bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of the Affordable Care Act on Women’s Postpartum Insurance and Depression in 5 States That Did Not Expand Medicaid, 2012–2015
Authors: Schuster Anne L.R. , Perraillon Marcelo C. , Paul Jennifer J. , Leiferman Jenn A. , Battaglia Catherine , Morrato Elaine H. 
Published: October 2021

Background:
Before the Affordable Care Act (ACA), most women who gained pregnancy-related Medicaid were not eligible for Medicaid as parents postpartum. The ACA aimed to expand health insurance coverage, in part, by expanding Medicaid; introducing mandates; reforming regulations; and establishing exchanges with federal subsidies. Federal subsidies offer a means to coverage for individuals with income at 100%–400% of the federal poverty level who do not qualify for Medicaid.

Objective:
The objective of this study was to identify the effects of the ACA’s non-Medicaid provisions on women’s postpartum insurance coverage and depressive symptoms in nonexpansion states with low parental Medicaid thresholds.

Participants:
Women with incomes at 100%–400% of the federal poverty level who had prenatal insurance and completed the Pregnancy Risk Assessment Monitoring System (2012–2015).

Setting:
Five non-Medicaid expansion states with Medicaid parental eligibility thresholds below the federal poverty level.

Design:
Interrupted time-series analyses were conducted to examine changes between pre-ACA (January 2012–November 2013) and post-ACA (December 2013–December 2015) trends for self-reported loss of postpartum insurance and symptoms of postpartum depression.

Results:
The sample included 9,472 women. Results showed significant post-ACA improvements where the: (1) trend for loss of postpartum insurance reversed (change of −0.26 percentage points per month, P=0.047) and (2) level of postpartum depressive symptoms decreased (change of −3.5 percentage points, P=0.042).

Conclusions:
In these 5 states, the ACA’s non-Medicaid provisions were associated with large increases in retention of postpartum insurance and reductions in postpartum depressive symptoms, although depressive symptoms findings are sensitive to model specification.
Colour me blue: chromoendoscopy and advanced detection methods in ulcerative colitis
Authors: Kiesslich Ralf 
Published: October 2021

Introduction
Surveillance colonoscopy is recommended in patients with long standing ulcerative colitis or Crohn's colitis. Chromoendoscopy is the main technique for increased detection of colitis-associated dysplasia. However, the recommendation was made on the basis of studies using standard definition colonoscopes.

Purpose of review
This review highlights randomized controlled trials and meta-analysis, which were published between 2018 and 2021 with the focus of conventional chromoendoscopy, virtual chromoendoscopy and high-definition imaging. In addition, studies investigating the value of random biopsies were also evaluated.

Recent findings
Chromoendoscopy increases the total number of colitis-associated dysplasia even by using high-definition colonoscopes. However, the procedure time is prolonged and there is no significant difference in the diagnostic yield of high definition alone and high definition with chromoendoscopy. Virtual chromoendoscopy seems not to develop a role for surveillance in inflammatory bowel disease (IBD) patients.

Summary
High-definition colonoscopy and conventional chromoendoscopy are key techniques for surveillance in IBD.
Exploratory study of optimal parameters of repetitive transcranial magnetic stimulation for neuropathic pain in the lower extremities
Authors: Mori Nobuhiko , Hosomi Koichi , Nishi Asaya , Matsugi Akiyoshi , Dong Dong , Oshino Satoru , Kishima Haruhiko , Saitoh Youichi 
Published: October 2021

Abstract

Introduction:
Pain relief from repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) is particularly poor in patients with leg pain. The optimal parameters for relieving leg pain remain poorly understood. The purpose of this study was to explore the optimal stimulation parameters of M1-rTMS for patients with leg pain.

Methods:
Eleven patients with neuropathic pain in the leg randomly underwent 6 conditions of M1-rTMS with different stimulation intensities, sites, and coil directions, including sham stimulation. The 5 active conditions were as follows: 90% or 110% of the resting motor threshold (RMT) on the M1 hand with an anteroposterior coil direction, 90% or 110% RMT on the M1 foot in the anteroposterior direction, and 90% RMT on the M1 foot in the mediolateral direction. Each condition was administered for 3 days. Pain intensity was evaluated using the Visual Analogue Scale and Short-Form McGill Pain Questionnaire 2 at baseline and up to 7 days after each intervention.

