bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in Caregiver-Reported Child Sleep Patterns and Problems by Family Socioeconomic Indicators
Authors: Lupini Francesca , Daniel Lauren C. , Mindell Jodi A. , Williamson Ariel A. 
Published: October 2023

Abstract:

Objective:
Previous studies of sleep patterns, as well as rates and correlates of perceived problems in early childhood, indicate variation by neighborhood-level socioeconomic indicators. The purpose of this study was to examine variation in (1) sleep patterns, behaviors, and problems by family-based socioeconomic indicators (income-to-needs ratio and caregiver education level) and (2) sociodemographic and sleep correlates of a caregiver-endorsed child sleep problem across and within socioeconomic indicator groups in a diverse sample.

Methods:
Two hundred eighty-three caregiver-child dyads (ages 1‐5 years) completed the Brief Child Sleep Questionnaire. Family-level socioeconomic indicators included income-to-needs ratio and caregiver educational level.

Results:
Sleep patterns varied based on income-to-needs ratio, with children living in poverty experiencing the longest sleep onset latencies and night awakening durations and shortest nighttime sleep durations. Rates of an endorsed child sleep problem were similar across income-to-needs groups. Although sleep patterns did not vary by caregiver education level, caregivers with an education beyond high school were more likely to endorse a child sleep problem; later bedtimes, more frequent night awakenings, and greater bedtime difficulties were the strongest correlates of a perceived sleep problem in this subgroup. No specific correlates of a child sleep problem emerged for those with a high school education or less.

Conclusion:
Sleep patterns may be more robustly linked to family income-to-needs ratio, whereas perceptions of a child sleep problem may be more linked to caregiver education level. Clinicians should consider expanding sleep screening questions to include specific sleep outcomes to effectively assess child sleep and guide intervention.
Association of Food Insecurity Status with Resolution of Mental Health Conditions in Children and Adolescents
Authors: Sanjeevi Namrata , Monsivais Pablo 
Published: October 2023

ABSTRACT:

Objective:
Adverse consequences related to unresolved mental health issues underscore the importance of identifying factors that impede resolution of mental health conditions. Although studies have identified food insecurity as a risk factor for the diagnosis of mental health conditions, its impact on unresolved mental health issues is not understood. The objective of this study is to investigate the association of food insecurity status with resolution of depression, anxiety, and behavioral/conduct problems in children and adolescents.

Methods:
Using National Survey of Children's Health 2016 to 2019, logistic regression analyses examined the relationship of food insecurity status with the diagnosis and resolution of depression, anxiety, and behavioral/conduct problems in children (aged 5–11 years) and adolescents (aged 12–17 years).

Results:
Mild, moderate, and severe food insecurity were significantly associated with higher odds of being diagnosed with depression, anxiety, and behavioral/conduct problems. Severe food insecurity was significantly associated with higher odds of unresolved behavioral/conduct problems in children (adjusted odds ratio [aOR], 10.09; 95% confidence interval [CI], 2.99–34.04), after adjustment for demographic covariates. In adolescents, severe food insecurity was significantly related to greater odds of unresolved depression (aOR, 6.64; 95% CI, 2.13–20.70), anxiety (aOR, 3.27; 95% CI, 1.31–8.14), and behavioral/conduct problems (aOR, 5.57; 95% CI, 2.09–14.85). These associations of severe food insecurity with unresolved mental health conditions were significant even after adjustment for the receipt of mental health care. Mild and moderate food insecurity were not significantly associated with unresolved mental health conditions.

Conclusion:
The findings suggest that severe food insecurity is associated with increased odds of unresolved mental health conditions in children and adolescents. This study highlights the importance of tailoring interventions to provide appropriate mental health services for children and adolescents from severely food insecure households.
Addressing Adolescent Suicidality in Pediatric Primary Care
Authors: Kenny Jessica , Kelsay Kimberly , Bunik Maya , Xiong Shengh , Millar Amanda , Talmi Ayelet 
Published: October 2023

Abstract

Objective:
This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents.

Methods:
A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic.

