bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Arabic version of the cyberchondria severity scale 12 items (CSS-12-Ar) among a sample of Lebanese adults
Authors: Hallit Souheil , Rogoza Radosław , Abi Semaan Carl , Azzi Vanessa , Sawma Toni , Obeid Sahar
Published: August 2023

Background

To the best of our knowledge, the Cyberchondria Severity Scale-12 (CSS-12) has not been translated into Arabic; therefore, our objective was to assess the psychometric properties of the Arabic version of the CSS (CSS-12-Ar) among a sample of Lebanese adults.

Methods

Participants were enrolled in January 2021. A confirmatory factor analysis (CFA) was carried out using the MPlus software v.7.2, reporting several goodness-of-fit indicators: Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). To evaluate measurement invariance across gender, we conducted higher-order multiple group confirmatory analysis using lavaan software.

Results

449 participants enrolled in this study (mean age: 24.34 ± 8.22 years, 70.6% females). Since the correlations between the four-factor model were very high (r > 0.8), we ran the higher-order CFA in which all first-order latent variables were loading a general factor. The analyzed model was well-fitted to the data χ2(50) = 173.34; p < 0.001; CFI = 0.926; RMSEA = 0.074 [0.062, 0.086]. The Cronbach’s alpha values were good for the total score (0.92), as well as for excessiveness (0.80), distress (0.77), reassurance (0.81) and compulsion (0.76). The results provided evidence of full scalar invariance across gender. The comparison of latent mean scores revealed no significant differences across gender, in either the cyberchondria total score or its facets. The CSS-12 score was positively associated with anxiety (r = 0.10; p = 0.003) (convergent validity), OCD (r = 0.11; p = 0.016) and stress (r = 0.35; p < 0.001) (concurrent validity).

Conclusion

The CSS-12-Ar was deemed a suitable scale to measure the severity of cyberchondria among Lebanese university students. We hope that researchers and clinicians can benefit now from this scale.
Oral-health-related quality of life in adolescents: umbrella review
Authors: Chimbinha Ítalo Gustavo Martins , Ferreira Brenda Nayara Carlos , Miranda Giovana Pessoa , Guedes Renata Saraiva
Published: August 2023

Background

To evaluate oral conditions, demographic and socioeconomic characteristics of oral health-related quality of life (OHRQoL) in adolescents.

Methods

Umbrella review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes (PRISMA) checklist. The search strategy used a combination of words, applied in the electronic databases PubMed, WebScience, Embase, Lilacs, Scopus and Cochrane. Included publications until January 2022, without restrictions. Data collection took place with systematized practices and the eligibility criteria were studies focusing on OHRQoL; teenagers; adolescentes; present the term “systematic review” and/or “meta-analysis” in the title or abstract. The quality assessment followed the Assessment of Multiple Systematic Reviews (AMSTAR 2) and the adherence of the article to the PRISMA was verified.

Results

Three hundred sixty-two articles were identified, and 22 were included, published between 2009 and 2022. 21 Systematic reviews focused on the English language. Most studies showed heterogeneity in the methodological structuring process: 10 articles were considered of low and 10 critically low quality. Clinical conditions associated with worsening in quality of life were dental caries, malocclusion, dental trauma, toothache, edentulism, need for orthodontic treatment, irregular brushing, and periodontal disease. Socioeconomic factors related to housing, parental education, access to health care, absence of siblings and nuclear family influence OHRQoL. Completion of orthodontic treatment, health promotion programs, dental care and safe housing all have a positive impact.

Conclusion

Worse oral health status, older age, female sex and worse socioeconomic status were significantly associated with worse OHRQoL.

Trial registration

PROSPERO CRD4202129352.
Implementation models and frameworks used to guide community-based physical activity programs for children: a scoping review
Authors: Ostermeier Emma , Burke Shauna M. , Gilliland Jason , Tucker Patricia
Published: August 2023

Background

The implementation of community-based programs is key to effective, sustainable initiatives that can support population-level changes in children’s physical activity. The purpose of this scoping review was to explore the implementation models and frameworks used to develop (process models), explore (determinant frameworks), and/or evaluate (evaluation frameworks) community-based physical activity programs for children. Also, the foundational components of the implementation models and frameworks and practical application in real-world settings were described.

Methods

The methodological framework developed by Arksey and O’Malley (2005) and the updated recommendations from Levac, Colquhoun and O’Brien (2010) were used to search, identify, and summarize applicable studies. This review also met the requirements in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews Checklist (PRISMA-ScR). A detailed search of six databases and three academic journals was conducted. Information about the article, the program, and the implementation model/framework were extracted and summarized.

