bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of maternal healthcare services among the women of reproductive age in the rural municipality of Nepal: a cross-sectional study
Authors: Adhikari Mukesh , Rajbanshi Manish , Karki Anita , Aryal Richa , Choulagai Bishnu Prasad 
Published: February 2025

BackgroundMaternal Mortality Ratio is one of the crucial indicators of the Sustainable Development Goal-3, which is to be achieved below 70 per 100 000 live births by 2030. It is essential to assess the current status of antenatal care (ANC), uptake of skilled birth attendants (SBAs), and postnatal care (PNC) to improve the health of a mother and child in developing countries like Nepal. This study assesses the utilisation and factors associated with maternal healthcare services among reproductive-aged women in the Shubhakalika Rural municipality of Nepal.MethodsA cross-sectional study using proportionate simple random sampling was performed to select 180 participants. A Nepali-translated tool based on Andersen’s Behaviour Model of healthcare service utilisation was used to collect the data. ANC services, SBAs, PNC services and continuum of care were dependent variables while independent variables were categorised into predisposing, enabling and need factors. Bivariate and multivariable regression analysis was performed using the Statistical Package of Social Sciences V.20 to determine the association between dependent and independent variables. All the tests were set at a CI of 95%.ResultsThis study included 180 participants with a mean (±SD) age of 24.3±4.9 years. Women whose husbands completed formal schooling were more likely to have four ANC visits (adjusted OR (AOR)=3.2, CI=1.0–10.3). Women with a planned pregnancy were significantly associated with the use of four ANC visits (AOR=10.3, CI=3.5–30.3), institutional delivery (AOR=3.2, CI=1.1–9.3) and continuum of care (AOR=7.4, CI=1.4–37.8). Ethnicity (AOR=2.4, CI=1.1–5.4), education of women (AOR=2.7, CI=1.0–7.7), having problems in receiving maternal healthcare services (AOR=4.5, CI=1.5–15.2) and distance to the nearest health facilities of less than 30 minutes (AOR=2.4, CI=1.0–5.7) were significantly associated with the use of institutional delivery. Similarly, women who were 18 years or above at the time of marriage were more likely to attend at least one PNC (AOR=3.2, CI=1.5–6.5) than women who were under 18. Meanwhile, women with health insurance were less likely to attend at least one PNC visit (AOR=0.3, CI=0.1–0.6) compared with those without health insurance.ConclusionWomen with planned pregnancies, higher education and husbands who completed formal schooling were more likely to access comprehensive maternal healthcare services, including ANC, institutional delivery and PNC. This study demonstrated proximity to health facilities, and lower ethnic groups were deprived of maternal healthcare services. These results emphasise the need to address socio-demographic disparities and improve healthcare accessibility. Since, health insurance programmes facilitate the utilisation of maternal healthcare services, efforts should focus on expanding coverage to reach the target population effectively, such as newly married couples.
Association of early versus late care seeking for sport-related concussion in adolescent athletes in Canada: a historical cohort study
Authors: Oh David Youngwoo , Germann Darrin , Cancelliere Carolina , Kazemi Mohsen , Marshall Cameron , Hogg-Johnson Sheilah 
Published: February 2025

ObjectivesThis study aims to examine the association of time to recovery between early versus late presentation to outpatient community-based concussion management clinics following sport-related concussion (SRC) among adolescent Canadian athletes.MethodsUsing electronic health records (between January 2017 and December 2019) from the Complete Concussion Management Inc (CCMI) database, this was a historical cohort study of Canadian athletes aged 12–18 presenting for care early (0–7 days) or late (8–28 days) after SRC. Time-to-recovery was defined as the date of clinician clearance to return to sport. Propensity scores were first derived from logistic regression with early versus late clinical presentation as the outcome. Cox proportional hazards regression analysis was then used to model the relationship between early versus late clinical presentation and time to recovery, while including the propensity score to adjust for confounding. The association was expressed using hazard rate ratios (HRR) with 95% CIs.ResultsA total of 4696 patient records (mean age of 14.71 (±1.69 SD); 57.7% male) were eligible. Early presentation to a concussion management clinic following SRC was associated with faster time to recovery (adjusted HRR 1.23; 95% CI 1.14 to 1.32, p<0.001). This association was consistent within each quintile of the propensity score. The median time to recovery was 18 versus 22 days in the early and late groups, respectively.ConclusionAdolescent athletes with SRC have favourable recovery trajectories when presenting for care up to 28 days. Time to recovery (clinician clearance to return to sport) may be quicker with an earlier presentation which can lead to a faster return to sport.
Mesothelioma risks and cumulative exposure to elongate mineral particles of various sizes in Minnesota taconite mining industry
Authors: Shao Yuan , Ramachandran Gurumurthy , Mandel Jeffrey H , MacLehose Richard F , Alexander Bruce H 
Published: February 2025

