bluuebunny/crossref_metadata_2025 huggingface dataset:
At home and abroad: Comparing sustainable behaviour and willingness to pay across contexts
Authors: Dodds Rachel , Holmes Mark Robert
Published: December 2023

Does a person’s everyday behavior at home influence their desire to travel sustainably and pay for it? Testing the Holmes, Dodds and Frochot (HDF) model, this research sought to understand the influence that daily behavior – measured by frugality, altruism, and pro-environmental behavior – has on both sustainable travel behavior and a traveler’s propensity to pay. This paper augments the HDF model in that it finds sustainable travel behavior to be not just a single construct, but rather influenced separately by sociocultural, environmental and local consumption behaviors. Second, this study also examines how these differences in sustainable travel influence the traveler’s propensity to pay. The findings of this study explain that day-to-day behavior at home does explain a traveler’s propensity to pay for sustainability efforts when traveling. Those who are more altruistic are more likely to be more environmentally friendly and more likely to look for local experiences when traveling. Those who are more environmentally minded at home are also more likely to seek out cultural, environmentally friendly and local experiences when traveling. In contrast, those who are more frugal are less likely to be environmentally friendly when traveling.
Lighting the Path for Incoming Special Education Teachers: Advice From Special Educators on AAC Practices
Authors: Young Rachel D. , Da Fonte Alexandra M. , Boesch Miriam C. , Shiheiber Hanneh S. , Neff Gillian C.
Published: December 2023

Special education teachers have students in their classrooms with a variety of needs, and it is their responsibility to meet these needs for all students. Research shows special education teachers oftentimes enter the field with limited knowledge and skills to serve students with complex communication needs. The lack of background in augmentative and alternative communication practices is detrimental, as communication skills are fundamental for students’ independence. To better understand the needs of special education teachers, a survey was conducted to identify recommendations from the experts, U.S. in-service special education teachers, to incoming educators on augmentative and alternative practices. Results show that certain participant demographics impacted the recommendations offered to incoming special education teachers. Practical implications for incoming special education teachers, school administrators, and teacher preparation programs are discussed, along with suggestion for future research directions.
Deserted myths and nuclear realities: Revisiting the symbolism of nuclear weapons in contemporary popular culture through Oppenheimer (2023)
Authors: Faux Emily
Published: December 2023

This article makes a necessary intervention in Critical Nuclear Studies which thus far lacks engagement with popular culture since the Cold War. There is a significant gap in our knowledge about contemporary representations of nuclear weapons and their significance for nuclear politics in the current moment. Using Oppenheimer (2023) as a catalyst, this article navigates a setting central to the origin story of nuclear weapons: the desert. The desert is shown to have a complex literal and symbolic history that is intertwined with nuclear politics and contributes to nuclear weapons’ continued mythological status in an age defined by an increasingly partisan trust and distrust in science. The desert setting in popular culture exemplifies the paradoxical and contradictory meanings of nuclear weapons and war. The desert is both the symbolic frontier to the land of opportunity and freedom, and a land of isolation and nothingness. In a retelling of the story of the Manhattan Project – the ‘origin story’ of nuclear weapons – Oppenheimer (2023) offers an opportunity to navigate these tropes in the current moment. Navigating competing representations of nuclear weapons and war reveals some of the hidden logics and relations of power that remain at the foundations of nuclear knowledge – from high politics to popular culture.
Comparison of hamate versus second or third toe osteochondral graft using magnetic resonance imaging for reconstruction of proximal interphalangeal fracture-dislocations
Authors: Hamilton Sam , Troupis Christopher , Hong Trudy , Tran Anthony , Troupis John , Leong James C. S.
Published: December 2023

Hemi-hamate arthroplasty is a method used to reconstruct complex fracture-dislocations of the proximal interphalangeal joint of the fingers. Other graft sites, including the toe second and third phalanges, have been proposed as alternatives to hemi-hamate arthroplasty due to variable clinical outcomes and anatomy. Through a prospective magnetic resonance imaging (MRI)-based study in asymptomatic individuals, we aimed to characterize the anatomy of the proximal interphalangeal joint and compare this with the hamate, second and third toes to determine the closest anatomical match using pre-determined measurements. Our results show that the second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. High-resolution MRI is a reliable method of characterizing the anatomy of these structures and could be a useful clinical tool in determining reconstructive options in the management of this challenging injury.

Level of evidence: II
Clinical characteristics, treatments, and outcomes of interferon-beta-induced thrombotic microangiopathy: a literature-based retrospective analysis
Authors: Wang Chunjiang , Fang Weijin , Sun Wei , Zhao Shaoli , Peng Liping
Published: December 2023

Background:

Thrombotic microangiopathy (TMA) is a rare side effect of interferon-beta (IFN-β) therapy. The clinical characteristics of IFN-β-induced TMA are unknown.

