bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity at time of death among persons with type 2 diabetes: a population-based study in Ontario, Canada
Authors: Rosella Laura C. , Negatu Ednah , Kornas Kathy , Chu Casey , Zhou Limei , Buajitti Emmalin 
Published: June 2023

AbstractObjectiveIndividuals with Type 2 Diabetes are likely to experience multimorbidity and accumulate multiple chronic conditions over their life. We aimed to identify causes of death and chronic conditions at the time of death in a population-based cohort, and to analyze variations in the presence of diabetes at the time of death overall and across income and immigrant status.Research design and methodsWe conducted a retrospective cohort study of 2,199,801 adult deaths from 1992 to 2017 in Ontario, Canada. We calculated the proportion of decedents with chronic conditions at time of death and causes of death. The risk of diabetes at the time of death was modeled across sociodemographic variables with a log binomial regression adjusting for sex, age, immigrant status, area-level income. comorbiditiesand time.ResultsThe leading causes of death in the cohort were cardiovascular and cancer. Decedents with diabetes had a higher prevalence of most chronic conditions than decedents without diabetes, including hypertension, osteo and other arthritis, chronic coronary syndrome, mood disorder, and congestive heart failure. The risk of diabetes at the time of death was 19% higher in immigrants (95%CI 1.18–1.20) and 15% higher in refugees (95%CI 1.12–1.18) compared to long-term residents, and 19% higher in the lowest income quintile (95%CI 1.18–1.20) relative to the highest income quintile, after adjusting for other covariates.ConclusionsIndividuals with diabetes have a greater multimorbidity burden at the time of death, underscoring the importance of multiple chronic disease management among those living with diabetes and further considerations of the social determinants of health.
The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial
Authors: Sirivichayakul Parach , Jirarattanasopha Varangkanar , Phonghanyudh Araya , Tunlayadechanont Pitchaya , Khumsub Ploychompoo , Duangthip Duangporn 
Published: June 2023

Abstract
Background
This 18-month randomized clinical trial aimed to compare the effectiveness of two topical fluoride applications versus placebo control on preventing development of approximal caries in primary teeth.

Methods
Preschool children were recruited if they had at least one initial approximal carious lesion at the distal surface of the canines, both approximal surfaces of the first molars, or the mesial surface of the second molars assessed from bitewing radiographs. The participants were randomly allocated into 3 intervention groups: Group 1 (placebo control), Group 2 (5% sodium fluoride [NaF] varnish), and Group 3 (38% silver diamine fluoride [SDF]). All agents were applied semiannually. Two calibrated examiners evaluated the caries development from bitewing radiographs. Caries development was recorded when the baseline sound surface or initial approximal carious lesion surface developed dentin caries (beyond the outer one-third of dentine) at the follow-up examination. The intention-to-treat approach was adopted. The Chi-square test was used to analyze the effectiveness of topical fluoride agents in preventing approximal caries development and the effect of other variables. The multi-level logistic regression analysis was performed to assess the relative effectiveness of topical fluoride agents in preventing approximal caries development at the 18-month follow-up.

Results
At baseline, 190 participants with 2,685 sound or initial carries at the approximal surfaces were recruited. No differences in participant demographic backgrounds, oral health related habits, or caries experience were observed among the 3 groups (P > 0.05). After 18 months, 155 (82%) participants remained in the study. The rates of developing approximal caries in Groups 1, 2, and 3 were 24.1%, 17.1%, and 27.2%, respectively (P < 0.001, χ2 test). After adjusting for confounding factors and clustering effect, the multilevel logistic regression analysis showed no differences in caries development rates between the 3 groups (P > 0.05). Tooth type and the extent of a carious lesion at baseline were the significant factors for caries development.

Conclusion
At 18-month follow-up, after adjusting for confounding factors and clustering effect, there were no statistically significant differences in preventing of approximal caries development between the semiannual application of 5%NaF, 38%SDF, or placebo.

