bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between chronic disease and substance use among older adults in Tennessee
Authors: Ahuja Manik , Stamey Jessica , Cimilluca Johanna , Al Skir Kawther , Herndon Mary K , Baggett Kathleen , Sathiyasaleen Thiveya , Fernandopulle Praveen 
Published: August 2023

Background: Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Design and methods: Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee ( N = 6242) and individuals over age 55 ( N = 3389). Results: At least 33.7% ( N = 1143) of older adults have a chronic disease, and 24.4% ( N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Conclusions: Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes.
Providers’ Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya
Authors: Cheboi Solomon K. , Lagat Kiprop , Nyawira Daisy , Kariuki Peris , Mutai Joseph , Nganga Wanjiru 
Published: August 2023

Background Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. Objective We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. Method The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Results Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly life-deforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. Conclusion The features of indigenous palliative care services are informed by the providers' distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.
Early B-cell development and B-cell maturation are impaired in patients with active hemophagocytic lymphohistiocytosis
Authors: Shim Jenny , Park Sunita , Venkateswaran Suresh , Kumar Deepak , Prince Chengyu , Parihar Vaunita , Maples Larkin , Waller Edmund K. , Kugathasan Subra , Briones Michael , Lee Miyoung , Henry Curtis J. , Prahalad Sampath , Chandrakasan Shanmuganathan 
Published: August 2023

Abstract
Hemophagocytic lymphohistiocytosis (HLH) is characterized by hyperinflammation and multiorgan dysfunction. Infections, including the reactivation of viruses, contribute to significant disease mortality in HLH. Although T-cell and natural killer cell–driven immune activation and dysregulation are well described, limited data exist on the status of B-cell compartment and humoral immune function in HLH. We noted marked suppression of early B-cell development in patients with active HLH. In vitro B-cell differentiation studies after exposure to HLH-defining cytokines, such as interferon gamma (IFN-γ) and tumor necrosis factor, recapitulated B-cell development arrest. Messenger RNA sequencing of human CD34+ cells exposed to IFN-γ demonstrated changes in genes and pathways affecting B-cell development and maturation. In addition, patients with active HLH exhibited a marked decrease in class-switched memory B (CSMB) cells and a decrease in bone marrow plasmablast/plasma cell compartments. The decrease in CSMB cells was associated with a decrease in circulating T follicular helper (cTfh) cells. Finally, lymph node and spleen evaluation in a patient with HLH revealed absent germinal center formation and hemophagocytosis with associated lymphopenia. Reassuringly, the frequency of CSMB and cTfh improved with the control of T-cell activation. Taken together, in patients with active HLH, these changes in B cells may affect the humoral immune response; however, further immune studies are needed to determine its clinical significance.
Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial
Authors: Taylor Stephanie J.C. , Sohanpal Ratna , Steed Liz , Marshall Karen , Chan Claire , Yaziji Nahel , Barradell Amy C. , Font-Gilabert Paulino , Healey Andrew , Hooper Richard , Kelly Moira J. , Mammoliti Kristie-Marie , Priebe Stefan , Rajasekaran Arvind , Roberts C. Michael , Rowland Vickie , Singh Sally J. , Smuk Melanie , Underwood Martin , Waseem Sarah , White Patrick , Wileman Vari , Pinnock Hilary 
Published: August 2023

BackgroundThe TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control).MethodsPeople with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6–8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use.ResultsThe intervention did not improve anxiety (HADS-A mean difference −0.60, 95% CI −1.40–0.21) or depression (HADS-D mean difference −0.66, 95% CI −1.39–0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective.ConclusionThis trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.
Outcome of lung transplantation for adults with interstitial lung disease associated with genetic disorders of the surfactant system
Authors: Bermudez Julien , Nathan Nadia , Coiffard Benjamin , Roux Antoine , Hirschi Sandrine , Degot Tristan , Bunel Vincent , Le Pavec Jérôme , Macey Julie , Le Borgne Aurélie , Legendre Marie , Cottin Vincent , Thomas Pascal-Alexandre , Borie Raphaël , Reynaud-Gaubert Martine 
Published: August 2023

