bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence, natural history and dynamic nature of chronic headache and medication overuse headache in Italy: The SPARTACUS study
Authors: Favoni Valentina , Mascarella Davide , Giannini Giulia , Bauleo Salvatore , Torelli Paola , Pierangeli Giulia , Cortelli Pietro , Cevoli Sabina ,   the SPARTACUS Study group
Published: March 2023

Background

Chronic headaches and medication overuse headache are common and burdening conditions. No studies have evaluated the prevalence of chronic headache and medication overuse headache in an unselected Italian population.

Methods

We performed a three-year cross-sectional and longitudinal population-based study to investigate prevalence, natural history, and prognostic factors of chronic headache. We delivered a self-administered questionnaire to 25,163 subjects. Chronic headache patients were interviewed by General Practitioners. After three years, medication overuse headache patients were invited to undergo a neurological evaluation at our Center.

Results

16,577 individuals completed the questionnaire; 6878 (41,5%) were episodic headache sufferers and 636 (3.8%) were chronic headache subjects. 239 (1.4%) patients were acute medication over-users. All medication overuse headache patients had migraine or headache with migrainous features. At the three-year follow-up of 98 patients, we observed conversion to episodic headaches in 53 (54.1%) patients. 27 (50.9%) patients remitted spontaneously.

Conclusions

We present the first prevalence data on chronic headache and medication overuse headache in an unselected Italian population and a high rate of spontaneous remission. These data support the interpretation of medication overuse headache as a specific migraine-related disorder that may reflect chronic migraine’s dynamic nature, the need for more specific medication overuse headache diagnostic criteria, and highlight the priority of targeted public health policies.
Attitudes Matter: Examining How Teaching Strategies for Attitudinal Change Help Adults Value Reflection and Calibrate Their Reflective Thinking
Authors: Roessger Kevin M.
Published: March 2023

Developing adults’ reflective thinking habits is an aim of adult education, but the best way to do it has been overlooked. Common strategies communicate the skills and knowledge needed to reflect while providing practice opportunities. Yet research indicates that reflective habits are comprised of not only skills and knowledge but also of attitudes toward reflection. This study investigated whether attitudinal change strategies in a reflective thinking workshop induced cognitive dissonance by helping adults appreciate reflection and calibrate their reflective behavior. Participants were randomly assigned to a skills-based or skills-based plus attitudinal change workshop. Pre-post measures of learners’ need for and engagement in reflection were taken. Multivariate analysis of covariance revealed that attitudinal change strategies induced dissonance by increasing the need for reflection while decreasing perceived engagement in reflection. Exclusively skills-based strategies failed to affect the need for reflection but increased perceived engagement in reflection, creating overconfidence. Implications for research and practice are offered.
The great resignation: Exploring the effect of regular and digital instructional leadership on teachers’ intention to leave
Authors: Berkovich Izhak
Published: March 2023

Research on the effect of COVID-19 and its aftermath on education is gaining momentum. Nevertheless, this expanding contemporary literature only scarcely addresses principals’ digital instructional leadership and has not investigated how principals’ regular instructional leadership aligns with it. Moreover, the emerging writing on the aftermath of COVID-19 notes the phenomenon of teacher shortages in schools as a result of a growing tendency of teachers to leave the profession, but the possible connection with various forms of principals’ instructional leadership remains unexplored. The purpose of this study was to examine the effect of combinations of different levels of principals’ regular instructional leadership and digital instructional leadership on teachers’ intention to leave. Cluster analysis of data of 267 school teachers in Israel was conducted. The results indicate an association between differences in teachers’ intention to leave the profession and mixtures of regular and digital instructional leadership. The results and their implications are discussed.
Electoral inequity
Authors: Boccard Nicolas
Published: March 2023

Ideally, a representative democracy awards a genuine vote to each adult. We study this issue in competitive democracies with an election model combining district apportionment and proportional representation. Four classic seat allocation rules, including d’Hondt, are reframed as Dutch auctions, allowing important properties to be easily derived. The pros and cons of these methods are stated in terms of economic inequality; Sainte Laguë’s is shown to best carry the genuine vote ideal, both for elections and for apportionment. We next expound the interplay between these two components in generating an inequitable treatment of voters and develop the scale-free index of inequity best fitted to their concern. We apply it to 40 countries for the apportionment of electoral districts. Lastly, we compute the same inequity index for recent parliamentary elections in 80 countries, finding that the majority system mistreats electors, thus putting a ‘price’ on government stability.
Re‐examining the impact of global foreign direct investment (FDI) inflows on haze pollution—considering the moderating mechanism of environmental regulation
Authors: Xie Ronghui , Zhang Shengjie
Published: March 2023

