bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient satisfaction and loyalty in Japanese primary care: a cross-sectional study
Authors: Kijima Tsunetaka , Matsushita Akira , Akai Kenju , Hamano Tsuyoshi , Takahashi Satoshi , Fujiwara Kazushige , Fujiwara Yuko , Sato Makoto , Nabika Toru , Sundquist Kristina , Sundquist Jan , Ishibashi Yutaka , Kumakura Shunichi 
Published: March 2021

AbstractBackgroundThis study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty.MethodsThis cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman’s correlation and structural equation modelling.ResultsOf 220 eligible patients, 206 participated in this study. We developed nine component scales:first contact (regular access),first contact (urgent access),longitudinality,coordination,comprehensiveness (variety of care),comprehensiveness (risk prevention),comprehensiveness (health promotion),family-centeredness, andcommunity orientation.Longitudinalityandfirst contact (urgent access)were related with patient satisfaction.Longitudinality,first contact (regular access), andfamily-centerednesswere related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable includinglongitudinalityandfirst contact (regular access), along withfamily-centeredness.ConclusionsWhile a patient satisfaction model could not be distilled from the data,longitudinality,first contact (urgent access), andfamily-centerednesswere identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients’ contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.
Health care providers’ experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study
Authors: Varsi Cecilie , Ledel Solem Ingrid Konstanse , Eide Hilde , Børøsund Elin , Kristjansdottir Olöf B. , Heldal Karina , Waxenberg Lori B. , Weiss Karen E. , Schreurs Karlein M. G. , Morrison Eleshia J. , Stubhaug Audun , Solberg Nes Lise 
Published: March 2021

Abstract
Background
Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers’ experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention.

Methods
Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis.

Results
The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers’ own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment.

Conclusions
This study offers insights into health care providers’ considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care.

Trial registration
ClinicalTrials.gov: NCT03705104
Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study
Authors: Maher Gillian M. , Ryan Lisa , McCarthy Fergus P. , Hughes Alun , Park Chloe , Fraser Abigail , Howe Laura D. , Kearney Patricia M. , O’Keeffe Linda M. 
Published: March 2021

Abstract
Background
Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Our objective was to examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years.

Methods
We conducted a prospective birth cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants were born between April 1, 1991, and December 31, 1992. Exposure of interest was age at peak height velocity (aPHV), an objective and validated growth-based measure of puberty onset. Outcome measures included cardiovascular structure and function at age 25 years: carotid intima-media thickness (CIMT), left ventricular mass index (LVMI) and relative wall thickness (RWT), pulse wave velocity (PWV) and systolic blood pressure (SBP). Multiple imputation was used to impute missing data on covariates and outcomes. Linear regression was used to examine the association between aPHV and each measure of cardiac structure and function, adjusting for maternal age, gestational age, household social class, maternal education, mother’s partner’s education, breastfeeding, parity, birthweight, maternal body mass index, maternal marital status, maternal prenatal smoking status and height and fat mass at age 9. All analyses were stratified by sex.

Results
A total of 2752–4571 participants were included in the imputed analyses. A 1-year older aPHV was not strongly associated with markers of cardiac structure and function in males and females at 25 years and most results spanned the null value. In adjusted analyses, a 1-year older aPHV was associated with 0.003 mm (95% confidence interval (CI) 0.00001, 0.006) and 0.0008 mm (95% CI − 0.002, 0.003) higher CIMT; 0.02 m/s (95% CI − 0.05, 0.09) and 0.02 m/s (95% CI − 0.04, 0.09) higher PWV; and 0.003 mmHg (95% CI − 0.60, 0.60) and 0.13 mmHg (95% CI − 0.44, 0.70) higher SBP, among males and females, respectively. A 1-year older aPHV was associated with − 0.55 g/m2.7 (95% CI − 0.03, − 1.08) and − 0.89 g/m2.7 (95% CI − 0.45, − 1.34) lower LVMI and − 0.001 (95% CI − 0.006, 0.002) and − 0.002 (95% CI − 0.006, 0.002) lower RWT among males and females.

Conclusions
Earlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.
Prenatal findings of cataract and arthrogryposis: recurrence of cerebro-oculo-facio-skeletal syndrome and review of differential diagnosis
Authors: Sirchia Fabio , Fantasia Ilaria , Feresin Agnese , Giorgio Elisa , Faletra Flavio , Mordeglia Denise , Barbieri Moira , Guida Valentina , De Luca Alessandro , Stampalija Tamara 
Published: March 2021

Abstract
Background
Cerebro-oculo-facio-skeletal syndrome (COFS) is a severe and progressive neurologic condition characterized by prenatal onset of arthrogryposis, cataract, microcephaly and growth failure. The aim of this study was to present a case of recurrence of the COFS syndrome and to propose a differential diagnosis flow-chart in case of prenatal findings of arthrogryposis and cataract.

