bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany
Authors: Bilgin Esma Sümeyya , Ülgüt Rojda , Schneider Nils , Stiel Stephanie 
Published: January 2022

Abstract
Background
The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines.

Aim
A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice.

Methods
The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions.

Results
The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints.

Conclusion
The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide.

Trial registration
The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).
Serum ferritin levels are associated with advanced liver fibrosis in treatment-naive autoimmune hepatitis
Authors: Chen Qingling , Gao Min , Yang Hang , Mei Ling , Zhong Rui , Han Ping , Liu Peiyan , Zhao Lili , Wang Jing , Li Jia 
Published: January 2022

Abstract
Background and aim
The association between iron-metabolism-related variables and liver fibrosis in chronic hepatitis C and nonalcoholic fatty liver disease is now well known. However, the relationship has not been extensively studied in autoimmune hepatitis (AIH). We aimed to investigate the association between variables associated with iron metabolism and advanced liver fibrosis among untreated patients with AIH.

Methods
Ninety-seven untreated AIH patients were enrolled in this cross-sectional study. All participants underwent iron metabolism index detection and liver biopsy. Multiple logistic regression analysis was used to explore the association of iron-metabolism-related variables with advanced liver fibrosis.

Results
Among the 97 AIH patients, 38 (39.2%) had advanced liver fibrosis, and 59 (60.8%) did not. In multivariate logistic regression analysis, immunoglobulin G (odds ratio [OR], 1.123; 95% confidence interval [CI] 1.023–1.232, P = 0.014), platelet count (OR 0.988; 95% CI 0.979–0.997, P = 0.013), prothrombin time (OR 1.758; 95% CI 1.143–2.704, P = 0.010) and ferritin (OR 1.002; 95% CI 1.001–1.004, P = 0.012) were independent risk factors for predicting advanced liver fibrosis in AIH patients.

Conclusion
Higher serum ferritin was independently associated with advanced liver fibrosis among patients with treatment-naive AIH.
Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS
Authors: Wei Kai , Liu Yong , Yang Junjie , Gu Nannan , Cao Xinyi , Zhao Xudong , Jiang Lijuan , Li Chunbo 
Published: January 2022

Abstract
Background
Although it has been suggested that loneliness is a risk factor for adverse health outcomes, living arrangement may confound the association. This study aimed to investigate whether the associations of loneliness with adverse health outcomes differ in community-dwelling older adults according to different living arrangements.

Methods
In the 2008/2009 wave of Chinese Longitudinal Healthy Longevity Survey, 13,738 community-dwelling older adults (≥65 years) were included for analyses. Living arrangements and loneliness were assessed. Health outcomes including cognitive and physical functions were assessed using MMSE, ADL/IADL scales and Frailty Index in the 2008/2009 and 2011/2012 waves; mortality was assessed in the 3-year follow-up from 2008/2009 to 2011/2012. The effect modificaitons of loneliness on adverse health outcomes by living arrangements were estimated using logistic regression or Cox proportional hazards regression models.

Results
Living alone older adults were significantly more likely to be lonely at baseline (52% vs 29.5%, OR = 1.90, 95% CI = 1.67–2.16, P < 0.001), compared with those living with others. Loneliness in older adults was a significant risk factor for prevalent cognitive impairment and frailty, and 3-year mortality, especially among those who lived with others (OR = 1.32, 95% CI = 1.15–1.52, P < 0.001; OR = 1.39, 95% CI = 1.24–1.57, P < 0.001; HR = 1.14, 95% CI = 1.05–1.24, P = 0.002, respectively). In contrast, among the living alone older adults, loneliness was only significantly associated with higher prevalence of frailty (OR = 1.42, 95% CI = 1.07–1.90, P = 0.017). Living arrangement significantly modified the associations of loneliness with prevalent cognitive impairment and 3-year mortality (P values for interaction = 0.005 and 0.026, respectively).

Conclusions
Living arrangement modifies the associations of loneliness with adverse health outcomes in community-dwelling older adults, and those who lived with others but felt lonely had worse cognitive and physical functions as well as higher mortality. Special attention should be paid to this population and more social services should be developed to reduce adverse health outcomes, in order to improve their quality of life and promote successful aging.
A mathematical model by route of transmission and fibrosis progression to estimate undiagnosed individuals with HCV in different Italian regions
Authors: Kondili Loreta A. , Andreoni Massimo , Alberti Alfredo , Lobello Salvatore , Babudieri Sergio , De Michina Antonella , Merolla Rocco , Marrocco Walter , Craxì Antonio 
Published: January 2022

Abstract
Background
Although an increase in hepatitis C virus (HCV) prevalence from Northern to Southern Italy has been reported, the burden of asymptomatic individuals in different Italian regions is currently unknown.

