bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstacles and Solutions Driving the Development of a National Teleradiology Network
Authors: Goelz Leonie , Arndt Holger , Hausmann Jens , Madeja Christian , Mutze Sven
Published: December 2021

Background: Teleradiology has the potential to link medical experts and specialties despite geographical separation. In a project report about hospital-based teleradiology, the significance of technical and human factors during the implementation and growth of a teleradiology network are explored. Evaluation: The article identifies major obstacles during the implementation and growth of the teleradiology network of the Berlin Trauma Hospital (BG Unfallkrankenhaus Berlin) between 2004 and 2020 in semi-structured interviews with senior staff members. Quantitative analysis of examination numbers, patient numbers, and profits relates the efforts of the staff members to the monetary benefits and success of the network. Identification of qualitative and quantitative factors for success: Soft and hard facilitators and solutions driving the development of the national teleradiology network are identified. Obstacles were often solved by technical innovations, but the time span between required personal efforts, endurance, and flexibility of local and external team members. The article describes innovations driven by teleradiology and hints at the impact of teleradiology on modern medical care by relating the expansion of the teleradiology network to patient transfers and profits. Conclusion: In addition to technical improvements, interpersonal collaborations were key to the success of the teleradiology network of the Berlin Trauma Hospital and remained a unique feature and selling point of this teleradiology network.
Effect of a Comprehensive Rehabilitation Program for Community Women with Urinary Incontinence: A Retrospect Cohort Study
Authors: Yang Sen-Ju , Liu Yi-Ting , Lo Su-Shun , Tsai Chih-Chun , Pan Po-Jung
Published: December 2021

Urinary incontinence (UI) is a common problem affecting older adult women globally, but studies regarding combined treatments for all types of UI are still lacking. Here we evaluate the efficacy of a comprehensive rehabilitation program for women with UI. A comprehensive rehabilitation program was introduced that combines pelvic floor muscle (PFM) exercises, functional electrical stimulation, and timely biofeedback during the training process. Data of patients with stress (SUI), urgency (UUI), or mixed (MUI) urinary incontinence who participated in this program between 2016 and 2019 were reviewed retrospectively. Seventy-three subjects (mean age 59.2 ± 12.7 years) were enrolled. After 12 weeks of rehabilitation, vaginal pressure and control accuracy increased in all groups. PFM maximum recruitment increased significantly at week 12 in SUI and UUI, but not in MUI. At week 6, only the SUI group had achieved significant improvements in vaginal pressure, PFM maximum recruitment and control accuracy. The Short-form Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) scores declined dramatically after the program started, and significant improvements were maintained to week 48. The comprehensive rehabilitation program is effective and decreases urinary leakage episodes and improves quality of life in women with UI, especially SUI.
Clustering Inflammatory Markers with Sociodemographic and Clinical Characteristics of Patients with Diabetes Type 2 Can Support Family Physicians’ Clinical Reasoning by Reducing Patients’ Complexity
Authors: Bosnic Zvonimir , Yildirim Pinar , Babič František , Šahinović Ines , Wittlinger Thomas , Martinović Ivo , Majnaric Ljiljana Trtica
Published: December 2021

Diabetes mellitus type 2 (DM2) is a complex disease associated with chronic inflammation, end-organ damage, and multiple comorbidities. Initiatives are emerging for a more personalized approach in managing DM2 patients. We hypothesized that by clustering inflammatory markers with variables indicating the sociodemographic and clinical contexts of patients with DM2, we could gain insights into the hidden phenotypes and the underlying pathophysiological backgrounds thereof. We applied the k-means algorithm and a total of 30 variables in a group of 174 primary care (PC) patients with DM2 aged 50 years and above and of both genders. We included some emerging markers of inflammation, specifically, neutrophil-to-lymphocyte ratio (NLR) and the cytokines IL-17A and IL-37. Multiple regression models were used to assess associations of inflammatory markers with other variables. Overall, we observed that the cytokines were more variable than the marker NLR. The set of inflammatory markers was needed to indicate the capacity of patients in the clusters for inflammatory cell recruitment from the circulation to the tissues, and subsequently for the progression of end-organ damage and vascular complications. The hypothalamus–pituitary–thyroid hormonal axis, in addition to the cytokine IL-37, may have a suppressive, inflammation-regulatory role. These results can help PC physicians with their clinical reasoning by reducing the complexity of diabetic patients.
Clinico-Epidemiological Profile and Outcome of Children with IgA Vasculitis in Aseer Region, Southwestern Saudi Arabia
Authors: Dawood Samy A. , Abodiah Abdoh M. , Alqahtani Saleh M. , Shati Ayed A. , Alqahtani Youssef A. , Alshehri Mohammed A. , Mahmood Syed E.
Published: December 2021