Results:
Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health (r = 0.24) and family navigators (r = 0.26) and BHCs conducting a risk assessment (r = 0.24), completing a safety plan (r = 0.21), involving caregivers (r = 0.29), sending the adolescent to the emergency department (r = 0.28), and referring to family navigators (r = 0.21; all p values < 0.05).

Conclusion:
The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.
Pulmonary, inflammatory, and oxidative effects of indoor nitrogen dioxide in patients with COPD
Authors: McHugh Erin G. , Grady Stephanie T. , Collins Christina M. , Moy Marilyn L. , Hart Jaime E. , Coull Brent A. , Schwartz Joel D. , Koutrakis Petros , Zhang J. , Garshick Eric 
Published: October 2023

Introduction:
Indoor nitrogen dioxide (NO2) sources include gas heating, cooking, and infiltration from outdoors. Associations with pulmonary function, systemic inflammation, and oxidative stress in patients with chronic obstructive pulmonary disease (COPD) are uncertain.

Methods:
We recruited 144 COPD patients at the VA Boston Healthcare System between 2012 and 2017. In-home NO2 was measured using an Ogawa passive sampling badge for a week seasonally followed by measuring plasma biomarkers of systemic inflammation (C-reactive protein [CRP] and interleukin-6 [IL-6]), urinary oxidative stress biomarkers (8-hydroxy-2'deoxyguanosine [8-OHdG] and malondialdehyde [MDA]), and pre- and postbronchodilator spirometry. Linear mixed effects regression with a random intercept for each subject was used to assess associations with weekly NO2. Effect modification by COPD severity and by body mass index (BMI) was examined using multiplicative interaction terms and stratum-specific effect estimates.

Results:
Median (25%ile, 75%ile) concentration of indoor NO2 was 6.8 (4.4, 11.2) ppb. There were no associations observed between NO2 with CRP, 8-OHdG, or MDA. Although the confidence intervals were wide, there was a reduction in prebronchodilator FEV1 and FVC among participants with more severe COPD (FEV1: –17.36 mL; –58.35, 23.60 and FVC: –28.22 mL; –91.49, 35.07) that was greater than in patients with less severe COPD (FEV1: –1.64 mL; –24.80, 21.57 and FVC: –6.22 mL; –42.16, 29.71). In participants with a BMI <30, there was a reduction in FEV1 and FVC.

Conclusions:
Low-level indoor NO2 was not associated with systemic inflammation or oxidative stress. There was a suggestive association with reduced lung function among patients with more severe COPD and among patients with a lower BMI.
Development, validation, and clinical utility of a risk prediction model for recurrent preeclampsia
Authors: Zhang Lizi , Wang Weiwei , Gong Jingjin , Wang Xinghe , Liang Jingying , Gu Shifeng , Su Minglian , Bi Shilei , Sun Manna , Chen Jingsi , Zheng Weitan , Wu Junwei , Wang Zhijian , Liu Jianmeng , Li Hongtian , Chen Dunjin , Du Lili 
Published: October 2023

Objectives:
We aim to establish a predictive model for recurrent preeclampsia.

Methods:
A retrospective review of medical records from three hospitals between 2010 and 2021 was conducted. The study included women who had two consecutive singleton deliveries at the same hospital, with the first delivery complicated by preeclampsia. A multivariable logistic regression model was constructed using a training cohort, and subsequently cross-validated and tested using an independent cohort. The model's performance was assessed in terms of discrimination and calibration, and its clinical utility was evaluated using decision curve analysis (DCA).

Results:
Among 296 405 deliveries, 694 women met the inclusion criteria, with 151 (21.8%) experiencing recurrent preeclampsia. The predictive model incorporated 10 risk factors from previous preeclampsia, including gestational weeks with elevated blood pressure, gestational diabetes mellitus (GDM), pericardial effusion, heart failure, limb edema, serum creatinine, white blood cell count, low platelet counts within one week before delivery, SBP on the first postpartum day, and postpartum antihypertensive use. Additionally, one risk factor from the index pregnancy was included, which was antihypertensive use before 20 weeks. The model demonstrated better discrimination, calibration, and a net benefit across a wide range of recurrent preeclampsia risk thresholds. Furthermore, the model has been translated into a clinical risk calculator, enabling clinicians to calculate individualized risks of recurrent preeclampsia.

