bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacists’ perceptions of the new pharmaceutical vaccination service in Romania: a comprehensive first two-years evaluation
Authors: Buicu Corneliu-Florin , Naidin Mihaela-Simona , Chereches Marius Calin , Dimulescu Marina-Daniela , Turcu-Stiolica Adina
Published: January 2025

Introduction

Pharmacy-based vaccination services are now available in 56 countries, including Romania, that started administering the flu-vaccines in the community pharmacies from 2022. Assessing how pharmacists managed this new pharmaceutical service in Romania is the subject of this study.

Methods

A cross-sectional study was conducted among all the pharmacies from Romania that were authorized to provide this service (442 pharmacies, from which 53 were in rural areas). An online survey was created using Google Forms and included 28 items, with 24 closed-ended questions and 4 open-ended questions. The questionnaire covered six sections: General information, Patient perspective, Authorization and training within the pharmacy, Administration of flu vaccine services, Pharmacy logistics, and Staff satisfaction. Descriptive statistics and chi-squared tests were applied.

Results

In total, 180 pharmacists participated (response rate was 41%), and the respondents were the pharmacists who administered flu vaccines in these pharmacies. Among the respondents, 92.8% were from urban community pharmacies, and most of them were from Bucharest (26.1%) and East Romania. 88% of respondents considered that this new service will significantly impact the future increase in vaccine coverage rates in Romania. Regarding patients’ perception of this pharmaceutical service (provided by pharmacists), the vaccination service was evaluated very positively by 63% patients and positively by 18% patients, with statistically different perceptions between the types of the pharmacies (p < 0.01). A very positive vaccination evaluation was observed more often among national chain pharmacies (73.1%) rather than among local chain pharmacies (35.9%) or independent pharmacies (36.4%). Regarding logistical barriers, 39% of pharmacies reported no issues with vaccine supply. Moreover, 97% of pharmacies had adequate protective materials to safely administer vaccines. In terms of overall satisfaction, 23% of pharmacists reported being very satisfied, while 39% indicated they were satisfied with the new pharmaceutical service they were providing. The majority (82%) felt that their salaries should be increased related to the vaccination service. Additionally, there is a need for improvements in the pharmacy schedule and the advance scheduling of vaccinations.

Conclusion

This study was developed to assist future health policies through expansion of advanced pharmaceutical services, and adding other vaccines to community pharmacy portfolios.
Decursinol angelate relieves inflammatory bowel disease by inhibiting the ROS/TXNIP/NLRP3 pathway and pyroptosis
Authors: Wang Yudi , Wang Jiamin , Chen Yonghu , Li Xuezheng , Jiang Zhe
Published: January 2025

Introduction

Despite evidence of the efficacy of decursinol angelate (DA), a prescription medication derived farom traditional Chinese medicine, in alleviating inflammatory bowel disease (IBD), the precise mechanisms behind its action remain unclear.

Methods

Lipopolysaccharides (LPS) and dextran sodium sulfate (DSS) induction were used as in vitro and in vivo models of IBD, respectively, to assess the role of DA in alleviating IBD. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the expression levels of pro-inflammatory cytokines in mouse serum, Western blot was performed to detect the expression of TXNIP/NLRP3 pathway tight junction (TJ) proteins in colon tissues and cells, and immunohistochemistry, immunofluorescence and immunohistochemistry, immunofluorescence and qRT-PCR were used to validate the proteins related to this signaling pathway. Molecular docking technique and co-immunoprecipitation (Co-IP) method assay were applied to evaluate the targeting effect of DA on NLRP3 proteins, and MCC950, a specific inhibitor of NLRP3, was used as a positive control for validation.

Results

Our research indicates that DA’s distinctive molecular mechanism could entail binding to the NLRP3 protein, thereby suppressing the activation of the NLRP3 pathway and diminishing the assembly and activation of the NLRP3 inflammasome, thus functioning as an anti-inflammatory agent.

Conclusion

DA may play a role in improving BD by inhibiting the activation of the ROS/TXNIP/NLRP3 signaling pathway and the release of inflammatory mediators, and by repairing the intestinal barrier function.
Huoxiang Zhengqi dropping pills alleviate exertional heat stroke–induced multiple organ injury through sustaining intestinal homeostasis via regulating MAPK/NF-κB pathway and gut microbiota in rats
Authors: Li Lei , Ma Jun , Li Zeshi , Chen Juelin , Zhou Jiawei , Wang Yawei , Pei Yankun , Gong Yitong , You Jianyao , Cao Yangyang , Wang Man , Chen Jikuai , Chang Wenjun , Ma Weiyi , Zhu Hanyu , Xiang Chuhan , Xu Shuogui , Song Qing
Published: January 2025

