bluuebunny/crossref_metadata_2025 huggingface dataset:
Polynomial fitting detrended autocorrelation kurtosis of 1.5D spectrum and its application in bearing fault feature extraction
Authors: Zhang Xiong , Li Jialu , Wu Wenbo , Wan Shuting , He Yuling , Wang Xiaolong
Published: January 2023

Kurtogram is a typical fault diagnosis algorithm, and its derivative methods are widely used in bearing fault signal processing. The key to such methods is to select the indexes that are specifically sensitive to periodic fault characteristics. The traditional time domain kurtosis index is too sensitive to non-periodic transient impulses, and the frequency domain index is too sensitive to harmonic components, which seriously affects the selection of resonance frequency band and the extraction of fault features. In view of this, a polynomial detrended autocorrelation kurtosis of 1.5D spectrum is proposed in this paper. Firstly, the original signal is decomposed by wavelet packet decomposition, and the 1.5D spectrum of each subband signal is calculated. Then, the 1.5D spectral autocorrelation coefficient of each subband is calculated, and the trend term is removed from the specific interval of autocorrelation coefficient by polynomial fitting. Finally, the kurtosis of the autocorrelation coefficient after removing the trend term is calculated to select the optimal resonance frequency band for analysis, so as to extract the fault feature information. The experimental data show that this method is sensitive to the fault characteristic frequency and frequency doubling with coupling relationship, and can suppress non-periodic transient impulse and harmonic interference.
Assessment of complications associated with female genital cutting among postnatal women in Chuko Primary Hospital, Sidama region, Southern Ethiopia
Authors: Yosef Yirgalem , Borsamo Abebe , Abeje Seblework
Published: January 2023

Objectives:

Female genital cutting is a genital operation for a nonmedical reason and involves the cutting away of a part or whole of the female external genitals. Postnatal women with genital cutting could be more vulnerable to circumcision-associated birth complications, and it is still a major health problem during childbirth and the postnatal period in Ethiopia. This study aimed to assess complications associated with female genital cutting among postnatal women in Chuko Primary Hospital, Sidama region, Southern Ethiopia.

Methods:

An institutional-based quantitative cross-sectional study design was conducted from 01 May 2021 to 15 June 2021. A systematic random sampling technique was used to select study participants. Data were collected by using a structured pretested questionnaire and reviewing medical records. The data were analyzed using SPSS version 23.0. Logistic regression analysis was computed to identify birth complications associated with female genital cutting from independent variables, and significance was declared at p < 0.05 with 95% CI.

Results:

The proportion of female genital cutting among the participants was 76.8% (95% confidence interval: 71.1, 81.2). Prolonged labor and birth asphyxia were statistically significant female genital cutting-associated birth complications.

Conclusion:

This study revealed a high proportion of complications associated with female genital cutting. Birth complications such as prolonged labor and birth asphyxia have a statistically significant association with it. Illiteracy and early marriage were the predominant reasons for female genital cutting. Therefore, healthcare providers should educate the rural communities to prevent early marriage and female genital cutting to prevent its complications.
Iodine status, impact of knowledge, and practice for adequate iodized salt utilization in house hold at North West Ethiopia
Authors: Molla Alebechaw , Giza Mastewal , Kebede Fassikaw , Kebede Tsehay
Published: January 2023

Introduction:

Iodine is one of the crucial micronutrients required for the normal growth of humans from the fetal stage to adulthood through the synthesis of thyroxin (t3) and triiodothyronine (t4) hormones in the thyroid gland for regulation of metabolism, protein synthesis, and brain development. This study aimed to assess iodine status, the impact of knowledge and practice for adequate iodized salt utilization in household levels in North West Ethiopia.

Method:

A population-based cross-sectional study was carried out using multistage sampling among 1398 residents from 28 December 2021 to 30 January 2022. A systematic random sampling technique was used to select the study participants. The collected data were entered into Epi-Data version 3.1 and then exported to STATA/R version 14 for further analysis. An adjusted odds ratio with 95% CI was used to declare statistical significance at p < 0.05.

