bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on left ventricular remodelling and longitudinal strain: a prospective observational study
Authors: Gamaza-Chulián Sergio , Díaz-Retamino Enrique , González-Testón Fátima , Gaitero José Carlos , Castillo María José , Alfaro Raquel , Rodríguez Elías , González-Caballero Eva , Martín-Santana Antonio 
Published: September 2021

AbstractBackgroundSodium-glucose cotransporter 2 inhibitors (SGLT2i) lower cardiovascular events in type 2 diabetes mellitus (T2DM) patients, although the mechanisms underlying these benefits are not clearly understood. Our aim was to study the effects of SGLT2i on left ventricular remodelling and longitudinal strain.MethodsBetween November 2019 and April 2020, we included 52 patients with T2DM ≥ 18 years old, with HbA1c between 6.5 and 10.0%, and estimated glomerular filtration ≥ 45 ml/min/1.73 m2. Patients were classified into SGLT2i group and control group, according to prescribed treatment by their referring physician. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and after 6 months of treatment.ResultsAmong the 52 included patients (44% females, mean age 66.8 ± 8.6 years, mean HbA1c was 7.40 ± 0.7%), 30 patients were prescribed SGLT2i and 22 patients were classified as control group. Mean change in indexed left ventricular mass (LVM) was − 0.85 ± 3.31 g/m2(p = 0.003) in the SGLT2i group, and + 2.34 ± 4.13 g/m2(p = 0.58) in the control group. Absolute value of Global Longitudinal Strain (GLS) increased by a mean of 1.29 ± 0.47 (p = 0.011) in the SGLT2i group, and 0.40 ± 0.62 (p = 0.34) in the control group. We did not find correlations between changes in LVM and GLS, and other variables like change in HbA1c.ConclusionsAmong patients with T2DM, SGLT2i were associated with a significant reduction in indexed LVM and a significant increment in longitudinal strain measured by speckle tracking echocardiography, which may explain in part the clinical benefits found in clinical trials.
Mitigating selection bias in organ allocation models
Authors: Schnellinger Erin M. , Cantu Edward , Harhay Michael O. , Schaubel Douglas E. , Kimmel Stephen E. , Stephens-Shields Alisa J. 
Published: September 2021

AbstractBackgroundThe lung allocation system in the U.S. prioritizes lung transplant candidates based on estimated pre- and post-transplant survival via the Lung Allocation Scores (LAS). However, these models do not account for selection bias, which results from individuals being removed from the waitlist due to receipt of transplant, as well as transplanted individuals necessarily having survived long enough to receive a transplant. Such selection biases lead to inaccurate predictions.MethodsWe used a weighted estimation strategy to account for selection bias in the pre- and post-transplant models used to calculate the LAS. We then created a modified LAS using these weights, and compared its performance to that of the existing LAS via time-dependent receiver operating characteristic (ROC) curves, calibration curves, and Bland-Altman plots.ResultsThe modified LAS exhibited better discrimination and calibration than the existing LAS, and led to changes in patient prioritization.ConclusionsOur approach to addressing selection bias is intuitive and can be applied to any organ allocation system that prioritizes patients based on estimated pre- and post-transplant survival. This work is especially relevant to current efforts to ensure more equitable distribution of organs.
Effect of sofosbuvir-based DAAs on changes in lower-density lipoprotein in HCV patients: a systematic review and meta-analysis
Authors: Wang Ying-Wen , Lee Wei-Ping , Huang Yi-Hsiang , Hou Ming-Chih , Lan Keng-Hsin 
Published: September 2021

Abstract
Background
Previous studies reported worsened lipid profiles in patients infected with hepatitis C virus (HCV) during direct-acting antivirals (DAAs) treatment. This study aimed to investigate the effect of sofosbuvir (SOF)-based DAAs on changes in low-density lipoprotein (LDL) in HCV patients.

Methods
A systematic review of articles published before 31 May 2021 was conducted by searching MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus. Eligible studies were those comparing SOF-based DAAs and non-SOF DAAs for HCV patients and providing numerical data for changes in LDL. Risk of Bias in Non-randomized Studies- of Interventions was used for assessing risk of bias, and meta-analysis was performed for changes in LDL.

