bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching for the Antioxidant, Anti-Inflammatory, and Neuroprotective Potential of Natural Food and Nutritional Supplements for Ocular Health in the Mediterranean Population
Authors: Valero-Vello Mar , Peris-Martínez Cristina , García-Medina José J. , Sanz-González Silvia M. , Ramírez Ana I. , Fernández-Albarral José A. , Galarreta-Mira David , Zanón-Moreno Vicente , Casaroli-Marano Ricardo P. , Pinazo-Duran María D.
Published: May 2021

Adherence to a healthy diet offers a valuable intervention to compete against the increasing cases of ocular diseases worldwide, such as dry eye disorders, myopia progression, cataracts, glaucoma, diabetic retinopathy, or age macular degeneration. Certain amounts of micronutrients must be daily provided for proper functioning of the visual system, such as vitamins, carotenoids, trace metals and omega-3 fatty acids. Among natural foods, the following have to be considered for boosting eye/vision health: fish, meat, eggs, nuts, legumes, citrus fruits, nuts, leafy green vegetables, orange-colored fruits/vegetables, olives-olive oil, and dairy products. Nutritional supplements have received much attention as potential tools for managing chronic-degenerative ocular diseases. A systematic search of PubMed, Web of Science, hand-searched publications and historical archives were performed by the professionals involved in this study, to include peer-reviewed articles in which natural food, nutrient content, and its potential relationship with ocular health. Five ophthalmologists and two researchers collected the characteristics, quality and suitability of the above studies. Finally, 177 publications from 1983 to 2021 were enclosed, mainly related to natural food, Mediterranean diet (MedDiet) and nutraceutic supplementation. For the first time, original studies with broccoli and tigernut (chufa de Valencia) regarding the ocular surface dysfunction, macular degeneration, diabetic retinopathy and glaucoma were enclosed. These can add value to the diet, counteract nutritional defects, and help in the early stages, as well as in the course of ophthalmic pathologies. The main purpose of this review, enclosed in the Special Issue “Health Benefits and Nutritional Quality of Fruits, Nuts and Vegetables,” is to identify directions for further research on the role of diet and nutrition in the eyes and vision, and the potential antioxidant, anti-inflammatory and neuroprotective effects of natural food (broccoli, saffron, tigernuts and walnuts), the Mediterranean Diet, and nutraceutic supplements that may supply a promising and highly affordable scenario for patients at risk of vision loss. This review work was designed and carried out by a multidisciplinary group involved in ophthalmology and ophthalmic research and especially in nutritional ophthalmology.
The Physical Adsorption of Gelatinized Starch with Tannic Acid Decreases the Inhibitory Activity of the Polyphenol against α-Amylase
Authors: Wang Yueyi , Li Shuangshuang , Bai Fangting , Cao Junwei , Sun Lijun
Published: May 2021

The effects of mixing orders of tannic acid (TA), starch, and α-amylase on the enzyme inhibition of TA were studied, including mixing TA with α-amylase before starch addition (order 1), mixing TA with pre-gelatinized starch before α-amylase addition (order 2) and co-gelatinizing TA with starch before α-amylase addition (order 3). It was found that the enzyme inhibition was always highest for order 1 because TA could bind with the enzyme active site thoroughly before digestion occurred. Both order 2 and 3 reduced α-amylase inhibition through decreasing binding of TA with the enzyme, which resulted from the non-covalent physical adsorption of TA with gelatinized starch. Interestingly, at low TA concentration, α-amylase inhibition for order 2 was higher than order 3, while at high TA concentration, the inhibition was shown with the opposite trend, which arose from the difference in the adsorption property between the pre-gelatinized and co-gelatinized starch at the corresponding TA concentrations. Moreover, both the crystalline structures and apparent morphology of starch were not significantly altered by TA addition for order 2 and 3. Conclusively, although a polyphenol has an acceptable inhibitory activity in vitro, the actual effect may not reach the expected one when taking processing procedures into account.
A New Machine Learning Forecasting Algorithm Based on Bivariate Copula Functions
Authors: Carrillo J. A. , Nieto M. , Velez J. F. , Velez D.
Published: May 2021

A novel forecasting method based on copula functions is proposed. It consists of an iterative algorithm in which a dependent variable is decomposed as a sum of error terms, where each one of them is estimated identifying the input variable which best “copulate” with it. The method has been tested over popular reference datasets, achieving competitive results in comparison with other well-known machine learning techniques.
Focused Strategies for Defining the Genetic Architecture of Congenital Heart Defects
Authors: Martin Lisa J. , Benson D. Woodrow
Published: May 2021

