bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plant-Based Diets and Cardiovascular Disease in Older Adults: An Integrative Literature Review
Authors: VanCleef Tricia R. , Hutchens Amy 
Published: July 2024

Cardiovascular disease (CVD) is the leading cause of mortality globally, disproportionately impacting older adults. Plant-based diets (PBDs) have emerged as a dietary strategy to mitigate CVD risk, characterized by foods derived from plants and minimal to no animal-derived foods. This integrative review assesses the effectiveness of PBDs for improving CVD risk factors in older adults. A search was conducted in CINAHL, PubMed, and Medline databases for studies of PBDs and CVD risk factors in individuals aged 65 years and older. Quality assessment was performed using the Mixed Methods Appraisal Tool (MMAT). Seventeen publications were analyzed, 7 experimental and 10 non-experimental. All studies showed at least one positive association between PBDs and cardiovascular health in older adults. Findings highlighted significant associations between PBD adherence and reductions in key CVD risk factors, such as low-density lipoprotein cholesterol (LDL-C), blood pressure, and body mass index (BMI), alongside potential benefits in reducing coronary artery calcium and enhancing endothelial function and serum isoflavone concentrations. There is evidence for the potential of PBDs as an effective dietary strategy to prevent the onset and progression of CVD in older adults and reduce the risk of CVD mortality. This review indicates the need for further research. Larger randomized control trials focused on older adults may strengthen the evidence base and guide healthcare recommendations. PBDs should be considered as a part of holistic CVD prevention and management strategies for older adults, encouraging dietary patterns that are rich in fruits, vegetables, legumes, beans, nuts, seeds, and whole grains.
Healthcare Provider Perspectives on Access to Healthcare for Chronic Low Back Pain Across Urban, Rural, and Remote Settings
Authors: Crockett Katie , Lovo Stacey , Irvine Alison , Trask Catherine , Oosman Sarah , McKinney Veronica , McDonald Terrence , Sari Nazmi , Martinez-Rueda Rosmary , Aiyer Harini , Carnegie Bertha , Custer Marie , McIntosh Stacey , Bath Brenna 
Published: July 2024

Introduction: Chronic low back pain (CLBP) is a debilitating condition that affects millions of people worldwide. Healthcare providers play a crucial role in improving access to care for patients with CLBP, but they face numerous challenges in doing so. This study focuses on healthcare provider perspectives of CLBP healthcare access. Methods: Semi-structured interviews were conducted with 16 healthcare providers across a variety of disciplines who care for people with CLBP across Saskatchewan, Canada. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Years of experience ranged from 1 to >20 years. Participants represented 11 disciplines across urban, rural, and/or remote settings. Four overarching themes were identified: (1) Challenges for healthcare providers; (2) Anticipating and recognizing barriers and consequences for patients; (3) Facilitators for healthcare providers and patients; (4) Recommendations on improving accessibility to healthcare. Several barriers were identified for healthcare providers to provide optimal, evidence-based care across Saskatchewan, including patient complexity and past experiences, access to resources and coordinating care. Healthcare providers recognized barriers for patients, which ultimately influenced healthcare provider decisions and care provision. Coordinated care and funding were identified as facilitators that support healthcare provider recommendations of multidisciplinary care and improving provider education to enhance provision of care for chronic low back pain. Conclusion: Future care models should build on these identified factors, while considering clinical and community-specific contexts.
Analyzing Substance Levels and Pain Perception in Painless Labor: The Impact of Spinal Epidural Analgesia
Authors: Agnesha Fahmi , Solikhah Eti Nurwening , Sari Djayanti , Ainunnisa Rianza 
Published: July 2024