Result:

The overall mean (±SD) age of participants was 34.9 (±12.8) years. About 678 (48.5%) had 15–80 ppm, 23 (1.6%) had >80 ppm, 533 (38.13%) had 1.1 ppm to 14.9 ppm, and 147 (10.5) had no iodine in salt (0 ppm) after assessed by Rapid Test Kit. Only 48.5% of the sampled household had used adequate iodized salt with ≥15 ppm. The overall burden of goiter was estimated at 11.4/1000 population. Adequate iodized salt utilization was significantly associated with having formal education (adjusted odds ratio = 1.89: 95% confidence interval: 1.4, 2.6, p = 0.001), monthly income ≥5000 ETB/month (adjusted odds ratio = 1.99: 95% confidence interval: 1.5, 2.9, p = 0.001), and good knowledge score (adjusted odds ratio = 1.6: 95% confidence interval: 1.12, 2.6, p = 0.03) were predictors for proper iodized salt utilization.

Conclusion:

Coverage of adequately iodized salt was low and respondents’ formal education, monthly income ≥5000 Ethiopian Birr/month, and good knowledge score were all significantly associated with proper iodized salt utilization. While the prevalence of goiter was not significantly identified as a public health problem as compared in the regions, however, in light of previous iodine deficiency in this region of Ethiopia, the salt iodization program should be done continually.
Political dynasties and democratization: A case study of Taiwan
Authors: Schafferer Christian
Published: January 2023

Political families in transitional societies are often seen in the context of corruption, democratic regression, deterioration of socio-economic development, inequality, and deprivation. High levels of dynasticism, however, also exist in advanced democratic societies. Using the example of Taiwan, this article explores the factors behind the evolution of electoral dynasties and how the behavior of hereditary politicians has been conditioned by democratization. More specifically, the article argues that legacy politicians are not per se the Pandora’s box of low-quality politics. Rather, they act like other networks of personal relations. As such, self-imposed ethical standards and inherited cultural norms may substantially restrain the intrinsic particularistic potentials of such networks, but in the long run only political modernization can prevent them from cultivating political capitalism—the predatory use of public resources. That is, political modernization conditions the behavior of electoral dynasties. It transforms particularistic networks into more progressive and programmatic forms of dynasticism.
Evaluating the Implementation of a Model of Integrated Behavioral Health in Primary Care: Perceptions of the Healthcare Team
Authors: Dunn Julia Alexandra , Chokron Garneau Hélène , Jawad Nadine , Zein Mira , Elder Kirsti Weng , Sattler Amelia , McGovern Mark
Published: January 2023

Objectives:

This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians.

Methods:

This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. The Integrated Behavioral Health Staff Perceptions Survey was administered to assess the comfort, confidence, and consistency of behavioral health practices. Confidential online surveys were distributed to primary care faculty and staff members before and post-implementation. Responses from providers and medical assistants were compared between pre- and post-implementation with linear regression analyses. The relationships between accessibility to behavioral health clinicians and a change in comfort, confidence, and consistency of behavioral health practices were explored using a linear mixed-effects model.

Results:

A total of 35 providers and medical assistants completed the survey both before and post-implementation of IBHPC. Over time, there were increasingly positive perceptions about the consistency of behavioral health screening ( P = .03) and overall confidence in addressing behavioral health concerns ( P = .005). Comfort in addressing behavioral health concerns did not significantly change for either providers or staff over time. Medical assistants were initially more confident and comfortable addressing behavioral health concerns than providers, but providers’ attitudes increased post-IBHPC implementation. Improved access to behavioral health clinicians was associated with greater consistency of screening and referral to specialty mental health care ( P < .001).

Conclusion:

The present study is the first to explore differences in provider and medical assistant perceptions during the course of an IBHPC implementation. Findings underscore the importance of integrating medical assistants, along with providers, into all phases of the implementation process.
Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States
Authors: Giusto Ali , Jack Helen E. , Magidson Jessica F. , Ayuku David , Johnson Savannah L. , Lovero Kathryn L. , Hankerson Sidney H. , Sweetland Annika C. , Myers Bronwyn , Fortunato dos Santos Palmira , Puffer Eve S. , Wainberg Milton L.
Published: January 2023