One important and frequently raised issue about foreign direct investment (FDI) is its potentially environmental consequences. In recent years, as severe haze pollution has broken out worldwide, whether FDI inflows increase PM2.5 spillages in a country has sparked a new round of heated discussion. This study attempts to empirically investigate how FDI affects haze pollution in various countries, by employing a cross-country panel dataset during the period 2010–2017, and further to examine the interactive effect of environmental regulation and FDI in the FDI–pollution nexus. Based on a two-way fixed-effects model with robust standard errors, the estimation results show that FDI inflows significantly lead to an increase in PM2.5 exposure, therefore, confirming the validity of the Pollution Haven Hypothesis. Moreover, environmental regulation generally appears to be ineffective in directly reducing haze pollution but acts as an essential underlying mechanism in the relationship between FDI and haze pollution. Under the moderation of environmental regulation, the positive marginal effect of FDI on PM2.5 continues to decrease until it becomes negative. The findings suggest that countries, especially developing countries and emerging economies should consider a mix of policies to manage its inward FDI to achieve sustainable development in the post-financial crisis era.
Intraperitoneal pretreatment of ellagic acid and chrysin alleviate ifosfamide-induced neurotoxicity, but betanin induces death in male wistar rats
Authors: Salimi Ahmad , Shabani Mohammad , Mohammadi Hossein , Sudi Vahid
Published: March 2023

Background

Ifosfamide (IFO) is a widely used antineoplastic drug with broad-spectrum efficacy against various types of cancer. However, different toxicities associated with IFO has limited its use. This study was to establish the prophylactic effects of betanin, chrysin and ellagic acid against IFO-induced neurotoxicity in rats.

Methods

Animals were randomly divided into eight groups, control, IFO, IFO + betanin, IFO + chrysin, IFO + ellagic acid, betanin, chrysin and ellagic acid groups. Betanin (50 mg/kg, i.p.), chrysin (25 mg/kg, i.p.) and ellagic acid (25 mg/kg, i.p.) were administered to rats once daily for two consecutive days. IFO (500 mg/kg, i.p.) was administered on third day.

Results

Results demonstrated that only ellagic acid markedly decreased the activity of acetylcholinesterase (AChE) and butrylcholinesterase (BChE) compared with IFO alone, while chrysin was only effective on BChE activity. Also, ellagic acid ameliorated IFO-induced lipid peroxidation and glutathione (GSH) depletion, while chrysin only decreased GSH depletion. Histopathological alteration in the IFO-induced brain tissues were decreased especially after administration of ellagic acid. Intraperitoneal pretreatment with betanin, followed by IFO resulted in death of all treated animals. In addition, all mitochondrial toxicity parameters induced by IFO in the rat brain tissue were ameliorated by ellagic acid, chrysin and even betanin.

Conclusion

Taken together, our results demonstrated that especially ellagic acid and to some extent chrysin show a typical neuroprotective effect on IFO-induced acute neurotoxicity through mitochondrial protection and antioxidant properties. Also, the results of our studies showed that pretreatment with betanin followed by IFO was lethal.
The Elle Woods effect: Being “girled” while reclaiming girliness
Authors: Scott Jocelyne Bartram
Published: March 2023

Using a case study of Elle Woods from Legally Blonde (2001), I assert that sorority communities are a prime example of the powerful impact of femmephobia in popular culture. Drawn from qualitative interview data with sorority women as well as media analysis and autoethnographic reflection, I use femme theory (Hoskin, 2017) and “girling” (Ahmed, 2017) to analyze a trend within my data that I label the “Elle Woods Effect.” Ultimately, I assert that the femmephobic dualistic tensions of the “Elle Woods Effect” demonstrate the off-screen impact of popular culture for femininized people and communities.
COVID-19 threat and negative attitudes toward outgroup and ingroup others: A multilevel analysis with coarsened exact matching
Authors: Kim Harris Hyun-soo
Published: March 2023

Using two waves of nationally representative data, the present study shows the extent to which the COVID-19 pandemic has exacerbated anti-outgroup and anti-ingroup attitudes among South Korean adults. To that end, in a quasi-experimental setting, it exploits the survey interview timing as a source of exogenous variation to investigate the causal influence of the COVID-19 pandemic. Data imbalance is initially corrected using the coarsened exact matching procedure. Then, a series of multilevel models, with data on 10,454 subjects nested in 34 wave–region units, are estimated with additional covariate adjustment to improve estimate precision. Results show that, first, those who are more relatively deprived became less inclined to support the granting of citizenship status to foreigners since the coronavirus outbreak. Second, the same trend was found among individuals who are more dissatisfied with the country’s overall economic condition. Third, in the wake of the global health crisis, Korean natives became less willing to pay additional taxes to support conational others who are economically underprivileged.
Regional comprehensive economic partnership (RCEP) and tourism: Four research propositions
Authors: Koh Sharon GM , Lee Grace HY , Kwok Andrei OJ
Published: March 2023