Introduction: Immunoglobulin A (IgA) vasculitis is one of the most common forms of primary vasculitis in children; it typically has a benign course but can be aggressive and require intervention. Aim of the work: The aim of this retrospective study was to evaluate the epidemiological and clinical profile and treatment modalities used for children with IgA vasculitis in the southwestern region of Saudi Arabia. Material and Methods: We reviewed the medical records of 89 children admitted to Abha Maternity and Children Hospital in the southwestern region of Saudi Arabia from January 2016 to December 2020 with a confirmed diagnosis of IgA vasculitis according to the European League Against Rheumatism/Paediatric Rheumatology International Trials Organisation/Pediatric Rheumatology European Society criteria. Results: Eighty-nine children had a confirmed diagnosis of IgA vasculitis, with 50 boys (56.2%) and 39 girls (43.8%; male-to-female ratio of 1.28:1) and a mean age at diagnosis of 5.87 ± 2.81 years. The mean hospital stay duration was 5.66 ± 4.72 days. Infections preceded 29.2% of the cases, with upper respiratory tract infections comprising 24.7%. Approximately 31.5% of the cases were diagnosed in summer, followed by autumn in 28% of the cases. Rash was present in 100%, arthritis in 72.2%, gastrointestinal tract involvement in 60.7%, and renal involvement in 23.5% of cases. Thrombocytosis and leukocytosis were found in 35% and 46% of all cases, and 52.3% and 47.6.25% of cases with renal involvement, respectively (OR = 2.035, 95% CI: 0.75–5.52 and OR = 1.393, 95% CI: 0.522–1.716, respectively). Approximately 26% of cases experienced relapses. Treatment was conservative in 23.6%, oral prednisolone in 23.6%, and pulse steroid in 45% of cases. Abdominal pain with lower gastrointestinal tract bleeding was the primary indication for initiating pulse steroid treatment. Conclusions: There were similarities and differences in the epidemiology and frequency of clinical manifestations of patients with IgA vasculitis compared to previous studies. Children presenting with such epidemiological and clinical profile need to be closely monitored and long-term follow-up is recommended to improve the outcomes.
Effect of Three Water Regimes on the Physiological and Anatomical Structure of Stem and Leaves of Different Citrus Rootstocks with Distinct Degrees of Tolerance to Drought Stress
Authors: Shafqat Waqar , Mazrou Yasser S. A. , Sami-ur-Rehman  , Nehela Yasser , Ikram Sufian , Bibi Sana , Naqvi Summar A. , Hameed Mansoor , Jaskani Muhammad Jafar
Published: December 2021

Citrus is grown globally throughout the subtropics and semi-arid to humid tropics. Abiotic stresses such as soil water deficit negatively affect plant growth, physiology, biochemistry, and anatomy. Herein, we investigated the effect(s) of three water regimes (control, moderate drought, and severe drought) on the physiological and anatomical structure of 10 different citrus rootstocks with different degrees of tolerance to drought stress. Brazilian sour orange and Gadha dahi performed well by avoiding desiccation and maintaining plant growth, plant water status, and biochemical characters, while Rangpur Poona nucellar (C. limonia) and Sunki × bentake were the most sensitive rootstocks at all stress conditions. At severe water stress, the highest root length (24.33 ± 0.58), shoot length (17.00 ± 1.00), root moisture content (57.67 ± 1.53), shoot moisture content (64.59 ± 1.71), and plant water potential (−1.57 ± 0.03) was observed in tolerant genotype, Brazilian sour orange. Likewise, chlorophyll a (2.70 ± 0.06), chlorophyll b (0.87 ± 0.06) and carotenoids (0.69 ± 0.08) were higher in the same genotype. The lowest H2O2 content (77.00 ± 1.00) and highest proline content (0.51 ± 0.06) were also recorded by Brazilian sour orange. The tolerance mechanism of tolerant genotypes was elucidated by modification in anatomical structures. Stem anatomy at severe drought, 27.5% increase in epidermal cell thickness, 25.4% in vascular bundle length, 30.5% in xylem thickness, 27.7% in the phloem cell area, 8% in the pith cell area, and 43.4% in cortical thickness were also observed in tolerant genotypes. Likewise, leaf anatomy showed an increase of 27.9% in epidermal cell thickness, 11.4% in vascular bundle length, 21% in xylem thickness, and 15% in phloem cell area in tolerant genotypes compared with sensitive ones. These modifications in tolerant genotypes enabled them to maintain steady nutrient transport while reducing the risk of embolisms, increasing water-flow resistance, and constant transport of nutrients across.
The Application of Pomegranate, Sugar Apple, and Eggplant Peel Extracts Suppresses Aspergillus flavus Growth and Aflatoxin B1 Biosynthesis Pathway
Authors: Ismail Ismail A. , Qari Sameer H. , Shawer Rady , Elshaer Moustafa M. , Dessoky Eldessoky S. , Youssef Nesrine H. , Hamad Najwa A. , Abdelkhalek Ahmed , Elsamra Ibrahim A. , Behiry Said I.
Published: December 2021

