bluuebunny/crossref_metadata_2025 huggingface dataset:
Thousands of CpGs Show DNA Methylation Differences in ACPA-Positive Individuals
Authors: Zeng Yixiao , Zhao Kaiqiong , Oros Klein Kathleen , Shao Xiaojian , Fritzler Marvin , Hudson Marie , Colmegna Inés , Pastinen Tomi , Bernatsky Sasha , Greenwood Celia
Published: August 2021

High levels of anti-citrullinated protein antibodies (ACPA) are often observed prior to a diagnosis of rheumatoid arthritis (RA). We undertook a replication study to confirm CpG sites showing evidence of differential methylation in subjects positive vs. negative for ACPA, in a new subset of 112 individuals sampled from the population cohort and biobank CARTaGENE in Quebec, Canada. Targeted custom capture bisulfite sequencing was conducted at approximately 5.3 million CpGs located in regulatory or hypomethylated regions from whole blood; library and protocol improvements had been instituted between the original and this replication study, enabling better coverage and additional identification of differentially methylated regions (DMRs). Using binomial regression models, we identified 19,472 ACPA-associated differentially methylated cytosines (DMCs), of which 430 overlapped with the 1909 DMCs reported by the original study; 814 DMRs of relevance were clustered by grouping adjacent DMCs into regions. Furthermore, we performed an additional integrative analysis by looking at the DMRs that overlap with RA related loci published in the GWAS Catalog, and protein-coding genes associated with these DMRs were enriched in the biological process of cell adhesion and involved in immune-related pathways.
Extended Phenotyping and Functional Validation Facilitate Diagnosis of a Complex Patient Harboring Genetic Variants in MCCC1 and GNB5 Causing Overlapping Phenotypes
Authors: Shao Zhuo , Masuho Ikuo , Tumber Anupreet , Maynes Jason T. , Tavares Erika , Ali Asim , Hewson Stacy , Schulze Andreas , Kannu Peter , Martemyanov Kirill A. , Vincent Ajoy
Published: August 2021

Identifying multiple ultra-rare genetic syndromes with overlapping phenotypes is a diagnostic conundrum in clinical genetics. This study investigated the pathogenicity of a homozygous missense variant in GNB5 (GNB5L; NM_016194.4: c.920T > G (p. Leu307Arg); GNB5S; NM_006578.4: c.794T > G (p. Leu265Arg)) identified through exome sequencing in a female child who also had 3-methylcrotonyl-CoA carboxylase (3-MCC) deficiency (newborn screening positive) and hemoglobin E trait. The proband presented with early-onset intellectual disability, the severity of which was more in keeping with GNB5-related disorder than 3-MCC deficiency. She later developed bradycardia and cardiac arrest, and upon re-phenotyping showed cone photo-transduction recovery deficit, all known only to GNB5-related disorders. Patient-derived fibroblast assays showed preserved GNB5S expression, but bioluminescence resonance energy transfer assay showed abolished function of the variant reconstituted Gβ5S containing RGS complexes for deactivation of D2 dopamine receptor activity, confirming variant pathogenicity. This study highlights the need for precise phenotyping and functional assays to facilitate variant classification and clinical diagnosis in patients with complex medical conditions.
GDF6 Knockdown in a Family with Multiple Synostosis Syndrome and Speech Impairment
Authors: Clarke Raymond A. , Fang Zhiming , Murrell Dedee , Sheriff Tabrez , Eapen Valsamma
Published: August 2021

Multiple synostoses syndrome type 4 (SYNS4; MIM 617898) is an autosomal dominant disorder characterized by carpal-tarsal coalition and otosclerosis-associated hearing loss. SYSN4 has been associated with GDF6 gain-of-function mutations. Here we report a five-generation SYNS4 family with a reduction in GDF6 expression resulting from a chromosomal breakpoint 3′ of GDF6. A 30-year medical history of the family indicated bilateral carpal-tarsal coalition in ~50% of affected family members and acquired otosclerosis-associated hearing loss in females only, whereas vertebral fusion was present in all affected family members, most of whom were speech impaired. All vertebral fusions were acquired postnatally in progressive fashion from a very early age. Thinning across the 2nd cervical vertebral interspace (C2-3) in the proband during infancy progressed to block fusion across C2-7 and T3-7 later in life. Carpal-tarsal coalition and pisiform expansion were bilaterally symmetrical within, but varied greatly between, affected family members. This is the first report of SYNS4 in a family with reduced GDF6 expression indicating a prenatal role for GDF6 in regulating development of the joints of the carpals and tarsals, the pisiform, ears, larynx, mouth and face and an overlapping postnatal role in suppression of aberrant ossification and synostosis of the joints of the inner ear (otosclerosis), larynx and vertebrae. RNAseq gene expression analysis indicated >10 fold knockdown of NOMO3, RBMXL1 and NEIL2 in both primary fibroblast cultures and fresh white blood cells. Together these results provide greater insight into the role of GDF6 in skeletal joint development.
Targeting the CDK6 Dependence of Ph+ Acute Lymphoblastic Leukemia
Authors: Porazzi Patrizia , De Dominici Marco , Salvino Joseph , Calabretta Bruno
Published: August 2021

