bluuebunny/crossref_metadata_2025 huggingface dataset:
Global stroke statistics 2023: Availability of reperfusion services around the world
Authors: Kim Joosup , Olaiya Muideen T , De Silva Deidre A , Norrving Bo , Bosch Jackie , De Sousa Diana A , Christensen Hanne K , Ranta Anna , Donnan Geoffrey A , Feigin Valery , Martins Sheila , Schwamm Lee H , Werring David J , Howard George , Owolabi Mayowa , Pandian Jeyaraj , Mikulik Robert , Thayabaranathan Tharshanah , Cadilhac Dominique A
Published: October 2023

Background:

Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed.

Aims:

To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services.

Methods:

We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary.

Results:

Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world.

Conclusion:

Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
An observational study to assess validity and reliability of smartphone sensor-based gait and balance assessments in multiple sclerosis: Floodlight GaitLab protocol
Authors: Rinderknecht Mike D , Zanon Mattia , Boonstra Tjitske A , Angelini Lorenza , Stanev Dimitar , Chan Gabriela González , Bunn Lisa , Dondelinger Frank , Hosking Richard , Freeman Jenny , Hobart Jeremy , Marsden Jonathan , Craveiro Licinio
Published: October 2023

Background

Gait and balance impairments are often present in people with multiple sclerosis (PwMS) and have a significant impact on quality of life and independence. Gold-standard quantitative tools for assessing gait and balance such as motion capture systems and force plates usually require complex technical setups. Wearable sensors, including those integrated into smartphones, offer a more frequent, convenient, and minimally burdensome assessment of functional disability in a home environment. We developed a novel smartphone sensor-based application (Floodlight) that is being used in multiple research and clinical contexts, but a complete validation of this technology is still lacking.

Methods

This protocol describes an observational study designed to evaluate the analytical and clinical validity of Floodlight gait and balance tests. Approximately 100 PwMS and 35 healthy controls will perform multiple gait and balance tasks in both laboratory-based and real-world environments in order to explore the following properties: (a) concurrent validity of the Floodlight gait and balance tests against gold-standard assessments; (b) reliability of Floodlight digital measures derived under different controlled gait and balance conditions, and different on-body sensor locations; (c) ecological validity of the tests; and (d) construct validity compared with clinician- and patient-reported assessments.

Conclusions

The Floodlight GaitLab study (ISRCTN15993728) represents a critical step in the technical validation of Floodlight technology to measure gait and balance in PwMS, and will also allow the development of new test designs and algorithms.
Multimodal Instruction and Mentor-Tutoring in an Intensive English Program
Authors: Wang Shih-ping , Chen Yih-Lan , Tseng Wen-Ta
Published: October 2023

The positive effects of multimodal instruction have been widely assumed, but few studies have looked into the impact of multimodal tutorials within the context of an Intensive English Program (IEP). Hence, to address the research gap, the aim of this study was to investigate the impact of multimodality and tutoring assistance within an IEP on the language proficiency of EFL learners. The IEP program consisted of two phases, featuring three forms of tutoring: non-tutoring, multimodality tutoring, and multimodality mentor-tutoring. The research questions were answered using both experimental and survey methods. The quasi-experimental study was conducted ( N = 467) with two fixed factors, that is, Type of Tutoring and Phase. A questionnaire was further distributed to measure students’ perceptions of learning, including learning effort (LE), perception of TA scaffolding (TASCAF), and willingness to continue learning (WTL). The results of two-way ANCOVA indicated a significant effect of Type of Tutoring ( p < .001), and interaction between Type of Tutoring and Phase ( p < .05). Structural equation modeling testing the model fitness (i.e., LE contributes significantly both directly and indirectly through TASCAF) indicated an acceptable goodness of fit (CFI = 0.952, SRMR = 0.036, and RMSEA = 0.80), supporting the significant contribution of Type of Tutoring to students’ English learning. In summary, the multimodal tutorial environment reinforced the contemporary tenet that language learning is fundamentally socially mediated. This aspect underscores the creation of a multimodal learning context with an optimal interplay among mentors, tutors, instructors, and students.
The Effects of Face Mask Types, Athletic Levels, and Caffeine Intake on Employee Performance, Productivity, and Perception
Authors: Mgaedeh Fatima , Stone Richard , Pulley Alexandria , Al-Daraghmeh Mohammad Y.
Published: October 2023