Results

The search retrieved 42,202 articles, of which 27 met the inclusion criteria. Eleven process models, one determinant framework, and two evaluation frameworks were identified. Nineteen components were developed from the models and frameworks. Tailoring, situational analysis, and element identification were common components among the identified models and frameworks.

Conclusions

Since the execution of interventions is vital for creating successful health-promoting initiatives, researchers and program developers should consider using implementation models and frameworks to guide their community-based physical activity programs. Further research examining the application of new and existing implementation models and frameworks in developing, exploring, and evaluating community-level programs is warranted.
Management of comminuted patellar fractures using suture reduction technique combined with the modified Kirschner-wire tension band
Authors: Huang Shenbo , Zou Chang , Kenmegne Guy Romeo , Yin Yijie , Lin Yixiang , Fang Yue
Published: August 2023

Objectives

Surgical management of comminuted patella fractures remains a major challenge for the surgeon. We developed a suture reduction (SR) technique to better preserve the comminuted patella. The study aimed to compare the suture reduction technique with conventional reduction (CR) technique in the management of comminuted patellar fractures using the modified Kirschner-wire (K-wire) tension band.

Methods

From May 2016 to September 2020, a total of 75 patients with comminuted patellar fracture were reviewed retrospectively. Among these cases, 35 patients were in the suture reduction group with a mean age of 52 years, while 40 patients were in the conventional reduction group with a mean age of 53 years. All cases were closed fractures. Comminuted patellar fractures were classified as type 34-C3 according to the AO/OTA classification. Radiographs of the knee were obtained at routine follow-up to evaluate the reduction quality and fracture union. Clinical outcomes including range of motion (ROM), visual analog scale (VAS), Lysholm, and Böstman grading scales were measured at the last follow-up. Postoperative complications were also recorded.

Results

The average time from injury to surgery was 5.4 days in suture reduction group and 3.7 days in conventional reduction group (p < 0.05). The surgical time of suture reduction group was less than that of conventional reduction group, but there was no significant difference (p = 0.110) regarding surgical time between the two groups. The average blood loss in suture reduction group was 42.9 ml, while the average blood loss in conventional reduction group was 69.3 ml (p < 0.001). There was no difference regarding fracture union, ROM and knee function score (Lysholm score and Böstman scale) between the two groups. The complication rates were 17.1% in suture reduction group and 12.5% in conventional reduction group respectively (p > 0.05).

Conclusions

In the treatment of comminuted patellar fractures with modified K-wire tension band, the use of suture reduction technique can shorten the surgical time, reduce the surgical trauma, and obtain satisfactory results. This new surgical technique may be particularly effective in management of comminuted patellar fractures when patellectomy would otherwise be considered.
Religious affiliation and oral health-related quality of life: a cross-sectional study based on a nationally representative survey in Germany
Authors: Moszka Nina , Aarabi Ghazal , Lieske Berit , König Hans-Helmut , Kretzler Benedikt , Zwar Larissa , Hajek André
Published: August 2023

Background

Studies have shown an association between a person’s religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL.

Methods

A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses.

Results

Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (β = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (β = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (β = 1.89, p < 0.01).

Conclusion

Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL.
Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis
Authors: Budu Eugene , Dadzie Louis Kobina , Salihu Tarif , Ahinkorah Bright Opoku , Ameyaw Edward Kwabena , Aboagye Richard Gyan , Seidu Abdul-Aziz , Yaya Sanni
Published: August 2023

Background

Contraceptive use is crucial to achieving Sustainable Development Goal 3. Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin. This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin.

Methods

We performed a cross-sectional analysis of the 2017-18 Benin Demographic and Health Survey data. A weighted sample of 7,360 sexually active women of reproductive age was included in the study. We used a concentration curve to plot the cumulative proportion of women using modern contraception. Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use.

Results

We noted that the richest women had higher odds of modern contraceptive use (adjusted odds ratio [aOR] = 1.67, CI = 1.22–2.30) compared to the poorest women. Other factors that showed significant associations with modern contraception use were age, marital status, religious affiliation, employment status, parity, women’s educational level, and ethnicity. We found that modern contraceptive use is highly concentrated among the rich, with rich women having a higher propensity of using modern contraception relative to the poor. Also, the disadvantaged to modern contraceptive use included the poor, those aged 45–49, married women, those working, those with four or more live births, rural residents, and women of Bariba and related ethnicity. Conversely, favourable concentration in modern contraceptive use was found among the rich, women aged 20–24, the divorced, women with two live births, the highly educated, those with media exposure, and women of Yoruba and related ethnicity.

