bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged Bleeding After Dental Extraction Due to Decreased Serum Level of Von Willebrand Factor Caused by Untreated Profound Hypothyroidism
Authors: Dagdeviren Cakir Aydilek , Yildirmak Zeynep Yildiz , Eren Simge , Özdemir Ebru Misirli , Özdemir Mustafa , Uçar Ahmet 
Published: January 2023

Background:
Delayed diagnosis of hypothyroidism may result in atypical presentations. Here, we report a case with decreased serum level and activity of von Willebrand factor due to untreated profound hypothyroidism

Observation:
A 9-year-old girl, presented with prolonged gingival bleeding after dental extraction. Clinical findings of the case were consistent with hypothyroidism, and the laboratory workup results revealed decreased serum level and activity of von Willebrand factor associated with profound hypothyroidism. Restoration of euthyroidism normalized the coagulation parameters.

Conclusion:
Delayed diagnosis of hypothyroidism may lead to atypical presentations such as bleeding diathesis. Profound hypothyroidism should be considered in the differential diagnosis of acquired von Willebrand disease to avoid undue treatment.
Factors Associated With Sun Protection Behaviors Among Childhood Cancer Survivors
Authors: Fluehr Melissa , Kwok Gary , Stapleton Jerod L. , Masterson Margaret , Devine Katie A. 
Published: January 2023

Background:
Childhood cancer survivors (CCS) are at increased risk of developing skin cancer. Engaging in sun-protective behaviors may ameliorate that risk, but prior work shows that survivors engage in suboptimal levels of sun-protective behaviors. Guided by the Health Belief Model (HBM), this study evaluated factors associated with sun-protective behavior among CCS.

Methods:
This is a secondary analysis of a survey study of 94 adult survivors of childhood cancer recruited from a long-term follow-up clinic. Participants reported their sun protection habits, skin type/sensitivity, barriers to sun protection, and perceived severity and susceptibility of getting skin cancer. Descriptive statistics were used to describe the prevalence of sun protection behaviors and hierarchical linear regression was used to evaluate predictors of sun protection behavior following the HBM.

Results:
On average, CCS engaged in moderate levels of sun-protective behaviors (M=2.53; SD=0.59). Hierarchical linear regression indicated that fair skin type (P=0.02) and higher perceived susceptibility relative to noncancer survivors (P=0.02) were associated with increased sun protection behaviors. Perceived barriers to sun protection were marginally significant (P=0.09), whereas other constructs from the HBM did not contribute significantly to the model.

Conclusions:
Although CCS are at increased risk of developing skin cancer, they engage in suboptimal levels of sun protection behaviors. Findings suggest that interventions to educate survivors about their unique risk of skin cancer and effective prevention behaviors are needed.
Predictors of Driving Cessation in Older Adults
Authors: Wood Isabella , Bhojak Tejal , Jia Yichen , Jacobsen Erin , Snitz Beth E. , Chang Chung-Chou H. , Ganguli Mary 
Published: January 2023

Background:
Changes in physical health and cognition during aging can result in some older adults to stop driving. In this population-based longitudinal study, we describe potential predictors of driving cessation in older adults.

Methods:
Age-stratified random population cohort of 1982 adults aged 65 years and older drawn from voter registration lists. Participant characteristics were measured using demographics, physical and self-rated health, sleeping habits, driving status, cognitive screening, modified Center for Epidemiologic Studies-Depression scale, clinical dementia rating, and mini-mental state examination.

Results:
Over 12 years of follow-up, 390 participants stopped driving. These individuals were older, more likely to be women and to have a clinical dementia rating score ≥1, had worse self-reported health, and more symptoms of depression, compared with those who were still driving. In addition, individuals with lower test performance in all cognitive domains, loss of visual acuity and fields, and bilateral hearing loss were more likely to stop driving.

Conclusions:
Age, sex, cognitive impairments, physical health, and depressive symptoms were associated with driving cessation in this cohort. By identifying potential driving cessation predictors, health care providers and families may better recognize these risk factors and begin the driving cessation discussion early.
Genome-wide association study suggests a critical contribution of the adaptive immune system to chronic post-surgical pain
Authors: Parisien Marc , van Reij Roel R.I. , Khoury Samar , Koseli Eda , Karaky Mohamad , van den Hoogen Nynke J. , Peng Garrie , Allegri Massimo , de Gregori Manuela , Chelly Jacques E. , Rakel Barbara A. , Aasvang Eske K. , Kehlet Henrik , Buhre Wolfgang F.F.A. , Bryant Camron D. , Damaj M. Imad , King Irah L. , Mogil Jeffrey S. , Joosten Elbert A.J. , Diatchenko Luda 
Published: January 2023