Ph+ ALL is a poor-prognosis leukemia subtype driven by the BCR-ABL1 oncogene, either the p190- or the p210-BCR/ABL isoform in a 70:30 ratio. Tyrosine Kinase inhibitors (TKIs) are the drugs of choice in the therapy of Ph+ ALL. In combination with standard chemotherapy, TKIs have markedly improved the outcome of Ph+ ALL, in particular if this treatment is followed by bone marrow transplantation. However, resistance to TKIs develops with high frequency, causing leukemia relapse that results in <5-year overall survival. Thus, new therapies are needed to address relapsed/TKI-resistant Ph+ ALL. We have shown that expression of cell cycle regulatory kinase CDK6, but not of the highly related CDK4 kinase, is required for the proliferation and survival of Ph+ ALL cells. Comparison of leukemia suppression induced by treatment with the clinically-approved dual CDK4/6 inhibitor palbociclib versus CDK6 silencing revealed that the latter treatment was markedly more effective, probably reflecting inhibition of CDK6 kinase-independent effects. Thus, we developed CDK4/6-targeted proteolysis-targeting chimeras (PROTACs) that preferentially degrade CDK6 over CDK4. One compound termed PROTAC YX-2-107, which degrades CDK6 by recruiting the Cereblon ubiquitin ligase, markedly suppressed leukemia burden in mice injected with de novo or TKI-resistant Ph+ ALL. The effect of PROTAC YX-2-107 was comparable or superior to that of palbociclib. The development of CDK6-selective PROTACs represents an effective strategy to exploit the “CDK6 dependence” of Ph+ ALL cells while sparing a high proportion of normal hematopoietic progenitors that depend on both CDK6 and CDK6 for their survival. In combination with other agents, CDK6-selective PROTACs may be valuable components of chemotherapy-free protocols for the therapy of Ph+ ALL and other CDK6-dependent hematological malignancies.
The Evaluation of Preference and Perceived Quality of Health Communication Icons Associated with COVID-19 Prevention Measures
Authors: Prasetyo Yogi Tri , Dewi Ratna Sari , Balatbat Naiomi M. , Antonio Michael Lancelot B. , Chuenyindee Thanatorn , Perwira Redi Anak Agung Ngurah , Young Michael Nayat , Diaz John Francis T. , Kurata Yoshiki B.
Published: August 2021

Icons have been widely utilized to describe and promote COVID-19 prevention measures. The purpose of this study was to analyze the preference and subjective design features of 133 existing icons associated with COVID-19 prevention measures published by the health and medical organizations of different countries. The 133 icons represent nineteen different function names, such as “Wash Hands” and “Wear Face Mask”. A total of 57 participants were recruited to perform two different tests: ranking test and subjective rating test. The ranking test was conducted to elicit the preference ranking of seven icon designs representing each function name. It was followed by a subjective rating test using 13 semantic scales on the two most preferred icons to analyze their perceived quality. Spearmen correlation was applied to derive the possible correlations between users’ rankings and the semantic scales, and Friedman’s test was also performed to determine the true difference between ranking in terms of each semantic scale to provide a fully meaningful interpretation of the data. Generally, findings from the current study showed that the image presented in the icon is the key point that affects the icons’ perceived quality. Interestingly, Spearman’s correlation analysis between preference ranking and semantic scales showed that vague–clear, weak–strong, incompatible–compatible, and ineffective–effective were the four strongest semantic scales that highly correlated with the preference ranking. Considering the significant relationships between the semantic distances and the functions, images depicted in an icon should be realistic and as close as possible to its respected function to cater to users’ preferences. In addition, the results of Spearman’s correlation and Friedman’s test also inferred that compatibility and clarity of icon elements are the main factors determining a particular icon’s preferability. This study is the first comprehensive study to evaluate the icons associated with the COVID-19 prevention measures. The findings of this study can be utilized as the basis for redesigning icons, particularly for icons related to COVID-19 prevention measures. Furthermore, the approach can also be applied and extended for evaluating other medical icons.
Association between the Serum Coenzyme Q10 Level and Seizure Control in Patients with Drug-Resistant Epilepsy
Authors: Liao Wei-Chen , Huang Chin-Wei , Hsiao Ya-Hsin , Sung Pi-Shan , Fu Tzu-Fun , Chang Alice Y. W. , Chang Hui Hua
Published: August 2021

