bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnitude of opportunistic infections and associated factors among HIV-infected individuals attending care and treatment clinics in Dar es Salaam, Tanzania: a hospital-based cross-sectional study
Authors: Njelekela Doris Andrew , Kishimba Rogath , Noah Mololo , Kamori Doreen , Majigo Mtebe , Joachim Agricola 
Published: January 2025

ObjectivesThis study aims to assess the magnitude of opportunistic infection (OI) and to identify factors associated with OIs among people living with HIV (PLHIV) on antiretroviral treatment (ART), attending HIV care and treatment clinics.DesignA hospital-based cross-sectional study.SettingThe study was conducted at Muhimbili National Hospital, Mwananyamala and Temeke Regional Referral Hospitals, in Dar es Salaam, Tanzania.ParticipantsWe enrolled 382 PLHIV on ART who were attending HIV care and treatment clinics in Dar es Salaam. Structured questionnaires were used to collect socio-demographic information, and a checklist was used to extract clinical characteristics from the client’s HIV care and treatment clinic cards. Information was subjected to descriptive and regression analysis using Stata V.13. All factors were considered significant at p<0.05.Primary outcomeMagnitude, spectrum of OI and associated factors among PLHIV using ART.ResultsA total of 382 PLHIV on ART were randomly selected and recruited in the study. The overall prevalence of OIs was 25.13%; the leading OI was tuberculosis affecting 58 patients (15.2%). CD4+ T cell counts≤200 cells/µL (aOR=13.61; 95% CI: 6.09 to 30.38) p<0.001, isoniazid preventive treatment (IPT) (aOR=4.10; 95% CI: 1.97 to 8.53) p<0.001, WHO clinical stage 4 (aOR=6.37; 95% CI: 1.47 to 27.61) p=0.013, divorced individuals (aOR=3.57; 95% CI: 1.43 to 8.90) p=0.006, male (aOR=3.04; 95% CI: 1.50 to 6.17) p=0.007, haemoglobin level<11.0 g/dL (aOR=2.25; 95% CI: 1.14 to 4.47) p=0.020 and level of education of primary and below (aOR=4.31; 95% CI: 1.8 to 10.32) p=0.001 showed significant association with OIs.ConclusionThere was still a high prevalence of OI observed in this study which needs to be addressed. CD4+ T cell counts of ≤200 cells/µL, advanced WHO clinical stages, no use of IPT prophylaxis, anaemia and low education level were predictors of OIs. Promptly implementing the test-and-treat protocol while an individual’s immunity is still strong and timely screening for OI are critical.
Association of quality of life in older patients with breast cancer: a cross-sectional study from China
Authors: Xiao Min , Ji Lei , Qian Xiaoyan , Chen Xi , Xiu Meng , Li Zhuoran , Cao Heng , Chen Shanshan , Li Qing , Li Qiao , Wang Xiang , Wang Jiani , Li Yiqun , Zheng Xiaojuan , Zhang Jintao , Zhang Pin 
Published: January 2025

