bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth
Authors: Martherus Tessa , Kuypers Kristel L. A. M. , Böhringer Stefan , Dekker Janneke , Witlox Ruben S. G. M. , Hooper Stuart B. , Pas Arjan B. te 
Published: December 2021

Background: Preterm infants are commonly supported with 5–8 cmH2O CPAP. However, animal studies demonstrate that high initial CPAP levels (12–15 cmH2O) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effect in preterm infants at birth.Methods: Preterm infants (24–30 weeks gestation) were randomized to PB-CPAP or 5–8 cmH2O CPAP for the first 10 min after birth. PB-CPAP consisted of 15 cmH2O CPAP that was decreased when infants were stabilized (heart rate ≥100 bpm, SpO2 ≥85%, FiO2 ≤ 0.4, spontaneous breathing) to 8 cmH2O with steps of ~2/3 cmH2O/min. Primary outcomes were feasibility and SpO2 in the first 5 min after birth. Secondary outcomes included physiological and breathing parameters and short-term neonatal outcomes. Planned enrollment was 42 infants.Results: The trial was stopped after enrolling 31 infants due to a low inclusion rate and recent changes in the local resuscitation guideline that conflict with the study protocol. Measurements were available for analysis in 28 infants (PB-CPAP n = 8, 5–8 cmH2O n = 20). Protocol deviations in the PB-CPAP group included one infant receiving 3 inflations with 15 cmH2O PEEP and two infants in which CPAP levels were decreased faster than described in the study protocol. In the 5–8 cmH2O CPAP group, three infants received 4, 10, and 12 cmH2O CPAP. During evaluations, caregivers indicated that the current PB-CPAP protocol was difficult to execute. The SpO2 in the first 5 min after birth was not different [61 (49–70) vs. 64 (47–74), p = 0.973]. However, infants receiving PB-CPAP achieved higher heart rates [121 (111–130) vs. 97 (82–119) bpm, p = 0.016] and duration of mask ventilation was shorter [0:42 (0:34–2:22) vs. 2:58 (1:36–6:03) min, p = 0.020]. Infants in the PB-CPAP group required 6:36 (5:49-11:03) min to stabilize, compared to 9:57 (6:58–15:06) min in the 5–8 cmH2O CPAP group (p = 0.256). There were no differences in short-term outcomes.Conclusion: Stabilization of preterm infants with PB-CPAP is feasible but tailoring CPAP appeared challenging. PB-CPAP did not lead to higher SpO2 but increased heart rate and shortened the duration of mask ventilation, which may reflect faster lung aeration.
Cognitive Performance During Night Work in the Cold
Authors: Færevik Hilde , Hansen Jakob Hønborg , Wiggen Øystein , Sandsund Mariann 
Published: December 2021

Objective: The objective of this study was to investigate how night work at low ambient temperatures affects cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal comfort, sleepiness, and cortisol. We hypothesized that cognitive performance is reduced at night compared with daytime and worsened when exposed to low ambient temperatures.Method: Eleven male subjects were recruited to perform three tests in a climatic chamber at night and daytime: Night –2°C, Night 23°C and Day 23°C. Each test lasted 6 h. Cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal sensation and comfort, cortisol levels and sleepiness were measured during the tests.Results: A lower mean skin temperature and corresponding lower thermal sensation were observed at Night –2°C compared to Day 23°C and Night 23°C. Night work caused increased sleepiness and lower cortisol levels, but was not affected by changes in ambient temperatures, thermal comfort, or skin temperatures. There was no effect of either day/night work nor ambient temperature on the short-term memory or reaction time test.Conclusion: Lower skin- and core temperature were observed at night when exposed to low ambient temperature (–2°C), but there was no effect on short-term memory or reaction time. Increased sleepiness and lower cortisol levels were observed at night compared to daytime and was not influenced by low ambient temperature at night. The result from this study suggests that cognitive performance (short-term memory and reaction time) is not adversely affected by night work when exposed to low ambient temperatures if adequate protective clothing is worn.
A Universal New Definition of Heart Failure With Improved Ejection Fraction for Patients With Coronary Artery Disease
Authors: Huang Haozhang , Liu Jin , Lei Min , Yang Zhou , Bao Kunming , Li Qiang , Lai Wenguang , Wang Bo , He Yibo , Chen Shiqun , Ou Chun-Quan , Abudukerimu Maimaitiaili , Hu Yuying , Tan Ning , Chen Jiyan , Liu Yong 
Published: December 2021

