bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social Withdrawal, Loneliness, and Health in Schizophrenia: Psychological and Neural Mechanisms
Authors: Fulford Daniel , Holt Daphne J 
Published: July 2023

Abstract

Background and Hypothesis
Some of the most debilitating aspects of schizophrenia and other serious mental illnesses (SMI) are the impairments in social perception, motivation, and behavior that frequently accompany these conditions. These impairments may ultimately lead to chronic social disconnection (ie, social withdrawal, objective isolation, and perceived social isolation or loneliness), which may contribute to the poor cardiometabolic health and early mortality commonly observed in SMI. However, the psychological and neurobiological mechanisms underlying relationships between impairments in social perception and motivation and social isolation and loneliness in SMI remain incompletely understood.

Study Design
A narrative, selective review of studies on social withdrawal, isolation, loneliness, and health in SMI.

Study Results
We describe some of what is known and hypothesized about the psychological and neurobiological mechanisms of social disconnection in the general population, and how these mechanisms may contribute to social isolation and loneliness, and their consequences, in individuals with SMI.

Conclusions
A synthesis of evolutionary and cognitive theories with the “social homeostasis” model of social isolation and loneliness represents one testable framework for understanding the dynamic cognitive and biological correlates, as well as the health consequences, of social disconnection in SMI. The development of such an understanding may provide the basis for novel approaches for preventing or treating both functional disability and poor physical health that diminish the quality and length of life for many individuals with these conditions.
Exploring Nurse Practitioner Students’ Perceptions of a Sleep e-Learning Program
Authors: Watach Alexa J. , McPhillips Miranda V. , Saconi Bruno , Lang-Gallagher Rebecca , Lyons M. Melanie , Renz Susan M. , Rosen Ilene M. , Sawyer Amy M. 
Published: July 2023

Abstract

AIM
The aim of this study was to explore nurse practitioner (NP) students’ perceptions of a sleep e-learning program.

BACKGROUND
Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis.

METHOD
The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis.

RESULTS
Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices.

CONCLUSION
NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.
Pregnancy-Associated Stroke and Outcomes Related to Timing and Hypertensive Disorders
Authors: Bitar Ghamar , Sibai Baha M. , Chen Han-Yang , Neff Natalie , Blackwell Sean , Chauhan Suneet P. , Bartal Michal Fishel 
Published: July 2023

OBJECTIVE:
To estimate temporal trends of stroke in the peripartum period and to assess the relationship between stroke and maternal adverse outcomes vis-à-vis timing and hypertension.

METHODS:
We conducted a retrospective, cross-sectional study using the National Inpatient Sample to identify hospitalizations with pregnancy-associated stroke in the United States (2016–2019). Temporal trends in pregnancy-associated stroke were examined according to timing of stroke (antepartum vs postpartum) and both prepregnancy and pregnancy hypertensive disorders (yes vs no). Multivariable Poisson regression models with robust error variance were used to examine the association among maternal adverse outcomes, timing of stroke, and hypertensive disorders.

RESULTS:
Among 15,977,644 pregnancy hospitalizations, 6,100 hospitalizations (38.2/100,000 hospitalizations) were with pregnancy-associated stroke. Of these, 3,635 (59.6%) had antepartum pregnancy-associated stroke and 2,465 (40.4%) had postpartum pregnancy-associated stroke; alternatively, 2,640 (43.3%) had hypertensive disorders, and 3,460 (56.7%) were without hypertensive disorders. From 2016 to 2019, the overall rate of pregnancy-associated stroke (37.5 to 40.8/100,000 pregnancy hospitalizations, P=.028), rate of postpartum pregnancy-associated stroke (14.6 to 17.6/100,000 pregnancy hospitalizations, P=.005), and rate of pregnancy-associated stroke with hypertensive disorders (14.9 to 17.2/100,000 pregnancy hospitalizations, P=.013) increased. Antepartum pregnancy-associated stroke and pregnancy-associated stroke without hypertensive disorders, however, remained stable. Despite higher risk of maternal morbidity in postpartum stroke hospitalizations, including mechanical ventilation and pneumonia, there was no significant difference in in-hospital mortality between antepartum and postpartum stroke. Similarly, between pregnancy-associated stroke with hypertensive disorders and stroke without hypertensive disorders, an increased risk of mechanical ventilation, seizure, and prolonged hospital stay was seen for stroke with hypertensive disorders without an increase in mortality.

