bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective analysis of gender-related characteristics in relation to cardiovascular disease in a population-based cohort in Amsterdam: the HELIUS study
Authors: Bolijn R , Kunst A E , Appelman Y , Galenkamp H , Moll Van Charante E P , Stronks K , Tan H L , Van Valkengoed I G M 
Published: October 2021

Abstract

Background
Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise.

Purpose
We aimed to establish the associations between selected gender-related characteristics and CVD incidence.

Methods
We linked baseline data of 18,058 participants without CVD from the multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013–2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status.

Results
In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35–4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34–0.95).

Conclusion
Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies, particularly in women.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw Gender and Health (grant number 8492ehab724.26598) and Gender and Prevention (grant number 555003016) programmes.European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381) and the COST Action PARQ (grant agreement number CA19137).
Post-COVID-19 syndrome: prospective evaluation of clinical and functional outcomes
Authors: Ybarra Falcon C , Aparisi A , Garcia Gomez M , Iglesias Echeverria C , Tobar J , Ladron R , Uribarri A , Jaurrieta Largo S , Catala P , Hinojosa W , Veras Burgos C , Marcos Mangas M , Carrasco Moraleja M , Amat Santos I J , San Roman Calvar A 
Published: October 2021

Abstract

Introduction
Coronavirus disease 2019 (COVID-19) is a highly pathogenic coronavirus characterized by by systemic inflammatory response with endothelial damage and a dysregulated coagulation system. Despite most patients survive the acute setting of COVID-19, their long-term clinical sequelae are highly unclear. We have sought to identify the impact of post-COVID-19 syndrome on mid-term follow-up and gain some additional insights about the potential explanation for persistence of dyspnea.

Methods
This is a 3-month prospective cohort study of previously hospitalised COVID-19 patients recruited from a single Spanish center, a small outpatient group without prior hospitalisation was also evaluated. Patients underwent serial testing with cardio-pulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis and quality of life questionaries. They were classify according to the presence of persistent dyspnea. Primary study outcome was predicted peak oxygen consumption (V02) according to CPET and predicted carbon monoxide diffusion capacity.

Results
Our study included 41 (58.6%) patients with dyspnea and 29 (41.4%) asymptomatic. Symptomatic patients had a higher proportion of females (73.2% vs. 51.7%), but comparable age and prevalence of cardiovascular risk factors. We did not observe differences among the assessed variables in transthoracic echocardiogram and pulmonary function test. Patients who referred dyspnea had smaller predicted peak O2 consumption (77.8 [64–92.5] vs. 99 [88–105]: p&lt;0.001), total distance in the 6-minute walking test (535 [467–600] vs. 611 [550–650] meters; p=0.001), and quality of life (KCCQ-23 60.1±18.6 vs. 82.8±11.3; p&lt;0.001). Additionally, abnormalities in CPET were suggestive of a ventilation/perfusion misthmach or hyperventilatory syndrome characterized by impaired ventilatory efficiency with a greater VE/VCO2 slope (32 [28.1–37.4] vs. 29.4 [26.9–31.4]; p=0.022) and low PETCO2 (34 [32–39] vs. 38 [36–40]; p=0.025).

Interpretation
In this study &gt;50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Compared to asymptomatic patients, among those who referred dyspnea our findings suggest potential ventilatory inefficiency.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Gerencia Regional de Salud de Castilla y Leόn; Grant from the Spanish Society of Cardiology Tabla de resultados
Digital therapeutics: a systematic review of clinical trials characteristics
Authors: Santoro E , Boscherini L , Caiani E G 
Published: October 2021

Abstract

Introduction
Digital therapeutics (DTx) are a subset of digital health tools delivering evidence-based therapeutic interventions that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are studied using randomized clinical trial methodology and reviewed, cleared or certified by regulatory bodies as required to support product claims regarding risk, efficacy, and intended use.

Purpose
To perform a systematic review of clinical research/studies conducted in the field of DTx with the aim to describe studies where DTx were used, classifying them by digital intervention and condition, and analysing and reporting the characteristics of clinical trials.

Methods
The U.S. National Library of Medicine ClinicalTrials.gov was searched using the terms “digital therapeutics”, “digital therapeutic”, “digital therapy”, and “digital therapies” within the fields “Intervention/treatment” and “Title/Acronym”, and the resulting trial characteristics were extracted and analysed.

