bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of renin–angiotensin–aldosterone-system inhibitor drugs on mortality in patients with atrial fibrillation and hypertension
Authors: Xu Wei , Yang Yan-min , Zhu Jun , Wu Shuang , Wang Juan , Zhang Han , Shao Xing-hui 
Published: April 2022

Abstract
Background
Renin–angiotensin–aldosterone-system inhibitors markedly play an active role in the primary prevention of atrial fibrillation (AF), but the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the mortality of patients with AF remains unclear. This study aimed to examine the relationship between treatment with ACEIs or ARBs and mortality in emergency department (ED) patients with AF and hypertension.

Methods
This multicenter study enrolled 2016 ED patients from September 2008 to April 2011; 1110 patients with AF and hypertension were analyzed. Patients were grouped according to whether they were treated with ACEI/ARB or not and completed a 1-year follow-up to evaluate outcomes including all-cause death, cardiovascular death, stroke, and major adverse events (MAEs).

Results
Among the 1110 patients with AF and hypertension, 574 (51.7%) received ACEI/ARB treatment. During the 1-year follow-up, 169 all-cause deaths (15.2%) and 100 cardiovascular deaths (9.0%) occurred, while 98 strokes (8.8%) and 255 MAEs (23.0%) occurred. According to the multivariate Cox regression analysis, ACEI/ARB therapy was significantly associated with a reduced risk of all-cause death (HR, 0.605; 95% CI 0.431–0.849; P = 0.004). Moreover, ACEI/ARB therapy was independently associated with a reduced risk of cardiovascular death (HR 0.585; 95% CI 0.372–0.921; P = 0.020) and MAEs (HR 0.651, 95% CI 0.496–0.855, P = 0.002) after adjusting for other risk factors.

Conclusions
Our results revealed that ACEI/ARB therapy was independently associated with a reduced risk of all-cause death, cardiovascular death, and MAEs in ED patients with AF and hypertension. These results provide evidence for a tertiary preventive treatment for patients with AF and hypertension.
Skin cancers and their risk factors in older persons: a population-based study
Authors: Sinikumpu Suvi-Päivikki , Jokelainen Jari , Keinänen-Kiukaanniemi Sirkka , Huilaja Laura 
Published: April 2022

Abstract
Background
The number of skin cancer is increasing rapidly. However, little is known about the risk factors of skin cancer in older persons. Our objectives were to determine the risk factors for skin cancer or its precursors in an older population. More specifically, to study the association of new skin cancers with previous skin cancer, sex, age, Fitzpatrick’s skin type, history of outdoor work and socioeconomic status (SES).

Methods
In this retrospective cross-sectional study of a large, well documented historical cohort data set a total body skin examination (TBSE) was performed for 552 participants aged between 70 and 93 years by dermatologists. The information gathered was augmented with health register data and self-reported data. The associations between skin cancer and its risk factors were studied by using the logistic regression analyses.

Results
According to the TBSE skin cancer/precursor was present in 25.5% of participants and was more common in males than in females (34.5% vs 20.2%, p < 0.001). Previous skin cancer increased the risk of subsequent skin cancer 2.6-fold (OR 2.56, 95% CI 1.43-4.55) and male sex nearly 2-fold (1.97, 95% CI 1.26-3.08). Specific risk factors for the first occurrence of skin cancer were male sex and outdoor work. There was also association between skin cancer and age and socioeconomic status.

Conclusions
TBSE is recommend for physicians treating older persons to allow early recognition of skin cancers or their precursors. Older males need particularly close attention.
Diagnostic performance of GeneXpert MTB/RIF in detecting MTB in smear-negative presumptive TB patients
Authors: Rimal Raksha , Shrestha Dhiraj , Pyakurel Susil , Poudel Rashmi , Shrestha Prasha , Rai Kul Raj , Ghimire Gokarna Raj , Rai Ganesh , Rai Shiba Kumar 
Published: April 2022

Abstract
Background
Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Control of TB is lingering by the lack of diagnostic tests that are simple, rapid, yet accurate. Thus, smear-negative pulmonary TB often misses the diagnosis. The study evaluated the performance of GeneXpert MTB/RIF assay for the detection of Mycobacterium tuberculosis (MTB).