Results
Six studies comprising 1248 patients were included, 848 patients treated with SOF-based DAAs and 400 patients with non-SOF DAAs vs. SOF-based DAAs group had significantly greater increases in LDL from baseline to week 4 than non-SOF DAAs group (P = 0.001). However, changes in LDL from baseline to the end of treatment (P = 0.060), to post-treatment week 12 (P = 0.263), and to post-treatment week 24 (P = 0.319) did not significantly differ between the two groups. Further comparison of SOF/ledipasvir with asunaprevir/daclatasvir revealed a similar trend in changes in LDL.

Conclusions
For HCV patients, SOF-based DAA regimens were associated with rapid and significant increases in LDL during the initial 4 weeks of treatment, and the changes did not sustain after the end of treatment. Potential mechanism might be related to the phosphoramidate side chain of SOF.
Trends in healthcare visits and antimicrobial prescriptions for acute infectious diarrhea in individuals aged 65 years or younger in Japan from 2013 to 2018 based on administrative claims database: a retrospective observational study
Authors: Ono Akane , Aoyagi Kensuke , Muraki Yuichi , Asai Yusuke , Tsuzuki Shinya , Koizumi Ryuji , Azuma Toshiaki , Kusama Yoshiki , Ohmagari Norio 
Published: September 2021

Abstract
Background
The inappropriate use of antimicrobials for acute infectious diarrhea is widespread and leads to the problem of antimicrobial resistance. To improve the use of antimicrobials, it is first necessary to understand the actual situation of diarrheal disease and to identify potential targets for intervention. This study aimed to investigate the recent epidemiological characteristics of and antimicrobial prescriptions for acute infectious diarrhea in Japan.

Methods
This was a retrospective observational study of outpatients aged 0–65 years, separated into children (age 0–17 years) and adults (age 18–65 years), diagnosed with acute infectious diarrhea, using the administrative claims database of the Japan Medical Data Center from 2013 to 2018. We evaluated the number of eligible visits/number of database registrants (defined as the visit rate). The analysis of the antimicrobial prescription rate was restricted to otherwise healthy individuals diagnosed with acute infectious diarrhea alone by excluding patients with multiple disease diagnoses and with medical backgrounds of chronic bowel diseases or immunocompromised conditions. We further classified them by diagnosis of bacterial or nonbacterial acute infectious diarrhea.

Results
The total number of eligible visits for acute infectious diarrhea was 2,600,065. The visit rate, calculated based on the number of eligible visits by database registrants, was higher in children (boys, 0.264; girls, 0.229) than in adults (men, 0.070; women, 0.079), with peaks in early summer and winter. The peaks for visits in adults lagged those of children. In total, 482,484 visits were analyzed to determine the antimicrobial prescription rate; 456,655 (94.6%) were diagnosed with nonbacterial acute infectious diarrhea. Compared with children (boys, 0.305; girls, 0.304), the antimicrobial prescription rate was higher in adults, and there were differences between sexes in adults (men, 0.465; women, 0.408). Fosfomycin and fluoroquinolone were most frequently used for nonbacterial acute infectious diarrhea in children (44.1%) and adults (50.3%), respectively.

Conclusions
These results revealed overprescription of antimicrobials for acute infectious diarrhea in this administrative claims database in Japan and contribute to the development of antimicrobial stewardship strategies and the identification of targets for efficiently reducing inappropriate antimicrobial use.
Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia
Authors: Kebede Eskinder , Kekulawala Melani 
Published: September 2021

Abstract
Background
Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births.

Methods
This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher’s exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.

Results
During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098–2.780), previous stillbirth (aOR 9.447, 95%CI 6.245–14.289), previous preterm birth (aOR 3.620, 95%CI 2.363–5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228–3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523–7.031).

Conclusion
Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.
Social support, anxiety symptoms, and depression symptoms among residents in standardized residency training programs: the mediating effects of emotional exhaustion
Authors: Zhang Hui , Cui Nianqi , Chen Dandan , Zou Ping , Shao Jing , Wang Xiyi , Zhang Yichi , Du Jiao , Du Chunxue , Zheng Deyi 
Published: September 2021

Abstract
Background
Although studies indicate that social support is related to emotional exhaustion, depression symptoms, and anxiety symptoms, the underlying mechanism between those variables remains unknown.

