bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Dysphagia on the Older Adults’ Nutritional Status and Meal Pattern
Authors: Saleedaeng Pongsak , Korwanich Narumanas , Muangpaisan Weerasak , Korwanich Kanyarat 
Published: March 2023

Introduction/Objectives: Dysphagia is a widespread clinical condition among older adults. Although known as a risk factor for nutritional status and dehydration, dysphagia also affects meal patterns. This study aimed to determine the relationship between dysphagia and undernutrition, as well as dietary consumption patterns in older adults. Methods: 268 older adults (144 women, 124 men) were included in the study. Mini Nutritional Assessment (MNA), dysphagia assessment (EAT-10), oral examination, and Semi-quantitative Food Frequency Questionnaire (SFFQ) were used for collecting data. Odds ratio and Chi square were used to compare independent variables in subjects with and without undernutrition as well as those who intake texture modified and non-texture modified diet. Results: Mean age of the undernutrition and normal nutrition groups was 68.9 ± 6.1 and 68.8 ± 6.0 years, respectively. The undernutrition group’s activities of daily living (ADL) were 19.7 ± 0.9, and the normal nutrition group was 19.8 ± 0.7. Older adults with dysphagia were 4.8 times more likely to experience undernutrition than older adults without dysphagia (95% CI = 1.75-13.13, P = .002). There was a statistically difference between the meal patterns among the dysphagic older adult group and the normal-swallowing older adults’ group at the .05 level. Conclusions: According to this study, dysphagia was associated with the nutritional status of older adults and dietary patterns. The study results suggested some recommendations for dental health personnel on oral care related to dietary consumption and dietary patterns in older adults.
Pediatric Epicardial Devices: Early and Midterm Outcomes
Authors: Griffeth Elaine M , Krishnan Prasad , Dearani Joseph A , Pahwa Siddharth , Ackerman Michael J , Wackel Philip L , Todd Austin , Cannon Bryan C 
Published: March 2023

Background Lead performance is suboptimal in young patients and a main cause of device system failure. Our objective was to assess early and midterm outcomes after epicardial device implantation in a contemporary pediatric cohort. Methods A total of 116 consecutive pediatric patients underwent 137 epicardial device implantations from 2010 to 2019. Forty pacemakers and 97 implantable cardioverter defibrillators (ICDs) were implanted. Lead failure was defined as leads repaired, replaced, or abandoned due to fracture, dislodgement, or dysfunction. Freedom from device system failure was determined using Kaplan-Meier analysis. Results Mean age at implantation was 10 ± 5 years, 46 (34%) were younger than 8 years old, 41 (30%) had prior cardiac surgery, and 38 (28%) had prior devices. Main indications were acquired heart block (17/40 [43%]), sinus node dysfunction (14/40 [35%]), and congenital heart block (7/40 [18%]) for pacemakers, and hypertrophic cardiomyopathy (46/97 [47%]), long QT syndrome (31/97 [32%]), and ventricular arrhythmia (17/97 [18%]) for ICDs. There were no early deaths. Three-year freedom from device system failure was 80% (95% CI 73%, 88%) for all patients and 88% (95% CI 79%, 99%) for patients <8 years old. Device system failure causes included lead fracture (20/34 [59%]), lead dysfunction (5/34 [15%]), lead dislodgement (5/34 [15%]), infection (3/34 [9%]), and pericarditis (1/34 [3%]). Reintervention was required in 26/34 (76%) device system failures. Conclusions Epicardial device implantation is safe, shows acceptable midterm outcomes in children, and is an effective option in patients younger than 8 years old. Close device surveillance continues to be essential to detect lead failure early and ensure timely reintervention.
Anterior Column Realignment Using an Anterior-To-Psoas Approach: A Radiographic-Anatomic Feasibility Study at L1-L5
Authors: Hirase Takashi , Shin Caleb , Thirumavalavan Jeyvikram , Boddapati Venkat , Lee Tiffany , Haghshenas Varan , Marco Rex AW 
Published: March 2023