Methods
The study was carried out from June to December 2016 in Nepal Tuberculosis Center, Bhaktapur, Nepal. A total of 173 sputum samples were collected and processed by microscopy [Auramine-O staining and Ziehl–Neelsen (ZN) staining], followed by GeneXpert MTB/RIF assay and culture in Lowenstein-Jensen (LJ) medium.

Results
Of 173 sputum samples, 162 (93.6%) were smear-negative. Of 162 smear-negative sputum samples, 35 (21.6%) were confirmed to have MTB by culture, and 31 (19.1%) by GeneXpert MTB/RIF assay. Of 31 GeneXpert-positive samples, 25 (80.6%) were susceptible, 4 (12.9%) were resistant, and 2 (6.45%) were intermediate to rifampicin. The sensitivity, specificity, positive predictive value, and negative predictive value of GeneXpert MTB/RIF assay for smear-negative sputum samples were 74.3%, 96.6%, 86.7%, and 92%, respectively. The GeneXpert MTB/RIF has a substantial diagnostic agreement of 90.91% with culture (Cohen’s Kappa coefficient = 0.73).

Conclusion
The diagnostic performance of GeneXpert MTB/RIF assay was almost on par with culture, and thus can be relied upon for MTB detection in smear-negative sputum samples.
Rickettsia conorii subsp. israelensis infection: a case report from southeast Iran
Authors: Latifian Mina , Khalili Mohammad , Farrokhnia Mehrdad , Mostafavi Ehsan , Esmaeili Saber 
Published: April 2022

Abstract
Background
Mediterranean spotted fever (MSF) is a zoonotic and vector-borne disease caused by Rickettsia conorii. We report a case (36 year-old-woman) of MSF caused by Rickettsia conorii from Iran.

Case presentation
In September 2019, the patient was admitted to the hospital in Kerman province with flu-like symptoms and maculopapular lesions. According to the laboratory results, thrombocytopenia, elevated liver enzymes, and cardiac enzymes were observed. Skin biopsy was examined for Crimean-Congo Hemorrhagic Fever (CCHF) and MSF using the Real-Time-PCR and ELISA method. Finally, the sample was positive for Rickettsia conorii subsp. israelensis and treated with doxycycline and completely recovered.

Conclusions
This study showed that MSF could be present in Iran. Therefore, identifying endemic areas in Iran for this disease should be on the agenda.
Information seeking about COVID-19 and associated factors among chronic patients in Bahir Dar city public hospitals, Northwest Ethiopia: a cross-sectional study
Authors: Kassie Sisay Yitayih , Melese Tesfahun , Handebo Simegnew , Sebastian Yakub , Ngusie Habtamu Setegn 
Published: April 2022

Abstract
Background
The health impacts of COVID-19 are not evenly distributed in societies. Chronic patients are highly affected and develop dangerous symptoms of COVID-19. Understanding their information seeking about COVID-19 may help to improve the effectiveness of public health strategies in the future, the adoption of safety measures, and minimize the spread of the pandemic. However, there is little evidence on information seeking specifically on COVID-19 in this study setting. Therefore, this study aimed to assess information seeking about COVID-19 and associated factors among chronic patients.

Method
An institutional-based cross-sectional study supplemented with qualitative data was conducted at Bahir Dar city public hospitals in Northwest Ethiopia from April 8 to June 15, 2021. A total of 423 chronic patients were selected using systematic random sampling techniques with an interval of 5. Bi-variable and multivariable logistic regression analysis was fitted to identify factors associated with information seeking about COVID-19. A p-value < 0.05 was used to declare statistical significance. Qualitative data were analyzed using a thematic approach. Finally, it was triangulated with quantitative findings.

Result
The proportion of information seeking about COVID-19 among chronic patients was 44.0% (95% CI = 39.0, 49.0). Being living in urban [AOR = 4.4, 95% CI (2.01, 9.58)], having high perceived susceptibility to COVID-19 [AOR = 3.4, 95%CI (1.98, 5.70)], having high perceived severity to COVID-19 [AOR = 1.7, 95%CI (1.04, 2.91)], having high self-efficacy to COVID-19 [AOR = 4.3, 95%CI (2.52, 7.34)], and having adequate health literacy [AOR = 1.8, 95%CI (1.10, 3.03)] were significant factors associated with information-seeking about COVID-19.