Objectives:

To explore the clinical characteristics of IFN-β-induced TMA and provide reference for the prevention of TMA.

Design:

Articles on IFN-β-induced TMA were collected by searching the literature in relevant Chinese and English databases from inception to 31 July 2023.

Methods:

Data in the articles were extracted and analyzed retrospectively.

Results:

Forty-seven patients, with a median age of 41 years (range 22, 66), were included in the analysis. The median time to the diagnosis of IFN-β-induced TMA was 8 years (range 0.1–30) after administration. The main clinical symptoms were neurological symptoms (51.1%), hypertension (78.7%), dyspnea (19.1%), edema (19.1%), asthenia/fatigue (19.1%), and digestive symptoms (17.0%). Most patients presented with hemolytic anemia (76.6%), thrombocytopenia (63.8%), and acute kidney injury (70.2%). All patients stopped IFN-β and received plasma exchange therapy (53.2%), systemic steroids (46.8%), antihypertensive therapy (46.8%), eculizumab (12.8%), and rituximab (12.8%). Kidney damage was not completely reversible; 40.4% of patients achieved renal function and hematology remission, 27.7% developed chronic kidney disease, 25.5% developed end-stage renal disease, and 2.1% died.

Conclusion:

IFN-β-induced TMA is a rare but serious complication that can be life-threatening. It may occur after many years of IFN-β therapy, and patients taking IFN-β should be monitored for symptoms such as headache and hypertension.
Race and Gender Representation in College and Career Readiness Research for Students With Emotional Behavioral Disorders
Authors: Freeman Jennifer , Carter Devon , Kern Lee , Liang Chris , Rosati Sarah , Sinnott Sarah , Mui Vivian
Published: December 2023

The purpose of this review was to investigate the extent to which students with emotional and behavioral disorders (EBD) are adequately represented in and benefiting from college and career readiness (CCR) intervention research across race and gender groups. We conducted a secondary analysis of 14 intervention studies meeting the criteria for a prior systematic literature review examining CCR for U.S. students with and at risk for emotional and behavioral problems. We found that the majority (86%) of studies reported the race and gender of participants and more recent studies were more likely to have included this information. Students with EBD are more likely to be Black and identify as male, while the participants in our study samples were more likely to be White/Caucasian and identify as female. All studies reported gender exclusively within a gender binary. Furthermore, only three studies provided overall school or district demographics, allowing the reader to assess the extent to which the participants were representative of the school/district population. Finally, only two studies parceled out findings by race, making it difficult to assess the overall extent to which interventions for CCR are effective for students across race and gender groups. Given the high priority currently placed on preparing all students for college and career, these findings have important implications for practitioners, researchers, and policymakers.
CircZNF609 regulates pulmonary fibrosis via miR-145-5p/KLF4 axis and its translation function
Authors: Sun Wenqing , Zhou Siyun , Peng Lan , Liu Yi , Cheng Demin , Wang Yue , Ni Chunhui
Published: December 2023

Background

Pulmonary fibrosis is a growing clinical problem that develops as a result of abnormal wound healing, leading to breathlessness, pulmonary dysfunction and ultimately death. However, therapeutic options for pulmonary fibrosis are limited because the underlying pathogenesis remains incompletely understood. Circular RNAs, as key regulators in various diseases, remain poorly understood in pulmonary fibrosis induced by silica.

Methods

We performed studies with fibroblast cell lines and silica-induced mouse pulmonary fibrosis models. The expression of circZNF609, miR-145-5p, and KLF4 was determined by quantitative real-time polymerase chain reaction (qRT-PCR) analysis. RNA immunoprecipitation (RIP) assays and m6A RNA immunoprecipitation assays (MeRIP), Western blotting, immunofluorescence assays, and CCK8 were performed to investigate the role of the circZNF609/miR-145-5p/KLF4 axis and circZNF609-encoded peptides in fibroblast activation.

Results

Our data showed that circZNF609 was downregulated in activated fibroblasts and silica-induced fibrotic mouse lung tissues. Overexpression of circZNF609 could inhibit fibroblast activation induced by transforming growth factor-β1 (TGF-β1). Mechanically, we revealed that circZNF609 regulates pulmonary fibrosis via miR-145-5p/KLF4 axis and circZNF609-encoded peptides. Furthermore, circZNF609 was highly methylated and its expression was controlled by N6-methyladenosine (m6A) modification. Lastly, in vivo studies revealed that overexpression of circZNF609 attenuates silica-induced lung fibrosis in mice.

