bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking
Authors: Wang Senhu , Li Lambert Zixin , Zhang Juan , Rehkopf David H. 
Published: February 2021

Aims: Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course—a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators. Methods: The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson–Holm–Breen (KHB) decomposition method. Results: Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking. Conclusions: Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.
The Gender Pain Gap: gender inequalities in pain across 19 European countries
Authors: Bimpong Kweku , Thomson Katie , Mcnamara Courtney L. , Balaj Mirza , Akhter Nasima , Bambra Clare , Todd Adam 
Published: February 2021

Aims: Chronic pain is increasingly considered to be an international public health issue, yet gender differences in chronic pain in Europe are under-examined. This work aimed to examine gender inequalities in pain across Europe. Methods: Data for 27,552 men and women aged 25–74 years in 19 European countries were taken from the social determinants of health module of the European Social Survey (2014). Inequalities in reporting pain were measured by means of adjusted rate differences (ARD) and relative adjusted rate risks (ARR). Results: At the pooled pan-European level, a greater proportion of women (62.3%) reported pain than men (55.5%) (ARD 5.5% (95% confidence intervals (CI) 4.1, 6.9), ARR 1.10 (95% CI 1.08, 1.13)). These inequalities were greatest for back/neck pain (ARD 5.8% (95% CI 4.4, 7.1), ARR 1.15 (95% CI 1.12, 1.19)), but were also significant for hand/arm pain (ARD 4.6% (95% CI 3.5, 5.7), ARR 1.24 (95% CI 1.17, 1.30)) and foot/leg pain (ARD 2.6% (95% CI 1.5, 3.8), ARR 1.12 (95% CI 1.07, 1.18)). There was considerable cross-national variation in gender pain inequalities across European countries. Conclusions: Significant gender pain inequalities exist across Europe whereby women experience more pain than men. The extent of the gender pain gap varies by country. The gender pain gap is a public health concern and should be considered in future prevention and management strategies.
Development of the workplace inclusion questionnaire (WIQ)
Authors: Sveinsdottir Vigdis , Johnsen Tone Langjordet , Fyhn Tonje , Opsahl Jon , Tveito Torill Helene , Indahl Aage , Eriksen Hege Randi , Reme Silje Endresen 
Published: February 2021

Aims: To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market. Methods: A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens ( N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case. Results: Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories. Conclusions: The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.
A path forward for Swedish drug policy?
Authors: Goldberg Ted 
Published: February 2021

Aims and premise: The primary aims of this article are to: describe some major aspects of the theoretical basis of the Swedish drug policy model, present alternative theoretical understandings which may pave the way for changes in drug policy, depict some problems with the Swedish model, introduce the primary principles for “the experimenting society”, and give concrete examples of when these have/have not been applied in Sweden. Some findings: Sweden’s predominantly biochemical approach should be replaced by a biopsychosocial model. The idea that all non-medical consumption of drugs is abuse is counterproductive. Differences between recreational and problematic consumers are discussed. The question of people’s motives for taking drugs has not been incorporated into Swedish drug policy. The stepping-stone hypothesis is examined. It was found that recreational and problematic consumption do not co-vary, indicating that these are two essentially different phenomena. Conclusion: After four decades with the current Swedish drug policy model we are further from our pronounced goal of striving towards becoming a drug-free society than when we started. Access to, and demand for, drugs has continually increased, and our drug policies have caused serious collateral damage. Consequently, there is good reason to re-think the course we have chosen. The Swedish version of the war on drugs has failed to achieve its goals and it is time to make peace. It is time to accept that we will never be drug-free and therefore must learn to live with narcotics. As nobody knows what is the best way to achieve this, we should approach the task with humility. We need to put prestige aside and become “the experimenting society”; that is, one that would vigorously try out possible solutions and make stringent, multidimensional evaluations of outcomes. When the evaluation of a reform shows it to have been ineffective or harmful, we should try other measures.
Moving from an era of open appendectomy to an era of laparoscopic appendectomy: A nationwide cohort study of adult patients undergoing surgery for appendicitis
Authors: Kleif Jakob , Thygesen Lau Caspar , Gögenur Ismail 
Published: February 2021

