bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiological Predictors of Competition Performance in CrossFit Athletes
Authors: Martínez-Gómez Rafael , Valenzuela Pedro L. , Alejo Lidia B. , Gil-Cabrera Jaime , Montalvo-Pérez Almudena , Talavera Eduardo , Lucia Alejandro , Moral-González Susana , Barranco-Gil David
Published: May 2020

The aim of this study was to determine the physiological variables that predict competition performance during a CrossFit competition. Fifteen male amateur CrossFit athletes (age, 35 ± 9 years; CrossFit experience, 40 ± 27 months) performed a series of laboratory-based tests (incremental load test for deep full squat and bench press; squat, countermovement and drop jump tests; and incremental running and Wingate tests) that were studied as potential predictors of CrossFit performance. Thereafter, they performed the five Workouts of the Day (WODs) corresponding to the CrossFit Games Open 2019, and we assessed the relationship between the laboratory-based markers and CrossFit performance with regression analyses. Overall CrossFit performance (i.e., final ranking considering the sum of all WODs, as assessed by number of repetitions, time spent in exercises or weight lifted) was significantly related to jump ability, mean and peak power output during the Wingate test, relative maximum strength for the deep full squat and the bench press, and maximum oxygen uptake (VO2max) and speed during the incremental test (all p < 0.05, r = 0.58–0.75). However, the relationship between CrossFit Performance and most laboratory markers varied depending on the analyzed WOD. Multiple linear regression analysis indicated that measures of lower-body muscle power (particularly jump ability) and VO2max explained together most of the variance (R2 = 81%, p < 0.001) in overall CrossFit performance. CrossFit performance is therefore associated with different power-, strength-, and aerobic-related markers.
An Analysis of Personal Learning Environments and Age-Related Psychosocial Factors of Unaccompanied Foreign Minors
Authors: Tomé-Fernández María , García-Garnica Marina , Martínez-Martínez Asunción , Olmedo-Moreno Eva María
Published: May 2020

Spain is one of the countries with the greatest influx of immigrants and, specifically, of unaccompanied foreign minors (UFMs). The educational and social inclusion of unaccompanied foreign minors poses both a challenge and a threat to current policy. Nonetheless, studies linking educational aspects to the phenomenon of the integration of these children are scarce and do not specify the most influential educational tools and strategies. In this sense, a descriptive, quantitative and cross-sectional research study is presented. The aim of this study is to examine whether variables such as age and the use of applications and social networks determine the personal learning environments (PLE) of unaccompanied foreign minors. The sample of the present study was formed by 624 individuals (♂ = 92.1% (n = 575); ♀ = 7.9% (n = 49)) aged between 8 and 17 years old. The majority came from Morocco and resided in the cities of Ceuta and Melilla. The “PLE and Social Integration of UFMs” questionnaire was used as the study instrument. Amongst the main findings, significant differences are highlighted in the personal learning environments as a function of age-related psychosocial factors as they pertain to unaccompanied foreign minors. Four factors were seen to exist in relation to the personal learning environments of unaccompanied foreign minors: self-concept of the learning process, planning and management of learning, use of resources and tools, and communication and social interaction. The same trend was observed in the four factors, with older age groups reporting better scores. On the other hand, results show that the use of applications and social networks have a significant and favourable impact on personal learning environment construction.
A Machine Learning-Based Approach for Predicting Patient Punctuality in Ambulatory Care Centers
Authors: Srinivas Sharan
Published: May 2020

Late-arriving patients have become a prominent concern in several ambulatory care clinics across the globe. Accommodating them could lead to detrimental ramifications such as schedule disruption and increased waiting time for forthcoming patients, which, in turn, could lead to patient dissatisfaction, reduced care quality, and physician burnout. However, rescheduling late arrivals could delay access to care. This paper aims to predict the patient-specific risk of late arrival using machine learning (ML) models. Data from two different ambulatory care facilities are extracted, and a comprehensive list of predictor variables is identified or derived from the electronic medical records. A comparative analysis of four ML algorithms (logistic regression, random forests, gradient boosting machine, and artificial neural networks) that differ in their training mechanism is conducted. The results indicate that ML algorithms can accurately predict patient lateness, but a single model cannot perform best with respect to predictive performance, training time, and interpretability. Prior history of late arrivals, age, and afternoon appointments are identified as critical predictors by all the models. The ML-based approach presented in this research can serve as a decision support tool and could be integrated into the appointment system for effectively managing and mitigating tardy arrivals.
The Effect of Smog-Related Factors on Korean Domestic Tourists’ Decision-Making Process
Authors: Wang JunHui , Kim JooHyang , Moon JiHyo , Song HakJun
Published: May 2020

