bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis
Authors: Ruyant Belabbas Elena , Manceau Charlotte , Wawrziczny Emilie 
Published: December 2023

Background Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers. Objective The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home. Method Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer’s disease. Interviews were analysed using Interpretative Phenomenological Analysis. Results Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer’s disease is a determining factor and allows the identification of three profiles of daughter caregivers: ‘the grateful’, ‘the resentful’ and ‘the ambivalent’, [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer’s disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm’s length when it is present. Discussion The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.
Telehealth Self-Management Support in Early Stroke Rehabilitation: A Feasibility Randomized Controlled Trial
Authors: Lee Danbi , Fischer Heidi , Yang Bishan , Tingey Jamie L. , Miller McKenzie , Kahlia Faran , Bombardier Charles H. 
Published: December 2023

Background: Skills to manage the chronic effect of stroke are often not sufficiently addressed in early stroke rehabilitation. Objectives: The study evaluated the feasibility of conducting a trial testing the efficacy of telehealth self-management support early in stroke recovery. Methodology: Process, resources, and scientific feasibility was assessed for a randomized controlled trial comparing the effect of motivational interviewing and a group-based self-management program to treatment-as-usual with first-time stroke patients. Data were analyzed using descriptive statistics, effect sizes, and thematic analysis. Results: Fifteen stroke patients were enrolled, and 10 completed the study (intervention n = 6). 100% attendance was achieved with technical support, reminders, and schedule flexibility. Participants were satisfied with the intervention and reported emotional benefits and gain of new insights. Perceived recovery showed moderate effect ( r = 0.54). Conclusion: The findings support the feasibility of an efficacy trial as well as the potential benefit of integrating telehealth self-management support early in stroke rehabilitation.
Exploring the link between Multimorbidity and direct healthcare costs in Ireland: A cross-sectional study
Authors: Walsh Sharon , Gillespie Paddy 
Published: December 2023

Background Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective. Methods Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs. Results For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371). Conclusion This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity
Association of intradialysis blood sodium level, blood pressure variability, and hydration status with hemodialysis-related headache: a prospective cohort study
Authors: Xiong Yuqin , You Nujia , Liao Ruoxi , Wu Ling , Liu Yao , Ling Ziying , Yu Yang 
Published: December 2023

Abstract
Objective
To identify primary factors contributing to hemodialysis-related headache (HRH) in maintenance hemodialysis (MHD) patients.

Methods
Adult outpatients receiving MHD were prospectively enrolled from a hemodialysis (HD) center of a tertiary hospital in China. Twelve dialysis sessions were successively monitored for each patient. HRH is defined as having at least three headache episodes that begin during HD and resolve within 72 h of HD session completion. Blood gas analysis during headache episodes and body composition analysis after dialysis were conducted. Hour-to-hour vital sign variability during dialysis was assessed using the metric of average real variability (ARV). Multivariable logistic regression analysis was conducted to explore the factors triggering HRH.

Results
A total of 95 Chinese MHD patients were enrolled, with 92 patients (60.9% were males) included in the final analysis. The mean age of the 92 patients was 59.3 ± 17.5 years, and the median dialysis vintage was 27.1 (12–46.2) months. Among them, 12 patients (13%) complained of 42 headache attacks, and eight (8.7%) were diagnosed with HRH. For eight patients with HRH, headache occurred 100.3 ± 69.5 min after the start of dialysis, with a mean VAS score of 4.3 ± 1 points. The quality of headaches was dull (six patients), pulsating (one patient), or stabbing pain (one patient); all the headaches were bilateral, with one having concomitant vomiting. The intradialysis headache duration and the whole headache duration were 98.8 ± 68.1 and 120 (65–217.5) minutes, respectively. Younger age (OR = 0.844, 95% CI 0.719–0.991, p = 0.039), decreased blood sodium level (OR = 0.309 in the range of 133–142 mmol/L, 95% CI 0.111–0.856, p = 0.024), increased ARV of intradialysis systolic blood pressure (OR = 3.067, 95% CI 1.006–9.348, p = 0.049) and ratio of overhydration to dry weight (OR = 1.990, 95% CI 1.033–3.832, p = 0.040) were found to be independent risk factors for HRH.

Conclusions
This study suggested a significant attribution of blood sodium, hydration status and blood pressure variability to HRH.
Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial
Authors: Xu Fang , Li Yanan , Wang Xupeng , Sun Ran , Zheng Zilei , Zhang Qi , Gao Mingyang , Tao Wei , Zhao Juan , Wang Qiujun 
Published: December 2023

Abstract
Background
Neuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its effect on neutrophil activation and inflammatory cytokine expression.