Drug-resistant epilepsy (DRE) is a chronic neurological disorder with somatic impacts and increased risk of metabolic comorbidities. Oxidative stress might play an important role in metabolic effects and as a regulator of seizure control, while coenzyme Q10 (CoQ10) could improve insulin sensitivity through antioxidant effects. We aimed to investigate the association between CoQ10 level and clinical outcome, represented by the seizure frequency and quality of life, in DRE patients. DRE patients (N = 33) had significantly higher serum insulin levels and lower scores on the physical domain of the World Health Organization Quality of Life questionnaire (WHOQoL) than gender-age matched controls. The serum CoQ10 level (2910.4 ± 1163.7 ng/mL) was much higher in DRE patients than the normal range. Moreover, the serum CoQ10 level was significantly correlated with the seizure frequency (r = −0.412, p = 0.037) and insulin level (r = 0.409, p = 0.038). Based on stratification by insulin resistance (HOMA-IR > 2.4), the subgroup analysis showed that patients with a greater HOMA-IR had higher CoQ10 levels and lower seizure frequency, and had a significantly worse quality of life. In summary, CoQ10 could be a mediator involved in the mechanism of epilepsy and serve as a biomarker of the clinical outcome in DER patients.
Weekly Semaglutide vs. Liraglutide Efficacy Profile: A Network Meta-Analysis
Authors: Alsugair Hassan A. , Alshugair Ibrahim F. , Alharbi Turki J. , Bin Rsheed Abdulaziz M. , Tourkmani Ayla M. , Al-Madani Wedad
Published: August 2021

Introduction: Glucagon-like peptide 1 receptor agonist (GLP-1 RA) is a class of hypoglycemic medications. Semaglutide once-weekly (QW) and liraglutide once-daily (OD) significantly improved glycemic control compared to placebo. To date, no long-term phase III trials directly comparing semaglutide and liraglutide are available. This network meta-analysis (NMA) aims to compare the long-term efficacy of semaglutide and liraglutide. Methods: PubMed, Embase, and Cochrane Library were searched from inception until June 2019 to identify relevant articles. Nine long-term randomized controlled trials comparing once-weekly semaglutide or liraglutide with placebo or other active comparisons were identified. The outcomes of interest were changes in HbA1c and weight after 52 weeks. A Bayesian framework and NMA were used for data synthesis. This is a sub-study of the protocol registered in PROSPERO (number CRD42018091598). Results: The data showed significant superiority in HbA1c reduction of semaglutide 1 mg QW over liraglutide 1.2 and 1.8 mg with a treatment difference of 0.47% and 0.3%, respectively. Semaglutide 0.5 mg QW was found to be significantly superior to liraglutide 1.2 mg in HbA1c reduction with a treatment difference of 0.17%. Regarding weight reduction analysis, semaglutide 0.5 and 1 mg QW were significantly associated with a greater reduction than liraglutide 0.6 mg with a treatment difference of 2.42 and 3.06 kg, respectively. However, no significant reduction was found in comparison to liraglutide 1.2 and 1.8 mg. Conclusions: Semaglutide improved the control of blood glucose and body weight. The capacity of long-term glycemic control and body weight control of semaglutide appears to be more effective than other GLP-1 RAs, including liraglutide. However, considering the number of included studies and potential limitations, more large-scale, head-to-head, well-designed randomized-controlled trials (RCTs) are needed to confirm these findings.
Rehabilitation Process Issues and Functional Performance after Total Hip and Knee Replacement
Authors: Fedonnikov Alexander S. , Andriyanova Elena A. , Kiselev Anton R. , Norkin Igor A.
Published: August 2021

(1) Background: to ensure satisfactory outcomes in patients who have undergone total hip or knee replacement, it is crucial to prioritize postoperative rehabilitation process and its management rather than the successful surgery alone. The goal of our study was to investigate the outcomes of rehabilitation process after the total hip or knee replacement, including local orthopedic follow-up, communication with local health authorities, patients’ satisfaction regarding rehabilitation, and their functional performance after the surgery. (2) Methods: the study included 523 patients who underwent total hip replacement, and 650 patients who underwent total knee replacement. All patients were surveyed via formalized phone interviews containing questions related to postoperative rehabilitation parameters and outcomes. (3) Results: in postsurgical period, nearly 70% of patients had regular local orthopedic follow-up. Lack of the latter at the local level was indicated by approximately 10% of patients, and the rest of the respondents note the practice of sporadic follow-up. Half of patients reported pains of various severity. Good physical activity (e.g., ability to walk unassisted within their residential district) was acknowledged by about a quarter of patients. Ability to walk unassisted was reported by just 54.5% of patients. (4) Conclusions: the disproportion between generally high patient satisfaction of rehabilitation management (>80%) and low feedback level on the part of local health authorities (9.4%) demonstrated lack of communication between the key parties involved in the rehabilitation process.
Efficiency of Osmotic Dehydration of Pomegranate Seeds in Polyols Solutions Using Response Surface Methodology
Authors: Bchir Brahim , Sebii Haifa , Danthine Sabine , Blecker Christophe , Besbes Souhail , Attia Hamadi , Bouaziz Mohamed Ali
Published: August 2021

