bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of surgical interventions in low-income and middle-income countries: a systematic review and critical analysis of recent evidence
Authors: Ifeanyichi Martilord , Mosso Lara Jose Luis , Tenkorang Phyllis , Kebede Meskerem Aleka , Bognini Maeve , Abdelhabeeb Alshaheed Nasraldin , Amaechina Uchenna , Ambreen Faiza , Sarabu Shreeja , Oladimeji Taiwo , Toguchi Ana Carolina , Hargest Rachel , Friebel Rocco 
Published: October 2024

Background
Cost-effectiveness evidence is a critical tool to support resource allocation decisions. There is growing recognition that the development of benefit packages for surgical care should be guided by such evidence, particularly in resource-constraint settings.

Methods
We conducted a systematic review of evidence (Medline, Embase, Global Health, EconLit and grey literature) on the cost-effectiveness of surgery across low-income and middle-income countries published between January 2013 and January 2023. We included studies with minor and major therapeutic surgeries and minimally invasive intraluminal and endovascular interventions. We computed and compared the average cost-effectiveness ratios (ACERs) for different surgical interventions to the respective national gross domestic product per capita to determine cost-effectiveness and to common traditional public health interventions.

Results
We identified 87 unique studies out of 20 070 articles screened. Studies spanned 23 countries, with China (n=20), Thailand (n=12), Brazil (n=8) and Iran (n=8) accounting for about 55% of the evidence. Overall, the median ACERs across procedure groups ranged from I$17/disability-adjusted life year (DALY) for laparotomies to I$170 186/DALY for bariatric surgeries. Most of the ACER estimates were classified as cost-effective (89%) or very cost-effective (76%). Low-complexity surgical interventions compared favourably to common public health interventions.

Conclusion
These findings reinforce the growing body of evidence that investments in surgery are economically smart. There remains however paucity of high-quality evidence that would allow decision-makers to assess the comparative cost-effectiveness of surgery and to determine best buys across a wide range of specialties and interventions. A concerted effort is needed to advance the generation and utilisation of economic evidence in the drive towards scale-up of surgical care across low-income and middle-income countries.
Changes in sleep patterns in people with a history of depression during the COVID-19 pandemic: a natural experiment
Authors: Shin Mirim , Crouse Jacob J , Byrne Enda M , Mitchell Brittany L , Lind Penelope , Parker Richard , Tonini Emiliana , Carpenter Joanne S , Wray Naomi R , Colodro-Conde Lucia , Medland Sarah E , Hickie Ian B 
Published: October 2024

Background
The COVID-19 pandemic, while a major stressor, increased flexibility in sleep–wake schedules.

Objectives
To investigate the impact of the pandemic on sleep patterns in people with a history of depression and identify sociodemographic, clinical or genetic predictors of those impacts.

Methods
6453 adults from the Australian Genetics of Depression Study (45±15 years; 75% women) completed surveys before (2016–2018) and during the pandemic (2020–2021). Participants were assigned to ‘short sleep’ (<6 hours), ‘optimal sleep’ (6–8 hours) or ‘long sleep’ (>8 hours). We focused on those having prepandemic ‘optimal sleep’.

Findings
Pre pandemic, the majority (70%, n=4514) reported optimal sleep, decreasing to 49% (n=3189) during the pandemic. Of these, 57% maintained optimal sleep, while 16% (n=725) shifted to ‘short sleep’ and 27% (n=1225) to ‘long sleep’. In group comparisons ‘optimal-to-short sleep’ group had worse prepandemic mental health and increased insomnia (p’s<0.001), along with an elevated depression genetic score (p=0.002). The ‘optimal-to-long sleep’ group were slightly younger and had higher distress (p’s<0.05), a greater propensity to being evening types (p<0.001) and an elevated depression genetic score (p=0.04). Multivariate predictors for ‘optimal-to-short sleep’ included reported stressful life events, psychological or somatic distress and insomnia severity (false discovery rate-corrected p values<0.004), while no significant predictors were identified for ‘optimal-to-long sleep’.

