bluuebunny/crossref_metadata_2025_split huggingface dataset:
Procedure Prioritization During a Nationwide Ban on Non-Urgent Healthcare: A Quasi-Experimental Retrospective Study of Hospital Data in Switzerland
Authors: Grischott Thomas , Mehra Tarun , Meyer Matthias R , Senn Oliver , Rachamin Yael 
Published: October 2024

Background: During the COVID-19 lockdown in spring 2020, Switzerland restricted non-urgent healthcare services to safeguard capacity. While prioritization of care was supposed to be driven by medical urgency, demographic factors or economic incentives might have influenced the hospitals’ resource allocation decisions. Objectives: This study investigates potential determinants of procedure prioritization in hospitalized patients during the lockdown period. Design: Quasi-experimental retrospective study of hospital data in Switzerland. Methods: We analyzed 496 456 adult patients with known insurance status and a recorded procedure, admitted for cardiovascular, orthopedic/musculoskeletal or oncological reasons from January 2017 (3 years before the COVID-19 outbreak) to mid-April 2020 (in the first year of the COVID-19 pandemic), to obtain admission rate ratios (ARRs, “lockdown” admission rates divided by “normal” rates) from negative binomial regression analysis of fortnightly admissions for frequent procedure-diagnosis combinations. Quade and Wilcoxon signed-rank tests compared ARRs between sex×age, insurance and comorbidity strata. Results: Admission rates showed significant reductions for 29 of 53 procedure-diagnosis combinations. Reductions varied strongly by emergency, with largest decreases in orthopedic procedures for arthrosis (osteoarthritis) and non-arthritic joint disorders, and the smallest in cerebral imaging for stroke patients and surgical procedures for malignant neoplasms. The only difference in ARRs between strata was a stronger decrease in admission rates for cardiovascular combinations for patients with private versus basic health insurance. Conclusion: While medical procedures were affected to varying degrees by the ban on non-urgent healthcare during the COVID-19 lockdown, we found no robust evidence that factors other than medical urgency influenced healthcare prioritization.
Prevalence and Predictors of Adverse Events Associated With Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetic Patients: A Cross-sectional Study
Authors: Reghunath Swetha R , Chackochan Ashna , Thunga Girish , Acharya Dinesh U , Shivashankara Kaniyoor Nagri , Ravindra Prabhu Attur , Acharya Leelavathi D 
Published: October 2024

Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India. Objective: To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM). Research design and methods: This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike’s information criterion and highest Pseudo R2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1. Results: Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006–1.020)], alkaline phosphatase [OR: 1.004 (1.001–1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012–1.366)] were significant predictors for AEs with DPP-4 inhibitors. Conclusion: The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.
Best supportive care for patients with primary progressive multiple sclerosis (PPMS) in Germany prior to ocrelizumab treatment: Final results from the RETRO PPMS study
Authors: Schreiber Herbert , Penner Iris-Katharina , Maier Tanja , Hieke-Schulz Stefanie , Leemhuis Jost , Ziemssen Tjalf 
Published: October 2024

Background Best supportive care (BSC) measures are an essential component for the management of primary progressive multiple sclerosis (PPMS). Objectives RETRO PPMS (ML39631) is the first study to systematically analyze the therapeutic journey and standard of BSC of patients with PPMS in Germany. Design This multicenter, non-interventional study retrospectively analyzed patient charts. Methods: Data were recorded up until the first infusion of ocrelizumab (July 2018 to October 2021). Medical history, disease status, disease activity and treatments were assessed from 12 months before PPMS diagnosis until study start. Acute interventions, BSC parameters and rehabilitation measures from the past 27 months were assessed. Results The core analysis population (N = 462) had a mean age (range) of 57.4 (27–85) years and mean disease duration of 13.7 (0.3–55.2) years. The most frequently reported symptoms were muscle spasticity, bladder disorder, ataxia, gait disturbance and fatigue. The most commonly used treatment was physical/occupational therapy (66.5% of patients); 47.2% received off-label treatment with corticosteroids/disease-modifying therapies. BSC measures for many symptoms were strikingly rare – especially for fatigue and cognitive impairment. Conclusion This analysis uncovers severe BSC deficits for many debilitating PPMS symptoms. There is still a large unmet need for innovative multidisciplinary care concepts and improvements in neurological primary and secondary care.
Regular cannabis smoking and carotid artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Corroon Jamie , Bradley Ryan , Grant Igor , Daniels Michael R , Denenberg Julie , Bancks Michael P , Allison Matthew A 
Published: October 2024