ObjectivesThe purpose of this study was to investigate the quality of life (QoL) of older Chinese patients with breast cancer and to explore further the associations of functions, symptoms, financial burdens and comorbidities with global health/quality of life (gQoL).DesignThis was a cross-sectional study carried out following the Strengthening the Reporting of Observational Studies in Epidemiology checklist.SettingThis study was conducted in two hospitals in Beijing from October 2021 to November 2022.ParticipantsPatients with breast cancer aged over 65 years were included in the final analysis, which comprised a total of 481 patients.Primary and secondary outcome measuresThe European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Charlson Comorbidity Index (CCI) were used to assess patients’ QoL and comorbidities. The data were analysed using network analysis and path analysis.ResultsOut of the 136 possible edges in the final networks, 84 (61.8%) were non-zero. ‘Fatigue’ was the central symptom and indirectly decreased the gQoL, which was mediated by increasing ‘financial difficulties’, ‘CCI’ and ‘role function’ (β = −0.35, p<0.001). ‘Physical function’ was also an important and direct intervention node that was indirectly related to gQoL, and this was mediated by ‘role function’ (β = −0.15, p=0.006). Path analysis accounted for 32.0% of the total effect.ConclusionsThe various dimensions of QoL are highly interrelated and mutually reinforcing. These results highlight the importance of improving the fatigue and physical function of older patients with breast cancer. Interventions targeting these symptoms may lead to an overall improvement in gQoL.Trial registration numberChiCTR2200056070; Public title: Frailty and Comorbidity in the Elderly Study (FACE Study).
Factors protecting against progression of myopia in school students exposed to societal change in Vietnam: a 3-year cohort study
Authors: Tran Xuan Minh Tri , Nguyen Hoang Thuy Linh , Tran Thao Vi , Seino Kaoruko , Ohno-Matsui Kyoko , Igarashi-Yokoi Tae , Vo Thang Van , Nakamura Keiko 
Published: January 2025

ObjectivesTo elucidate the incidence of myopia, progression of refractive error, axial length (AL) elongation and factors associated with myopia in secondary school students in Vietnam.DesignProspective cohort study.SettingsHue Healthy Adolescent Cohort Study, Hue City, Vietnam.Participants3-year longitudinal data were available for 355 secondary school students (mean age 11.60±0.36, 46.8% girls). Noncycloplegic refraction and AL measurements were performed at baseline and the 3-year follow-up examinations.Primary and secondary outcome measuresThe primary outcomes were myopia incidence and progression. Myopia, emmetropia and hyperopia were defined as spherical equivalent (SE)≤−1.0 diopters (D), −0.5 D<SE < +0.5 D and SE ≥ +0.5 D in the right eye, respectively. The cumulative incidence of myopia was defined as the proportion of students who were not myopic at baseline but who subsequently developed myopia during the follow-up period. Factors associated with myopia incidence and progression were analysed using logistic and linear regression models, respectively.ResultsBaseline mean SE and AL were −0.94±1.66 D and 23.36±0.93 mm, respectively. The cumulative and annual incidences of myopia were 40.6% and 12.5%, respectively. Spending more time outdoors was associated with a significantly decreased incidence of myopia (adjusted OR 0.499; 95% CI: 0.329–0.757), less myopic SE progression (β=0.337; 95% CI: 0.254, 0.640) and slower AL elongation (β=−0.289; 95% CI: −0.202 to –0.071). In contrast, a study using computers was significantly associated with greater myopic progression in SE (β=−0.184; 95% CI: −0.699 to –0.112) and AL elongation (β=0.208; 95% CI: 0.062, 0.263).ConclusionThis longitudinal assessment revealed both myopia incidence and progression and identified myopia-risk and myopia-protective behavioural factors in a Vietnamese cohort of secondary school students. The results highlight the high prevalence and considerable incidence of myopia, and the need for further effective strategies to reduce the risk of myopia by managing computer time and increasing outdoor time.
What should be publicly funded in the Colombian health system? A mixed methods study of citizens’ perceptions
Authors: Vélez Claudia Marcela , Díaz-Hernández Diana Patricia , Velázquez-Salazar Pamela , Hernández-Herrera Gilma , Patiño-Lugo Daniel Felipe , Salazar-Blanco Olga Francisca , Rodríguez-Corredor Leydi Camila , Vélez-Marín Viviana María , Velásquez Juan Carlos , Jaramillo-García Anny Julieth 
Published: January 2025