Aims: The aims of this study were to describe the characteristics and outcomes of the universal new definition of heart failure with improved ejection fraction (HFimpEF) and to identify predictors for HFimpEF among patients with coronary artery disease (CAD).Methods: CAD subjects with heart failure with reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline were enrolled from the real-world registry of the Cardiorenal ImprovemeNt study from January 2007 to December 2018. The new definition of HFimpEF was defined as left ventricular EF (LVEF) of≤40% at baseline and with improvement of up to 40% and at least a ≥ 10% increase during 1 month to 1 year after discharge.Results: Of the 747 CAD patients with HFrEF (86.7% males, mean age: 61.4 ± 11 years), 267 (35.7%) patients conformed to the new HFimpEF definition. Patients with HFimpEF were younger (adjusted odds ratio [aOR]: 0.98 [0.97–0.99]) and had a higher rate of hypertension (aOR:1.43 [1.04–1.98]), lower rate of percutaneous coronary intervention (PCI) treatment at the time of detection of HFrEF (aOR: 0.48 [0.34–0.69]), history of PCI (aOR: 0.51 [0.28–0.88]), history of acute myocardial infarction (aOR: 0.40 [0.21–0.70]), and lower left ventricular end diastolic diameter (aOR: 0.92 [0.90–0.95]). During 3.3-year follow-up, patients with HFimpEF demonstrated lower rates of long-term all-cause mortality (13.1% vs. 20.8%, aHR: 0.61[0.41–0.90]).Conclusion: In our study, CAD patients with HFimpEF achieved a better prognosis compared to those with persistent HFrEF. Patients with CAD meeting the criteria for the universal definition of HFimpEF tended to be younger, presented fewer clinical comorbidities, and had lower left ventricular end diastolic diameter.
The Impact of Coping Skills in Post-traumatic Growth of Healthcare Providers: When Mental Health Is Deteriorating Due to COVID-19 Pandemic
Authors: Prekazi Lulejete , Hajrullahu Vjosa , Bahtiri Shegë , Kryeziu Blerta , Hyseni Blertë , Taganoviq Besarta , Gallopeni Florim 
Published: December 2021

Background:Frontline healthcare providers are consistently exposed to potentially traumatic events while assisting patients with COVID-19. Post-traumatic growth (PTG) happens when a person can transform trauma and use adversity in one’s advantage. In response to limited studies on positive outcomes that may occur from the pandemic; this study aimed to elucidate the positive impact of coping with COVID-19 outbreak on mental health, such as PTG.Methodology:The study comprised a sample of 691 healthcare providers 59% female, including physicians (n= 138) and nurses (n= 550), working in public health facilities in Kosovo, with an average age of 41.6 years (SD= 10.79). They were asked to complete a questionnaire with four parts: Socio-demographic, GHQ-28, COPE and PTGI. A deterioration of mental health with somatic symptoms leading to the escalation due to COVID-19 outbreak was found.Results:Female healthcare providers reported more clinical symptoms as well as higher coping skills scores than men. The domains in which positive changes were most frequently observed were Relating to Others, New Possibilities and Personal Strength. There was no significant direct effect of mental health on PTG in the mediation model, though a significant indirect effect was observed for coping skills.Conclusion:The results suggest that levels of mental health exacerbation do not play a conclusive role in determining levels of PTG, as long coping mechanisms are in place. The development and implementation of interventions to minimize COVID-19-related mental health consequences, by fostering PTG among healthcare providers could be highly beneficial in pandemic response work.
Anxiety and Insomnia Among Urban Slum Dwellers in Bangladesh: The Role of COVID-19 and Its Associated Factors
Authors: Koly Kamrun Nahar , Khanam Mosammat Ivylata , Islam Md. Saiful , Mahmood Shehrin Shaila , Hanifi Syed Manzoor Ahmed , Reidpath Daniel D. , Khatun Fatema , Rasheed Sabrina 
Published: December 2021