This study investigates the influence of polyol compounds (sorbitol and erythritol) on the osmotic dehydration process of pomegranate seeds. The efficacy of the osmotic dehydration process was estimated based on the determination of water loss, weight reduction, solid gain, and effective diffusivity and also through a comparison of the results obtained between sucrose and polyol osmotic solutions. Response surface methodology was used to optimize the osmotic process. Quality attributes of pomegranate seeds were determined through the assessment of physical (texture and color) characteristics. This innovative research applies alternative solutions in the osmotic process, which until now, have not been commonly used in the osmotic dehydration of pomegranate seeds processing by researchers worldwide. Results revealed the excellent correlation of experimental values with the model. Erythritol and sorbitol exhibit stronger efficiency than sucrose. However, erythritol was not satisfactory due to the high solid gain. Therefore, the sorbitol osmotic agent seems to be the most suitable for the osmotic dehydration of pomegranate seeds. The optimal condition for maximum water loss (38.61%), weight reduction (37.77%), and effective diffusivity (4.01 × 10−8 m2/s) and minimum solid gain (−0.37%) were 13.03 min, 27.77 °Brix, and 37.7 °C, using a sorbitol solution. Results of texture and color revealed the major impact of erythritol and sorbitol osmotic agents on seed characteristics during the osmotic dehydration process.
Transcriptome Analysis Reveals Potential Mechanisms for Ethylene-Inducible Pedicel–Fruit Abscission Zone Activation in Non-Climacteric Sweet Cherry (Prunus avium L.)
Authors: Hewitt Seanna , Kilian Benjamin , Koepke Tyson , Abarca Jonathan , Whiting Matthew , Dhingra Amit
Published: August 2021

The harvesting of sweet cherry (Prunus avium L.) fruit is a labor-intensive process. The mechanical harvesting of sweet cherry fruit is feasible; however, it is dependent on the formation of an abscission zone at the fruit–pedicel junction. The natural propensity for pedicel-–fruit abscission zone (PFAZ) activation varies by cultivar, and the general molecular basis for PFAZ activation is not well characterized. In this study, ethylene-inducible change in pedicel fruit retention force (PFRF) was recorded in a developmental time-course with a concomitant analysis of the PFAZ transcriptome from three sweet cherry cultivars. In ‘Skeena’, mean PFRF for both control and treatment fruit dropped below the 0.40 kg-force (3.92 N) threshold for mechanical harvesting, indicating the activation of a discrete PFAZ. In ‘Bing’, mean PFRF for both control and treatment groups decreased over time. However, a mean PFRF conducive to mechanical harvesting was achieved only in the ethylene-treated fruit. While in ‘Chelan’ the mean PFRF of the control and treatment groups did not meet the threshold required for efficient mechanical harvesting. Transcriptome analysis of the PFAZ region followed by the functional annotation, differential expression analysis, and gene ontology (GO) enrichment analyses of the data facilitated the identification of phytohormone-responsive and abscission-related transcripts, as well as processes that exhibited differential expression and enrichment in a cultivar-dependent manner over the developmental time-course. Additionally, read alignment-based variant calling revealed several short variants in differentially expressed genes, associated with enriched gene ontologies and associated metabolic processes, lending potential insight into the genetic basis for different abscission responses between the cultivars. These results provide genetic targets for the induction or inhibition of PFAZ activation, depending on the desire to harvest the fruit with or without the stem attached. Understanding the genetic mechanisms underlying the development of the PFAZ will inform future cultivar development while laying a foundation for mechanized sweet cherry harvest.
Bringing Light into Darkness—Comparison of Different Personal Dosimeters for Assessment of Solar Ultraviolet Exposure
Authors: Strehl Claudine , Heepenstrick Timo , Knuschke Peter , Wittlich Marc
Published: August 2021

(1) Measuring personal exposure to solar ultraviolet radiation (UVR) poses a major challenges for researchers. Often, the study design determines the measuring devices that can be used, be it the duration of measurements or size restrictions on different body parts. It is therefore of great importance that measuring devices produce comparable results despite technical differences and modes of operation. Particularly when measurement results from different studies dealing with personal UV exposure are to be compared with each other, the need for intercomparability and intercalibration factors between different measurement systems becomes significant. (2) Three commonly used dosimeter types—(polysulphone film (PSF), biological, and electronic dosimeters)—were selected to perform intercalibration measurements. They differ in measurement principle and sensitivity, measurement accuracy, and susceptibility to inaccuracies. The aim was to derive intercalibration factors for these dosimeter types. (3) While a calibration factor between PSF and electronic dosimeters of about 1.3 could be derived for direct irradiation of the dosimeters, this was not the case for larger angles of incidence of solar radiation with increasing fractions of diffuse irradiation. Electronic dosimeters show small standard deviation across all measurements. For biological dosimeters, no intercalibration factor could be found with respect to PSF and electronic dosimeters. In a use case, the relation between steady-state measurements and personal measurements was studied. On average, persons acquired only a small fraction of the ambient radiation.
Hypoxic Exercise Exacerbates Hypoxemia and Acute Mountain Sickness in Obesity: A Case Analysis
Authors: Xu Jing , Zeng Jinshu , Yan Yelei , Xu Fei
Published: August 2021

