bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Need for Mental Health Care and Associated Factors and Outcomes in Older Adults Consulting in Primary Care
Authors: Lamoureux-Lamarche Catherine , Berbiche Djamal , Vasiliadis Helen-Maria 
Published: November 2021

Objective To assess the individual and health system factors and health-related outcomes associated with perceived need for mental health care in older adults consulting in primary care. Method This longitudinal cohort study was conducted among 771 cognitively intact older adults aged ≥65 years recruited in primary care practices in Quebec between 2011 and 2013 and followed 4 years later. Predisposing, enabling and need factors were based on Andersen’s framework on help-seeking behaviors. Health-related outcomes included course of common mental disorders (CMDs), change in quality of life and societal costs. Perceived need for care (PNC) was categorized as no need, met and unmet need. Multinomial regression analyses were conducted to assess the association between study variables and PNC in the overall and the subsample of participants with a CMD at baseline. Results As compared with individuals reporting no need, those with an unmet need were more likely to have cognitive decline and lower continuity of care; while those with a met need were more likely to report decreased health-related quality of life. As compared with individuals with an unmet need, those reporting a met need were more likely to report ≥ 3 physical diseases and an incident and persistent CMD, and less likely to show cognitive decline. In participants with a CMD, individuals reporting a met as compared with no need were more likely to be categorized as receiving minimally adequate care and a persistent CMD. Need for care was not associated with societal costs related to health service use. Conclusions Overall, physicians should focus on individuals with cognitive impairment and lower continuity of care which was associated with unmet mental health need. Improved follow-up in these populations may improve health care needs and outcomes.
The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease
Authors: Chen Lan , Chen Lijun , Zheng Han , Wu Sunying , Wang Saibin 
Published: November 2021

Background and purpose High blood urea nitrogen (BUN) is associated with an elevated risk of mortality in various diseases, such as heart failure and pneumonia. Heart failure and pneumonia are common comorbidities of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, data on the relationship of BUN levels with mortality in patients with AECOPD are sparse. The purpose of this study was to evaluate the correlation between BUN level and in-hospital mortality in a cohort of patients with AECOPD who presented at the emergency department (ED). Methods A total of 842 patients with AECOPD were enrolled in the retrospective observational study from January 2018 to September 2020. The outcome was all-cause in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and logistic regression models were performed to evaluate the association of BUN levels with in-hospital mortality in patients with AECOPD. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics, and logistic regression models were also performed in the propensity score matching cohort. Results During hospitalization, 26 patients (3.09%) died from all causes, 142 patients (16.86%) needed invasive ventilation, and 190 patients (22.57%) were admitted to the ICU. The mean level of blood urea nitrogen was 7.5 ± 4.5 mmol/L. Patients in the hospital non-survivor group had higher BUN levels (13.48 ± 9.62 mmol/L vs. 7.35 ± 4.14 mmol/L, p < 0.001) than those in the survivor group. The area under the curve (AUC) was 0.76 (95% CI 0.73–0.79, p < 0.001), and the optimal BUN level cutoff was 7.63 mmol/L for hospital mortality. As a continuous variable, BUN level was associated with hospital mortality after adjusting respiratory rate, level of consciousness, pH, PCO2, lactic acid, albumin, glucose, CRP, hemoglobin, platelet distribution width, D-dimer, and pro-B-type natriuretic peptide (OR 1.10, 95% CI 1.03–1.17, p=0.005). The OR of hospital mortality was significantly higher in the BUN level ≥7.63 mmol/L group than in the BUN level <7.63 mmol/L group in adjusted model (OR 3.29, 95% CI 1.05–10.29, p=0.041). Similar results were found after multiple imputation and in the propensity score matching cohort. Conclusions Increased BUN level at ED admission is associated with hospital mortality in patients with AECOPD who present at the ED. The level of 7.63 mmol/L can be used as a cutoff value for critical stratification.
Automatic extraction of 12 cardiovascular concepts from German discharge letters using pre-trained language models
Authors: Richter-Pechanski Phillip , Geis Nicolas A , Kiriakou Christina , Schwab Dominic M , Dieterich Christoph 
Published: November 2021

