bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare-seeking delays and associated factors among immigrant patients with acute ischaemic stroke in Shenzhen: a retrospective observational study
Authors: Li Changyu , Wu Zongbi , Jiang Youli , Zhao Qingshi , Li Yanfeng 
Published: January 2025

ObjectiveTo examine healthcare-seeking delays among immigrant patients with acute ischaemic stroke (AIS), identifying key factors contributing to these delays and proposing evidence-based interventions for policy formulation and research.DesignA retrospective observational study analysing healthcare-seeking behaviours and delay times among immigrant patients with AIS treated at the Department of Neurology, Longhua District People’s Hospital, Shenzhen, from December 2021 to October 2023. The study included 1356 patients with AIS, all part of the immigrant population as defined by Shenzhen Statistical Yearbook criteria. The study investigated sociodemographic, clinical data and stroke-specific scales (modified Rankin Scale, National Institutes of Health Stroke Scale, Glasgow Coma Scale) to identify factors influencing delays.SettingThe study was conducted in Shenzhen, a city characterised by a significant immigrant population, providing insights applicable to urban regions with similar demographics.ResultsOf the 1356 patients studied, 82.6% (n=1120) experienced healthcare-seeking delays, with a median delay of 12.67 hours (IQR: 3.5–28.8). Factors associated with prolonged delays included lack of stroke awareness (92.96% delay rate), low educational attainment, self-transportation to the hospital (adjusted OR (aOR): 2.36, 95% CI: 1.57 to 3.54) and wake-up strokes (aOR: 4.37, 95% CI: 2.28 to 8.36). Conversely, factors associated with shorter delays included cardioembolic strokes (aOR: 0.50, 95% CI: 0.28 to 0.90) and atrial fibrillation (aOR: 0.45, 95% CI: 0.23 to 0.89). Delay rates were significantly lower among patients referred by emergency medical services compared with those self-transporting. These findings highlight the influence of clinical, socioeconomic and demographic factors on delays in seeking care.ConclusionHealthcare-seeking delays in stroke care among immigrants, shaped by awareness, socioeconomic and clinical factors, necessitate urgent educational, policy and healthcare reforms. Enhancing early symptom recognition and promoting emergency service utilisation are essential for improving access to care and outcomes in this vulnerable group.
Cohort profile: Swedish families of the 1990s (SWIFT90)
Authors: Straatmann Viviane S. , Rajesh Tanishta , Jackisch Josephine , Almquist Ylva B. 
Published: January 2025

PurposeThe Swedish Families of the 1990s (SWIFT90) is a population-based national register cohort that follows everyone born between 1990 and 1999, their parents and siblings. The cohort was set up primarily to investigate factors associated with biological parents’ involvement with child welfare services and their outcomes following child(ren) placement in out-of-home care (OHC) under the research project ‘Drivers of inequalities of families involved in child welfare services (DRIVERS)’.ParticipantsThis cohort is defined as families consisting of parents and their children, of which at least one was born between 1990 and 1999 in Sweden, which totals 1 075 037 children. The children are linked to both (adoptive or biological) parents and their siblings, so the total number of individuals in the SWIFT90 yields a total sample of n=3 292 417. These families are followed through multiple national registers including information on income, education, inpatient care, mortality and criminal offences. SWIFT90 compiles administrative data spanning from 1960 to 2022, which reflects the most recent data available at the time of the data request.Findings to dateSWIFT90 provides information on 61 982 parents (fathers=31 028; mothers=30 954) with children placed in OHC and their respective children (38,084). Several covariates could be assessed for the parental generation, therefore, providing a comprehensive picture of socioeconomic and health-related aspects of families with children born in the 1990s and placed in OHC in Sweden.Future plansSWIFT90 will be used to investigate the socioeconomic and health trajectories of families involved with the child welfare system. With this cohort study ia possible to examine whether the inclusion of certain covariates alters the association between parental characteristics and child welfare outcomes. Future studies could also guide initiatives to prevent vulnerable circumstances among biological parents from escalating to the point where child placement into OHC becomes necessary. Additionally, they could help enhance the conditions of biological families and support opportunities for reunification after placement has occurred.
Association between the intensity of statin therapy and physical activity 1 year after acute coronary syndrome: a multicentre prospective cohort study in Switzerland
Authors: Boudon Alex , Locatelli Isabella , Gencer Baris , Carballo David , Klingenberg Roland , Räber Lorenz , Windecker Stephan , Rodondi Nicolas , Lüscher Thomas , Matter Christian M , Mach François , Muller Olivier , Nanchen David 
Published: January 2025

