bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health lifestyles during adolescence: clustering of health behaviours and social determinants in Italian adolescents
Authors: Velasco V , Gragnano A , Ghelfi M ,   Gruppo Regionale HBSC Lombardia 2014, Vecchio L P 
Published: October 2021

AbstractBackgroundHealth behaviours in adolescence have a high impact on both current and future health. The literature claims a focus on social determinants and shows that these behaviours are associated. The concept of ‘health lifestyles’ should be considered to account for co-occurring health behaviours and determinants interactions. The aim of this study is to increase our understanding of adolescents’ health lifestyles and to (i) cluster adolescents according to a comprehensive number of health behaviours and (ii) describe these groups according to sociodemographic characteristics, perceptions of life contexts (family, school, peers or neighbourhood) and perceived physical and psychosocial health conditions.MethodsIn Italy, 906 15-year-old students participated in the cross-national Health Behaviour of School-aged Children study. Clusters were identified by applying the KAMILA clustering method and compared using analysis of variance and chi-squared tests.Results: Four clusters were identified: ‘substance consumers’, ‘media lovers’, ‘active students’ and ‘passive students’. Each cluster exhibited different characteristics related to health behaviours and social determinants.ConclusionsInteresting associations between health behaviours were identified, which showed the relevance of considering the adolescents’ overall lifestyles. The description of each cluster permitted the identification of risks and protective factors, which may be important for designing effective health promotion activities.
Defining renal remission in an international cohort of 248 children and adolescents with lupus nephritis
Authors: De Mutiis Chiara , Wenderfer Scott E , Orjuela Alvaro , Bagga Arvind , Basu Biswanath , Sar Tanmoy , Aggarwal Amita , Jain Avinash , Yap Hui-Kim , Ito Shuichi , Ohnishi Ai , Iwata Naomi , Kasapcopur Ozgur , Laurent Audrey , Mastrangelo Antonio , Ogura Masao , Shima Yuko , Rianthavorn Pornpimol , Silva Clovis A , Trindade Vitor , Dormi Ada , Tullus Kjell 
Published: October 2021

Abstract

Objective
We studied the rate of remission of LN in an international cohort of 248 children and adolescents with biopsy-proven LN. Five different definitions from scientific studies and the definitions recommended by the ACR and Kidney Disease: Improving Global Outcomes were used.

Methods
Anonymized clinical data in patients with biopsy-proven LN class ≥III (International Society of Nephrology/Royal Pathology Society) diagnosed and treated in the last 10 years in 23 international centres from 10 countries were collected. We compared the rate of patients in complete and partial remission applying the different definitions.

Results
The mean age at diagnosis was 11 years and 4 months, and 177 were females. The number of patients in complete and partial remission varied a great deal between the different definitions. At 24 months, between 50% and 78.8% of the patients were in full remission as defined by the different criteria. The number of patients in partial remission was low, between 2.3% and 25%. No difference in achieved remission was found between boys and girls or between children and adolescents (P &gt; 0.05). Patients with East Asian ethnicity reached remission more often than other ethnicities (P = 0.03–0.0008). Patients treated in high-income countries showed a higher percentage of complete remission at 12 and 24 months (P = 0.002–0.000001).

Conclusion
The rate of children and adolescents with LN achieving remission varied hugely with the definition used. Our results give important information for long-awaited treatment studies in children and young people.
Reliability of the Clozapine:N-Desmethylclozapine (CLZ:NDMC) Ratio
Authors: Solomon Shirlee Daniela , Powell Valerie , Sanches Marcos , Borlido Carol , Burton Leah , De Luca Vincenzo , Rajji Tarek , Remington Gary 
Published: October 2021

