bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis
Authors: Espejo-Paeres Carolina , Núñez-Gil Iván J , Estrada Vicente , Fernández-Pérez Cristina , Uribe-Heredia Giovanna , Cabré-Verdiell Clara , Uribarri Aitor , Romero Rodolfo , García-Aguado Marcos , Fernández-Rozas Inmaculada , Becerra-Muñoz Victor , Pepe Martino , Cerrato Enrico , Raposeiras-Roubín Sergio , Barrionuevo-Ramos María , Aveiga-Ligua Freddy , Aguilar-Andrea Carolina , Alfonso-Rodríguez Emilio , Ugo Fabrizio , García-Prieto Juan Fortunato , Feltes Gisela , Akin Ibrahim , Huang Jia , Jativa Jorge , Fernández-Ortiz Antonio , Macaya Carlos , Carrero-Fernández Ana , Signes-Costa Jaime 
Published: June 2021

BackgroundSmoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.MethodsWe included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.ResultsFinally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0–77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p<0.001 for both). All cause-death was higher among smokers (active or former smokers) compared with non-smokers (27.6 vs 18.4%, p<0.001). Following a multivariate analysis, current smoking was considered as an independent predictor of mortality (OR 1.77, 95% CI 1.11 to 2.82, p=0.017) and a combined endpoint of severe disease (OR 1.68, 95% CI 1.16 to 2.43, p=0.006).ConclusionSmoking has a negative prognostic impact on patients hospitalised with COVID-19.
Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)—a cross-sectional study
Authors: Mendivil Carlos O , Gutiérrez Romero Sebastián A , Peláez-Jaramillo María J , Nieves-Barreto Luz D , Montaño-Rodríguez Angélica , Betancourt-Villamizar Eddy 
Published: June 2021

ObjectivesDiabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia.SettingThe Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities.ParticipantsBetween June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire.Primary and secondary outcome measuresPrevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes.ResultsThe overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes.ConclusionsDiabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.
Social capital and pneumococcal vaccination (PPSV23) in community-dwelling older Japanese: a JAGES multilevel cross-sectional study
Authors: Iwai-Saito Kousuke , Shobugawa Yugo , Kondo Katsunori 
Published: June 2021

ObjectiveInequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses.DesignCross-sectional study.SettingWe used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures.ParticipantsThe target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled.Primary outcome measureThe primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities.ResultsAfter adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one.ConclusionsOlder adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.
Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019
Authors: AlSawahli Heba , Mpyet Caleb D , Ezzelarab Gamal , Hassanin Ibrahim , Shalaby Mohammad , Safa Omar , Almansour Ahmed 
Published: June 2021

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.
Copper and zinc concentrations in the breast milk of mothers undergoing treatment for Wilson’s disease: a prospective study
Authors: Kodama Hiroko , Anan Yasumi , Izumi Yoichi , Sato Yasuhiro , Ogra Yasumitsu 
Published: June 2021

ObjectiveTo evaluate the concentrations of copper and zinc in the breast milk of mothers undergoing treatment for Wilson’s disease (WD) and clarify whether they can safely breast feed their infants.DesignThis was an observational and prospective study in an individual-based case series.SettingBreast milk samples were collected from participants across Japan from 2007 to 2018 at the Department of Pediatrics, Teikyo University in Tokyo. This was a primary-care level study. Clinical data were collected from the participants’ physicians.PatientsEighteen Japanese mothers with WD who were treated with trientine, penicillamine or zinc, and 25 healthy mothers as controls, were enrolled.Main outcome measuresWhey exacted from the milk was used to evaluate the distribution of copper by high-performance liquid chromatography-inductively coupled plasma mass spectrometry. Copper and zinc concentrations in the breast milk samples were analysed by atomic absorption spectrometry.ResultsCopper distribution was normal in the breast milk of mothers with WD treated with trientine, penicillamine or zinc. No peak was detected for trientine-bound or penicillamine-bound copper. The mean copper concentrations in the mature breast milk of patients treated with trientine, penicillamine and zinc were 29.6, 26 and 38 µg/dL, respectively, and were within the normal range compared with the value in healthy controls (33 µg/dL). Likewise, mean zinc concentrations were normal in the mature breast milk of patients treated with trientine and penicillamine (153 and 134 µg/dL, respectively vs 160 µg/dL in healthy controls). Zinc concentrations in the breast milk of mothers treated with zinc were significantly higher than those in control milk. All infants were born normally, breast fed by mothers undergoing treatment and exhibited normal development.ConclusionsOur results suggest that mothers with WD can safely breast feed their infants, even if they are receiving treatment for WD.
Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation
Authors: Hesselink Gijs , Sir Özcan , Koster Nadia , Tolsma Carolien , Munsterman Maartje , Olde Rikkert Marcel , Schoon Yvonne 
Published: June 2021

