bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of the Mobile ‘Blood Pressure Management Application’ on Hypertension Self-Management Enhancement: A Randomized Controlled Trial
Authors: Bozorgi Ali , Hosseini Hamed , Eftekhar Hassan , Majdzadeh Reza , Yoonessi Ali , Ramezankhani Ali , Mansouri Mehdi , Ashoorkhani Mahnaz 
Published: March 2020

Abstract
Background: Self-management of hypertension is of great significance given its increasing incidence and its associated disabilities. In view of the increased use of mobile health in medicine, the present study evaluated the effect of a self-management application on patient adherence to hypertension treatment.
Methods: This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed-up until the 24th week. Data on the primary outcome (adherence to treatment) and secondary outcomes (adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (General Linear Model).
Results: The treatment adherence score increased by an average of 5.9 (95% CI: 5.0-6.7) in the intervention group compared to the control group. Scores of 'adherence to the low-fat and low-salt diet plans' were 1.7 (95% CI: 1.3-2.1) and 1.5 (95% CI: 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 minutes (95% CI: 61.7-138.3) per week in the intervention group.
Conclusion: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones, mHealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries.
Trial registration: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on January 1st 2016.
Distribution of malaria patients seeking care in different types of health facilities during the implementation of National Malaria Elimination Program
Authors: Li Gang , Zhang Donglan , Chen Zhuo , Feng Da , Chen Xiaoyu , Tang Shangfeng , Son Heejung , Wang Zhenhua , Xi Yuanhang , Feng Zhanchun 
Published: March 2020

Abstract
Background: China launched the National Malaria Elimination Program (NMEP) in 2010 that set the goal that all health facilities had the ability to diagnose malaria along with the hospitals at all levels had the ability to treat malaria by 2015. To provide a reference for the control of imported malaria, we conducted a study on the distribution of malaria patients seeking care in different types of health facilities. Methods: There were two data source. One was obtained through the Infectious Diseases Information Reporting Management System (IDIRMS), which only contained the name of health facilities and the number of cases. The other was obtained through multistage stratified cluster sampling. Descriptive statistical analysis was used to investigate the distribution of malaria patients attending different types of health facilities (hospitals, township hospitals and CDCs), hospital tiers (county-level, prefecture-level or provincial-level) and hospital levels (primary, secondary or tertiary), and the Chi-square test was used to compare the proportions of patients seeking care outside their current residence region between different types of hospitals. Point maps were drawn to visualize the spatial distribution of hospitals reporting malaria cases, and flow maps were created to show spatial flow of malaria patients by using the ArcGIS software. Results: The proportions of malaria patients who sought care in hospitals, township hospitals, and Centers for Disease Control and Prevention (CDCs) were 81.7%, 14.7% and 3.6%, respectively. For those who sought care in hospitals, the percentages who sought care in provincial-level, prefecture-level and county-level hospitals were 17.4%, 60.5% and 22.1%, correspondingly; the proportions of malaria patients who sought care in tertiary hospitals, secondary hospitals, and primary hospitals were 59.8%, 39.9% and 0.3%, respectively. Moreover, the proportions of patients seeking care in hospitals within county and prefectural administrative area were 18.2%, 63.4%, respectively. Conclusion: During the implementation of NMEP, malaria patients tended to seek care in tertiary hospitals and prefecture-level hospitals, and more than half of patients could be treated in hospitals in prefecture-level areas. In the current phase, it is necessary to establish referral system from county-level hospitals to higher-level hospitals for malaria treatment.
Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: Evidence from EDHS 2016
Authors: Nigatu Araya Mesfin , Birhanu Abraham Yeneneh , Endehabtu Berhanu Fikadie 
Published: March 2020

Abstract
Background : The early age of sexual initiation will contribute a lot for various risks such as mistimed pregnancy followed by insecure termination, developing fistula and contracting sexually transmitted infections which are currently the major public health concerns, particularly for low-income countries. Therefore, the purpose of this study was to detect spatial clusters and identify factors associated with an early age sexual initiation of women in the reproductive age group. Methods : We used a population-based nationwide representative Ethiopian demographic and health survey 2016 data for this analysis. A total of 12,033 respondents of reproductive age (15–49 years) who had at least one event of sexual initiation was retrieved and included for the analysis. Spatial cluster detection and autocorrelation analysis were also done to explore the patterns of early age sexual initiation. Results : The median age at first sexual intercourse among respondents was 16 (±3.3) years and more than half (66.2%), had their first intercourse before the age of 18 years. The spatial variations of the age of sexual initiation was nonrandom and clustered with a Moran's I = 0.413 (P-value < 0.001). In addition, five significant spatial clusters were also identified. Moreover, the probability of starting sex at an earlier age was associated with the respondent’s residence, marital status, educational attainment and wealth index. Conclusion : This study found a higher proportion of an early age sexual initiation of women. Socio-demographic variables were also significantly associated with early sexual initiation. The SaTScan analysis identified five statistical significant spatial clusters which indicate that there were geographical variations. Therefore, targeted and integrated interventions focusing on the identified high spot clustered areas are recommended to reduce early age sexual initiation. Keywords : Early sexual initiation, geographical variations, Ethiopia
Neuroanatomical underpinnings of autism symptomatology in carriers and non-carriers of the 22q11.2 microdeletion
Authors: Gudbrandsen Maria , Bletsch Anke , Mann Caroline , Daly Eileen , Murphy Clodagh M , Stoencheva Vladimira , Blackmore Charlotte , Rogdaki Maria , Kushan Leila , Bearden Carrie E , Murphy Declan G.M , Craig Michael C , Ecker Christine 
Published: March 2020