Since the COVID-19 pandemic, face masks have been a standard part of our daily lives. Many continue to wear face masks to this day, and some even double up on their face masks. This research is a continuation of a previous investigation of the effect of face mask types, athletic levels, and caffeine intake on retail employees' performance, productivity, and perception. Findings showed that face mask types significantly affected the feeling of unfit and odor. In addition, the kind of face mask had a significant effect on the body temperature ratings. Also, employees who considered themselves to be athletic gave lower ratings of overall discomfort than other employees. The interaction of different types of face masks with the wearing of eyeglasses has been demonstrated to have a significant effect on the stress levels of workers and the amount of time it takes for them to comprehend others.
Acceptance of Future Home Technologies and Services: Comparing Different Tasks, Scenarios and User Characteristics
Authors: FakhrHosseini Shabnam , Lee Chaiwoo , Lee Sheng-Hung , Cerino Lauren , Coughlin Joseph
Published: October 2023

While capabilities and applications of smart and intelligent home technologies continue to be developed, not much is known regarding how users of various characteristics and backgrounds feel about the emerging possibilities. In this study, a large-scale online survey was conducted with a diverse group of respondents to describe preferences and acceptance of potential future home technology system concepts addressing different tasks and objectives, as well as utilizing varied degrees of technology integration and automation. Results indicated a sense of uncertainty regarding future home technology, with slightly positive but overall neutral levels of interest, and mostly neutral intention to use various presented system concepts. Findings also illustrate gaps in future home technology acceptance between individuals of different attitudinal and behavioral characteristics, in addition to basic demographic traits, with implications for future design and distribution to address expectations stemming from past technology experiences and overall lifestyle.
Adapting to Imperfect Automation: The Impact of Experience on Dependence Behavior and Response Strategies
Authors: Schuler Patrik T. , Yang X. Jessie
Published: October 2023

This study examined the impact of experience on individuals’ dependence behavior and response strategies when interacting with imperfect automation. 41 participants used an automated aid to complete a dual-task scenario comprising of a compensatory tracking task and a threat detection task. The entire experiment was divided into four quarters and multi-level models (MLM) were built to investigate the relationship between experience and the dependent variables. Results show that compliance and reliance behaviors and perfor- mance scores significantly increased as participants gained more experience with automation. In addition, as the experiment progressed, a significant number of participants adapted to the automation and resorted to an extreme use response strategy. The findings of this study suggest that automation response strategies are not static and most individual operators eventually follow or discard the automation. Understanding individual response strategies can support the development of individualized automation systems and improve operator training.
Cooperative Driving Automation Messaging Designs
Authors: Sanchez Robert , Ahmed Ananna , Olko Sarah , Eisert Jesse , Jannat Mafruhatul
Published: October 2023

Cooperative driving automation (CDA) has the potential to facilitate vehicle-to-everything (V2X), vehicle-to-infrastructure (V2I), and vehicle-to-vehicle (V2V) communications to improve traffic operations and safety. In this study, the researchers assessed several V2I and V2V message design configurations and characteristics. The study was conducted online through Web-conferencing sessions. The researchers presented 24 participants with different driving scenarios followed by relevant in-vehicle CDA message designs. The participants were then asked open- and closed-ended questions on message understanding, situational expectations, message effectiveness, and design preferences. The messages using V2I designs tended to be clearer and better understood than those using V2V designs. Certain colors (green, red) and designs (lines, numbers) tended to be more effective. This study provided insights into drivers’ perceptions of several CDA V2I and V2V message designs for specific scenarios. This study’s findings will help future researchers and practitioners select appropriate CDA messages to improve overall transportation operations and safety.
Actions, not Actor Identities, Affect Beliefs About Cooperation in Human-Machine Teaming
Authors: Funke Gregory , Tolston Michael , Bowers Margaret , Holderby Katherine
Published: October 2023