The year 2022 marks the significance of the Regional Comprehensive Economic Partnership (RCEP) as the agreement enters into force after nearly one decade of negotiations. While the pandemic exposed the vulnerability of the tourism industry to the changing market reality, it also created an impetus for Asia-Pacific regionalism. The RCEP marks the first time a monumental trade agreement is ratified virtually, and member states will be the primary beneficiary given the correct response and strategy. Thus, the Asia-Pacific is set to become one of the fastest-growing regions in the coming decade as countries agree to enhance trade and investment. Our study examines the potential economic implications of the RCEP on tourism. We offer four interrelated proposals rooted in the tenets of tourism-led growth. Tourism researchers are encouraged to refine the propositions.
Social workers’ voluntary political participation: Testing a civic engagement model
Authors: Kim Jangmin , Yoon Hyunwoo , Oh Seung-Hwan
Published: March 2023

With rapidly changing and complex social problems, social workers’ political participation has received increasing attention in promoting social justice and human rights. However, limited studies have examined significant factors that motivate social workers’ voluntary political participation in South Korea. Furthermore, little is known about how significant factors differ by the different types of voluntary political participation. Drawing on the civic engagement model, this study attempted to fill this research gap by analyzing nationally representative data collected from 4,375 social workers in South Korea in 2020.

Findings

For the resource domain, social workers’ political information was a significant factor to motivate all types of voluntary political participation especially greater for voting and lobbying. For the psychological engagement domain, social workers’ interest in politics was a strong factor in voting and campaigning. Political efficacy was a significant factor in lobbying and protest activities. When social workers had a radical political ideology, they were more likely to engage in protest activities. For the recruitment network domain, social workers’ membership in a political party significantly increased all types of voluntary political participation except for voting.

Applications

This study suggests that resources, psychological engagement, and recruitment networks are essential for promoting Korean social workers’ voluntary political participation. However, the effects of the three domains can vary across the different types of voluntary political participation Therefore, social workers should receive a wide range of opportunities to learn and engage in varying types of voluntary political participation through effective social work education, organizational support, and community partnerships.
Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women
Authors: Spurlock Elizabeth J. , Pickler Rita H. , Ruiz R. Jeanne , Ford Jodi , Gillespie Shannon , Kue Jennifer
Published: March 2023

Introduction: There is evidence that Mexican Americans are more likely to have cesarean birth than non-Hispanic White Americans. The purpose of this study was to identify factors related to acculturation along with psychological and sociodemographic factors associated with birth mode in a prospective cohort of Mexican American women in Texas. Methods: This secondary analysis included 244 Mexican American pregnant women. Women with a prior cesarean birth were excluded. Variable selection was guided by Berry's Theoretical Framework of Acculturation. Correlations and logistic regression were used to examine relationships and predict risk of cesarean birth. Mediators and moderators were also considered. Results: Eighty women birthed by cesarean. Analytic and parent samples were similar in all demographics. After controlling for parity in logistic regression, greater Spanish language-related acculturative stress (adjusted odds ratio [AOR], 1.06, 95% confidence interval [CI] [1.01, 1.11], p = .028) and experience of discrimination (AOR, 1.18, 95% CI [1.00, 1.38], p = .044) increased the odds of cesarean birth. The relationship between acculturative stress and birth mode was moderated by birth facility. Conclusion: Acculturative stress and discrimination may play a role in birth mode for Mexican American women birthing in Texas. Birth facility and acculturative stress may be interacting in ways that have clinical significance but are yet unexplored.
Solitary amyloid tumor of the palate: A case report and literature review
Authors: Razmara Farnoosh , Derakhshan Samira , Mahdavi Nazanin , Mohammadi Saba
Published: March 2023