Conclusion
The overall proportion of information seeking about COVID-19 among chronic patients was low. Thus, health promotion programs should emphasize the chronic patients living in a rural area; enhance perceived risk and severity of COVID-19, enhancing self-efficacy and health literacy interventions to improve information seeking.
Socio-economic determinants of maternal health care utilization in Kailahun District, Sierra Leone, 2020
Authors: Kangbai Desmond Maada , Bandoh Delia Akosua , Manu Alexander , Kangbai Joetrice Yewah , Kenu Ernest , Addo-Lartey Adolphina 
Published: April 2022

Abstract
Background
Ascertaining the key determinants of maternal healthcare service utilization and their relative importance is critical to priority setting in policy development. Sierra Leone has one of the world’s highest maternal death ratios in the context of a weak health system. The objectives of this study were to determine; the level of utilization of Antenatal Care (ANC), Skilled Delivery Attendants (SDA), Postnatal Care (PNC) services, and factors that influence the utilization of these services.

Methods
We conducted a community-based cross-sectional study involving 554 women of reproductive age (15–49 years) who had at least one delivery in the last 3 years and lived in the Kailahun District, Sierra Leone from November 2019 to October 2020. Data were analysed using analysed using bivariate, multivariate and multinomial logistic regression models.

Results
The median age of respondents was 25 years (Q1 = 17 years, Q3 = 30 years). Eighty-nine percent (89%) had 4 or more ANC visits. Only 35.9% of women were delivered by SDA. Women residing in urban areas had over six-fold increased odds of utilizing SDA as compared to women residing in rural areas (AOR = 6.20, 95% CI = 3.61–10.63). Women whose husbands had a primary level of education had 2.38 times increased odds of utilizing SDA than women whose husbands had no education (AOR = 2.38, 95% CI = 1.30–4.35). Women that walked longer distances (30–60 min) to seek healthcare had 2.98 times increased odds of utilizing SBA than those that walked shorter distances (< 30 min) (AOR = 2.98, 95% CI = 1.67–5.33). Women who had a secondary/vocational level of education had 2.35 times increased odds of utilizing the standard PNC category as compared to those with no education (OR = 2.35, 95% CI = 1.19–4.63).

Conclusion
The majority of women had 4 or more ANC visits yet the use of skilled birth attendants was low. Urban residence and education were significantly associated with the use of the standard PNC category. To improve the utilization of maternal health care services, national healthcare policies should target the advancement of education, train skilled Maternal Healthcare (MHC) attendants, rural infrastructure, and the empowerment of women.
Clinicopathological features of HER2 positive metastatic colorectal cancer and survival analysis of anti-HER2 treatment
Authors: Yang Liu , Li Wenfei , Lu Zhihao , Lu Ming , Zhou Jun , Peng Zhi , Zhang Xiaotian , Wang Xicheng , Shen Lin , Li Jian 
Published: April 2022

Abstract
Background
We aimed to investigate response and prognostic factors in patients with human epidermal growth factor receptor 2 (HER2) positive metastatic colorectal cancer (mCRC) and compare the curative effect on patients who received different therapy regimens (including chemotherapy and chemotherapy combined with targeted drugs).

Methods
We retrospectively analyzed all HER2 positive mCRC patients treated at Peking University Cancer Hospital between September 2011 and February 2021. We divided 63 HER2 positive mCRC into group A and group B according to the use of trastuzumab or not. Besides, we assigned four subgroups according to the first-line therapies of KRAS/NRAS/BRAF WT patients. The Kaplan–Meier estimator was used to calculate PFS and OS. Univariable analysis and Cox proportional hazards models were used to analyze the association between clinicopathological features and survival outcomes.

Results
Among 63 patients, 54 (85.7%) were KRAS/NRAS/BRAF wild-type (WT). Univariate analysis showed that the male sex, primary lesions in the right colon, simultaneous metastasis, and unresectable primary lesions were significant risk factors for poor survival of HER2 positive mCRC (P < 0.05). Using Cox proportional hazards models, we found that the two factors of gender and resection of primary lesions were independent prognostic factors (P < 0.05). The median PFS and median OS of HER2-positive patients with mCRC who received first-line treatment were 8.4 months [95% confidence interval (CI): 5.0–11.7] and 48.2 months (95% CI: 23.5–72.8), respectively. The log-rank test revealed a significant difference in median OS survival between group A and group B (χ2 = 5.852, P = 0.016), and the two groups were divided according to the use or absence of trastuzumab treatment. In KRAS/NRAS/BRAF WT patients, there was a significant difference in median PFS and median OS between the fourth group patients (chemotherapy plus trastuzumab) and each of the other three groups (P < 0.05).

