bluuebunny/crossref_metadata_2025_split huggingface dataset:
The chronobiology of migraine: a systematic review
Authors: Poulsen Amanda Holmen , Younis Samaira , Thuraiaiyah Janu , Ashina Messoud 
Published: July 2021

AbstractBackgroundThe paroxysmal nature of migraine is a hallmark of the disease. Some patients report increased attack frequency at certain seasons or towards the end of the week, while others experience diurnal variations of migraine attack onset. This systematic review investigates the chronobiology of migraine and its relation to the periodicity of attacks in existing literature to further understand the oscillating nature of migraine.Main bodyPubMed and Embase were systematically searched and screened for eligible articles with outcome measures relating to a circadian, weekly or seasonal distribution of migraine attacks. We found that the majority of studies reported morning hours (6 am–12 pm) as the peak time of onset for migraine attacks. More studies reported Saturday as weekly peak day of attack. There was no clear seasonal variation of migraine due to methodological differences (primarily related to location), however four out of five studies conducted in Norway reported the same yearly peak time indicating a possible seasonal periodicity phenomenon of migraine.ConclusionsThe findings of the current review suggest a possible role of chronobiologic rhythms to the periodicity of migraine attacks. Future studies are, however, still needed to provide more knowledge of the oscillating nature of migraine.
Risk factors and predictive value of perioperative neurocognitive disorders in elderly patients with gastrointestinal tumors
Authors: Li Yong-Li , Huang Hui-Fan , Le Yuan 
Published: July 2021

Abstract
Background
This study aims to investigate the risk factors of perioperative neurocognitive disorders (PNDs) mainly including postoperative cognitive dysfunction (POCD) in elderly patients with gastrointestinal tumors, and evaluate its predictive value.

Methods
A total of 222 eligible elderly patients (≥65 years) scheduled for elective gastroenterectomy under general anesthesia were enrolled. The cognitive function assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of risk factors for early POCD. The risk factors for POCD were analyzed using univariate and multivariate logistic regression model.

Results
Of all the 222 enrolled patients, 91 (41.0%) developed early POCD and 40 (18.0%) were identified as major POCD within 7 days after the surgery. Visual analogue score (VAS, 1st day, resting) ≥4 (OR = 7.618[3.231–17.962], P < 0.001) and alcohol exposure (OR = 2.398[1.174–4.900], P = 0.016) were independent risk factors for early POCD. VAS score (1st, resting) ≥4 (OR = 13.823[4.779–39.981], P < 0.001), preoperative white blood cell (WBC) levels ≥10 × 10*9/L (OR = 5.548[1.128–26.221], P = 0.035), blood loss ≥500 ml (OR = 3.317[1.094–10.059], P = 0.034), history of hypertension (OR = 3.046[1.267–7.322], P = 0.013), and neutrophil–lymphocyte ratio (NLR) ≥2 (OR = 3.261[1.020–10.419], P = 0.046) were independent risk factors for major POCD. Receiver operating characteristic curve analysis indicated that VAS score (1st day, resting) was a significant predictor for major POCD with a cut-off value of 2.68 and an area under the curve of 0.860 (95% confidence interval: 0.801–0.920, P < 0.001).

Conclusions
The risk factors for early POCD after gastroenterectomy included high VAS score (1st day, resting) and alcohol exposure. High VAS score, preoperative WBC levels ≥10 × 10*9/L, blood loss ≥500 ml, NLR ≥2, and history of hypertension were independent risk factors for major POCD. Among them, VAS score was one of the important predictors.
The experiences of Chinese general practitioners in communicating with people with type 2 diabetes—a focus group study
Authors: Yao Mi , Zhang Dong-ying , Fan Jie-ting , Lin Kai , Haroon Shamil , Jackson Dawn , Li Hai , Chen Wei , Lehman Richard , Cheng Kar Keung 
Published: July 2021

Abstract
Background
China has more ascertained cases of diabetes than any other country. Much of the care of people with type 2 diabetes (T2DM) in China is managed by GPs and this will increase with the implementation of health care reforms aimed at strengthening China’s primary health care system. Diabetes care requires effective communication between physicians and patients, yet little is known about this area in China. We aimed to explore the experiences of Chinese GPs in communicating with diabetes patients and how this may relate to communication skills training.

Methods
Focus groups with Chinese GPs were undertaken. Purposive sampling was used to recruit 15 GPs from Guangzhou city in China. All data were audio-recorded and transcribed. A thematic analysis using the Framework Method was applied to code the data and identify themes.

