bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Effectiveness of Contemporary P2Y
12
Inhibitors in an East Asian Population With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study
Authors: Yun Ji Eun , Kim Yun Jung , Park Ji Jeong , Kim Sehee , Park Keunhui , Cho Min Soo , Nam Gi‐Byoung , Park Duk‐Woo 
Published: July 2019

Background

Prior reports indicate that the effect of P2Y
12
inhibitors may be different in East Asian patients (“East Asian paradox”); therefore, understanding the outcomes associated with potent P2Y
12
inhibitors in different populations is clinically important.

Methods and Results

In this observational cohort study using administrative healthcare data sets, we compared safety and effectiveness of contemporary P2Y
12
inhibitors in patients with acute coronary syndrome. The primary safety outcomes were major and any bleeding, and the primary effectiveness outcomes were major cardiovascular events (a composite of cardiovascular death, myocardial infarction, or stroke) and all‐cause mortality. Among 70 715 patients with acute coronary syndrome, 56 216 (79.5%) used clopidogrel, 11 402 (16.1%) used ticagrelor, and 3097 (4.4%) used prasugrel. The median follow‐up period was 18.0 months (interquartile range: 9.6–26.4 months). In a propensity‐matched cohort, compared with clopidogrel, ticagrelor was associated with a higher risk of any bleeding (hazard ratio: 1.23; 95%
CI
, 1.14–1.33) but a lower risk of mortality (hazard ratio: 0.76; 95%
CI
, 0.63–0.91). Prasugrel, compared with clopidogrel, was associated with higher risks of any bleeding (hazard ratio: 1.23; 95%
CI
, 1.06–1.43) and major bleeding (hazard ratio: 1.50; 95%
CI
, 1.01–2.21) but a similar risk of effectiveness outcomes. No significant difference was noted between ticagrelor and prasugrel with respect to key safety or effectiveness outcomes. Several sensitivity analyses showed similar results.

Conclusions
In East Asian patients with acute coronary syndrome, compared with clopidogrel, ticagrelor was associated with an increased risk of bleeding but a decreased risk of mortality. Prasugrel was associated with an increase of any bleeding without difference in effectiveness outcomes. The risks of bleeding and ischemic events were similar between ticagrelor and prasugrel.
Effects of Genetically Determined Iron Status on Risk of Venous Thromboembolism and Carotid Atherosclerotic Disease: A Mendelian Randomization Study
Authors: Gill Dipender , Brewer Christopher F. , Monori Grace , Trégouët David‐Alexandre , Franceschini Nora , Giambartolomei Claudia ,   INVENT Consortium, Tzoulaki Ioanna , Dehghan Abbas 
Published: July 2019

Background
Systemic iron status has been implicated in atherosclerosis and thrombosis. The aim of this study was to investigate the effect of genetically determined iron status on carotid intima‐media thickness, carotid plaque, and venous thromboembolism using Mendelian randomization.

Methods and Results
Genetic instrumental variables for iron status were selected from a genome‐wide meta‐analysis of 48 972 subjects. Genetic association estimates for carotid intima‐media thickness and carotid plaque were obtained using data from 71 128 and 48 434 participants, respectively, and estimates for venous thromboembolism were obtained using data from a study incorporating 7507 cases and 52 632 controls. Conventional 2‐sample summary data Mendelian randomization was performed for the main analysis. Higher genetically determined iron status was associated with increased risk of venous thromboembolism. Odds ratios per SD increase in biomarker levels were 1.37 (95% CI 1.14‐1.66) for serum iron, 1.25 (1.09‐1.43) for transferrin saturation, 1.92 (1.28‐2.88) for ferritin, and 0.76 (0.63‐0.92) for serum transferrin (with higher transferrin levels representing lower iron status). In contrast, higher iron status was associated with lower risk of carotid plaque. Corresponding odds ratios were 0.85 (0.73‐0.99) for serum iron and 0.89 (0.80‐1.00) for transferrin saturation, with concordant trends for serum transferrin and ferritin that did not reach statistical significance. There was no Mendelian randomization evidence of an effect of iron status on carotid intima‐media thickness.