Conclusion and implications
The COVID-19 pandemic, a natural experiment, elicited significant shifts in sleep patterns among people with a history of depression, revealing associations with diverse prepandemic demographic and clinical characteristics. Understanding these dynamics may inform the selection of interventions for people with depression facing major challenges.
Changes in the intestinal microbiome of the preterm baby associated with stopping non-invasive pressure support: a prospective cohort study
Authors: Hutchinson Richard , Wade William , Millar Michael , Ansbro Katherine , Stacey Fiona , Costeloe Kate , Fleming Paul 
Published: October 2024

BackgroundIntestinal dysbiosis is implicated in the pathogenesis of necrotising enterocolitis and late-onset sepsis in preterm babies. The provision of non-invasive positive pressure ventilation is a common clinical intervention in preterm babies, and may be hypothesised to adversely affect intestinal bacterial growth, through increased aerophagia and induction of a hyperoxic intestinal environment; however this relationship has not been previously well characterised.MethodologyIn this prospectively recruited cohort study, high-throughput 16S rRNA gene sequencing was combined with contemporaneous clinical data collection, to assess within-subject changes in microbiome development around the time of transitioning from non-invasive positive pressure respiratory support to unsupported spontaneous breathing.ResultsIn a group of 14 preterm infants, bacterial diversity was seen to increase by 0.34 units/week (inverse Simpson index) at the point of transitioning off non-invasive positive pressure respiratory support. Correspondingly, a significant increase in anaerobic genera (Bifidobacteriaspp,Veillonellaspp), and a non-significant fall in Enterobacteriaceae was also seen at this time.ConclusionsProvision of non-invasive positive pressure ventilation is associated with suppression of both diversity accrual and obligate anaerobic growth in the preterm intestine. This has clinical implications in view of the widespread use of non-invasive positive pressure ventilation in preterm neonatal care (and wider adult use), and demonstrates the need for potential strategies (eg, probiotic support; reduced aerophagia) to support the development of a healthy gut microbiome during this time.
Player and match characteristics associated with head acceleration events in elite-level men’s and women’s rugby union matches
Authors: Allan David , Tooby James , Starling Lindsay , Tucker Ross , Falvey Éanna C , Salmon Danielle M , Brown James , Hudson Sam , Stokes Keith A , Jones Ben , Kemp Simon P T , O'Halloran Patrick , Cross Matt , Tierney Gregory 
Published: October 2024

ObjectiveTo examine the likelihood of head acceleration events (HAEs) as a function of previously identified risk factors: match time, player status (starter or substitute) and pitch location in elite-level men’s and women’s rugby union matches.MethodsInstrumented mouthguard data were collected from 179 and 107 players in the men’s and women’s games and synchronised to video-coded match footage. Head peak resultant linear acceleration (PLA) and peak resultant angular acceleration were extracted from each HAE. Field location was determined for HAEs linked to a tackle, carry or ruck. HAE incidence was calculated per player hour across PLA recording thresholds with 95% CIs estimated. Propensity was calculated as the percentage of contact events that caused HAEs across PLA recording thresholds, with a 95% CI estimated. Significance was assessed by non-overlapping 95% CIs.Results29 099 and 6277 HAEs were collected from 1214 and 577 player-matches in the men’s and women’s games. No significant differences in match quarter HAE incidence or propensity were found. Substitutes had higher HAE incidence than starters at lower PLA recording thresholds for men but similar HAE propensity. HAEs were more likely to occur in field locations with high contact event occurrence.ConclusionStrategies to reduce HAE incidence need not consider match time or status as a substitute or starter as HAE rates are similar throughout matches, without differences in propensity between starters and substitutes. HAE incidence is proportional to contact frequency, and strategies that reduce either frequency or propensity for contact to cause head contact may be explored.
Developing a data-driven multimodal injury and illness prevention programme in male professional football based on a risk management model: the IP2NetWork
Authors: Hassanmirzaei Bahar , Schumacher Yorck , Tabben Montassar , Bahr Roald 
Published: October 2024