Case presentation
We report a case of recurrence of COFS3 syndrome within the same family, with similar diagnostic features. In the first case the COFS syndrome remained undiagnosed, while in the second case, due to prenatal findings of arthrogryposis and cataract, genetic investigation focusing on responsible genes of COFS (ERCC5, ERCC6 and FKTN genes) was carried out. The fetus was found to be compound heterozygous for two different ERCC5 mutations, confirming the clinical suspect of COFS syndrome. A review of the literature on possible causative genes of prenatal cataract and arthrogryposis was performed and we present a flow-chart to guide differential diagnosis and possible genetic testing in case of these findings.

Conclusion
COFS syndrome is a rare autosomic recessive condition. However, it can be suspected and diagnosed prenatally. The flow-chart illustrates a pathway to guide differential diagnosis according to the prenatal findings. Main syndromes, key testing and specific genes are included. Targeted molecular testing should be offered to the couple in order to reach a diagnosis and assess the recurrence risk for future pregnancies.
New susceptibility alleles associated with severe coronary artery stenosis in the Lebanese population
Authors: Wakim Victor , Abi Khalil Elie , Salloum Angelique K. , Khazen Georges , Ghassibe-Sabbagh Michella , Zalloua Pierre A. 
Published: March 2021

Abstract
Background
Coronary Artery Disease (CAD) is the narrowing or blockage of the coronary arteries. It is closely associated with numerous genetics and environmental factors that have been extensively evaluated in various populations. In recent studies, severe phenotypes have been strongly linked to genetic risk factors.

Methods
This study investigated the association of clinical, demographic, and genetic factors with severe coronary artery stenosis phenotypes in our population composed of 1734 individuals with severe coronary stenosis (≥ 50% in coronary vessels) and comparing them to 757 controls with no evidence of stenosis on angiography. We performed generalized linear model (GLM) genome-wide association studies to evaluate three stratification models and their associations to characteristics of the clinical disease. In model 1, patients were not stratified. In model 2, patients were stratified based on presence or absence of CAD family history (FxCAD). In model 3, patients were stratified by young age of CAD onset.

Results
Eight SNPs (single nucleotide polymorphism) were significantly associated with severe CAD phenotypes in the various models $$\left( {p < 5 \times 10^{ - 7} } \right)$$

p
<
5
×

10

-
7

, four of these SNPs were associated with severe CAD and the four others were specifically significant for young CAD patients. While these SNPs were not previously reported for association with CAD, six of them are present in genes that have already been linked to coronary disease.

Conclusion
In conclusion, this study presents new genetic factors associated with severe stenosis and highlights different risk factors associated with a young age at diagnosis of CAD.
Visceral pressure stimulator for exploring hollow organ pain: a pilot study
Authors: DeLong Michael , Gil-Silva Mauricio , Hong Veronica Minsu , Babyok Olivia , Kolber Benedict J. 
Published: March 2021

Abstract
Background
The regulation and control of pressure stimuli is useful for many studies of pain and nociception especially those in the visceral pain field. In many in vivo experiments, distinct air and liquid stimuli at varying pressures are delivered to hollow organs such as the bladder, vagina, and colon. These stimuli are coupled with behavioral, molecular, or physiological read-outs of the response to the stimulus. Care must be taken to deliver precise timed stimuli during experimentation. For example, stimuli signals can be used online to precisely time-lock the stimulus with a physiological output. Such precision requires the development of specialized hardware to control the stimulus (e.g., air) while providing a precise read-out of pressure and stimulus signal markers.

Methods
In this study, we designed a timed pressure regulator [termed visceral pressure stimulator (VPS)] to control air flow, measure pressure (in mmHg), and send stimuli markers to online software. The device was built using a simple circuit and primarily off-the-shelf parts. A separate custom inline analog-to-digital pressure converter was used to validate the real pressure output of the VPS.

Results
Using commercial physiological software (Spike2, CED), we were able to measure mouse bladder pressure continuously during delivery of unique air stimulus trials in a mouse while simultaneously recording an electromyogram (EMG) of the overlying abdominal muscles.

