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in all quadrants. Our findings show that the choroid and RNFL are affected before the emergence of ocular symptoms in malnourished children.

PURPOSE
We aimed to determine whether the RNFL, a component of the neuronal structure, and the choroid, supplying the retina, are affected in children with malnutrition using spectral-domain optical coherence tomography.

METHODS
One hundred twenty-six malnourished patients without ocular symptoms, aged between 5 and 10 years, and 116 healthy children were included in the study. Age, sex, weight-for-age (WFA) z score, height-for-age z score, body mass index–for–age z score, and spectral-domain optical coherence tomography data were recorded.

RESULTS
Average RNFL thickness was 96.5 μm (82.0 to 128.0 μm) in the malnutrition group and 111.0 μm (95.0 to 128.0 μm) in the control group (P < .001). Retinal nerve fiber layer thickness was statistically significantly lower in all quadrants in malnourished patients compared with the control group. Median choroidal thickness in the foveal center was 304.0 μm (250.0 to 375.0 μm) in the malnutrition group and 345.0 μm (280.0 to 403.0 μm) in the control group (P < .001). Choroidal thickness in all quadrants was also statistically significantly lower in malnourished patients. Positive correlation was determined between average RNFL thicknesses and WFA z score. Average RNFL thickness decreased as WFA z score decreased (r = 0.730 and P < .001). Positive correlation was also observed between choroidal thickness in the foveal center and WFA z score. Foveal center choroidal thickness decreased in line with WFA z score (r = 0.786 and P < .001).

CONCLUSIONS
Our results show that the retinal nerve fiber layer and choroidal thickness decreased in malnourished children without clinically reported ocular symptoms. A decreased retinal nerve fiber layer and choroidal thickness may be an important clue to the prevention of retinal pathologies that may develop at later ages if the malnutrition is not addressed.