bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017–18
Authors: Karan Anup , Farooqui Habib Hasan , Hussain Suhaib , Hussain Mohammad Akhtar , Selvaraj Sakthivel , Mathur Manu Raj 
Published: September 2022

Abstract
Background
The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure.

Methods
We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017–2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households.

Results
Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674—46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359–63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest.

Conclusions
Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
Gaps in expectations and current practices of pharmacy services among doctors and patients – an exploratory study in a Sri Lankan tertiary care hospital providing free healthcare
Authors: Anjalee J. A. L. , Rutter V. , Samaranayake N. R. 
Published: September 2022

AbstractThe pharmacist is an important link between doctor and patient. To optimise patient care, it is essential that expectations of doctors and patients regarding pharmacy services are met. Hence the objective of this study was to assess the satisfaction levels of doctors and patients on pharmacy services currently provided, and their expectations from pharmacy services. This cross sectional study was conducted in selected clinics of a university based teaching hospital. Questionnaires developed in-house by referring previously published resources, content validated by a group of experts, and face validated through a pilot study were used. Doctors and patients of chronic disease clinics were selected for the study. All doctors involved in prescribing for more than six months, and patients or their regular care givers attending clinics for more than one year were included. Mentally incapacitated patients were excluded. An interviewee administered questionnaire was distributed to doctors and an interviewer administered questionnaire was used for patients. Exploratory factor analysis (EFA) (principal component analysis with Varimax rotation) was conducted to divide variables of the questionnaires into reliable components. Response rate of doctors was 82.3%. Among them 59.6% (50/84) doctors said that they have a good relationship with pharmacists, and 89.3% (75/84) expected communication with pharmacists more often. EFA for doctors’ perceptions resulted in four components. A statistically significant difference was observed between doctors’ expectation (95.9% - 81/84) and current practice (22.6% - 19/84) on communicating medication issues (p<0.001). A total of 380 patients participated. EFA for patients’ perceptions resulted in ten components. The majority considered pharmacists as an integral part of the healthcare system (98.7% - 375/380) and experts in medication (84.7% - 322/380). They further perceived that dispensed medications are safe (82.9% - 315/380) and of good quality (76.3% - 290/380). Further 95.5% (363/380) were satisfied with dispensing label information. A statistically significant difference was found between the expectations (93% - 353/380) and satisfaction levels (86.5% - 329/380) of patients on pharmacy services (p=0.003). According to findings, both doctors and patients held a positive perception on pharmacy services and pharmacists, but the statistically significant gap reported between expectations and current level of pharmacy service, highlighting both the potential and scope for service improvement.
Characteristics of different asthma phenotypes associated with cough: a prospective, multicenter survey in China
Authors: Zhou Jianmeng , Yi Fang , Wu Feng , Xu Pusheng , Chen Meihua , Shen Huahao , Lin Lin , Zhang Yunhui , Li Suyun , Wu Changgui , Yuan Yadong , Wang Gang , Ye Xianwei , Zhang Ping , Tang Huaping , Ma Qianli , Huang Lanqing , Qiu Zhongmin , Deng Haiyan , Qiu Chen , Shi Guochao , Pan Jiayu , Luo Wei , Chung Kian Fan , Zhong Nanshan , Lai Kefang ,   the CPA Cohort Study Group, Chen Ruchong , Guan Weijie , Xie Yanqing , Jiang Mei , Gao Jie , Hua Wen , Cai Guangyun , Chen Cuiyi , Zhou Mingjuan , Xu Yanyan , Wang Minghang , Guo Yimin , Li Xue , Liu Lei , Yao Hongmei , Wen Hong , Chen Jianyou , Zhang Xuemei , Zhang Zhiping , Yu Li , Chen Dandan , Du Wei , Chen Qiaoli , Li Hu , Peng Wen , Zhang Liting , Tang Jiaman , Liu Baojuan , Zhan Chen , Huang Lianrong , Chen Xiaomei 
Published: September 2022

Abstract
Background
Asthma is a heterogeneous disease with variable symptoms, which presents with cough either as the sole or predominant symptom with or without wheezing. We compared the clinical and pathophysiological characteristics of cough predominant asthma (CPA), cough variant asthma (CVA) and classic asthma (CA) in order to determine any differential phenotypic traits.