Conclusions

Our data indicate that circZNF609 is a critical regulator of fibroblast activation and silica-induced lung fibrosis. The circZNF609 and its derived peptides may represent novel promising targets for the treatment of pulmonary fibrosis.
Tuberculosis reactivation demonstrated by choroiditis and inflammatory choroidal neovascular membrane in a patient treated with immune checkpoint inhibitors for malignant mucosal melanoma
Authors: Murphy Melissa L. , Rogers Duncan
Published: December 2023

Purpose

To describe a complex case of ocular tuberculosis reactivation with anterior uveitis, choroiditis and inflammatory choroidal neovascular membrane (CNVM) following immune checkpoint inhibitor (ICPI) treatment of malignant mucosal melanoma.

Methods

A retrospective collection of medical history, clinical findings and multimodal imaging with literature review of the topic was conducted.

Results

A 52-year-old Romanian female developed reduced vision and photophobia after three cycles of ICPI therapy comprised of ipilimumab and nivolumab. Bilateral anterior uveitis, multiple left eye choroidal lesions and a CNVM were confirmed using slit-lamp examination with ancillary multimodal imaging. Retinal changes in the right eye as well as a history of previously treated posterior uveitis and high-risk ethnicity increased clinical suspicion for ocular tuberculosis (TB) reactivation. The diagnosis was confirmed by TB positivity on polymerase chain reaction (PCR) analysis of lung aspirate followed by significant clinical improvement on systemic anti-tubercular therapy (ATT), systemic steroids and anti-vascular endothelial growth factor (VEGF) therapy.

Conclusions

ICPIs can cause a myriad of ocular issues, both by primary immunomodulatory effects as well as secondary reactivation of latent disease.
Identification of the CONSTANS-like family in Cymbidium sinense, and their functional characterization
Authors: Lu Youfa , Li Tengji , Zhao Xiaolan , Wang Mingjun , Huang Jiexian , Huang Ziqin , Teixeira da Silva Jaime A. , Duan Jun , Si Can , Zhang Jianxia
Published: December 2023

Background

Cymbidium sinense is an orchid that is typically used as a potted plant, given its high-grade ornamental characteristics, and is most frequently distributed in China and SE Asia. The inability to strictly regulate flowering in this economically important potted and cut-flower orchid is a bottleneck that limits its industrial development. Studies on C. sinense flowering time genes would help to elucidate the mechanism regulating flowering. There are very few studies on the genetic regulation of flowering pathways in C. sinense. Photoperiod significantly affects the flowering of C. sinense, but it was unknown how the CONSTANS gene family is involved in regulating flowering.

Results

In this study, eight CONSTANS-like genes were identified and cloned. They were divided into three groups based on a phylogenetic analysis. Five representative CsCOL genes (CsCOL3/4/6/8/9) were selected from the three groups to perform expression characterization and functional study. CsCOL3/4/6/8/9 are nucleus-localized proteins, and all five CsCOL genes were expressed in all organs, mainly in leaves followed by sepals. The expression levels of CsCOL3/4 (group I) were higher in all organs than other CsCOL genes. Developmental stage specific expression revealed that the expression of CsCOL3/4/9 peaked at the initial flowering stage. In contrast, the transcript level of CsCOL6/8 was highest at the pedicel development stage. Photoperiodic experiments demonstrated that the transcripts of the five CsCOL genes exhibited distinct diurnal rhythms. Under LD conditions, the overexpression of CsCOL3/4 promoted early flowering, and CsCOL6 had little effect on flowering time, whereas CsCOL8 delayed flowering of Arabidopsis thaliana. However, under SD conditions, overexpression of CsCOL4/6/8 promoted early flowering and the rosette leaves growth, and CsCOL3 induced flower bud formation in transgenic Arabidopsis.

Conclusion

The phylogenetic analysis, temporal and spatial expression patterns, photoperiodic rhythms and functional study indicate that CsCOL family members in C. sinense were involved in growth, development and flowering regulation through different photoperiodic pathway. The results will be useful for future research on mechanisms pertaining to photoperiod-dependent flowering, and will also facilitate genetic engineering-based research that uses Cymbidium flowering time genes.
Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis
Authors: Gupta Nitin , Boodman Carl , Jouego Christelle Genevieve , Van Den Broucke Steven
Published: December 2023

Introduction

Scrub typhus is a bacterial mite-borne disease associated with poor clinical outcomes if not treated adequately. The study aimed to compare the time to defervescence, clinical failure, mortality and treatment-related adverse effects of two common drugs (doxycycline and azithromycin) used for its treatment.

Methodology

This was a systematic review and meta-analysis. All studies up to 20.03.2023 were screened for eligibility in Pubmed and Embase using a search string containing terms related to scrub typhus, doxycycline and azithromycin. After two phases of screening, all comparative studies where doxycycline and azithromycin were used to treat scrub typhus were included. The studies were critically appraised using standardised tools, and a meta-analysis was performed for time to defervescence (primary outcome), clinical failure, mortality and treatment-related adverse effects.

