bluuebunny/crossref_metadata_2025_split huggingface dataset:
A smartphone game to prevent HIV among young Kenyans: Household dynamics of gameplay in a feasibility study
Authors: Winskell Kate , Sabben Gaëlle , Ondeng’e Ken , Odero Isdorah , Akelo Victor , Mudhune Victor 
Published: March 2019

Objective: mHealth interventions often favour individual-level effects. This is particularly problematic in contexts where social support and shifts in social norms are critical to sustained behaviour change. Mobile digital games represent a promising health education strategy for youth, including in low-resource settings. We sought to better understand the interpersonal and social interactions that can be elicited by digital games for health. Design: We piloted Tumaini, a smartphone game rooted in interactive narrative designed to prevent HIV among young Africans (aged 11–14), in a randomised controlled feasibility study and analysed reports of the household dynamics surrounding gameplay. Following a 16-day intervention period, phone gameplay log files were downloaded, and intervention arm participants ( n = 30) completed a gameplay experience survey; eight focus group discussions were held, four with intervention arm participants ( n = 27) and four with their parents ( n = 22). Setting: This study took place in Kisumu, Kenya, in Spring 2017. Method: Descriptive statistics were computed from survey responses and log files. Focus group transcripts were labelled, analysed thematically and compared demographically using MAXQDA software. Results: Data from log files, surveys and focus groups indicate that the game generated considerable interaction and dialogue with parents, siblings and friends and served as a catalyst for children to act as advocates for healthful decisions about sex, both within the family and beyond. The game showed a high level of acceptability with parents. Conclusion: Serious digital games using a smartphone platform can generate considerable household interaction. Games can model and facilitate these exchanges, maximising multi-level effects. An additional app for parents could reinforce these effects.
Prevalence and Associated Risk Factors of Diabetes in the African Immigrant Population of Sacramento County, California
Authors: Kindarara Désiré M. , Silva Graciela E. 
Published: March 2019

Purpose The purpose of this study was to determine the prevalence and associated risk factors of diabetes in the African immigrant population in Sacramento County, California. Methods A cross-sectional study was conducted in Sacramento County, California, from June to August 2018. The convenience sample included 126 African immigrants aged 21 years and older. Sociodemographic and clinical characteristics were collected. Hemoglobin A1C (A1C) level, blood pressure, height, and weight were measured per standard methods. Data were analyzed using descriptive statistics and χ2 test at value of P < .05. Results Of 126 adult individuals included in this study, 32 (25.4%) had diabetes, of whom 25 (19.8%) were previously diagnosed and 7 (5.6%) represented new cases of diabetes. Also, 36 (28.6%) had prediabetes, of whom 24 (19.1%) had previously been told they had prediabetes and 12 (9.5%) represented new cases of prediabetes. Diabetes and prediabetes were significantly higher among participants in the age group of 36 to 60 years, married, employed full-time, and those with hypertension, high blood cholesterol, and participating in 0 to 2 days per week of moderate physical activities. Only one-fifth of all participants with previously known diabetes or previously on treatment had a good glycemic control status. Conclusions The present study found a high prevalence of prediabetes, diabetes, and multiple risk factors of diabetes in the African immigrant population, as well as a poor glycemic control among those with diabetes, calling for urgent attention. Strategies aimed to improving a healthy lifestyle in the African immigrant population are necessary to reduce the burden of diabetes.
Nondisplaced fractures on hip CT: added value of dual-energy CT virtual non-calcium imaging for detection of bone marrow edema using visual and quantitative analyses
Authors: Jang Seong Won , Chung Bo Mi , Kim Wan Tae , Gil Jea Ryung 
Published: March 2019

