bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Disease and Risk of Thyroid Disease: Evidence from the National Nurse Health Cohort in China
Authors: Wang Peng , Zhang Heli , Wang Jing , Che Ying , Zhuo Lin , Yu Miao , Hu Xianjing , Li Peitao , Geng Rongmei , Zhan Siyan , Li Baohua 
Published: June 2023

Background Previous studies have shown that metabolic diseases are risk factors for thyroid disease; most studies are cross-sectional design. We aimed to evaluate the causal relationship between thyroid and metabolic diseases in a cohort of Chinese nurses. Methods We conducted an ambispective cohort study of the National Nurses’ Health Study. Thyroid disease data based on ultrasonography from 2017 to 2021 were collected. We described thyroid disease incidence and the risk factors associated with a cluster of metabolic factors. We used the Mann‒Whitney U test, repeated-measures ANOVA and multivariable Cox proportional hazard regression to analyze the data. Results A total of 1529 female nurses without thyroid disease were enrolled in 2017, of which, complete data were available for 1269 nurses. In 2018–2020, thyroid nodule incidence ranged from 32.8%-46.3%, thyroiditis incidence was 13.4%–14.3%, and goiter incidence was 4.1%–29.1%, thyroid adenoma and thyroid tumors incidence were 0.1%–0.5% and 1%–1.5%. We also found that NAFLAD was an independent risk factor for thyroid adenoma ( p = .003). The age at diagnosis was an independent risk factor for goiter ( p <. 001) and thyroid nodules ( p < .001). Fasting blood glucose was an independent risk factor for thyroid tumors ( p = .004). The age at diagnosis ( p = .003), Body Mass Index ( p = .006) and menopause ( p = .031) were risk factors for thyroiditis. Conclusion Thyroid disease incidence among nurses is increasing. Age at diagnosis, BMI, fasting blood glucose, and nonalcoholic fatty liver disease are independent risk factors for different types of thyroid disease. This study provides evidence for future studies to further explore the pathogenesis and prevention of thyroid diseases.
Estimating the number of people living with dementia at different stages of the condition in India: A Delphi process
Authors: Farina Nicolas , Rajagopalan Jayeeta , Alladi Suvarna , Ibnidris Aliaa , Ferri Cleusa P , Knapp Martin , Comas-Herrera Adelina 
Published: June 2023

Introduction Numerous studies have previously estimated the dementia prevalence in India. However, as these estimates use different methodologies and sampling strategies, generating definitive prevalence estimates can be difficult. Methods A Delphi process involving eight clinical and academic experts provided prevalence estimates of dementia within India, split by sex and age. The experts were also asked to estimate the number of people potentially living at different stages of the condition. A priori criteria were used to ascertain the point in which consensus was achieved. Results Our consensus estimates generated a dementia prevalence of 2.8% (95% CI = 1.9 to 3.6) for those aged 60 years and above in India. Consensus was achieved across age and sex prevalence estimates, with the exception of one (females aged 60–64). Our experts estimated that 42.9% of people living with dementia in India had a mild severity. Conclusions The findings indicate that there could be approximately 3.9 million people living with dementia in India, of which 1.7 million could be living with dementia of mild severity. Such estimates can better help researchers and policy makers to estimate the true cost and impact of dementia in India and can inform resource allocation decisions.
Association of digital health literacy and information-seeking behaviors among physicians during COVID-19 in Ethiopia: A cross-sectional study
Authors: Assaye Bayou Tilahun , Kassa Mitiku , Belachew Muluken , Birhanu Sefefe , Worku Aynadis 
Published: June 2023

Background Universal access to health information is a requirement for all global health strategies in the era of pandemics. Getting health information from the internet is a great concern for the quality of patient healthcare. This study aimed to determine the association between digital health literacy and information-seeking behavior among physicians during COVID-19. Methods An institutional-based cross-sectional study was conducted from December to February 2021 with a total sample size of 423. A pretest was performed among physicians before the actual data collection. After the data collection, the data were checked, cleaned, and exported into STATA v. 14. Descriptive statistics, binary logistic regression, and multivariable logistic regression analysis were applied. Then a 95% CI and a p-value of less than 0.05 were used to declare statistical significance. Results The study revealed that 53.81% of physicians had high digital health literacy and 52.46% had high information-seeking behaviors. Health information-seeking behaviors were determined by digital health literacy, which was 2.25 times more likely than those who had low digital health literacy (AOR = 2.25, 95% CI: [1.11–4.57]). Health-related websites (67.5%) were the most common sources of health information, and 63.30% of physicians find digital health literacy easy or very easy to learn. However, 206 (50.92%) find it difficult or very difficult to decide if the information is reliable, verified, and up-to-date. Internet access (AOR = 1.90, 95% CI: [1.16–3.12]), frequency of searching for information (AOR = 5.35, 95% CI: [2.01–14.29]). All were discovered to be significantly associated with physicians’ health information-seeking behaviors. Conclusions Digital health literacy is a key to seeking health information online for appropriate decision-making. Increasing internet access, and providing ICT training, and integrate it into the health information revolution agendas, helping to disseminate health information and provide timely, reliable, and relevant news and genuine information needed for their work.
Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
Authors: Tanaka Miho J. , LaPorte Zachary L. , Perry Nicholas P.J. , Velasquez Hammerle Maria V. , Nukala Varun , Liu Fang 
Published: June 2023

