bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of relative phase analysis to evaluate continuous interlimb coordination and stability in individuals with lower limb loss: Design and protocol for a retrospective analysis
Authors: Sidiropoulos Alexis N , Herlihy David V , Maikos Jason T 
Published: November 2023

IntroductionThe number of people with lower limb loss continues to grow, though most research to date has been non-committal and lacks the appropriate clinical guidance required for proper prosthetic prescription. Previous literature using traditional spatiotemporal and biomechanical measures has not accurately identified differences in gait patterns when using different prosthetic devices. Therefore, a knowledge gap remains. To aid in determining the impact of different devices on gait in individuals with lower limb loss, a more sensitive quantitative measure should be used to supplement traditional biomechanical analyses. Continuous measures of coordination and stability, evaluated using relative phase analysis, has been shown to detect changes in gait patterns when traditional variables cannot. However, these measures have yet to be fully assessed in this population. This investigation will fill the knowledge gap by using relative phase analysis to provide a comprehensive description of kinematic behaviour by evaluating continuous interlimb coordination and stability for individuals with lower limb loss.Methods and analysisBiomechanical analysis of individuals with lower limb loss during walking activities will be evaluated using relative phase analysis to identify the continuous interlimb coordination and stability relationships between the upper and lower extremities of these individuals. Three-dimensional motion capture will enable kinematic properties of movement to be captured and analysed. Non-traditional measures of analysis will be used.Ethics and disseminationThis study was approved by the Veterans Affairs New York Harbor Healthcare System Institutional Review Board (IRBNet #1573135, MIRB #1775). Findings will be disseminated through peer-reviewed publications, academic conference presentations, invited workshops, webinars and seminars.
Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh
Authors: Xie Wubin , Paul Rina Rani , Goon Ian Y , Anan Aysha , Rahim Aminur , Hossain Md Mokbul , Hersch Fred , Oldenburg Brian , Chambers John , Mridha Malay Kanti 
Published: November 2023

ObjectiveThe critical shortage of healthcare workers, particularly in rural areas, is a major barrier to quality care for non-communicable diseases (NCD) in low-income and middle-income countries. In this proof-of-concept study, we aimed to test a decentralised model for integrated diabetes and hypertension management in rural Bangladesh to improve accessibility and quality of care.Design and settingThe study is a single-cohort proof-of-concept study. The key interventions comprised shifting screening, routine monitoring and dispensing of medication refills from a doctor-managed subdistrict NCD clinic to non-physician health worker-managed village-level community clinics; a digital care coordination platform was developed for electronic health records, point-of-care support, referral and routine patient follow-up. The study was conducted in the Parbatipur subdistrict, Rangpur Division, Bangladesh.ParticipantsA total of 624 participants were enrolled in the study (mean (SD) age, 59.5 (12.0); 65.1% female).OutcomesChanges in blood pressure and blood glucose control, patient retention and patient-visit volume at the NCD clinic and community clinics.ResultsThe proportion of patients with uncontrolled blood pressure reduced from 60% at baseline to 26% at the third month of follow-up, a 56% (incidence rate ratio 0.44; 95% CI 0.33 to 0.57) reduction after adjustment for covariates. The proportion of patients with uncontrolled blood glucose decreased from 74% to 43% at the third month of follow-up. Attrition rates immediately after baseline and during the entire study period were 29.1% and 36.2%, respectively.ConclusionThe proof-of-concept study highlights the potential for involving lower-level primary care facilities and non-physician health workers to rapidly expand much-needed services to patients with hypertension and diabetes in Bangladesh and in similar global settings. Further investigations are needed to evaluate the effectiveness of decentralised hypertension and diabetes care.
Six month incidence of major adverse cardiovascular events among adults with HIV in northern Tanzania: a prospective observational study
Authors: Stark Kristen , O'Leary Paige R.E. , Sakita Francis M , Ford James S , Mmbaga Blandina T , Blass Beau , Gedion Kalipa , Coaxum Lauren A , Rutta Alice , Galson Sophie Wolfe , Rugakingira Anzibert , Manavalan Preeti , Bloomfield Gerald S , Hertz Julian T 
Published: November 2023

