bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘I really feel like I am ageing early’: an interpretative phenomenological analysis of the lived experience of young adults with life-limiting conditions (YALLC)
Authors: Ting Celene , Chen Xiangyi , Poh Ya Nee , Yeo Zhi Zheng , Ang Qishun Raymond , Chong Poh Heng 
Published: January 2024

ObjectivesThis study aims to explore the lived experience of young adults with life-limiting conditions (YALLC) and how they perceive and navigate adulthood, to identify challenges and opportunities for improved care and support.MethodsA qualitative study using interpretative phenomenological analysis to understand how young adults who survived childhood serious illness make sense of current circumstances. Seven YALLC with different diagnoses ranging from 19 to 39 years were recruited through purposive sampling in a specialist paediatric palliative care service/adult hospice. In-depth, semistructured interviews were conducted, and verbatim transcripts analysed iteratively.ResultsFour major themes emerged: (1) living with limitations and in limbo—compressed timelines and confusion, triggered by dissonance between age-expected versus developmentally appropriate aspirations and goals; (2) experiencing identity crises, confronting existential concerns and chasing the elusive goal of enduring connection—struggle between public versus self-identities, including issues around self-worth and purpose; (3) striving for autonomy while tolerating interdependence/codependence—tensions arising from their desire for independence against the need to rely on others and (4) accepting and appreciating LLC as integral to one’s existence—demonstrating adaptability, creativity and resilience. Themes highlight a complex interplay of push-pull factors encountered by YALLC at multiple levels as they strive for a normative or negotiated life course.ConclusionYALLC face an intricate web of physical, psychoemotional, social and financial challenges compounded by underlying, persistent or progressive illnesses. Contextual understanding and identified gaps from this study will guide affirmative strategies to improve quality of life among a growing cohort.
Healthy enough to work up to age 67 and beyond? A longitudinal population-based study on time trends in working life expectancy free of cardiovascular diseases based on German health insurance data
Authors: Epping Jelena , Tetzlaff Fabian , Mond Lieselotte , Tetzlaff Juliane 
Published: January 2024

BackgroundDue to the rising life expectancy in Western countries, the discussion about the increase in the retirement age is becoming more important. However, the prolongation of working lives cannot be implemented successfully without considering the health status of the (potential) employees. In this study, time trends in working life expectancy (WLE) free of widespread cardiovascular diseases (CVD) as well as the proportion of CVD-free working life years are reported.MethodsClaims data from a German statutory health insurance provider is used to analyse CVD-free WLE. Three periods were defined to assess time trends: 2006–2008 (n=2 075 248), 2011–2013 (n=2 302 127) and 2016–2018 (n=2 579 985). Based on transition rates between the states labour force, non-labour force, CVD and death, CVD-free years spent in the labour force were estimated for each age using multistate life table analyses.ResultsThe length of CVD-free WLE increased over time. This increase was stronger in women than in men (+6.4 years vs +2.4 years at age 18). Given the increase in total WLE of the study population, the proportion of CVD-free WLE in total WLE remained stable over time.ConclusionsThe results show that working life years free of CVD increased strongly over the last 13 years and can keep pace with the increase in the length of working lives. Healthier working conditions as well as more efforts in promoting healthy nutrition and less sedentary behaviour could help to further reduce the incidence of CVD and thus contribute to longer healthy working lives.
Perceived social support and the experience of intimate partner violence among married and cohabiting young women in urban slums, Ibadan, Nigeria: a descriptive study
Authors: Okedare Omowumi O , Fawole Olufunmilayo I 
Published: January 2024