Conclusion:
Our study demonstrates that a predictive tool utilizing routine clinical and laboratory factors can accurately estimate the risk of recurrent preeclampsia. This predictive model has the potential to facilitate shared decision-making by providing personalized and risk-stratified care.
Hypertension prevalence, coding and control in an urban primary care setting in the UK between 2014 and 2021
Authors: Basta Karol , Ledwaba-Chapman Lesedi , Dodhia Hiten , Ashworth Mark , Whitney David , Dalrymple Kathryn , Wang Yanzhong 
Published: October 2023

Objective:
Hypertension is a leading preventable cause of mortality, yet high rates of undiagnosed and uncontrolled hypertension continue. The burden falls most heavily on some ethnic minorities and the socially deprived, with the COVID-19 pandemic having further widened inequalities. We sought to determine the prevalence and predictors of unmeasured blood pressure (BP), uncoded elevated BP and uncontrolled hypertension in primary care across 2014–2021.

Methods:
A population-based cohort study using data from all 41 general practices in a socioeconomically diverse inner-city borough. BP measurements, sociodemographic, lifestyle and clinical factors were extracted from anonymized primary care data. Hypertension and BP control were defined using NICE guidelines. Associations between patient characteristics and hypertension outcomes were identified using logistical regression modelling.

Results:
Of 549 082 patients, 39.5% had unmeasured BP; predictors included male sex [AOR 2.40, 95% confidence interval (95% CI) 2.26–2.43] and registration in the pandemic years. Of 71 970 adults with elevated BP, 36.0% were uncoded; predictors included obesity (AOR 2.51, 95% CI 2.42–2.60) and increasing age. Of 44 648 adults on the hypertension register, 46.8% had uncontrolled hypertension; predictors included black ethnicity compared to white (AOR 1.54, 95% CI 1.41–1.68) and cardiovascular co-morbidities (AOR 1.23, 95% CI 1.21–1.25). Social deprivation was only weakly or not significantly associated with hypertension outcomes.

Conclusion:
The burden of uncoded elevated BP and uncontrolled hypertension is high. Obesity and male sex were associated with uncoded elevated BP and uncontrolled hypertension. Black ethnicity was associated with uncontrolled hypertension. Initiatives are needed to optimize hypertension coding and control, with an emphasis on specific population subgroups.
Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial
Authors: Peeters Laura E.J. , Kappers M.H.W. , Hesselink D.A. , van der Net J.B. , Hartong S.C.C. , van de Laar R. , Ezzahti M. , van de Ven P.J.G. , van der Meer I.M. , de Bruijne E.L.E. , Kroon A.A. , Indhirajanti-Tomasoa S. , van der Linde N.A.J. , Bahmany S. , Boersma E. , Massey E. K. , van Dijk L. , van Gelder T. , Koch Birgit C.P. , Versmissen Jorie 
Published: October 2023

Background:
Adherence to antihypertensive drugs (AHDs) is crucial for controlling blood pressure (BP). We aimed to determine the effectiveness of measuring AHD concentrations using a dried blood spot (DBS) sampling method to identify nonadherence, combined with personalized feedback, in reducing resistant hypertension.

Methods:
We conducted a multicenter, randomized, controlled trial (RHYME-RCT, ICTRP NTR6914) in patients with established resistant hypertension. Patients were randomized to receive either an intervention with standard of care (SoC) or SoC alone. SoC consisted of BP measurement and DBS sampling at baseline, 3 months (t3), 6 months (t6), and 12 months (t12); AHD concentrations were measured but not reported in this arm. In the intervention arm, results on AHD concentrations were discussed during a personalized feedback conversation at baseline and t3. Study endpoints included the proportion of patients with RH and AHD adherence at t12.