ObjectivesWith the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients’ retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions.MethodsA nonrandomised pre–post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8–30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions.ResultsA total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8–30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back.ConclusionsDischarging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.
Massive PD-L1 and CD8 double positive TILs characterize an immunosuppressive microenvironment with high mutational burden in lung cancer
Authors: Zhang Libin , Chen Yanhui , Wang Han , Xu Zheyuan , Wang Yang , Li Sixing , Liu Jun , Chen Yun , Luo Hongli , Wu Lijia , Yang Ying , Zhang Henghui , Peng Hao 
Published: June 2021

BackgroundProgrammed cell death ligand 1 (PD-L1) expressed on tumor and immune cells are both associated with the response to programmed cell death 1 (PD-1) pathway blockade therapy. Here, we examine the role of CD8+PD-L1+ tumor-infiltrating lymphocyte (Tils) in the tumor microenvironment of non-small cell lung cancer (NSCLC).MethodsTumor tissue samples of a total of 378 patients from two NSCLC cohorts were collected retrospectively. Tumor genetic variations were measured by targeted next-generation sequencing of 543 oncogenes. Tils were assessed by multiplex immunohistochemistry assay. Correlations among Tils, tumor genetic variations, and clinicopathological characteristics were analyzed.ResultsThe levels of CD8+PD-L1+ Tils varied in NSCLC tumor tissues. Tumor samples with high CD8+PD-L1+ Tils had higher levels of CD8+ Tils, CD68+ macrophages, PD-L1+ tumor cells, PD-1+ Tils, and CD163+ M2-type macrophages, and also had a higher tumor mutation burden, all of which collectively constituted a typically hot but immunosuppressive tumor microenvironment. Therefore, in a non-immunotherapy cohort, we observed that the higher the CD8+PD-L1+ Tils level in the tumor tissue, the worse the prognosis (progression-free survival; cohort A, stage I–II tumor; p=0.005). Contrarily, in an immunotherapy cohort, where the immune suppression was blocked by anti-PD-1 treatment, the higher the CD8+PD-L1+ Tils level, the better the response to the anti-PD-1 treatment (complete response/partial response vs stable disease/progressive disease; cohort B; p=0.0337).ConclusionsCD8+PD-L1+ Tils may be an indicator of the hot but immunosuppressive tumor microenvironment which is related to a high tumor mutation burden. PD-1 pathway blockade therapy can help to mitigate this immunosuppression and obtain better curative effects.
IL-6 contributes to metastatic switch via the differentiation of monocytic-dendritic progenitors into prometastatic immune cells
Authors: Magidey-Klein Ksenia , Cooper Tim J , Kveler Ksenya , Normand Rachelly , Zhang Tongwu , Timaner Michael , Raviv Ziv , James Brian P. , Gazit Roi , Ronai Ze'ev A. , Shen-Orr Shai , Shaked Yuval 
Published: June 2021