BackgroundSocial support is an important factor for improving the outcome of intimate partner violence (IPV) among abused women. Gaps exist on the role of social support among young women who have experienced IPV in Nigeria. Therefore, this study examined the influence of social support on the experience of IPV married and cohabiting young women in urban slums of Ibadan, Nigeria.MethodsThis study was a community-based household survey conducted in ten slum communities in the five local government areas of Ibadan municipality among 314 young women. Outcome variable was the experience of physical, psychological and any IPV. Socio-demographic characteristics were summarised using frequency and percentage. Level of statistical significance was set at α0.05.ResultsThe mean age of respondents was 22.25±1.75 years and the mean spousal age difference was 7.15±3.87 years. Majority of the respondents were married (62.1%), and have been in a union for 0–4 years (68.8%). More than half (56.4%) justified IPV perpetration. Majority of the respondents reported having experienced psychological IPV (66.6%) and at least one form of IPV (86.3%) but have never told anyone about their IPV experience (58.1%). Social support was a predictor of psychological and any IPV, but not physical IPV. Type of union and duration of union significantly predicted all forms of IPV.ConclusionPrevalence of IPV is higher among women in cohabiting relationships. Social support from family and friends helps abused women cope with the experience of IPV. Thus, IPV prevention should target the social support system available to abused women.
Preferences for virtual versus in-person mental and physical healthcare in Canada: a descriptive study from a cohort of youth and their parents enriched for severe mental illness
Authors: Mazurka Raegan , Vallis Emily Howes , Chen Lucy , Freeman Kathryn , Langley Ross , Ross Briana , Arora Swasti , Kahn Mica , Howard Cynthia , Liu Dara , Cumby Jill , Brennan Maureen L , Hickcox Samuel E , Bagnell Alexa L , Propper Lukas , Pavlova Barbara , Uher Rudolf 
Published: January 2024

BackgroundVirtual care may improve access to healthcare and may be well suited to digitally connected youth, but experts caution that privacy and technology barriers could perpetuate access inequities. Success of virtual care will depend on its alignment with patient preferences. However, information on preferences for virtual and in-person healthcare is missing, especially for youth. We sought to quantify preferences for and barriers to virtual versus in-person mental and physical healthcare in youth and their parents, including in vulnerable segments of the population such as families with a parent with severe mental illness (SMI).MethodsParticipants were 219 youth and 326 parents from the Families Overcoming Risks and Building Opportunities for Wellbeing cohort from Canada, of which 61% of youth had at least one parent with SMI. Participants were interviewed about healthcare preferences and access to privacy/technology between October 2021 and December 2022.ResultsOverall, youth reported a preference for in-person mental (66.6%) and physical healthcare (74.7%) versus virtual care or no preference, and to a somewhat lesser degree, so did their parents (48.0% and 53.9%). Half of participants reported privacy/technology barriers to virtual care, with privacy being the most common barrier. Preferences and barriers varied as a function of parent SMI status, socioeconomic status and rural residence.ConclusionsThe majority of youth and parents in this study prefer in-person healthcare, and the preference is stronger in youth and in vulnerable segments of the population. Lack of privacy may be a greater barrier to virtual care than access to technology.
Global, regional and national burden of retinopathy of prematurity among childhood and adolescent: a spatiotemporal analysis based on the Global Burden of Disease Study 2019
Authors: Wang Sufang , Liu Jun , Zhang Xiurong , Liu Yonggang , Li Jiaxin , Wang Hao , Luo Xiaoyang , Liu Shunming , Liu Lei , Zhang Jie 
Published: January 2024

BackgroundThis study aimed to provide a comprehensive assessment of burden estimates and the secular trend of vision loss due to retinopathy of prematurity (ROP) among people younger than 20 years, at the global, regional and national levels.MethodsData were obtained from the Global Burden of Disease Study 2019 database. The average annual percentage change (AAPC) was calculated to quantify the temporal trends in the measures of vision loss.ResultsIn 2019, the global age-standardised rates (ASRs) of prevalence per 100 000 population was 86.4 for vision loss, specifically, 35 for moderate vision loss, 19.9 for severe vision loss, 31.6 for blindness due to ROP among people younger than 20 years. Moreover, the ASR of years lived with disability per 100 000 was 10.6 for vision loss, specifically, 1.1 for moderate vision loss, 3.6 for severe vision loss, 5.9 for blindness, respectively. From 1990 to 2019, the ASR of prevalence of blindness and vision loss due to ROP significantly increased, while its burden slightly decreased. Males showed higher ASR of prevalence than females in 2019, whereas females have larger increasing trend than males from 1990 to 2019. The global highest ASR of disease burden was observed in South Asia and Southern sub-Saharan Africa, as well as low sociodemographic index (SDI) regions in 2019.ConclusionsGlobally, although the burden decreased, the prevalence of childhood and adulthood vision loss due to ROP continues to increase. Reasonable resource allocation and advanced intervention are recommended to prevent and control the vision loss due to ROP.
Heightened long-term cardiovascular risks after exacerbation of chronic obstructive pulmonary disease
Authors: Hawkins Nathaniel M , Nordon Clementine , Rhodes Kirsty , Talukdar Manisha , McMullen Suzanne , Ekwaru Paul , Pham Tram , Randhawa Arsh K , Sin Don D 
Published: January 2024