ABSTRACTChronic post-surgical pain affects a large proportion of people undergoing surgery, delaying recovery time and worsening quality of life. Although many environmental variables have been established as risk factors, less is known about genetic risk. To uncover genetic risk factors we performed genome-wide association studies in post-surgical cohorts of five surgery types— hysterectomy, mastectomy, abdominal, hernia, and knee— totaling 1350 individuals. Genetic associations between post-surgical chronic pain levels on a numeric rating scale (NRS) and additive genetic effects at common SNPs were evaluated. We observed genome-wide significant hits in almost all cohorts that displayed significance at the SNP, gene, and pathway levels. The cohorts were then combined via a GWAS meta-analysis framework for further analyses. Using partitioned heritability, we found that loci at genes specifically expressed in the immune system carried enriched heritability, especially genes related to B and T cells. The relevance of B cells in particular was then demonstrated in mouse postoperative pain assays. Taken altogether, our results suggest a role for the adaptive immune system in chronic post-surgical pain.
Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada
Authors: Hossin M. Zakir , de la Cruz Lorena Fernández , McKay Kyla A , Toberlander Tim , Sandström Anna , Razaz Neda 
Published: January 2023

AbstractImportanceMaternal cardiac disease is associated with impaired placentation and adverse neonatal outcomes, but whether it increases the risk of subsequent neurodevelopmental disorders in offspring remains unknown.ObjectiveTo assess the associations between pre-existing maternal cardiovascular disease (CVD) and attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in offspring.DesignPopulation-based cohort study.SettingSweden and British Columbia (BC), Canada.ParticipantsSingletons live-born without major malformations between 1990 and 2019. The Swedish Medical Birth Register and the BC Vital Statistics were linked to hospital and physician billing records for identification of exposure and outcomes. All children were followed from age 1 until the outcome, death, emigration, or December 2020.ExposureA composite of pre-conception maternal CVDs: cerebrovascular disease, arrhythmia, heart failure, valvular, and congenital heart diseases.Main Outcomes and MeasuresDiagnoses of ADHD, ASD, and ID. The incidence of ADHD, ASD, and ID, comparing offspring of mothers with versus without CVD, was calculated as adjusted hazard ratios (aHRs). These results were compared to models using paternal CVD as negative-control exposure. Fixed-effect meta-analysis was performed to combine the aHRs from Sweden and BC.ResultsWe analysed 3,587,257 offspring (48.9% female) – 2,699,675 in Sweden and 887,582 in BC. The meta-analysis suggests that compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD (95% CI: 1.10-1.20) and ASD (95% CI: 1.07-1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (aHR 1.31; 95% CI: 1.02-1.61), cerebrovascular disease (aHR 1.20; 95% CI: 1.08-1.32), congenital heart disease (aHR 1.18; 95% CI: 1.08-1.27), arrhythmia (aHR 1.13; 95% CI: 1.08-1.19), and valvular heart disease (aHR 1.12; 95% CI: 1.00-1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (aHR 1.25; 95% CI: 1.04-1.46), congenital heart disease (aHR 1.17; 95% CI: 1.01-1.33), and arrythmia (HR 1.12; 95% CI: 1.01-1.21). Paternal CVDs, except for cerebrovascular disease, did not show associations.Conclusion and RelevancePre-existing maternal CVD was associated with excess risk of ADHD and ASD in offspring. The associations were broadly robust to genetic confounding, warranting further research to identify the underlying intrauterine mechanisms.
Primary care coding activity related to the use of online consultation systems or remote consulting: an analysis of 53 million peoples’ health records using OpenSAFELY
Authors: Fonseca Martina , MacKenna Brian , Mehrkar Amir ,   The OpenSAFELY Collaborative, Walters Caroline E , Hickman George , Pearson Jonathan , Fisher Louis , Inglesby Peter , Bacon Seb , Davy Simon , Hulme William , Goldacre Ben , Koffman Ofra , Bakhai Minal 
Published: January 2023

