bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Distress and Behaviors for Parents of Adolescents With Chronic Pain Enrolled in an Intensive Interdisciplinary Pain Program
Authors: Weiss Karen E. , Junghans-Rutelonis Ashley N. , Aaron Rachel V. , Harbeck-Weber Cynthia , McTate Emily , Luedtke Connie , Bruce Barbara K. 
Published: June 2019

Objectives:
Intensive interdisciplinary treatment is emerging as an effective treatment of chronic pain in youth. These programs often include a parental component with the belief that targeting parental distress and responses to a child’s pain will improve outcomes. However, few studies have evaluated the impact of a parental intervention in the interdisciplinary treatment of pediatric chronic pain. The present study consists of a nonrandomized pre-post design to evaluate change in psychological and behavioral functioning of parents who participated in intensive parent programming that utilized cognitive-behavioral therapy and acceptance and commitment therapy, delivered within the context of an interdisciplinary intensive 3-week pain treatment program for youth with chronic pain.

Materials and Methods:
Two hundred twelve parents and their children participated in the study, with 116 participants completing 3-month follow-up measures. Parents completed measures of depressive symptoms, pain catastrophizing, protective responses, and psychological flexibility at admission, discharge, and 3 months after the program. Child functional disability was assessed at the same time points. We examined change in parent factors over time, while controlling for change in child distress.

Results:
Parents reported significant improvements in all areas of functioning from admission to discharge and improvements were maintained at 3-month follow-up.

Discussion:
This study provides evidence suggesting parent interventions can be effective in reducing parent distress and behaviors known to be associated with child outcomes.
The Microsurgical Treatment of Lumbar Disc Herniation
Authors: Burkhardt Benedikt W. , Grimm Marietta , Schwerdtfeger Karsten , Oertel Joachim M. 
Published: June 2019

Study Design.
Level 3, cohort study.

Objective.
The aim of this study was to assess long-term clinical outcome, and rate of reoperation following microsurgical subtotal discectomy (MSD).

Summary of Background Data.
Lumbar disc herniation (LDH) is a common cause of discomfort. Studies with >25 years of follow-up are rare and the reported rate of clinical success and reoperation are not well understood.

Methods.
Retrospectively, files with complete documentation of preoperative and postoperative neurological status, process during hospitalization, detailed report of MSD, outpatient visit notes, and full contact information of patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Patients were contacted for personal follow-up assessment which included Oswestry Disability Index (ODI), EQ-5D, and MacNab criteria, usage of pain medication for leg and back pain, limitations in daily life, and repeated procedures at the lumbar spine.

Results.
A total of 355 patients were randomly selected and contacted for final follow-up and 158 patients with a mean follow-up 32 years participated in the study. Clinical success rate was 86.0%, mean ODI was 9% (0–58%), 69.6% of the patients were pain free, 13.9% of patients reported the daily intake of pain medication for back and leg pain. Reoperations were performed in 47 of the patients (29.7%), whereas the rate for recurrent disc herniation at the same level was 8.2%. Reoperation within the first 2 years after initial MSD had negative influence on clinical success. The preoperative physical working status and sex and working status had no influence on the clinical success.

Conclusion.
The MSD is an effective technique to achieve a high rate of patient satisfaction, and high rate of functional recovery. The overall reoperation rate is 30% within 30 years but only 8.2% of the patients underwent reoperation because of recurrent disc herniation at the same level.

Level of Evidence: 3
Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population
Authors: Oura Petteri , Niinimäki Jaakko , Karppinen Jaro , Nurkkala Marjukka 
Published: June 2019

Study Design.
A population-based birth cohort study.

Objective.
To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population.

Summary of Background Data.
Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking.

Methods.
This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders.

Results.
Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex.

Conclusion.
Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings.

Level of Evidence: 3
Treatment of Mild Cervical Myelopathy
Authors: Bond Michael , McIntosh Greg , Fisher Charles , Jacobs Bradley , Johnson Michael , Bailey Christopher S. , Christie Sean , Charest-Morin Raphaele , Paquet Jérome , Nataraj Andrew , Cadotte David , Wilson Jeff , Manson Neil , Hall Hamilton , Thomas Kenneth , Rampersaud Yoga Raja , Dea Nicolas 
Published: June 2019

Study Design.
Prospective Cohort

Objective.
The aim of this study was to evaluate which demographic, clinical, or radiographic factors are associated with selection for surgical intervention in patients with mild cervical spondylotic myelopathy (CSM).