Even though the green revolution was a significant turning point in agriculture, it was also marked by the widespread use of chemical pesticides, which prompted severe concerns about their influence on human and environmental health. As a result, the demand for healthier and more environmentally friendly alternatives to control plant diseases and avoid food spoilage is intensifying. Among the proposed alternatives, food by-product extracts, especially from the most consumed fruits in Egypt, eggplant, sugar apple, and pomegranate peel wastes, were largely ignored. Hence, we chose them to evaluate their antifungal and antiaflatoxigenic activities against maize fungus, Aspergillus flavus. All the extracts exhibited multiple degrees of antifungal growth and aflatoxin B1 (AFB1) inhibitory activities (35.52% to 91.18%) in broth media. Additionally, diethyl ether 50% eggplant, ethanol 75% sugar apple, and diethyl ether 25% pomegranate extracts exhibited the highest AFB1 inhibition, of 96.11%, 94.85%, and 78.83%, respectively, after one month of treated-maize storage. At the same time, Topsin fungicide demonstrated an AFB1 inhibition ratio of 72.95%. The relative transcriptional levels of three structural and two regulatory genes, aflD, aflP, aflQ, aflR, and aflS, were downregulated compared to the infected control. The phenolic content (116.88 mg GAEs/g DW) was highest in the 25% diethyl ether pomegranate peel extract, while the antioxidant activity was highest in the 75% ethanol sugar apple extract (94.02 µg/mL). The most abundant active compounds were found in the GC-MS analysis of the fruit peel extracts: α-kaurene, α-fenchene, p-allylphenol, octadecanoic acid, 3,5-dihydroxy phenol, hexestrol, xanthinin, and linoleic acid. Finally, the three fruit peel waste extracts could be a prospective source of friendly ecological compounds that act as environmentally safer and more protective alternatives to inhibit AFB1 production in maize storage.
Distribution and Important Areas for the Conservation of Amphibians in the Province of Seville, Spain: Identifying Priorities
Authors: Rodríguez-Rodríguez Eduardo José , Carmona-González Rafael
Published: December 2021

Amphibians are among the most threatened vertebrates in the world due to habitat destruction, emerging diseases, and climate change, and therefore, it is of critical importance to identify the risk and conservation measures for their populations. In this work, we aimed to identify the status of amphibian distribution in the province of Seville, in the south of Spain. We additionally wanted to identify critical conservation areas and propose measures of conservation for the whole community as well as specific taxa. To do this, we mapped the distribution of amphibians using our own data and bibliography and translated it into a 10 × 10 km2 UTM grid. Our work has allowed us to identify several areas of importance for amphibians in the province and populations of some species that need special attention.
Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population
Authors: Matsui Kentaro , Yoshiike Takuya , Nagao Kentaro , Utsumi Tomohiro , Tsuru Ayumi , Otsuki Rei , Ayabe Naoko , Hazumi Megumi , Suzuki Masahiro , Saitoh Kaori , Aritake-Okada Sayaka , Inoue Yuichi , Kuriyama Kenichi
Published: December 2021

This study aimed to determine whether both subjective sleep quality and sleep duration are directly associated with quality of life (QOL), as well as indirectly associated with QOL through insomnia symptoms. Individuals aged 20–69 years without mental illness (n = 9305) were enrolled in this web-based cross-sectional survey. The Short Form-8 was used to assess physical and mental QOL. We used the Pittsburgh Sleep Quality Index (PSQI) and extracted items related to subjective sleep quality and sleep duration. Insomnia symptoms were also extracted from the PSQI. The hypothesized models were tested using structural equation modeling. Worse sleep quality, but not shorter sleep duration, was related to worse physical QOL. Both worse sleep quality and shorter sleep duration were related to worse mental QOL. Insomnia symptoms mediated these relationships. Subgroup analyses revealed a U-shaped relationship between sleep duration and physical/mental QOL. However, the relationship between sleep quality and physical/mental QOL was consistent regardless of sleep duration. The results suggest that subjective sleep quality has a more coherent association with QOL than subjective sleep duration. Because of its high feasibility, a questionnaire on overall sleep quality could be a useful indicator in future epidemiological studies of strategies for improving QOL.
Intestinal Barrier in Human Health and Disease
Authors: Di Tommaso Natalia , Gasbarrini Antonio , Ponziani Francesca Romana
Published: December 2021

