bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age as a moderating factor of treatment resistance in depression
Authors: Kautzky Alexander , Bartova Lucie , Fugger Gernot , Dold Markus , Souery Daniel , Montgomery Stuart , Zohar Joseph , Mendlewicz Julien , Fabbri Chiara , Serretti Alessandro , Rujescu Dan , Kasper Siegfried 
Published: April 2023

Abstract

Background
Treatment-resistant depression (TRD) is an important clinical challenge and may present differently between age groups.

Methods
A total of 893 depressed patients recruited within the framework of the European research consortium “Group for the Studies of Resistant Depression” were assessed by generalized linear models regarding age effects (both as numerical and factorial predictors) on treatment outcome, number of lifetime depressive episodes, hospitalization time, and duration of the current episode. Effects of age as numerical predictor on the severity of common depressive symptoms, measured with Montgomery–Åsberg Depression Rating Scale (MADRS) for two-time points, were assessed by linear mixed models, respectively, for patients showing TRD and treatment response. A corrected p threshold of 0.001 was applied.

Results
Overall symptom load reflected by MADRS (p < 0.0001) and lifetime hospitalization time (p < 0.0001) increased with age in TRD patients but not treatment responders. In TRD, higher age was predicting symptom severity of inner tension, reduced appetite, concentrations difficulties, and lassitude (all p ≤ 0.001). Regarding clinical significance, older TRD patients were more likely to report severe symptoms (item score > 4) for these items both before and after treatment (all p ≤ 0.001).

Conclusions
In this naturalistic sample of severely ill depressed patients, antidepressant treatment protocols were equally effective in addressing TRD in old age. However, specific symptoms such as sadness, appetite, and concentration showed an age-dependent presentation, impacting residual symptoms in severely affected TRD patients and calling for a precision approach by a better integration of age profiles in treatment recommendations.
Postoperative Adjuvant Anastrozole for 10 or 5 Years in Patients With Hormone Receptor–Positive Breast Cancer: AERAS, a Randomized Multicenter Open-Label Phase III Trial
Authors: Iwase Takuji , Saji Shigehira , Iijima Kotaro , Higaki Kenji , Ohtani Shoichiro , Sato Yasuyuki , Hozumi Yasuo , Hasegawa Yoshie , Yanagita Yasuhiro , Takei Hiroyuki , Tanaka Maki , Masuoka Hideji , Tanabe Masahiko , Egawa Chiyomi , Komoike Yoshifumi , Nakamura Toshitaka , Ohtsu Hiroshi , Mukai Hirofumi 
Published: April 2023

PURPOSE Treatment with an aromatase inhibitor for 5 years is the standard treatment for postmenopausal hormone receptor–positive breast cancer. We investigated the effects of extending this treatment to 10 years on disease-free survival (DFS). PATIENTS AND METHODS This prospective, randomized, multicenter open-label phase III study assessed the effect of extending anastrozole treatment for an additional 5 years in postmenopausal patients who were disease-free after treatment with either 5 years of anastrozole alone or 2-3 years of tamoxifen followed by 2-3 years of anastrozole. Patients were allocated randomly (1:1) to continue anastrozole for an additional 5 years or stop anastrozole. The primary end point was DFS, including breast cancer recurrence, second primary cancers, and death from any cause. This study is registered with University Hospital Medical Information Network, Japan (UMIN) clinical trials registry (UMIN000000818). RESULTS We enrolled 1,697 patients from 117 facilities between November 2007 and November 2012. Follow-up information was available for 1,593 patients (n = 787 in the continue group, n = 806 in the stop group), who were defined as the full analysis set, including 144 patients previously treated with tamoxifen and 259 patients who underwent breast-conserving surgery without irradiation. The 5-year DFS rates were 91% (95% CI, 89 to 93) in the continue group and 86% (95% CI, 83 to 88) in the stop group (hazard ratio, 0.61; 95% CI, 0.46 to 0.82; P < .0010). Notably, extended anastrozole treatment reduced the incidence of local recurrence (continue group, n = 10; stop group, n = 27) and second primary cancers (continue group, n = 27; stop group, n = 52). There was no significant difference in overall or distant DFS. Menopausal or bone-related all-grade adverse events were more frequent among patients in the continue group than those in the stop group, but the incidence of grade ≥3 adverse events was <1% in both groups. CONCLUSION Continuing adjuvant anastrozole for an additional 5 years after 5 years of initial treatment with anastrozole or tamoxifen followed by anastrozole was well tolerated and improved DFS. Although no difference in overall survival was observed as in other trials, extended anastrozole therapy could be one treatment choice in postmenopausal patients with hormone receptor–positive breast cancer.
Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes
Authors: Haines Melanie S , Kaur Snimarjot , Scarff Geetanjali , Lauze Meghan , Gerweck Anu , Slattery Meghan , Oreskovic Nicolas M , Ackerman Kathryn E , Tenforde Adam S , Popp Kristin L , Bouxsein Mary L , Miller Karen K , Misra Madhusmita 
Published: April 2023

