bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation
Authors: Adams Meredith E. , Marmor Schelomo 
Published: April 2021

ObjectiveEnsuring that patients with dizziness present to the most appropriate level of care and provider are key goals of quality and cost improvement efforts. Using a symptom‐defined cohort of adults presenting for dizziness evaluations, we aimed to identify patient factors associated with ambulatory clinic vs emergency department (ED) presentations, evaluating provider specialty, and assigned diagnoses.Study DesignCross‐sectional study.SettingOptumLabs Data Warehouse (OLDW), a longitudinal, real‐world data asset with deidentified administrative claims.MethodsWe performed a cross‐sectional analysis of adults (older than 18 years) who received new dizziness diagnoses (2006‐2015) and identified factors associated with setting and provider at initial presentation using multivariable regression models.ResultsOf 805,454 individuals with dizziness (median age 52 years, 62% women, 29% black, Asian, or Hispanic), 23% presented to EDs and 77% to clinics (76% primary care, 7% otolaryngology, 5% cardiology, 3% neurology). Predictors of ED presentation were younger age, male sex, black race, lower education, and medical comorbidity. Predictors of primary care clinic presentation were older age and race/ethnicity other than white. Nonetiologic symptom diagnoses alone were assigned to 51% and were most associated with age older than 75 years (odds ratio, 2.90; 95% CI, 2.86‐2.94).ConclusionAdults with dizziness often present to a level of care that may be higher than is optimal. Differential care seeking and diagnoses by age, sex, and race/ethnicity reflect influences beyond dizziness presentation acuity. Targeted patient resources, triage systems, provider education, and cross‐specialty partnerships are needed to direct dizzy patients to appropriate settings and providers to improve care.
Forkhead box F2 as a novel prognostic biomarker and potential therapeutic target in human cancers prone to bone metastasis: a meta-analysis
Authors: Chen Qing , Zhou Lei , Chen Fancheng , Hu Annan , Wang Ketao , Liang Haifeng , Dong Jian 
Published: April 2021

Objective To undertake a systematic review and meta-analysis to evaluate the prognostic value of Forkhead box F2 (FOXF2) levels in different types of cancers prone to bone metastasis. Methods A systematic search of publications listed in electronic databases (The Web of Science, EMBASE®, PubMed®, PMC, Science Direct and CNKI) from inception to 5 November 2020 was conducted. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were used to assess the relationship between FOXF2 levels and patient prognosis including overall survival (OS) and disease-free survival (DFS). Results Sixteen studies enrolling 8461 participants were included in the meta-analysis. High levels of FOXF2 were a predictor of OS (HR: 0.66; 95% CI 0.51, 0.86) and DFS (HR: 0.60; 95% CI 0.48, 0.76). The trim-and-fill analysis, sensitivity analysis and subgroup analyses stratified by the study characteristics confirmed the robustness of the results. Conclusion These current findings indicate that high FOXF2 levels could be an indicator of a good prognosis in cancer patients with tumours that are prone to bone metastasis. FOXF2 levels might be a clinically important prognostic biomarker.
Novel model predicts prognosis for patients with diffuse large B-cell lymphoma in first relapse after initial R-CHOP therapy: a single-institution study in China
Authors: Wang Wei , Yin Jingjing , Zhang Wei , Zhang Yan , Zhou Daobin , Zhao Danqing , Wei Chong 
Published: April 2021

Objective To develop a prognostic model for Chinese patients with relapsed diffuse large B-cell lymphoma (DLBCL) after initial R-CHOP therapy. Methods We retrospectively analyzed the characteristics and survival outcomes of 79 patients with relapsed DLBCL initially treated with R-CHOP at Peking Union Medical College Hospital from February 2012 to September 2016. We used the data to develop a novel prognostic model. Results The median age at the start of salvage therapy was 59 (17–85) years and median time from diagnosis to relapse was 319 (49–1018) days. Multivariate analysis identified short time to relapse (TTR) and B symptoms as independent prognostic factors for reduced progression-free survival (PFS) and overall survival (OS). We created a new prognostic scoring system including TTR, lactate dehydrogenase, absolute lymphocyte count at relapse, and B symptoms, referred to as the TLLB model, which could separate patients into three risk groups with 2-year PFS and OS rates of 70.7%, 40.0%, and 11.1%, and 87.5%, 53.7%, and 29.4%, respectively. Conclusion TTR and B symptoms can be used as important predictors of survival in patients with DLBCL. The TLLB system provides a useful prognostic model compared with the previous TTL system.
Prediction model that combines with multidisciplinary analysis for clinical evaluation of malignancy risk of solid breast nodules
Authors: Dong Bin , Hu Qiaohong , He Hongfeng , Liu Ying 
Published: April 2021