ObjectiveTo examine the risk of adverse cardiovascular (CV) events following an exacerbation of chronic obstructive pulmonary disease (COPD).MethodsThis retrospective cohort study identified patients with COPD using administrative data from Alberta, Canada from 2014 to 2019. Exposure periods were 12 months following moderate or severe exacerbations; the reference period was time preceding a first exacerbation. The primary outcome was the composite of all-cause death or a first hospitalisation for acute coronary syndrome, heart failure (HF), arrhythmia or cerebral ischaemia. Time-dependent Cox regression models estimated covariate-adjusted risks associated with six exposure subperiods following exacerbation.ResultsAmong 1 42 787 patients (mean age 68.1 years and 51.7% men) 61 981 (43.4%) experienced at least one exacerbation and 34 068 (23.9%) died during median follow-up of 64 months. The primary outcome occurred in 43 564 (30.5%) patients with an incidence rate prior to exacerbation of 5.43 (95% CI 5.36 to 5.50) per 100 person-years. This increased to 95.61 per 100 person-years in the 1–7 days postexacerbation (adjusted HR 15.86, 95% CI 15.17 to 16.58) and remained increased for up to 1 year. The risk of both the composite and individual CV events was increased following either a moderate or a severe exacerbation, though greater and more prolonged following severe exacerbation. The highest magnitude of increased risk was observed for HF decompensation (1–7 days, HR 72.34, 95% CI 64.43 to 81.22).ConclusionModerate and severe COPD exacerbations are independent risk factors for adverse CV events, especially HF decompensation. The impact of optimising COPD management on CV outcomes should be evaluated.
Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease
Authors: Castelijns Maria C , Hageman Steven H J , Teraa Martin , van der Meer Manon G , Westerink Jan , ten Berg Jurrien , Visseren Frank L J 
Published: January 2024

ObjectiveAssessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD).MethodsInclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA), Prevention of Cardiovascular events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction (PEGASUS-TIMI) and Dual Antiplatelet Therapy (DAPT) study were applied to coronary artery disease (CAD) and/or peripheral artery disease (PAD) patients from Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) to determine real-world eligibility. Eligible and ineligible patients were compared on baseline characteristics, cardiovascular events, major bleeding and mortality.ResultsEligibility ranged from 11%–94% for CAD to 75%–90% for patients with PAD. Cardiovascular, bleeding and mortality risks were higher in COMPASS-eligible patients with CAD (rate ratios (RR) 1.98 (95% CI 1.74 to 2.26), 2.02 (95% CI 1.47 to 2.78) and 3.11 (95% CI 2.71 to 3.57), respectively) and CHARISMA-eligible patients (RR 1.51 (95% CI 1.12 to 2.06), 2.25 (95% CI 1.01 to 6.21) and 4.43 (95% CI 2.79 to 7.51), respectively), and lower in COMPASS-eligible patients with PAD (RR 0.45 (95% CI 0.36 to 0.56), 0.29 (95% CI 0.18 to 0.46) and 0.45 (95% CI 0.38 to 0.54), respectively) and DAPT-eligible patients with CAD (RR CVD 0.49 (95% CI 0.34 to 0.69) and mortality 0.67 (95% CI 0.48 to 0.94)) than ineligible patients. After adjustment for trial eligibility criteria, only higher cardiovascular and mortality risks in COMPASS-eligible patients with CAD and lower cardiovascular risks in CHARISMA-eligible and DAPT-eligible patients persisted with CAD.ConclusionA large proportion of contemporary CVD patients would be eligible for intensified antithrombotic treatment trials, with mostly similar adjusted event risks to ineligible patients. Trial-based guideline recommendations are largely applicable to real-world patients.
Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes
Authors: van der Velden Rachel M J , Bonander Carl , Crijns Harry J G M , Kemp-Gudmundsdottir Katrin , Engdahl Johan , Linz Dominik , Svennberg Emma 
Published: January 2024