Congenital heart defects (CHD) are malformations present at birth that occur during heart development. Increasing evidence supports a genetic origin of CHD, but in the process important challenges have been identified. This review begins with information about CHD and the importance of detailed phenotyping of study subjects. To facilitate appropriate genetic study design, we review DNA structure, genetic variation in the human genome and tools to identify the genetic variation of interest. Analytic approaches powered for both common and rare variants are assessed. While the ideal outcome of genetic studies is to identify variants that have a causal role, a more realistic goal for genetic analytics is to identify variants in specific genes that influence the occurrence of a phenotype and which provide keys to open biologic doors that inform how the genetic variants modulate heart development. It has never been truer that good genetic studies start with good planning. Continued progress in unraveling the genetic underpinnings of CHD will require multidisciplinary collaboration between geneticists, quantitative scientists, clinicians, and developmental biologists.
ATTRv in Lazio-Italy: A High-Prevalence Region in a Non-Endemic Country
Authors: Luigetti Marco , Guglielmino Valeria , Antonini Giovanni , Casali Carlo , Ceccanti Marco , Chiappini Maria Grazia , De Giglio Laura , Di Lazzaro Vincenzo , Di Muzio Antonio , Goglia Mariangela , Inghilleri Maurizio , Leonardi Luca , Massa Roberto , Pennisi Elena Maria , Petrucci Antonio , Proietti Emanuela , Rispoli Marianna , Sabatelli Mario , Di Girolamo Marco
Published: May 2021

Hereditary transthyretin amyloidosis (ATTRv, v for variant) prevalence in Italy, a non-endemic region, has been established by ATTRv amyloidosis Italian Registry. However, values of prevalence were extremely heterogeneous, considering different regions. To properly establish the prevalence of the disease in the Lazio region, a survey was sent to university regional hospitals and to main regional hospitals, in order to collect all affected patients regularly followed. We identified 100 ATTRv patients and, considering a Lazio population of 5.8/million, we estimated a ATTRv prevalence of 17.2/million. The ATTRv amyloidosis Italian Registry reported a prevalence of 8.0/million in Lazio, while our survey showed a value of double this. Our survey documented a high-prevalence for a non-endemic country. The increased awareness of the disease among general practitioners and medical specialists is a fundamental step to reduce the diagnostic delay and start an effective treatment of this disease.
Heritable Connective Tissue Disorders in Childhood: Increased Fatigue, Pain, Disability and Decreased General Health
Authors: Warnink-Kavelaars Jessica , de Koning Lisanne , Rombaut Lies , Alsem Mattijs , Menke Leonie , Oosterlaan Jaap , Buizer Annemieke , Engelbert Raoul ,   on behalf of the Pediatric Heritable Connective Tissue Disorders Study Group
Published: May 2021

Heritable Connective Tissue Disorders (HCTD) show an overlap in the physical features that can evolve in childhood. It is unclear to what extent children with HCTD experience burden of disease. This study aims to quantify fatigue, pain, disability and general health with standardized validated questionnaires. Methods. This observational, multicenter study included 107 children, aged 4–18 years, with Marfan syndrome (MFS), 58%; Loeys-Dietz syndrome (LDS), 7%; Ehlers-Danlos syndromes (EDS), 8%; and hypermobile Ehlers-Danlos syndrome (hEDS), 27%. The assessments included PROMIS Fatigue Parent–Proxy and Pediatric self-report, pain and general health Visual-Analogue-Scales (VAS) and a Childhood Health Assessment Questionnaire (CHAQ). Results. Compared to normative data, the total HCTD-group showed significantly higher parent-rated fatigue T-scores (M = 53 (SD = 12), p = 0.004, d = 0.3), pain VAS scores (M = 2.8 (SD = 3.1), p < 0.001, d = 1.27), general health VAS scores (M = 2.5 (SD = 1.8), p < 0.001, d = 2.04) and CHAQ disability index scores (M = 0.9 (SD = 0.7), p < 0.001, d = 1.23). HCTD-subgroups showed similar results. The most adverse sequels were reported in children with hEDS, whereas the least were reported in those with MFS. Disability showed significant relationships with fatigue (p < 0.001, rs = 0.68), pain (p < 0.001, rs = 0.64) and general health (p < 0.001, rs = 0.59). Conclusions. Compared to normative data, children and adolescents with HCTD reported increased fatigue, pain, disability and decreased general health, with most differences translating into very large-sized effects. This new knowledge calls for systematic monitoring with standardized validated questionnaires, physical assessments and tailored interventions in clinical care.
The Genes of Freedom: Genome-Wide Insights into Marronage, Admixture and Ethnogenesis in the Gulf of Guinea
Authors: Almeida João , Fehn Anne-Maria , Ferreira Margarida , Machado Teresa , Hagemeijer Tjerk , Rocha Jorge , Gayà-Vidal Magdalena
Published: May 2021