ObjectivesWe aimed to prospectively describe incident cardiovascular events among people living with HIV (PLWH) in northern Tanzania. Secondary aims of this study were to understand non-communicable disease care-seeking behaviour and patient preferences for cardiovascular care and education.DesignA prospective observational study.SettingThis study was conducted at the Majengo HIV Care and Treatment Clinic, an outpatient government-funded clinic in Moshi, TanzaniaParticipantsAdult patients presenting to an HIV clinic for routine care in northern Tanzania were enrolled from 1 September 2020 to 1 March 2021.InterventionsAt enrolment, participants completed a survey and a resting 12-lead ECG was obtained. At 6 month follow-up, a repeat survey regarding interim health events and repeat ECG was obtained.Primary and secondary outcome measuresInterim major adverse cardiovascular events (MACE) were defined by: self-reported interim stroke, self-reported hospitalisation for heart failure, self-reported interim myocardial infarction, interim myocardial infarction by ECG criteria (new pathologic Q waves in two contiguous leads) or death due to cardiovascular disease (CVD).ResultsOf 500 enrolled participants, 477 (95.4%) completed 6 month follow-up and 3 (0.6%) died. Over the 6 month follow-up period, 11 MACE occurred (3 strokes, 6 myocardial infarctions, 1 heart failure hospitalisation and 1 cardiovascular death), resulting in an incidence rate of 4.58 MACE per 100 person-years. Of participants completing 6 month follow-up, 31 (6.5%) reported a new non-communicable disease diagnosis, including 23 (4.8%) with a new hypertension diagnosis.ConclusionsThe incidence of MACE among PLWH in Tanzania is high. These findings are an important preliminary step in understanding the landscape of CVD among PLWH in Tanzania and highlight the need for interventions to reduce cardiovascular risk in this population.
Association between the number of teeth and incident pre-diabetes among middle-aged adults with periodontal disease: a retrospective cohort analysis of Japanese claims data
Authors: Hasegawa Kohei , Sakurai Akinari , Mizuki Masaru , Kurita Hiroshi , Tsukahara Teruomi , Nomiyama Tetsuo 
Published: November 2023

ObjectivesTo investigate the association between the number of teeth and the new onset of pre-diabetes.DesignRetrospective cohort study.SettingThe National Database of Health Insurance Claims and Specific Health Checkups of Japan, which holds information from both the yearly health check-up programme known as the ‘Specific Health Checkup’ and health insurance claims data.Participants1 098 371 normoglycaemic subjects who participated in the Specific Health Checkup programme every year from fiscal year (FY) 2015 to FY 2018 and had dental insurance claims data with a diagnosis of periodontal disease during FY 2016.Outcome measuresIncidence of pre-diabetes or diabetes observed at the Specific Health Checkup during FY 2018.ResultsAmong the participants, 1 77 908 subjects developed pre-diabetes, and 579 developed diabetes at the check-up during the subsequent follow-up year. Compared with the subjects with 26–28 teeth, those with 20–25, 15–19 or 1–14 teeth were associated with an increased likelihood of developing pre-diabetes or diabetes onset with adjusted ORs of 1.03 (95% CI: 1.02 to 1.05), 1.06 (1.03 to 1.09) and 1.07 (1.04 to 1.11), respectively. No clear modifications were observed for age, sex, body mass index or current smoking.ConclusionsHaving fewer teeth was associated with a higher incidence of pre-diabetes. Due to the limitations of this study, however, causality remains undetermined.
PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT): a prospective longitudinal study protocol investigating the prevalence, severity and determinants of atherosclerotic cardiovascular disease in the young adult Pakistani population
Authors: Hanif Bashir , Sheikh Sana , Peerwani Ghazal , Cainzos-Achirica Miguel , Javed Wajiha , Baqar Jaffer Bin , Samad Zainab , Bashir Faiza , S Virani Salim , Nasir Khurram , Aijaz Saba 
Published: November 2023

IntroductionAtherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity, mortality and health expenditures worldwide. Despite having higher ASCVD in the Pakistani population, data on subclinical coronary atherosclerosis in young Pakistanis remain scarce. The PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT) aims to assess the prevalence, severity and determinants of subclinical coronary atherosclerosis among Pakistani men (35–60 years) and women (35–65 years) free of clinically symptomatic ASCVD and will assess 5-year rates of ASCVD events.Methods and analysisPAK-SEHAT is an ongoing prospective cohort study with 2000 participants from all provinces of Pakistan who will be interviewed at the baseline along with phlebotomy, measurement of carotid intima-media thickness (CIMT) and coronary CT angiography (CCTA). Phlebotomy will be repeated at 2.5 years, whereas CIMT and CCTA will be repeated at 5 years. We will report the frequency of maximal coronary stenosis ≥50% and ≥70%, number of coronary vessels with plaque and the number of coronary segments affected per participant on CCTA. We will use Cox proportional hazards regression models to evaluate the association between baseline characteristics and incident ASCVD events during follow-up. These associations will be presented as HRs with 95% CIs.Ethics and disseminationThe study protocol was approved by the Tabba Heart Institute Institutional Review Board (THI/IRB/FQ/22-09-2021/016). All study procedures are consistent with the principles of the Declaration of Helsinki. Findings of the study will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberNCT05156736.
Single-facility study of the effectiveness of rehabilitation therapy using wearable hybrid assistive limb for patients with bleeding disorders: study protocol for a randomised controlled trial
Authors: Mawarikado Yuya , Sakata Asuka , Inagaki Yusuke , Shirai Daisuke , Tatsumi Kohei , Nogami Keiji , Tanaka Yasuhito , Kido Akira , Shima Midori 
Published: November 2023

IntroductionHaemophilic arthropathy, a serious complication of haemophilia, results from recurrent joint bleeding, causing progressive joint damage and severely impacting patient quality of life. Rehabilitation therapy (RT) effectively addresses declining physical function due to joint degradation, but pain during RT can hinder its success. Therefore, an effective pain-alleviating treatment method is required. The single-joint hybrid assistive limb (HAL-SJ), a powered exoskeleton, measures bioelectric potential during muscle contraction and provides motorised support, potentially alleviating pain.ObjectiveThis study outlines our protocol for a randomised, prospective, single-blind (evaluator) trial aimed to investigate the effects of HAL-SJ on pain reduction during RT, kinesiophobia and other physical functions in patients with haemophilia.Methods and analysisThis two-group comparison intervention study will include 24 male patients aged 12–85 years diagnosed with a bleeding disorder necessitating RT for pain and physical function improvement. The primary outcome measures pain changes during the first and second RT session in patients receiving HAL-SJ-assisted RT compared with traditional RT without HAL-SJ. The secondary outcomes include kinesiophobia (Japanese version of the Tampa Scale for Kinesiophobia), standing position gait (zebris FDM-T treadmill), range of motion (manual goniometer) and body surface temperature (infrared thermography camera) during the study period of up to 3 months or until the end of 10 RTs. RT intensity remains below that required to move the affected joint against gravity, given HAL-SJ’s muscular support. The follow-up period extends to 1 month after the last RT. Intergroup study variables are compared by an unpaired t-test or Mann-Whitney test. Intragroup comparisons of secondary outcomes are analysed by a paired t-test or Wilcoxon signed-rank test.Ethics and disseminationThis study was approved by the accreditation committee of Nara Medical University Hospital. The study results will disseminate through publication in a peer-reviewed journal.Trial registration numberjRCTs052220076.
Chronotypes and their association with sleep quality among Chinese college students of Anhui Province: a cross-sectional study
Authors: Tong Xin , Gao Mei-mei , Zhang Liu , Song Jian-gen , Feng Ying , Tao Yujing , Zhu Li-jun , Wen Li-ying , Jin Yue-long , Chang Wei-wei 
Published: November 2023