The present study aims to explore Korean domestic tourists’ decision-making processes by utilizing an extended model of goal-directed behavior (EMGB) as a theoretical framework. Integrating government policy (PLY) and protection motivation for smog (PMS) with the original model of goal-directed behavior (MGB) makes it easier to better understand the formation process of tourists’ behavioral intentions for domestic travel. Structural equation modeling (SEM) is employed to identify the structural relationships among the latent variables. The results of the EMGB indicated that desire had the strongest effect on the behavioral intention of tourists to travel domestically; positive anticipated emotion is the main source of desire, followed by negative anticipated emotion. Government PLY on smog has a significant, positive and indirect effect on behavioral intentions of domestic or potential tourists through the protection motive theory. We found that desires are verified as a determinant of the behavioral intention’s formation, more significant than that of perceived behavioral control, frequency of past behavior and protection motivation. In addition, this study offers theoretical and practical suggestions.
Attention-Deficit/Hyperactivity Disorder, Its Pharmacotherapy, and Adrenal Gland Dysfunction: A Nationwide Population-Based Study in Taiwan
Authors: Peng Pin-Han , Tsai Meng-Yun , Lee Sheng-Yu , Liao Po-Cheng , Shyu Yu-Chiau , Wang Liang-Jen
Published: May 2020

This study aims to examine the co-occurrence rate of attention deficit hyperactivity disorder (ADHD) and adrenal gland disorders, as well as whether pharmacotherapy may affect ADHD patients’ risk of developing adrenal gland disorder. One group of patients newly diagnosed with ADHD (n = 75,247) and one group of age- and gender-matching controls (n = 75,247) were chosen from Taiwan′s National Health Insurance database during the period of January 1999 to December 2011. Both patients and controls were monitored through December 31, 2011, in order to identify the occurrence of adrenal gland disorders (ICD-9-CM code 255.X). We also explored the potential effect of methylphenidate (MPH) and atomoxetine (ATX) treatments on the risk of developing adrenal gland disorders. We found that ADHD patients showed a significantly increased probability of developing an adrenal gland disorder compared to the control group (0.2% of ADHD vs. 0.1% of controls). However, neither MPH nor ATX treatment significantly influenced the patients’ risk of developing adrenal gland dysfunction. We propose that patients with ADHD had greater comorbid rates with adrenal gland dysfunction than the control subjects. Nevertheless, undergoing treatment with MPH or ATX did not significantly influence the risk of developing adrenal gland dysfunction among ADHD patients.
Determinants of Frequent Attendance in Primary Care. Study Protocol for a Systematic Review of Longitudinal Studies
Authors: Hajek André , Kretzler Benedikt , König Hans-Helmut
Published: May 2020

Thus far, no study has systematically synthesized longitudinal studies investigating the determinants of frequent attendance in primary care. Consequently, the purpose of our systematic review is to give an overview of evidence based on longitudinal observational studies analyzing the determinants of frequent attendance. Three electronic databases (Medline, PsycINFO, CINAHL) will be searched. Moreover, the reference lists of studies included in our systematic review will be searched manually. Longitudinal observational studies examining the determinants of frequent attendance in primary care will be included. Disease-specific samples will be excluded. Data extraction focuses on methods (e.g., measurement of frequent attendance, statistical analysis), characteristics of the sample and key results. Furthermore, the quality of the studies included will be examined using an appropriate tool. Two reviewers will perform study selection, data extraction, and quality assessment. A meta-analysis will be conducted (if possible).
Caries Increment and Salivary Microbiome during University Life: A Prospective Cohort Study
Authors: Uchida-Fukuhara Yoko , Ekuni Daisuke , Islam Md Monirul , Kataoka Kota , Taniguchi-Tabata Ayano , Fukuhara Daiki , Toyama Naoki , Kobayashi Terumasa , Fujimori Kohei , Sawada Nanami , Iwasaki Yoshiaki , Morita Manabu
Published: May 2020

