bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing antibiotics to immigrants: a qualitative study of general practitioners’ and pharmacists’ experiences
Authors: Lescure Dominique L. A. , van Oorschot Wilbert , Brouwer Rob , van der Velden Janneke , Tjon-A-Tsien Aimée M. L. , Bonnema Iris V. , Verheij Theo J. M. , Richardus Jan Hendrik , Voeten Hélène A. C. M. 
Published: May 2022

Abstract
Background
If healthcare professionals perceive that patients strongly expect to be prescribed antibiotics, inappropriate prescriptions may result. As it is unknown whether this happens more often with certain patient groups, we explored whether general practitioners (GPs) and pharmacists perceived such expectations when they provided antibiotics to immigrant patients.

Methods
Ten GPs and five pharmacists from Rotterdam, the Netherlands, were interviewed on the basis of a semi-structured topic guide. Atlas.ti software was then used to conduct a thematic analysis.

Results
GPs felt that immigrant patients, especially those who had arrived recently, were more likely to expect to receive antibiotics than native Dutch patients. However, these expectations had decreased over the last years and did not always lead immigrants to exert pressure on them. Except for language barriers, the factors reported by GPs to influence their antibiotic prescribing behaviour were unrelated to patients’ immigrant background. If there was a language barrier, GPs experienced greater diagnostic uncertainty and needed additional time to obtain and communicate correct information. To overcome language barriers, they often used point-of-care testing to convince patients that antibiotics were unnecessary. Although pharmacists rarely experienced problems dispensing antibiotics to immigrants, they and GPs both struggled to find effective ways of overcoming language barriers, and stressed the need for multi-language support materials.

Conclusion
While pharmacists rarely experience any problems providing antibiotics to immigrants, GPs regularly face language barriers with immigrant patients, which complicate the diagnostic process and communicating information in the limited available time. This sometimes leads antibiotics to be prescribed inappropriately.
Underdiagnosis and underreporting of vertebral fractures on chest radiographs in men aged over 50 years or postmenopausal women with and without type 2 diabetes mellitus: a retrospective cohort study
Authors: Na Ding , Cong Ma , Zhang-Xin Wen , Rong Chen , Qin-Yi Wang , Yang-Na Ou , Zhi-Feng Sheng 
Published: May 2022

Abstract
Background
Osteoporotic vertebral fractures are often clinically silent and unrecognized. The present study aimed to determine whether routine chest radiographs could be a potential screening tool for identifying missed vertebral fractures in men aged over 50 years or postmenopausal women, especially those with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of undetected vertebral fractures in elderly Chinese patients with and without T2DM.

Methods
Clinical data and chest radiographs of 567 individuals with T2DM (T2DM group) and 583 without diabetes (nondiabetic group) at a tertiary hospital in central south China were extracted from the records. Vertebral fractures were specifically looked for on chest radiographs and classified using the Genant semi-quantitative scale. Prevalence was compared between the two groups.

Results
Mean age and sex composition were comparable between the two groups. Mean weight and body mass index were significantly lower in the T2DM group. In both groups, fractures mostly involved the T11–12 and L1 vertebrae. Moderate/severe fractures were identified in 33.3% individuals in the T2DM group (31.4% men and 36.0% women) versus 23.2% individuals (20.9% men and 25.5% women) in the nondiabetic group.

Conclusions
Routine chest radiographs could be a useful screening tool for identifying asymptomatic vertebral fractures.
Trial registration The study was designed as an observational retrospective study, therefore a trial registration was not necessary.
Empagliflozin in kidney transplant recipients with chronic kidney disease G3a-4 and metabolic syndrome: Five Japanese cases
Authors: Miyazaki Ryoichi , Miyagi Kyoko 
Published: May 2022

Abstract
Background
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to exert cardiorenal protective effects in diabetic patients and are widely used clinically. In addition, an increasing number of reports now suggest these drugs may even be beneficial in non-diabetic patients. However, SGLT2 inhibitors are rarely prescribed for kidney transplant recipients due to the risk of renal graft damage and urogenital infections.

Case presentation
We report the cases of 5 renal transplant recipients with chronic kidney disease G3a-4 and metabolic syndrome who were administered the SGLT2 inhibitor empagliflozin, which yielded beneficial results in 4 cases. With the exception of one patient with an initial estimated glomerular filtration rate (eGFR) of less than 30 ml/min/1.73 m2, administration of empagliflozin elicited beneficial metabolic effects. There were no significant reductions in eGFR before or after empagliflozin administration, and no dehydration or urogenital infections were observed during the treatment course.