The forced migration of millions of Africans during the Atlantic Slave Trade led to the emergence of new genetic and linguistic identities, thereby providing a unique opportunity to study the mechanisms giving rise to human biological and cultural variation. Here we focus on the archipelago of São Tomé and Príncipe in the Gulf of Guinea, which hosted one of the earliest plantation societies relying exclusively on slave labor. We analyze the genetic variation in 25 individuals from three communities who speak distinct creole languages (Forros, Principenses and Angolares), using genomic data from expanded exomes in combination with a contextual dataset from Europe and Africa, including newly generated data from 28 Bantu speakers from Angola. Our findings show that while all islanders display mixed contributions from the Gulf of Guinea and Angola, the Angolares are characterized by extreme genetic differentiation and inbreeding, consistent with an admixed maroon isolate. In line with a more prominent Bantu contribution to their creole language, we additionally found that a previously reported high-frequency Y-chromosome haplotype in the Angolares has a likely Angolan origin, suggesting that their genetic, linguistic and social characteristics were influenced by a small group of dominant men who achieved disproportionate reproductive success.
Polymorphism in the GATM Locus Associated with Dialysis-Independent Chronic Kidney Disease but Not Dialysis-Dependent Kidney Failure
Authors: Šalamon Špela , Bevc Sebastjan , Ekart Robert , Hojs Radovan , Potočnik Uroš
Published: May 2021

The ten most statistically significant estimated glomerular filtration rate (eGFRcrea)-associated loci from genome-wide association studies (GWAs) are tested for associations with chronic kidney disease (CKD) in 208 patients, including dialysis-independent CKD and dialysis-dependent end-stage renal disease (kidney failure). The allele A of intergenic SNP rs2453533 (near GATM) is more frequent in dialysis-independent CKD patients (n = 135, adjusted p = 0.020) but not dialysis-dependent kidney failure patients (n = 73) compared to healthy controls (n = 309). The allele C of intronic SNP rs4293393 (UMOD) is more frequent in healthy controls (adjusted p = 0.042) than in CKD patients. The Allele T of intronic SNP rs9895661 (BCAS3) is associated with decreased eGFRcys (adjusted p = 0.001) and eGFRcrea (adjusted p = 0.017). Our results provide further evidence of a genetic difference between dialysis-independent CKD and dialysis-dependent kidney failure, and add the GATM gene locus to the list of loci associated only with dialysis-independent CKD. GATM risk allele carriers in the dialysis-independent group may have a genetic susceptibility to higher creatinine production rather than increased serum creatinine due to kidney malfunction, and therefore, do not progress to dialysis-dependent kidney failure. When using eGFRcrea for CKD diagnosis, physicians might benefit from information about creatinine-increasing loci.
Editorial Special Issue: “Nordic and European Modernisms”
Authors: Lothe Jakob
Published: May 2021

This Special Issue of Humanities explores the growth and development of Nordic modernisms in a European context [...]
Challenges and Opportunities of Targeted Behavioral Interventions for Groups at Risk for Developing Rheumatoid Arthritis
Authors: Zaccardelli Alessandra , Sparks Jeffrey A.
Published: May 2021

Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Early interventions are crucial to slowing progression to and potentially preventing RA onset. Modification of behaviors among at-risk individuals may decrease RA risk. There are several challenges and opportunities in implementing preventative behavioral interventions, which may vary within different at-risk groups. Methods: We performed a narrative review of the literature, including meta-analyses focused on RA risk-related behaviors as well as publications investigating the potential efficacy of behavioral modifications on RA risk. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical RA. Meta-analyses have been performed for smoking, excess body weight, and physical activity. Likelihood of adopting behavioral modifications may increase as RA risk increases. Conclusions: Clinicians may be able to tailor preventative approaches to various RA at-risk groups to help reduce RA risk, but further research is needed. A better understanding of the relationship of behaviors with RA risk and optimized approaches to implementing behavioral changes may allow for clinicians to tailor their preventative approaches for at-risk individuals.
Still Asking ‘What Works’: A Punishment Question for the Ages or an Aging Punishment Question?
Authors: Lucken Karol
Published: May 2021

