bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of General and Musculoskeletal Health Literacy Disparities in Pediatric Sports Injury Patient and Guardian Populations
Authors: Su Lisa , Shaw Kylie , Serpa Rebecka O. , Grotts Jonathan , Bowen Richard , Beck Jennifer 
Published: June 2019

Background:
Increased participation of adolescents in organized sports has led to an increase in pediatric sports injury. Limited health literacy puts patients at risk for worse outcomes through decreased compliance. We aim to evaluate the extent of health literacy disparities in pediatric sports medicine populations.

Methods:
Patients aged 10 to 17 years and their consenting guardians visiting clinic for treatment of a sports-related injury completed a unique questionnaire including self-reported health literacy measures and direct assessment of knowledge regarding care for musculoskeletal injuries. Statistical analysis based on socioeconomic factors and demographics was performed using t tests.

Results:
A total of 268 patient surveys (14.37±1.94 y) and 251 guardian surveys (43.62±9.08 y) were collected. In self-reported general health literacy scores for guardians, all categories except ethnicity played a statistically significant role, with higher health literacy scores associated with higher education, use of English as the primary language at home, private insurance, and female guardians (P<0.001, <0.001, <0.001, 0.011). In contrast, age was the only factor affecting scores in the patient population (P=0.015). Among self-reported musculoskeletal health literacy and directly measured musculoskeletal literacy scores, there were significant differences in groups by age, primary language, and level of education (P=0.020, 0.003).

Conclusions:
Significant disparities in general and musculoskeletal health literacy exist within pediatric sports medicine populations, most notably between guardian groups. Improving disparities in health literacy for these populations may best be aimed at guardians, using medical education through verbal/written instruction in multiple languages.

Level of Evidence:
Level IV.
Prenatal Diethylstilbestrol Exposure and Risk of Depression in Women and Men
Authors: Titus Linda , Hatch Elizabeth E. , Palmer Julie R. , Huo Dezheng , Strohsnitter William C. , Adam Ervin , Ricker Winnie , Hyer Marianne , Hoover Robert N. , Troisi Rebecca 
Published: June 2019

Background:
Prenatal exposure to diethylstilbestrol (DES), an endocrine-disrupting chemical, may be associated with depression in adulthood, but previous findings are inconsistent.

Methods:
Women (3,888 DES exposed and 1,729 unexposed) and men (1,021 DES exposed and 1,042 unexposed) participating in the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study were queried in 2011 for any history of depression diagnosis or treatment. Hazard ratios (HRs; 95% confidence intervals [CIs]) estimated the associations between prenatal DES exposure and depression risk.

Results:
Depression was reported by 993 (26%) exposed and 405 (23%) unexposed women, and 177 (17%) exposed and 181 (17%) unexposed men. Compared with the unexposed, HRs for DES and depression were 1.1 (95% CI = 0.9, 1.2) in women and 1.0 (95% CI = 0.8, 1.2) in men. For medication-treated depression, the HRs (CIs) were 1.1 (0.9, 1.2) in women and 0.9 (0.7, 1.2) in men. In women, the HR (CI) for exposure to a low cumulative DES dose was 1.2 (1.0, 1.4), and for DES exposure before 8 weeks’ gestation was 1.2 (1.0, 1.4). In men, the HR for low dose was 1.2 (95% CI = 0.9, 1.6) and there was no association with timing. In women, associations were uninfluenced by the presence of DES-related vaginal epithelial changes or a prior diagnosis of DES-related adverse outcomes.

Conclusions:
Prenatal DES exposure was not associated overall with risk of depression in women or men. In women, exposure in early gestation or to a low cumulative dose may be weakly associated with an increased depression risk.
Revisiting redundancy in hospitals—A case-based research study
Authors: Tay Huay Ling , Singh Prakash J. 
Published: June 2019

Background
Redundancy is mostly conceived as “waste” resulting from inefficient operations that ought to be eliminated. However, there are scholars who challenge this view and argue that redundancy is an essential element in facilitating reliable and safe operations in health care delivery processes. The ambiguity on redundancy has led to limited insights in health care settings.