Abstract

Context
Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners.

Objective
To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength.

Design
Cross-sectional.

Setting
Clinical research center.

Participants
39 men (20 runners, 19 controls), ages 16–30 years.

Main Outcome Measures
Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability.

Results
Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (−1.4 ± 0.8 vs −0.8 ± 0.8) lower (P &lt; .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA &lt;median had lower lumbar spine (−1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs −0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA &lt;median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P &lt; .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners.

Conclusions
Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
Short-term Intensive Lifestyle Therapy in a Worksite Setting Improves Cardiometabolic Health in People With Obesity
Authors: Schweitzer George G , Beckner David C , Smith Gordon I , Klein Samuel 
Published: April 2023

Abstract

Context
The Pritikin Program, which provides intensive lifestyle therapy, has been shown to improve cardiometabolic outcomes when provided as a residential program.

Objective
The purpose of the present study was to conduct a short-term, randomized, controlled trial to evaluate the feasibility and clinical efficacy of treatment with the Pritikin Program in an outpatient worksite setting.

Methods
Cardiometabolic outcomes were evaluated in people with overweight/obesity and ≥2 metabolic abnormalities (high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, HbA1c &gt; 5.7%), before and after they were randomized to 6 weeks of standard care (n = 26) or intensive lifestyle therapy, based on the Pritikin Program (n = 28). Participants in the lifestyle intervention group were provided all food as packed-out meals and participated in group nutrition, behavioral education, cooking classes, and exercise sessions 3 times per week at a worksite location.

Results
Compared with standard care, intensive lifestyle therapy decreased body weight (−5.0% vs −0.5%), HbA1c (−15.5% vs +2.3%), plasma total cholesterol (−9.8% vs +7.7%), low-density lipoprotein cholesterol (−10.3% vs +9.3%) and triglyceride (−21.7% vs +3.0%) concentrations, and systolic blood pressure (−7.0% vs 0%) (all P values &lt; .02), and increased exercise tolerance (time to exhaustion walking on a treadmill by +23.7% vs +4.5%; P &lt; .001).

Conclusion
This study demonstrates the feasibility and clinical effectiveness of short-term, intensive outpatient lifestyle therapy in people with overweight/obesity and increased risk of coronary heart disease when all food is provided and the intervention is conducted at a convenient worksite setting.
Η πολιτική ταυτότητα, η φιλοσοφία και οι εκπαιδευτικές μεταρρυθμίσεις του Ελευθερίου Βενιζέλου
Authors: Μεταξούδης Ελευθέριος Θεόδωρος 
Published: April 2023