Trial registration
The study was registered in the Thai Clinical Trials Registry under the number TCTR20190315003 on 15/03/2019.
Tocotrienol-rich fraction reduces retinal inflammation and angiogenesis in rats with streptozotocin-induced diabetes
Authors: Sadikan Muhammad Zulfiqah , Abdul Nasir Nurul Alimah , Bakar Nor Salmah , Iezhitsa Igor , Agarwal Renu 
Published: June 2023

Abstract
Background
Diabetic retinopathy (DR) is the second commonest microvascular complication of diabetes mellitus. It is characterized by chronic inflammation and angiogenesis. Palm oil-derived tocotrienol-rich fraction (TRF), a substance with anti-inflammatory and anti-angiogenic properties, may provide protection against DR development. Therefore, in this study, we investigated the effect of TRF on retinal vascular and morphological changes in diabetic rats. The effects of TRF on the retinal expression of inflammatory and angiogenic markers were also studied in the streptozotocin (STZ)-induced diabetic rats.

Methods
Male Sprague Dawley rats weighing 200–250 g were grouped into normal rats (N) and diabetic rats. Diabetes was induced by intraperitoneal injection of streptozotocin (55 mg/kg body weight) whereas N similarly received citrate buffer. STZ-injected rats with blood glucose of more than 20 mmol/L were considered diabetic and were divided into vehicle-treated (DV) and TRF-treated (DT) groups. N and DV received vehicle, whereas DT received TRF (100 mg/kg body weight) via oral gavage once daily for 12 weeks. Fundus images were captured at week 0 (baseline), week 6 and week 12 post-STZ induction to estimate vascular diameters. At the end of experimental period, rats were euthanized, and retinal tissues were collected for morphometric analysis and measurement of NFκB, phospho-NFκB (Ser536), HIF-1α using immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA). Retinal inflammatory and angiogenic cytokines expression were measured by ELISA and real-time quantitative PCR.

Results
TRF preserved the retinal layer thickness (GCL, IPL, INL and OR; p < 0.05) and retinal venous diameter (p < 0.001). TRF also lowered the retinal NFκB activation (p < 0.05) as well as expressions of IL-1β, IL-6, TNF-α, IFN-γ, iNOS and MCP-1 (p < 0.05) compared to vehicle-treated diabetic rats. Moreover, TRF also reduced retinal expression of VEGF (p < 0.001), IGF-1 (p < 0.001) and HIF-1α (p < 0.05) compared to vehicle-treated rats with diabetes.

Conclusion
Oral TRF provided protection against retinal inflammation and angiogenesis in rats with STZ-induced diabetes by suppressing the expression of the markers of retinal inflammation and angiogenesis.
Effects of Si-Miao-Yong-An decoction on myocardial I/R rats by regulating gut microbiota to inhibit LPS-induced TLR4/NF-κB signaling pathway
Authors: Cui Yuting , Zhang Fangyuan , Xu Weiming , Li Ziyun , Zou Jiaxi , Gao Ping , Hu Jingqing 
Published: June 2023

AbstractBackgroundCoronary Artery Disease (CAD) is primarily caused by inflammation which is closely linked to the gut microbiota. Si-Miao-Yong-An (SMYA) decoction is a traditional Chinese herbal formula with anti-inflammatory properties that found to be effective against CAD. However, it is still unclear whether SMYA can modulate gut microbiota and whether it contributes to the improvement of CAD by reducing inflammation and regulating the gut microbiota.MethodsThe identification of components in the SMYA extract was conducted using the HPLC method. A total of four groups of SD rats were orally administered with SMYA for 28 days. The levels of inflammatory biomarkers and myocardial damage biomarkers were measured through ELISA, while echocardiography was used to assess heart function. Histological alterations in the myocardial and colonic tissues were examined following H&E staining. Western blotting was performed to evaluate protein expression, whereas alterations in gut microbiota were determined by 16 s rDNA sequencing.ResultsSMYA was found to enhance cardiac function and decrease the expression of serum CK-MB and LDH. SMYA was also observed to inhibit the TLR4/NF-κB signaling pathway by downregulating the protein expression of myocardial TLR4, MyD88, and p-P65, leading to a reduction in serum pro-inflammatory factors. SMYA modified the composition of gut microbiota by decreasing the Firmicutes/Bacteroidetes ratio, modulating Prevotellaceae_Ga6A1 and Prevotellaceae_NK3B3 linked to the LPS/TLR4/NF-κB pathway, and increasing beneficial microbiota such as Bacteroidetes, Alloprevotella, and other bacterial species. Moreover, SMYA was found to safeguard the intestinal mucosal and villi structures, elevate the expression of tight junction protein (ZO-1, occludin), and reduce intestinal permeability and inflammation.ConclusionsThe results indicate that SMYA has the potential to modulate the gut microbiota and protect the intestinal barrier, thereby reducing the translocation of LPS into circulation. SMYA was also found to inhibit the LPS-induced TLR4/NF-κB signaling pathway, leading to a decrease in the release of inflammatory factors, which ultimately mitigated myocardial injury. Hence, SMYA holds promise as a therapeutic agent for the management of CAD.
Assessment of virtual education during the covid-19 pandemic from the perspective of faculty members and students: a cross-sectional descriptive study in northwest Iran
Authors: Heydari Mohammad , Mousazadeh Yalda , Salmani Roghayeh , Mehraeen Esmaeil 
Published: June 2023