The purpose of this 3-year prospective cohort study was to explore the relationship between an increase in dental caries and oral microbiome among Japanese university students. We analyzed 487 students who volunteered to receive oral examinations and answer baseline (2013) and follow-up (2016) questionnaires. Of these students, salivary samples were randomly collected from 55 students at follow-up and analyzed using next-generation sequencing. Students were divided into two groups: increased group (Δdecayed, missing, and filled teeth (ΔDMFT) score increased during the 3-year period) and non-increased group (ΔDMFT did not increase). Thirteen phyla, 21 classes, 32 orders, 48 families, 72 genera, and 156 species were identified. Microbial diversity in the increased group (n = 14) was similar to that in the non-increased group (n = 41). Relative abundances of the family Prevotellaceae (p = 0.007) and genera Alloprevotella (p = 0.007) and Dialister (p = 0.039) were enriched in the increased group compared with the non-increased group. Some bacterial taxonomic clades were differentially present between the two groups. These results may contribute to the development of new dental caries prevention strategies, including the development of detection kits and enlightenment activities for these bacteria.
Towards Precision Medicine: Inclusion of Sex and Gender Aspects in COVID-19 Clinical Studies—Acting Now before It Is Too Late—A Joint Call for Action
Authors: Bischof Evelyne , Oertelt-Prigione Sabine , Morgan Rosemary , Klein Sabra ,   The Sex and Gender in COVID19 Clinical Trials Working Group (SGC),   Gender and COVID19 Working Group
Published: May 2020

The COVID-19 global pandemic is accelerating investigations for effective vaccines and repurposable validated therapeutics [...]
Artificial Intelligence (AI)-Driven Molar Angulation Measurements to Predict Third Molar Eruption on Panoramic Radiographs
Authors: Vranckx Myrthel , Van Gerven Adriaan , Willems Holger , Vandemeulebroucke Arne , Ferreira Leite André , Politis Constantinus , Jacobs Reinhilde
Published: May 2020

The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n = 588) and validation (n = 250) of the network. A fully convolutional neural network with ResNet-101 backbone jointly predicted the molar segmentation maps and an estimate of the orientation lines, which was then iteratively refined by regression on the mesial and distal sides of the segmentation contours. Accuracy was quantified as the fraction of correct angulations (with predefined error intervals) compared to human reference measurements. Performance differences between the network and reference measurements were visually assessed using Bland−Altman plots. The quantitative analysis for automatic molar segmentation resulted in mean IoUs approximating 90%. Mean Hausdorff distances were lowest for first and second molars. The network angulation measurements reached accuracies of 79.7% [−2.5°; 2.5°] and 98.1% [−5°; 5°], combined with a clinically significant reduction in user-time of >53%. In conclusion, this study validated a new and unique AI-driven tool for fast, accurate, and consistent automated measurement of molar angulations on panoramic radiographs. Complementing the dental practitioner with accurate AI-tools will facilitate and optimize dental care and synergistically lead to ever-increasing diagnostic accuracies.
Ecosystem Services and Their Driving Forces in the Middle Reaches of the Yangtze River Urban Agglomerations, China
Authors: Chen Wanxu , Chi Guangqing , Li Jiangfeng
Published: May 2020

The impact of human activities on ecosystems can be measured by ecosystem services. The study of ecosystem services is an essential part of coupled human and natural systems. However, there is limited understanding about the driving forces of ecosystem services, especially from a spatial perspective. This study attempts to fill the gap by examining the driving forces of ecosystem services with an integrated spatial approach. The results indicate that more than US$430 billion of ecosystem services value (ESV) is produced annually in the Middle Reaches of the Yangtze River Urban Agglomerations (MRYRUA), with forestland providing the largest proportion of total ESV (≥75%) and hydrological regulation function accounting for the largest proportion of total ESV (≥15%). The average ESV in the surrounding areas is obviously higher than those in the metropolitan areas, in the plains areas, and along major traffic routes. Spatial dependence and spatial spillover effects were observed in the ecosystem services in the MRYRUA. Spatial regression results indicate that road density, proportion of developed land, and river density are negatively associated with ecosystem services, while distance to a socioeconomic center, proportion of forestland land, elevation, and precipitation are positively associated with ecosystem services. The findings in this study suggest that these driving factors and the spillover effect should be taken into consideration in ecosystem protection and land-use policymaking in urban agglomerations.
Respiratory Diseases, Malaria and Leishmaniasis: Temporal and Spatial Association with Fire Occurrences from Knowledge Discovery and Data Mining
Authors: Schroeder Lucas , Roberto Veronez Mauricio , Menezes de Souza Eniuce , Brum Diego , Gonzaga Luiz , Rofatto Vinicius Francisco
Published: May 2020