BackgroundIn recent years, citizens have become more interested and willing to influence health policy decision-making, and governments worldwide are more prone to citizen engagement in such processes. Prioritising which health technologies should be publicly funded is one decision that requires prudence and consideration of the values and expectations of the people who will be affected by it.ObjectiveTo identify and understand the citizens’ perceptions about which health technologies should be publicly funded in Colombia.DesignSequential exploratory mixed methods study; the first was a qualitative embedded case study, and the second was a Q methodology study.Participants46 citizens were interviewed, and 30 citizens ordered a Q-sample of 45 statements.AnalysisInterviews were content analysed. We performed a content analysis of the interviews, and, for the quantitative strand, we performed a principal component analysis and varimax rotation to identify view patterns. We also estimated the z-scores of each statement and the load to each factor. We jointly interpreted both sets of findings.ResultsWe identified two general approaches citizens used to consider public funding of healthcare technologies. One approach endorsed full coverage of all health technologies required by every Colombian. In the second approach, public funding is conditional on the characteristics of the person who needs the technology, their disease/condition, the kind of technology required and the expectation of efficient health system performance. When integrating the results of the Q methodology, we found five patterns of points of view about the public funding of health technologies.ConclusionColombian citizens consider and balance a range of different factors when making decisions about which health technologies are publicly funded. Citizens not only use technical criteria to decide but also provide the perspective and values of those affected by the decision.
Seeking abortion medications online: experiences from a mystery client study in Colombia
Authors: Arango Daniel Arango , Cartwright Alice F , Braccia Ava , Moore Ann , Vivas Maria M 
Published: January 2025

ObjectivesWhile Colombians gained broad legal access to abortion in 2022, people still lack knowledge about its availability and face variable quality of care at health facilities. This study sought to understand whether online sellers provide the instructions and medication dosages necessary for effective medication abortions.DesignThe study design involved mystery clients contacting sellers identified across websites and social media platforms (Facebook, Instagram, and TikTok) to purchase abortion pills. Unique sellers were contacted with two profiles (first and second trimester pregnancy gestational ages). Mystery clients documented information received on physical effects, complications and how to take the pills from the sellers in a predesigned survey in SurveyCTO.SettingThe study was conducted in Colombia from July to September 2023. We documented and described sellers’ conversations with mystery clients and pills received. We identified 161 sellers across platforms, which resulted in 65 unique sellers after deduplication. We attempted to contact each unique seller twice.ResultsAlmost all sellers screened for gestational age using last menstrual period. Bleeding (84.6%) and cramping (66.7%) were the physical effects most commonly mentioned to mystery clients, although pain was mentioned to second trimester clients more often than first (40.5% vs 22.0%). Less than 17% of sellers highlighted possible complications that could require medical attention. Almost 90% of purchases were received (88.9%). All contained manufacturer-branded misoprostol and 77.5% were undamaged aluminium blister packages. While 82.6% of first trimester clients were instructed to take an initial misoprostol dosage in line with Colombia’s Ministry of Health guidelines, all second trimester clients were told to take a dosage exceeding the recommended amount. Although most sellers provided appropriate information on administration routes for the pills, sellers also provided contradictory and unnecessary instructions.ConclusionOnline sellers of abortion pills may persist even as legal abortion becomes more widely available in Colombia. While misoprostol was received from many of these sellers, they did not provide sufficient information about potential complications or accurate dosing instructions to second trimester clients. Accurate medication abortion information specific to Colombia should be made more accessible so that people can more easily navigate the new care landscape.
Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study
Authors: Liang Tao , Jiang Jiayi , Li Xinyi , Ma Haohan , Zhang Xiaonan , Deng Gang , Deng Weiping , Guan Lichang , Zhang Kaijun , Jiang Lei , Tan Ning , Cai Xujie , Xu Lishu 
Published: January 2025