Results

Of 744 articles from two databases, ten were included in the meta-analysis. All but two studies had a high risk of bias. The meta-analysis for time to defervescence had a high heterogeneity and did not show any significant difference between doxycycline and azithromycin arms [Mean difference of -3.37 hours (95%CI: -10.31 to 3.57), p=0.34]. When the analysis was restricted to studies that included only severe scrub typhus, doxycycline was found to have a shorter time to defervescence [mean difference of -10.15 (95%CI: -19.83 to -0.46) hours, p=0.04]. Additionally, there was no difference between the two arms concerning clinical failure, mortality and treatment-related adverse effects.

Conclusion

The current data from studies with a high risk of bias did not find statistically significant differences in clinical outcomes between doxycycline and azithromycin for scrub typhus
No association between blood-based markers of immune system and migraine status: a population-based cohort study
Authors: Acarsoy Cevdet , Ruiter Rikje , Bos Daniel , Ikram M. Kamran
Published: December 2023

Background

Although some evidence implicates the immune system in migraine attacks, its role during attack-free periods remains largely unexplored. Therefore, we assessed the association between the immune system and migraine status.

Methods

From the population-based Rotterdam Study, we included 6593 participants who underwent blood sampling and migraine assessments. In the blood samples, we measured white blood-cell-based immune markers. As a marker for the innate immune system, granulocyte and platelet counts were determined, whereas lymphocyte counts were used as a marker for the adaptive immune system. Migraine was assessed using a validated questionnaire based on ICHD-2 criteria. We investigated associations between blood-cell counts and migraine using logistic regression models adjusting for age, sex and other variables.

Results

Mean age of participants was 65.6 ± 11.2 years and 56.7% were female. The lifetime prevalence of migraine was 15.1% (995/6593). We found no statistically significant associations between granulocyte (odds ratio [OR] per standard deviation increase 1.01 95% Confidence Interval [CI]: 0.93–1.09), platelet (OR 1.01 CI: 0.94–1.09) or lymphocyte counts (OR 1.01 CI: 0.93–1.08) and migraine status.

Conclusions

Our results do not support an association between white blood-cell-based immunity markers and migraine status.
The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis
Authors: Wang Yanchi , Gu Jian , Zhang Feng , Xu Xujuan
Published: December 2023

Background

Prenatal stress is a highly prevalent mental disorder experienced by pregnant women. This study assessed the prevalence and influencing factors of prenatal stress and investigated the mediating role of social support and resilience between self-efficacy and prenatal stress among pregnant women in China.

Methods

A convenience sample comprising 1071 pregnant women from three hospitals in Nantong, Jiangsu Province, China, was recruited between February and June 2023. These participants completed a set of general survey questionnaires and were assessed using the Pregnancy Pressure Scale, Perceived Social Support Scale, the 10-item Connor–Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. Furthermore, a hierarchical multiple regression model was employed to investigate the relevant factors and mediators of prenatal stress symptoms. A structural equation model was used to examine the mediating role of social support and resilience in the relationship between self-efficacy and prenatal stress.

Results

The results of the multivariate regression analysis indicated significant associations between prenatal stress and parity, self-efficacy, social support, and resilience (P < 0.001). Self-efficacy accounted for 35.33% of the total effect, with a direct effect of -2.5306 (95% confidence interval [CI]: -4.0309 to -1,0303). Further examination through mediation analysis revealed the mediating roles of social support and resilience in the relationship between self-efficacy and prenatal stress. The mediating effect of social support was − 1.5933 (95% CI: -2.2907 to -0.9496), accounting for 22.24% of the total effect. Similarly, resilience exhibited a mediating effect of -3.0388 (95% CI: -4.3844 to -1.7135), accounting for 42.43% of the total effect.

Conclusion

The mediation analysis revealed that among pregnant women in China, the influence of self-efficacy on prenatal stress is channelled through social support and resilience. Therefore, enhancing social support, resilience, and self-efficacy might alleviate prenatal stress.
Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study
Authors: Çaylan Nilgün , Yalçın Sıddika Songül , Tezel Başak , Üner Oben , Aydin Şirin , Kara Fatih
Published: December 2023

Background

The aim of this study is to examine the features of critical congenital heart disease (CCHD).

Methods

The study was planned as a retrospective cohort study. Data for the study were obtained through national data collection systems and 2018–2020 CCHD cohort was established. In this study, we divided the patients into two groups: Group 1 included seven primary target diseases of the newborn CCHD screening program and Group 2 included secondary target diseases.