Background: Studies on cannabis use and adverse cardiovascular outcomes have reported conflicting results. Research on its relationship to calcified arterial plaque remains limited. Methods: Cross-sectional data from 2152 participants at Exam 6 (2016–2018) in the Multi-Ethnic Study of Atherosclerosis (MESA) were analyzed, including self-reported cannabis smoking patterns and carotid artery calcification (CAC) as measured via computed tomography. Multivariable relative and absolute risk regression models were used to estimate adjusted prevalence ratios (PRs) and prevalence differences, respectively, for the presence of calcified plaque. Multivariable linear regression was then used to compare group differences in the extent of CAC in those with calcified plaque. Results: A minority of participants ( n = 159, 7.4%) reported a history of regular cannabis smoking. Among all participants, 36.1% ( n = 777) had detectable CAC. In models adjusted for demographics, behavioral, and clinical cardiovascular disease factors, a history of regular cannabis smoking was not associated with the prevalence of CAC in either common carotid artery (PR: 1.14, 95% CI: 0.88 to 1.49). In the subset of participants with calcified plaque, and in separate fully adjusted multivariable linear regression models, a history of regular cannabis smoking was not associated with increased calcium volume (difference = 7.7%, 95% CI: –21.8 to 48.5), calcium density (difference = 0.4%, 95% CI: –6.6 to 7.9), or Agatston score (difference = 32.1%, 95% CI: –31.8 to 155.8) in either carotid artery. Models exploring potential effect modification by age, race/ethnicity, and tobacco smoking status showed no significant association, except for higher CAC prevalence in men with a history of regular cannabis smoking. Conclusions: In a racially and ethnically diverse cohort of older adults with a moderately high prevalence of CAC, no associations were found between a history of regular cannabis smoking, duration, or recency of cannabis smoking, and the prevalence of carotid calcified plaque. These findings were consistent across age, race/ethnicity, and cigarette smoking, except for an increased prevalence in men with a history of regular cannabis smoking. Similarly, in a subgroup with CAC, no association was found between a history of regular cannabis smoking and extent of calcification as measured by volume, density, and Agatston score.
Lifestyle factors as predictors of incident functional somatic disorder. Five-year follow-up of The DanFunD study
Authors: JØrgensen Torben , Jacobsen Rikke K. , Weinreich Petersen Marie , Bjerregaard Anne A. , Ulfbeck Schovsbo Signe , Gormsen Lise K. , Falgaard Eplov Lene , Linneberg Allan , Fink Per , Eriksen Benros Michael , Dantoft Thomas 
Published: October 2024

Aims: To assess whether lifestyle factors, including sleep pattern, are predictors for the development of functional somatic disorder (FSD). Methods: A population-based prospective cohort of 9656 men and women aged 18–76 years was established in 2011–2015 and invited for re-examination in 2017–2020, when 5738 participated. Median follow-up period was 65 months. Participants filled in validated questionnaires on lifestyle, sleep pattern and various delimitations of FSD, which were operationalized using two different approaches: bodily distress syndrome (BDS) and functional somatic syndromes (FSS) (i.e. chronic fatigue, chronic widespread pain (CWP), irritable bowel, and multiple chemical sensitivity (MCS)). Baseline lifestyle and sleep pattern in relation to incidence of BDS and FSS (chronic fatigue, CWP, irritable bowel, MCS) was analysed by logistic regressions, adjusted for age, sex and subjective social status. Results: Inferior sleep quality at baseline predicted both incidence of BDS and all FSS delimitations except MCS. Smoking, alcohol intake, and low physical activity, but not diet, were predictors for the development of BDS. No uniform pattern was observed for the FSS. Smoking predicted development of chronic fatigue, CWP and irritable bowel, but not MCS. Alcohol and food quality only influenced the development of chronic fatigue whereas low physical activity only influenced the development of chronic fatigue and CWP. Conclusions: Lifestyle factors and sleep pattern seem to be predictors for some delimitations of FSD, but the importance of the various lifestyle factors is different for the different delimitations. The study shows the importance of analysing the various FSSs separately.
Algorithm for forming hospital care episodes by combining attendance contacts in the Danish National Patient Register: A methodological consensus-driven study
Authors: Gregersen Rasmus , Fox Maule Cathrine , Bjørn Jensen Camilla , Winther-Jensen Matilde , Helms Andreasen Anne , Nygaard Hanne , Pottegård Anton , Schmidt Morten , Paaske Johnsen Søren , Petersen Janne , Villumsen Marie 
Published: October 2024