ObjectiveTo evaluate adherence and adherence consistency to the handheld ECG device-based screening protocol and their association with adverse cerebral and cardiovascular outcomes in two systematic atrial fibrillation (AF) screening programmes.MethodsIn 2012 (Systematic ECG Screening for Atrial Fibrillation Among 75-Year Old Subjects in the Region of Stockholm and Halland, Sweden (STROKESTOP) study) and 2016 (Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide (STROKESTOP II) study), half of all 75- and 76-year-old inhabitants of up to two Swedish regions were invited to participate in a systematic AF screening programme. Participants were instructed to perform 30-second measurements twice daily in STROKESTOP and four times daily in STROKESTOP II for 2 weeks. Adherence was defined as the number of measurements performed divided by the number of measurements asked, whereas adherence consistency was defined as the number of days with complete registrations.ResultsIn total, 6436 participants (55.7% female) from STROKESTOP and 3712 (59.8% female) from STROKESTOP II were included. Median adherence and adherence consistency were 100 (92–100)% and 12 (11–13) days in STROKESTOP and 90 (75–98)% and 8 (3–11) days in STROKESTOP II. Female sex and lower education were factors associated with both optimal adherence and adherence consistency in both studies. In STROKESTOP, low adherence and adherence consistency were associated with higher risk of adverse cerebral and cardiovascular outcomes (HR for composite primary endpoint 1.30 (1.11 to 1.51), p=0.001), including stroke (HR 1.68 (1.22 to 2.32), p=0.001) and dementia (1.67 (1.27 to 2.19), p<0.001).ConclusionsAdherence to twice daily handheld ECG measurements in STROKESTOP was higher than to four times daily measurements in STROKESTOP II. Female sex and lower educational attainment were associated with ≥100% adherence and adherence consistency. Low adherence and adherence consistency were associated with a higher risk of adverse outcomes.
Multiomics profiling reveals the benefits of gamma-delta (γδ) T lymphocytes for improving the tumor microenvironment, immunotherapy efficacy and prognosis in cervical cancer
Authors: Li Junyi , Cao Yuanjie , Liu Yancheng , Yu Lu , Zhang Zhen , Wang Xiaofeng , Bai Hui , Zhang Yuhan , Liu Shaochuan , Gao Miaomiao , Lu Chenglu , Li Chen , Guan Yong , Tao Zhen , Wu Zhiqiang , Chen Jie , Yuan Zhiyong 
Published: January 2024

BackgroundAs an unconventional subpopulation of T lymphocytes, γδ T cells can recognize antigens independently of major histocompatibility complex restrictions. Recent studies have indicated that γδ T cells play contrasting roles in tumor microenvironments—promoting tumor progression in some cancers (eg, gallbladder and leukemia) while suppressing it in others (eg, lung and gastric). γδ T cells are mainly enriched in peripheral mucosal tissues. As the cervix is a mucosa-rich tissue, the role of γδ T cells in cervical cancer warrants further investigation.MethodsWe employed a multiomics strategy that integrated abundant data from single-cell and bulk transcriptome sequencing, whole exome sequencing, genotyping array, immunohistochemistry, and MRI.ResultsHeterogeneity was observed in the level of γδ T-cell infiltration in cervical cancer tissues, mainly associated with the tumor somatic mutational landscape. Definitely, γδ T cells play a beneficial role in the prognosis of patients with cervical cancer. First, γδ T cells exert direct cytotoxic effects in the tumor microenvironment of cervical cancer through the dynamic evolution of cellular states at both poles. Second, higher levels of γδ T-cell infiltration also shape the microenvironment of immune activation with cancer-suppressive properties. We found that these intricate features can be observed by MRI-based radiomics models to non-invasively assess γδ T-cell proportions in tumor tissues in patients. Importantly, patients with high infiltration levels of γδ T cells may be more amenable to immunotherapies including immune checkpoint inhibitors and autologous tumor-infiltrating lymphocyte therapies, than to chemoradiotherapy.Conclusionsγδ T cells play a beneficial role in antitumor immunity in cervical cancer. The abundance of γδ T cells in cervical cancerous tissue is associated with higher response rates to immunotherapy.
Assessing the clinical reasoning of ChatGPT for mechanical thrombectomy in patients with stroke
Authors: Chen Tse Chiang , Couldwell Mitchell W , Singer Jorie , Singer Alyssa , Koduri Laila , Kaminski Emily , Nguyen Khoa , Multala Evan , Dumont Aaron S , Wang Arthur 
Published: January 2024