Conclusion

The study has shown that wealthy women are more likely to utilize contraceptives than the poor. This is because wealthy women could afford both the service itself and the travel costs to the health facility, hence overcoming any economic barriers to using modern contraception. Other factors such as age, marital status, religion, employment status, parity, mother’s educational level, and ethnicity were associated with contraceptive use in Benin. The Benin government and other stakeholders should develop family planning intercession techniques that address both the supply and demand sides of the equation, with a focus on reaching the illiterate and under-resourced population without admittance to modern contraception.
The effect of date fruit consumption on early postpartum hemorrhage: a randomized clinical trial
Authors: Niknami Maryam , Farash Maryam , Rahnavardi Mona , Maroufizadeh Saman , Darkhaneh Roya Faraji
Published: August 2023

Background

Postpartum hemorrhage, anemia, and iron deficiency are important health problems. Using safe, cheap, and available methods to reduce the amount of hemorrhage after childbirth can be effective for the mother's health during this period. Therefore, this study was conducted to determine the effect of date fruit consumption on the amount of hemorrhage after natural childbirth.

Methods

This randomized clinical trial was conducted on 98 women referred to the maternity ward of Al-Zahra Hospital in Rasht using the available sampling method. The primary outcome was postpartum hemorrhage, measured using the Pictorial Blood Loss Assessment Chart (PBLAC). Two hours after delivery, 100 g of date fruits were given to the intervention group, and the amount of hemorrhage was recorded during the first 24 h. Comparison between the two groups was done with the Mann–Whitney test with the Hodges–Lehmann estimator and corresponding exact conditional nonparametric confidence interval (CI) as effect estimate. A P < 0.05 was considered significant.

Results

The median of postpartum hemorrhage after normal delivery in the date and control groups was 35.0 [interquartile range (IQR): 22.0 to 39.8] and 39.0 [IQR: 27.5 to 64.5], respectively. Using the Hodges–Lehmann estimator, on average, the median postpartum hemorrhage in the date group was 9.0 (95% CI: 2.00–18.0) units lower than the control group (P = 0.009).

Conclusion

Consumption of dates effectively reduces the amount of hemorrhage after natural childbirth; thus, consuming this fruit during postpartum period is recommended. Also to confirm the findings, it is recommended to conduct similar studies in this field.

Trial registration

This trial was registered with the Iranian Registry of Clinical Trials; https://www.irct.ir/trial/59197 (IRCT20210607051505N2) on 31/10/2021.
Psychometric evaluation of the Persian version of the Hospital Survey on Patient Safety Culture Questionnaire (HSOPSC) in neonatal intensive care units: a methodological study
Authors: Babaie Mohadese , Nourian Manijeh , Atashzadeh-Shoorideh Foroozan , Manoochehri Houman , Nasiri Malihe
Published: August 2023

Background

A valid and reliable tool compatible with the culture is needed to evaluate the safety culture as one of the vital and promotional components in improving the quality of safety and health care. This study aimed to investigate the psychometric properties of the Persian version of the “Hospital Survey on Patient Safety Culture (HSOPSC)” in physicians and nurses working in Neonatal Intensive Care Units.

Methods

In this methodological research, the qualitative face, content validity, and construct validity were performed by Confirmatory Factor Analysis to the psychometric evaluation of the HSOPSC questionnaire. Based on convenience sampling and the inclusion criteria, 360 individuals completed the questionnaire. Internal consistency and stability were measured. Data analysis was performed using SPSS 21 and LISREL.

Results

In examining the construct validity, fit indices were not appropriate for the 12-dimension model of the Persian version. According to T-value, six heterogeneous items and a dimension were omitted. The 11-dimension model with 36 items showed an appropriate fit with the data. Cronbach’s alpha was evaluated at 0.79, and the stability was 0.82 (p˂0.001).

Conclusion

The Persian version of HSOPSC with 11 dimensions and 36 items has favorable validity and reliability and can be used in NICUs.
Impact of a dTcaP booster vaccine awareness campaign initiated by the French national health insurance for adults aged 25 years in 2021
Authors: Hurtaud Aline , Coomans Capucine , Vuillemin Brigitte , Benamar Akima , Couraud Maxime , Pham Bach-Nga , Sanchez Stéphane , Barbe Coralie
Published: August 2023

Background

Vaccination schedules differ from country to country. In France, the diphtheria, tetanus, pertussis, poliomyelitis (dTcaP) booster vaccine coverage for adults aged 25 has been lower than those recommended. We evaluated the impact of an awareness campaign undertaken by the French national health insurance system in 2021.