Purpose
This article seeks to provide clarity by investigating the conceptualization of redundancy within and across disparate contexts within hospital operations.

Design/Methodology/Approach
An exploratory study using different hospital departments was conducted in two large hospitals as case studies to allow for in-depth understanding of the conceptualization of redundancy across hospital departments. Data sources included 42 semistructured interviews, surveys, field notes from site observations, and document analysis.

Results/Findings
The findings revealed alternative conceptualizations of redundancy, these being safety, care, heterogeneity, sustenance, and waste, and highlight their dominance in distinct hospital departments. The first four categories are positive in connotation, whereas the last, waste, has a negative connotation. Further, the analysis revealed that the conceptualization of redundancy is context dependent.

Conclusion
Contrary to the general cognition of redundancy in the social science and management literature, our research found that redundancy might have a valuable role to play in core health care management concerns such as patient-centeredness, patient safety, and quality of care. This work is one of the first comprehensive studies on redundancy in the health care settings and is expected to steer scholarly conversations on redundancy in a more positive light.

Practical Implications
Overall, this article serves as a call to health care operations decision makers and chiefs of hospitals to reexamine their current approach and management practices on redundancy.
Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation
Authors: Leung Kai Ching Peter , Au Sunny Chi Lik , Ko Tak Chuen Simon 
Published: June 2019

Purpose:

Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome.

Methods:
A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented.

Results:
Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management.

Conclusions:

Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.
Incidence of Vicarious Trauma in Correctional Health and Forensic Mental Health Staff in New South Wales, Australia
Authors: Newman Claire , Eason Michelle , Kinghorn Grant 
Published: June 2019

ABSTRACT

Background:
Correctional health and forensic mental health (FMH) staff may experience vicarious trauma (VT) as a result of cumulative and repeated exposure to traumatic material in their professional roles.

Aim:
This study aimed to determine the incidence of VT in a sample of correctional health and FMH staff.

Methods:
A cross-sectional survey including 135 correctional health and FMH staff participating in a VT management program was conducted. Survey respondents completed the Vicarious Trauma Scale and Impacts of Events Scale-Revised.

Findings:
Most respondents had moderate or high VT (n = 78, 57.8%, and n = 40, 29.6%, respectively). Low psychological distress was reported, with posttraumatic stress disorder symptoms being experienced either mildly or not at all by most respondents. A significant relationship between total Vicarious Trauma Scale score and total Impacts of Events Scale-Revised score (r = 0.471, p = 0.000) was found, indicating that a higher level of VT was associated with an increased risk of posttraumatic stress disorder symptoms. A higher level of VT was also associated with increased reports of avoidance, intrusion, and hyperarousal (r = 0.382, p = 0.000; r = 0.489, p = 0.000; and r = 0.440, p = 0.000, respectively).

Conclusion:
Correctional health and FMH staff are at risk of developing VT and associated psychological distress.

Implications for Clinical FMH Nursing Practice:
Correctional health and FMH organizations have the responsibility to ensure nurses are aware of the effects of VT and to provide opportunities for nurses to participate in VT education and management programs.
There might be a distinctive clinical phenotype of constipation with non-cardiac chest pain which responds to combination laxatives
Authors: Park Jae Yong , Oh Sooyeon , Han Yoo Min , Lee Jooyoung , Kim Joo Sung , Jung Hyun Chae , Hong Kyoung Sup 
Published: June 2019

