bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value-based care in obstetrics: comparison between vaginal birth and caesarean section
Authors: Negrini Romulo , da Silva Ferreira Raquel Domingues , Guimarães Daniela Zaros 
Published: April 2021

Abstract
Background
Healthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies.

Results
A total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies).

Conclusion
Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.
High prevalence of vitamin D deficiency among normotensive and hypertensive pregnant women in Ghana
Authors: Fondjo Linda Ahenkorah , Tashie Worlanyo , Owiredu William K. B. A. , Adu-Gyamfi Enoch Appiah , Seidu Laila 
Published: April 2021

Abstract
Background
Hypovitaminosis D in pregnancy is associated with adverse health outcomes in mothers, newborns and infants. This study assessed the levels of 25-hydroxyvitamin D [25(OH)D] in normotensive pregnancies and in preeclampsia, evaluated the association between vitamin D deficiency and preeclampsia risk; and determined the foeto-maternal outcome in preeclamptic women with vitamin D deficiency.

Methods
This case-control study was conducted among pregnant women who visited the Comboni Hospital, in Ghana from January 2017 to May 2018 for antenatal care. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Socio-demographic, clinical and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of 25- hydroxyvitamin D [25(OH)D] using enzyme-linked immunosorbent assay technique. Lipids (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) were also estimated.

Results
A total of 81.7% of the study participants had vitamin D deficiency. Of these, 88.6% of the women with PE had vitamin D deficiency compared to 75.0% in the NP. Vitamin D levels were significantly reduced in the PE women compared to the normotensive pregnant women (p = 0.001). A higher proportion of the preeclamptic women who were vitamin D deficient had preterm delivery (p < 0:0001) and delivered low birth weight infants (p < 0:0001), and infants with IUGR (p < 0:0001) compared to the control group (p < 0:0001). Pregnant women with PE presented with significant dyslipidemia, evidenced by significantly elevated TC (p = 0.008), LDL (p < 0.0001), triglycerides (p = 0.017) and a significantly reduced HDL (p = 0.001) as compared to NP. In the preeclamptic women, serum 25(OH) D showed an inverse, but not significant association with TC (β = − 0.043, p = 0.722, TG (β = − 0.144, p = 0.210) and LDL (β = − 0.076, p = 0.524) and a positive, but not significant association with HDL (β = 0.171, p = 0.156).

Conclusion
The prevalence of vitamin D deficiency is high in both normotensive pregnancies and pregnancies complicated by preeclampsia but amplified in preeclampsia. Higher proportion of pregnant women with hypovitaminosis D had preterm babies and delivered low birth weight neonates. Additional studies are needed to explore the potential benefits and optimal dosing of vitamin D use in pregnancy, especially in sub-Saharan Africa.
The effect of sexual health education on sexual activity, sexual quality of life, and sexual violence in pregnancy: a prospective randomized controlled trial
Authors: Alizadeh Shiva , Riazi Hedyeh , Majd Hamid Alavi , Ozgoli Giti 
Published: April 2021

Abstract
Background
Some women avoid sexual intercourse during pregnancy due to the physiological changes they undergo during this period as well as their fear of causing harm to the fetus and to themselves, which can lead to problems in sexual health. The aim of the present study was to investigate the effects of a sexual health education package on the dimensions of sexual health in pregnant women.

Methods
This randomized, longitudinal, clinical trial was carried out in 2018–2019 on 154 pregnant women in early to late pregnancy who presented to comprehensive health centers in Rasht, Iran, and were divided into three groups: Group A or the training group (50 participants), Group B or the self-training group (53 participants), and Group C or the control group (51 participants). The study tools included the Pregnancy Sexual Response Inventory (PSRI), the Sexual Quality of Life-Female (SQOL-F) and the Sexual Violence Questionnaire. The dimensions of sexual health were examined before beginning each intervention in each trimester of pregnancy and then at the end of pregnancy using these questionnaires. The collected data were analyzed using statistical tests, namely the Chi-square test, one-way ANOVA, Cochrane’s test, and the repeated measures ANOVA at a significance level of P < 0.05.

Results
There was no statistically significant difference in the mean total scores of SQOL-F and PSRI in the three groups at baseline. As for the intergroup results, there was a statistically significant difference in the mean score of SQOL-F and PSRI at the end of pregnancy. The mean scores of PSRI and SQOL-F in the training group (Group A) increased from the beginning to the end of pregnancy compared to the control and self-training groups. As for the intergroup comparisons, there was no statistically significant difference in the mean total scores of sexual violence among the pregnant women in the different groups in the third trimester of pregnancy and at the end of the third trimester. Although sexual violence was not statistically significant, the number of sexually-violated women in the training group decreased during the training period compared to the self-training and control groups.

