bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries
Authors: Oduro Joseph Kojo , Okyere Joshua , Nyador Jonas Kwame Mawuli Tawiah 
Published: March 2023

Abstract
Background
Increasing trends in risky health behaviours contribute to chronic health problems among the rapidly growing ageing population. Therefore, we examined the association between risky health behaviours and chronic health conditions among persons 50 years and older.

Methods
This study was a secondary analysis of longitudinal survey data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave 1) conducted by the World Health Organization. Multilevel logistic regression techniques were used to examine high social cohesion among the aged. The output was reported as odds ratios (OR) and adjusted odds ratios (aOR).

Results
Generally, the level of chronic conditions was 81.5% for all countries. Older adults in Ghana had the highest chronic conditions (94.0%) while the Russian Federation recorded the lowest (58.6%). The risk of chronic conditions was higher among the oldest-old (OR = 1.70, 95% CI = 1.29, 2.25), those who smoke tobacco (OR = 1.13, 95% CI = 1.01, 1.25) or drink alcohol (OR = 1.17, 95% CI = 1.06,1.29), and among those who live in rural areas (OR = 1.31, 95% CI = 1.16, 1.49). However, the odds were lower among females (OR = 0.88, 95% CI = 0.69,0.85), and those who were not working (OR = 0.52, 95% CI = 0.47, 0.58).

Conclusion
We conclude that it is important to improve the health status of older people. To achieve this, there must be interventions and policies to facilitate the adoption of healthy or physically active lifestyles among older people. This could be achieved by strengthening advocacy and health education about the dangers of living a sedentary lifestyle, consuming alcohol and tobacco. Whatever behavioural change interventions, advocacy and health education must target high-risk sub-populations including the oldest-old, and those with low economic status. Given the regional disparities identified, it is necessary to prioritise older people residing in rural areas. The study underscores a need to provide more primary healthcare facilities in the rural areas of the countries included in this study. Such an initiative is likely to increase accessibility to healthcare services and information that would impact positively on the lifestyle behaviours of older people.
Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy
Authors: Trevisan Caterina , Noale Marianna , Zatti Giancarlo , Vetrano Davide Liborio , Maggi Stefania , Sergi Giuseppe 
Published: March 2023

Abstract
Background
There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association.

Methods
Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year.

Results
Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03).

Conclusions
The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.
The effect of volunteer-led activities on the quality of life of volunteers, residents, and employees of a long-term care institution: a cohort study
Authors: de Sandes-Guimarães Luisa Veras , dos Santos Patrícia Carla , Alves Carla Patricia Grossi Palácio , Cervato Carina Junqueira , Silva Ana Paula Alves , Leão Eliseth Ribeiro 
Published: March 2023

Abstract
Background
The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults’ daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers.

Methods
This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents’ daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution.

Results
Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z − 2.332, p < .05), residents their overall health (Z − 2.409, p < .05) and employees in their overall QoL perception (Z − 2.714, p < .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL.

Conclusions
Evidence from this study suggests that volunteers’ return positively impacted different QoL aspects for volunteers, residents, and employees.
Moderation effects of serotype on dengue severity across pregnancy status in Mexico
Authors: Annan Esther , Nguyen Uyen-Sa D. T. , Treviño Jesús , Wan Yaacob Wan Fairos , Mangla Sherry , Pathak Ashok Kumar , Nandy Rajesh , Haque Ubydul 
Published: March 2023

Abstract
Background
Pregnancy increases a woman’s risk of severe dengue. To the best of our knowledge, the moderation effect of the dengue serotype among pregnant women has not been studied in Mexico. This study explores how pregnancy interacted with the dengue serotype from 2012 to 2020 in Mexico.

Method
Information from 2469 notifying health units in Mexican municipalities was used for this cross-sectional analysis. Multiple logistic regression with interaction effects was chosen as the final model and sensitivity analysis was done to assess potential exposure misclassification of pregnancy status.

