bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between bone mass, hormone levels, and body composition in postmenopausal women
Authors: Fighera Tayane M. , Santos Betânia R. , Motta Letícia , Casanova Gislaine , Spritzer Poli Mara 
Published: February 2023

Abstract

Objectives
The aim of this study was to explore body composition parameters and hormone levels as risk factors for low bone mass (osteopenia/osteoporosis) in postmenopausal women.

Methods
We analyzed biorepository samples from 139 postmenopausal women with no clinical evidence of cardiovascular disease. Inclusion criteria were menopause occurring after 40 years of age and no use of hormone therapy in the past 3 months. Bone mineral density and body composition were assessed by dual-energy x-ray absorptiometry. Sex hormone–binding globulin (SHBG) and follicle-stimulating hormone (FSH) levels were measured in all participants. Serum estradiol was measured by gas chromatography/tandem mass spectrometry in a subset of 57 participants. Free estrogen index was calculated by dividing estradiol by SHBG × 100.

Results
Body mass index (25.0 [22.5-26.5] vs 27.7 [26.6-31.9] kg/m2, P < 0.001), estradiol (3.0 [2.7-4.5] vs 6.0 [2.7-15.0] pg/mL, P = 0.006), waist circumference (84 ± 9 vs 93 ± 12 cm, P < 0.001), appendicular lean mass (ALM) (15.739 ± 2.129 vs 17.184 ± 2.104 kg, P = 0.001), and fat mass index (9.36 [7.29-11.43] vs 11.38 [9.95-15.33] kg/m2, P < 0.001) were lower in women with low bone mass by dual-energy x-ray absorptiometry. Univariate analysis showed that free estrogen index, time since menopause, SHBG, and fat mass were significant predictors of low bone mass, and ALM was a significant predictor against low bone mass. Appendicular lean mass persisted as an independent predictor against low bone mass in multivariate models with fat mass and SHBG. In turn, fat mass was no longer significant in this multivariate model after inclusion of SHBG. No association of FSH with low bone mass was observed.

Conclusions
Appendicular lean mass was a significant independent predictor against low bone mass in postmenopausal women. Further prospective studies are needed to investigate whether lean mass, fat mass, and FSH have a direct effect on bone mass in postmenopausal women, adding to the consequences of hypoestrogenism in this group.
Menopausal symptoms in breast cancer patients receiving adjuvant endocrine therapy and their relationships with health-promoting behaviors and social support
Authors: Wei Tingting , Li Xia , Qiang Wanmin , Zhang Yan , Ren Hailing , Zhang Qiupeng , Jin Xue 
Published: February 2023

Abstract

Objective
To investigate the prevalence and severity of menopausal symptoms in patients with breast cancer undergoing adjuvant endocrine therapy and explore the relationships of these symptoms with health-promoting behaviors and social support.

Methods
This cross-sectional study investigated 226 participants from December 2020 to December 2021 in China. Data were collected using the sociodemographic information questionnaire, Menopause Rating Scale, the Health-Promoting Lifestyle Profile II, and Perceived Social Support Survey. Multivariate step regression was used to analyze the potential factors of menopausal symptoms.

Results
In our sample of 226 patients, 92.9% reported at least one menopausal symptom with a mean score of 13 points (interquartile range, 9-18 points). The highest prevalence of most symptoms included hot flashes/night sweats, fatigue, joint and muscular discomfort, irritability, and sleep problems. In the regression models, health responsibility (β = −0.15, P = 0.03), spiritual growth (β = −0.28, P < 0.01), friend support (β = −0.43, P < 0.01), and other support (β = −0.31, P = 0.01) were negatively associated with menopausal symptoms.

Conclusions
The prevalence and severity of menopausal symptoms are high in breast cancer patients undergoing adjuvant endocrine therapy. Higher health-promoting behaviors and social support are associated with fewer menopausal symptoms. The findings highlight the clinical implications in terms of developing appropriate strategies for managing menopausal symptoms.
Associations between the impact of menopausal symptoms and fall-related self-efficacy
Authors: Espírito Santo João , Hita-Contreras Fidel , Marques de Loureiro Nuno Eduardo , Brandão Loureiro Vânia , Aibar-Almazán Agustín , Carcelén-Fraile María del Carmen , Ortiz-Quesada Raúl 
Published: February 2023

Abstract

Objective
To analyze the association between the severity of menopausal symptoms and two important fall risk factors, namely balance confidence and fear of falling, among Portuguese and Spanish postmenopausal women 65 years or older.

Methods
A cross-sectional, observational study was conducted on 363 women (66.21 ± 9.00 y) from several Portuguese and Spanish locations. The Menopause Rating Scale was used to evaluate the severity of menopausal symptoms, while the Falls Efficacy Scale-International and Activities-specific Balance Confidence Scale-16 items were used to assess balance confidence and fear of falling, respectively. Anxiety and depression (evaluated by the Hospital Anxiety and Depression Scale), age, time since the onset of menopause, body mass index, history of falls, osteoporosis, smoking habit, physical activity level, and nocturia were considered as potential confounders. Independent associations were analyzed after adjusting for potential confounding variables. Student's t test, bivariate correlations, and multivariate linear regression analysis were performed.