Background: Inflammation affects labor by influencing contractions and dilation. Pain, often linked to tissue ischemia, involves mediators like nitric oxide (NO), TNF-α, and substance P (SP). Neuraxial analgesia, including combined spinal epidural analgesia (SEA) with levobupivacaine, is preferred for its effectiveness and minimal side effects in painless labor. Understanding the impact of painless labor techniques on biomolecular processes such as NO, TNF-α, and substance P levels is crucial for improving pain management strategies. This study investigates these effects in parturients undergoing SEA with levobupivacaine, contributing to the development of novel pain medications and enhancing obstetric care. Methods: This experimental study, conducted at a General Hospital in Indonesia, involved 60 expectant mothers in labor or in the third trimester, expected to give birth vaginally at Permata Hati Metro Hospital. Blood serum was used for analysis, and serum NO, TNF-α, and SP levels were assessed using ELISA kit. Results: There's a significant decrease in NO levels before and post-treatment in the SEA group compared to the control group (p < 0.05). However, no significant difference in TNF-α levels was observed between groups before and after treatment (p > 0.05). Additionally, there was no significant difference in SP levels between groups before treatment, but a significant difference was seen after treatment (p < 0.05). SEA significantly reduced labor pain compared to the control group (P < 0.05), with notable improvements in vital signs and APGAR scores, while also shortening labor duration (P < 0.001). Conclusion: In conclusion, SEA with levobupivacaine during painless labor reduces NO levels significantly and shows a trend of decreasing TNF-α and substance P levels, although not statistically significant, with clinical benefits for both patients and babies.
Physical inactivity among American single-female caregivers: An analysis of the 2020 behavioral risk factor surveillance system
Authors: Hoch Johanna M , Dlugonski Deirdre , Slone Stacey , Hogg-Graham Rachel , Jones Maureen 
Published: July 2024

Background: Many adults in the United States do not reach the recommended levels of activity needed for health benefits. Single-female caregivers present a unique and vulnerable population that is often less active than their partnered peers or single-male caregivers. Objective: The primary objective of this cross-sectional investigation was to identify the prevalence of physical inactivity in single-family, female-led households and determine differences in personal factors and social characteristics between physically active and not physically active single-female caregivers. A secondary objective was to examine associations among the social characteristic variables and physical inactivity in single-female caregiver households. Finally, we examined the odds single-female caregivers who are physically inactive reported chronic health conditions. Design: Cross-sectional survey design. Methods: We used the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data. Participants were selected based on pre-determined criteria for inclusion. Results: There was a 39.3% prevalence of physical inactivity among single-female caregivers in the sample. Single-female caregivers who were physically inactive had greater odds of having a history of multiple chronic health conditions. Conclusion: Healthcare providers and other community stakeholders should explore existing physical activity promotion strategies to increase physical activity in single-female caregivers. Future research should employ more rigorous, prospective research designs to determine if these chronic conditions and various social characteristics are caused by physical inactivity.
Comparing open and closed cell stents in idiopathic intracranial hypertension: A comprehensive meta-analysis of clinical outcomes
Authors: Batista Sávio , Palavani Lucca B , Verly Gabriel , Ferreira Marcio Yuri , Sanches João Pedro Bittar , Silva Guilherme Melo , Pinheiro Agostinho C , Almeida Filho José Alberto 
Published: July 2024

Background: Open cell stents (OC) and closed cell stents (CC) each offer unique advantages and potential drawbacks in the context of idiopathic intracranial hypertension (IIH) treatment. We aim to investigate the safety and efficacy of using OC and CC for IIH. Methods: We conducted a systematic review in PubMed, Embase, and Cochrane Library databases following the PRISMA guidelines. Eligible studies included ≥4 patients with IIH treated by OC or CC. Primary outcomes were headache, visual acuity, and papilledema status before and after the procedure. Additionally, failure rate, minor complications, major complications, and total complications were assessed. Pooled analysis of the OC group and CC group were done separately and then compared. Results: Twenty-four studies were included. Of these, 20 reported on OC and 6 reported on CC. Pooled analysis of failure rate was 8% (4%–12%) in OC and 5% (0%–11%) in CC. For headache improvement rate: 78% (70%–86%) in OC and 81% (66%–69%) in CC. For visual acuity improvement: 78% (65%–92%) in OC and 76% (29%–100%) in CC. For papilledema improvement: 88% (77%–98%) in OC and 82% (67%–98%) in CC. For minor complications: 0% (0%–1%) in OC and 0% (0%–2%) in CC. For major complications: 0% (0%–1%) in OC and 2% (0%–6%) in CC. Total complications: 0% (0%–1%) in OC and 2% (0%–6%) in CC. Conclusion: Low failure and complication rates were found in both OC and CC, with no significant difference between them in effectiveness. The CC showed a slight but significant increase in major and total complications compared to the OC. Additionally, a subtle yet significantly lower failure rate was identified in the CC.
Novel insights into causal effects of serum lipids, lipid metabolites, and lipid-modifying targets on the risk of intracerebral aneurysm
Authors: Qiu Youjia , Song Bingyi , Yin Ziqian , Wang Menghan , Tao Yuchen , Xie Minjia , Duan Aojie , Chen Zhouqing , Si Ke , Wang Zhong 
Published: July 2024