Methods
We studied the effect of pre-infusion of 4 mL/kg 3% hypertonic saline vs. 4 mL/kg 0.9% normal saline on POD in patients undergoing shoulder arthroscopy in a prospective, randomized, double-blind, controlled trial. Neutrophil surface molecules (CD11b, CD66b and CD64) were analyzed by flow cytometry. Circulating concentrations of inflammatory factors IL-1β, IL-6, TNF-α and neurological damage factor S100β were assessed by enzyme immunoassay. The Confusion Assessment Method-Chinese Revision (CAM-CR) was applied for the assessment of POD 1–3 days after surgery.

Results
The incidence of POD in group H was significantly lower than that in group N (7.14% vs 26.83%, P = 0.036). The expression levels of inflammatory cytokines ( IL-6 and TNF-α) and neutrophil surface markers (CD11b and CD66b) were significantly lower in group H than in group N at 24 h after surgery (P = 0.018, P < 0.001, P < 0.001, P = 0.024). There were no significant differences in postoperative pain, nausea and vomiting, infection, phlebitis, and patients satisfaction between the two groups.

Conclusion
Pre-infusion of HS can reduce the incidence of POD and the immune-inflammatory response.

Trial registration
Chinese Clinical Trial Registry (14/4/2022, registration number: ChiCTR2200058681.
The effect of fibrinoid necrosis on the clinical features and outcomes of primary IgA nephropathy
Authors: Chen Hongshan , Liu Youxia , Wei Li , Wang He , Zheng Zhenfeng , Yan Tiekun , Jia Junya , Li Dong 
Published: December 2023

Abstract
Background
To explore the clinicopathologic features and outcomes of IgAN patients who presented with fibrinoid necrosis (FN) lesions or not and the effect of immunosuppressive (IS) treatment in IgAN patients with FN lesions as well.

Methods
This was a retrospective cohort study with 665 patients diagnosed with primary IgAN from January 2010 to December 2020 in Tianjin Medical University General Hospital and having detailed baseline and follow-up characteristics. Patients were divided into two groups depending on the appearance of FN lesions. Patients with FN lesions were recruited into Group FN1, while patients who were not found FN lesions in their renal biopsy specimens were recruited into Group FN0. Compare the differences between Group FN0 and Group FN1 in baseline clinicopathologic features, treatment solutions and follow-up data as well. To evaluate the impact of different fractions of FN lesions on baseline characteristics and prognosis of IgAN, we subdivided patients in Group FN1 into 3 groups depending on the FN lesions distribution, Mild Group: 0 < FN% < 1/16; Moderate Group: 1/16 < FN% < 1/10; Severe Group: FN% > 1/10. Furthermore, we compared the differences in baseline clinicopathologic features, treatment solutions and follow-up data among these three groups. Kidney endpoint event was defined as patients went into end-stage kidney disease (ESKD), which estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m^2, regularly chronic dialysis over 6 months or received renal transplantation surgery. The kidney composite endpoint was defined by a ≥ 30% reduction in eGFR, double Scr increase than on-set, ESKD, chronic dialysis over 6 months or renal transplantation. Compare the survival from a composite endpoint rate in different groups by Kaplan-Meier survival curve. The univariate and multivariate Cox models were used to establish the basic model for renal outcomes in patients with FN lesions.

Results
(1) A total of 230 patients (34.59%) were found FN lesions in all participants. Patients with FN lesions suffered more severe hematuria than those without. On the hand of pathological characteristic, patients with FN lesions showed higher proportions of M1, E1, C1/C2 and T1/T2 lesions compared with those without FN lesions. (2) The 1-year, 3-year, and 5-year survival of the composite endpoint were lower in the FN1 group than FN0 group. (3) After adjusting for clinicopathological variables, the presence of FN lesions was a significantly independent risk factor for composite endpoint. By using multivariate Cox regression analyses, we also found when the fraction of FN lesions exceeded 10%, the risk of progression into composite endpoint increased 3.927 times.

Conclusion
Fibrinoid necrosis of capillary loops is an independent risk factor of poor renal outcomes. More effective treatment should be considered for those who had FN lesions.
Clinical value of the low-grade inflammation score in aneurysmal subarachnoid hemorrhage
Authors: wang Ling , Chen Ling , Jin Yang , Cao Xiangyang , Xue Liujun , Cheng Qiantao 
Published: December 2023

Abstract
Background and purpose
Multiple inflammatory biomarkers have been shown to predict symptomatic cerebral vasospasm (SCVS) and poor functional outcome in patients with aneurysmal subarachnoid hemorrhage. However, the impact of the low-grade inflammation (LGI) score, which can reflect the synergistic effects of five individual inflammatory biomarkers on SCVS and poor functional outcome on aneurysmal subarachnoid hemorrhage (aSAH), has not yet been well established. The aim of this study was to evaluate the impact of the LGI score on SCVS and poor functional outcome in aSAH patients.