BackgroundMetastasis is the major cause of death in patients with cancer. Myeloid skewing of hematopoietic cells is a prominent promoter of metastasis. However, the reservoir of these cells in the bone marrow (BM) compartment and their differentiation pattern from hematopoietic stem and progenitor cells (HSPCs) have not been explored.MethodsWe used a unique model system consisting of tumor cell clones with low metastatic potential or high metastatic potential (met-low and met-high, respectively) to investigate the fate of HSPC differentiation using murine melanoma and breast carcinoma. Single-cell RNA sequencing (scRNA-seq) analysis was performed on HSPC obtained from the BM of met-low and met-high tumors. A proteomic screen of tumor-conditioned medium integrated with the scRNA-seq data analysis was performed to analyze the potential cross talk between cancer cells and HSPCs. Adoptive transfer of tumor-educated HSPC subsets obtained from green fluorescent protein (GFP)+ tagged mice was then carried out to identify the contribution of committed HSPCs to tumor spread. Peripheral mononuclear cells obtained from patients with breast and lung cancer were analyzed for HSPC subsets.ResultsMice bearing met-high tumors exhibited a significant increase in the percentage of HSPCs in the BM in comparison with tumor-free mice or mice bearing met-low tumors. ScRNA-seq analysis of these HSPCs revealed that met-high tumors enriched the monocyte-dendritic progenitors (MDPs) but not granulocyte-monocyte progenitors (GMPs). A proteomic screen of tumor- conditioned medium integrated with the scRNA-seq data analysis revealed that the interleukin 6 (IL-6)–IL-6 receptor axis is highly active in HSPC-derived MDP cells. Consequently, loss of function and gain of function of IL-6 in tumor cells resulted in decreased and increased metastasis and corresponding MDP levels, respectively. Importantly, IL-6-educated MDPs induce metastasis within mice bearing met-low tumors—through further differentiation into immunosuppressive macrophages and not dendritic cells. Consistently, MDP but not GMP levels in peripheral blood of breast and lung cancer patients are correlated with tumor aggressiveness.ConclusionsOur study reveals a new role for tumor-derived IL-6 in hijacking the HSPC differentiation program toward prometastatic MDPs that functionally differentiate into immunosuppressive monocytes to support the metastatic switch.
Identifying leadership in medical trainees: evaluation of a competency-based approach
Authors: Jones Samantha K. , Chan Ka Hong , Bourdage Joshua S. , Bharwani Aleem 
Published: June 2021

BackgroundAs medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to develop and evaluate leaders across all levels of medical organisations.MethodIn Phase One, the authors derived desired leadership traits and behaviours in the medical context from a panel of subject matter experts (SMEs). Traits and behaviours were then combined into multifaceted competencies which were ranked and further refined through evaluation with additional SMEs. In Phase Two, the final seven competencies were evaluated with 181 medical trainees and 167 supervisors between 2017 and 2018 to determine the validity of rapid-form and long-form leadership assessments of medical trainees. Self and supervisor reports of the seven competencies were compared with validated trait and leadership behaviour measures as well as clinical performance evaluations.ResultsThe final seven leadership competencies were: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. Results demonstrate initial validity for rapid-form and long-form leadership evaluations; however, perceptions of good leadership may differ between trainees and supervisors. Further, negative leadership behaviours (eg, incivility) are generally not punished by supervisors and some positive leadership behaviours (eg, ethical leadership) were associated with poor leadership and clinical performance evaluations by supervisors. Supervisor perceptions of leadership were significantly driven by trainee scores on social boldness (a facet of extraversion).ConclusionsA multicompetency framework effectively evaluates leadership in medicine. To more effectively reinforcepositive leadership behaviours and discourage negative leadership behaviours in medical students and resident physicians, we recommend that medical educators:: (1) Use validated frameworks to build leadership curriculum and evaluations. (2) Use short-term and long-term assessment tools. (3) Teach assessors how to evaluate leaders and encourage positive leadership behaviours early in training.
Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation
Authors: Jackson Adam , Frobert Ole , Boye Larsen Dennis , Arendt-Nielsen Lars , Björkenheim Anna 
Published: June 2021

ObjectiveMost patients with atrial fibrillation (AF) report symptoms, while one-third are asymptomatic. We hypothesised that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.MethodsThirty individuals with permanent AF (15 symptomatic and 15 asymptomatic) completed the Atrial Fibrillation 6 (AF6) and short form 36 Health Survey questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalised pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to measures of pain sensitisation.ResultsThe symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), and impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared with the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP on both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum.ConclusionsPatients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.Trial registration numberNCT04649437.