bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the clinical factors affecting lithium dose and plasma level and the effect of brand
Authors: Paton Carol , Bassett Paul , Rendora Olivia , Barnes Thomas R. E.
Published: October 2024

Background:

Optimal use of lithium involves adjustment of the dose, to keep the plasma level within the narrow, recommended range. Brand-specific prescribing has long been considered critical to achieving this aim, but this is a convention based on very limited data.

Objectives:

To explore the effect of selected demographic and clinical factors on the relationship between lithium dose and plasma level and determine whether there is an independent effect of lithium brand.

Design:

Analysis of clinical audit data collected in 2023 as part of a quality improvement programme addressing the use of lithium, conducted by the Prescribing Observatory for Mental Health.

Methods:

Data were collected from clinical records using a bespoke proforma, submitted online and analysed using SPSS.

Results:

Data were submitted for 4405 patients who had been prescribed solid-dosage formulations of lithium for more than a year. Priadel® was prescribed for 3722 (84%) of these patients, Camcolit® for 112 (2.5%) and the prescription was written generically for 554 (12.5%). Compared with Priadel, where Camcolit was prescribed, the mean daily dose was 10% higher and the mean plasma lithium level was 11% higher. A multivariable analysis was conducted to explore the relationship between selected clinical variables and maintenance lithium dose. This found that in 4213 patients whose most recent plasma lithium level was between 0.3 and 1.19 mmol/L, the variables age, sex, ethnicity, psychiatric diagnosis and the severity of chronic kidney disease were independently associated with dose while the brand of lithium prescribed was not.

Conclusion:

Our findings replicate those of previous studies with respect to the demographic and clinical variables that can be expected to influence lithium dosage in routine clinical practice. This reinforces the need to titrate the dosage for each individual patient, to achieve and maintain the target plasma level. However, the findings suggest that the Priadel and Camcolit brands of lithium are essentially interchangeable.
Cost Analysis of a Patient Portal Used to Remotely Monitor COVID-19 Patients in Quebec
Authors: Attieh Randa , Pomey Marie-Pascale , Lebouché Bertrand , Ma Yuanchao , Hijal Tarek , Poder Thomas G.
Published: October 2024

Background:

Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated.

Objective:

To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology.

Methods:

A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec’s health-care system perspective.

Results:

27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient.

Conclusion:

This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.
Using Machine Learning Algorithms to Predict Postoperative Anterior Bone Loss Following Anterior Cervical Disc Replacement
Authors: Zong Rui , Guo Can , He Jun-bo , Wu Ting-kui , Liu Hao
Published: October 2024

Study Design

Machine learning model.

Objectives

This study aimed to develop and validate a machine learning (ML) model to predict moderate-severe anterior bone loss (ABL) following anterior cervical disc replacement (ACDR).

Methods

A retrospective review of patients undergoing ACDR or Hybrid surgery (HS) at a single center was performed. Patients diagnosed as C3-7 single- or multi-level cervical disc degenerative diseases (CDDD) with more than 2 years of follow-up and complete pre- and postoperative radiological imaging were included. An ML-based algorithm was developed to predict moderate-severe ABL based on perioperative demographic, clinical, and radiographic parameters. Model performance was evaluated in terms of discrimination and overall performance.

Results

A total of 339 ACDR segments were included (61.65% female, mean age 45.65 ± 8.03 years). During a follow-up period of 45.65 ± 8.03 months, 103 (30.38%) segments developed moderate-severe ABL. The model demonstrated good discrimination and overall performance according to precision (moderate-severe ABL: 0.71 ± 0.07, none-mild ABL: 0.73 ± 0.08), recall (moderate-severe ABL: 0.69 ± 0.08, none-mild ABL: 0.75 ± 0.07), F1-score (moderate-severe ABL: 0.70 ± 0.08, none-mild ABL: 0.74 ± 0.07), and area under the curve (AUC) (0.74 ± 0.10). The most important predictive features were higher height change, higher post-segmental angle, and longer operation time.