Results
In total, 560 clinical trials were retrieved on January 10, 2021. Most of them (n=424, 75.7%) were excluded because they were observational studies (n=82), non-randomized/single arm assignment studies (n=123), not involving any digital health tool (n=181), or involving digital health tools not classified as DTx (n=38). Of the remaining 136 trials, the DTx intervention was delivered through apps (n=57, 41.9%), web-based systems (n=35, 25.7%), videogames (n=12, 8.8%), virtual reality (n=6, 4.4%), text messages (n=5, 3.7%), social media platform (n=4, 2.9%), computer-based systems (n=3, 2.2%), or other (n=14, 10.3%), and applied to the following clinical scenarios: mental health (n=47, 34.6%), chronic pain and chronic diseases (n=26, 19.1%), smoking and other substances abuse or addiction (n=17, 12.5%), insomnia and sleeping disorders (n=12, 8.8%), obesity and physical activity (n=11, 8.1%), cardiovascular diseases (n=10, 7.3%), and other conditions (n=13, 9.6%). Apps were used more frequently for chronic pain (54%) and sleeping disorders (67%), while videogames and web-based systems were adopted for mental health in 21.3% and 38% of the trials, respectively, and text messages were preferred in 18.2% of obesity and 17.6% of addiction trials, respectively Sixty-eight trials (50%) started in the last three years (2019, 2020, and 2021), while 54.4% were ongoing, 33.8% completed, 2.9% stopped early, and 8.8% with status unknown.

Conclusions
The term “digital therapeutics” was very often incorrectly used by researchers when they register their trials in ClinicalTrials.gov, improperly including studies involving the use of digital health tools to support a drug intake or monitor a condition. Mobile apps, web-based systems and videogames were the most adopted technologies to deliver DTx, while mental health diseases, chronic pain, and addiction were the conditions in which they were most frequently studied.

Funding Acknowledgement
Type of funding sources: None.
The use of elctronic cigarettes among medical student in Casablanca
Authors: Tsoumbou-Bakana G , Alafifi Y , Traore B , Hassoune S , Nani S 
Published: October 2021

Abstract

Introduction
The electronic cigarette is an electronic device containing or not nicotine that produces vapours that are inhaled by users, thus mimicking the use of conventional cigarettes. These devices nevertheless contain components that are harmful to health. They have become particularly popular in recent years, especially among young people.

Objective
To estimate the frequency of e-cigarette use among medical students and to describe perceptions and practices of e-cigarette use.

Methods
This was a descriptive cross-sectional study conducted from August 2020 to March 2021 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. The data were collected through a selfadministered, pre-tested, online questionnaire. The sample size was calculated a priori and statistical analyses were carried out using RStudio software.

Results
A total of 491 students were collected with a mean age of 21.03+/- 2.35 years, 66% were female, 51.9% were undergraduates and 20.6% were first year students. The frequency of e-cigarette use was 20.2%, and smoking was 20.8%. Of the 99 e-cigarette users, 75.75% had used e-cigarettes in the past 12 months. More than 21.9% of e-cigarette users used it daily, the most frequent reasons for use were curiosity (88.6%) and imitation (58.4%). Regarding perceptions, 22.1% felt more or less informed about the risks of e-cigarettes, 54.8% agreed that e-cigarettes are an effective way to quit smoking and 29.5% thought they would be more effective than nicotine replacement therapies.

Conclusions
The frequency of e-cigarette use is high among future doctors despite their knowledge of the health effects of its use. Preventive measures should be implemented to improve the health of students.

Key messages
Medical student are a subgroup particulary vulnarable to e-cigarette use. The perceptions of medical students, future health care providers, are heterogeneous.
Hospital Patients’ migration among Italian Regions
Authors: Nante N , Guarducci G , Messina G , Fabrizio M , Urbani A 
Published: October 2021

Abstract

Background
At the beginning of the 2000s the federalization of the Italian National Health Service gave to the Regions greater financial and political responsibility: 21 Regional Health Services were set up with administrative and planning independence. They are in a potential competitive regime, since the citizens are free to choose their place of treatment. The aim of our research was to analyze fulfillment of needs for hospital services on site and Patients' migration to hospitals of other Regions.

Methods
We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2013 to 2017. The subjects of the analysis (catchment areas) were the hospital networks of Italian Regions. Interregional flows were carried out from data of Residents, Attractions and Escapes, which were developed through Attraction and Escape Indexes. Graphic representation was produced with Gandy's Nomogram.

Results
In the studied period, we observed an important decrease in hospitalizations and a simultaneous increase in interregional mobility. At the same time, admissions to hospital managed by Local Health Authorities and to Private Clinics increased. According to the Major Diagnostic Categories the main causes of hospitalizations in mobility were Musculoskeletal System And Connective Tissue Diseases (MDC 8), Cardiovascular System Diseases (MDC 5), Nervous System Diseases (MDC 1) and Digestive System Diseases (MDC 6). There were discrepancies between the Regions of Northern/Central Italy (higher Attraction Indexes) and Southern Italy (higher Escape Indexes). According to Gandy's Nomogram only nine Regions showed a good public hospital planning: Lombardy, A.P. of Bolzano, Veneto, Friuli V.G., E. Romagna, Tuscany, Umbria, Latium and Molise.