Results
A total of 363 women (66.21 ± 9.00 y) participated in the study, 192 from Portugal and 171 from Spain. Linear regression analysis indicates that more severe menopausal symptoms at a somatovegetative level (beta coefficient [β] = −0.25; 95% confidence interval [95% CI], −2.09 to −0.81; P = <0.001), a higher body mass index (β = −0.16; 95% CI, −1.22 to −0.22; P = 0.005), and osteoporosis (β = 0.14; 95% CI, 1.36 to 10.08; P = 0.010) were associated with lower balance confidence values. On the other hand, a higher score in the Menopause Rating Scale somatovegetative domain (β = 0.22; 95% CI, 0.27–0.79; P = <0.001), depression (β = 0.36; 95% CI, 0.59-1.08; P = <0.001), and years after the menopause onset (β = 0.15; 95% CI, 0.04-0.22; P = 0.006) were linked to increased fear of falling.

Conclusions
The findings of our study show that, after taking into account possible confounders, increased severity of menopausal symptoms at a somatic level was associated with heightened fear of falling and diminished balance confidence.
Cardiovascular utility of single cell RNA-Seq
Authors: Safabakhsh Sina , Ma Wei Feng , Miller Clint L. , Laksman Zachary 
Published: February 2023

Purpose of review
Cardiovascular diseases remain the leading causes of morbidity and mortality globally. Single-cell RNA sequencing has the potential to improve diagnostics, risk stratification, and provide novel therapeutic targets that have the potential to improve patient outcomes.

Recent findings
Here, we provide an overview of the basic processes underlying single-cell RNA sequencing, including library preparation, data processing, and downstream analyses. We briefly discuss how the technique has been adapted to related medical disciplines, including hematology and oncology, with short term translational impact. We discuss potential applications of this technology within cardiology as well as recent innovative research within the field. We also discuss future directions to translate this technology to other high impact clinical areas.

Summary
The use of single-cell RNA sequencing technology has made significant advancements in the field of cardiology, with ongoing growth in terms of applications and uptake. Most of the current research has focused on structural or atherosclerotic heart disease. Future areas that stand to benefit from this technology include cardiac electrophysiology and cardio-oncology.
Exercise Self-efficacy Improvements During Cardiac Rehabilitation
Authors: Candelaria Dion , Kirkness Ann , Bruntsch Christine , Gullick Janice , Randall Sue , Ladak Laila Akbar , Gallagher Robyn 
Published: February 2023

Purpose:The objective of this study was to determine exercise self-efficacy improvements during cardiac rehabilitation (CR) and identify predictors of exercise self-efficacy change in CR participants.Methods:Patients with coronary heart disease at four metropolitan CR sites completed the Exercise Self-efficacy Scale at entry and completion. A general linear model identified independent predictors of change in exercise self-efficacy.Results:The mean age of patients (n = 194) was 65.9 ± 10.5 yr, and 81% were males. The majority (80%) were married or partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (n = 91, 47%) or remote-delivered (n = 103, 54%). Exercise self-efficacy mean scores improved significantly from 25.2 ± 5.8 at CR entry to 26.2 ± 6.3 points at completion (P= .025). The majority of patients (59%) improved their self-efficacy scores, 34% worsened, and 7% had no change. Predictors of reduced exercise self-efficacy change were being from an ethnic minority (B =−2.96), not having a spouse/partner (B =−2.42), attending in-person CR (B =1.75), and having higher exercise self-efficacy at entry (B =−0.37) (adjustedR2= 0.247).Conclusions:Confidence for self-directed exercise improves in most, but not all, patients during CR. Those at risk for poor improvement (ethnic minorities, single patients) may need extra or tailored support, and screening for exercise self-efficacy at CR entry and completion is recommended. Differences identified from CR delivery mode need exploration using robust methods to account for complex factors.
Association of Perceived Health Competence With Cardiac Rehabilitation Initiation
Authors: Hu Jiun-Ruey , Huang Shi , Bosworth Hayden B. , Freedland Kenneth E. , Mayberry Lindsay S. , Kripalani Sunil , Wallston Kenneth A. , Roumie Christianne L. , Bachmann Justin M. 
Published: February 2023

Purpose:
Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics.

Methods:
The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation.

Results:
A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030).

Conclusion:
Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.
Pursuing innovation in academic medical centers
Authors: Meer Elana , Ezzeddine Iman , Chao Jessica , Nembhard Ingrid M. 
Published: February 2023

Background
Academic medical centers (AMCs) are well recognized for their innovations that enhance frontline care, but there is little study of their innovation management processes, which is key for advancing theory regarding the effectiveness of innovation efforts to improve care.

Purpose
We aimed to identify organizational models used for frontline innovation by AMCs in the United States, core activities within models, and factors that influence innovation success.

Methods
We conducted a qualitative study of 12 AMCs using data from semistructured interviews with centers’ innovation leaders. Inclusion required satisfying two of three criteria in 2021 (only met by 35 AMCs nationally): listed in the professional association of innovation leaders (Council of 33), Becker’s review of most innovative hospitals, and/or top 20 U.S. News and World Report best hospitals honor roll. We analyzed the interview data using the constant comparative method.

