bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and in vivo confocal microscopy characteristics of Candida keratitis following keratoplasty
Authors: Zhang Chen , Li Fei , Liu Hui , Jia Zhe , Zhao Shaozhen 
Published: September 2023

Abstract
Background
We present six patients who developed Candida keratitis postoperatively. The clinical features, diagnostic testing including in vivo confocal microscopy, and outcomes are presented.

Methods
Six patients who developed Candida keratitis following penetrating and endothelial keratoplasty, were referred to Tianjin Medical University Eye Hospital between 2018 to 2021.The diagnosis was established following cultures of either corneal scraping or biopsy. In vivo confocal microscopy examination was also performed to confirm the diagnosis and characterize the morphology, distribution and the depth of Candida spp. All patients were treated with topical voriconazole (VCZ) 1% and natamycin (NTM) 5%. Patients with mid/deep stromal keratitis or interface infection were treated additionally with intrastromal or interface VCZ irrigation (0.05 mg/0.1mL).

Results
The cultures of corneal scrapings (4 cases) or biopsies (2 cases) were all positive for Candida spp. In vivo confocal microscopy examination was positive for fungal elements in five of the six patients. The infection resolved in five of the six patients. The patients’ final uncorrected visual acuity (UCVA) ranged from hand movements (HM) to 20/80.

Conclusion
In vivo confocal microscopy is a useful non-invasive clinical technique for confirming the diagnosis of Candida keratitis. Intrastromal and interface irrigated VCZ injections are effective treatment options.
Clinical correlates and thyroid hormones of metabolic syndrome in first-episode and drug-naïve major depressive disorder outpatients with and without hyperglycemia: a comprehensive cross-sectional study
Authors: Zheng Siyang , Wang Zhiyang , Yang Limin , Zhang Xiangyang 
Published: September 2023

AbstractHyperglycemia and metabolic syndrome (MetS) are common in patients with major depressive disorder (MDD). This study aimed to explore the prevalence and clinical factors of MetS in first-episode and drug-naïve MDD (FEDND) patients with and without hyperglycemia. A total of 1,718 FEDND patients’ symptoms were assessed using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS). Blood glucose levels, metabolic index, and thyroid hormones were measured during fasting. The prevalence of MetS in FEDND patients with hyperglycemia was 35.67 times higher than in FEDND patients without hyperglycemia. FEDND patients with MetS were older, had later age of onset, and were predominantly married than those without MetS (p < 0.05). Among FEDND patients without hyperglycemia, suicide attempts, severe anxiety, HAMD, HAMA, PANSS subscale scores, thyroid stimulating hormone, antithyroglobulin, and total cholesterol levels were all higher in patients with MetS than those without MetS (all p < 0.05). In FEDND patients without hyperglycemia, the combination of age and TgAb distinguished those patients with and without MetS. Our results suggest a high prevalence of MetS in FEDND patients with hyperglycemia. Several clinical variables and thyroid function-related hormones impact MetS in patients with FEDND.
Evaluation of the pilot wastewater surveillance for SARS-CoV-2 in Norway, June 2022 – March 2023
Authors: Amato Ettore , Hyllestad Susanne , Heradstveit Petter , Langlete Petter , Moen Line Victoria , Rohringer Andreas , Pires João , Baz Lomba Jose Antonio , Bragstad Karoline , Feruglio Siri Laura , Aavitsland Preben , Madslien Elisabeth Henie 
Published: September 2023

Abstract
Background
During the COVID-19 pandemic, wastewater-based surveillance gained great international interest as an additional tool to monitor SARS-CoV-2. In autumn 2021, the Norwegian Institute of Public Health decided to pilot a national wastewater surveillance (WWS) system for SARS-CoV-2 and its variants between June 2022 and March 2023. We evaluated the system to assess if it met its objectives and its attribute-based performance.

Methods
We adapted the available guidelines for evaluation of surveillance systems. The evaluation was carried out as a descriptive analysis and consisted of the following three steps: (i) description of the WWS system, (ii) identification of users and stakeholders, and (iii) analysis of the system’s attributes and performance including sensitivity, specificity, timeliness, usefulness, representativeness, simplicity, flexibility, stability, and communication. Cross-correlation analysis was performed to assess the system’s ability to provide early warning signal of new wave of infections.

Results
The pilot WWS system was a national surveillance system using existing wastewater infrastructures from the largest Norwegian municipalities. We found that the system was sensitive, timely, useful, representative, simple, flexible, acceptable, and stable to follow the general trend of infection. Preliminary results indicate that the system could provide an early signal of changes in variant distribution. However, challenges may arise with: (i) specificity due to temporary fluctuations of RNA levels in wastewater, (ii) representativeness when downscaling, and (iii) flexibility and acceptability when upscaling the system due to limited resources and/or capacity.