Results:
Forty-nine patients were randomized to receive the intervention+SoC, and 51 were randomized to receive SoC alone. The proportion of adherent patients improved from 70.0 to 92.5% in the intervention+SoC arm (P = 0.008, n = 40) and remained the same in the SoC arm (71.4%, n = 42). The difference in adherence between the arms was statistically significant (P = 0.014). The prevalence of resistant hypertension decreased to 75.0% in the intervention+SoC arm (P < 0.001, n = 40) and 59.5% in the SoC arm (P < 0.001, n = 42) at t12; the difference between the arms was statistically nonsignificant (P = 0.14).

Conclusion:
Personalized feedback conversations based on DBS-derived AHD concentrations improved AHD adherence but did not reduce the prevalence of RH.
Home Health Agencies With High Quality of Patient Care Star Ratings Reduced Short-Term Hospitalization Rates and Increased Days Independently at Home
Authors: Li Jun 
Published: October 2023

Background:
Critics argue that Medicare’s Quality of Patient Care home health star ratings are inaccurate. Valid ratings are essential to help patients find high-quality care.

Objective:
The aim of this study was to determine whether using the highest-rated home health agency available in a ZIP code improves outcomes.

Research Design:
A retrospective study of 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. An instrumental variables approach is used to address the endogeneity of agency choice, where the instrument is the differential proximity of the patient to the closest highest-rated and closest lower-rated agency.

Outcomes:
Days independently at home; health care setting-specific days and death; hospitalization, emergency department use, and institutionalization risk.

Results:
Treatment by the highest-rated agencies available decreased risks (in percentage points) of hospitalization (−3.2; 95% CI, −4.1 to −2.3), emergency department use (−2.2; 95% CI, −3.2 to −1.1), and institutionalization (−0.9; 95% CI, −1.3 to −0.5) during the initial episode, and increased days independently at home by 2.6% or 3.75 (95% CI, 2.20–5.29) days in the 180 days after the end of the initial episode. Treatment effects were more pronounced for agencies that were above-average (6.51 d; 95% CI, 4.15–8.87), had ≥1 more star than the next-best agency (7.80 d; 95% CI, 4.13–11.47), and nonrural residents (4.57 d; 95% CI, 2.75–6.40). Effects were positive for both postacute (3.40; 95% CI, 1.80–5.00) and community-entry (5.60; 95% CI, 2.30–8.89) patients.

Conclusions:
Medicare’s Quality of Patient Care star rating correlates with reduced short-term hospitalizations and emergency department use and increased days independently at home in the longer term.
Evaluation of the Completeness of Managed Care Data to Identify Cancer Diagnoses and Treatments for Patients in the SEER-Medicare Data
Authors: Warren Joan L. , Parsons Helen M. , Mariotto Angela B. , Boyd Eric , Enewold Lindsey 
Published: October 2023

Background:
The utility of codes on Medicare Advantage (MA) data to capture cancer diagnoses and treatment for cancer patients is unknown.

Objective:
This study compared cancer diagnoses and treatments on MA encounter data (MA data) with the Surveillance, Epidemiology, and End-Results (SEER) data.

Subjects:
Subjects were patients enrolled in either MA or Medicare fee-for-service (MFFS) when diagnosed with incident breast, colorectal, prostate, or lung cancer, 2015–2017, in a SEER cancer registry.

Measures:
MA data, from 2 months before to 12 months following SEER diagnosis, were reviewed to identify cancer diagnoses, surgery, chemotherapy, and radiotherapy (RT). MA data were compared with SEER to determine their sensitivity to capture cancer diagnoses and sensitivity/specificity to identify surgeries. The agreement between SEER and Medicare data regarding receipt of chemotherapy and RT was measured by Kappa statistics. A similar comparison to SEER diagnoses/treatments was made using MFFS claims to provide context for the SEER-MA comparison.

Results:
The study included 186,449 patients, 38% in MA. MA data had 92%+ sensitivity to identify SEER cancer diagnosis and 90%+ sensitivity for cancer surgery. Specificity for surgery was >84%, except for breast cancer (52%). Kappa statistics for agreement between SEER and MA data regarding chemotherapy varied by cancer, 0.61–0.82, and for receipt of RT exceeded 0.75 for all cancers. Results observed for MFFS claims were similar to those in MA data.