BackgroundInterstitial lung disease associated with genetic disorders of the surfactant system is a rare entity in adults that can lead to lung transplantation. Our objective was to describe the outcome of these patients after lung transplantation.MethodsWe conducted a retrospective, multicentre study, on adults who underwent lung transplantation for such disease in the French lung transplant centres network, from 1997 to 2018.Results20 patients carrying mutations inSFTPA1(n=5),SFTPA2(n=7) orSFTPC(n=8) were included. Median interquartile range (IQR) age at diagnosis was 45 (40–48) years, and median (IQR) age at lung transplantation was 51 (45–54) years. Median overall survival after transplantation was 8.6 years. Two patients had a pre-transplant history of lung cancer, and two developed post-transplant lung cancer. Female gender and a body mass index <25 kg·m−2were significantly associated with a better prognosis, whereas transplantation in high emergency was associated with a worst prognosis.ConclusionsLung transplantation in adults with interstitial lung disease associated with genetic disorders of surfactant system may be a valid therapeutic option. Our data suggest that these patients may have a good prognosis. Immunosuppressive protocol was not changed for these patients, and close lung cancer screening is needed before and after transplantation.
Pulmonary arterial wedge pressure increase during exercise in patients diagnosed with pulmonary arterial or chronic thromboembolic pulmonary hypertension
Authors: Müller Julian , Mayer Laura , Schneider Simon R. , Titz Anna , Schwarz Esther I. , Saxer Stephanie , Furian Michael , Grünig Ekkehard , Ulrich Silvia , Lichtblau Mona 
Published: August 2023

BackgroundThe course of pulmonary arterial wedge pressure (PAWP) during exercise in patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH), further abbreviated as pulmonary vascular disease (PVD), is still unknown. The aim of the study was to describe PAWP during exercise in patients with PVD.MethodsIn this cross-sectional study, right heart catheter (RHC) data including PAWP, recorded during semi-supine, stepwise cycle exercise in patients with PVD, were analysed retrospectively. We investigated PAWP changes during exercise until end-exercise.ResultsIn 121 patients (59 female, 66 CTEPH, 55 PAH, 62±17 years) resting PAWP was 10.2±4.1 mmHg. Corresponding peak changes in PAWP during exercise were +2.9 mmHg (95% CI 2.1–3.7 mmHg, p<0.001). Patients ≥50 years had a significantly higher increase in PAWP during exercise compared with those <50 years (p<0.001). The PAWP/cardiac output (CO) slopes were 3.9 WU for all patients, and 1.6 WU for patients <50 years and 4.5 WU for those ≥50 years.ConclusionIn patients with PVD, PAWP increased slightly but significantly with the onset of exercise compared to resting values. The increase in PAWP during exercise was age-dependent, with patients ≥50 years showing a rapid PAWP increase even with minimal exercise. PAWP/CO slopes >2 WU are common in patients with PVD aged ≥50 years without exceeding the PAWP of 25 mmHg during exercise.
Assessment of sedentary behaviour in individuals with COPD: how many days are necessary?
Authors: Bertoche Mariana Pereira , Furlanetto Karina Couto , Hirata Raquel Pastrello , Sartori Larissa , Schneider Lorena Paltanin , Mantoani Leandro Cruz , Brito Igor , Dala Pola Daniele Caroline , Hernandes Nidia Aparecida , Pitta Fabio 
Published: August 2023

ObjectiveThe objective of the present study was to define the minimum number of monitoring days required for the adequate cross-sectional assessment of sedentary behaviour in individuals with chronic obstructive pulmonary disease (COPD).MethodsIn this cross-sectional study, the sedentary behaviour of individuals with COPD was assessed using two physical activity monitors during awake time for seven consecutive days. Time spent per day in activities requiring ≤1.5 metabolic equivalents (METs) and in sitting, lying and sitting+lying positions was calculated taking into account the average of 7 days (as a reference in all analyses) and of all 119 possible combinations of 2­­–6 days. Intraclass correlation coefficients (ICCs) and linear regression analyses were performed for all combinations.Results91 individuals were analysed (47 female, 66±9 years, forced expiratory volume in 1 s 50±15% predicted). For the variables time spent per day in activities ≤1.5METs and sitting, the average of any combination of at least four assessment days was sufficient to adequately reflect the average of 7 days (adjusted R2≥0.929, ICC≥0.962, p<0.0001 for all). For time spent per day lying and sitting+lying, only two assessment days were enough (adjusted R2≥0.937, ICC≥0.968, p<0.0001 for all). Results were maintained independently of patient sex, disease severity, day of the week, daylight time or daytime naps.ConclusionsThe average of 4 days of objective monitoring was sufficient to adequately reflect the results of a 1-week assessment of the main outcomes related to sedentary behaviour in individuals with moderate to very severe COPD, regardless of sex, disease severity, day of the week, daylight time and occurrence of daytime naps.
Effect of betanin synthesis on photosynthesis and tyrosine metabolism in transgenic carrot
Authors: Wang Bo , Wang Ya-Hui , Deng Yuan-Jie , Yao Quan-Hong , Xiong Ai-Sheng 
Published: August 2023

