bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in healthcare utilization and depression among young mothers: The role of family functioning
Authors: Whittaker Shannon , Martinez Isabel , Kershaw Trace 
Published: September 2023

Background: Extant research suggests that disparities in healthcare utilization and experiences of mental health disorders such as depression exist across sociodemographic groups. One understudied pathway that may have significant implications for these disparities is the role of family functioning. How families interact, communicate, and adapt may vary, but these relationships remain integral for vulnerable subsets of the population due to their seemingly protective properties. Yet, few studies have examined the relationship between family functioning and health. Objective: The aim of this study was to explore family functioning as a predictor for healthcare utilization and depression among young mothers and as a moderator of disparities for each of these outcomes. Design/methods: This analysis uses data from a prospective cohort study which was conducted with 296 pregnant young women recruited from obstetrics clinics in Connecticut between July 2007 and February 2011 and followed 1-year postpartum. Logistic regression models were used to assess family functioning, race/ethnicity, and immigrant status as predictors of healthcare utilization and depression. Family functioning was evaluated as a moderator for both outcomes. Results: Black and Latina mothers had decreased odds of using physical healthcare services (odds ratioBlack = 0.13, p < 0.001; odds ratioLatina = 0.31, p = 0.02). Family functioning was associated with decreased odds of using mental healthcare services (odds ratio = 0.97, p = 0.04) and had a protective effect against depression (odds ratio = 0.96, p = 0.003). Family functioning significantly moderated the relationship between immigrant status and physical healthcare utilization, Black race/ethnicity and physical healthcare utilization, and Other race/ethnicity and depression. Conclusion: Family functioning is a significant factor associated with both healthcare utilization and depression among young mothers. It should be a strongly considered component within healthcare settings to mitigate risks among vulnerable populations.
Comparison of triamcinolone with pentoxifylline and vitamin E efficacy in the treatment of stage 2 and 3 oral submucous fibrosis: A randomized clinical trial
Authors: Shah Saeed Ullah , Nigar Seeme , Yousofi Rahima , Maqsood Afsheen , Altamash Sara , lal Abhishek , Khan Zarak , Ahmed Naseer , Heboyan Artak 
Published: September 2023

Objective: The objective of this study was to assess the effectiveness of triamcinolone in combination with pentoxifylline and vitamin E in the treatment of patients with level two and three oral submucous fibrosis. Methods: The study aimed to compare the efficacy of corticosteroid injections (triamcinolone) versus pentoxifylline and vitamin E in the therapy of patients with stage two and three oral submucous fibrosis. A total of 42 participants with indications and features of oral submucous fibrosis were enrolled between January 2020 and September 2021. The patients’ age and mouth opening were evaluated, and descriptive statistics and paired t-test were used for analytical investigation. Results: The study showed a statistically significant improvement in both treatment groups ( p = 0.001) concerning pre- and post-treatment deviations. However, when comparing the standard differences in treatment outcomes between the two study groups, only mouth opening exhibited a statistically significant difference ( p = 0.001). Conclusions: The findings indicate that a treatment regimen combining pentoxifylline and triamcinolone can significantly alleviate oral submucous fibrosis symptoms, including mouth opening, pain, and flaring agitation, thereby enhancing the affected individual’s quality of life.
Prospective Comparison of Postoperative Pain and Opioid Consumption Between Primary Repair and Reconstruction of the Anterior Cruciate Ligament
Authors: Vermeijden Harmen D. , Holuba Kurt , Yang Xiuyi A. , O’Brien Robert , van der List Jelle P. , DiFelice Gregory S. 
Published: September 2023

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans. Purpose: To assess postoperative pain and daily opioid use after ACL repair versus ACLR and to assess whether ACL repair could be performed successfully without using long-acting nerve blocks. Study Design: Cohort study; Level of evidence, 2. Methods: All eligible patients who underwent ACL surgery between 2019 and 2022 were prospectively enrolled. Patients were treated with primary repair if proximal tears with sufficient tissue quality were present; otherwise, they underwent single-bundle ACLR with either hamstring tendon or quadriceps tendon autograft. The patients were divided into 3 groups: ACLR with adductor canal nerve block (up to 20 mL of 0.25% bupivacaine with 2 mg dexamethasone), primary repair with nerve block, and primary repair without nerve block. Pain visual analog scale and number of opioids used were recorded during the first 14 postoperative days (PODs). Furthermore, patients completed the Quality of Recovery-15 (QoR-15) survey, and range of motion was assessed. Group differences were compared using Mann-Whitney U test and chi-square test. Results: Seventy-eight patients were included: 30 (39%) underwent ACLR, 19 (24%) ACL repair with nerve block, and 29 (37%) ACL repair without nerve block. Overall, the ACL repair group used significantly fewer opioids than the ACLR group on POD 1 (1 vs 3, P = .027) and POD 2 (1 vs 3, P = .014) while also using fewer opioids in total (3 vs 8, P = .038). This difference was even more marked when only analyzing those patients who received postoperative nerve blocks (1 vs 8, P = .029). Repair patients had significantly higher QoR-15 scores throughout the first postoperative week, and they had greater range of motion (all P < .05). There were no significant differences in pain scores, opioid usage, or QoR-15 scores between patients who underwent repair with versus without nerve block. Conclusion: The ACL repair group experienced less postoperative pain during the first 2 weeks after surgery and used significantly fewer opioids than the ACLR group. Furthermore, they had improved knee function and higher recovery quality than patients who underwent ACLR during the initial postoperative period. Postoperative nerve blocks may not be necessary after ACL repair.
Need of clearer guidelines at an organizational level with improved collaboration and improved management of handball players with a head injury - The SWEdish CONcussion study in elite handball
Authors: Sjöbrink Sofia , Classon Jennie 
Published: September 2023