Results:
Visual Analogue Scale scores were significantly reduced after the following active rTMS conditions: 90% RMT on the M1 hand, 90% RMT on the M1 foot with any coil direction, and 110% RMT on the M1 foot. The Short-Form McGill Pain Questionnaire 2 results were similar to those obtained using the Visual Analogue Scale. The analgesic effect of rTMS with stimulus intensity above the RMT was not superior to that below the RMT.

Conclusion:
We suggest that the optimal stimulation parameters of rTMS for patients with neuropathic pain in the leg may target the M1 foot or M1 hand with an intensity below the RMT.
Safety and efficacy of remote electrical neuromodulation for the acute treatment of chronic migraine: an open-label study
Authors: Grosberg Brian , Rabany Liron , Lin Tamar , Harris Dagan , Vizel Maya , Ironi Alon , O'Carroll Christopher P. , Schim Jack 
Published: October 2021

Abstract

Introduction:
Remote electrical neuromodulation (REN) is an acute treatment of migraine. The results from several studies in patients with episodic migraine suggest that REN is an effective and safe acute treatment of migraine. A recent pilot study provided initial support that REN is effective in patients with chronic migraine as well.

Objectives:
The current study aimed to validate and provide further evidence for the safety and efficacy of REN in a large sample of patients impacted by chronic migraine.

Methods:
In this open-label, single-arm study, patients with chronic migraine treated their headaches with the REN device (Nerivio, Theranica Bio-Electronics Ltd, Israel) for 4 weeks. Participants used an electronic diary to record their symptoms at treatment initiation, 2 hours after treatment, and 24 hours after treatment. The primary end point was the percentage of subjects who achieved pain relief at 2 hours posttreatment. Secondary end points included pain freedom and improvement of associated symptoms and functional disability.

Results:
One hundred twenty-six subjects were enrolled into the study, of which 91 subjects had an evaluable treatment with REN. Pain relief and pain disappearance at 2 hours were achieved by 59.3% (54/91) and 20.9% (19/91) of modified intent-to-treat subjects, respectively (with worst-case sensitivity analysis indicating 54.5% and 19.2%, respectively). Sustained pain relief at 24 hours was observed in 64.4% (29/45) of those who achieved pain relief at 2 hours (with worst-case sensitivity analysis indicating 45.6%). The findings of the study show that REN has a favorable effect on nausea, photophobia, and phonophobia and improves functional ability. One device-related adverse event was reported.

Conclusions:
Remote electrical neuromodulation treatments results in the relief of migraine headaches and associated symptoms, thus offering a drug-free acute treatment option for people with chronic migraine.

Trial registration:
ClinicalTrials.gov NCT04194008.
Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for High-Volume Entry Points in Uganda
Authors: Katureebe Cordelia , Ashburn Kim , Machekano Rhoderick , Gill Michelle M. , Gross Jessica , Kazooba Patrick , Kiyonga Angehulha , Taasi Geoffrey , Adler Michelle , Nazziwa Esther , Rivadeneira Emilia D. , Kekitiinwa Adeodata , Magongo Eleanor , Matovu John Bosco , Nantume Sophie , Bitarakwate Edward 
Published: October 2021

Introduction:
Because of low pediatric HIV prevalence, more tests are needed to find 1 HIV-positive child compared with adults. In Uganda, the number needed to test (NNT) to find 1 new HIV-positive child was 64 in outpatient departments (OPDs) and 31 through index testing. We aimed to develop and validate a pediatric (1.5–14 years) screening tool to optimize testing approaches.

Methods:
Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for intercluster correlations.

Results:
A total of 3482 children were enrolled. The optimal model included reported HIV-positive maternal status or 2/5 symptoms (sickly in the last 3 months, recurring skin problems, weight loss, not growing well, and history of tuberculosis). The proposed tool had sensitivity of 83.6% [95% confidence interval (CI): 68.1 to 92.4] and specificity of 62.5% (95% CI: 55.0 to 69.4). The tool was validated in a sample of 11,342 children; sensitivity was 87.8% (95% CI: 80.9 to 92.5) and specificity 62.6% (95% CI: 54.8 to 69.7) across OPDs and community sites. In OPDs, sensitivity was 88.1% (95% CI: 80.8 to 92.8) and specificity 69.0% (95% CI: 61.9 to 75.3). The NNT was 43 (95% CI: 28 to 67) across settings and 28 (95% CI: 20 to 38) for OPD.