Background and objective: During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. Methods: During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. Results: A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35–88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9–56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). Conclusions: In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000–2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.
Workplace silence behavior and its consequences on nurses: A new Egyptian validation scale of nursing motives
Authors: Abd El-Fattah Mohamed Aly Nagah , El-Shanawany Safaa M , Ghanem Maha 
Published: February 2021

Background Workplace silence behavior is a social collective phenomenon. It refers to nurses choosing to withhold their ideas, opinions and concerns about critical issues in their workplace. Workplace silence behavior poses a threat to organizational ethics and success. It also has adverse effects on the performance of nurses in health organizations. Underlying nursing causes of silence behaviors could be related to individual, social and organizational attributes in health care settings. Objectives The study aimed to develop a new Egyptian validation scale for measuring nursing motives of workplace silence behavior and identify consequences of workplace silence behavior on nurses. Methods A cross-sectional correlational study was implemented using questionnaires on workplace silence behavior, nursing motives and nurses' consequences, collected from 332 nurses working in critical and toxicology care settings of Alexandria Main University Hospital. Results Egyptian scale was shown to be a good fit model of exploratory (36 nursing motives emerged in six dimensions with total variance of 73.3%) and confirmatory factor analysis tests (X2 = 1381.47, NNFI =0. 90, CFI = 0.91, RMSEA = 0.057). It also had high reliability tests with coefficient of alpha (0.85), Pearson (0.75) and Kendall coefficient of 0.72. High level of workplace silence behaviors showed a negative association with organizational dis-identification, fair citizenship behavior, and fair nurses' performance and declined reporting of patient adverse events. It also appeared to be in a positive association with higher levels of cynicism. Conclusion The Egyptian scale was proved to be reliable and valid for measuring the underlying nursing causes of silence behaviors in the hospital workplace. Measuring nursing motives of workplace silence behaviors will help nurse managers to reduce negative outcomes of workplace silence behaviors and improve organizational outcomes.
The relationship between nurses’ conscientious intelligence levels and care behaviors: A cross-sectional study
Authors: Ozcan Sadiye 
Published: February 2021

Background Nurses are the main protectors of goodness, honesty and morality in patient care. Conscience allows nurses to be understanding and careful while they provide patient care. In this research the researcher aimed to determine the relationship between conscientious intelligence levels and caring behaviours of nurses and to determine the factors affecting the conscientious intelligence levels and caring behaviours. Methods This research designed as a descriptive, cross-sectional and correlation study included 314 nurses working at three hospitals in eastern Turkey. The data were collected by the researcher at a time when the nurses were available and not working. Written and oral informed consent was obtained from all the participants. Results A moderate significant positive correlation was observed between conscientious intelligence levels and caring behaviours of nurses. The length of service in nursing, sex and being pleased with the nursing profession were associated with conscientious intelligence levels and caring behaviours. Conclusion At the end of this research, it was determined that nurses with high conscientious intelligence had better caring behaviours. Although it is very important for nurses to be knowledgeable of and competent at providing care, taking their conscience into consideration in the care of his or her patients is more important. If a nurse is not pleased with the nursing profession, his or her behaviour should be monitored when he or she provides care for the patient. Persons without conscientious values should not be accepted into the nursing profession.
Serum Exosomal lncRNA DLX6-AS1 Is a Promising Biomarker for Prognosis Prediction of Cervical Cancer
Authors: Ding Xian-zhen , Zhang Shi-qiang , Deng Xiao-lan , Qiang Jin-hu 
Published: February 2021