The expectation that punishment be effective at controlling crime is a longstanding convention in the U.S., and no doubt elsewhere. While the history of American punishment has not been shaped entirely by the question of efficacy, it has played a predominant role in justifying penal policy for over 200 years. The question has become even more salient in policy decision-making of late, as research has begun to certify and consolidate findings on what is effective at reducing recidivism. What is lacking in this ongoing conversation, however, is a critique of this penal policy question and the answers it generates in the form of recidivism rates. The current paper fills this void by interrogating the claims of the evaluation literature, namely that better proof of what is effective is available and that more research is still needed. The questions and findings of 19th, 20th, and 21st Century seekers of what is effective in the American adult penal system are recounted and analyzed using several data sources. They include government reports, professional association meeting minutes, legislative documents, scholarly reports, individual studies, research reviews, and statistical analysis of systematic reviews. Ultimately, an overarching narrative is provided that deepens and challenges our understanding of what is known about what is effective.
Physiological and Biochemical Characterization of the GABA Shunt Pathway in Pea (Pisum sativum L.) Seedlings under Drought Stress
Authors: AL-Quraan Nisreen A. , Al-Ajlouni Zakaria I. , Qawasma Nima F.
Published: May 2021

The physiological and biochemical role of the γ-aminobutyric acid (GABA) shunt pathway in green pea seedlings (Pisum sativum L.) was studied in response to soil water holding capacity levels: 80%, 60%, 40%, 20%, and 10% grown under continuous light at 25 °C for 7 days and 14 days, separately. Characterization of seeds germination pattern, seedlings growth (plant height, fresh and dry weight, and chlorophyll contents), GABA shunt metabolite (GABA, glutamate, and alanine) levels, total protein and carbohydrate levels, and oxidative damage (MDA level) were examined. Data showed a significant effect of drought stress on seed germination, plant growth, GABA shunt metabolites level, total protein and carbohydrate contents, and MDA level. A significant decline in seed germination percentage was recorded at a 20% drought level, which indicated that 20% of soil water holding capacity is the threshold value of water availability for normal germination after 14 days. Seedling fresh weight, dry weight, and plant height were significantly reduced with a positive correlation as water availability was decreased. There was a significant decrease with a positive correlation in Chl a and Chl b contents in response to 7 days and 14 days of drought. GABA shunt metabolites were significantly increased with a negative correlation as water availability decreased. Pea seedlings showed a significant increase in protein content as drought stress was increased. Total carbohydrate levels increased significantly when the amount of water availability decreased. MDA content increased slightly but significantly after 7 days and sharply after 14 days under all water stress levels. The maximum increase in MDA content was observed at 20% and 10% water levels. Overall, the significant increases in GABA, protein and carbohydrate contents were to cope with the physiological impact of drought stress on Pisum sativum L. seedlings by maintaining cellular osmotic adjustment, protecting plants from oxidative stress, balancing carbon and nitrogen (C:N) metabolism, and maintaining cell metabolic homeostasis and cell turgor. The results presented in this study indicated that severe (less than 40% water content of the holding capacity) and long-term drought stress should be avoided during the germination stage to ensure proper seedling growth and metabolism in Pisum sativum L.
Forchlorfenuron Application Induced Parthenocarpic Fruit Formation without Affecting Fruit Quality of Cucumber
Authors: Su Li , Wang Miaoqing , Wang Yuean , Sharif Rahat , Ren Nannan , Qian Chunlu , Xu Jun , Chen Xuehao , Qi Xiaohua
Published: May 2021

The plant growth regulator forchlorfenuron is often applied to promote fruit setting and development in cucumber production. However, the effect of forchlorfenuron on the appearance and nutritional quality of cucumber is unknown. In the present study, forchlorfenuron was applied to female flowers 1 day before anthesis and at the day of anthesis. The application of forchlorfenuron successfully induced parthenocarpic fruit formation in cucumber. In addition, cytokinin-responsive genes were upregulated under forchlorfenuron treatment. Fruit treated with forchlorfenuron did not differ from pollinated fruit in shape, texture and major nutrients, such as protein, total flavonoids and vitamin C, with the exception of the lower phenolic acid content. Overall, our finding suggests that forchlorfenuron could be vital in promoting the parthenocarpic fruit set without altering the quality of cucumber.
Work–Family Conflict on Children’s Internet Addiction: Role of Parenting Styles in Korean Working Mother
Authors: Yang Hwa-Mi , Kim Hye-Ryoung
Published: May 2021