Conclusions:
This HIV screening tool has high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.
Impact of Parental Consanguinity on the Frequency of Orofacial Clefts in Jordan
Authors: Jabaiti Samir , Salah Bareqa , Al-lawama Manar , AlRyalat Saif Aldeen , Jabaiti Omar , Al-Mikhi Bana , Alsmady Danah M. , Al-Basti Habib 
Published: October 2021

Abstract
Orofacial clefts (OFCs) are the most common craniofacial congenital anomalies, and its prevalence is highest among Asian populations. The aim of this retrospective case-control study is to evaluate the effect of parental consanguinity on the frequency of OFCs at Jordan University Hospital over a 15-year-period. The study group consists of all patients with OFCs presented to the major tertiary referral center in Jordan during the last 15 years, along with age and gender-matched controls. The authors analyzed the risk of different predictors, including consanguinity, on the development of OFCs, both cleft lip with or without cleft palate (CL/P) and cleft palate only. A total of 332 participants were included in this study, with a mean age of 74.36 (±48.75) months. The authors included 129 (38.9%) OFCs, and 203 (61.1%) controls. The percentage of parental consanguinity among OFCs group was 41.1%, compared to only 24.1% for controls, a difference that was statistically significant (P = 0.001). On logistic regression analysis, the authors found that parental consanguinity is a significant predictor for the occurrence of OFCs (P = 0.007), where people with consanguineous marriage have 2 times higher risk (odds ratio of 0.504, with 95% confidence interval 0.306–0.830) to have offspring with OFCs. Moreover, lower birth weight babies are also significantly more associated with OFCs (P = 0.014), with an odds ratio of 1.819 (95% confidence interval 1.131 2.926). Among the Jordanian population, the authors found that consanguinity and lower birth weight were the only variables significantly associated with the development of OFCs.
Evaluation of COVID-19 vaccine breakthrough infections among immunocompromised patients fully vaccinated with BNT162b2
Authors: Di Fusco Manuela , Moran Mary M , Cane Alejandro , Curcio Daniel , Khan Farid , Malhotra Deepa , Surinach Andy , Miles Amanda , Swerdlow David , McLaughlin John M , Nguyen Jennifer L 
Published: October 2021

AbstractObjectiveTo evaluate COVID-19 vaccine breakthrough infections among immunocompromised (IC) individuals.MethodsIndividuals vaccinated with BNT162b2 were selected from the US HealthVerity database (12/10/2020-7/8/2021). COVID-19 vaccine breakthrough infections were examined in fully vaccinated (≥14 days after 2nddose) IC individuals (IC cohort), 12 mutually exclusive IC condition groups, and a non-IC cohort. IC conditions were identified using an algorithm based on diagnosis codes and immunosuppressive (IS) medication usage.ResultsOf 1,277,747 individuals ≥16 years of age who received 2 BNT162b2 doses, 225,796 (17.7%) were identified as IC (median age: 58 years; 56.3% female). The most prevalent IC conditions were solid malignancy (32.0%), kidney disease (19.5%), and rheumatologic/inflammatory conditions (16.7%). Among the fully vaccinated IC and non-IC cohorts, a total of 978 breakthrough infections were observed during the study period; 124 (12.7%) resulted in hospitalization and 2 (0.2%) were inpatient deaths. IC individuals accounted for 38.2% (N=374) of all breakthrough infections, 59.7% (N=74) of all hospitalizations, and 100% (N=2) of inpatient deaths. The proportion with breakthrough infections was 3 times higher in the IC cohort compared to the non-IC cohort (N=374 [0.18%] vs. N=604 [0.06%]; unadjusted incidence rates were 0.89 and 0.34 per 100 person-years, respectively. Organ transplant recipients had the highest incidence rate; those with >1 IC condition, antimetabolite usage, primary immunodeficiencies, and hematologic malignancies also had higher incidence rates compared to the overall IC cohort. Incidence rates in older (≥65 years old) IC individuals were generally higher versus younger IC individuals (<65).LimitationsThis retrospective analysis relied on coding accuracy and had limited capture of COVID-19 vaccine receipt.ConclusionsCOVID-19 vaccine breakthrough infections are rare but are more common and severe in IC individuals. The findings from this large study support FDA authorization and CDC recommendations to offer a 3rdvaccine dose to increase protection among IC individuals.
Statistical power in clinical trials of interventions for mood, anxiety, and psychotic disorders
Authors: de Vries Ymkje Anna , Schoevers Robert A. , Higgins Julian P. T. , Munafò Marcus R. , Bastiaansen Jojanneke A. 
Published: October 2021

