bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of caregiver demands on growing family capabilities provide home care for dementia-affected seniors
Authors: Sya’diyah Hidayatus , Efendi Ferry , Mahmudah  , Saidah Qori’ Ila , Poddar Sandeep 
Published: September 2023

Background: The elderly with dementia occur cognitive decline and they are considered normal by the family, and then causing the need for care from elderly. This is not following the ability of home care by the family as an informal caregiver for the elderly with dementia. The purpose of this study was to analyze the effect of caregiver demands on the ability of families to do home care for elderly dementia. Design and methods: An analytical observational study with a cross-sectional design. The sample size is 100 respondents with a cluster random sampling technique. Data were collected by questionnaire and analyzed using SEM-PLS. Results: Caregiver demands have a direct effect on increasing the family’s ability to do home care for elderly dementia with a p-value = 0.011 ( p ≤ 0.05), t statistic value of 2.557 (≥1.96). Caregiver demands have four indicators, including care receiver impairment, caregiving activities, competency of caregivers, and caregiver/family relationship with elderly dementia. The condition of the elderly who experience various changes supports the increasing need for care to receive care and recovery as well as special attention from the family. Conclusion: The higher the need for care, the higher the family’s ability to do home care. This research implies that the family has a duty in the health sector to provide care for the elderly at home/home care, which strengthens the need for care, this supports caregiver empowerment and increases the independence of the elderly with dementia.
Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia
Authors: Cha EunSeok , Joung Kyong Hye , Shin Yun-A , Son Nak-Hoon , Kim Hyun Jin , Faulkner Melissa Spezia 
Published: September 2023

Purpose: The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D). Methods: Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0). Results: Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass. Conclusions: Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.
Target trial emulation with multi-state model analysis to assess treatment effectiveness using clinical COVID-19 data
Authors: Martinuka Oksana , Hazard Derek , Marateb Hamid Reza , Maringe Camille , Mansourian Marjan , Rubio-Rivas Manuel , Wolkewitz Martin 
Published: September 2023

Abstract
Background
Real-world observational data are an important source of evidence on the treatment effectiveness for patients hospitalized with coronavirus disease 2019 (COVID-19). However, observational studies evaluating treatment effectiveness based on longitudinal data are often prone to methodological biases such as immortal time bias, confounding bias, and competing risks.

Methods
For exemplary target trial emulation, we used a cohort of patients hospitalized with COVID-19 (n = 501) in a single centre. We described the methodology for evaluating the effectiveness of a single-dose treatment, emulated a trial using real-world data, and drafted a hypothetical study protocol describing the main components. To avoid immortal time and time-fixed confounding biases, we applied the clone-censor-weight technique. We set a 5-day grace period as a period of time when treatment could be initiated. We used the inverse probability of censoring weights to account for the selection bias introduced by artificial censoring. To estimate the treatment effects, we took the multi-state model approach. We considered a multi-state model with five states. The primary endpoint was defined as clinical severity status, assessed by a 5-point ordinal scale on day 30. Differences between the treatment group and standard of care treatment group were calculated using a proportional odds model and shown as odds ratios. Additionally, the weighted cause-specific hazards and transition probabilities for each treatment arm were presented.

Results
Our study demonstrates that trial emulation with a multi-state model analysis is a suitable approach to address observational data limitations, evaluate treatment effects on clinically heterogeneous in-hospital death and discharge alive endpoints, and consider the intermediate state of admission to ICU. The multi-state model analysis allows us to summarize results using stacked probability plots that make it easier to interpret results.

Conclusions
Extending the emulated target trial approach to multi-state model analysis complements treatment effectiveness analysis by gaining information on competing events. Combining two methodologies offers an option to address immortal time bias, confounding bias, and competing risk events. This methodological approach can provide additional insight for decision-making, particularly when data from randomized controlled trials (RCTs) are unavailable.
A scoping review of risk factors for urinary incontinence in older men
Authors: Olagundoye Olawunmi , Odusanya Benjamin , Kung Janice Y. , Gibson William , Wagg Adrian 
Published: September 2023

Abstract
Background
Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

Methods
The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI’s Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI’s three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

Results
Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson’s disease (n = 7).

Conclusion
There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

Registration
A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/].
Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study
Authors: Åberg Anna Cristina , Petersson Johanna R. , Giedraitis Vilmantas , McKee Kevin J. , Rosendahl Erik , Halvorsen Kjartan , Berglund Lars 
Published: September 2023

Abstract
Background
While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.

Methods
The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.

Results
During follow-up time (median (range) 3.7 (0.1–6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.

Conclusions
TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.