The intestinal mucosa provides a selective permeable barrier for nutrient absorption and protection from external factors. It consists of epithelial cells, immune cells and their secretions. The gut microbiota participates in regulating the integrity and function of the intestinal barrier in a homeostatic balance. Pathogens, xenobiotics and food can disrupt the intestinal barrier, promoting systemic inflammation and tissue damage. Genetic and immune factors predispose individuals to gut barrier dysfunction, and changes in the composition and function of the gut microbiota are central to this process. The progressive identification of these changes has led to the development of the concept of ‘leaky gut syndrome’ and ‘gut dysbiosis’, which underlie the relationship between intestinal barrier impairment, metabolic diseases and autoimmunity. Understanding the mechanisms underlying this process is an intriguing subject of research for the diagnosis and treatment of various intestinal and extraintestinal diseases.
Co-Design of a Neurodevelopment Assessment Scale: A Study Protocol
Authors: Masi Anne , Azim Syeda Ishra , Lam-Cassettari Christa , Dadds Mark , Mendoza Diaz Antonio , Henry Georgina , Karlov Lisa , Lin Ping-I , Mallitt Kylie-Ann , Montgomery Alicia , Strnadová Iva , Whitehouse Andrew , Eapen Valsamma
Published: December 2021

Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., ‘social validity’), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual’s unique profile in a holistic and efficient manner.
Perceived Stress Levels among Ukrainian Migrant and LGBT+ Minorities in Poland during the COVID-19 Pandemic
Authors: Michalski Tomasz , Brosz Maciej , Stepien Joanna , Biernacka Karolina , Blaszczyk Michal , Grabowski Jakub
Published: December 2021

The Coronavirus disease 2019 (COVID-19) pandemic, immigrant status and being a member of the LGBT+ community are all independent factors associated with increased stress levels. Few studies provide more complex analysis on this issue, and there has been no research on the cumulative burden of perceived stress that people belonging to both minorities experience in the current epidemiological situation. The aim of this study was to assess the ability to deal with an external situation during the third wave of the COVID-19 pandemic in Poland in the following groups with different stress levels (total sample n = 370): Polish heterosexual men (n = 202), heterosexual men from Ukraine (n = 131) and homo- and bisexual men (men who have sex with men—MSM) from Ukraine (n = 37). A Perceived Stress Scale (PSS-10) was used. The analysis of the survey did not show statistically significant differences between the three study groups in the general level of perceived stress (24.71, 24.77 and 26.49 points, respectively, p = 0.551), but it revealed numerous differences in coping with various aspects of everyday functioning between these groups. Negative assessment of one’s own health proved to be the main factor negatively affecting the level of perceived stress, however specific health risks, medical history or the participants’ previous experience have not been taken into account in the study. Our research shows differences in the needs, resources and methods of coping with stress between men who are Polish citizens and migrants from Ukraine, both heterosexual and belonging to the MSM group. Proper identification and addressing of these needs, taking into account different availability of health services, could be the responsibility of NGOs or insurance providers. This should result in the reduction of mental health burdens and the risk of developing serious mental disorders, and consequently in better functioning of persons belonging to minorities and in a reduced burden on the health care system.
Region-Specific Associations between Environmental Factors and Escherichia coli in Freshwater Beaches in Toronto and Niagara Region, Canada
Authors: Sanchez Johanna , Tustin Jordan , Heasley Cole , Patel Mahesh , Kelly Jeremy , Habjan Anthony , Waterhouse Ryan , Young Ian
Published: December 2021

Poor freshwater beach quality, measured by Escherichia coli (E. coli) levels, poses a risk of recreational water illness. This study linked environmental data to E. coli geometric means collected at 18 beaches in Toronto (2008–2019) and the Niagara Region (2011–2019) to examine the environmental predictors of E. coli. We developed region-specific models using mixed effects models to examine E. coli as a continuous variable and recommended thresholds of E. coli concentration (100 CFU/100 mL and 200 CFU/100 mL). Substantial clustering of E. coli values at the beach level was observed in Toronto, while minimal clustering was seen in Niagara, suggesting an important beach-specific effect in Toronto beaches. Air temperature and turbidity (measured directly or visually observed) were positively associated with E. coli in all models in both regions. In Toronto, waterfowl counts, rainfall, stream discharge and water temperature were positively associated with E. coli levels, while solar irradiance and water level were negatively associated. In Niagara, wave height and water level had a positive association with E. coli, while rainfall was negatively associated. The differences in regional models suggest the importance of a region-specific approach to addressing beach water quality. The results can guide beach monitoring and management practices, including predictive modelling.
Biological Well-Being and Inequality in Canary Islands: Lanzarote (Cohorts 1886–1982)
Authors: Candela-Martínez Begoña , Martínez-Carrión José M. , Román-Cervantes Cándido
Published: December 2021

