bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative poverty is associated with increased risk of diabetic ketoacidosis at onset of type 1 diabetes in children. A Swedish national population‐based study in 2014–2019
Authors: Wersäll Johan H. , Ekelund Jan , Åkesson Karin , Hanas Ragnar , Adolfsson Peter , Ricksten Sven‐Erik , Forsander Gun 
Published: January 2024

AbstractAimsThe aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty.MethodsA national population‐based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new‐onset type 1 diabetes in the period of 2014–2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at‐risk‐of‐poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi‐variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis.ResultsChildren from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12–1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35–3.25, p = 0.001), as compared to children from households without relative poverty.ConclusionsRelative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high‐income country with publicly reimbursed health care.
Transsulfuration and folate pathways in rheumatoid arthritis: A systematic review and meta‐analysis
Authors: Mangoni Arduino A. , Zinellu Angelo 
Published: January 2024

AbstractBackgroundMetabolomic assessment of the transsulfuration and folic acid biochemical pathways could lead to the identification of promising biomarkers of nitric oxide dysregulation and oxidative stress in rheumatoid arthritis (RA).MethodsWe conducted a systematic review and meta‐analysis of transsulfuration (methionine, homocysteine, and cysteine) and folic acid (folic acid, vitamin B6, and vitamin B12) metabolites in RA patients in remission and healthy controls. Electronic databases were searched from inception to 15 July 2023 for relevant articles. We assessed the risk of bias using the JBI checklist and the certainty of evidence using GRADE.ResultsIn 28 eligible studies, compared to controls, RA patients had significantly higher concentrations of homocysteine (standardized mean difference, SMD = 0.74, 95% CI 0.54–0.93, p < 0.001; low certainty of evidence) and methionine (SMD = 1.00, 95% CI 0.57–1.44, p < 0.001; low certainty) and lower concentrations of vitamin B6 (SMD = −6.62, 95% CI −9.65 to −3.60, p < 0.001; low certainty). By contrast, there were non‐significant between‐group differences in vitamin B12 and folic acid. In meta‐regression and subgroup analysis, there were no associations between the effect size and several study and patient characteristics except for homocysteine (year of publication, C‐reactive protein, triglycerides, and analytical method) and folic acid (biological matrix).ConclusionsThe results of our study suggest that homocysteine, methionine, and vitamin B6 are promising biomarkers to assess nitric oxide dysregulation and oxidative stress in RA. (PROSPERO registration number: CRD42023461081).
Participant and caregiver perspectives on health feedback from a healthy lifestyle check
Authors: Lee Miranda D. , Wild Cervantée E. K. , Taiapa Ken J. , Rawiri Ngauru T. , Egli Victoria , Maessen Sarah E. , Anderson Yvonne C. 
Published: January 2024

AbstractIntroductionThe usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme.MethodsThis qualitative study, informed by Kaupapa Māori principles, included focus groups of children aged 5–11 years and young people aged 12–18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio‐recorded, transcribed and analysed using thematic analysis.FindingsKey themes were identified: letters sometimes acted as ‘discourses of disempowerment’—some participants experienced a lack of safety, depersonalisation with medical jargon and ‘feeling like a number’. Participants described the need for acknowledgement and affirmation in written communication—health feedback should include validation, choice regarding content, respectful tone and a strengths‐based approach to health messages.InterpretationLetters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health.Patient ContributionThis study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community‐based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Māori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym.
The use of medicaments in the management of symptomatic irreversible pulpitis: A community‐based cohort study
Authors: Edwards David , Rasaiah Sabrina , Kirkevang Lise‐Lotte , Vaeth Michael , Stone Simon J. , Obara Ilona , Durham Justin , Whitworth John 
Published: January 2024

