bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do we need to screen for de-novo diabetes mellitus in chronic hepatitis C patients after a sustained virological response?
Authors: Mousa Nasser , Abdel-Razik Ahmed , Farag Raghda , Shabana Walaa , Elgamal Ayman , El-Wakeel Niveen , Elzehery Rasha , Elkashef Wagdi , Eldars Waleed 
Published: June 2017

Background and aim
There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated with a combination therapy (interferon and ribavirin) and have achieved a virological response (SVR) worldwide. The aim of this study is to evaluate the risk factors for de-novo diabetes mellitus in CHC patients treated with combination therapy (interferon and ribavirin) and have achieved an SVR.

Patients and methods
A total of 214 nondiabetic CHC patients with SVR and baseline homeostasis model assessment (HOMA) less than or equal to 2 were divided into group A, which included 108 patients with a BMI less than 25, and group B, which included 106 patients with a BMI of at least 25 and less than 30. HOMA insulin resistance (IR) and BMI were measured at the baseline, at achievement of an SVR, and 1 year after achievement of an SVR. Leptin levels were assessed at baseline and 1 year after achievement of an SVR in patients with increased BMI.

Results
One year after SVR, 36 (33.33%) patients from group A developed increasing BMI with no significant changes in HOMA versus that at SVR (P=0.53), but showed a significant reduction versus baseline HOMA (P=0.02). In group B, 68 (64.1%) patients showed increased BMI of at least 25, with a significant increase in HOMA versus that at SVR (P=0.02), and with no significant reduction versus baseline HOMA (P=0.44). In group B, serum leptin showed a significant reduction 12 months after achievement of an SVR versus baseline in patients with increased BMI. Six patients from group B with increased BMI after 1 year developed de-novo IR and type two diabetes mellitus.

Conclusion
In nondiabetic CHC patients with SVR and baseline BMI of at least 25, the post-SVR increase in BMI predisposed to an increase in HOMA-IR and could be considered a predisposing factor for diabetes mellitus.
Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury
Authors: Basso D. Michele , Lang Catherine E. 
Published: June 2017

Background and Purpose:
Nearly 4 decades of investigation into the plasticity of the nervous system suggest that both timing and dose could matter. This article provides a synopsis of our lectures at the IV STEP meeting, which presented a perspective of current data on the issues of timing and dose for adult stroke and spinal cord injury motor rehabilitation.

Summary of Key Points:
For stroke, the prevailing evidence suggests that greater amounts of therapy do not result in better outcomes for upper extremity interventions, regardless of timing. Whether or not greater amounts of therapy result in better outcomes for lower extremity and mobility interventions needs to be explicitly tested. For spinal cord injury, there is a complex interaction of timing postinjury, task-specificity, and the microenvironment of the spinal cord. Inflammation appears to be a key determinant of whether or not an intervention will be beneficial or maladaptive, and specific retraining of eccentric control during gait may be necessary.

Recommendations for Clinical Practice:
To move beyond the limitations of our current interventions and to effectively reach nonresponders, greater precision in task-specific interventions that are well-timed to the cellular environment may hold the key. Neurorehabilitation that ameliorates persistent deficits, attains greater recovery, and reclaims nonresponders will decrease institutionalization, improve quality of life, and prevent multiple secondary complications common after stroke and spinal cord injury.
Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management
Authors: Page Charlotte M. , Hughes Brenna L. , Rhee Eleanor H.J. , Kuller Jeffrey A. 
Published: June 2017

Importance
An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission.

Objectives
The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management.

Evidence Acquisition
Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration.

Results
Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy.

Conclusions and Relevance
Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completion of this educational activity, the obstetrician/gynecologist should be able to summarize current knowledge on the impact of pregnancy on maternal chronic hepatitis C, identify risks that maternal hepatitis C infection presents to the fetus, discuss the evidence on perinatal interventions and the risk of vertical transmission of HCV, and outline how to screen for, diagnose, and provide appropriate prenatal care for hepatitis C in pregnancy.
The Limits of Electronic Fetal Heart Rate Monitoring in the Prevention of Neonatal Metabolic Acidemia
Authors: Clark Steven L. , Hamilton Emily F. , Garite Thomas J. , Timmins Audra , Warrick Philip A. , Smith Samuel 
Published: June 2017

(Abstracted from Am J Obstet Gynecol 2017;216:163.e1–163.e6)
Despite advances in technology and training, averting the neurologic injury causing hypoxia-induced fetal metabolic acidemia has not been demonstrated. By examining fetal heart rate tracings of infants with base deficit of more than 12 and base deficit of less than 8, this study seeks to assess the validity of electronic fetal heart rate monitoring (EFM) in preventing adverse metabolic acidemia–related outcomes and validate a fetal heart rate interpretation algorithm, specifically designed to assist with the management of category II fetal heart rate tracings.
Narrative Review: Sexually Transmitted Diseases and Homeless Youth—What Do We Know About Sexually Transmitted Disease Prevalence and Risk?
Authors: Caccamo Alexandra , Kachur Rachel , Williams Samantha P. 
Published: June 2017

Background
Homelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population.