Results
Seven males and 8 females from 12 general practices attended 4 focus groups with a mean age of 37.6 years and 7.5 years’ work experience. Four major themes were identified: diversity in diabetic patients, communication with patients, patient-doctor relationship, and communication skills training. GPs reported facing a wide variety of diabetes patients in their daily practice. They believed insufficient knowledge and misunderstanding of diabetes was common among patients. They highlighted several challenges in communicating with diabetes patients, such as insufficient consultation time, poor communication regarding blood glucose monitoring and misunderstanding the risk of complications. They used terms such as “blind spot” or “not on the same channel” to describe gaps in their patients’ understanding of diabetes and its management, and cited this as a cause of ineffective patient-doctor communication. Mutual understanding of diabetes was perceived to be an important factor towards building positive patient-doctor relationships. Although GPs believed communication skills training was necessary, they reported rarely received this.

Conclusions
Chinese GPs reported facing challenges in communicating with diabetes patients. Some of these were perceived as being due to the patients themselves, others were attributed to system constraints, and some were seen as related to a lack of clinician training. The study identified key issues for the development of primary care-based management of diabetes in China, and for developing appropriate communication skills training programs for the primary care workforce.
Maximum resection and immunotherapy improve glioblastoma patient survival: a retrospective single-institution prognostic analysis
Authors: Ishikawa Eiichi , Sugii Narushi , Matsuda Masahide , Kohzuki Hidehiro , Tsurubuchi Takao , Akutsu Hiroyoshi , Takano Shingo , Mizumoto Masashi , Sakurai Hideyuki , Matsumura Akira 
Published: July 2021

AbstractGlioblastoma (GBM) is a refractory disease with a poor prognosis and various methods, including maximum resection and immunotherapy, have been tested to improve outcomes. In this retrospective study we analyzed the prognostic factors of 277 newly diagnosed GBM patients over 11 years of consecutive cases at our institution to evaluate the effect of these methods on prognosis. Various data, including the extent of removal (EOR) and type of adjuvant therapy, were examined and prognostic relationships were analyzed. The median overall survival (OS) of the entire 277-case cohort, 200 non-biopsy cases, and 77 biopsy cases was 16.6 months, 19.7 months, and 9.7 months, respectively. Gross total removal (GTR; 100% of EOR) was achieved in 32.9% of the cases. Univariate analysis revealed younger age, right side, higher Karnofsky performance status, GTR, intraoperative magnetic resonance imaging (MRI) use for removal, proton therapy, combination immunotherapy, and discharge to home as good prognostic factors. Intraoperative MRI use and EOR were closely related. In the multivariate analysis, GTR, proton therapy, and a combination of immunotherapies, including autologous formalin-fixed tumor vaccine, were the significant prognostic factors. A multivariate analysis of 91 GTR cases showed that immunotherapy contributed to prognostic improvements. The median OS and 5-year OS % values were 36.9 months and 43.3% in GTR cases receiving immunotherapy. In conclusion, GTR, proton therapy, and immunotherapy were good prognostic factors in single-center GBM cases. Tumor vaccine therapy for GTR cases achieved a notably high median survival time and long-term survival ratio, indicating its usefulness in GTR cases.
A novel ferroptosis-related 12-gene signature predicts clinical prognosis and reveals immune relevancy in clear cell renal cell carcinoma
Authors: Hong Yingkai , Lin Mingen , Ou Dehua , Huang Zhuangkai , Shen Peilin 
Published: July 2021

AbstractBackgroundClear cell renal cell carcinoma (ccRCC) is still highly aggressive and lethal even with various therapeutic approaches. As the kidney is an iron metabolism-related organ, exploring and assessing the clinical value of ferroptosis, an iron-dependent regulated cell death, is practical and important.MethodsPrognostic ferroptosis-related differentially expressed genes (DEGs) were identified from the KIRC cohort in the cancer genome atlas (TCGA) database, from which a prognostic signature was established using Lasso-penalized Cox regression analysis. Each patient in the KIRC cohort and the E-MTAB-1980 cohort (from the ArrayExpress database) was assigned a calculated signature-correlated risk score and categorized to be either in the high- or low-risk group divided by the median risk score in the KIRC cohort. Then, the independent prognostic value of the signature was further assessed by Kaplan-Meier (K-M) survival, time-dependent receiver operating characteristic (ROC) and Cox regression analyses based on overall survival (OS) in both cohorts. Finally, risk-related DEGs were identified in both cohorts and subjected to enrichment analyses for Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and immune infiltration.ResultsAmong 60 ferroptosis-related genes, 32 prognostic DEGs were identified, from which we constructed a prognostic 12-gene signature with CARS1, HMGCR, CHAC1, GOT1, CD44, STEAP3, AKR1C1, CBS, DPP4, FANCD2, SLC1A5 and NCOA4. Patients in both cohorts were divided into high- and low-risk groups, which were visually distributed in two sets and had positive-risk-related mortality. The K-M survival and the ROC curves validated that the signature has prognostic value withP < 0.05 and area under the curve > 0.7 in both cohorts, respectively. Multivariate Cox regression further confirmed the risk score as an independent prognostic predictor for OS. Commonly enriched terms in GO and KEGG not only showed a high iron correlation but also, interestingly, immune relevance of 3 immune cells (macrophages, mast cells and regulatory T cells) and 1 immune-related function (antigen processing cell co-stimulation).ConclusionWe established a novel 12 ferroptosis-related-gene signature that was proven to be an independent prognostic predictor for OS and inferred to be related to tumour immunity in ccRCC; however, the underlying mechanism is still poorly characterized and needs further exploration.
Development of a health behavior scale for older adults living alone receiving public assistance
Authors: Isozaki Ayano , Tadaka Etsuko 
Published: July 2021