Conclusions

Utilizing a ML approach, this study successfully identified risk factors and accurately predicted the development of moderate-severe ABL following ACDR, demonstrating robust discrimination and overall performance. By overcoming the limitations of traditional statistical methods, ML can enhance discovery, clinical decision-making, and intraoperative techniques.
International collaboration for sustainable development in the Third Space: A conceptual framework and relevant approaches based on China-US sponge city exchange
Authors: Smith Joseph S
Published: October 2024

International collaboration for sustainable development is increasingly crucial in the face of global environmental challenges. This article presents a conceptual framework and relevant approaches for such collaboration, focusing on the Third Space—a dynamic arena where diverse cultures converge, contest, and cooperate. Drawing on a China-US sponge city exchange as a case study, the article explores how language and communication, relationships and culture, team performance and policies, and technology and outreach intersect in the pursuit of sustainable urban development. Through autoethnographic analysis grounded in pedagogical theories and real-world experiences, the study elucidates key themes and strategies for successful international collaboration, answering the question “how can international teams better collaborate towards sustainable development?” The resulting conceptual framework provides valuable insights for practitioners, policymakers, and researchers seeking to navigate the complexities of sustainable development across international borders.
Book review: Elisabeth Rosenthal, An American Sickness: How Health Care Became Big Business and How You Can Take it Back
Authors: Das Roshni
Published: October 2024

Elisabeth Rosenthal, An American Sickness: How Health Care Became Big Business and How You Can Take it Back. New York: Penguin Press, 2017, 432 pp., $18. ISBN9780143 110859.
Effectiveness of In-Home, Augmented Reality–Based Telerehabilitation After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial
Authors: Lim Ji Young , Yu Hee Ju , Kim Seo Hyun , Lee Jong In , Lim Jae-Young , Wang Joon Ho , Hwang Ji Hye
Published: October 2024

Background:

New digital technology–based rehabilitation may be a viable option for patients after anterior cruciate ligament reconstruction (ACLR), with advantages such as easy access to treatment and learning as well as cost-effectiveness.

Purpose:

To investigate the effects of an augmented reality (AR)–based, telerehabilitation system in patients after ACLR compared with a brochure-based rehabilitation program in terms of patient-reported outcomes and functional performance measures.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

This was a multicenter, assessor-blinded study. Enrolled participants were allocated randomly to either the intervention group, who underwent AR-based telerehabilitation system, or to the control group, who underwent a brochure-based rehabilitation program with a self-log. Both groups performed the same postoperative rehabilitation exercise protocol. Subjective knee function was assessed using the International Knee Documentation Committee (IKDC) as the primary outcome; secondary outcomes were a numeric rating scale for pain, the EuroQol 5-Dimension 5-Level, isometric knee strength, range of motion, and the single-leg hop test. The intervention group also completed a satisfaction survey. Follow-up was conducted at 2, 6, 12, and 24 weeks postoperatively.

Results:

A total of 28 patients were enrolled in each group; 1 patient in the control group was lost to follow-up. Patients in both groups demonstrated improvement on all outcomes over time. There were no significant between-group differences in the IKDC score from baseline to 12 weeks postoperatively. The intervention group saw a greater increase in the relative isometric strength of the quadriceps on the involved limb at 6, 12, and 24 weeks postoperatively ( P < .05 for all). No significant group differences were observed in the remaining secondary outcomes.

Conclusion:

Study findings indicated that patients who underwent AR-based telerehabilitation in the early rehabilitation phase after ACLR demonstrated similar improvements as those who followed a brochure-based rehabilitation program and had a quicker recovery of knee extensor strength.

Registration:

NCT04513327 (ClinicalTrials.gov identifier).
Migrant Deaths in New Mexico: What is Known; What is Unknown
Authors: Hernandez Jasmine R. , Edgar Heather J. H.
Published: October 2024

Executive Summary

The United States is no stranger to migration across its borders. In 2020, its Southwestern border saw a drastic increase in apprehensions by the Border Patrol. While imperfect and an undercount of the true number of migration events, apprehension data is often used as a proxy to understand migration patterns. The rise in migration was coupled with an increased but unknown number of deaths along migration routes. This article focuses on the New Mexico portion of the El Paso Border Patrol Sector and the increased migrant caseload at New Mexico’s Office of the Medical Investigator (OMI) over the last few years. To the best of our knowledge, this article is the first academic study to examine migrant deaths in detail in southern New Mexico. We begin by contextualizing the changing pattern of migrant deaths in New Mexico within the broader framework of border policing strategies that have intentionally pushed migration routes to remote areas. We describe the work of the OMI, highlighting its very recent initiatives to track migrant deaths in its database. We then discuss the changes seen by the OMI in its migrant caseload from fiscal year (FY) 2009 to 2023, with the most drastic increase in cases occurring from 2022 to 2023. For instance, the data indicate that most of the identified migrants that have died in New Mexico were recovered in June and July (45 percent), crossed through Doña Ana County (66 percent), were male (60 percent), and among those identified, were from Mexico (65 percent) and between 20 and 39 years of age (69 percent). Of the 248 cases of migrant deaths, 87 percent have been identified. The most common causes of death were undetermined (46 percent) and environmental exposure (41 percent). We then explore the effects of changing governmental policies and state initiatives to curb/reduce migration in the US on OMI’s increased caseload. We discuss the impact that the rapid shift in migration deaths is having on the OMI and how OMI is working to respond and adjust to the dynamic situation.