Background: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear length to support this has not been described. Purpose: To describe measurements to quantify trochlear length on sagittal magnetic resonance imaging in patients with and without patellar instability and to correlate trochlear length with measurements of trochlear dysplasia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 66 age- and sex-matched knees (36 female and 30 male; mean age, 20.8 ± 4.8 years) were included in this study, of which 33 had patellar instability. Trochlear extension length (TEL) and trochlear alpha angle (TAA) were measured on 3 sagittal magnetic resonance imaging scans (center of the knee, center of the medial condyle, and center of the lateral condyle), and measurements were compared between symptomatic and control knees. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to describe the accuracy of each measurement to distinguish between knees with and without patellar instability. Linear and multivariate regression analyses were performed to assess the relationship between sagittal measurements and axial measurements of trochlear dysplasia, including lateral trochlear inclination, sulcus angle, and trochlear depth, as well as patient size reflected by the epicondylar distance. Results: In symptomatic knees, the central trochlea extended more proximally than in control knees, as determined by the TEL (14.0 ± 3.0 vs 11.5 ± 2.3 mm, respectively; P < .001) and TAA (68.4° ± 3.8° vs 70.5° ± 3.4°, respectively; P = .017). AUC calculations showed that a TEL ≥11 mm at the central trochlea was predictive of patellar instability in both male and female knees (AUC = 0.83 and 0.77, respectively), as was a TAA ≤67° in female knees (AUC = 0.72). An independent association between the central TEL and sulcus angle was found. The central TEL showed a weak correlation with patient size, as measured by the epicondylar distance, while the TAA did not. Conclusion: In knees with symptomatic patellar instability, the central trochlea was found to extend 2.5 mm more proximally than in control knees, and this increase in length correlated with severity of trochlear dysplasia. As radiographic examinations of the trochlea and grooveplasty procedures are often based on the proximal extent of the cartilaginous trochlea, further studies are needed to identify the role of trochlear length in the assessment and treatment of trochlear dysplasia in the setting of patellar instability.
Long-term Quality of Life in Patients After ACL Reconstruction With Concomitant Meniscal Injury Treatment: Patient-Reported Outcomes at Minimum 10-Year Follow-up
Authors: Chalatsis Georgios , Mitrousias Vasileios , Siouras Athanasios , Panteliadou Freideriki , Tziolas Ioannis , Solomou Chrysovalantis , Hantes Michael 
Published: June 2023

Background: Long-term studies of patients after anterior cruciate ligament (ACL) reconstruction with or without concomitant meniscal tear treatment are limited. Purposes: To (1) report postoperative outcomes after anatomic ACL reconstruction with a hamstring autograft, (2) investigate how concomitant treatment of meniscal injury could affect these outcomes, and (3) evaluate the association between quality of life and activity levels at a minimum 10-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients treated with a unilateral, anatomic ACL reconstruction between 2005 and 2011 were investigated. The following patient-reported outcome measures (PROMs) were reported for the overall sample as well as a subsample of patients with meniscal injury: International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, Tegner activity scale, 5-level EQ-5D (EQ-5D-5L), and patient satisfaction. Sex, age, body mass index (BMI), and meniscal injury treatment (meniscectomy vs meniscal repair) were examined as patient-specific risk factors regarding long-term activity and quality of life. Results: Overall, 106 patients, 90 men (85%) and 16 women (15%), were enrolled in the study, with a mean follow-up of 13.2 years. The ACL retear rate was 2.8%. The mean scores were 80.6 ± 16.7 (IKDC-SKF), 87.4 ± 15.0 (KOOS), 90.5 ± 11.5 (Lysholm), 5.6 ± 1.9 (Tegner), and 91.8 ± 14.5 (EQ-5D-5L). The majority (90.6%) of patients considered their knee state satisfactory during follow-up. When compared with patients who underwent meniscal repair, patients who underwent meniscectomy had statistically significantly lower scores on all PROMs except for the Tegner and EQ-5D-5L ( P < .05 for all). The mean difference between the 2 groups was ≥7 points on all PROM scores. Patient sex, age, and BMI did not affect PROM scores. There was a statistically significant, strong positive correlation between quality of life and activity. Conclusion: Patients had few or no symptoms and considered their knee state satisfactory 13.2 years after anatomic ACL reconstruction. Patients with concomitant meniscal tears having undergone meniscal repair had improved PROMs compared with those treated with meniscectomy. Finally, participation in activities of daily living and sports was interrelated with quality of life and was not affected by patient age, sex, or BMI.
Struck by stroke - experiences of living with stroke in a rural area in Uganda
Authors: Timm Linda , Kamwesiga Julius , Kigozi Sulaiman , Ytterberg Charlotte , Eriksson Gunilla , Guidetti Susanne 
Published: June 2023