Methods

A randomized, controlled study with adults residing in the Ardennes region was conducted to evaluate the effect on vaccine coverage of the booster vaccine reminder campaign carried out via letter and/or email and/or SMS. The randomization unit was the municipal administrative area (canton). Ten cantons were grouped into the intervention group (INT) and nine were the control group (CON). Outcomes were the booster vaccine delivery and the consultation of a general practitioner (GP) within 12 months (since the French national health insurance running the campaign suggested patients to consult their GP).

Results

A total of 1,975 adults were included (INT: 67.3% vs. CON: 32.7%). Of them, 331 received a booster vaccine (INT: 17.4% vs. CON: 15.5%; p = 0.29), and 1,442 consulted a GP (INT: 73.7% vs. CON: 76.8%; p = 0.14). Those who consulted a GP had more frequent vaccine delivery (INT: 19.1% vs. CON: 10.5%; p < 0.0001).

Conclusions

This study found that the awareness campaign run by the French national health insurance did not improve the uptake of the dTcaP booster and that there was a low rate of vaccinated adults aged 25 years. A GP consultation was associated with dTcaP booster vaccine delivery which may show that there is a need of involving GPs in vaccination follow-ups. Patients recognize GPs as providers of credible information and they may play a key role in individualized preventive healthcare actions. Systematic consultations with GPs for follow-up could be proposed to insured adults aged 25 years in the future.
Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study
Authors: Pergeline Jeanne , Rey Sylvie , Fresson Jeanne , Debeugny Gonzague , Rachas Antoine , Tuppin Philippe
Published: August 2023

Background

Nationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night.

Methods

Children were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome.

Results

Among 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable.

Conclusion

Higher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.
The supportive care needs survey short form 34 (SCNS-SF34): translation and cultural adaptation into the Nepali language among patients with cervical cancer in Nepal
Authors: Dhakal Kamala , Chen Changying , Wang Panpan , Mboineki Joanes Faustine , Getu Mikiyas Amare , Boyes Allison , Sharma Chandrakala , Ghimire Bijesh Raj , Adhikari Abish , Adhikari Bibhav , Shrestha Daya Laxmi
Published: August 2023

Background

A questionnaire developed in one language must be translated and adapted when it will be used with patients speaking a different language and care should be taken to maintain equivalence between the source language (SL) version and its translated version. The objective of this study was to test the linguistic and cultural validity of a Nepali language version of the Supportive Care Need Survey – Short Form 34 (SCNS-SF34) used with the Nepali population.

Methods

Translation of the SCNS-SF34 was carried out by following Beaton’s guidelines and Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) by a research team. The translated version was administered to patients with cervical cancer in Nepal. The following steps were performed as part of the study: translation, content validity assessment, reliability assessment and measurement of errors.

Results

The study reports item content validity (I-CVI) was > 0.78 and scale content validity (S-CVI) was − 0.89, 0.91 and 0.90 respectively in semantic, cultural, and conceptual aspects. The study found a content validity ratio (CVR) of 0.9 to 1, Cronbach’s α of 0.90, correlation significant at the 0.01 level (2-tailed), and clarity of the questionnaire at 91.29%. The standard error of measurement (SEM) and small detectable changes (SDC) for overall care need scores were measured 2.70 and 7.47 respectively. All items were accepted as per the original SCNS-SF34. Following the respondents’ suggestions, simpler Nepali words were chosen in some items to replace the words in the preliminary Nepali version of SCNS-SF34.

Conclusion

Preliminary findings show that the Nepali translation of SCNS-SF34 is practical and applicable to the Nepali population. Financial supportive care needs, supportive care for caretakers and problems during patient hospital stays are essential to include in the questionnaire to further explore supportive care needs.
Characterization of a human placental clearance system to regulate serotonin levels in the fetoplacental unit
Authors: Staud Frantisek , Pan Xin , Karahoda Rona , Dong Xiaojing , Kastner Petr , Horackova Hana , Vachalova Veronika , Markert Udo R. , Abad Cilia
Published: August 2023

Background

Serotonin (5-HT) is a biogenic monoamine with diverse functions in multiple human organs and tissues. During pregnancy, tightly regulated levels of 5-HT in the fetoplacental unit are critical for proper placental functions, fetal development, and programming. Despite being a non-neuronal organ, the placenta expresses a suite of homeostatic proteins, membrane transporters and metabolizing enzymes, to regulate monoamine levels. We hypothesized that placental 5-HT clearance is important for maintaining 5-HT levels in the fetoplacental unit. We therefore investigated placental 5-HT uptake from the umbilical circulation at physiological and supraphysiological levels as well as placental metabolism of 5-HT to 5-hydroxyindoleacetic acid (5-HIAA) and 5-HIAA efflux from trophoblast cells.