AbstractClozapine represents the only agent approved for treatment resistant schizophrenia (TRS). Clear dosing guidelines have been difficult to delineate, and therapeutic drug monitoring (TDM) has become a common method to guide clinical use. In this context, attention has also focused on the ratio between clozapine (CLZ) and its metabolite, N-desmethylclozapine (NDMC). The CLZ:NDMC ratio has been implicated in cognition, an important clinical domain in schizophrenia, and various clinico-demographic factors are thought to impact it. To date, the reliability of the CLZ:NDMC ratio has not been established, and the present study aimed to (i) calculate the intraclass correlation coefficient (ICC) for the CLZ:NDMC ratio to assess reliability, and (ii) investigate the effect of selected clinico-demographic factors. The sample consisted of 100 patients diagnosed with schizophrenia or schizoaffective disorder being treated with clozapine, stabilized on their current dose, and able to provide at least 2 TDM samples. The calculated ICC for the CLZ:NDMC ratio was 0.65, while sex and co-administration of a mood stabilizer, specifically divalproex sodium, were found to significantly impact the ratio. In conclusion, the CLZ:NDMC ratio is moderately reliable, and can be influenced by clinical variables that warrant further investigation. Key limitations of the present investigation include inability to collect data on relevant variables such as smoking and ethnicity, as well as categorical exclusion of known inhibitors/inducers of clozapine metabolism. At the same time, these limitations underscore the challenges in utilizing such measures in clinical practice.
Mechanical Pain Sensitivity in Postamputation Pain
Authors: Beisheim-Ryan Emma H. , Pohlig Ryan T. , Hicks Gregory E. , Horne John R. , Medina Jared , Sions Jaclyn M. 
Published: October 2021

Objectives:
Postamputation, clinical markers of pain-related peripheral and central nervous system hypersensitivity remain understudied. This study aimed to identify whether adults with postamputation pain demonstrate greater pain sensitivity in primary (ie, amputated region) and secondary (ie, nonamputated region) sites, as compared with pain-free peers and controls with intact limbs.

Methods:
Ninety-four participants postunilateral, transtibial amputation (59 with pain, 35 pain-free) and 39 controls underwent pain-pressure threshold (PPT) testing at 10 sites. Pain-pressure thresholds were normalized to sex-specific control data using Z score conversions. Normalized primary-site and secondary-site PPTs were compared between groups using multivariate analysis of variance (P<0.050).

Results:
Compared with pain-free peers, adults with postamputation pain demonstrated reduced normalized PPTs across primary and secondary sites (mean difference=0.61-0.74, P=0.001 to 0.007). Compared with controls, adults with postamputation pain demonstrated reduced normalized PPTs (mean difference=0.52, P=0.026) only at primary sites.

Discussion:
Adults with postamputation pain demonstrate greater amputated region pain sensitivity as compared with pain-free peers or controls with intact limbs, indicating peripheral sensitization persists even after limb healing. Secondary-site pain sensitivity was similar between controls and adults with postamputation pain, suggesting central nervous system hypersensitivity may not be ubiquitous with postamputation pain. Studies are needed to investigate mechanisms underlying pain sensitivity differences between adults with and without postamputation pain.
Complementary and Integrative Approaches in Obstetrics and Gynecology
Authors: Barbieri Anna , Fenske Suzanne 
Published: October 2021

Abstract:
Integrative medicine is a holistic approach to health care that acknowledges multiple dimensions of health, including its physical, emotional, and spiritual aspects. It approaches health not just as absence of disease but as a state of optimal vitality, and utilizes all appropriate evidence-based modalities, including lifestyle interventions, complementary treatments, and conventional allopathic methods, in one paradigm. Utilization of non-conventional therapies by women and interest in integrative care is very high. Much disinformation exists and many women engage in non-conventional therapies without medical advice, sometimes benefiting from them, but also possibly delaying needed care or placing themselves at risk. Research and clinical interest in non-conventional methods also is rising within the medical community, with increased recognition of the value of an integrative health model for individuals and communities. Obstetrician–gynecologists are in a unique position to support their patients in holistic health optimization by choosing beneficial integrative strategies while identifying potentially harmful practices.
Mobile Hysteroscopy With the Use of a Smartphone as a Cost-Effective, Diagnostic Technique
Authors: Kathopoulis Nikolaos , Chatzipapas Ioannis 
Published: October 2021

BACKGROUND:
Smartphone technology can be adapted to promote cable-free, wireless, and cost-effective diagnostic mobile office hysteroscopy.

INSTRUMENT:
We developed a new cable-free setup by coupling a rigid 30°, 2-mm-diameter hysteroscope to a smartphone using a commercially available adapter and using a portable and rechargeable light-emitting diode cold light source. The new setup cost is considerably lower compared with that of a typical endoscopic tower.

