bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between maternal rectovaginal group B streptococcus and the risk of stillbirth: a meta-analysis
Authors: Wang Yujue , Liu Jingjing , Song Jinlian , Zhang Teng 
Published: January 2025

Background
Group B streptococcus (GBS) colonization in pregnant women is associated with adverse perinatal outcomes, including stillbirth. This meta-analysis investigated the relationship between maternal rectovaginal GBS colonization and the risk of stillbirth.

Methods
We conducted a comprehensive literature search across several databases, including PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure, covering studies published from the inception of the database until September 9, 2024. The search focused on observational studies comparing the risk of stillbirth in pregnant women with and without rectovaginal GBS colonization. Results were summarized using odds ratios (ORs) and 95% confidence intervals (CIs), and a random-effects model was used to account for potential heterogeneity.

Results
A total of ten studies comprising 121,195 pregnant women were included in the analysis. The pooled results indicated no significant overall association between maternal rectovaginal GBS colonization and the risk of stillbirth (OR: 1.66, 95% CI [0.95–2.91], p = 0.08; I2 = 84%). However, sensitivity analyses revealed a significant association in studies that included intrapartum antibiotic prophylaxis (IAP) (OR: 1.36, 95% CI [1.02–1.80], p = 0.03). Subgroup analyses demonstrated a significant association between maternal rectovaginal GBS colonization and stillbirth risk in retrospective studies (OR: 2.62, p = 0.04) and in studies employing multivariate analysis (OR: 2.11, p = 0.04).

Conclusions
While the meta-analysis did not find a significant overall association between maternal rectovaginal GBS colonization and stillbirth, significant associations were noted under specific conditions, such as studies using IAP, retrospective designs, and multivariate analyses. Further research is needed to clarify these associations.
An Investigation of Psychological Factors Determining Credit Card Usage among Young Professionals: Insights from the Banking Sector in Sri Lanka
Authors: Kalinga M. L. , Karunarathna M. M. S. A. , Siriwardhana B. G. L. A. , Gunawardhana K. A. K. 
Published: January 2025

Aims: This study aims to investigate the psychological factors that determine the credit card usage of young banking professionals in Sri Lanka, addressing a critical gap in the literature.
Study Design: This is a quantitative study utilizing Partial Least Square – Structural Equation Modelling (PLS-SEM).
Place and Duration of Study: The study was conducted among young banking professionals in Sri Lanka. Data collection took place over a specified period (please insert the exact dates if available).
Methodology: The study employed a web-based structured questionnaire with responses from 384 young bankers. The questionnaire used a five-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). The analysis focused on the relationships and magnitudes among the dependent variable (Credit Card Usage) and independent constructs (Attitude, Convenience, Financial Optimism, Social Status, and Usage Patterns).
Results: The analysis revealed a positive relationship between Credit Card Usage and the independent constructs. Convenience was found to have the most influential effect on credit card usage among young professional bankers in Sri Lanka. The findings provide valuable insights for financial institutions in shaping their credit card facilities and services specifically for banking professionals.
Conclusion: This study offers significant implications for financial institutions in Sri Lanka. However, the focus on young banking professionals limits the generalizability of the findings to the wider community. Future studies should explore different professional groups to identify psychological insights from various professional demographics in Sri Lanka.
The Role of Company Size Moderating the Effect of Capital Structure and Profitability to Firm Value in Consumer Non-Cyclicals Businesses on the Indonesian Stock Exchange
Authors: Sulistiyo Heru , Sitawati Riana , Sutono  
Published: January 2025