Methods

We employed a systematic approach using advanced organ-, tissue-, and cellular-level models of the human placenta to investigate the transport and metabolism of 5-HT in the fetoplacental unit. Human placentas from uncomplicated term pregnancies were used for perfusion studies, culturing explants, and isolating primary trophoblast cells.

Results

Using the dually perfused placenta, we observed a high and concentration-dependent placental extraction of 5-HT from the fetal circulation. Subsequently, within the placenta, 5-HT was metabolized to 5-hydroxyindoleacetic acid (5-HIAA), which was then unidirectionally excreted to the maternal circulation. In the explant cultures and primary trophoblast cells, we show concentration- and inhibitor-dependent 5-HT uptake and metabolism and subsequent 5-HIAA release into the media. Droplet digital PCR revealed that the dominant gene in all models was MAO-A, supporting the crucial role of 5-HT metabolism in placental 5-HT clearance.

Conclusions

Taken together, we present transcriptional and functional evidence that the human placenta has an efficient 5-HT clearance system involving (1) removal of 5-HT from the fetal circulation by OCT3, (2) metabolism to 5-HIAA by MAO-A, and (3) selective 5-HIAA excretion to the maternal circulation via the MRP2 transporter. This synchronized mechanism is critical for regulating 5-HT in the fetoplacental unit; however, it can be compromised by external insults such as antidepressant drugs.
Regulation and clinical potential of telomerase reverse transcriptase (TERT/hTERT) in breast cancer
Authors: Yang Ruozhu , Han Yi , Guan Xinyu , Hong Yue , Meng Jiahao , Ding Shirong , Long Qian , Yi Wenjun
Published: August 2023

Telomerase reverse transcriptase (TERT/hTERT) serves as the pivotal catalytic subunit of telomerase, a crucial enzyme responsible for telomere maintenance and human genome stability. The high activation of hTERT, observed in over 90% of tumors, plays a significant role in tumor initiation and progression. An in-depth exploration of hTERT activation mechanisms in cancer holds promise for advancing our understanding of the disease and developing more effective treatment strategies. In breast cancer, the expression of hTERT is regulated by epigenetic, transcriptional, post-translational modification mechanisms and DNA variation. Besides its canonical function in telomere maintenance, hTERT exerts non-canonical roles that contribute to disease progression through telomerase-independent mechanisms. This comprehensive review summarizes the regulatory mechanisms governing hTERT in breast cancer and elucidates the functional implications of its activation. Given the overexpression of hTERT in most breast cancer cells, the detection of hTERT and its associated molecules are potential for enhancing early screening and prognostic evaluation of breast cancer. Although still in its early stages, therapeutic approaches targeting hTERT and its regulatory molecules show promise as viable strategies for breast cancer treatment. These methods are also discussed in this paper.
Brexit, trade and the governance of non-communicable diseases: a research agenda
Authors: Hawkins Benjamin , Barlow Pepita , van Schalkwyk May CI , Holden Chris
Published: August 2023

Background

The UK’s post-Brexit trade strategy has potentially important implications for population health and equity. In particular, it will impact on the structural risk factors for non-communicable diseases (NCDs), including the consumption of health-harming commodities such as tobacco, alcohol and ultra-processed food and beverages. This article catalogues recent developments in UK trade policy. It then presents a narrative review of the existing research literature on trade and health and previous, prospective studies on the health impacts of Brexit. In so doing it identifies key questions and foci for a future research agenda on the implications of UK’s emerging trade regime for NCD prevention.

Main text

We identify five key areas for future research. (1) Additional scholarship to document the health effects of key trade agreements negotiated by the UK government; (2) The implications of these agreements for policy-making to address health impacts, including the potential for legal challenges under dispute settlement mechanisms; (3) The strategic objectives being pursued by the UK government and the extent to which they support or undermine public health; (4) The process of trade policy-making, its openness to public health interests and actors and the impact of the political and ideological legacy of Brexit on outcomes; (5) The impact of the UK’s post-Brexit trade policy on partner countries and blocs and their cumulative impact on the global trade regime.

Conclusions

Further research is urgently need to understand the ways in which the UK’s post-Brexit trade strategy will impact on NCDs and policy responses to address these, including the openness of the trade policy architecture to health issues. The outcomes of this process will have wider systemic effects on the global trade regime with implications for health. Researchers must be cognizant of the ideological components of the policy debate which have been absent from previous analysis of Brexit, trade and health.
Intersectional inequalities in exclusive breastfeeding practices in India: analysis of national family health survey-4
Authors: Valappil Haseena Chekrain , Jayalakshmi Rajeev , Sewor Christian
Published: August 2023

Background

Exclusive breastfeeding in the initial six months of infancy plays a significant role in the physical and cognitive development of the child. One in two children below six months of age in India is not receiving exclusive breastfeeding, with the rates varying considerably between and within states. In this study, we investigated the effect of intersecting inequalities in exclusive breastfeeding practice amongst children below six months in India.