Exertional heat stroke (EHS) is a life-threatening condition characterized by hyperthermia and multi-organ dysfunction, often associated with intestinal barrier disruption. This study evaluated the protective effects of Huoxiang Zhengqi Dropping Pills (HXZQD) against EHS in a rat model. HXZQD was administered via oral gavage at low, medium, and high doses, followed by EHS induction through exercise under high-temperature and high-humidity conditions. The findings revealed that high-dose HXZQD significantly delayed the onset of EHS, reduced core body temperature elevations, and mitigated multi-organ injury, as evidenced by biochemical markers and histopathological examination. This study showed that HXZQD alleviated EHS-induced intestinal damage by preserving barrier proteins (ZO-1, Occludin, and Ecadherin) and maintaining intestinal barrier integrity. Transmission electron microscopy confirmed the preservation of tight junction structures. Further analysis indicated that HXZQD modulated the MAPK/NF-κB signaling pathways, inhibiting heat stress-induced activation and reducing inflammation. Additionally, HXZQD positively regulated gut microbiota, increasing the proportion of beneficial Lactococcus and decreasing harmful Streptococcus. These findings suggest that HXZQD maintains intestinal homeostasis during EHS by preserving barrier function and modulating gut microbiota, offering a promising preventive approach for EHS management.
On destabilising quasi-normal modes with a radially concentrated perturbation
Authors: Boyanov Valentin
Published: January 2025

In this work we explore some aspects of the spectral instability of back hole quasi-normal modes, using a specific model as an example. The model is that of a small bump perturbation to the effective potential of linear axial gravitational waves on a Schwarzschild background, and our focus is on three different aspects of the instability: identifying and distinguishing between the two different types of instabilities studied previously in the literature, quantifying the size of the perturbations applied to the system and testing the validity of the pseudospectral numerical method in providing a convergent result for this measure, and finally, relating the size and other features of the perturbation to the degree of destabilisation of the spectrum.
Enhancing home-based physical activity for neurodivergent children: adapting the InPACT at Home program with AI and universal design
Authors: Sapre Tania , Miller Haylie L. , Schwartz Anna , Ketcheson Leah R. , Price Alanna , Winkelseth Kerry , Barcelona Jeanne M. , Zernicke Ronald F. , Hasson Rebecca E.
Published: January 2025

Purpose

While it is common practice for schools across the United States to include neurodivergent children in physical education classes, many programs outside of school—such as those at home or in the community—are not effectively tailored to meet their support needs. This gap contributes to lower levels of physical activity among neurodivergent children. Our objective was to address this issue by systematically adapting the InPACT (Interrupting Prolonged sitting with ACTivity) at Home program to enable neurodivergent children to safely engage in physical activity at home.

Methods

The rapid-cycle research adaptation process involved several key steps: (1) sorting and grouping video content based on different types of skills and exercises (problem exploration); (2) assembling an expert team to guide the development of the instructions (knowledge exploration); and (3) using generative artificial intelligence (AI) to create concise instructions and cue words for each skill/exercise (solution development). These outputs were then fine-tuned by the expert team. The refinements were guided by the Universal Design for Learning (UDL) principle of “Representation,” which acknowledges that learners perceive and understand information in diverse ways.

Results

From the 132 InPACT at Home videos, over 500 activities were identified and categorized into main skill groups: jumping, core, lateral, sport, upper body, lower body, and compound movements. Expert meetings emphasized the importance of the “Three C’s”—consistency, conciseness, and clarity—in crafting instructions, along with the use of simple, elementary sight words. AI was employed to generate and refine prompts like “Provide simplified step-by-step instructions for a jumping jack, suitable for a neurodivergent child” and “Condense the step-by-step instructions for a jumping jack, suitable for a neurodivergent child”.

Discussion

The adaptation of the existing InPACT at Home program was guided by dissemination and implementation science frameworks, aiming to increase equitable access to structured youth physical activity opportunities for neurodivergent children. By incorporating AI and UDL principles, we aim to further enhance the program’s accessibility. Our next steps include evaluating the effectiveness of our program adaptations in encouraging participation in the InPACT at Home program and subsequently increasing physical activity levels among neurodivergent children.
Knockout of BnaX.SGT.a caused significant sinapine reduction in transgene-free rapeseed mutants generated by protoplast-based CRISPR RNP editing
Authors: Moss Oliver , Li Xueyuan , Wang Eu Sheng , Kanagarajan Selvaraju , Guan Rui , Ivarson Emelie , Zhu Li-Hua
Published: January 2025

