bluuebunny/crossref_metadata_2025_split huggingface dataset:
Activation of astrocytes in the basal forebrain in mice facilitates isoflurane-induced loss of consciousness and prolongs recovery
Authors: Lin Jialing , Cheng Xuefeng , Wang Haoyuan , Du Lin , Li Xiangyu , Zhao Gaofeng , Xie Chuangbo 
Published: June 2023

Abstract
Objectives
General anesthesia results in a state of unconsciousness that is similar to sleep. In recent years, increasing evidence has reported that astrocytes play a crucial role in regulating sleep. However, whether astrocytes are involved in general anesthesia is unknown.

Methods
In the present study, the designer receptors exclusively activated by designer drugs (DREADDs) approach was utilized to specifically activate astrocytes in the basal forebrain (BF) and observed its effect on isoflurane anesthesia. One the other side, L-α-aminoadipic acid was used to selectively inhibit astrocytes in the BF and investigated its influence on isoflurane-induced hypnotic effect. During the anesthesia experiment, cortical electroencephalography (EEG) signals were recorded as well.

Results
The chemogenetic activation group had a significantly shorter isoflurane induction time, longer recovery time, and higher delta power of EEG during anesthesia maintenance and recovery periods than the control group. Inhibition of astrocytes in the BF delayed isoflurane-induced loss of consciousness, promoted recovery, decreased delta power and increased beta and gamma power during maintenance and recovery periods.

Conclusions
The present study suggests that astrocytes in the BF region are involved in isoflurane anesthesia and may be a potential target for regulating the consciousness state of anesthesia.
Classification based on event in survival machine learning analysis of cardiovascular disease cohort
Authors: Ahmad Shokh Mukhtar , Ahmed Nawzad Muhammed 
Published: June 2023

AbstractThe aim of this study is to assess the effectiveness of supervised learning classification models in predicting patient outcomes in a survival analysis problem involving cardiovascular patients with a significant cured fraction. The sample comprised 919 patients (365 females and 554 males) who were referred to Sulaymaniyah Cardiac Hospital and followed up for a maximum of 650 days between 2021 and 2023. During the research period, 162 patients (17.6%) died, and the cure fraction in this cohort was confirmed using the Mahler and Zhu test (P < 0.01). To determine the best patient status prediction procedure, several machine learning classifications were applied. The patients were classified into alive and dead using various machine learning algorithms, with almost similar results based on several indicators. However, random forest was identified as the best method in most indicators, with an Area under ROC of 0.934. The only weakness of this method was its relatively poor performance in correctly diagnosing deceased patients, whereas SVM with FP Rate of 0.263 performed better in this regard. Logistic and simple regression also showed better performance than other methods, with an Area under ROC of 0.911 and 0.909 respectively.
Traumatic cardiac arrest – a nationwide Danish study
Authors: Wolthers Signe Amalie , Jensen Theo Walther , Breindahl Niklas , Milling Louise , Blomberg Stig Nikolaj , Andersen Lars Bredevang , Mikkelsen Søren , Torp-Pedersen Christian , Christensen Helle Collatz 
Published: June 2023

Abstract
Background
Cardiac arrest following trauma is a leading cause of death, mandating urgent treatment. This study aimed to investigate and compare the incidence, prognostic factors, and survival between patients suffering from traumatic cardiac arrest (TCA) and non-traumatic cardiac arrest (non-TCA).

Methods
This cohort study included all patients suffering from out-of-hospital cardiac arrest in Denmark between 2016 and 2021. TCAs were identified in the prehospital medical record and linked to the out-of-hospital cardiac arrest registry. Descriptive and multivariable analyses were performed with 30-day survival as the primary outcome.

Results
A total of 30,215 patients with out-of-hospital cardiac arrests were included. Among those, 984 (3.3%) were TCA. TCA patients were younger and predominantly male (77.5% vs 63.6%, p =  < 0.01) compared to non-TCA patients. Return of spontaneous circulation occurred in 27.3% of cases vs 32.3% in non-TCA patients, p < 0.01, and 30-day survival was 7.3% vs 14.2%, p < 0.01. An initial shockable rhythm was associated with increased survival (aOR = 11.45, 95% CI [6.24 – 21.24] in TCA patients. When comparing TCA with non-TCA other trauma and penetrating trauma were associated with lower survival (aOR: 0.2, 95% CI [0.02–0.54] and aOR: 0.1, 95% CI [0.03 – 0.31], respectively. Non-TCA was associated with an aOR: 3.47, 95% CI [2.53 – 4,91].