Background: Studying complete hospital care episodes from register data, for instance when assessing length of stay, discharges and readmissions, can cause methodological difficulties due to the lack of a contact linkage identifier. We aimed to develop an algorithm combining sequential attendance contacts in the Danish National Patient Register (DNPR) into hospital care episodes, spanning the entire duration and all contacts from hospital arrival to departure. Methods: The algorithm was developed under the consensus of experts from research institutions across Denmark. It reads in second and third version DNPR data, deletes contacts without attendance, duplicates elective outpatient contacts corresponding to attendance dates and modifies contact types (e.g. repeated acute contacts), among others. Thereafter, sequential contacts within 4 h are marked as the same hospital care episode, consisting of one or more DNPR contact. We tested the algorithm in a data set of adults living in Denmark during 2013–2021 and compared different hourly cut-offs. Results: For the demonstration, we included 120.2 m contacts from 5.7 m persons, combined into 105.9 m hospital care episodes. Of the hospital care episodes, 6.4% were acute inpatients, 8.3% were acute outpatients, 2.0% were elective inpatients and 83.3% were elective outpatients. Using 4 h as our recommendation, 3-h, 5-h and 6-h cut-offs for contact combining revealed only minor differences in the number of hospital care episodes (<0.4%), whereas 12-h (<1.7%) and 24-h cut-offs (<43.1%) had a larger impact. Conclusions: The algorithm automates data reading, modification and linkage of sequential attendance contacts. The algorithm can be initiated as a SAS macro and is available from an online repository.
The Norwegian Counties Public Health Survey (NCPHS): a design study
Authors: AarØ Leif Edvard , Knapstad Marit , Nilsen Thomas , Skogen Jens Christoffer , Nes Ragnhild Bang , Leino Tony , Riise Ingunn Agnete , Johansen Rune , GrØtvedt Liv , Vedaa Øystein , Stigen Ole Trygve , Reneflot Anne , Gulseth Hanne LØvdal , Klepp Knut-Inge 
Published: October 2024

Background: Effective public health initiatives should be founded on a comprehensive and robust understanding of health-related factors including societal and community contexts. The Norwegian Counties Public Health Survey (NCPHS) aims for insights into the adult population on topics relevant for planning public health practices at county and municipality levels. Methods: The NCPHS includes a core questionnaire on public health-related topics and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register and ‘washed’ against the Common Contact Register to retrieve digital contact information and exclude those who cannot be contacted electronically. NCPHS was piloted in 2015 and 2018 (four counties). After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400,000. Results: Expedient data analysis has enabled the Norwegian Institute of Public Health to present comprehensive reports within 6 weeks of completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment and self-reported sufficiency of household income. Tables are also made available at the municipality level. Conclusions: The NCPHS represents a valuable addition to existing data sources, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions and for evaluation of policies and interventions. The value of such a system during times of crisis was demonstrated during the COVID-19 pandemic.
Epidemiological investigation support application and user evaluation based on infectious disease self-management model in the endemic era
Authors: Park Jihwan , Rho Mi Jung 
Published: October 2024

Objectives: Rapid epidemiological investigations are fundamental to prevent the spread of infectious diseases such as coronavirus disease 2019. An epidemiological investigation presents significant challenges for both epidemiologists and infected individuals. It requires creating an environment that enables people to independently manage infectious diseases and voluntarily participate in epidemiological investigations. Methods: We developed the KODARI application, an epidemiological investigation support system that users can voluntarily use. We developed the questionnaires based on literature reviews. We evaluated the application through an online survey from December 2 to 14, 2022. Results: The application automatically or manually collect epidemiological investigation information. The application improved data accuracy through accurate information collection. It voluntarily can transmit self-management information to epidemiologist terminals or users in real time. We collected 248 users from an online survey. Most users had high ratings and willingness to use. They have willingness to manage infectious patients was substantial. The application was evaluated as helpful for epidemiological investigations and could shorten the time required for epidemiological investigations by more than 30 min. Conclusion: The application proposes a model based on people’s voluntary participation. We demonstrated that the application could enhance epidemiological investigations and diminish the duration of existing epidemiological investigation processes.
Predicting Bone Marrow Metastasis in Neuroblastoma: An Explainable Machine Learning Approach Using Contrast-Enhanced Computed Tomography Radiomics Features
Authors: Wang Haoru , He Ling , Chen Xin , Ding Shuang , Xie Mingye , Cai Jinhua 
Published: October 2024

