bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey
Authors: Shibre Gebretsadik , Zegeye Betregiorgis , Idriss-Wheeler Dina , Ahinkorah Bright Opoku , Oladimeji Olanrewaju , Yaya Sanni 
Published: August 2020

Abstract
Background
In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola.

Methods
We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates.

Results
The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75).

Conclusion
The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.
Protocol for Minute Calisthenics: a randomized controlled study of a daily, habit-based, bodyweight resistance training program
Authors: Hollingsworth Joshua C. , Young Kaelin C. , Abdullah Siraj F. , Wadsworth Danielle D. , Abukhader Ahmad , Elfenbein Bari , Holley Zachary 
Published: August 2020

AbstractBackgroundResistance-training (RT) provides significant health benefits. However, roughly 3/4 of adults in the United States do not meet current Physical Activity Guidelines in this regard. There has been a call for research examining the effectiveness of interventions to increase participation in physical activity and to better understand the dose response relationship upon health outcomes. Studies are needed that assess the effectiveness of RT programs that are time-efficient and simple to perform. This fully-powered, randomized controlled study will assess a habit-based RT program consisting of one set of push-ups, angled-rows, and bodyweight-squats performed every weekday for 12–24 weeks in untrained individuals.MethodsForty–60 untrained osteopathic medical students and college/university employees who work in an office setting will be recruited and randomized (1:1) to an intervention or waitlist control group. After 12-week follow-up assessment, the intervention group will continue the program and the control group will initiate the program for 12 weeks. In addition to the equipment and training needed to safely perform the exercises, all participants will receive training in the Tiny Habits® Method (THM) and digital coaching for the duration of the study. Participants will complete weekly assessments regarding the program during their initial 12-week intervention phase. The primary outcome is the change from baseline to 12 weeks in the intervention group versus the control group, in the combined number of repetitions performed in one set of each of the three exercises (composite repetitions) under a standardized protocol. Secondary outcomes include adherence to and satisfaction with the program, and change from baseline to 12- and 24-week follow-up in blood pressure, fasting lipid panel, hemoglobin A1c, body mass index, anthropometry, body composition, mid-thigh muscle thickness, and habit strength.DiscussionThis study will evaluate a simple, habit-based RT intervention in untrained individuals. The approach is unique in that it utilizes brief but frequent bodyweight exercises and, via the THM, focuses on consistency and habit formation first, with effort being increased as participants are motivated and able. If effective, the program can be easily scaled for wider adoption.Trial registrationThis study was prospectively registered at ClinicalTrials.gov, identifierNCT04207567, on December 23rd, 2019.
Correlation analysis between CARMEN variants and alcohol-induced osteonecrosis of the femoral head in the Chinese population
Authors: Guo Yongchang , Cao Yuju , Gong Shunguo , Zhang Sumei , Hou Fengzhi , Zhang Xinjie , Hu Jiangeng , Yang Zhimin , Yi Juanjuan , Luo Dan , Chen Xifeng , Song Jingbo 
Published: August 2020

AbstractBackgroundOsteonecrosis of the femoral head (ONFH) is a complicated disease associated with trauma, hormone abuse and excessive alcohol consumption. Polymorphisms of long non-coding RNAs have been also linked with the development of ONFH. Our research aimed to explore the relationship betweenCARMEN(Cardiac Mesoderm Enhancer-Associated Non-Coding RNA) variants and ONFH risk.MethodsOur study used Agena MassARRAY Assay to genotype 6 selected single nucleotide polymorphisms (SNPs) in 731 participants (308 alcohol-induced ONFH patients and 423 controls). We used odds ratios (ORs) and 95% confidence intervals (CIs) to calculate the effect of gene polymorphisms on the occurrence of alcohol-induced ONFH by logistic regression analysis and haplotype analysis.ResultsOur overall analysis illustrated that rs13177623 and rs12654195 had an association with a reduced risk of ONFH after adjustment for age and gender. We also found that rs13177623, rs12654195 and rs11168100 were associated with a decreased susceptibility to alcohol-induced ONFH in people ≤45 years. In addition, the necrotic sites stratification analysis showed that rs12654195 was only found to be related to alcohol-induced ONFH risk in the recessive model. In patients with different clinical stages, rs353300 was observed to be associated with a higher incidence of ONFH. Individuals with different genotypes of rs13177623, rs12654195 and rs11168100 had significantly different clinical parameters (cholinesterase, globulin, percentage of neutrophils and the absolute value of lymphocytes).ConclusionsOur data provided new light on the association betweenCARMENpolymorphisms and alcohol-induced ONFH risk in the Chinese Han population.
Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus
Authors: Yang Shun-Jie , Ding Zhong-Jun , Li Jian , Xue Yang , Chen Gang 
Published: August 2020