CONCLUSION:
A nationally representative sample of hospitalizations in the United States indicates an increasing trend in the rate of postpartum stroke. Almost half of hospitalizations with pregnancy-associated stroke have concomitant hypertensive disorders. Risk of adverse outcomes, but not mortality, is elevated in patients with stroke occurring in the postpartum period and stroke associated with hypertensive disorders.
Role of Maternal Age in Increasing Severe Maternal Morbidity Rates in the United States
Authors: Berger Blair O. , Jeffers Noelene K. , Wolfson Carrie , Gemmill Alison 
Published: July 2023

OBJECTIVE:
To evaluate a commonly proposed explanation for increasing rates of severe maternal morbidity (SMM) in the United States: shifts in the birthing population to older maternal ages, a known risk factor for SMM.

METHODS:
We conducted a cross-sectional analysis comparing delivery hospitalizations from two time points (2008–2009 to 2017–2018) using hospital discharge data from the National Inpatient Sample. We used demographic decomposition techniques to evaluate whether increasing rates of SMM and nontransfusion SMM were explained by population-level increases in maternal age or changes in age-specific rates. Analyses were stratified by race and ethnicity.

RESULTS:
Rates of SMM and nontransfusion SMM significantly increased in the United States between 2008 and 2018 from 135.6 to 170.5 and 58.8 to 67.9 per 10,000 delivery hospitalizations, respectively, with increases observed for nearly all racial and ethnic groups. Over this same period, the proportion of births to people younger than age 25 years decreased and births to people of advanced maternal age (35 years and older) increased, with the largest increases occurring among people identified as non-Hispanic American Indian/Alaskan Native (9.8–13.0%), non-Hispanic Black (10.7–14.4%), and Hispanic (12.1–17.1%). Decomposition analyses indicated that the changing maternal age distribution had little effect on SMM trends. Rather, increases in SMM and nontransfusion SMM were primarily driven by increases in age-specific SMM rates, including rising rates among younger people. Contributions of maternal age shifts were minimal for all racial and ethnic groups except among non-Hispanic Black people, for which 17–34% of the rise in SMM was due to increasing maternal age.

CONCLUSION:
Except among certain racial groups, increases in U.S. population-level SMM rates over the past decade were due to increases in age-specific rates rather than shifts to older maternal age among the birthing population. Increasing SMM rates across the maternal age spectrum could indicate worsening prepregnancy health status of the birthing population.
Association Between Adult-Onset Hearing Loss and Income: A Systematic Review
Authors: Mossman Audrey , DeMario Virgil K. , Price Carrie , Seal Stella M. , Willink Amber , Reed Nicholas S. , Nieman Carrie L. 
Published: July 2023

Introduction:
Hearing loss has been shown to be associated with both negative health outcomes and low socioeconomic position, including lower income. Despite this, a thorough review of the existing literature on this relationship has not yet been performed.

Objectives:
To evaluate available literature on the possible association between income and adult-onset hearing loss.

Design:
A search was conducted in eight databases for all relevant literature using terms focused on hearing loss and income. Studies reporting the presence or absence of an association between income and hearing loss, full-text English-language access, and a predominantly adult population (≥18 years old) were eligible. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias.

Results:
The initial literature search yielded 2994 references with three additional sources added through citation searching. After duplicate removal, 2355 articles underwent title and abstract screening. This yielded 161 articles eligible for full-text review resulting in 46 articles that were included in qualitative synthesis. Of the included studies, 41 of 46 articles found an association between income and adult-onset hearing loss. Due to heterogeneity among study designs, a meta-analysis was not performed.

Conclusions:
The available literature consistently supports an association between income and adult-onset hearing loss but is limited entirely to cross-sectional studies with the directionality remaining unknown. An aging population and the negative health outcomes associated with hearing loss, emphasize the importance of understanding and addressing the role of social determinants of health in the prevention and management of hearing loss.
Predictors of Susceptibility to Noise and Speech Masking Among School-Age Children With Hearing Loss or Typical Hearing
Authors: Lalonde Kaylah , Walker Elizabeth A. , Leibold Lori J. , McCreery Ryan W. 
Published: July 2023

Objectives:
The purpose of this study was to evaluate effects of masker type and hearing group on the relationship between school-age children’s speech recognition and age, vocabulary, working memory, and selective attention. This study also explored effects of masker type and hearing group on the time course of maturation of masked speech recognition.