Conclusion
Empagliflozin showed some positive effects in 4 cases with better renal function than CKD stage 4. Further studies will be required to clarify the efficacy and safety of SGLT2 inhibitors in a larger group of patients with similar medical conditions.
The diagnostic dilemma of idiopathic intracranial hypertension in a child with acute lymphoblastic leukemia: COVID-19 or cytosine arabinoside?
Authors: Rakez Rim , Boufrikha Wiem , Lakhal Sana , Boughammoura Amel , Laatiri Mohamed Adnene 
Published: May 2022

Abstract
Background
Idiopathic intracranial hypertension is a rare neurological condition among children. Its manifestations vary from mild headaches to loss of vision. Although rare, COVID-19 infection and high dose cytosine arabinoside have been reported as risk factors for this neurological disorder. In patients with acute leukemia, idiopathic intracranial hypertension diagnosis is simple, but finding its etiology can be difficult.

Case presentation
We report a case of a 9-year-old boy with an ongoing treatment for T-acute lymphoblastic leukemia presenting with persistent headaches and diplopia. A diagnosis of idiopathic intracranial hypertension was retained based on clinical, imaging and laboratory findings. Due to its rarity, we describe its clinical and therapeutic features and highlight the challenging etiological dilemma between COVID-19 infection and high dose cytosine arabinoside administration.

Conclusion
Persistent headache in a pediatric patient with leukemia can be due to many neurological disorders other than leukemic relapse. Given the improvement of the neurological symptoms after the SARS-CoV-2 PCR negativization and the successful re-introduction of high dose cytosine Arabinoside, the diagnosis of idiopathic intracranial hypertension associated with Covid-19 infection was withheld.
Cardiac disease in pregnancy and the first year postpartum: a story of mental health, identity and connection
Authors: Hutchens Jane , Frawley Jane , Sullivan Elizabeth A. 
Published: May 2022

Abstract
Background
Women with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum.

Methods
A qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework.

Results
Analysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing.

Conclusion
Acknowledging and understanding the breadth, complexity and depth of women’s experiences is fundamental to improving outcomes. Our findings provide unique insights into women’s experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.
Androgen Deprivation therapy for Oligo-recurrent Prostate cancer in addition to radioTherapy (ADOPT): study protocol for a randomised phase III trial
Authors: Janssen J. , Staal F. H. E. , Brouwer C. L. , Langendijk J. A. , de Jong I. J. , van Moorselaar R. J. A. , Schuit E. , Verzijlbergen J. F. , Smeenk R. J. , Aluwini S. 
Published: May 2022

Abstract
Background
More than 60% of oligo-recurrent prostate cancer (PCa) patients treated with metastasis-directed radiotherapy (MDRT) develop biochemical recurrence within 2 years. This recurrence rate emphasises the need for improved treatment and patient selection. In line with the treatment of primary PCa, the efficacy of MDRT may be enhanced when combined with androgen-deprivation therapy (ADT). Furthermore, the availability of PSMA PET/CT offers an excellent tool for optimal patient selection for MDRT. This phase III randomised controlled trial will investigate the role of the addition of ADT to MDRT in oligo-recurrent PCa patients selected with PSMA PET/CT to enhance oncological outcome.

Methods
Two hundred and eighty patients will be randomised in a 1:1 ratio to the standard treatment arm (MDRT alone) or the experimental arm (MDRT + 6 months ADT). Patients with biochemical recurrence after primary treatment of PCa presenting with ≤ 4 metastases will be included. The primary endpoint is the 2.5-year metastases progression-free survival (MPFS). Secondary endpoints are acute and late toxicity, quality of life, biochemical progression-free survival, overall survival, and the sensitivity of the PSMA PET/CT for detecting oligometastases at low PSA-levels. So far, between March 2020 and December 2021, one hundred patients have been included.

Discussion
This phase III randomised controlled trial will assess the possible benefit of the addition of 6 months ADT to MDRT on metastases progression-free survival, toxicity, QoL and survival in PCa patients with 1–4 recurrent oligometastatic lesions.

