bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke
Authors: Lee Eung-Joon , Kim Seung Jae , Bae Jeonghoon , Lee Eun Ji , Kwon Oh Deog , Jeong Han-Yeong , Kim Yongsung , Jeong Hae-Bong 
Published: March 2021

Background and purpose
Previous studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke.

Methods
Consecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late (>4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival.

Results
Among the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS]: 0−2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04–3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90–0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18–2.13), female sex (aOR: 1.71, 95% CI: 1.14–2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03–3.00 compared to >12 years of schooling) were independent predictors of late arrival.

Conclusions
Thus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.
Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy–An observational study
Authors: Holm Anna , Henriksson Martin , Alfredsson Joakim , Janzon Magnus , Johansson Therese , Swahn Eva , Vial Dominique , Sederholm Lawesson Sofia 
Published: March 2021

ObjectivesBleeding is the most common non-ischemic complication in patients with coronary revascularisation procedures, associated with prolonged hospitalisation and increased mortality. Many factors predispose for bleeds in these patients, among those sex. Anyhow, few studies have characterised the population receiving triple antithrombotic therapy (TAT) as well as long term bleeds from a sex perspective. We investigated the one year rate of bleeds in patients receiving TAT, potential sex disparities and premature discontinuation of TAT. We also assessed health care costs in bleeders vs non-bleeders.SettingThree hospitals in the County of Östergötland, Sweden during 2009–2015.ParticipantsAll patients discharged with TAT registered in the SWEDEHEART registry.Primary and secondary outcome measuresAll bleeds receiving medical attention during one-year follow-up were collected by retrieving relevant information about each patient from medical records. Resource use associated with bleeds was assigned unit cost to estimate the health care costs associated with bleeding episodes.ResultsAmong 272 patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p = 0.01) and bled more (48.6 vs. 37.1%, p = 0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively.ConclusionThe high bleeding incidence in patients with TAT, especially in women, is a cause of concern. There is a need for an adequately sized randomised, controlled trial to determine a safe but still effective treatment for these patients.
Experience of gender-based violence and its effect on depressive symptoms among Indian adolescent girls: Evidence from UDAYA survey
Authors: Patel Ratna , Gupte Samriddhi S. , Srivastava Shobhit , Kumar Pradeep , Chauhan Shekhar , Govindu Mani Deep , Dhillon Preeti 
Published: March 2021

Background
Violence against women has been one of the most prominent issue and a major public health concern. It is a principle violation of basic human rights and has both physical and mental effect on the victim. This study focuses on married and unmarried girls aged 15 to 19 years, belonging to Uttar Pradesh and Bihar, India. This study attempts to examine depression level among married and unmarried girls who have faced violence against them. With the unprecedented growth in social networking, online digital platform and its accessibility, the study also brings out the pertinent aspect of internet based violence and its psychological outcome on adolescent girls. Hence, the study can be seen as an important and needed value addition to the existing pool of knowledge on the subject.

Methods
The study uses Understanding the lives of adolescents and young adults (UDAYA) project data for Uttar Pradesh and Bihar. Depressive symptoms among adolescent girl is the outcome variable of the study. Descriptive statistic and bivariate analysis has been used to get to preliminary results. Chi-squared test is used to test the significant of variables. Further, multi-variate analysis (logistic regression) was used.

Results
Almost 29, 23 and 26 percent of married adolescent girls had faced emotional, physical and sexual violence respectively. It was found that about five per cent of unmarried and eight per cent of married girls had high depressive symptoms. It was found that unmarried adolescent girls who had witnessed their father beating mother were 71 percent more likely to suffer from higher depressive symptoms [OR: 1.71, 1.09–2.69]. Adolescents who faced perpetrated bullying had 90 per cent [OR: 1.90, 1.32–2.72] and 86 per cent [OR: 1.86, 0.98–3.52] higher likelihood to suffer from higher depressive symptoms.

Conclusion
The study goes beyond intimate partner violence and includes various covariates to explain the association between violence and depressive symptoms among married and unmarried adolescents. Hence, more inclusive policies are needed to address the issue of violence against women as the spectrum of the violence is expanding with time.
Macular pigment changes after cataract surgery with yellow-tinted intraocular lens implantation
Authors: Obana Akira , Gohto Yuko , Asaoka Ryo 
Published: March 2021

Purpose
We previously reported that macular pigment optical density (MPOD) levels decreased during a long follow-up period after clear intraocular lens (IOL) implant surgery presumably due to excessive light exposure. We examined changes in MPOD levels in the eyes that received yellow-tinted IOL implant surgery.