Introduction: Different serum lipid and lipid-lowering agents are reported to be related to the occurrence of intracerebral aneurysm (IA). However, the causal relationship between them requires further investigation. Patients and methods: Mendelian randomization (MR) analysis was performed on IA and its subtypes by using instrumental variants associated with six serum lipids, 249 lipid metabolic traits, and 10 lipid-lowering agents that were extracted from the largest genome-wide association study. Phenome-wide MR analyses were conducted to identify potential phenotypes associated with significant lipid-lowering agents. Results: After multiple comparison adjustments ( p < 0.0083), genetically proxied triglyceride (TG) (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.07–1.47, p = 0.005) and high-density lipoprotein cholesterol (HDL-C) levels (OR 0.93, 95% CI 0.89–0.98, p = 0.008) showed causal relationships with the risk of IA. Four lipid metabolic traits showed a causal relationship with the risk of IA ( p < 0.0002). As confirmed by drug target MR, the causal relationship between the HMGCR target and IA, HMGCR target and subarachnoid hemorrhage (SAH), ANGPTL3 target and SAH, CETP target, and SAH remained statistically significant after multiple adjustments ( p < 0.005). Additionally, phenome-wide MR did not identify other diseases linked to the significant lipid-lowering agent ( p < 6.39 × 10−5). Discussion and conclusion: This study not only supports that serum lipids (TG and HDL-C) are associated with IA but also confirms the positive effect and absence of safety concerns of intervening HMGCR, ANGPTL3, and CETP targets in IA and its subtypes, opening new avenues for IA treatment.
Medication Engagement, Determinants of Health, and A1C Levels Among Adults With Type 2 Diabetes within a Tribal Health System
Authors: Nelson Tarah , Wilkie Diana J. , Yao Yingwei , Segal Richard , DeVaughan-Circles Ashley , Donahoo William T. , Goins R. Turner , Manson Spero M. , Legaspi Anatolia B. , Scarton Lisa 
Published: July 2024

Purpose The purpose of this study was to examine the association between determinants of health, medication engagement, and A1C levels in adults with type 2 diabetes (T2DM) receiving Tribal health and pharmacy services. Methods A retrospective analysis of 2020-2021 electronic health record data was conducted and included adult patients with T2DM using Choctaw Nation Health Services Authority prescribed ≥1 noninsulin glucose-lowering medication in 2020, had ≥1 A1C value in 2020 and 2021, and had a valid zip code in 2021. Patients receiving both insulin and other noninsulin glucose-lowering medication were included. The proportion of days covered (PDC) was used to calculate medication engagement. Statistical analyses included bivariate analysis and linear regression. Results There were 3787 patients included in the analyses; 62.5% were considered engaged (PDC ≥ 0.8). The mean 2020 A1C level was 8.0 (64 mmol/mol) ± 1.8; 33% had an A1C of <7%, 42% had an A1C of 7% to 9%, and 25% had an A1C >9%. The mean A1C in 2021 was 7.9 (63 mmol/mol) ± 1.7; 34% had an A1C of <7%, 44% had an A1C of 7% to 9%, and 22% had an A1C >9%. Older age was weakly correlated with higher engagement; higher engagement was associated with lower A1C levels while adjusting for covariates. Conclusions Medication engagement was associated with lower A1C levels, and older age was weakly associated with higher engagement to noninsulin glucose-lowering medications, consistent with previous literature. No determinants of health were significantly associated with A1C levels while adjusting for covariates.
Development of an IMU based 2-segment foot model for an applicable medical gait analysis
Authors: Bauer Leandra , Hamberger Maximilian Anselm , Böcker Wolfgang , Polzer Hans , Baumbach Sebastian Felix 
Published: July 2024

Abstract
Background
The two most commonly instrumented gait analysis tools used are Optical Motion Capture systems (OMC) and Inertial Measurement Units (IMU). To date, OMC based gait analysis is considered the gold-standard. Still, it is space-, cost-, and time-intense. On the other hand IMU systems are more cost- and time effective but simulate the whole foot as a single segment. To get a more detailed model of the foot and ankle, a new 2-segment foot model using IMU was developed, comparable to the multi-segment foot models assessed by OMC.