AbstractBackgroundPrevious research has suggested that statistical power is suboptimal in many biomedical disciplines, but it is unclear whether power is better in trials for particular interventions, disorders, or outcome types. We therefore performed a detailed examination of power in trials of psychotherapy, pharmacotherapy, and complementary and alternative medicine (CAM) for mood, anxiety, and psychotic disorders.MethodsWe extracted data from the Cochrane Database of Systematic Reviews (Mental Health). We focused on continuous efficacy outcomes and estimated power to detect standardized effect sizes (SMD=0.20-0.80, primary effect size SMD=0.40) and the meta-analytic effect size (ESMA). We performed meta-regression to estimate the influence of including underpowered studies in meta-analyses.ResultsWe included 216 reviews with 8809 meta-analyses and 36540 studies. Statistical power for continuous efficacy outcomes was very low across intervention and disorder types (overall median [IQR] power for SMD=0.40: 0.33 [0.19-0.54]; for ESMA: 0.15 [0.07-0.44]), only reaching conventionally acceptable levels (80%) for SMD=0.80. Median power to detect the ESMA was higher in TAU/waitlist-controlled (0.54-0.66) or placebo-controlled (0.15-0.40) trials than in trials comparing active treatments (0.07-0.10). Meta-regression indicated that adequately-powered studies produced smaller effect sizes than underpowered studies (B=-0.06, p=0.008).ConclusionsPower to detect both fixed and meta-analytic effect sizes in clinical trials in psychiatry was low across all interventions and disorders examined. As underpowered studies produced larger effect sizes than adequately-powered studies, these results confirm the need to increase sample sizes and to reduce reporting bias against studies reporting null results to improve the reliability of the published literature.
Hepatitis C virus infection and tobacco smoking - joint health effects and implications for treatment of both: A systematic review
Authors: Taye Belaynew W 
Published: October 2021

SummaryBackgroundTobacco smoking and hepatitis C virus (HCV) infection cause many diseases independently. The interaction of these conditions on health effects has not been widely studied. There is a paucity of information on addressing tobacco smoking in HCV treatment settings. This review examines the relationship between tobacco smoking and HCV infection and health outcomes and discusses opportunities for treating both conditions.MethodsA systematic review was conducted following the PRISMA 2009 guidelines(Registration No.: CRD42019127771). We searched PubMed, EMBASE, Web of Science, and CINAHL on the health effects of tobacco smoking and HCV infection using keywords and MeSH terms for hepatitis C, tobacco smoking, hepatocellular carcinoma (HCC), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), cardiovascular diseases (CVD), and chronic kidney disease (CKD). We used the Newcastle-Ottawa Scale, a measurement tool to assess systematic reviews (AMSTAR-2), and international narrative systematic assessment (INSA) tools to assess the methodological quality of the included studies.FindingsTobacco smoking and HCV infection share similar underlying risk factors and hence it is unsurprising that tobacco smoking prevalence is higher in people living with HCV (PLHCV) than in the general population. Tobacco smoking and HCV infection have additive or multiplicative interaction to cause HCC, COPD, DM, CVD, and CKD. Anti-HCV direct-acting antiviral (DAA) treatment is highly efficacious and widely accessible in many countries, but untreated tobacco smoking addiction may undermine the achievement of optimal health outcomes possible from HCV treatment.InterpretationThe scale-up of DAA treatment programs globally is an opportunity to address the high prevalence of tobacco smoking in PLHCV by concurrently offering tobacco smoking cessation treatment. Simultaneous initiation of smoking cessation therapy at HCV treatment centres is likely to be cost-effective at maximizing the health gains afforded by DAA treatment. Studies are needed to evaluate the effect of tobacco smoking cessation on the sustained virologic response in DAA treated patients.
Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke
Authors: Shijoh Yoko , Saito Shota , Dai Zhehao , Ohde Sachiko 
Published: October 2021

