bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal migration and health in South Africa: determinants of healthcare utilisation in a young adult cohort
Authors: Ginsburg Carren , Collinson Mark A. , Gómez-Olivé F. Xavier , Gross Mark , Harawa Sadson , Lurie Mark N. , Mukondwa Keith , Pheiffer Chantel F. , Tollman Stephen , Wang Rebecca , White Michael J. 
Published: March 2021

AbstractBackgroundIn South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa’s rural northeast.MethodsA 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis.ResultsHealth service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate.ConclusionsMigrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage.
Social trust and emotional health in rural older adults in China: the mediating and moderating role of subjective well-being and subjective social status
Authors: Chen Hongsheng , Zhu Zhenjun 
Published: March 2021

Abstract
Background
China is becoming an aging society. The emotional health of the elderly is gaining importance. Social trust is an important factor affecting emotional health, but existing studies have rarely considered the various effects of different types of social trust on rural elderly emotional health. Few studies have analysed the role of subjective well-being and subjective social status in the relationship between social trust and elderly emotional health.

Methods
Using the data of the China Labor-force Dynamics Survey 2016 (CLDS 2016) and regression models, this study selected 2084 rural respondents aged 60 years and above to analyse the impact of social trust on their emotional health. Social trust was divided into three categories: trust in family members, trust in friends, and trust in neighbours. This study also examined the mediating and moderating effects of subjective well-being and subjective social status on the relationship between social trust and emotional health.

Results
Trust in family members was significantly and positively associated with emotional health (coefficient = 0.194, P < 0.01) and subjective well-being (coefficient = 0.177, P < 0.01). Trust in friends was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.097, P < 0.01; coefficient = 0.174, P < 0.01, respectively). Trust in neighbours was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.088, P < 0.01; coefficient = 0.177, P < 0.01; respectively). Subjective well-being effectively reduced the impact of social trust in family, friends, and neighbours on the emotional health of the elderly by 0.023, 0.022, and 0.023, respectively. Trust in friends and neighbours significantly and positively affected respondents’ subjective social status (coefficient = 0.120, P < 0.05; coefficient = 0.090, P < 0.10; respectively). Subjective social status effectively reduced the impact of social trust in friends and neighbours on the emotional health of the elderly both by 0.004. The positive relationship between trust in family members and emotional health is weakened by subjective well-being.

Conclusions
Social trust, especially family relationships, play an important role in maintaining the emotional health of the rural elderly. In response to population ageing, more social policies must be introduced to care for the rural elderly and help them lead a happy and satisfactory life.
Driver-passenger communicative stress and psychological distress among Chinese bus drivers: the mediating effect of job burnout
Authors: Tu Zhihao , He Jingwen , Zhou Na , Shen Xinghua 
Published: March 2021

Abstract
Background
This study aimed to investigate the relationship between driver-passenger communicative stress and psychological distress among bus drivers, as well as whether job burnout mediates the effect of driver-passenger communicative stress on psychological distress.

Methods
A questionnaire consisting of a 12-item version of the General Health Questionnaire (GHQ-12), a one-item driver-passenger communicative stress scale, the Maslach Burnout Inventory-General Survey (MBI-GS), as well as sociodemographic and work factors, was distributed to 310 bus drivers in Shanghai, of which 307 completed it (99.0% response rate). A parallel multiple mediation model with bootstrap approach, was calculated to test the mediating effect.

Results
Driver-passenger communicative stress, emotional exhaustion and cynicism were positively associated with psychological distress. Communicative stress was significantly positively linked with two of the three dimensions of burnout (emotional exhaustion and cynicism) and dependent variable. Emotional exhaustion and cynicism were positively associated with the dependent variable. The results indicate that emotional exhaustion and cynicism partially mediated the effect of communicative stress on psychological health, and that 60.0% of this effect can be explained by mediating effects, in which emotional exhaustion and cynicism weighed 63.2% and 36.8%, respectively.

Conclusions
Communicative stress had effects on psychological distress among Chinese bus drivers, and job burnout was a mediator in this relationship.
Covid-19 and gender: lower rate but same mortality of severe disease in women—an observational study
Authors:   HPG23 Covid-19 Study Group, Raimondi Federico , Novelli Luca , Ghirardi Arianna , Russo Filippo Maria , Pellegrini Dario , Biza Roberta , Trapasso Roberta , Giuliani Lisa , Anelli Marisa , Amoroso Mariangela , Allegri Chiara , Imeri Gianluca , Sanfilippo Claudia , Comandini Sofia , Hila England , Manesso Leonardo , Gandini Lucia , Mandelli Pietro , Monti Martina , Gori Mauro , Senni Michele , Lorini Ferdinando Luca , Rizzi Marco , Barbui Tiziano , Paris Laura , Rambaldi Alessandro , Cosentini Roberto , Guagliumi Giulio , Cesa Simonetta , Colledan Michele , Sessa Maria , Masciulli Arianna , Gavazzi Antonello , Buoro Sabrina , Remuzzi Giuseppe , Ruggenenti Piero , Callegaro Annapaola , Gianatti Andrea , Farina Claudio , Bellasi Antonio , Sironi Sandro , Fagiuoli Stefano , Di Marco Fabiano 
Published: March 2021

Abstract
Background
Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients.