Results
Innovative AMCs pursue innovation through innovation centers (using a centralized or multicenter model) or within clinical departments (department-level model). All three models emphasize seven activities, although performed differently: sourcing ideas, developing ideas, implementing innovations, fundraising, managing partnerships, measuring success, and managing mindset. Several factors influenced success: role performance, operational challenges, technology, public policy, customer clarity, stakeholder buy-in, diversity of input, and focus. The centralized model struggled less with standardization and coordination issues.

Conclusion
AMCs have options for structuring their innovation efforts. However, there are consistent activities for successful innovation management and factors that they must manage.

Practice Implications
AMCs can select among innovation models to fit their circumstances but likely need to perform seven activities well for success.
Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury
Authors: Venkatesan Umesh M. , Rabinowitz Amanda R. , Bernier Rachel A. , Soto Jose A. , Hillary Frank G. 
Published: February 2023

Objective:
To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI).

Setting:
Outpatient research laboratory.

Participants:
Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI (N = 118).

Design:
Cross-sectional observational study.

Main Measures:
MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata (N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes.

Results:
EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND.

Conclusion:
The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.
Cognitive Performance, Depression, and Anxiety 1 Year After Traumatic Brain Injury
Authors: Keatley Eva S. , Bombardier Charles H. , Watson Eric , Kumar Raj G. , Novack Thomas , Monden Kimberley R. , Dams-O'Connor Kristen 
Published: February 2023

Objectives:
To evaluate associations between depression, anxiety, and cognitive impairment among individuals with complicated mild to severe traumatic brain injury (TBI) 1 year after injury.

Setting:
Multiple inpatient rehabilitation units across the United States.

Participants:
A total of 498 adults 16 years and older who completed inpatient rehabilitation for complicated mild to severe TBI.

Design:
Secondary analysis of a prospective, multicenter, cross-sectional observational cohort study.

Main Measures:
Assessments of depression (Traumatic Brain Injury Quality of Life [TBI-QOL] Depression) and anxiety (TBI-QOL Anxiety) as well as a telephone-based brief screening measure of cognitive functioning (Brief Test of Adult Cognition by Telephone [BTACT]).

Results:
We found an inverse relationship between self-reported depression symptoms and the BTACT Composite score (β = −0.18, P < .01) and anxiety symptoms and the BTACT Composite score (β = −0.20, P < .01). There was no evidence this relationship varied by injury severity. Exploratory analyses showed depression and anxiety were negatively correlated with both BTACT Executive Function factor score and BTACT Memory factor score.

Conclusions:
Both depression and anxiety have a small but significant negative association with cognitive performance in the context of complicated mild to severe TBI. These findings highlight the importance of considering depression and anxiety when interpreting TBI-related neuropsychological impairments, even among more severe TBI.
Clinician Perspectives on Providing Concussion Assessment and Management via Telehealth: A Mixed-Methods Study
Authors: van Ierssel Jacqueline , O'Neil Jennifer , King Judy , Zemek Roger , Sveistrup Heidi 
Published: February 2023

Objective:
To examine clinician perspectives regarding the use of telehealth for concussion assessment and management.

Setting:
A Pan-Canadian survey.

Participants:
Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14).

Design:
Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design.

Main Outcome Measures:

Survey: A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups: 10 open-ended questions explored survey results in more detail.

Results:
Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented.

Conclusions:
From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.
Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81 Months Postinjury
Authors: Rempe Gary , Petranovich Christine , Narad Megan E. , Yeates Keith Owen , Taylor H. Gerry , Stancin Terry , Wade Shari 
Published: February 2023

Objective:
To explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis.

Participants:
A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI.

Design:
Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined.

Measures:
Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire).

Results:
Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory (P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race.

Conclusion:
Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
Using a Capsular Tension Ring (CTR) Inserter for CTR Explantation in Cases of Posteriorly Dislocated Intraocular Lens–CTR–Capsule Complex
Authors: Henderson Matthew N. , Masia Hayden A. , Prenner Jonathan L. , Fine Howard F. 
Published: February 2023

Purpose:
Explantation of a dislocated capsular tension ring (CTR) from the vitreous cavity can be challenging, typically requiring a bimanual hand-shake technique or cutting the CTR into segments. We present three cases of dislocated intraocular lens (IOL)–CTR–capsule complexes in which CTRs were explanted efficiently and safely by using a CTR inserter (CTR-I) through a clear corneal incision.

Methods:
Retrospective case series.

Results:
Capsular tension rings were successfully explanted by freeing the eyelet of the CTR from the capsule, engaging it with the CTR-I hook and retracting the CTR into the device’s shaft while maintaining the entire IOL–CTR–capsule complex in a safe position behind the iris plane. No complications of the procedure were observed in all three cases. All patients had subsequent uneventful IOL exchange through sutureless scleral fixation during the same surgery.

Conclusion:
The CTR inserter provides a simple and efficient approach to CTR removal from IOL–CTR–capsule complexes dislocated into the vitreous cavity. Greater awareness of this technique among providers is needed.