Summary of Background Data.
Surgery has not been shown superior to best conservative management in mild CSM comparative studies; trials of conservative management represent an acceptable alternative to surgical decompression. It is unknown what patients benefit from surgery.

Methods.
This is a prospective study of patients with mild CSM, defined as modified Japanese Orthopaedic Association Score (mJOA) ≥15. Patients were recruited from seven sites contributing to the Canadian Spine Outcomes Research Network. Demographic, clinical, radiographic and health related quality of life data were collected on all patients at baseline. Multivariate logistic regression modeling was used to identify factors associated with surgical intervention.

Results.
There were 122 patients enrolled, 105 (86.0%) were treated surgically, and 17 (14.0%) were treated nonoperatively. Overall mean age was 54.8 years (SD 12.6) with 80 (65.5%) males. Bivariate analysis revealed no statistically significant differences between surgical and nonoperative groups with respect to age, sex, BMI, smoking status, number of comorbidities and duration of symptoms; mJOA scores were significantly higher in the nonoperative group (16.8 [SD 0.99] vs. 15.9 [SD 0.89], P < 0.001). There was a statistically significant difference in Neck Disability Index, SF12 Physical Component, SF12 Mental Component Score, EQ5D, and PHQ-9 scores between groups; those treated surgically had worse baseline questionnaire scores (P < 0.05). There was no difference in radiographic parameters between groups. Multivariable analysis revealed that lower quality of life scores on EQ5D were associated with selection for surgical management (P < 0.018).

Conclusion.
Patients treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to baseline demographic or radiographic parameters. Patients with worse EQ5D scores had higher odds of surgical intervention.

Level of Evidence: 3
Regional Differences in the Cost and Utilization of Nonoperative Management Within 3 Months Prior to Lumbar Microdiscectomy
Authors: Davison Mark A. , Lilly Daniel T. , Desai Shyam A. , Vuong Victoria D. , Moreno Jessica , Cheng Joseph , Bagley Carlos , Adogwa Owoicho 
Published: June 2019

Study Design.
Retrospective cohort study.

Objective.
The purpose of this investigation was to evaluate the regional variations in the use of nonoperative therapies in patients diagnosed with a lumbar intervertebral disc herniation 3 months prior to undergoing microdiscectomy surgery.

Summary of Background Data.
Regional variations in the management of chronic pain conditions have been previously identified. Patients suffering from a lumbar intervertebral disc herniation are typically treated with a brief course of conservative management prior to attempting microdiscectomy surgery. Whether regional differences exist in the utilization or costs of maximum nonoperative therapy (MNT) remains unknown.

Methods.
Medical records from patients diagnosed with a lumbar intervertebral disc herniation undergoing 1, 2, or 3-level index microdiscectomy operations between 2007 and 2017 were gathered from the HORTHO insurance database consisting of private/commercially insured and Medicare Advantage beneficiaries. Patient regional designation was divided into Midwest, Northeast, South, and West territories and was derived from the insurance claim location. The utilization of MNT within 3 months after initial lumbar herniation diagnosis in adult patients was analyzed.

Results.
Our population consisted of 13,106 patients who underwent primary index microdiscectomy surgery. Significant regional variation was identified in the nonoperative therapy failure rate (P<0.0001), with the highest proportion of Midwest patients failing (2.7%). There were statistical differences in the regional distribution of patients utilizing NSAIDs (P<0.0001), muscle relaxants (P <0.0001), lumbar epidural steroid injections (P <0.0001), physical therapy and occupational therapy sessions (P <0.0001), chiropractor treatments (P <0.0001), and emergency department services (P = 0.0049). The total direct cost associated with all MNT prior to microdiscectomy was $13,205,924, with 59.6% from the South, 31.1% from the Midwest, 8.3% from the West, and 1.1% from the Northeast.