Rapeseed (Brassica napus L.) is known for its high-quality seed oil and protein content. However, its use in animal feed is restricted due to antinutritional factors present in the seedcake, with sinapine being one of the main compounds that reduces palatability. Attempts to develop rapeseed germplasm with lower sinapine levels through traditional breeding methods have shown limited progress. Genetic transformation methods could create new genotypes with reduced sinapine levels by silencing key genes involved in sinapine biosynthesis, though these methods often result in transgenic or genetically modified plants. The recent development of CRISPR-Cas technology provides a precise and efficient approach to crop improvement, with the potential to generate transgene-free mutants. In this study, we targeted the BnaX.SGT.a genes for knockout using CRISPR-Cas editing. By utilizing our newly established protoplast regeneration and transfection protocol for rapeseed, we demonstrated that DNA-free CRISPR editing via protoplast-based ribonucleoprotein (RNP) delivery was highly effective. We achieved successful knockout of the BnaX.SGT.a paralogues, with an average mutation efficiency of over 30%. Sequencing results revealed a variety of mutation types, from 1 bp insertions to 10 bp deletions, with most mutants exhibiting frameshift mutations that led to premature stop codons. The mutants displayed no visible phenotypic differences in growth patterns or flowering compared to the wild type. Importantly, sinapine content was significantly reduced in all T2 generation mutants analysed, while seed weight remained comparable between mutants and the wild type.
LC-MS/MS-based metabolomic study provides insights into altitude-dependent variations in flavonoid profiles of strawberries
Authors: Rao Muhammad Junaid , Wang Huaizheng , Lei Huaming , Zhang Hongcha , Duan Xiande , Bao Liuyuan , Yang Chengcui , Han Duo , Zhang Yongzhi , Yang Shunqiang , Duan Mingzheng
Published: January 2025

Environmental conditions significantly influence the metabolic composition and quality attributes of fruits. This study investigated the impact of altitude-associated environmental variation on flavonoid profiles and fruit quality parameters by comparing the “Red Face” strawberry variety grown in two distinct locations: high-altitude-associated environmental conditions in Zhaotong and low-altitude conditions in Dandong. Using LC-MS/MS analysis, we identified 163 bioactive flavonoids, comprising 85 flavonols, 37 flavanones, 33 flavones, and 8 flavanonols. The high-altitude environment of Zhaotong significantly enhanced specific flavonoid compounds, with notable increases in neohesperidin (20.4-fold), tamarixetin-3-O-glucoside-7-O-rhamnoside (17.7-fold), isovitexin (9.1-fold), and hesperidin (8.5-fold) compared to Dandong-grown fruits. Conversely, Dandong-grown fruits showed higher levels of chrysoeriol-7-O-glucoside (53.9-fold), 6-hydroxykaempferol-6,7-O-diglucoside (36.3-fold), and eucalyptin (9.7-fold). The tricetin 3’-glucuronide (24.49% vs 15.31%) and quercetin-4’-O-glucuronide (24.15% vs 15.59%), are the major flavonoids identified in Zhaotong strawberries than Dandong-grown fruits. Furthermore, strawberries cultivated in Zhaotong demonstrated superior antioxidant activities and capacity, increased quality parameters, including higher sugar content (15.30°Brix vs 10.96°Brix), increased ascorbic acid (15.73 mg/g vs 8.53 mg/g), and optimal firmness (20.51 N vs 23.16 N) than Dandong strawberries. These findings suggest that high-altitude cultivation conditions positively influence strawberry fruit characteristics, enhancing both bioactive compound profiles and overall fruit quality. This research provides valuable insights for optimizing strawberry cultivation conditions to maximize nutritional and commercial value.
Six weeks that changed the preterm infant brain: lessons learned from the Family Nurture Intervention randomized controlled trials
Authors: Ludwig Robert J. , Myers Michael M. , Welch Martha G.
Published: January 2025

Aim

We review extensive results from two randomized controlled trials conducted over 9 years, comparing standard care (SC) in level-4 neonatal intensive care units (NICUs) with SC plus Family Nurture Intervention (FNI).

Methods

FNI included ~six weeks of facilitated mother-infant interactions aimed at achieving mother-infant ‘autonomic emotional connection’, a novel construct that describes the emotional mother-baby relationship at the level of the autonomic nervous system.

Results and conclusion

Thus far, 18 peer-reviewed publications documented significant positive short-and long-term effects of FNI on infant neurobehavioral functioning, developmental trajectories and both mother and child autonomic health through five years. The observed profound effects of FNI on central and autonomic nervous system function following a relatively short intervention support a novel autonomic theory of emotions. We discuss the theoretical and clinical advances that grew out of the trials and speculate on how FNI changes the mother-infant relationship from ‘dysregulation’ to autonomic emotional co-regulation. We review new constructs and tools that can be used to view and measure the mother-infant autonomic emotional relationship. We present a simple blueprint to improve preterm birth outcomes. Finally, we discuss the significance of our findings and possible impact on the future of preterm infant care worldwide.
The influence of emotional intelligence on learning burnout in Chinese art college students: the chain mediation effect of self-acceptance and perceived stress
Authors: Zhang Meng , Fah Lay Yoon
Published: January 2025

Introduction

Art college students are under special pressure from a few sources, including study, employment, friends, emotions, family relations and other aspects. This can lead to a reasonable degree of learning burnout among art college students, which will have a negative impact on their physical and mental health, as well as their study and employment. However, there is a paucity of empirical studies on learning burnout among art students. Furthermore, the factors and mechanisms that contribute to learning burnout among art students remain unclear. The purpose of this study was to examine the relationship between emotional intelligence and learning burnout in Chinese art college students, and to identify the role of self-acceptance and perceived stress as sequential mediators.