Based on spillover and crossover models in the family system, we hypothesized the mediating effect of parenting style in the association between maternal work–family conflict (WFC) and children’s problematic internet (PIU). This is a cross-sectional study using data from the 10th wave Panel Study on Korean Children (PSKC) in 2017. The study subjects were 707 mothers and their children. The WFC was measured using the Marshall and Barnett scale, parenting style by the Parenting Styles and Dimension Questionnaire developed by Robinson, and the PIU of a child by the K-Scale for adolescent observers. As a result, maternal WFC had a positive association with the PIU of a child. Maternal WFC also had a link with parenting styles. Specifically, WFC had a negative association with an authoritative parenting style, and a positive association with authoritarian and permissive parenting styles. Regarding the relationship between maternal WFC and the PIU of a child, parenting styles showed a mediating effect for authoritative (z = 2.08, p = 0.037), authoritarian (z = 2.71, p = 0.007), and permissive (z = 3.14, p = 0.002). Based on the results, we assert that when planning an intervention to reduce children’s PIU for working mothers, a multifaceted approach is essential, including both WFC and parenting behavior.
Responses of Spring Discharge to Different Rainfall Events for Single-Conduit Karst Aquifers in Western Hunan Province, China
Authors: Chang Wei , Wan Junwei , Tan Jiahua , Wang Zongxing , Jiang Cong , Huang Kun
Published: May 2021

It is a challenge to describe the hydrogeological characteristics of karst aquifers due to the complex structure with extremely high heterogeneity. As the response of karst aquifers to rainfall events, spring discharge variations after precipitation can be used to identify the internal structure of karst systems. In this study, responses of spring discharge to different kinds of precipitations are investigated by continuously monitoring precipitation and karst spring flow at a single-conduit karst aquifer in western Hunan province, China. Recession curves were used to analyze hydrodynamic behaviors and separate recession stages. The results show that the shape of the recession curve was changed under different rainfall conditions. Recession processes can be divided in to three recession stages under heavy rain conditions due to water drainage mainly from conduits, fracture, and matrix at each stage, but only one recession stage representing drainage mainly from matrix in the case of light rain. With the change in amount and intensity of precipitation, the calculated recession coefficient at each stage changes in an order of magnitude. The influence of precipitation on the recharge coefficient and the discharge composition at each recession are discussed, and then the conceptual model diagram of water filling and releasing in the single-conduit karst aquifers is concluded. The findings provide more insight understand on hydraulic behaviors of karst spring under different types of rainfall events and provide support for water resource management in karst regions.
Epileptic Seizures Detection Using Deep Learning Techniques: A Review
Authors: Shoeibi Afshin , Khodatars Marjane , Ghassemi Navid , Jafari Mahboobeh , Moridian Parisa , Alizadehsani Roohallah , Panahiazar Maryam , Khozeimeh Fahime , Zare Assef , Hosseini-Nejad Hossein , Khosravi Abbas , Atiya Amir F. , Aminshahidi Diba , Hussain Sadiq , Rouhani Modjtaba , Nahavandi Saeid , Acharya Udyavara Rajendra
Published: May 2021

A variety of screening approaches have been proposed to diagnose epileptic seizures, using electroencephalography (EEG) and magnetic resonance imaging (MRI) modalities. Artificial intelligence encompasses a variety of areas, and one of its branches is deep learning (DL). Before the rise of DL, conventional machine learning algorithms involving feature extraction were performed. This limited their performance to the ability of those handcrafting the features. However, in DL, the extraction of features and classification are entirely automated. The advent of these techniques in many areas of medicine, such as in the diagnosis of epileptic seizures, has made significant advances. In this study, a comprehensive overview of works focused on automated epileptic seizure detection using DL techniques and neuroimaging modalities is presented. Various methods proposed to diagnose epileptic seizures automatically using EEG and MRI modalities are described. In addition, rehabilitation systems developed for epileptic seizures using DL have been analyzed, and a summary is provided. The rehabilitation tools include cloud computing techniques and hardware required for implementation of DL algorithms. The important challenges in accurate detection of automated epileptic seizures using DL with EEG and MRI modalities are discussed. The advantages and limitations in employing DL-based techniques for epileptic seizures diagnosis are presented. Finally, the most promising DL models proposed and possible future works on automated epileptic seizure detection are delineated.
The Mediating Role of Job Competence between Safety Participation and Behavioral Compliance
Authors: Wang Jia-Ming , Liao Pin-Chao , Yu Guan-Biao
Published: May 2021

The effective improvement of employee behavioral compliance and safety performance is an important subject related to the sustainable development of the construction industry. Based on data from a Chinese company (n = 290), this study used a partial least squares-structural equation model to clarify the relationship among safety participation, job competence, and behavioral compliance. Empirical analysis found that: (1) safety participation had a significant positive impact on employees’ behavioral compliance; and (2) job competence played a partial mediating role between safety participation and behavioral compliance. By selecting two new perspectives of safety participation and job competence, this study derived new factors affecting behavioral compliance, constructed a new theory about safety management, and conducted an in-depth discussion on improving behavioral compliance theoretically. Practically, the research put forward a new decision-making model, deconstructed the mechanism between safety participation and behavioral compliance, and provided new guiding strategies for improving employee behavioral compliance.
Association between Anxiety, Quality of Life and Academic Performance of the Final-Year-Students in Latvia
Authors: Zile Inta , Bite Ieva , Krumina Indra , Folkmanis Valdis , Tzivian Lilian
Published: May 2021