ObjectivesThe aim of this study is to derive and validate a reliable indicator for predicting an increased risk of postoperative mortality in elderly patients undergoing curative resection for colorectal cancer (CRC).DesignThis study is of multicentre retrospective design.Setting and participantsA total of 1227 CRC patients undergoing curative resection (age ≥65 years) from three distinct cohorts were retrospective enrolled. Participant cohorts consisted of the derivation (n=845), external validation (n=95) and localised validation (n=287) groups. The carcinoembryonic antigen (CEA) to lymphocyte ratio (CLR) was derived from the derivation cohort and subsequently validated in two additional cohorts. The observed end point was all-cause death during the follow-up period postoperation.ResultsIn the derivation cohort, CLR demonstrated an independent association with all-cause mortality. In the two validation cohorts, CLR also presented a strong discriminatory ability in predicting postoperative all-cause death, with the area under the curve (AUC) of 0.68 in the external cohort and 0.78 in the localised cohort. Survival analyses revealed that CRC patients with CLR ≤2.53 tended to have better overall survival than those with CLR >2.53 (p<0.05 for all cohorts). Multivariate Cox proportional hazard models indicated that CLR ≤2.53 was significantly associated with reduced mortality risk in the derivation (HR: 0.405, p<0.001), external validation (HR: 0.519, p=0.039) and localised validation cohorts (HR: 0.167, p<0.001).ConclusionsPreoperative CLR serves as a reliable predictor of all-cause death following curative resection in elderly patients with CRC. Individuals with CLR exceeding 2.53 are inclined to a lower overall survival probability.
Chronic kidney disease progression in patients with previous type 2 diabetes and/or hypertension: a population-based cohort study from primary care in Spain
Authors: Cunillera-Puértolas Oriol , Vizcaya David , Cobo-Guerrero Sílvia , Romano-Sánchez José , Bundó-Luque Daniel , Arbiol-Roca Ariadna , Salvador-González Betlem 
Published: January 2025

ObjectivesTo evaluate whether between hypertension and type 2 diabetes (T2D)—established drivers of chronic kidney disease (CKD) progression—one might be more strongly associated with CKD progression than the other.DesignCohort study using a primary care database (electronic health records).SettingPrimary care in Catalonia, Spain.Participants438 273 patients with CKD identified from the Information System for Research in Primary Care database in Catalonia (2007–2017) and stratified into four mutually exclusive groups based on the presence/absence of hypertension and/or T2D. Distribution of the CKD study cohort was as follows: CKD with hypertension (51.1%), CKD with T2D (3.9%), CKD with hypertension and T2D (32.8%), CKD without hypertension and T2D (12.2%).Primary and secondary outcome measuresPatients were followed up to identify the occurrence of severe kidney impairment (SKI) and kidney failure (kidney replacement therapy/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2). Subdistributional hazard ratios (sHRs) were estimated using Cox regression adjusted for confounders.ResultsCompared with the CKD without hypertension and T2D group, adjusted sHRs (95% CIs) for SKI/kidney failure were 1.77 (1.65 to 1.89) for CKD with hypertension and T2D, 1.50 (1.41 to 1.59) for CKD with hypertension and 1.21 (1.09 to 1.34) for CKD with T2D, and for kidney failure were 1.24 (1.10 to 1.39) for CKD with hypertension, 0.74 (0.61 to 0.90) for CKD with T2D and 1.09 (0.96 to 1.24) for CKD with hypertension and T2D. The strongest risk factors for CKD progression were low eGFR and albuminuria, even at mild-moderate levels.ConclusionsHypertension could be associated with an equal/greater risk of CKD progression as T2D. Efforts to slow CKD progression should target both patients with hypertension and T2D, focusing on the identification, close monitoring and effective management of albuminuria and reduced eGFR.
Protocol for a multicentre, prospective, open-label, randomised controlled trial to compare PROs and safety outcomes between preoperative and postmastectomy radiotherapy in locally advanced breast cancer patients with immediate reconstruction via a deep inferior epigastric perforator flap (CAPPELLA) in China
Authors: Hao Shuang , Hou Jianjing , Zhang Li , Zhou Changming , Hou Yifeng , Yu Keda , Hu Zhen , Liu Guangyu , Di Genhong , Shao Zhi Min , Yu Xiaoli , Wu Jiong 
Published: January 2025