ObjectivesTo assess the association between the intensity of statin therapy and the level of physical activity in patients 1 year after an acute coronary syndrome (ACS).DesignProspective cohort study from the Special Program University Medicine-Acute Coronary Syndromes.SettingFour university hospital centres in Switzerland.Participants2274 patients with a main diagnosis of ACS between 2009 and 2017 who were available for a 1-year follow-up visit 1 year after hospital discharge.Outcome measuresSelf-reported physical activity was assessed with the International Physical Activity Questionnaire. The level of physical activity in metabolic equivalent-minutes per week (MET-min/week) was first stratified into sedentary and physically active categories and then analysed continuously among physically active patients. Analyses were performed using a propensity score weighting approach.ResultsOne year after ACS, 1222 (53.7%) patients were on high-intensity statin therapy, 890 (39.1%) were on low/moderate-intensity statin therapy and 162 (7.1%) were not on statin therapy. Compared with non-statin users, low-/moderate-intensity statin users and high-intensity statin users were more likely to be physically active than sedentary, with a fully adjusted OR of 2.86 (95% CI 1.12 to 7.26) and 4.52 (95% CI 1.68 to 12.20), respectively. Among physically active patients, physical activity level was similar across all statin user categories, with median levels of 2792.5, 2712.0 and 2839.5 MET-min/week in non-statin, moderate/low-statin and high-statin users, respectively (p=0.307).ConclusionsOne year after ACS, neither low-/moderate-intensity nor high-intensity statin uses were associated with reduced self-reported physical activity compared with non-statin use. The concern that statin therapy may impair physical activity among ACS patients was not confirmed in this study.
Development and external validation of the SMA2SH2ERS risk prediction model for aneurysmal subarachnoid haemorrhage in the general population: a population-based prospective cohort study
Authors: Klieverik Vita M. , Kanning Jos P. , Rissanen Ina L. , Rannikmae Kristiina , Martinsen Amy E. , Winsvold Bendik S. , Geerlings Mirjam I. , Ruigrok Ynte M. 
Published: January 2025

ObjectivesAneurysmal subarachnoid haemorrhage (ASAH) is a severe stroke type, preventable by screening for intracranial aneurysms followed by treatment in high-risk individuals. We aimed to develop and validate a risk prediction model for ASAH in the general population to identify high-risk individuals.DesignWe used the population-based prospective cohort studies of the United Kingdom (UK) Biobank for model development and the Trøndelag Health (HUNT) Study for model validation.ParticipantsParticipants missing data were excluded. A total of 456 856 individuals from the UK Biobank and 46 483 individuals from the HUNT Study were included.Primary and secondary outcome measuresIncident ASAH identified using the International Classification of Diseases codes, ICD-9 430 and ICD-10 I600 to I609 codes.ResultsIn the development cohort, ASAH occurred in 738 (0.2%) during 5 407 909 person-years of follow-up. We developed a multivariable Cox regression model to identify predictors for ASAH. Predictive performance was assessed using discrimination and calibration, and we corrected for overfitting using bootstrapping techniques. Predictors for ASAH were sex (S), diabetes mellitus (M), age and alcohol consumption (A2), smoking (S), hypertension and hypercholesterolaemia (H2), educational attainment (E), regular physical activity (R) and family history of stroke (S; SMA2SH2ERS), and multiple interactions between these predictors. The concordance statistic (c-statistic) of the model in the development cohort was 0.62 (95% CI 0.60 to 0.64). Predicted absolute 10-year ASAH risk varied from 0.042% to 0.52%. In the validation cohort, 220 individuals developed ASAH, and the c-statistic of this model was 0.64 (95% CI 0.58 to 0.69). Both models showed reasonable calibration.ConclusionsOur SMA2SH2ERS model provides ASAH risk estimates between 0.042% and 0.52% for the general population. While overall ASAH risk is low, the model identifies individuals with up to 12 times increased risk compared with those at the lowest risk.
Effect of metformin on the clinical outcomes of stroke in patients with diabetes: a systematic review and meta-analysis
Authors: Liu Jianyi , Huang Zhihua , Luo Fuqun , Guo Yizhi , Li Yandeng , Wen Jun , Zhu Jianming 
Published: January 2025

