bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of maternal food quality score (FQS) with breast milk nutrient content and antioxidant content of infant urine: a cross-sectional study
Authors: Karbasi Samira , Mohamadian Malihe , Naseri Mohsen , Yahya Hanafi-Bojd Mohammad , Khorasanchi Zahra , Morovatdar Negar , Zarban Asghar , Bahrami Afsane , Ferns Gordon A. 
Published: February 2023

Abstract
Background
Breast milk (BM) is a complex fluid with a variable composition within women over time and between women in the population. The BM compositional differences are likely to be partly due to maternal dietary patterns. This study aimed to evaluate food quality score (FQS) in lactating mothers and its association with quality indicators of BM and antioxidant content of infant urine.

Methods
This cross-sectional study was undertaken in 350 lactating women aged 20 to 35 years. Data on dietary intake was collected using a validated food frequency questionnaire (FFQ) containing 65 food items. The FQS was calculated by integrating the scores obtained from healthy and unhealthy food groups. Subjects were categorized according to FQS adherence, with the greatest adherence being allocated to the third tertile and those with the lowest FQS in the first tertile. Antioxidant activity of the BM and infant urine samples was assessed using the Ferric reducing antioxidant power (FRAP), 2, 2′-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman’s assay. The total content of BM protein, calcium, and triglyceride was measured using standard biochemical kits.

Results
BM from mothers from the third tertile of FQS contained significantly higher DPPH, thiol, calcium, and protein levels compared to BM from those in the lowest tertile (p˂0.05). Infant urinary DPPH and FRAP was also significantly higher in the highest tertile vs. the lowest tertile (p˂0.05).

Conclusion
High maternal adherence to the FQS was associated with a high BM quality and antioxidant content of infant urine.
A novel preoperative inflammation score system established for postoperative prognosis predicting of intrahepatic cholangiocarcinoma
Authors: Fu Jun , Chen Qinjunjie , Lai Zisen , Lin Kongying , Fang Guoxu , Ding Zongren , Gao Yuzhen , Zeng Yongyi 
Published: February 2023

Abstract
Background
Inflammation is implicated in tumorigenesis and has been reported as an important prognostic factor in cancers. In this study, we aimed to develop and validate a novel inflammation score (IFS) system based on 12 inflammatory markers and explore its impact on intrahepatic cholangiocarcinoma (ICC) survival after hepatectomy.

Methods
Clinical data of 446 ICC patients undergoing surgical treatment were collected from the Primary Liver Cancer Big Data, and then served as a training cohort to establish the IFS. Furthermore, an internal validation cohort including 175 patients was used as internal validation cohort of the IFS. A survival tree analysis was used to divide ICC patients into three groups (low-, median-, and high- IFS-score groups) according to different IFS values. Kaplan-Meier (KM) curves were used to compare the overall survival (OS) and recurrence-free survival (RFS) rates among three different groups. Cox regression analyses were applied to explore the independent risk factors influencing OS and RFS.

Results
In the training cohort, 149 patients were in the low-IFS-score group, 187 in the median-IFS-score group, and 110 in the high-IFS-score group. KM curves showed that the high-IFS-score group had worse OS and RFS rates than those of the low- and median-IFS-score groups (P < 0.001) in both the training and validation cohorts. Moreover, multivariable Cox analyses identified high IFS as an independent risk factor for OS and RFS in the training cohort. The area under the curve values for OS prediction of IFS were 0.703 and 0.664 in the training and validation cohorts, respectively, which were higher than those of the American Joint Committee on Cancer (AJCC) 7th edition TNM stage, AJCC 8th edition TNM stage, and the Child-Pugh score.

Conclusion
Our results revealed the IFS was an independent risk factor for OS and RFS in patients with ICC after hepatectomy and could serve as an effective prognostic prediction system in daily clinical practice.
Postoperative complications after successful primary rhegmatogenous retinal detachment repair
Authors: Motta Lorenzo , Frisina Rino , Ripa Matteo , Gius Irene , Greggio Angelo , Tozzi Luigi , De Salvo Gabriella , Meduri Alessandro 
Published: February 2023

Abstract
Background
To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).

Methods
Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup.

