bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing epidemiology of chronic hepatitis C: patients are older and at a more advanced stage at the time of diagnosis
Authors: Iliaz Raim , Yuce Tuba , Torun Sinan , Cavus Bilger , Gulluoglu Mine , Bozaci Muruvvet , Karaca Cetin , Akyuz Filiz , Demir Kadir , Besisik Fatih , Kaymakoglu Sabahattin 
Published: March 2019

Introduction and aim
Over the years, there has been a change in the profile of patients with chronic hepatitis C (CHC). In recent years, more patients with CHC have presented to the clinics at the cirrhotic stage, with decompensated liver disease, and with hepatocellular carcinoma. The aim of this study was to investigate the changing epidemiological, clinical, and virological characteristics of CHC patients.

Patients and methods
A total of 313 CHC patients were included in this study. The patients were classified into group 1 (1996–2001) and group 2 (2011–2016). Epidemiological, clinical, and virological differences were investigated between two periods.

Results
Overall, 44.7% (n = 140) of the patients were in group 1. The sex distribution between the two groups was similar. The patients in group 2 was older than those in group 1 (54 ± 15 vs. 45 ± 12 years, retrospectively, P < 0.001). Whereas 19.8% of the patients in group 1 were treatment-experienced, this rate was found to be 35.5% in group 2 (P = 0.01). Patients who presented in the first period had fewer comorbidities compared with group 2 (P < 0.001). More patients in group 2 had liver cirrhosis than group 1 (45.1 vs. 18.6%, respectively, P < 0.001). Among the patients with cirrhosis, the rate of decompensation was higher in group 2 (46.7 vs. 23.3%, P = 0.03). The presence of hepatocellular carcinoma was significantly higher in group 2 than group 1 (12.8 vs. 3.6%, respectively, P = 0.004).

Conclusion
In recent years, CHC patients have presented to hospitals with advanced stage of liver disease; these patients are older and have more comorbidities.
Variables Impacting the Time Taken to Wean Children From Enteral Tube Feeding to Oral Intake
Authors: Lively Emily J. , McAllister Sue , Doeltgen Sebastian H. 
Published: March 2019

ABSTRACTObjectives:This study investigated biological factors, which may influence the time taken for children to wean from enteral to oral intake.Methods:Retrospective case‐note audit of 62 tube‐fed children (nasogastric or percutaneous endoscopic gastrostomy) aged 6 months to 8 years, participating in an intensive tube weaning program. Program design included family‐focused mealtimes, child autonomy, and appetite stimulation. A regression model was developed, which shows the combination of variables with the most predictive power for time taken to wean.Results:Data from 62 children who were highly dependent (minimum 93% of calories provided enterally) on tube feeding for an extended period of time (mean = 2.1 years) were analysed. Children's mean body mass index z score at time of weaning was −0.47 (standard deviation 1.03) (mean weight = 10.54 kg) and 54 (87%) presented with a range of medical conditions. Forty‐four children (71%) remained completely tube free at 3 months postintervention and an additional 5 children (10%) were fully tube weaned within 10 months of program commencement. Type of feeding tube, medical complexity, age, and length of time tube fed all significantly correlated with time taken to wean. Logistic regression modelling indicated that the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors of time taken to wean.Conclusions:Biological factors usually considered to impact on successful weaning from tube feeding (volume of oral intake, oral skill, or mealtime behaviours) were not relevant; however, the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors. The impact of psychosocial factors should be investigated to identify if these mitigated the effects of the biological variables.
Brown Bag Medication Review
Authors: Murtha Eileen , Elder Betty , Faragher Mary 
Published: March 2019

Background:
Medication nonadherence has been linked to health literacy and poor patient outcomes. The Health Literacy Universal Precautions Toolkit addresses both issues.

Purpose:
A brown bag medication review was implemented to identify medication nonadherence in a Midwestern clinic.

Methods:
Adult patients were instructed to bring all prescribed and over-the-counter medication to office visits. A reviewer transcribed administration directions and the patient's verbal instruction of how the medication is taken.