Conclusion:
For 4 common cancers, MA data included most cancer diagnoses and general types of cancer treatment reported in the SEER data. More research is needed to assess additional cancers and detailed treatments.
Intrapyloric Botulinum Toxin Injection for Refractory Nausea and Vomiting in Pediatric Patients
Authors: Osgood Peter T. , Essner Bonnie S. , Fountain Laura , Sullivan Erin C. , Meegan Carol , Fortunato John E. 
Published: October 2023

Objectives:
Chronic nausea and vomiting may be associated with gastroparesis or other conditions. Poor mechanistic understanding of symptoms often precludes targeted therapy. Numerous case series suggest that intrapyloric botulinum toxin injection (IPBI) may be beneficial in treating gastroparesis and dyspepsia in children. We hypothesized that nausea, vomiting, and other symptoms, independent of gastroparesis, may improve with IPBI. We sought to identify gastric emptying (GE) and manometric patterns in IPBI responders versus nonresponders.

Methods:
Electronic records of 25 pediatric patients who received IPBI for refractory nausea, vomiting, or both were retrospectively reviewed. We assessed symptom improvement post-IPBI and compared symptoms, GE, and antroduodenal manometry (ADM) findings between IPBI responders and nonresponders.

Results:
At least one major symptom improved in 19 patients (76%) after IPBI. Of 22 patients completing a GE study, 14 had delayed GE with no significant difference between IPBI responders and nonresponders. Of 22 patients who underwent ADM, 18 had normal fasting peristalsis, 5 had postprandial antral hypomotility, 4 had neuropathic findings, and 19 had pylorospasm. IPBI responders, compared to nonresponders, demonstrated higher antral pressures with feeding (P < 0.0001) and shorter duration of pylorospasm (P = 0.0036). Antral pressures did not differ significantly with fasting or following motilin agonists.

Conclusions:
Our findings suggest that IPBI may have therapeutic benefit in pediatric patients with chronic nausea and/or vomiting, independent of gastroparesis. ADM findings of intact antral peristalsis and elevated antral pressures, in conjunction with efficacy of IPBI, support pyloric non-relaxation as a potential contributor to nausea and/or vomiting in pediatric patients.
Frequency of migraine and its associated triggers and relievers among medical students of Lahore: a cross-sectional study
Authors: Liaquat Amna , Sheikh Wahab Azmat , Yousaf Iram , Mumtaz Hassan , Zafar Maria , Khan Sherwani Aisha Haq 
Published: October 2023

Introduction:
Headache is a widely prevalent illness that negatively impacts people’s lives, leaving them functionally incapable of performing regular everyday tasks. The global burden of headache is 40%, of which migraine accounts for 47%.

Objective:
This study aims to determine the frequency of migraine among medical students of Lahore and its characteristics, associated triggers, and relievers among medical students.

Methodology:
A cross-sectional study was conducted in medical colleges after obtaining ethical approval. Migraine was diagnosed using the criteria provided in the International Classification of Headache Disorders, Third Edition (ICHD-3), and data on triggers, relief, and demographics were collected. The information is analyzed using SPSS 22.

Result:
The data were collected from 522 medical students. The average age of the students was 21.3 ± 2.0 SD (in years). About 146 (28.0%) of the medical students have migraine according to ICHD-3 criteria and were diagnosed initially. Gender was insignificantly associated with migraine (P-value=0.32). Students with psoriasis, hypertension, and polycystic ovarian syndrome were statistically significantly related to migraines with a P-value=0.002. Dehydration is the most frequent aggravator, and adequate sleep is the most frequent reliever of migraine.

Conclusion:
The findings show a high frequency of migraine. They are similar in both genders, depicting that stressful lifestyles, inadequate sleep patterns, and bizarre dietary habits make them more prone to migraine episodes. So, further, detailed studies should be done on evaluating triggers and relievers of migraine and their interrelations with migraine so we can focus on preventive strategies, diagnosis, and treatment of migraine.