Methods
A probabilistic approach, including a Markov chain for liver disease progression, was applied to estimate current HCV viraemic burden. The model defined prevalence by geographic area using an estimated annual historical HCV incidence by age, treatment rate, and migration rate from the Italian National database. Viraemic infection by age group was estimated for each region by main HCV transmission routes of individuals for stage F0–F3 (i.e. patients without liver cirrhosis and thus potentially asymptomatic) and F4 (patients with liver cirrhosis, thus potentially symptomatic).

Results
By January 2020, it was estimated that there were 409,184 Italian individuals with HCV (prevalence of 0.68%; 95% CI: 0.54–0.82%), of which 300,171 (0.50%; 95% CI: 0.4–0.6%) were stage F0–F3. Considering all individuals with HCV in stage F0–F3, the geographical distributions (expressed as the proportion of HCV infected individuals by macroarea within the overall estimated number of F0–F3 individuals and prevalence values, expressed as the percentage of individuals with HCV versus the overall number of individuals for each macroarea) were as follows: North 42.1% (0.45%; 95% CI: 0.36–0.55%), Central 24.1% (0.61%; 95% CI: 0.48–0.74%), South 23.2% (0.50%; 95% CI: 0.4–0.61%), and the Isles 10.6% (0.49%; 95% CI: 0.39–0.59%). The population of people who inject drugs accounted for 50.4% of all individuals infected (F0–F3). Undiagnosed individuals (F0–F3) were ~ 15 years younger (⁓ 50 years) compared with patients with stage F4 (⁓ 65 years), with similar age distributions across macroareas. In contrast to what has been reported on HCV epidemiology in Italy, an increasing trend in the proportion of potentially undiagnosed individuals with HCV (absolute number within the F0–F3) from South (23.2%) to North (42.1%) emerged, independent of similar regional prevalence values.

Conclusion
This targeted approach, which addresses the specific profile of undiagnosed individuals, is helpful in planning effective elimination strategies by region in Italy and could be a useful methodology for other countries in implementing their elimination plans.
One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study
Authors: Boltzmann Melanie , Schmidt Simone B. , Gutenbrunner Christoph , Krauss Joachim K. , Höglinger Günter U. , Rollnik Jens D. 
Published: January 2022

Abstract
Background
The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation.

Methods
Early neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge.

Results
Two hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51–75) and a median duration of their disease of 18 days (IQR = 12–28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up.

Conclusion
Age was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.
Simpson-Golabi-Behmel syndrome in one of the Dichorionic-diamniotic twin: a case report and literature review
Authors: Guo Yongbing , Zhang Huijing , Fan Lixin , Chen Junya , Zhang Xiaoxiao , Yang Huixia , Sun Yu 
Published: January 2022

Abstract
Background
Simpson-Golabi-Behmel syndrome (SGBS) is a rare X-linked overgrowth syndrome. The main clinical manifestations are overgrowth and multiple malformations.

Case presentation
A 38-year-old Chinese woman was pregnant with dichorionic-diamniotic (DCDA) twins after in-vitro fertilization. Series of ultrasound examinations indicated that the measurements (abdominal circumference and estimated foetal weight) of one twin were significantly greater than those of the other one. The genetic testing results of the larger baby indicated of Simpson-Golabi-Behmel syndrome.

Conclusion
SGBS is difficult to diagnose due to different clinical manifestations. Clinicians need to be more aware of typical SGBS’s clinical findings and choose genetic testing methods individually to improve its prenatal diagnosis.
Dietary cholesterol and egg intake are associated with the risk of gestational diabetes: a prospective study from Southwest China
Authors: Zhang Yiqi , Lan Xi , Li Fei , Sun Hong , Zhang Ju , Li Run , Gao Yan , Dong Hongli , Cai Congjie , Zeng Guo 
Published: January 2022

Abstract
Background
An increasing body of evidence suggests that cholesterol intake increases during pregnancy and may influence the risk of gestational diabetes mellitus (GDM). However, existing evidence remains controversial and limited. The present study aimed to determine the relation among dietary cholesterol, specifically egg consumption, in pregnant Chinese women and their risk of GDM.