AbstractBackgroundThe pandemic accelerated work by the NHS in England to enable and stimulate use of online consultation systems across all practices, for improved access to primary care.ObjectiveWe aimed to explore general practice coding activity associated with the use of online consultation systems in terms of trends, COVID-19 effect, variation and quality.MethodsWith the approval of NHS England, OpenSAFELY-TPP and OpenSAFELY-EMIS were used to query and analysein siturecords of electronic health record systems of over 53 million patients in over 6,400 practices, mainly in 2019-2020. SNOMED CT codes relevant to online consultation systems and written online consultations were identified. Coded events were described by volumes, practice coverage, trends pre- and post-COVID-19 and inter-practice and sociodemographic variation.Results3,550,762 relevant coding events were found in TPP practices, with code eConsultation detected in 84% of practices. Coding activity related to digital forms of interaction increased rapidly from March 2020 at the onset of the COVID-19 pandemic, though we found large variation in coding instance rates among practices in England. Code instances were more commonly found among females, those aged 18-40, those least deprived or white. eConsultation coded activity was more commonly found recorded among patients with a history of asthma or depression.ConclusionsWe successfully queried general practice coding activity relevant to the use of online consultation systems, showing increased adoption as well as key areas of variation during the COVID-19 pandemic. The work can be expanded to support monitoring of coding quality and underlying activity. In future, large-scale impact evaluation studies can be implemented within the platform, namely looking at resource utilisation and patient outcomes.
Spatiotemporal transmission of SARS-CoV-2 lineages during 2020-2021 in Pernambuco - Brazil
Authors: Machado Lais Ceschini , Dezordi Filipe Zimmer , de Lima Gustavo Barbosa , de Lima Raul Emídio , Silva Lilian Caroliny Amorim , Pereira Leandro de Mattos , da Silva Alexandre Freitas , Neto Antonio Marinho da Silva , Oliveira André Luiz Sá de , Armstrong Anderson da Costa , Pessoa-e-Silva Rômulo , Loyo Rodrigo Moraes , Silva Barbara de Oliveira , de Almeida Anderson Rodrigues , Pitta Maira Galdino da Rocha , Santos Francisco de Assis da Silva , Siqueira Marilda Mendonça , Resende Paola Cristina , Delatorre Edson , Naveca Felipe Gomes , Miyajima Fabio , Gräf Tiago , do Carmo Rodrigo Feliciano , Pereira Michelly Cristiny , Campos Tulio de Lima , Bezerra Matheus Filgueira , Paiva Marcelo Henrique Santos , Wallau Gabriel da Luz 
Published: January 2023

AbstractIn recent years, the SARS-CoV-2 viruses emerged and spread around the world, leaving a large death toll and long-lasting impact on survivors. As of January 2023, Brazil is still among the countries with the highest number of registered deaths. This continental-size and pluralistic country experienced a heterogenous implementation of non-pharmacological and pharmacological interventions which, associated with large socioeconomic differences between the country regions, has led to distinct virus spread dynamics across the country. Here we investigate the spatiotemporal dispersion of emerging SARS-CoV-2 lineages and its dynamics in distinct epidemiological scenarios in the first two years of the pandemics in the Pernambuco state (Northeast Brazil). We generated a total of 1389 new SARS-CoV-2 genomes from June 2020 to August 2021 covering all major regions of the state. This sampling captured the arrival, communitary transmission and the circulation of the B1.1, B.1.1.28 and B.1.1.33 lineages in the first eight months of the pandemics, the emergence of the former variant of interest P.2 and the emergence and fast replacement of all previous variants by the more transmissible variant of concern P.1 (Gamma) lineage. Based on the incidence and lineage spread pattern we observed that there was an East-to-West to inner state pattern of transmission which is in agreement with the transmission of more populous metropolitan areas to medium and small size country-side cities in the state. Such transmission patterns may be partially explained by the main routes of traffic across municipalities in the state. Nevertheless, inter-state traffic was also another important source of lineage introduction and spread into the state. Our results highlight that the fine grained intrastate analysis of lineages and incidence spread can provide actionable insights for planning future non-pharmacological intervention for air-borne transmissible human pathogens.
Prospective Evaluation of a 90-day Mortality Prediction Model: From Silent Pilots to Real Time Deployment in the EHR*
Authors: Rossi Lorenzo A. , Roberts Laura , Zachariah Finly 
Published: January 2023

AbstractPrognostication in oncology is increasingly difficult due to the rapid evolution of therapies with significant improvement of survival. Accurate prognostication is essential to provide optimal, value-driven end of life care for cancer patients, and can promote goals of care (GOC) conversations with the potential to minimize chemotherapy or ICU utilization in the last weeks of life, and possibly increase hospice admission and length of stay.1There are several recent publications on the application of machine learning for prognostication.2,3We developed a 90-day mortality prediction model trained with data in the Electronic Health Records (EHR). After a non-interventional pilot stage, we deployed the model in February 2021 in the real-time Electronic Health Record Epic infrastructure of our cancer center. Here we present the model and evaluate its overall performance for the first 7.5 months since the go-live and outline our evaluation process for the next stages.
Awareness and utilization of free maternal healthcare services among women in Mt. Elgon Sub-County, Kenya
Authors: Furechi Oliver 
Published: January 2023