Objective Few studies have systematically developed predictive models for clinical evaluation of the malignancy risk of solid breast nodules. We performed a retrospective review of female patients who underwent breast surgery or puncture, aiming to establish a predictive model for evaluating the clinical malignancy risk of solid breast nodules. Method Multivariable logistic regression was used to identify independent variables and establish a predictive model based on a model group (207 nodules). The regression model was further validated using a validation group (112 nodules). Results We identified six independent risk factors (X3, boundary; X4, margin; X6, resistive index; X7, S/L ratio; X9, increase of maximum sectional area; and X14, microcalcification) using multivariate analysis. The combined predictive formula for our model was: Z=−5.937 + 1.435X3 + 1.820X4 + 1.760X6 + 2.312X7 + 3.018X9 + 2.494X14. The accuracy, sensitivity, specificity, missed diagnosis rate, misdiagnosis rate, negative likelihood ratio, and positive likelihood ratio of the model were 88.39%, 90.00%, 87.80%, 10.00%, 12.20%, 7.38, and 0.11, respectively. Conclusion This predictive model is simple, practical, and effective for evaluation of the malignancy risk of solid breast nodules in clinical settings.
Imbalance between T helper 1 and regulatory T cells plays a detrimental role in experimental Parkinson’s disease in mice
Authors: Li Wenjie , Luo Yuan , Xu Hongyu , Ma Qianqian , Yao Qi 
Published: April 2021

Objective Parkinson’s disease (PD) is a degenerative disorder characterized by steady motor function loss. PD pathogenesis remains inconclusive, but aberrant immune responses might play important roles. We hypothesized that imbalance between T helper (Th) 1 and regulatory T (Treg) cells was essential in experimental PD. Methods Th1 and Treg cells from the blood of patients with PD and healthy volunteer blood were measured by flow cytometry. Experimental PD was induced in mice by peritoneal injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Experimental PD severity was measured by open field test behavior assessments (distance moved, rearing, and grooming). Mice were administered neutralizing anti-tumor necrosis factor (TNF) α to inhibit Th1 effects. Treg cells were depleted by anti-CD25 neutralizing antibodies or isolated and transferred to experimental PD mice. Results Patients with PD had fewer Treg and more Th1 cells than healthy volunteers. Experimental PD mice exhibited fewer Treg and more Th1 cells. Treg cell depletion exacerbated experimental PD, whereas TNFα neutralization attenuated PD in mice. Treg transfer to experimental PD mice reduced PD severity. Mechanistically, anti-TNFα antibody administration and Treg transfer increased Treg and reduced Th1 cell abundance in the brain. Conclusion Th1 and Treg cell imbalance plays an essential role in mouse experimental PD pathogenesis.
Stigma Associated With Sickle Cell Disease in Kumasi, Ghana
Authors: Buser Julie M. , Bakari Ashura , Seidu Abdul-Aziz , Paintsil Vivian , Osei-Akoto Alex , Amoah Rexford , Otoo Benjamin , Moyer Cheryl A. 
Published: April 2021

Introduction People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana. Methodology Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants. Results Participants ( n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance. Discussion The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD.
CT findings and the prognostic value of the Koret CT score in cats with traumatic brain injury
Authors: Mann Ohad , Peery Dana , Bader Segev Ronnie , Klainbart Sigal , Kelmer Efrat , Sobarzo Ariel , Shub Vered , Rapoport Kira , Shamir Merav H , Chai Orit 
Published: April 2021

Objectives The aims of this study were to evaluate associations between abnormal head CT findings and outcome, and to examine the prognostic value of the Koret CT score (KCTS) in cats sustaining acute traumatic brain injury (TBI). Methods The medical records of cats hospitalised with TBI that underwent head CT scans within 72 h of admission were retrospectively reviewed. CT scans were evaluated independently by a radiologist and a neurologist who were blinded to the outcome. A KCTS and modified Glasgow Coma Scale (MGCS) were assigned to each cat and the association between abnormal CT findings, KCTS, MGCS and outcome were analysed. Results Fourteen cats were included in the study: nine (64.2%) survivors and five (35.7%) non-survivors. Of the nine cats that were discharged, one was a short-term survivor (10 days) and eight (57.1%) were long-term survivors (⩾6 months). Abnormal CT findings included lateral ventricle asymmetry/midline shift (42.8%), intracranial haemorrhage (35.7%), caudotentorial lesions (14.2%) and cranial vault fractures (14.2%), all of which were depressed. Intracranial haemorrhage was found to be significantly and negatively associated with short-term ( P = 0.005) and long-term ( P = 0.023) survival. KCTS was significantly associated with short-term survival ( P = 0.002) and long-term survival ( P = 0.004). A KCTS cut-off value of 2 yielded a 100% sensitivity and 100% specificity for short-term survival and 100% sensitivity and 80% specificity for long-term survival. A MGCS cut-off value of ⩾13 was associated with a 100% sensitivity and 100% specificity for short-term survival, and with a 100% sensitivity and 80% specificity for long-term survival. Conclusions and relevance KCTS, performed up to 72 h from injury, can be used as an additional diagnostic tool for the prediction of survival in cats with TBI.
Ten weeks in: COVID-19-related distress in adults with autism spectrum disorder
Authors: Adams Ryan E , Zheng Shuting , Taylor Julie Lounds , Bishop Somer L 
Published: April 2021