Methods
We identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000–2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth.

Results
Eight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior.

Conclusions
Sexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.
The Impact of Multiple Viral Respiratory Infections on Outcomes for Critically Ill Children*
Authors: Chauhan Jigar C. , Slamon Nicholas B. 
Published: June 2017

Objective:
Advances in molecular diagnosis have led to increased testing for single and multiviral respiratory infection in routine clinical practice. This study compares outcomes between single and multiviral respiratory infections in children younger than 5 years old admitted to the PICU with respiratory failure.

Design:
Retrospective, single-center, cohort study.

Setting:
Tertiary-care, freestanding children’s hospital.

Patients:
Children younger than 5 years old admitted to the PICU with respiratory failure and positive respiratory molecular panel. Children with comorbidity or history of similar infections were excluded. After exclusions, the children were divided into single or multiviral groups. Their demographics and PICU outcomes were compared and analyzed.

Interventions:
None.

Measurements and Main Results:
Four hundred seventy-seven children with respiratory failure tested positive on respiratory panel, out of which 432 had single and 45 had multiple viruses. Children with multiple viruses had a longer PICU stay (4.5 d) compared with the single viral group (3 d; p < 0.002). Multiviral infections were associated with higher utilization of central line (odds ratio, 2.4; 95% CI, 1.3–4.6; p = 0.008) but not with the need of invasive ventilation requirement or cardiovascular dysfunction. Further analysis among invasively ventilated patients showed multiviral infections resulted in higher association of prolonged ventilation (> 7 d) (odds ratio, 3.4; 95% CI, 1.2–9.4; p = 0.01) and bacterial lower respiratory tract infection confirmed by quantitative bronchoalveolar lavage (odds ratio, 2.1; 95% CI, 1.1–11.2; p = 0.03). Infections with human rhinovirus/Enterovirus, Adenovirus, parainfluenza, and influenza formed a significantly larger proportions of cases (p = 0.00089) as multiviral infections compared with individual infections.

Conclusions:
Multiviral infections were associated with longer PICU stay, with prolonged mechanical ventilation, with bacterial lower respiratory infections, and with central line requirement. Certain common viruses resulted in higher percentages of PICU admission as multiviral infections.
Building a Pediatric Oral Health Training Curriculum for Community Health Workers
Authors: Martin Molly , Frese William , Lumsden Christie , Sandoval Anna 
Published: June 2017

Objectives:
Community health workers (CHWs) are a promising approach to oral health promotion in high-risk populations. This article describes the process of creating a pediatric oral health CHW training curriculum.

Design:
Existing curricula were identified through outreach efforts to experts in the oral health and CHW fields, as well as PubMed and Google searches. After coding basic information, curricula were mapped to define oral health domains. Then group discussion was employed to determine final curriculum contents.

Setting:
United States.

Inclusion Criteria:
Curricula were included if they addressed oral health, were in English or Spanish, involved US populations, did not target dental clinicians, and whether sufficient data could be obtained.

Main Outcome Measures:
Curricula were evaluated for delivery format, number of hours, target audience, inclusion of CHWs, completeness, and oral health content.

Results:
Eighteen unique curricula were identified; 14 (78%) were CHW specific. Pathologic factors, caries formation, toothbrushing basics, flossing, nutrition, sugar-sweetened beverages, oral health recommendations, baby bottle tooth decay, fluoride treatments, and fluoride were covered to some extent in 75% of curricula. More than half did not mention types of teeth, oral health during pregnancy, antifluoride, cultural humility, and special needs populations. After comparing CHW curricula with non-CHW curricula, the original 26 oral health domains were condensed into 10 CHW training domains.

Conclusion:
Using existing evidence and expert insight, an oral health CHW training curriculum outline was created that emphasizes behaviors, social support, and navigation assistance to promote preventive oral health behaviors in families of young children. This has implications beyond oral health. CHW programs are expanding to address the social determinants of health. The process of creating this curriculum and its basic elements can be applied to other disease areas. Clearly defined trainings that are made publicly available, such as this one, support efforts to standardize the CHW field in preparation for CHW certification and reimbursement in the future.
Building Data and Information Capacity in Environmental Public Health: A Best-Worst Scaling Experiment
Authors: Wallar Lauren E. , Sargeant Jan M. , McEwen Scott A. , Mercer Nicola J. , Papadopoulos Andrew 
Published: June 2017

Context:
Environmental public health practitioners rely on information technology (IT) to maintain and improve environmental health. However, current systems have limited capacity. A better understanding of the importance of IT features is needed to enhance data and information capacity.