Background
Artificial intelligence (AI) has become a promising tool in medicine. ChatGPT, a large language model AI Chatbot, shows promise in supporting clinical practice. We assess the potential of ChatGPT as a clinical reasoning tool for mechanical thrombectomy in patients with stroke.

Methods
An internal validation of the abilities of ChatGPT was first performed using artificially created patient scenarios before assessment of real patient scenarios from the medical center’s stroke database. All patients with large vessel occlusions who underwent mechanical thrombectomy at Tulane Medical Center between January 1, 2022 and December 31, 2022 were included in the study. The performance of ChatGPT in evaluating which patients should undergo mechanical thrombectomy was compared with the decisions made by board-certified stroke neurologists and neurointerventionalists. The interpretation skills, clinical reasoning, and accuracy of ChatGPT were analyzed.

Results
102 patients with large vessel occlusions underwent mechanical thrombectomy. ChatGPT agreed with the physician’s decision whether or not to pursue thrombectomy in 54.3% of the cases. ChatGPT had mistakes in 8.8% of the cases, consisting of mathematics, logic, and misinterpretation errors. In the internal validation phase, ChatGPT was able to provide nuanced clinical reasoning and was able to perform multi-step thinking, although with an increased rate of making mistakes.

Conclusion
ChatGPT shows promise in clinical reasoning, including the ability to factor a patient’s underlying comorbidities when considering mechanical thrombectomy. However, ChatGPT is prone to errors as well and should not be relied on as a sole decision-making tool in its present form, but it has potential to assist clinicians with more efficient work flow.
Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis
Authors: Kiefer David , Schneider Lucia , Braun Jürgen , Kiltz Uta , Kolle Niklas , Andreica Ioana , Tsiami Styliani , Buehring Bjoern , Sewerin Philipp , Herbold Susanne , Baraliakos Xenofon 
Published: January 2024

ObjectivePatients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to compare the performance of patients with axSpA regarding mobility measures including performance-based tests and objective electronic assessments with the Epionics SPINE device (ES) at different times of the day compared with healthy controls (HC).MethodsObservational trial, consecutive inpatients with axSpA (n=100) and 20 HCs were examined in the morning (V1: before 10:00 am) and in the afternoon (V2: after 02:00 pm) by the Bath Ankylosing Spondylitis Metrology Index (BASMI), the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and ES measurements, including range of motion (RoM) and range of kinematics (RoK).ResultsThe assessments of patients with axSpA performed in the morning clearly differed from those in the afternoon, especially regarding performance-based tests. Significant improvements were seen for BASMI (4.0±3.8 to 3.8±1.9; p<0.001), ASPI (36.2±18.3 to 28.8±11.9 s; p<0.001), SPPB (10.1±1.5 to 10.7±1.4 points; p<0.001) and for ES measures of speed (RoK; p<0.018) but not for RoM, except for lateral flexion (13.3±7.4 to 14.7±8.2°; p=0.002). This time of assessment-related variability was not observed in HC.ConclusionThe spinal mobility of patients with axSpA was worse in the morning but significantly improved in the afternoon. This was captured best by performance-based measures and was not seen in HC. The diurnal variation of mobility has implications for clinical studies, suggesting that the time of assessments needs to be standardised.