ABSTRACTMaternal mortality remains a matter of public health concern with over 300,000 women dying while giving birth annually. This has driven policy makers to come up with free maternal healthcare services as policy intervention. The Kenyan Government adopted the free maternal healthcare policy in 2013. The policy exempts maternal services from user fees in all public health facilities. This is aimed at promoting skilled delivery to reduce pregnancy-related mortality. In Mt Elgon sub-county, only 45 percent of women deliver in a health facility, this is below the national average of 61.5 percent.This paper presents results from a cross-sectional study conducted in January 2021 in Mt Elgon Sub-County among 377 randomly selected women who delivered in the preceding 12 months and 4 FGDs with women of reproductive age. Descriptive statistics were undertaken while Chi-Square test was used for inferential statistics. Andersen behavioral model of health service use was used to examine how womens demographic characteristics and awareness regarding the free maternal health policy has affected utilization of maternal healthcare services. The results indicate that respondents were generally aware that there is a government policy on free maternal health policy. However, gaps still exist in terms of pushing awareness towards universal reach, infrastructure development, health worker patient ratio, timely provision of essential supplies and long distance to health facilities This calls for increased sensitization utilizing community health volunteers and allocation of financial and human resources allocation to the department of health within County Governments.
Call detail record aggregation methodology impacts infectious disease models informed by human mobility
Authors: Gibbs Hamish , Musah Anwar , Seidu Omar , Ampofo William , Asiedu-Bekoe Franklin , Gray Jonathan , Adewole Wole A. , Cheshire James , Marks Michael , Eggo Rosalind M. 
Published: January 2023

AbstractThis paper demonstrates how two different methods used to calculate population-level mobility from Call Detail Records (CDR) produce varying predictions of the spread of epidemics informed by these data. Our findings are based on one CDR dataset describing inter-district movement in Ghana in 2021, produced using two different aggregation methodologies. One methodology, “all pairs,” is designed to retain long distance network connections while the other, “sequential” methodology is designed to accurately reflect the volume of travel between locations. We show how the choice of methodology feeds through models of human mobility to the predictions of a metapopulation SEIR model of disease transmission. We also show that this impact varies depending on the location of pathogen introduction and transmissibility. For central locations or highly transmissible diseases, we do not observe significant differences between aggregation methodologies on the predicted spread of disease. For less transmissible diseases or those introduced into remote locations, we find that the choice of aggregation methodology influences the speed of spatial spread as well as the size of the peak number of infections in individual districts. Our findings can help researchers and users of epidemiological models to understand how methodological choices at the level of model inputs may influence the results of models of infectious disease transmission, as well as the circumstances in which these choices do not alter model predictions.Author SummaryPredicting the sub-national spread of infectious disease requires accurate measurements of inter-regional travel networks. Often, this information is derived from the patterns of mobile device connections to the cellular network. This travel data is then used as an input to epidemiological models of infection transmission, defining the likelihood that disease is “exported” between regions. In this paper, we use one mobile device dataset collected in Ghana in 2021, aggregated according to two different methodologies which represent different aspects of inter-regional travel. We show how the choice of aggregation methodology leads to different predicted epidemics, and highlight the conditions under which models of infection transmission may be influenced by methodological choices in the aggregation of travel data used to parameterize these models. For example, we show how aggregation methodology changes predicted epidemics for less-transmissible infections and under certain models of human movement. We also highlight areas of relative stability, where aggregation choices do not alter predicted epidemics, such as cases where an infection is highly transmissible or is introduced into a central location.
Access to medicines for the treatment of chronic diseases in Chile: qualitative analysis of perceived patient barriers and facilitators in five regions of the country
Authors: Laborde Carla Castillo , Matute Isabel , Sgombich Ximena , Jofré Daniel 
Published: January 2023

AbstractPurposeTo know patients’ perceptions of barriers and facilitators in access to medicines in general, and those associated with the treatment of three chronic conditions of high prevalence in Chile: diabetes, dyslipidemia and hypertension. Methods: Ten focus groups of patients with these diseases, diagnosed for at least six months and prescribed medication, were included. These were carried out in five regions of Chile: Arica, in the north, Aysén, in the south, and Valparaíso, Metropolitan, and Maule, in the central zone. The criteria for the formation of groups were region, age, health system (public or private) and socioeconomic level (residence commune). Sessions were recorded, transcribed, and analyzed by categories.ResultsThe experience of access to medicines is determined by the insurance system, the experience of care with public or private providers, and geographical-administrative difference between capital and other regions. Beneficiaries of public sector, despite their greater socioeconomic vulnerability, perceive greater protection in access: access conditions, delivery reliability and adherence to pharmacological treatment are met. The main problem observed is the financing of treatments not covered by the health system. Policyholders in private sector perceive that they have access to medicines of better quality than those provided free of charge by public sector, but raise fears associated with the inability to afford them and distrust in the process, linked to alliances between laboratories and physicians. Public sector beneficiaries value territorial coverage of primary care, which guarantees access in isolated areas. Regarding the type of provider, public sector shows greater capacity for user loyalty, which is expressed in regular visits and follow-up; unlike discontinuous examinations among private sector beneficiaries.ConclusionsDifferent access conditions both at the territorial level and in the health subsystems are evident. It is necessary to make progress in addressing the problem of access to medicines in a comprehensive manner.