Trial registration
ClinicalTrials.gov, NCT04302454. Registered 10 March 2020.
Clinical impact of primary tumor sidedness and sex on unresectable post-recurrence survival in resected pathological stage II-III colorectal cancers: a nationwide multicenter retrospective study
Authors: Abe Shinya , Kawai Kazushige , Nozawa Hiroaki , Sasaki Kazuhito , Murono Koji , Emoto Shigenobu , Ozawa Tsuyoshi , Yokoyama Yuichiro , Nagai Yuzo , Anzai Hiroyuki , Sonoda Hirofumi , Yamauchi Shinichi , Sugihara Kenichi , Ishihara Soichiro 
Published: May 2022

Abstract
Background
Several studies have demonstrated that right-sided tumors have poorer prognosis than left-sided tumors in patients with unresectable colorectal cancer (CRC). The predictive ability of the tumor sidedness in CRC treated with chemotherapy in each sex is unclear.

Methods
Subjects were 964 unresectable recurrent patients treated with chemotherapy with stage II-III CRC after curative resection between 2004 and 2012. Post-recurrence cancer-specific survival (CSS) for each sex was examined.

Results
Patients were 603 males (222 right-side tumors (cecum to transverse colon) and 381 left-sided tumors (descending colon to rectum)), and 361 females (167 right-side tumors and 194 left-sided tumors). Right-sided tumors developed peritoneal recurrences in males and females. Left-sided tumors were associated with locoregional recurrences in males and with lung recurrences in females. Right-sided tumors were associated with shorter post-recurrence CSS in both sexes. In males, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.53, P < 0.0001) together with the presence of regional lymph node metastasis histopathological type of other than differentiated adenocarcinoma, the recurrence of liver only, the recurrence of peritoneal dissemination only, and relapse-free interval less than one-year. In females, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.50, P = 0.0019) together with advanced depth of invasion, the presence of regional lymph node metastasis, and recurrence of liver only.

Conclusions
Primary tumor sidedness in both sexes in unresectable recurrent CRC patients treated with chemotherapy may have prognostic implications for post-recurrence CSS.
A rare case of congenital pupillary abnormality: a case report
Authors: Hao Lancao , Ma Zicheng , Song Chenjie , Zhu Siquan 
Published: May 2022

Abstract
Background
Congenital anomalies of the pupil are quite varied, including abnormal size, shape, color, response to stimulus, and function. We are here reporting an unusual case presented with the absence of pupillary opening with folds of iris tissue at the center. Only an extremely small pupil (diameter < 0.5 mm) could be observed during the operation.

Case presentation
A 15-year-old male patient visited our outpatient clinic due to vision difficulty in his right eye for more than ten years. The best-corrected visual acuity was 2.0 logMAR and 0 logMAR for the right and left eye, respectively. There were amblyopia, astigmatism and constant exotropia in his right eye. Ophthalmic examination of the right eye showed flat iris root, minimal iris pigmentation, and the pupil area was entirely covered by iris tissue. Lens status and fundus evaluation could not be commented. The left eye was found to be within normal limit. Based on ophthalmic examination, the admission diagnosis was given as acorea. Pupilloplasty was performed on the right eye due to the situation that the iris tissue blocked the visual axis, which led to visual impairment and stimulus deprivation amblyopia. However, an extremely small pupil at the center of his pupillary area was observed during the operation. The postoperative course was favorable, and a normal pupil was secured. Hospital discharge diagnosis was given as microcoria, and amblyopia treatment was followed.

Conclusions
We report a rare case of congenital pupillary abnormality. The further diagnosis was given as microcoria, which should be differentiated from acorea. For this kind of pupil disorder which blocks the visual axis, early diagnosis and treatment can help prevent the development of stimulus deprivation amblyopia.
Association between dietary fat quality indices with anthropometric measurements in children and adolescents
Authors: Mozafarinia Maedeh , Heidari-Beni Motahar , Abbasi Behnood , Kelishadi Roya 
Published: May 2022

Abstract
Background
The association between anthropometric measures and dietary fat quality indices is unclear in pediatric age groups. The present study aimed to assess the association between dietary lipophilic index (LI) and thrombogenic index (TI) as dietary fat quality indices with anthropometric measurements in children and adolescents.

Method
This nationwide cross-sectional study was conducted on 4323 students aged 6-18 years that were selected by multistage cluster sampling from 31 provinces of Iran. Dietary intake was collected using a validated food frequency questionnaire and dietary LI and TI were calculated by formula. Data on anthropometric measures were collected by standard protocols.

Results
The multivariate regression analysis revealed that TI and LI had inverse association with neck circumference Z-score (β = 0.11, p = 0.013 and β = 0.12 p = 0.006, respectively). There was a positive correlation between LI with height Z-score (β = 0.12, 95% CI: 0.01, p = 0.009). However, there was no significant association between LI and TI with other anthropometric indices (P > 0.05).