Conclusion.
These findings indicate that regional differences exist in the utilization and costs of MNT of a lumbar intervertebral herniated disc prior to microdiscectomy surgery.

Level of Evidence: 3
Increased Risk of Opioid Overdose Death Following Cold Weather: A Case–Crossover Study
Authors: Goedel William C. , Marshall Brandon D. L. , Spangler Keith R. , Alexander-Scott Nicole , Green Traci C. , Wellenius Gregory A. , Weinberger Kate R. 
Published: June 2019

Background:
The United States is in the midst of an opioid overdose crisis. Little is known about the role of environmental factors in increasing risk of fatal opioid overdose.

Methods:
We conducted a case–crossover analysis of 3,275 opioid overdose deaths recorded in Connecticut and Rhode Island in 2014–2017. We compared the mean ambient temperature on the day of death, as well as average temperature up to 14 days before death, to referent periods matched on year, month, and day of week.

Results:
Low average temperatures over the 3–7 days before death were associated with higher odds of fatal opioid overdose. Relative to 11°C, an average temperature of 0°C over the 7 days before death was associated with a 30% higher odds of death (odds ratio: 1.3; 95% confidence interval, 1.1, 1.5).

Conclusions:
Low average temperature may be associated with higher risk of death due to opioid overdose.
Diagnosed Sleep Apnea and Cardiovascular Disease in Atrial Fibrillation Patients
Authors: Ogilvie Rachel P. , MacLehose Richard F. , Alonso Alvaro , Norby Faye L. , Lakshminarayan Kamakshi , Iber Conrad , Chen Lin Y. , Lutsey Pamela L. 
Published: June 2019

Background:
Atrial fibrillation and obstructive sleep apnea are common conditions, but little is known about obstructive sleep apnea and cardiovascular risk among atrial fibrillation patients.

Methods:
Using the Truven Health MarketScan databases, we constructed a prospective cohort of atrial fibrillation patients from 2007 to 2014. Atrial fibrillation, obstructive sleep apnea, stroke, myocardial infarction, and confounders were defined using the International Classification of Disease-9-CM codes. We matched individuals with an obstructive sleep apnea diagnosis with up to five individuals without a diagnosis by age, sex, and enrollment date. Cox proportional hazards models adjusted for confounders and high-dimensional propensity scores. We included migraines as a control outcome. Bias analysis used published sensitivities and specificities to generate rate ratios adjusted for obstructive sleep apnea misclassification.

Results:
We matched 56,969 individuals with an obstructive sleep apnea diagnosis to 323,246 without. During a mean follow-up of 16 months, 3234 incident strokes and 4639 incident myocardial infarctions occurred. After adjustment, obstructive sleep apnea diagnosis was strongly associated with reduced risk of incident stroke (hazard ratio = 0.48, 95% confidence interval = 0.43, 0.53) and myocardial infarction (0.40, [0.37, 0.44]) and a smaller reduced risk of migraines (0.82, [0.68, 0.99]). Bias analysis produced wide-ranging or inestimable rate ratios adjusted for misclassification of obstructive sleep apnea.

Conclusions:
Obstructive sleep apnea diagnosis in atrial fibrillation patients was strongly associated with reduced risk of incident cardiovascular disease. We discuss misclassification, selection bias, and residual confounding as potential explanations.
Bayesian Methods for Exposure Misclassification Adjustment in a Mediation Analysis
Authors: Blouin Brittany , Casapia Martin , Kaufman Jay S. , Joseph Lawrence , Larson Charles , Gyorkos Theresa W. 
Published: June 2019

Background:
Soil-transmitted helminth infections have been found to be associated with child development. The objective was to investigate hemoglobin levels and malnutrition as mediators of the association between Ascaris infection and intelligence quotient (IQ) scores in children.

Methods:
We conducted a longitudinal cohort study in Iquitos, Peru, between September 2011 and July 2016. A total of 1760 children were recruited at 1 year of age and followed up annually to 5 years. We measured Ascaris infection and malnutrition at each study visit, and hemoglobin levels were measured as of age 3. The exposure was defined as the number of detected Ascaris infections between age 1 and 5. We measured IQ scores at age 5 and used Bayesian models to correct exposure misclassification.