Conclusions
Our results showed that the pilot WWS system met most of its surveillance objectives. The system was able to provide an early warning signal of 1-2 weeks, and the system was useful to monitor infections at population level and complement routine surveillance when individual testing activity was low. However, temporary fluctuations of WWS values need to be carefully interpreted. To improve quality and efficiency, we recommend to standardise and validate methods for assessing trends of new waves of infection and variants, evaluate the WWS system using a longer operational period particularly for new variants, and conduct prevalence studies in the population to calibrate the system and improve data interpretation.
Association between serum 25- hydroxyvitamin D and albuminuiria in middle-aged and older Chinese patients with type 2 diabetes
Authors: Zhang Luyan , Guo Qian , Xu Yanjia , Wei Wenzhen , Wang Yu 
Published: September 2023

Abstract
Objective
The objective was to analyze the relationship between serum 25-hydroxy-vitamin D (25(OH)D) level and albuminuiria in middle-aged and older patients with type 2 diabetes of Gansu Province.

Methods
Data pertaining to 380 in-patients with type 2 diabetes were collected. Subjects were classified groups based on gender,age,25(OH)D,BMI and UACR.Serum 25(OH)D and other clinical characteristics among various UACR groups were compared.The relationship between albuminuiria and 25(OH)D was analyzed.

Results
Out of the 380 subjects, 83.4%were classified as vitamin D deficiency, 14.5%were classified as vitamin D insufficiency, while 2.1% were classified as vitamin D sufficiency. Among the participants,41% had albuminuria (microalbuminuria,28.7%;macroalbuminuria,12.3%).The prevalence of 25(OH)D deficiency in the albuminuria group(84.6%) was significantly higher than that in the normoalbuminuria group(82.6%)(Mann–Whitney U test:Z = -3.86,P = 0.000); patients with macroalbuminuria had the highest prevalence of 25(OH)D deficiency (91.5%; P < 0.01 versus normoalbuminuria).A binary logistic analysis demonstrated that 25(OH)D were protective factors for albuminuria.

Conclusions
The prevalence of vitamin D deficiency in patients with albuminuria was overtly higher than that in patients without albuminuria among middle-aged and older adults with type 2 diabetes.
Association between number of remaining teeth and incident depression in a rural Chilean cohort
Authors: Ortuño Duniel , Martínez Constanza , Caneo Constanza 
Published: September 2023

Abstract
Objectives
Previous studies have established an association between tooth loss and depression. However, longitudinal evidence is scarce and needs to be verified in other populations. The aim of this study was to examine the longitudinal association between the number of remaining teeth and incident depression at 2- and 4-years follow-up in individuals enrolled in the Maule cohort (MAUCO) in Chile.

Methods
This prospective study used the information of individuals, aged 38 to 74 years, excluding those with depression at baseline. The number of remaining teeth at baseline was determined in four groups: “20 or more teeth”, “10 to 19 teeth”, “1 to 9 teeth” and “no natural teeth”. Depression was measured through the PHQ-9. Logistic regression was performed to calculate the odds ratios (OR) for incidence depression at both periods of follow-ups, adjusting for age, sex, educational attainment, diabetes mellitus II, and stressful events at follow-up. Also, we performed adjusted multinomial logistic models to analysis the association between the number of remaining teeth and depression severity.

Results
In total individuals (n = 3335 at follow 1, n = 2461 at follow 2), all groups have ORs for incident depression above 1 considering 20 or more teeth as reference. In men, those with 10–19 teeth have 2.44 times higher odds of incident depression than those with 20 or more teeth (OR 2.44, CI 95% 1.33–4.50). Edentulous subjects at 4 years follow-up had 2.24 times higher odds of depression than those with more than 20 teeth (OR 2.24 CI 95%1.35–3.72). In women, the ORs (CI 95%) of incident depression were 2.56 (1.50–4.39), 1.56 (1.02–2.40) and 1.27 (0.90–1.81) for “none”, “1–9”, “10–19” respectively in comparison to the reference group. In edentulous individuals at baseline, the odds for each of the comparisons “mild vs no”, “moderate vs no”, “moderately severe vs no” and “severe vs no” were above 1, at both follow-ups.

Conclusion
Individuals with less than 20 teeth in the mouth could had higher odds of incident depression at 2- and 4-years follow-up, with differences between men and women. Also, in our study, edentulism was associated with increased odds of incident depression at 4-years follow-up in women, and with higher levels of severity of depressive symptoms.
The mediating role of menstrual irregularity on obesity and sexual function in Chinese women with pelvic floor disorders: a cross-sectional study
Authors: Lv Xiaoyang , Yang Huijun , Yan Miaomiao , Jin Xuli , Shen Xin , Li Shu , Zhang Miqing , Su Sha , Liu Xiaoyan , Chen Jie 
Published: September 2023

Abstract
Background
Sexual problems are common among women with pelvic floor disorders (PFD). Few studies have explored the relationship between obesity and sexual function in women with PFD. This study aimed to prove that obesity was a risk factor for worse sexual function in women with PFD, and to investigate the mediating role of menstrual irregularity.