Research question
Can an IMU based 2-segment foot model be developed to provide a more detailed representation of the foot and ankle kinematics?

Methods
To establish a 2-segment foot model, in addition to the previous 1-segment foot model an IMU sensor was added to the calcaneus. This allowed the differentiation between the hindfoot and forefoot kinematics. 30 healthy individuals (mean age 27 ± 7 years) were recruited to create a norm data set of a healthy cohort. Moreover, the kinematic data of the 2-segment foot model were compared to those of the traditional 1-segment foot model using statistical parametric mapping.

Results
The 2-segment foot model proved to be applicable. Furthermore, it allowed for a more detailed representation of the foot and ankle joints, similar to other multi-segment foot model. The healthy cohort’s norm data set showed a homogeneous motion pattern for gait.

Conclusion
The 2-segment foot model allows for an extension of IMU-based gait analysis. Futures studies must prove the reliability and validity of the 2-segment foot model in healthy and pathologic situations.

Level of evidence
Level II.
Examining the knowledge level of nurses regarding aseptic non touch technique in nurses: a cross-sectional study
Authors: Chen Yilin , Cao Xiuzhu , Liu Chang , Sheng Wanting , Wang Jie , Zhao Linfang 
Published: July 2024

Abstract
Background
Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice.

Methods
The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses.

Results
A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master’s degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest.

Conclusions
ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use.
Readiness to provide comprehensive emergency obstetric and neonatal care: a cross-sectional study in 30 health facilities in Tanzania
Authors: Juma Damas , Stordal Ketil , Kamala Benjamin , Bishanga Dunstan R. , Kalolo Albino , Moshiro Robert , Kvaløy Jan Terje , Manongi Rachel 
Published: July 2024

Abstract
Background
Despite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities’ capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities’ readiness to provide comprehensive emergency obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania.

Methods
A cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization’s Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher’s exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance.

Results
The overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels.

Conclusion
Facilities’ readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities’ readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.
Postoperative monitoring of ovariohysterectomy carried out with two types of surgical sutures in shelter cats and differences in selected blood parameters between shelter and pet cats
Authors: Cymbryłowicz Jacek , Jawor Paulina , Wierzbicki Heliodor , Trębacz Piotr , Stefaniak Tadeusz 
Published: July 2024

Abstract
Background
Reduction of inflammation and early detection of complications after surgical procedures are important objectives for proper veterinary practice. This study aimed to evaluate the differences between shelter and pet female cats in selected acute-phase parameters scheduled to ovariohysterectomy. Postoperative monitoring after ovariohysterectomy with the same laboratory parameters was performed in shelter cats, in which two different types of surgical sutures were used for the entire procedure. The experimental group comprised 40 female cats from animal shelters (‘shelter cats,’ n = 40). These cats were divided into two subgroups: group A (n = 20) operated on with absorbable sutures and group NA (n = 20) operated on with non-absorbable sutures. In addition, the same parameters were evaluated in pet female cats (n = 19). Blood was collected from shelter cats immediately before surgery (term 0), at 24 and 72 h (terms 1 and 3, respectively), and at 7 and 14 days (terms 7 and 14, respectively) after ovariohysterectomy. Blood samples from the pet cat group were collected only once.

Result
The mean haptoglobin concentration before ovariohysterectomy in pet cats was significantly lower than that in shelter cats. Fibrinogen concentration was significantly lower in pet cats than in cats from group A. Serum albumin, beta-1, beta-2, and gamma-globulin concentrations were significantly higher in the shelter cats than in the pet cats. Subcutaneous tissue thickening at the site of the postoperative wound was observed in five patients cats (25%) in group A, and two (10%) cats in the NA group.

Conclusion
These results indicate that ovariohysterectomy leads to local and general inflammatory responses. The majority of cats from animal shelters suffered from subclinical inflammation.