Results:
The study found 58% (n = 28) of 48 participants were nonadherent for at least 1 medication; 26% (n = 72) of all medications were nonadherent; and mental health drugs were the highest nonadherence category at 38% (n = 11). The majority of medication nonadherence was due to lack of access.

Conclusions:
This drug utilization review was found helpful in identification of causes for medication nonadherence, assisting prescribers, and improving patient education.
Poverty, Toxic Stress, and Education in Children Born Preterm
Authors: Kelly Michelle M. , Li Kati 
Published: March 2019

Background
Preterm birth, defined as birth before the completion of 37 weeks of gestation, is a multifactorial global epidemic with psychosocial, economic, and physical ramifications affecting the child, family, and community at large. Toxic stress—the results of exposure to adverse childhood experiences—results in changes to brain structure and function that negatively affects future health.

Objectives
The aim of this study was to apply the eco-bio-developmental (EBD) model of poverty and preterm birth to the cross-sectional data of the 2016 National Survey of Children’s Health to evaluate the associations between poverty, toxic stress, and prematurity on neurodevelopmental and educational outcomes.

Methods
A subset of data representing children ages 6–11 years old (n = 15,010) from the 2016 National Survey of Children’s Health was used for multivariate analysis of demographic variables and neurodevelopmental and educational outcome variables. Pearson’s chi-square, logistic regression, and interaction effects explored the relationships between prematurity, toxic stress, and poverty.

Results
Children in this sample born preterm had a higher incidence of toxic stress, poverty, developmental delay, learning disability, intellectual disability, speech/language disorders, attention-deficit disorder (ADD)/attention-deficit/hyperactivity disorder (ADHD), autism, and special education/early intervention plans. The combination of poverty, toxic stress, and preterm birth significantly increased the risk of these conditions. After accounting for gender, insurance coverage, race, and parental education, children in the sample born preterm were more likely to experience developmental delay, intellectual disability, speech/language disorder, learning disability, and ADD/ADHD. Toxic stress increased the incidence of ADD/ADHD and autism in both the preterm and full-term samples.

Discussion
The negative effect of poverty and toxic stress on children born preterm, as depicted by the eco-bio-developmental model, is supported by this analysis. Healthcare providers are encouraged to address the tripartite vulnerability resulting from prematurity, poverty, and toxic stress.
Spectacle Coverage among Urban Schoolchildren with Refractive Error Provided Subsidized Spectacles in North India
Authors: Gupta Vivek , Saxena Rohit , Vashist Praveen , Bhardwaj Amit , Pandey Ravindra Mohan , Tandon Radhika , Menon Vimla 
Published: March 2019

SIGNIFICANCE
Provision of subsidized spectacles to schoolchildren with refractive error in Delhi was associated with increased spectacle coverage.

PURPOSE
Studies involving free spectacle distribution and self-purchase of spectacles often report poor compliance. We assessed 1-year spectacle coverage among schoolchildren with refractive error who were provided subsidized spectacles.

METHODS
This was a study of a prospective cohort of 10,114 students from 20 randomly selected schools of Delhi. Children were presumed to have refractive error when unaided visual acuity was worse than or equal to 6/12 in either eye and a best-corrected visual acuity better than or equal to 6/9.5 in both eyes (n = 1503). Children with unmet need of spectacles (presenting with a visual acuity worse than 6/9.5 in the worse eye) were provided subsidized spectacles (n = 1191). Coverage was established by direct observation at baseline and after 1 year through unannounced visits.

