bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between fatty liver index and onset of diabetes: secondary analysis of a population-based cohort study
Authors: Zhu Yanqiong , Hu Haofei , Wu Yumei , Rao Yinhua , Li Qixiang , Duan Xuehui , Yao Guopeng , Yin Hekun , Luo Ziyi 
Published: April 2023

Abstract
Background
According to research, the fatty liver index (FLI) is associated with diabetes. However, few studies have been conducted to investigate the relationship between FLI and diabetes risk from various perspectives. This study comprehensively investigated the relationship between FLI and incident diabetes in a large Japanese population.

Methods
This retrospective cohort study included 14,280 participants from Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables are FLI and risk of type 2 diabetes mellitus (T2DM), respectively. To examine the link between FLI and incident T2DM, Cox proportional-hazards regression was employed. In addition, we performed a number of sensitivity studies to guarantee the validity of the results. Moreover, we conducted subgroup analyses.

Results
After adjusting covariates, the results showed that FLI was positively associated with the risk of T2DM (HR = 1.019, 95%CI: 1.012, 1.025). Additionally, the sensitivity analysis showed how reliable the outcomes were. And a stronger association between FLI and incident T2DM was observed in the regular exercisers (HR = 1.036, 95%CI: 1.019–1.053, P < 0.0001) and the population without ethanol consumption (HR = 1.028, 95%CI: 1.017–1.039, P < 0.0001). Besides, receiver operating characteristic (ROC) curve analysis showed that FLI was better than waist circumference, triglycerides, body mass index, and gamma-glutamyl transferase in predicting incident T2DM.

Conclusion
FLI is positively associated with incident T2DM.
The Thai version of the COVID-19 Yorkshire Rehabilitation Scale: a valid instrument for the psychometric assessment of the community members in Bangkok, Thailand
Authors: Partiprajak Suphamas , Krongthaeo Suphanna , Piaseu Noppawan , Wongsathikun Jatuporn , Kongsuwan Anon 
Published: April 2023

Abstract
Background
Coronavirus disease 2019 (COVID-19) can develop into a long-term COVID in some cases, which can have a major impact on various health systems requiring appropriate treatment involving multi-disciplinary healthcare. The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) is a standardized tool widely used for screening the symptoms and severity of long-term COVID. Translation of the English version of the C19-YRS into the Thai language and testing it is essential for the psychometric evaluation of the severity of the long-term COVID syndrome prior to providing rehabilitation care for community members.

Methods
Forward-and back-translations including cross-cultural aspects were conducted in order to develop a preliminary Thai version of that tool. Five experts evaluated the content validity of the tool and produced a highly valid index. A cross-sectional study was then conducted on a sample of 337 Thai community members recovering from COVID-19. Assessment of internal consistency and individual item analyses were also performed.

Results
The content validity resulted in valid indices. The analyses showed that 14 items had acceptable internal consistency, based on the corrected item correlations. However, five symptom severity items and two functional ability items were deleted. The Cronbach’s alpha coefficient of the final C19-YRS was 0.723, indicating acceptable internal consistency and reliability of the survey instrument.

Conclusions
This study indicated that the Thai C19-YRS tool had acceptable validity and reliability for the evaluation and testing of the psychometric variables in a Thai community population. The survey instrument also had acceptable validity and reliability for screening the symptoms and severity of long-term COVID. Further studies are warranted in order to standardize the various applications of this tool.
Caregivers perception of common neonatal illnesses and their management among rural dwellers in Enugu state, Nigeria: a qualitative study
Authors: Chime Onyinye H , Eneh Chizoma I. , Asinobi Isaac N , Ekwochi Uchenna , Ndu Ikenna Kingsley , Nduagubam Obinna C , Amadi Ogechukwu F , Osuorah Donatus Chidiebere 
Published: April 2023

Abstract
Background
Neonatal mortality continues to be a challenge in Nigeria, where low-quality care, caregivers’ ignorance of signs of neonatal illnesses, and prevalent use of unorthodox alternatives to health care predominate. Misconceptions originating and propagating as traditional practices and concepts can be linked to adverse neonatal outcomes and increased neonatal mortality. This study explores the perceptions of causes and management of neonatal illness among caregivers in rural communities in Enugu state, Nigeria.