ObjectivesTo describe the prevalence of chronotype and sleep quality among Chinese college students and explore the relationship between chronotype and sleep quality.DesignA cross-sectional study.SettingFour colleges and universities in Anhui, China, between November and December 2020.ParticipantsA total of 4768 college students were recruited using a stratified, multistage, cluster sampling survey.Outcome measuresMorningness-Eveningness Questionnaire 19 was used to determine the chronotype of the students and the Pittsburgh Sleep Quality Index (PSQI) was used to measure their sleep quality. The multiple logistic regression model was used to explore the potential association between chronotype and sleep quality.ResultsThe self-reported proportions of evening-type (E-type), neutral-type and morning-type among college students were 51.17%, 45.14% and 3.69%, respectively. The mean PSQI score was 4.97±2.82 and the prevalence of poor sleep quality was 18.2%. After adjusting the covariates by multiple logistic regression analysis, E-type was positively associated with subjective sleep quality (OR=1.671, 95% CI 1.414 to 1.975), sleep latency (OR=1.436, 95% CI 1.252 to 1.647), sleep duration (OR=2.149, 95% CI 1.506 to 3.067), habitual sleep efficiency (OR=1.702, 95% CI 1.329 to 2.180), daytime dysfunction (OR=1.602, 95% CI 1.412 to 1.818) and overall poor sleep quality (OR=1.866, 95% CI 1.586 to 2.196).ConclusionsCollege students mainly exhibited E-type, and an elevated prevalence of poor sleep quality existed among these students. The E-type was positively associated with poor sleep quality.
Predictors of outcome in sciatica patients following an epidural steroid injection: the POiSE prospective observational cohort study protocol
Authors: Stynes Siobhan , Snell Kym IE , Riley Richard D , Konstantinou Kika , Cherrington Andrea , Daud Noor , Ostelo Raymond , O'Dowd John , Foster Nadine E 
Published: November 2023

IntroductionSciatica can be very painful and, in most cases, is due to pressure on a spinal nerve root from a disc herniation with associated inflammation. For some patients, the pain persists, and one management option is a spinal epidural steroid injection (ESI). The aim of an ESI is to relieve leg pain, improve function and reduce the need for surgery. ESIs work well in some patients but not in others, but we cannot identify these patient subgroups currently. This study aims to identify factors, including patient characteristics, clinical examination and imaging findings, that help in predicting who does well and who does not after an ESI. The overall objective is to develop a prognostic model to support individualised patient and clinical decision-making regarding ESI.MethodsPOiSE is a prospective cohort study of 439 patients with sciatica referred by their clinician for an ESI. Participants will receive weekly text messages until 12 weeks following their ESIand then again at 24 weeks following their ESI to collect data on leg pain severity. Questionnaires will be sent to participants at baseline, 6, 12 and 24 weeks after their ESI to collect data on pain, disability, recovery and additional interventions. The prognosis for the cohort will be described. The primary outcome measure for the prognostic model is leg pain at 6 weeks. Prognostic models will also be developed for secondary outcomes of disability and recovery at 6 weeks and additional interventions at 24 weeks following ESI. Statistical analyses will include multivariable linear and logistic regression with mixed effects model.Ethics and disseminationThe POiSE study has received ethical approval (South Central Berkshire B Research Ethics Committee 21/SC/0257). Dissemination will be guided by our patient and public engagement group and will include scientific publications, conference presentations and social media.
Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study
Authors: Wondie Wubet Tazeb , Legesse Bruck Tesfaye , Mekonnen Gebrehiwot Berie , Degaga Gosa Tesfaye , Zemariam Alemu Birara , Gedefaw Gezahagn Demsu , Abebe Dereje Esubalew , Kassie Yohannes Tesfahun , Gonete Almaz Tefera , Belay Alamirew Enyew , Wubneh Chalachew Adugna 
Published: November 2023