This study examined COVID-19-related distress among adults with autism spectrum disorder and its associations with demographic and mental health information. A sample of 275 adults (ages 18–35) in the United States, all capable of providing self-reports, was recruited from a large national registry. Adults completed online surveys of mental health symptoms just before COVID-19 was declared a pandemic. Two months later, they completed the same surveys of mental health symptoms, and also reported about distress they had experienced as a result of the COVID-19 pandemic. Nearly two-thirds (65.9%) endorsed some form of COVID-related distress with a little over half reporting any individual form of distress. Although depressive and anxiety symptoms did not change from Time 1 to Time 2 on average, higher levels of COVID-related distress was associated with an increase in depressive and anxiety symptoms between Time 1 and Time 2. In addition, women and those who reported higher anxiety symptoms before the pandemic were more likely to report some form of COVID-related distress. The findings suggest that as this global crisis continues to unfold, it will be critical to ensure that adults with autism spectrum disorder who were experiencing mental health challenges prior to the pandemic receive appropriate monitoring. Lay abstract This study used data collected from 275 adults in the United States with autism spectrum disorder both before the pandemic and then 10 weeks into the pandemic to assess COVID-19-related distress and its impact. Two-thirds of those surveyed reported some type of distress related to the pandemic (i.e. difficulty coping or negative impact on emotional and mental health). While there were no changes in depressive and anxiety symptoms from prior to COVID-19 to 10 week later in the group as a whole, self-reported distress predicted increases in both anxiety and depression across the two timepoints. Furthermore, adults with higher levels of anxiety prior to the pandemic were more likely to report distress, and women were more likely to report a negative impact of the pandemic on their emotional and mental health. Findings highlight the importance of monitoring with adults with autism spectrum disorder to assess their need for mental health support, and providing ongoing support to those who already experience anxiety even before the pandemic.
Why do parents refuse childhood vaccination? Reasons reported in Finland
Authors: Nurmi Johanna , Harman Bronwyn 
Published: April 2021

Aims: This article examines the reasons for partial and complete refusal of childhood vaccination as reported by parents in Finland. It analyzes perceptions and experiences central in vaccination decisions. Methods: The analysis is based on 38 in-depth interviews with Finnish parents who have refused all or several vaccines for their children. The interviews were analyzed using qualitative content analysis. Results: Three categories of reasons were identified in the analysis: 1) risks and effects of vaccination – concern about and/or experiences of possible side-effects was the most important reason for avoiding vaccines; 2) distrust – participants did not trust vaccination recommendations made by health officials and medical professionals due to perceived bias in medical research, ties between health officials and the pharmaceutical industry, and personal experiences of (suspected) adverse effects and the way these concerns were received in healthcare institutions; 3) health perceptions and practices – parents supported their vaccination choices with complementary and alternative medicine treatments and alternative health understandings. Many stated that contracting vaccine-preventable illnesses would provide longer lasting and more ‘natural’ immunity than vaccination, and possibly other health benefits. Conclusions: A loss of trust in medical and public health actors was central to the process in which parents came to question, contest, and eventually refuse childhood vaccination. The adverse effects of the Pandemrix vaccine in 2009–2010 have been important in leading to distrust and contestation. Distrust may relate to personal experiences of (suspected) adverse effects or to broader concerns over the neutrality of health authorities and the trustworthiness of medical research.
Hypoechogenicity of the midbrain raphe detected by transcranial sonography: an imaging biomarker for depression in migraine patients
Authors: Zhang YiShui , Liu Ying , Han Ruoyun , Liu Kangding , Xing Yingqi 
Published: April 2021