This work highlights the collateral damage of border security measures, underscored by the increasing number of deaths and challenges faced by the OMI. We consider the need for new and amended policies aimed at mitigating the humanitarian crisis that continues to unfold, emphasizing the need for the humane treatment of migrants. Finally, we suggest allocating resources to death investigating agencies. These resources would provide essential support to find, identify, and repatriate migrants, improve agencies’ abilities to collaborate with governmental agencies and programs such as Border Patrol’s Missing Migrant Program, and improve our understanding of the circumstances along the Southwestern border.
Peer and Social Correlates of Smoking among Saudi Youth
Authors: Alqahtani Rajaa T. , Moody James , Alhemodi Naurah N. , Alghamdi Mohammed S. , Alhajhussein Serene
Published: October 2024

Smoking declines are uneven around the world, and we have few studies on the correlates of youth smoking in contexts like Saudi Arabia, where declines have been slowest. Using a broadly socio-ecological framework and network data, we report on one of the few studies to simultaneously examine peer, family, and school features associated with smoking in the Saudi context. We find strong and consistent peer and family associations with both occasional and regular smoking via direct modeling (level of peers/family that also smoke) and substantive interactions (lying to parents in the family domain, engaging in unsupervised youth-centric activities, or seeking popularity in the peer domain). Although our design precludes causal claims, our results are consistent with smoking initiation being driven by occasional use surrounding attempts to gain youth social status, whereas regular use depends on implicit family and peer acceptance.
Can urban agglomeration policies promote regional economic agglomeration? Evidence from the Yangtze River Economic Belt in China
Authors: Hu Peipei , Huang Yingjun , He Qiankun , Zhang Gencheng
Published: October 2024

The impact of implementing urban agglomeration policies (UAPs) on regional economic agglomeration is crucial for achieving coordinated regional development. This study examines the effects of UAPs on economic agglomeration in the Yangtze River Economic Belt (YREB) in China using panel data from 108 cities spanning from 2006 to 2020. Various research methodologies, such as spatio-temporal variation analysis, Differences-in-Differences (DID), Propensity Score Matching DID (PSM-DID), and Spatial Autocorrelation DID (SACDID) models, are employed. The results indicate a diffusion effect in economic agglomeration of the YREB, leading to a transition from a multilevel center-periphery structure to a contiguous clustering pattern. UAPs have, however, resulted in the concentration of the regional economy towards central cities. Urban agglomerations exhibit an internal siphon effect and a diffusion effect on their exterior. The combination of these two effects manifests itself as a certain degree of siphon. Specifically, UAPs have caused both siphon and diffusion effects in the middle region of the YREB, with less significant impacts in the eastern and western regions. The siphon effects of central cities are influenced by both geographical distance from other cities and, more importantly, economic disparities between them. During the study period, the UAPs served as the indirect rather than direct factor of regional economic coordination.
Hemiarthroplasty in Proximal Humerus Fractures: Does Modular Metaphyseal Stem Design Lead to Better Results? An Analysis of 24 Cases
Authors: Godolias Periklis , Plümer Jonathan , Cibura Charlotte , Gerstmeyer Julius R , Bernstorff Maria A , Heep Hansjörg , Dudda Marcel , Schildhauer Thomas A , Königshausen Matthias
Published: October 2024

Introduction

Anatomic hemiarthroplasty (aHA) is a treatment option for non-reconstructable constructable multifragment proximal humeral fractures that preserves range of motion. Our study aims to evaluate the radiographic and clinical outcomes of patients who received a modular aHA with anatomical sizing of the tubercle-bearing metaphyseal components.

Materials and Methods

The medical records of thirty-nine consecutive patients were reviewed. Patients were treated at a single institution with aHA as first-line treatment following a non-reconstructable constructable proximal humeral fracture. Tubercle resorption and cranialization of the aHA were analyzed using radiographic controls. Patient clinical function was assessed using the Constant Murley Score (CS).

Results

Twenty-four patients (62%) were available for clinical follow-up, with a mean CS of 54 points after a mean 56-month follow-up period. There was no significant difference in functional outcome on average between patients with healed tubercles (CS = 57) and resorbed tubercles (CS = 51). Radiographic follow-up was available in 33 patients (85%), demonstrating healed tubercles in 33% of the patients. Patients with resorbed tubercles had significant smaller acromio-humeral distances (AHD) than patients with healed tubercles (p = 0.043). A positive correlation was observed between greater AHD and increased constant scores (p = 0.022).

