bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex-specific frailty and chronological age normative carotid artery intima-media thickness values using the Canadian longitudinal study of aging
Authors: O’Brien Myles W , Kimmerly Derek S , Theou Olga 
Published: February 2023

Objectives Carotid intima-media-thickness (cIMT) is predictive of future cardiovascular events, increases with chronological age, and greater in males. The accumulation of health deficits (or frailty) is a marker of biological age. However, normative cIMT values are lacking and would be an important comparative tool for healthcare providers and researchers. This study aimed to establish sex-specific normative cIMT values across chronological age and frailty levels (i.e. biological age). Methods Frailty and right common cIMT data were extracted from the Canadian Longitudinal Study of Aging baseline comprehensive cohort of middle-aged and older adults ( n = 10,209; 5000 females). cIMT was assessed via high-resolution ultrasound. Frailty was determined using a 52-item frailty index. Ordinary least squares and quantile regressions were conducted between age (years or frailty index) with cIMT (average or maximum), separately for males and females. Results In both sexes, average and maximum cIMT increased with higher chronological age and frailty. Both cIMT metrics increased non-linearly (quadratic-cIMT term) with advancing age (β-coefficients for quadratic and linear terms: all, p < 0.001), except for the linear relationship between average and maximum cIMT with chronological age among males ( p < 0.001). Sex-specific normative average and maximum cIMT values were established (1st–99th percentiles, 5% increments), separately for chronological and biological ages. Conclusions This is the largest sample of adults to establish normative cIMT outcomes that includes older adults. The chronological age and frailty-related normative cIMT outcomes will serve as a useful resource for healthcare professionals and researchers to establish “normal” age- and sex-specific cIMT values.
Gender differences in mortality and long-term functional outcomes after first-ever ischemic stroke: A prospective cohort study
Authors: Yun Sang Moon , Shin Seyoung , Chang Won Hyuk , Kim Deog Young , Lee Jongmin , Sohn Min Kyun , Song Min-Keun , Shin Yong-Il , Lee Yang-Soo , Joo Min Cheol , Lee So Young , Han Junhee , Ahn Jeonghoon , Oh Gyung-Jae , Kim Yun-Hee 
Published: February 2023

Background: Although many studies about survival rates and functional outcomes after stroke have been published, studies on gender differences have reported conflicting results. Aims: To determine whether there are differences in mortality and functional outcomes during the first 5 years after a first-ever ischemic stroke in Korean males and females. Method: This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation, a prospective multicenter cohort study. Multifaceted functional assessments were performed repeatedly from 7 days to 60 months after stroke onset to test motor, ambulatory, cognitive, language, and swallowing functions as well as activities of daily living (ADLs) in patients with first-ever stroke. Of 10,636 first-ever-stroke patients admitted to nine representative hospitals in Korea, 8210 were ischemic stroke patients included in the mortality analysis. Among them, 6258 patients provided informed consent and 3508 completed functional assessments for 60 months. Gender-related differences in 5-year mortality and functional recovery were analyzed. Result: Women showed a significantly higher 5-year mortality rate than men after correction for possible covariates ( p  < 0.05). In terms of functional outcomes, women showed worse ambulatory, cognitive, language, and ADL outcomes than men after adjusting for covariates (all p  < 0.05). The 5-year recovery pattern differed significantly between genders only for ADL function (β-coefficient estimate = 0.34; p  = 0.03). Conclusion: Five-year mortality rate, functional outcomes, and recovery patterns after first-ever ischemic stroke differed significantly by gender. These results suggest the need for gender-specific stroke care and long-term management strategies.
Is Helicobacter pylori infection associated with pancreatic cancer? A systematic review and meta-analysis of observational studies
Authors: Zhou Ben-Gang , Mei Yu-Zhou , Wang Jing-Shu , Xia Jian-Lei , Jiang Xin , Ju Sheng-Yong , Ding Yan-Bing 
Published: February 2023