Abstract
Background: A crucial step to understanding the mechanistic underpinnings of autism spectrum disorder (ASD), is to examine if the biological underpinnings of ASD in genetic high-risk conditions, like 22q11.2 Deletion Syndrome (22q11.2DS), are similar to those in idiopathic illness. This study aimed to examine if ASD symptomatology in 22q11.2DS is underpinned by the same – or distinct – neural systems that mediate these symptoms in non-deletion carriers. Methods: We examined vertex-wise estimates of regional cortical volume (rCV), surface area (SA), and cortical thickness across 131 individuals between (6-25 years) including (1) 50 individuals with 22q11.2DS, out of which n=25 had a diagnosis of ASD, (2) 40 non-carriers of the microdeletion with a diagnosis of ASD (i.e. idiopathic ASD), and (3) 41 typically developing (TD) controls. We employed a 2-by-2 factorial design to identify neuroanatomical variability associated with the main effects of 22q11.2DS and ASD, as well as their interaction. Further, using canonical correlation analysis (CCA), we compared neuroanatomical variability associated with the complex (i.e. multivariate) clinical phenotype of ASD between 22q11.2 deletion carriers and non-carriers. Results: The set of brain regions associated with the main effect of 22q11.2DS was distinct from the neuroanatomical underpinnings of the main effect of ASD. Moreover, significant 22q11.2DS-by-ASD interactions were observed for rCV and SA in the dorsolateral prefrontal cortex, precentral gyrus, and posterior cingulate cortex, suggesting that neuroanatomy of ASD is significantly modulated by 22q11.2DS ( p <0.01). We further established that the multivariate patterns of neuroanatomical variability associated with differences in symptom profiles significantly differed between 22q11.2 deletion carriers and non-carriers (RV coef =0.06, p <0.7 vs. RV coef =0.196, p <0.0001). Limitations: We employed a multicenter design to overcome single-site recruitment limitations, however, FreeSurfer derived measures of surface anatomy have been shown to be highly reliable across scanner platforms and field-strengths’. Further, we controlled for gender to address the differing distribution between idiopathic ASD individuals and the other groups. Nonetheless, the gender distribution in our sample reflects that of the respective populations, adding to the generalizability of our results. Last, we included individuals with a relatively wide age range (i.e. 6-25 years). Conclusions: Our findings indicate that neuroanatomical correlates of ASD symptomatology in carriers of the 22q11.2 microdeletion diverge from those in idiopathic ASD.
Roles of neutrophil/lymphocyte ratio in prognosis and in differentiation of potential beneficiaries in HER2-positive breast cancer with trastuzumab therapy
Authors: Ding Nianhua , Huang Juan , Li Ningsha , Yuan Jiaqi , Wang Shouman , Xiao Zhi 
Published: March 2020

Abstract
Background
The relationship of neutrophil/lymphocyte ratio (NLR) to prognosis of HER2-positive breast cancer (BC) is not well studied. We aimed to assess the prognostic role of NLR in HER2-positive BC patients treated with or without trastuzumab.
Methods
The clinical data of 843 HER2-positive BC patients from July 2013 to July 2018 were collected. The difference among variables was calculated by chi-square test. The associations between clinicopathological factors, NLR and disease-free survival (DFS) were analyzed by univariate and multivariate analyses.
Results
Patients were divided into three groups. In group 1 containing 255 patients without trastuzumab treatment, pretreatment NLR showed no predictive value. Patients with trastuzumab treatment were divided into two groups on equal, according to pretreatment NLR values, low NLR (group 2) and high NLR (group 3). Patients in group 2 showed significantly higher 3-year DFS rate than patients in group 1 and group 3 (95.3% vs. 91.6% vs. 90.5%, respectively, P = 0.011); patients in the group 1 and group 3 had a similar 3-year DFS outcome. Multivariate analysis showed high pretreatment NLR was significantly associated with shorter DFS (HR = 2.917, 95% CI=1.055-8.062, P = 0.039) in HER2-positive BC patients treated with trastuzumab.
Conclusions
Among HER2-positive trastuzumab-treated BC patients, low pretreatment NLR value was associated with better DFS, and it might help to differentiate potential beneficiaries of trastuzumab treatment.
Scaling-up an evidence-based intervention for osteoarthritis in real world settings: A pragmatic evaluation using the RE-AIM framework
Authors: Walker Andrew , Boaz Annette , Gibney Amber , Zambelli Zoe , Hurley Michael V 
Published: March 2020

