bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study
Authors: Ramakrishnan Rema , Doherty Aiden , Smith-Byrne Karl , Rahimi Kazem , Bennett Derrick , Woodward Mark , Walmsley Rosemary , Dwyer Terence 
Published: January 2021

Background
Higher levels of physical activity (PA) are associated with a lower risk of cardiovascular disease (CVD). However, uncertainty exists on whether the inverse relationship between PA and incidence of CVD is greater at the highest levels of PA. Past studies have mostly relied on self-reported evidence from questionnaire-based PA, which is crude and cannot capture all PA undertaken. We investigated the association between accelerometer-measured moderate, vigorous, and total PA and incident CVD.

Methods and findings
We obtained accelerometer-measured moderate-intensity and vigorous-intensity physical activities and total volume of PA, over a 7-day period in 2013–2015, for 90,211 participants without prior or concurrent CVD in the UK Biobank cohort. Participants in the lowest category of total PA smoked more, had higher body mass index and C-reactive protein, and were diagnosed with hypertension. PA was associated with 3,617 incident CVD cases during 440,004 person-years of follow-up (median (interquartile range [IQR]): 5.2 (1.2) years) using Cox regression models. We found a linear dose–response relationship for PA, whether measured as moderate-intensity, vigorous-intensity, or as total volume, with risk of incident of CVD. Hazard ratios (HRs) and 95% confidence intervals for increasing quarters of the PA distribution relative to the lowest fourth were for moderate-intensity PA: 0.71 (0.65, 0.77), 0.59 (0.54, 0.65), and 0.46 (0.41, 0.51); for vigorous-intensity PA: 0.70 (0.64, 0.77), 0.54 (0.49,0.59), and 0.41 (0.37,0.46); and for total volume of PA: 0.73 (0.67, 0.79), 0.63 (0.57, 0.69), and 0.47 (0.43, 0.52). We took account of potential confounders but unmeasured confounding remains a possibility, and while removal of early deaths did not affect the estimated HRs, we cannot completely dismiss the likelihood that reverse causality has contributed to the findings. Another possible limitation of this work is the quantification of PA intensity-levels based on methods validated in relatively small studies.

Conclusions
In this study, we found no evidence of a threshold for the inverse association between objectively measured moderate, vigorous, and total PA with CVD. Our findings suggest that PA is not only associated with lower risk for of CVD, but the greatest benefit is seen for those who are active at the highest level.
Social determinants of mortality from COVID-19: A simulation study using NHANES
Authors: Seligman Benjamin , Ferranna Maddalena , Bloom David E. 
Published: January 2021

BackgroundThe COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level.Methods and findingsWe estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%–59.6%,p< 0.001), individuals with income below the median (67.5%, 95% CI 63.4%–71.5%,p< 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% –27.9%,p< 0.001), and veterans (19.5%, 95% CI 15.8%–23.4%,p< 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents.ConclusionsSubstantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.
The epidemiological status of urogenital schistosomiasis among reproductive aged individuals in the Tiko Health Area- a semi-urban setting in the Mount Cameroon area
Authors: Ndassi Vicky Daonyle , Anchang-Kimbi Judith Kuoh , Sumbele Irene Ule Ngole , Ngufor Lennin Azaofah , Nadege Kouemou , Kimbi Helen Kuokuo 
Published: January 2021

Background
Urogenital schistosomiasis (UGS) caused by S. haematobium has enormous reproductive health consequences including infertility. Reproductive aged individuals are a neglected group and not included in control programs in Cameroon. This study investigated the prevalence and severity of S. haematobium infection in the context of gender and socio-economic structures that shape behaviour among reproductive aged individuals living in Tiko, a semi-urban setting, Cameroon.

Methodology/Principal findings
A cross-sectional study was carried out in the Tiko Health District (THD) between May to September 2019. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document data on socio-demographic and stream contact behaviour. A urine sample was collected and screened for the presence of S. haematobium ova using reagent strips, filtration and microscopy. The overall prevalence of S. haematobium infection was 22.8% (95% CL: 19.27–26.73) with geometric mean egg load of 18.74 (range: 1–1600) per 10ml of urine. Younger age group (15 – 20years) (OR: 5.13; 95% CL: 1.35–19.42), male (OR: 2.60 3.07; 95% CL: 1.54–4.40) and awareness of UGS (OR: 1.73; 95% CL: 1.02–2.95) were associated with higher odds of exposure to infection. Significantly higher intensity of infection was seen in males, singles and in the age group 15–30 years. It is worth noting that males carried out more activities which entailed longer duration in streams.