Background: Although mental health is an important part of health and wellbeing, very little is known about the impact of the COVID-19 pandemic on the mental health of marginalized communities like urban slum dwellers. Our study estimated the prevalence of generalized anxiety disorder and insomnia among the residents of the informal settlements of Dhaka, Bangladesh, during the COVID-19 pandemic.Methods: A cross-sectional phone-based survey was conducted from October to November 2020 among adult residents of five informal settlements of Dhaka city randomly chosen from an existing Urban Health and Demographic Surveillance Systems (UHDSS) run by icddr,b. Data on Generalized Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI) were collected. A multinomial logistic regression was performed to assess the associated factors of anxiety and insomnia.Results: Of the total 586 participants, the prevalence of mild to severe anxiety and insomnia were 53% and 43%, respectively. As per the multinomial regression analysis, participants with mild anxiety were significantly more likely to be older (&gt;50 years) and afraid of COVID-19 infection. Likewise, participants with moderate/severe anxiety were significantly more likely to share less household facilities (e.g., toilet, kitchen, water) (OR: 2.23; 95% CI: 1.31–3.79), to have difficulties in food availability (OR: 2.76; 95% CI: 1.10–6.93), to be afraid of self (OR: 5.27; 95% CI: 2.82–9.88), and to worry about the family members (OR: 2.26; 95% CI: 1.23–4.17) getting infected. Participants with mild insomnia were significantly more likely to share fewer household facilities and be afraid of being infected with COVID-19 infection. Moreover, participants with moderate/severe insomnia were significantly more likely to be female (OR: 1.90; 95% CI: 1.02–3.56), to receive food aid (OR: 0.50; 95% CI: 0.29–0.88), to be afraid of self (OR: 3.85; 95% CI: 1.81–8.19), and to worry about someone like friends or neighbors (OR: 2.45; 95% CI: 1.07–5.58) getting infected with COVID-19.Conclusions: We found elevated prevalence of both anxiety and insomnia among the urban poor of Bangladesh in the context of COVID-19. This indicates the importance of integrating mental health in the mitigation and recovery efforts related to similar crises for the urban poor in the future.
Associated Effects of Meaning in Life and Social Adjustment Among Chinese Undergraduate Students With Left-Behind Experiences in the Post-epidemic Period
Authors: Ge Ying , Shuai Mei-Qiong , Luo Jie , Wenger Jay L. , Lu Cun-Yang 
Published: December 2021

Background: The outbreak of COVID-19 has brought about radical changes in social life. The study focuses on a special group, Chinese undergraduate students with left-behind experiences. Specifically, the study addresses how such students feel and grasp the meaning in life and how they adapt to the current social environment after experiencing the impermanence of life. The correlation between the meaning in life and social adjustment in the post-epidemic period is evaluated.Methods: The Meaning in Life Scale and the Social Adjustment Scale were used to test 988 undergraduate students. Multi-factor analysis, correlation, regression, and dominance analysis were performed on the test results.Results: (1) During the epidemic, Chinese undergraduate students generally had low meaning in life scores, including below-average values for life goals, and middle-range scores for social adjustment. (2) Having or not having left-behind experiences had an important influence on the meaning in life and social adjustment of undergraduates: undergraduates with left-behind experiences performed better than those without left-behind experiences in terms of meaning in life, while their social adjustment was weaker than those without left-behind experiences. (3) The zest for life and freedom of life of undergraduates in both groups negatively predicted social adjustment, and zest for life preferentially influenced social adjustment. Zest for life also had a significant effect on life value in the group without left-behind experiences. Zest for life was a priority factor influencing social adjustment.Conclusion: The epidemic and left-behind experiences are important factors influencing the relationship between meaning in life and social adjustment among Chinese undergraduate students.
Number of Seclusions in the Netherlands Higher in the 7 Years Since the End of a Nationwide Seclusion-Reduction Program
Authors: Vruwink Fleur J. , Wierdsma André , Noorthoorn Eric O. , Nijman Henk L. I. , Mulder Cornelis L. 
Published: December 2021