Conclusions
These findings support previous work to suggest that higher genetically determined iron status is protective against some forms of atherosclerotic disease but increases the risk of thrombosis related to stasis of blood.
A review of the Madagascan species of the genus Cestradoretus Ohaus (Coleoptera: Scarabaeidae: Rutelinae: Adoretini)
Authors: FROLOV ANDREY V. , MONTREUIL OLIVIER 
Published: July 2019

The genus Cestradoretus Ohaus, 1912 was erected by Ohaus (1912) to accommodate a Madagascan Adoretini species, C. tenuirostris Ohaus, 1912. This genus is characterized by the adults having the apex of the labrum with a long, fine, acute process curved downwards. In the addition to the above mentioned paper, Ohaus (1912) also described C. acomys Ohaus, 1912 from Tanzania, and later moved Adoretus tarsatus Klug, 1855, described from Mozambique, to Cestradoretus (Ohaus 1916). Later, Machatschke (1965) described two species from Africa, C. freyi Machatschke, 1965 from Botswana and C. minusculus Machatschke, 1965 from Somalia, and Frey (1976) described C. clypealis Frey, 1976 from Somalia. Thus, Cestradoretus included six species, one from Madagascar and five from Africa.
Examining the (Dis)Agreement between Etiology and Consequences of Adults’ and Youths’ Perceptions of Collective Efficacy in Boston
Authors: Tucker Riley , Zimmerman Gregory M. , Stowell Jacob I. , Jones David Squier 
Published: July 2019

Objectives: To examine the extent to which adults’ and youths’ perceptions of collective efficacy align, the shared and unique correlates of adults’ and youths’ perceptions, and the effects of adults’ and youths’ perceptions on youths’ violence. Method: Descriptive analysis, hierarchical linear modeling, and spatial analysis analyze 1,636 youths from the 2008 Boston Youth Survey and 1,677 adults distributed across 85 neighborhoods from the 2008 Boston Neighborhood Study. Results: Descriptive analysis indicates that Boston adults’ and youths’ perceptions are largely divergent. Spatial analysis indicates that there is not clustering of either adults’ or youths’ perceptions across Boston neighborhoods. Multilevel models indicate that adults’ and youths’ perceptions exhibit divergent etiology: Adults’ perceptions align closely with neighborhood collective efficacy and with their own neighborhood perceptions, while youths’ perceptions are largely a function of individual differences (race and age) and sociobehavioral factors (social support and educational expectations). Youths’ perceptions of collective efficacy, rather than aggregated adults’ perceptions of collective efficacy, are inversely associated with youths’ violence. Conclusions: Adults’ and youths’ perceptions of collective efficacy represent distinct constructs. Research should focus on the divergent processes through which adults’ and youths’ perceptions are generated and the differential effects of adults’ and youths’ perceptions on youths’ behaviors.
Risk factors and psychological impact of syncope in migraine patients
Authors: Kuan Ai Seon , Chen Shih-Pin , Wang Yen-Feng , Fuh Jong-Ling , Cheng Chun-Yu , Peng Kuan-Po , Wang Shuu-Jiun 
Published: July 2019

Background Migraine is associated with syncope. We investigated risk factors for syncope and burden of syncope in migraine patients. Methods Participants were recruited from a headache clinic. All participants provided information on lifestyle, co-morbidity, syncope, headache and suicide, and completed the MIDAS and HADS questionnaires. Genetic data were available for a subset of participants. Risk of syncope in relation to participant’s characteristics and migraine susceptibility loci, and risks of psychological disorders associated with syncope, were calculated using logistic regression. Results Underweight, regular tea intake, diabetes mellitus, and migraine with aura were associated with increased syncope risks, with adjusted ORs of 1.76 (95% CI 1.03–3.03), 1.84 (95% CI 1.22–2.79), 4.70 (95% CI 1.58–13.95), and 1.78 (95% CI 1.03–3.10), respectively. Preliminary results showed that rs11172113 in LRP1 was associated with syncope risks. Comorbid syncope in migraine patients was associated with increased risks of depression (OR 1.95, 95% CI 1.18–3.22) and suicide attempt (OR 2.85, 95% CI 1.48–5.48). Conclusion Our study showed the potential roles of vascular risk factors in the association between migraine and syncope. Modifiable risk factors for syncope in patients with migraine include body mass index and tea intake. The debilitating psychological impact of co-morbid syncope in migraine patients warrants clinical attention of treating physicians.
Effectiveness of an Educational Manual to Promote Infant Feeding Practices in Primary Health Care
Authors: Relvas Gláubia Rocha Barbosa , Buccini Gabriela , Potvin Louise , Venancio Sonia 
Published: July 2019