Objective A vast amount of medical data is still stored in unstructured text documents. We present an automated method of information extraction from German unstructured clinical routine data from the cardiology domain enabling their usage in state-of-the-art data-driven deep learning projects. Methods We evaluated pre-trained language models to extract a set of 12 cardiovascular concepts in German discharge letters. We compared three bidirectional encoder representations from transformers pre-trained on different corpora and fine-tuned them on the task of cardiovascular concept extraction using 204 discharge letters manually annotated by cardiologists at the University Hospital Heidelberg. We compared our results with traditional machine learning methods based on a long short-term memory network and a conditional random field. Results Our best performing model, based on publicly available German pre-trained bidirectional encoder representations from the transformer model, achieved a token-wise micro-average F1-score of 86% and outperformed the baseline by at least 6%. Moreover, this approach achieved the best trade-off between precision (positive predictive value) and recall (sensitivity). Conclusion Our results show the applicability of state-of-the-art deep learning methods using pre-trained language models for the task of cardiovascular concept extraction using limited training data. This minimizes annotation efforts, which are currently the bottleneck of any application of data-driven deep learning projects in the clinical domain for German and many other European languages.
Postpartum Hemorrhage and its Associated Factors Among Women who Gave Birth at Yirgalem General Hospital, Sidama Regional State, Ethiopia
Authors: Amanuel Tedla , Dache Azmach , Dona Aregahegn 
Published: November 2021

Background Globally, postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. In developing countries, it accounts for more than 30% of all maternal deaths. So, understanding its burden in the health care setting is significant. Thus, this study aimed to assess the magnitude of PPH and its associated factors among women who gave birth at Yirgalem General Hospital, Sidama Region, Ethiopia. Methods A cross-sectional study was conducted from March 12 to 26, 2020 among randomly selected 298 women. Data were collected using an interviewer-administered, structured, and pretested questionnaire. EpiData version 3.1 and SPSS version 20 were used to enter and analyze the data, respectively. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. Adjusted odds ratio with 95% confidence interval (CI) was used to measure the presence and strength of association between the independent and the outcome variables. A P-value ≤.05 was considered to declare statistical significance. Result The magnitude of PPH was 9.4% [95% CI: 6.0, 12.8]. Prolonged labor (≥24 h) [AOR = 3.4, 95% CI: 1.1, 9.9], giving birth by cesarean section [AOR = 5.8, 95% CI: 1.1, 22.0], and instrumental vaginal delivery [AOR = 3.7, 95% CI: 1.1, 12.7], and having a history of the uterine atony [AOR = 4.8, 95% CI: 1.4, 16.6] during their last delivery were factors significantly associated with PPH. Conclusion The magnitude of PPH was high. Healthcare professionals should manage the progress of labor and take all necessary measures at right time. Also, giving attention to the safety of delivery-related procedures and early related potential risks is crucial.
NeuRank: learning to rank with neural networks for drug–target interaction prediction
Authors: Wu Xiujin , Zeng Wenhua , Lin Fan , Zhou Xiuze 
Published: November 2021

AbstractBackgroundExperimental verification of a drug discovery process is expensive and time-consuming. Therefore, recently, the demand to more efficiently and effectively identify drug–target interactions (DTIs) has intensified.ResultsWe treat the prediction of DTIs as a ranking problem and propose a neural network architecture, NeuRank, to address it. Also, we assume that similar drug compounds are likely to interact with similar target proteins. Thus, in our model, we add drug and target similarities, which are very effective at improving the prediction of DTIs. Then, we develop NeuRank from a point-wise to a pair-wise, and further to list-wise model.ConclusionFinally, results from extensive experiments on five public data sets (DrugBank, Enzymes, Ion Channels, G-Protein-Coupled Receptors, and Nuclear Receptors) show that, in identifying DTIs, our models achieve better performance than other state-of-the-art methods.
The mtDNA mutation spectrum in the PolG mutator mouse reveals germline and somatic selection
Authors: Maclaine Kendra D. , Stebbings Kevin A. , Llano Daniel A. , Havird Justin C. 
Published: November 2021

Abstract
Background
Mitochondrial DNA (mtDNA) codes for products necessary for electron transport and mitochondrial gene translation. mtDNA mutations can lead to human disease and influence organismal fitness. The PolG mutator mouse lacks mtDNA proofreading function and rapidly accumulates mtDNA mutations, making it a model for examining the causes and consequences of mitochondrial mutations. Premature aging in PolG mice and their physiology have been examined in depth, but the location, frequency, and diversity of their mtDNA mutations remain understudied. Identifying the locations and spectra of mtDNA mutations in PolG mice can shed light on how selection shapes mtDNA, both within and across organisms.