Introduction: Between 2006 and 2012 the Dutch government funded a nationwide program for reducing the use of seclusion. Although an initial first trend study showed that the reported number of seclusions declined during the program, the objective of a 10% annual decrease was not met. We wished to establish whether the decline had continued after funding ended in 2012.Method: Using quasi Poisson time series modeling, we retrospectively analyzed the nationally reported numbers of seclusion and involuntary medication between 1998 and 2019, i.e., before, during and after the end of the nationwide program, with and without correction for the number of involuntary admissions.Results: With and without correction for the number of involuntary admissions, there were more seclusions in the seven years after the nationwide program than during the nationwide program. Although the reported number of involuntary medications also increased, the rate of increase was slower after the end of the nationwide program than before.Conclusions: Rather than continuing to decrease after the end of the nationwide program, the number of seclusions rose. This may mean that interventions intended to reduce the use of seclusion within this program are not properly sustained in daily clinical care without an ongoing national program.
Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study
Authors: Bejerot Susanne , Hylén Ulrika , Glans Martin , Hesselmark Eva , Humble Mats B. 
Published: December 2021

Background: Individuals with generalised joint hypermobility (GJH, present in 10–20% of the general population) are at increased risk of being diagnosed with a range of psychiatric and rheumatological conditions. It is unknown whether Paediatric acute-onset neuropsychiatric syndrome (PANS), characterised by childhood onset obsessive-compulsive disorder or restricted eating and typically associated with several comorbid neuropsychiatric symptoms, is associated with GJH. It is also unknown whether extensive psychiatric comorbidity is associated with GJH.Method: This is a case-control study including 105 participants. We compared three groups: Individuals with PANS, individuals with other mental disorders and healthy controls. Joint mobility was assessed with the Beighton scoring system, psychiatric comorbidity with the M.I.N.I. or MINI-KID interview and symptoms of PANS with the PsychoNeuroInflammatory related Signs and Symptoms Inventory (PNISSI).Results: Hypermobility was similar across groups, and high rates of psychiatric comorbidity was not associated with higher Beighton scores.Conclusion: Although GJH is associated with several psychiatric conditions, such as ADHD and anxiety, this does not seem to be the case for PANS according to this preliminary study.
Longitudinal Effects of Stressful Life Events on Problematic Smartphone Use and the Mediating Roles of Mental Health Problems in Chinese Undergraduate Students
Authors: Zhao Chengjia , Ding Nani , Yang Xue , Xu Huihui , Lai Xinyi , Tu Xiaolian , Lv Yijun , Xu Dongwu , Zhang Guohua 
Published: December 2021

Background and Aims: This three-wave longitudinal study investigated the effects of stressful life events on problematic smartphone use and the mediating roles of mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) in Chinese undergraduate students.Methods: A total of 197 undergraduate students completed the three-wave surveys. Their severity of stressful life events, mental health problems, and problematic smartphone use were assessed.Results: Regression analyses revealed that stressful life events at T1 was significantly associated with problematic smartphone use at T3. Mediation analyses showed that mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) at T2 fully mediated the association between stressful life events at T1 and problematic smartphone use at T3 (B = 0.042, 0.034, and 0.022, respectively).Conclusions: The present study revealed that stressful life events and mental health problems (i.e., depressive symptoms, poor sleep quality, and suicidal ideation) are predictors of problematic smartphone use in Chinese college students.
Rare Malignant Indications for Liver Transplantation: A Collaborative Transplant Study Report
Authors: Houben Philipp , Schimmack Simon , Unterrainer Christian , Döhler Bernd , Mehrabi Arianeb , Süsal Caner 
Published: December 2021