Results
Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).

Conclusions
The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.
Chinese residents’ knowledge about and behavior towards dairy products: a cross-sectional study
Authors: Wei Jun , Wang Jian 
Published: February 2023

Abstract
Background
Chinese residents generally had insufficient intake of dairy products. The correct mastery of dairy related knowledge helps to develop a good habit of dairy intake. Dairy intake and purchasing behavior were related to multiple factors. As an attempt to lay a scientific basis for guiding the rational intake of dairy by Chinese residents, we launched a survey to discover Chinese residents’ knowledge about dairy product, intake and purchasing behavior of dairy and its influencing factors.

Methods
An online survey was conducted from May to June 2021, and 2500 Chinese residents aged 16–65 were selected using the convenient sampling method. A self-designed questionnaire was adopted. Analysis of the demographic and sociological factors influencing Chinese residents' knowledge about dairy products, behavior towards dairy intake and purchasing were measured.

Results
The average score of knowledge about dairy product of Chinese residents was 4.13 ± 1.50 points. 99.7% of the respondents considered that drinking milk was beneficial, whereas only 12.8% gained a correct insight into the specific benefits of drinking milk. 4.6% of the respondents correctly knew what nutrients they could get from milk. 4.0% of the respondents could correctly identify the type of dairy product. 50.5% of the respondents knew that adult should drink at least 300 ml milk per day. Female, young and high-income residents had better dairy knowledge, while residents with lactose intolerance and whose family members do not have a milk-drinking habit had worse dairy knowledge (P < 0.05). On average, Chinese residents consumed 255.61 ± 88.40 ml dairy product per day. The elderly residents, residents with low education level, residents who lived with family members without milk-drinking habits and residents with poor knowledge of dairy product had worse dairy intake behavior (P < 0.05). When purchasing dairy products, young and middle-aged people (54.20% of those aged ≤ 30, 58.97% of those aged 31–44, and 57.08% of those aged 45–59) were most concerned about whether probiotics were added to dairy products. The elderly (47.25%) were most concerned about whether dairy products were low sugar / sugar free. Chinese residents (52.24%) tended to purchase small-packaged dairy products that could be consumed easily anytime and anywhere.

Conclusion
Chinese residents had a lack of knowledge regarding dairy products, and their dairy intake was insufficient. We should further strengthen the popularization of dairy product related knowledge, guide residents to choose dairy products correctly, and increase the intake of dairy products by Chinese residents.
Parameters associated with radiographic distal surface caries in the mandibular second molar adjacent to an impacted third molar
Authors: Toedtling Verena , Forouzanfar Tim , Brand Henk S. 
Published: February 2023

Abstract
Background
To determine the risk factors for the development of radiographic distal surface caries (rDSC) in patients who attend routine dental check-ups during an era of National Institute for Health Care Excellence third molar surgery guidelines.

Methods
Radiographs taken during routine dental examinations involving 1012 patients from Manchester, UK were accessed. Clinical parameters, oral health, patient demographics, and socioeconomic factors were assessed. Risk factors were identified by multivariate logistic regression analysis.

Results
The detected rate of rDSC was 63.9% and rDSC was distributed homogenously across all five socioeconomic groups (p = 0.425). Risk factors associated with rDSC (p < 0.001) were identified as partially erupted mesio-angularly impacted mandibular third molars, third molars with compromised molar to molar contact points, loss of lamina dura of ≥ 2 mm, male gender, increasing age, and a higher modified Decayed Missing Filled Tooth score.

Conclusion
rDSC was significantly associated with the angulation of third molars, the compromised contact position of the adjacent third molar, the periodontal status of the distal aspect of the second molar and the cumulative history of oral health in a population governed by specific third molar guidelines. An active approach to third molar surgical management could reduce rDSC and serve this population, irrespective of patients’ socioeconomic or deprivation status.
Effect of oral gargle containing Lespedeza cuneata extract on periodontal health improvement and disease prevention: a randomized, controlled clinical trial
Authors: Kim Yu-Rin , Nam Seoul-Hee 
Published: February 2023

Abstract
Background
This study aimed to evaluate the antiplaque and antibacterial effects of a mouthwash containing Lespedeza cuneata (LC) extract through clinical periodontal disease (PD) indicators and changes in PD-causing bacteria.