Aims: Study this is about the firm value, aiming to test company size to moderate the influence of capital structure and profitability on the firm value in consumer non-cyclical business listed on the Indonesia Stock Exchange (IDX).
Study Design: The design of this research study is correlational.
Place and Duration of Study: Consumer non-cyclical business on the Indonesia Stock Exchange (IDX) issuers in 2018-2022.
Methodology: This study's population was 122 non-cyclical consumer companies listed on the Indonesia Stock Exchange from 2018 to 2022. From the population, a sample of 56 was selected based on the purposive sampling method with 5 years of observation (2018-2022), so the number of samples was 280. However, there were 18 outlier data, so the final sample was 262. Data were collected using documentary methods and analyzed using a quasi-moderation model, which was processed with SPSS 24.
Results: The study's results indicate that company size can moderate the effect of capital structure and profitability on company value. This means that capital structure and profitability on a larger company scale can strengthen the increase in company value. However, partially or individually, company size, capital structure, and profitability do not affect company value.
Conclusion: The top-based results of the contribution study support the signalling theory and prove that empirical improvement in the size of a company can moderately influence the capital structure and profitability on increased firm value.
ANÁLISE ANATOMOPATOLÓGICA DE PLACENTAS DE GESTANTES COM COVID-19
Authors: Ribeiro André , Vilela Ana Carolina Tubaldini , Reis Leonardo Frasson dos , Vasconcelos Maria Paula Moraes , Batista de Oliveira Rafael , Almeida Vitor Ribeiro Rodrigo 
Published: January 2025

Introdução: Sabe-se que em outras infecções virais no período gestacional, há a associação entre a doença e achados placentários específicos, entretanto, em relação à COVID-19, o conhecimento ainda é limitado. Objetivo: analisar a existência de alterações placentárias em gestantes que contraíram a COVID-19, como também avaliar a correlação com manifestações clínicas e comorbidades da binômio. Metodologia: trata-se de um estudo observacional analítico transversal retrospectivo, que analisou 81 placentas de gestantes que atendiam aos critérios de elegibilidade, além de ter sido realizada a análise de dados estatísticos valendo-se dos softwares Software Microsoft Excel® e JAMOVI®. Resultados: 46,91% das gestantes apresentaram a doença no terceiro trimestre da gestação, enquanto que 33,33%, no segundo trimestre; e 9,8%, no primeiro trimestre. No anatomopatológico, a maioria das placentas apresentaram calcificações grosseiras e níveis de fibrina subcoriônica aumentado. Conclusão: observou-se a existência de alterações anatomopatológicas nas placentas de gestantes infectadas pela COVID-19, entretanto outros estudos são necessários para testar a associação direta.
Características sociodemográficas e qualidade de vida de pessoas com hipertensão arterial sistêmica atendidas em unidades básicas de saúde: um estudo de associação
Authors: Souza Graciete Pereira de , Santos Luama Araújo dos , Souza Lana Mércia Santiago de , Araújo Edilene Maria Queiroz 
Published: January 2025

Introdução: a hipertensão arterial sistêmica (HAS) é uma doença silenciosa, de alta prevalência, que prejudica a qualidade de vida relacionada à saúde (QVRS). Objetivo: avaliar a QVRS de indivíduos com HAS acompanhados em Unidades Básicas de Saúde de Salvador, nos anos de 2022 e 2023, e associá-la com fatores sociodemográficos, tempo de diagnóstico, estágio da HAS e estilo de vida. Metodologia: trata-se de um estudo observacional, analítico, transversal, realizado em 205 indivíduos, maiores de 20 anos, com diagnóstico prévio de HAS e pressão arterial sistólica ≥ 140 mmHg e/ou diastólica ≥ 90 mmHg. Foram coletados dados sociodemográficos, clínicos e de estilo de vida, os quais foram associados aos domínios mental e somático do Mini Cuestionario de Calidad de Vida en Hipertensión Arterial. O estudo foi aprovado pelo Comitê de Ética da Universidade do Estado da Bahia (UNEB), sob o número 43203121.5.3005.5662. Resultados: a QVRS da população estudada apresentou pior escore no domínio mental, comparado ao somático (mediana 7,0 e 5,0, respectivamente). O gênero feminino apresentou pior QV no domínio somático (mediana. 7,0; IC: 4,0-9,0; p = 0,012), se comparado ao masculino (mediana. 3,0; IC:2,5-4,0; p = 0,157). Pessoas sedentárias obtiveram pior score (mediana. 7,0; IC:6,51-9,0; p = 0,045) no domínio mental, se comparadas a indivíduos ativos (mediana 6,0; IC:4,0-8,0; p = 0,119). Estágio da PA e tempo de diagnóstico não apresentaram associação significativa com a QVRS. Conclusão: a QVRS da amostra estudada é moderada. Mulheres apresentaram pior escore no domínio somático, e a prática adequada de exercícios físicos demonstrou uma associação positiva com a QVRS, no domínio mental.
Once-Weekly Insulin Icodec vs Once-Daily Insulin Degludec in Adults With Insulin-Naive Type 2 Diabetes
Authors: Lingvay Ildiko , Asong Marisse , Desouza Cyrus , Gourdy Pierre , Kar Soumitra , Vianna André , Vilsbøll Tina , Vinther Siri , Mu Yiming 
Published: June 2023