Background: The high comorbidity of migraine and depression is suggestive of shared risk factors or common mechanisms between the two diseases. In individuals with a depressive disorder, there is a high prevalence of altered midbrain raphe (MBR) echogenicity, detectable via transcranial sonography (TCS), that is suggested to be linked with a dysfunction of the serotoninergic system. In patients with migraine, this alteration has seldom been explored in earlier studies, and conclusions are often lacking. Our study aimed to elucidate whether this alteration is specific to migraine and to determine whether it is related with depression. Methods: This study enrolled patients with migraine ( n = 100, 72% female) and patients with tension-type headache disorders (TTH) ( n = 62, 78.5% female) from a headache clinic. In addition, 79 healthy subjects (79.7% female) were recruited as controls. All participants underwent a standard interview to evaluate headache information and an interview with psychiatrists for depression evaluation. TCS examinations were performed on all participants. Results: Patients with migraine had a higher rate of MBR hypoechogenicity (28%) compared with that of healthy controls (15.2%) and that of patients with TTH (12.9%). In patients with migraine, reduced MBR echogenicity was associated with depressive symptoms assessed using the Hamilton Depression Rating Scale (HAM-D). No association between migraine self-medication and MBR echogenicity was found. Conclusion: Reduced-echoic MBR detected by TCS is prevalent in migraine patients and is associated with depressive symptoms. TCS-detected hypoechogenic MBR abnormality could be an imaging biomarker of depressive symptoms in patients with migraine.
Factors affecting drug survival of an alternative TNF inhibitor and secukinumab in patients with ankylosing spondylitis switching from the first TNF inhibitor
Authors: Kwon Oh Chan , Park Jung Hwan , Park Min-Chan 
Published: April 2021

Background: To investigate factors associated with drug survival of an alternative tumour necrosis factor inhibitor (TNFi) and secukinumab (SEC) after switching from the first TNFi in patients with ankylosing spondylitis (AS). Methods: We included a total of 78 patients with AS who switched to an alternative TNFi ( n = 56) or SEC ( n = 22) from the first TNFi. Patient characteristics at the time of switching and drug discontinuation rate were compared between the two groups. Cox regression analyses were performed to evaluate factors associated with the risk of discontinuing the alternative TNFi and SEC. Results: The proportion of patients with syndesmophytes was numerically lower (28.6% versus 45.5%, p = 0.155) and the C-reactive protein (CRP) level was numerically higher [3.8 (1.0–15.4) mg/L versus 1.1 (0.5–3.5) mg/L, p = 0.060] in patients who received an alternative TNFi. The drug discontinuation rate (alternative TNFi: 35.7% versus SEC: 36.4%, p = 0.957) and reasons for discontinuation were similar (primary failure, p = 0.342; secondary failure, p > 0.999; and adverse events, p = 0.670) between the two groups. A higher CRP level at switching was associated with a lower risk (adjusted HR = 0.93, 95% CI = 0.87–0.99, p = 0.022) of discontinuing the alternative TNFi, and primary failure of the first TNFi was associated with a higher risk [adjusted HR (HR) = 5.20, 95% confidence interval (CI) = 1.91–14.11, p = 0.001]. Current smokers (adjusted HR = 5.77, 95% CI = 1.20–27.74, p = 0.029) and the presence of syndesmophytes (adjusted HR = 7.49, 95% CI = 1.39–40.23, p = 0.019) were associated with a higher risk of discontinuing SEC. Conclusion: When switching the drug from the first TNFi in patients with AS, an alternative TNFi could be preferable in patients with higher CRP levels or syndesmophytes, or current smokers, whereas SEC could be a better choice in patients who presented primary failure of the first TNFi in terms of drug survival.
Excess deaths in treatment-resistant depression
Authors: Brenner Philip , Reutfors Johan , Nijs Michel , Andersson Therese M-L 
Published: April 2021

Background: Patients with treatment-resistant depression (TRD) have an increased mortality risk compared with other patients with depression, but it is not known how this translates into absolute numbers of excess deaths. Methods: Swedish national registers were used to identify a cohort of 118,774 antidepressant initiators 18–69 years old with a depression diagnosis. Patients who initiated a third consecutive treatment trial were classified as having TRD. Flexible parametric survival models were used to estimate the mortality risk due to all causes and external causes (suicides and accidents), comparing TRD patients with patients with other depression while adjusting for clinical and sociodemographic covariates and including interactions with TRD, age, and Charlson comorbidity index (CCI) for a number of somatic comorbidities. Standardized survival was estimated, as were numbers of excess deaths among TRD patients within each age and comorbidity category. Results: Compared with the mortality risk of other depressed patients, patients with TRD experienced excess deaths in most age and comorbidity categories in the range of 7–16 deaths per 1000 patients during 5 years. Highest numbers for all-cause excess deaths were found among patients 18–29 years old with CCI 1, where 16 [95% confidence interval 5–28] of the expected 37 [25–48] deaths per 1000 patients were excess deaths. The majority of the excess deaths were due to external causes. Conclusion: Patients with TRD experience significant numbers of excess deaths compared with other patients with depression.
Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study
Authors: Herron Daniel , Chew-Graham Carolyn A , Hider Samantha , Machin Annabelle , Paskins Zoe , Cooke Kendra , Desilva Erandie Ediriweera , Jinks Clare 
Published: April 2021

Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.