The main objective of this study was to investigate the association between final-year students’ anxiety level and quality of life (QOL) with their academic achievements. A longitudinal study was performed in regular schools and in high-rated gymnasiums at the beginning and at the end of the school year. Multiple linear regression models were built for the association between level of anxiety/QOL with academic achievements. Type of school and gender—but not the level of anxiety—were the main predictors of academic achievements of 287 adolescents (e.g., for mathematics, the effect estimates were: β = −1.71 [95% confidence interval −2.21; −1.21]; β = −0.50 [−0.95; −0.06], β = 0.09 [−0.02; 0.20] for the type of school, gender, and changes in level of anxiety, respectively). To conclude, particular efforts should be made to reduce the level of anxiety in girls, especially those that study in high-rated schools.
Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)
Authors: Represas-Carrera Francisco , Couso-Viana Sabela , Méndez-López Fátima , Masluk Bárbara , Magallón-Botaya Rosa , Recio-Rodríguez Jose I. , Pombo Haizea , Leiva-Rus Alfonso , Gil-Girbau Montserrat , Motrico Emma , Martí-Lluch Ruth , Gude Francisco , Clavería Ana
Published: May 2021

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45–75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions’ effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45–75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = −0.09 (95% CI: −0.29–0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: −0.32–0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01–0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64–1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55–1.73), no smoking OR = 0.61 (95% CI: 0.54–1.06), EVA adjusted mean difference = −1.26 (95% CI: −4.98–2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
COVID-19 Pandemic Affects the Medical Students’ Learning Process and Assaults Their Psychological Wellbeing
Authors: Aftab Marium , Abadi Alsaleem Mohammed , Nahar Shamsun , Ahmed Razia Aftab , Mahmood Syed Esam , Madaan Manik , Ahmad Ausaf
Published: May 2021

Background: With the emergence of the COVID-19 pandemic, people are living within a milieu of stress, anxiety, and fear. Medical students are susceptible to these emotional injuries, but their psychological wellbeing and learning may further be assaulted by future uncertainties and altered teaching and training programs. Our objective was to find the extent of the psychological impact of the pandemic and the learning difficulties they are experiencing; Methodology: This cross-sectional study included 418 undergraduate and postgraduate medical students from all over the world. A questionnaire was uploaded in Google survey form. It included background characteristics, questions for psychiatric impact like PHQ-9, GAD-7, ZF-OCS, and questions for learning difficulties perceived in comparison to the pre-pandemic time. Results: Among participants, 34.9% of students were male and 65.1% female. Around 46.4% belonged to the WHO, Eastern Mediterranean region, 26.8% from South East Asia region, 17.5% from the region of America, 5.5% from the European region,2.2%from the Western Pacific region, and 1.7% from the African region. Symptoms due to psychiatric illness were noticed in 393 (93.1%); depression in 386 (92.3%), anxiety in 158 (37.8%), obsessive compulsion disorder in 225 (53.8%), and post-traumatic stress syndrome in 129 (39.9%). Female gender, geographical region, and history of previous psychiatric illness were significantly related to almost all the psychiatric illnesses. Regarding learning difficulty, 96% of students faced problems: trouble with memorizing in 54.0%, concentration problems in 67.0%, about 55.5% of students made more mistakes, while 44.5% noted an increase in reaction time for solving questions. In addition, 90% experienced greater difficulty in overall learning during the pandemic in comparison to the pre-pandemic time. Conclusion: Assault on psychological wellbeing, struggling to memorize, inattention and difficulty in concentration on studies, along with perceived overall trouble with learning, have emerged as collateral damage from the COVID-19 pandemic with respect to medical students.
Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review
Authors: Pizzol Damiano , Trott Mike , Grabovac Igor , Antunes Mario , Colangelo Anna Claudia , Ippoliti Simona , Ilie Cristian Petre , Carrie Anne , Veronese Nicola , Smith Lee
Published: May 2021

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.
The Soundscape of the COVID-19 Lockdown: Barcelona Noise Monitoring Network Case Study
Authors: Bonet-Solà Daniel , Martínez-Suquía Carme , Alsina-Pagès Rosa Ma , Bergadà Pau
Published: May 2021