Methods
This was a cross-sectional study involving 783 women with PFD from Shandong Province, China between June 2020 and February 2021. Female sexual function was assessed using the Pelvic Organ Prolapse/UI Sexual Questionnaire-12 (PISQ-12). Obesity was defined as BMI ≥ 28.0. Menstrual irregularity was defined as menstrual cycles ≥ 35 or menstrual cycles < 25 days. Logistic regression and multiple linear regression were employed to explore the association among obesity, menstrual irregularity and sexual function.

Results
Obesity was associated with worse PISQ-12 scores compared with normal- weight women (mean score 28.14 ± 7.03 versus 32.75 ± 5.66, p < 0.001). After adjusting for controlling variables, women with obesity (β= -3.74, p < 0.001) and menstrual irregularity (β= -3.41, p < 0.001) had a worse sexual function. Menstrual irregularity had a mediation effect on the association between obesity and sexual function.

Conclusions
This study provided evidence that obesity was associated with worse sexual function in women with PFDs, and the effect of obesity on sexual function was partially mediated by menstrual irregularity. Weight control may have potential benefits for improving sexual function and preventing female sexual dysfunction. It’s also important to pay attention to the menstrual cycle.
Mother-daughter communication of sexual and reproductive health (SRH) matters and associated factors among sinhalese adolescent girls aged 14–19 years, in Sri Lanka
Authors: Mataraarachchi D. , A Pathirana T.E. , Buddhika P.K Mahesh , C Vithana P.V.S. 
Published: September 2023

Abstract
Introduction
School-based and community-based sexuality education has not shown a significant impact on the sexual and reproductive health (SRH) outcomes of Sri Lankan adolescents. Parents, as the primary educators of adolescents, could potentially serve as better sources for providing individualized sexuality education to their children.

Objective
To assess the sexual and reproductive health (SRH) topics discussed between mothers and daughters, barriers to communication, and associations of SRH communication among Sinhala adolescent girls aged 14–19 years in Sri Lanka.

Methods
A descriptive cross-sectional study was conducted among a sample of 810 Sinhala adolescent girls using a pre-tested, self-administered questionnaire. Descriptive statistics pertaining to mother-daughter communication in SRH matters were presented using frequencies and percentages. Bivariate analysis was performed to evaluate the association of selected socio-demographic factors with mother-daughter SRH communication, while binary logistic analysis was used to assess the independent association of chosen demographic factors with mother-daughter SRH communication.

Results
The majority of the respondents (67.1%, n = 540) indicated a willingness to discuss SRH matters with their mothers. For 78.2% (n = 632) of the respondents, the mother was the preferred source of SRH information. Common topics discussed between the mothers and daughters included issues related to menstruation (88.4%, n = 701) and maintaining personal boundaries (94%, n = 718), whereas less discussed topics included homosexuality (21%, n = 166), and preventing unwanted pregnancy (38.6%, n = 305). Cultural barriers, fear of mothers’ reactions, and mothers’ lack of confidence in responding to their daughter’s SRH matters were the main barriers to discussing SRH topics with mothers. Adolescent girls’ age, and family income level were significantly associated with mother-daughter SRH communication.

Conclusions and recommendations
Although a majority of adolescent girls preferred to share their sexual health concerns with their mothers, a notable barrier was the lack of confidence from the mother’s side. Furthermore, the scope of mother-daughter sexual communication in this study was largely limited to less sensitive topics. In light of these findings, it is suggested that interventions targeted at parents be developed alongside school-based sex education for adolescents. These interventions should aim to enhance parents’ knowledge and skills in discussing sexual health matters with their adolescent children.
Artificial intelligence for non-mass breast lesions detection and classification on ultrasound images: a comparative study
Authors: Li Guoqiu , Tian Hongtian , Wu Huaiyu , Huang Zhibin , Yang Keen , Li Jian , Luo Yuwei , Shi Siyuan , Cui Chen , Xu Jinfeng , Dong Fajin 
Published: September 2023

Abstract
Background
This retrospective study aims to validate the effectiveness of artificial intelligence (AI) to detect and classify non-mass breast lesions (NMLs) on ultrasound (US) images.

Methods
A total of 228 patients with NMLs and 596 volunteers without breast lesions on US images were enrolled in the study from January 2020 to December 2022. The pathological results served as the gold standard for NMLs. Two AI models were developed to accurately detect and classify NMLs on US images, including DenseNet121_448 and MobileNet_448. To evaluate and compare the diagnostic performance of AI models, the area under the curve (AUC), accuracy, specificity and sensitivity was employed.