ObjectivesAn excess of mesothelioma has been previously observed in iron ore miners in Northeastern Minnesota. This study explored the potential association between mesothelioma and elongate mineral particle (EMP) exposures in the Minnesota taconite mining industry, examining both regulated and non-regulated EMP dimensions.MethodsA nested case–control study design within the Mineral Resources Health Assessment Programme cohort analysed 104 mesothelioma cases and 410 controls. Cumulative EMP exposures were assessed across various dimensional definitions, including regulated (National Institute for Occupational Safety and Health, NIOSH) and non-regulated EMPs. Conditional logistic regression models were applied to estimate mesothelioma risk linked to employment duration and cumulative EMP exposure while adjusting for potential confounding variables.ResultsConsistent with earlier assessments, mesothelioma was associated with the number of years employed in the taconite industry (rate ratio (RR) 1.02, 95% CI 1.00 to 1.05) and cumulative NIOSH EMP exposure ((EMP/cc)×years) in taconite mining and processing (RR 1.20, 95% CI 0.99 to 1.46). Positive associations were also observed with mesothelioma and cumulative exposure to non-regulated EMPs.ConclusionsThis study supported the main conclusions in the previous study that the data were consistent with an association between mesothelioma and employment duration and with NIOSH EMP exposure in taconite mining and processing. However, the 95% CI indicates the data are also compatible with a null effect. Given the limitations we cite in the manuscript, additional study is needed to clarify the effect. Additionally, this study found possible evidence of a positive association between mesothelioma and cumulative exposure to Chatfield EMP, Suzuki EMP and Cleavage Fragments in the Minnesota taconite worker population.
Nonstatic Reissner–Nordstr$$\phi $$m metric in the perturbative f(R) theory: embedding in the background of the FLRW cosmology, uniqueness of solutions, the TOV equation
Authors: Ky Pham Van 
Published: February 2025

Abstract
This article introduces a nonstatic Reissner–Nordstr

$$\phi $$

ϕ

m metric, a metric that does not emit electromagnetic waves but can emit gravitational waves. We first use the GR theory to study a charged spherically symmetric gravitational source (CSSGS), the obtained results are further improved in comparison with the previous studies. In particular, this article considers that the field is not necessarily static. The metric tensors

$$ g_{\mu \nu } $$

g

μ
ν

are considered both outside and inside the gravitational source (the results show that in the first case

$$ g_{\mu \nu } $$

g

μ
ν

are time independent, in the latter case they are time dependent). The gravitational acceleration and the event horizon of a charged black hole are investigated. The results prove that the gravitational field is always attractive. We then use the perturbative f(R) theory to consider CSSGS. The obtained results not only correct the solution of Einstein’s equation in magnitude (this will describe astronomical and cosmological quantities more accurately than Einstein’s equation), but also reveal new effects. Outside the gravitational source, the metric tensors can depend on time, this makes it possible for a spherically symmetric gravitational source to emit gravitational waves (Einstein’s equation cannot give this effect). However, a spherically symmetric field still does not emit electromagnetic waves. Next, we present a new method for embedding the spherically symmetric metrics of a star (or a black hole) in the background of the FLRW cosmological. Finally, we discuss the uniqueness of the solutions of the f(R) theory. The perturbative TOV equation is also found.
Microcirculatory Resistance After Primary Percutaneous Coronary Intervention Predicts Residual Myocardial Damage and Scar Formation
Authors: Candreva Alessandro , Gotschy Alexander , Stehli Julia , Bissig Lea , Lodi Rizzini Maurizio , Chiastra Claudio , Gallo Diego , Morbiducci Umberto , Klingenberg Roland , Heg Dik , Matter Christian M. , Ruschitzka Frank , Manka Robert , Stähli Barbara E. 
Published: February 2025

Background
Coronary microvascular dysfunction has been associated with adverse cardiovascular events following acute myocardial infarction. This study evaluates the role of the angiography‐derived index of microcirculatory resistance (angio‐IMR) in predicting myocardial damage in patients with ST‐segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