ObjectivesStroke is a major cause of death and disability globally, especially among diabetic patients. In this study, we aim to scrutinise the effects of metformin on the clinical outcomes of stroke in diabetic patients.DesignThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesPubMed, Embase and Web of Science databases were searched between their inception and 5 December 2023.Eligibility criteria for selecting studiesStudies investigating the effect of metformin on the clinical outcomes of stroke in patients with diabetes were included.Data extraction and synthesisThe effect of metformin on the clinical outcomes of stroke in patients with diabetes was identified using combined ORs and 95% CIs.ResultsA total of 11 studies involving 18 525 participants were included in this review. Pooled analysis has demonstrated that prestroke metformin use could reduce the probability of poor course after stroke by 34% in diabetes mellitus (DM) patients (OR=0.66, 95% CI: 0.61 to 0.72) and reduce the probability of death by 43% (OR=0.57, 95% CI: 0.51 to 0.64).ConclusionsPrestroke metformin use is beneficial for the improvement of clinical outcomes in patients who had a stroke with DM, although the potential bias should be carefully considered.PROSPERO registration numberCRD42024496056.
Subnational trends and inequalities of under-immunisation and zero-dose among children aged 12–23 months in Uganda: a national population-based cross-sectional study
Authors: Wasswa Ronald , Kananura Rornald Muhumuza , Waiswa Peter , Requejo Jennifer Harris , Santos Thiago M , Barros Aluisio J D 
Published: January 2025

ObjectiveDespite the Global Vaccine Action Plan’s goal of at least 90% vaccine coverage for all children, Uganda has made limited progress in vaccination over the past decade. The objective of this study was to examine the subnational trends in the prevalence and inequalities in under-immunisation and zero-dose among children aged 12–23 months in Uganda.Study designA retrospective national cross-sectional study.SettingUgandaParticipantsUganda Demographic and Health Survey secondary data of only children aged 12–23 months. The samples selected for analyses were 1507 in 2006, 1409 in 2011 and 2650 children in 2016.Outcome measureThe primary outcomes were under-immunisation and zero-dose vaccination.Absolute and relative inequality measures were used in the analysis.ResultsFrom 2006 to 2016, the under-vaccination rate decreased by 21%, but remained high at 40.8%. The zero-dose vaccination rate dropped by 82%, affecting 1.2% of children in 2016. Subnational inequalities in under-vaccination increased over time with widening gaps between regions. While inequalities across wealth quintiles, maternal education levels and places of residence narrowed, children of mothers with lower education levels continued to have the highest under-vaccination rates. The rural–urban gap for zero-dose vaccination remained unchanged, with rural children disproportionately impacted.ConclusionWhile some progress was made in reducing under-vaccination rates in Uganda within the study period, no region achieved an under-vaccination rate below 20%. This indicates significant challenges in reaching the Sustainable Development Goal target of at least 80% immunisation coverage. Targeted interventions are necessary to improve healthcare access, enhance public health communication and strengthen the health system, particularly in underserved communities and among vulnerable populations.
Experiences and opinions of adults with type 1 diabetes on the android-based open-source closed-loop system in China: a qualitative study
Authors: Huang Qingying , Ni Ying , Lei Mengyun , Ling Ping , Yan Jinhua , Guo Xiaodi , Yang Daizhi , Wang Chaofan 
Published: January 2025

Objective
As an emerging technology, Android-based open-source closed-loop system also called Android Artificial Pancreas System (AAPS), has been increasingly validated by evidence for its effectiveness in improving glycaemic outcomes, positioning it as a crucial option for managing type 1 diabetes (T1D). However, there are still only a few studies examining the experiences of using AAPS, and relevant qualitative studies have not been conducted in Asia so far. This study aimed to explore the experiences and opinions of adult patients with T1D on the AAPS.