Conclusions
This device will be useful for those who need to (1) deliver distinct pressure stimuli while (2) measuring the pressure in real-time and (3) monitoring stimulus on–off using physiological software.
Road traffic noise, noise sensitivity, noise annoyance, psychological and physical health and mortality
Authors: Stansfeld Stephen , Clark Charlotte , Smuk Melanie , Gallacher John , Babisch Wolfgang 
Published: March 2021

AbstractBackgroundBoth physical and psychological health outcomes have been associated with exposure to environmental noise. Noise sensitivity could have the same moderating effect on physical and psychological health outcomes related to environmental noise exposure as on annoyance but this has been little tested.MethodsA cohort of 2398 men between 45 and 59 years, the longitudinal Caerphilly Collaborative Heart Disease study, was established in 1984/88 and followed into the mid-1990s. Road traffic noise maps were assessed at baseline. Psychological ill-health was measured in phase 2 in 1984/88, phase 3 (1989/93) and phase 4 (1993/7). Ischaemic heart disease was measured in clinic at baseline and through hospital records and records of deaths during follow up. We examined the longitudinal associations between road traffic noise and ischaemic heart disease morbidity and mortality using Cox Proportional Hazard Models and psychological ill-health using Logistic Regression; we also examined whether noise sensitivity and noise annoyance might moderate these associations. We also tested if noise sensitivity and noise annoyance were longitudinal predictors of ischaemic heart disease morbidity and mortality and psychological ill-health.ResultsRoad traffic noise was not associated with ischaemic heart disease morbidity or mortality. Neither noise sensitivity nor noise annoyance moderated the effects of road traffic noise on ischaemic heart disease morbidity or mortality. High noise sensitivity was associated with lower ischaemic heart disease mortality risk (HR = 0.74, 95%CI 0.57, 0.97). Road traffic noise was associated with Phase 4 psychological ill-health but only among those exposed to 56-60dBA (fully adjusted OR = 1.82 95%CI 1.07, 3.07). Noise sensitivity moderated the association of road traffic noise exposure with psychological ill-health. High noise sensitivity was associated longitudinally with psychological ill-health at phase 3 (OR = 1.85 95%CI 1.23, 2.78) and phase 4 (OR = 1.65 95%CI 1.09, 2.50). Noise annoyance predicted psychological ill-health at phase 4 (OR = 2.47 95%CI 1.00, 6.13).ConclusionsNoise sensitivity is a specific predictor of psychological ill-health and may be part of a wider construct of environmental susceptibility. Noise sensitivity may increase the risk of psychological ill-health when exposed to road traffic noise. Noise annoyance may be a mediator of the effects of road traffic noise on psychological ill-health.
A method for estimating neighborhood characterization in studies of the association with availability of sit-down restaurants and supermarkets
Authors: Peng Ke , Rodriguez Daniel A. , Hirsch Jana A. , Gordon-Larsen Penny 
Published: March 2021

Abstract
Background
Although neighborhood-level access to food differs by sociodemographic factors, a majority of research on neighborhoods and food access has used a single construct of neighborhood context, such as income or race. Therefore, the many interrelated built environment and sociodemographic characteristics of neighborhoods obscure relationships between neighborhood factors and food access.

Methods
The objective of this study was to account for the many interrelated characteristics of food-related neighborhood environments and examine the association between neighborhood type and relative availability of sit-down restaurants and supermarkets. Using cluster analyses with multiple measures of neighborhood characteristics (e.g., population density, mix of land use, and sociodemographic factors) we identified six neighborhood types in 1993 in the Twin Cities Region, Minnesota. We then used mixed effects regression models to estimate differences in the relative availability of sit-down restaurants and supermarkets in 1993, 2001, and 2011 across the six neighborhood types.

Results
We defined six types of neighborhoods that existed in 1993, namely, urban core, inner city, urban, aging suburb, high-income suburb, and suburban edge. Between 1993 and 2011, inner city neighborhoods experienced a greater increase in the percent of sit-down restaurants compared with urban core, urban, and aging suburbs. Differences in the percent of sit-down restaurants between inner city and aging suburbs, high-income suburbs and suburban edge neighborhoods increased between 1993 and 2011. Similarly, aging suburb neighborhoods had a greater percent of supermarkets compared with urban and high-income suburb neighborhoods in 2001 and 2011, but not in 1993, suggesting a more varied distribution of food stores across neighborhoods over time. Thus, the classification of neighborhood type based on sociodemographic and built environment characteristics resulted in a complex and increasingly varied distribution of restaurants and food stores.