Methods

This study employed a completely random survey of three art universities in China to investigate the status of emotional intelligence, self-acceptance, perceived stress and learning burnout among art students and their relationships. The data was analyzed using an independent sample t-test and structural equation modelling.

Results

A total of 678 valid samples were obtained from a study of Chinese art students. No significant differences were observed in the scores of emotional intelligences, self-acceptance, perceived stress, and learning burnout among participants of different genders. The results of the structural equation modelling indicated that emotional intelligence was negatively associated with learning burnout (β = −0.282, p < 0.001). The results indicated that self-acceptance (β = −0.140, p < 0.001) and perceived stress (β = −0.072, p < 0.001) had independent mediating effects. Furthermore, self-acceptance and perceived stress exhibited sequence mediating effects (β = −0.039, p < 0.001).

Conclusion

The results of the study confirm that emotional intelligence is a significant factor in the learning burnout of art students. Furthermore, the findings demonstrate the mediating effect of self-acceptance and perceived pressure on this relationship. The findings provide a novel explanation for the mechanism underlying college students’ learning burnout.
Longitudinal reciprocal relationship between media violence exposure and aggression among junior high school students in China: a cross-lagged analysis
Authors: Dou Yifei , Zhang Meng
Published: January 2025

Introduction

Increasing evidence has shown that media violence exposure can influence individual aggression. However, the question of whether there is a causal relationship between media violence exposure and aggression remains complex and contentious. This study aims to examine the dynamic reciprocal relations between media violence exposure and aggression among junior high school students in China.

Methods

Using the Exposure to Violent Media Questionnaire (ETVMQ) and the Buss-Warren Aggression questionnaire (BWAQ), 259 junior high school students were tracked three times over a period of 1 year. A cross-lagged panel model was constructed to analyze the reciprocal relationship between media violence exposure and aggression over time.

Results

(1) Media violence exposure and aggression were significantly and positively correlated in all three assessments. (2) Cross-lagged analysis revealed that media violence exposure at Time 1(T1) significantly positively predicted aggression at Time 2(T2), and subsequently significantly positively predicted media violence exposure at Time 3(T3). Additionally, media violence exposure at T2 significantly positively predicted aggression at T3. (3) Multi-group analysis revealed that gender, family economic status, and family location had no significant moderating effects on the cross-lagged effects between media violence exposure and aggression. The cross-lagged effects did not differ by gender, family economic status, or family location.

Conclusion

There is a positive reciprocal relationship between media violence exposure and aggression among Chinese junior high school students, and this reciprocal relationship demonstrates stability across gender and family environments. Media violence exposure is not only a risk factor for increasing aggression among Chinese junior high school students but also a negative outcome of high aggression.
Self-imposed pressure or joyful learning: emotions of Chinese as a foreign language learners in feedback on academic writing
Authors: Liu Ruoxi , Xin Ping
Published: January 2025

Although writing feedback is widely believed to elicit a range of emotions, studies on the emotional experiences of L2 students with this teaching and learning tool, as well as their regulation strategies, remain largely underexplored. Drawing on the analytical framework of academic emotions from the perspective of positive psychology, this study examines two Chinese as foreign language (CFL) students’ emotional reactions to their teacher’s oral and written feedback and their emotion regulation strategies. The main data includes interviews, retrospective oral reports, students’ reflection journals, academic writings, and teacher feedback. The study found that feedback aroused students’ academic achievement emotions, cognitive emotions, and social emotions across various dimensions of valence and activation. Over the course of three feedback processes within one semester, the two learners’ emotions gradually became neutral or positive. They effectively employed emotion-oriented, appraisal-oriented, and situation-oriented strategies to manage negative emotions and adapt to feedback. The findings suggest that paying attention to the intrinsic values of feedback may help learners experience more positive academic emotions, while paying too much attention to its extrinsic values may lead to negative emotions.
How digital leadership adds affective commitment of new generation employees: an affective events perspective
Authors: Li Hongting , Li Futian , Ma Junyi , Liu Bo
Published: January 2025

How do leaders’ responses to the digital era affect new generation employees’ affective commitment? As digital leaders have led to new ways of distributing digital resources and building virtual relationships, employees are facing a shift in the way of interaction, which influences their affective response to organizations. This study aims to understand how digital leaders interact with new generation employees to influence changes in employees’ affective commitment to organizations. We have developed a chain mediating model and tested it on data collected from 408 new generation employees working in China. Ultimately, we found that digital leadership is associated with more positive changes in new generation employees’ affective commitment. Furthermore, both employee empowerment and employee voice behavior mediate the relationship between digital leadership and affective commitment, forming a chain mediation mechanism in this relationship. We conclude with a discussion of theoretical implications and practical applications.
The relationship between social support and work engagement of rural teachers: a moderated mediation model
Authors: Wu Shengwen , Xu Qiangqiang , Tian Huidong , Li Rongrong , Wu Xiaopeng
Published: January 2025

Aim

This paper aims to investigate the relationship between social support and rural teachers’ work engagement while exploring the mediating effect of mindfulness in teaching and the moderating effect of psychological safety.