AbstractProton pump inhibitor (PPI)-refractory non-cardiac chest pain (NCCP) is often resolved when constipation was relieved. This study aimed to investigate the clinical features of patients with both NCCP and constipated functional bowel disorders (FBD).Among 692 consecutive patients diagnosed with functional constipation or irritable bowel syndrome with constipation and underwent anorectal manometry (ARM) in our hospital, PPI-refractory NCCP was present in 37. The clinical course of various torso symptoms including NCCP and ARM findings were retrospectively evaluated.The mean age was lower in the NCCP than in the non-NCCP group (57.4 vs 61.3 years, respectively,P = .042). Back pain (16.2% vs 2.0%,P < .001) and sharp abdominal pain (13.5% vs 0.9%,P < .001) were more common in the NCCP group. Increased resting pressure (16.2% vs 6.9%,P = .036) and squeezing pressure (62.2% vs 50.7%,P = .049) of the anal sphincter, increased urgency volume (40.5% vs 23.2%,P = .004), and maximal volume (25.7% vs 15.0%,P = .032) for rectal sensation were more frequently observed in the NCCP group. After taking laxatives for 1 to 3 months, 81.1% of patients with NCCP reported improvement.Subjects with NCCP showed decreased rectal sensation more frequently at anorectal manometry. Majority of patients with NCCP reported improvement of symptom upon relief of constipation. Constipation might be a therapeutic target in patients with NCCP related to constipated functional bowel disorders.
Acute onset neurological symptoms in Wilson disease after traumatic, surgical or emotional events
Authors: Li Liang-Yong , Zhu Xiao-Qun , Tao Wei-Wei , Yang Wen-Ming , Chen Huai-Zhen , Wang Yu 
Published: June 2019

Abstract
Acute onset neurological symptoms evoked by traumatic, surgical, or emotional events in Wilson disease (WD) have never been reported and its clinical characteristics are unclear.
We aimed to summarize the clinical characteristics of a special WD whose neurological symptoms acutely developed after traumatic, surgical, or emotional events.
Retrospective pilot study.
Thirty-one patients who had acute onset neurological symptom as an initial presentation of WD or a new presentation of hepatic WD after mild trauma, surgery, or emotional events were retrospectively studied. All patients were followed for half to 1 year after regular anti-copper treatment.
The averaged latency for neurological symptom presentation was 2.79 ± 1.21 hours. The most frequent neurological symptoms were tremor (74%) and basal ganglia (BG) lesions were detected on magnetic resonance imaging in all patients. Lesions in other regions were much less frequently detected. Neurological symptom score and its recovery after treatment were correlated with lesion location: BG area and BG plus other brain areas. Neurological symptoms improved in 21 patients who received timely anti-copper treatment but continued to deteriorate in 6 patients who did not accept regular anti-copper treatment for delayed diagnosis.
A diagnosis of WD should be considered when adolescents or adults experience acute presentation of extrapyramidal systems after traumatic, surgical, or emotional stimulation. Timely anti-copper therapy usually gives rise to an excellent prognosis.
Correlation of fatigue with other disease related and psychosocial factors in patients with rheumatoid arthritis treated with tocilizumab
Authors: Corominas Héctor , Alegre Cayetano , Narváez Javier , Fernández-Cid Carlos Marras , Torrente-Segarra Vicenç , Gómez Manuel Rodríguez , Pan Francisco Maceiras , Morlà Rosa María , Martínez Fernando José Rodríguez , Gómez-Centeno Antoni , Ares Laura Losada , Molina Rocío González , González-Albo Silvia Paredes , Dalmau-Carolà Joan , Pérez-García Carolina , Álvarez Ceferino Barbazán , Ercole Liliana , Terrancle Maria Ángeles 
Published: June 2019