BackgroundCurrent injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.ObjectiveTo address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.SettingThe team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.MethodsIn 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.ResultsOut of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.ConclusionWe have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP2(Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.
Systemic messenger RNA replacement therapy is effective in a novel clinically relevant model of acute intermittent porphyria developed in non-human primates
Authors: Córdoba Karol M , Jericó Daniel , Jiang Lei , Collantes María , Alegre Manuel , García-Ruiz Leyre , Manzanilla Oscar , Sampedro Ana , Herranz Jose M , Insausti Iñigo , Martinez de la Cuesta Antonio , Urigo Francesco , Alcaide Patricia , Morán María , Martín Miguel A , Lanciego José Luis , Lefebvre Thibaud , Gouya Laurent , Quincoces Gemma , Unzu Carmen , Hervas-Stubbs Sandra , Falcón-Pérez Juan M , Alegre Estíbaliz , Aldaz Azucena , Fernández-Seara María A , Peñuelas Iván , Berraondo Pedro , Martini Paolo G V , Avila Matias A , Fontanellas Antonio 
Published: October 2024

Objective
Acute intermittent porphyria (AIP) is a rare metabolic disorder caused by haploinsufficiency of hepatic porphobilinogen deaminase (PBGD), the third enzyme of the heme biosynthesis. Individuals with AIP experience neurovisceral attacks closely associated with hepatic overproduction of potentially neurotoxic heme precursors.

Design

We replicated AIP in non-human primates (NHPs) through selective knockdown of the hepatic
PBGD
gene and evaluated the safety and therapeutic efficacy of human PBGD (hPBGD) mRNA rescue.

Results
Intrahepatic administration of a recombinant adeno-associated viral vector containing short hairpin RNA against endogenous PBGD mRNA resulted in sustained PBGD activity inhibition in liver tissue for up to 7 months postinjection. The administration of porphyrinogenic drugs to NHPs induced hepatic heme synthesis, elevated urinary porphyrin precursors and reproduced acute attack symptoms in patients with AIP, including pain, motor disturbances and increased brain GABAergic activity. The model also recapitulated functional anomalies associated with AIP, such as reduced brain perfusion and cerebral glucose uptake, disturbances in hepatic TCA cycle, one-carbon metabolism, drug biotransformation, lipidomic profile and abnormal mitochondrial respiratory chain activity. Additionally, repeated systemic administrations of hPBGD mRNA in this AIP NHP model restored hepatic PBGD levels and activity, providing successful protection against acute attacks, metabolic changes in the liver and CNS disturbances. This approach demonstrated better efficacy than the current standards of care for AIP.

Conclusion
This novel model significantly expands our understanding of AIP at the molecular, biochemical and clinical levels and confirms the safety and translatability of multiple systemic administration of hPBGD mRNA as a potential aetiological AIP treatment.
New-onset atrial fibrillation after coronary surgery and stroke risk: a nationwide cohort study
Authors: Taha Amar , Martinsson Andreas , Nielsen Susanne J , Rezk Mary , Pivodic Aldina , Gudbjartsson Tomas , Herrmann Florian Ernst Martin , Bergfeldt Lennart B , Jeppsson Anders 
Published: October 2024