Amyloidosis is often caused by the abnormal extracellular accumulation of amyloid in organs and tissues. This condition, affecting the head and neck region, is typically localized, and may also involve the oral cavity, particularly the tongue and buccal mucosa. As a solitary manifestation, the localized amyloidosis occurring intraosseous is highly infrequent. In addition, localized amyloidosis has a great rate of recurrence. In this paper, a 50-year-old female patient with the chief complaint of pain in the anterior of the maxilla is reported. According to clinical examination, no significant pathologic lesion was seen. The radiographic image showed a radiolucent lesion around teeth four and five. The treatment of choice for the patient was an excisional biopsy. As amyloidosis diagnosis is clinically challenging, biopsy and histologic examination of lesions are necessary in this regard. Accordingly, it is concluded that long-term follow-up is mandatory in case of localized amyloidosis because late recurrence can occur in some cases.
The contradictory behaviour of Russia in response to the 2014 Ukrainian revolution
Authors: Everett Judas
Published: March 2023

This article addresses the contradictory behaviour of the Russian Federation in reacting to the events of the 2014 Ukrainian revolution. The Russian response saw significant aggression, but also seemingly involving inaction or even restraint in other areas. The question is what are some plausible explanations for this contradictory behaviour. In order to answer this question, relevant terminology is defined, then the subnational level is focused on and Most Similar System Design is utilised. Then cases involving significant aggression are considered, before moving on to those seemingly involving inaction or even restraint. Finally, these two elements are reconciled, producing a clear picture of the overall similarities, the inconsistencies and the crucial differences. The article finds the crucial differences to be the level of loyalty to the Kremlin and willingness to engage in collaboration or cooperation. The focus on loyalty to the Kremlin and the issue of willingness to collaborate is revealing.
Exploring changes in residential preference during COVID-19: Implications to contemporary urban planning
Authors: Wolday Fitwi , Böcker Lars
Published: March 2023

The advent of the COVID-19 pandemic and the subsequent lockdown has reshuffled our daily routines and activity spaces. The home and its immediate environment have attained a critical role in coping with the confinement both as living, working and recreational space. Drawing on a longitudinal survey from greater Oslo, we analyze shifts in residential preferences amidst COVID-19. Given the pandemic induced movement restrictions, we pay special attention to the mediating role of perceived accessibility on the link between several sociodemographic/locational/housing characteristics on preference shifts. Amidst a drop in perceived accessibility, outdoor assets like gardens or balconies, and motility by car and public transport are amongst the residential and locational amenities that have gained most in people’s considerations for a new dwelling peri-pandemically. Dwelling satisfaction and preferences with regard to neighborhood density, dwelling size, and work-proximity, have remained largely unchanged despite a clear trend towards more teleworking. Our results can be understood as a nod of approval to contemporary compact urban planning. Nonetheless challenges as to bolstering its resilience still linger and more needs to be done to mitigate the inequalities in (perceived) access to in-home, near-home, and mobility assets that we have also observed to have (re)-immerged in the wake of the pandemic.
Implementation of an evidence-based tobacco control intervention for school teachers in India: Evaluating the effects of a capacity-building strategy
Authors: Nagler Eve M. , Pednekar Mangesh , Sinha Dhirendra Narain , Stoddard Anne M. , Narake Sameer , Adhikari Keyuri , Jones Leah , Lando Harry , Vriniotis Mary , Gupta Prakash , Sorensen Glorian
Published: March 2023

Background

Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure.

Method

We used a training-of-trainers (TOT) “cascade” implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data.

Results

For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach.

Conclusions

This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers.

Trial registration

NCT05346991.
Disrupting the discourse: Applying critical race theory as a conceptual framework for reflecting on learning and teaching in higher education
Authors: Brazant Kevin J
Published: March 2023

The Higher Education Sector in Britain, United Kingdom (UK) is currently being taken to task regarding issues of structural inequality and unfair outcomes for student learners from non-white backgrounds, also referred to as the degree awarding gap. How do we disrupt the narrative concerning race, and more specifically as part of our learning, teaching and assessment practices? Using Critical Race Theory, a project, ‘Disrupt the Discourse,’ an initiative launched in 2021 is a small scale case study piloting the application of the aforementioned theory as part of learning and teaching in a Higher Education Institution based in London. The project explored issues of curriculum design, and assessment practices in response to the issue of the degree awarding gap. The initiative explicitly explores uncomfortable conversations about race as part of learning and teaching practice and by working with a team of anti-racist scholars, a curriculum framework and digital toolkit to explore the lived experiences of student and staff was created. Feedback from the pilot was encouraging, academics from different curriculum disciplines and cultural backgrounds saw the initiative as instrumental in re considering assessment practices, curriculum content and pedagogy as part of learning and teaching practice.
Association between obesity and short- and medium-term mortality in critically ill patients with atrial fibrillation: a retrospective cohort study
Authors: Yang Duo , Ye Shujun , Zhang Kaihong , Huang Zhiliang , Zhang Longsheng
Published: March 2023

Background

There has been controversy about how obesity affects the clinical prognosis for patients with atrial fibrillation (AF), and the relationship between obesity and outcomes in critically ill patients with AF remains unclear. The purpose of this study was to explore the association between obesity and short- and medium-term mortality in critically ill patients with AF.