Results

There were 9884 CCHD cases, with a prevalence of 27.8 per 10,000 live births. Of the cases 44.4% were in Group 1 (12.3 per 10,000) and 54.8% were in Group 2 (15.2 per 10,000). Of all cases 55.5% were male and the female/male ratio was 1/1.2. While 21.8% of the cases were premature, 23.0% were babies with low birth weight (LBW), 4.8% were born from multiple pregnancies. The highest prevalence of CCHD was found in LBW (84.8 per 10,000), premature infants (57.8 per 10,000) (p < 0.001). The fatality rate in the cohort was 16.6% in the neonatal period, 31.6% in the first year of life respectively. The mean estimated survival time in the birth cohort was 40.0 months (95% CI: 39.5–40.6). The mean survival time for Group 1 diseases was 33.4 months (95% CI: 32.5–34.2), while it was 45.4 months (95% CI: 44.7–46.0) for Group 2 diseases (p < 0.001). Preterm birth, LBW, maternal age and region were evaluated as factors associated with mortality risk.

Conclusion

This study showed that CCHDs are common in Turkey and mortality rates are high. There are regional differences in CCHD both prevalence and survival. Improving prenatal diagnosis rates and expanding neonatal CCHD screening are of key importance.
Development and validation of a pediatric model predicting trauma-related mortality
Authors: Evans Mary , Rajasekaran Karthik , Murala Anish , Moreira Alvaro
Published: December 2023

Objectives

To develop a prediction model of mortality in pediatric trauma-based injuries. Our secondary objective was to transform this model into a translational tool for clinical use.

Study design

A retrospective cohort study of children ≤ 18 years was derived from the National Trauma Data Bank between the years of 2007 to 2015. The goal was to identify clinical or physiologic variables that would serve as predictors for pediatric death. Data was split into a development cohort (80%) to build the model and then tested in an internal validation cohort (20%) and a temporal cohort. The area under the receiver operating characteristic curve (AUC) was assessed for the new model.

Results

In 693,192 children, the mortality rate was 1.4% (n = 9,785). Most subjects were male (67%), White (65%), and incurred an unintentional injury (92%). The proposed model had an AUC of 96.4% (95% CI: 95.9%-96.9%). In contrast, the Injury Severity Score yielded an AUC of 92.9% (95% CI: 92.2%-93.6%), while the Revised Trauma Score resulted in an AUC of 95.0% (95% CI: 94.4%-95.6%).

Conclusion

The TRAGIC + Model (Temperature, Race, Age, GCS, Injury Type, Cardiac-systolic blood pressure + Mechanism of Injury and Sex) is a new pediatric mortality prediction model that leverages variables easily obtained upon trauma admission.
Psychosocial factors of insomnia in depression: a network approach
Authors: Zhang Nan , Ma Simeng , Wang Peilin , Yao Lihua , Kang Lijun , Wang Wei , Nie Zhaowen , Chen Mianmian , Ma Ci , Liu Zhongchun
Published: December 2023

Background

Insomnia symptoms in patients with major depressive disorder (MDD) are common and deleterious. Childhood trauma, personality traits, interpersonal distress, and social support contribute to insomnia, but how they interact to affect insomnia remains uncertain.

Methods

A total of 791 patients with MDD completed the Insomnia Severity Index, Eysenck Personality Questionnaire, Interpersonal Relationship Comprehensive Diagnostic Scale, Childhood Trauma Questionnaire, Social Support Rating Scale and Hamilton Depression Scale-17. This study utilized network analyses to identify the central symptoms of insomnia and their associations with psychosocial factors.

Results

Worrying about sleep was identified as the central symptom in the insomnia network, insomnia and associated personality network, insomnia and associated interpersonal disturbance network, insomnia and associated childhood trauma network, insomnia and associated social support network, and the integrated network of insomnia symptoms and associated psychosocial factors. In the networks of insomnia symptoms and individual psychosocial factors, most psychosocial factors (other than childhood trauma) were directly or indirectly related to insomnia symptoms; however, neuroticism was the only factor directly associated with insomnia symptoms before and after controlling for covariates. In the final integrated network of insomnia symptoms and psychosocial factors, neuroticism was a bridge node and mediated the relationships of social support and interpersonal disturbances with insomnia symptoms, which is clearly presented in the shortest pathways.

Conclusions

Worrying about sleep and neuroticism were prominent in the integrated network of insomnia symptoms and associated psychosocial factors, and the edge between them connected psychosocial factors and insomnia symptoms in MDD patients.
National and regional economic inequalities in first- and second-hand tobacco consumption among women of reproductive ages in Iran
Authors: Arabi Samira , Jahanmehr Nader , Khoramrooz Maryam
Published: December 2023

Introduction

The epidemic of tobacco consumption is one of the major public health threats the world has been facing so far. This study was performed to investigate the economic inequalities in tobacco consumption among women of reproductive ages at national and regional levels in Iran.