Abstract
Background : Scaling-up and sustaining effective healthcare interventions is essential for improving healthcare; however, relatively little is known about these processes. In addition to quantitative experimental designs we need approaches that use embedded, observational studies on practice-led, naturally-occurring scale-up processes. There are also tensions between having adequately rigorous systems to monitor and evaluate scale-up well that are proportionate and pragmatic in practice. The study investigated the scale-up of an evidence-based complex intervention for knee and hip osteoarthritis (ESCAPE-pain) within ‘real-world’ settings by England’s 15 Academic Health Science Networks (AHSNs). Methods : A pragmatic evaluation of the scale-up of ESCAPE-pain using the RE-AIM framework to measure reach, effectiveness, adoption, implementation and maintenance. The evaluation used routine monitoring data collected from April 2014 to December 2019 as part of a national scale-up programme. Results : Between 2014-2018 ESCAPE-pain was adopted by over 110 clinical and non-clinical sites reaching over 9,000 people with osteoarthritis. The programme showed sustained clinical effectiveness (pain, function and quality of life) and high levels of adherence (78.5% completing 75% of the programme) within a range of real world settings. 770 people (physiotherapists and exercise professionals) have been trained to deliver ESCAPE-pain and 84.1% of sites have continued to deliver the programme post-implementation. Conclusions : ESCAPE-pain successfully moved from being an efficacious “research intervention” into an effective intervention within ‘real world’ clinical and non-clinical community settings. However, scale-up has been a gradual process requiring on-going, dedicated resources over 5 years by a national network of Academic Health Science Networks (AHSNs). Whilst the collection of monitoring and evaluation data is critical in understanding implementation and scale-up, there remain significant challenges in developing systems sufficiently rigorous, proportionate and locally acceptable.
Traditional Chinese medicine Lingguizhugan decoction treating non-alcoholic fatty liver disease with spleen-yang deficiency pattern: Study protocol for a multicenter randomized controlled trial
Authors: Xu Jing-juan , Wang Rui-rui , You Sheng-fu , Zhang Lei , Zheng Pei-yong , Ji Guang , Liu Bao-cheng 
Published: March 2020

Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury induced by excessive fat accumulation in liver, which is closely related to insulin resistance (IR). Traditional Chinese medicine (TCM) has showed good curative effects and unique advantages in the prevention and treatment of NADLD, particularly in improving IR, liver function and clinical symptoms. This study will examine the efficacy and safety of Lingguizhugan decoction (LGZG) in the treatment of non-alcoholic fatty liver disease with spleen-yang deficiency pattern, and assess the optimal dosage. Methods/design This study is a three-arm, dose-optimization, randomized, double-blinded, placebo-controlled clinical trial. A total of 243 NAFLD patients will be recruited and randomly assigned to standard dose Lingguizhugan decoction (SLGD) group, low dose Lingguizhugan decoction (LLGD) group, or the control group. The clinical indicator will be assessed during the 12-week intervention and follow-up 4 weeks. The primary outcome is the percentage of patients whose the decline of HOMA-IR reaches one standard unit. Secondary outcomes include body weight, body mass index, liver function, blood lipid metabolism, blood glucose metabolism, liver-kidney echo ratio, quantitative rating of clinical symptoms and signs, collecting sample(s) from participants, the medical outcomes study(MOS) item short from health survey(SF-36), Self-rating Depressive Scale(SAS), and Self-rating Anxiety Scale(SDS). Discussion This study will provide initial evidence regarding the efficacy and safety of LGZG in the treatment of NAFLD with spleen-yang deficiency pattern, meanwhile establish the demonstration technique, and promote its application in community healthcare center. In addition, potential mechanism will be explored based on research of oral and gut microbiota.
Associations of an empirical dietary pattern with cardiometabolic risk factors in Malaysian adolescents
Authors: Emi Aishah , Gan Wan Ying , Shariff Zalilah Mohd , Zaini Azriyanti Anuar , Shamsuddin Nurainul Hana , Appukutty Mahenderan , Appannah Geeta 
Published: March 2020