Conclusion/Significance
The prevalence obtained shows that Tiko is a moderate-risk area for UGS with underlying morbidity-inducing infection intensity. The severity of the infection is more in males. Awareness of the disease is not enough to protect these communities from infection, but provision of public infrastructures and health education will limit contact with infested water and thus curtail the infection. There is an urgent need to involve all age groups in control programs.
The impact of community based continuous training project on improving couples’ knowledge on birth preparedness and complication readiness in rural setting Tanzania; A controlled quasi-experimental study
Authors: Moshi Fabiola V. , Kibusi Stephen M. , Fabian Flora Masumbuo 
Published: January 2021

BackgroundIt is widely accepted that community-based interventions are vital strategies towards reduction of maternal and neonatal mortalities in developing counties. This study aimed at finding the impact a Community Based Continuous Training (CBCT) project in improving couples’ knowledge on birth preparedness and complication readiness in rural Tanzania.MethodThe quasi-experimental study design with control was adopted to determine the impact of CBCT in improving knowledge on birth preparedness and complication readiness. The study was conducted from June 2017 until March 2018. A multi-stage sampling technique was employed to obtain 561couples. Pre-test and post-training intervention information were collected using semi-structured questionnaires. The impact of CBCT was determined using both independent t-test and paired t-test. Linear regression analysis was used to establish the association between the project and the change in knowledge mean scores. The effect size was calculated using Cohen’s d.ResultsAt post-test assessment, knowledge mean scores were significantly higher in the intervention group among both pregnant women (m = 14.47±5.49) and their male partners (m = 14.1±5.76) as compared to control group among both pregnant women (m = 9.09±6.44) and their male partners (m = 9.98±6.65) with large effect size of 0.9 among pregnant women and medium effect size of 0.66 among male respondents. When the mean scores were compared within groups among both pregnant women and male partners in the intervention group, there were a significant increase in knowledge mean scores at post-test assessment as compared to pre-test assessment with large effect size of Cohen’s d = 1.4 among pregnant women and 1.5 among male partners. After adjusting for the confounders, the predictors of change in knowledge among pregnant women were the CBCT project (β = 0.346, p<0.000) and ethnic group [Mambwe (β = -0.524, p = 0.001)] and the predictors of change in knowledge among male partners were the CBCT project (β = 1.058, p<0.001) and walking distance [more than five kilometers (β = -0.55, p< 0.05)].ConclusionThis interventional study which focused on knowledge empowerment and behavior change among expecting couples was both feasible and effective on improving knowledge about birth preparedness and complication readiness in rural settings of Tanzania.
Intravitreal bevacizumab versus intravitreal triamcinolone for diabetic macular edema–Systematic review, meta-analysis and meta-regression
Authors: Abdel-Maboud Mohamed , Menshawy Esraa , Bahbah Eshak I. , Outani Oumaima , Menshawy Amr 
Published: January 2021

Background
The most frequent cause of vision loss from diabetic retinopathy is diabetic macular edema (DME). Earlier clinical trials tried to examine the role of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB) in DME; they either qualified IVT over IVB or IVB over IVT or did not exhibit a significant difference.

Objective
This paper aims to compare the efficacy and safety of IVB versus IVT alone or combined IVB+IVT in the treatment of DME.

Methods
We systematically searched PubMed, CENTRAL, Scopus, Embase, Science Direct, OVID, and Web of Science for randomized controlled trials of IVB versus IVT alone or combined IVB+IVT and IVT versus the combined IVB+IVT in DME patients.