Methods
Based on a sample of 254 residents in standardized residency training programs, two mediation models were tested in which emotional exhaustion served as a mediator in the relationship between social support and anxiety symptoms/depression symptoms. We used the following self-reported questionnaires as instruments to collect data: zung self-rating depression scale, zung self-rating anxiety scale, social support rating scale, and emotional exhaustion scale.

Results
In the final study sample, the mean age of the residents was 25.92 years old (SD =1.88), and a total of 41.3% were male, and 58.7% were female. This current study suggested that social support was proven to be a relevant factor affecting anxiety symptoms and depression symptoms. Particularly, the results also indicated that emotional exhaustion partially mediated the impact of social support on anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program.

Conclusions
Our study signifies that enhancements in social support and reduction of emotional exhaustion can directly or indirectly affect anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program. These findings will offer insight for health-sector managers to develop programs aimed at social support and adopt individual-level interventions and organization-level interventions to reduce emotional exhaustion.
Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger
Authors: Kohlmann Kristin , Sudfeld Christopher R. , Garba Souna , Guindo Ousmane , Grais Rebecca F. , Isanaka Sheila 
Published: September 2021

Abstract
Background
Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger.

Methods
From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < − 2 and stunted if they had a length-for-age Z-score < − 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations.

Results
Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age.

Conclusions
These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth.

Trial registration
ClinicalTrials.gov Identifier: NCT02145000.
COVID-19, body mass index and cholesterol: an ecological study using global data
Authors: Sarmadi Mohammad , Ahmadi-Soleimani S. Mohammad , Fararouei Mohammad , Dianatinasab Mostafa 
Published: September 2021

Abstract
Background
Coronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19.

Methods
In this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann–Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19.

Results
Incidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (β = 2396.81 and β = 30,932.80, p < 0.01,‌ respectively) and mortality ratio (β = 38.18 and β = 417.52, p < 0.05,‌ respectively) after adjusting for socioeconomic and demographic factors.

Conclusion
Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.
Analyzing disparities in COVID-19 testing trends according to risk for COVID-19 severity across New York City
Authors: Lieberman-Cribbin Wil , Alpert Naomi , Flores Raja , Taioli Emanuela 
Published: September 2021

AbstractBackgroundGiven the interplay between race and comorbidities on COVID-19 morbidity and mortality, it is vital that testing be performed in areas of greatest need, where more severe cases are expected. The goal of this analysis is to evaluate COVID-19 testing data in NYC relative to risk factors for COVID-19 disease severity and demographic characteristics of NYC neighborhoods.MethodsCOVID-19 testing and the racial/ethnic composition of NYC Zip Code Tabulation Areas (ZCTA) were obtained from the NYC Coronavirus data repository and the American Community Survey, respectively. The prevalence of neighborhood-level risk factors for COVID-19 severity according to the Centers for Disease Control and Prevention criteria for risk of severe illness and complications from COVID-19 were used to create a ZCTA-level risk index. Poisson regressions were performed to study the ratio of total tests relative to the total ZCTA population and the proportion of positive tests relative to the total tests performed over time.ResultsFrom March 2nd-April 6th, the total tests/population (%) was positively associated with the proportion of white residents (IRRadj: 1.0003, 95% CI: 1.0003–1.0004) and the COVID risk index (IRRadj: 1.038, 95% CI: 1.029–1.046). The risk index (IRRadj: 1.017, 95% CI: 0.939–1.101) was not associated with total tests performed from April 6th-May 12th, and inversely associated from May 12th-July 6th (IRRadj: 0.862, 95% CI: 0.814–0.913). From March 2nd-April 6th the COVID risk index was not statistically associated (IRRadj: 1.010, 95% CI: 0.987–1.034) with positive tests/total tests. From April 6th-May 12th, the COVID risk index was positively associated (IRRadj: 1.031, 95% CI: 1.002–1.060), while from May 12th-July 6th, the risk index was inversely associated (IRRadj: 1.135, 95% CI: 1.042–1.237) with positivity.ConclusionsTesting in NYC has suffered from the lack of availability in high-risk populations, and was initially limited as a diagnostic tool for those with severe symptoms, which were mostly concentrated in areas where vulnerable residents live. Subsequent time periods of testing were not targeted in areas according to COVID-19 disease risk, as these areas still experience more positive tests.
The Mediterranean diet and dietary approach to stop hypertension (DASH)-style diet are differently associated with lipid profile in a large sample of Iranian adults: a cross-sectional study of Shahedieh cohort
Authors: Panbehkar-Jouybari Monireh , Mollahosseini Mehdi , Salehi-Abargouei Amin , Fallahzadeh Hossein , Mirzaei Masoud , Hosseinzadeh Mahdieh 
Published: September 2021