AbstractBackgroundSince the coronavirus outbreak, many countries have replaced traditional education with virtual education in order to prevent the disease spread, and also avoid stopping education. The aim of the present study was to assess the virtual education status at Khalkhal University of Medical Sciences during the covid-19 pandemic from the perspective of students and faculty members.MethodsThis is a descriptive-cross-sectional study that was conducted between December 2021and February 2022. The study population included faculty members and students who were selected by consensus. Data collection instruments included demographic information form and a virtual education assessment questionnaire. Data analysis was carried out using independent T-test, one sample T-test, Pearson Correlation, and ANOVA test in SPSS software.ResultsA total of 231 students and 22 faculty members of Khalkhal University of Medical Sciences participated in the present study. The response rate was 66.57%. The mean and standard deviation of assessment scores of students (3.3 ± 0.72) were lower than those of faculty members (3.94 ± 0.64), which showed a statistically significant difference (p < 0.01). User access to the virtual education system (3.8 ± 0.85) and lesson presentation (4.28 ± 0.71) obtained the highest scores from the perspective of students and faculty members, respectively. There was a statistically significant association between employment status and the assessment score of faculty members (p = 0.01), and the field of study (p < 0.01), the year of university entrance (p = 0.01), and the assessment score of students.ConclusionThe results showed a higher than mean assessment score in both groups of faculty members and students. There was a difference between faculty members and students in terms of virtual education scores in the parts that require the creation of better processes and more complete capabilities in the systems, which seems that more detailed planning and reforms will improve the process of virtual education.
Factors affecting the self-efficacy of medical teachers during a health crisis – a qualitative study on the example of the COVID-19 pandemic
Authors: Cerbin-Koczorowska Magdalena , Przymuszała Piotr , Zielińska-Tomczak Łucja 
Published: June 2023

Abstract
Background
The diversity of tasks entrusted to medical teachers with their simultaneous responsibility for the safety of patients and the effective education of future healthcare professionals requires maintaining a skillful balance between their teaching, scientific and clinical activities. Meanwhile, the COVID-19 pandemic disrupted the work of both healthcare facilities and medical universities, forcing already overworked medical teachers to establish a new balance. One’s ability to perform effectively in new, ambiguous, or unpredictable situations was described by Albert Bandura as a self-efficacy concept. Consequently, this study aimed to identify factors affecting the self-efficacy of medical teachers and the influence of the COVID-19 pandemic on them.

Methods
Twenty-five semi-structured interviews with medical teachers were conducted using a flexible thematic guide. They were transcribed and analyzed by two independent researchers (researcher triangulation) with phenomenology as the qualitative approach.

Results
Identified themes demonstrate a process of the evolvement of clinical teachers’ self-efficacy in response to the sudden outbreak of the COVID-19 pandemic, namely the decline of self-efficacy in the first phase of the crisis, followed by building task-specific self-efficacy and the development of general self-efficacy.

Conclusions
The study shows the significance of providing care and support for medical teachers during a health crisis. Crisis management decision-makers at educational and healthcare institutions should consider the different roles of medical teachers and the possibility of overburden associated with the cumulation of the excessive number of patient, didactic, and research duties. Moreover, faculty development initiatives and teamwork should become a vital part of the organizational culture of medical universities. A dedicated tool acknowledging the specificity and context of medical teachers’ work seems necessary to quantitatively evaluate their sense of self-efficacy.
Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care
Authors: Baniasadi Tayebeh , Hassaniazad Mehdi , Rostam Niakan Kalhori Sharareh , Shahi Mehraban , Ghazisaeedi Marjan 
Published: June 2023

Abstract
Background
Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries.