Methods
Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization.

Results
431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134–273] vs 238 mmHg [150–281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan–Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687).

Conclusion
Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.
Comprehensiveness and validity of a multidimensional assessment in patients with chronic low back pain: a prospective cohort study
Authors: Benz Thomas , Lehmann Susanne , Elfering Achim , Sandor Peter S. , Angst Felix 
Published: March 2021

Abstract
Background
Chronic low back pain is a multidimensional syndrome affecting physical activity and function, health-related quality of life and employment status. The aim of the study was to quantify the cross-sectional and longitudinal validity of single measurement scales in specific construct domains and to examine how they combine to build a comprehensive outcome, covering the complex construct of chronic low back pain before and after a standardized interdisciplinary pain program.

Methods
This prospective cohort study assessed 177 patients using the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Symptom Checklist-90-Revised (SCL-90-R), the Oswestry Disability Index (ODI), and 2 functional performance tests, the Back Performance Scale (BPS) and the 6-Minute Walking Distance (6MWD). The comprehensiveness and overlap of the constructs used were quantified cross-sectionally and longitudinally by bivariate correlations, exploratory factor analysis, and effect sizes.

Results
The mean age of the participants was 48.0 years (+/− 12.7); 59.3% were female. Correlations of baseline scores ranged from r = − 0.01 (BPS with MPI Life control) to r = 0.76 (SF-36 Mental health with MPI Negative mood). SF-36 Physical functioning correlated highest with the functional performance tests (r = 0.58 BPS, 0.67 6MWD) and ODI (0.56). Correlations of change scores (difference of follow-up – baseline score) were consistent but weaker. Factor analysis revealed 2 factors: “psychosocial” and “pain & function” (totally explained variance 44.0–60.9%). Psychosocial factors loaded strongest (up to 0.89 SCL-90-R) on the first factor, covering 2/3 of the explained variance. Pain and function (ing) loaded more strongly on the second factor (up to 0.81 SF-36 Physical functioning at follow-up). All scales showed improvements, with effect sizes ranging from 0.16–0.67.

Conclusions
Our results confirm previous findings that the chronic low back pain syndrome is highly multifactorial and comprises many more dimensions of health and quality of life than merely back-related functioning. A comprehensive outcome measurement should include the predominant psychosocial domain and a broad spectrum of measurement constructs in order to assess the full complexity of the chronic low back syndrome. Convergence and divergence of the scales capture the overlapping contents and nuances within the constructs.
The effect of physiotherapy in rotator cuff injury patients with platelet-rich plasma: study protocol of a non-randomized controlled trial
Authors: Zhang Chi , Wang Jianxiong , Wang Li , Xie Yujie , Sun Fuhua , Jiang Wei , Miyamoto Akira , Lei Lei 
Published: March 2021

AbstractBackgroundThe study aims to identify whether Platelet-rich plasma (PRP) combined with early physiotherapy has an advantage over PRP alone for rotator cuff injury patients, regarding pain release, function score, tear size, and quality of life improvement.MethodsThis is a single-center prospective non-randomized study implemented in July 2019 at the Affiliated Hospital of Southwest Medical University in Sichuan. Three hundred-forteen patients with rotator cuff injury aged over 18 years were recruited. Participants were assigned to the experiment group (PRP plus physiotherapy) or control group (PRP) by their desire. We used the Constant-Murley score to assess the shoulder function, the Visual Analogue Scale to evaluate shoulder pain, and the MOS Item Short-form Health Survey (SF-12) to measure the quality of life. MRI was applied to measure tear size, and the follow-up duration is 12 months.DiscussionOur findings will give information on the effects of PRP and physiotherapy on rotator cuff injuries. Physiotherapy might be added to improve the effects of PRP in patients with rotator cuff injuries.Trial registrationThis study was registered in the Chinese clinical trial registry on September 1st, 2019 (ChiCTR1900025563).
Localization of recurrent lesions following ileocolic resection for Crohn’s disease
Authors: Ikeuchi Hiroki , Uchino Motoi , Bando Toshihiro , Horio Yuki , Kuwahara Ryuichi , Minagawa Tomohiro , Goto Yoshiko , Kusunoki Kurando , Ikeda Masataka , Beppu Naohito , Takesue Yoshio 
Published: March 2021

Abstract
Background
Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion.