Methods

Data from the fourth National Family Health Survey (NFHS-4) was used for the study. The study used a weighed sample of 211,145 infants below six months. Exclusive breastfeeding practice was assessed based on the previous 24-hours feeding practice of the child. Intersecting social categories were created based on place of residence, religion, wealth index, and mothers’ education. A binary logistic regression model was used to explore inequalities in the practice of exclusive breastfeeding based on the intersecting social categories.

Results

Exclusive breastfeeding practices varied significantly between the intersecting categories of religion, place of residence, wealth index, and education of the mother. Exclusive breastfeeding practice prevalence was the highest amongst children born in the Urban-Secondary-Poor-Others group (57.9%) and lowest amongst the Rural-Primary-Rich-Others category (34.5). In comparison to children in the most disadvantaged category (Rural-Primary-Poor-Others), children born in the Rural-Secondary-Poor-Others category had the highest odds [OR (odds ratio) 1.213; 95% CI 1.024, 1.437] of being exclusively breastfed, whilst children within the Rural-Primary-Rich-Others category had the lowest odds (OR 0.494; 95% CI 0.345, 0.708). Wide disparities were observed in the odds of engaging in exclusive breastfeeding practice amongst the middle groups than between the most advantaged and the most disadvantaged groups. The inequality indices show varied distribution of exclusive breastfeeding prevalence across the intersecting groups with higher exclusive breastfeeding prevalence noted amongst disadvantaged groups.

Conclusions

The study found that intersecting inequalities in exclusive breastfeeding exist in India. In order to improve exclusive breastfeeding practice, targeted interventions must acknowledge and adopt a comprehensive approach that addresses inherent inequalities resulting from the intersection of various axes of social stratification.
The prognostic value of 11th Japanese classification and 8th AJCC staging systems in Chinese patients with esophageal squamous cell carcinoma
Authors: Zhang Xi-qin , Miao Chuan-wang , Liu Lan-pin , Wang Cun-liang , Chen Jia-zhen , Li Wan-hu , Hu Xu-dong
Published: August 2023

Background

Two staging systems, the 8th staging system by the American Joint Committee on Cancer (AJCC) and the 11th Japanese classification by Japan Esophageal Society (JES), are currently applied in the clinic for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). The differences between the two staging systems have been widely researched. However, little studies focus on the differences in specific staging between the two systems. Therefore, we aimed to compare the performance of different staging in predicting overall survival (OS) of Chinese patients with ESCC.

Methods

This retrospective study included 268 patients who underwent radical esophagectomy and mediastinal lymph node dissection for ESCC between January 2008 and December 2013. Patients were staged by the 8th AJCC and 11th JES staging systems. OS was estimated using the Kaplan–Meier method and compared between N stages and between stage groupings using the log-rank test. Cox proportional hazards regression analysis was performed to identify factors independently related to outcome. Further, we compared the concordance indexes (C-indexes) of the two staging systems.

Results

The mean age was 61.25 ± 7.056 years, median follow-up was 44.82 months, and 5-year OS rate was 47%. The OS was well predicted by the 8th AJCC N staging (P < 0.001) and the 11th JES N staging (P < 0.001), with a c-index of 0.638 (95% CI: 0.592–0.683) for AJCC N staging and 0.627 (95% CI: 0.583–0.670) for JES N staging (P = 0.13). In addition, the OS was also well predicted by stage groupings of the 8th AJCC (P < 0.001) and the 11th JES systems (P < 0.001), with a c-index of 0.658 (95% CI: 0.616–0.699) for 8th AJCC stage grouping and 0.629 (95% CI: 0.589–0.668) for the11th JES stage grouping (P = 0.211).

Conclusions

The prognostic effect of 11th JES staging system is comparable with that of AJCC 8th staging system for patients with ESCC. Therefore, both systems are applicable to clinical practice.
Oral administration of 6-methylsulfinylhexyl isothiocyanate extracted from wasabi is safe and improves the fatigue and sleep of healthy volunteers
Authors: Nakajima Ryota , Kanou Masanobu , Tokushima Masahiko , Iwama Yoshitaka , Yamana Kei
Published: August 2023

Background

This study aimed to conduct a preliminary evaluation of the effects of 6-methylsulfinylhexyl isothiocyanate (6-MSITC) contained in wasabi rhizomes on fatigue and sleep and to examine its safety through overdose study.