Purpose To predict bone marrow metastasis in neuroblastoma using contrast-enhanced computed tomography (CECT) radiomics features and explainable machine learning. Methods This cohort study retrospectively included a total of 345 neuroblastoma patients who underwent testing for bone marrow metastatic status. Tumor lesions on CECT images were delineated by two radiologists, and 1409 radiomics features were extracted. Correlation analysis, Least Absolute Shrinkage and Selection Operator regression, and one-way analysis of variance were used to identify radiomics features associated with bone marrow metastasis. A predictive model for bone marrow metastasis was then developed using the support vector machine algorithm based on the selected radiomics features. The performance of the radiomics model was evaluated using the area under the curve (AUC), 95% confidence interval (CI), accuracy, sensitivity, and specificity. Results The radiomics model included 16 features, with a predominant focus on texture features (12/16, 75%). In the training set, the model demonstrated an AUC of 0.891 (95% CI: 0.848-0.933), an accuracy of 0.831 (95% CI: 0.829-0.832), a sensitivity of 0.893 (95% CI: 0.840-0.946), and a specificity of 0.757 (95% CI: 0.677-0.837). In the test set, the AUC, accuracy, sensitivity, and specificity were 0.807 (95% CI: 0.720-0.893), 0.767 (95% CI: 0.764-0.770), 0.696 (95% CI: 0.576-0.817), and 0.851 (95% CI: 0.749-0.953), respectively. Conclusion Radiomics features extracted from CECT images are associated with the presence of bone marrow metastasis in neuroblastoma, providing potential new imaging biomarkers for predicting bone marrow metastasis in this disease.
Prognostic value of the TP53 mutation in patients with pancreatic ductal adenocarcinoma receiving FOLFIRINOX
Authors: Kim Min Kyu , Cho In Rae , Kim Yooeun , Choi Jin Ho , Jung Kwangrok , Kim Jaihwan , Kim Sheehyun , Yun Hongseok , Yoon Jeesun , Oh Do-Youn , Kim Kwangsoo , Lee Sang Hyub 
Published: October 2024

Background: KRAS, TP53, CDKN2A, and SMAD4 have been the main driver mutations in pancreatic ductal adenocarcinoma (PDAC). Studies on the clinical significance and treatment response to 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) regimen in terms of the presence of these mutations remain inconclusive. Objectives: This study aimed to compare the survival outcome and response to FOLFIRINOX chemotherapy based on the presence of four driver mutation genes. Design: A multi-center retrospective study conducted at two tertiary medical centers. Methods: This study analyzed PDAC patients who were treated with FOLFIRINOX chemotherapy as the initial treatment. Tumor specimens were analyzed by a targeted next-generation sequencing platform at two tertiary referral hospitals from January 2016 to March 2022. Patients’ demographics, survival outcomes, and chemotherapeutic response were investigated and compared according to the presence of driver mutations. Results: The analysis included 100 patients. KRAS mutation was identified in 92 (92.0%) patients, followed by TP53, CDKN2A, and SMAD4 in 63 (63.0%), 18 (18.0%), and 17 (17.0%) patients, respectively. The TP53 wild-type group demonstrated longer overall survival (OS) than the TP53 mutated group (median OS: 29 vs 19 months, p = 0.03), and TP53 served as a prognostic factor for survival (hazard ratio = 1.74, 95% confidence interval: 1.00–3.00, p = 0.048). The difference in OS according to TP53 mutation was intensified in localized pancreatic adenocarcinoma (37 vs 19 months, p = 0.01). The TP53 wild-type group demonstrated a higher objective response rate to FOLFIRINOX chemotherapy than the TP53 mutation group in localized pancreatic adenocarcinoma (50.0% vs 17.6%, p = 0.024). Conclusion: PDAC patients with wild-type TP53 demonstrated longer OS than those with TP53 mutation, and this trend was intensified in patients with localized disease. This result may be due to an impaired response to FOLFIRINOX chemotherapy in patients with TP53 mutation.
The impact of neurological impairment and tone on hip joint development
Authors: Ciftci Sadettin , Almeida da Silva Luiz Carlos , Howard Jason J , Shrader Michael Wade , Miller Freeman 
Published: October 2024

Purpose: The purpose of this study was to define how different force environments by neuromuscular diagnosis (hypertonic versus hypotonic) impact the growth and morphology of the proximal femoral and acetabular regions relative to typically developing children. Methods: Children with cerebral palsy and spinal muscular atrophy were compared with typically developing children aged 6 months to 11 years. Routine pelvic radiographs were evaluated using measures of hip geometry for the proximal femur and acetabulum. The data were analyzed using general linear models to estimate the developmental patterns according to age and diagnosis. Results: One hundred eighty-four children met the inclusion criteria: 58 spastic cerebral palsy Gross Motor Function Classification System I–V (263 hips), 32 spinal muscular atrophy (79 hips)), and 94 typically developing (187 hips) were included with a mean age of 4.9 ± 3.1 years. Using spinal muscular atrophy as a reference, significant differences in proximal femoral development included long thin versus short neck ( p < 0.01) and round versus flat epiphysis ( p = 0.001). A thin neck-wide epiphysis was found in spinal muscular atrophy versus thick neck-small epiphysis for typically developing ( p < 0.05). The ratio of acetabular width to proximal femoral epiphysis width differed significantly for typically developing ( p = 0.001) compared with cerebral palsy and spinal muscular atrophy. There was a negative correlation between migration percentage and acetabular width to epiphysis width in children with cerebral palsy, but no correlation in children with spinal muscular atrophy. Conclusion: Hip geometry was impacted by the force environment experienced during growth. These findings emphasize the crucial roles of gross motor function, muscle tone, and strength differences in determining hip morphology. Level of Evidence: III, retrospective case control.