AbstractAimTo investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom.MethodologyAll patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre‐operatively, data regarding patients' numerical ratings scale (NRS), pain score (0–10), analgesic use, oral‐health impact profile‐14 (OHIP‐14) and need for time away from work were collected. For 7 days post‐operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed‐effects model with post hoc Tukey's multiple comparisons test for continuous data and chi‐squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel–Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre‐ and post‐operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2‐points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work.ResultsEighty‐five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self‐reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015).ConclusionsThis study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.
Oral frailty: A concept analysis
Authors: Yang Chengfengyi , Gao Yajing , An Ran , Lan Yue , Yang Yue , Wan Qiaoqin 
Published: January 2024

AbstractAimTo clarify the concept of oral frailty to provide a clear and standardized conceptual basis for further research in older people.DesignRodgers and Knafl's evolutionary concept analysis approach.MethodsThe narrative analysis detailedly extracted and synthesized the attributes of oral frailty, as well as its antecedents, consequences and related terms under the guidance of Rodgers' evolutionary method.Data SourcesMultiple databases including Pubmed, CINAHL and Cochrane were searched using selected search terms ‘oral frail*’, ‘oral health’ and ‘aged’ respectively. Articles written between 2013 and 2023 were included, and grey literature was excluded.ResultsA total of 32 articles were included for further analysis and synthesis. The attributes of oral frailty were hypofunction, predisposing in nature, non‐specific and multidimensional. Antecedents of prefrailty were classified into four categories, namely, sociodemographic characteristics, comorbidity, physical function and psychosocial factors. Consequences of oral frailty include three themes: increased risk of adverse outcomes, poor nutritional status and possibility of social withdrawal. Related terms that had shared attributes with oral frailty were oral health, functional dentition, oral hypofunction and deterioration of oral function.ConclusionsOral frailty is an age‐related phenomenon reflected in decreased oral function. The findings of this concept analysis are conducive to understanding and clarifying the oral frailty, which can help clinicians or other healthcare providers to consider how to distinguish oral frailty in older adults and further promote the development of this field.ImpactOral frailty is increasingly recognized as an age‐related phenomenon reflected in decreased oral function. As it is newly proposed, no consensus has been reached regarding the theoretical and operational concept of it. Through clarifying the concept, this paper will guide future healthcare research on oral frailty regarding the influencing factors, mechanisms and interventions, thus raising the awareness with regard to oral health among older adults.What does this paper contribute to the wider global clinical community?

In the context of older adults, oral frailty is a concept that requires further research to guide future theoretical development, and the influencing factors, mechanisms and interventions need to be further studied.

Raise awareness with regard to oral health among older people and more attention will be paid to the early identification and intervention of oral frailty, so as to further improve the quality of life of older adults.
Challenges and needs in cerebrovascular disease pathway: A qualitative descriptive study from the patients' and healthcare professionals' perspectives
Authors: Härkönen Henna , Myllykangas Kirsi , Gomes Julius , Immonen Milla , Kärppä Mikko , Hyvämäki Piia , Jansson Miia 
Published: January 2024

AbstractAim(s)To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway.DesignA qualitative descriptive study.MethodsSemi‐structured in‐person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary‐level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting.ResultsOverall, 19 generic and 79 sub‐categories describing perceived challenges with 17 generic and 62 sub‐categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke.ConclusionSeveral challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long‐term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services.Implications for the Profession and/or Patient CareThe results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway.ImpactThis study identified several patient‐related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high‐quality cerebrovascular disease care.Reporting MethodWe have adhered to relevant EQUATOR guidelines with the COREQ reporting method.Patient or Public ContributionNo patient or public involvement.
Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high‐risk infected device extraction
Authors: English Carter , Fan Dali , Ing Frank , Cortez Daniel 
Published: January 2024

AbstractIntroductionPatients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime.MethodsWe present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy.ResultsA 27‐year‐old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status‐post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy‐based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser‐lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial‐mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices.ConclusionOur case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices.
Hypertensive disorders of pregnancy and midlife maternal cognition in a prospective cohort study
Authors: Birnie Kate , Catov Janet , Anderson Emma L. , Lapidaire Winok , Kilpi Fanny , Lawlor Deborah A. , Fraser Abigail 
Published: January 2024

AbstractHypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disorders, with recent evidence linking pre‐eclampsia with vascular dementia. We examined associations of HDP with cognitive performance measured in midlife, in a prospective cohort study, the Avon Longitudinal Study of Parents and Children. Six cognitive function domains were measured 20 years after pregnancy at a mean age of 51 years. The cognition tests were repeated at clinics in the following two years. Cognitive function domains measured were immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence, and verbal fluency. Exposures were pre‐eclampsia, gestational hypertension (GH), and a combined category of any HDP, all compared to normotensive pregnancy. Of 3393 pregnancies included in the analysis, GH was experienced by 417 (12.3%) and pre‐eclampsia by 57 (1.7%). GH was associated with lower verbal episodic memory, in the delayed logic memory test (‐0.16 SDs; 95% CI ‐0.30, ‐0.03; p = .015) and there was weak evidence of an association with the immediate logic memory test (‐0.13 SDs; ‐0.27, 0.001; p = .058). However, we did not see steeper declines by age for women with GH and there was no evidence of associations with other cognitive domains or for pre‐eclampsia with any domains. Results were not substantially changed after controlling for midlife blood pressure. Our findings suggest that a history of GH is associated with slightly reduced episodic memory 20 years after pregnancy, but we found no evidence of a quicker age‐related decline compared to women with normotensive pregnancies.
Nrf2/HO‐1, NF‐κB and PI3K/Akt signalling pathways decipher the therapeutic mechanism of pitavastatin in early phase liver fibrosis in rats
Authors: Elbaset Marawan A. , Mohamed Bassim M. S. A. , Hessin Alyaa , Abd El‐Rahman Sahar S. , Esatbeyoglu Tuba , Afifi Sherif M. , Fayed Hany M. 
Published: January 2024

AbstractLiver fibrosis is a common chronic hepatic disease. This study aimed to investigate the effect of pitavastatin (Pit) against thioacetamide (TAA)‐induced liver fibrosis. Rats were divided into four groups: (1) control group; (2) TAA group (100 mg/kg, i.p.) three times weekly for 2 weeks; (3 and 4) TAA/Pit‐treated group, in which Pit was administered orally (0.4 and 0.8 mg/kg/day) for 2 weeks following TAA injections. TAA caused liver damage manifested by elevated serum transaminases, reduced albumin and histological alterations. Hepatic malondialdehyde (MDA) was increased, and glutathione (GSH) and superoxide dismutase (SOD) were decreased in TAA‐administered rats. TAA upregulated the inflammatory markers NF‐κB, NF‐κB p65, TNF‐α and IL‐6. Treatment with Pit ameliorated serum transaminases, elevated serum albumin and prevented histopathological changes in TAA‐intoxicated rats. Pit suppressed MDA, NF‐κB, NF‐κB p65, the inflammatory cytokines and PI3K mRNA in TAA‐intoxicated rats. In addition, Pit enhanced hepatic antioxidants and boosted the nuclear factor erythroid 2–related factor 2 (Nrf2) and heme oxygenase‐1 (HO‐1) mRNA. Moreover, immunohistological studies supported the ability of Pit to reduce liver fibrosis via suppressing p‐AKT expression. In conclusion, Pit effectively prevents TAA‐induced liver fibrosis by attenuating oxidative stress and the inflammatory response. The hepatoprotective efficacy of Pit was associated with the upregulation of Nrf2/HO‐1 and downregulation of NF‐κB and PI3K/Akt signalling pathways.
Development and validation of a rule‐based algorithm to identify periodontal diagnosis using structured electronic health record data
Authors: Tokede Bunmi , Brandon Ryan , Lee Chun‐Teh , Lin Guo‐Hao , White Joel , Yansane Alfa , Jiang Xiaoqian , Kalenderian Elsbeth , Walji Muhammad 
Published: January 2024

AbstractAimTo develop and validate an automated electronic health record (EHR)‐based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions.Materials and MethodsUsing material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento‐enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites.ResultsThree‐hundred and twenty‐three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together.ConclusionsOur findings suggest that a rule‐based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey‐zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.