Methods

A sample of 866 rural teachers was recruited, in order to complete the Mindfulness in Teaching Scale, Social Support Rating Scale, Psychological Safety Scale, and Utrecht Work Engagement Scale.

Results

The study findings indicate that: (1) social support positively influenced the work engagement of rural teachers; (2) further, mindfulness in teaching partially mediated the effect of social support on rural teachers’ work engagement; (3) psychological safety moderated the second half of the pathway of “social support → mindfulness in teaching → work engagement” while the positive correlation between mindfulness in teaching and work engagement was stronger among rural teachers with high psychological safety.

Conclusion

Social support documented a strong correlation with work engagement while mindfulness in teaching mediated the pathway between the aforementioned variables. Furthermore, psychological safety moderated the second half of the mediated pathway (the link from mindfulness in teaching to work engagement). Hence, the study outcomes reveal the influential mechanism of social support on the work engagement of rural teachers. This finding suggests that we need to further improve the social support system and its effect mechanism in order to improve the rural teachers’ work engagement. At the same time, it is also very important to create a good psychological working environment to ensure that they maintain a good level of mindfulness in teaching.
Generational diversity and team innovation: the roles of conflict and shared leadership
Authors: Wang Lingyi , Duan Xu
Published: January 2025

The increasing generational diversity in modern teams has sparked an ongoing debate about its impact on team performance. Grounded in decision-making and social identity theories, this study explores the multifaceted relationship between generational diversity and team innovation performance, examining the mediating roles of cognitive and affective conflicts and the moderating role of shared leadership. The findings from a three-wave survey of five multi-generational teams in a Chinese organization reveal that generational diversity predicts both cognitive and affective conflicts, which subsequently exert opposing effects on team innovation. Shared leadership positively moderates the relationship between cognitive conflict and team innovation, amplifying the indirect positive effect of generational diversity. However, shared leadership does not moderate the relationship between affective conflict and team innovation. These results offer a more nuanced understanding of the dual role of generational diversity in team innovation and underscore the importance of shared leadership in harnessing its potential benefits.
Poor self-reported sleep is associated with prolonged white matter T2 relaxation in psychotic disorders
Authors: Yesilkaya Umit Haluk , Chen Xi , Watford Lauren , McCoy Emma , Sen Meltem , Genc Ilgin , Du Fei , Ongur Dost , Yuksel Cagri
Published: January 2025

Background

Psychotic disorders are characterized by white matter (WM) abnormalities; however, their relationship with the various aspects of illness presentation remains unclear. Sleep disturbances are common in psychosis, and emerging evidence suggests that sleep plays a critical role in WM physiology. Therefore, it is plausible that sleep disturbances are associated with impaired WM integrity in these disorders. To test this hypothesis, we examined the association of self-reported sleep disturbances with WM transverse (T2) relaxation times in a cross-diagnostic sample of patients with psychosis.

Methods

A total of 28 patients with psychosis (11 schizophrenia spectrum disorders and 17 bipolar disorder with psychotic features) were included. Metabolite (N-acetyl aspartate, choline, and creatine) and water T2 relaxation times were measured in the anterior corona radiata at 4T. Sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI).

Results

PSQI total score showed a moderate to strong positive correlation with water T2 (r = 0.64, p< 0.001). Linear regressions showed that this association was independent of the overall severity of depressive, manic, or psychotic symptoms. In our exploratory analysis, sleep disturbance was correlated with free water percentage, suggesting that increased extracellular water may be a mechanism underlying the association of disturbed sleep and prolonged water T2 relaxation.

Conclusion

Our results highlight the connection between poor sleep and WM abnormalities in psychotic disorders. Future research using objective sleep measures and neuroimaging techniques suitable to probe free water is needed to further our insight into this relationship.
Prevalence, consequences, and contributing factors beyond verbal and physical workplace violence against nurses in peripheral hospitals
Authors: Alnaeem Mohammad M. , Hasan Suleiman Khaled , Alzoubi Majdi M. , Sumaqa Yasmeen Abu , Al-Mugheed Khalid , Saeed Alabdullah Amany Anwar , Farghaly Abdelaliem Sally Mohammed
Published: January 2025

Background

Globally, nearly one-third of workplace violence (WPV) occurs in the health sector. Exposure to WPV among Jordanian nurses has been widely speculated to be underreported. Understanding of the factors contributing to WPV among nurses and their consequences is limited.

Objectives

This study aimed to examine the consequences and contributing factors of WPV and explore suggestions for reducing WPV among nurses working in peripheral hospitals.