Design
Semi-structured interviews and the Insulin Dosing Systems: Perceptions, Ideas, Reflections and Expectations questionnaires were conducted among patients. The questionnaire was scored on a 100-point scale. Thematic analysis was adopted to analyse the transcribed text. Recruitment of interviewees would be halted when no new themes emerged. The scores of the questionnaire on AAPS satisfaction were calculated, and the Mann-Whitney U test was used to compare the results of different sections of the questionnaire.

Setting
Guangdong Province in China.

Participants
This study recruited patients with T1D from the Guangdong T1D translational medicine study and the ‘Tang Tang Quan’ T1D online community in China, who participated in a clinical trial on the efficacy and safety of AAPS.

Results
The study interviewed 20 adults with T1D aged 32±9.94 years. The T1D duration was 10.93±6.26 years and the glycated haemoglobin was 7.38±0.53%. Five main themes were identified: (1) expectations and feedback on AAPS; (2) impact on quality of life; (3) impact on blood glucose management; (4) user experiences; (5) suggestions for AAPS. The average score of AAPS satisfaction was 73.69 (65.94, 85.94). Mann-Whitney U test suggested that the satisfaction derived from glucose management with AAPS surpassed the satisfaction attributed to the enhancement of their overall quality of life (p<0.05).

Conclusions
Adults with T1D had generally positive experiences with AAPS. The future focus of AAPS research and development should be on optimising glycaemic management, improving device experience and reducing costs.

Trial registration number

NCT05726461; Pre-results
.
Examining the Mediating Role of Grit and Self‐Efficacy in the Association Between Growth Mindset and Job Satisfaction in a Sample of Chinese Nurses
Authors: Zhang Xiaoyan , Qiu Chen , Li Xiaolin , Shekara Aniruddha , Suo Xueling , Wang Song 
Published: January 2025

Aims: This study aimed to explore the relationship between growth mindset and job satisfaction among Chinese nurses, and to examine the underlying mediating role of grit and self‐efficacy in this relationship.Background: As a long‐standing research topic in nursing management, job satisfaction plays an essential role in patient care, healthcare organizations, and nurses’ career planning and development. Therefore, it is extremely important to explore the psychosocial factors that contribute to nurses’ job satisfaction.Design: A descriptive, cross‐sectional survey design was used.Methods: Data were collected from 709 nurses during the COVID‐19 pandemic in southwest of China by using standard measures of growth mindset, grit, self‐efficacy, and job satisfaction. Models 4 and 6 in the SPSS PROCESS 3.2 macroprogram were used to analyze the mediating effects.Results: We found a positive relationship between Chinese nurses’ growth mindset and their job satisfaction; grit and self‐efficacy played a mediating role in this relationship. Moreover, there was a significant chain mediating effect of grit and self‐efficacy on the relationship between growth mindset and job satisfaction.Conclusions: Our study highlights the complex interactions among growth mindset, grit, self‐efficacy, and job satisfaction by revealing that grit and self‐efficacy serve as parallel and sequential mediators in the link between growth mindset and job satisfaction among Chinese nurses.Implications for Nursing Management: Nursing administrators can attempt to promote nurses’ growth mindset and enhance their grit and self‐efficacy, thereby improving job satisfaction.Reporting Method: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria were used to report the survey results.
Prognostic Implications of Sex in Patients With Heart Failure With Mildly Reduced Ejection Fraction: Results From a Large‐Scaled Registry
Authors: Reinhardt Marielen , Behnes Michael , Weidner Kathrin , Abumayyaleh Mohammad , Lau Felix , Schmitt Alexander , Abel Noah , Duerschmied Daniel , Weiß Christel , Akin Muharrem , Akin Ibrahim , Schupp Tobias 
Published: January 2025

Background
The study investigates the prognostic impact of sex and sex‐related differences in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). More data regarding the characterization of patients and their outcomes in the presence of HFmrEF are needed.