Objective: Deregulation of long noncoding RNAs (lncRNAs) is involved in the initiation and progression of cancer. LncRNA DLX6-AS1 is regarded as an oncogene in many cancer types. However, the clinical role of serum exosomal lncRNA DLX6-AS1 in cervical cancer (CC) is poorly known. This study aimed to analyze the diagnostic and prognostic value of serum exosomal lncRNA DLX6-AS1 in CC. Methods: A total of 114 patients with CC, 60 patients with CIN (cervical intraepithelial neoplasia), and 110 healthy women were enrolled in this study. Real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to measure the serum exosomal lncRNA DLX6-AS1 levels in all participants. Results: Serum exosomal lncRNA DLX6-AS1 level was significantly elevated in CC patients compared with CIN patients and normal controls. In addition, high serum exosomal lncRNA DLX6-AS1 expression was positively associated with lymph node metastasis, differentiation, FIGO stage, and shortened survival. Patients with high serum exosomal lncRNA DLX6-AS1 expression were more prone to have a relapse. Furthermore, univariate and multivariate analyses suggested that serum exosomal lncRNA DLX6-AS1 was a potential prognostic indicator for overall survival of CC patients. Conclusions: These findings demonstrated that serum lncRNA DLX6-AS1 might serve as a promising marker for the diagnosis and prognosis prediction of CC.
Treatment and Predictors of Recurrent Internal Carotid Artery In-Stent Restenosis
Authors: Mihály Zsuzsanna , Vértes Miklós , Entz László , Dósa Edit 
Published: February 2021

Purpose: We aimed to examine the effectiveness of different therapeutic options for and to identify the possible risk factors of recurrent internal carotid artery (ICA) in-stent restenosis (ISR). Methods: Forty-six ICA ISRs, which were reintervened at least once, were retrospectively analyzed regarding clinical and imaging characteristics, as well as invasive treatment type (percutaneous transluminal angioplasty [PTA] with a plain balloon, PTA with a drug-eluting balloon [DEB], re-stenting) used. Results: The median follow-up was 29.5 months (IQR, 8.5-52.8 months) in patients who underwent reintervention for ICA ISR. Stent occlusion occurred in 3 patients (6.5%). One ISR recurrence was noted in 10 patients (21.7%); reintervention was carried out in 7 cases (7/10 [70%]; PTA, N = 5; PTA with a DEB, N = 1; re-stenting, N = 1), while 3 patients (3/10; 30%) received best medical treatment. Two ISR recurrences were observed in 3 patients (6.5%); all of them underwent reintervention (PTA, N = 1; PTA with a DEB, N = 2). Three ISR recurrences were seen in 1 patient (2.2%), who was treated with PTA. No recurrence was observed in those patients, who had DEB treatment. Multiple logistic regression analysis revealed statin therapy to be a protective factor against recurrent ISR (OR, 0.17; 95% CI, 0.03-0.84; P = .029). Conclusion: Our study suggests that PTA with a DEB is the most effective for the treatment of recurrent ISR, and confirms the importance of statin use in patients who have had a carotid reintervention.
Pre-procedural color duplex ultrasound evaluation predicts restenosis after long-segment superficial femoral artery stenting
Authors: Gao Mingjie , Hua Yang , Jia Lingyun , Zhao Xinyu , Liu Ran , Gao Xixiang , Dardik Alan 
Published: February 2021

Objectives Restenosis after stenting for superficial femoral artery atherosclerotic disease remains a significant clinical problem, especially for long-segment lesions. We assessed predictors of in-stent restenosis in patients with long-segment superficial femoral artery disease and hypothesized that pre-procedural ultrasound assessment would predict in-stent restenosis. Methods This single-center study retrospectively analyzed 283 limbs in 243 patients who treated with superficial femoral artery nitinol stent placement for long-segment (≥15 cm) lesions between 2015 and 2018. Color duplex ultrasound was performed pre-procedure and post-procedure at 3, 6, 12, 24, and 36 months. The endpoint was ≥50% in-stent restenosis in the superficial femoral artery. Primary patency rates were analyzed with Kaplan–Meier survival analysis and compared using the log-rank test. A multivariable Cox proportional hazards model was used to evaluate the risk factors for in-stent restenosis. Results The median length of lesions was 25.8 ± 8.1 cm. The cumulative freedom from ≥50% in-stent restenosis at 3, 6, 12, 24, and 36 months was 95.3%, 78.3%, 56.0%, 30.6%, and 15.9%, respectively. Univariate and multivariate Cox regression analysis showed that cumulative lesion length ≥ 25 cm (hazard ratio 1.681; p =  0.003), calcified plaque (hazard ratio 1.549, p =  0.006), poor runoff scores >10 (hazard ratio 1.870, p =  0.003), and chronic renal failure (hazard ratio 2.075, p =  0.009) were independent risk factors for in-stent restenosis. The agreement rate between ultrasound and angiography was 92.6% for cumulative lesion length ( κ 0.851) and 91.9% for runoff score ( κ 0.872). Conclusions The results indicate that pre-procedural color duplex ultrasound evaluation is helpful for the selection of appropriate candidates for superficial femoral artery stent placement. Cumulative lesion length ≥25 cm, plaque calcification, poor distal runoff, and chronic renal failure independently predicted in-stent restenosis.
Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry
Authors: Reyes Valdivia Andrés , Chaudhuri Arindam , Milner Ross , Pratesi Giovanni , Reijnen Michel MPJ , Tinelli Giovanni , Schuurmann Richte , Barbante Matteo , Babrowski Trissa A , Pitoulias Georgios , Tshomba Yamume , Gandarias Claudio , Badawy Ayman , de Vries Jean-Paul PM 
Published: February 2021