Results
Here, we characterized somatic and germline mtDNA mutations in brain and liver tissue of PolG mice to quantify mutation count (number of unique mutations) and frequency (mutation prevalence). Overall, mtDNA mutation count and frequency were the lowest in the D-loop, where an mtDNA origin of replication is located, but otherwise uniform across the mitochondrial genome. Somatic mtDNA mutations have a higher mutation count than germline mutations. However, germline mutations maintain a higher frequency and were also more likely to be silent. Cytosine to thymine mutations characteristic of replication errors were the plurality of basepair changes, and missense C to T mutations primarily resulted in increased protein hydrophobicity. Unlike wild type mice, PolG mice do not appear to show strand asymmetry in mtDNA mutations. Indel mutations had a lower count and frequency than point mutations and tended to be short, frameshift deletions.

Conclusions
Our results provide strong evidence that purifying selection plays a major role in the mtDNA of PolG mice. Missense mutations were less likely to be passed down in the germline, and they were less likely to spread to high frequencies. The D-loop appears to have resistance to mutations, either through selection or as a by-product of replication processes. Missense mutations that decrease hydrophobicity also tend to be selected against, reflecting the membrane-bound nature of mtDNA-encoded proteins. The abundance of mutations from polymerase errors compared with reactive oxygen species (ROS) damage supports previous studies suggesting ROS plays a minimal role in exacerbating the PolG phenotype, but our findings on strand asymmetry provide discussion for the role of polymerase errors in wild type organisms. Our results provide further insight on how selection shapes mtDNA mutations and on the aging mechanisms in PolG mice.
Prognostic significance of pretreatment serum free fatty acid in patients with diffuse large B-cell lymphoma in the rituximab era: a retrospective analysis
Authors: Fan Liping , Lin Qiuyan , Huang Xiaoling , Fu Danhui , Huang Haobo 
Published: November 2021

AbstractBackgroundFatty acid metabolism is reportedly associated with various cancers. However, the role of pretreatment serum free fatty acid (FFA) levels in diffuse large B-cell lymphoma (DLBCL) prognosis is still unclear, and our study aimed to better elucidate its influence on clinical outcomes.MethodsThe medical records of 221 newly diagnosed DLBCL patients admitted to Fujian Medical University Union Hospital from January 2011 to December 2016 were analysed retrospectively. Receiver operating characteristic curve analysis was used to determine a cut-off value for pretreatment serum FFA levels for prognostic prediction in DLBCL patients. The relationship between pretreatment serum FFA levels and clinical and laboratory parameters was analysed. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS).ResultsNewly diagnosed DLBCL patients with high pretreatment serum FFA levels (≥0.495 mmol/l) had more B symptoms, higher serum lactate dehydrogenase levels (> upper limit of normal), >1 extranodal site, and higher International Prognostic Index score (3–5) compared to those with low pretreatment serum FFA levels (<0.495 mmol/l). Higher serum FFA levels were independent prognostic factors for poor OS, but not PFS.ConclusionsHigh pretreatment serum FFA levels are associated with lower survival in untreated DLBCL patients.
Health-related quality of life one year after the diagnosis of oesophageal cancer: a population-based study from the Swedish National Registry for Oesophageal and Gastric Cancer
Authors: Sunde Berit , Lindblad Mats , Malmström Marlene , Hedberg Jakob , Lagergren Pernilla , Nilsson Magnus 
Published: November 2021

Abstract
Background
Population-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients.

Methods
This is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI.

Results
A total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI − 20 to − 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI − 33 to − 3).