Acute mountain sickness (AMS) is a common syndrome characterized by headache, dizziness, loss of appetite, weakness, and nausea. As a major public health issue, obesity has increased in high altitude urban residents and intermittent commuters to high altitudes. The present study investigated acute hypoxic exposure and hypoxic exercise on hypoxemia severity and AMS symptoms in a physically active obese man. In this case analysis, peripheral oxygen saturation (SpO2) was used to evaluate hypoxemia, heart rate (HR) and blood pressure (BP) were used to reflect the function of autonomic nervous system (ANS), and Lake Louise scoring (LLS) was used to assess AMS. The results showed that acute hypoxic exposure led to severe hypoxemia (SpO2 = 72%) and tachycardia (HRrest = 97 bpm), and acute hypoxic exercise exacerbated severe hypoxemia (SpO2 = 59%) and ANS dysfunction (HRpeak = 167 bpm, SBP/DBP = 210/97 mmHg). At the end of the 6-h acute hypoxic exposure, the case developed severe AMS (LLS = 10) symptoms of headache, gastrointestinal distress, cyanosis, vomiting, poor appetite, and fatigue. The findings of the case study suggest that high physical activity level appears did not show a reliable protective effect against severe hypoxemia, ANS dysfunction, and severe AMS symptoms in acute hypoxia exposure and hypoxia exercise.
Correlations between Physical Activity Participation and the Environment in Children and Adolescents: A Systematic Review and Meta-Analysis Using Ecological Frameworks
Authors: Li Longxi , Moosbrugger Michelle E.
Published: August 2021

Physical activity (PA) and sports are efficient ways to promote the young generation’s physical and mental health and development. This study expected to demonstrate the complexity of correlates associated with children’s and adolescents’ non-organized PA participation. Following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA), a systematic review and meta-analysis were applied. Seven electronic databases were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. The internal validity of the systematic reviews thus identified was evaluated using a validated quality instrument. Calculations were produced in SPSS 27.0 and Comprehensive Meta-Analysis 3.3. Thirty-nine eligible studies (N = 324,953) with moderate to high quality were included. No potential publication bias was detected using statistical analyses. The meta-analysis revealed that the overall ecological factors correlated positively with children and adolescents’ PA; the meta-analytic average of the correlations was (′r = 0.32, p < 0.001). Results from subgroup analysis indicated that theory-based influence factors achieved moderate effect with boys (′r = 0.37, p < 0.001) and girls (′r = 0.32, p < 0.001) in PA participation. Interestingly, higher correlations were found between ecological factors and twins’ PA participation (′r = 0.61, p = 0.001). Further, individual (′r = 0.32, p < 0.001), macro-, and chronosystems factors (′r = 0.50, p < 0.001) appeared slightly more influential than microsystems factors (′r = 0.28, p < 0.001) on children and adolescents’ PA participation. Although findings from the included studies covered were to some extent heterogeneous, it is possible to identify consistent correlates of PA in children and adolescents. The results supported that PA is a complex and multi-dimensional behavior, which is determined by numerous biological, psychological, sociocultural, and environmental factors. Future studies that focus on the integration effect of macrosystem and chronosystem environmental factors, and apply longitudinal designs and objective measurements are encouraged to further unfold the complexity of the ecological system and its implications in promoting children and adolescents’ PA participation.
Impact of Economic Development Level and Agricultural Water Use on Agricultural Production Scale in China
Authors: Pang Jiaxing , Wang Ningfei , Li Xue , Li Xiang , Wang Huiyu , Chen Xingpeng
Published: August 2021

The change of agricultural production scale is directly related to food security and the stable development of social economy. Particularly, the influence of economic development level and agricultural water use on agricultural production scale cannot be ignored. Therefore, this paper uses the fully modified ordinary least squares (FMOLS) and the Dumitrescu–Hurlin panel causality test models to discuss the effects of the level of economic development, agricultural water use, the level of urbanization, and the market price of agricultural products on the scale of agricultural production in China. The analysis results indicated that agricultural water use, the level of urbanization, and the market price of agricultural products promoted an increase of the scale of agricultural production at the total sample level; a 1% increase for these three variables will result in an increase of the scale of agricultural production of 0.634%, 0.377%, and 0.292%, respectively. The influence of economic development level on agricultural production scale accords with Kuznets curve. However, at the regional level, the influence of each variable on the eastern region is consistent with the trend of the total sample. In the central region, the impact of economic development on agricultural production scale shows a U-shaped curve, and the improvement of urbanization level inhibits the expansion of agricultural production scale. In the western region, all variables failed to pass the significance test. The results of the FMOLS model were validated by the fixed effects model. The results of causality tests showed that bidirectional causality existed between the scale of agricultural production and the level of economic development, the scale of agricultural production and agricultural water use, the level of economic development and the market price of agricultural products, and the level of urbanization and the market price of agricultural products. In different regions, there were differences in causality between variables. Therefore, based on the empirical results, we put forward some policy suggestions to maintain the scale of agricultural production.
Engaging Parents of Lower-Socioeconomic Positions in Internet- and Mobile-Based Interventions for Youth Mental Health: A Qualitative Investigation
Authors: Broomfield Grace , Wade Catherine , Yap Marie B. H.
Published: August 2021