IntroductionRespiratory distress syndrome is a catastrophic respiratory problem among low birth weight neonates. It increases the suffering of neonates and the economic expenditure of the countries. Notably, it is a major public health issue in low-income and middle-income countries such as Ethiopia. Despite this, studies regarding respiratory distress syndrome among low birth weight neonates were limited in Ethiopia.ObjectiveTo assess the incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first 7 days in Northwest Ethiopia Comprehensive Specialized Hospitals.MethodMulticentred institution-based retrospective follow-up study was conducted from 19 September 2021 to 1 January 2023, among 423 low birthweight neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.6. and analysed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Weibull regression was carried out to identify predictors of respiratory distress syndrome. Statistical significance was declared at a p≤0.05.ResultThe incidence rate of respiratory distress syndrome was found to be 10.78 (95% CI 9.35 to 12.42) per 100 neonate days. Fifth minute Appearance, Pulse, Grimace, Activity, Respiration (APGAR score) <7 (AHR 1.86; 95% CI 1.18 to 2.92), multiple pregnancy (AHR 1.43; 95% CI 1.04 to 1.96), caesarean section delivery (AHR 0.62; 95% CI 0.41 to 0.93), prematurity (AHR 1.56; 95% CI 1.06 to 2.30) and birth weight <1000 g (AHR 3.14; 95% CI 1.81 to 5.40) and 1000–1499 g (AHR 2.06; 95% CI 1.42 to 2.83) were significant predictors.ConclusionThe incidence of respiratory distress syndrome was higher than other studies conducted on other groups of neonates. Multiple pregnancy, fifth minute APGAR score, caesarean section, prematurity, extremely low birth weight and very low birth weight were predictors of respiratory distress syndrome. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention for these predictors.
Morphological subtypes of colorectal low-grade intraepithelial neoplasia: diagnostic reproducibility, frequency and clinical impact
Authors: Lang-Schwarz Corinna , Büttner-Herold Maike , Burian Stephan , Erber Ramona , Hartmann Arndt , Jesinghaus Moritz , Kamarádová Kateřina , Rubio Carlos A , Seitz Gerhard , Sterlacci William , Vieth Michael , Bertz Simone 
Published: November 2023

AimsSpecial histomorphological subtypes of colorectal low-grade intraepithelial neoplasia (LGIN) with variable prognostic impact were recently described in patients with inflammatory bowel disease (IBD) referred to as non-conventional dysplasia. However, they can also be found in patients without IBD. We aimed to analyse the reproducibility, frequency and prognostic impact of non-conventional colorectal LGIN in patients with and without IBD.MethodsSix pathologists evaluated 500 specimens of five different LGIN-cohorts from patients with and without IBD. Non-conventional LGIN included hypermucinous, goblet cell-deficient, Paneth cell-rich and crypt cell dysplasia. A goblet cell-rich type and non-conventional LGIN, not otherwise specified were added. Results were compared with the original expert-consented diagnosis from archived pathology records.ResultsFour or more pathologists agreed in 86.0% of all cases. Non-conventional LGIN was seen in 44.4%, more frequently in patients with IBD (52%; non-IBD: 39.3%, p=0.005). In patients with IBD non-conventional LGIN associated with more frequent and earlier LGIN relapse (p=0.006, p=0.025), high-grade intraepithelial neoplasia (p=0.003), larger lesion size (p=0.001), non-polypoid lesions (p=0.019) and additional risk factors (p=0.034). Results were highly comparable with expert-consented diagnoses. In patients without IBD, non-conventional LGIN may indicate a higher risk for concurrent or subsequent colorectal carcinoma (CRC, p=0.056 and p=0.061, respectively). Frequencies and association with high-grade intraepithelial neoplasia or CRC varied between the different LGIN subtypes.ConclusionsNon-conventional histomorphology in colorectal LGIN is frequent and highly reproducible. Our results indicate an increased risk for CRC in patients with non-conventional LGIN, probably independent of IBD. We recommend reporting non-conventional LGIN in routine pathology reports.
Intergenerational relationship between parental famine exposure and offspring’s obesity risks
Authors: Hu Kai , Cui Aoyuan , Zhang Xiao 
Published: November 2023

BackgroundThe intergenerational relationship between parental famine exposure and the obesity risks of offspring has not been well studied.MethodsUsing a cohort of 3654 respondents whose parents were born between 1950 and 1964 from the national data of the China Family Panel Studies, this study examines the associations between parental exposure to the 1959–1961 Chinese famine and offspring’s body mass index (BMI). A cross-sectional difference-in-difference design was used to estimate the effects of parental famine exposures on offspring’s BMI by exploiting temporal variations in the duration and period of famine across the parental birth cohorts between 1950 and 1964, and geographical variations in the famine severity at the province level.ResultsAfter adjusting individual characteristics and province-level fixed effects, we found that parental famine exposures in the preschool and school-age stages were associated with an increased BMI of offspring while there was not a significant association between prenatal famine exposure and offspring’s BMI. The stratified analyses further show that the effects of parental famine exposure did not follow the same trajectory in subgroups.ConclusionsFamine experiences of parents were associated with increased BMI of offspring, suggesting an intergenerational impact of severe malnutrition on obesity risks.