Methods
In 20 clinics across China, a total of 2088 patients were finally recruited, including 327 CVA, 1041 CPA and 720 CA patients. We recorded cough and wheezing visual analogue scale, Leicester cough questionnaire (LCQ) and asthma control test scores. Fractional exhaled nitric oxide (FeNO), induced sputum cell counts, and capsaicin cough challenge were also measured and compared.

Results
CPA patients more frequently presented with cough as the initial symptom, and laryngeal symptoms (p < 0.001), had less symptoms related with rhinitis/sinusitis and gastroesophageal reflux (p < 0.05) than CA patients. Comorbidities including rhinitis and gastroesophageal reflux were similar, while the proportion of COPD and bronchiectasis was higher in CA patients. There were no differences in FeNO levels, sputum eosinophil and neutrophil counts, FEV1 (%pred) decreased from CVA to CPA to CA patients (p < 0.001). Cough sensitivity was higher in CVA and CPA compared to CA (p < 0.001), and was positively correlated with LCQ scores.

Conclusions
CVA, CPA and CA can be distinguished by the presence of laryngeal symptoms, cough sensitivity and airflow obstruction. Asthma-associated chronic cough was not associated with airway inflammation or comorbidities in our cohort.
Trial registration The Chinese Clinical Trial Registration Center, ChiCTR-POC-17011646, 13 June 2017
Effect of age and sex on prescriptions for outpatients with bipolar disorder in the MUSUBI study: a cross‑sectional study
Authors: Kawamata Yasushi , Yasui-Furukori Norio , Adachi Naoto , Ueda Hitoshi , Hongo Seiji , Azekawa Takaharu , Kubota Yukihisa , Katsumoto Eiichi , Edagawa Koji , Goto Eiichiro , Miki Kazuhira , Kato Masaki , Nakagawa Atsuo , Kikuchi Toshiaki , Tsuboi Takashi , Yoshimura Reiji , Shimoda Kazutaka , Watanabe Koichiro 
Published: September 2022

Abstract
Background
Childbearing-aged female patients and elderly patients with bipolar disorder need special attention for pharmacological treatments, but current guidelines provide little information on their pharmacological treatment. In particular, the risk/benefit balance of pharmacological treatment for childbearing-aged females with bipolar disorder is a growing concern. Therefore, we aimed to address the effect of age and sex on psychotropic drug prescription for outpatients with bipolar disorder.

Methods
The MUlticenter treatment SUrvey for BIpolar disorder in Japanese psychiatric clinics (MUSUBI) study was conducted, and data on age, sex, and details of pharmacological treatment were collected.

Results
A total of 3106 outpatients were included in this study. Among young females (age  ≤ 39), 25% were prescribed valproate. There was no significant difference in the frequency and daily dose of valproate prescription for young females among all groups. Valproate prescriptions were significantly less frequent among young males and more frequent among middle-aged males. Lithium prescriptions were significantly less frequent among young females and more frequent among older males (age  ≥ 65) and older females. Lamotrigine prescriptions were significantly more frequent among young males and young females and less frequent among older males and older females. Carbamazepine prescriptions were significantly less frequent among young males and more frequent among older males.

Conclusions
Biased information about the risk and safety of valproate and lithium for young females was suggested, and further study to correct this bias is needed. Older patients were prescribed lithium more commonly than lamotrigine. Further studies are needed to determine the actual pharmacotherapy for elderly individuals.
Performance evaluation of combining ICESat-2 and GEDI laser altimetry missions for inland lake level retrievals
Authors: Zhang Zhijie , Chen Guodong , Bo Yanchen , Guo Xiaozu , Bao Jianteng 
Published: September 2022