Background Dual-energy computed tomography (DECT) virtual non-calcium (VNCa) imaging can demonstrate bone marrow edema. Purpose To evaluate the added value of DECT VNCa imaging for detection of non-displaced fractures on hip CT and to determine the attenuation value cut-off to identify bone marrow edema around fractures. Material and Methods We identified 35 patients who underwent DECT due to suspicion of a non-displaced fracture of the proximal femur or pelvic bone. Twenty-seven non-displaced fractures were present in 24 patients, while 11 patients had no fractures. Radiological, clinical follow-up, or surgical record was the standard of reference. Two radiologists visually interpreted CT images in two sessions: one with bone reconstruction images only and one with bone reconstruction images and VNCa images. Diagnostic performances were compared between the two reading sessions. Quantitative analyses of CT numbers on VNCa images were performed and a cut-off value was obtained through receiver operating characteristic (ROC) analysis. Results In the visual analysis, area under the curve, sensitivity, and negative predictive value were improved in the second session with VNCa images for both readers. In the quantitative analysis, a cut-off value of –55.3 HU yielded 100% sensitivity, 94% specificity, 95.4% accuracy, 69.0% positive predictive value, and 100% negative predictive value for detection of non-displaced fractures. Conclusion Visual and quantitative analyses of VNCa images may be useful in detection of non-displaced fractures in the proximal femur and in pelvic bones.
Propofol-based sedation does not negatively influence oxygenator running time compared to midazolam in patients with extracorporeal membrane oxygenation
Authors: Lamm Wolfgang , Nagler Bernhard , Hermann Alexander , Robak Oliver , Schellongowski Peter , Buchtele Nina , Bojic Andja , Schmid Monika , Zauner Christian , Heinz Gottfried , Ullrich Roman , Staudinger Thomas 
Published: March 2019

Objective: Patients on extracorporeal membrane oxygenation are frequently in need for sedation. Use of propofol has been associated with impaired oxygenator function due to adsorption to the membrane as well as lipid load. The aim of our retrospective analysis was to compare two different sedation regimens containing either propofol or midazolam with respect to oxygenator running time. Methods: Midazolam was used in 73 patients whereas propofol was used in 49 patients, respectively. In the propofol group, veno-arterial–extracorporeal membrane oxygenation was used predominantly (84%), while veno-venous–extracorporeal membrane oxygenation was used more often in the midazolam group (64%). Results: Oxygenator running time until first exchange was 7 days in both groups ( p = 0.759). No statistically significant differences could be observed between the subgroup of patients receiving lipid-free (n = 24) and lipid-containing (n = 31) parenteral nutrition, respectively. Laboratory parameters like triglycerides, free hemoglobin, fibrinogen, platelets, and activated partial thromboplastin time were not significantly different between both sedation regimens ( p = 0.462, p = 0.489, p = 0.960, p = 0.134, and p = 0.843) and were not associated with oxygenator running time. Conclusion: The use of propofol as sedative seems suitable in patients undergoing extracorporeal membrane oxygenation therapy.
Early experience of a regional trauma center in Gangwon province: First step toward organizing a regional trauma system
Authors: Kim Kwangmin , Shim Hongjin , Jung Pil Young , Kim Seongyup , Bang Hui-Jae , Kwon Hye Youn , Choi Young Un , Bae Keum Seok , Jang Ji Young 
Published: March 2019

Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015. Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center. Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified. Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 ± 26.1) than in the before trauma center group (84.7 ± 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment. Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.
Obesity is not associated with hip failure in patients with articular surface replacement of the hip
Authors: Ray Gabrielle S , Laaksonen Inari , Galea Vincent P , Madanat Rami , Muratoglu Orhun , Malchau Henrik 
Published: March 2019