Abstract
Background
Betalain is a natural pigment with important nutritional value and broad application prospects. Previously, we produced betanin biosynthesis transgenic carrots via expressing optimized genes CYP76AD1S, cDOPA5GTS and DODA1S. Betanin can accumulate throughout the whole transgenic carrots. But the effects of betanin accumulation on the metabolism of transgenic plants and whether it produces unexpected effects are still unclear.

Results
The accumulation of betanin in leaves can significantly improve its antioxidant capacity and induce a decrease of chlorophyll content. Transcriptome and metabolomics analysis showed that 14.0% of genes and 33.1% of metabolites were significantly different, and metabolic pathways related to photosynthesis and tyrosine metabolism were markedly altered. Combined analysis showed that phenylpropane biosynthesis pathway significantly enriched the differentially expressed genes and significantly altered metabolites.

Conclusions
Results showed that the metabolic status was significantly altered between transgenic and non-transgenic carrots, especially the photosynthesis and tyrosine metabolism. The extra consumption of tyrosine and accumulation of betanin might be the leading causes.
The role of plant growth promoting rhizobacteria in plant drought stress responses
Authors: Chieb Maha , Gachomo Emma W. 
Published: August 2023

AbstractClimate change has exacerbated the effects of abiotic stresses on plant growth and productivity. Drought is one of the most important abiotic stress factors that interfere with plant growth and development. Plant selection and breeding as well as genetic engineering methods used to improve crop drought tolerance are expensive and time consuming. Plants use a myriad of adaptative mechanisms to cope with the adverse effects of drought stress including the association with beneficial microorganisms such as plant growth promoting rhizobacteria (PGPR). Inoculation of plant roots with different PGPR species has been shown to promote drought tolerance through a variety of interconnected physiological, biochemical, molecular, nutritional, metabolic, and cellular processes, which include enhanced plant growth, root elongation, phytohormone production or inhibition, and production of volatile organic compounds. Therefore, plant colonization by PGPR is an eco-friendly agricultural method to improve plant growth and productivity. Notably, the processes regulated and enhanced by PGPR can promote plant growth as well as enhance drought tolerance. This review addresses the current knowledge on how drought stress affects plant growth and development and describes how PGPR can trigger plant drought stress responses at the physiological, morphological, and molecular levels.
Recognition of visual symptoms in stroke: a challenge to patients, bystanders, and Emergency Medical Services
Authors: Berg Kristina Parsberg , Sørensen Viktor Frederik Idin , Blomberg Stig Nikolaj Fasmer , Christensen Helle Collatz , Kruuse Christina 
Published: August 2023

Abstract
Background
Identification of visual symptoms as a sign of acute stroke can be challenging for both first line healthcare professionals and lay persons. Failed recognition of visual symptoms by medical dispatchers at the Emergency Medical Dispatch Center (EMDC-112) or personnel at the Out-of-Hours Health Service (OOHS) may delay stroke revascularization. We aimed to identify correct system response to visual symptoms in emergency calls.

Methods
Phone calls from patient or bystander to the EMDC-112 or OOHS, which included visual symptoms on patients later verified with stroke/Transient ischemic attack (TIA) diagnosis, were analyzed. Data were stratified according to hospitalization within and after 4.5 h from symptom onset. Descriptive and multiple logistic regression analysis were performed.

Results
Of 517 calls identified, 290 calls fulfilled inclusion criteria. Only 30% of the patients received correct visitation by the medical dispatchers and referral to the hospital by a high-priority ambulance. Correct visitation was associated with early contact (adjusted OR: 2.37, 95% CI: 1.11, 5.03), contact to the EMDC-112 (adjusted OR: 3.18, 95% CI: 1.80, 5.62), and when the medical dispatcher asked additional questions on typical stroke symptoms (adjusted OR: 6.36, 95% CI: 3.01, 13.43). No specific visual symptom was associated with stroke recognition and fast hospitalization.