Results:
We included a sample of 781 children in the analysis. In results adjusted for Ascaris misclassification, mean hemoglobin levels mediated the association between Ascaris infection and IQ scores. The natural direct effects (not mediated by hemoglobin) (95% CrI) and natural indirect effects (mediated by hemoglobin) (95% CrI) were compared with no or one infection: −0.9 (−4.6, 2.8) and −4.3 (−6.9, −1.6) for the effect of two infections; −1.4 (−3.8, 1.0) and −1.2 (−2.0, −0.4) for three infections; and −0.4 (−3.2, 2.4) and −2.7 (−4.3, −1.0) for four or five infections.

Conclusion:
Our results are consistent with the hypothesis that hemoglobin levels mediate the association between Ascaris infection and IQ scores. Additional research investigating the effect of including iron supplements in STH control programs is warranted.
Timing and Amount of Gestational Weight Gain in Association with Adverse Birth Outcomes
Authors: Darling Anne Marie , Werler Martha M. , Cantonwine David E. , Fawzi Wafaie W. , McElrath Thomas F. 
Published: June 2019

Background:
Most existing research on gestational weight gain and pregnancy outcomes has not accounted for timing of weight gain. The area under the weight gain curve (AUC) provides a single measure that incorporates both timing of weight gain and total amount gained. This study evaluated predictors and outcomes associated with second- and third-trimester weight gain AUC from the second and third trimester using time-to-event analysis to account for the correlation between gestational weight gain and gestational duration.

Methods:
Our prospective cohort study used data from the LifeCodes study at Brigham and Women’s Hospital. Maternal weights were available from all prenatal and study visits. We used log–Poisson models with empirical variance estimation to identify predictors of total AUC from 14 weeks to delivery and Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between AUC quintile and adverse pregnancy outcomes.

Results:
Compared to the middle quintile, the highest quintile of accumulated pound–days was associated with a decreased hazard of spontaneous preterm birth among multigravid women (HR = 0.44; 95% CI = 0.23, 0.84), a decreased hazard of small-for-gestational-age births (HR = 0.65; 95% CI = 0.45, 0.92) overall and an increased hazard of large-for-gestational-age births among normal and underweight women (HR = 3.21; 95% CI = 1.50, 6.89)

Conclusions:
In our study, a pattern of gestational weight gain characterized by more rapid gains earlier in pregnancy was associated with improved pregnancy outcomes in some subgroups of pregnant women.
MANAGEMENT OF RETINAL HEMANGIOBLASTOMA IN VON HIPPEL–LINDAU DISEASE
Authors: Wiley Henry E. , Krivosic Valerie , Gaudric Alain , Gorin Michael B. , Shields Carol , Shields Jerry , Aronow Mary E. , Chew Emily Y. 
Published: June 2019

Purpose:
To review the current state of diagnosis and management of retinal hemangioblastoma and retinal vascular proliferation arising from von Hippel–Lindau (VHL) disease.

Methods:
A review of the literature was performed. Consensus was reached among authors regarding current practice, with reference to published data where possible.

Results:
von Hippel–Lindau disease and its ocular manifestations are relatively rare, and there is limited evidence in the literature on which to base management. There was consensus on core principles, including 1) recognition and diagnosis of von Hippel–Lindau disease when present, with appropriate referral for care of this potentially lethal systemic condition; 2) regular ophthalmic evaluation for individuals with von Hippel–Lindau disease, to identify and offer timely treatment for new or active retinal hemangioblastomas; 3) ablative treatment of retinal hemangioblastomas that can be safely destroyed, to lower risk of vision loss; 4) observation or consideration of nonablative treatments for retinal hemangioblastomas that cannot be safely destroyed; and 5) observation of asymptomatic retinal vascular proliferation, with consideration of vitrectomy for lesions exerting effects on vision.