Conclusions
The North/Centre Regions have a public hospital planning able to be better to meet the care needs of their citizens and to attract Patients than the South ones.

Key messages
The study of Patients’ mobility is relevant in order to evaluate equity and quality of care provided by different Italian Regions. Patients' mobility has also an important economic implications.
Italian health workers’ knowledge, attitudes and behaviours towards COVID-19 vaccination
Authors: Regazzi L , Paladini A , Marziali E , Lontano A , Calabrò G E , Messina R , Laurenti P , Boccia S , Ricciardi W , Cadeddu C 
Published: October 2021

Abstract

Background
Vaccine hesitancy is the reluctance or refusal to be vaccinated. While it has been widely studied for various contagious diseases, there is still a lack of knowledge about this phenomenon for COVID-19, especially if health workers' hesitancy is considered.

Methods
An extensive review of the literature was conducted to identify the main determinants of vaccine hesitancy in health workers, as well as to find already validated surveys to evaluate the knowledge, attitudes and behaviors (KAB) of health workers towards vaccination, both in general and with specific regard to COVID-19. Building on the available information, a new survey was developed to assess the KAB of Italian health care workers towards COVID-19 vaccination after validation with a pilot study in a diverse sample of 30 Italian health workers.

Results
A new survey was validated to assess the KAB of health workers towards COVID-19 vaccination in Italian health workers. The survey requires about 6 minutes to complete and is composed of 30 questions, investigating different domains: socio-demographic and professional characteristics (6); health status (2); attitudes (11); behaviors (6); knowledge (4). The survey will be administered to a representative sample of at least 385 Italian health workers through the web platform SurveyMonkey in the period June-September 2021. Preliminary results will be available by the end of October 2021.

Conclusions
By analyzing KAB towards COVID-19 vaccination with a new tool, the magnitude and determinants of health worker's COVID-19 vaccine hesitancy will be evaluated to understand how to improve health workers' perception towards COVID-19 vaccination and, consequently, foster their positive influence on the general population.

Key messages
We explore the knowledge, attitudes and behaviors towards COVID-19 vaccination in all categories of health workers operating on the Italian territory to understand the reasons of vaccine hesitancy. Understanding the determinants of COVID-19 vaccine hesitancy in Italian health workers is necessary given their influence on the perception of the general population in Italy.
The impact of a printed educational booklet on disease awareness in women with gestational diabetes
Authors: Staynova R , Vasileva E , Stankova T , Yanachkova V 
Published: October 2021

Abstract

Background
Gestational diabetes mellitus (GDM) is a major health concern which could lead to adverse pregnancy outcomes. Women with newly diagnosed GDM need additional information and education about this pregnancy complication. The aim of current study was to evaluate the impact of a printed educational booklet on disease awareness in women with GDM.

Methods
One hundred and thirty-five pregnant women with newly diagnosed GDM who attended antenatal clinic were randomly assigned to either an intervention (n = 45) or a control group (n = 90). The women from intervention group received additional printed educational booklet about GDM management, while patients from the control group received standard care. The booklet includes information about risk factors, treatment alternatives, self-monitoring of blood glucose, nutritional management and lifestyle modification. After one month a self-administered written questionnaire was used for evaluation of women's knowledge about GDM management. Descriptive statistics and chi-square test were used to analyse the data.

Results
Demographic and maternal characteristics were similar in both groups. The overall mean age was 32.3 years ranging from 24 to 45. The correct answers about diabetes complications awareness were reported in more than 50% of women in both groups. There was a significant difference in knowledge about the risk factors for GDM (85% in the intervention group versus 44% in the control group, P &lt; 0.001). The number of correct answers was higher in the intervention group regarding GDM treatment (92% compared to 79% in the control group, P &lt; 0.01), self-monitoring of blood glucose and outcomes of GDM (P &lt; 0.001). The differences in nutritional knowledge were not statistically significant.

Conclusions
The results from the study show that printed educational materials can improve patients' knowledge about GDM management as well as their health literacy and motivation.

Key messages
Providing a printed educational booklet in addition to standard pregnancy care for women with GDM may be beneficial for achieving therapeutic goals. The booklet used in this study could assist healthcare providers in improving the knowledge and educational process of women with GDM.
Adverse childhood experiences and risky behaviours in two Tunisian University Hospitals
Authors: Mlouki I , Nouira S , Omrane A , Ourchefeni M , Omri N , Youssef F Ben , Sfar H , El Absi M , El Mhamdi S 
Published: October 2021

Abstract

Introduction
According to the Health Word Organization (WHO), adverse childhood experiences (ACEs) have several harmful outcomes on mental health in adolescence and later life. We aimed at investigating the relationship between ACEs and risky behaviors among Tunisian health professionals.