The efficacy of future human-machine teams will be determined by the ability of machine agents to work cooperatively with their human teammates. The ways teammates engage in cooperative teamwork behaviors might affect human beliefs about expressed cooperativity, and these changes in beliefs might depend on the identity of a teammate as a human or machine. In the current experiment we investigated how violations of cooperation expectations, presented to participants in a narrative vignette, influenced ratings on a measure of cooperation derived from social interdependence theory. As expected, participants rated vignette actors as less cooperative if the story included violated cooperation expectations, but consistent with previous research, the identities of the actors as humans or robots did not appear to influence ratings. Overall, this is a useful expansion on previous work describing the factors that influence perceptions of cooperation in human-machine teaming.
Reference Values and Determinants of Spatiotemporal and Kinetic Variables in Recreational Runners
Authors: Malisoux Laurent , Napier Christopher , Gette Paul , Delattre Nicolas , Theisen Daniel
Published: October 2023

Background:

Identifying atypical lower limb biomechanics may help prevent the occurrence or recurrence of running-related injuries. No reference values for spatiotemporal or kinetic variables in healthy recreational runners are available in the scientific literature to support clinical management.

Purpose:

To (1) present speed- and sex-stratified reference values for spatiotemporal and kinetic variables in healthy adult recreational runners; (2) identify the determinants of these biomechanical variables; and (3) develop reference regression equations that can be used as a guide in a clinical context.

Study Design:

Descriptive laboratory study.

Methods:

This study involved 860 healthy recreational runners (age, 19-65 years [38.5% women]) tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes with either hard or soft cushioning. Twelve common spatiotemporal and kinetic variables—including contact time, flight time, duty factor, vertical oscillation, step cadence, step length, vertical impact peak (VIP), time to VIP, vertical average loading rate, vertical stiffness, peak vertical ground-reaction force (GRF), and peak braking force—were derived from GRF recordings. Reference values for each biomechanical variable were calculated using descriptive statistics and stratified by sex and running speed category (≤7, 8, 9, 10, 11, 12, 13, 14, and ≥15 km/h). Correlations and multiple regression analyses were performed to identify potential determinants independently associated with each biomechanical variable and generate reference equations.

Results:

The mean running speed was 10.5 ± 1.3 km/h and 9 ± 1.1 km/h in men and women, respectively. While all potential predictors were significantly correlated with many of the 12 biomechanical variables, only running speed showed high correlations ( r > 0.7). The adjusted R2 of the multiple regression equations ranged from 0.19 to 0.88.

Conclusion:

This study provides reference values and equations that may guide clinicians and researchers in interpreting spatiotemporal and kinetic variables in recreational runners.

Clinical Relevance:

The reference values can be used as targets for clinicians working with recreational runners in cases where there is a clinical suspicion of a causal relationship between atypical biomechanics and running-related injury.
An Integrative Review of Grandparents’ Experiences in Childhood Cancer
Authors: Wilson Jennifer L.
Published: October 2023

Background: While it is generally accepted that childhood cancer has a profound impact on the family unit, there has been little focus on the experiences of grandparents who are affected by the diagnosis. Grandparents play an integral role throughout the child's illness trajectory as they are called upon to provide support physically, spiritually, emotionally, and at times financially. This integrative review examines the current research specific to grandparents’ experiences of childhood cancer. Method: CINAHL, PubMed, and Web of Science were searched using the key terms “grandparent*” AND “experience*” AND “child*” AND “cancer.” Inclusion criteria used for this review were as follows: electronic full text, peer-reviewed, and published in English between 2012 and 2022. Results: Grandparents of children with cancer experience an emotional whirlwind, a double-whammy effect, the giving and receiving of support, a balancing act, and attempt to find meaning throughout the diagnosis. They feel unacknowledged and unsupported by the health care team. Discussion: It is difficult to deny the emotional and familial impact the child's cancer diagnosis has not only on the child and immediate family but also on grandparents. While the reports of grandparents are consistent across studies, there have been lackluster attempts to mitigate the suffering experienced by this group. Pediatric oncology nurses, with their family-centered care approach, are in a unique position to uncover and meet the specific needs of grandparents of children diagnosed with cancer.
Differential dissolution of interlayer, octahedral and tetrahedral cations of vermiculite in oxalic acid
Authors: Zhang Yu , Sun Hongjuan , Peng Tongjiang , Luo Liming , Zeng Li
Published: October 2023