Methods
A population-based study that included 1617 pregnant women was conducted in 2017. At baseline, dietary information was collected by 24-hour dietary recalls over three days. GDM was diagnosed by a 75 g 2-hr oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Logistic regression models were used to examine the associations of dietary cholesterol and egg intake with GDM. In addition, path analysis including cholesterol intake, plasma lipid profiles and GDM risk was conducted.

Results
The average total cholesterol intake was 340.8 mg/d, and cholesterol from eggs accounted for 59.2%. The odds ratio (OR) of GDM risk was 1.48 for the highest quartile of total cholesterol intake compared to the lowest quartile (95% CI 1.10-2.00; Ptrend = 0.015) after adjustment for potential risk factors for GDM. Moreover, cholesterol from eggs rather than from other foods was positively associated with incident GDM (OR=1.09, 95% CI 1.03-1.17). Each additional egg consumed per day was positively correlated with a higher risk of GDM (OR=1.32, 95% CI 1.11-1.58). Path analysis indicated that cholesterol intake not only increased the risk of GDM by elevating plasma total cholesterol (TC), but also increased the risk of GDM through other non hyperlipidemia pathways.

Conclusions
Maternal dietary cholesterol intake was significantly associated with incident GDM, and egg consumption was a major driver of the association in this population. More studies are needed to substantiate these findings and to explore the underlying mechanisms.
NSAID use and unnatural deaths after cancer diagnosis: a nationwide cohort study in Sweden
Authors: Shen Qing , Sjölander Arvid , Sloan Erica K. , Walker Adam K. , Fall Katja , Valdimarsdottir Unnur , Sparén Pär , Smedby Karin E. , Fang Fang 
Published: January 2022

AbstractBackgroundCancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of these outcomes.MethodsFollowing a cohort of 388,443 cancer patients diagnosed between October 2005 and December 2014 in Sweden, we ascertained dispense of aspirin or non-aspirin NSAIDs from 3 months before cancer diagnosis onward and defined the on-medication period as from date of drug dispense until the prescribed dosage was consumed. Follow-up time outside medicated periods and time from unexposed patients were defined as off-medication periods. We used Cox models to estimate hazard ratios (HRs) of death due to suicide or accident, by comparing the on-medication periods with off-medication periods.ResultsIn total, 29.7% of the cancer patients had low-dose aspirin dispensed and 29.1% had non-aspirin NSAIDs dispensed. Patients with aspirin use were more likely to be male than patients without aspirin use. Compared with off-medication periods, there was a 22% lower risk of accidental death (N = 651; HR 0.78, 95% confidence interval [CI]: 0.70 to 0.87) during on-medication periods with aspirin. The use of aspirin was not associated with risk of suicide (N = 59; HR 0.96, 95% CI: 0.66 to 1.39). No association was noted between use of non-aspirin NSAIDs and the risk of suicide (N = 13; HR 0.95, 95% CI: 0.42 to 2.18) or accidental death (N = 59; HR 0.92, 95% CI: 0.68 to 1.26).ConclusionsIntake of low-dose aspirin after cancer diagnosis was associated with a lower risk of unnatural deaths among cancer patients.
Two novel prognostic models for ovarian cancer respectively based on ferroptosis and necroptosis
Authors: Li Yang , Gong Xiaojin , Hu Tongxiu , Chen Yurong 
Published: January 2022

Abstract
Background
Platinum-resistant cases account for 25% of ovarian cancer patients. Our aim was to construct two novel prognostic models based on gene expression data respectively from ferroptosis and necroptosis, for predicting the prognosis of advanced ovarian cancer patients with platinum treatment.

Methods
According to the different overall survivals, we screened differentially expressed genes (DEGs) from 85 ferroptosis-related and 159 necroptosis-related gene expression data in the GSE32062 cohort, to establish two ovarian cancer prognostic models based on calculating risk factors of DEGs, and log-rank test was used for statistical significance test of survival data. Subsequently, we validated the two models in the GSE26712 cohort and the GSE17260 cohort. In addition, we took gene enrichment and microenvironment analyses respectively using limma package and GSVA software to compare the differences between high- and low-risk ovarian cancer patients.