AbstractBackgroundDue to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM.MethodsPatients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes.P < 0.05 was considered statistically significant.ResultsA total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4 ~ 97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9 ~ 64.9; IQR, 9.7) (P < 0.001). Male sex was predictive of a higher IKDC score (P = 0.023, OR = 1.702). Compared with BMI ≥25 kg/m2,< 18.5 kg/m2was associated with better IKDC score (P = 0.026, OR = 3.016). Contrasting with age of onset ≥45 years,≤14 years(P < 0.001, OR = 20.780) and14 ~ 25 years(P < 0.001, OR = 8.516) were associated with better IKDC score. In comparison with symptoms duration> 24 months, IKDC scores for patients with symptoms duration≤1 month(P = 0.001, OR = 3.511),1 ~ 6 months(P < 0.001, OR = 3.463) and6 ~ 24 months(P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III ~ IV, no injury (P < 0.001, OR = 6.379) and grade I (P = 0.01, OR = 4.332) were associated with higher IKDC score.ConclusionsArthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5 kg/m2, age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade ≥ 2) reduces postoperative effect.
A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature
Authors: Liu Hui-Pu , Chang Wen-Yen , Hsu Chin-Wen , Chien Shan-Tao , Huang Zheng-Yi , Kung Wen-Ching , Liu Ping-Hung 
Published: August 2020

Abstract
Background
Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach.

Case presentation
An 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding.

Conclusion
For PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.
Renal arteriovenous fistula after retrograde ureteroscopic lithotripsy for the lower ureteral stones: a rare case report
Authors: Liu Wan-Zhang , Huang Ting , Fang Li , Cheng Yue 
Published: August 2020

Abstract
Background
Renal arteriovenous fistula was rarely reported in retrograde endoscopic procedure. Up to now, there is still an absence of report on the formation of renal arteriovenous fistula after semi-rigid ureteroscopic lithotripsy for lower ureteral stones.

Case presentation
An 83-year-old man was admitted to our hospital complaining about intermittent left flank pain that had persisted for 1 week. He suffered medium hypertension and nephrolithiasis treated with left open ureterolithotomy and two ureteroscopic lithotripsies. Non-contrast abdominal CT scan revealed two left lower ureteral stones diametered 8 mm and 7 mm respectively with mild hydronephrosis. A retrograde semi-rigid ureteroscopic lithotripsy was performed to remove the stones, after which two Double-J stents were placed for the ureteral stricture. Due to the continuous gross hematuria and hemoglobin droppings 2 days after operation, a variety of conservative therapies, including blood transfusion and bed rest, were adopted. Then, the patient was discharged with a stable hemoglobin. However, he presented himself to our emergency department with aggravating left flank pain and severe gross hematuria as little as 2 days later. Emergent digital subtraction angiography was conducted to reveal an arteriovenous fistula in the left kidney, which was embolized with two platinum coils to stop the bleeding. His hematuria was resolved in 3 days, and two Double-J stents were removed in 4 weeks. The patient was followed up for 1 year, during which no hematuria or flank pain recurred.

Conclusion
This is the first case report on the formation of renal arteriovenous fistula after semi-rigid ureteroscopic lithotripsy. In this case, elevated intrapelvic pressure, historical surgery and hydronephrosis might be associated with the primary risk of the complication.
Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017)
Authors: Borraccino Alberto , Campagna Sara , Politano Gianfranco , Dalmasso Marco , Dimonte Valerio , Gianino Maria Michela 
Published: August 2020

AbstractBackgroundCurrent policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors.MethodsA pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013–2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered.ResultsThe 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = − 0.18,p = 0.796, 95% confidence interval [CI] = − 1.59;1.22, b-squared = − 1.25,p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms).ConclusionOur results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend.
Virtual reality video promotes effectiveness in advance care planning
Authors: Hsieh Wan-Ting 
Published: August 2020

Abstract
Background
In 2019, the Patient Autonomy Act went into effect, allowing Taiwanese citizens to establish legal advance decisions. In an effort to secure a more realistic and accurate perception of situations, a virtual reality video was developed by the palliative care team of Chi-Mei hospital in southern Taiwan for citizens to use before advance care planning. This study explores the change in participants’ preference and certainty regarding end-of-life decisions after using this tool.