Abstract
To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.
A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.
Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9 ± 12.5 years, disease duration 8.7 ± 7.4 years). Mean change in C-reactive protein level from baseline to week 12 was −11.2 ± 4.0 (P < .001). Mean Disease Activity Index score (DAS28) decreased from 5.5 ± 1.0 at baseline to 2.7 ± 1.3 (P < .001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was −5.4 ± 11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.
Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients.
Analysis of circulating blood and tissue biopsy PDX1 and MSX2 gene expression in patients with pancreatic cancer
Authors: Duarte-Medrano Gilberto , Lopez-Méndez Iván , Ramírez-Luna Miguel Ángel , Valdovinos-Andraca Francisco , Cruz-Martínez Rodrigo , Medina-Vera Isabel , Pérez-Monter Carlos , Téllez-Ávila Félix Ignacio 
Published: June 2019

Abstract
Early diagnosis of pancreatic cancer (PC) is based on endoscopic ultrasound (EUS). However, EUS is invasive and requires a high level of technical skill. Recently, liquid biopsies have achieved the same sensitivity and specificity for the diagnosis of numerous pathologies, including cancer. Insulin-promoting factor 1 (PDX1) and Msh-homeobox 2 (MSX2), 2 homeotic genes, have been confirmed to be related to pancreatic oncogenesis.
The aim of this study is to establish the diagnostic utility of circulating serum levels of MSX2 and PDX1 expression in patients with PC.
A prospective study was conducted from January 2014 to February 2017. Patients with a suspected diagnosis of PC who underwent fine needle aspiration biopsy guided by EUS (EUS-FNA) were included in the study, in addition to non-PC control subjects. Both tissue and blood serum samples were submitted to histopathological analysis and measurement of PDX1 and MSX2 gene expression by means of qRT-PCR.
Patients were divided into non-PC, malignant pathology (MP), or benign pathology (BP) groups. Significant differences in both MSX2 [2.05 (1.66–4.60) vs 0.83 (0.49–1.60), P = .006] and PDX1 [2.59 (1.28–10.12) vs 1.02 (0.81–1.17), P = .036] gene expression were found in blood samples of PC compared with non-PC subjects. We also observed a significant increase in MSX2 transcripts in tissue biopsy samples of patients diagnosed with MP compared with those with BP [1.98 (1.44–4.61) and 0.66 (0.45–1.54), respectively, P = .012]. The ROC curves indicate a sensitivity and specificity of 80% for PDX1 and 86% for MSX2.
Gene expression of MSX2 in tissue samples obtained by EUS-FNA and serum expression of MSX2 and PDX1 were higher in patients with PC.
TLR4/NF-κB signaling pathway gene single nucleotide polymorphisms alter gene expression levels and affect ARDS occurrence and prognosis outcomes
Authors: Ding Yueping , Feng Qijia , Chen Jianshi , Song Jia 
Published: June 2019

Abstract

Background:
To study the occurrence and prognosis of acute respiratory distress syndrome (ARDS) using single nucleotide polymorphisms (SNPs) of TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci in the TLR4/NF-κB pathway.

Methods:
Genotypes were analyzed for TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci. Plasma TNF-α and IL-6 levels and MyD88 mRNA expression in peripheral blood mononuclear cells (PBMCs) of 300 ARDS patients and 300 non-ARDS patients (control group) were examined. The patients were followed up for 60 days, and the prognosis outcome was recorded.

Results:
The TNF-α rs1800629 locus A allele and the IL-6 rs1800796 locus G allele were found to be risk factors for ARDS (adjusted OR = 1.452, 95% CI: 1.211–1.689, P < .001 and adjusted OR = 1.205, 95% CI: 1.058–1.358, P = .005, respectively). The G allele at MyD88 rs7744 locus was a protective factor against ARDS (adjusted OR = 0.748, 95% CI: 0.631–0.876, P < .001). Compared with the other groups, homozygotes for TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci had higher expression levels, of which homozygotes for TNF-α rs1800629 and IL-6 rs1800796 loci had lower 60-day survival rates, while MyD88 rs7744 locus homozygotes had a higher 60-day survival rate.