Μέσα από το μεγάλο και συνεχές μεταρρυθμιστικό έργο, που διαπέρασε και μεταμόρφωσε την Ελληνική κοινωνία, μπορεί και πρέπει, να ερευνηθεί και να σκιαγραφηθεί το ιδεολογικό και πολιτικό πορτρέτο του Ελευθερίου Βενιζέλου. Το πορτρέτο ενός βαθιά φιλελεύθερου ηγέτη, ο οποίος όμως, υπερβαίνοντας το φιλελευθερισμό, εγκολπώνει στοιχεία πολιτικού ριζοσπαστισμού. Το φιλελεύθερο και ριζοσπαστικό αυτό πνεύμα, το οποίο εφαρμόστηκε στο σύνολο των εκπαιδευτικών πεδίων της χώρας, υπεράνω όλων των κομματικών ανταγωνισμών και των φορέων εκπροσώπησής τους, σε θέματα όπως, της γλώσσας για τη διδασκαλική διαδικασία, στο ζήτημα της διάρθρωσης της εκπαίδευσης, στην ανύψωση του μορφωτικού επιπέδου για την επίτευξη της επιζητούμενης πολιτικής κοινωνικοποίησης των μαθητών (και κυρίως των γυναικών), αλλά και στην επιβολή μιας αναγκαίας συνθήκης για τη στροφή της εκπαίδευσης στα ζωντανά στοιχεία του πολιτισμού, είναι ζητήματα τα οποία αυτή η εργασία πραγματεύεται.
Το μοντέλο των τριών διαστάσεων της μάθησης του Illeris μέσω ενός ποιήματος και της τεχνικής «Συνέντευξη από ειδικό»
Authors: Χρήστου Μαρία 
Published: April 2023

Στο παρόν άρθρο παρουσιάζεται μια πρόταση εμβάθυνσης στις τρεις διαστάσεις της μάθησης, σύμφωνα με το μοντέλο του Illeris (περιεχόμενο, υποκίνηση, αλληλεπίδραση με το περιβάλλον μάθησης), μέσω της κριτικής επεξεργασίας του ποιήματος του Νικηφόρου Βρεττάκου «Τα δεκατέσσερα παιδιά», σε συνδυασμό με την εκπαιδευτική τεχνική «Συνέντευξη από ειδικό». Έναυσμα υπήρξε ο τρόπος που προσεγγίστηκε κριτικά το ποίημα του Βρεττάκου από την Ομάδα Αυτομόρφωσης της Επιστημονικής Ένωσης Εκπαίδευσης Ενηλίκων (E.E.E.E.) σε μια από τις διαδικτυακές συναντήσεις της κατά το έτος 2020 – 2021, με στόχο την εμβάθυνση σε θέματα που σχετίζονται με τον τρόπο που μαθαίνουμε. Αρχικά γίνεται αναφορά στις τρεις διαστάσεις της μάθησης, σύμφωνα με το μοντέλο του Illeris, αλλά και στον τρόπο αντιμετώπισής τους από τη μεριά των εκπαιδευτικών, λαμβάνοντας υπόψη τις αντιστάσεις που μπορεί να προβάλουν στην περίπτωση που έρθουν αντιμέτωποι με δύσκολες εκπαιδευτικές συνθήκες στα σχολεία που εργάζονται. Κατόπιν, γίνεται αναφορά στη συμβολή της τέχνης ως μέσο προσέγγισης θεωρητικών ζητημάτων, αλλά και ως μέσο αναστοχασμού των προσωπικών πεποιθήσεων των αποδεκτών. Στη συνέχεια, παρουσιάζονται συγκεκριμένα θέματα που αναδείχθηκαν από τα μέλη της Ομάδας Αυτομόρφωσης της Ε.Ε.Ε.Ε. σχετικά με τις τρεις διαστάσεις της μάθησης, μέσω της κριτικής επεξεργασίας του ποιήματος του Νικηφόρου Βρεττάκου, αξιοποιώντας την τεχνική ανάλυσης λογοτεχνικών έργων τέχνης της Αντιγόνης Βλαβιανού. Κατόπιν, αξιοποιώντας την εκπαιδευτική τεχνική «Συνέντευξη από ειδικό» επιχειρείται η εμβάθυνση στα προαναφερθέντα θέματα που αναδείχθηκαν από την επεξεργασία του ποιήματος, μέσα από το προσωπικό βίωμα ενός συνταξιούχου εκπαιδευτικού, ο οποίος στις αρχές της δεκαετίας του 1960 βίωσε ανάλογες εκπαιδευτικές συνθήκες με αυτές που περιγράφονται στο ποίημα, όπως μας τα διηγήθηκε σε συνέντευξη που μας παραχώρησε. Ακολουθεί συζήτηση και σύνοψη συμπερασμάτων.
Το κείμενο θα μπορούσε να αποτελέσει μια πρόταση προσέγγισης θεωρητικών ζητημάτων για όλες τις βαθμίδες εκπαίδευσης, με τις ανάλογες προσαρμογές και την κατάλληλη καθοδήγηση από τον διδάσκοντα, λαμβάνοντας υπόψη την ηλικία, τις εμπειρίες και τα βιώματα των εκπαιδευομένων. Χωρίς να παραβλέπουμε τη σημασία απόδοσης ενός θεωρητικού ζητήματος με τη χρήση του επιστημονικού λόγου, σε όλες τις βαθμίδες εκπαίδευσης και στην εκπαίδευση ενηλίκων, προτείνουμε παράλληλα την προσέγγιση του ίδιου θεωρητικού ζητήματος μέσω της κριτικής επεξεργασίας σημαντικών έργων τέχνης, με κατάλληλη τεχνική, όπως επίσης και μέσω της αξιοποίησης της εκπαιδευτικής τεχνικής «Συνέντευξη από ειδικό», η οποία ενισχύει την εμπέδωση της θεωρίας και την εμβάθυνση σε αυτήν. Σε όλο το άρθρο χρησιμοποιείται ένα γένος, χάριν οικονομίας του λόγου, χωρίς αυτό να παραπέμπει σε οποιαδήποτε διάκριση με βάση το φύλο.
Current and future opportunities of autodissemination of pyriproxyfen approach for malaria vector control in urban and rural Africa
Authors: Mmbaga Augustino Thabiti , Lwetoijera Dickson Wilson 
Published: April 2023