BackgroundNew-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) increases ischaemic stroke risk, yet factors influencing this risk remain unclear. We sought to identify factors associated with 1-year ischaemic stroke risk, compare the CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, previous Stroke/transient ischaemic attack (TIA), Vascular disease, Age 65–74 years, Sex category) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) scores’ predictive abilities for ischaemic stroke, and assess oral anticoagulation (OAC) dispensing at discharge in patients with POAF.MethodsThis nationwide cohort study used prospectively collected data from four mandatory Swedish national registries. All first-time isolated CABG patients who developed POAF during 2007–2020 were included. Multivariable logistic models were used to identify ischaemic stroke predictors and C-statistics to assess the predictive abilities of the CHA2DS2-VASc and ATRIA scores in patients without OAC. OAC dispensing patterns were described based on stroke-associated factors.ResultsIn total, 10 435 patients with POAF were identified. Out of those not receiving OAC (n=6903), 3.1% experienced an ischaemic stroke within 1 year. Advancing age (adjusted OR (aOR) 1.86 per 10-year increase, 95% CI 1.45 to 2.38), prior ischaemic stroke (aOR 18.56, 95% CI 10.05 to 34.28 at 60 years, aOR 5.95, 95% CI 3.78 to 9.37 at 80 years, interaction p<0.001), myocardial infarction (aOR 1.55, 95% CI 1.14 to 2.10) and heart failure (aOR 1.53, 95% CI 1.06 to 2.21) were independently associated with ischaemic stroke. The area under the receiver-operating characteristic curve was 0.72 (0.69–0.76) and 0.74 (0.70–0.78) for CHA2DS2-VASc and ATRIA, respectively (p=0.021). Altogether, 71.0% of patients with a stroke risk >2%/year, according to the CHA2DS2-VASc score, were not discharged on OAC.ConclusionsPrior ischaemic stroke, advancing age, history of heart failure and myocardial infarction were associated with 1-year ischaemic stroke risk in patients with POAF after CABG. CHA2DS2-VASc and ATRIA scores predicted stroke risk with similar accuracy as in non-surgical atrial fibrillation cohorts. OAC dispense at discharge does not seem to reflect individual stroke risk.
Prognostic nutritional index as a predictor of surgical complications in women with gynecological cancer
Authors: Bermúdez-Pineda Bianca , García-Luna Miguel Ángel , Oñate-Ocaña Luis Fernando , Morales-Piélago Gabriela Fernanda , Cantú-De León David Francisco , Reynoso-Noverón Nancy 
Published: October 2024

ObjectiveTo analyze the association between the prognostic nutritional index and surgical morbidity in women with gynecologic cancers.MethodsThis is a retrospective cohort study of women with ovarian, endometrial, or cervical cancer who underwent surgery between January 2013 and December 2020 at a cancer center. Demographic and clinical data were extracted from electronic medical records. The prognostic nutritional index was calculated during the immediate pre-operative period. Binomial logistic regression was conducted to identify the association of the prognostic nutritional index with the outcome of surgical complications after Clavien-Dindo classification, adjusting for confounding variables.ResultsA total of 1000 women were included: 114 (11.4%) were diagnosed with cervical cancer, 551 (55.1%) with ovarian cancer, and 335 (33.5%) with endometrial cancer. Patients with a prognostic nutritional index >40 had a decreased possibility of surgical complications (OR=0.39, 95% CI 0.29 to 0.52); basal blood hemoglobin, volume of surgical bleeding, operative time, and length of hospital stay were also explanatory factors. The prognostic nutritional index has a significant effect on patients with endometrial and cervical cancer, but conversely is not significant in patients with ovarian cancer.ConclusionThe prognostic nutritional index is associated with surgical morbidity in endometrial and cervical cancers and thus can be a useful tool for predicting morbidity and guide pre-operative interventions in patients with gynecological cancers.
Systematic literature review of published cases of reactive plasmacytosis in peripheral blood and bone marrow
Authors: Munoz de Toro Margarita , Fernandez-Pol Sebastian 
Published: October 2024

AimsThis study aims to summarise published cases of reactive plasmacytosis to provide a resource to aid haematopathologists and clinicians in the diagnostic workup of reactive plasmacytosis.MethodsWe searched published articles on reactive plasmacytosis on PubMed, Scopus and Google Scholar. Data were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Cases were classified into six categories, namely: (1) infection, (2) angioimmunoblastic T-cell lymphoma (AITL), (3) other malignancies, (4) drug associated, (5) autoimmune diseases and (6) others. Plasma cell percentage in peripheral blood and/or bone marrow was tabulated. Descriptive statistics were reported as median with IQR, using JASP Team.Results87 articles which reported on 146 patients were included. Infectious diseases represented most cases associated with reactive plasmacytosis (n=46, 31% of all cases), with viral infections being the most frequent (n=31, 21% of all cases). AITL was the second most frequent aetiology (n=34, 23% of all cases), followed by medications (n=28, 19% of all cases), other malignancies (n=18, 12% of all cases), miscellaneous aetiologies (n=11, 7% of all cases) and autoimmune diseases (n=9, 6% of all cases). The absolute and relative levels of plasma cells in each diagnostic category showed marked variation and ranges largely overlapped between categories.ConclusionsIn patients with an increase in the number and/or proportion of plasma cells in peripheral blood and/or bone marrow, clinical context and a broad differential diagnosis are necessary to direct further evaluation and arrive at a correct diagnosis. Our literature review suggests that evaluation for infectious causes and AITL may be of the greatest yield in many cases.
5-Hydroxymethylcytosine in circulating cell-free DNA as a potential diagnostic biomarker for SLE
Authors: Tong Xinya , Chen Wenwen , Ye Lele , Xiong Yanling , Xu Yuan , Luo Yunhui , Xia Xinhang , Xu Zexia , Lin Yutong , Zhu Xinqi , Wang Nan , Xue Xiangyang , Zhang Huidi , Guo Gangqiang 
Published: October 2024