RESULTS
Mean age of cohort was 12.0 ± 2.0 years, and 566 (37.7%) were girls. Baseline spectacle coverage was 29.3% (95% confidence interval [CI], 27.1 to 31.7%), which improved to 65.9% (95% CI, 56.0 to 61.6%) among all children (n = 1470) and 58.8% (95% CI, 56.0 to 61.6%) among children with unmet need (n = 1163) at 1 year. Uptake of the subsidized spectacles was 98.6%. On multivariate regression, the odds of spectacle use were greatest when unaided vision was poor: 55.5% when visual acuity was better than or equal to 6/9.5, 74.8% when visual acuity was 6/19 to 6/60 (adjusted odds ratio, 2.5; 95% CI, 1.7 to 3.5), and 91.5% when visual acuity was worse than 6/60 (adjusted odds ratio, 3.1; 95% CI, 1.0 to 9.5). Sex (boys, 66.3%; girls, 65.3%) and socioeconomic status (lower, 58.6%; middle, 61.8%; upper middle, 70.7%) were not associated with coverage. Increasing maternal education and baseline spectacle use were associated with coverage. However, 38.0% were wearing spectacles prescribed by the project, and 61.9% of the spectacles being used at 1 year were purchased in the open market.

CONCLUSIONS
Spectacle coverage after 1 year increased through a subsidized spectacle scheme, particularly for children with poor uncorrected vision.
The Relationship between Visual Acuity, Subjective Vision, and Willingness to Purchase Simultaneous-image Contact Lenses
Authors: Jong Monica , Tilia Daniel , Sha Jennifer , Diec Jennie , Thomas Varghese , Bakaraju Ravi C. 
Published: March 2019

SIGNIFICANCE
This study reports that subjective vision ratings are better indicators of willingness to purchase simultaneous-image contact lenses than visual acuities and are more valuable in evaluating contact lens performance.

PURPOSE
The purpose of this study was to investigate the relationship between visual acuities, subjective vision ratings, and willingness to purchase simultaneous-image contact lenses in presbyopes.

METHODS
A retrospective analysis of visual acuities, subjective vision ratings, and willingness to purchase from final visits of two masked, crossover clinical trials of nine prototype and four commercially available simultaneous-image contact lenses in 141 presbyopes was performed. Pearson correlation and area under the receiver operating characteristic curve determined correlations between variables.

RESULTS
Most subjective vision ratings were weakly correlated (r < 0.3) with visual acuity at all distances and illumination. Moderate correlations (r, 95% confidence intervals) were found between overall vision satisfaction ratings with visual acuity at 40 (−0.34, −0.28 to −0.40) and 50 cm (−0.33, −0.27 to −0.39), near-vision ratings (daytime) with visual acuity at 40 (−0.48, −0.43 to −0.53) and 50 cm (−0.46; −0.41 to −0.51), and intermediate-vision ratings (daytime) with visual acuity at 40 (−0.39, −0.33 to −0.45) and 50 cm (−0.41, −0.35 to −0.46). Highest discrimination for willingness to purchase was with overall vision satisfaction (area under curve, 0.93) and vision stability (daytime; area under curve, 0.77). Ratings from 4 to 9 for vision satisfaction showed a linear increase in willingness to purchase: a 1-unit increase in vision satisfaction increased willingness to purchase by 20%. Ratings lower than 4 had 0% willingness to purchase. Other subjective ratings showed similar relationships, albeit only 10 to 15% increase in willingness to purchase per unit increase for ratings higher than 4.

CONCLUSIONS
Subjective vision ratings are a better indicator of simultaneous-image contact lens performance than visual acuity. Overall vision satisfaction and vision stability are key predictors of willingness to purchase. Subjective vision ratings should be used to evaluate performance rather than visual acuity alone.
Visuo-oculomotor Function and Reaction Times in Athletes with and without Concussion
Authors: Cochrane Graham D. , Christy Jennifer B. , Almutairi Anwar , Busettini Claudio , Swanson Mark W. , Weise Katherine K. 
Published: March 2019