Developments in anthropometric history in the Iberian Peninsula have been remarkable in recent decades. In contrast, we barely know about the behavior of insular population groups and infants’ and adults’ growth during the nutritional transition in the Canary Islands. This paper analyzes the height, weight and body mass index of military recruits (conscripts) in a rural municipality from the eastern Canaries during the economic modernization process throughout the 20th century. The case study (municipality of San Bartolomé (SB) in Lanzarote, the island closest to the African continent) uses anthropometric data of military recruits from 1907–2001 (cohorts from 1886 to 1982). The final sample is composed of 1921 recruits’ records that were measured and weighed at the ages of 19–21 years old when adolescent growth had finished. The long-term anthropometric study is carried out using two approaches: a malnutrition and growth retardation approach and an inequality perspective. In the first one, we use the methodology recommended by the World Health Organization (WHO) that is based on z-scores. In the second one, we implement several inequality dimensions such as the coefficient of variation (CV), percentiles and an analysis for height and BMI evolution by five socioeconomic categories. The data suggest that improvements in biological well-being were due to advances in nutrition since the 1960s. They show that infant nutrition is sensitively associated with economic growth and demographic and epidemiological changes.
Needs for International Benchmarking of Road Safety Management Based on Mobility Exposure Measures and Risk Patterns
Authors: González-Sánchez Guadalupe , Olmo-Sánchez María Isabel , Maeso-González Elvira , Gutiérrez-Bedmar Mario , García-Rodríguez Antonio
Published: December 2021

Each year, 1.35 million people worldwide die due to Road Traffic Injuries (RTI), highlighting the need for further research. The risk of RTI is usually estimated as the number of casualties divided by the level of exposure in a population. Identifying the most appropriate exposure measures is one of the most important current challenges in this field. This paper presents an analysis of exposure measures used in empirical studies on road accidents. The results show a large variability in the exposure measures used, ranging from more general measures (such as population figures or vehicle fleet) to more specific measures related to mobility (such as number of trips, distances or travel time). A comparison of the risk patterns found shows that there is a partial consensus on the profiles with the highest risk of road traffic injuries. In conclusion, there is a need for the international standardization of criteria and data to be recorded, at least injury severity and measures of exposure to mobility, as the travel time disaggregated by socio-demographic variables and mode of transport. Such data would provide higher-quality results on risk profiles and facilitate the implementation of more effective, knowledge-based road safety policies.
Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis
Authors: Latina Roberto , Iacorossi Laura , Fauci Alice , Biffi Annalisa , Castellini Greta , Coclite Daniela , D’Angelo Daniela , Gianola Silvia , Mari Veronica , Napoletano Antonello , Porcu Gloria , Ruggeri Matteo , Iannone Primiano , Chiara Osvaldo ,   on behalf of INIH—Major Trauma
Published: December 2021

Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19–1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed.
Low QRS Voltage in Limb Leads Indicates Accompanying Precordial Voltage Attenuation Resulting in Underestimation of Left Ventricular Hypertrophy
Authors: Gwag Hye-Bin , Lee Su-Hyun , Kim Hyeon-Jun , Kim June-Soo , On Young-Keun , Park Seung-Jung , Park Kyoung-Min
Published: December 2021

Low QRS voltage (LQRSV) in electrocardiography (ECG) often occurs in limb leads without apparent cause. However, its clinical significance is obscure in healthy populations. We reviewed patients aged over 60 who were scheduled for non-cardiac surgery in two hospitals. Patients underwent pre-operative ECG, echocardiography, pulmonary function test, and chest X-ray. Patients with LQRSV isolated to limb leads and patients without LQRSV were selected from separate hospitals. Among the 9832 patients screened in one hospital, 292 (3.0%) showed LQRSV in limb leads. One-hundred and ninety-four without LQRSV were selected as the control from the 216 patients screened at the other hospital. For primary analysis, patients with structural heart disease or classic etiologies of LQRSV were excluded. Patients with LQRSV had a higher proportion of male and a greater body mass index. Precordial QRS voltages were smaller, whereas left ventricular mass index and the prevalence of echocardiographic left ventricular hypertrophy (LVH) was higher in patients with LQRSV than in those without. Consequentially, diagnostic performance of precordial voltage criteria for LVH was particularly poor in patients with LQRSV in limb leads. LQRSV in limb leads frequently occurs without apparent etiologies. ECG voltage criteria may underestimate LVH in a relatively healthy population with LQRSV in limb leads.
Validation of the Romanian Version of the Toronto Empathy Questionnaire (TEQ) among Undergraduate Medical Students
Authors: Ursoniu Sorin , Serban Costela Lacrimioara , Giurgi-Oncu Catalina , Rivis Ioana Alexandra , Bucur Adina , Bredicean Ana-Cristina , Papava Ion
Published: December 2021