Methods and Results

In this post hoc analysis of the CLEVER‐ACS (Controlled‐Level Everolimus in Acute Coronary Syndromes) trial, the associations between post‐PCI angio‐IMR of infarct‐related coronary arteries (IRAs) and infarct size, microvascular obstruction, and left ventricular ejection fraction at 30 days as assessed by cardiac magnetic resonance were investigated. High post‐PCI angio‐IMR was defined as ≥40 mm Hg*s . In non‐IRAs, angio‐IMR was measured before IRA‐PCI. A total of 52 IRAs and 94 non‐IRAs of 52 patients were analyzed. Post‐PCI angio‐IMR was 41.5 (interquartile range [IQR], 28.5–55.7) mm Hg*s  in IRAs and pre‐PCI angio‐IMR was 43.7 (IQR, 31.7–54.0) mm Hg*s in non‐IRAs (
P
=0.70). Patients with high post‐PCI angio‐IMR (52%) exhibited a larger myocardial infarct size (36.0 [IQR, 23.0–52.5] g versus 14.5 [IQR, 6.50–26.5] g,
P
<0.001) and a lower left ventricular ejection fraction (46.5% [IQR, 39.5%–49.5%] versus 55.0% [IQR, 48.0%–61.4%],
P
=0.002) at 30 days as compared with those with low post‐PCI angio‐IMR values. Post‐PCI angio‐IMR positively correlated with myocardial infarct size (r=0.45,
P
=0.001) and extent of microvascular obstruction (r=0.40,
P
=0.004) at 30 days. Post‐PCI angio‐IMR predicted myocardial infarct size (area under the curve, 0.78 [IQR, 0.65–0.92];
P
=0.001) and extent of microvascular obstruction (area under the curve, 0.74 [IQR, 0.60–0.89];
P
=0.009) at 30 days.

Conclusions
In patients with ST‐segment–elevation myocardial infarction, post‐PCI angio‐IMR was identified as independent predictor of myocardial infarct size and extent of microvascular obstruction.

Registration

URL: https://
clinicaltrials.gov
; Unique Identifier: NCT01529554.
Dietary Cholesterol and Myocardial Infarction in the Million Veteran Program
Authors: Nguyen Xuan‐Mai T. , Li Yanping , Nyaeme Mark S. , Panigrahy Neha , Houghton Serena , Ivey Kerry L. , Shiekh Shamlan , Willett Walter C. , Hu Frank B. , Gaziano J. Michael , Wilson Peter W. F. , Cho Kelly , Djousse Luc ,   the VA Million Veteran Program
Published: February 2025

Background
Coronary artery disease is a leading cause of morbidity and mortality in the United States. Coronary artery disease can lead to major complications including myocardial infarction (MI). The association of dietary cholesterol with coronary artery disease remains inconsistent. We examined the relation of dietary cholesterol with the incidence of MI among participants of the Million Veteran Program.

Methods and Results
The Million Veteran Program is a prospective cohort database collecting genetic and nongenetic factors influencing chronic diseases. We analyzed data from 180 156 veterans with complete information on relevant dietary intake. The association between dietary cholesterol and MI risk was assessed using both linear and nonlinear models. Statistical significance was determined using the Wald test for linear trends and the likelihood ratio test for nonlinearity, alongside comparisons between high (≥300 mg/d) and low (<300 mg/d) cholesterol intake groups. In this study of 180 156 veterans with mean follow‐up of 3.5 years, we observed a linear, dose–response association between dietary cholesterol intake and risk of MI, with every 100‐mg/d increment in cholesterol intake associated with a 5% higher MI risk (relative risk [RR], 1.05 [95% CI, 1.02–1.08]). Subjects consuming >300 mg/d of cholesterol had a 15% increased MI risk compared with those consuming less (RR, 1.15 [95% CI, 1.06–1.25]).

Conclusions
We found that dietary cholesterol intake was linearly associated with greater risk of MI. These findings contribute to the growing literature highlighting the impact dietary cholesterol has on cardiovascular health. Reductions in cholesterol intake, which can be achieved by decreasing the intake of meat and eggs, may reduce the risk of incident MI.
Outcomes and Disease Management in Patients With Atrial Fibrillation ≥80 Years: Data From a Consecutive 11‐Year Real‐World Registry
Authors: Yildirim Mustafa , Milles Barbara Ruth , Hund Hauke , Biener Moritz , Müller‐Hennessen Matthias , Frey Norbert , Katus Hugo A. , Giannitsis Evangelos , Salbach Christian 
Published: February 2025

Background
As the population ages, atrial fibrillation (AF) prevalence increases, but data on optimal oral anticoagulation (OAC) in patients ≥80 years remain limited. This study tested whether direct OACs offer comparable benefits to vitamin K antagonists in patients ≥80 years with AF presenting to the emergency department.