Conclusions

The final patient outcome measures demonstrated a positive correlation with a greater acromio-humeral distance and tubercle healing rates. However, the modular stem design with sizing of the metaphyseal components did not result in superior outcomes when compared with the literature.
Best Practice Recommendations for Conducting and Reporting Controlled Trials in Clinical Hypnosis Research
Authors: Kekecs Zoltan , Moss Donald , Whorwell Peter J. , Varga Katalin , Terhune Devin B. , Shenefelt Philip D. , Palsson Olafur S. , Benedittis Giuseppe De , Elkins Gary
Published: October 2024

There is an abundance of outcomes research for clinical hypnosis showing promising results. Nonetheless, hypnosis is still underutilized in clinical care. For a behavioral intervention to enter mainstream clinical care, efficacy needs to be demonstrated with exceptionally high quality of evidence, and its reporting needs to be complete and sufficiently clear to enable replication and clinical use. The present article provides best practice guidelines formulated by the Task Force for Establishing Efficacy Standards for Clinical Hypnosis for conducting and reporting clinical hypnosis research.The recommendations are presented in two tiers. Tier I recommendations include essential best practices, such as a call for the use of detailed research and intervention manuals, plans for and reporting of participant-education about hypnosis, the use of hypnotizability scales with good psychometric properties, and clear reporting of the hypnotizability measurement. Tier I also includes the sharing of intervention manuals, the reporting of the induction procedure, the labeling of the intervention for participants, and the definition of hypnosis used. Tier II includes preferred recommendations, calling for measurement of adherence to home practice, measurement of hypnotizability using scales with both subjective and behavioral measures of responsiveness, and the involvement of participants from the full hypnotizability spectrum. Tier II also includes the assessment of variables related to proposed mechanisms of action, the reporting of participants prior hypnosis experiences, and the relationship of expectancies and treatment outcomes.This list of recommendations will be useful for researchers, reviewers, and journal editors alike when conducting, reporting, or evaluating studies involving clinical hypnosis.
Outdoor recreation contributes to ecological changes along coastlines: Temperate United States cases highlight key impacts and ways forward
Authors: Kesling Joshua Redford
Published: October 2024

Coastal natural areas including sandy and rocky beaches comprise some of the United States’ most critical recreational and ecological resources. Through collaboration, governmental conservation agencies and non-profits forecast that over 2 billion coastline visits occur each year. Under contemporary conditions, coastal resource overuse endangers the integrity of both social and ecological systems. Existing and mounting concerns call for different coastal zone management strategies, including research into poorly understood and emerging disturbances. This work explains how recreational disturbances influence coastal environments through wildlife behavior changes, plant dynamics, and the quality of abiotic ecosystem elements. Atlantic and Pacific cases indicate that some outdoor recreation systems strongly affect habitat quality, sensitive species, and interacting communities. New insight into outdoor recreation’s contributions to ecosystem change will inform how coastal zone management agencies can implement stronger co-existence strategies for people and nature.
Use of Fast-Setting Bone Graft Substitute to Allow Single-Stage Revision Anterior Cruciate Ligament Reconstruction
Authors: Khan Shehzaad A. , Stephens Alastair , Spalding Tim , Thompson Peter
Published: October 2024

Background:

The overall revision rate for primary anterior cruciate ligament reconstruction (ACLR) has increased over the past decade, with the commonest mode of failure being a combination of traumatic, technical, and biological factors. The challenge in revision ACLR is the need to address malpositioned or widened tunnels with the ideal scenario being single-stage revision, with widened and type 2 tunnels being the most difficult scenarios to deal with. Tunnels can be filled using autograft, allograft, and more recently described bone graft substitute (BGS). In this video, we describe a technique using fast-setting BGS to fill the problem of malpositioned tunnel or tunnels to allow single-stage revision ACLR.

Indications:

This technique is indicated in patients undergoing revision ACLR where tunnels are nearly right (type 2) with no widening at the joint surface aperture.

Technique Description:

Following preparation of the notch, the femoral tunnels are prepared in the normal fashion to remove all the previous graft and to create fresh bleeding surfaces. The fluid in the knee is completely drained, and the femoral tunnel is repeatedly dried with ribbon gauze that is left in place until ready to inject. The BGS, genex (Biocomposites Ltd), is mixed and loaded into the delivery syringe before injecting arthroscopically. After 15 minutes, the new anatomic femoral tunnel is then prepared in routine fashion. The same steps are repeated for the tibial tunnel.