Conclusion
The results obtained in the intervention group compared to the control group revealed the effectiveness of the sexual health education package in terms of improvement in the dimensions of sexual health. According to the results, in order to maintain and promote the sexual health of pregnant women, health care providers are recommended to offer sexual health training during pregnancy along with other health care services.

Trial registration
IRCT20190427043398N1; the trial was registered on June 2, 2019. (retrospective registration).
Distinct diagnostic and prognostic values of Glypicans gene expression in patients with hepatocellular carcinoma
Authors: Wang Jian-Yao , Wang Xiang-Kun , Zhu Guang-Zhi , Zhou Xin , Yao Jun , Ma Xiao-Peng , Wang Bin , Peng Tao 
Published: April 2021

Abstract
Backgroud
In our current work, we aimed to investigate the expressions of glypican (GPC) family genes at the mRNA level and assess their prognostic significances in patients with hepatocellular carcinoma (HCC).

Methods
The pathological roles of GPC family genes were examined using bioinformatics analysis. The diagnostic values of GPC genes were explored with the Gene Expression Profiling Interactive Analysis. Moreover, the mRNA expression and prognostic values of GPC genes were assessed via the KM plotter database.

Results
Our data showed that the expression of GPC-3 was dramatically increased in the liver tumor tissue. Moreover, the expressions of the other five GPC family members were not significantly different between the tumor and normal liver tissues (P > 0.05). Furthermore, the up-regulation of GPC-1 at the mRNA level was dramatically correlated to the reduced overall survival (OS) for all HCC patients (hazard ratio = 2.03, 95% confidence intervals =1.44–2.87, P = 4.1e-05) compared with its low-expression group. Besides, the prognosis of the Caucasians was related to most GPC family genes, while the prognosis of the Asian race was only related to the expression of GPC-2. Besides, for pathological factors, including stage, grade, AJCC, and vascular invasion, the higher the pathological grade and vascular invasiveness, the lower the expression levels of GPC family genes (P < 0.05). Finally, the expression levels of GPC-1, 2, and 3 in the hepatitis group were related to the poor prognosis of HCC in the risk factor (alcohol consumption and hepatitis) subgroup (P < 0.05).

Conclusions
Our findings indicated that GPC-3 was dysregulated in HCC compared with paracancerous tissues. The expression of GPC-1 could be used as a potent predictive index for the general prognosis of HCC. The pathology, patients, and risk factors might affect the prognostic value of GPC family genes in HCC.
Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial
Authors: Engbersen M. P. , Rijsemus C. J. V. , Nederend J. , Aalbers A. G. J. , de Hingh I. H. J. T. , Retel V. , Lambregts D. M. J. , Van der Hoeven E. J. R. J. , Boerma D. , Wiezer M. J. , De Vries M. , Madsen E. V. E. , Brandt-Kerkhof A. R. M. , Van Koeverden S. , De Reuver P. R. , Beets-Tan R. G. H. , Kok N. F. M. , Lahaye M. J. 
Published: April 2021

Abstract
Background
Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging.

Methods
The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis.

Conclusion
This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC.

Trial registration
Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175.
Incidence and survival of epithelial ovarian, fallopian tube, peritoneal, and undesignated abdominal/pelvic cancers in Sweden 1960–2014: A population-based cohort study
Authors: Leandersson Pia , Hogberg Thomas , Dickman Paul W. , Malander Susanne , Borgfeldt Christer 
Published: April 2021