Background and Objectives: Recent observational studies have investigated the association between Helicobacter pylori ( H. pylori) infection and pancreatic cancer with conflicting data. Therefore, we conducted a systematic review and meta-analysis to assess the potential association. Design: This is a systematic review and meta-analysis. Methods: We searched three databases (PubMed, Embase, and Web of Science) from inception to 30 August 2022. The summary results as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) were pooled by generic inverse variance method based on random-effects model. Results: A total of 20 observational studies involving 67,718 participants were included in the meta-analysis. Meta-analysis of data from 12 case–control studies and 5 nested case–control studies showed that there was no significant association between H. pylori infection and the risk of pancreatic cancer (OR = 1.20, 95% CI = 0.95–1.51, p = 0.13). Similarly, we also did not find significant association between cytotoxin-associated gene A (CagA) positive strains, CagA negative strains, vacuolating cytotoxin gene A (VacA) positive strains H. pylori infection, and the risk of pancreatic cancer. Meta-analysis of data from three cohort studies showed that H. pylori infection was not significantly associated with an increased risk of incident pancreatic cancer (HR = 1.26, 95% CI = 0.65–2.42, p = 0.50). Conclusion: We found insufficient evidence to support the proposed association between H. pylori infection and increased risk of pancreatic cancer. To better understand any association, future evidence from large, well-designed, high-quality prospective cohort studies that accounts for diverse ethnic populations, certain H. pylori strains, and confounding factors would be useful to settle this controversy.
Preconception care in sub-Saharan Africa: A systematic review and meta-analysis on the prevalence and its correlation with knowledge level among women in the reproductive age group
Authors: Woldeyohannes Demelash , Tekalegn Yohannes , Sahiledengle Biniyam , Hailemariam Zeleke , Erkalo Desta , Zegeye Abraham , Tamrat Habtamu , Habte Akililu , Tamene Aiggan , Endale Fitsum , Ertiban Biruk , Ejajo Tekle , Kelbiso Lolamo , Liranso Lombamo , Desta Fikreab , Ermias Dejene , Mwanri Lillian , Enticott Joanne C. 
Published: February 2023

Objective: Preconception care is aimed to promote optimal health in women before conception to reduce or prevent poor pregnancy outcomes. Although there are several published primary studies from sub-Saharan African countries on preconception care, they need to quantify the extent of preconception care utilization, the knowledge level about preconception care, and the association among women in the reproductive age group in this region. This systematic review and meta-analysis aimed to estimate the pooled utilization of preconception care, pooled knowledge level about preconception care, and their association among women in the reproductive age group in sub-Saharan Africa. Methods: Databases including PubMed, Science Direct, Hinari, Google Scholar, and Cochrane library were systematically searched for relevant literature. Additionally, the references of included articles were checked for additional possible sources. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of preconception care, knowledge level of preconception care, and their correlation among reproductive-aged women in sub-Saharan African countries. Results: Of the identified 1593 articles, 20 studies were included in the final analysis. The pooled utilization of preconception care and good knowledge level about preconception care among women of reproductive age were found to be 24.05% (95% confidence interval: 16.61, 31.49) and 33.27% (95% confidence interval: 24.78, 41.77), respectively. Women in the reproductive age group with good knowledge levels were greater than two times more likely to utilize the preconception care than the women with poor knowledge levels in sub-Saharan African countries (odds ratio: 2.35, 95% confidence interval: 1.16, 4.76). Conclusion: In sub-Saharan African countries, the utilization of preconception care and knowledge toward preconception care were low. Additionally, the current meta-analysis found good knowledge level to be significantly associated with the utilization of preconception care among women of reproductive age. These findings indicate that it is imperative to launch programs to improve the knowledge level about preconception care utilization among women in the reproductive age group in sub-Saharan African countries.
The potentiality of biostimulant (Lawsonia inermis L.) on some morpho-physiological, biochemical traits, productivity and grain quality of Triticum aestivum L.
Authors: Maksoud Salwa A. , Gad Khaled I. , Hamed Eman Y. M. 
Published: February 2023

Abstract
Background
In conformity with the international trend to substitute the artificial agro-chemicals by natural products to improve growth and productivity of crops, there is a necessity to focus on the environment sustainable and eco-friendly resources to increase crops productivity per unit area. One of these resources is the use of biostimulants. The aim of this study is to allow the vertical expansion of wheat crop by improving its growth and productivity per unit area as well as enhancing its grain quality using henna leaf extract as a biostimulant.

Results
Field study was conducted to evaluate the potentiality of different doses of henna leaf extract (HLE) for improving the performance of wheat plants (Triticum aestivum L.) at three development stages. Results revealed that the response was dose dependent hence both 0.5 and 1.0 g/L doses significantly enhanced the growth of shoot and root systems, biochemical traits, yield and yield related components with being 1.0 g/L the most effective one. Furthermore, 1.0 g/L HLE markedly enhanced the quality of the yielded grains as revealed by increasing the content of soluble sugars (23%), starch (19%), gluten (50%), soluble proteins (37%), amylase activity (27%), total phenolics, flavonoids and tannins (67, 87 and 23%, respectively) as well as some elements including Ca (184%), Na and Fe (10%). Also, HPLC analysis of grains revealed that 1.0 g/L dose significantly increased the level of different phytohormones, soluble sugars and flavonoids (quercetin, resveratrol and catechin).

Conclusion
Application of Henna (Lawsonia inermis) leaf extract at 1.0 g/L dose as a combination of seed priming and foliar spray can be recommended as a nonpolluting, inexpensive promising biostimulant, it can effectively enhance wheat growth, biochemical traits and productivity as well as improving the quality of the yielded grains.
The effectiveness of atrial fibrillation special clinic on oral anticoagulant use for high risk atrial fibrillation patients managed in the community
Authors: Lau Ka Man , Leung To Fung , Li Yim Chu , Chen Catherine Xiao Rui 
Published: February 2023

Abstract
Background
Service gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.