Medical professionals require adequate abilities to identify others’ emotions and express personal emotions. We aimed to determine the validity and reliability of an empathy measuring tool in medical students for this study. We employed Spreng’s Toronto Empathy Questionnaire (TEQ) as a starting point for this validation. The process was performed in several steps, including an English-Romanian-English translation and a focus group meeting to establish each question’s degree of understandability and usability, with minor improvements of wording in each step. We checked internal and external consistency in a pilot group (n = 67). For construct and convergent validity, we used a sample of 649 students. The overall internal and external reliability performed well, with Cronbach’s alpha = 0.727 and respective ICC = 0.776. The principal component analysis resulted in 3 components: prosocial helping behavior, inappropriate sensitivity, dismissive attitude. Component 1 includes positively worded questions, and components 2 and 3 include negatively worded questions. Women had significantly higher scores than men in convergent validity, but we did not highlight any differences for other demographic factors. The Romanian version of the TEQ is a reliable and valid tool to measure empathy among undergraduate medical students that may be further used in subsequent research.
Spanish Adaptation of the Experiential Approach Scale (EAS)
Authors: Reyes-Martín Salvador , Hernández-López Mónica , Rodríguez-Valverde Miguel
Published: December 2021

Psychological inflexibility is a transdiagnostic dimension associated to psychological distress and poor mental health and quality of life. While multiple instruments have been developed for the assessment of patterns of inflexible responding to aversive private events (e.g., unwanted cognitions and emotions), the Experiential Approach Scale (EAS) is the first instrument specifically designed to assess inflexible responding to appetitive private events (e.g., desired affective states). In this study, we explored the factor structure, internal consistency, and convergent validity of a Spanish adaptation of the EAS with a convenience sample of college students from Spain (n = 206; 79% female). A two-factor solution demonstrated very good fit to the data and was similar to the original two-subscale EAS structure: Anxious Clinging and Experience Prolonging. The scale showed adequate overall (α = 0.85) and subscale (αs: 0.90 and 0.89) internal consistency. Unlike the original instrument, both subscales were uncorrelated. Anxious Clinging correlated positively with experiential avoidance and with measures of negative affect and psychopathology, and negatively with positive affect, subjective happiness, and life satisfaction. In turn, Experience Prolonging correlated negatively with psychopathology and positively with positive affect, subjective happiness, and life satisfaction. Our results point to Anxious Clinging as the only EAS subscale contributing to psychological inflexibility.
The A Body Shape Index Might Be a Stronger Predictor of Chronic Kidney Disease Than BMI in a Senior Population
Authors: Kim Bokun , Kim Gwonmin , Kim Eonho , Park Jonghwan , Isobe Tomonori , Sakae Takeji , Oh Sechang
Published: December 2021

The A Body Shape Index (ABSI) was recently introduced to quantify abdominal adiposity relative to the body mass index (BMI) and height. This cross-sectional study was performed to explore whether the ABSI is linked to chronic kidney disease (CKD) in older adults and compare the predictive capacity of the ABSI versus BMI for CKD. In total, 7053 people aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups based on their estimated glomerular filtration rate (eGFR). The correlation of the ABSI with the eGFR and the differences and trends in the ABSI and BMI among the groups were analyzed, and the cutoff points for moderate-to-severe CKD were calculated. The association between the ABSI and CKD was stronger than that between the BMI and CKD. The ABSI had a better capacity to discriminate the CKD stage than did the BMI. The capacity of the ABSI to predict moderate-to-severe CKD was higher than that of the BMI and was more substantial in women than men. The ABSI cutoff points for CKD were ≥0.0822 and 0.0795 in men and women, respectively. In conclusion, the ABSI serves as a better index than the BMI for screening and detecting high-risk individuals with CKD.
Remediation of Smelter Contaminated Soil by Sequential Washing Using Biosurfactants
Authors: Gusiatin Zygmunt Mariusz , Kumpiene Jurate , Carabante Ivan , Radziemska Maja , Brtnicky Martin
Published: December 2021