Growing literature supports the use of internet- and mobile-based interventions (IMIs) targeting parenting behaviours to prevent child and adolescent mental health difficulties. However, parents of lower-socioeconomic positions (SEP) are underserved by these interventions. To avoid contributing to existing mental health inequalities, additional efforts are needed to understand the engagement needs of lower-SEP parents. This study qualitatively explored lower-SEP parents’ perspectives on how program features could facilitate their engagement in IMIs for youth mental health. We conducted semi-structured interviews with 16 lower-SEP parents of children aged 0–18 to identify important program features. Participants were mostly female (81.3%) and aged between 26 and 56 years. Transcriptions were analysed using inductive thematic analysis. Twenty-three modifiable program features important to lower-SEP parents’ engagement in IMIs were identified. These features aligned with one of three overarching themes explaining their importance to parents’ willingness to engage: (1) It will help my child; (2) I feel like I can do it; (3) It can easily fit into my life. The relative importance of program features varied based on parents’ specific social and economic challenges. These findings offer initial directions for program developers in optimising IMIs to overcome barriers to engagement for lower-SEP parents.
Dust Emission Monitoring in Cement Plant Mills: A Case Study in Romania
Authors: Ciobanu Cristian , Istrate Irina Aura , Tudor Paula , Voicu Gheorghe
Published: August 2021

This paper presents aspects of monitoring material dust emissions from stationary emission sources (monthly dust measurements performed on cement mill stacks—mill outlet and separator outlet). Additionally, the Portland cement mill technological process (its component parts), as well as the solutions regarding the reduction of the air emissions level, following the emission limit values (VLE), established in the integrated environmental authorization (AIM) from a cement factory in Romania, were analyzed. The paper focused on analyzing the data obtained in three different years for PM10 and dust concentrations (2018–2020). For each year, the measurements have been done in 3 months, each in a different season. The average values for each year for working conditions were: 30.22 mg/m3 (2018), 27.38 mg/m3 (2019), and 27.51 mg/m3 (2020) for working conditions and for normal conditions: 34.22 mg/m3 (2018), 30.49 mg/m3 (2019), and 30.16 mg/m3 (2020). For all 3 years, the values measured in spring were higher than the other two, both for work and normal conditions.
Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan
Authors: Wang Yueh-Hsin , Li Hui-Chun , Liao Kuang-Yu , Chen Tzeng-Ji , Hwang Shinn-Jang
Published: August 2021

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.
Theory-Based Social and Non-Social Engagement Features in Smoking Cessation Mobile Apps: A Content Analysis
Authors: Yang Qinghua
Published: August 2021

Despite the ubiquity of smartphone ownership and the increasing integration of social engagement features in smoking cessation apps to engage users, the social and non-social engagement features that are present in current smoking cessation apps and the effectiveness of these features in engaging users remain understudied. To fill the gap in the literature, a content analysis of free and paid smoking cessation mobile apps was conducted to examine (a) the presence of social features (i.e., social support, social announcement, and social referencing) and non-social engagement features (e.g., personal environmental changes, goal setting, progress tracking, reinforcement tracking, self-monitoring, and personalized recommendations) and (b) their relationships with user engagement scores measured by the Mobile App Rating Scale. In this study, 28.2% of the smoking cessation apps enable social announcement and 8.1% offered the social support feature. Only two apps provided a social referencing feature (1.3%). No app included reinforcement tracking, with the percentage of other non-social engagement features ranging from 9.4% to 49.0%. Social support (β = 0.30, p < 0.001), social announcement (β = 0.21, p < 0.05), and social referencing (β = 0.18, p < 0.05) were significant predictors of user engagement. Regarding the non-social engagement features, personal environment changes (β = 0.38, p < 0.001), progress tracking (β = 0.18, p < 0.05), and personalized recommendations (β = 0.37, p < 0.001) significantly predicted user engagement. The findings not only contribute to the mobile communication literature by applying and extending the theory-based mobile health apps engagement typology, but also inform the future architecture design of smoking cessation mobile apps.
Prevalence of Burnout Syndrome and Job Satisfaction in Music Therapists in Spain: A Cross-Sectional, Descriptive Study
Authors: Sequera-Martín Manuel , Ramos-Fuentes María Isabel , Garrido-Ardila Elisa María , Sánchez-Sánchez Carmen , de la Torre-Risquez Antonia , Rodríguez-Mansilla Juan
Published: August 2021