Subjects and methods
This was a prospective, observational study. Fifty-five eyes of 35 patients were studied. MPOD levels were measured with a dual-wavelength autofluorescence technique on day 4; months 1, 3, and 6; and years 1 and 2 postoperatively. The average optical densities at 0°- 2° eccentricities (local MPODs) and total volumes of MPOD (MPOVs) in the area within 1.5° and 9° eccentricities were analyzed.

Results
The mean local MPOD at baseline (on day 4) was 0.79 at 0°, 0.71 at 0.5°, 0.68 at 0.9°, and 0.32 at 2°. The mean MPOV within 1.5° and 9° at baseline was 2950 and 18,897, respectively. Local MPOD at 0.9° and 2° and MPOVs were slightly decreased at month 1 and increased after that. The increase reached statistical significance in local MPOD at 0.5° and 2° and MPOVs (Tukey–Kramer test). The changes in MPOV within 9° at year 2 [(MPOV on year 2 − MPOV on day 4) / MPOV on day 4] were from −0.21 to 1.18 (mean and standard deviation: 1.14 ± 0.28). The MPOV of 15 eyes increased more than 10% from the initial value, was maintained within 10% in 21 eyes, and deteriorated more than 10% in only 3 eyes.

Conclusions
Local MPOD and MPOV tended to slightly decrease month 1 postoperatively and gradually increased after that, but the rates of increases in MPOD levels were small. Yellow-tinted IOLs that have a lower transmittance of blue light might be preferable for preserving MPOD levels after surgery.
Identifying optimal COVID-19 testing strategies for schools and businesses: Balancing testing frequency, individual test technology, and cost
Authors: Lyng Gregory D. , Sheils Natalie E. , Kennedy Caleb J. , Griffin Daniel O. , Berke Ethan M. 
Published: March 2021

Background
COVID-19 test sensitivity and specificity have been widely examined and discussed, yet optimal use of these tests will depend on the goals of testing, the population or setting, and the anticipated underlying disease prevalence. We model various combinations of key variables to identify and compare a range of effective and practical surveillance strategies for schools and businesses.

Methods
We coupled a simulated data set incorporating actual community prevalence and test performance characteristics to a susceptible, infectious, removed (SIR) compartmental model, modeling the impact of base and tunable variables including test sensitivity, testing frequency, results lag, sample pooling, disease prevalence, externally-acquired infections, symptom checking, and test cost on outcomes including case reduction and false positives.

Findings
Increasing testing frequency was associated with a non-linear positive effect on cases averted over 100 days. While precise reductions in cumulative number of infections depended on community disease prevalence, testing every 3 days versus every 14 days (even with a lower sensitivity test) reduces the disease burden substantially. Pooling provided cost savings and made a high-frequency approach practical; one high-performing strategy, testing every 3 days, yielded per person per day costs as low as $1.32.

Interpretation
A range of practically viable testing strategies emerged for schools and businesses. Key characteristics of these strategies include high frequency testing with a moderate or high sensitivity test and minimal results delay. Sample pooling allowed for operational efficiency and cost savings with minimal loss of model performance.
Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis
Authors: Zheng Xiaolan , Li Jinhui , Yue Peng , Liu Lei , Li Jiawen , Zhou Kaiyu , Hua Yimin , Li Yifei 
Published: March 2021

BackgroundCoronary artery lesion (CAL) caused by Kawasaki disease (KD) is a leading cause of acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAL. Although most of the current studies have shown a certain correlation between CAL and IVIG resistance, the conclusions are not completely consistent. Thus, we performed this meta-analysis to evaluate the association between IVIG resistance and CAL in KD.MethodsPubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through April 21, 2020 were searched to detect relevant studies. Data analysis was performed with STATA 15.1.ResultsA total of 53 relevant studies were eligible to this analysis, including 30312 KD patients, of which 4750 were IVIG resistance and 25562 were responders. There was a significant difference found between IVIG resistance and IVIG response groups in the incidence of CAL (P < 0.001, odds ratio (OR), 3.89; 95% confidence interval (CI) (3.18, 4.75)). The heterogeneity test results showed that the I2value was 74.8%. The meta-regression analysis showed that the study regions might be the sources of heterogeneity. The subgroup analysis suggested that the incidence of CAL in the IVIG resistance group was still higher than that in the IVIG response group under different regions, IVIG resistance diagnostic criteria, CAL diagnostic criteria, and study types. Meanwhile, the sensitivity analysis did not find any significant impact from every single study.ConclusionsThis is the first meta-analysis to reveal the incidence of CAL was associated with IVIG resistance in KD patients. Further well-designed studies with uniform criteria are needed to evaluate the incidence of CAL in IVIG resistant patients.
Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records
Authors: Ruderman Michael A. , Kim Bo , Stolzmann Kelly , Connolly Samantha , Miller Christopher J. , Bauer Mark S. 
Published: March 2021