Conclusion
Survival from TCA is lower than in non-TCA. TCA has different predictors of outcome compared to non-TCA, illustrating the differences regarding the aetiologies of cardiac arrest. Presenting with an initial shockable cardiac rhythm might be associated with a favourable outcome in TCA.
Qualitative study on the use of emergency services by people with serious mental disorder in Spain
Authors: Pérez-Milena Alejandro , Ramos-Ruiz Juan Andrés , Zafra-Ramirez Natalia , Noguera-Cuenca Carmen , Rodríguez-Bayón Antonina , Ruiz-Díaz Beatriz 
Published: June 2023

Abstract
Background
The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain.

Methods
Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation.

Results
Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them.

Conclusions
The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.
Predictors of not maintaining regular medical follow-up after stroke
Authors: Springer Mellanie V. , Skolarus Lesli E. , Feng Chunyang , Burke James F. 
Published: June 2023

Abstract
Background
Regular medical follow-up after stroke is important to reduce the risk of post-stroke complications and hospital readmission. Little is known about the factors associated with stroke survivors not maintaining regular medical follow-up. We sought to quantify the prevalence and predictors of stroke survivors not maintaining regular medical follow-up over time.

Methods
We conducted a retrospective cohort study of stroke survivors in the National Health and Aging Trends Study (2011–2018), a national longitudinal sample of United States Medicare beneficiaries. Our primary outcome was not maintaining regular medical follow-up. We performed a cox regression to estimate predictors of not maintaining regular medical follow-up.

Results
There were 1330 stroke survivors included, 150 of whom (11.3%) did not maintain regular medical follow-up. Stroke survivor characteristics associated with not maintaining regular medical follow-up included not having restrictions in social activities (HR 0.64, 95% CI 0.41, 1.01 for having restrictions in social activities compared to not having restrictions in social activities), greater limitations in self-care activities (HR 1.13, 95% CI 1.03, 1.23), and probable dementia (HR 2.23, 95% CI 1.42, 3.49 compared to no dementia).

Conclusions
The majority of stroke survivors maintain regular medical follow-up over time. Strategies to retain stroke survivors in regular medical follow-up should be directed towards stroke survivors who do not have restrictions in social activity participation, those with greater limitations in self-care activities, and those with probable dementia.
Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil
Authors: Piva Veridiana Monteiro Ramos , Voget Verena , Nucci Luciana Bertoldi 
Published: June 2023

Abstract
Background
The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU – Adequacy of the prenatal care utilization) index and CS rates.

Methods
We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014–2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth – either public healthcare or private health insurers – and maternal sociodemographic data.

Results
CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries.

Conclusion
Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
Cytokine quantification and association with cervical length in a prospective cohort of pregnant women
Authors: Herren Helmer , Marcolin Alessandra C. , Barbieri Marco A. , Bettiol Heloisa , Cardoso Viviane C. , Quintana Silvana M. , Cavalli Ricardo C. 
Published: June 2023

Abstract
Background
Preterm birth is a leading cause of infant morbidity and mortality; its multifactorial causes are an obstacle to understanding etiology and pathogenesis. The importance of cytokines and inflammation in its etiology and association with the short cervix is nowadays well-proven. To date, there are no reliable biological or biochemical markers to predict preterm birth; even though the length of the cervix has high specificity, its sensitivity with the cervix below 2.5 cm is low.

Objective
We study the association of plasma cytokine levels and cervical length in search of predictors of preterm birth.

Study design
We evaluated a total of 1400 pregnant women carrying a single fetus between 20 and 25 weeks of gestation, and 1370 of them after childbirth in a nested case–control study of a prenatal cohort. Eligible pregnant women were interviewed and submitted to obstetric morphological and transvaginal ultrasound with cervical length measurement, gynecological examination, and blood collection. Preterm birth occurred in 133 women, 129 included in the study, and a control group randomly selected at a 2:1 ratio. A total of 41 cytokines with a higher probability of being associated with preterm birth or being of significance during labor were determined.

Results
Cytokine and cervical length analysis by multivariate analysis of the conditional interference tree revealed that growth-related oncogene values of less than 2293 pg/mL were significantly associated with a cervical length of less than 2.5 cm.