AbstractBackgroundClosure of a patent foramen ovale reduces the risk of recurrent stroke compared with medical therapy alone in young patients with cryptogenic strokes revealed by randomized control trials. Some cost-effectiveness analyses outside Japan have shown that patent foramen ovale closure is cost-effective, but no studies have examined cost-effectiveness in Japan. The objective of this study is to assess cost-effectiveness, from the perspective of a Japanese healthcare payer, of patent foramen ovale closure versus medical therapy alone for the patients with patent foramen ovale related cryptogenic strokes.MethodsA cost-effectiveness study was conducted by developing a decision tree and a Markov model. Probabilities and a 5.9-year time horizon followed the RESPECT study. Utilities and costs were based upon published studies and assumptions. The model cycle was one month. All assumptions were assessed by experts, including a cardiologist and a statistical expert. The target population comprised patients with cryptogenic stroke and patent foramen ovale, aged 60 years or younger. Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses and probabilistic sensitivity analyses were conducted to assess robustness.ResultsIncremental cost-effectiveness ratio of patent foramen ovale closure compared with medical therapy was estimated at ¥3,318,152 per quality-adjusted life years gained. One-way sensitivity analysis showed that the stable state utility score difference between patent foramen ovale closure and medical therapy had the largest impact on incremental cost-effectiveness ratio. Patent foramen ovale closure is cost-effective at a stable state utility score difference of >0.051, compared with medical therapy. Probabilistic sensitivity analyses demonstrated that patent foramen ovale closure was 50.3% cost-effective with a willingness-to-pay threshold of ¥5,000,000 / quality-adjusted life years.ConclusionsFrom a healthcare payer perspective, patent foramen ovale closure may be cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were ≤60 years.
Clinical and genomic epidemiology ofmcr-9-carrying carbapenem-resistant Enterobacterales isolates in Metropolitan Atlanta, 2012-2017
Authors: Babiker Ahmed , Bower Chris , Lutgring Joseph D. , Howard-Anderson Jessica , Ansari Uzma , McAllister Gillian , Adamczyk Michelle , Breaker Erin , Satola Sarah W. , Jacob Jesse T. , Woodworth Michael H. 
Published: October 2021

AbstractColistin is a last-resort antibiotic for multidrug-resistant gram-negative infections. Recently, the ninth allele of the mobile colistin resistance (mcr) gene family, designatedmcr-9, was reported. However, its clinical and public health significance remains unclear. We queried genomes of carbapenem-resistant Enterobacterales (CRE) formcr-9from a convenience sample of clinical isolates collected between 2012-2017 through the Georgia Emerging Infections Program, a population- and laboratory-based surveillance program. Isolates underwent phenotypic characterization and whole genome sequencing. Phenotypic characteristics, genomic features, and clinical outcomes ofmcr-9positive and negative CRE cases were then compared. Among 235 sequenced CRE genomes, thirteen (6%) were found to harbormcr-9, all of which wereEnterobacter cloacaecomplex. The median MIC, rates of heteroresistance and inducible resistance to colistin were similar betweenmcr-9positive and negative isolates. However, rates of resistance were higher among mcr-9 positive isolates across most antibiotic classes. All cases had significant healthcare exposures. The 90-day mortality was similarly high in bothmcr-9positive (31%) and negative (7%) CRE cases. Nucleotide identity and phylogenetic analysis did not reveal geo-temporal clustering.mcr-9positive isolates had a significantly higher number of median [range] AMR genes (16 [4-22] vs. 6 [2-15];p<0.001) compared tomcr-9negative isolates. Pan genome tests confirmed a significant association ofmcr-9detection with mobile genetic element and heavy metal resistance genes. Overall, the presence ofmcr-9was not associated with significant changes in colistin resistance or clinical outcomes but continued genomic surveillance to monitor for emergence of AMR genes is warranted.