SIGNIFICANCEOculomotor tests in concussion commonly show impairment in smooth pursuit and saccadic function. Honing in on the systems likely to be affected by concussion will streamline use of oculomotor function as a supplemental diagnostic and prognostic tool, as well as improve our understanding of the pathophysiology of concussion.PURPOSEThis study investigates oculomotor function between concussed and healthy collegiate athletes and determines measurement test-retest reliability of those tools.METHODSEighty-seven healthy athletes were recruited from a U.S. Division 1 sports university and completed a 30-minute vestibular ocular testing battery in an enclosed rotary chair system equipped with 100-Hz eye-tracking goggles. Forty-three individuals completed the battery twice. Twenty-eight individuals with a current diagnosis of concussion also completed the battery. All participants were aged 18 to 24 years. Bivariate statistical tests examined differences in scores across groups, and intraclass coefficients were computed to test reliability.RESULTSConcussed individuals had significantly longer saccadic, visual, and dual-task reaction times and reduced saccadic accuracy. There was no difference in optokinetic reflex gain, but few concussed individuals tolerated the task. Reaction time latencies and optokinetic gain show moderate test-retest reliability. Smooth pursuit tasks and saccadic accuracies showed poor test-retest reliability.CONCLUSIONSSaccadic latency was the most sensitive oculomotor function to change after concussion and was reliable over time. Saccadic accuracy was significantly lower in the concussed group but had poor retest reliability. Optokinetic gain may warrant more investigation because of its high test-retest reliability and symptom provocation in concussion, despite not showing a significant difference between groups.
Preliminary evidence that hydroxyurea is associated with attenuated peripheral sensitization in adults with sickle cell disease
Authors: Letzen Janelle E. , Lanzkron Sophie , Bond Kasey , Carroll Christopher Patrick , Haythornthwaite Jennifer A. , Nance Sabrina , Campbell Claudia M. 
Published: March 2019

AbstractIntroduction:Hydroxyurea (HU) is a drug that targets the underlying pathophysiology of sickle cell disease (SCD); however, it continues to be an underutilized treatment for adults. Previous research suggests that HU treatment can result in fewer hospital contacts for acute vaso-occlusive pain crises (VOC). Hydroxyurea's impact on non-VOC pain, however, is not well established.Objectives:This study examined whether HU moderated patterns of static and dynamic pain processing and clinical pain in SCD individuals.Methods:Fifty-eight patients with SCD (N taking HU = 17) underwent quantitative sensory testing (QST) and completed twice daily symptom diaries for 12 weeks. Quantitative sensory testing established thermal threshold and tolerance, mechanical thresholds, and thermal and mechanical temporal summation of pain.Results:Groups did not differ in age, sex, or opioid use. After controlling for morphine use, QST results showed that participants taking HU had higher heat and mechanical pain thresholds (static QST measures) but not thermal and mechanical temporal summation (dynamic QST measures). Participants taking HU also reported lower VOC pain compared with SCD participants not taking HU; however, HU did not moderate non-VOC clinical pain ratings.Conclusion:Findings cautiously suggest that HU acts on pain hypersensitivity and VOC pain, rather than inhibiting pain facilitation and non-VOC pain. These differences may reflect HU's influence on peripheral rather than central sensitization. Future research is warranted to replicate these findings in a larger sample and determine whether early HU administration can prevent peripheral sensitization in SCD individuals.
Breast Reconstruction with Free Abdominal Flaps Is Associated with Persistent Lower Extremity Venous Stasis
Authors: Momeni Arash , Sorice Sarah C. , Li Alexander Y. , Nguyen Dung H. , Pannucci Christopher 
Published: March 2019

Background:
Previous work has demonstrated the occurrence of lower extremity venous stasis in the early postoperative period after breast reconstruction with free abdominal flaps. The authors investigated whether venous stasis persisted through the day of discharge, thus potentially exposing patients to an elevated risk of venous thromboembolism following discharge.

Methods:
Patients who underwent breast reconstruction with free abdominal flaps were enrolled prospectively and underwent duplex ultrasound of the common femoral vein at the following time points: preoperatively, postoperative day 1, and day of discharge. Parameters of interest included common femoral vein diameter, area, and maximum flow velocity.