IntroductionDespite its therapeutic advantages, postmastectomy radiotherapy (PMRT) increases the risk of complications and often leads to poor cosmesis in women undergoing breast reconstruction. Preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction is technically feasible, with low rates of surgical complications and good short-term oncological outcomes. Further evaluation in a randomised trial comparing preoperative radiotherapy versus conventional PMRT in breast reconstruction is required to assess both oncological and patient-reported outcomes (PROs).Methods and analysisThe CAPPELLA trial is a prospective, multicentre, open-label, randomised controlled trial across nine centres comparing PROs and safety outcomes between preoperative and postoperative radiotherapy in patients with locally advanced breast cancer requiring immediate DIEP flap reconstruction. Female patients aged >18 years with breast cancer who are treated with neoadjuvant systemic treatment, require both mastectomy and radiotherapy and are suitable for DIEP flap reconstruction will be included. Patients will be randomly assigned (1:1) to a preoperative radiotherapy group or a postoperative radiotherapy group. Stratification will be performed by cancer centre at initial diagnosis. The radiation volumes will include the ipsilateral breast/chest wall, supraclavicular lymph nodes, undissected axilla and internal mammary nodes. The dose regimen will be 42.56 Gy in 16 fractions. The primary endpoint will be satisfaction with the breast domain of the BREAST-Q at 2 years postoperatively. The secondary endpoints will include PROs at 3, 12 and 24 months postoperatively in both groups, aesthetic assessment, complication rates, rates of total pathological complete response (tpCR) and tumour safety. All patients will be followed up for 36 months postoperatively. The app software will be used to collect all data prospectively. Data will be analysed using SPSS and Stata software. The target sample size will be 80 participants.Ethics and disseminationThis study will be performed according to the Helsinki Declaration. All patients will be asked to provide informed consent before enrolment. Approval for this study was provided by the independent ethics committee and institutional review board of Fudan University Shanghai Cancer Centre. We will present the study results at national and international meetings and publish them in a scientific peer-reviewed journal.Trial registration numberNCT05512286.
Medical complexity in emergency and urgent care settings: a scoping review protocol
Authors: Bele Sumedh , Chisolm Cassandra , Lategan Conne , Yakubets Kate , Lorenzetti Diane , Uwamahoro Marie-Claire , Popeski Naomi , Turin Tanvir C , Lang Eddy , Rabi Doreen 
Published: January 2025

IntroductionConsidering the impact of non-medical factors (personal and social) on patients with multiple chronic conditions, the term ‘medical complexity’ is gaining traction as it encompasses both medical and non-medical aspects of patients’ medical needs. When primary care is not able to provide timely care for chronic challenges or acute concerns, complex patients require care in emergency or urgent care settings. The concept of medical complexity is continually evolving, although without a universally accepted or standardised definition that determines if an adult patient is considered complex. Therefore, this scoping review aims to understand how medical complexity is defined, identify its defining attributes and examine its use in clinical care research. We also aim to consolidate and evaluate the evidence to suggest a more comprehensive and standardised definition of medical complexity and/or highlight key components required to define medical complexity in urgent care and emergency department settings.Methods and analysisThis protocol is developed according to the approach described by Arksey and O’Malley (2005) and expanded by Levac and colleagues. We will use Walker and Avant’s method of concept analysis (2005) to gain a comprehensive understanding of the concept of medical complexity. We will systematically search MEDLINE, CINAHL Plus, EMBASE, APA PsycINFO and Cochrane Library. A grey literature search will be conducted in Google and Google Scholar to identify additional information. Two reviewers will independently screen titles and abstracts for inclusion, followed by a screening of the full text of potentially relevant articles. Relevant data will be extracted from these studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used to report the selection of studies at different stages.Ethics and disseminationScoping review methodology uses and reviews publicly available studies and data, so ethics approval is not required. We will disseminate the results of this scoping review through peer-reviewed publications and presentations at academic conferences and scientific meetings. We will also share these results with key stakeholders, including healthcare providers, community organisations and healthcare system leaders.