Results
A total of 1243 eyes of 17 trials were included in our meta-analysis and regression. Repeated injections of IVB were superior at improving VA comparing with those of IVT at 12, 24, 48-weeks, and IVB+IVT at 12, 24, 48-weeks. Single injections were comparable across the three arms regarding BCVA improvement. CMT reductions were also comparable across the three arms. Meanwhile, the overall safety regarding intraocular pressure and intraocular hypertension significantly favored the IVB group. Improvement in VA was best modified with CMT reduction from 480 um to 320um. This association was significant at 12-weeks in the three arms and persisted till 24-weeks and 48-weeks exclusively in the IVB group.

Conclusions and relevance
Our analysis reveals that repeated successive injections associate with better BCVA compared to single injection. Current evidence affirms that IVB is superior to IVT and IVB+IVT at improving BCVA, comparable at reducing CMT, and presents a better safety profile in the treatment of DME.
Prevalence and correlates of metabolic syndrome and its components in adults with psychotic disorders in Eldoret, Kenya
Authors: Kwobah Edith , Koen Nastassja , Mwangi Ann , Atwoli Lukoye , Stein Dan J. 
Published: January 2021

Background
A high prevalence of metabolic syndrome and its components in patients with psychotic disorders may increase the risk for cardiovascular diseases. Unfortunately, relatively little work in this field has emerged from low-resourced contexts. This study investigated the prevalence, correlates, and treatment patterns of metabolic disorders in patients with psychotic disorders in Western Kenya.

Methods
300 patients with psychosis and 300 controls were recruited at Moi Teaching and Referral Hospital in Eldoret, Kenya. Data on demographic characteristics, weight, height, abdominal circumference, blood pressure, blood glucose, lipid profile, and treatments were collected. Categorical and continuous data were compared between the patient and control groups using Pearson’s chi-squared tests and t-tests, respectively. Variables found to be significantly different between these groups were included in logistic regression models to determine potential predictors of metabolic syndrome.

Results
Compared to controls, patients with psychosis were found to have a higher mean random blood glucose [5.23 vs 4.79, p = 0.003], higher body mass index [5.23 vs 4.79, p = 0.001], higher triglycerides [1.98 vs 1.56, p<0.001], larger waist circumference [89.23 vs 86.39, p = 0.009] and lower high density lipoprotein [1.22 vs 1.32, p<0.001]. The odds of developing metabolic syndrome were increased with age [OR = 1.05, CI: 1.02–1.07] and presence of a psychotic disorder [OR = 2.09 [CI 1.23–3.55]; and were reduced with female gender [OR 0.41, CI 0.25–0.67], among those who were never married [OR 0.52, CI 0.28–0.94] and among the widowed/separated/ divorced marital status [OR 0.38, CI 0.17–0.81]. While the majority of patients received treatment with olanzapine, there was no association between olanzapine use and metabolic syndrome and its components. More than half of the patients in this study sample were not receiving treatment for the various components of metabolic syndrome.

Conclusion
In the study setting of Eldoret, metabolic syndrome and its components were more prevalent among patients with psychotic disorders than in controls; and a clear treatment gap for these disorders was evident. There is a need for efforts to ensure adequate screening and treatment for these physical disorders in resource-limited settings.
Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies
Authors: Lesage Aurore , Leclère Brice , Moret Leïla , Le Glatin Clément 
Published: January 2021

Objectives
To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary).

Methods
The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the “Trials” section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations.

Results
Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes.

Conclusions
Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.
Hypoxia-induced mitochondrial abnormalities in cells of the placenta
Authors: Vangrieken Philippe , Al-Nasiry Salwan , Bast Aalt , Leermakers Pieter A. , Tulen Christy B. M. , Janssen Ger. M. J. , Kaminski Iris , Geomini Iris , Lemmens Titus , Schiffers Paul M. H. , van Schooten Frederik J. , Remels Alex H. V. 
Published: January 2021

Introduction
Impaired utero-placental perfusion is a well-known feature of early preeclampsia and is associated with placental hypoxia and oxidative stress. Although aberrations at the level of the mitochondrion have been implicated in PE pathophysiology, whether or not hypoxia-induced mitochondrial abnormalities contribute to placental oxidative stress is unknown.