Methods

The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 9282 critically ill patients with AF. Patients were categorized into four groups based on their body mass index (BMI) values: underweight, normal-weight, overweight, and obese. The outcomes of this study were 30-day, 90-day, and 1-year all-cause mortality. Cox proportional-hazards models and restricted cubic spline analyses were performed to investigate the association between BMI and mortality.

Results

For 30-day mortality, after adjustment for all confounding factors, the hazard ratio (HR) with 95% confidence interval (CI) for the underweight, overweight, and obese categories were 1.58 (1.21, 2.07), 0.82 (0.72, 0.93), and 0.79 (0.68, 0.91), respectively, compared to the normal-weight category. Using multivariable-adjusted restricted cubic spline analysis, an “L-shaped” correlation was observed between BMI and 30-day mortality. For each 1 kg/m2 increase in BMI when BMI was less than 30 kg/m2, the risk of 30-day mortality decreased by 6.4% (HR, 95% CI: 0.936 [0.918, 0.954]; P < 0.001); however, this relationship was not present when BMI was greater than or equal to 30 kg/m2. Similar results were observed for 90-day and 1-year mortality.

Conclusions

There was a nonlinear relationship between BMI and all-cause mortality among critically ill patients with AF. All-cause mortality and the BMI were negatively correlated when the BMI was less than 30 kg/m2.
Gender differences in premature mortality for cardiovascular disease in India, 2017–18
Authors: Kundu Jhumki , James K. S. , Hossain Babul , Chakraborty Ruchira
Published: March 2023

Background

The present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017–18.

Methods

The information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson’s correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied.

Results

Men have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50–54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1–4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women).

Conclusion

YLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.
Therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery for sarcoma: a systematic review
Authors: van Kouswijk H. W. , van Keeken H. G. , Ploegmakers J. J. W. , Seeber G. H. , van den Akker-Scheek I.
Published: March 2023

Background

An increasing number of patients are surviving sarcoma after lower limb-salvage surgery (LSS) and are left with functional limitations. This systematic review aimed to determine the therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery (LSS) for sarcoma.

Methods

A systematic review was conducted using formal narrative synthesis of intervention studies (with and without control group) identified through PubMed, Embase, Cochrane Library, CINAHL, and PEDro databases. Studies were included if participants were treated with LSS for unilateral lower limb sarcoma and followed an exercise intervention using active exercise, physical training, or rehabilitation before and/or after surgery. This review’s outcome measures were interventions’ therapeutic validity, assessed using the CONTENT scale (0 to 9); methodological quality, identified using the Downs & Black checklist (0 to 28); interventions’ effectiveness, assessed based on differences in outcome measures between intervention and control groups; and certainty of evidence, classified according to the GRADE approach.

Results

Seven studies involving 214 participants were included. None of the included interventions were therapeutically valid (median 5, range 1–5). All but one study were of at least fair methodological quality (median 18, range 14–21). There was very low-quality evidence that exercise interventions resulted in increased knee range of motion (MD 10–15°) or compliance (MD 30%), and reduced functionality scores (MD -5%) compared to usual care.

Conclusions

We found overall low therapeutic validity of interventions, performed in overall low-quality studies. Combined with the very low certainty of evidence, the results prevent drawing valid conclusions on the interventions’ effectiveness. Future studies should aim for uniformity among their methodological approaches and outcome measures, using the CONTENT scale as a template to avert insufficient reporting.

Trial registration

PROSPERO CRD42021244635.
Application of machine learning in prediction of bone cement leakage during single-level thoracolumbar percutaneous vertebroplasty
Authors: Deng Guobing , Zhu Jichong , Lu Qing , Liu Chong , Liang Tuo , Jiang Jie , Li Hao , Zhou Chenxing , Wu Shaofeng , Chen Tianyou , Chen Jiarui , Yao Yuanlin , Liao Shian , Yu Chaojie , Huang Shengsheng , Sun Xuhua , Chen Liyi , Ye Zhen , Guo Hao , Chen Wuhua , Jiang Wenyong , Fan Binguang , Yang Zhenwei , Gu Wenfei , Wang Yihan , Zhan Xinli
Published: March 2023

Background

In the elderly, osteoporotic vertebral compression fractures (OVCFs) of the thoracolumbar vertebra are common, and percutaneous vertebroplasty (PVP) is a common surgical method after fracture. Machine learning (ML) was used in this study to assist clinicians in preventing bone cement leakage during PVP surgery.