Objective: To test the hypothesis that a continuing educational strategy (ie, “the manual”) in primary health-care improves infant feeding practices among infants under 1 year of age. Methods: A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to support continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estratégia Amamenta e Alimenta Brasil with health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results: Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions: The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.
Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life
Authors: Merchant Shaila J. , Brogly Susan B. , Booth Christopher M. , Goldie Craig , Peng Yingwei , Nanji Sulaiman , Patel Sunil V. , Lajkosz Katherine , Baxter Nancy N. 
Published: July 2019

Background: There is variation in the clinical management of intestinal obstruction (IO) in patients with cancer. We describe the management of cancer-associated IO near the end of life in a population-based cohort with universal health coverage. Methods: Patients who died of gastric, colorectal, ovarian, and pancreatic cancers from 2002 to 2015 were identified from the Ontario Cancer Registry. Those with ≥1 hospital admission for IO in the final year of life were identified from administrative data. Management of IO at index admission was categorized as surgery, gastrostomy, stent, feeding jejunostomy, and medical management. Trends in management over the study period were assessed by the Cochran-Armitage test. Results: The cohort included 57 378 patients (gastric [n = 7448, 13%], colorectal [n = 30 577 53%], ovarian [n = 6273, 11%], and pancreatic [n = 13 080, 23%] cancers). Of those, 7618 (13%) patients had ≥1 admission for IO in the final year of life. Of these patients, 2657 (35%) patients were managed with a surgical/procedural intervention at index admission (surgery [86%], gastrostomy [8%], stent [6%], and jejunostomy [0.4%]); the remaining patients (n = 4961, 65%) received medical management. Over the study period, there was a small but statistically significant increase in the use of stents (0% in 2002 to 5% in 2015, P < .0001) and gastrostomy tubes (2% in 2002 to 4% in 2015, P = .002) and a large decrease in the use of surgery (41% in 2002 to 28% in 2015, P = .04). Conclusions: Management of IO has changed over time with the increased use of stents and gastrostomy tubes and decreased use of surgery.
Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature
Authors: Boles Sama , Martinez-Rios Claudia , Tibussek Daniel , Pohl Daniela 
Published: July 2019

Idiopathic intracranial hypertension, or pseudotumor cerebri, is an increase in cerebrospinal fluid pressure of unknown etiology. It is mostly seen in adults, less frequently in adolescents, rarely in younger children. Only 5 infants meeting idiopathic intracranial hypertension criteria have been mentioned in the literature. We report a case of a previously healthy 9-month-old boy who presented with irritability, decreased appetite, and a bulging fontanelle. Computed tomography (CT) head imaging and cerebrospinal fluid studies revealed normal results. The patient’s symptoms transiently resolved after the initial lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cmH2O and led to a diagnosis of idiopathic intracranial hypertension in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/d was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide dose was increased to 37 mg/kg/d, with no further relapses to date. A diagnosis of idiopathic intracranial hypertension is challenging in infants, because the patients cannot yet verbalize typical idiopathic intracranial hypertension–related symptoms such as positional headaches, diplopia, or pulsatile tinnitus. Furthermore, it is more difficult to assess papilledema in that age group. If undetected and untreated, idiopathic intracranial hypertension may result in permanent visual deficits. Little is known about idiopathic intracranial hypertension in infants, and age-specific treatment guidelines are lacking. We discuss this rare case of infantile idiopathic intracranial hypertension and provide a review of the literature, including an overview of disease characteristics and outcomes of idiopathic intracranial hypertension in this very young age group.
Teaching Palliative Care to Health Professional Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Donne Jack , Odrowaz Thomas , Pike Sarah , Youl Bonnie , Lo Kristin 
Published: July 2019

Background: End-of-life care is challenging on health professionals’ mental and emotional state. Palliative care education can support health professional students’ transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area. Purpose: To collate the relevant information regarding how to teach health professional students about palliative care. Method: The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students’ knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis. Results: The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors. Conclusions: Palliative care education is effective in improving health professional students’ knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.
Comparison of Pain Perception in Patients Affected by Cleft and Cranio Facial Anomalies Treated With Traditional Fixed Appliances or Invisalign
Authors: Meazzini Maria Costanza , Tortora Chiara , Mazzoleni Fabio , Autelitano Luca 
Published: July 2019