Background: Our main aim was to investigate whether obese patients were at increased risk of elevated metal ion levels and/or adverse local tissue reaction (ALTR) after being treated with articular surface replacement (ASR) hip arthroplasty. Methods: This study included 360 patients who underwent metal-on-metal (MoM) hip resurfacing (HRA) or total hip arthroplasty (THA). 95 patients (26%) were underweight/normal weight (BMI < 25 kg/m2), 139 (39%) were overweight (BMI 25–30 kg/m2), and 126 (36%) were obese (BMI ⩾ 30 kg/m2). Blood metal ion levels and patient-reported outcome measures (PROMs) were obtained, and a sub-cohort of 85 patients had MARS MRI performed. Logistic regression analyses were used to assess the associations between obesity and metal ions, as well as ALTR. Results: BMI was not associated with either elevated metal ion levels or ALTR. In HRA patients, female gender (OR 3.0; p = 0.019) and pain (OR 2.3; p = 0.046) were associated with elevated Co levels. Female patients had increased risk of elevated Cr levels (OR 3.0; p = 0.02). In THA patients, female gender (OR 2.2; p = 0.004) and VAS satisfaction (OR 2.1; p = 0.01) were associated with elevated Co levels. Female gender (OR 3.6; p = 0.001) and time from surgery (OR 1.4; p = 0.005) were associated with Cr levels. In the sub-cohort, ALTR was associated with Co levels (OR 16.1; p = 0.002) in HRA patients. Conclusion: Patients with BMI ⩾ 30 kg/m2 present no increased risk for elevated metal ion levels or development of ALTR.
Factors influencing adherence to therapeutic recommendations made after diagnostic reassessment of medically unexplained symptoms in children and adolescents
Authors: Bonduelle Sam LB , Vanderfaeillie Johan , Denijs Katrien , Lampo Annik , Imeraj Lindita 
Published: March 2019

Background: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. Objectives: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. Methods: Parents of 27 children aged 7–17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. Results: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. Conclusion: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.
Role of polymorphisms of MSX1 and PAX9 genes in palatal impaction of maxillary canines
Authors: Devi M S Anjana , Padmanabhan Sridevi 
Published: March 2019

Objective: Maxillary canines are the second-most commonly impacted teeth. About two-thirds of the impacted maxillary canines are palatally impacted. Studies in the past have shown that 40% of cases with palatal impaction of maxillary canines presented with agenesis of third molars. Sporadic agenesis of third molars have been associated with polymorphisms in the MSX1 and PAX9 genes. The present study aims at evaluating the association between polymorphisms of PAX9, MSX1 and palatally impacted canines in a random population sample. Design and setting: Fifty individuals with palatally impacted maxillary canines and 50 gender and age-matched controls were included in this study. Methods: Single nucleotide polymorphisms (SNPs), rs12532 of MSX1 and rs2073247 of PAX9, were genotyped using polymerase chain reaction and restriction fragment length polymorphism. The significance of the differences among the groups was assessed by odds ratio and Chi-squared test with a 95% confidence interval Results: Single nucleotide polymorphisms rs12532 [MSX1] and rs 2073247 [PAX9] showed a statistically significant association with palatal impaction of maxillary canines. In addition, the combined presence of the AG/CT genotypes of these genes in an individual caused a significant increase in the risk for palatal impaction. Conclusion: These results suggest that the rs12532 and rs2073247 polymorphisms of genes MSX1 and PAX9 are positively associated with palatal impaction of maxillary canines. Future studies investigating various other SNPs of these genes in a larger sample of different populations could provide clinching details.
Orthodontic referral management systems: Do they make a difference?
Authors: Carty Orla , Toor Henna , Morris Timothy A , Harrison Jayne E 
Published: March 2019