Methods

The clinical data of 374 patients with thoracolumbar OVCFs who underwent single-level PVP at The First People's Hospital of Chenzhou were chosen. It included 150 patients with bone cement leakage and 224 patients without it. We screened the feature variables using four ML methods and used the intersection to generate the prediction model. In addition, predictive models were used in the validation cohort.

Results

The ML method was used to select five factors to create a Nomogram diagnostic model. The nomogram model's AUC was 0.646667, and its C value was 0.647. The calibration curves revealed a consistent relationship between nomogram predictions and actual probabilities. In 91 randomized samples, the AUC of this nomogram model was 0.7555116.

Conclusion

In this study, we invented a prediction model for bone cement leakage in single-segment PVP surgery, which can help doctors in performing better surgery with reduced risk.
SERPINE1 and its co-expressed genes are associated with the progression of clear cell renal cell carcinoma
Authors: Guo Lingyu , An Tian , Wan Ziyan , Huang Zhixin , Chong Tie
Published: March 2023

Background

Clear cell renal cell carcinoma(ccRCC) is a frequently occurring malignant tumor of the urinary system. Despite extensive research, the regulatory mechanisms underlying the pathogenesis and progression of ccRCC remain largely unknown.

Methods

We downloaded 5 ccRCC expression profiles from the Gene Expression Omnibus (GEO) database and obtained the list of differentially expressed genes (DEGs). Using String and Cytoscape tools, we determined the hub genes of ccRCC, and then analyzed their relationship with ccRCC patient survival. Ultimately, we identified SERPINE1 as a prognostic factor in ccRCC. Meanwhile, we confirmed the role of SERPINE1 in 786-O cells by cell transfection and in vitro experiments.

Results

Our analysis yielded a total of 258 differentially expressed genes, comprising 105 down-regulated genes and 153 up-regulated genes. Survival analysis of SERPINE1 expression in The Cancer Genome Atlas (TCGA) confirmed its association with the increase of tumor grade, lymph node metastasis, and tumor stage, as well as with shorter survival. Furthermore, we found that SERPINE1 expression levels were associated with CD8 + T cells, CD4 + T cells, B cells, macrophages, neutrophils, and dendritic cells. Cell experiments showed that knockdown SERPINE1 expression could inhibit the proliferation, migration and invasion of ccRCC cells. Among the co-expressed genes with the highest correlation, ITGA5, SLC2A3, SLC2A14, SHC1, CEBPB, and ADA were overexpressed and associated with shorter overall survival (OS) in ccRCC.

Conclusions

In this study, we identified hub genes that are strongly related to ccRCC, and highlights the potential utility of overexpressed SERPINE1 and its co-expressed genes could be used as prognostic and diagnostic biomarkers in ccRCC.
Prevalence of high-risk human papillomavirus infections and associated factors among women living with HIV in Shashemene town public health facilities, Southern Ethiopia
Authors: Megersa Tariku , Dango Sisay , Kumsa Kebede , Lemma Kebebew , Lencha Bikila
Published: March 2023

Background

Every year, large number of women are suffering from cervical cancer. Particularly women living with HIV are at high-risk of being suffered with it. Early testing of high-risk human papillomavirus infection can significantly reduce the incidence of cervical cancer. However, lack of early and regular testing has been identified as one of the major problems among risky populations.

Methods

Institutional-based cross-sectional study design was conducted among women living with HIV in Shashemene town public health facilities with a total sample size of 406 from February 1–March 30, 2022. Systematic random sampling technique was employed to select the study subjects. A structured questionnaire and checklist was used to collect data. The collected data were cleaned, coded, and entered into Epi-info version 7.2.5 and exported to statistical package for social science version 24 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of high-risk human papillomavirus. Odds ratio with 95% confidence interval was used to test association between exposure and outcome under study and p-value < 0.05 was considered significant.

Results

The prevalence of high-risk HPV infections among study participant was 173(35.2%) with 95% CI (30.5%-40.1%). Prevalence of high-risk HPV type 16, 18 and other high-risk HPV types were 62(15.3%), 23(5.7%) and 58(14.3%), respectively. Having history of sexually transmitted infections [AOR = 3.120; 95% CI (1.977–4.923)], Endline CD4 count < 200 cells/mm3 [AOR = 3.072; 95% CI(1.009–9.350)], Endline HIV viral-load ≥ 50 copies/ml [AOR = 3.446; 95% CI(1.368–8.683)] and more than one-lifetime sexual partner [AOR = 2.112; 95% CI(1.297–3.441)] were significantly associated with high-risk HPV infections.