Conclusions
As well as a cervical length shorter than 2.5 cm, growth-related oncogene levels of less than 2293 pg/ml may be associated with an increased risk of PB. Analysis based on the association of biomarkers and of the interaction between cytokines is a promising pathway in search of a predictor of preterm birth.
Hyponatremia and its associated factors in children admitted to the pediatric intensive care unit in eastern Ethiopia: a cross-sectional study
Authors: Berhanu Yeshi , Yusuf Turina , Mohammed Ahmed , Meseret Fentahun , Demeke Habteyohans Betelhem , Alemu Ayichew , Tolosa Gadissa , Keneni Mulualem , Weldegebreal Fitsum , Desalew Assefa 
Published: June 2023

Abstract
Background
Hyponatremia is a serious problem that leads to substantial increases morbidity and mortality in critically ill children. The identification of risk factors, implementation of preventive measures, and timely diagnosis and management are crucial to reduce adverse events related to hyponatremia. Despite the higher burden of the problem in Ethiopia, evidence related to the risk factors for hyponatremia among children in Ethiopia is limited; in particular, no study has been identified in eastern Ethiopia. Therefore, we aimed to determine the magnitude of hyponatremia and its associated factors in children admitted to the pediatric intensive care unit at the Hiwot Fana Comprehensive Specialized University Hospital.

Methods
A facility-based cross-sectional study was conducted using 422 medical records of pediatric patients admitted to the pediatric intensive care unit at Hiwot Fana Comprehensive Specialized University Hospital from January 2019 to December 2022. Medical records were reviewed to collect data. Data were analyzed using a statistical package for social sciences (SPSS) version 26. A binary logistic regression model with an adjusted odds ratio (aOR) and a 95% confidence interval (CI) was used to identify factors associated with the outcome variable. Statistical significance was set at p < 0.05.

Results
The magnitude of hyponatremia was 39.1% (95% CL: 34.4–43.8%). The age of the child (aOR = 2.37;95% CL:1.31–4.31), diagnosis of sepsis (aOR = 2.33; 95% CL:1.41–3.84), surgical procedures (aOR = 2.39; 95% CL:1.26–4.56), nutritional status (aOR = 2.60; 95% CL:1.51–4.49), and length of hospital stay (aOR = 3.04; 95% CL: 1.73–5.33) were factors significantly associated with hyponatremia.

Conclusions
Four out of ten children admitted to pediatric intensive care units had hyponatremia. Hyponatremia was significantly associated with the age of the child, malnutrition, sepsis, surgical procedures, and length of hospital stay. To reduce the burden of hyponatremia and associated mortality, attention should be focused on improving the care of malnourished children, and those with sepsis, and the quality of postoperative monitoring services. Moreover, intervention strategies aimed at reducing the burden of hyponatremia should target the identified factors.
Victimization among adolescents of female sex workers: findings from the children of at-risk parents (CARP) study in Uganda
Authors: Ouma Simple , Abbo Catherine , Natala Nakita , McCoy Molly , Kroupina Maria 
Published: June 2023

Abstract
Background
Female sex workers (FSWs) live and work in high-risk environments, experience high levels of adversity, and have multigenerational trauma that can negatively affect their children. Yet not much is known about the prevalence of victimization (i.e., exposure to maltreatment and trauma) among children of FSWs. This study compared the prevalence of lifetime victimization among adolescents of FSWs and adolescents of non-FSWs in Gulu City, Northern Uganda.

Methods
A comparative cross-sectional study was conducted among adolescents (10–17 years) enrolled in the Children of At-Risk Parents (CARP) study. This study included 147 adolescents of FSWs and 147 adolescents of non-FSWs selected for comparison in Gulu City, Northern Uganda. The adolescents of FSWs were identified through their mothers using respondent-driven sampling. Data on the residence of FSWs guided a proportionate stratified sampling of adolescents of non-FSWs. Using the Juvenile Victimization Questionnaire, we screened for 34 different types of victimization during participants’ lifetimes. Percentage point differences within groups of adolescents and comparison between adolescents of FSWs and non-FSWs were calculated using STATA version 14.1. Statistical significance was set to p < 0.05.

Results
99.3% of the participants experienced at least one form of lifetime victimization. The median number of lifetime victimizations was 12.4. Overall, lifetime victimization was higher among adolescents of FSWs than non-FSWs (13.4 vs. 11.5), male vs. female adolescents (13.4 vs. 11.9), and older [14–17 years] vs. younger (10–13 years) adolescents (14.0 vs. 11.7). Further, more adolescents of FSWs experienced lifetime victimization in the following domains and subdomains, all of which were statistically significant: kidnap (15.8% vs. 4.8%), emotional abuse (65.8% vs. 50.0%), emotional neglect (37.4% vs. 21.1%), physical intimidation (10.2% vs. 4.1%), relational aggression (36.4% vs. 18.4%), verbal aggression (68.7% vs. 46.9%), sexual victimization (31.3% vs. 17.7%), verbal sexual harassment (20.4% vs. 5.4%), exposure to murder scene (42.9% vs. 26.5%), witness to domestic violence (39.5% vs. 26.5%), and witness to the murder of relatives (31.3% vs. 21.1%). Conversely, more adolescents of non-FSWs experienced caregiver victimization than the adolescents of FSWs (98.0 vs. 92.5; p < 0.05).