Conclusions
The two factors of gender and resection for primary lesion may be independent prognostic factors of advanced HER2 positive colorectal cancer patients. For patients with HER2-positive mCRC, patients in the chemotherapy combined with trastuzumab group have better efficacy than those without trastuzumab.
Thickness measurements taken with the spectralis OCT increase with decreasing signal strength
Authors: Gershoni Assaf , Barayev Edward , Vainer Igor , Allon Raviv , Yavnieli Roy , Shapira Yinon , Mimouni Michael , Geffen Noa , Nemet Arie Yehuda , Segal Ori 
Published: April 2022

Abstract
Background
Optical coherence tomography (OCT) is used worldwide by clinicians to evaluate macular and retinal nerve fiber layer (RNFL) characteristics. It is frequently utilized to assess disease severity, progression and efficacy of treatment, and therefore must be reliable and reproducible.

Objective
To examine the influence of signal strength on macular thickness parameters, macular volume measurement and RNFL thickness measured by spectral-domain optical coherence tomography (SD-OCT).

Methods
Macular thickness parameters, macular volume measurement and RNFL thickness were measured by the Spectralis® OCT (Heidelberg Engineering, Heidelberg, Germany). In each eye, the focusing knob was adjusted to obtain 4 images with different signal strengths – Low (below 15), Moderate (15-20), Good (20-25) and Excellent (above 25). The relationship between signal strength and measured data was assessed using the mixed model procedure.

Results
A total of 71 eyes of 41 healthy subjects were included. Central macular thickness, macular volume and mean RNFL thickness increased with decreasing signal strength. Specifically, eyes with excellent signal strength showed significantly thinner central macular thickness (p = 0.023), macular volume (p = 0.047), and mean RNFL thickness (p = 0.0139).

Conclusions
Higher signal strength is associated with lower macular thickness, macular volume and RNFL thickness measurements. The mean differences between excellent and low-quality measurements were small implicating that SD-OCT is a reliable imaging tool even at low quality scans. It is imperative that the physician compares the signal strength of all scans, as minute differences may alter results.
Outcomes of combined endoscopic vitrectomy and posteriorly placed glaucoma drainage devices in pediatric patients
Authors: Jacobson A , Besirli CG , Bohnsack BL 
Published: April 2022

Abstract
Background
This study aims to describe outcomes of posteriorly-placed glaucoma drainage devices (GDD) with concurrent endoscopic vitrectomy in pediatric patients with glaucoma and corneal opacification.

Methods
This retrospective case series identified patients under 18 years of age who underwent posteriorly-placed GDD implantation with concurrent endoscopic vitrectomy between 2012 and 2021. Data collected included ocular diagnoses, prior intraocular surgeries, type and position of GDD, surgical complications, and additional surgeries. Preoperative and final visual acuity, intraocular pressure (IOP), number of glaucoma medications, and exam findings were also recorded. Surgical data included type and position of GDD, Success was defined as IOP between 5-21 mmHg without visually devastating complication or need for additional glaucoma surgery.

Results
Ten patients (14 eyes) with sclerocornea (6), Peters Anomaly (4), corneal decompensation from increased IOP (3), and corneal scar (1) underwent combined endoscopic vitrectomy with posteriorly-placed GDD (Baerveldt (10 eyes), Ahmed (4 eyes)) at 4.6 ± 5.8 years of age. Four eyes of 3 patients remained successful at final follow-up, while 10 eyes of 7 patients required 2.4 ± 1.3 additional surgeries for glaucoma (7) or hypotony (3). Kaplan Meier analysis demonstrated 1- and 2-year survival rates of 36% and 18%, respectively. At final follow-up (3.7 ± 2.4 years), after an average of 4.4 ± 2.4 glaucoma surgeries, 13 of 14 eyes had obtained IOP control on significantly fewer (p<0.0001) IOP-lowering medications. Additional complications included retinal detachment (2), chronic corneal graft failure (2), phthisis (1) and band keratopathy (1).