Trial registration
ClinicalTrials.gov Identifier: NCT05893524: https://www.clinicaltrials.gov/study/NCT05893524?id=NCT05893524&rank=1.
Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease
Authors: Sihaklang Boonyanurak , Getsuwan Songpon , Pattanaprateep Oraluck , Butsriphum Napapat , Lertudomphonwanit Chatmanee , Tanpowpong Pornthep , Thirapattaraphan Chollasak , Treepongkaruna Suporn 
Published: September 2023

Abstract
Background
Timing for liver transplantation (LT) in biliary atresia (BA) children with end-stage liver disease (ESLD) is associated with all-cause mortality. The cut-off value of pediatric end-stage liver disease (PELD) score for LT consideration varies across institutions. We aimed to determine the cost-effectiveness of LT to prevent death among BA children registered on the waiting list with different severities of ESLD.

Methods
Subjects were BA children aged < 12 years at a transplant center between 2010 and 2021. A decision tree was developed for cost-effectiveness analysis from a hospital perspective to compare all-cause death between patients initially registered with a low PELD score (< 15) and a high PELD score (≥ 15). Each patient’s direct medical cost was retrieved from the beginning of registration until 5 years after LT, adjusted with an inflation rate to 2022 Thai Baht (THB).

Results
Among 176 children, 138 (78.4%) were initially registered with the high PELD score. The cost and mortality rate of the low PELD score group (THB1,413,424 or USD41,904 per patient and 31.6% mortality) were less than the high PELD score group (THB1,781,180 or USD52,807 per patient and 47.9% mortality), demonstrating the incremental cost-effectiveness ratio (ICER) of THB2,259,717 or USD66,994 per death prevented. The cost of early post-operative admission had the highest effect on the ICER. Considering the break-even analysis, cost among children initially registered at the low PELD score was also less expensive over time.

Conclusions
Registration for LT at PELD score < 15 was more cost-effective to prevent death among BA children with ESLD.
Psychometric and structural properties of the Karolinska Exhaustion Disorder Scale: a 1,072-patient study
Authors: Lindsäter Elin , van de Leur Jakob Clason , Rück Christian , Hedman-Lagerlöf Erik , Bianchi Renzo 
Published: September 2023

Abstract
Objective
Exhaustion disorder is a stress-related diagnosis that was introduced in 2005 to the Swedish version of the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). The Karolinska Exhaustion Disorder Scale (KEDS) was developed to assess exhaustion disorder symptomatology. While the KEDS is intended to reflect a single construct and be used based on its total score, the instrument's characteristics have received limited attention. This study investigated the KEDS’s psychometric and structural properties in a large clinical sample.

Methods
The study relied on data from 1,072 patients diagnosed with exhaustion disorder that were included in two clinical trials in Sweden. We investigated the dimensionality, homogeneity, and reliability of the KEDS using advanced statistical techniques, including exploratory structural equation modeling (ESEM) bifactor analysis.

Results
A one-factor confirmatory analytic model exhibited a poor fit, suggesting at least a degree of multidimensionality. The ESEM bifactor analysis found the general factor to explain about 72% of the common variance extracted, with an omega hierarchical coefficient of 0.680. Thus, the ESEM bifactor analysis did not clearly support the scale’s essential unidimensionality. A homogeneity analysis revealed a scale-level H of only 0.296, suggesting that KEDS’s total scores do not accurately rank individuals on the latent continuum assumed to underlie the measure. The KEDS’s reliability was modest, signaling considerable measurement error.

Conclusion
Findings reveal important limitations to the KEDS with possible implications for the status of exhaustion disorder as a nosological category.

Trial registration
This study was pre-registered on Open Science Framework (osf.io) on April 24, 2022 (https://osf.io/p34sq/).
Drowning rates among children and adolescents (aged 7–17) in Israel during the years 2008–2018
Authors: Abihasira Sigalit , Moran Daniel S. , Orr Daniela , Eliyahu Uri 
Published: September 2023

Abstract
Objective
Drowning is one of the leading causes of death among children and youth worldwide. This study aims to examine differences in the rates of drowning (fatal and non-fatal drowning) among children and youth in Israel stratified by age, sex, sector, place of drowning, and the drowning outcome. In addition, we compared the results of studies reported in other countries in specific age groups based on statistics of about 100,000 drowning cases.

Method
A statistical analysis of 474 drownings between 2008 and 2018 was conducted. All cases refer to youngsters aged 7–17 in the State of Israel. Statistical analysis was performed on data obtained from the Beterem – Safe Kids Israel organization and from the Israel Central Bureau of Statistics. Disparities between groups within the examined population were analyzed based on gender, sector (Jewish versus non-Jewish), and drowning site.