Objectives We aim to describe real-world outcomes from multicenter data about the efficacy of adjunct Heli-FX EndoAnchor usage in preventing or repairing failures during infrarenal endovascular aneurysm repair (EVAR), so-called EndoSutured-aneurysm-repair (ESAR). Methods The current study has been assigned an identifier (NCT04100499) at the US National Library of Medicine ( https://ClinicalTrials.gov ). It is an observational retrospective study of prospectively collected data from seven vascular surgery departments between June 2010 and December 2019. Patients included in the ANCHOR registry were excluded from this analysis. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center’s practice. Follow-up imaging was scheduled according to each center’s protocol, which necessarily included either abdominal ultrasound or radiography or computed tomographic scan imaging. The main outcomes analyzed were technical success, freedom from type Ia endoleaks (IaEL), all-cause and aneurysm-related mortality, and sac variation and trends evaluated for those with at least six months imaging follow-up. Results Two hundred and seventy-five patients underwent ESAR in participating centers during the study period. After exclusions, 221 patients (184 males, 37 females, mean age 75 ± 8.3 years) were finally included for analysis. Median follow-up for the cohort was 27 (interquartile range 12–48) months. A median 6 (interquartile range 3) EndoAnchors were deployed at ESAR, 175 (79%) procedures were primary and 46 (21%) revision cases, 40 associated with type IaEL. Technical success at operation (initial), 30-day, and overall success were 89, 95.5, and 96.8%, respectively; the 30-day success was higher due to those with subsequent spontaneous proximal endoleak seal. At two years, freedom from type IaEL was 94% for the whole series; 96% and 86% for the primary and revision groups, respectively; whereas freedom from all-cause mortality, aneurysm-related mortality, and reintervention was 89%, 98%, and 87%, respectively. Sac evolution pre-ESAR was 66 ± 15.1 vs. post ESAR 61 ± 17.5 (p < 0.001) and for 180 patients with at least six-month follow-up, 92.2% of them being in a stable (51%) or regression (41%) situation. Conclusions This real-world registry demonstrates that adjunct EndoAnchor usage at EVAR achieves high rates of freedom from type IaEL at mid-term including in a high number of patients with hostile neck anatomy, with positive trends in sac-size evolution. Further data with longer follow-up may help to establish EndoAnchor usage as a routine adjunct to EVAR, especially in hostile necks.
Hyperechoic kidneys in a patient with bronchiectasis
Authors: Umolu AG , Venn R , Maxwell D , Al Shiekh Ali Z , Howlett DC 
Published: February 2021

Introduction Hyperechoic renal cortex in a normal-sized kidney has a range of causes, some of which irreparably damage the kidney and should initiate further investigations. Case Report We present a 72-year-old woman with longstanding bronchiectasis, noticed to have worsening renal function. Renal tract ultrasonography showed hyperechoic normal-sized kidneys. Renal biopsy confirmed amyloidosis. Discussion Imaging findings in renal amyloidosis tend to be non-specific and are not always present. However, ultrasonography findings of hyperechoic cortex in normal-sized kidneys should not be ignored. Conclusion Renal impairment from blood chemistry in addition to hyperechoic kidneys may be the key to diagnosing secondary amyloidosis in a patient with bronchiectasis, a rare association but important to recognise.