bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study
Authors: Anderberg Mats , Dahlberg Mikael , Wennberg Peter 
Published: March 2021

Aim: There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden. Design: The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis. Results: Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome. Conclusion: The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.
The construction of meaning in alcohol addiction: A narrative study of socially excluded people’s stories about alcohol
Authors: Eriksen Line Lund , Hoeck Bente 
Published: March 2021

Aim: The aim of this study is to illuminate the experience of living with alcohol addiction from the perspective of socially excluded people outside the healthcare system. It presents the results from a qualitative study of five personal narratives from socially excluded men living with alcohol addiction in Denmark. The group is rarely heard and often underprioritised in the Danish healthcare system, contributing to the social inequality in public health. Therefore, giving them a voice will contribute important insight into the individuals’ own experiences and understandings of their situations. Design: Five semi-structured interviews were conducted with socially excluded people living with alcohol addiction. Positioned in a narrative methodology, the focus of the study was on the construction of meaning on a structural, performative and thematic level of the narratives of addiction, as told by the person with addiction. Results: Social identities as “alcoholics” were constructed across the narratives; however, there was a distinct difference between the different informants’ own positions. Some constructed meaning in their addiction by including an identity as a stereotypical “drunk” defined as a certain type of unhealthy, unkempt, low-income addict. Others distanced themselves from this identity. Furthermore, alcohol was presented with a double meaning, being associated with positive memories and relationships as well as negative consequences and bad experiences, complicating a potential wish for sobriety. Conclusions: The study illuminates the individual perspectives in the identity construction of socially excluded people with alcohol addiction. When relating to the characteristics of the stereotypical “drunk”, the individuals’ self-perspectives may differ from the common understanding. The constructed identities reflected the participants’ lived experience with addiction, with alcohol as an unavoidable life companion, consequently creating individual meaning in one’s addiction.
Colour stability of 3D-printed resin orthodontic brackets
Authors: Haynie Allison S , English Jeryl D , Paravina Rade D , Moon Audrey , Hanigan James , Abu Al Tamn Mustafa A , Kasper F Kurtis 
Published: March 2021

Objective: To evaluate the colour stability of polymeric resins that could be used to 3D-print orthodontic brackets. Design: In vitro, laboratory study Materials and Methods: Disc-shaped specimens were fabricated via 3D printing using three resins: Dental LT; Dental SG; and Clear. Five conditions were evaluated for each resin (n = 10 per treatment per resin) to assess its corresponding effect on colour and translucency: immersion in (1) red wine, (2) coffee, (3) tea and (4) distilled water (control), and (5) exposure to accelerated aging. Colour and translucency measurements were made before and after exposure using a spectrophotometer. Mean colour differences (ΔE00) and changes in translucency parameter (ΔTP00) were calculated for each sample using the CIEDE2000 colour difference formula. Results: Statistically significant effects of the resin material, the treatment condition and interactions effects of material and condition were observed for ΔE00 and ΔTP00 ( P < 0.001). The most pronounced changes in colour (ΔE00) were a result of the staining effects of wine on all three resins, ranging from 14.5 ± 0.6 to 20.8 ± 1.2. Dental LT, Dental SG and Clear resins all showed changes in colour when exposed to certain staining agents. Dental SG and Clear resins exhibited changes in colour with aging, while the colour of Dental LT resin remained stable with aging. Conclusions: The colour changes of the resins investigated does not support their use in 3D-printed aesthetic bracket applications.
Time-dependent shift of the relationship between systolic blood pressure and clinical outcome in acute lacunar stroke
Authors: Shin Dong W , Gorelick Philip B , Bae Hee-Joon ,   the Clinical Research Collaboration for Stroke in Korea (CRCS-K) Investigators
Published: March 2021