Abstract
Background
To reduce health disparities, prevention of non-communicable diseases (NCD) by performing desirable health behavior in older adults living alone with low socioeconomic status is an essential strategy in public health. Self-perception of personal power and practical skills for daily health are key elements of desirable health behavior. However, methods for measuring these concepts have not been established. This study aimed to develop a health behavior scale for older adults living alone receiving public assistance (HBSO).

Methods
The self-administered mail survey covered 2818 older adults living alone receiving public assistance (OAP) randomly selected from the list of people receiving public assistance (Seikatsu-hogo in Japanese) at all 1250 local social welfare offices across Japan. Construct validity was confirmed using confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha. The self-efficacy for health promotion scale and Health check-up status were administered to assess the criteria-related validity of the HBSO.

Results
In total, 1280 participants (response rate: 45.4%) responded, of which 1069 (37.9%) provided valid responses. Confirmatory factor analysis identified 10 items from two factors (self-perception of personal power and practical skills for daily health) with a goodness of fit index of 0.973, adjusted goodness of fit index of 0.953, comparative fit index of 0.954, and root mean square error of approximation of 0.049. Cronbach’s alpha was 0.75. The total HBSO score was significantly positively correlated with the self-efficacy for health promotion scale (r = 0.672, p < 0.001) and the group with health check-up had significantly higher HBSO scores than the group without it (p < 0.001).

Conclusions
The HBSO is an easy-to-self-administer instrument that is reliable and valid for OAP. The HBSO could facilitate appropriate assessment of OAP who need to improve their health behavior to prevent NCD, and could be used to determine effective support.
Knowledge and attitude on prevention of COVID-19 among community health workers in Nepal-a cross-sectional study
Authors: Shrestha Amul , Thapa Tek Bahadur , Giri Mahendra , Kumar Sanjiv , Dhobi Sakil , Thapa Haikali , Dhami Pawan Prakash , Shahi Arun , Ghimire Ajita , Rathaur Ela Singh 
Published: July 2021

Abstract
Background
Emerging and reemerging pathogens are global challenges for public health and the pandemic of Coronavirus disease 2019is a reemerging case of an infectious disease caused by Severe Acute Respiratory Syndrome-Corornavirus-2. Health care worker worldwide are at higher risk worldwide and the situation is the same in Nepal. The knowledge and attitude of health workers will certainly mark the outcome towards this pandemic. So, this study aims to assess the knowledge and attitude of community health workers towards the prevention of COVID-19 virus.

Methods
A descriptive cross-sectional study was carried out among the community health workers of various provinces of Nepal. A semi-structured, self-administered questionnaire was prepared in Google form and circulated to the sampled health workers through various social media platforms like face book, messenger, Instagram and g-mails. A total of 650 invitations were send and among them 420 responded and among them only 399 provided complete response. Responses containing anonymized data was collected analyzed in using SPSS-version-20. The results were interpreted and was checked with various demographic and enabling factors using chi-square test and logistic regression model. Also, ethical approval was taken from NHRC (Nepal Health Research Council (protocol registration number: 360/2020P) prior to the conduction of study.

Results
Out the total sample size of 450, we took 399 responses taking into consideration all the inclusion criteria. So, from 399 valid response, 230 (47.6%) were males and 169 (42.4%) were females. 380 (95.2%) employed participants thought that wearing PPE will reduce the chances of getting COVID-19, majority of the participants 80.5% (321) responded that COVID-19 will successfully be controlled and staffs receiving excellent support from palika had high knowledge level. Knowledge level was significantly associated with the enabling factor “support from palika” (P = 0.045).45.9% of the respondents had no availability of COVID-19 response medical items for prevention of COVID-19 at their respective health facilities. Also the logistic regression analysis revealed that the odds of knowledge level was 2 times higher (AOR=1.913 at 95% CI: 1.266-2.891) compared to the female participants (Ref- female).