Background
Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization.

Rationale
Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention.

Objectives
(i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics.

Methods
Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect.

Results
The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51–0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15–7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41–0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31–0.86).

Conclusion
Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.
Use of gastric acid–suppressive agents increases the risk of dementia in patients with upper gastrointestinal disease: A population-based retrospective cohort study
Authors: Lin Hsiu-Chen , Huang Kuan-Tzu , Lin Hsiu-Li , Uang Yow-Sheng , Ho Yi , Keller Joseph Jordan , Wang Li-Hsuan 
Published: March 2021

Background
Prescriptions for gastric acid–suppressive agents, including proton-pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs), are rising. However, little data exist regarding their association with dementia in the Asian population. The objective of this study was thus to investigate the impact of the use of PPIs and H2RAs on the risk of dementia in an Asian population with upper gastrointestinal disease (UGID).

Methods
We conducted a population-based retrospective cohort study with a 10-year follow-up using data from 2000 to 2015 derived from Taiwan’s Longitudinal Health Insurance Database. We included 6711 patients with UGID receiving gastric acid–suppressive agents, 6711 patients with UGID not receiving agents, and 6711 patients without UGID or treatment thereof, all at least 20 years of age. Groups were matched for age, sex, and index date. The association between gastric acid–suppressive agent use and dementia was analyzed using a Cox proportional hazards regression model adjusted for potential confounders.

Results
The adjusted hazard ratio (aHR) of dementia for patients with UGID receiving gastric acid–suppressive agents compared with patients with UGID without gastric acid–suppressive agents was 1.470 (95% confidence interval [CI] 1.267–1.705, p < 0.001). Both PPIs and H2RAs increase the risk of dementia (PPIs: aHR 1.886 [95% CI 1.377–2.582], p < 0.001; H2RAs: aHR 1.357 [95% CI 1.098–1.678], p < 0.01), with PPIs exhibiting significantly greater risk (aHR 1.456 [95% CI 1.022–2.075], p < 0.05).

Conclusions
Our results demonstrate an increased risk of dementia in patients with UGID receiving gastric acid–suppressive agents, including PPIs and H2RAs, and the use of PPIs was associated with a significantly greater risk than H2RA use.
Frequency of relapse for severe acute malnutrition and associated factors among under five children admitted to health facilities in Hadiya Zone, South Ethiopia
Authors: Lambebo Abera , Temiru Deselegn , Belachew Tefera 
Published: March 2021

Background
Severe acute malnutrition is a common cause of morbidity and mortality among under five children in Ethiopia. A child may experience more than one episode of SAM depending on the improvement of the underlying factors. However, there is no study that determined the frequency of relapse of SAM cases after discharge in Ethiopia.

Objective
To identify the frequency of relapse and associated factors among children discharged after undergoing treatment for SAM in Hadiya Zone, South, Ethiopia.

Methods
An institution based retrospective cohort study was done among children admitted to health posts for treatment of SAM from 2014/2015-2019/2020 under-five children’s after discharge in health post for severe acute malnutrition in the last five years in Hadiya zone, SNNPR, Ethiopia. Both first admission data and relapse data were abstracted from the records of the SAM children from Aguste 1–30 /2020 Using a data collection format. Data were coded and edited manually, then doubly entered into Epi-Data statistical software version 3.1 and then exported to SPSS for windows version 26. After checking all the assumptions finally Negative binomial regression for poison has been used. All tests were two sided and P values <0.05 were used to declare statistical significance.