Physical and/or chemical changes such as refinement, component dissolution, exchange/adsorption, structural evolution and recombination of phyllosilicate minerals occur continuously in a naturally weakly acidic water environment. To compare the differential dissolution of cations that occupy various sites in vermiculite, trioctahedral vermiculite was dissolved in various concentrations of oxalate for 24 h and in 0.2 M oxalate for various durations. The concentration of ions in the leaching solution and the phase, structure and morphology of the original samples and acid-leached samples were analysed. Structural analysis showed that the 001 reflections of vermiculite gradually shifted to a higher angle and eventually disappeared after the dissolution of interlayer cations caused by acid leaching. The amount and rate of dissolution of each cation in the vermiculite showed that the octahedral cation Mg2+ is more soluble than Fe2+ and Fe3+. The dissolution rates of Al3+, Mg2+ and Ca2+ were greatest in the first 4 h and then decreased gradually. Amorphous silicon dioxide and calcium oxalate were formed during acid leaching, and calcium oxalate was formed in the first 4 h. After leaching with oxalate for various periods, the cation-exchange capacity (CEC) of the samples first increased and then decreased. Micromorphology analysis showed that the acid erosion process started from the edges. The results of this work contribute to our understanding of many natural geochemical processes, and they will be useful for several applications such as soil improvement, ecological restoration and environmental protection.
Type 2 diabetes progression in an adult Ugandan population with new-onset diabetes: an observational prospective study
Authors: Kibirige Davis , Sekitoleko Isaac , Lumu William , Nyirenda Moffat J.
Published: October 2023

Background

The rate of progression of type 2 diabetes following diagnosis varies across individuals and populations. Studies investigating the progression of type 2 diabetes in adult African populations with newly diagnosed diabetes are limited. We aimed to investigate the prevalence and predictors of short-term (one year) diabetes progression in an adult Ugandan population with new-onset type 2 diabetes (type 2 diabetes diagnosed in < 3 months) initiated on oral hypoglycaemic agents (OHA).

Methods

Two hundred and seven adult participants with type 2 diabetes diagnosed within the previous three months were followed up for 12 months. We investigated the association of specific demographic, clinical, and metabolic characteristics, and short-term diabetes progression (defined as glycated haemoglobin or HbA1c ≥ 8% on ≥ 2 OHA and/or treatment intensification).

Results

One hundred sixteen participants (56%) completed the follow-up period. Sixty-four participants (55.2%, 95% CI 45.7–64.4) showed evidence of diabetes progression during the 12-month period of follow-up. An HbA1c ≥ 8% on ≥ 2 OHA and treatment intensification were noted in 44.8% and 29.3% of the participants, respectively. On multivariate analysis, only the female gender (AOR 3.2, 95% CI 1.1–9.2, p = 0.03) was noted to be independently associated with short-term diabetes progression.

Conclusion

Short-term diabetes progression was relatively common in this study population and was independently associated with the female gender. Early intensified diabetes therapy in adult Ugandan female patients with new-onset type 2 diabetes should be emphasised to avert rapid short-term diabetes progression.
The burden of anemia among Chinese HIV-infected patients following the initiation of antiretroviral therapy in the treat-all era: a nationwide cohort study
Authors: Wei Lai , Zhao Yan , Gan Xiumin , Zhao Decai , Wu Yasong , Dou Zhihui , Ma Ye
Published: October 2023

Background

To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era.

Methods

All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death.

Results

Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80–3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67–6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55–2.76; moderate anemia: aHR = 4.60; 95% CI:4.40–4.81; severe anemia: aHR = 6.41; 95% CI:5.94–6.91).