Background: Handball is a contact sport, and a head-injury is one of many possible injuries. The diagnosis concussion has been reported as one of the more complex sports injuries, both regarding the diagnostic procedure and the sports medical management and rehabilitation. Hereby a handball-related head-injury is expected to be challenging both for the players and for the medical-team and there is a need to explore how medical team professionals’ reason regarding management and return to play. Objectives: The aim of the study was to explore how the medical team in Swedish elite handball, medical doctors and physiotherapists, reason regarding principals of managing a handball related head-injury and return to sport decisions. Methods: A Qualitative individual interview study with a semi-structured interview guide was performed. Data was analyzed with content analysis and an inductive approach. Study participants were eight medical doctors and twelve physiotherapist supporting Swedish elite handball team during the season of 2019/2020. Results: The participants descriptions and reasoning regarding management and return to play principals emerged into the following three main categories; “Organization and working routine”; “Experienced complicating factors and feeling insufficient and scarce”; “Management strategies”. Together with nine subcategories the analysis exposed a variety of principals, challenges and expressed needs related to the process of medical decisions and management for handball players sustaining a head injury. Conclusion: The results reveal a need for clearer guidelines, enhanced collaboration, and improved management of head-injuries. There is also an expressed need for sharpened handball rules and regulations as well as a need of clarified health-care pathways for players with more complex post-concussion symptoms. The medical team members expressed an uncertainty regarding symptoms due to the concussion, so being acquainted with the player is hereby very important.
Group Versus Individual Diabetes Education for Persons With Experience of Homelessness in Canada
Authors: McSweeney Breanna , Campbell Rachel B. , Grewal Eshleen K. , Gu Jenny , Campbell David J. T. 
Published: September 2023

Purpose: The purpose of the study was to explore various forms of diabetes self-management education (DSME), including group and individual sessions, for persons with lived experiences of homelessness (PWLEH) in Canada. Methods: A qualitative descriptive study using open-ended interviews with health care and homeless sector service providers was utilized to serve those experiencing homelessness in 5 cities across Canada. NVivo qualitative data analysis software was used to facilitate thematic analysis, focusing on variations in DSME for PWLEH. Results: We conducted interviews with 96 unique health and social care providers. Four themes were identified through focused coding of interviews. First, the use of a harm reduction approach during diabetes education tailored to PWLEH considered patients’ access to food, medications, and supplies and other comorbidities, including mental health and substance use disorders. The second theme related to the unsuitability of the curriculum in mainstream diabetes education in a group setting for PWLEH. Third, the role of group education in community building is to create supportive relationships among members. The final theme was the importance of trust and confidentiality in DSME, which were most easily maintained during individual education, compared to group formats. Conclusions: Overall, PWLEH experience unique challenges in managing diabetes. DSME adapted to these individuals’ unique needs may be more successful and could be delivered in both individual and group settings.
Accessing and re-accessing mental health walk-in clinics for children and families
Authors: Sarmiento Catalina , Reid Graham J. 
Published: September 2023

Background: Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). Objectives: (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Design: Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. Results: About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. Conclusion: MHWCs can save families’ time, and both agencies’ time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.
COVID-19 vaccination-related headache showed two different clusters in the long-term course: a prospective multicenter follow-up study (COVA-Head Study)
Authors: Atalar Arife Çimen , Acarlı Ayşe Nur Özdağ , Baykan Betül , Martelletti Paolo , Bolay Hayrunnisa , Ertaş Mustafa , Ekizoğlu Esme , Karadaş Ömer , Polat Burcu , Gençdal Işıl Yazıcı , Azorin David Garcia , Mitsikostas Dimos , Apostolakopoulou Loukia , Genç Hamit , Dikmen Pınar Yalınay , Demirel Esra Acıman , Aydınlar Elif Ilgaz , Gözübatık-Celik Rabia Gökçen , Shafiyev Javid , Taşdelen Bahar , Özge Aynur 
Published: September 2023

Abstract
Background
Although acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches.

Methods
A multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination.

Results
Among the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 ± 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005).

Conclusion
The identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care.
Emergency care utilization and patients’ outcome before and after COVID-19 national lockdown in Iran: a cross-sectional study
Authors: Ghanbari Vahid , Khatony Alireza , Janatolmakan Maryam , Rezaeian Shahab , Rostamnia Leili 
Published: September 2023

Abstract
Introduction
COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients’ outcome in the emergency department (ED).

Method
Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period.