Conclusions
Childhood victimization is highly prevalent in Northern Uganda and disproportionately affects the adolescents of FSWs. Therefore, government and development partners should urgently develop policies and interventions targeting prevention, early detection, and timely management of victimization in this vulnerable population.
The effectiveness of a health education intervention to reduce anxiety in quarantined COVID-19 patients: a randomized controlled trial
Authors: Zemni Imen , Gara Amel , Nasraoui Hadhba , Kacem Meriem , Maatouk Amani , Trimeche Oumeyma , Abroug Hela , Fredj Manel Ben , Bennasrallah Cyrine , Dhouib Wafa , Bouanene Ines , Belguith Asma Sriha 
Published: June 2023

Abstract
Introduction
The COVID-19 pandemic is regarded as a serious public health concern that boosts levels of stress and anxiety which could be explained by several reasons, including social isolation. In this regard, we aimed to assess the impact of health education on the anxiety level of COVID-19 patients during the isolation period.

Methods
This is a randomized controlled trial conducted between February 2021 and June 2021. Patients tested positive for Covid-19 with mild to moderate forms were randomized to Education (n = 267) or control (n = 269). The education group received a phone health education session on day 1 (D1) following the diagnosis. The three components of the health education intervention were an explanation of the coronavirus disease, what to do in the event of complications, and the recommended preventive measures. The two groups received a telephone evaluation of their Hospital Anxiety and Depression scores on D1 and day seven D7 following the positive diagnosis. The primary outcome was the rate of anxiety reduction in each group on D7 based on a HAD-A score ≥ 8. Secondary outcomes were the rate of anxiety reduction on D7 based on a HAD-A score ≥ 11, the percentage of people complying with isolation and the scores of adherences to preventive measures during the isolation in each group.

Results
Hundred and ninety-six patients in the intervention group and 206 patients in the control group completed the study. The sociodemographic, clinical, and initial anxiety level features of the intervention and control groups were comparable at baseline (p ≥ 0.05). On D7, the education group’s anxiety level (HAD-A ≥ 8) decreased from 26 to 16.3% (p = 0.013) while in the control group it increased from 19.4 to 22.8% (p = 0.37). Thus, the percentage change in anxiety between D1 and D7 (delta D7 – D1) was − 9.7% in the Education group and + 3.4% in the Control group. Using the HAD-A ≥ 11 thresholds, the percentage of anxiety decreased from 15.3 to 11.2% (p = 0.26) between D1 and D7, while it increased in the control group from 9.7 to 15.7% (p = 0.045). Thus, the education group’s change in anxiety (delta D7 - D1) was − 4.1%, while the control group’s change was + 6%.

Conclusion
During an outbreak, providing health education to quarantined patients may be beneficial to reduce the psychological impact of the disease.

Trial registration number
ClinicalTrials.gov Identifier: NCT05715593, retrospectively registered on 8/02/2023 https://clinicaltrials.gov/ct2/results?term=NCT05715593&Search=Search.
Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data
Authors: Hoefsloot W , Dacheva E , van der Laan R , Krol M , van Ingen J , Obradovic M , Liu Ximeng 
Published: June 2023

Abstract
Purpose
Real-world data on antibiotic management of nontuberculous mycobacterial lung disease (NTM-LD) is limited for many countries. This study aimed to evaluate real-world treatment practices of NTM-LD in the Netherlands using medication dispensing data.

Methods
A retrospective longitudinal real-world study was conducted using IQVIA’s Dutch pharmaceutical dispensing database. The data are collected monthly and include approximately 70% of all outpatient prescriptions in the Netherlands. Patients initiated on specific NTM-LD treatment regimens between October 2015 and September 2020 were included. The main areas of investigation were initial treatment regimens, persistence on treatment, treatment switching, treatment compliance in terms of medication possession rate (MPR) and restarts of treatment.

Results
The database included 465 unique patients initiated on triple- or dual-drug regimens for the treatment of NTM-LD. Treatment switches were common and occurred approximately 1.6 per quarter throughout the treatment period. The average MPR of patients initiated on triple-drug therapy was 90%. The median time on therapy for these patients was 119 days; after six months and one year, 47% and 20% of the patients, respectively, were still on antibiotic therapy. Of 187 patients initiated on triple-drug therapy, 33 (18%) patients restarted antibiotic therapy after the initial treatment had been stopped.

Conclusion
When on therapy, patients were compliant with the NTM-LD treatment; however, many patients stopped their therapy prematurely, treatment switches often occurred, and part of patients had to restart their therapy after a longer treatment gap. NTM-LD management should be improved through greater guideline adherence and appropriate involvement of expert centers.