Methods

A total of 20 healthy volunteers who were experiencing daily fatigue were given powder containing 6-MSITC (4.8 mg/day of 6-MSITC) extracted from wasabi for 4 weeks. Then, fatigue, sleep, autonomic nervous functioning, stress, and immunity were evaluated. In addition, an overdose safety study of the extract powder (up to 16 mg/day of 6-MSITC for 4 weeks) was performed with 30 healthy volunteers in a double-blind, placebo-controlled method.

Results

The powder containing 6-MSITC did not improve fatigue after a mental task, but fatigue before the mental task, sleep, and mood were improved significantly after 4 weeks intake. No changes were observed in the autonomic nerve function, stress, or immune markers. In the overdose safety study, no changes in the parameters ​​or side effects were observed, and the results showed that high doses of the extract powder containing 6-MSITC is safe.

Conclusion

This study confirmed the possibility that this powder extracted from wasabi that contains 6-MSITC might improve fatigue and sleep. However, because the effectiveness evaluation in this study was a single-arm, open-label study and there was no placebo control group, these points must be considered when interpreting the results. Safety was confirmed in an overdose study of more than three times the amount compared to that in the efficacy evaluation study. In the future, further research should be conducted on its effectiveness for treating fatigue and sleep problems.

Trial registration

UMIN clinical trial registration system, UMIN000049913. Registered 27 December 2022 Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000056818
Interaction of lncRNA Gm2044 and EEF2 promotes estradiol synthesis in ovarian follicular granulosa cells
Authors: Hu Ke , Wang Chen , Xu Yifan , Li Fan , Han Xuefeng , Song Chuanwang , Liang Meng
Published: August 2023

The functions and molecular mechanisms of long noncoding RNA (lncRNA) in reproduction have been widely studied at present. However, lncRNA regulating hormone synthesis in ovarian follicular granulosa cells has not been sufficiently studied. Our previous research demonstrated that lncRNA Gm2044 could promote estradiol synthesis in follicular granulosa cells. In this study, we identified 21 binding proteins of lncRNA Gm2044 in ovarian follicles using comprehensive identification of RNA-binding proteins by mass spectrometry (ChIRP-MS). RNA immunoprecipitation (RNA IP) and reverse transcription PCR (RT-PCR) confirmed that lncRNA Gm2044 can interact with eukaryotic translation elongation factor 2 (EEF2) protein. Furthermore, we constructed lncRNA Gm2044 knockout mice using the CRISPR/Cas9 method. Although the follicular development and fertility of female lncRNA Gm2044 knockout mice were not affected, the serum estradiol concentration in female lncRNA Gm2044 knockout mice significantly decreased. Western blotting and ELISA revealed that lncRNA Gm2044 may promote the binding of EEF2 to Nr5a1 mRNA and then enhance the Nr5a1 mRNA translation, and the upregulated NR5A1 protein can strengthen estradiol synthesis. To determine the potential signaling pathway of lncRNA Gm2044 regulating estradiol synthesis, transcriptome sequencing was performed for ovaries of adult lncRNA Gm2044 knockout mice, which identified 565 significant up-regulated genes and 303 significant down-regulated genes, which were then analyzed with Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) and validated by molecular experiments. Understanding how lncRNA Gm2044/EEF2 protein regulates estradiol synthesis will help treat estrogen-related reproductive diseases.
Clinical characteristics and prognosis in systemic lupus erythematosus-associated pulmonary arterial hypertension based on consensus clustering and risk prediction model
Authors: Dai Mengmeng , Zhang Chunyi , Li Chaoying , Wang Qianqian , Gao Congcong , Yue Runzhi , Yao Menghui , Su Zhaohui , Zheng Zhaohui
Published: August 2023

Background

Pulmonary arterial hypertension (PAH) is a severe complication of systemic lupus erythematosus (SLE). This study aims to explore the clinical characteristics and prognosis in SLE-PAH based on consensus clustering and risk prediction model.

Methods

A total of 205 PAH (including 163 SLE-PAH and 42 idiopathic PAH) patients were enrolled retrospectively based on medical records at the First Affiliated Hospital of Zhengzhou University from July 2014 to June 2021. Unsupervised consensus clustering was used to identify SLE-PAH subtypes that best represent the data pattern. The Kaplan–Meier survival was analyzed in different subtypes. Besides, the least absolute shrinkage and selection operator combined with Cox proportional hazards regression model were performed to construct the SLE-PAH risk prediction model.