Background and aims This study explores the relationship between systolic blood pressure during the acute period of stroke and poor functional outcome in patients with lacunar stroke, emphasizing a possible time-dependent nature of the relationship. Methods Based on multicenter stroke registry data, patients with acute lacunar stroke were identified, and systolic blood pressure levels at eight time points (1, 2, 4, 8, 16, 24, 48, and 72 h) after stroke onset were extracted at the 15 participating centers in South Korea. Poor functional outcome was defined as a three-month modified Rankin Scale score of 2–6. Non-linear restricted cubic spline and linear models were used for assessing the relationship at each time point. Results A total of 97,349 systolic blood pressure measurements of 3,042 patients were analyzed. At 1 h and 4 h after stroke onset, the relationship between systolic blood pressure and poor outcome showed a non-linear association. The nadir was 155 mmHg at 1 h and 124 mmHg at 4 h. After this time period, a higher systolic blood pressure was associated with a poorer outcome. This linear relationship weakened over time after 12 h (coefficient values of the adjusted linear models: 0.0081 at 8 h, 0.0105 at 12 h, 0.0102 at 24 h, 0.0082 at 48 h, 0.0054 at 72 h). Conclusions Based on our cohort of large number of lacunar stroke patients, our findings suggest that systolic blood pressure levels may follow a time-dependent course in relation to prediction of outcome at three months. The findings may be valuable for hypothesis generation in association with clinical trial development for blood pressure control in acute stroke patients.
Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms
Authors: Nogueira Raul G , Jovin Tudor G , Haussen Diogo C , Gupta Rishi , Jadhav Ashutov , Budzik Ronald F , Baxter Blaise , Krajina Antonin , Bonafe Alain , Malek Ali , Narata Ana Paula , Shields Ryan , Zhang Yanchang , Morgan Patricia , Bartolini Bruno , English Joey , Mohammaden Mahmoud , Frankel Michael R , Liebeskind David S , Veznedaroglu Erol ,   for the Trevo Registry and DAWN Trial Investigators
Published: March 2021

Background The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized. Aim We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows. Methods Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6 h) or extended (>6–24 h) treatment window. Patients with baseline National Institutes of Health Stroke Scale (NIHSS) ≥ 10 and intracranial internal carotid artery or middle cerebral artery-M1-segment occlusion and pre-morbid modified Rankin scale (mRS) 0–1 (“DAWN-like” cohort) served as the population for the primary analysis. The relationship between time to treatment and 90-day mRS, analyzed in ordinal (mRS shift) and dichotomized (good outcome, mRS 0–2) fashion, was compared within and across the extended and early windows. Results A total of 1603 out of 2008 patients qualified. Despite longer time to treatment (9[7–13.9] vs. 3.4[2.5–4.3] h, p < 0.001), extended-window patients ( n = 257) had similar rates of symptomatic intracranial hemorrhage (sICH; 0.8% vs. 1.7%, p = 0.293) and 90-day-mortality (10.5% vs. 9.6%, p = 0.714) with only slightly lower rates of 90-day good outcomes (50.4% vs. 57.6%, p = 0.047) versus early-window patients ( n = 709). Time to treatment was associated with 90-day disability in both ordinal (adjusted odd ratio (aOR), ≥ 1-point mRS shift: 0.75; 95%CI [0.66–0.86], p < 0.001) and dichotomized (aOR, mRS 0–2: 0.73; 95%CI [0.62–0.86], p < 0.001) analyses in the early- but not in the extended-window (aOR, mRS shift: 0.96; 95%CI [0.90–1.02], p = 0.15; aOR, mRS0–2: 0.97; 95%CI [0.90–1.04], p = 0.41). Early-window patients had significantly lower 90-day functional disability (aOR, mRS shift: 1.533; 95%CI [1.138–2.065], p = 0.005) and a trend towards higher rates of good outcomes (aOR, mRS 0–2: 1.391; 95%CI [0.972–1.990], p = 0.071). Conclusions The impact of time to thrombectomy on outcomes appears to be time dependent with a steep influence in the early followed by a less significant plateau in the extended window. However, every effort should be made to shorten treatment times regardless of ischemia duration.
The smoking-dyslipidaemia dyad: A potent synergistic risk for atherosclerotic coronary artery disease
Authors: Prakash Vineet , Jaker Sams , Burgan Amjad , Jacques Adam , Fluck David , Sharma Pankaj , Fry Christopher H , Han Thang S 
Published: March 2021

