bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in daily asthma medication sales in association with air pollution levels in Greater Stockholm
Authors: Tornevi Andreas , Olstrup Henrik , Forsberg Bertil 
Published: June 2023

Background:
Daily air pollution levels are known to influence the number of patients with acute asthma. We investigated the short-term effects of air pollution exposure on the daily number of asthma medication purchases in the Greater Stockholm area, Sweden.

Methods:
We conducted a time-series study with data on asthma medication purchases and daily mean values of particulate matter ≤10 µm (PM10), nitrogen oxides (NO
x
), and ozone during 2018–2019. We used nonlinear distributed lag quasi-Poisson regression models to estimate the associations between air pollution levels and medication purchases, adjusting for meteorological variables, pollen levels, day of the week, and long-term trends. The models established linear relationships between air pollutants and the outcome, and potential delayed effects were smoothed with a spline across a lag period of 2 weeks. We applied separate models for each municipality (n = 21) in Greater Stockholm, and calculated pooled estimates to achieve combined results for the whole region.

Results:
We observed associations between daily levels of air pollution and purchases of asthma medications, most clearly for PM10. The pooled estimates of the relative risks for asthma medication purchases across all 21 municipalities associated with a 10 μg m−3 increase in PM10 the same day (lag 0) was 1.7% [95% confidence interval (CI): 1.2%, 2.1%], a cumulative increase of 4.6% (95% CI: 3.7%, 5.6%) over one week (lag 0−6), and a 6.5% (95% CI: 5%, 8%) increase over 2 weeks (lag 0−13). The corresponding pooled effect per 10 μg m−3 increase in NO
x
and ozone were 2.8% (95% CI: 1.6%, 4.1%) and 0.7% (95% CI: 0%, 1.4%) over 2 weeks (lag 0−13), respectively.

Conclusions:
Our study revealed short-term associations between air pollution, especially PM10, and purchases of asthma medications.
Postoperative Psychological Impact on Teenagers after Gynecomastia Correction
Authors: Lashin Riham , Youssef Ramy A. , Elshahat Ahmed , Mohamed Eman Nagy 
Published: June 2023

Background:
Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers.

Methods:
This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients’ satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done.

Results:
Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were “uniformly good to excellent” on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant.

Conclusions:
Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.
The Development and Validation of a Psychometric Tool to Assess Behavioral Factors Impacting Personal Dosimeter Use among Medical Radiation Workers
Authors: Mohd Ridzwan Siti Farizwana , Fritschi Lin , Bhoo-Pathy Nirmala , Hum Wee Lei 
Published: June 2023

Abstract
Personal dosimeters are used by medical radiation workers (MRWs) to monitor their radiation dose from external sources and comply with radiation safety guidelines. Nevertheless, there is evidence of inconsistent use of the devices among MRWs. Behavioral factors influencing the use of personal dosimeters have never been explored. Using established behavioral models, we aimed to develop a psychometric tool to measure the behavioral factors influencing dosimeter use and establish its feasibility, reliability, and validity. A 37-item tool was developed based on a qualitative study and review of the literature. The content relevancy was assessed by six field experts before it was piloted and re-tested on MRWs. The construct validity of the tool was analyzed using exploratory factor analysis to confirm its psychometric properties. Face validation was performed by academicians, field experts, and MRWs to enhance the tool’s readability. The 37 items in the tool belonged to five constructs in the early phase. However, the validation study revealed a reliable 27 item tool with seven constructs, namely: “Attitude,” “Social factors,” “Ability to perform if facilitated,” “Ability to overcome shortcomings,” “Self-efficacy,” “Complexity,” and “Perceived usefulness.” The item-construct validity index of accepted items was >0.83, and Cronbach’s alpha for each construct ranged between 0.70 to 0.96, while factor loading for each item was between 0.723 to 0.963. All results were considered “good” and “excellent.” The new tool appears to be valid, reliable, and feasible to measure behavioral factors influencing personal dosimeter use among MRWs, which is helpful to facilitate the planning of interventions to improve behaviors in occupational radiation monitoring.
Does Arterial Stiffness Predict Cardiovascular Disease in Older Adults With an Intellectual Disability?
Authors: O'Brien Frances , McCallion Philip , Ryan Caitriona , Paul Avejay , Burke Éilish , Echiverri Simmoune , McCarron Mary 
Published: June 2023

Background
Arterial stiffness has been associated with an increased risk of cardiovascular disease (CVD) in some patient populations.