Background: Burnout syndrome and job satisfaction are topics of increasing interest due to their relevance in people’s health and well-being. Besides, they are considered very relevant in the fields of social and health care studies. Objective: The objective of this study was to analyse the professional profile of music therapists in Spain and the prevalence of burnout syndrome and job satisfaction among them. Methods: This was an observational, descriptive, cross-sectional study, carried out using an ad-hoc online questionnaire, the Maslach Scale and the general satisfaction scale on a sample of employed Spanish music therapists with more than two years of working experience in Spain. Results: Eighty questionnaires were analysed. The majority of the participants were between 30–39 years old (38.8%) and were women (85%). They combined their profession with other occupations (76.3%), mostly in care roles with a fix term contract and were self-employed (40%). The prevalence of burnout syndrome was 3.8% (p < 0.001) and the predisposition or tendency to develop this condition was over 57.5% (p < 0.001). The highest levels of burnout syndrome were found in professionals with trainee contracts (p = 0.001), in those who were providing training (p = 0.021), who attended 6 to 10 patients per week (p = 0.001), who were usually working with a therapist colleague (p = 0.046) and those who did not take prescribed psychotropic drugs (p = 0.034). The highest level of job satisfaction was observed in music therapists working in the field of disability (p = 0.010) and mental health (p = 0.022) and with seniority in their job position. The lowest level of job satisfaction was seen in music therapists with trainee contracts (p = 0.041), with less working hours per week (p = 0.016), working in the field of education (p = 0.006) and in those who did not feel valued by their colleagues (p < 0.001) or by the director of the centre where they worked (p < 0.001). Conclusions: Based on the results of this study, Spanish music therapists show a low prevalence of burnout syndrome but a moderate-high predisposition to develop it. Music therapists with burnout syndrome are those who work longer hours and perform their job in palliative care setting. In general, music therapists have a high level of both intrinsic and extrinsic job satisfaction. The lowest level of job satisfaction was found in music therapists with trainee contracts and the highest in music therapists with senior positions.
Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs
Authors: Renzaho Andre M. N. , Dachi Gilbert , Tesfaselassie Kibrom , Abebe Kiross Tefera , Kassim Ismail , Alam Qutab , Shaban Nawal Sadick , Shiweredo Tesfatsion , Vinathan Hari , Jaiswal Chandrakala , Abraham Hellen Martin , Miluwa Khamisa Ayoub , Mahumud Rashidul Alam , Ategbo Eric , Ndiaye Biram , Ayoya Mohamed Ag
Published: August 2021

Community-based management of severe wasting (CMSW) programs have solely focused on exit outcome indicators, often omitting data on nutrition emergency preparedness and scalability. This study aimed to document good practices and generate evidence on the effectiveness and scalability of CMSW programs to guide future nutrition interventions in South Sudan. A total of 69 CMSW program implementation documents and policies were authenticated and retained for analysis, complemented with the analyses of aggregated secondary data obtained over five (2016–2020 for CMSW program performance) to six (wasting prevention) years (2014–2019). Findings suggest a strong and harmonised coordination of CMSW program implementation, facilitated timely and with quality care through an integrated and harmonised multi-agency and multidisciplinary approach. There were challenges to the institutionalisation and ownership of CMSW programs: a weak health system, fragile health budget that relied on external assistance, and limited opportunities for competency-based learning and knowledge transfer. Between 2014 and 2019, the prevalence of wasting fluctuated according to the agricultural cycle and remained above the emergency threshold of 15% during the July to August lean season. However, during the same period, under-five and crude mortality rates (10,000/day) declined respectively from 1.17 (95% confidence interval (CI): 0.91, 1.43) and 1.00 (95% CI: 0.75, 1.25) to 0.57 (95% CI: 0.38, 0.76) and 0.55 (95% CI: 0.39, 0.70). Both indicators remained below the emergency thresholds, hence suggesting that the emergency response was under control. Over a five-year period (2016–2020), a total of 1,105,546 children (52% girls, 48% boys) were admitted to CMSW programs. The five-year pooled performance indicators (mean [standard deviations]) was 86.4 (18.9%) for recovery, 2.1 (7.8%) for deaths, 5.2 (10.3%) for defaulting, 1.7 (5.7%) for non-recovery, 4.6 (13.5%) for medical transfers, 2.2 (4.7%) for relapse, 3.3 (15.0) g/kg/day for weight gain velocity, and 6.7 (3.7) weeks for the length of stay in the program. In conclusion, all key performance indicators, except the weight gain velocity, met or exceeded the Humanitarian Charter and Minimum Standards in Humanitarian Response. Our findings demonstrate the possibility of implementing robust and resilient CMSAM programs in protracted conflict environments, informed by global guidelines and protocols. They also depict challenges to institutionalisation and ownership.
Potential Help-Seeking Behaviors Associated with Better Self-Rated Health among Rural Older Patients: A Cross-Sectional Study
Authors: Ohta Ryuichi , Sato Mikiya , Kitayuguchi Jun , Maeno Tetsuhiro , Sano Chiaki
Published: August 2021