This paper presents experimental results from the use of biosurfactants in the remediation of a soil from a smelter in Poland. In the soil, concentrations of Cu (1659.1 mg/kg) and Pb (290.8 mg/kg) exceeded the limit values. Triple batch washing was tested as a soil treatment. Three main variants were used, each starting with a different plant-derived (saponin, S; tannic acid, T) or microbial (rhamnolipids, R) biosurfactant solution in the first washing, followed by 9 different sequences using combinations of the tested biosurfactants (27 in total). The efficiency of the washing was determined based on the concentration of metal removed after each washing (CR), the cumulative removal efficiency (Ecumulative) and metal stability (calculated as the reduced partition index, Ir, based on the metal fractions from BCR sequential extraction). The type of biosurfactant sequence influenced the CR values. The variants that began with S and R had the highest average Ecumulative for Cu and Pb, respectively. The Ecumulative value correlated very strongly (r > 0.8) with the stability of the residual metals in the soil. The average Ecumulative and stability of Cu were the highest, 87.4% and 0.40, respectively, with the S-S-S, S-S-T, S-S-R and S-R-T sequences. Lead removal and stability were the highest, 64–73% and 0.36–0.41, respectively, with the R-R-R, R-R-S, R-S-R and R-S-S sequences. Although the loss of biosurfactants was below 10% after each washing, sequential washing with biosurfactants enriched the soil with external organic carbon by an average of 27-fold (S-first variant), 24-fold (R first) or 19-fold (T first). With regard to environmental limit values, metal stability and organic carbon resources, sequential washing with different biosurfactants is a beneficial strategy for the remediation of smelter-contaminated soil with given properties.
Identifying Targets for Interventions to Increase Earplug Use in Noisy Recreational Settings: A Qualitative Interview Study
Authors: Loughran Michael T. , Couth Samuel , Plack Christopher J. , Armitage Christopher J.
Published: December 2021

Earplugs can reduce the risk of hearing loss and tinnitus. However, earplug use during noisy recreational activities is uncommon, and methods for increasing uptake and regular use have had limited efficacy. The aim of the present study was to examine barriers and enablers of ever-performers (e.g., people who have used earplugs) and never-performers (e.g., people who have not used earplugs) to identify targets to inform the content of interventions to increase uptake and regular use of earplugs in recreational settings. The Capabilities, Opportunities, and Motivations model of Behaviour (COM-B) informed the outline for 20 semi-structured telephone interviews (ever-performers, N = 8, age range = 20–45 years; never-performers, N = 12; age range = 20–50 years). Thematic analysis was used to identify barriers and enablers to earplug use, which were mapped onto the Theoretical Domains Framework (TDF). Six key domains of the TDF were identified. Ever-performers described being more exposed to ‘social influences’ (e.g., facilitators such as friends/peers) and were more positive than never-performers concerning ‘beliefs about consequences’ (e.g., earplug protection outweighs any negative effects on listening/communication). Involvement of ‘emotion’ (e.g., fear of losing ability to listen to music) and ‘reinforcement’ tactics (e.g., creating habits/routines) were discussed by ever-performers, but were not mentioned by never-performers. Both groups reported lack of ‘environmental context and resources’ (e.g., prompts and cues), and their own ‘memory, attention, and decision processes’ (e.g., deciding when to use earplugs) as barriers to earplug use. The present research identifies the variables that would need to change in order to increase earplug uptake and use in recreational settings among ever-performers and never-performers. Further work is required to translate these findings into testable interventions by selecting appropriate intervention functions (e.g., modelling), policy categories (e.g., communication/marketing), behaviour change techniques (e.g., demonstration of behaviour), and mode of delivery (e.g., face-to-face).
PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents
Authors: Canova Cristina , Di Nisio Andrea , Barbieri Giulia , Russo Francesca , Fletcher Tony , Batzella Erich , Dalla Zuanna Teresa , Pitter Gisella
Published: December 2021

Background: Residents of a large area of north-eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations that were quantifiable in at least 40% of samples and lipid profile, blood pressure (BP) and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14–19 years) and 2693 children (8–11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic BP were measured, and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. The weighted quantile sum regression approach was used to assess PFAS-mixture effects for each outcome. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a lesser extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Higher serum concentrations of PFAS, particularly PFOS, were associated with lower BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. These results were confirmed by the multi-pollutant analysis. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.
Evidence of Animal-Assisted Therapy in Neurological Diseases in Adults: A Systematic Review
Authors: Rodríguez-Martínez María del Carmen , De la Plana Maestre Alba , Armenta-Peinado Juan Antonio , Barbancho Miguel Ángel , García-Casares Natalia
Published: December 2021

Background: In recent years, the possibility of intervening humans with animal-assisted therapy (AAT) has been growing due to numerous physical, psychological, and social benefits provided to humanity, enabling them to maintain or improve their quality of life. There exist different animals through which this therapy can be performed. The purpose of this systematic review will focus on the effects of AAT in several neurological diseases. Methods: The search of clinical trials was carried out in the PubMed, Scielo, Embase and PEDro databases. The selection of articles was made according to the different inclusion and exclusion criteria, incorporating those that approached neurological diseases to be reviewed. Results: Twenty-five clinical trials were identified, seventeen of which were finally included in the review. The results indicate that animal-assisted therapy (AAT) in different neurological diseases has many benefits in several areas, for example, in motor and physical ability as well as in mental and behavioural health. Conclusions: This systematic review provides occupational therapy practitioners with evidence on the use of activity based on animal-assisted therapy as a novel field of intervention that can complement other therapies and obtain benefits in different populations.
Biological Well-Being during the “Economic Miracle” in Spain: Height, Weight and Body Mass Index of Conscripts in the City of Madrid, 1955–1974
Authors: Sánchez-García Elena , Martinez-Carrión José-Miguel , Terán Jose Manuel , Varea Carlos
Published: December 2021