Methods
This single‐center retrospective all‐comer study used data from the Heidelberg Registry of Atrial Fibrillation, including patients with AF presenting to the emergency department of the University Hospital of Heidelberg from June 2009 until March 2020. Data were analyzed by age for outcomes and risk factors for predefined end points.

Results

Patients ≥80 years comprised 32.2% of AF cases. Hazard ratios (HRs) for the primary end point (all‐cause mortality, stroke, or myocardial infarction) and secondary end point (including major bleeding) were 3.09 (95% CI, 2.73–3.21) and 2.96 (95% CI, 2.73–3.21) for patients ≥80 years, compared with younger patients. Anticoagulation rates were slightly lower in patients ≥80 years (67.9% versus 70.5%,
P
=0.0070). OAC use, particularly the use of direct OACs, increased over time. Patients ≥80 years without OACs had higher HRs for primary (3.48 [95% CI, 3.07–3.94]) and secondary end points (3.23 [95% CI, 2.86–3.64]) compared with those with OACs. Vitamin K antagonist use was linked to higher HR for stroke or major bleeding events (HR, 1.25 [95% CI, 1.05–1.50]), rising to 1.64 (95% CI, 1.34–2.01) after excluding reduced direct OAC doses.

Conclusions
Our data highlight patients ≥80 years as an important and vulnerable subpopulation of patients with AF, where evidence for optimal OAC therapy remains conflicting.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT05995561.
Comparative Outcomes of Glucagon‐Like Peptide‐1 Receptor Agonists to Dipeptidyl Peptidase 4 Inhibitors in Patients With Heart Failure and Type 2 Diabetes
Authors: Kishimori Takefumi , Kato Takao , Wada Atsuyuki , Tani Akira , Yamaji Ryosuke , Koike Jumpei , Iwasaki Yoshihiro , Matsumoto Takehiro , Yagi Takafumi , Okada Masaharu 
Published: February 2025

Background
Clinical trials showed that glucagon‐like peptide‐1 receptor agonist (GLP1‐RA) significantly improved the control of diabetes and reduced body weight compared with dipeptidyl peptidase 4 inhibitor (DPP‐4i). However, it is unclear whether GLP1‐RA is effective compared with DPP‐4i in patients with heart failure (HF) with type 2 diabetes (T2D). The purpose of this study was to evaluate the risk of GLP1‐RA compared with DPP‐4i in all‐cause death and hospitalization in patients with HF and T2D.

Methods
This multicenter retrospective observational study using TriNetX, a global health care data and analytics platform, included patients with HF and T2D who had received GLP1‐RA or DPP‐4i from January 1, 2018, to December 31, 2022. Primary outcome was 12‐month incidence of all‐cause death. Secondary outcome was hospitalization. We used odds ratios (ORs) and 95% CIs to evaluate outcome measures.

Results
Among 1 005 097 patients with HF and T2D, 57 965 initiated GLP1‐RA and 77 098 initiated DPP‐4i. After propensity score matching, the number of participants in both the GLP1‐RA group and the DPP‐4i group was 36 557. The proportion of 12‐month incidence of all‐cause death was lower in the GLP1‐RA group than in the DPP‐4i group (5.9% [2140/36 557] versus 8.5% [3103/36 557]; OR, 0.67 [95% CI, 0.63–0.71]).The proportion of 12‐month incidence of hospitalization was also lower in the GLP1‐RA group than in the DPP‐4i group (42.3% [15 455/36 557] versus 48.5% [17 733/36 557]; OR, 0.78 [95% CI, 0.76–0.80]).