AbstractMonitoring lake water levels is important to fully understand the characteristics and mechanism of lake dynamic change, the impact of climate change and human activities on lakes, etc. This paper first individually evaluated the performance of the newly released Global Ecosystem Dynamics Investigation (GEDI) and the successor of the Ice, Cloud, and Land Elevation Satellite mission (ICESat-2) for inland lake level retrieval over four typical lakes (Chaohu Lake, Hongze Lake, Gaoyou Lake and Taihu Lake) using in situ gauge data, then the lake levels of the two missions were combined to derive long time-series lake water levels. A comparison of the mission results with in situ water levels validated the accuracy of the ICESat-2 with R varying from 0.957 to 0.995, MAE 0.03 m-0.10 m and RMSE 0.04 m-0.13 m; however, larger bias occurred in GEDI results with R spanning from 0.560 to 0.952, MAE 0.31 m-0.38 m and RMSE 0.35 m-0.46 m. Before the lake levels were combined, GEDI bias correction was carried out. The correlation coefficients and annual change rate differences between the combined and the in situ data were 0.964 and 0.06 m/yr, 0.852 and 0.05 m/yr, 0.888 and 0.05 m/yr, and 0.899 and 0.02 m/yr for Lake Chaohu, Hongze, Gaoyou and Taihu, respectively. Except for individual months and seasonal differences caused by GEDI estimations, the general trend of monthly, seasonal, and annual dynamics of inland lake water levels captured by combined GEDI and ICESat-2 missions were consistent with measurements from hydrological stations. These encouraging results demonstrate that combining the two missions has great potential for frequent and accurate lake level monitoring and could be a valuable resource for the study of hydrological and climatic change.
The 100 most impactful articles on the rotator cuff: an altmetric analysis of online media
Authors: Haislup Brett D. , Rate William R. , Civilette Matthew D. , Cohen Andrew S. , Bodendorfer Blake M. , Gould Heath P. 
Published: September 2022

Abstract
Purpose
The purpose of our study was to use the Altmetric Attention Score (AAS) to evaluate the 100 most impactful articles in online media pertaining to the rotator cuff and compare their characteristics to the most-cited rotator cuff articles in the scientific literature.

Methods
We performed an article extraction using Altmetric Explorer to identify all published articles pertaining to the rotator cuff. The top 100 articles with the highest AAS were included for analysis. Several data elements were extracted for each included article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e. the number of times the article was mentioned in news, blog, Twitter, Facebook, and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or other.

Results
The 100 articles with the highest AAS were published between 2009 and 2020, with AAS ranging from 47 to 676 (median: 74.5, 25th percentile: 59.5, 75th percentile: 114.5). Of all online media sources, Twitter correlated most strongly with AAS (r = 0.9007, r2 = 0.8112). The selected articles were most frequently published in the American Journal of Sports Medicine (13), the Journal of Shoulder and Elbow Surgery (11), and the Journal of Bone and Joint Surgery (7). The most common article type was Systematic Review/Meta-Analysis (29%), followed by Randomized Controlled Trial (15%). The top 3 AAS articles were all published by authors based in Europe.

Conclusion
The most impactful rotator cuff articles in online media generated substantial online attention. These studies were often performed in Europe and tended to be high level of evidence, focusing on treatment of rotator cuff pathology. The rotator cuff articles that produced the most online attention differed from a previous report of the most-cited rotator cuff articles, suggesting that alternative metrics may be used in concert with conventional bibliometrics to obtain a more complete representation of scientific impact.
Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients
Authors: Zhang Yanli , Zhang Hanjing , Li Song , Li Yuetong , Hu Cunjie , Li Hongyu 
Published: September 2022

Abstract
Background
With the accelerated pace of people’s life and the changing dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today’s society. The speedily rising hypertensive patients have become one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. Currently, there is a lack of local assessment tools for low salt consumption in mainland China.

Objective
To develop a short-form version of the Chinese Health Literacy Scale For Low Salt Consumption instrument for use in mainland China.

Methods
A cross-sectional design was conducted on a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in the diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test-retest reliability.

Results
The CHLSalt-22 demonstrated adequate internal consistency, good test-retest reliability, satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS).

Conclusion
The results indicate that the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) version has good reliability and validity and can be considered a tool to assess health literacy related to salt consumption in health screenings.
Intermittent fasting during adjuvant chemotherapy may promote differential stress resistance in breast cancer patients
Authors: Omar Enas M. , Omran Gamal A. , Mustafa Mohamed F. , El-Khodary Noha M. 
Published: September 2022

Abstract
Background
Preclinical studies prove that short-term fasting secures healthy cells against chemotherapy side effects and makes malignant cells more vulnerable to them. This study aimed to examine the effects of intermittent fasting (IF) during adjuvant chemotherapy AC (doxorubicin, cyclophosphamide) protocol in breast cancer (BC) patients.