The lockdown social measures in Spain due to COVID-19 caused a significant decrease in urban noise levels, which was observed in most of the large cities. This paper presents an analysis of the noise levels in Barcelona, Spain, by means of an accurate analysis of the most relevant sensors deployed in the Barcelona Noise Monitoring Network. In this work, we present the LAeq levels in eight different locations from January 2020 to June 2020—from Superblocks to industrial zones—including and detailing all stages of the lockdown. Several comparisons were conducted with the monitoring data available from the former years (2019 and 2018—when available). The results of the analysis in Barcelona show a drastic LAeq reduction (−9 dBA), especially in nightlife areas of the city, moderate to high LAeq change (−7 dBA) in commercial and restaurants areas and a small decrease in LAeq (−5 dBA) in dense traffic areas.
Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes
Authors: Ohta Ryuichi , Ryu Yoshinori , Sano Chiaki
Published: May 2021

This study aimed to clarify the effect of coronavirus disease (hereafter, COVID-19) control on patients’ health conditions and staff’s working conditions in rural nursing homes. An interventional study including all staff and patients in a rural nursing home was performed from 1 April 2019 to 31 March 2021. Infection control measures against COVID-19 were initiated on 1 April 2020. The primary outcome was the frequency of patients’ medical care visits to the outpatient and emergency departments. The secondary outcome was the number of days-off taken by staff. Each group (pre- and post-COVID-19 control groups) had 48 participants. The number of visits to the outpatient department reduced from the pre-COVID-19 to post-COVID-19 control period the difference in number of visits to the emergency department was not significant, due to the low statistical power. The number of days-off taken by the staff was increased from the pre-COVID-19 to post-COVID-19 control period. This is the first study investigating COVID-19 control measures in a rural nursing home. It may help reduce the number of patient visits to medical facilities without increasing the risk of emergencies. A strict health check of the staff can allow staff to take more days off in rural contexts.
Representations of Free-Living and Unrestrained Dogs as an Emerging Public Health Issue in Australian Newspapers
Authors: Degeling Chris , Hall Julie , van Eeden Lily M. , Finlay Summer M. , Gurung Suk Maya , Brookes Victoria J.
Published: May 2021

That dogs can live and breed as free-living animals contributes to public health risks including zoonotic transmission, dog bites, and compromising people’s sense of safety in public spaces. In Australia, free-living dog populations are comprised of domestic dogs, dingoes, and dog–dingo hybrids, and are described using various terms (for example, stray or community), depending on social or geographic context. Urban expansion and regional migration mean that risks associated with contact between humans and free-living dogs are increasing. Public health authorities, local governments, and community organisations have called for transdisciplinary partnerships to address dog-related health risks with a sustainable long-term approach. Values pluralism and a lack of sustained community engagement in affected areas have meant that the outcome of such efforts to date has been mixed. To identify ideas in public circulation about the impact of unrestrained and free-living dogs on human health and well-being, and understand the framework through which these animals are problematised and solutions are proposed in public discourse, we systematically examined coverage of these issues in print media. Our analyses indicate that reporting in Australian newspapers tends to frame the public health impacts of free-living dogs as problems of public order requiring direct government action to re-establish control. The public health impacts of free-living dog populations in Australia have complex causes that intersect at the nexus between human and canine behaviour, agricultural and land management practices, local bylaws, and efforts to conserve ecological systems. Placing responsibility on governments limits opportunities for greater community involvement in developing integrated One Health approaches. Better-quality evidence of the impacts of dog populations on community health and well-being, and broad community support are needed to reshape public debates on animal control, which, ultimately, will promote more effective approaches to mitigate dog-related public health risks at the human–animal–environment interface.
Motives and Barriers Related to Physical Activity and Sport across Social Backgrounds: Implications for Health Promotion
Authors: Pedersen Marlene Rosager Lund , Hansen Anne Faber , Elmose-Østerlund Karsten
Published: May 2021

Studies have found physical inactivity to be a significant health risk factor and have demonstrated how physical inactivity behaviour varies according to social background. As a result, differences according to social background must be considered when examining motives and barriers related to physical activity and sport. This scoping review examines motives and barriers related to physical activity and sport among people with different social backgrounds, including age, socioeconomic status, gender, ethnic minority background and disability status. A systematic literature search was performed in four scientific databases and yielded 2935 articles of which 58 articles met the inclusion criteria. We identified common motives for physical activity and sport as health benefits, well-being, enjoyment, social interaction, and social support; common barriers as time restrictions, fatigue and lack of energy, financial restrictions, health-related restrictions, low motivation, and shortage of facilities. We also identified several motives and barriers that were specific to or more pronounced among people with different social backgrounds. The knowledge about motives and barriers related to physical activity and sport provided in this article can inform health promotion initiatives that seek to improve public health both in general and when specifically targeting groups of people with different social backgrounds.
Physical Activity as a Predictor of the Level of Stress and Quality of Sleep during COVID-19 Lockdown
Authors: Lipert Anna , Kozłowski Remigiusz , Timler Dariusz , Marczak Michał , Musiał Kamila , Rasmus Paweł , Kamecka Karolina , Jegier Anna
Published: May 2021