The relationship between the fires occurrences and diseases is an essential issue for making public health policy and environment protecting strategy. Thanks to the Internet, today, we have a huge amount of health data and fire occurrence reports at our disposal. The challenge, therefore, is how to deal with 4 Vs (volume, variety, velocity and veracity) associated with these data. To overcome this problem, in this paper, we propose a method that combines techniques based on Data Mining and Knowledge Discovery from Databases (KDD) to discover spatial and temporal association between diseases and the fire occurrences. Here, the case study was addressed to Malaria, Leishmaniasis and respiratory diseases in Brazil. Instead of losing a lot of time verifying the consistency of the database, the proposed method uses Decision Tree, a machine learning-based supervised classification, to perform a fast management and extract only relevant and strategic information, with the knowledge of how reliable the database is. Namely, States, Biomes and period of the year (months) with the highest rate of fires could be identified with great success rates and in few seconds. Then, the K-means, an unsupervised learning algorithms that solves the well-known clustering problem, is employed to identify the groups of cities where the fire occurrences is more expressive. Finally, the steps associated with KDD is perfomed to extract useful information from mined data. In that case, Spearman’s rank correlation coefficient, a nonparametric measure of rank correlation, is computed to infer the statistical dependence between fire occurrences and those diseases. Moreover, maps are also generated to represent the distribution of the mined data. From the results, it was possible to identify that each region showed a susceptible behaviour to some disease as well as some degree of correlation with fire outbreak, mainly in the drought period.
The Quality of Life of Seniors Hospitalized Due to Cardiovascular Diseases in Poland
Authors: Sygit Katarzyna , Siedlecka-Pasierbiak Katarzyna , Sygit Marian , Cipora Elżbieta
Published: May 2020

Introduction: In the light of the increased ageing of the world population, social policy needs to be focused on actions aimed at improving the quality of life of older people. Objective: The main objective of this study was to assess the quality of life in a population of seniors hospitalized due to cardiovascular disease. Materials and methods: The study included 408 elderly patients hospitalized for cardiovascular diseases in the Poddębickie Centrum Zdrowia Hospital in Poddębice, Łódzkie voivodship, Poland. The study used two survey questionnaires: the author’s survey questionnaire and the standardized SF36v2 Questionnaire. Statistical analysis of the obtained test results was carried out in the R program, version 3.5.1. Results: Having analyzed the health status of the study group, it was found that the largest group of subjects (84.07%) were treated due to hypertension. Among the ailments that hindered daily functioning, the respondents indicated primarily poor eyesight (53.68%). Patients assessed their own health as ‘mediocre’ (average) (58.58%). The analysis of the study results from the SF36v2 Questionnaire showed that the highest quality of life was in the limited activity due to emotional problems (RE) dimension, social functioning (SF), and physical functioning (PF); the weakest scores were observed in vitality (VT), general health perception (GH), and health transition (HT) dimensions. Conclusions: The significant demographic, social and socio-medical factors that determined respondents’ quality of life were: age, gender, marital status, education and health situation. The analysis of quality of life according to the SF36v2 Questionnaire showed that the study group functioned better in the mental dimension (MCS—mental component summary, overall mental health) than in the physical one (PCS—physical component summary, total physical health).
Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China
Authors: Zhang Yao , Zhang Haoyu , Ma Xindong , Di Qian
Published: May 2020

(1) Background: The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. Vast resources have been allocated to control the pandemic and treat patients. However, little attention has been paid to the adverse impact on mental health or effective mitigation strategies to improve mental health. (2) Purpose: The aim of this study was to assess the adverse impact of the COVID-19 outbreak on Chinese college students’ mental health, understand the underlying mechanisms, and explore feasible mitigation strategies. (3) Methods: During the peak time of the COVID-19 outbreak in China, we conducted longitudinal surveys of sixty-six college students. Structured questionnaires collected information on demographics, physical activity, negative emotions, sleep quality, and aggressiveness level. A mixed-effect model was used to evaluate associations between variables, and the mediating effect of sleep quality was further explored. A generalized additive model was used to determine the dose-response relationships between the COVID-19 death count, physical activity, and negative emotions. (4) Results: The COVID-19 death count showed a direct negative impact on general sleep quality (β = 1.37, 95% confidence interval [95% CI]: 0.55, 2.19) and reduced aggressiveness (β = −6.57, 95% CI: −12.78, −0.36). In contrast, the COVID-19 death count imposed not a direct but an indirect impact on general negative emotions (indirect effect (IE) = 0.81, p = 0.012), stress (IE = 0.40, p < 0.001), and anxiety (IE = 0.27, p = 0.004) with sleep quality as a mediator. Moreover, physical activity directly alleviated general negative emotions (β = −0.12, 95% CI: −0.22, −0.01), and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs. (5) Conclusions: (a) The severity of the COVID-19 outbreak has an indirect effect on negative emotions by affecting sleep quality. (b) A possible mitigation strategy for improving mental health includes taking suitable amounts of daily physical activity and sleeping well. (c) The COVID-19 outbreak has reduced people’s aggressiveness, probably by making people realize the fragility and preciousness of life.
The Mental Health Burden of the COVID-19 Pandemic on Physical Therapists
Authors: Yang Seoyon , Kwak Sang Gyu , Ko Eun Jae , Chang Min Cheol
Published: May 2020