Results

Clustering analysis defined two subtypes, cluster 1 (n = 134) and cluster 2 (n = 29). Compared with cluster 1, SLE-PAH patients in cluster 2 had less favorable levels of poor cardiac, kidney, and coagulation function markers, with higher SLE disease activity, less frequency of PAH medications, and lower survival rate within 2 years (86.2% vs. 92.8%) (P < 0.05). The risk prediction model was also constructed, including older age at diagnosis (≥ 38 years), anti-dsDNA antibody, neuropsychiatric lupus, and platelet distribution width (PDW).

Conclusions

Consensus clustering identified two distinct SLE-PAH subtypes which were associated with survival outcomes. Four prognostic factors for death were discovered to construct the SLE-PAH risk prediction model.
Unintended consequences of technology in competency-based education: A qualitative study of lessons learned in an OtoHNS program
Authors: Ott Mary , Apramian Tavis , Cristancho Sayra , Roth Kathryn
Published: August 2023

Background

Formative feedback and entrustment ratings on assessments of entrustable professional activities (EPAs) are intended to support learner self-regulation and inform entrustment decisions in competency-based medical education. Technology platforms have been developed to facilitate these goals, but little is known about their effects on these new assessment practices. This study investigates how users interacted with an e-portfolio in an OtoHNS surgery program transitioning to a Canadian approach to competency-based assessment, Competence by Design.

Methods

We employed a sociomaterial perspective on technology and grounded theory methods of iterative data collection and analysis to study this OtoHNS program's use of an e-portfolio for assessment purposes. All residents (n = 14) and competency committee members (n = 7) participated in the study; data included feedback in resident portfolios, observation of use of the e-portfolio in a competency committee meeting, and a focus group with residents to explore how they used the e-portfolio and visualize interfaces that would better meet their needs.

Results

Use of the e-portfolio to document, access, and interpret assessment data was problematic for both residents and faculty, but the residents faced more challenges. While faculty were slowed in making entrustment decisions, formative assessments were not actionable for residents. Workarounds to these barriers resulted in a “numbers game” residents played to acquire EPAs. Themes prioritized needs for searchable, contextual, visual, and mobile aspects of technology design to support use of assessment data for resident learning.

Conclusion

Best practices of technology design begin by understanding user needs. Insights from this study support recommendations for improved technology design centred on learner needs to provide OtoHNS residents a more formative experience of competency-based training.

Graphical Abstract
Data analysis for vague contingency data
Authors: Aslam Muhammad , Alamri Faten S.
Published: August 2023

The existing Fisher’s exact test has been widely applied for investigating whether the difference between the observed frequencies is significant or not. The existing Fisher’s exact test can be applied only when the observed frequencies are in determinate form and has no vogues information. In practice, due to the complicity in the production process, it is not always possible to have observed frequencies in determinate form. Therefore, the use of the existing Fisher’s exact test may mislead the industrial engineers. The paper presents the modification of Fisher’s exact test using neutrosophic statistics. The operational process, simulation study, and application using the production data will be given in the paper. From the analysis of industrial data, it can be concluded that the proposed Fisher’s exact test performs well than the existing Fisher’s exact test.
Estimating geotechnical parameters using semisupervised learning: An example from the Dutch offshore wind farm zone
Authors: Di Haibin , Pham Nam , Abubakar Aria
Published: August 2023

Wind energy is considered to be of great importance for promoting energy transition and achieving net-zero carbon emission. Reliable modeling and monitoring of the near-subsurface geology are crucial for successful wind farm selection, construction, operation, and maintenance. For optimal characterization of shallow seafloor sediments, 2D ultrahigh-resolution (UHR) seismic survey and 1D cone-penetration testing (CPT) often are acquired, processed, interpreted, and integrated for building 3D ground models of essential geotechnical parameters such as friction. Such a task faces multiple challenges, such as limited CPT availability, strong noise contamination in UHR seismic data, and heavy manual efforts for completing the traditional workflows, particularly acoustic impedance inversion. This study accelerates the integration by a semisupervised learning workflow with three highlights. First, it enables geotechnical parameter estimation directly from UHR seismic data without impedance inversion. The second comes from the use of a pretrained feature engine to reduce the risk of overfitting while mapping massive UHR seismic data with sparse CPT measurements through deep learning. More importantly, it allows incorporating other geologic/geophysical information, such as a predefined structural model, to further constrain the machine learning and boost its generalization capability. Its values are validated through applications to the Dutch wind farm zone for estimating four geotechnical parameters, including cone-tip resistance, sleeve friction, pore-water pressure, and the derived friction ratio, in two example scenarios: (1) UHR seismic data only and (2) UHR seismic data and an 11-layer structural model. The results verify the feasibility of data-driven geotechnical parameter estimation. In addition to the two demonstrated scenarios, our workflow can be further customized for embedding more constraints, e.g., prestack seismic and elastic/static property models, given their availability in a wind farm of interest.