Abstract
Background
The association between the Mediterranean diet (MED) or dietary approach to stop hypertension (DASH) and cardiovascular disease (CVD) risk factors is well-documented. Nevertheless, a consistent relationship with the Middle East population has yet to be known. Thus, we aimed to investigate the association between DASH/MED and blood lipids in Iranian adults.

Methods
Four thousand seven hundred forty participants, aged 35–70 years (mean: 50.0) participated in the Shahedieh cohort study in Yazd, Iran, were followed from 2016 until now. Participants provided dietary and blood lipid data through a validated semi-quantitative food frequency questionnaire, and blood samples were taken after a fasted state. We used binary logistic regression to examine the association between DASH/MED scores and blood lipids.

Results
In the participants who ingested a DASH-like diet the third vs. the first tertile of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, and LDL/HDL (high-density lipoprotein) ratio reduced significantly (P < 0.01). While in the participants who ingested the MED-like diet the HDL level increased significantly( 52.8 ± 12. 3 vs. 51.6 ± 11.6, P < 0.01). In Binary logistic regression, higher adherence to the DASH diet showed 19 % lower odds of high TC level (OR: 0.81; 95 %CI: 0.69–0.95) and 18 % lower odds of high LDL/HDL ratio (OR: 0.82; 95 %CI: 0.70–0.96). Besides, high adherence to the MED diet was associated with lower odds of LDL/HDL ratio (OR: 0.85; 95 %CI: 0.72–0.99).

Conclusions
Our findings suggest that TC, TG, LDL, LDL/HDL ratio, and HDL improved in participants who ingested a DASH-like diet and the LDL/HDL ratio improved in participants who ingested MED-like diet and, subsequently they might have a protective effect on CVDs risk. Further epidemiological studies are needed to confirm our findings.
Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: A prospective observational study
Authors: Takata Ryo , Kanehira Mitsugu , Kato Yoichiro , Matsuura Tomohiko , Kato Renpei , Maekawa Shigekatsu , Obara Wataru 
Published: September 2021

AbstractBackgroundA virtual reality (VR) simulator is utilized as an inexpensive tool for gaining basic technical competence in robotic-assisted surgery (RAS). We evaluated operator 3D motion sickness while using a VR simulator and assessed whether it can be reduced by repeating the training.MethodsThis prospective observational study was conducted at the Department of Urology, Iwate Medical University, a tertiary training hospital in an urban setting. A total of 30 undergraduate medical students participated in the study. We compared whether the VR simulator improved the students’ skills in operating the da Vinci robot. Fifteen students underwent training with a VR simulator for 4 h a day for 5 days. Then, motion sickness was determined using the Visual Analog Scale and Simulator Sickness Questionnaire (SSQ) before and after the training.ResultsManipulation time significantly improved after training compared to before training (293.9 ± 72.4 versus 143.6 ± 18.4 s;p < 0.001). Although motion sickness worsened after each training session, it gradually improved with continuous practice with the VR simulator. SSQ subscores showed that the VR simulator induced nausea, disorientation, and oculomotor strain, and oculomotor strain was significantly improved with repeated training.ConclusionsIn undergraduate students, practice with the VR simulator improved RAS skills and operator 3D motion sickness caused by 3D manipulation of the da Vinci robot.