Objective:
(1) Rank IT features according to the percentage of respondents who rated them as essential to an information management system and (2) quantify the relative importance of a subset of these features using best-worst scaling.

Design:
Information technology features were initially identified from a previously published systematic review of software evaluation criteria and a list of software options from a private corporation specializing in inspection software. Duplicates and features unrelated to environmental public health were removed. The condensed list was refined by a working group of environmental public health management to a final list of 57 IT features. The essentialness of features was electronically rated by environmental public health managers. Features where 50% to 80% of respondents rated them as essential (n = 26) were subsequently evaluated using best-worst scaling.

Setting:
Ontario, Canada.

Participants:
Environmental public health professionals in local public health.

Main Outcome Measure:
Importance scores of IT features.

Results:
The majority of IT features (47/57) were considered essential to an information management system by at least half of the respondents (n = 52). The highest-rated features were delivery to printer, software encryption capability, and software maintenance services. Of the 26 features evaluated in the best-worst scaling exercise, the most important features were orientation to all practice areas, off-line capability, and ability to view past inspection reports and results.

Conclusions:
The development of a single, unified environmental public health information management system that fulfills the reporting and functionality needs of system users is recommended. This system should be implemented by all public health units to support data and information capacity in local environmental public health. This study can be used to guide vendor evaluation, negotiation, and selection in local environmental public health, and provides an example of academia-practice partnerships and the use of best-worst scaling in public health research.
Brief Report: Appraising Viral Load Thresholds and Adherence Support Recommendations in the World Health Organization Guidelines for Detection and Management of Virologic Failure
Authors: McCluskey Suzanne M. , Boum Yap , Musinguzi Nicholas , Haberer Jessica E. , Martin Jeffrey N. , Hunt Peter W. , Marconi Vincent C. , Bangsberg David R. , Siedner Mark J. 
Published: June 2017

Background:
The World Health Organization defines HIV virologic failure as 2 consecutive viral loads >1000 copies/mL, measured 3–6 months apart, with interval adherence support. We sought to empirically evaluate these guidelines using data from an observational cohort.

Setting:
The Uganda AIDS Rural Treatment Outcomes study observed adults with HIV in southwestern Uganda from the time of antiretroviral therapy (ART) initiation and monitored adherence with electronic pill bottles.

Methods:
We included participants on ART with a detectable HIV RNA viral load and who remained on the same regimen until the subsequent measurement. We fit logistic regression models with viral resuppression as the outcome of interest and both initial viral load level and average adherence as predictors of interest.

Results:
We analyzed 139 events. Median ART duration was 0.92 years, and 100% were on a nonnucleoside reverse-transcriptase inhibitor–based regimen. Viral resuppression occurred in 88% of those with initial HIV RNA <1000 copies/mL and 42% if HIV RNA was >1000 copies/mL (P <0.001). Adherence after detectable viremia predicted viral resuppression for those with HIV RNA <1000 copies/mL (P = 0.011) but was not associated with resuppression for those with HIV RNA >1000 copies/mL (P = 0.894; interaction term P = 0.077).

Conclusions:
Among patients on ART with detectable HIV RNA >1000 copies/mL who remain on the same regimen, only 42% resuppressed at next measurement, and there was no association between interval adherence and viral resuppression. These data support consideration of resistance testing to help guide management of virologic failure in resource-limited settings.
Recurrence Risk Stratification After Preoperative Chemoradiation of Esophageal Adenocarcinoma
Authors: Xi Mian , Hallemeier Christopher L. , Merrell Kenneth W. , Liao Zhongxing , Murphy Mariela A. Blum , Ho Linus , Hofstetter Wayne L. , Mehran Reza , Lee Jeffrey H. , Bhutani Manoop S. , Weston Brian , Maru Dipen M. , Komaki Ritsuko , Ajani Jaffer A. , Lin Steven H. 
Published: June 2017

Objective:
To discern recurrence risk stratification and investigate its influence on postoperative surveillance in patients with esophageal adenocarcinoma (EAC) after neoadjuvant chemoradiotherapy (CRT).

Background:
Reports documenting recurrence risk stratification in EAC after neoadjuvant CRT are scarce.

Methods:
Between 1998 and 2014, 601 patients with EAC who underwent neoadjuvant CRT followed by esophagectomy were included for analysis. The pattern, site, timing, and frequency of the first recurrence and potential prognostic factors for developing recurrences were analyzed. This cohort was used as the training set to propose a recurrence risk stratification system, and the stratification was further validated in another cohort of 172 patients.