Background Smoking and dyslipidaemia are known individual risk factors of coronary artery disease (CAD). The present study examined the combined risk of smoking and dyslipidaemia on coronary atherosclerosis. Methods Coronary artery calcium (CAC), measured by cardiac CT, was used to assess the extent of CAD, which was related to smoking and dyslipidaemia using logistic regression, adjusted for age, sex, hypertension, BMI and family history of ischaemic heart disease. Results Seventy-one patients (46 men, 25 women: median age of 53.7yrs; IQR = 47.0–59.5) were recruited. The mean log10 CAC score in never-smokers without dyslipidaemia (reference group) was 0.37 (SD = 0.73), while the value in those with a history of smoking was 0.44 ± 0.48 (mean difference: 0.07, 95%CI:–0.67 to 0.81, p = 0.844), dyslipidaemia was 1.07 ± 1.08 (mean difference: 0.71, 95%CI: 0.24 to 1.17, p = 0.003), and both risk factors was 1.82 ± 0.64 (mean difference: 1.45, 95%CI:0.88 to 2.02, p < 0.001). For individuals in the reference group, the proportions with none, one and multiple vessel disease were 80.6%, 16.1% and 3.2%; for those with a history of smoking or with dyslipidaemia were 50.0%, 25.0% and 25.0%; and for those with both risk factors were 8.3%, 25.0% and 66.7%. Patients with a history of both risk factors had greater adjusted risks of having one- vessel disease - OR = 14.3 (95%CI = 2.1–98.2) or multiple vessel disease: OR = 51.8 (95%CI = 4.2–609.6). Conclusions Smoking and dyslipidaemia together are associated with high coronary artery calcification and CAD, independent of other major risk factors.
Remote certification of out-of-hospital deaths in a Canadian Province: An 8-year experience of a novel practice
Authors: Tanguay Alain , Lebon Johann , Hébert Denise 
Published: March 2021

Introduction: Certification of out-of-hospital deaths is challenging as physicians are often unavailable at the scene. In these situations, emergency medical services will generally transport the decedent to the nearest hospital. In 2011, a remote death certification program was implemented in the province of Québec, Canada. The program was managed through an online medical control center and enabled death certification by a remote physician. We sought to evaluate the implementation and feasibility of the remote death certification program and to describe the challenges we experienced. Methods: We retrospectively reviewed all remote death certification requests received at the online medical control center between 2011 and 2019. Data were collected from the online medical control center database and records. Feasibility was determined by evaluating the remote death certification rate. Results: Overall, 84.1% of remote death certification requests were realized, producing a total of 9776 death certificates. Male decedents accounted for 61.5% of remote death certification requests and were more likely than females to undergo a coroner’s investigation for cause of death (36.3% vs 20.8%, p = 0.017). Urban/mixed regions had higher rates of achieved remote death certifications (mean 87.3% vs 76.9%, p = 0.033) and putrefied bodies (mean 3.8% vs 2.2%, p = 0.137) compared to rural regions. Among unrealized remote death certification requests, the most common reason was failure of relatives to designate a funeral home (36.8%). Conclusion: Our 8-year experience with the remote death certification program demonstrates that despite facing numerous challenges, this process is feasible and offers a valuable option to manage out-of-hospital deaths. The remote death certification program is spreading in the remaining regions of Québec. Future studies will aim to quantify how much time this process saves for emergency medical services in each region of the province.
Incidence and pattern of stroke among patients admitted to medical ward at Yirgalem General Hospital, Sidama Regional State, Southern-Ethiopia
Authors: Agazhe Mequanint , Eshetu Daniel , Arsicha Admasu , Hamato Assefa , Petros Assefa , Dabaro Desalegn , Yohanis Nigussie , Getahun Bekalu , Hirigo Agete Tadewos 
Published: March 2021