We evaluated the mental health burden of coronavirus disease (COVID-19) on physical therapists, including their stress and anxiety levels, who were at risk of developing psychological distress and other mental health symptoms. A questionnaire survey was conducted with physical therapists of three university hospitals in South Korea on 10 April 2020. The questionnaires evaluated the presence of anxiety and depression in the respondents. Among the 65 physical therapists who completed our survey, 21 (32.3%) and 12 (18.5%) physical therapists reported having symptoms of anxiety and depression, respectively. If a physical therapist was living with a ≤6-year-old infant or child, the possibility of the presence of anxiety was significantly higher. The risk of depression among those who were in their 30 s and 50 s was significantly higher than among those in their 20 s. Thus, physical therapists living with a ≤6-year-old infant or child and those in their 30 s and 50 s need special attention.
Gender Differences in Cognitive Impairment among Rural Elderly in China
Authors: Wang Jing , Xiao Lily Dongxia , Wang Kai , Luo Yan , Li Xiaomei
Published: May 2020

Elders in rural areas of developing countries are particularly vulnerable to cognitive impairment and gender disparities are notable. Yet, evidence related to gender differences in cognitive impairment in these settings is scarce. This study examined gender differences in cognitive impairment among elderly people aged 65 and above in rural China. A multi-site cross-sectional survey was conducted. In total, 550 males and 700 females were recruited. The Chinese version of the Mini-Mental Status Examination was applied for cognitive impairment screening. Demographic information, lifestyle factors, psychosocial factors, and health-related information were assessed. The prevalence of cognitive impairment was 40.0%in males and 45.1% in females, respectively. Females showed significant higher prevalence after age 75 (62.7% vs. 45.4%, p < 0.005). Older age, hearing impairment, and activities of daily living dependence were common factors associated with cognitive impairment in both females and males. For males, living in a neighborhood with poor social interactions and diabetes were risk factors, while tea consumption was a protective factor. For females, vision impairment and illiteracy were additional risk factors. Individualized interventions and standardized measurements of cognitive function should be developed to suit older populations living in rural and less-developed areas, through collective efforts involving all stakeholders and multidisciplinary teamwork.
A National Communication Campaign in Indonesia Is Associated with Improved WASH-Related Knowledge and Behaviors in Indonesian Mothers
Authors: Hanson Curtis , Allen Emily , Fullmer Margie , O’Brien Rachel , Dearden Kirk , Garn Joshua , Novianti Rachmi Cut , Glenn Jeffrey , West Joshua , Crookston Benjamin , Hall Parley
Published: May 2020

Background: Water, sanitation, and hygiene (WASH) behaviors play a significant role in stunting. Knowledge and behaviors regarding WASH among caregivers are critical to providing children with chances to survive and thrive. The purpose of this study is to determine if exposure to a national communication campaign using media and interpersonal communication (IPC) is associated with WASH-related knowledge and behaviors among Indonesian mothers with children under the age of two. Methods: Data came from a cross-sectional survey of 1734 mothers with children under the age of two. The measures included exposure to two different interventions: media messages (media) and interpersonal communication strategies (IPC) and WASH-related knowledge and behavior. Multiple logistic regression was used to examine the association between intervention exposure and study variables. Results: Exposure to both media and IPC interventions was associated with participants having a higher knowledge of appropriate defecation practices (p < 0.001), higher knowledge of proper handwashing practices (p < 0.001), and higher self-reported handwashing at critical times (p < 0.001) but was not associated with reported practicing of appropriate defecation (OR = 0.780, 95% CI: 0.566–1.101). Mothers exposed to only media interventions were more likely to have knowledge of appropriate defecation practices (p < 0.001) and to have reported practicing appropriate defecation behaviors (OR = 1.539, 95% CI: 1.173–2.019). Mothers exposed to only IPC interventions were more likely to have reported handwashing at critical times (p = 0.009). Conclusions: Exposure to both media and IPC interventions was associated with increased knowledge and optimal behaviors related to WASH. These findings demonstrate the value of communications campaigns that use mass media coupled with IPC to improve WASH knowledge and behavior.
Effect of Different Running Exercise Modalities on Post-Exercise Oxidative Stress Markers in Trained Athletes
Authors: Souissi Wajdi , Bouzid Mohamed Amine , Farjallah Mohamed Amine , Ben Mahmoud Lobna , Boudaya Mariem , Engel Florian A. , Sahnoun Zouheir
Published: May 2020