Conclusions

In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.
Changes in radiomic and radiologic features in meningiomas after radiation therapy
Authors: Jo Sang Won , Kim Eun Soo , Yoon Dae Young , Kwon Mi Jung
Published: October 2023

Objectives

This study evaluated the radiologic and radiomic features extracted from magnetic resonance imaging (MRI) in meningioma after radiation therapy and investigated the impact of radiation therapy in treating meningioma based on routine brain MRI.

Methods

Observation (n = 100) and radiation therapy (n = 62) patients with meningioma who underwent MRI were randomly divided (7:3 ratio) into training (n = 118) and validation (n = 44) groups. Radiologic findings were analyzed. Radiomic features (filter types: original, square, logarithm, exponential, wavelet; feature types: first order, texture, shape) were extracted from the MRI. The most significant radiomic features were selected and applied to quantify the imaging phenotype using random forest machine learning algorithms. Area under the curve (AUC), sensitivity, and specificity for predicting both the training and validation sets were computed with multiple-hypothesis correction.

Results

The radiologic difference in the maximum area and diameter of meningiomas between two groups was statistically significant. The tumor decreased in the treatment group. A total of 241 series and 1691 radiomic features were extracted from the training set. In univariate analysis, 24 radiomic features were significantly different (P < 0.05) between both groups. Best subsets were one original, three first-order, and six wavelet-based features, with an AUC of 0.87, showing significant differences (P < 0.05) in multivariate analysis. When applying the model, AUC was 0.76 and 0.79 for the training and validation set, respectively.

Conclusion

In meningioma cases, better size reduction can be expected after radiation treatment. The radiomic model using MRI showed significant changes in radiomic features after radiation treatment.
First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors
Authors: Abdo Ritbano , Demelash Minychil , Seid Abdulrezak Mohammed , Mussema Abdulhakim
Published: October 2023

Background

Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa.

Methods

Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger’s test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis.

Results

A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3–41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5–3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2–1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4–2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2–2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5–2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7–2.1; I2 = 94.4%).

Conclusion

Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women.

Trial registration

PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).
Recanalization of Xen45 gel stent implant occlusion using 10 − 0 nylon suture in refractory glaucoma: a case report
Authors: Zhang Yao , Xiang Haotian , Zhang Yangyang , Tang Li
Published: October 2023

Background

Xen Gel Stent implant is a new minimally invasive surgical treatment for glaucoma that has been proven effectiveness and safety profile. However, it may also lead to some complications. Xen Gel Stent occlusion is a relatively rare complication reported less frequently and has limited treatment experience. In our case report, we proposed a novel surgical treatment using a 10 − 0 nylon suture to successfully recanalize the occluded Xen45 Gel Stent.

Case presentation

A 16-year-old female patient had bilateral juvenile glaucoma for the past 5 years. Her right eye had undergone three glaucoma surgeries but failed. At a presentation to our hospital, the right eye’s intraocular pressure (IOP) was 30 mmHg despite applying four different active principles. Xen45 Gel Stent implant was chosen for treatment, but six days after implantation, the IOP rose to 40 mmHg as a result of an anterior chamber tip occlusion of the Xen45 Gel Stent. Nd: YAG laser shockwave therapy was attempted but failed. The patient eventually had to return to the operating room for a revision procedure. The Xen45 Gel Stent was recanalized from the ab externo by making an L-shaped conjunctival incision at the fornix base and threading a 10 − 0 nylon suture through it. The IOP was successfully controlled in the 11-month follow-up without medication.

Conclusion

If postoperative occlusion arises after Xen45 Gel Stent implantation, surgery using 10 − 0 nylon suture to recanalize Xen45 Gel Stent should be considered as a relatively safe, effective that does not require removal of Xen45 Gel Stent.
The Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study: a protocol
Authors: Rohsiswatmo Rinawati , Hikmahrachim Hardya Gustada , Sjahrulla Muhamad Azharry Rully , Marsubrin Putri Maharani Tristanita , Kaban Risma Kerina , Roeslani Rosalina Dewi , Iskandar Adhi Teguh Perma , Sukarja Distyayu , Kautsar Ahmad , Urwah Ivo , Gunardi Hartono , Devaera Yoga
Published: October 2023

Background

Indonesia has high numbers of preterm birth, i.e., around 600,000 preterm births annually. It imposes a significant burden on the Indonesia’s healthcare system. Indonesia therefore requires its own evidence-based reference to manage premature neonates and ex-preterm infants who subsequently survived. No long-term study on preterm infants in Indonesia has been conducted, therefore we aim to evaluate growth and development on ex-preterm infants until the pre-pubertal stage.