Background: The coronavirus pandemic and the government restrictions significantly disturbed the daily functioning of people, thereby influencing healthy behaviors, such as physical activity—the core indicator of well-being. This study evaluates the associations between physical activity (PA), the level of stress and quality of sleep during the COVID-19 pandemic lockdown. Methods: An online survey was distributed during the governmental lockdown in April 2020 and included measures for assessing physical activity, stress and sleep. The surveyed participants included all adults aged 18 years and over. The final data were collected from the 1959 respondents using: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI). Findings: Almost half of the respondents indicated a low level of PA, performing only 60 min of PA daily. Most of the participants reported a moderate or high level of stress (57% and 29%, respectively) and 64% of them reported poor quality of sleep. People with low levels of stress performed on average 85.1 min/day of walking (WPA), 40.9 min/day of moderate PA (MPA) or 52.6 min/day of vigorous PA (VPA). People with good quality of sleep performed 82.9 min/day of WPA, 43.6 min/day MPA and 40.5 min/day VPA. Interpretation: The results from the study indicate that the volume of daily PA may be a predictor of the level of stress and sleep quality in adults during the COVID-19 pandemic lockdown. To retain a low level of stress and good quality of sleep, a lifestyle that allows to achieve a moderate level of physical activity should be maintained. The optimal daily dose of PA is at least 70 min per day, involving different intensities.
Climate Change, Weather, Housing Precarity, and Homelessness: A Systematic Review of Reviews
Authors: Bezgrebelna Mariya , McKenzie Kwame , Wells Samantha , Ravindran Arun , Kral Michael , Christensen Julia , Stergiopoulos Vicky , Gaetz Stephen , Kidd Sean A.
Published: May 2021

This systematic review of reviews was conducted to examine housing precarity and homelessness in relation to climate change and weather extremes internationally. In a thematic analysis of 15 reviews (5 systematic and 10 non-systematic), the following themes emerged: risk factors for homelessness/housing precarity, temperature extremes, health concerns, structural factors, natural disasters, and housing. First, an increased risk of homelessness has been found for people who are vulnerably housed and populations in lower socio-economic positions due to energy insecurity and climate change-induced natural hazards. Second, homeless/vulnerably-housed populations are disproportionately exposed to climatic events (temperature extremes and natural disasters). Third, the physical and mental health of homeless/vulnerably-housed populations is projected to be impacted by weather extremes and climate change. Fourth, while green infrastructure may have positive effects for homeless/vulnerably-housed populations, housing remains a major concern in urban environments. Finally, structural changes must be implemented. Recommendations for addressing the impact of climate change on homelessness and housing precarity were generated, including interventions focusing on homelessness/housing precarity and reducing the effects of weather extremes, improved housing and urban planning, and further research on homelessness/housing precarity and climate change. To further enhance the impact of these initiatives, we suggest employing the Human Rights-Based Approach (HRBA).
Risk of Respiratory Infectious Diseases and the Role of Methylphenidate in Children with Attention-Deficit/Hyperactivity Disorder: A Population-Based Cohort Study
Authors: Li Dian-Jeng , Chen Yi-Lung , Hsiao Ray C. , Chen Hsiu-Lin , Yen Cheng-Fang
Published: May 2021

Children with attention-deficit/hyperactivity disorder (ADHD) are commonly affected by medical illness. The aim of the present study was to explore the risks of contracting respiratory infectious diseases (RIDs), including upper and lower RIDs and influenza, in children with ADHD. We also examined whether methylphenidate has a protective effect regarding the risk of contracting RIDs among children with ADHD who have a history of methylphenidate treatment. Children in the Taiwan Maternal and Child Health Database from 2004 to 2016 were included in the present study. Upper and lower RIDs, influenza, ADHD, age, sex, and records of methylphenidate prescription were identified. A Cox proportional hazards regression model was used to estimate the significance of the risk of RIDs among children with ADHD in comparison with that among children without ADHD after adjustment for sex and age. The self-controlled case series analysis was conducted to examine the protective effect of methylphenidate treatment against RIDs. In total, 85,853 children with ADHD and 1,458,750 children without ADHD were included in the study. After controlling for sociodemographic variables, we observed that children with ADHD had significantly higher risks of upper RIDs, lower RIDs, and influenza infection than did those without ADHD. Among the children with ADHD who had a history of methylphenidate treatment, the risk of contracting RIDs was lower during the methylphenidate treatment period than during the nontreatment period. Children with ADHD had a higher RID risk than those without ADHD. Methylphenidate might reduce the risk of RIDs among children with ADHD who have a history of methylphenidate treatment.