Methods

This descriptive, cross-sectional study included 431 Jordanian nurses. Data were collected using a self-report instrument between December 2022 and June 2023. A modified version of the ILO/ICN/WHO/PSI Workplace Violence in the Health Sector Country Case Study Questionnaire developed and validated in 2003 was used.

Results

The ages of the participants ranged from 20 to 49 years. A total of 349 nurses (81%) had experienced verbal violence, while 110 (25.5%) had experienced physical violence. Of the 110 nurses who were physically attacked, 44 (40 %) reported that an investigation was conducted to determine the cause of the incident. Approximately 38.2% of incidents involving physical violence in the last 12 months involved the use of weapons. The current study revealed that 59.6% of the nurses reported that verbal incidents were common in their workplace. The highest level of agreement among all participants was leniency in applying penalties to perpetrators of violence inside hospitals. The majority of participants (95.8%) agreed that improving staff-patient communication skills would effectively reduce violence.

Conclusion

Creating awareness among healthcare professionals, patients, and the general public regarding the impact of WPV and the importance of respect and professionalism is crucial.
Burnout and its relationship with depressive symptoms in primary school teachers under the “Double Reduction” policy in China
Authors: Zhong Yunhui , Lai Shuixiu , Li Yibo , Yang Kan , Tang Hong , Zhang Xiang-yang
Published: January 2025

Background

The “Double Reduction” policy requires schools to reduce Chinese students’ extracurricular activities and homework to lessen academic stress and improve mental well-being. However, there is limited research on primary school teachers’ psychological well-being within the context of the “Double Reduction” policy. This study examined self-reported burnout levels of primary school teachers and investigated the relationship between burnout and depressive symptoms in the context of the “Double Reduction” policy in China.

Methods

A cross-sectional survey recruited 3,199 primary school teachers from 15 cities across China. The teachers’ burnout levels were assessed with the Maslach Burnout Inventory, and depressive symptoms were evaluated with the Patient Health Questionnaire depression scale.

Results

Under the “Double Reduction” policy in China, 66.6% of the primary school teachers experience burnout. Individual and work-related characteristics were independently correlated with burnout. These factors included holding a bachelor’s degree (OR = 2.244, 95% CI: 1.559–3.230, p < 0.001), being married (OR = 0.598, 95% CI: 0.443–0.807, p < 0.001), being dissatisfied with one’s income (OR = 2.602, 95% CI: 2.191–3.090, p < 0.001), and having an intermediate professional title (OR = 1.351, 95% CI: 1.086–1.681, p = 0.007). The correlation coefficients between burnout subscale scores and depressive symptoms were 0.588 for emotional exhaustion, 0.585 for cynicism, and − 0.180 for professional efficacy (all p < 0.001).

Conclusion

Our findings indicate that the prevalence of burnout among primary school teachers in China is exceptionally high, particularly under the “Double Reduction” policy. This situation is correlated with various psychological disorders, including depression. It is crucial to urgently implement psychological interventions for primary school teachers. Specifically, psychological assistance should be targeted at educators who are bachelor degree holders, married, dissatisfied with their income, and holders of an intermediate professional title.
Design of the Focus on Restaurant Engagement to Strengthen Health (FRESH) study: leveraging systems science to work with independently-owned restaurants to increase access to and promotion of healthful foods
Authors: Colón-Ramos Uriyoán , Lewis Emma C. , Tucker Anna Claire , Poirier Lisa , Pathiravasan Chathurangi H. , Estradé Michelle , Igusa Takeru , Wolfson Julia A. , Mui Yeeli , Vélez-Burgess Veronica , Thomas Audrey E. , Hua Shuxian , Cheskin Lawrence J. , Trujillo Antonio J. , Oladimeji Ayoyemi T. , Williamson Stacey , Romero Rosalinda , Hernández Patricia Sánchez , Gittelsohn Joel
Published: January 2025

Background

High dietary quality can protect against diet-related chronic diseases. In the United States, racial and ethnic minorities and those with lower incomes consistently exhibit lower dietary quality. Independently-owned restaurants are a common prepared food source in minority low-income communities, but there are significant knowledge gaps on how to work with these restaurants to offer healthy food, due to underlying and dynamic complexities associated with providing healthy food options.

Methods

The Focus on Restaurant Engagement to Strengthen Health (FRESH) study addresses this complex problem by leveraging systems science approaches to work with independently-owned restaurants. FRESH has two interrelated objectives: (1) to test impact on regular customer dietary quality via a multisite cluster randomized controlled trial in two low-income urban areas (Baltimore and the Washington DC metropolitan area), and (2) to use systems science approaches to develop, parameterize, and calibrate a simulation model. The intervention is theory-and practice-based, comprising three phases: restaurant engagement, low-sugar beverages and healthy meals. The FRESH intervention will be implemented for 12 months in a total of 24 intervention and 24 comparison restaurants. The study is powered to detect a 5-point change in the Healthy Eating Index (HEI) score of regular customers, which would signify a meaningful shift toward healthier eating patterns.