Results
A total of 228 NMLs patients confirmed by postoperative pathology with 870 US images and 596 volunteers with 1003 US images were enrolled. In the detection experiment, the MobileNet_448 achieved the good performance in the testing set, with the AUC, accuracy, sensitivity, and specificity were 0.999 (95%CI: 0.997-1.000),96.5%,96.9% and 96.1%, respectively. It was no statistically significant compared to DenseNet121_448. In the classification experiment, the MobileNet_448 model achieved the highest diagnostic performance in the testing set, with the AUC, accuracy, sensitivity, and specificity were 0.837 (95%CI: 0.990-1.000), 70.5%, 80.3% and 74.6%, respectively.

Conclusions
This study suggests that the AI models, particularly MobileNet_448, can effectively detect and classify NMLs in US images. This technique has the potential to improve early diagnostic accuracy for NMLs.
Notifications of work-related injuries and diseases: an observational study on a mining disaster
Authors: Costa da Silva Rita de Cássia , Pires de Novais Maykon Anderson , Zucchi Paola 
Published: September 2023

Abstract
Introduction
Accidents at work are events that endanger the health and life of workers. They are considered a public health problem, being the object of studies and actions in the Brazilian health system. The collapsed of the ore tailings dam in the municipality of Brumadinho, Brazil, in January 2019, shocked the world due to the proportion of environmental and human damage caused. In this context, concern for the health of workers gained prominence. This paper evaluated the impact of the collapse of the mining tailings dam in Brumadinho, on notifications of occupational health problems before and after the disaster.

Methods
An observational, longitudinal and retrospective study, of the time series type with a statistical approach was carried out on notifications of work-related injuries and diseases, available in the local database of the Notifiable Diseases Information System between January 2017 and December 2021.

Results
During the study period, 520 notifications of work-related injuries and conditions were registered. Of this total, 67.3% were serious work accidents, 26.0% mental disorders, 12.3% accidents with biological material and 2.9% repetitive strain injuries/musculoskeletal disorders, occupational dermatoses and induced hearing loss by noise. Occurrences were more frequent in 2019, the year in which the mining disaster occurred, recording 65.2% of total notifications. Regarding the volume of notifications after the disaster, there was a statistically significant reduction (p < 0.001) for accidents with biological material; significant increase for severe work accident and mental disorder. The average time between the occurrence of the injury and the notification showed a statistically significant reduction for accidents involving biological material (p = 0.001) and a significant increase for serious accidents at work (p = 0.016).

Conclusions
It was demonstrated that there were changes in the number of notifications when comparing the period before and after the mining disaster, with a consequent impact on the health of workers, which may persist over the years.
Public involvement in the Swedish health system: citizen dialogues with unclear outcomes
Authors: Fredriksson Mio , Modigh Anton 
Published: September 2023

Abstract
Background
In systems with representative democracy, there is a growing consensus that citizens should have the possibility to participate in decisions that affect them, extending beyond just voting in national or local/regional elections. However, significant uncertainty remains regarding the role of public involvement in decision-making, not least in healthcare. In this article, we focus on citizen dialogues (CDs) in a health system that is politically governed and decentralised. The aim of the study was to evaluate the functioning of citizen dialogues in the Swedish health system in terms of representation, process, content, and outcomes.

Methods
This study was conducted using a qualitative case design focusing on CDs at the regional level in Sweden. The regional level is politically elected and responsible for funding and provision of healthcare. The data consist of public documents describing and evaluating the CDs and interviews, which were analysed drawing on a modified version of the Abelson et al. analytical framework for evaluating public involvement in healthcare.

Results
Some CDs were an attempt to counteract political inequality by inviting groups that are less represented, while others aimed to increase legitimacy by reducing the distance between policymakers and citizens. The results from the CDs—which were often held in the beginning of a potential policy process—were often stated to be used as input in decision-making, but how was not made clear. Generally, the CDs formed an opportunity for members of the public to express preferences (on a broad topic) rather than developing preferences, with a risk of suggestions being too unspecific to be useful in decision-making. The more disinterested public perspective, in comparison with patients, reinforced the risk of triviality. A need for better follow-up on the impact of the CDs on actual decision-making was mentioned as a necessary step for progress.

Conclusions
It is unclear how input from CDs is used in policymaking in the politically governed regions responsible for healthcare in Sweden. The analysis points to policy input from CDs being too general and a lack of documentation of how it is used. We need to know more about how much weight input from CDs carry in relation to other types of information that politicians use, and in relation to other types of patient and public involvement.
Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting
Authors: Haurand Jean Marc , Haschemi Jafer , Oehler Daniel , Heinen Yvonne , Polzin Amin , Kelm Malte , Horn Patrick 
Published: September 2023

Abstract
Aims
We aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system.

Methods
First, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs.

Results
In the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation.

Conclusion
The major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.