Results:

Twenty patients underwent single-stage revision ACLR using this technique. There have been no reruptures in this series. All eligible patients at the 12-month follow-up had grade 0 or 1 laxity on clinical examination and full incorporation of the BGS on radiographs. There were no complications related to the BGS during the intra- or postoperative period.

Discussion/Conclusion:

We describe a technique that allows revision ACLR to be performed as single stage in a subset of patients with type 2 tunnels with successful short- to mid-term results. We have found this to be a safe and effective way to avoid 2-stage surgery in a subgroup of cases who have a challenging problem for surgeons to manage.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
“It’s Really About Those Social Determinants of Health that Drive It”: Addressing Food Insecurity in Rural Veterans
Authors: Heuer Jacquelyn N. , Bradley Sarah E. , Hahm Bridget , Pettey Kristin , Besterman-Dahan Karen
Published: October 2024

Background

The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans.

Methods

Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices.

Results

Current VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health.

Conclusions

Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.
Polidocanol inhibits Enterococcus faecalis virulence factors by targeting fsr quorum sensing system
Authors: Ashraf Dina , Shaaban Mona I. , Hassan Ramadan , El-Aziz Abeer M. Abd
Published: October 2024

Background

The wide spread of antimicrobial resistance in Enterococcus faecalis is a critical global concern, leading to increasingly limited treatment options. The fsr quorum sensing (QS) plays a critical role in the pathogenicity of E. faecalis, allowing bacteria to coordinate gene expression and regulate many virulence factors. Therefore, fsr QS of E. faecalis represents a potential therapeutic target that provides an effective strategy to treat antibiotic-resistant infections induced by E. faecalis.

Methods

In this study, distribution of different virulence factors including, gelatinase, protease, cell surface hydrophobicity and biofilm formation in sixty clinical isolates of Enterococcus faecalis was investigated. Sixty-six compounds were tested for their activity against fsr QS. The minimal inhibitory concentration of the tested compounds was evaluated using the microbroth dilution method. The effect of sub-inhibitory concentrations of the tested compounds on fsr QS was investigated using the gelatinase assay method. Additionally, the effect of potential QS inhibitor on the virulence factors was estimated. Quantitative real-time PCR was used to investigate the effect of the potential inhibitor on fsr QS related genes (fsrB-fsrC) and (gelE-sprE) and virulence associated genes including, asa1 and epbA.

Results

The assessment of polidocanol activity against the fsr QS system was demonstrated by studying its effect on gelatinase production in E. faecalis clinical isolates. Sub-lethal concentrations of polidocanol showed a significant reduction in gelatinase and protease production by 54% to 70% and 64% to 85%, respectively. Additionally, it significantly reduced biofilm formation (P < 0.01) and interrupted mature biofilm at concentrations of ½, 1 × and 2 × MIC. Furthermore, polidocanol significantly decreased cell surface hydrophobicity (P < 0.01). Polidocanol at ½ MIC showed a significant reduction in the expression of QS genes including fsrB, fsrC, gelE and sprE by 57% to 97% without affecting bacterial viability. Moreover, it reduced the expression of virulence associated genes (asa1 and epbA) (P < 0.01).

Conclusion

Polidocanol appears to be a promising option for treating of E. faecalis infections by targeting the fsr QS system and exhibiting anti-biofilm activity.
Making sense together: dance improvisation as a framework for a collaborative interdisciplinary learning processes
Authors: Nelson Lisa , Laroche Julien , Figueiredo Nara , Fiadeiro João , Dumit Joseph , Bachrach Asaf
Published: October 2024

This editorial outlines the outcome of an interdisciplinary session on collective sense-making through dance improvisation, which took place during the ‘Neural and Social Bases of Creative Movement’ workshop. We argue that joint improvisation practices place the scientist in a privileged position to reveal the nature of cognitive and creative behaviors.
Understanding mealtime behavioral problems in nursing home residents living with dementia: a group concept mapping approach
Authors: van Buuren Eline C.P. , Perry Marieke , Bakker Christian , Koopmans Raymond T.C.M. , van der Steen Jenny T.
Published: October 2024

Background

Persons with dementia frequently experience mealtime behavioral problems that can result in reduced or lack of intake of food or fluids. Multiple underlying causes and expressions of mealtime behavioral problems complicate its interpretation and intervention, because problems originating from cognitive and functional decline and behavioral changes may interact. Healthcare professionals and family caregivers may encounter a variety of practical and moral dilemmas in dealing with these problems. We aimed at a better understanding of mealtime behavioral problems and related complex issues in nursing home residents with dementia from a daily practice perspective.