Study Design Cross-sectional radioanatomic study. Objective To determine the feasibility of performing an anterior column realignment (ACR) using an anterior-to-psoas (ATP) approach at L1-L5. Methods Axial magnetic resonance images (MRI) of the L1-L5 disc levels obtained at a single institution were obtained and analyzed. The feasibility of performing an ACR was assessed using a combination of the size of the left oblique corridor (OC), the psoas morphology using the modified Moro classification, and the anterior disc edge to great vessel distance. Results Three hundred MRI studies obtained from 300 patients were included. All patients had a measurable left OC at the L1-L4 levels. Twenty patients (6.7%) had no measurable OC at the L4-L5 level. According to the modified Moro’s classification, a high-rising psoas was seen in 4 patients (1.3%) at the L3-L4 level and 57 patients (19.0%) at the L4-L5 level. An ALL release was considered high risk due to no measurable space between the anterior disc edge and the great vessels in 54 patients (18.0%) at the L1-L2 level, 39 patients (13.0%) at the L2-L3 level, 119 patients (39.7%) at the L3-L4 level, and 226 patients (75.3%) at the L4-L5 level. Conclusion ACR using an ATP approach is the most radioanatomically feasible at L2-L3. The L4-L5 level has the highest risk with regards to both the ATP approach and the ALL release for an ACR due to high rates of unmeasurable left OC and space between the anterior disc edge and the great vessels.
Women's Perspectives on Cultural Sensitivity of Midwives During Intrapartum Care at a Maternity Ward in a National Referral Hospital in Zimbabwe
Authors: Mantula Fennie , Chamisa Judith Audrey , Nunu Wilfred Njabulo , Nyanhongo Prisca Sophia 
Published: March 2023

Introduction Midwives attend intrapartum women of diverse ethnic backgrounds who each bring their cultural beliefs into the labor and delivery rooms. The International Confederation of Midwives has recommended providing culturally appropriate maternity care in its quest to increase skilled birth attendance and subsequently improve maternal and newborn health. Objective This study aimed to examine midwives’ cultural sensitivity during intrapartum care from women's perspectives, and how this relates to women's satisfaction with maternity care services. Methods A qualitative phenomenological design was employed. Two focus group discussions were conducted with 16 women who had delivered in the labor ward of the selected national referral maternity unit. An interpretive phenomenological approach was used to analyze the data. Results This study revealed ineffective midwife–woman collaboration that excludes the incorporation of women's cultural beliefs in the design of maternity care plans. Emotional, physical, and informational support in the care provided to women during labor and childbirth was found to be incompetent. This suggests that midwives are not sensitive to cultural norms and do not provide woman-centered intrapartum care. Conclusion Various factors implying midwives’ lack of cultural sensitivity in their provision of intrapartum care were identified. Resultantly, women's expectations of labor are not met and this could negatively affect future maternity care-seeking behaviors. This study's findings provide policy makers, midwifery program managers and implementers with better insights for developing targeted interventions to improve cultural sensitivity for the delivery of respectful maternity care. Identifying factors that affect the implementation of culture-sensitive care by midwives could guide the adjustments required in midwifery education and practice.
Perception of Nurses’ Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria
Authors: Bello Cecilia Bukola , Ogunlade Oluwasayo Bolarinwa , Esan Deborah Tolulope , Ijabadeniyi Olasupo Augustine , Bello Adebanke Covenant 
Published: March 2023

Introduction Family members of hospitalized patients are often faced with challenges and may experience difficulty in coping without appropriate support. The aim of this study was to assess hospitalized patients' family members' perception of nurses' support. Methods A cross-sectional descriptive design was utilized. A total of 138 family members of hospitalized patients in a tertiary health facility were selected using a purposive sampling technique. Data were collected with an adopted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, and multiple regression. The level of significance was set at 0.05 ( p < .05. Also, age, gender, and type of family were the predictors of emotional support ( R2 = 84, F(6, 131) = 5.92, p < .05. Results The mean score of cognitive support was 9.92, emotional support was 15.59 while the overall mean score was 39.42. More than half (60.9%) reported that nurses never and rarely provided available and easy-to-read literature about the health problem of their patient (Mean = 2.30 ± 1.00). More than half (58.0%) reported that nurses never and rarely provided ideas, information and thoughts in a manner that allowed family members to think and learn. (Mean = 2.27 ± 0.98). About 1 out of 3 reported poor perception of cognitive support. While less than half (45.7%) reported poor perception of emotional support. Age, gender and relationship were predictors of cognitive support (R2 = .63, F (6,131) = 4.46, p < 0.05). Also, age, gender and type of family were the predictors of emotional support (R2 = .84, F (6,131) = 5.92, p < 0.05). Conclusion A significant number of families of hospitalized patients reported poor perception of cognitive, emotional, and overall support from nurses. Adequate staffing is a prerequisite for effective family support. Nurses also need appropriate training in providing family support. The focus of family support training should emphasize practices that nurses can use in everyday interactions with patients and family members.
Male Student Challenges in a Maternity Nursing Clinical Course in a Middle Eastern Country: Strategies for Improved Performance and Future Implications for Nursing Education and Practice
Authors: Raghavan Divya , Matua Gerald Amandu , Seshan Vidya , John Prince Emi 
Published: March 2023