Result
The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly.

Conclusion
Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.
Development of the “living well” concept for older people with dementia
Authors: Kim Jiyoung , Shin Nayeon 
Published: September 2023

Abstract
Background
An important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of “living well” that is suitable for older people with dementia and then develop this conceptualization from the perspectives of both older people and caregivers. This study analyzed the concept of “living well” among older people with dementia.

Methods
Following Schwartz-Barcott and Kim’s hybrid model, this study comprised theoretical, fieldwork, and final analytic phases. In the theoretical phase, we reviewed the extant literature. In the fieldwork phase, we conducted in-depth interviews with 12 participants (five older people with dementia, two family members, and five nurses), followed by qualitative content analysis. In the final analytic phase, we defined the concept of “living well” by comprehensively analyzing the data from the theoretical phase and results from the fieldwork phase.

Results
We derived physical, mental, and social relationship dimensions of the conceptualization of “living well” for older people with dementia. The physical dimensions were “ability for daily living” and “symptom management.” The mental dimensions were “psychological health,” “psychological stability,” “maintaining identity and growth,” and “human dignity.” Finally, the social relationship dimensions were “maintaining social relations and community connectivity” and “government support.”

Conclusions
Our analysis of the concept of “living well” can be used for developing tools and interventions to improve the ability of older people with dementia to live well.
Effects of functional performance and national health insurance cost on length of hospitalization for postacute care in stroke: a retrospective observational study
Authors: Chou Hsiang-Yun , Ma Shang-Chun , Tsai Ya-Wen , Shih Chia-Li , Yeh Chieh-Ting 
Published: September 2023

Abstract
Background
The postacute care for cerebrovascular disease (PAC-CVD) program was launched in Taiwan nearly a decade ago. However, no clear regulations regarding length of stay (LOS) in the program and extension standards exist. Thus, the allocation of limited medical resources such as hospital beds is a major issue.

Methods
This novel study retrospectively investigated the effects of functional performance and national health insurance (NHI) costs on PAC-CVD LOS. Data for 263 patients with stroke who participated in the PAC-CVD program were analysed. Hierarchical multiple regression was used to estimate the effects of functional performance and NHI costs on LOS at three time points: weeks 3, 6, and 9.

Results
At week 3, age, NHI costs, modified Rankin scale score, and Barthel index significantly affected LOS, whereas at week 6, age and NHI costs were significant factors. However, functional performance and NHI costs were not significant factors at week 9.

Conclusions
The study provides crucial insights into the factors affecting LOS in the PAC-CVD program, and the results can enable medical decision-makers and health care teams to develop inpatient rehabilitation plans or provide transfer arrangements tailored to patients. Specifically, this study highlights the importance of early functional recovery and consideration of NHI costs when managing LOS in the PAC-CVD program.
An online, public health framework supporting behaviour change to reduce dementia risk: interim results from the ISLAND study linking ageing and neurodegenerative disease
Authors: Bartlett Larissa , Bindoff Aidan , Doherty Kathleen , Kim Sarang , Eccleston Claire , Kitsos Alex , Roccati Eddy , Alty Jane , King Anna E. , Vickers James C. 
Published: September 2023

Abstract
Background
Unmanaged cardiometabolic health, low physical and cognitive activity, poor diet, obesity, smoking and excessive alcohol consumption are modifiable health risk factors for dementia and public health approaches to dementia prevention have been called for. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) is a dementia prevention public health study examining whether improving knowledge about modifiable dementia risk factors supports behaviour changes that reduce future dementia risk.

Methods
Residents of Tasmania, Australia, aged 50 + years who joined the 10-year ISLAND study were asked to complete annual online surveys about their knowledge, motivations and behaviours related to modifiable dementia risk. ISLAND included two knowledge-based interventions: a personalised Dementia Risk Profile (DRP) report based on survey responses, and the option to do a 4-week Preventing Dementia Massive Open Online Course (PDMOOC). Longitudinal regression models assessed changes in the number and type of risk factors, with effects moderated by exposures to the DRP report and engagement with the PDMOOC. Knowledge and motivational factors related to dementia risk were examined as mediators of risk behaviour change.

Results
Data collected between October 2019 and October 2022 (n = 3038, av. 63.7 years, 71.6% female) showed the mean number of modifiable dementia risk factors per participant (range 0 to 9) reduced from 2.17 (SD 1.24) to 1.66 (SD 1.11). This change was associated with the number of exposures to the DRP report (p = .042) and was stronger for PDMOOC participants (p = .001). The interaction between DRP and PDMOOC exposures yielded a significant improvement in risk scores (p = .004). The effect of PDMOOC engagement on behaviour change was partly mediated by increased knowledge (12%, p = .013). Self-efficacy enhanced the effect of knowledge on behaviour change, while perceived susceptibility to dementia mitigated this relationship.

Conclusions
The ISLAND framework and interventions, a personalised DRP report and the four-week PDMOOC, work independently and synergistically to increase dementia risk knowledge and stimulate health behaviour change for dementia risk reduction. ISLAND offers a feasible and scalable public health approach for redressing the rising prevalence of dementia.