BackgroundSLE is a complex autoimmune disease with heterogeneous manifestations and unpredictable outcomes. Early diagnosis is challenging due to non-specific symptoms, and current treatments only manage symptoms. Epigenetic alternations, including 5-Hydroxymethylome (5hmC) modifications, are important contributors to SLE pathogenesis. However, the 5hmC modification status in circulating cell-free DNA (cfDNA) of patients with SLE remains largely unexplored. We investigated the distribution of 5hmC in cfDNA of patients with SLE and healthy controls (HCs), and explored its potential as an SLE diagnosis marker.MethodsWe used 5hmC-Seal to generate genome-wide 5hmC profiles of plasma cfDNA and bioinformatics analysis to screen differentially hydroxymethylated regions (DhMRs). In vitro mechanistic exploration was conducted to investigate the regulatory effect of CCCTC-binding factor (CTCF) in 5hmC candidate biomarkers.ResultsWe found distinct differences in genomic regions and 5hmC modification motif patterns between patients with SLE and HCs, varying with disease progression. Increased 5hmC modification enrichment was detected in SLE. Additionally, we screened 151 genes with hyper-5hmC, which are significantly involved in SLE-related processes, and 5hmC-modifiedBCL2,CD83,ETS1andGZMBas SLE biomarkers. Our findings suggest that CTCF regulates 5hmC modification of these genes by recruiting TET (ten-eleven translocation) protein, and CTCF knockdown affected the protein expression of these genes in vitro.ConclusionsOur findings demonstrate the increased 5hmC distribution in plasma cfDNA in different disease activity in patients with SLE compared with HCs and relating DhMRs involved in SLE-associated pathways. Furthermore, we identified a panel of SLE relevant biomarkers, and these viewpoints could provide insight into the pathogenesis of SLE.
Are state abortion bans an occupational health hazard for obstetrician-gynaecologists? Findings from a multistate qualitative study
Authors: Sabbath Erika L , McKetchnie Samantha M , Arora Kavita S , Buchbinder Mara 
Published: October 2024

ObjectivesSince the US Supreme Court’s Dobbs v. Jackson decision, 17 states have imposed near-total abortion bans. These bans may negatively impact health and well-being of obstetrician-gynaecologists (OB-GYNs), due to high levels of work-related stress that the laws have created for them. The goal of the present study is to evaluate the impacts of post-Dobbs v. Jackson state abortion bans on occupational health and well-being of OB-GYNs.MethodsThe Study of OB-GYNs in Post-Roe America is a qualitative study of 54 OB-GYNs practising in 13 of the 14 states with near-total abortion bans as of March 2023. Using volunteer sampling methods, participants were recruited for semistructured qualitative interviews via videoconference from March to August 2023.ResultsThematic analysis of interview transcripts identified six major domains of health and well-being impacts of state abortion bans on OB-GYNs: anxiety and depression, burden of negative emotions, burn-out, coping-related health behaviours, sleep disruption and personal relationships.ConclusionsState abortion bans following the 2022 Dobbs decision may impact the health and well-being not only of pregnant patients but also of their providers. These provider health impacts include mental health and burn-out but also extend to physical health outcomes and the work–life interface.