The aim of this study was to examine the effect of running exercise modality on oxidative stress. Thirteen endurance athletes (age: 21.46 ± 0.66 years) performed three different running exercise modalities (Continuous running exercise (CR): continuous running exercise at 75% of VO2max for 25 min; intermittent running exercise #1 (15/15): intermittent running protocol, 15 s running at 75% of VO2max, 15 s passive recovery, performed for 50 min; intermittent running exercise #2 (30/30): intermittent running protocol, 30 s running at 75% of VO2max, 30 s passive recovery, performed for 50 min) in a randomized order. Blood samples were drawn at rest and immediately after each running exercise and assessed for malondialdehyde (MDA), advanced oxidation protein products (AOPP), superoxide dismutase(SOD), and glutathione peroxidase (GPX) activities. MDA increased by 55% following 30/30 exercise (p < 0.01), while it remained unchanged with CR and15/15 exercise. SOD increased after CR (+13.9%, p < 0.05), and also remained unchanged after 15/15 (p > 0.05) and decreased after 30/30 (−19.7% p < 0.05). GPX and AOPP did not change after exercise in all experimental sessions (p > 0.05). In conclusion, 30/30 intermittent running induced higher lipid damages than the 15/15 and CR exercise. 15/15 intermittent exercise promoted a better balance between free radicals production and antioxidant defense compared to continuous exercise and intermittent 30/30 exercise.
Nitrogen-Dioxide Remains a Valid Air Quality Indicator
Authors: Moshammer Hanns , Poteser Michael , Kundi Michael , Lemmerer Kathrin , Weitensfelder Lisbeth , Wallner Peter , Hutter Hans-Peter
Published: May 2020

In epidemiological studies, both spatial and temporal variations in nitrogen dioxide (NO2) are a robust predictor of health risks. Compared to particulate matter, the experimental evidence for harmful effects at typical ambient concentrations is less extensive and not as clear for NO2. In the wake of the “Diesel emission scandal—Dieselgate”, the scientific basis of current limit values for ambient NO2 concentrations was attacked by industry lobbyists. It was argued that associations between NO2 levels and medical endpoints were not causal, as NO2 in older studies served as a proxy for aggressive particulate matter from incineration processes. With the introduction of particle filters in diesel cars, NO2 would have lost its meaning as a health indicator. Austria has a high percentage of diesel-powered cars (56%). If, indeed, associations between NO2 concentrations and health risks in previous studies were only due to older engines without a particle filter, we should expect a reduction in effect estimates over time as an increasing number of diesel cars on the roads were outfitted with particle filters. In previous time series studies from Vienna over shorter time intervals, we have demonstrated distributed lag effects over days up to two weeks and previous day effects of NO2 on total mortality. In a simplified model, we now assess the effect estimates for moving 5-year periods from the beginning of NO2 monitoring in Vienna (1987) until the year 2018 of same and previous day NO2 on total daily mortality. Contrary to industry claims of a spurious, no longer valid indicator function of NO2, effect estimates remained fairly stable, indicating an increase in total mortality of previous day NO2 by 0.52% (95% CI: 0.35–0.7%) per 10 µg/m3 change in NO2 concentration.
Surveillance of a Pest Through a Public Health Information System: The Case of the Blackfly (Simulium erythrocephalum) in Zaragoza (Spain) during 2009–2015
Authors: Ruiz-Arrondo Ignacio , Oteo José A. , Lucientes Javier , Muniesa Ana , de Blas Ignacio
Published: May 2020