Methods
Participants were at least 20 years old and capable of reading and understanding the information provided in the written handout with information about the legal process of making an advance decision. They completed pre-test questionnaires, viewed a six-minute 360-degree virtual reality video on a portable headset, and then completed a post-test questionnaire about their preference on the five medical options—CPR, life-sustaining treatments, antibiotics, blood transfusion, and artificial nutrition and hydration—followed by feedback on the helpfulness of the virtual reality. The control group included 40 participants who only read the handout and completed pre-test and post-test questionnaires.

Results
After viewing the virtual reality video, preference for not using CPR, life-sustaining treatment, antibiotics, blood transfusion, and artificial nutrition and hydration increased significantly in the virtual reality intervention group. Uncertainty regarding the five medical options mentioned above significantly decreased. The intervention was generally recognized by participants for its help in making decisions.

Discussion
The decrease in the number of participants who could not make decisions indicates that the virtual reality video may be helpful for users in making end-of-life decision. According to feedback, the virtual reality video helped equip users with better understanding of medical scenarios, and that it is a good decision tool for advance care planning.

Conclusion
This is the first study since the Patient Autonomy Act has been passed that explores the effectiveness of using a virtual reality video as a decision tool in advance care planning and reveals decreased preference of CPR, life sustaining treatment, antibiotics, blood transfusion, and artificial nutrition and hydration after intervention. This decision aid proved to be an effective tool for clarifying their end-of-life care preferences.
PAMs inhibits monoamine oxidase a activity and reduces glioma tumor growth, a potential adjuvant treatment for glioma
Authors: Li Pei-Chuan , Chen Shih-Yi , Xiangfei Danzhou , Mao Canquan , Wu Chieh-His , Shih Jean Chen 
Published: August 2020

Abstract
Background
Monoamine oxidase (MAO) A catalyzes oxidative deamination of monoamine neurotransmitters and dietary amines and regulates brain development and functions. Recently, we showed that MAO A mediates the progression and migration of glioma and MAO A inhibitors reduce glioma cell growth. Glioblastoma (GBM) is a common and most malignant brain tumor which is difficult to treat. Temozolomide (TMZ) is the current standard chemotherapy for glioma, but tumors usually become resistant and recur. So far, no effective therapy for TMZ-resistant glioma is available. Natural plant antimicrobial solution (PAMs) is a Chinese herbal medicine which has been used for decades without toxicity and has multiple medical functions including anti- inflammatory effects. Here, we report the effects of PAMs on glioblastoma growth.

Methods
The growth of TMZ -sensitive (U251S),-resistant (U251R) human glioma cells, and mouse glioma cell line GL-26 were assessed by MTS colorimetric assay, colony formation, and cell migration assays.
Male C57BL/6 mice were implanted subcutaneously or intracranial with luciferase-positive mouse glioma GL-26 cells and treated with vehicle; MAO A inhibitor clorgyline (10 mg/kg); TMZ (1 mg/kg); PAMs (48 mg/kg) alone or in combination with TMZ (1 mg/kg) for 14 days. At the end of the treatment, mice were sacrificed, MAO A catalytic activity in tumors was measured, and tumor sizes were determined by imaging and weight.

Results
These results show that PAMs inhibits MAO A catalytic activity in all three glioma cell lines studied U251S, U251R, and GL-26. PAMs reduced glioma growth and has greater effects in combination with low dose of TMZ than PAMS or TMZ alone in all three cell lines as shown by MTS, colony formation, and cell migration assays. Using the subcutaneous or intracranial GL-26 glioma mouse model, PAMs reduced the tumor growth and MAO A activity, similar to the MAO A inhibitor clorgyline. Combining PAMs with non-toxic dose TMZ increased survival to a greater extent than those of PAMs or TMZ alone.

Conclusions
This is the first study which suggests that PAMs alone or co-administration with low doses of TMZ may be a potential adjuvant to reduce the toxicity of TMZ and to abrogate drug resistance for the effective treatment of glioma.
The need for home care physicians in Japan – 2020 to 2060
Authors: Iwata Hiroyoshi , Matsushima Masato , Watanabe Takamasa , Sugiyama Yoshifumi , Yokobayashi Kenichi , Son Daisuke , Satoi Yoshinao , Yoshida Eriko , Satake Sumiko , Hinata Yuki , Fujinuma Yasuki 
Published: August 2020

AbstractBackgroundJapan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060.MethodsOur estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count.ResultsResults were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030’s, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040.ConclusionThe results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.