Methods and Results

Consecutive patients hospitalized with HFmrEF (ie, left ventricular ejection fraction 41%–49% and signs or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Female patients were compared with male patients with regard to the primary end point of all‐cause mortality at 30 months (median follow‐up). Statistical analyses comprised Kaplan–Meier, multivariable Cox proportional regression analyses and propensity score matching. From a total of 2184 patients hospitalized with HFmrEF, 64.6% were male. Female patients with HFmrEF were older than male patients (median age 78 versus 73 years;
P
=0.001) and had lower rates of ischemic cardiomyopathy (46.6% versus 63.6%;
P
=0.001). Within the entire study cohort, sex was not associated with the risk of all‐cause mortality (hazard ratio [HR], 0.931 [95% CI, 0.797–1.088];
P
=0.372). However, male sex was associated with a lower risk of HF‐related rehospitalization at 30 months (HR, 0.761 [95% CI, 0.600–0.966];
P
=0.026), which was confirmed after multivariable adjustment (HR, 0.759 [95% CI, 0.592–0.973];
P
=0.029) and propensity score matching (HR, 0.722 [95% CI, 0.539–0.967];
P
=0.029).

Conclusion
Although almost two thirds of patients hospitalized with HFmrEF were male, sex was no predictor for the risk of all‐cause mortality at 30 months. However, female sex was associated with a higher risk of HF‐related rehospitalization.

Registration
URL: https://clinicaltrials.gov; Unique identifier: NCT05603390.
Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes
Authors: Masri Ahmad , Chen Yong , Colavecchia A. Carmine , Benjumea Darrin , Crowley Aaron , Jhingran Priti , Kent Matthew , Wogen Jenifer , Pankratova Cindi , Jimenez Alvir Jose Maria , Bhambri Rahul 
Published: January 2025

Background
The coexistence of transthyretin cardiac amyloidosis (ATTR‐CA) and aortic stenosis (AS) is increasingly recognized, but the clinical consequences are unclear. We aimed to characterize clinical outcomes in AS plus ATTR‐CA compared with only AS or ATTR‐CA.

Methods and Results

In a retrospective cohort study, patients with AS only, ATTR‐CA only, or AS plus ATTR‐CA were identified using all‐payer claims data (2015–2021). Eligible patients had ≥1 claim for AS or cardiac amyloidosis (excluding light‐chain cardiac amyloidosis); were aged ≥60 years; and were continuously enrolled in medical plans for ≥6 months after diagnosis. Ad hoc subanalyses were conducted in patients with aortic valve replacement at first diagnosis (surrogate for severe AS). Of 355 430 eligible patients, 345 771 (97.3%), 8453 (2.4%), and 1239 (0.3%) were included in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts, respectively; 41 312 (11.9%), 14 (0.2%), and 212 (17.1%) had aortic valve replacement. Two‐year mortality rates were 16.1% (95% CI, 15.9–16.2), 14.8% (95% CI, 13.9–15.7), and 19.2% (95% CI, 16.9–21.8) in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts; heart failure hospitalization rates were 29.4% (95% CI, 29.2–29.5), 22.8% (95% CI, 21.9–23.8), and 48.7% (95% CI, 45.7–51.7). AS plus ATTR‐CA was associated with increased risk of death (HR, 1.3 [95% CI, 1.1–1.4];
P
<0.0001) and heart‐failure hospitalization (HR, 1.9 [95% CI, 1.8–2.1];
P
<0.0001) versus AS alone. In the aortic valve replacement subgroup, AS plus ATTR‐CA was associated with an increased mortality rate (HR, 1.4 [95% CI, 1.1–1.8];
P
=0.003) but not heart failure hospitalization (HR, 1.1 [95% CI, 0.9–1.3];
P
=0.07) versus AS only.

Conclusions
Patients with AS plus ATTR‐CA experience worse clinical outcomes than patients with AS only. Increased awareness of these coexisting conditions may help facilitate earlier screening and improve prognosis.