Design:
Participants included 31 children with normal hearing (CNH) and 41 children with mild to severe bilateral sensorineural hearing loss (CHL), between 6.7 and 13 years of age. Children with hearing aids used their personal hearing aids throughout testing. Audiometric thresholds and standardized measures of vocabulary, working memory, and selective attention were obtained from each child, along with masked sentence recognition thresholds in a steady state, speech-spectrum noise (SSN) and in a two-talker speech masker (TTS). Aided audibility through children’s hearing aids was calculated based on the Speech Intelligibility Index (SII) for all children wearing hearing aids. Linear mixed effects models were used to examine the contribution of group, age, vocabulary, working memory, and attention to individual differences in speech recognition thresholds in each masker. Additional models were constructed to examine the role of aided audibility on masked speech recognition in CHL. Finally, to explore the time course of maturation of masked speech perception, linear mixed effects models were used to examine interactions between age, masker type, and hearing group as predictors of masked speech recognition.

Results:
Children’s thresholds were higher in TTS than in SSN. There was no interaction of hearing group and masker type. CHL had higher thresholds than CNH in both maskers. In both hearing groups and masker types, children with better vocabularies had lower thresholds. An interaction of hearing group and attention was observed only in the TTS. Among CNH, attention predicted thresholds in TTS. Among CHL, vocabulary and aided audibility predicted thresholds in TTS. In both maskers, thresholds decreased as a function of age at a similar rate in CNH and CHL.

Conclusions:
The factors contributing to individual differences in speech recognition differed as a function of masker type. In TTS, the factors contributing to individual difference in speech recognition further differed as a function of hearing group. Whereas attention predicted variance for CNH in TTS, vocabulary and aided audibility predicted variance in CHL. CHL required a more favorable signal to noise ratio (SNR) to recognize speech in TTS than in SSN (mean = +1 dB in TTS, −3 dB in SSN). We posit that failures in auditory stream segregation limit the extent to which CHL can recognize speech in a speech masker. Larger sample sizes or longitudinal data are needed to characterize the time course of maturation of masked speech perception in CHL.
Association of Neighborhood Socioeconomic Deprivation with Utilization and Costs of Anterior Cervical Discectomy and Fusion
Authors: Lizzappi Malcolm , Bronheim Rachel S. , Raad Micheal , Hicks Caitlin W. , Skolasky Richard L. , Riley Lee H. , Lee Sang H. , Jain Amit 
Published: July 2023

Study Design.
Retrospective analysis

Objective.
The aim of our study was to analyze the association of Area Deprivation Index (ADI) with utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery.

Summary of Background Data.
ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings.

Methods.
The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed.

Results.
A total of 13,362 patients (4,984 inpatient and 8,378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5,974 (44.71%) in ADI2, and 4,987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were: increasing ADI, outpatient surgical setting, non-hispanic ethnicity, current tobacco use, and diagnoses of: obesity, and gastroesophageal reflux disease (GERD). Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/ Medicaid insurance status, and diagnoses of cervical disc herniation or myelopathy. Factors associated with higher costs of care were: increasing ADI, older age, black/ African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease, and cervical myelopathy. Factors associated with lower costs of care were: outpatient surgical setting, female sex, and diagnoses of GERD and cervical disc herniation.

Conclusion.
Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI.

Level of Evidence.
3
Mortality from cerebrovascular diseases in China: Exploration of recent and future trends
Authors: Lv Bin , Song Ge , Jing Feng , Li Mingyu , Zhou Hua , Li Wanjun , Lin Jiacai , Yu Shengyuan , Wang Jun , Cao Xiangyu , Tian Chenglin 
Published: July 2023

Abstract

Background:
Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.

Methods:
We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention's Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models.

Results:
In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/105) and rural areas (123.0/105) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/105), the western region had a slightly lower mortality (123.5/105), and the eastern region had the lowest mortality (97.3/105). The age-specific mortality showed an accelerated upward trend from aged 55–59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02–3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030.

Conclusion:
The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.
Survival benefit and impact of adjuvant chemotherapy following systemic neoadjuvant chemotherapy in patients with resected pancreas ductal adenocarcinoma: A retrospective cohort study
Authors: Pu Ning , Wu Wenchuan , Liu Siyao , Xie Yuqi , Yin Hanlin , Chen Qiangda , He Taochen , Xu Zhihang , Wang Wenquan , Yu Jun , Liu Liang , Lou Wenhui 
Published: July 2023

Background:
Patients with pancreatic ductal adenocarcinoma (PDAC) are increasingly receiving systemic neoadjuvant chemotherapy (NAC), particularly those with borderline resectable and locally advanced disease. However, the specific role of additional adjuvant chemotherapy (AC) in these patients is unknown. The objective of this study is to further assess the clinical benefit and impact of systemic AC in patients with resected PDAC after NAC.