Methods
This was a cross-sectional qualitative study among female caregivers of children residing in rural communities in Enugu state. A total of six focus group discussions (FGDs) were conducted; three in each of the communities, using an FGD guide developed by the researchers. Using pre-determined themes, thematic content analysis was used to analyze the data.

Results
The mean age of respondents was 37.2 ± 13.5 years. Neonatal illnesses were reportedly presented in two forms; mild and severe forms. The common causes of the mild illnesses reported were fever, jaundice, eye discharge, skin disorders, and depressed fontanelle. The severe ones were convulsion, breathlessness/difficulty or fast breathing, draining pus from the umbilicus, and failure-to-thrive. The caregivers’ perceptions of causes and management of each illness varied. While some believed these illnesses could be managed with unorthodox treatments, others perceived the need to visit health centers for medical care.

Conclusions
Caregivers’ perception on the causes and management of common neonatal illnesses in these communities is poor. Obvious gaps were identified in this study. There is a need to design appropriate interventions to dispel the myths and improve the knowledge of these caregivers on neonatal illnesses towards adopting good health-seeking behaviours.
Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study
Authors: Vahabi Mandana , Mishra Gauravi , Pimple Sharmila , Wong Josephine Pui-Hing , Khan Momina , Prakash Vijayshree , Anand Kavita , Narushima Miya , Lofters Aisha K. 
Published: April 2023

Abstract
Background
While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman–centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India.

Methods
Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30–69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants’ uptake of cervical cancer screening was assessed after attendance in SHE.

Findings
Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS.

Conclusions
The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.
Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging
Authors: Sialino L. D. , Wijnhoven H. A.H. , van Oostrom S. H. , Picavet H. S.J. , Verschuren W. M.M. , Visser M. , Vader S. , Schaap L. A. 
Published: April 2023

Abstract
Background
Women have a higher life expectancy than men but experience more years with physical disabilities in daily life at older ages, especially women with a migration background. This pinpoints older women as an important target group for strategies that stimulate healthy lifestyle, which benefits healthy aging. Our study investigates motivators and barriers for healthy lifestyles and perspectives on determinants of healthy aging of older women. This provides essential information for developing targeted strategies.

Methods
Data was collected by semi-structured digital interviews from February till June 2021. Women aged 55 years and older living in the Netherlands (n = 34) with a native Dutch (n = 24), Turkish (n = 6) or Moroccan (n = 4) migration background were included. Two main subjects were investigated: (1) motivators and barriers on their current lifestyles regarding smoking, alcohol consumption, physical activity, diet and sleep and (2) perspectives on determinants of healthy aging. Interviews were analyzed using Krueger’s framework.

Results
Personal health was the most common motivator for a healthy lifestyle. In addition, peer pressure and being outdoors were specific motivators for physical activity. Bad weather conditions and personal dislike to be active were specific barriers. The social environment, personal preferences and personal belief to compensate with other healthy lifestyle behaviors were barriers for low alcohol consumption. Personal preferences (liking unhealthy food and not making time) were the main barriers for a healthy diet. Sleep was not perceived as a form of lifestyle behavior, but rather as a personal trait. Since there were no smokers, specific barriers were not mentioned. For Turkish-Dutch and Moroccan-Dutch women, additional barriers and motivators were culture and religion. These were strong motivators to abstain from alcohol consumption and smoking, but a barrier for a healthy diet. With regard to perspectives on determinants of healthy aging, positive views on aging and being physically active were perceived as most important. Women often wanted to increase their physical activity or healthy diet to stimulate healthy aging. Among Turkish-Dutch and Moroccan-Dutch women, healthy aging was also perceived as something in the hands of God.

Conclusions
Although motivators and barriers for a healthy lifestyle and perspectives on healthy aging vary for distinct lifestyles, personal health is a common motivator across all lifestyles. Having a migration background added culture and religion as distinct barriers and motivations. Strategies to improve lifestyle among older women should therefore have a tailored, culture sensitive approach (if applicable) for distinct lifestyle factors.
Short Telomere Syndrome presenting with pulmonary fibrosis, liver cirrhosis and hepatopulmonary syndrome: a case report
Authors: Baird Andrew , Gomes Marcio , Souza Carolina A. , Magner Kate , Alvarez Gonzalo 
Published: April 2023

Abstract
Background
Idiopathic pulmonary fibrosis is thought to result from aberrant post-injury activation of epithelial cells leading to fibroblast proliferation and activation. A number of genetic aetiologies have been implicated in this disease process, including, among others, the short telomere syndromes. Short telomere syndromes follow an autosomal dominant pattern of inheritance resulting in shortened telomere length, which consequently leads to accelerated cell death. Organs with rapid cell turnover are most affected.