Methods
A total of 63 subjects participated in this double-blind clinical trial. Subjects were divided into two groups: 32 participants gargled with LC extract, and 31 used saline. Scaling was performed 1 week before the experiment to secure the homogeneity of the subjects’ oral conditions. After gargling with 15 ml of each solution for 1 min, participants spit out the solution to remove any residual mouthwash solution. Then, PD-related bacteria were measured via the O’Leary index, plaque index (PI), and gingival index (GI). The clinical data were collected three times: before gargling, immediately after gargling, and 5 d after gargling.

Results
After 5 d, the O’Leary index, PI, and GI scores were significantly reduced in the LC extract gargle group (p < 0.05). PD-inducing Gram-positive and -negative bacteria were also reduced, confirming the LC extract’s effect on periodontal health improvement and disease prevention.

Conclusion
Mouthwash containing LC extract, a new alternative natural substance that is safe and effective, may be used to treat PD because of its ability to inhibit and prevent PD.
Analysis of the effect of hashimoto's thyroiditis and insulin resistance on ovarian volume in patients with polycystic ovary syndrome
Authors: Gencer Gülcan , Serin Aliye Nigar , Gencer Kerem 
Published: February 2023

Abstract
Objective
In this study, patients were divided into two groups. Patients with polycystic ovary syndrome (PCOS) and patients with polycystic ovary syndrome + Hashimoto's Thyroid (PCOS + HT). The effect of insulin resistance on ovarian volume in patients divided into two groups and the change in ovarian volume with the addition of HT to PCOS will be investigated.

Material and methods
46 PCOS patients and 46 PCOS patients diagnosed with HT were included in this study. A detailed medical history was taken from all participants. Polycystic ovary image was evaluated as below or above 10 ml and antral follicles were counted by transvaginal ultrasound. Insulin resistance of the patients was evaluated according to the fasting insulin (HOMA) index.

Results
Insulin resistance was found to be associated with fasting insulin, HOMA index, body mass index and right ovarian volume in patients diagnosed with PCOS. Among the patients diagnosed with PCOS + HT, insulin resistance was found to be significantly correlated with fasting insulin, HOMA index, (BMI), (SHBG) and left ovarian volume. An increase in right ovarian volume was found in 37.5% of patients with PCOS without insulin resistance and in 76.3% of patients with insulin resistance. An increase in left ovarian volume was found in 35.7% of patients without insulin resistance diagnosed with PCOS + HT and in 68.8% of patients with insulin resistance.

Conclusions
This study shows that ovarian volume should be evaluated in every PCOS patient in order to predict insulin resistance, which causes long-term metabolic diseases, and that all PCOS patients with increased ovarian volume should be investigated for insulin resistance. In addition, it has been observed that insulin resistance affects left ovarian volume in patients with PCOS + HT, whereas insulin resistance affects the volume of the right ovary more in patients with PCOS. At least one ovary has been found to be affected by long-term metabolic diseases. While there was a greater increase in ovarian volume with the addition of insulin resistance, no significant change was observed in the number of patients with increased ovarian volume (PCOS-58, PCOS + HT-57) with the addition of HT finding.
Role of narrative medicine-based education in cultivating empathy in residents
Authors: Zhao Jianhua , Xiantao Ouyang , Li Qiong , Liu Hao , Wang Fan , Li Qing , Xu Zhixiu , Ji Sibei , Yue Shuangzhu 
Published: February 2023

Abstract
Objective
To explore the role of narrative medicine-based education in standardized empathy training for residents.

Methods
Among the 2018–2020 residents at the First Affiliated Hospital of Xinxiang Medical University, 230 receiving neurology training were enrolled in this study and randomly divided into study and control groups. The study group received narrative medicine-based education and standardized routine resident training. The Jefferson Scale of Empathy–Medical Student version (JSE–MS) was used to evaluate empathy in the study group, and the neurological professional knowledge test scores of the two groups were also compared.

Results
In the study group, the empathy score was higher than the preteaching score (P < 0.01). The neurological professional knowledge examination score was higher in the study group than in the control group, albeit not significantly.