AbstractBackgroundDespite improved surgical and oncological treatment, ovarian cancer continues to be the most lethal of the gynecologic malignancies. We aimed to analyze survival trends in epithelial ovarian cancer with regard to age, tumor site, and morphology in Sweden 1960 to 2014.MethodsA nationwide population-based study was conducted using data from the Swedish Cancer Registry on 46,350 women aged 18 or older with a diagnosis of epithelial ovarian, fallopian tube, peritoneal, or undesignated abdominal/pelvic cancer 1960 to 2014. Analyses of age-standardized incidence and relative survival (RS) were performed and time trends modelled according to age, tumor site, and morphology.ResultsOverall incidence of ovarian, tubal, peritoneal, and undesignated abdominal/pelvic cancers declined since 1980. Median age at diagnosis increased. Serous carcinoma increased in incidence. RS at 1, 2 and 5 years from diagnosis improved since 1960, although not for the youngest and the oldest patients. Ten-year RS did not improve. The best RS was found for fallopian tube cancer and the worst RS for undesignated abdominal/pelvic cancer. Among the morphologic subgroups, endometrioid carcinoma had the best RS.ConclusionsSurvival in epithelial ovarian, tubal, peritoneal, and undesignated abdominal/pelvic cancers in Sweden has improved over the last six decades. Advances in epithelial ovarian cancer treatment have extended life for the first 5 years from diagnosis but 10-year survival remains poor.
Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis
Authors: Ortega-Morán Juan Francisco , Azpeitia Águeda , Sánchez-Peralta Luisa F. , Bote-Curiel Luis , Pagador Blas , Cabezón Virginia , Saratxaga Cristina L. , Sánchez-Margallo Francisco M. 
Published: April 2021

Abstract
Background
The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies.

Methods
Semi-structured interviews and an online survey were used.

Results
Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation.

Conclusions
This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation.
Excess of all-cause mortality is only partially explained by COVID-19 in Veneto (Italy) during spring outbreak
Authors: Gallo Elisa , Prosepe Ilaria , Lorenzoni Giulia , Acar Aslihan Şentürk , Lanera Corrado , Berchialla Paola , Azzolina Danila , Gregori Dario 
Published: April 2021

Abstract
Background
Italy has been the first European country to be affected by the COVID-19 epidemic which started out at the end of February. In this report, we focus our attention on the Veneto Region, in the North-East of Italy, which is one of the areas that were first affected by the rapid spread of SARS-CoV-2. We aim to evaluate the trend of all-cause mortality and to give a description of the characteristics of the studied population.

Methods
Data used in the analyses were released by the majority of municipalities and cover the 93% of the total population living in the Veneto Region. We evaluated the trend of overall mortality from Jan.01 to Jun.30. 2020. Moreover we compared the COVID-19-related deaths to the overall deaths.

Results
From March 2020, the overall mortality rate increased exponentially, affecting males and people aged > 76 the most. The confirmed COVID-19-related death rate in the Veneto region between Mar.01 and Apr.302020 is 30 per 100,000 inhabitants. In contrast, the all-cause mortality increase registered in the same months in the municipalities included in the study is 219 per 100,000 inhabitants.

Conclusions
COVID-19 has a primary role in the increase in mortality but does not entirely explain such a high number of deaths. Strategies need to be developed to reduce this gap in case of future waves of the pandemic.
HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: a retrospective cohort study
Authors: You Xinyi , Gilmour Stuart , Cao Wangnan , Lau Joseph Tak-fai , Hao Chun , Gu Jing , Le Phuong Mai , Peng Liping , Wei Dannuo , Deng Yang , Wang Xiaodong , Zou Huachun , Li Jibin , Hao Yuantao , Li Jinghua 
Published: April 2021

Abstract
Background
The prevalence of HIV among men who have sex with men (MSM) in southwest China is still increasing. This study aimed to investigate the trend in HIV incidence and its associated risk factors among MSM in Chengdu, China.

Method
Incidence data were collected from the largest local non-governmental organization (NGO) serving MSM in Chengdu between 2012 and 2018, while information on sexual behaviors was collected from 2014. All MSM who received voluntary counseling and testing services (VCT) in the collaborating NGO at least twice during the study period were included. We calculated the HIV incidence density among MSM every 2 years and the overall incidence rate. A Cox proportional hazards regression model was employed to identify risk factors for HIV infection.

Result
A total of 4578 HIV-negative participants were included in the cohort. The total incidence density was 5.95 (95% CI: 5.37–6.56)/100 person-years (PYs) between 2012 and 2018. The segmented incidence density was 9.02 (95% CI: 7.46–10.78), 5.85 (95% CI: 4.86–6.97), 5.43 (95% CI: 4.53–6.46), and 3.09 (95% CI: 2.07–4.41)/100 PYs in 2012–2013, 2014–2015, 2016–2017, and 2018, respectively. After adjusting for sociodemographic characteristics, compared to participants without sexual partners within 6 months, MSM with one fixed partner (Adjusted Hazard Ratio, AHR = 1.18, 95% CI: 0.44–3.19) and more than five partners (AHR = 2.24, 95% CI: 0.81–6.20) had increased risk of HIV infection. MSM who used condom inconsistently had a higher risk of HIV infection (AHR = 1.87, 95% CI: 1.46–2.38) compared to consistent condom users.