Method
Quasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.

Results
Among the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.

Conclusion
AFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.
Determining the key performance indicators of human resource management of military hospital managers; a TOPSIS study
Authors: Fanaei Sadegh , Zareiyan Armin , Shahraki Saeid , Mirzaei Abasat 
Published: February 2023

AbstractBackgroundProper human resource management in military health centers leads to long-term development and improved health-care quality. As a result, the purpose of this research is to identify the key performance indicators of human resource management for military hospital managers, and the unique indicators of military hospitals were obtained.MethodsThis cross-sectional study was performed by the TOPSIS method in the fall of 2021. This study used a checklist consisting of 20 performance indicators of human resource management, which were scored by 20 senior military hospital managers based on two criteria: "importance" and "measurability in military hospitals". The Shannon entropy method was used to weight the indicators, and the BT-TOPSIS Solver software was used to analyze and prioritize them.ResultsAmong the 20 indicators in human resource management, the staff satisfaction index in military hospitals, the competitiveness rate of salaries in military hospitals relative to the national sector, the number of permanent staff in military hospitals, and the percentage of contract labor costs in military hospitals have the highest coefficient, respectively.ConclusionsThe importance of human resource management and organizational performance is due to their influence on each other. As a result, human resource management should pay special attention to the professional and personal development of human resources, as this has an impact on the performance of the organization in the long run. In light of the sensitive nature of human resource management and its crucial role in achieving any organization's strategic goals, selecting appropriate indicators is essential.The Department of Military Health requires indicators unique to the military sector to assess the human resource management of the military hospital, since according to the existing circumstances, the indicators of the military sector and those of the civilian sector are different.
Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study
Authors: Yang Qing , Zhou Chen-Chen , Chen Ying , Pei Jin-Dan , Hua Xiao-Lin , Yao Li-Ping 
Published: February 2023

Abstract
Background
The use of cervical strain elastography for nulliparous women during late-term pregnancy remains unclear. This study assesses the predictive value of late-term cervical strain elastography for successful induction of labor (IOL) in nulliparous women.

Methods
This single-centered, prospective study included 86 patients undergoing IOL between January 2020 and March 2022. Univariate and multivariate analyses were conducted to identify predictive factors for successful IOL. The predictive values were assessed using the area under receiver operating characteristic (ROC) curves.

Results
IOL was successful in 58 patients. The hardness ratio and cervical length were significantly associated with successful late-term IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.

Conclusions
The hardness ratio and cervical length assessed by cervical strain elastography during late-term pregnancy are predictors of the success of IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.
Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study
Authors: Yang Yuxuan , Yu Min 
Published: February 2023

Abstract
Background

Reducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China.

Methods
A cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson’s model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization.

Results
Place of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC.

Conclusions
Inequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization.
We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women’s health literacy.
Single-copy Snail upregulation causes partial epithelial-mesenchymal transition in colon cancer cells
Authors: Junaid Fatima , Tomic Goran , Kemp Richard , Winton Doug J. 
Published: February 2023

Abstract
Background
Epithelial-mesenchymal transition (EMT) is an embryonic programme implicated in cancer stem cells, metastasis and therapeutic resistance. Its role in cancer progression remains controversial because the transition can be partial or complete in different models and contexts.

Methods
Using human colon cancer DLD-1 cells, we engineered a cell line with a single-copy of Snail that was doxycycline-inducible and compared it to existing EMT models in DLD-1. The effect of Snail upregulation was characterised functionally, morphologically, and by transcriptional profiling and protein expression.

Results
Induction with doxycycline increased Snail expression to a level similar to that observed in cancer cell lines spontaneously expressing Snail and results in partial EMT. In comparison, higher levels of overexpression arising from introduction of episomal-Snail, results in complete EMT. DLD-1 cells with partial EMT show chemoresistance in vitro, increased tumour growth in vivo and decreased apoptosis.

Conclusions
These findings highlight that the amount of bioavailable Snail can dictate phenotypic outcome and that partial EMT may be a preferred outcome of models operating within a natural range of Snail overexpression.
Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016
Authors: Sidahmed Sahar , Geyer Siegfried , Beller Johannes 
Published: February 2023

Abstract
Background
Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified.

Methods
Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using “wealth index” and “weight perception” as additional variables.

Results
There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged “60 years or older” with a wealth index of “rich” or “richer”, followed by participants from the same age group who were “poor” or “poorer” and participants aged “40–59 years” with a wealth index of “rich” or “richer”. Subsequently were participants from the age group “15–39 years” with a weight perception of “overweight” or “obese”.

Conclusion
Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.