Results
In the last five year there were the proportion of relapsed cases were 9.6%, 95% CI: (7.7%, 11.7%) On multivariable negative binomial regression model, after adjusting for background variables relapse of severe acute undernutrition was significantly associated with having edema during admission with (IRR = 2.21, 95% CI:1.303–3.732), being in the age group of 6–11 months (IRR = 4.74,95% CI:1.79–12.53), discharge MUAC for the first admission (P = 0.001, IRR = 0.37, 95% CI:0.270–0.50) increase the risk of incidence rate ratio(IRR) relapse case of severe acute under nutrition.

Conclusion
Frequency of SAM relapse was positively associated with age, having edema during admission, while it was negatively associated with discharge MUAC. The results imply the need for reviewing the discharge criteria taking into account the recovery of MUAC as a marker for lean tissue accretion, especially in edematous children and those in the younger age.
Different clinical impact of hyperuricemia according to etiologies of chronic kidney disease: Gonryo Study
Authors: Watanabe Kimio , Nakayama Masaaki , Yamamoto Tae , Yamada Gen , Sato Hiroshi , Miyazaki Mariko , Ito Sadayoshi 
Published: March 2021

Background
Hyperuricemia is highly prevalent in chronic kidney disease (CKD) patients, but the evidence for a relationship between uric acid (UA) and clinical outcomes in CKD patients is limited and inconsistent. We hypothesized that UA has a different impact on clinical outcomes according to the underlying disease causing CKD.

Methods
This study prospectively investigated the associations between UA and renal and non-renal outcomes according to the underlying disease causing CKD in 2,797 Japanese patients under the care of nephrologists. The patients were categorized into four groups: primary renal disease (n = 1306), hypertensive nephropathy (n = 467), diabetic nephropathy (n = 275), and other nephropathy (n = 749). The renal outcome was defined as end-stage renal disease (ESRD), and the non-renal outcome was defined as a composite endpoint of cardiovascular events (CVEs) and all-cause mortality.

Results
During a median 4.8-year follow-up, 359 (12.8%) patients reached the renal outcome, and 260 (9.3%) reached the non-renal outcome. In the all-patient analysis, hyperuricemia was not associated with the risks for renal and non-renal outcomes, but in primary renal disease (PRD) and hypertensive renal disease (HTN) patients, hyperuricemia was significantly associated with non-renal outcomes. Per 1 mg/dl higher UA level, multivariable adjusted hazard ratio was 1.248 (95% CI: 1.003 to 1.553) for PRD, and 1.250 (1.035 to 1.510) for HTN. Allopurinol did not reduce the risks for renal and non-renal outcomes, both in all patients and in the subgroup analysis.

Conclusions
The effect of hyperuricemia on clinical outcomes in CKD patients varies according to the underlying disease causing CKD. Hyperuricemia is an independent risk factor for non-renal outcomes in primary renal disease and hypertensive renal disease patients. Allopurinol did not decrease the risks for renal and non-renal outcomes.
Potency of Chitosan and Chitooligochitosan (COS) as Prebiotics for Streptococcus thermophillus and Lactobacillus bulgaricus Probiotics
Authors: Yudiati Ervia , Sedjati Sri , Susanto Adha , Azhar Nuril , Alghazeer Rabia 
Published: March 2021

Lately, chitosan as a result of chitin deacetilation has known as potencial compound as food industry, pharmacy and environmental agents. The weakness of chitosan is the low water solubility and high viscosity. The size reduction by cutting the β-1, 4 glicosidic bond to improve the bioactivity is the alternative solution. This research aims to find out the addition of chitosan and COS for the Streptococcus thermophillus FNCC – 0041 and Lactobacillus bulgaricus FNCC – 0040 probiotics bacteria culture. S. thermophillus and L. bulgaricus were cultured in the MRS Broth media with addition of Commercial Chitosan (CC), Commercial Oligochitosan (COC), Self-production Chitosan (PC) and Self-production Oligochitosan (POC) in different doses (0.05; 0.1; and 0.2 mg.ml-1). Percentage DD on those treatments was similar. The spectra vibration of The FT-IR analysis of PC and POC were fit to the CC and COC. In chitosan treatments, the best growth of S. thermophilus was reached at 0.2 mg/mL PC, while in chitooligochitosan was from 0.20 mg/mL COC treatments, respectively. The addition of different type of chitosan have a significant effect (p<0.05) to the growth of S. thermophillus, but have not resulted the significant effect to the L. bulgaricus (p>0.05) growth. So, therefore the addition of chitosan and COS as prebiotics for the probiotics were in dose dependant manner. Compare to chitosan commercial, our chitosan production have a good potency to be developed.