Conclusions
Use of GLP1‐RA for patients with HF and T2D was associated with reduced 12‐month incidence of all‐cause death and hospitalization compared with DPP‐4i.
Silent Myocardial Infarction and Risk of Stroke Recurrence: A Post Hoc Analysis of the IRIS Trial
Authors: Ridha Mohamed , Zhang Cenai , McCullough Stephen , Viscoli Catherine M. , Sharma Richa , Kamel Hooman , Merkler Alexander E. 
Published: February 2025

Background
Unrecognized or silent myocardial infarction (MI) detected on an ECG is associated with first‐ever stroke, but the impact on stroke recurrence is unknown. We aimed to determine the association of silent MI with stroke recurrence in patients with a recent ischemic stroke.

Methods and Results
Subjects from the IRIS (Insulin Resistance Intervention After Stroke) trial with an available ECG were included. Clinical MI was defined as a history of hospitalization for MI. Silent MI was defined as ECG evidence of MI in the absence of clinical MI. The primary outcome was recurrent stroke. Ischemic stroke and subtype were assessed as secondary outcomes. Multivariable Cox regression analysis adjusted for demographics, pioglitazone, and vascular risk factors was used to examine the association between MI and stroke recurrence. A total of 2282 participants met the inclusion criteria. Clinical and silent MI were identified in 161 (7.1%) and 94 (4.1%) subjects, respectively. Over the study period, 209 recurrent strokes occurred, with 191 classified as ischemic. In the fully adjusted model, silent MI was significantly associated with any stroke (hazard ratio [HR], 2.29 [95% CI, 1.34–3.90]) and ischemic stroke (HR, 2.09 [95% CI, 1.18–3.70]) recurrence. Clinical MI was associated with stroke recurrence in the unadjusted analysis but not in the fully adjusted model (HR, 1.31 [95% CI, 0.81–2.11]). Silent MI was not associated with potential cardioembolic subtypes (HR, 1.50 [95% CI, 0.70–3.22]).

Conclusions
Among patients with a recent ischemic stroke, silent MI was associated with stroke recurrence. Tailored prevention strategies in this population warrant future investigation.

Registration

URL:
https://clinicaltrials.gov
. Unique Identifier: NCT00091949.
Bempedoic Acid for Prevention of Cardiovascular Events in People With Obesity: A CLEAR Outcomes Subset Analysis
Authors: Bays Harold E. , Bloedon LeAnne , Brennan Danielle , Lei Lei , Lincoff A. Michael , Nicholls Stephen J. , Plutzky Jorge , Powell Heather A. , Nissen Steven E. 
Published: February 2025

Background
Obesity and hypercholesterolemia independently increase cardiovascular disease risk. This analysis evaluated the efficacy and safety of bempedoic acid in people with obesity participating in the CLEAR (Cholesterol Lowering via Bempedoic Acid [ECT1002], an ACL‐Inhibiting Regimen) Outcomes trial.

Methods

CLEAR Outcomes randomized 13 970 patients to daily bempedoic acid 180 mg or placebo. Exploratory outcomes including major adverse cardiovascular events‐4 (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization), low‐density lipoprotein cholesterol, hs‐CRP (high‐sensitivity C‐reactive protein), weight change, and safety were assessed over a median of 40.7 months in 6177 patients with baseline body mass index ≥30 kg/m
2
.

Results
In people with obesity, bempedoic acid resulted in placebo‐corrected reductions in low‐density lipoprotein cholesterol of −22.5% and hs‐CRP of −23.2% at 6 months. Bempedoic acid treatment resulted in a major adverse cardiovascular events‐4 reduction of 23% (hazard ratio [HR], 0.77 [95% CI, 0.67–0.89]) versus placebo. Nonfatal and fatal MI were reduced by 32% (HR, 0.68 [95% CI, 0.53–0.86]), coronary revascularization was reduced by 24% (HR, 0.76 [95% CI, 0.63–0.92]), and fatal and nonfatal stroke were reduced by 36% (HR, 0.64 [95% CI, 0.45–0.89]) compared with placebo. At month 36, mean±SD change in weight from baseline was −2.3 (6.3) kg for bempedoic acid and −1.4 (6.1) kg for placebo. Adverse events were reported in 87.4% of bempedoic acid patients and 86.7% of placebo patients. The mean±SD change in uric acid at 6 months was 0.81 (1.26) mg/dL for bempedoic acid versus −0.04 (1.05) mg/dL for placebo.

Conclusions
Among people with obesity, bempedoic acid reduced major adverse cardiovascular events, low‐density lipoprotein cholesterol, and hs‐CRP, with a safety profile consistent with previous reports.

Registration

URL:
https://www.clinicaltrials.gov
; Unique Identifier: NCT02993406.