Conclusion

More than one third of women living with HIV had high-risk HPV. Having history of STI, low CD4 count, high viral load and multiple sexual partners were associated with high risk HPV. HIV positive women with these risk factors should be given special consideration in clinical and public health intervention.
A health communication campaign for prevention of osteoporosis in rural elderly women
Authors: Dastmanesh Solmaz , Karimi Masoud , Ghahremani Leila , Seif Mozhgan , Zare Elahe
Published: March 2023

Background

Osteoporosis, as the most common metabolic disease and the leading cause of death among older people, affects more than 200 million women throughout the world. This study aimed to evaluate the effect of a health communication campaign on knowledge, attitude, and practice of older women towards prevention and control of osteoporosis.

Methods

In this multi-stage mixed methods study, 30 days’ health communication campaign for prevention of osteoporosis was conducted on 60- 75-year-old women, in rural areas of Fasa, Iran. Subjects were divided into two groups, control (n = 103) and intervention (n = 98). Data were collected using a researcher-made questionnaire and analyzed by SPSS 25.0. The significance level was set at < 0.05.

Results

Inter-group group analysis revealed that the mean scores of knowledge, attitude, and practice were not significantly different between the two groups before the intervention, but after the intervention, unlike the behavior (P = 0.569), mean scores of knowledge (p < 0.001) and attitude (p < 0.001) of the intervention group were significantly more than the control group. Intra-group comparisons showed that, unlike the control group, the mean scores of knowledge (p < 0.001), attitudes (p < 0.001), and behavior (P < 0.001) increased significantly in the intervention group.

Conclusions

Health communication campaign is an effective way to change the knowledge and attitude and to a lesser extent the practice of the eldery toward prevention and control of osteoporosis.
Creating a sport and exercise medicine undergraduate syllabus: a delphi study
Authors: Vishnubala Dane , Iqbal Adil , Marino Katherine , Pandya Tej , Salman David , Pringle Andy , Nykjaer Camilla , Bazira Peter , Eastwood David , Finn Gabrielle
Published: March 2023

Background

Sport and Exercise Medicine (SEM) is a growing speciality in the United Kingdom (UK). This growth has not been replicated in SEM teaching at an undergraduate level and SEM-related topics in schools of medicine in the UK are under-represented. As SEM continues to develop as a specialty it is important to consider how it is embedded at all levels of training. The aim of this project was to establish a consensus on SEM-related skills and knowledge relevant for undergraduate medical students in the UK, ultimately creating a curriculum of learning objectives (LOs).

Methods

A modified Delphi survey was utilised to seek consensus on LOs suitable for incorporation into UK medical school curricula. An expert panel with adequate knowledge in the field was recruited. The initial curriculum was created by the research team using already established postgraduate SEM curricula. All learning objectives were sent to the expert panel for opinions in phases. Levels of agreement and comments made by the expert panel were reviewed after each phase until a consensus on each learning objective was made.

Results

The expert panel was made up of 45 individuals, with 35 also completing phase 2 (78% retention rate). The initial curriculum contained 58 learning objectives separated into 9 themes. In phase 1 31% (18/58) were accepted outright, 48% (28/58) were altered and 19% (11/58) were rejected. Two additional learning objectives were added. Of the 49 LOs included in phase 2, 98% (48/49) were accepted. The final curriculum was made up of 9 sub-themes and 48 LOs.

Conclusion

Sport and Exercise Medicine is a broad ranging and rapidly growing speciality. It is important to establish SEM education in all levels of medical education, including undergraduate level. This is the first published version of a Delphi SEM curriculum for undergraduate medical teaching.
Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study
Authors: Cash-Gibson Lucinda , Martinez-Herrera Eliana , Benach Joan
Published: March 2023

Background

Evidence on health inequalities has been growing over the past few decades, yet the capacity to produce research on health inequalities varies between countries worldwide and needs to be strengthened. More in-depth understanding of the sociohistorical, political and institutional processes that enable this type of research and related research capacity to be generated in different contexts is needed. A recent bibliometric analysis of the health inequalities research field found inequalities in the global production of this type of research. It also found the United Kingdom to be the second-highest global contributor to this research field after the United States. This study aims to understand why and how the United Kingdom, as an example of a “high producer” of health inequalities research, has been able to generate so much health inequalities research over the past five decades, and which main mechanisms might have been involved in generating this specific research capacity over time.