Results
Pregnant women were found to have higher odds of severe dengue [1.50 (95% CI 1.41, 1.59)]. The odds of dengue severity varied for pregnant women with DENV-1 [1.45, (95% CI 1.21, 1.74)], DENV-2 [1.33, (95% CI 1.18, 1.53)] and DENV-4 [3.78, (95% CI 1.14, 12.59)]. While the odds of severe dengue were generally higher for pregnant women compared with non-pregnant women with DENV-1 and DENV-2, the odds of disease severity were much higher for those infected with the DENV-4 serotype.

Conclusion
The effect of pregnancy on severe dengue is moderated by the dengue serotype. Future studies on genetic diversification may potentially elucidate this serotype-specific effect among pregnant women in Mexico.
Mycobacterium tuberculosis lineage 4 associated with cavitations and treatment failure
Authors: Ordaz-Vázquez Anabel , Torres-González Pedro , Ferreyra-Reyes Leticia , Canizales-Quintero Sergio , Delgado-Sánchez Guadalupe , García-García Lourdes , Ponce-De-León Alfredo , Sifuentes-Osornio José , Bobadilla-Del-Valle Miriam 
Published: March 2023

Abstract
Background
Mycobacterium tuberculosis genotyping has been crucial to determining the distribution and impact of different families on disease clinical presentation. The aim of the study was to evaluate the associations among sociodemographic and clinical characteristics and M. tuberculosis lineages from patients with pulmonary tuberculosis in Orizaba, Veracruz, Mexico.

Methods
We analyzed data from 755 patients whose isolates were typified by 24-loci mycobacterial interspersed repetitive unit–variable number of tandem repeats (MIRU–VNTR). The associations among patient characteristics and sublineages found were evaluated using logistic regression analysis.

Results
Among M. tuberculosis isolates, 730/755 (96.6%) were assigned to eight sublineages of lineage 4 (Euro-American). Alcohol consumption (adjusted odds ratio [aOR] 1.528, 95% confidence interval (CI) 1.041–2.243; p = 0.030), diabetes mellitus type 2 (aOR 1.625, 95% CI 1.130–2.337; p = 0.009), sputum smear positivity grade (3+) (aOR 2.198, 95% CI 1.524–3.168; p < 0.001) and LAM sublineage isolates (aOR 1.023, 95% CI 1.023–2.333; p = 0.039) were associated with the presence of cavitations. Resistance to at least one drug (aOR 25.763, 95% CI 7.096–93.543; p < 0.001) and having isolates other than Haarlem and LAM sublineages (aOR 6.740, 95% CI 1.704–26.661; p = 0.007) were associated with treatment failure. In a second model, multidrug resistance was associated with treatment failure (aOR 31.497, 95% CI 5.119–193.815; p < 0.001). Having more than 6 years of formal education was not associated with treatment failure.

Conclusions
Knowing M. tuberculosis genetic diversity plays an essential role in disease development and outcomes, and could have important implications for guiding treatment and improving tuberculosis control.
Elderly onset atypical Lemierre’s syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report
Authors: Mishima Koji , Aoki Kazunobu , Shirai Yusuke , Aritomo Hiroshi , Iwasaka Maiko , Katsura Masakazu , Tatsutani Tomofumi , Ikeuchi Hiroko , Oryoji Kensuke , Mizuki Shinichi 
Published: March 2023

Abstract
Background
Typical Lemierre’s syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre’s syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck.

Case presentation
We describe an atypical Lemierre’s syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre’s syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day.

Conclusion
Clinicians should consider Lemierre’s syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.
A cross-sectional study: a breathomics based pulmonary tuberculosis detection method
Authors: Fu Liang , Wang Lei , Wang Haibo , Yang Min , Yang Qianting , Lin Yi , Guan Shanyi , Deng Yongcong , Liu Lei , Li Qingyun , He Mengqi , Zhang Peize , Chen Haibin , Deng Guofang 
Published: March 2023

Abstract
Background
Diagnostics for pulmonary tuberculosis (PTB) are usually inaccurate, expensive, or complicated. The breathomics-based method may be an attractive option for fast and noninvasive PTB detection.

Method
Exhaled breath samples were collected from 518 PTB patients and 887 controls and tested on the real-time high-pressure photon ionization time-of-flight mass spectrometer. Machine learning algorithms were employed for breathomics analysis and PTB detection mode, whose performance was evaluated in 430 blinded clinical patients.