Methods

We at the Cipto Mangunkusumo General Hospital (CMGH) designed a prospective cohort study of preterm infants, i.e., the Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study. At least 500 subjects will be recruited with an estimation of two-year recruitment (i.e., the recruitment phase will be completed before 2024). The CIPTO study will observe long-term outcomes of ex-preterm infants, primarily on growth and developmental milestones until 8 years old. Aims of this study are to determine the ex-preterm outcomes and to generate an evidence-based reference of preterm care for ensuring optimum outcomes. The pre-specified long-term outcomes in this study are survival rates, growth outcomes, neurodevelopmental outcomes, feeding behavior, as well as hearing and vision impairments. Growth and neurodevelopmental outcomes will be assessed at 0, 2, 4, 6, 9, 12, 15, 18 and 24 months of corrected age as well as at 3, 4, 5, 6, 7 and 8 years old.

Discussion

The CIPTO study is the first prospective cohort in Indonesia focusing on preterm infants born at the CMGH. With a follow up until 8 years old, this study may provide useful insights to generate an evidence-based, Indonesia’s health care reference in managing premature infants and ensuring the optimum outcomes of ex-preterm infants.
Regional disparities in food security and depression among single-person households in the Republic of Korea
Authors: Kim Seong-Ah , Choi Seul Ki
Published: October 2023

Background

Single-person households constitute over 40% of all households in the Republic of Korea and are more vulnerable to food insecurity and depression than multi-person households. There is a lack of research on examining whether regional characteristics are associated with the degree of food insecurity and depression among single-person households. This study aimed to examine the regional disparities in food security and depression among single-person households in the Republic of Korea.

Methods

A total of 227,873 adults from the 2019 Korean Community Health Survey was included in the analysis. According to population density and poverty rate, the residence of the participants was classified into four regions: metropolitan areas with high population density were classified into areas with low poverty rates (Region 1) and high poverty rates (Region 2), and provinces with low population density were classified into areas with low poverty rates (Region 3) and high poverty rates (Region 4). Using a single item of household food security, those who had experienced a lack of food due to financial difficulties over the past year were classified as food insecure. Depression was measured using the Patient Health Questionnaire-9. Odds ratios and 95% confidence intervals (CI) for the risk of food insecurity and depression according to regional characteristics were calculated after adjusting for potential confounding variables.

Results

After adjusting for confounding variables, single-person households in regions with high population density, Regions 1 and 2, had 1.16 times (95% CI = 1.04–1.30) and 1.43 times (95% CI = 1.27–1.61) higher odds of food insecurity, respectively, compared to those in Region 4. Single-person households in regions with low poverty rates, Regions 1 and 3, had 1.54 times (95% CI = 1.34–1.77) and 1.21 times (95% CI = 1.01–1.46) higher odds of depression, respectively, than those in Region 4. Among those who lived alone, the middle-aged, having low income, receiving livelihood benefits, or having a low educational attainment had higher odds of experiencing both food insecurity and depression than their counterparts.

Conclusions

As the risk of food insecurity and depression in single-person households differs according to regional characteristics, local governments need to implement policies for single-person households in consideration of these distinct characteristics.
The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment
Authors: Mei Yujin , Yang Xue , Gui Jiaofeng , Li Yuqing , Zhang Xiaoyun , Wang Ying , Chen Wenyue , Chen Mingjia , Liu Changjun , Zhang Lin
Published: October 2023

Background

Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.

Methods

From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.

Results

(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."