Conclusion:
Ocular outcomes can be gratifying in many cases with appropriate management. Improved understanding of the molecular basis for the disease creates an opportunity for rational design of better therapies.
EFFICACY AND SAFETY OF A TREAT-AND-EXTEND REGIMEN WITH AFLIBERCEPT IN TREATMENT-NAIVE PATIENTS WITH TYPE 3 NEOVASCULARIZATION
Authors: Arias Luis , Cervera Enrique , Vilimelis Jaume Crespí , Escobar José Juan , Escobar Antonio Gómez , Zapata Miguel Ángel ,   on behalf of the AFLIRAP Trial Investigators
Published: June 2019

Purpose:
To evaluate 52-week efficacy and safety of a treat-and-extend regimen of intravitreal aflibercept 2 mg on treatment-naive Type 3 neovascularization lesions.

Methods:
Phase IV, prospective, open-label, single-arm, multicenter trial including patients with untreated Stage I/II Type 3 neovascularization lesions and baseline best-corrected visual acuity between 78 and 23 Early Treatment Diabetic Retinopathy Study letters. Primary endpoint: mean change in best-corrected visual acuity from baseline at 52 weeks.

Results:
Thirty-two eyes from 32 patients were included (mean ± SD age: 78.2 ± 7.7 years, 68.8% females, baseline best-corrected visual acuity: 57.9 ± 15.4 [Snellen fraction 20/70]). Best-corrected visual acuity increased by 10.5 ± 15.9 Early Treatment Diabetic Retinopathy Study letters at Week 52 (P = 0.0001). The mean foveal and choroidal thickness decreased by 129.1 ± 80.1 µm (P < 0.0001) and 64.3 ± 96.5 (P = 0.0001), respectively. The proportion of patients with intraretinal/subretinal fluid decreased from 28 (87.5%) at baseline to 3 (11.5%) at Week 52 (P < 0.0001). Pigment epithelial detachment and lesion area showed nonsignificant changes over 52 weeks. The mean number of injections was 8.0 ± 2.0. Seven (21.9%) patients experienced treatment-related adverse events and two (6.3%) experienced serious adverse events; one (3.1%) ocular serious adverse event requiring treatment withdrawal, endophthalmitis, and one (3.1%) nonocular spontaneously resolved serious adverse event, palpitations. One (3.1%) patient experienced an APTC ATE: nonfatal stroke not related to trial treatment.

Conclusion:
A treat-and-extend regimen of aflibercept improves visual acuity and retinal edema in eyes with Type 3 neovascularization over 52 weeks with good tolerability.
FAILED LASER RETINOPEXY IN A PATIENT UNDERGOING PAZOPANIB THERAPY
Authors: Lifton Jacob , Chow Audrey , Moshfeghi Andrew A. 
Published: June 2019

Purpose:
To report a case of failed endolaser retinopexy in patient taking pazopanib and possible association with impaired retinal remodeling.

Methods:
Case report.

Results:
A 68-year-old man with a history of radiation-induced high-grade metastatic mediastinal leiomyosarcoma, on pazopanib 600 mg daily, presented with a superior retinal tear 2 months after initiating pazopanib. The patient was treated with pars plana vitrectomy and endolaser retinopexy without any immediate complications. One month postoperatively, the patient was found to have a new superior macula-sparing rhegmatogenous retinal detachment extending through the laser barricade nasally. A large proportion of the laser lesions in this area had notably remained chalk-white. The patient underwent pars plana vitrectomy with scleral buckling, and repeat endolaser retinopexy. Pazopanib therapy was stopped 1 week later in consultation with the oncology team and was reinitiated after the retina seemed stable under silicone oil for several weeks. The scars from the patient's repeat endolaser retinopexy remained pale white at his clinic visit 2 months after the procedure, and at that time, his initial laser scars had only just begun to darken with pigment. Four and a half months after the initial vitrectomy and endolaser retinopexy, and three and a half months after his repeat vitrectomy and endolaser retinopexy, all the patient's laser scars have developed increased pigment, and his retina remains completely flat under silicone oil tamponade.

Conclusion:
Pazopanib may have had an adverse effect on retinal wound healing after vitrectomy with endolaser retinopexy, leading to persistence of pale laser lesions many weeks after laser application. It is possible that this may have impaired the typical development of chorioretinal laser scar formation and led to subsequent retinal detachment.