Results
The breathomics-based PTB detection model achieved an accuracy of 92.6%, a sensitivity of 91.7%, a specificity of 93.0%, and an AUC of 0.975 in the blinded test set (n = 430). Age, sex, and anti-tuberculosis treatment does not significantly impact PTB detection performance. In distinguishing PTB from other pulmonary diseases (n = 182), the VOC modes also achieve good performance with an accuracy of 91.2%, a sensitivity of 91.7%, a specificity of 88.0%, and an AUC of 0.961.

Conclusions
The simple and noninvasive breathomics-based PTB detection method was demonstrated with high sensitivity and specificity, potentially valuable for clinical PTB screening and diagnosis.
Modelling the impact of combining HIV prevention interventions on HIV dynamics in fishing communities in Uganda
Authors: Kremer Cécile , Kamali Anatoli , Kuteesa Monica , Seeley Janet , Hens Niel , Nsubuga Rebecca N 
Published: March 2023

Abstract
Background
In countries with mature generalized HIV epidemics such as Uganda, there are still groups of individuals that are disproportionately affected. Among the key populations in Uganda are fishing communities, which make up about 10% of the population. Compared to the general population, HIV prevalence and incidence among individuals living in these communities is high. This high HIV burden has been attributed to several factors including limited access to prevention and treatment services as well as ongoing high-risk sexual behaviour.

Methods
We investigated the impact of combined HIV prevention interventions on HIV transmission dynamics in high-risk fishing communities in Uganda using a deterministic compartmental model. The model was calibrated to seroprevalence data from a census performed in 2014. To account for remaining uncertainty in the calibrated model parameters, 50 000 simulated scenarios were modelled to investigate the impact of combined prevention interventions.

Results
The projected HIV incidence decreased from 1.87 per 100 PY without intervention scale-up to 0.25 per 100 PY after 15 years (2014–2029) of intervention scale-up. A potential combination achieving this 87% reduction in incidence over 15 years in Ugandan FCs included condom use in about 60% of sexual acts, 23% of susceptible men circumcised, 87% of people living with HIV aware of their status, 75% of those on ART, and about 3% of susceptible individuals on oral PrEP. Uncertainty analysis revealed relative reductions in incidence ranging from 30.9 to 86.8%. Sensitivity analyses suggested that condom use and early ART were the most important interventions.

Conclusion
Reducing HIV incidence, as well as prevalence and AIDS-related mortality, in these high-risk fishing communities in Uganda is attainable over 15 years with a combination prevention package. Our projected intervention coverage levels are well within the national targets set by the Uganda government and enable coming close to reaching the UNAIDS 95-95-95 targets to end AIDS as a public health threat by 2030.
Co-morbidity associated with development of severe COVID-19 before vaccine availability: a retrospective cohort study in the first pandemic year among the middle-aged and elderly in Jönköping county, Sweden
Authors: Nordvall Dennis , Drobin Dan , Timpka Toomas , Hahn Robert G. 
Published: March 2023

Abstract
Background
In preparation of future pandemics, it is important to recognise population-level determinants associated with development of severe illness before efficient vaccines and evidence-based therapeutic measures are available. The aim of this study was to identify pre-pandemic diagnoses recorded in a middle-aged and elderly population that were associated with development of severe COVID-19 during the first pandemic year.

Methods
A cohort study design was used. Severe COVID-19 was defined as a course of illness that resulted in hospital admission or death. A retrospective analysis was performed that comprised all individuals aged 39 years and older (N = 189,951) living in Jönköping County, Sweden. All diagnosed morbidity recorded in contacts with health care during the pre-pandemic year 2019 was used to identify which diagnoses that were associated with development of severe COVID-19 in the first pandemic year 2020. The analyses were performed separately for each diagnosis using binary logistic regression with adjustment for sex and age.

Results
Severe COVID-19 was suffered by 0.67% (N = 1,280) of the middle-aged and elderly population in the first pandemic year. Individuals previously diagnosed with dementia, cerebral palsy, kidney failure, type 2 diabetes mellitus, hypertension, and obesity were at higher risk of developing severe COVID-19. For patients with Type 2 diabetes mellitus, the odds ratio (OR) was 2.18 (95% confidence interval, 1.92–2.48). Type 1 diabetes mellitus was not associated with increased risk.