Conclusions

Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.
Prevalence of adolescent-reported food insecurity and the determinants including coping strategies living in urban slum communities of Bangladesh during the era of COVID-19: a cross-sectional study
Authors: Yasmin SM Taniya , Yasmin SM Taslima , Sultan Sarah , Hong Seo Ah
Published: October 2023

Background

As food insecurity (FI) continues to rise worldwide especially in developing countries like Bangladesh, adolescent experience of FI have received minimal attention globally. This study aimed to identify the prevalence of adolescent-reported FI and its association with individual and socio-environmental factors as well as coping strategies amongst a sample of adolescents living in urban slum areas of Bangladesh in the times of the Coronavirus 19 (COVID-19) pandemic.

Methods

A descriptive cross sectional study was conducted amongst 326 adolescents (12–18 years) living in the urban slums of Narayanganj, Dhaka from April to May, 2022. Adolescent-reported FI was assessed using a structured questionnaire adopted from Household Food Insecurity Access Scale (HFIAS). Descriptive statistics, Chi-square tests and ordinal logistic regression were used to draw inference.

Results

Prevalence of adolescent-reported FI was high (46.6% moderate and 29.8% severe). The likelihood of experiencing moderate or severe FI versus no/mild FI were 1.7 times (95% Confidence Interval (CI) [1.1, 2.5]) higher in younger adolescents and 5 times (95% CI [2.3, 12.7]) higher in unemployed youth. Socio-environmental factors determining the economic status of a household such as higher number of family members, only one earning family member, unemployed father, no household assets, food aid received by the family during pandemic and positive COVID-19 infection in family were associated with moderate and severe FI. Coping strategies such as a higher number of food seeking strategies (Adjusted Odds Ratio (AOR) 3.4, 95% CI [1.9, 5.9]), substance use (AOR 6.2, 95% CI [1.2, 31.7]) and stopping school (AOR 3.3, 95% CI [1.9, 5.7]) increased odds for moderate and severe FI. Stratified by drop-out of school status, an association between food seeking strategies and FI remained significant among those school-going, while there was no association among those dropping out of school.

Conclusion

This study showed that adolescents living in urban slum communities in Bangladesh are at very high risk of FI and resort to harmful coping strategies. Our study highlights the importance of further research in adolescent reported FI and coping strategies in low to middle income countries (LMICs) and create appropriate interventions to lower FI among this group and improve their state of health and wellbeing.
Effects of pulmonary air leak on patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis
Authors: Zhong Zhuan , Guo Jia , Li Xingzhao , Han Yingying
Published: October 2023

Background

Coronavirus disease 2019 (COVID-19) has posed increasing challenges to global health systems. We aimed to understand the effects of pulmonary air leak (PAL), including pneumothorax, pneumomediastinum and subcutaneous emphysema, on patients with COVID-19.

Methods

We searched PubMed, Embase and Web of Science for data and performed a meta-analysis with a random-effects model using Stata 14.0. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Thirty-five articles were included in the meta-analysis. The data came from 14 countries and included 3,047 COVID-19 patients with PAL, 11,3679 COVID-19 patients without PAL and 361 non-COVID-19 patients with PAL. We found that the incidence of PAL was much higher in COVID-19 patients than in non-COVID-19 patients (odds ratio (OR) = 6.13, 95% CI: 2.09–18.00). We found that the group of COVID-19 patients with PAL had a longer hospital stay (standardized mean difference (SMD) = 0.79, 95% CI: 0.27–1.30) and intensive care unit (ICU) stay (SMD = 0.51, 95% CI: 0.19–0.83) and comprised more ICU (OR = 15.16, 95% CI: 6.51–35.29) and mechanical ventilation patients (OR = 5.52, 95% CI: 1.69–17.99); furthermore, the mortality rate was also higher (OR = 2.62, 95% CI: 1.80–3.82).

Conclusions

Patients with lung injuries caused by COVID-19 may develop PAL. COVID-19 patients with PAL require more medical resources, have more serious conditions and have worse clinical outcomes.