ImportanceOnce-weekly insulin icodec could provide a simpler dosing alternative to daily basal insulin in people with type 2 diabetes.ObjectiveTo evaluate the efficacy and safety of once-weekly icodec vs once-daily insulin degludec in people with insulin-naive type 2 diabetes.Design, Setting, and ParticipantsRandomized, double-masked, noninferiority, treat-to-target, phase 3a trial conducted from March 2021 to June 2022 at 92 sites in 11 countries in adults with type 2 diabetes treated with any noninsulin glucose-lowering agents with hemoglobin A1c (HbA1c) of 7%-11% (53-97 mmol/mol).InterventionsParticipants were randomly assigned in a 1:1 ratio to receive either once-weekly icodec and once-daily placebo (icodec group; n = 294) or once-daily degludec and once-weekly placebo (degludec group; n = 294).Main Outcomes and MeasuresThe primary end point was change in HbA1c from baseline to week 26 (noninferiority margin, 0.3% percentage points). Secondary end points included change in fasting plasma glucose from baseline to week 26, mean weekly insulin dose during the last 2 weeks of treatment, body weight change from baseline to week 26, and number of level 2 (clinically significant; glucose level &amp;lt;54 mg/dL) and level 3 (severe; requiring external assistance for recovery) hypoglycemic episodes.ResultsAmong 588 randomized participants (mean [SD] age, 58 [10] years; 219 [37%] women), 564 (96%) completed the trial. Mean HbA1c level decreased from 8.6% (observed) to 7.0% (estimated) at 26 weeks in the icodec group and from 8.5% (observed) to 7.2% (estimated) in the degludec group (estimated treatment difference [ETD], −0.2 [95% CI, −0.3 to −0.1] percentage points), confirming noninferiority (P &amp;lt; .001) and superiority (P = .002). There were no significant differences between the icodec and degludec groups for fasting plasma glucose change from baseline to week 26 (ETD, 0 [95% CI, −6 to 5] mg/dL; P = .90), mean weekly insulin dose during the last 2 weeks of treatment, or body weight change from baseline to week 26 (2.8 kg vs 2.3 kg; ETD, 0.46 [95% CI, −0.19 to 1.10] kg; P = .17). Combined level 2 or 3 hypoglycemia rates were numerically higher in the icodec group than the degludec group from week 0 to 31 (0.31 vs 0.15 events per patient-year exposure; P = .11) and statistically higher in the icodec group from week 0 to 26 (0.35 vs 0.12 events per patient-year exposure; P = .01).Conclusions and RelevanceAmong people with insulin-naive type 2 diabetes, once-weekly icodec demonstrated superior HbA1c reduction to once-daily degludec after 26 weeks of treatment, with no difference in weight change and a higher rate of combined level 2 or 3 hypoglycemic events in the context of less than 1 event per patient-year exposure in both groups.Trial RegistrationClinicalTrials.gov Identifier: NCT04795531
Growth of Medicare Advantage After Plan Payment Reductions
Authors: Schwartz Aaron L. , Kim Seyoun , Navathe Amol S. , Gupta Atul 
Published: June 2023