Aims: To assess the performance of the referral management system (RMS) compared to a previous paper-based referral system and to determine whether referrals reflected the patients’ malocclusion and met current guidelines. Design: Three-cycle audit. Setting: Orthodontic Department, Liverpool University Dental Hospital, UK. Participants: Consecutive new orthodontic patient referrals. Methods: Data were collected prospectively from orthodontic referral letters and new patient clinic proformas (2016–2017). Cycle 1 assessed the original paper-based referral form, Cycle 2 assessed the first RMS online form and Cycle 3 assessed a modified RMS form. Results: Cycles 1, 2 and 3 audited 83, 84 and 81 referrals, respectively. Agreement between the reason for referral and the new patient clinic findings was moderate for Cycles 1 and 3 (Kappa = 0.47 and 0.60, respectively) and fair for Cycle 2 (Kappa = 0.40). In Cycles 1, 2 and 3, the proportion of new patients appropriate for hospital orthodontic care reduced from 52% to 51% and 40%, respectively. None of the three cycles reached the 90% target for compliance with current referral guidelines. Conclusions: Cycle 3’s RMS form gave a truer reflection of the patients’ malocclusion but reduced the proportion of appropriate referrals. Further audit is required in this area to investigate the cost-effectiveness and clinical benefits of the RMS.
Nasal Symptoms Reduction and Decreased Neutrophilia in Japanese Cedar Pollinosis With Prophylactic Treatment With a Combination of Montelukast, Fexofenadine, and Fluticasone Nasal Spray
Authors: Otsuka Hirokuni , Otsuka Kuninori , Matsune Shoji , Okubo Kimihiro 
Published: March 2019

Background and Objective We reported neutrophil-associated tissue damage in cedar pollinosis subjects with refractory nasal symptoms prior to pollinosis season. Because the leukotriene receptor antagonist, montelukast, can inhibit neutrophil recruitment and activation, we investigated its effects on symptom relief and nasal neutrophilia in pollinosis subjects in the preseason. Methods In the pollinosis preseason, symptomatic (PreSyP, n = 149) and asymptomatic subjects (PreAsP, n = 145) were prophylactically treated, and in season symptomatic subjects (InSyP, n = 134) were treated. Individuals were assigned to 1 of 2 treatment protocols: administration of cetirizine and fluticasone nasal spray (Cet-Flu) or montelukast, fexofenadine, and fluticasone nasal spray (Mo-Fex-Flu). Differences in symptom relief and inflammatory cell infiltration in nasal swabs were investigated. Results In pollen season, 59% of PreSyP subjects given Cet-Flu and 88% of those treated with Mo-Fex-Flu had none or mild symptoms ( P < .00001). In PreAsP subjects in season, 71% of Cet-Flu and 98% of Mo-Fex-Flu recipients had none to mild symptoms ( P < .0000001). The proportions of subjects in the PreSyP group with nasal swabs with neutrophils 1+ to 3+ before and after treatment by Mo-Fex-Flu were 59% and 18%, respectively ( P < .0001), and in PreAsyP, subjects with neutrophils 2+ to 3+ were 17% and 5%, respectively ( P = .034). In PreSyP, a significant reduction in the percentage of subjects with mast cells >1+ was seen following both Cet-Flu ( P = .027) and Mo-Fex-Flu ( P = .0014) treatments. Conclusion In PreSyP and PreAsP subjects, treatments with Mo-Fex-Flu were more effective than Cet-Flu to reduce nasal symptom scores. These effects were associated with reduction in the number of neutrophils and mast cells in nasal swabs.
Return-to-Sport Testing After Medial Patellofemoral Ligament Reconstruction in Adolescent Athletes
Authors: Saper Michael G. , Fantozzi Peter , Bompadre Viviana , Racicot Mimi , Schmale Gregory A. 
Published: March 2019