Introduction As the number of males, entering nursing and midwifery increase in number, challenges faced by these males during training sessions also is on rise. Since these challenges vary from culture to culture, it is essential to understand the experiences and challenges of male nursing students during their nursing education. Aim To explore the challenges faced by male nursing students in learning maternal health nursing and the remedial strategies to improve their performance as identified by the students. Design A descriptive qualitative research design using focus group discussion method was used. Methods Twenty-two (22) undergraduate male nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018 were purposively selected to participate in the study through five (5) focus groups each comprising between four to six students. Results Three themes emerged from the study: (a) cultural constraints in the clinical learning process; (b) traditional gender-biased role expectations, and (c) alternative teaching strategies. In terms of “ cultural constraints,” the students felt the Arabic culture was the main barrier in direct patient care in midwifery practice. In relation to “ gender-biased role expectations,” the students reported that they felt “ not accepted and isolated” in midwifery clinical areas. Thirdly, the “ alternative teaching strategies” relate to the student's remedy to the cultural constraints and the gender bias faced that undermined their learning and overall performance in maternity nursing course . These alternative ways of learning included, “ increased involvement of nurses and midwives in teaching learning”; “ cultivating positive relationship between the clinical instructor and students,” and the “ use of high fidelity simulation to learn skills in midwifery education.” Conclusion The study findings revealed that male student nurses face significant challenges in maternity nursing course.
Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series
Authors: Lameire Darius Luke , Abdel Khalik Hassaan , Del Balso Christopher , Daniels Timothy , Halai Mansur 
Published: March 2023

Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.
Successful combined umbilical cord blood and bone marrow transplantation from an HLA-matched sibling for MPS VI: a case report
Authors: Haria Pankti , Kedage Vinayak , Dalvi Pradnya , Sanghavi Satyen , Chandran Parvathi 
Published: March 2023

Mucopolysaccharidosis type VI (MPS VI), also known as Maroteaux–Lamy syndrome, polydystrophic dwarfism, and arysulfatase B (ASB) deficiency, is a lysosomal storage disorder with autosomal recessive inheritance characterized by progressive multisystem involved that causes many tissues and organs to enlarge and become inflamed. Skeletal deformities are common that progress and worsen in varying degrees thus affecting quality of life and life expectancy. Many studies have shown that allogeneic hematopoietic stem cell transplantation can reduce morbidity and enhance the survival and quality of life in such patients. We present a case of a 6-year-old girl diagnosed with MPS VI at the age of 3 years. Thereafter the patient developed various complications of the disease causing morbidity. She was then treated with combined umbilical cord blood (UCB) and bone marrow (BM) transplantation from complete human leukocyte antigen–matched (6/6) donor which was her younger sibling. The transplant was successful without any serious adverse effects. No additional treatments such as enzyme replacement therapy (ERT) were required. The transplantation of UCB along with BM can be considered as an effective treatment approach for this rare disease. Plain language summary Case of MPS VI treated with stem cell transplantation This article reports a case of a 6-year-old girl who was diagnosed with mucopolysaccharidosis type VI also known as MPS VI, an autosomal recessive disorder that caused her arysulfatase B (ASB) deficiency. This disorder affects growth velocity, gives coarse facial features, gives rise to skeletal deformities, frequent upper-airway infections, enlarged liver and spleen, hearing loss, and joint stiffness. However, very few studies have reported definitive ways to treat or cure MPS VI. To help her combat this disorder, combined umbilical cord blood and bone marrow transplantation was done. This transplant alleviated her symptoms, and the patient did not need any further treatment. Follow-up, 4 years after transplantation, shows normal enzyme level, no complications, and improved quality of life.
Exosomal Mir-3613-3p derived from oxygen–glucose deprivation-treated brain microvascular endothelial cell promotes microglial M1 polarization
Authors: Zhang Mengqi , Wu Qian , Tang Mimi , Chen Zhuohui , Wu Haiyue 
Published: March 2023

Abstract
Background
Brain microvascular endothelial cell (BMEC) injury can affect neuronal survival by modulating immune responses through the microenvironment. Exosomes are important vehicles of transport between cells. However, the regulation of the subtypes of microglia by BMECs through the exosome transport of microRNAs (miRNAs) has not been established.

Methods
In this study, exosomes from normal and oxygen–glucose deprivation (OGD)-cultured BMECs were collected, and differentially expressed miRNAs were analyzed. BMEC proliferation, migration, and tube formation were analyzed using MTS, transwell, and tube formation assays. M1 and M2 microglia and apoptosis were analyzed using flow cytometry. miRNA expression was analyzed using real-time polymerase chain reaction (RT-qPCR), and IL-1β, iNOS, IL-6, IL-10, and RC3H1 protein concentrations were analyzed using western blotting.