Case presentation
We describe a case of a 53-year-old man with a chief complaint of cough and dyspnea on exertion. His presentation was otherwise significant for features of accelerated aging, including a history of osteoporosis and early greying, and a family history of pulmonary fibrosis in his father. Pulmonary function testing revealed a restrictive pattern with severely reduced diffusion capacity and high resolution CT of the chest showed diffuse lung disease with mild fibrosis, in pattern suggesting an alternative diagnosis to IPF. Biopsy of the lung was in keeping with chronic fibrosing interstitial pneumonia. Imaging of the abdomen showed splenomegaly, hepatic cirrhosis and portal hypertension. Transthoracic contrast echocardiogram showed intrapulmonary shunting consistent with hepatopulmonary syndrome. Given the constellation of early aging, idiopathic pulmonary fibrosis, cryptogenic cirrhosis and a family history of pulmonary fibrosis in this patient, the Short Telomere Syndrome was suspected. Peripheral blood was sent for Flow-cytometry FISH, which demonstrated granulocyte telomere length below the 10th percentile for the patient’s age, consistent with a diagnosis of Short Telomere Syndrome in this clinical context. Targeted genetic testing of mutations known to be associated with short telomere was negative though it was acknowledged that the full spectrum of disease-causing mutations remains unknown. Given the extensive fibrosis on biopsy and his progressive hypoxemia he was treated with mycophenolate and prednisone. Ultimately, he developed progressive respiratory failure and underwent double lung and concurrent liver transplant 18 months after the initial diagnosis was made.

Conclusions
Short Telomere Syndrome is a rare cause of end stage organ disease and testing lacks sensitivity making diagnosis challenging. Organ transplant is still the mainstay of treatment. Nevertheless, disease identification is important because of implications for family member screening and the possibility of future treatment options.
Xanthogranulomatous pyelonephritis with polycystic kidney disease as a mimic of cystic renal cell carcinoma: a case report
Authors: Yi Mei , Liu Yong , Chen Qi 
Published: April 2023

AbstractBackgroundXanthogranulomatous pyelonephritis (XGP) is a rare chronic pyelonephritis that often mimics other renal diseases, when combined with autosomal dominant polycystic kidney disease(ADPKD), preoperative diagnosis is exceedingly difficult. It is important for clinicians to be aware of an XGP with ADPKD since a misdiagnosis can lead to unnecessary surgical intervention.Case presentationHere, we report a case of a 66-year-old female with a history of bilateral ADPKD and urinary tract infection admitted to our hospital due to right flank pain, feeble, and low-grade fever. Contrast-enhanced ultrasound revealed a malignant mass of the right kidney suspected to be a cystic renal cell carcinoma with polycystic kidney disease. In addition, contrast-enhanced computed tomography (CT) and fluorine 18 fluorodeoxyglucose PET/CT (18F FDG PET/CT) showed similar results. Subsequently, the patient underwent a right radical nephrectomy, but histopathological examination revealed XGP with ADPKD. On the follow-up, the patient's symptoms were relieved.ConclusionsXGP should be kept in mind during the differential diagnosis of renal masses with ADPKD even in the absence of characteristic clinical symptoms and imaging manifestations.
Exploring patient perspectives on the secondary use of their personal health information: an interview study
Authors: Dobson Rosie , Wihongi Helen , Whittaker Robyn 
Published: April 2023

Abstract
Background
The increased digitalisation of health records has resulted in increased opportunities for the secondary use of health information for advancing healthcare. Understanding how patients want their health information used is vital to ensure health services use it in an appropriate and patient-informed manner. The aim of this study was to explore patient perceptions of the use of their health information beyond their immediate care.

Methods
Semi-structured in-depth interviews were conducted with current users of health services in Aotearoa New Zealand. Different scenarios formed the basis of the discussions in the interviews covering different types of information use (current practice, artificial intelligence and machine learning, clinical calculators, research, registries, and public health surveillance). Transcripts were analysed using thematic analysis.