Methods
A cross sectional study was conducted between November 2018 and March 2019 among health care workers in two University Hospitals in Tunisia. We assessed exposure to violence in the hospital, behavioral (cyberaddiction) and chemical addiction (tobacco and alcohol use). ACEs were screened using the Arabic validated version of the Adverse childhood experiences-International Questionnaire (ACE-IQ) developed by the WHO.

Results
A total of 546 health professionals were enrolled with a mean age of 34.5 ± 9.6 years and a majority being female (70%). Almost 34.8% were doctors. The majority of them (67.3%) reported exposure to physical violence at work by patient or their families. The most common hazardous practice was internet addiction (18.5%) followed by tobacco use (13.2%). All health risk behaviors were significantly more prevalent among males and youth (&lt;35 years) (p &lt; 0.01). After adjustment for violence at work and socidemographic characteristics, logistic regression revealed that ACEs especially physical violence (OR = 1.8; IC [1.1-2.9]), emotional abuse (OR = 4.5 [1.2-16.6]) and bullying (OR = 2.6 [1.6-4.2]) increase the risk of the adoption of addictive behaviors among health caregivers.

Conclusions
Policy makers might implement collaborative interventions with psychiatrics targeting the prevention of early life adversities, this could be helpful to delay the onset of risky behaviors.

Key messages
Exposure to early life adversities increase the risk of addictive behaviors among health caregivers. Collaborative interventions with psychiatrics targeting screening childhood adversities could be helpful to delay the onset of risky behaviours.
Risk factors associated with Salmonella specific antimicrobial resistance: animal and meat samples
Authors: Costa M , Cardo M , Cara d'Anjo M , Leite A 
Published: October 2021

Abstract

The food system is seen as a major source of antimicrobial resistance (AMR), a threat that has led to an increase of the global burden of infectious diseases. Thus, AMR occurrence was studied in animals and derived meat from Portugal, 2014-2018. AMR surveillance data from Portugal was used. Salmonella AMR was estimated for broilers, laying hens, broiler and pig meat. AMR associated factors were studied: population, year, season, sampler, (HACCP, industry, official, official/industry). AMR occurrence in more than half isolates was assessed using a multivariate logistic regression and a backward stepwise method for each antimicrobial class model, presenting adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). This study included 832 Salmonella isolates. Resistance to more than half isolates was observed to (fluoro)quinolones (broilers:52%; broiler meat:53%), penicillins (pig meat:56%), tetracyclines (pig meat:80%), sulphonamides (pig meat:62%). AMR was more likely to occur to penicillins, tetracyclines, sulphonamides in broiler meat (respectively, aOR 3.18;95%CI 1.95-5.18, 3.38;95%CI 1.27-9.19, 2.46;95%CI 1.44-4.19) and pig meat (respectively, aOR 9.39;95%CI 6.01-14.51, 53.84;95%CI 21.61-144.91, 14.58;95%CI 9.16-23.66), compared to broilers. A lesser AMR chance was observed to (fluoro)quinolones in 2017 and 2018 (respectively, aOR 0.07;95%CI 0.00-0.36, 0.13;95%CI 0.06-0.24) while a higher chance was found to tetracyclines in 2016 and 2018 (respectively, aOR 8.08;95%CI 2.25-30.74, 2.56;95%CI 1.14-6.00), compared to 2014. A higher chance for resistance was detected in spring to (fluoro)quinolones (aOR 2.32;95%CI 1.23-4.46) and penicillins (aOR 2.11;95%CI 1.20-3.78) and summer to (fluoro)quinolones (aOR 2.77;95%CI 1.46-5.35), compared to winter. These results indicate a need to reinforce biosecurity and disease prevention during spring and summer to tackle penicillins, tetracyclines and sulphonamides AMR in animal meat, but also (fluoro)quinolones in broilers.

Key messages
Biosecurity and prevention measures need to be reinforced during spring and summer to mitigate Salmonella AMR occurrence across the food system. Critical AMR occurrence to (fluoro)quinolones was found to be more associated with broilers.
Studying mutation rate evolution in primates—the effects of computational pipelines and parameter choices
Authors: Pfeifer Susanne P 
Published: October 2021

Abstract
This commentary investigates the important role of computational pipeline and parameter choices in performing mutation rate estimation, using the recent article published in this journal by Bergeron et al. entitled “The germline mutational process in rhesus macaque and its implications for phylogenetic dating” as an illustrative example.