Typifying historical populations using anthropometric indicators such as height, BMI and weight allows for an analysis of the prevalence of obesity and malnutrition. This study evaluates secular changes in height, weight and body mass for men cohorts at 21 years old, born between 1934 and 1954 who were called up between 1955 and 1974, in the city of Madrid, Spain. In this study we prove the hypothesis that anthropometric variables increase thanks to improvement in diet and significant investments in hygiene and health infrastructure during the 1960s. The results of our analysis show a positive secular change in the trends for height (an increase of 4.67 cm), weight (6.400 kg) and BMI (0.90 Kg/m2), the result of a recovery in standards of living following the war and the autarchy of the 1940s. We also observed a slight trend towards obesity and a reduction in underweight categories at the end of the period is also observed. In conclusion, the secular trends of anthropometric variables in the city of Madrid reflect the recovery of living standards after the deterioration of the nutritional status suffered during the Spanish Civil War (1936–1939) and the deprivation of the autarchic period.
Achievements and Challenges for Higher Education during the COVID-19 Pandemic: A Rapid Review of Media in Africa
Authors: Sonn Inge K. , Du Plessis Marieta , Jansen Van Vuuren Carel D. , Marais Janene , Wagener Emma , Roman Nicolette V.
Published: December 2021

The coronavirus (COVID-19) pandemic struck globally and has affected higher education institutions (HEIs) and their operations, indirectly impacting the progress of the Sustainable Development Goal 4 achieved thus far. This article addresses HEIs achievements and challenges experienced in the wake of the pandemic. Online news media reports played a facilitative role in providing information to the HEI communities. A rapid review exploring online news media messages relating to higher education at the onset of the COVID-19 pandemic in Africa was utilised. Narrative synthesis was used to analyse the data. The results highlight HEIs achievements, which aim to ensure that all students receive the same level of education and provision in terms of devices and mental health support. However, challenges were also experienced at HEIs and include students feeling uncertainty and fear regarding completing their education. Furthermore, the results also show that not all students received the same level of education due to contextual factors, thus deepening the existing social disparities in Africa. The pandemic provides an opportunity for HEIs to embed the components of global citizenship education into the curriculum and to work in an innovative way to promote Sustainable Development Goal 4.
Influence of COVID-19 Pandemic Uncertainty in Negative Emotional States and Resilience as Mediators against Suicide Ideation, Drug Addiction and Alcoholism
Authors: García-Rivera Blanca Rosa , García-Alcaraz Jorge Luis , Mendoza-Martínez Ignacio Alejandro , Olguin-Tiznado Jesús Everardo , García-Alcaráz Pedro , Aranibar Mónica Fernanda , Camargo-Wilson Claudia
Published: December 2021

This research uses structural equation modeling to determine the influence of uncertainty due to the COVID-19 pandemic as an independent variable in the negative emotional states and resilience (as mediating variables) vs. drug addiction, alcoholism, and suicide ideation as dependent variables in 5557 students from a public state university in Northern Mexico. The five variables are related through eight hypotheses and tested using partial least squares. We used an adapted questionnaire sent by email in May 2020. Findings show that uncertainty facing the COVID-19 pandemic had a direct and significant influence on negative emotional states and a significant inverse effect on resilience; in the trajectory, drug addiction and alcoholism, and suicide ideation are explained.
Food Availability, Motivational-Related Factors, and Food Consumption: A Path Model Study with Children
Authors: Pereira Beatriz , Rosário Pedro , Núñez José Carlos , Rosendo Daniela , Roces Cristina , Magalhães Paula
Published: December 2021

The promotion of children’s healthy eating is a key public health priority. However, children’s food consumption is a complex phenomenon with several contributing factors, and there is a call to continue developing comprehensive models with several variables acting simultaneously. The present study aimed to examine the role different motivational-related variables (e.g., self-regulation, self-efficacy) may play in children’s consumption of healthy and unhealthy foods. To address this goal, data were collected in a sample of 242 fifth and sixth graders with access to both healthy and unhealthy foods at home. A path model was conducted to analyze networks of relationships between motivational-related variables and children’s healthy and unhealthy eating. The gender variable was included as a covariate to control its effect. The data showed that self-regulation for healthy eating mediates the relationship between the predictor variables (i.e., knowledge, attitude, and self-efficacy) and the type of food consumption (healthy and unhealthy). Current data contribute to understanding the complexity behind food consumption by providing a comprehensive model with motivational-related factors associated with both healthy and unhealthy eating. The present findings are likely to help inform the development of early preventive interventions focused on the promotion of healthy eating.