Methods:
Data on PDAC patients with or without AC following systemic NAC and surgical resection were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2006 and 2019. A matched cohort was created using propensity score matching (PSM), and baseline characteristics were balanced to reduce bias. Overall survival (OS) and cancer-specific survival (CSS) were calculated using matching cohorts.

Results:
The study enrolled a total of 1,589 patients, with 623 (39.2%) in the AC group and 966 (51.8%) in the non-AC group (mean age, 64.0 [9.9] years; 766 [48.2%] were females and 823 [51.8%] were males). All patients received NAC, and among the crude population, 582 (36.6%) received neoadjuvant radiotherapy, while 168 (10.6%) received adjuvant radiotherapy. Following the 1:1 PSM, 597 patients from each group were evaluated further. The AC and non-AC groups had significantly different median OS (30.0 vs. 25.0 mo, P=0.002) and CSS (33.0 vs. 27.0 mo, P=0.004). After multivariate Cox regression analysis, systemic AC was independently associated with improved survival (P=0.003, HR=0.782; 95%CI, 0.667-0.917 for OS; P=0.004, HR=0.784; 95%CI, 0.663-0.926 for CSS), and age, tumor grade, and AJCC N staging were also independent predictors of survival. Only patients younger than 65 years old and those with a pathological N1 category showed a significant association between systemic AC and improved survival in the subgroup analysis adjusted for these covariates.

Conclusion:
Systemic AC provides a significant survival benefit in patients with resected PDAC following NAC compared to non-AC patients. Our study discovered that younger patients, patients with aggressive tumors and potentially well response to NAC might benefit from AC to achieve prolonged survival after curative tumor resection.
The safety and efficacy of oral antiviral drug VV116 for treatment of COVID-19: A systematic review
Authors: Xiao Ningkun , Huang Xinlin , Kang Xiaotian , Zang Wanli , Li Bo , Kiselev Sergey 
Published: July 2023

Background:
Recent trials have highlighted the potential of oral antiviral VV116 in the treatment of patients with mild COVID-19. However, no comprehensive studies have assessed the safety and efficacy of VV116. Therefore, we conducted a systematic review to assess the safety and efficacy of VV116.

Methods:
A comprehensive search was conducted on PubMed, Scopus, and Google Scholar websites, with a cutoff date of March 23, to identify pertinent studies.

Results:
The results from the 3 included studies indicated that no serious adverse events were reported in the VV116 experimental groups, which exhibited a 2.57-day faster time to viral shedding than the control group and demonstrated non-inferiority to the nirmatrelvir-ritonavir control group in alleviating major symptoms.

Discussion:
Collectively, available studies suggest a reliable safety and efficacy profile for VV116. However, the limited number of trials was insufficient for meta-analysis, and the included population consisted of younger individuals with mild and moderate symptoms, not encompassing the elderly who are severely affected by COVID-19. We hope that more studies will be conducted in the future to ensure that VV116 has a more reliable safety and efficacy profile in the clinical setting, especially in severe or critical patients.
Case reports of primary lymphedema tarda in South Korea: Two case reports of unilateral primary lymphedema tarda in lower extremities
Authors: Dho Wonsik , Seo Zee Won , Son Ju Hyun , Lee Chang-Hyung 
Published: July 2023

Rationale:
Primary lymphedema is a form of lymphedema marked by a dysfunction of the lymphatic system without preceding medical conditions. One rare subtype of primary lymphedema, lymphedema tarda, occurs in those older than 35 years and is difficult to diagnose. This paper reports 2 cases of unilateral lymphedema tarda in the lower extremities in South Korea.

Patient concerns:
The 2 patients complained of worsening swelling in the lower extremity for several months without any direct surgical or traumatic history related to the inguinal or lower extremity lymphatic system.

Diagnosis:
Primary lymphedema tarda may be determined by ultrasonography. Other vascular or infection-origin causes were excluded from further evaluations.

Interventions:
To confirm primary lymphedema tarda, lymphangiography was performed. In each case, lower extremity lymphangiography indicated dermal backflow and no lymph node uptake at the inguinal node of the affected side, which was compatible with lymphedema.

Outcomes:
The patients reported slight improvement in the symptoms after several weeks of rehabilitation.

Lessons:
This paper is the first report of the unilateral primary lymphedema tarda in South Korea. Further investigations are warranted to find the related etiology of this rare disease and a multimodality regimen is needed for improvement of symptoms.