Methods

We used a mixed-method Group Concept Mapping approach in this study, and collected data online with a panel of 67 healthcare professionals, researchers and relatives from across The Netherlands. The participants contributed to either or all of the following phases: (1) the generation of ideas (brainstorm), (2) sorting, and (3) rating of the ideas. Subsequent phases included data analysis with Groupwisdom® software and interpretation of the results. Multidimensional scaling and hierarchical cluster analysis resulted in a concept map visualizing the coherence and importance of ideas. Bridging values were calculated, with low values indicating a distinct, clear concept.

Results

Brainstorming resulted in 285 statements representing 85 ideas. The concept map visualized three categories capturing ten clusters which describe the management of mealtime behavioral problems, causes of mealtime behavioral problems, and expressions and interpretations of mealtime behavioral problems. Concepts reflecting direct consequences, ethical components, and considerations to handle challenging situations overlapped on the concept map with the highest bridging values (range 0.58–0.87).

Conclusion

This study added to unraveling the complex nature of mealtime behavioral problems, as perceived in practice. It is recommended to comprehensively analyze all components in the management of these problems, in particular being aware of ethical factors and align care for residents with dementia accordingly.
The Practical and Social Functioning (PSF) scale: development and measurement properties of an instrument for assessing activity and social participation among people with serious mental illness
Authors: Clausen Hanne , Ruud Torleif
Published: October 2024

Background

Participation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the “International Classification of Functioning, Disability and Health (ICF)” framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings.

Methods

The PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures.

Results

The final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect.

Conclusion

The development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning.

Trial registration

The study Implementation of Guidelines for the Treatment of Psychoses was registered retrospectively on 31 August 2017 at ClinicalTrials.gov (NCT03271242).
Diabetes knowledge, health literacy and diabetes self-care among older adults living with diabetes in Alexandria, Egypt
Authors: Abdallah Soha Magdy Ahmed , Ayoub Abla Ibrahim , Makhlouf Mohamed Mohei Eldin , Ashour Ayat
Published: October 2024

Background

Type 2 diabetes is a rising health problem, especially in older adults. Health literacy and the degree of diabetes knowledge are among the factors that may influence diabetes self-care activities. The aim of this study was to assess factors affecting self-care activities among older adults living with type 2 diabetes in Alexandria, Egypt.

Methods

A cross-sectional study included 400 older adults over the age of 60 with type 2 diabetes, recruited from diabetes outpatient clinics affiliated to the health insurance organization in Alexandria, Egypt. A predesigned, structured interview questionnaire was used to assess sociodemographic factors, personal habits, medical history, and drug history. The All Aspects of Health Literacy Scale (AAHLS) and the numeracy section of the Short Test of Functional Health Literacy in Adults (STOFHLA) were used to assess the level of health literacy. Diabetes Knowledge Test 2 (DKT2) was used to assess diabetes knowledge and Summary of Diabetes Self-care Activities scale was used to assess self-care activities. Multiple logistic regression analysis was used to examine the relationship between health literacy and self-care.

Results

The mean age of the participants was 65.75 ± 5.15 years, and 56.2% of them were males. The mean duration of diabetes was 10.61 ± 5.28 years, 14.3% were illiterate, and 37.2% were university graduates. Positive correlations were found between health literacy, diabetes knowledge, and diabetes self-care activities (p < 0.001). Health literacy and diabetes knowledge were found to be significant predictors of diabetes self-care activities in older adults (aOR = 1.132; 95% CI:1.062–1.207, p < 0.001 and aOR = 1.313; 95% CI: 1.178–1.464, p < 0.001; respectively).

Conclusions

Health literacy and diabetes knowledge were found to be predictors of good self-care activities in older adults living with diabetes. Health educators and health care professionals should focus on health education and the enhancement of diabetes knowledge to improve self-care activities and eventually glycemic control in older adults living with diabetes.
Problematic social Internet use and associations with ADHD symptoms in girls: a longitudinal observational study
Authors: Halkett Ashley , Hinshaw Stephen P.
Published: October 2024

Background

Problematic Internet use (i.e., Internet use that disrupts functioning in other important domains; PIU) is increasingly prevalent worldwide, particularly among youth. One form of PIU relates specifically to interpersonal interaction and communication, deemed social PIU. Social PIU has been linked to various forms of psychopathology, including attention-deficit/hyperactivity disorder (ADHD). Yet with limited longitudinal research, the direction of this association remains unclear. Moreover, little research investigates whether social PIU is linked to one or both symptom dimensions of ADHD (inattention vs. hyperactivity/impulsivity).

Methods

The present study utilized data from the largest extant longitudinal study of girls with childhood-diagnosed ADHD (N = 228). Linear regression and structural equation models were used to analyze social PIU as both a prospective predictor and outcome of ADHD symptoms.