Results
We found that miR-3613-3p was enriched in BMEC exosome by miRNA GeneChip assay and RT-qPCR analysis. miR-3613-3p knockdown enhanced cell survival, migration, and angiogenesis in the OGD-treated BMECs. In addition, BMECs secrete miR-3613-3p to transfer into microglia via exosomes, and miR-3613-3p binds to the RC3H1 3′ untranslated region (UTR) to reduce RC3H1 protein levels in microglia. Exosomal miR-3613-3p promotes microglial M1 polarization by inhibiting RC3H1 protein levels. BMEC exosomal miR-3613-3p reduces neuronal survival by regulating microglial M1 polarization.

Conclusions
miR-3613-3p knockdown enhances BMEC functions under OGD conditions. Interfering with miR-3613-3p expression in BMSCs reduced the enrichment of miR-3613-3p in exosomes and enhanced M2 polarization of microglia, which contributed to reduced neuronal apoptosis.
General practitioners’ views towards management of common mental health disorders: Τhe critical role of continuing medical education
Authors: Papachristopoulos Ilias , Sazakli Eleni , Leotsinidis Michalis 
Published: March 2023

Abstract
Background
The disability burden of common mental health disorders is enormous and should be faced at the first point of contact in the healthcare system. General Practitioners (GPs) are called to recognize, diagnose, and manage patients with mental health disorders, a task which is not always addressed successfully. The study aims at examining the relationship between mental health education of GPs and self-reported opinions on the care they provide to patients with mental disorders in Greece.

Methods
A questionnaire investigating GPs' viewpoints regarding diagnostic methods, referral rates and overall management of patients with mental disorders, and how these are impacted by their education on mental health, was employed, in a randomly selected sample of 353 GPs in Greece. Suggestions and proposals about improvement of ongoing mental health training, along with organizational reforming were also recorded.

Results
Received Continuing Medical Education (CME) is characterized as insufficient by 56.1% of the GPs. More than half of the GPs participate in clinical tutorials and mental health conferences once per three years or less. The level of educational score on mental health is associated positively with decisiveness on management of patients and increases self-confidence. A percentage of 77.6% states knowledge of the appropriate treatment and 56.1% agree to initiate treatment without referring to a specialist. However, low to moderate self-confidence about diagnosis and treatment is stated by 47.5%. According to GPs, critical points for improving mental health primary care are the liaison psychiatry and high degree of CME.

Conclusion
Greek GPs are calling for focused and continuing medical education, in the field of psychiatry, along with essential structural and organizational reforming of the healthcare system, including an efficient liaison psychiatry.
Midlife perceived stress is associated with cognitive decline across three decades
Authors: Christensen Dinne Skjærlund , Garde Ellen , Siebner Hartwig Roman , Mortensen Erik Lykke 
Published: March 2023

Abstract
Background
Research indicates detrimental effects of stress on brain health and cognitive functioning, but population-based studies using comprehensive measures of cognitive decline is lacking. The present study examined the association of midlife perceived stress with cognitive decline from young adulthood to late midlife, controlling for early life circumstances, education and trait stress (neuroticism).

Methods
The sample consisted of 292 members of the Copenhagen Perinatal Cohort (1959–1961) with continued participation in two subsequent follow-up studies. Cognitive ability was assessed in young adulthood (mean age 27 years) and midlife (mean age 56 years) using the full Wechsler Adult Intelligence Scale (WAIS), and perceived stress was measured at midlife using the Perceived Stress Scale. The association of midlife perceived stress with decline in Verbal, Performance and Full-Scale IQ was assessed in multiple regression models based on Full Information Maximum Likelihood estimation.

Results
Over a mean retest interval of 29 years, average decline in IQ score was 2.42 (SD 7.98) in Verbal IQ and 8.87 (SD 9.37) in Performance IQ. Mean decline in Full-scale IQ was 5.63 (SD 7.48), with a retest correlation of 0.83. Controlling for parental socio-economic position, education and young adult IQ, higher perceived stress at midlife was significantly associated with greater decline in Verbal (β = − 0.012), Performance (β = − 0.025), and Full-scale IQ (β = − 0.021), all p < .05. Across IQ scales, additionally controlling for neuroticism in young adulthood and change in neuroticism had only minor effects on the association of midlife perceived stress with decline.

Conclusions
Despite very high retest correlations, decline was observed on all WAIS IQ scales. In fully adjusted models, higher midlife perceived stress was associated with greater decline on all scales, indicating a negative association of stress with cognitive ability. The association was strongest for Performance and Full-scale IQ, perhaps reflecting the greater decline on these IQ scales compared to Verbal IQ.