Introduction: Hepatocellular carcinoma (HCC) is by far the leading malignant indication for liver transplantation (LT). Few other malignancies, including cholangiocellular carcinoma (CCC), metastases from neuroendocrine tumors (NET), and sarcomas of the liver (LSAR), also are commonly accepted indications for LT. However, there is limited information on their outcome after LT.Methods: Graft and patient survival in 14,623 LTs performed in patients with hepatocellular carcinoma, CCC, NET, and LSAR from 1988 to 2017 and reported to the Collaborative Transplant Study were analyzed.Results: The study group consisted of 13,862 patients who had HCC (94.8%), 498 (3.4%) who had CCC, 100 (0.7%) who had NET, and 163 (1.1%) who had LSAR. CCC patients showed a 5-year graft survival rate of 32.1%, strikingly lower than the 63.2% rate in HCC, 51.6% rate in NET, and 64.5% rate in LSAR patients (P &lt; 0.001 for all vs. CCC). Multivariable Cox regression analysis revealed a significantly higher risk of graft loss and death due to cancer during the first five post-transplant years in CCC vs. HCC patients (HR 1.77 and 2.56; P &lt; 0.001 for both). The same risks were increased also in NET and LSAR patients but did not reach statistical significance.Conclusion: Among patients with rare malignant indications for LT, CCC patients showed significantly impaired graft as well as patient survival compared to HCC patients. The observed differences might challenge traditional decision-making processes for LT indication and palliative treatment in specific hepatic malignancies.
How do people with knee osteoarthritis perceive and manage flares? A qualitative study
Authors: Parry Emma , Dikomitis Lisa , Peat George , Chew-Graham Carolyn A 
Published: December 2021

BackgroundAcute flares in people with osteoarthritis (OA) are poorly understood. There is uncertainty around the nature of flares, their impact, and how these are managed.AimTo explore understandings and experiences of flares in people with knee OA, and to describe self-management and help-seeking strategies.Design & settingQualitative interview study of people with knee OA in England.MethodSemi-structured interviews were undertaken with 15 people with knee OA. Thematic analysis was applied using constant comparison methods.ResultsThe following four main themes were identified: experiencing pain; consequences of acute pain; predicting and avoiding acute pain; and response to acute pain. People with OA described minor episodes that were frequent, fleeting, occurred during everyday activity, had minimal impact, and were generally predictable. This contrasted with severe episodes that were infrequent, had greater impact, and were less likely to be predictable. The latter generally led to feelings of low confidence, vulnerability, and of being a burden. The term ‘flare’ was often used to describe the severe events but this was applied inconsistently and some would describe a flare as any increase in pain. Participants used numerous self-management strategies but tended to seek help when these had been exhausted, their symptoms led to emotional distress, disturbed sleep, or pain experience worse than usual. Previous experiences shaped whether people sought help and who they sought help from.ConclusionSevere episodes of pain are likely to be synonymous with flares. Developing a common language about flares will allow a shared understanding of these events, early identification, and appropriate management.
Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis
Authors: Sampson Chris , Bell Eleanor , Cole Amanda , Miller Christopher B , Marriott Tracey , Williams Matt , Rose James 
Published: December 2021

BackgroundSleepio is an automated digital program that delivers digital cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties; however, evidence for the possible impact of Sleepio use on healthcare costs in the UK has not, to the authors’ knowledge, previously been developed.AimTo identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the NHS in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series (ITS) to compare the trend in primary care costs before and after the rollout of Sleepio.MethodPrimary care data for people with relevant characteristics from nine general practices in Buckinghamshire was used. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10 705 patients included in the sample, the total saving over the 65-week follow-up period was £71 027. This corresponds to £6.64 per person in the sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.