Material and methods
This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians.

Results
The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians’ dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users’ satisfaction and willingness to use the system.

Conclusion
Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.
Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial
Authors: Van Hout Marie Claire , Zalwango Flavia , Akugizibwe Mathias , Chaka Moreen Namulundu , Birungi Josephine , Okebe Joseph , Jaffar Shabbar , Bachmann Max , Murdoch Jamie 
Published: June 2023

AbstractBackgroundSub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up‘one-stop’integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration.MethodsThe PE was conducted in one integrated care clinic, and consisted of 48 in-depth interviews with stakeholders (patients, healthcare providers, policy-makers, international organisation, and clinical researchers); three focus group discussions with community leaders and members (n = 15); and 8 h of clinic-based observation. An inductive analytical approach collected and analysed the data using the Empirical Phenomenological Psychological five-step method. Bronfenbrenner’s ecological framework was subsequently used to conceptualise integrated care across multiple contextual levels (macro, meso, micro).ResultsFour main themes emerged; Implementing the integrated care model within healthcare facilities enhances detection of NCDs and comprehensive co-morbid care; Challenges of NCD drug supply chains; HIV stigma reduction over time, and Health education talks as a mechanism for change. Positive aspects of integrated care centred on the avoidance of duplication of care processes; increased capacity for screening, diagnosis and treatment of previously undiagnosed comorbid conditions; and broadening of skills of health workers to manage multiple conditions. Patients were motivated to continue receiving integrated care, despite frequent NCD drug stock-outs; and development of peer initiatives to purchase NCD drugs. Initial concerns about potential disruption of HIV care were overcome, leading to staff motivation to continue delivering integrated care.ConclusionsImplementing integrated care has the potential to sustainably reduce duplication of services, improve retention in care and treatment adherence for co/multi-morbid patients, encourage knowledge-sharing between patients and providers, and reduce HIV stigma.Trial registration numberISRCTN43896688.
Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis
Authors: Tang Xue , Zhang Xinyu , Chen Yajing , Yan Jiaqi , Qian Mengcen , Ying Xiaohua 
Published: June 2023

AbstractBackgroundIn 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals.MethodsWe used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary).ResultsWe included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%,P = 0.000), tertiary (0.6%,P = 0.000), secondary (0.4%,P = 0.047) and primary hospitals (0.9%,P = 0.039). The monthly trend of LOS increased significantly in public (0.022 days,P = 0.041) and primary (0.235 days,P = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points,P = 0.002) and secondary (0.037 percentage points,P = 0.002) hospitals.ConclusionsWe conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.
Impact of physical activity on healthcare costs: a systematic review
Authors: Duijvestijn Marjolein , de Wit G. Ardine , van Gils Paul F. , Wendel-Vos G. C. Wanda 
Published: June 2023

Abstract
Background
This systematic review aims to describe the relation between physical inactivity and healthcare costs, by taking into account healthcare costs of physical-inactivity-related diseases (common practice), including physical-activity-related injuries (new) and costs in life-years gained due to avoiding diseases (new), whenever available. Moreover, the association between physical inactivity and healthcare costs may both be negatively and positively impacted by increased physical activity.

Methods
A systematic review was conducted, including records reporting on physical (in)activity in relation to healthcare costs for a general population. Studies were required to report sufficient information to calculate the percentage of total healthcare costs potentially attributable to physical inactivity.

Results
Of the 264 records identified, 25 were included in this review. Included studies showed substantial variation in the assessment methods of physical activity and in type of costs included. Overall, studies showed that physical inactivity is related to higher healthcare costs. Only one study included costs of healthcare resources used in prolonged life when physical-inactivity-related diseases were averted, showing net higher healthcare costs. No study included healthcare costs for physical-activity-related injuries.

Conclusions
Physical inactivity is associated with higher healthcare costs in the general population in the short-term. However, in the long-term aversion of diseases related with physical inactivity may increase longevity and, as a consequence, healthcare costs in life-years gained. Future studies should use a broad definition of costs, including costs in life-years gained and costs related to physical-activity-related injuries.