Conclusion
The addition of narrative medicine-based education in standardized training improved empathy and may have improved the professional knowledge of neurology residents.
Interprofessional education as a potential foundation for future team-based prevention of alcohol use disorder
Authors: Edwards Scott , Ferguson Tekeda F. , Gasparini Sonia , Mercante Donald E. , Molina Patricia E. , Gunaldo Tina P. 
Published: February 2023

Abstract
Background
Effective screening of alcohol use and prevention of alcohol use disorder (AUD) requires the continuous preparation of educated and confident providers across all health professions who will ideally work in close collaboration in their future practices. As one mechanism for achieving this goal, the development and provision of interprofessional education (IPE) training modules for health care students may cultivate beneficial interactions among future health providers early in their formative education.

Methods
In the present study, we assessed attitudes about alcohol and confidence in screening and AUD prevention in 459 students at our health sciences center. Students represented ten different health professions (audiology, cardiovascular sonography, dental hygiene, dentistry, medicine, nursing, physical therapy, public health, respiratory therapy, and speech language pathology programs). For purposes of this exercise, students were divided into small, professionally diverse teams. Responses to ten survey questions (Likert scale) were collected via a web-based platform. These assessments were collected before and after a case-based exercise that provided information to students on the risks of excessive alcohol use as well as the effective screening and team-based management of individuals susceptible to AUD.

Results
Wilcoxon signed-rank analyses revealed that the exercise led to significant decreases in stigma toward individuals engaging in at-risk alcohol use. We also discovered significant increases in self-reported knowledge and confidence in personal qualifications needed to initiate brief interventions to reduce alcohol use. Focused analyses of students from individual health programs uncovered unique improvements according to question theme and health profession.

Conclusion
Our findings demonstrate the utility and effectiveness of single, focused IPE-based exercises to impact personal attitudes and confidence in young health professions learners. While additional longitudinal cohort follow-up studies are needed, these results may translate into more effective and collaborative AUD treatment in future clinical settings.
Clinical associate students’ perceptions of factors that influence their developing professional identity: a qualitative study
Authors: Mgobozi Aviwe , McNamee Lakshini , Couper Ian 
Published: February 2023

Abstract
Background
New cadres of clinicians, known as clinical associates, physician assistants, or clinical officers have evolved globally within many health systems to broaden access to care by increasing human resources. The training of clinical associates started in 2009 in South Africa, entailing the attainment of knowledge, clinical skills, and attitude competencies. Less formal educational attention has been focused on the process of developing personal and professional identities.

Method
This study utilized a qualitative interpretivist approach to explore professional identity development. A convenient sample of 42 clinical associate students at the University of Witwatersrand in Johannesburg were interviewed using focus groups to explore their perceptions of factors that influenced their professional identity formation. A semi-structured interview guide was used in six focus group discussions, involving 22 first-year and 20 third-year students. The transcriptions from the focus group audio recordings were thematically analyzed.

Results
The multi-dimensional and complex factors that were identified were organized into three overarching themes, identified as individual factors which derive from personal needs and aspirations, training-related factors consisting of influences from the academic platforms, and lastly, student perceptions of the collective identity of the clinical associate profession influenced their developing professional identity.

Conclusion
The newness of the identity of the profession in South Africa has contributed to dissonance in student identities. The study recognizes an opportunity for strengthening the identity of the clinical associate profession in South Africa through improving educational platforms to limit barriers to identity development and effectively enhancing the role and integration of the profession in the healthcare system. This can be achieved by increasing stakeholder advocacy, communities of practice, inter-professional education, and the visibility of role models.
Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital
Authors: Cardoso Ricardo Bertoglio , Marcolino Miriam Allein Zago , Marcolino Milena Soriano , Fortis Camila Felix , Moreira Leila Beltrami , Coutinho Ana Paula , Clausell Nadine Oliveira , Nabi Junaid , Kaplan Robert S. , Etges Ana Paula Beck da Silva , Polanczyk Carisi Anne 
Published: February 2023

Abstract
Background
The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients’ care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification.

Methods
This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated.

Results
A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p <  0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient.

Conclusions
This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.