PROSPERO registration number

CRD42022365047.
Correlation between vitamin D levels in serum and the risk of dental caries in children: a systematic review and meta-analysis
Authors: Li Zizhan , Wei Xiao , Shao Zhongjun , Liu Huan , Bai Shizhu
Published: October 2023

Background

Vitamin D plays a crucial role in oral health, and its deficiency is associated to significant changes in oral health diseases. We aimed to explore the relationship between levels of 25-hydroxyvitamin D (25(OH) D) and dental caries in children.

Methods

Four electronic databases were searched by two investigators including PubMed, Embase, Web of Science, and Cochrane Library. Dental caries results were presented as either prevalence or based on the index of primary and permanent teeth/surfaces with decaying, missing, and filled areas, while vitamin D levels were determined through laboratory testing. Two researchers independently selected studies, collected information, assessed risk of bias, and evaluated the study quality. Any disagreements were resolved through discussion.

Results

A total of 13 studies were included, comprising 5 cross-sectional studies, 5 cohort studies, 3 case–control studies, all of which had high methodological quality. Our meta-analysis showed that children with vitamin D deficiency had a 22% higher risk of dental caries than those with normal vitamin D levels, with a relative risk (RR) of 1.22 and a 95% confidence interval (CI) of 1.18 to 1. 25. Further subgroup analysis according to the three types of studies showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (cohort studies: 62%; cross-sectional studies, 19%; and case–control studies, 5%). Additionally, according to age, subgroup analysis also showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (permanent teeth studies, 28%; deciduous teeth studies, 68%; and mixed dentition studies 8%).

Conclusions

Levels of 25 (OH) D have been found negatively associated with dental caries in children, indicating that low vitamin D levels may be considered a potential risk factor to this dental disease.
Application and interpretation of machine learning models in predicting the risk of severe obstructive sleep apnea in adults
Authors: Shi Yewen , Zhang Yitong , Cao Zine , Ma Lina , Yuan Yuqi , Niu Xiaoxin , Su Yonglong , Xie Yushan , Chen Xi , Xing Liang , Hei Xinhong , Liu Haiqin , Wu Shinan , Li Wenle , Ren Xiaoyong
Published: October 2023

Background

Obstructive sleep apnea (OSA) is a globally prevalent disease with a complex diagnostic method. Severe OSA is associated with multi-system dysfunction. We aimed to develop an interpretable machine learning (ML) model for predicting the risk of severe OSA and analyzing the risk factors based on clinical characteristics and questionnaires.

Methods

This was a retrospective study comprising 1656 subjects who presented and underwent polysomnography (PSG) between 2018 and 2021. A total of 23 variables were included, and after univariate analysis, 15 variables were selected for further preprocessing. Six types of classification models were used to evaluate the ability to predict severe OSA, namely logistic regression (LR), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), bootstrapped aggregating (Bagging), and multilayer perceptron (MLP). All models used the area under the receiver operating characteristic curve (AUC) was calculated as the performance metric. We also drew SHapley Additive exPlanations (SHAP) plots to interpret predictive results and to analyze the relative importance of risk factors. An online calculator was developed to estimate the risk of severe OSA in individuals.

Results

Among the enrolled subjects, 61.47% (1018/1656) were diagnosed with severe OSA. Multivariate LR analysis showed that 10 of 23 variables were independent risk factors for severe OSA. The GBM model showed the best performance (AUC = 0.857, accuracy = 0.766, sensitivity = 0.798, specificity = 0.734). An online calculator was developed to estimate the risk of severe OSA based on the GBM model. Finally, waist circumference, neck circumference, the Epworth Sleepiness Scale, age, and the Berlin questionnaire were revealed by the SHAP plot as the top five critical variables contributing to the diagnosis of severe OSA. Additionally, two typical cases were analyzed to interpret the contribution of each variable to the outcome prediction in a single patient.

Conclusions

We established six risk prediction models for severe OSA using ML algorithms. Among them, the GBM model performed best. The model facilitates individualized assessment and further clinical strategies for patients with suspected severe OSA. This will help to identify patients with severe OSA as early as possible and ensure their timely treatment.

Trial registration

Retrospectively registered.