Introduction: In the current days, stroke has become one of the common reasons for admission in many health care setups and becoming an alarming public health problem in Ethiopia. Hence, this study aimed to assess the incidence and associated factors of stroke among patients admitted to the medical wards in Yirgalem hospital. Methods: An institution-based retrospective cross-sectional study design was carried out from 01 January 2017, to 30 December 2019. Admitted adult patients’ medical charts were used to collect all required information using structured checklists. Data were analyzed using statistical package for social sciences (SPSS) version 20 software, and a p value < 0.05 was accepted as statistically significant. Result: From a total of 3016 admitted patients, the incidence of stroke was 3.15% (n = 95). Of the 95 stroke cases, 58.9% were males and 69.5% of them were urban dwellers. 62.1% (59/95) of the stroke patients had an ischemic stroke, whereas 37.9% (36/95) had a hemorrhagic stroke. Patients with age ⩾ 65 years, smokers, hypertension, and type-II diabetes had significantly higher ischemic stroke when compared to patients with hemorrhagic stroke (62.7% vs 30.5%, p = 0.008), (49.1% vs 11.1%, p ⩽ 0.0001), and (71.2%vs 13.9%, p < 0.0001), respectively. While patients with hypertension had a significantly higher rate of hemorrhagic stroke when compared to patients with ischemic stroke (88.9% vs 61%, p = 0.003). Conclusion: The majority of stroke patients had cardiovascular problems and hypertension. More than 44% and 34.7% of them had a history of alcoholism and smoking. Therefore, proper management of hypertension, lifestyle modification, early screening and management of strok risks and avoiding risk-full personal behaviors like smoking and alcoholism are important tools to limit or prevent stroke-related morbidity and mortality.
Bacterial uropathogens and susceptibility testing among patients diagnosed with urinary tract infections at Hiwot Fana Specialized University Hospital, Eastern Ethiopia
Authors: Tesfa Tewodros , Baye Yohannes , Sisay Mekonnen , Amare Firehiwot , Gashaw Tigist 
Published: March 2021

Background: Urinary tract infection is a common infection posing a significant healthcare burden globally. Currently, it is becoming hard to manage due to the drug resistance of uropathogens. This study aimed to evaluate the rate of culture positivity and the susceptibility pattern of isolates among clinically diagnosed patients with urinary tract infection. Methods: An institution-based cross-sectional study was conducted on patients clinically diagnosed with urinary tract infections and received a drug prescription at Hiwot Fana Specialized University Hospital from August 2018 to June 2019. A clean-catch mid-stream urine specimen was collected and bacterial identification and susceptibility test were performed using standard microbiological methods. Data were entered into EpiInfo 7 and exported to STATA 15 for analysis. Data were analyzed using descriptive analysis and bi-variate and multivariate regression analyses and presented with graphs, frequency, and tables. Results: A total of 687 urine samples were collected from patients with clinically diagnosed urinary tract infections. The mean age was 31 years and 56.62% were female. 28.38% of the participants had a culture-positive result, of which 86.15% had monomicrobial infections. Inpatients (AOR = 3.8, 95% CI = (1.8–7.9)) and hypertensive patients (AOR = 2.1, 95% CI = (1.1–4.4)) had higher odds of culture-positive results. Staphylococcus species (35.3%), E. coli (25.34%), Pseudomonas species (6.8%), and other Enterobacterales are isolated. Most isolates showed resistance to more than one drug, and amikacin, gentamicin, and nitrofurantoin showed relatively higher activity against isolates. Conclusion: About one-third of the clinically diagnosed patients with urinary tract infection were culture-positive with many types of bacterial uropathogens. Inpatients and hypertensive patients had a higher risk of developing bacterial infections. Bacterial isolates showed different percentages of susceptibility to the tested antibiotics.
Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience
Authors: John Joseph B , MacCormick Angus , MacDonagh Ruaraidh , Speakman Mark J , Vennam Ramesh , Burns-Cox Nicholas 
Published: March 2021

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.
Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center
Authors: Srinivasan Tarika , Sutton Erica J. , Beck Annika T. , Cuellar Idali , Hernandez Valentina , Pacyna Joel E. , Shaibi Gabriel Q. , Kullo Iftikhar J. , Lindor Noralane M. , Singh Davinder , Sharp Richard R. 
Published: March 2021

Introduction: Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.