Objectives
The aims of this study were to investigate (1) whether there is an association between arterial stiffness, as measured by the Mobil-O-Graph, and risk for CVD in a population of individuals with intellectual disability and (2) whether arterial stiffness can predict the risk for CVD.

Methods
This cross-sectional study included 58 individuals who participated in wave 4 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (2019–2020). Statistical models were used to address the first aim, whereas machine learning models were used to improve the accuracy of risk predictions in the second aim.

Results
Sample characteristics were mean (SD) age of 60.69 (10.48) years, women (62.1%), mild/moderate level of intellectual disability (91.4%), living in community group homes (53.4%), overweight/obese (84.5%), high cholesterol (46.6%), alcohol consumption (48.3%), hypertension (25.9%), diabetes (17.24%), and smokers (3.4%). Mean (SD) pulse wave velocity (arterial stiffness measured by Mobil-O-Graph) was 8.776 (1.6) m/s. Cardiovascular disease risk categories, calculated using SCORE2, were low-to-moderate risk (44.8%), high risk (46.6%), and very high risk (8.6%). Using proportional odds logistic regression, significant associations were found between arterial stiffness, diabetes diagnosis, and CVD risk SCORE2 (P < .001). We also found the Mobil-O-Graph can predict risk of CVD, with prediction accuracy of the proportional odds logistic regression model approximately 60.12% (SE, 3.2%). Machine learning models, k-nearest neighbor, and random forest improved model predictions over and above proportional odds logistic regression at 75.85% and 77.7%, respectively.

Conclusions
Arterial stiffness, as measured by the noninvasive Mobil-O-Graph, can be used to predict risk of CVD in individuals with intellectual disabilities.
Neoadjuvant Intensity Modulated Radiotherapy for a Single and Small (<= 5cm) Hepatitis B Virus-Related Hepatocellular Carcinoma Predicted to Have High Risks of Microvascular Invasion: A Randomized Clinical Trial
Authors: Wei Xubiao , Jiang Yabo , Feng Shuang , Lu Chongde , Huo Lei , Zhou Bin , Meng Yan , Lau Wan Yee , Zheng Yaxin , Cheng Shuqun 
Published: June 2023

Background:
The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored.

Materials and Methods:
Consecutive patients with a resectable single and small (<= 5 cm) Hepatitis B Virus (HBV)-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18Gy with fractionated doses of 3Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications.

Results:
There were 30 patients randomized to each of the 2 groups. In the neoadjuvant RT group, 3 patients violated the study protocol, with 2 having upfront hepatectomy and 1 radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58-70 mo) in the neoadjuvant RT group, and 68 months (interquartile range, 62-75 mo) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-, 2-, 3- and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group (P = 0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% (P = 0.399).

Conclusion and Relevance:
For patients with a resectable single and small HBV-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared to patients who underwent upfront surgery.
Delirium in the Era of COVID-19
Authors: Byrnes Tru , Pate Kimberly , Cochran Allyson R. , Belin Latasia 
Published: June 2023

Background:
Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19).

Purpose:
To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States.

Methods:
A retrospective study of 1502 patients admitted between 2020 and 2021 was completed.

Results:
Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001).

Conclusions:
Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery.
Description and Implications of Falls in Patients Hospitalized Due to COVID-19
Authors: Venema Dawn M. , Hester Amy , Clapper Kellie , Kennel Victoria , Quigley Patricia , Reames Christina , Skinner Anne 
Published: June 2023

Background:
Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery.

Purpose:
To describe and explore falls in patients hospitalized with COVID-19.

Methods:
We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test.

Results:
Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment.