Results

Inattentive ADHD symptoms were positively associated with concurrent social PIU in initial regression models but were non-significant in path analyses. Social PIU was only marginally significant in predicting subsequent inattention six years later. Symptoms of hyperactivity/impulsivity were unrelated to social PIU among girls at either time point.

Conclusions

Inattentive ADHD symptoms were initially positively linked to concurrent problems with social Internet use, but bidirectional associations were non-significant in path analyses. Relations between PIU and ADHD in girls may be less robust than previously thought, although further longitudinal research with clinical samples is needed to clarify which groups of adolescents are particularly vulnerable to social PIU and its long-term effects.
Hypoxic glioma-derived exosomal miR-25-3p promotes macrophage M2 polarization by activating the PI3K-AKT-mTOR signaling pathway
Authors: Xue Zhiwei , Liu Junzhi , Xing Wenchen , Mu Feiyu , Wu Yanzhao , Zhao Jiangli , Liu Xuchen , Wang Donghai , Wang Jian , Li Xingang , Wang Jiwei , Huang Bin
Published: October 2024

Background

Exosomes (EXO) play crucial roles in intercellular communication and glioma microenvironment modulation. Tumor-associated macrophages are more likely to become M2-like type macrophages in the immunosuppressive microenvironment. Here, we aimed to investigate the effects and molecular mechanisms of hypoxic glioma-derived exosomes mediated M2-like macrophage polarization.

Methods

Highly expressed miRNAs in exosomes derived from glioma cells cultured under hypoxia condition compared to normoxic condition were identified through microRNA sequencing. The polarization status of macrophages was determined using qRT-PCR, Western blotting, flow cytometry, and immunohistochemistry. By using RNA-seq, we aimed to identify the downstream target genes regulated by miR-25-3p in macrophages and investigate the mechanistic pathways through which it exerts its effects. The proliferation and migration capabilities of glioma cells were assessed through EdU, Transwell assays, and in vivo experiments.

Results

We found that miR-25-3p was upregulated in the exosomes derived from hypoxic glioma cells and can be transferred to the macrophage. In macrophages, miR-25-3p downregulates the expression of PHLPP2, thereby activating the PI3K-AKT-mTOR signaling pathway, ultimately leading to macrophage M2 polarization. As part of a feedback loop, M2-polarized macrophages can, in turn, promote malignant glioma progression.

Conclusion

Our study reveals that miR-25-3p from hypoxic glioma cells is delivered to macrophages via exosomes as a mediator, promoting M2 polarization of macrophages through the miR-25-3p/PHLPP2/PI3K-AKT signaling pathway. This study suggests that targeted interventions to modulate miR-25-3p expression, transmission, or inhibition of PI3K-AKT pathway activation can disrupt the immune-suppressive microenvironment, providing a novel approach for immunotherapy in gliomas.

Graphical Abstract
Association between serum IgM and all-cause mortality risk in Chinese centenarians: a prospective cohort study
Authors: Zhang Weiguang , Duan Yuting , Li Zhe , Niu Yue , Wang Bin , Feng Zhe , Sun Ding , Li Hao , Zhang Zehao , Qu Zeyu , Liu Miao , Hu Hongyan , Zhu Qiao , Chen Yujian , Ning Chaoxue , Fu Shihui , Yang Shanshan , Wang Shengshu , Zhao Yali , He Yao , Chen Xiangmei , Chen Yizhi
Published: October 2024

Background

We investigated the associations between IgM, IgG, IgA, and IgE levels and all-cause mortality risk in Chinese centenarians.

Methods

All participants were from the China Hainan Centenarian Cohort Study. Eligible participants were divided into quartiles based on their IgM, IgG, IgA, and IgE levels. We used restricted cubic spline analyses, Cox regression analyses, and Kaplan–Meier survival curves to analyze associations between IgM, IgG, IgA, and IgE and all-cause mortality risk.

Results

A total of 906 centenarian participants were included in this study (81.2% female; median age, 102 years). During a median follow-up of 30.1 months, 838 (92.5%) participants died. Restricted cubic spline analysis revealed a nonlinear relationship (“L” type) between serum IgM level and all-cause mortality. Compared with the higher three quartiles of serum IgM level, the lowest quartile was associated with a higher risk of death (Q1 versus Q2-Q4: HR, 1.365; 95% CI, 1.166–1.598; P < 0.001). Among individuals for whom IgM < 0.708 g/L (Q1), the risk of all-cause mortality was 36.5% higher. Kaplan–Meier analyses showed that centenarians with lower serum IgM levels had significantly shorter median survival time (Q1 versus Q2-Q4: 26 months versus 32 months, log-rank P = 0.001).