Methods
The LGI score was calculated as the sum of 10 quantiles of each individual inflammatory biomarker. The association of the LGI score with the risk of SCVS and poor functional outcome was analyzed with multivariate logistical regression.

Results
A total of 270 eligible aSAH patients were included in this study: 74 (27.4%) had SCVS, and 79 (29.3%) had poor functional outcomes. After adjusting for confounders, a higher LGI score was revealed to independently predict SCVS (OR, 1.083; 95% CI, 1.011–1.161; P = 0.024) and poor functional outcome (OR, 1.132; 95% CI, 1.023–1.252; P = 0.016), and the second and third tertile group had higher risk of SCVS than lowest tertile group (OR, 2.826; 95% CI, 1.090–7.327; P = 0.033) (OR, 3.243; 95% CI, 1.258–8.358; P = 0.015). The receiver operating characteristic (ROC) curve uncovered the ability of the LGI score to distinguish patients with and without SCVS (area under the curve [AUC] = 0.746; 95% CI, 0.690–0.797; P < 0.001) and poor functional outcomes (area under the curve [AUC] = 0.799; 95% CI, 0.746–0.845; P < 0.001), the predictive value of LGI on SCVS and poor functional outcome is superior than PLT, NLR and WBC, but there was no statistical difference between LGI and CRP for predicting SCVS (P = 0.567) and poor functional outcome (P = 0.171).

Conclusions
A higher LGI which represents severe low grade inflammation status is associated with SCVS and poor functional outcome at 3 months after aSAH.
Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study
Authors: Lei Lei , Li Yi , Xu Huilin , Zhang Qin , Wu Jiacai , Zhao Shoujv , Zhang Xiaochao , Xu Min , Zhang Shuai 
Published: December 2023

Abstract
Background
Delirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes.

Methods
This observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization.

Results
The incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05).

Conclusions
Delirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.
Income is not an equalizer: health development inequities by ethnoracial backgrounds in California kindergartners
Authors: Perrigo Judith L. , Block E. Piper , Aguilar Efren , Beck Chandler , Halfon Neal 
Published: December 2023

Abstract
Background
Early childhood health development is positively associated with income, but the strength of this relationship with ethnoracial background remains unclear. This study examined the extent of health development inequities among California kindergarteners based on ethnoracial backgrounds and neighborhood-level income.

Methods
This cross-sectional study assessed health development inequities by analyzing neighborhood-level income, ethnoracial background, and health development data for California kindergarteners. Student-level data (n = 106,574) were collected through teacher report between 2010–2020 across 52 school districts and 964 schools. Student addresses were geocoded and linked to American Community Survey neighborhood income levels. Health development was measured using the Early Development Instrument, a population-level measure which includes physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge domains. Outcomes included being “on-track” in each domain as well as overall health development.

Results
Using a Generalized Estimation Equation with a log-link function, while accounting for interactions between ethnoracial background, income, and income-squared, we found significant health development inequities by ethnoracial background and neighborhood-level income. Regarding overall health development, as well as the physical, social and emotional domains, Black students had a lower likelihood of being on-track compared to the weighted average across income levels, whereas Asian students surpassed the weighted average. White students exhibited the steepest slope, and at the lowest income levels, their health development scores were akin to their Black and Hispanic/Latino/a low-income counterparts but resembled their Asian counterparts at higher income levels. For the general knowledge and communication domain, white students consistently had the highest likelihood of being on-track, while Hispanic/Latino/a students had the lowest likelihood across all income levels.

Conclusion
This study examines health development inequities among California kindergarteners in diverse communities. Our analysis shows that the relationship between neighborhood-level income and kindergartners’ health development varies by domain and is weaker for students of color. Given the scarcity of population-level data on health development outcomes, these analyses offer valuable insights for identifying ecosystems necessitating support in promoting equitable early childhood health development.
Physiotherapy practice in women’s health: awareness and attitudes of obstetricians and gynecologists in Ghana
Authors: Koranteng Yaa Boatemaa , Adu-Bonsaffoh Kwame , Oppong-Yeboah Bertha 
Published: December 2023

AbstractBackgroundPhysiotherapy is relatively well integrated into women’s health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women’s health among obstetricians/gynecologists and factors associated with its utilization in Ghana.MethodsA cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an “Awareness and Attitude Questionnaire” adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors’ awareness level of physiotherapy’s role in women’s health and years of clinical practice.ResultsSixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29–65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists’ role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors’ awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors’ attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice.ConclusionAlthough obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women’s health in the hospital.