ImportanceVarious policy proposals would reduce federal payments to Medicare Advantage (MA) plans. However, it is unclear whether payment reductions would compromise beneficiary access to the MA program.ObjectiveTo quantify the association between MA payment reductions under the Affordable Care Act (ACA) and MA enrollment growth.Design, Setting, and ParticipantsThis retrospective cohort study examined the MA market before and after the ACA, which mandated cuts to MA benchmark payment rates. Using 2008 to 2019 county-level enrollment and payment data, a difference-in-differences analysis was conducted comparing MA enrollment changes between counties with larger vs smaller benchmark reductions, before vs after the ACA.Main Outcomes and MeasuresThe primary outcome was the MA enrollment rate, defined as the proportion of a county’s Medicare beneficiaries enrolled in MA. A secondary analysis examined MA plan payments per member per month.ResultsAmong 3138 counties with 37 639 county-year observations, ACA-induced benchmark cuts were sizeable and varied, ranging from 0% to 42.9% (mean [SD], 5.9% [6.6%]). Counties with benchmark cuts above the 75th percentile had population-weighted average benchmark cuts of 14.9% compared with 4.4% in other counties. In the 8 years following the ACA, there was no differential change in MA enrollment between counties with larger vs smaller benchmark cuts (difference-in-differences estimate, 0.02 [95% CI, −1.18 to 1.21] percentage points; P = .98). Plan payments differentially fell in counties with larger benchmark cuts by $78.35 (95% CI, $62.21-$94.48) per member per month (P &amp;lt; .001).Conclusion and RelevanceThis cohort study found no evidence that the MA benchmark and ensuing payment cuts imposed by the ACA were associated with reduced MA enrollment, compromising access to MA. This evidence can inform ongoing policy debates regarding the growth of MA, concerns about excess payments to MA plans, and proposed Medicare reforms, including further reductions in MA payments.
Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals
Authors: Kozhimannil Katy Backes , Leonard Stephanie A. , Handley Sara C. , Passarella Molly , Main Elliott K. , Lorch Scott A. , Phibbs Ciaran S. 
Published: June 2023

ImportanceIdentifying hospital factors associated with severe maternal morbidity (SMM) is essential to clinical and policy efforts.ObjectiveTo assess associations between obstetric volume and SMM in rural and urban hospitals and examine whether these associations differ for low-risk and higher-risk patients.Design, Setting, and ParticipantsThis retrospective cross-sectional study of linked vital statistics and patient discharge data was conducted from 2022 to 2023. Live births and stillbirths (≥20 weeks’ gestation) at hospitals in California (2004-2018), Michigan (2004-2020), Pennsylvania (2004-2014), and South Carolina (2004-2020) were included. Data were analyzed from December 2022 to May 2023.ExposuresAnnual birth volume categories (low, medium, medium-high, and high) for hospitals in urban (10-500, 501-1000, 1001-2000, and &amp;gt;2000) and rural (10-110, 111-240, 241-460, and &amp;gt;460) counties.Main Outcome and MeasuresThe main outcome was SMM (excluding blood transfusion); covariates included age, payer status, educational attainment, race and ethnicity, and obstetric comorbidities. Analyses were stratified for low-risk and higher-risk obstetric patients based on presence of at least 1 clinical comorbidity.ResultsAmong more than 11 million urban births and 519 953 rural births, rates of SMM ranged from 0.73% to 0.50% across urban hospital volume categories (high to low) and from 0.47% to 0.70% across rural hospital volume categories (high to low). Risk of SMM was elevated for patients who gave birth at rural hospitals with annual birth volume of 10 to 110 (adjusted risk ratio [ARR], 1.65; 95% CI, 1.14-2.39), 111 to 240 (ARR, 1.37; 95% CI, 1.10-1.70), and 241 to 460 (ARR, 1.26; 95% CI, 1.05-1.51), compared with rural hospitals with greater than 460 births. Increased risk of SMM occurred for low-risk and higher-risk obstetric patients who delivered at rural hospitals with lower birth volumes, with low-risk rural patients having notable discrepancies in SMM risk between low (ARR, 2.32; 95% CI, 1.32-4.07), medium (ARR, 1.66; 95% CI, 1.20-2.28), and medium-high (ARR, 1.68; 95% CI, 1.29-2.18) volume hospitals compared with high volume (&amp;gt;460 births) rural hospitals. Among hospitals in urban counties, there was no significant association between birth volume and SMM for low-risk or higher-risk obstetric patients.Conclusions and RelevanceIn this cross-sectional study of births in US rural and urban counties, risk of SMM was elevated for low-risk and higher-risk obstetric patients who gave birth in lower-volume hospitals in rural counties, compared with similar patients who gave birth at rural hospitals with greater than 460 annual births. These findings imply a need for tailored quality improvement strategies for lower volume hospitals in rural communities.
Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance
Authors: Tao Ran , Hess Timothy M. , Kuchnia Adam , Hermsen Joshua , Raza Farhan , Dhingra Ravi 
Published: June 2023

ImportancePretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.ObjectiveTo investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.Design, Setting, and ParticipantsAll adult patients (&amp;gt;18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.ExposureRecipient’s body mass index (BMI) in categories (&amp;lt;18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.Main OutcomeAll-cause death posttransplant on follow-up.ResultsThe mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.Conclusion and RelevanceIn this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.
Characteristics of Medical Evacuation by Train in Ukraine, 2022
Authors: Walravens Stig , Zharkova Albina , De Weggheleire Anja , Burton Marie , Cabrol Jean-Clément , Lee James S. 
Published: June 2023

ImportanceThe 2022 war in Ukraine severely affected access to health care for patients in the conflict-affected regions and limited options for medical evacuation. Air transport, a common method of medical evacuation in war zones, was unsafe due to the conflict of 2 modernized military forces that were in possession of aircraft and surface-to-air weapons; therefore, Médecins Sans Frontières, in collaboration with the Ukrainian railway company and Ukrainian health agencies, addressed this by initiating medical evacuation via medically customized trains.ObjectiveTo describe the implementation of medical evacuation trains aimed at improving the access to health care for war-affected patients.Design, Setting, and ParticipantsThis case series describes the remodeling of 2 trains used for medical evacuation in a conflict zone during the war in Ukraine. The study was conducted from March 30 to November 30, 2022. One train had minimal adjustments and could be rapidly deployed to address the most pressing humanitarian needs, while the other underwent major structural modifications to provide intensive care capacity. The report details the medical capabilities of the trains, the organization of referrals, and operational challenges encountered. Additionally, it includes a case series on the characteristics of patients transported in the initial 8 months, based on routinely collected programmatic descriptive data of all patients transported by the medical trains.ResultsIn 8 months, 2481 patients (male-female ratio, 1.07; male, 1136 [46%]; female 1058 [43%]; missing data, 287 [12%]; median age, 63 years [range, 0-98 years]) were evacuated from 11 cities near the Ukrainian conflict frontline to safer areas. Initially, the trains predominantly evacuated trauma patients, but over the course of the war, the patient characteristics changed with more medical and nonacute conditions, and fewer trauma patients. The main reason for entry into the intensive care unit train carriage was for close monitoring and observation, and the main interventions performed were primarily for respiratory failure.Conclusions and RelevanceThe findings of this study suggest that medical evacuation in a war zone by converted trains is possible and can improve access to health care for war-affected patients. The presence of intensive care capacity on board allows for transport of more severely ill or injured individuals. However, the target population should not be limited to trauma patients, as health care institutions affected host a much broader population whose needs and urgency for evacuation may change over time.