AbstractBackgroundThe global burden of stroke is increasing and persons with low socioeconomic status are among those worst affected. In Uganda, stroke is estimated to be the sixth highest ranking cause of death. The Ugandan healthcare system is reported to be inequitable, where poorer populations often live in rural areas with long distances to health care. Stroke rehabilitation is often scarce, with less financial and human resources. The aim of this study was to explore and describe the consequences of stroke in daily activities in everyday life for people in a rural part of Masaka in Uganda.MethodsQualitative study design. Fourteen persons who had had stroke and were living in their home environment were interviewed about their experiences of having a stroke and managing their lives after the stroke incident. The interviews were analysed using thematic analysis. In addition, sociodemographic data and level of independence (Barthel Index and Stroke Impact Scale 3.0) was collected to describe participant characteristics.ResultsMost of the participants had major consequences of stroke and described that they were dependent on support for managing their daily activities. Five themes were identified in the analysis: (1) Accepting and adapting to new ways of managing everyday life, (2) Changing roles and hierarchical positions, (3) Depending on caregiver support, (4) Interrupted care due to economic constraints, (5) Stroke leading to losses and losses leading to stroke.ConclusionsThe consequences of stroke on the persons’ daily lives clearly reached beyond the person with stroke, affecting the whole family and their proximate social networks. These consequences included increased burdens on caregivers and a worsened economic situation for all persons affected. Therefore, interventions for stroke management should preferably not only target the individual affected by stroke, but also support the caregivers in the caring and rehabilitation process. Home rehabilitation approaches with a focus on improving health literacy are suggested.
Slack in the infrastructure of intensive care units: resilience management in the post-pandemic era
Authors: Marczyk Carlos Emilio Stigler , Saurin Tarcisio Abreu , Bulhões Iamara Rossi , Patriarca Riccardo , Bilotta Federico 
Published: June 2023

Abstract
Background
Although slack is an asset to resilient hospitals, it is usually explicitly discussed only in terms of the quantity and quality of beds and staff. This paper expands this view by addressing slack in four infrastructures of intensive care units (ICUs) (physical space, electricity supply, oxygen supply, and air treatment) during the COVID pandemic.

Methods
The study occurred in a leading private hospital in Brazil, aiming at the identification of slack in four units originally designed as ICUs and two units adapted as ICUs. Data collection was based on 12 interviews with healthcare professionals, documents, and comparison between infrastructures and regulatory requirements.

Results
Twenty-seven instantiations of slack were identified, with several indications that the adapted ICUs did not provide infrastructure conditions as good as the designed ones. Findings gave rise to five propositions addressing: relationships intra and inter infrastructures; the need for adapted ICUs that match as closely as possible the designed ICUs; the consideration of both clinical and engineering perspectives in design; and the need for the revision of some requirements of the Brazilian regulations.

Conclusions
Results are relevant to both the designers of the infrastructures and to the designers of clinical activities as these must take place in fit-for-purpose workspaces. Top management might also benefit as they are the ultimate responsible for decision-making on whether or not to invest in slack. The pandemic dramatically demonstrated the value of investing in slack resources, creating momentum for this discussion in health services.
Clinical significance of immunohistochemical expression of DDR1 and β-catenin in colorectal carcinoma
Authors: Dawoud Marwa Mohammed , Salah Marwa , Mohamed Asmaa Shams El Dein 
Published: June 2023

Abstract
Background
Despite recent advances in therapy modalities of colorectal cancer (CRC), it is still the third cause of cancer-related deaths worldwide. Thus, the search for new target therapies became mandatory. DDR1 is a collagen receptor that has a suggested role in cellular proliferation, tumor invasion, and metastasis.

Material and methods
Forty-eight cases of CRC, 20 of CR adenoma, and 8 cases of non-tumoral colonic tissue were subjected to immunohistochemistry by DDR1 and β-catenin antibodies. Results were compared among the different studied groups and correlated with clinicopathologic data and available survival data. Also, the expression of both proteins was compared versus each other. Results were compared among the 3 studied groups and correlated with clinicopathologic and survival data.