Methods
Forty-eight newly diagnosed human epidermal growth factor receptor 2-negative (HER2 negative) BC patients were divided equally into two groups (24 each). The first group was recruited to fast intermittently for three consecutive days around chemotherapy for 18 h a day from 12 am to 6 pm and eats through 6 h a day from 6 pm to 12 am with permission of drinking water during fasting hours (IF group). This IF was repeated every 3 weeks for four cycles. The second group is a non-fasting (NF) group that was allowed to eat regularly. Toxicity in the two groups was compared. Hematologic, metabolic, and inflammatory parameters were measured and compared.

Results
Toxicity related to the gastrointestinal tract (GIT) was reduced in the IF group. Hematologic parameters showed no significant variations between the two studied groups after cycle 4. There was a significant increase in median glucose and median insulin levels (P < 0.001 and P = 0.001, respectively) in the NF group between baseline and after cycle 4. In addition, there was a significant decrease in the median insulin level (P = 0.002) in the IF group between the two time points.

Conclusion
IF throughout chemotherapy was well tolerated and decreased the toxicity of chemotherapy. Additionally, IF-improved metabolic profiles of patients may have a positive impact on the clinical efficacy of chemotherapy.
The Utility of Monitoring Potassium in Transgender, Gender Diverse, and Nonbinary Individuals on Spironolactone
Authors: Hayes Hailey , Russell Rachel , Haugen Amber , Nagavally Sneha , Sarvaideo Jenna 
Published: September 2022

Abstract

Context
Current Endocrine Society guidelines recommend that transgender women taking spironolactone have their potassium levels checked every 3 months for the first year after initiating therapy and annually thereafter to monitor for hyperkalemia.

Objective
The goal of this study was to assess the need for such frequent potassium monitoring and to investigate whether age plays a role in potassium abnormalities in transgender, gender diverse, and nonbinary (TGDNB) individuals taking spironolactone.

Methods
Using EPIC-Clarity, a retrospective study of healthy, adult individuals with gender-identity disorder listed in their problem list and taking spironolactone was performed. We analyzed the incidence of hyperkalemia in this population. Data from June 2006 through November 2021 were obtained. Exclusion criteria included hypertension, renal failure, diabetes mellitus, heart failure, and medications that affect the renin–angiotensin–aldosterone system.

Results
318 healthy TGDNB individuals met our inclusion criteria. We identified 8/318 (2.5%) individuals with hyperkalemia on spironolactone. There was a significant difference in incidence of hyperkalemia events in those &gt;45 years old and those ≤45 years old (8.9% vs 1.5%, P = .016).

Conclusion
Our data suggest the incidence of hyperkalemia in our TGDNB population is low, particularly in those ≤45 years old; however, this risk increases with age. These findings suggest practice guidelines may need to be adjusted to minimize unnecessary testing in the population ≤45 years old who are not plagued by comorbidities that affect potassium handling.
Case series of perianal and pelvic MRI imaging findings in monkeypox
Authors: Gan Jason , Patel Janki , Ainsworth Eleanor , Patel Aatish , O'Hara Geraldine , Elowaidy Ahmed 
Published: September 2022

Abstract
Monkeypox is a viral infection historically rarely seen in humans, but currently the focus of international attention due to a multi-country outbreak outside endemic countries of Central and West Africa, where cases are typically confined. Perianal pain and lesions have recently been recognised as a feature of monkeypox. We present a case series of the imaging findings of patients with monkeypox, including active proctitis, anal canal inflammation, and perianal inflammation. The aim is to increase awareness of perianal and rectal monkeypox MRI imaging features during this current outbreak.
Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study
Authors: Jha Kanistika , Adhikari Manoj 
Published: September 2022

Background: Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods: A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results: Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 1.54in mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.73 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 5.60±1.24 to 4.20±0.86 degrees, (P=0.31) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions: Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.