Conclusion

Serum IgM levels in centenarians significantly correlated with the risk of death, suggesting that they are suitable for predicting the overall risk of death in centenarians and can be used as an independent predictor of death.
Pro-inflammatory cytokines increase temporarily after adjuvant treatment for breast cancer in postmenopausal women: a longitudinal study
Authors: Lindholm Agnes , Abrahamsen Marie-Louise , Buch-Larsen Kristian , Marina Djordje , Andersson Michael , Helge Jørn Wulff , Schwarz Peter , Dela Flemming , Gillberg Linn
Published: October 2024

Background

Breast cancer patients have an increased risk of cardiometabolic disease and for many patients, adjuvant therapy causes an altered lipid profile, insulin resistance and inflammation. Previous follow-up studies are inconclusive regarding the duration of therapy-induced inflammation. We examined the acute and persistent changes of adjuvant chemotherapy on inflammatory and metabolic health markers in breast cancer patients.

Methods

Plasma levels of IL-6, IL-8, IL-10, IFN-γ, TNF-α, high-sensitivity C-reactive protein (hsCRP) and metabolic health parameters were analyzed before, shortly after and every six months up to two years after adjuvant chemotherapy treatment in 51 postmenopausal early breast cancer (EBC) patients, as well as in 41 healthy age- and BMI-matched controls. A target-specific multiplex assay was applied for cytokine measurements.

Results

Before initiation of adjuvant therapy, plasma IL-8 levels were higher in EBC patients (31%, p = 0.0001). Also, a larger proportion of the patients had a hsCRP level above 2 mg/L (41%) compared to the controls (17%, Χ2 = 5.15, p = 0.023). Plasma levels of all five cytokines, but not hsCRP, were significantly increased after compared to before adjuvant chemotherapy (15–48% increase; all p ≤ 0.05). Already six months after ending chemotherapy treatment, all plasma cytokine levels were significantly reduced and close to pre-chemotherapy levels. Adjuvant chemotherapy caused a worsened lipid profile (increased triglycerides, lower HDL levels), insulin resistance and increased plasma insulin levels that remained high during the first year after chemotherapy.

Conclusion

Postmenopausal women with EBC have temporarily increased plasma levels of pro-inflammatory cytokines after adjuvant chemotherapy. Although transient, the therapy-induced increase in plasma cytokine levels, together with dyslipidemia and insulin resistance, may contribute to cardiometabolic risk in breast cancer patients treated with adjuvant chemotherapy.

Trial registration

The clinical trial (registration number NCT03784651) was registered on www.clinicaltrials.gov on 24 December 2018.
The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial
Authors: Bockting Claudi , Bosmans Guy , Bergers Nele , Gavan Luana , Hiligsmann Mickaël , de Beurs Derek , Molenberghs Geert , Wijnen Ben , Lokkerbol Joran , van der Spek Nadia
Published: October 2024

Background

Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with devastating consequences for individuals and their families, and substantial economic costs. However, psychological and pharmacological treatments currently recommended in guidelines for treatment of high-risk youth for fatal suicide have limited effect. In line with the World Health Organization’s (WHO) recommendation to involve the family in treatment of these youth, attachment-based family therapy (ABFT) was developed, a 16-week attachment and emotion-focused treatment, implemented in mental health care settings across various European countries in the past years, and becoming increasingly popular among therapists. However, the (cost-)effectiveness of ABFT has not been studied in emerging adults. In the proposed pragmatic randomized controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of ABFT compared to treatment as usual (TAU) on suicidality, as delivered in daily practice.

Methods

This pragmatic multicenter study in the Netherlands and Belgium includes 13 participating sites. Participants are suicidal young adults (≥ 31 SIQ-JR score) between 16 and 30 years old who seek mental health treatment (n = 142) and their caregivers. The primary outcome is suicidality (SIQ-JR), with assessments at baseline, post-intervention (5 months after baseline), 3, 6, and 12 months after intervention. We predict that, compared to TAU, ABFT will lead to a stronger reduction in suicidality and will be more cost-effective, over the course of all time points. We also expect stronger decreases in depressive symptoms, given that suicidality is very common in individuals with depressive disorder, as well as more improvement in family functioning, autonomy, entrapment, and young adult attachment, in the ABFT condition.

Discussion

This study can contribute to improving the care for suicidal youngsters with high mortality risk. Treatment of suicidal emerging adults is understudied. The results will inform clinical guidelines and policy makers and improve treatment of suicidal emerging adults.

Trial registration

This trial is registered on ClinicalTrials.gov (NCT05965622, first posted on July 28, 2023).