Background: Animals and people in many Spanish regions are increasingly being affected by blackfly bites in the last decade. Because of blackflies, the city of Zaragoza has become in recent years a paradigm of discomfort in Europe, with thousands of citizens affected. The OMI-AP system (Stacks, Barcelona, Spain) implemented by the Government of Aragón, a software that manages the electronic medical history of all patients, has been evaluated in order to document the increase of insect bite recorded by the primary care consultations in Zaragoza after the first outbreak of blackflies occurred in 2011. Methods: An observational, ecological and longitudinal study of insect bites recorded at the primary care consultations was carried out in primary care during the period 2009–2015. Results: The incidence of medical consultations by insect bites in Basic Health Areas (BHA) near to rivers is higher than the furthest BHA. Rural BHA are more affected by insect bites than the urban ones. The increase of medical assistance due to insect bites in Zaragoza since 2011 is correlated with the blackflies bites. Conclusions: This tool was very useful to describe the initial stage of this public health problem. It could be used for guiding public health responses in terms of surveillance and management of this pest.
Risk for Irritable Bowel Syndrome in Patients with Helicobacter Pylori Infection: A Nationwide Population-Based Study Cohort Study in Taiwan
Authors: Liang Chia-Ming , Hsu Chih-Hsiung , Chung Chi-Hsiang , Chen Chao-Yang , Wang Lin-Yin , Hsu Sheng-Der , Chang Pi-Kai , Hong Zhi-Jie , Chien Wu-Chien , Hu Je-Ming
Published: May 2020

Background: The association between Helicobacter pylori (H. pylori) infection and the risk of developing irritable bowel syndrome (IBS) has yet to be investigated; thus, we conducted this nationwide cohort study to examine the association in patients from Taiwan. Methods: A total of approximately 2669 individuals with newly diagnosed H. pylori infection and 10,676 age- and sex-matched patients without a diagnosis of H. pylori infection from 2000 to 2013 were identified from Taiwan’s National Health Insurance Research Database. The Kaplan–Meier method was used to determine the cumulative incidence of H. pylori infection in each cohort. Whether the patient underwent H. pylori eradication therapy was also determined. Results: The cumulative incidence of IBS was higher in the H. pylori-infected cohort than in the comparison cohort (log-rank test, p < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of IBS (adjusted hazard ratio (aHR) 3.108, p < 0.001). In addition, the H. pylori-infected cohort who did not receive eradication therapy had a higher risk of IBS than the non-H. pylori-infected cohort (adjusted HR 4.16, p < 0.001). The H. pylori-infected cohort who received eradication therapy had a lower risk of IBS than the comparison cohort (adjusted HR 0.464, p = 0.037). Conclusions: Based on a retrospective follow-up, nationwide study in Taiwan, H. pylori infection was associated with an increased risk of IBS; however, aggressive H. pylori infection eradication therapy can also reduce the risk of IBS. Further underlying biological mechanistic research is needed.
Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis
Authors: Gianfredi Vincenza , Blandi Lorenzo , Cacitti Stefano , Minelli Mirko , Signorelli Carlo , Amerio Andrea , Odone Anna
Published: May 2020

Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.
Depression and Anxiety in Hong Kong during COVID-19
Authors: Choi Edmond Pui Hang , Hui Bryant Pui Hung , Wan Eric Yuk Fai
Published: May 2020

It has been three months since the first confirmed case of coronavirus disease 2019 (COVID-19) in Hong Kong, and people now have a more complete picture of the extent of the pandemic. Therefore, it is time to evaluate the impacts of COVID-19 on mental health. The current population-based study aimed to evaluate the depression and anxiety of people in Hong Kong during the COVID-19 pandemic. Respondents were randomly recruited and asked to complete a structured questionnaire, including the patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder-7 (GAD-7), the global rating of change scale and items related to COVID-19. Of the 500 respondents included in the study, 19% had depression (PHQ-9 score ≥ 10) and 14% had anxiety (GAD score ≥ 10). In addition, 25.4% reported that their mental health had deteriorated since the pandemic. Multiple logistic regression analysis found that not experiencing the SARS outbreak in 2003, being worried about being infected by COVID-19, being bothered by having not enough surgical masks and being bothered by not being able to work from home were associated with a poorer mental health status. Psychological support, such as brief, home-based psychological interventions, should be provided to citizens during the pandemic.
Shell Growth of Large Benthic Foraminifera under Heavy Metals Pollution: Implications for Geochemical Monitoring of Coastal Environments
Authors: Ben-Eliahu Nir , Herut Barak , Rahav Eyal , Abramovich Sigal
Published: May 2020