Conclusions:
Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.
Relationship Between Self-Directed Learning, Grit, and Compassionate Teaching in Doctoral Nursing Education
Authors: White Krista A. , Ruth-Sahd Lisa A. , Slota Peggy 
Published: June 2023

Background:
The capacity to be self-directed, take responsibility for one's learning, and possess grit, perseverance, and passion for long-term goals is fundamental to doctoral education. Compassionate teaching (CT) strategies may help foster these traits.

Purpose:
This study explored CT strategies, self-directedness, and grit in doctoral nursing education.

Methods:
A mixed-methods design examined doctor of nursing (DNP) graduates' (N = 227) perceptions of self-directedness, grit, and CT using an online survey and interviews.

Results:
A weak direct correlation existed between CT strategies and grit. A weak-to-moderate direct significant correlation existed between CT strategies and self-directedness. Participants were moderately self-directed with postmasters-DNP graduates being more self-directed than postbaccalaureate-DNP graduates. Qualitative results validated that CT strategies include committing time to relationship building, providing timely critical feedback while being kind, and treating students fairly.

Conclusions:
Faculty who embrace rigor and compassion are appreciated by students and are perceived to foster self-directedness and grit.
Acculturative Stress, Resilience, and a Syndemic Factor Among Latinx Immigrants
Authors: Gonzalez-Guarda Rosa M. , McCabe Brian E. , Nagy Gabriela A. , Stafford Allison M. , Matos Lisvel , Lu Min , Felsman Irene , Rocha-Goldberg Pillar , Cervantes Richard C. 
Published: June 2023

Background
The process of immigration and subsequent adaptation can expose Latinx immigrants to chronic and compounding challenges (i.e., acculturative stress), but little is known about how resilience factors and these stressors interact to influence syndemic conditions, intertwined epidemics that disproportionally affect historically marginalized communities.

Objectives
The purpose of this study was to describe the influence of acculturative stress and resilience on the syndemic factor underlying substance abuse, intimate partner violence, HIV risk, and mental conditions.

Methods
Baseline cross-sectional data from a community-engaged, longitudinal study of 391 adult (ages 18–44 years) Latinx immigrants in North Carolina were obtained using standardized measures available in English and Spanish. Structural equation modeling tested the syndemic model, and random forest variable importance identified the most influential types of acculturative stressors and resilience factors, including their interactions, on the syndemic factor.

Results
Results indicated that a single syndemic factor explained variations in heavy drinking, drug use, intimate partner violence, depression, and anxiety and fit the data well. Age, being a woman, acculturative stress, acculturation to the United States, and emotional support were significantly related to the syndemic factor. The relationship between acculturative stress and the syndemic factor was buffered by ethnic pride, coping, enculturation, social support, and individual resilience. The most influential acculturative stressors were marital, family, and occupation/economic stress.

Discussion
Findings from this study underscore the importance of considering the co-occurrence of behavioral and mental health conditions among Latinx immigrants. Health promotion programs for Latinx immigrants should address acculturative stress and bolster ethnic pride, social support, and coping as sources of resilience.
Hospital Community Benefit Reporting: How Group Reporting Practices Limit Accountability
Authors: Cronin Cory E. , Singh Simone , Puro Neeraj , Franz Berkeley 
Published: June 2023

Objective:
To identify the prevalence of group reporting of hospital community benefit efforts to the Internal Revenue Service (IRS) and understand hospital and community characteristics associated with this practice.

Design:
The study was based on data collected from publicly available community benefit reports from 2010 to 2019, as well as secondary data from the 2020 American Hospital Association (AHA) Annual Survey. The sample was drawn from the entire nonprofit US hospital population reporting community benefit activities. The analytic plan employed descriptive statistics and bivariate analysis.

Setting:
The United States.

Participants:
All data are self-reported by US hospitals, either through the publication of community benefit reports (IRS Form 990 Schedule H) or a response to the AHA Annual Survey.

Main Outcome Measure(s):
Analyzed variables include whether a hospital reported its community benefit expenditures individually or as a group member; community benefit spending as a percentage of hospital operating expenses; and whether the hospital was part of a multihospital system, with consideration of hospital and community characteristics.