Help-seeking behaviors (HSB) for mild symptoms vary because of differences in health care resources and patients’ backgrounds. Potential HSBs for lay and professional care use are related to patients’ health conditions. However, there is a lack of evidence of the relation between them. This study examined the relation between patients’ potential HSBs and self-rated health (SRH). The cross-sectional study involved 169 patients, aged above 65 years, who visited a Japanese rural clinic. A validated checklist was used to assess potential patients’ HSBs. A chi-square test and logistic regression were performed to examine the relation between patients’ self-rated health and HSB regarding lay and professional care use. Participants were 77.5 years old, on average (SD = 8.3). Results reveal that having regular exercise habits (OR = 2.42, p = 0.04), adequate sleep (OR = 4.35, p = 0.006), work (OR = 2.59, p = 0.03), high socioeconomic status (OR = 6.67, p = 0.001), and using both lay and professional care (OR = 2.39, p = 0.046) were significantly correlated with high self-rated health. Living alone was negatively correlated with higher SRH (OR = 0.23, p = 0.015). To improve rural patients’ health care, in addition to improving their health management skills, potential HSB for mild symptoms should be investigated and interventions that consider patients’ socioeconomic factors and living conditions should be implemented.
Family Policy and Child Well-Being: The Case of Montenegro in the European Perspective
Authors: Bošković Branko , Churchill Harriet , Hamzallari Oriola
Published: August 2021

Family policies and family support measures have been identified as having major implications for child well-being, particularly through their role in influencing parental and family resources, circumstances and behaviour. The official approach to family policies focuses on opportunities for families to balance their work and family duties and care for their children. This paper analyses the type of policies available in Montenegro compared to the European Union. Potentially, Montenegro will become an EU member state, thus it is important to take a look at Montenegrin practice, as children should have equal life chances and protection of their well-being. Having a solid legal framework per se does not necessarily result in significant positive outcomes, and this paper analyses whether children in Montenegro have the same opportunities for development, in the context of family policies, as their counterparts in the rest of Europe. The focus of the paper will be on the criteria that define family rights and obligations, eligibility, availability and use of family policies in Montenegro. Based on the specific measures and datasets examined, the analysis considers the degree to which a period of family policy investment in Montenegro has been accompanied by improvements in child well-being and family resources, and undertakes comparisons in these regards with EU-wide family policy and child well-being trends. The paper uses a welfare state theoretical approach, with the focus on social investment and relevant data on children’s well-being obtained from the Eurostat, the OECD and the official national statistics.
Motor Function of Children with SMA1 and SMA2 Depends on the Neck and Trunk Muscle Strength, Deformation of the Spine, and the Range of Motion in the Limb Joints
Authors: Stępień Agnieszka , Gajewska Ewa , Rekowski Witold
Published: August 2021

The purpose of this study was to investigate the functional relationships between selected ranges of motion of the neck, upper and lower limbs, the strength of the neck and trunk muscles, postural parameters, and the motor function of children with SMA1 and SMA2—27 children, aged 6 months-15 years, with genetically confirmed spinal muscular atrophy type 1 (19 children) and 2 (8 children) undergoing pharmacological treatment. All children were examined, according to the methodology, including the motor function evaluation, measurement of selected ranges of motion, assessment of postural parameters, and measurement of neck and trunk muscle strength. The functional status of 15 children was assessed with the CHOP INTEND (CHOP group) scale and of 12 children with the HFMSE (HFMSE group). The results obtained showed that, in children examined with the CHOP scale, greater limitation of flexion in the shoulder joints was observed. As the deformation of the chest increased, the functional abilities of children deteriorated. In participants examined with the CHOP group, the ranges of neck rotation decreased with the increase of the chest deformity. In the HFMSE group, the ranges of head rotation showed a strong relationship with some parameters of muscle strength and the sum of the R coefficients. Participants showed many significant relationships between the range of motion in the neck and joints of the limbs, with more significant relationships in the CHOP group. The following conclusions were made: motor skills of children with SMA depend on muscle strength, range of motion, and deformities of the spine and chest; the development of scoliosis adversely affects the motor function, ranges of motion, and muscle strength; and movement ranges are related to motor skills and strength values.
Effects on Heart Rate Variability of Stress Level Responses to the Properties of Indoor Environmental Colors: A Preliminary Study
Authors: Oh Jiyoung , Lee Haengwoo , Park Heykyung
Published: August 2021

Color is the most potent stimulating factor affecting human vision, and the environmental color of an indoor space is a spatial component that affects the environmental stress level. As one of the methods of assessing the physiological response of the autonomic nervous system that influences stress, heart rate variability (HRV) has been utilized as a tool for measuring the user’s stress response in color environments. This study aims to identify the effects of the changes of hue, brightness, and saturation in environmental colors on the HRV of two groups with different stress levels—the stress potential group (n = 15) and the healthy group (n = 12)—based on their stress level indicated by the Psychosocial Well-being Index (PWI). The ln(LF), ln(HF), and RMSSD values collected during the subjects’ exposure to 12 environments colors of red and yellow with adjusted saturation and brightness, were statistically analyzed using t-test and two-way ANOVA. The results show that the HRV values in the two groups did not significantly vary in response to the changes in hue, brightness and saturation. The two groups’ stress factors distinguished according to the stress levels by the PWI scale affected the In(LF) parameter, which demonstrates that the PWI index can be utilized as a reliable scale for measuring stress levels. The ultra-short HRV measurement record and the use of a sole In(LF) parameter for stress assessment are regarded as the limitations of this study.