EXPERIENCE:
We performed both standard hysteroscopy and hysteroscopy using the new portable setup in 40 patients for a variety of benign gynecologic indications. The operating time was compared between the two methods, as was the pain perceived by the patients. Videos from the two setups were blindly reviewed and scored by experts regarding image resolution, brightness, color, and overall image quality. The new technique was acceptable for diagnosis in 97.5% of the videos.

CONCLUSION:
We report a promising initial experience using a smartphone to provide a convenient, cable-free, low-cost, office hysteroscopy system.
Outcomes in Twins Compared With Singletons Subsequent to Preterm Prelabor Rupture of Membranes
Authors: Fishel Bartal Michal , Ugwu Lynda G. , Grobman William A. , Bailit Jennifer L. , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Caritis Steve N. , Prasad Mona , Tita Alan T. N. , Saade George R. , Rouse Dwight J. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: October 2021

OBJECTIVE:
To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations.

METHODS:
We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008–2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded. The coprimary outcomes for this analysis were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III or IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II or III, bronchopulmonary dysplasia, stillbirth subsequent to admission, or neonatal death before discharge). Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% CIs for twin compared with singleton gestations.

RESULTS:
Of 1,531 (1.3%) individuals who met eligibility criteria for this analysis, 218 (14.2%) had twin gestations. The median gestational age at preterm PROM was similar between those with twins and singletons (31.2 weeks [interquartile range 27.4–32.9] vs 30.6 weeks [interquartile range 26.9–32.7], P=.23); however, those with twin gestations had a shorter median latency period (2.0 days [interquartile range 1.0–5.0] vs 3.0 days [interquartile range 2.0–8.0], P<.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, adjusted OR 0.97, 95% CI 0.66–1.42) or composite neonatal morbidity (20.4% vs 20.5%, OR 0.97, 95% CI 0.72–1.31) did not differ between groups.

CONCLUSION:
In a large, diverse cohort, the likelihood of composite maternal or neonatal morbidity per fetus after preterm PROM was similar for twin and singleton gestations.
Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes
Authors: Miller Emily S. , Fleming Oriana , Ekpe Etoroabasi E. , Grobman William A. , Heard-Garris Nia 
Published: October 2021

OBJECTIVE:
To examine the association between adverse childhood experiences and adverse pregnancy outcomes.

METHODS:
This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses.

RESULTS:
Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06–2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38–2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99–1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05–1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth.

CONCLUSION:
One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.
Transfusion Preparedness in the Labor and Delivery Unit
Authors: Benson Ashley E. , Metcalf Ryan A. , Cail Kelly , Rollins Mark D. , Warrick Christine M. , Falkner Dane , Clark Erin A.S. , Nelson Richard E. , Einerson Brett D. 
Published: October 2021

OBJECTIVE:
To evaluate patient safety, resource utilization, and transfusion-related cost after a policy change from universal type and screen to selective type and screen on admission to labor and delivery.

METHODS:
Between October 2017 and September 2019, we performed a single-center implementation study focusing on risk-based type and screen instead of universal type and screen. Implementation of our policy was October 2018 and compared 1 year preimplementation with 1 year postimplementation. Patients were risk-stratified in alignment with California Maternal Quality Care Collaborative recommendations. Under the new policy, the blood bank holds a blood sample for processing (hold clot) on patients at low- and medium-risk of hemorrhage. Type and screen and crossmatch are obtained on high-risk patients or with a prior positive antibody screen. We collected patient outcomes, safety and cost data, and compliance and resource utilization metrics. Cost included direct costs of transfusion-related testing in the labor and delivery unit during the study period, from a health system perspective.

RESULTS:
In 1 year postimplementation, there were no differences in emergency-release transfusion events (4 vs 3, P>.99). There were fewer emergency-release red blood cell (RBC) units transfused (9 vs 24, P=.002) and O-negative RBC units transfused (8 vs 18, P=.016) postimplementation compared with preimplementation. Hysterectomies (0.05% vs 0.1%, P=.44) and intensive care unit admissions (0.45% vs 0.51%, P=.43) were not different postimplementation compared with preimplementation. Postimplementation, mean monthly type and screen-related costs (ABO typing, antibody screen, and antibody workup costs) were lower, $9,753 compared with $20,676 in the preimplementation year, P<.001.