Results
Twelve interviews were conducted with individual’s representative of key ethnicity groups and rural/urban populations, and at the time of recruitment, had been accessing a diverse range of health services. Participants ranged from high users of health care (e.g., weekly dialysis) through to low users (e.g., one-off presentation to the emergency department). Four interrelated overarching themes were identified from the transcripts describing the main issues for participants: helping others, sharing of data is important, trust, and respect.

Conclusions
People currently engaging with health services are supportive of their health information being used to help others, advance science, and contribute to the greater good but their support is conditional. People need to be able to trust the health service to protect, care for, and respect their health information and ensure no harm comes from its use. This study has identified key considerations for services and researchers to reflect on when using patient health information for secondary purposes to ensure they use it in a patient-informed way.

Trial registration
NA.
Diagnosis of autism in a rare case of tyrosine hydroxylase deficiency: a case report
Authors: Reyes Zoe Maria Dominique , Lynch Emma , Henry Julia , De Simone Lenika Marina , Sobotka Sarah A. 
Published: April 2023

Abstract
Background
Tyrosine hydroxylase deficiency (THD) is a rare movement disorder with broad phenotypic expression caused by bi-allelic mutations in the TH gene, which encode for tyrosine hydroxylase (TH) protein. Some patients with THD have improvement in dystonia with carbidopa–levodopa, a synthetic form of dopamine typically used in Parkinson’s disease, and are considered to have dopa-responsive THD. THD has been found in 0.5–1 per million persons, although due to overlapping symptoms with other disorders and the need for genetic testing, prevalence is likely underestimated. Existing literature describes some patients with THD having intellectual disability, but comorbid autism spectrum disorder (ASD) has not been reported.

Case presentation
A nearly 3-year-old boy was referred to pediatric neurology due to hypotonia, delayed motor milestones, and expressive speech delay. Whole exome sequencing confirmed tyrosine hydroxylase deficiency, detecting a novel variant p.S307C first reported here. The child was treated with carbidopa–levodopa with an excellent response, resulting in improved balance, fewer falls, and improved ability to jump, run and climb stairs. He was determined to have dopa-responsive THD. Due to his delays in expressive speech, the boy also had an assessment with a developmental and behavioral pediatrician, who identified a pattern of social pragmatic speech delay, sensory sensitivities, and restricted interests, and determined that he met criteria for a diagnosis of ASD.

Conclusions
While ASD can stand alone as a clinical diagnosis, it is also a cardinal feature of other genetically-based neurological disorders. To our knowledge, this is the first case that describes a patient with both disorders. Perhaps THD may be among the genetic disorders linked with ASD.
Expression of TFRC helps to improve the antineoplastic effect of Ara-C on AML cells through a targeted delivery carrier
Authors: Wu Xinzhou , Jiao Zhouguang , Zhang Junying , Li Feng , Li Yuhua 
Published: April 2023

Abstract
Background
Currently, high doses of cytarabine arabinoside (Ara-C)-based combined chemotherapy are commonly used in acute myeloid leukemia (AML) therapy, but severe adverse effects and poor suppression effects in leukemia cells limit the clinical therapeutic efficiency of Ara-C-based chemotherapy due to a lack of targeting selectivity. To improve the therapeutic effect of Ara-C in AML, here, since we confirmed that transferrin receptor 1 (TFRC) expression in AML cells was constant, we generated Ara-C@HFn by encapsulating free Ara-C into self-assembled heavy ferritin chain (HFn, the ligand of TFRC) nanocages.

Results
The analysis of clinically relevant data suggested that the high expression levels of TFRC from AML cells would not decrease significantly after treatment with Ara-C. Ara-C@HFn can be efficiently internalized by leukemia cells, showing stronger cytotoxic effects in vitro and reducing the burden of leukemia in AML mice more effectively in vivo than free Ara-C. Ara-C@HFn treatment showed no acute toxicity in visceral organs of mice. Moreover, the analysis of clinically relevant data also suggested that there are several drugs (such as tamibarotene and ABT199) that would not cause significant expression down-regulation of TFRC in AML cells (after treatment).

Conclusion
The above results suggested that TFRC can be used as a constant and effective target for drug targeting delivery of AML cells. Thus Ara-C@HFn treatment can become a safe and efficient strategy for AML therapy by specifically delivering Ara-C to AML cells. Besides, the HFn nanocages are promising for improving antineoplastic effect of other AML-related therapy drugs that do not cause downregulated expression of TFRC in AML cells.

Graphical Abstract