Conclusions
Proper and adequate knowledge and attitude towards COVID-19 is a paramount in the prevention and control of SARS-COV-2. Health care workers are knowledgeable about COVID-19 and are proactively practicing the preventive measures to minimize the spread of infection but some lack optimistic attitude. Hence, the constantly updated educational programs related to COVID-19 will surely contribute to improving the healthcare workers knowledge and attitude towards COVID-19.
Patterns of child mortality in rural area of Burkina Faso: evidence from the Nanoro health and demographic surveillance system (HDSS)
Authors: Noori Navideh , Derra Karim , Valea Innocent , Oron Assaf P. , Welgo Aminata , Rouamba Toussaint , Boua Palwende Romuald , Somé Athanase M. , Rouamba Eli , Wenger Edward , Sorgho Hermann , Tinto Halidou , Ouédraogo Andre Lin 
Published: July 2021

Abstract
Background
Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but patterns and potential drivers of heterogeneity in child mortality in the district had not been studied. Similar studies in other districts indicated proximity to health facilities as a risk factor, usually without distinction between facility types.

Methods
Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and proximity to inpatient and outpatient health facilities, seasonality of death, age group, and standard demographic risk factors.

Results
Living in homes 40–60 min and > 60 min travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13–2.06) and 1.74 (95% CI: 1.27–2.40) greater hazard of under-5 mortality, respectively, than living in homes < 20 min from an inpatient facility. No such association was found for outpatient facilities. The wet season (July–November) was associated with 1.28 (95% CI: 1.07, 1.53) higher under-5 mortality than the dry season (December–June), likely reflecting the malaria season.

Conclusions
Our results emphasize the importance of geographical proximity to health care, distinguish between inpatient and outpatient facilities, and also show a seasonal effect, probably driven by malaria.
Work-related musculoskeletal symptoms among Iranian nurses and their relationship with fatigue: a cross-sectional study
Authors: Hosseini Elahe , Daneshmandi Hadi , Bashiri Azadeh , Sharifian Roxana 
Published: July 2021

Abstract
Background
The present study aimed to determine the prevalence of work-related musculoskeletal symptoms (WMSs), identify potential factors associated with WMSs, and determine the association between WMSs and fatigue among nurses.

Methods
This cross-sectional study was carried out among 500 Iranian nurses. Data was gathered by the 1) Persian version of the Nordic musculoskeletal questionnaire (P-NMQ) to examine WMSs, and 2) Persian version of the Multidimensional Assessment of Fatigue (P-MAF) Scale to evaluate fatigue among the study population. Then, data was analyzed by SPSS version 21 using the χ2 test, multiple logistic regression for detection of potential factors associated with WMSs, and multiple linear regression for detection of potential factors associated with fatigue.

Results
Ankles/feet, lower back, knees, and shoulders had the highest prevalence of WMSs among nurses within the last 12 months prior to the study. Independent variables including age, job tenure, gender, smoking, shift work, and type of employment were significantly associated with WMSs in different body regions with odds ratios (ORs) ranging from 1.635–2.835. Moreover, WMSs in some body regions were associated with subscales of fatigue and total fatigue.

Conclusions
Ergonomic and organizational interventions for fitting the job to the nurses considering demographic/occupational characteristics are highly essential to improve musculoskeletal system health and relieve fatigue.
Lentiviral CRISPR-guided RNA library screening identified Adam17 as an upstream negative regulator of Procr in mammary epithelium
Authors: Wu Ting , Wang Yinghua , Xiao Tianxiong , Ai Yirui , Li Jinsong , Zeng Yi Arial , Yu Qing Cissy 
Published: July 2021

Abstract
Background
Protein C receptor (Procr) has recently been shown to mark resident adult stem cells in the mammary gland, vascular system, and pancreatic islets. More so, high Procr expression was also detected and used as indicator for subsets of triple-negative breast cancers (TNBCs). Previous study has revealed Procr as a target of Wnt/β-catenin signaling; however, direct upstream regulatory mechanism of Procr remains unknown. To comprehend the molecular role of Procr during physiology and pathology, elucidating the upstream effectors of Procr is necessary. Here, we provide a system for screening negative regulators of Procr, which could be adapted for broad molecular analysis on membrane proteins.

Results
We established a screening system which combines CRISPR-Cas9 guided gene disruption with fluorescence activated cell sorting technique (FACS). CommaDβ (murine epithelial cells line) was used for the initial Procr upstream effector screening using lentiviral CRISPR-gRNA library. Shortlisted genes were further validated through individual lentiviral gRNA infection followed by Procr expression evaluation. Adam17 was identified as a specific negative inhibitor of Procr expression. In addition, MDA-MB-231 cells and Hs578T cells (human breast cancer cell lines) were used to verify the conserved regulation of ADAM17 over PROCR expression.

Conclusion
We established an efficient CRISPR-Cas9/FACS screening system, which identifies the regulators of membrane proteins. Through this system, we identified Adam17 as the negative regulator of Procr membrane expression both in mammary epithelial cells and breast cancer cells.