Abstract
Background: This study aimed to identify a dietary pattern (DP) characterised mainly by high intakes of free sugar and other nutrients hypothesised to be associated with obesity such as dietary energy density (DED), percentage of energy from total fat and fibre density in adolescents from three southern states of Peninsular Malaysia, and its associations with cardiometabolic risk factors. Methods: This is a cross-sectional study among 335 adolescents who provided both dietary information assessed using a validated food frequency questionnaire (FFQ) and biochemical parameters including lipid profile, blood glucose, serum insulin and homeostatic model assessment-insulin resistance (HOMA-IR). Anthropometric measurements included weight (kg), height (cm) and waist circumference (cm), while body mass index (BMI) in kg/m2 was estimated, respectively. Reduced rank regression (RRR) identified a DP with percentage of energy from sugar and total fat, DED and fibre density intake as response variables. Results: The identified ‘high sugar, high fibre, high DED and low fat’ DP was characterised by high intakes of sugar-sweetened beverages, fruits, sweets and low intakes of meat and cereal. Adolescents in the highest tertile of the identified DP had about 3.0 (OR=2.7; 95%CI: 1.3, 5.6) and 2.0 (OR=1.9; 95%CI: 1.0, 3.5) times higher odds of having dyslipideamia or elevated total cholesterol and LDL-cholesterol level, respectively compared to adolescents in the lowest tertile DP after adjusting for sex, school location, maternal education, physical activity, dietary misreporting and BMI z-score. This DP was not significantly associated with overweight and obesity.Conclusions: Higher adherence to a DP characterised mainly by free sugars and DED was associated with greater odds of having dyslipideamia, elevated total cholesterol and LDL-cholesterol levels in Malaysian adolescents.
General trends in freshwater ecological restoration practice in China over the past two decades: the driving factors and the evaluation of restoration outcome
Authors: Wu Juan , Dai Yanran , Cheng Shuiping 
Published: March 2020

Abstract
Background

Although freshwater ecological restoration (FER) has undergone an immense development over the past two decades in China either in the number of projects or in the spatial scale of implementations, a dearth of clear and comprehensive trends in this field is still a particular concern. We conducted a literature survey through searching the database of Web of Science between 1997-2017 to investigate the driving force behind FER practice and to summarize the restoration outcomes.

Results

A total of 2047 publications were hit and 198 of them were finally retained after manual screening. The number of studies in this field has been steadily increasing in recent years and their provincial distribution is positively correlated with GDP growth and the investment to pollution control and environmental protection, suggesting that economic development is a key driving factor of FER practice. Among the remained articles, nearly half (46.5%) focus on lake ecosystems, and 34.8% and 32.8% of the studies indicate that land reclamation and eutrophication are the predominant causes of freshwater ecosystem degradation. The overarching target of the restoration is biodiversity increase (31.4%), followed by water quality improvement (24.7%) and ecosystem services (23.9%). Revegetation is a dominant restoration approach (40.9%). Reference sites for assessment of restoration projects are normally control locations without intervention (60%), or the status of the targeted sites before the interventions. For the restoration outcome evaluation, 86% of the studies present positive outcomes in terms of water quality improvement, and 79% have improvement in biological features. The most frequently monitored organisms are macrophytes (31%), followed by benthos as indicators of ecological condition.

Conclusions

Economic growth, water pollution and investment into environmental protection are the main driving factors of FER practice in China. The effort of restoration and evaluation over the past two decades has not been limited to improving hydrological function and water quality, but also pay increasingly more attention to biological processes and ecological integrity, and further the ecosystem services in recent years. However, the lack of long-term monitoring and socioeconomic attributes considered in restoration success assessments are still particular issues needed to be addressed in the future FER researches and projects.
Correlation between clinical risk factors and tracheal intubation difficulty in infants with Pierre-Robin syndrome: A retrospective study
Authors: Liu Yanli , Wang Jiashuo , Zhong Shan 
Published: March 2020

Abstract
Background: Difficult tracheal intubation is a common problem encountered by anesthesiologists in the clinic. This study was conducted to assess the difficulty of tracheal intubation in infants with Pierre Robin syndrome (PRS) by incorporating computed tomography (CT) to guide airway management for anesthesia.
Methods: In this retrospective study, we analyzed case-level clinical data and CT images of 96 infants with PRS. First, a clinically experienced physician labeled CT images, after which the color space conversion, binarization, contour acquisition, and area calculation processing were performed on the annotated files. Finally, the correlation coefficient between the seven clinical factors and tracheal intubation difficulty, as well as the differences in each risk factor under tracheal intubation difficulty were calculated.
Results: The absolute value of the correlation coefficient between the throat area and tracheal intubation difficulty was 0.54; the observed difference was statistically significant. Body surface area, weight, and gender also showed significant difference under tracheal intubation difficulty.
Conclusions: There is a significant correlation between throat area and tracheal intubation difficulty in infants with PRS. Body surface area, weight and gender may have an impact on tracheal intubation difficulty in infants with PRS.