Discussion

The FRESH study will test a novel, multilevel, multisite intervention that aims to improve access to healthier prepared food options among small, independently-owned restaurants located in under-resourced settings. The design of the FRESH intervention and its evaluation are described, as well as plans for the development of a system dynamics simulation model for policymakers and other stakeholders to virtually test future restaurant-based interventions.

Clinical trial registration

https://clinicaltrials.gov, identifier, NCT05869149.
Inequalities in utilization of maternal health services in Ethiopia: evidence from the PMA Ethiopia longitudinal survey
Authors: Hagos Asebe , Tiruneh Misganaw Guadie , Jejaw Melak , Demissie Kaleb Assegid , Baffa Lemlem Daniel , Geberu Demiss Mulatu , Teshale Getachew , Tafere Tesfahun Zemene
Published: January 2025

Background

Previous studies documented the existence of substantial inequalities in the utilization of maternal health services across different population subgroups in Ethiopia. Regularly monitoring the state of inequality could enhance efforts to address health inequality in the utilization of maternal health services. Therefore, this study aimed to measure the level of inequalities in the utilization of maternal health services in Ethiopia.

Method

The study used data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) dataset. Longitudinal data was collected from a weighted sample of 1966 postpartum women using multistage stratified cluster sampling techniques between November 2021 to October 2022. We assessed inequality in maternal health services using three indicators: antenatal care four (ANC), skilled birth attendants (SBA), and postnatal care (PNC). Age, economic status, education level, place of residence, and subnational regions were used as dimensions for measuring inequality. The analysis was conducted using Health Equity Assessment Toolkit Plus (HEAT Plus) software. We computed the summary measure of health inequality: Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF).

Result

The simple summary measures of inequality difference (D) reported a high level of inequality in the utilization of maternal health services in ANC four, SBA, and PNC across economic, education, residence, and subnational regions. The difference (D) in maternal health service utilization between advantaged and disadvantaged population groups exceeded 20 percentage points in all four dimensions of inequality for the three maternal health indicators. Similarly, the complex summary measures of inequality (PAR and PAF) also showed high levels of inequality in the utilization of ANC four, SBA, and PNC across all four dimensions of inequality. However, there was no age-related inequality in the use of maternal health services.

Conclusion

A high level of socioeconomic and geographic area related inequality was observed in the utilization of ANC four, SBA, and PNC services in Ethiopia. Women from socioeconomically disadvantaged subgroups and women from disadvantaged geographic areas significantly lagged behind in the utilization of maternal health services. Therefore, implementing targeted interventions for the most disadvantaged groups can help to reduce inequality in accessing maternal health services.
Self-rated health status and associated factors in Ilam, west of Iran: results of a population-based cross-sectional study
Authors: Bazyar Mohammad , Kakaei Hojatollah , Azadi Hamed , Jalilian Mohsen , Mansournia Mohammad Ali , Malekan Kamran , Pakzad Reza
Published: January 2025

Background

Self-rated health (SRH) is a single-item subjective indicator that asks individuals to assess their overall health and acts as a good indicator to reveal general health status. This study aimed to determine the SRH status and determining factors.

Methods

This was a population-based cross sectional study conducted in Ilam city (West of Iran) in 2023. A total of 1,370 people were invited to participate in the study using multi-stage stratified cluster random sampling method. Demographic and SRH status data were collected by face-to-face interview. SRH was indicated by a single question in five scales of very good, good, fair, poor and very poor. Multiple ordinal logistic regression was used for data analysis.

Results

The 59.38% (95% CI: 56.76 to 62) participants reported a good SRH status. By ordinal multiple logistic regression, odds ratio (OR) and 95% confidence interval (CI) was calculated and based on that, female gender [OR: 1.68 (1.29 to 2.20)], not having insurance coverage [OR: 1.35; (1.01 to 1.80)], history of job loss [OR: 1.72; (1.28 to 2.31)], hopelessness for the future [OR: 5.07; (3.96 to 6.49)], and having underlying diseases [OR: 2.95; (2.25 to 3.88)], were positively associated with poor SRH status. The Kurd race [OR: 0.45; (0.25 to 0.78)], higher economic status [OR: 0.72; (0.54 to 0.96)] and use of health care service [OR: 0.68; (0.53 to 0.88)] were negatively associated with poor SRH status. The most effective variables for poor SRH status were hopelessness about the future and suffering from underlying diseases.

Conclusion

It is important to devise corrective measures and effective public health policies to address causes and factors associated with poor SRH. It is also necessary for local health officials to allocate financial resources and introduce other kinds of supportive initiatives to provide targeted support for those who are struggling with poverty and suffering chronic diseases.
Integrating deep learning in public health: a novel approach to PICC-RVT risk assessment
Authors: Li Yue , Nie Shengxiao , Wang Lei , Li Dongsheng , Ma Shengmiao , Li Ting , Sun Hong
Published: January 2025

Background

Machine learning is pivotal for predicting Peripherally Inserted Central Catheter-related venous thrombosis (PICC-RVT) risk, facilitating early diagnosis and proactive treatment. Existing models often assess PICC-RVT risk as static and discrete outcomes, which may limit their practical application.