Methods

We used data from 10,339 women of reproductive ages (18–49 years) who participated in Iran’s 7th Non-Communicable Disease Risk Factor Surveillance (STEPS). Wagstaff normalized concentration index and decomposition method were applied to measure economic inequalities in first- and second-hand tobacco consumption and determine their corresponding contributory factors, respectively.

Results

The prevalence of women’s first-hand tobacco consumption, and their exposure to second-hand smoke in the home, and workplace were 3.6%, 28.3%, and 8.4%, respectively. First- and second-hand tobacco consumption was significantly more concentrated among low-economic women. Exposure to home second-hand smoke, education, and economic status had the largest contributions to the measured inequality in first-hand tobacco consumption (48.9%, 38.9%, and 30.8%, respectively). The measured inequality in women’s secondhand smoke exposure at home was explained by their level of education (43.8%), economic status (30.3%), and residency in rural areas (18%), and at work by residency in rural areas (42.2%), economic status (38.8%), and level of education (32%). Our results also revealed diversity in the geographical distribution of inequalities in rural and urban areas and five regions of the country.

Conclusion

The present study highlighted the need for more enforcement of tobacco control rules and increasing tobacco taxes as general measures. Furthermore, there is a need for gender-sensitive initiatives at national and regional levels to educate, support, and empower low-economic women and households for tobacco cessation, and complying with restrictive smoking rules.
The mediating role of health literacy between the presence of chronic disease and psychological distress among older persons in Xi’an city of China
Authors: Guo Kun , Ouyang Jing , Minhat Halimatus Sakdiah
Published: December 2023

Background

The increased number of older persons in China, and the prevalence of most chronic diseases raised with age significantly increased the total disease burden. When a person ages, psychological distress happens when they are faced with stressors that they cannot cope with. Psychological distress refers to non-specific symptoms of depression, anxiety, and stress. Health literacy influences several health outcomes, such as emotional functioning among the population. The primary purpose of this study is to examine the mediator role of health literacy between the presence of chronic disease and psychological distress among older persons living in Xi’an city. Thus, this study used the Cognitive Behavior Theory (CBT) as a combination of the basic behavioral and cognitive psychology principles to explain the cognitive processes associated with psychological distress.

Methods

This study employs a quantitative research design using a cross-sectional survey of 300 older persons over 60 years living in the six urban districts of Xi’an city. Data were collected using the Health Literacy Questionnaire (HLQ) and the Depression Anxiety Stress Scale (DASS-21). This study employed descriptive statistics and inferential methods to analyze the data. The inferential methods applied structural equation modeling (SEM) to test the hypothesis of the mediator role of health literacy between the presence of chronic disease and psychological distress.

Results

In this study, chronic disease had an effect on health literacy among older persons living in Xi’an city (β=-0.047, p < 0.01); chronic disease impact on psychological distress among older persons living in Xi’an city (β = 0.047, p < 0.01); health literacy was identified effect on psychological distress among older persons in Xi’an city (β=-0.738, p < 0.001); health literacy as a partial mediator between chronic disease and psychological distress (β = 0.07, p < 0.01).

Conclusion

Psychological distress among older persons is affected by chronic disease and health literacy. Health literacy had a partial mediating effect on the presence of chronic disease and psychological distress. Improved health literacy measures should be considered when treating older persons with psychological distress.
Prevalence of type 2 diabetes (T2D) in Lebanon: association with inflammatory and infectious clinical markers
Authors: Chedid Pia , Sokhn Elie Salem
Published: December 2023

Background

Diabetes is a growing health concern in the Middle East, particularly in countries with high rates of obesity and unhealthy lifestyles. Therefore, this study aimed to determine the prevalence of type 2 diabetes (T2D) in Lebanon and its association with clinical markers of inflammation and infection.

Methods

This cross-sectional study examined retrospectively the medical laboratory record of 4093 patients from all Lebanese regions.

Prevalence of T2D and its association with age, gender, calcium, vitamin D (VitD), neutrophils-to-lymphocytes ratio (NLR), and C-reactive protein (CRP) were determined. The prevalence of infection in a subpopulation of 712 patients tested from blood, body fluid, sputum, swab, tissue, and urine samples and its etiology was also assessed.

Results

Overall, 17% (n = 690) of our participants had T2D, and the mean HbA1c was 5.9% ± 1.2. Age, gender, triglycerides, NLR, and calcemia were significantly associated with T2D. The prevalence of infections in a subgroup of 712 patients was 11.1% (n = 79). Urinary tract infections (UTIs) caused by Escherichia coli (E. coli) were the most common cause of infection, with the highest prevalence in the pre-diabetic group. Serum CRP level was significantly higher in the diabetic group than the pre-diabetic and control groups. Diabetic patients also presented a significantly higher percentage of NLR > 3 compared to the pre-diabetic and control groups.