Conclusion
Diagnoses suggesting service provision at long-term healthcare facilities and co-morbidity with components of the metabolic syndrome were associated with an increased risk of developing severe COVID-19 in a middle-aged and elderly population before vaccines were available.
Incidence, accuracy, and barriers of diagnosing healthcare-associated infections: a case study in southeast Iran
Authors: Nasiri Naser , Sharifi Ali , Ghasemzadeh Iman , Khalili Malahat , Karamoozian Ali , Khalooei Ali , Beigzadeh Amin , Haghdoost AliAkbar , Sharifi Hamid 
Published: March 2023

Abstract
Background
Healthcare-associated infections (HAIs) are a threat to patients. Accurate surveillance is required to identify and prevent HAIs. To estimate the incidence rate, report the accuracy and identify the barriers of reporting HAIs using a mixed-method study.

Methods
In this quantitative study, we externally evaluated the incidence rate and accuracy of the routine surveillance system in one of the main hospitals by an active follow-up of patients from September to December 2021. We used in-depth interviews with 18 experts to identify the barriers of the routine surveillance system.

Results
Among 404 hospitalized patients, 88 HAIs were detected. The estimated rate of HAIs was 17.1 (95% Confidence Intervals 95: 14.1, 21.1) per 1000 patient-days follow-up. However, in the same period, 116 HAIs were reported by the routine surveillance system, but the agreement between the two approaches was low (sensitivity = 61.4%, specificity = 82.6%, negative predictive value = 89.7%, and positive predictive validity = 46.5%). The minimum and maximum positive predictive values were observed in urinary tract infection (32.3%) and surgical site infection (60.9%). The main barrier of reporting HAIs was lack of cooperation in reporting HAIs by infection control link nurses and laboratory supervisors.

Conclusions
The discrepancy between the longitudinal study findings and the routine surveillance might be related to the inaccessibility of the surveillance system to clinical information of patients. In this regard, decreasing the barriers, increasing the knowledge of infection control nurses and other nurses, as well as the development of hospital information systems are necessary.
Core genome sequencing and genotyping of Leptospira interrogans in clinical samples by target capture sequencing
Authors: Grillova Linda , Cokelaer Thomas , Mariet Jean-François , da Fonseca Juliana Pipoli , Picardeau Mathieu 
Published: March 2023

Abstract
Background
The life-threatening pathogen Leptospira interrogans is the most common agent of leptospirosis, an emerging zoonotic disease. However, little is known about the strains that are currently circulating worldwide due to the fastidious nature of the bacteria and the difficulty to isolate cultures. In addition, the paucity of bacteria in blood and other clinical samples has proven to be a considerable challenge for directly genotyping the agent of leptospirosis directly from patient material. Our understanding of the genetic diversity of strains during human infection is therefore limited.

Methods
Here, we carried out hybridization capture followed by Illumina sequencing of the core genome directly from 20 clinical samples that were PCR positive for pathogenic Leptospira to elucidate the genetic diversity of currently circulating Leptospira strains in mainland France.

Results
Capture with RNA probes covering the L. interrogans core genome resulted in a 72 to 13,000-fold increase in pathogen reads relative to standard sequencing without capture. Variant analysis of the genomes sequenced from the biological samples using 273 Leptospira reference genomes was then carried out to determine the genotype of the infecting strain. For samples with sufficient coverage (19/20 samples with coverage > 8×), we could unambiguously identify L. interrogans serovars Icterohaemorrhagiae and Copenhageni (14 samples), L. kirschneri serovar Grippotyphosa (4 samples), and L. interrogans serovar Pyrogenes (1 sample) as the infecting strains.

Conclusions
We obtained high-quality genomic data with suitable coverage for confident core genome genotyping of the agent of leptospirosis for most of our clinical samples. The recovery of the genome of the serovars Icterohaemorrhagiae and Copenhageni directly from multiple clinical samples revealed low adaptive diversification of the core genes during human infection. The ability to generate culture-free genomic data opens new opportunities for better understanding of the epidemiology of this fastidious pathogen and pathogenesis of this neglected disease.