Results:
A total of 150 patients (25.0%) achieved pathologic complete response (pCR) after neoadjuvant CRT and the rest were defined as the non-pCR group (n = 451) in the training cohort. After a median follow-up of 63.6 months, the pCR group demonstrated a significantly lower locoregional (4.7% vs 19.1%) and distant recurrence rate (22.0% vs.44.6%) than the non-pCR group (P < 0.001). Based on independent prognostic factors, patients were stratified into 4 recurrence risk categories: pCR with clinical stage I/II, pCR with clinical stage III, non-pCR with pN0, and non-pCR with pN+, with corresponding 5-year recurrence-free survival rates of 88.7%, 65.8%, 55.3%, and 33.0%, respectively (P < 0.001). The risk stratification was reproducible in the validation cohort.

Conclusions:
We proposed a recurrence risk stratification system for EAC patients based on pathologic response and pretreatment clinical stage. Risk-based postoperative surveillance strategies could be developed for different risk categories.
Genetic architecture of early childhood growth phenotypes gives insights into their link with later obesity
Authors: De Silva N. Maneka G. , Sebert Sylvain , Alves Alexessander Couto , Sovio Ulla , Das Shikta , Taal Rob , Warrington Nicole M. , Lewin Alexandra M. , Kaakinen Marika , Cousminer Diana , Thiering Elisabeth , Timpson Nicholas J. , Karhunen Ville , Bond Tom , Estivill Xavier , Lindi Virpi , Bradfield Jonathan P. , Geller Frank , Coin Lachlan J.M. , Loh Marie , Barton Sheila J. , Beilin Lawrence J. , Bisgaard Hans , Bønnelykke Klaus , Alili Rohia , Hatoum Ida J. , Schramm Katharina , Cartwright Rufus , Charles Marie-Aline , Salerno Vincenzo , Clément Karine , van Duijn Cornelia M. , Moltchanova Elena , Eriksson Johan G. , Elks Cathy , Feenstra Bjarke , Flexeder Claudia , Franks Stephen , Frayling Timothy M. , Freathy Rachel M. , Elliott Paul , Widén Elisabeth , Hakonarson Hakon , Hattersley Andrew T. , Rodriguez Alina , Banterle Marco , Heinrich Joachim , Heude Barbara , Holloway John W. , Hofman Albert , Hyppönen Elina , Inskip Hazel , Kaplan Lee M. , Hedman Asa K. , Läärä Esa , Prokisch Holger , Grallert Harald , Lakka Timo A. , Lawlor Debbie A. , Melbye Mads , Ahluwalia Tarunveer S. , Marinelli Marcella , Millwood Iona Y. , Palmer Lyle J. , Pennell Craig E. , Perry John R. , Ring Susan M. , Savolainen Markku , Stefansson Kari , Thorleifsson Gudmar , Rivadeneira Fernando , Standl Marie , Sunyer Jordi , Tiesler Carla M.T. , Uitterlinden Andre G. , Prokopenko Inga , Herzig Karl-Heinz , Smith George Davey , O'Reilly Paul , Felix Janine F. , Buxton Jessica L. , Blakemore Alexandra I.F. , Ong Ken K. , Grant Struan F.A. , Jaddoe Vincent W.V. , McCarthy Mark I. , Järvelin Marjo-Riitta 
Published: June 2017

AbstractEarly childhood growth patterns are associated with adult metabolic health, but the underlying mechanisms are unclear. We performed genome-wide meta-analyses and follow-up in up to 22,769 European children for six early growth phenotypes derived from longitudinal data: peak height and weight velocities, age and body mass index (BMI) at adiposity peak (AP~9 months) and rebound (AR~5-6 years). We identified four associated loci (P< 5x10−8):LEPR/LEPROTwith BMI at AP,FTOandTFAP2Bwith Age at AR andGNPDA2with BMI at AR. The observed AR-associated SNPs atFTO, TFAP2BandGNPDA2represent known adult BMI-associated variants. The common BMI at AP associated variant atLEPR/LEPROTwas not associated with adult BMI but was associated withLEPROTgene expression levels, especially in subcutaneous fat (P<2x10−51). We identify strong positive genetic correlations between early growth and later adiposity traits, and analysis of the full discovery stage results for Age at AR revealed enrichment for insulin-like growth factor 1 (IGF-1) signaling and apolipoprotein pathways. This genome-wide association study suggests mechanistic links between early childhood growth and adiposity in later childhood and adulthood, highlighting these early growth phenotypes as potential targets for the prevention of obesity.