Conclusion:
The effect of TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 SNPs on gene expression level is a likely cause of ARDS occurrence and poor prognosis.
A retrospective study of mechanisms of anterior cruciate ligament injuries in high school basketball, handball, judo, soccer, and volleyball
Authors: Takahashi Saeko , Nagano Yasuharu , Ito Wataru , Kido Yosuke , Okuwaki Toru 
Published: June 2019

Abstract
The purpose of this study was to analyze the mechanism of anterior cruciate ligament (ACL) injuries among male and female high school students across several different sports to understand ACL injury trends.
A total of 1000 cases involving high school students who suffered ACL injuries during school activities (soccer, basketball, volleyball, handball, and judo) and who received insurance benefits through the Injury and Accident Mutual Aid Benefit System, were included to clarify the various mechanisms of ACL injuries. The mechanism of ACL injury was divided into contact and non-contact injuries. Contact injuries were further divided into direct and indirect contact injuries. Non-contact ACL injuries were also further divided into landing injuries, which involved jump-landing movements, and cutting and stopping injuries, which involved movement with a change of direction and deceleration.
Overall, 99.0% of judo ACL injuries were categorized as contact ACL injuries. With regards to ball sports, the number of non-contact ACL injuries among basketball, volleyball, and handball players was significantly higher than the number of contact injuries (67.0%, 86.5%, and 68.5% respectively). With regards to female soccer and basketball players, the number of indirect ACL injuries was higher than direct injuries (72.2% and 76.7%, respectively).
Volleyball was associated with a higher rate of non-contact injuries. Soccer, basketball, and handball were associated with more or similar rates of indirect and non-contact injuries than direct injuries. Judo was associated with a higher rate of contact injuries.
Integrative cancer treatment may have a survival benefit in patients with lung cancer
Authors: Bae Kyeore , Kim Eunseok , Kong Ji-Sook , Kim Jeehye , Park So-jung , Jun Hyeong joon , Cho Chong-kwan , Kim Mi Kyung , Yoo Hwa-Seung 
Published: June 2019

Abstract
Integrative oncology is being increasingly adopted in mainstream cancer care to strengthen anticancer effects and to control cancer-related symptoms.
The objective of this study is to identify the characteristics of patients with lung cancer treated at an integrative cancer center in Korea and to determine the effects of integrative cancer treatment (ICT) on survival outcome in traditional Korean medicine (TKM).
We reviewed medical records for lung cancer patients who visited a single integrative clinical setting, East-West Cancer Center, between January 2014 and December 2015. We classified the patients into groups according to their ICT and whether or not they underwent anticancer traditional Korean Medicine treatment with a multiherbal formula containing Panax notoginseng Radix, Cordyceps militaris, P ginseng C.A.Mey., and Boswellia carterii BIRDWOOD (HangAmDan-B), with a herbal formula containing Rhus verniciflua Stoke, or with cultivated wild ginseng pharmacopuncture. A descriptive analysis of the characteristics and a survival analysis using the Kaplan-Meier curves with log rank test and a Cox proportional hazard model were performed.
A total of 91 patients were included, and the majority had advanced-stage cancer. Of those patients, 45.1% were in the mono-TKM group and 39.6% were integrative group. Patients with advanced stage had significantly higher mortality than patients with early stage (crude hazard ratio [HR]: 4.41, 95% confidence interval [CI]: 1.56–12.5; adjusted HR: 6.31, 95% CI: 1.24–32.1). In the unadjusted model, for patients in the integrative group, the mortality rate was reduced by 50% compared to mono-TKM group with statistical significance. After adjusting confounders, the mortality rate of integrative group was reduced by 6% compared to mono-TKM group, suggesting positive effect on survival probability of integrative group.
The results suggest that integration of TKM and conventional cancer treatment may have survival benefits in patients with lung cancer. Even though this study has limitations including heterogeneity between treatment groups, the study results suggest that ICT has positive effect on survival probability. To clarify the impacts of ICT for lung cancer and other cancers on survival outcome, further prospective study with a rigorous study design is required in multiclinical setting.