Conclusion
The quality of dietary fats was associated with some anthropometric indices. Further large-scale studies are required to highlight the importance of dietary fat quality indices in relation to cardio-metabolic risk factors in pediatric age groups. Reducing intake of saturated fatty acids, increasing consumption of monounsaturated fatty acids and a balanced intake of omega-3 and omega-6 to reduce the risk of cardiovascular diseases risk factors are recommended.
Smartphone addiction and its associated factors among freshmen medical students in China: a cross-sectional study
Authors: Liu Huan , Zhou Zhiqing , Zhu Ergang , Huang Long , Zhang Ming 
Published: May 2022

Abstract
Background
With smartphone use widespread worldwide, smartphone addiction is an emerging epidemic. This study aims to investigate the prevalence of smartphone addiction among freshmen medical students and to explore its association with personal factors, mental health, and professional identity.

Methods
This cross-sectional study was conducted from October 10th to November 10th, 2020 and included 2,182 first-year college students at Wannan Medical College, China. The smartphone addiction test, professional identity, and a 12-item general health questionnaire were used for this cross-sectional survey. Pearson’s correlation coefficient (r) was employed to examine the correlations between smartphone addiction and mental health and professional identity. Binary logistic regression analysis was carried out to assess the factors influencing smartphone addiction. Of the 2,182 students, 866 (39.7%) were identified as having smartphone addiction. The logistic regression analysis shows that four factors (professional identity scale, poor mental health, smartphone use before sleep, and perceived study pressure) were significantly associated with smartphone addiction.

Conclusions
This cross-sectional study suggests that smartphone addiction is common among Chinese freshmen medical students. Smartphone addiction was common among the freshmen medical students surveyed. The findings imply that promotional programs, aimed at enhancing mental health and professional identity among freshmen medical students, help to reduce smartphone addiction in this population.
Community and individual level determinants and spatial distribution of deworming among preschool age children in Ethiopia: spatial and multi-level analysis
Authors: Belay Daniel Gashaneh , Asratie Melaku Hunie , Gashaw Moges , Tsega Nuhamin Tesfa , Endalew Mastewal , Aragaw Fantu Mamo 
Published: May 2022

AbstractBackgroundSoil-transmitted helminths caused millions of morbidity of preschool age children in sub-Saharan Africa with low socio-economic status and lack of clean water and sanitation. In Ethiopia, nearly half of children are affected by intestinal parasites. Despite this prevalence, deworming medication utilization among preschool age children is low. Hence, this study aimed to assess the community and individual level determinants and spatial distributions of deworming among preschool age children in Ethiopia.MethodsCrossectional collected 2016 Ethiopian Demographic and Health Survey datasets with a total weighted 8146 children 12–59 months old were used for this study. The data were cleaned, extracted, and analyzed using STAT Version 16 software and exported to MS excel for spatial analysis. In addition, ArcGIS and SaTScan software were used to detect the geographic distribution of deworming utilization among preschool age children.ResultsThe magnitude of deworming among preschool age children in Ethiopia was 13.32% (95% CI: 12.60, 14.08) and ranges from the lowest 3.34% (95% CI: 1.01, 10.45) Afar region to the highest 28.66% (95% CI:24.95, 32.69) Tigray region. In multilevel multivariable logistics regression analysis; variables such as secondary and above women education [AOR = 1.89; 95%CI; 1.32, 2.73], women who have occupation [AOR = 1.47; 95%CI; 1.23, 1.76], child with 12–23 months old [AOR = 2.00; 95%CI; 1.62, 2.46], having ANC visit [AOR = 1.68; 95%CI; 1.35, 2.08], households that have media exposure [AOR = 1.50; 95%CI; 1.22, 1.85] were significantly associated with deworming among preschool age children. Afar, Eastern Amhara, Dire Dewa, Harari, Somalia, and Eastern SNNPE regions were cold spot regions with Global Moran’s I value 0.268 (p < 0.0001) for deworming of preschool age children.ConclusionsThe prevalence of deworming among preschool age children in Ethiopia is relatively low. Individual-level factors such as; maternal education and occupation, having ANC visit, child age, household media exposure, and community-level variables such as; community media usage had a significant association with deworming among preschool age children in Ethiopia. These findings highlight that, the Ministry of Health (MOH) Ethiopia should prepare a regular campaign for deworming programs for preschool age children. Mass media promotion of deworming should be strengthened. The Ministry of Education should work to strengthen women’s education, household and community media exposure. Prior attention should be given to low deworming regions such as Afar, Somalia, Diredewa, and Harari regions.