Results:
Between 2010 and 2019, more than 40% of hospitals participated in group reporting, with most doing so consistently. System membership and hospital size were significantly and positively tied to group reporting, with state community benefit policy tied to the lower prevalence of group reporting.

Conclusions:
The high prevalence of group reporting limits accountability to communities and restricts an accurate assessment of community benefit expenditures, counter to policy intentions. Stakeholders should consider what modifications to reporting rules could be made to promote transparency and to ensure that the effects of community benefit policies align with intentions.
The Keller Funnel, Capsular Contracture, and Conflict of Interest
Authors: Swanson Eric 
Published: June 2023

Background
The Keller funnel (Allergan; AbbVie Inc, North Chicago, IL) is commonly used to insert breast implants as part of a “no touch” protocol. Many plastic surgeons believe that this device reduces the risk of capsular contracture. This review was undertaken to evaluate the evidence regarding any reduction in capsular contracture rate, other possible benefits, safety and to investigate financial conflict of interest.

Methods
A PubMed electronic literature search was conducted to identify studies comparing capsular contracture rates with and without the Keller funnel. The Open Payments database was accessed for information regarding corporate payments to plastic surgeons.

Results
Two retrospective historical case-control studies, published in 2016 and 2018, were identified. Both studies had important confounders, including implant type and placement, which are known to affect capsular contracture rates. Major financial conflicts of interest were present. Most authors did not disclose these conflicts, which totaled more than $1 million and were usually categorized as gifts from Allergan, which purchased the Keller funnel in 2017.

Discussion
Financial conflict of interest, along with publication bias, creates a bias toward publication of positive findings. No reliable evidence supports a “no touch” technique, which is a misnomer because manual handling of implants is unavoidable, even when using a funnel. Recent microbiological studies do not support a specific bacterial etiology for capsular contracture. No evidence supports contamination by the surgeon touching the implant. Among other proposed benefits, such as reduced operating time, less contamination, a shorter incision, and less implant trauma, only a slightly shorter incision (1 cm) is supported by the evidence. The cost is $150 per funnel.

Conclusions
No reliable evidence supports the use of a Keller funnel to reduce the risk of capsular contracture. Both supportive studies contain confounding variables, limited follow-up time, and no plausible scientific basis for efficacy. Institutional review board approval of studies on human subjects is not optional. Financial conflicts of interest are extraordinary in their magnitude and potential for creating undue influence. Greater transparency and honest disclosures are needed.
Fecal Incontinence and the Risk of Urinary Tract Infection in Patients Presenting for Urogynecological Consultation
Authors: Jansen Sierra M. , Pellino Katherine , Zhou Qianqian , Brown Heidi W. , Heisler Christine A. 
Published: June 2023

Importance
Urinary tract infection (UTI) is common in urogynecology patients. Patients with fecal incontinence (FI) often attribute their UTIs to FI, but this association has not been evaluated.

Objectives
The objectives of this study were to compare the prevalence of UTI in urogynecology patients with and without FI and to characterize factors associated with UTI and recurrent UTI.

Study Design
This retrospective cohort study included all new adult patients who presented to an academic female pelvic medicine and reconstructive surgery practice with FI from January 2014 through December 2017. Patients were age-matched to new adult patients with stage <2 pelvic organ prolapse without FI. All urine culture results from 1 year before and 1 year after the first visit were identified. Logistic regression identified factors associated with UTI.

Results
Among 399 patients, 106 (27%) had a culture-confirmed UTI in the year before or after their first urogynecology visit; the prevalence of UTI was 23% (45/198) in patients with FI and 30% (61/201) in those without FI (P = 0.09). The rate of recurrent UTI was 11.5% overall and did not differ among those with and without FI. In multivariate models, variables that were statistically significantly associated with UTI included age, diabetes mellitus, anterior vaginal wall prolapse, and sexual activity. Fecal incontinence was not associated with any or recurrent UTI.

Conclusions
The prevalence of UTI and recurrent UTI was similar in urogynecology patients with and without FI. Variables that were associated with UTI risk included older age, sexual activity, diabetes mellitus, and anterior vaginal wall prolapse.