Despite the progress made in reducing malaria burden, new ways to address the increasing challenges of insecticide resistance and the invasion and spread of exotic malaria vectors such as Anopheles stephensi in Africa are urgently needed. While African countries are adopting larviciding as a complementary intervention for malaria vector control, the autodissemination technology has the potential to overcome barriers associated with the identification and treatment of prolific habitats that impede conventional larviciding approaches in rural settings. The autodissemination technology as a “lure and release” strategy works by exploiting the resting behavior of gravid mosquitoes to transfer lethal concentration of biological or chemical insecticide such as pyriproxyfen (PPF), an insect growth regulator (IGRs) to their oviposition sites and result in adult emergence. Despite the evidence of the autodissemination approach to control other mosquito-borne diseases, there is growing and promising evidence for its use in controlling malaria vectors in Africa, which highlights the momentous research that needs to be sustained. This article reviews the evidence for efficacy of the autodissemination approach using PPF and discusses its potential as efficient and affordable complementary malaria vector control intervention in Africa. In the previous studies that were done in controlled semi-field environments, autodissemination with PPF demonstrated its potential in reducing densities of captive population of malaria vectors such as Anopheles gambiae and Anopheles arabiensis. Of importance, empirical evidence and biology-informed mathematical models to demonstrate the utility of the autodissemination approach to control wild populations of malaria vectors under field environment either alone or in combination with other tools are underway. Among others, the key determining factors for future introduction of this approach at scale is having scalable autodissemination devices, optimized PPF formulations, assess its integration/complementarity to existing conventional larviciding, and community perception and acceptance of the autodissemination approach.
Nurses' effort for providing end-of-life care in paediatric oncology: a phenomenological study
Authors: Ghaljeh Mahnaz , Rezaee Nasrin , Mardani-Hamooleh Marjan 
Published: April 2023

Background: Many children with cancer are hospitalised before the end of life and need special care. To improve the delivery of care for children, it is necessary to understand the insights, emotions and feelings of nurses. Aim: This study aimed to explore the lived experiences of nurses providing end-of-life care for children with cancer. Methods: A phenomenological hermeneutic approach was used to analyse the experience of 14 oncology nurses working in a children's hospital who were caring for children with cancer. Findings: Three themes and seven subthemes emerged from the analysis. The three main themes were: pain management (relieving physical pain and reducing the mental pain of the child and family); respect-based care (for the values and beliefs of the child and family and honesty in providing information to them); and negative reflections of care (psychological trauma, cultural challenges and futile care). Conclusion: The results of the present study showed that, despite the problems experienced by the nurses, they were still trying to provide life-sustaining care for children with cancer.
Methotrexate as a corticosteroid-sparing agent in leprosy reactions: A French multicenter retrospective study
Authors: Jaume Léa , Hau Estelle , Monsel Gentiane , Mahé Antoine , Bertolotti Antoine , Petit Antoine , Le Britney , Chauveau Marie , Duhamel Elisabeth , Maisonobe Thierry , Bagot Martine , Bouaziz Jean-David , Mougari Faïza , Cambau Emmanuelle , Jachiet Marie ,   Groupe d’infectiologie en dermatologie et des infections sexuellement transmissibles (GrIDIST)
Published: April 2023

Introduction
Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs.