Objectives

This study aims to evaluate the effectiveness of seven diverse machine learning algorithms, including three deep learning and four traditional machine learning models, that incorporate time-series data to assess PICC-RVT risk. It also seeks to identify key predictive factors for PICC-RVT using these models.

Methods

We conducted a retrospective multi-center cohort study involving 5,272 patients who underwent PICC placement. After preprocessing patient data, the models were trained. Demographic, clinical pathology, and treatment data were analyzed to identify predictive factors. A variable analysis was then conducted to determine the most significant predictors of PICC-RVT. Model performance was evaluated using the Concordance Index (c-index) and the composite Brier score, and the Intraclass Correlation Coefficient (ICC) from cross-validation folds assessed model stability.

Results

Deep learning models generally outperformed traditional machine learning models in terms of predictive accuracy (mean c-index: 0.949 vs. 0.732; mean integrated Brier score: 0.046 vs. 0.093). Specifically, the DeepSurv model demonstrated exceptional precision in risk assessment (c-index: 0.95). Stability varied with the number of predictive factors, with Cox-Time showing the highest ICC (0.974) with 16 predictive factors, and DeepSurv the most stable with 26 predictive factors (ICC: 0.983). Key predictors across models included albumin levels, prefill sealant type, and activated partial thromboplastin time.

Conclusion

Machine learning models that incorporate time-to-event data can effectively predict PICC-RVT risk. The DeepSurv model, in particular, shows excellent discriminative and calibration capabilities. Albumin levels, type of prefill sealant, and activated partial thromboplastin time are critical indicators for identifying and managing high-risk PICC-RVT patients.
Campylobacter colonization and undernutrition in infants in rural eastern Ethiopia — a longitudinal community-based birth cohort study
Authors: Chen Dehao , McKune Sarah Lindley , Yang Yang , Usmane Ibsa Aliyi , Ahmed Ibsa Abdusemed , Amin Jafer Kedir , Ibrahim Abdulmuen Mohammed , Seran Abadir Jemal , Shaik Nurmohammad , Ojeda Amanda , Hassen Bahar Mummed , Deblais Loic , Ahmedo Belisa Usmael , Hassen Kedir Abdi , Bhrane Mussie , Li Xiaolong , Singh Nitya , Roba Kedir Teji , French Nigel P. , Rajashekara Gireesh , Manary Mark J. , Hassen Jemal Yusuf , Havelaar Arie Hendrik ,   on behalf of the CAGED Research Team
Published: January 2025

Background

Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings.

Methods

We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering.

Results

The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from −0.45 at 3–4 months of age to −2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers’ handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ.

Conclusion

This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.
Exploring the association between socioeconomic inequalities in chronic respiratory disease and all-cause mortality in China: findings from the China Health and Retirement Longitudinal Study
Authors: Zhang Zhuo , Shi Guoshuai , Jin Faguang , Zhang Yan
Published: January 2025

Objective

Research on the inequality of chronic respiratory disease (CRD) is limited, and the association between CRD and all-cause mortality is not well-established. Investigating the distribution of CRD and its associated mortality risks is essential for improving CRD conditions and developing targeted intervention measures. This study aimed to explore the relationship between inequalities in CRD and all-cause mortality in China.

Methods

This study utilized nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020, wave 1–wave 5), including a total of 14,743 subjects. The concentration index was employed to measure socioeconomic-related inequality in CRD, and the concentration index decomposition method was used to describe its influencing factors. Cox proportional hazards regression model was employed to examine the association between CRD and all-cause mortality.

Results

The prevalence of CRD was 11.79% (95% CI: 10.98, 12.66) in China. The concentration index for CRD was −0.050 (95% CI: −0.075, −0.026), indicating a certain degree of inequality in its prevalence. Chronic lung disease (concentration index = −0.046, 95% CI: −0.073, −0.019), asthma (concentration index = −0.102, 95% CI: −0.148, −0.056), and asthma-chronic obstructive pulmonary disease overlap syndrome (concentration index = −0.114, 95% CI: −0.173, −0.055) also exhibited a pro-poor distribution. The decomposition analysis of the concentration index for CRD revealed that age, education level, and economic status played substantial roles in contributing to the observed inequality. Additionally, Cox regression analysis showed that participants with CRD had an increased risk of all-cause mortality (HR = 1.49, 95% CI: 1.34, 1.65).

Conclusion

Inequalities exists in CRDs in China, with the prevalence of these diseases primarily concentrated among economically disadvantaged groups. Additionally, CRD increases the risk of all-cause mortality. Addressing the root causes of economic inequalities and enhancing the educational attainment of individuals with low socioeconomic status can help improve the situation.