Results:
Thirty patients with a mean age of 50.3 years (range, 29 to 70 years) underwent breast reconstruction with 52 free abdominal flaps. A significant increase in common femoral vein diameter (19.1 percent; p < 0.01) and area (46.8 percent; p < 0.01) correlated with a significant reduction in maximum flow velocity (−10.9 percent; p = 0.03) between baseline and postoperative day 1. These changes persisted through the day of discharge [common femoral vein diameter, 17.8 percent (p < 0.01); area, 46 percent (p < 0.01); and maximum flow velocity, −11.3 percent (p = 0.01)]. Venous parameters were not influenced by unilateral versus bilateral flap harvest (p = 0.48).

Conclusions:
Postoperative lower extremity venous stasis following autologous breast reconstruction with free abdominal flaps seems to persist through the day of discharge. This finding may explain why patients remain at risk for venous thromboembolism after discharge. Although the authors’ findings are at odds with current venous thromboembolism prophylaxis recommendations, additional studies are indicated to examine whether these findings translate into venous thromboembolism events.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery
Authors: Wolvetang Nicolaas H. A. , Lans Jonathan , Verhiel Svenna H. W. L. , Notermans Bo J. W. , Chen Neal C. , Eberlin Kyle R. 
Published: March 2019

Background:
Neuromas are caused by irregular and disorganized regeneration following nerve injury. Many surgical techniques have been described to address neuroma with varying success. The aim of this study was to evaluate predictive factors for secondary surgery after initial surgical intervention for symptomatic neuroma along with a description of the anatomical distribution of surgically treated symptomatic neuromas.

Methods:
Five hundred ninety-eight patients with 641 neuromas that underwent primary surgery for neuroma were identified retrospectively. The diagnosis of neuroma was based on physical examination and patient history in the medical charts. Neuromas were treated by excision, implantation in muscle or bone, excision with direct neurorrhaphy with or without nerve grafting, or other treatments.

Results:
The rate of secondary surgery for neuroma was 7.8 percent, and secondary operations were performed at a median of 16.1 months. Excision alone or excision with implantation into bone or muscle had higher rates of secondary surgery compared with excision and direct neurorrhaphy with or without nerve graft. Neuromas were located in the upper extremity (49.61 percent), lower extremity (46.65 percent), and the groin/trunk (3.74 percent).

Conclusions:
Symptomatic neuromas are located predominantly in the extremities, and surgery can improve pain, with low secondary surgery rates. Excision with direct neurorrhaphy with or without nerve grafting was associated with lower reoperation rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Appropriate Use of Intravenous Unfractionated Heparin after Digital Replantation: A Randomized Controlled Trial Involving Three Groups
Authors: Nishijima Akio , Yamamoto Naoto , Gosho Masahiko , Yanagibayashi Satoshi , Yoshida Ryuichi , Takikawa Megumi , Hayasaka Rie , Nagano Hisato , Maruyama Eri , Sekido Mitsuru 
Published: March 2019

Background:
The purpose of this study was to clarify the appropriate use of unfractionated heparin as an anticoagulation agent after digital replantation.

Methods:
This study was a prospective, randomized, single-blind, blinded-endpoint method, three-arm, parallel-group, controlled clinical trial conducted at a single institution. A total of 88 patients (101 fingers) following digital amputation and subsequent repair by anastomosis of both arteries and veins were randomly allocated into three groups: (1) control group (no heparin dose), (2) low-dose heparin group (10,000 IU/day), and (3) high-dose heparin group (start at 15,000 IU/day, then adjust the dose to achieve an activated partial thromboplastin time of 1.5 to 2.5 times the baseline). The outcomes were assessed regarding the proportion of success at 2 weeks after replantation of amputated digits, total or partial necrosis, and occurrence of complications.

Results:
No significant differences were found among the three groups, except for complications of congestion. The odds ratio of the heparin group compared with the control group for a success proportion was 5.40 (95 percent CI, 0.85 to 34.20; p = 0.027) in subjects aged 50 years or older. Significant elevations of activated partial thromboplastin time, aspartate transaminase, and alanine aminotransferase occurred in high-dose heparin groups on day 7.

Conclusion:
Unfractionated heparin administration is considered effective for patients aged 50 years or older, although the routine use of unfractionated heparin is not necessary after digital replantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.