This study was promoted by the recent efforts using larger benthic foraminiferal (LBF) shells geochemistry for the monitoring of heavy metals (HMs) pollution in the marine environment. The shell itself acts as a recorder of the ambient water chemistry in low to extreme HMs-polluted environments, allowing the monitoring of recent-past pollution events. This concept, known as sclerochronology, requires the addition of new parts (i.e., new shell) even in extreme pollution events. We evaluated the physiological resilience of three LBF species with different shell types and symbionts to enriched concentrations of Cd, Cu, and Pb at levels several folds higher than the ecological criteria maximum concentration (CMC) (165–166, 33–43, 1001–1206 µg L−1, respectively), which is derived from aquatic organisms’ toxicity tests. The physiological response of the holobiont was expressed by growth rates quantified by the addition of new chambers (new shell parts), and by the chlorophyll a of the algal symbionts. The growth rate decrease varied between 0% and 30% compared to the unamended control for all HMs tested, whereas the algal symbionts exhibited a general non-fatal but significant response to Pb and Cu. Our results highlight that shell growth inhibition of LBF is predicted in extreme concentrations of 57 × CMC of Cu and 523 × CMC of Cd, providing a proof of concept for shell geochemistry monitoring, which is currently not used in the regulatory sectors.
Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data
Authors: Moreno-Juste Aida , Poblador-Plou Beatriz , Aza-Pascual-Salcedo Mercedes , González-Rubio Francisca , Malo Sara , Librero López Julián , Pico-Soler Victoria , Giménez Labrador Eva , Mucherino Sara , Orlando Valentina , Menditto Enrica , Prados-Torres Alexandra , Gimeno-Miguel Antonio
Published: May 2020

The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes.
Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement
Authors: Vu Giap Van , Ngo Chau Quy , Phan Phuong Thu , Doan Lan Phuong Thi , Nguyen Toan Thi , Nguyen Mai Hong , Nguyen Diep Ngoc , Nguyen Nguyen Thao Thi , Nguyen Huong Lan Thi , Hoang Chi Linh , Vu Linh Gia , Latkin Carl A. , Tran Bach Xuan , Ho Roger C. M. , Ho Cyrus S. H.
Published: May 2020

The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants’ health.
Ethiopian Health Care Workers’ Insights into and Responses to Intimate Partner Violence in Pregnancy—A Qualitative Study
Authors: Gashaw Bosena Tebeje , Schei Berit , Solbraekke Kari Nyheim , Magnus Jeanette H.
Published: May 2020

Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy.
Exploring the Potential of Deep Learning Segmentation for Mountain Roads Generalisation
Authors: Courtial Azelle , El Ayedi Achraf , Touya Guillaume , Zhang Xiang
Published: May 2020

Among cartographic generalisation problems, the generalisation of sinuous bends in mountain roads has always been a popular one due to its difficulty. Recent research showed the potential of deep learning techniques to overcome some remaining research problems regarding the automation of cartographic generalisation. This paper explores this potential on the popular mountain road generalisation problem, which requires smoothing the road, enlarging the bend summits, and schematising the bend series by removing some of the bends. We modelled the mountain road generalisation as a deep learning problem by generating an image from input vector road data, and tried to generate it as an output of the model a new image of the generalised roads. Similarly to previous studies on building generalisation, we used a U-Net architecture to generate the generalised image from the ungeneralised image. The deep learning model was trained and evaluated on a dataset composed of roads in the Alps extracted from IGN (the French national mapping agency) maps at 1:250,000 (output) and 1:25,000 (input) scale. The results are encouraging as the output image looks like a generalised version of the roads and the accuracy of pixel segmentation is around 65%. The model learns how to smooth the output roads, and that it needs to displace and enlarge symbols but does not always correctly achieve these operations. This article shows the ability of deep learning to understand and manage the geographic information for generalisation, but also highlights challenges to come.
Synthesis, Properties, and Biodegradation of Sequential Poly(Ester Amide)s Containing γ-Aminobutyric Acid
Authors: Nakayama Yuushou , Watanabe Kazumasa , Tanaka Ryo , Shiono Takeshi , Kawasaki Norioki , Yamano Naoko , Nakayama Atsuyoshi
Published: May 2020

Poly(ester amide)s are attracting attention because they potentially have excellent thermal and mechanical properties as well as biodegradability. In this study, we synthesized a series of novel poly(ester amide)s by introducing γ-aminobutyric acid (GABA) regularly into polyesters, and investigated their properties and biodegradabilities. GABA is the monomer unit of biodegradable polyamide 4 (PA4). The new poly(ester amide)s were synthesized from the reaction of ammonium tosylate derivatives of alkylene bis(γ-aminobutylate) and p-nitrophenyl esters of dicarboxylic acids. All the obtained polymers showed relatively high melting temperatures (Tm). Their thermal decomposition temperatures were improved in comparison with that of PA4 and higher enough than their Tm. The poly(ester amide)s exhibited higher biodegradability in seawater than the corresponding homopolyesters. Their biodegradabilities in activated sludge were also studied.