Conclusion
The decreased HIV incidence density among MSM was potentially related to the successful comprehensive HIV prevention strategies in Chengdu. Multiple male sexual partnerships and inconsistent condom use during anal intercourse were risk factors associated with HIV occurrence.
Health issues and healthcare utilization among adults who reported exposure to tear gas during 2020 Portland (OR) protests: a cross-sectional survey
Authors: Torgrimson-Ojerio Britta N. , Mularski Karen S. , Peyton Madeline R. , Keast Erin M. , Hassan Asha , Ivlev Ilya 
Published: April 2021

Abstract
Background
Repeated use of chemical irritants for crowd-control by local and federal law enforcement during sustained racial justice protests in the U.S. has raised concerns about potential adverse health effects. The objective of this study was to describe the health consequences of exposure to tear gas agents and associated healthcare utilization among adults reporting recent exposure to tear gas.

Methods
A cross-sectional, self-administered web-based survey of a convenience sample of 2257 adults reporting recent exposure to tear gas in Portland, Oregon (U.S.), administered between July 30, 2020-August 20, 2020. Descriptive analyses were conducted on socioeconomic characteristics, reported health issues, utilization of healthcare services, and frequency of reported exposure to tear gas. Associations between reported mental health issues, healthcare utilization and race and/or ethnic categories were assessed using a chi-square test. For tests of association, racial and/or ethnic categories were divided into White/Non-Hispanic only and all other racial/ethnic categories due to a small number of Black, American Indian or Alaska Native, Asian/Pacific Islander, Hispanic participants and participants with multiple race and/or ethnic background. Effect sizes for the differences were expressed as Cramer’s V, a metric that measures associations between nominal responses. The Cochran-Armitage trend test was used to assess the relationship between health issues and the number of reported days of exposure to tear gas (i.e., a proxy dose of exposure) grouped into 1 day, 2–4 days, and ≥ 5 days. Missing data (item non-response) were omitted from the analysis.

Results
Almost all respondents (2116; 93.8%) reported physical (2114; 93.7%) or psychological (1635; 72.4%) health issues experienced immediately after (2105; 93.3%) or days following (1944; 86.1%) the exposure. A slightly higher proportion experienced delayed head or gastrointestinal tract issues compared with immediate complaints. The majority (1233; 54.6%) reported receiving or planning to seek medical or mental care. We observed a positive exposure-response trend for all except mouth-related delayed issues (p < 0.01).

Conclusion
Persons who reported exposer to tear gas agents also reported physical and psychological health issues over a multiple-day period. Health issues reported increased with the frequency of reported exposure, indicating a potential dose-response; these health effects often led to healthcare utilization. This study provides evidence of potential unexpected harms of tear gas in civilians.
Dynamic evolution of emphysema and airway remodeling in two mouse models of COPD
Authors: Yang Yue , Di Tingting , Zhang Zixiao , Liu Jiaxin , Fu Congli , Wu Yan , Bian Tao 
Published: April 2021

Abstract
Background
Establishment of a mouse model is important for investigating the mechanism of chronic obstructive pulmonary disease (COPD). In this study, we observed and compared the evolution of the pathology in two mouse models of COPD induced by cigarette smoke (CS) exposure alone or in combination with lipopolysaccharide (LPS).

Methods
One hundred eight wild-type C57BL/6 mice were equally divided into three groups: the (1) control group, (2) CS-exposed group (CS group), and (3) CS + LPS-exposed group (CS + LPS group). The body weight of the mice was recorded, and noninvasive lung function tests were performed monthly. Inflammation was evaluated by counting the number of inflammatory cells in bronchoalveolar lavage fluid and measuring the expression of the IL-6 mRNA in mouse lung tissue. Changes in pathology were assessed by performing hematoxylin and eosin and Masson staining of lung tissue sections.

Results
The two treatments induced emphysema and airway remodeling and decreased lung function. Emphysema was induced after 1 month of exposure to CS or CS + LPS, while airway remodeling was induced after 2 months of exposure to CS + LPS and 3 months of exposure to CS. Moreover, the mice in the CS + LPS group exhibited more severe inflammation and airway remodeling than the mice in the CS group, but the two treatments induced similar levels of emphysema.

Conclusion
Compared with the single CS exposure method, the CS + LPS exposure method is a more suitable model of COPD in airway remodeling research. Conversely, the CS exposure method is a more suitable model of COPD for emphysema research due to its simple operation.