Conclusions
The temporal increase in the relative availability of sit-down restaurants in inner cities after accounting for all restaurants might be partly related to a higher proportion of residents who eat-away-from-home, which is associated with higher calorie and fat intake.
LDL/HDL cholesterol ratio is associated with new-onset NAFLD in Chinese non-obese people with normal lipids: a 5-year longitudinal cohort study
Authors: Zou Yang , Zhong Ling , Hu Chong , Zhong Mingchun , Peng Nan , Sheng Guotai 
Published: March 2021

Abstract
Background
Low-density lipoprotein to high density lipoprotein (LDL/HDL) cholesterol ratio has been reported to predict the risk of many metabolic diseases. However, the association between the LDL/HDL cholesterol ratio and nonalcoholic fatty liver disease (NAFLD) has not been established.

Methods
A longitudinal cohort design was adopted in this study; 9767 non-obese subjects without NAFLD were included and analyzed. The subjects were grouped according to the quintile of LDL/HDL cholesterol ratio. The cumulative incidence of NAFLD and the independent effect of the LDL/HDL cholesterol ratio on NAFLD during 5 years of follow-up were calculated using the Kaplan-Meier method and Cox proportional-hazards regression model.

Results
During the 5-year follow-up period, 841 subjects were diagnosed with new-onset NAFLD, and the 1-, 2-, 3-, 4-, and 5-year cumulative incidence rates of NAFLD were 1.16, 4.65, 8.33, 12.43, and 25.14%, respectively. In the multivariable-adjusted Cox proportional-hazards regression model, the LDL/HDL cholesterol ratio was significantly associated with the risk for NAFLD (HR: 1.66, 95% CI: 1.38–1.99, P trend< 0.001), especially among young people (HR: 3.96, 95% CI: 1.50–10.46, P interaction< 0.05). Additionally, receiver operating characteristic curve analysis showed that the LDL/HDL cholesterol ratio was better than HDL cholesterol and LDL cholesterol in predicting new-onset NAFLD.

Conclusions
LDL/HDL cholesterol ratio is an independent predictor of NAFLD in Chinese non-obese people with normal lipids, and its predictive value is higher than that of other lipoproteins. In clinical practice, the LDL/HDL cholesterol ratio can be used to identify people at high risk of NAFLD.
Therapies with CCL25 require controlled release via microparticles to avoid strong inflammatory reactions
Authors: Spinnen J. , Fröhlich K. , Sinner N. , Stolk M. , Ringe J. , Shopperly L. , Sittinger M. , Dehne T. , Seifert M. 
Published: March 2021

Abstract
Background
Chemokine therapy with C–C motif chemokine ligand 25 (CCL25) is currently under investigation as a promising approach to treat articular cartilage degeneration. We developed a delayed release mechanism based on Poly (lactic-co-glycolic acid) (PLGA) microparticle encapsulation for intraarticular injections to ensure prolonged release of therapeutic dosages. However, CCL25 plays an important role in immune cell regulation and inflammatory processes like T-cell homing and chronic tissue inflammation. Therefore, the potential of CCL25 to activate immune cells must be assessed more thoroughly before further translation into clinical practice. The aim of this study was to evaluate the reaction of different immune cell subsets upon stimulation with different dosages of CCL25 in comparison to CCL25 released from PLGA particles.

Results
Immune cell subsets were treated for up to 5 days with CCL25 and subsequently analyzed regarding their cytokine secretion, surface marker expression, polarization, and migratory behavior. The CCL25 receptor C–C chemokine receptor type 9 (CCR9) was expressed to a different extent on all immune cell subsets. Direct stimulation of peripheral blood mononuclear cells (PBMCs) with high dosages of CCL25 resulted in strong increases in the secretion of monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), interleukin-1β (IL-1β), tumor-necrosis-factor-α (TNF-α) and interferon-γ (IFN-γ), upregulation of human leukocyte antigen-DR (HLA-DR) on monocytes and CD4+ T-cells, as well as immune cell migration along a CCL25 gradient. Immune cell stimulation with the supernatants from CCL25 loaded PLGA microparticles caused moderate increases in MCP-1, IL-8, and IL-1β levels, but no changes in surface marker expression or migration. Both CCL25-loaded and unloaded PLGA microparticles induced an increase in IL-8 and MCP-1 release in PBMCs and macrophages, and a slight shift of the surface marker profile towards the direction of M2-macrophage polarization.

Conclusions
While supernatants of CCL25 loaded PLGA microparticles did not provoke strong inflammatory reactions, direct stimulation with CCL25 shows the critical potential to induce global inflammatory activation of human leukocytes at certain concentrations. These findings underline the importance of a safe and reliable release system in a therapeutic setup. Failure of the delivery system could result in strong local and systemic inflammatory reactions that could potentially negate the benefits of chemokine therapy.