Introduction: The objective of this prospective study was to compare the difference in pain perception between treatment with aligners (AL) and fixed appliances (FA) in patients affected by cleft and craniofacial anomalies (CFA). Methods: The sample consisted of 100 syndromic caucasian patients affected by various CFA from 2 different hospitals. Fifty patients treated with AL were matched for sex, age, and CFA with a control sample of 50 patients treated with FA. A modification of the Mc Gill Pain Questionnaire was adapted to our needs. Results: Statistical differences were found. Aligners induced more tightness and tension than FA, while FA induced more pain descriptors and patients reported a higher intake of painkillers. Conclusions: The results of this study documented a higher pain perception with FA than with AL in patients affected by CFA. The higher sensitivity to pain in cleft and craniofacial patients with fixed treatment could be related to their higher prior sensitization, given the past surgeries and orthodontic treatments. Thus, this study might suggest that Invisalign treatment might be a further interesting treatment option for patients with cleft in order to reduce their burden of orthodontic pain.
Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus
Authors: Sidon Eliezer , Rogero Ryan , Bell Timothy , McDonald Elizabeth , Shakked Rachel J. , Fuchs Daniel , Daniel Joseph N. , Pedowitz David I. , Raikin Steven M. 
Published: July 2019

Background: Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus. Methods: This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years. Results: The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances. Conclusion: Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence. Level of Evidence: Level IV, retrospective case-series.
Estimating the direct contribution of tourism to Rwanda’s economy: Tourism satellite account methodology
Authors: Odunga Pius O , Manyara Geoffrey , Yobesia Mark 
Published: July 2019

The tourism industry is poised to command a significant role in the economy of Rwanda, a low-income developing country that is rapidly transforming into a service-oriented economy. However, the industry does not exist as a distinct entity in a country’s national accounts leading to difficulties in estimating its role. Besides, the existence of a significant informal sector aggravates the situation. This study used tourism satellite accounts approach to estimate the economic contribution of tourism. Using primary data from various tourism surveys, six core tables of the tourism satellite accounts framework are presented to estimate the direct economic contribution of tourism to Rwanda’s economy in 2014. In this year, a total of 1,219,529 international tourists visited the country while 560,000 residents took part in domestic tourism trips resulting in internal tourism expenditure/consumption amounting to RWF 261.2bn. This generated an estimated RWF 197.5bn as gross value added by the tourism characteristic industries. Direct tourism gross value added was estimated at RWF 120.0bn while direct tourism gross domestic product, a measure of the direct effects of internal tourism consumption on gross domestic product of the economy was computed at RWF 128.3bn (or 2.5% of Rwanda’s gross domestic product) in the year. In addition to the core six tourism satellite accounts tables, the levels of tourism employment (about 89,000 jobs) tourism gross fixed capital formation (slightly over RWF 200bn) and tourism collective consumption (over RWF 7bn) were estimated. Under this study, the international methodological recommendations on tourism satellite accounts were implemented for Rwanda. The contribution of tourism to gross domestic product, employment, investment, and collective consumption was quantified and estimated. Informal sector tourism activities were included in these estimates. Gross fixed capital formation and collective consumption estimates are tentative due to conceptual considerations documented by the methodological framework.
Helping factors in an outdoor adventure program
Authors: Gargano Virginie , Turcotte Daniel 
Published: July 2019

Summary A number of studies have addressed outdoor and adventure programs over the past 50 years. Despite empirical evidence that demonstrates the personal benefits of group interventions, research investigating the mechanisms responsible for these effects is scarce. This is particularly so for groups in natural outdoor and adventure settings. There is therefore a need to improve our understanding of the processes involved. This research focused on personal and interpersonal processes that occurred during an outdoor group expedition. Semi-structured interviews were undertaken with 23 subjects aged between 17 and 21 who had participated in an 18-day expedition. The data are examined through a theoretical framework known as “helping factors” often used when studying benefits of a group intervention. Findings The results show that participation in the program promoted self-understanding, interpersonal learning, socializing techniques, and cohesion. Altruism, imitative behavior, universality, and imparting information were also important. As for existential factors, corrective recapitulation of the family, catharsis, and hope, these were rarely mentioned if not absent. Applications The results give a better understanding of the helping factors in such programs and of their potential role in the group process, as well as their application in social work practice.