Conclusion

The prevalence of T2D is increasing in the Lebanese population compared to prior reports. These results should be considered to guide effective public health preventive strategies.
Patterns of healthcare use among children with immigrant and non-immigrant backgrounds in 2019 and 2020: evidence from the CRIAS cohort study in the metropolitan area of Lisbon, Portugal
Authors: Muggli Zélia , Mertens Thierry E. , Amado Regina , Vaz Dora , Loureiro Helena , Martins Maria Rosário O.
Published: December 2023

Background

International migrant families may face various barriers in the access and use of health services. Evidence on immigrant children’s health care or prevention facilities’ utilisation patterns is scarce in Portugal. Therefore, the objectives of this study were to compare health services use between immigrant and non-immigrant children in the Metropolitan Area of Lisbon in 2019–2020 with the aim of informing public policies towards equitable access to, and use of health services.

Methods

The CRIAS (Health Trajectories of Immigrant Children) prospective cohort study enrolled 420 children (51.6% immigrant) born in 2015 and attending primary health care (PHC) services in 2019. We compared primary health care facilities and hospital paediatric emergency department (ED) utilisation patterns in the public National Health Service, together with reported private practitioners use, between immigrant and non-immigrant children in 2019 and 2020. The Pearson chi-squared test, Fisher-Freeman-Halton Exact test, two-proportion z-test and Mann‒Whitney U test were used to examine the differences between the two groups.

Results

In 2019, no significant differences in PHC consultations attendance between the two groups were observed. However, first-generation immigrant children (children residing in Portugal born in a non-European Union country) accessed fewer routine health assessments compared to non-immigrant children (63.4% vs. 79.2%). When children were acutely ill, 136 parents, of whom 55.9% were parents of non-immigrant children, reported not attending PHC as the first point of contact. Among those, nearly four times more non-immigrant children sought healthcare in the private sector than immigrant children (p < 0.001). Throughout 2019, immigrant children used ED more often than non-immigrant children (53.5% vs. 40.4%, p = 0.010), as their parents reported difficulties in accessing PHC. In 2020, during the COVID-19 pandemic, fewer immigrant children accessed PHC compared to non-immigrant children (70% vs. 80%, p = 0.018). Both non-immigrant and immigrant children reduced ED use by 2.5 times, with a higher decrease among immigrant children (46% vs. 34%). In both 2019 and 2020, over 80% of immigrant and non-immigrant children used ED for conditions classified as having low clinical priority.

Conclusion

Beyond identifying health care use inequalities between immigrant and non-immigrant children, the study points to urgent needs for public policy and economic investments to strengthen PHC for all children rather than for some.
What motivates individuals to share information with governments when adopting health technologies during the COVID-19 pandemic?
Authors: Peng Zixuan , Namyalo Prossy Kiddu , Chen Xu , Lv Mingjie , Coyte Peter C.
Published: December 2023

Background

While digital governance has been adopted by governments around the world to assist in the management of the COVID-19 pandemic, the effectiveness of its implementation relies on the collection and use of personal information. This study examines the willingness of individuals to engage in information-sharing with governments when adopting health technologies during the COVID-19 pandemic.

Methods

Data were obtained from a cross-sectional survey of 4,800 individuals drawn from 16 cities in China in 2021. Tobit regression models were used to assess the impacts of an array of determinants on an individual’s willingness to share information with governments when adopting health technologies.

Results

Individuals who perceived a higher level of helpfulness, risk, expectations from others, weariness toward privacy issues, and were sensitive to positive outcomes were more willing to share information with governments when adopting health technologies during the COVID-19 pandemic. Across all the subgroups, self-efficacy only reduced the willingness to share information with governments for individuals who spent more than seven hours per day online. The negative impacts of being sensitive to negative outcomes on the willingness to share information were only found among females and the less educated group.

Conclusions

This study revealed the seemingly paradoxical behavior of individuals who perceived high risks of sharing information and a sense of fatigue toward privacy issues yet continued to be willing to share their information with their governments when adopting health technologies during the COVID-19 pandemic. This work highlighted significant differential motivations for sharing information with governments when using health technologies during a pandemic. Tailored policies that resonate with population sub-groups were suggested to be proposed to facilitate crisis management in future situations.
Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol
Authors: Rosenstein Brent , Montpetit Chanelle , Vaillancourt Nicolas , Dover Geoffrey , Khalini-Mahani Najmeh , Weiss Christina , Papula Lee Ann , Melek Antonys , Fortin Maryse
Published: December 2023

Background

Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients’ outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.

Methods

This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.

Discussion

This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients’ pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.