Results
Of the 474 drownings that occurred during 2008–2018, 38.4% ended in death. 79% of the cases occurred in pools. The Arab minority sector (21.1% of the general population) accounted for 25.1% of all drownings, males accounted for 70.5% of the drowning cases, and the age group with the most drownings (48.5%) was that of 15–17 years. The Jewish population was involved in more than 75% of drownings in places designated for bathing and in more than 83% of all disaster scenarios, whereas the Arab minority was involved in more than 61% of drownings in places not designated for bathing.

Conclusions
The results are comparable to those of other studies worldwide. Boys drown twice as much as girls, mainly in the age group of 15–17. This may be explained by overconfidence in boys and a tendency to overestimate their actual swimming abilities. Most drownings occur in pools. Drowning among the Jewish population occurs mainly in designated bathing sites.

Practical applications
The findings can and, in fact, must be used to inform and educate the younger generation as to the potential dangers involving bathing in designated bathing sites.
Characterizing neck injuries in the national football league: a descriptive epidemiology study
Authors: Dow Bobby , Doucet Dakota , Vemu Sree M. , Boddapati Venkat , Marco Rex A. W. , Hirase Takashi 
Published: September 2023

Abstract
Background
Neck injury is a common and often debilitating injury among athletes participating in American football. Limited data exists regarding neck injuries among elite athletes in the National Football League (NFL). To characterize the epidemiology of non-season ending, season-ending, and career-ending neck injuries in the NFL from 2016 through 2021.

Methods
Athletes who sustained neck injuries were identified using the NFL’s injured reserve (IR) list between the 2016 and 2021 seasons. Demographics and return to sport (RTS) data were collected. Available game footages were reviewed to identify the mechanism of injury (MOI). Injury incidence rates were calculated based on per team play basis.

Results
During the 6-year study period, 464 players (mean age 26.8 ± 3.2 years) were placed on the injury reserve list due to neck injuries. There were 285 defensive players and 179 offensive players injured (61.4 vs 38.6%, respectively, p < 0.001). Defensive back was the most common position to sustain a neck injury (111 players, 23.9%). 407 players (87.7%) sustained non-season-ending injuries with a mean RTS at 9.2 ± 11.3 days. 36 players (7.8%) sustained season-ending injuries with a mean RTS at 378.6 ± 162.0 days. 21 players (4.5%) sustained career-ending injuries. The overall incidence of neck injuries was 23.5 per 10,000 team plays. The incidence of season-ending injuries and career-ending injuries were 1.82 and 1.06 per 10,000 team plays, respectively. There were 38 injuries with available footages for MOI assessment (23 non-season-ending, 9 season-ending, 6 career-ending). Head-to-head contact was seen in 15 injuries (39.5%), head-down tackling in 11 injuries (28.9%), direct extremity-to-head contact in 7 injuries (18.4%), and head-to-ground contact in 5 injuries (13.2%). There was no significant difference in age, position, or MOI among players sustaining non-season-ending, season-ending, and career-ending injuries.

Conclusion
There is a high incidence of neck injuries among NFL athletes with predictable MOIs including head-to-head contact, head-down tackling, direct extremity-to-head contact, and head-to-ground contact. Defensive players were more likely to sustain neck injuries compared to offensive players. Defensive back was the most common position to sustain a neck injury.

Level of evidence
III.
Causes of death after testicular cancer diagnosis: a US population-based analysis
Authors: Wang Zhongyuan , Li Baochao , Xing Jiajun , Gong Zixuan , Xu Aiming , Wang Zengjun 
Published: September 2023

Abstract
Background
After the introduction of cisplatin-based chemotherapy, the survival time of testicular cancer (TC) patients has improved dramatically. However, the overall risk of death in patients with TC remains significantly higher than in the general population. The aim of this study was to assess and quantify the causes of death after TC diagnosis.

Method
In total, 44,975 men with TC in the United States diagnosed and registered by the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2018 were studied. In this study, standardized mortality rates (SMRs) were calculated for each cause of death in TC individuals and further analyzed in strata according to age and race.

Result
Of the included participants, 3,573 (7.94%) died during the follow-up period. The greatest proportion of deaths (38.20%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from TC itself and other cancers. For non-malignant conditions, the most common causes of death within 1 years after diagnosis were accidents and adverse effects (53, 4.75%) followed by diseases of heart (45, 4.04%). However, > 1 years after diagnosis, the most common noncancer causes of death were heart diseases. Results of stratified analysis show that non-Hispanic White TC participants have a lower SMR (0.68, 95% CI, 33.39–38.67) from Cerebrovascular Diseases than the general U.S. population.

Conclusions
Although TC remains the most common cause of death after TC diagnosis, other non-TC causes of death represent a significant number of deaths among TC men. These findings help TC survivors understand the various health risks that may occur at different follow-up periods.