Results
We constructed two ovarian cancer prognostic models: a ferroptosis-related model based on eight-gene expression signature and a necroptosis-related model based on ten-gene expression signature. The two models performed well in the GSE26712 cohort, but the performance of necroptosis-related model was not well in the GSE17260 cohort. Gene enrichment and microenvironment analyses indicated that the main differences between high- and low- risk ovarian cancer patients occurred in the immune-related indexes, including the specific immune cells abundance and overall immune indexes.

Conclusion
In this study, ovarian cancer prognostic models based on ferroptosis and necroptosis have been preliminarily validated in predicting prognosis of advanced patients treated with platinum drugs. And the risk score calculated by these two models reflected immune microenvironment. Future work is needed to find out other gene signatures and clinical characteristics to affect the accuracy and applicability of the two ovarian cancer prognostic models.
Paediatric lung injury due to accidental ingestion of meperfluthrin: a case report
Authors: Li Zhongqiang , Wu Xuejun , Lv Gaomei , Ren Zhijuan , Yang Huimin , Xu Leilei , Guan Qingli , Meng Xiuqi 
Published: January 2022

Abstract
Background
It is common for children to accidentally ingest chemical drugs with different degrees of toxicity. Meperfluthrin is a highly effective and easy-to-use pyrethroid pesticide with low toxicity. It is widely used in electric mosquito coils. This type of electric mosquito coil is used in daily life, which increases the chance of exposure among children and, consequently, may lead to accidental ingestion. There are only few reports of meperfluthrin poisoning causing lung injury in children. We report a rare clinical case of lung injury wherein a child ingested meperfluthrin orally.

Case presentation
We report the case of a 1-year-old boy who accidentally swallowed an electric mosquito coil containing meperfluthrin and developed cough and fever. The patient’s parents observed him swallowing the electric mosquito coil (Qiangshou®). Although he was stopped, the child had already swallowed approximately 10 ml of the liquid. According to the instructions, it contained 9 mg/ml of meperfluthrin, thus, it was assumed that he ingested meperfluthrin at a dose of approximately 90 mg. Computed tomography (CT) of his lungs showed uneven brightness in both lungs with multiple spots, scaly shadows, and mesh. Density of the shadows indicated lung parenchymal and interstitial lung disease. Lung tidal function tests indicated obstructive ventilation dysfunction. After evaluation and treatment, his cough drastically reduced, his fever disappeared, and his lung CT findings showed improvement. Therefore, accidental ingestion of meperfluthrin led to acute lung injury in a paediatric patient. Because of prompt treatment, his lung lesions recovered well.

Conclusions
Meperfluthrin causes airway mucosal damage and hypersensitivity. Lung CT and lung tidal function measurements can be used to monitor changes in the condition. Presently, there is a lack of specific detoxification drugs for meperfluthrin poisoning. Thus, the focus of treatment is to protect the airway mucosa and reduce inflammatory reactions.
Influencing factors of residents’ environmental health literacy in Shaanxi province, China: a cross-sectional study
Authors: Zhao Yan , Sheng Yun , Zhou Jieting , Wang Hao , Chilufya Mumba Mulutula , Liu Xuan , Mohamed Alaa Osman , Han Jing , Qu Chengjuan 
Published: January 2022

Abstract
Background
This study comprehensively analyzed the basic conditions and influencing factors of the residents' environmental health literacy (EHL) level in Shaanxi Province, China in 2020, and provided a scientific basis for exploring new ideas and new methods to improve the EHL level of the whole people.

Methods
In the cross-sectional study with a multi-stage random sampling method, 1320 participants were recruited in 6 neighborhood committees (administrative villages) from the Shaanxi province of China between 15–69 years old. The Core Questions for Assessment of EHL of Chinese Citizens (Trial Implementation) was adopted to measure the EHL of the respondents.

Results
The survey showed the level of EHL of residents is 17.6% in Shaanxi in 2020. Among them, the basic concepts, basic knowledge, and basic skills classification literacy levels are 34.7%, 6.89%, and 37.95% respectively. The EHL ratio of rural residents is significantly lower than that of urban residents (12.38 vs. 29.02%). A noticeable difference was shown in various aspects and environmental health issues of EHL between urban and rural populations.

Conclusions
Many factors are affecting the level of EHL. Education and science popularization of basic environmental and health knowledge in key areas and populations should be strengthened, and behavioral interventions should be carried out according to the characteristics of the population.