Conclusions
Management of glaucoma in pediatric eyes with corneal opacification is challenging and often requires multiple surgeries. A combined endoscopic vitrectomy and posteriorly placed GDD is a viable technique to establish aqueous humor outflow. Although the success rate is low, this surgical approach may be useful in ultimately obtaining IOP control and preserving vision in these complex eyes.
Parent perceived barriers and facilitators of children’s adventurous play in Britain: a framework analysis
Authors: Oliver Brooke E. , Nesbit Rachel J. , McCloy Rachel , Harvey Kate , Dodd Helen F. 
Published: April 2022

AbstractBackgroundFrom a public health perspective there is growing interest in children’s play, including play involving risk and adventure, in relation to children’s physical and mental health. Regarding mental health, it is theorised that adventurous play, where children experience thrilling, exciting emotions, offers important learning opportunities that prepare children for dealing with uncertainty and help prevent anxiety. Despite these benefits, adventurous play has decreased substantially within a generation. Parents have a key role in facilitating or limiting children’s opportunities for adventurous play, but research identifying the barriers and facilitators parents perceive in relation to adventurous play is scarce. The present study therefore examined the barriers to and facilitators of adventurous play as perceived by parents of school-aged children in Britain.MethodsThis study analysed data from a subsample of parents in Britain (n = 377) who participated in the nationally representative British Children’s Play Survey. Parents responded to two open-ended questions pertaining to the barriers to and facilitators of children’s adventurous play. Responses were analysed using a qualitative Framework Analysis, an approach suitable for managing large datasets with specific research questions.ResultsFour framework categories were identified: Social Environment; Physical Environment; Risk of Injury; Child Factors. Social Environment included barriers and facilitators related to parents, family and peers, as well as community and society. Dominant themes within the Social Environment related to perceptions about the certainty of child safety, such as supervision and the safety of society. Beliefs about the benefits of adventurous play for development and well-being were also important in the Social Environment. Physical Environment factors focused on safety and practical issues. Risk of Injury captured concerns about children being injured during play. Child Factors included child attributes, such as play preference, developmental ability and trait-like characteristics.ConclusionsImproved understanding of what influences parent perceptions of adventurous play can inform public health interventions designed to improve children’s opportunities for and engagement in adventurous play, with a view to promote children’s physical and mental health.
Smoking cessation aids and strategies: a population-based survey of former and current smokers in Norway
Authors: Lund Marianne , Lund Ingeborg 
Published: April 2022

Abstract
Background
In Norway, tobacco consumption is equally divided between combustible (cigarettes) and non-combustible (snus) tobacco. In the process of quitting, people who smoke can choose between several smoking cessation aids and strategies based on what is available on the market or what are recommended as cessation aids. A quit attempt may be planned or unplanned and consist of a gradual decline in consumption or an abrupt quitting. This study explores smoking cessation aids and strategies used at the latest quit attempt among people who have ever smoked. How prevalent is the use of various cessation aids and strategies, and do they correlate with each other? Are there any differences in successful quits depending on the use of a specific cessation aid or strategy?

Method
We used repeated cross-sectional representative surveys in Norway for 2017, 2018, 2019 and 2020. The analytic sample consists of people aged 20 years or older who have ever smoked daily, more precisely current daily smokers with at least one quit attempt (n = 476), and former daily smokers who quit in 2012 or later (n = 397). Participants answered questions on cessation aids and strategies used at their last quit attempt. Logistic regression analysis was used to estimate the associations between cessation aids and strategies and sociodemographic and smoking-related variables and successful quit attempts.

Results
Fifty-six percent of people who ever smoked daily reported any use of cessation aids, and nicotine replacement therapy (NRT), snus and e-cigarettes were the most commonly used cessation aids. Snus and web/mobile use was associated with successful quits, while NRT was associated with unsuccessful quit attempts. When exclusive use was separated from the combined use of several aids, only snus was associated with successful quits.

Conclusion
Snus use was found to be a “stand-alone” cessation aid, and only weakly associated with the use of other cessation aids. Further investigation of cessation aid preferences is needed, especially among smokers with little or no contact with health services and/or for whom traditional cessation aids have no appeal.