Trial registration

NCT05823857, registered prospectively on April 27th, 2023.
The STAR care pathway for patients with chronic pain after total knee replacement: four-year follow-up of a randomised controlled trial
Authors: Bertram Wendy , Wylde Vikki , Howells Nick , Shirkey Beverly , Peters Tim J. , Zhu Liang , Noble Sian , Johnson Emma , Beswick Andrew D. , Moore Andrew , Bruce Julie , Walsh David , Eccleston Christopher , Gooberman-Hill Rachael
Published: December 2023

Background

The Support and Treatment After Replacement (STAR) care pathway is a clinically important and cost-effective intervention found to improve pain outcomes over one year for people with chronic pain three months after total knee replacement (TKR). We followed up STAR trial participants to evaluate the longer-term clinical- and cost-effectiveness of this care pathway.

Methods

Participants who remained enrolled on the trial at one year were contacted by post at a median of four years after randomisation and invited to complete a questionnaire comprising the same outcomes collected during the trial. We captured pain (co-primary outcome using the Brief Pain Inventory (BPI) pain severity and interference scales; scored 0–10, best to worst), function, neuropathic characteristics, emotional aspects of pain, health-related quality of life, and satisfaction. Electronic hospital informatics data on hospital resource use for the period of one to four years post-randomisation were collected from participating hospital sites. The economic evaluation took an National Health Service (NHS) secondary care perspective, with a four-year time horizon.

Results

Overall, 226/337 (67%) of participants returned completed follow-up questionnaires, yielding adjusted between-group differences in BPI means of -0.42 (95% confidence interval, CI (-1.07, 0.23); p = 0.20) for pain severity and − 0.64 (95% CI -1.41, 0.12); p = 0.10) for pain interference. Analysis using a multiple imputed data set (n = 337) showed an incremental net monetary benefit in favour of the STAR care pathway of £3,525 (95% CI -£990 to £8,039) at a £20,000/QALY willingness-to-pay threshold, leading to a probability that the intervention was cost-effective of 0.94.

Conclusions

The magnitude of the longer-term benefits of the STAR care pathway are uncertain due to attrition of trial participants; however, there is a suggestion of some degree of sustained clinical benefit at four years. The care pathway remained cost-effective at four years.

Trial registration

ISRCTN: 92,545,361.
Microbiological evaluation of conjunctival anopthalmic flora after using digital 3D-printed ocular prosthesis compared to conventional one: a randomized clinical trial
Authors: Tahmawy Yassmin A. , Mohamed Faten S. , Elfeki Suzan , Abd-ELLAH Mervat E.
Published: December 2023

Background

This study aims to assess the influence of using 3D-printed acrylic resin versus conventional Poly-methyl methacrylate (PMMA) for fabricating ocular prostheses on the biofilm and microbial flora of anophthalmic socket.

Methods

A randomized controlled trial was designed as a parallel group study. Participants were allocated randomly into two groups: the control group, which received conventionally fabricated ocular prostheses (CG, n = 11), and the test group, which received digitally 3D-printed ocular prostheses (DG, n = 11). Microbiological analysis was conducted before prosthesis insertion and three months after using the ocular prosthesis. Swab samples were inoculated on blood agar, MacConkey’s agar, and Sabouraud’s dextrose agar (SDA) for isolating Gram-positive, Gram-negative, and fungal organisms, respectively. Subsequently, the plates were incubated at 37 degrees Celsius for 48 h. Additionally, a validated questionnaire was used for subjective clinical evaluation, including parameters such as comfort level, socket discharge, lacrimation, and frequency of lubrication for each ocular prosthesis patient in both groups.

Results

Test group (DG, n = 11) exhibited a positive, though statistically insignificant, difference (p > 0.001) in microbial growth when compared to the control group (CG, n = 11). A statistically significant difference was observed in comfort levels between the two groups, with more comfort level within group II (test group) patients. While parameters such as discharge amount, discharge location, lacrimation and lubrication frequency displayed statistically insignificant differences between the two groups, all parameters showed improved results after three months of prosthesis use.

Conclusions

The choice of ocular prosthesis fabrication technique did not yield a statistically significant difference in anophthalmic flora. However, the 3D-printed acrylic resin, as an artificial eye material, displayed potential advantages in reducing the colonization of opportunistic pathogens. All subjective clinical evaluation parameters exhibited enhanced outcomes after three months of prosthesis use, emphasizing the need for an adaptation period during which patients complains are alleviated. In comparison with PMMA, 3D-printed acrylic resin showcased a certain degree of anti-colonization ability against pathogenic bacteria, along with a significant level of patient comfort, suggesting its potential as a promising material for ocular prostheses.

Trial registration

This parallel double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05584865, 18/10/2022.