Conclusions
One year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT.
Health priority-setting for official development assistance in low-income and middle-income countries: a Best Fit Framework Synthesis study with primary data from Ethiopia, Nigeria and Tanzania
Authors: Kwete Xiaoxiao Jiang , Berhane Yemane , Mwanyika-Sando Mary , Oduola Ayo , Liu Yuning , Workneh Firehiwot , Hagos Smret , Killewo Japhet , Mosha Dominic , Chukwu Angela , Salami Kabiru , Yusuf Bidemi , Tang Kun , Zheng Zhi-Jie , Atun Rifat , Fawzi Wafaie 
Published: November 2021

Abstract
Background
Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This process at country level has not been well studied.

Methods
This paper developed and applied a new framework to analyze decision-making process for priority setting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refine the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed.

Results
A framework was developed based on 40 articles selected from 6860 distinct search records. Twenty-one interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specific challenges faced by each country. We found that multiple stakeholders working around one national plan was the preferred approach used for priority setting in the countries studied.

Conclusions
Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership of priority setting for ODA and improve aid effectiveness.
The clinical characteristics of patients with pulmonary hypertension combined with obstructive sleep apnoea
Authors: Yan Lu , Zhao Zhihui , Zhao Qing , Jin Qi , Zhang Yi , Li Xin , Duan Anqi , Luo Qin , Liu Zhihong 
Published: November 2021

Abstract
Objective
Obstructive sleep apnoea (OSA) is one cause of pulmonary hypertension (PH) and can also emerge along with PH. The clinical diagnosis and treatment of OSA in patients with PH are still controversial. The purpose of this clinical observation study was to observe and summarize the incidence and clinical characteristics of OSA in patients with PH and to explore possible predictors of PH combined with OSA.

Methods
Patients with PH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from December 2018 to December 2020 were enrolled. OSA was defined as an apnoea–hypopnoea index of ≥ 5/h with ≥ 50% of apnoeic events being obstructive. Baseline clinical characteristics and parameters were collected to compare PH patients with and without OSA. Logistic regression analysis was run to determine the risk factors for OSA in PH patients.

Results
A total of 35 (25%) of 140 patients had OSA. OSA is relatively frequent in patients with PH, especially in patients with chronic thromboembolic pulmonary hypertension and patients with lung disease– or hypoxia-associated PH. The patients who had OSA were mostly male and had a higher age and a lower daytime arterial oxygen pressure. Logistic regression analysis found that older age, male sex, and lower daytime arterial blood oxygen pressure correlated with OSA in PH patients.

Conclusion
OSA is common in patients with PH. Lower daytime arterial oxygen pressure is a risk factor for OSA in older male patients with PH.
Swedish primary healthcare practitioners’ perspectives on the impact of arts on prescription for patients and the wider society: a qualitative interview study
Authors: Jensen Anita , Bungay Hilary 
Published: November 2021

Abstract
Background
There is growing evidence that participating in arts activities are beneficial for mental health and wellbeing. Many patients attending primary care services have mental ill-health or social issues that healthcare practitioners currently do not have adequate ways of supporting. This study set out to explore the perspectives of primary healthcare practitioners on Arts on Prescription (AoP) as an additional referral pathway.

Methods
A qualitative exploratory descriptive approach within an interpretive framework using semi-structured interviews was used to explore healthcare practitioners’ perspectives and experiences of AoP programmes in Sweden. Ten interviews were conducted with healthcare practitioners in primary care. Data were analysed using an inductive thematic approach.

Results
The healthcare practitioners interviewed, recognised the need for more holistic approaches to care for those with mental health issues. They perceived that AoP is beneficial for patients in terms of motivation, creating routines, providing social interactions, and increasing self-esteem. In addition, AoP was felt to have the potential to impact upon current service provision and wider society. However, whilst the opportunity to refer patients to AoP in conjunction with conventional treatments was valued, participants reported that time pressures on practitioners and the continuing dominance of the medical model of care were barriers to wider acceptance amongst practitioners at the present time.

Conclusions
AoP enabled primary healthcare practitioners to offer an additional pathway for patients that is an adjunct to the traditional care pathway. However, the programmes tend to be project-based and often time limited. For programmes to be sustainable and be included as part of a wider range of interventions available to healthcare practitioners’ suitable levels of funding would be required.