Methods
We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation.

Results
Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3–14) after stopping treatment.

Conclusion
MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence.
Active management of the third stage of labour in Ethiopia: A systematic review and meta-analysis
Authors: Mihretie Gedefaye Nibret , Ayele Alemu Degu , Liyeh Tewachew Muche , Beyene Fentahun Yenealem , Kassa Bekalu Getnet , Arega Dawit Tiruneh , Belay Habtamu Gebrehana , Worke Mulugeta Dile 
Published: April 2023

Background
Post-partum haemorrhage occurs in over 10% of all births and is the leading cause of maternal mortality, accounting for 25% of all maternal deaths worldwide. Active management of the third stage of labor is the most important intervention for reducing maternal morbidity and mortality by preventing postpartum hemorrhage. Previously, documented primary studies had been great discrepancy, inconsistent results, and there is a lack of comprehensive study. Hence, this systematic review and meta-analysis were intended to assess the prevalence and associated factors of the practice of active management of the third stage of labour among obstetric care providers in Ethiopia.

Method
Cross-sectional studies were systematically searched from January 01, 2010, to December 24, 2020, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of active management of the third stage of labour practice and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies’ heterogeneity. A funnel plot and Egger’s test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years and the sample sizes.

Results
Seven hundred fifty articles were extracted. The final ten studies were included in this systematic review, including 2438 participants. The pooled prevalence of practices of active management of the third stage of labour among obstetric care providers in Ethiopia was 39.65% (30.86, 48.45%). Educational status (OR = 6.11, 95%CI, 1.51–10.72), obstetric care training (OR = 3.56, 95% CI: 2.66, 4.45), work experience (OR = 2.17, 95%CI, 0.47, 3.87) and knowledge of active management of the third stage of labour (OR = 4.5, 95% CI: 2.71, 6.28) were significantly associated with active management of the third stage of labour practices.

Conclusion
The practice of active management of the third stage of labour in Ethiopia was low. This study showed that educational status, taking obstetric care training, knowledge of AMTSL, and work experience of obstetric care providers were associated with of practices of active management of the third stage of labour. Therefore, obstetric care professionals should improve their academic level, knowledge, and skills in order to provide useful service to AMTSL and save mothers’ lives. All obstetric care providers should get obstetric care training. Furthermore, the government should increase obstetric care professionals’ educational level.
Translation and cultural adaptation of MedStopper®—A web-based decision aid for deprescribing in older adults: A protocol
Authors: Monteiro Luís , Baptista Sofia , Ribeiro-Vaz Inês , McCormack James , Matos Cristiano , Teixeira Andreia , Monteiro-Soares Matilde , Martins Carlos 
Published: April 2023

BackgroundOlder patients are more likely to have medication-related problems, which are associated with changes in pharmacokinetics and pharmacodynamics, multimorbidity, and polypharmacy. Polypharmacy and inappropriate prescribing are well-known risk factors which commonly cause adverse clinical outcomes in older people. Prescribers struggle to identify potentially inappropriate medications and to choose an adequate tapering approach.Methods/designThe goal of the study is to translate and culturally adapt MedStopper®, an original English language web-based decision aid system in deprescribing medication, to the Portuguese population. A translation-back translation method, with validation of the obtained Portuguese version of MedStopper® will be used, followed by a comprehension test.DiscussionThis is the first research in the Portuguese primary care setting that aims to provide a useful online tool for the appropriate prescription of older patients. The translated version in Portuguese version of the MedStopper® tool will represent an advance that seeks to continue improving the management of medications in the elderly. The adaptation into Portuguese of the educational tool provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients older than 65 that reliable and easier to use.Trial registrationRetrospectively registered.