Methods
We examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded.

Results
A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4–27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14).

Conclusions
Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.
Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction
Authors: Cao Yuepeng , Chen Qing , Ni Zhizhan , Wu Feng , Huang Chenshen , Zhou Jinzhe , Zhang Songze , Ge Bujun , Huang Qi 
Published: March 2021

Abstract
Background
Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results.

Methods
A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence.

Results
Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052–5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053–1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116–2.607), p = 0.014) were positively correlated with overall survival in matched patients.

Conclusions
Self-expanding metal stents as “a bridge to surgery” are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.
Tinospora cordifolia chloroform extract inhibits LPS-induced inflammation via NF-κB inactivation in THP-1cells and improves survival in sepsis
Authors: Philip Sheena , Tom Greeshma , Balakrishnan Nair Padmaja , Sundaram Sankar , Velikkakathu Vasumathy Asha 
Published: March 2021

Abstract
Background
Tinospora cordifolia (Willd).Miers is a perennial climbing medicinal shrub that has been traditionally used for the treatment of chronic inflammatory ailments. Our previous pre- clinical studies on anti-inflammatory effects, proved that the chloroform extract of T. cordifolia (CETC) suppressed the LPS induced up-regulation of pro-inflammatory biomarkers, hence, further follow up study was carried out to evaluate whether CETC can exhibit a protective effect against LPS induced lethal endotoxemia in vivo and also to analyze the impact of CETC pre-treatment on the secretion of pro-inflammatory cytokines in vitro by THP-1 cells.

Methods
To corroborate our previous preclinical studies on inflammation, we investigated the mechanism of the anti-inflammatory effect of T. cordifolia on THP-cells which were pre-incubated with CETC (30 min) and stimulated subsequently with LPS (1 μg/ml) for 20 h. Levels as well as gene expressions of various cytokines were compared with that of LPS alone incubated cells. Alongside, in vivo oral anti-inflammatory efficacy against LPS induced endotoxemia study was effectuated, wherein rats were administered with CETC 48, 24, 12 and 1 h prior to the injection of LPS and the survival of rats were monitored upto 10 days. Cytokine levels were quantified by ELISA. Nitrite levels were measured using Griess reagent. Expression of pro-inflammatory proteins was inspected in rat tissues by histochemical and immuno -histochemical examinations.

Results
CETC was able to down-regulate the up-regulation of pro-inflammatory biomarkers in THP-1 macrophages though blockade of NF-κB nuclear translocation and could improve the survival rate during endotoxemic episodes with a marked suppression of the tissue expression of pro-inflammatory proteins.

Conclusion
These findings concomitantly reveal the anti-inflammatory mechanism of CETC and support us to move forward for the development of drugs against disorders resulting from deregulated immune reactions.
An outpatient telehealth elective for displaced clinical learners during the COVID-19 pandemic
Authors: Weber Alec M. , Dua Anoushka , Chang Kitae , Jupalli Hamsitha , Rizwan Farsha , Chouthai Abhishek , Chen Catherine 
Published: March 2021

Abstract
Background
In response to the COVID-19 pandemic, medical schools suspended clinical rotations. This displacement of medical students from wards has limited experiential learning. Concurrently, outpatient practices are experiencing reduced volumes of in-person visits and are shifting towards virtual healthcare, a transition that comes with its own logistical challenges. This article describes a workflow that enabled medical students to engage in meaningful clinical education while helping an institution’s outpatient practices implement remote telemedicine visits.

Methods
A 4-week virtual elective was designed to allow clinical learners to participate in virtual telemedicine patient encounters. Students were prepared with EMR training and introduced to a novel workflow that supported healthcare providers in the outpatient setting. Patients were consented to telehealth services before encounters with medical students. All collected clinical information was documented in the EMR, after which students transitioned patients to a virtual Doxy.me video appointment. Surveys were used to evaluate clinical and educational outcomes of students’ participation. Elective evaluations and student reflections were also collected.

Results
Survey results showed students felt well-prepared to initiate patient encounters. They expressed comfort while engaging with patients virtually during telemedicine appointments. Students identified clinical educational value, citing opportunities to develop patient management plans consistent with in-person experiences. A significant healthcare burden was also alleviated by student involvement. Over 1000 total scheduled appointments were serviced by students who transitioned more than 80 % of patients into virtual attending provider waiting rooms.

Conclusions
After piloting this elective with fourth-year students, pre-clerkship students were also recruited to act in a role normally associated with clinical learners (e.g., elicit patient histories, conduct a review of systems, etc.). Furthermore, additional telemedicine electives are being designed so medical students can contribute to patient care without risk of exposure to COVID-19. These efforts will allow students to continue with their clinical education during the pandemic. Medical educators can adopt a similar workflow to suit evolving remote learning needs.