Background: Return to sport (RTS) after patellar stabilization surgery involves the return of strength and dynamic knee stability, which can be assessed using isometric strength and functional performance testing. Purpose: To investigate the results of isometric strength and functional RTS testing between the surgical and uninvolved limbs in adolescent patients who underwent medial patellofemoral ligament (MPFL) reconstruction for patellar instability. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of adolescent patients who underwent MPFL reconstruction identified 28 patients (20 female, 8 male) who also underwent isometric and functional RTS testing. Data were compared with the uninvolved limb. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences in peak torque were compared using the Wilcoxon signed-rank test. Correlations were examined between dependent and independent variables using the Spearman correlation. Results: The mean age of the patients was 14.9 years (range, 12-16 years). Reconstruction was performed with a hamstring autograft in 17 (60.7%) patients. Concomitant tibial tubercle osteotomy was performed in 10 (35.7%) patients. Testing was performed at a mean 7.4 months (range, 5.5-11.9 months) postoperatively. The mean LSIs for quadriceps and hamstring strength were 85.3% and 95.1%, respectively. For knee extension, there was a statistically significant difference between isometric peak torque measured in the surgical and uninvolved limbs ( P = .001). Only 32.0% of patients passed all 4 hop tests. Also, 63.0% of patients achieved an anterior reach asymmetry of <4 cm on the Lower Quarter Y-Balance Test (YBT-LQ). There were no statistically significant differences in isometric strength testing, hop tests, or the YBT-LQ based on graft type or concomitant procedures. There was no correlation between isometric strength and performance on the YBT-LQ or hop tests. Conclusion: Adolescent athletes undergoing MPFL reconstruction may need prolonged rehabilitation programs beyond 8 months to allow the adequate recovery of muscle strength for safe RTS. There is a significant deficit in isometric quadriceps strength in the surgical limb after surgery. Further investigation is needed to determine safe RTS criteria after MPFL reconstruction in the pediatric and adolescent population.
The Eating Experience: Adaptive and Maladaptive Strategies of Older Adults with Tooth Loss
Authors: Zelig R. , Jones V.M. , Touger-Decker R. , Hoskin E.R. , Singer S.R. , Byham-Gray L. , Radler D.R. , Rothpletz-Puglia P. 
Published: March 2019

Objective: To explore the eating experience and eating-related quality of life (ERQOL) of community-dwelling older adults with tooth loss. Method: Nineteen older adults from the clinics of a northeast US dental school who met inclusion criteria ( >65 y old, <20 teeth, and no dentures) composed the sample. For this mixed methods study, demographic characteristics, number and location of teeth, Mini Nutritional Assessment–Short Form score, and anthropometrics data were collected; semistructured interviews were conducted to collect in-depth information about the eating experience and ERQOL. Thematic analysis was completed with NVivo 12 software (QSR International). Results: Participants’ mean age was 71.3 y (SD = 5.2); 52.6% ( n = 10) were women; 63.2% ( n = 12) were Black or African American. The mean Mini Nutritional Assessment–Short Form score of 12.1 was reflective of normal nutrition status; 31.6% ( n = 6) of patients were at risk for malnutrition or were malnourished. Fifteen percent ( n = 3) were fully edentulous; 84.2% ( n = 16) had 1 to 19 teeth (mean = 10.8, SD = 6.5). The 2 overarching themes identified were adaptive and maladaptive behavioral responses to tooth loss. Adaptive strategies included modification in food preparation and cooking methods, food texture selection, meal timing, and approaches to chewing. Maladaptive behaviors included food avoidance and limiting eating and smiling in front of others. Psychosocial factors, including finances, limited food choices and ERQOL, whereas the support of family and friends enhanced ERQOL according to participants. Conclusion: Older adults with tooth loss exhibit both adaptive and maladaptive behaviors that affect their eating experience, dietary intake, and ERQOL. While many expressed positive adaptive coping strategies, they also described maladaptive behaviors, including avoidance of healthy foods and limiting eating during social interactions, which may affect their nutritional status and overall health and well-being. Further research is needed to explore how duration and severity of tooth loss influence these behaviors and risk of malnutrition. Interprofessional approaches are needed to support positive adaptation and coping with tooth loss. Knowledge Transfer Statement: The results of this study can be used by health professionals treating patients with tooth loss in an effort to improve their eating experience and eating-related quality of life. The findings provide data to support further studies and the need for evidence-based guidelines and educational materials to meet the unique needs of older adults with tooth loss.