Conclusions
First line healthcare professionals had significant problems in identifying visual symptoms as a sign of acute stroke and eliciting correct response. This highlights an urgent need to improve knowledge of visual symptoms in acute stroke and emphasize correct response to stroke symptoms in general.
Interrelationship between arterial hypertension, health service costs, therapeutic treatment and physical activity
Authors: Lima dos Santos Lionai , Codogno Jamile Sanches , Camilo Turi-Lynch Bruna , Araujo Monique Yndawe Castanho , Fernandes Romulo Araujo , de Oliveira Gomes Grace Angelica , Crankson Shirley , Anokye Nana 
Published: August 2023

Abstract
Background
Arterial hypertension is a high prevalence disease that increase healthcare costs and affects physical activity level. This study aimed to analyse the interrelationship between arterial hypertension, health service costs, therapeutic treatment, and physical activity in patients with cardiovascular diseases.

Method
Cross-sectional study that evaluated 306 patients from a hospital in Presidente Prudente-Brazil. Based on their medical diagnosis, they were classified into multiple groups to access primary care and hospital-related costs variations. Then, using data from medical records and face to face interviews, they were examined on their treatment adherence and physical activity practice. Healthcare costs were accessed using medical records. Finally, the generalised linear model was used to analyse the interrelationship between treatment adherence, physical activity, health care costs and arterial hypertension. The data were analysed with Stata/MP4 16, and a p-value of less than 5% was used to determine statistical significance.

Results
The group that adhered to the arterial hypertension treatments but were physically inactive presented higher costs with consultation (US$=24.1, 95%CI = 1.90;46,3)​​ medication (US$=56.60, 95%CI = 1.65; 111.5) and total primary health care costs (US$=71.60, 95%CI = 19.2; 123.9) even after adjusting for confounding variables, meanwhile those participants that adhered to the treatments and were physical active did not present difference in healthcare cost when compared to normotensive and physical active participants.

Conclusion
To be adherent to hypertension treatment were related to higher health care costs meanwhile been physical activity were related to lower health care costs and the combination of both showed that be adherent and physical activity represent the same cost with health than those normotensive and active emphasizing the importance of adherence and physical activity in the hypertensive treatment.
The impact of integrase inhibitors on steatosis and fibrosis biomarkers in persons with HIV naïve to antiretroviral therapy
Authors: Fernandes Sara Rodrigues , Leite Ana Rita , Lino Rita , Guimarães André Rodrigues , Pineiro Carmela , Serrão Rosário , Freitas Paula 
Published: August 2023

Abstract
Background
Non-alcoholic Fatty Liver Disease (NAFLD) has a high prevalence among persons with HIV infection. Since Integrase Strand Transfer Inhibitors (INSTIs) are used worldwide and have been associated with weight gain, we must determine their effect in the development of NAFLD and Non-alcoholic Steatohepatitis (NASH) in these patients. The aim of this study was to explore the impact of INSTIs on variation of liver steatosis and fibrosis in the ART-naïve person with HIV, using Hepatic Steatosis Index (HSI), Fibrosis-4 Index (FIB-4), BARD score and NAFLD Fibrosis Score (NFS).

Methods
We performed a monocentric, retrospective cohort study in ART-naïve persons with HIV that initiated INSTI based regimens between December 2019 and January 2022. Data was collected at baseline, 6 and 12 months after initiation. Demographic, clinical and laboratory characteristics, hepatic steatosis, and fibrosis scores were compared between baseline and last visit at 12 months. Linear regression models were performed to analyse the associations between analytical data at baseline and hepatic scores variation during the 12 months of treatment. Models were performed unadjusted and adjusted for age and sex.

Results
99 patients were included in our study. 82% were male and median age was 36 years. We observed a significant increase in body mass index (BMI), HDL, platelet count, albumin, and creatinine and a significant decrease in AST levels. HSI showed no statistically significant differences during follow-up (p = 0.114). We observed a significant decrease in FIB-4 (p = 0.007) and NFS (p = 0.002). BARD score showed a significant increase (p = 0.006). The linear regression model demonstrated a significant negative association between baseline HIV RNA and FIB-4 change (β= -0.08, 95% CI [-0.16 to -0.00], p = 0.045), suggesting that higher HIV RNA loads at baseline were associated with a greater decrease in FIB-4.

Conclusion
INSTIs seem to have no impact on hepatic steatosis, even though they were associated with a significant increase in BMI. This might be explained by the direct effect of a dolutegravir-containing regimen and/or by the “return-to-health effect” observed with ART initiation. Furthermore, INSTIs were associated with a reduction in risk of liver fibrosis in ART-naïve persons with HIV, possibly due to their effect on viral suppression.