Methods
We explored whether abnormalities in mitochondrial metabolism contribute to hypoxia-induced placental oxidative stress by using both healthy term placentae as well as a trophoblast cell line (BeWo cells) exposed to hypoxia. Furthermore, we explored the therapeutic potential of the antioxidants MitoQ and quercetin in preventing hypoxia-induced placental oxidative stress.

Results
Both in placental explants as well as BeWo cells, hypoxia resulted in reductions in mitochondrial content, decreased abundance of key molecules involved in the electron transport chain and increased expression and activity of glycolytic enzymes. Furthermore, expression levels of key regulators of mitochondrial biogenesis were decreased while the abundance of constituents of the mitophagy, autophagy and mitochondrial fission machinery was increased in response to hypoxia. In addition, placental hypoxia was associated with increased oxidative stress, inflammation, and apoptosis. Moreover, experiments with MitoQ revealed that hypoxia-induced reactive oxygen species originated from the mitochondria in the trophoblasts.

Discussion
This study is the first to demonstrate that placental hypoxia is associated with mitochondrial-generated reactive oxygen species and significant alterations in the molecular pathways controlling mitochondrial content and function. Furthermore, our data indicate that targeting mitochondrial oxidative stress may have therapeutic benefit in the management of pathologies related to placental hypoxia.
Efficient gene expression signature for a breast cancer immuno-subtype
Authors: Galili Ben , Tekpli Xavier , Kristensen Vessela N. , Yakhini Zohar 
Published: January 2021

Motivation and backgroundThe patient’s immune system plays an important role in cancer pathogenesis, prognosis and susceptibility to treatment. Recent work introduced an immune related breast cancer. This subtyping is based on the expression profiles of the tumor samples. Specifically, one study showed that analyzing 658 genes can lead to a signature for subtyping tumors. Furthermore, this classification is independent of other known molecular and clinical breast cancer subtyping. Finally, that study shows that the suggested subtyping has significant prognostic implications.ResultsIn this work we develop an efficient signature associated with survival in breast cancer. We begin by developing a more efficient signature for the above-mentioned breast cancer immune-based subtyping. This signature represents better performance with a set of 579 genes that obtains an improved Area Under Curve (AUC). We then determine a set of 193 genes and an associated classification rule that yield subtypes with a much stronger statistically significant (log rank p-value < 2 × 10−4in a test cohort) difference in survival. To obtain these improved results we develop a feature selection process that matches the high-dimensionality character of the data and the dual performance objectives, driven by survival and anchored by the literature subtyping.
Effect of ethanol in carbon monoxide poisoning and delayed neurologic sequelae: A prospective observational study
Authors: Choi Sungwoo , Han Sangsoo , Nah Sangun , Lee Young Hwan , Cho Young Soon , Lim Hoon , Kim Myeong Sik , Kim Gi Woon 
Published: January 2021

Objectives
Carbon monoxide (CO) is one of the most common poisoning substances, which causes mortality and morbidity worldwide. Delayed neurologic sequelae (DNS) have been reported to occur from several days to months after exposure to CO. Thus, there is a need for prevention, recognition, and treatment of DNS. Patients with CO poisoning as a component of intentional suicide often also consume ethanol, but there is debate regarding its role in DNS. We explored whether ethanol has a neuroprotective effect in CO poisoning.

Methods
This prospective observational study included patients who visited the emergency department from August 2016 to August 2019 due to CO poisoning. After treatment of acute CO poisoning, patients were interviewed by telephone to ascertain whether DNS had occurred within 2 weeks, 1 month, and 3 months from the time of CO exposure.

Results
During the study period, 171 patients were enrolled. 28 patients (16.37%) developed DNS. The initial Glasgow Coma Scale (GCS) scores were 15 (10.5–15) for the non-DNS group and 10 (7–15) for the DNS group (p = 0.002). The ethanol levels were 11.01 ± 17.58 mg/dL and 1.49 ± 2.63 mg/dL for each group (p < 0.001). In multivariate logistic regression analysis, the GCS score had an odds ratio of 0.770 (p < 0.001) and the ethanol level had 0.882 (p < 0.030) for onset of DNS.

Conclusions
Higher ethanol level and higher initial GCS score were associated with lower incidence of DNS. Ethanol could have a neuroprotective effect on the occurrence of DNS in CO poisoning patients.