Methods

We conducted a realist explanatory case study, which included 12 semi-structured interviews, to test six theoretical mechanisms that we proposed might have been involved in this process. Data from the interviews and grey and scientific literature were triangulated to inform our findings.

Results

We found evidence to suggest that at least four of our proposed mechanisms have been activated by certain conditions and have contributed to the health inequalities research production process in the United Kingdom over the past 50 years. Limited evidence suggests that two new mechanisms might have potentially also been at play.

Conclusions

Valuable learning can be established from this case study, which explores the United Kingdom’s experience in developing a strong national health inequalities research tradition, and the potential mechanisms involved in this process. More research is needed to explore additional facilitating and inhibiting mechanisms and other factors involved in this process in this context, as well as in other settings where less health inequalities research has been produced. This type of in-depth knowledge could be used to guide the development of new health inequalities research capacity-strengthening strategies and support the development of novel approaches and solutions aiming to tackle health inequalities.
The Glioma-IRE project − Molecular profiling in patients with glioma: steps toward an individualized diagnostic and therapeutic approach
Authors: Villani Veronica , Casini Beatrice , Tanzilli Antonio , Lecce Mario , Rasile Fabrizio , Telera Stefano , Pace Andrea , Piludu Francesca , Terrenato Irene , Rollo Francesca , De Nicola Francesca , Fanciulli Maurizio , Pallocca Matteo , Ciliberto Gennaro , Carosi Mariantonia
Published: March 2023

Background

This study aimed to characterize the genetic profile of patients with glioma and discuss the impact of next-generation sequencing in glioma diagnosis and treatment.

Methods

Between 2019 and 2022, we analyzed the genetic profile of 99 patients with glioma through the Oncomine Focus Assay. The assay enables the detection of mutations in 52 driver genes, including single nucleotide variants (SNVs), copy number variants (CNVs), and gene fusions. We also collected and analyzed patients’ clinic characteristics and treatment outcomes.

Results

Over a period of 35 months, 700 patients with glioma followed by our neuro-oncology unit were screened, and 99 were enrolled in the study; most of the patients were excluded for inadequate non-morphological MRI or lack/inadequacy of the tissue samples. Based on our findings, most patients with glioma present mutations, such as SNVs, CNVs or gene fusions. Our data were similar to those reported by The Cancer Genome Atlas Program in terms of frequency of SNVs and CNVs, while we observed more cases of gene fusions. Median overall survival, progression-free survival, and time to progression were significantly lower for patients with grade VI glioblastoma than those with other gliomas. Only four patients were offered a targeted treatment based on the mutation detected; however, only one received treatment, the others could not receive the selected treatment because of worsening clinical status.

Conclusion

Routine timely molecular profiling in patients with glioma should be implemented to offer patients an individualized diagnostic approach and provide them with advanced targeted therapy options if available.
Dynamics of factors associated with rates of COVID-19 cases and deaths in African countries
Authors: Obasanjo Iyabo O. , Ahmad Zain , Akkaladevi Somasheker , Adekoya Adeyemi , Abass Olayide
Published: March 2023

Background

African countries have not had the high case and death rates from COVID-19 as was predicted early in the pandemic. It is not well understood what factors modulated the rate of COVID-19 cases and death on the continent.

Methods

We collated data from the World Bank data site, Our World in Data and Freedom House for African for 54 African countries who are members of the African Union. We used them as explanatory variables in two general linear model regression analyses. COVID cases and deaths per 100,000 obtained from WHO COVID-19 dashboard on August 12, 2021, as outcome variables in two prediction models.

Results

GDP, percentage of population under 14 years of age, Maternal Mortality Ratio, number of international tourists visiting per year and public transportation closures were not significant in predicting COVID-19 cases. Higher percentage of unemployed adults in the population, lower percentage of the population over 25 years of age with secondary education, internal travel restrictions increased spread of COVID-19 while international travel restrictions were associated with lower COVID-19 cases per 100,000 population. Higher levels of democratization results in higher cases of COVID-19. Unemployment, education and democratization were still significant for COVID-19 death in the same direction as they were for COVID-19 cases. Number of tourism visitors per year was also associated with higher COVID-19 death rates but not with case rates.

Conclusion

In African countries, internal movement restrictions enacted to inhibit COVID-19, had the opposite effect and enabled COVID-19 spread. Low Education levels and high unemployment were associated with having higher death rates from COVID-19. More studies are needed to understand the impact of tourism on COVID-19 and other infectious diseases arising from other regions on African countries, in order to put in place adequate control protocols.