Results
It revealed a stepwise increase of DDR1 expression among studied groups toward carcinoma (P = 0.006). DDR1 expression showed a direct association with stage D in the modified Dukes’ staging system (P = 0.013), higher-grade histologic types (P = 0.008), and lymph node invasion (P = 0.028) but inverse correlation with the presence of intratumoral inflammatory response (TIR) (P = 0.001). The shortest OS was associated with strong intensity of DDR1 (P = 0.012). The DDR1 and β-catenin expressions were significantly correlated (P = 0.028), and the combined expression of both was correlated with TNM staging (P = 0.017).

Conclusion
DDR1 overexpression is a frequent feature in CRC and CR adenoma. DDR1 is a poor prognostic factor and a suppressor of the TIR. DDR1 and β-catenin seem to have a synergistic action.
Individualized 3D-printed navigation template-assisted tension band wiring for olecranon fractures
Authors: Xiong Xu , Chen Ya-Ling , Zhao Lan , Li Hao , Xu Min , Shuang Feng 
Published: June 2023

Abstract
Purpose
3D printing techniques guide precision medicine and show great development potential in clinical applications. The purpose of this study was to compare the clinical outcomes of 3D-printed navigation templates versus free-hand in tension band wiring (TBW) procedures for olecranon fractures.

Methods
Patients who underwent TBW due to Mayo type II olecranon fractures between January 2019 and December 2021 in our hospital were prospectively enrolled in the study. The patients were divided into the 3D printed navigation template guiding TBW group (3D printed group) and the free-hand TBW group (free-hand group). The primary endpoint of this study was the success rate of the bicortical placement of Kirschner wires (K-wires). Times of intraoperative fluoroscopy, operation times, complications, VAS scores, and Mayo Elbow Performance Scores (MEPS) were analyzed as the secondary outcomes measure.

Results
The success rate of the bicortical placement of K-wires was 85.7% in the 3D Printed group was significantly higher than the free-hand group (60%). There were fewer times of intraoperative fluoroscopy in the 3D Printed group (1.43 ± 0.51) than that in the free-hand group (2.60 ± 1.00) with statistical significance (P < 0.05). At the date of the last follow-up, four patients suffer from pain and skin injury at the K-wires insertion site in the 3D Printed group and 14 patients in the free-hand group, a significant difference between the two groups (P < 0.05). No statistically significant differences were found in operation time, VAS scores, and MEPS between the two groups.

Conclusions
The individualized 3D-printed navigation template-assisted TBW demonstrated good accuracy and resulted in reduced times of intraoperative fluoroscopy and complication compared to the free-hand TBW for olecranon fractures.
Effectiveness of a theory-based educational intervention on work-related musculoskeletal disorders preventive behaviors among assembly-line female workers: a study protocol for a randomized controlled trial
Authors: Hosseini Zakieh Sadat , Tavafian Sedigheh Sadat , Ahmadi Omran , Maghbouli Reza 
Published: June 2023

Abstract
Background
The use of preventive behaviors of musculoskeletal disorders (MSDs) requires proper training, which leads to correct decisions regarding maintaining postures at work and performing stretching exercises. Due to very repetitive work, applying manual force, improper postures, and static contractions of proximal muscles, assembly-line female workers suffer from musculoskeletal pains. It is assumed that structured and theory-based educational intervention using a learning-by-doing (LBD) approach may increase the preventive behaviors against MSDs and reduce the consequences of these disorders.

Methods
This randomized controlled trial (RCT) will be conducted in three phases: phase 1: validation of the compiled questionnaire, phase 2: determining the social cognitive theory (SCT) constructs that predict the preventive behaviors of MSDs in assembly-line female workers, and phase 3: designing and implementing the educational theory. The educational intervention is based on the LBD approach, and the study population includes assembly-line female workers in electronic industries of Iran, who are randomly divided into two intervention and control groups. The intervention group received the educational intervention in the workplace and the control group does not receive any intervention. The theory-based educational intervention includes evidence-based information along with pictures, fact sheets, and published literature about a good posture at work and the need to perform proper stretching exercises. The educational intervention aims to improve the knowledge, skills, self-efficacy, and intention of assembly-line female workers to adopt preventive behaviors of MSDs.

Discussion
The present study will evaluate the effects of maintaining a good posture at work and performing stretching exercises on the adherence to preventive behaviors of MSDs among assembly-line female workers. The developed intervention is easily implemented and evaluated in a short period of time based on the improved score of the rapid upper limb assessment (RULA) method and the mean score of adherence to stretching exercises and can be provided by a health, safety, and environment (HSE) expert.

Trial registration
ClinicalTrials.gov IRCT20220825055792N1. Registered on 23 September 2022 with the IRCTID.