CONCLUSION:
Implementation of selective type and screen policy in the labor and delivery unit was associated with projected annual savings of $181,000 in an institution with 4,000 deliveries per year, without evidence of increased maternal morbidity.
Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension
Authors: Suresh Sunitha C. , Duncan Colleen , Kaur Harjot , Mueller Ariel , Tung Avery , Perdigao Joana L. , Khosla Kavia , Dhir Rohin , Stewart Karie , Wallace Kedra , Ahn Roy , Rana Sarosh 
Published: October 2021

OBJECTIVE:
To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy.

METHODS:
This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed.

RESULTS:
A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race.

CONCLUSION:
A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.
Reduced Semantic Context and Signal-to-Noise Ratio Increase Listening Effort As Measured Using Functional Near-Infrared Spectroscopy
Authors: Rovetti Joseph , Goy Huiwen , Zara Michael , Russo Frank A. 
Published: October 2021

Objectives:
Understanding speech-in-noise can be highly effortful. Decreasing the signal-to-noise ratio (SNR) of speech increases listening effort, but it is relatively unclear if decreasing the level of semantic context does as well. The current study used functional near-infrared spectroscopy to evaluate two primary hypotheses: (1) listening effort (operationalized as oxygenation of the left lateral PFC) increases as the SNR decreases and (2) listening effort increases as context decreases.

Design:
Twenty-eight younger adults with normal hearing completed the Revised Speech Perception in Noise Test, in which they listened to sentences and reported the final word. These sentences either had an easy SNR (+4 dB) or a hard SNR (−2 dB), and were either low in semantic context (e.g., “Tom could have thought about the sport”) or high in context (e.g., “She had to vacuum the rug”). PFC oxygenation was measured throughout using functional near-infrared spectroscopy.

Results:
Accuracy on the Revised Speech Perception in Noise Test was worse when the SNR was hard than when it was easy, and worse for sentences low in semantic context than high in context. Similarly, oxygenation across the entire PFC (including the left lateral PFC) was greater when the SNR was hard, and left lateral PFC oxygenation was greater when context was low.

Conclusions:
These results suggest that activation of the left lateral PFC (interpreted here as reflecting listening effort) increases to compensate for acoustic and linguistic challenges. This may reflect the increased engagement of domain-general and domain-specific processes subserved by the dorsolateral prefrontal cortex (e.g., cognitive control) and inferior frontal gyrus (e.g., predicting the sensory consequences of articulatory gestures), respectively.
Breech Presentation in Twins as a Risk Factor for Developmental Dysplasia of the Hip
Authors: Oh Eun Ji , Min Jae Jung , Kwon Soon-Sun , Kim Seong Been , Choi Chang Won , Jung Young Hwa , Oh Kyung Joon , Park Jee Yoon , Park Moon Seok 
Published: October 2021

Introduction:
Identifying risk factors associated with developmental dysplasia of the hip (DDH) is essential for early diagnosis and treatment. Breech presentation is a major DDH risk factor, possibly because of crowding of the fetus within the uterus. In multifetal pregnancy, fetuses are generally smaller than singletons, which may obscure the effect of breech presentation on fetal hips. Only a few studies have investigated the occurrence of DDH in multifetal pregnancies. In this study, we aimed to evaluate whether the breech presentation is a major risk factor of DDH in twin pregnancies.

Methods:
This retrospective study included 491 consecutive live births (after 23+0 weeks gestation) delivered through cesarean section with at least 1 baby with noncephalic presentation in single or twin pregnancies from April 2013 to October 2018. We analyzed the incidence of DDH and its associated factors, including sex, breech, and multifetal pregnancy, with a generalized linear mixed model.

Results:
The incidence of DDH was 12.5% in singleton with breech presentation, 9.8% in twin-breech presentation, and 0.7% in twin-cephalic presentation. Multivariate analysis showed that singleton-breech presentation (P=0.003), twin-breech presentation (P=0.003), and female sex (P=0.008) were independent risk factors for DDH.

Conclusion:
Breech presentation is an independent risk factor for DDH in twin pregnancies, although twin pregnancy itself is not an independent risk factor for DDH.