Structural barriers perpetuate mental-health disparities for minoritized U.S. populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental-health-care access and relevance. Mutual capacity-building partnerships between low- and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and share GMH strategies through a case series of said partnerships between Kenya and North Carolina, South Africa and Maryland, and Mozambique and New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included qualitative formative work and partnership building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science—and facilitating learning across settings—can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.
Evaluating the Effect of Gastroesophageal Reflux Disease on Postoperative Dysphagia Following Anterior Cervical Spine Surgery-A Prospective, Multicenter Study
Authors: Mazmudar Aditya , Paziuk Taylor , Mangan John , Tran Khoa , Oh Samuel , Li Sandy , Sherrod Brandon , Bisson Erica , Brodke Darrel , Kepler Christopher , Schroeder Gregory , Vaccaro Alexander , Hilibrand Alan , Rihn Jeffrey A.
Published: January 2023

Study Design

Prospective cohort study.

Objectives

The purpose of this study was to prospectively evaluate the impact of a preoperative diagnosis of gastroesophageal reflux disease on the incidence and severity of postoperative dysphagia in a multicenter population.

Methods

After Institutional Review Board approval, written informed consent was obtained from all participating patients. Patients over 18 years of age who underwent an elective anterior cervical discectomy and fusion for a degenerative condition were prospectively enrolled at two academic centers from the years 2018 to 2020. Patients were separated into two groups: those with and without a preoperative diagnosis of GERD. Continuous variables were assessed using either an independent t-test or Mann Whitney U-test for parametric and non-parametric data. All categorical variables were compared using a chi-square test.

Results

A total of 116 patients met study criteria and were subsequently enrolled. Overall rates of postoperative dysphagia increased to 47.3% (n = 53) at 2-weeks but eventually decreased towards the preoperative prevalence of 25.0% at the 24-week mark. Patients with preoperative diagnosis of GERD had lower dysphagia severity scores on a continuous variable analysis in both the DSQ and EAT-10 surveys at 2-week follow-up in addition to the Bazaz survey at 24-week follow-up. Our follow up at 24-weeks was 85.7%.

Conclusions

Our study shows that having a preoperative diagnosis of GERD has no significant effect on the incidence of dysphagia following ACDF. Nevertheless, having a preoperative diagnosis of GERD does seem to provide some protective effect on the severity of dysphagia that this patient population develops at multiple intervals over a 24-week postoperative period.
Fear of COVID-19 and poor accessibility of comprehensive care has caused delay in initiation of antenatal care among pregnant women in Southwest Ethiopia: the need for disaster resilient and accessible maternal health care
Authors: Zenu Sabit , Shuremu Muluneh , Tolesa Amanuel
Published: January 2023

Background:

Antenatal care (ANC) is care provided to pregnant women in order to ensure positive health outcomes for both mother and baby. Late ANC contact lacks the opportunity to provide interventions that are effective early in the pregnancy. A huge proportion of pregnant women present late. The aim of this study was to identify determinants of late enrollment in the ANC among pregnant women in public health centers in Ilu Ababor Zone, South-West Ethiopia.

Design and methods:

A facility-based case-control study was conducted on 270 randomly selected pregnant women (135 cases and 135 controls). A pretested interviewer-administered questionnaire was used to collect data. Multi-variable logistic regression was run to identify the determinants of late ANC initiation. The adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to determine statistical significance at a P-value of 0.05.

Result:

A total of 270 pregnant women were interviewed, making a response rate of 97%. Unplanned pregnancy [AOR: 2.8; 95% CI: (1.3, 6.0)], lack of information on time of ANC initiation [AOR: 2.7; 95% CI:(1.02, 5.0)], older age [AOR: 2.2; 95% CI:(1.01, 4.7)], not attending ANC in the previous pregnancy [AOR: 4.07; 95% CI: (1.8, 9.5)], and fear of COVID-19 were determinants of late initiation of ANC in the study area.

Conclusion:

Age, pregnancy and care-related factors, and fear of COVID-19 were determinants of late initiation of ANC. Community-based provision of comprehensive information on planned pregnancy and the ANC is important. A resilient system has to be built to deliver essential health services during emergencies like COVID-19.
Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations
Authors: Chaichana Tanakorn , Apivatgaroon Adinun , Rujiraphum Possawat , Sanguanjit Prakasit , Chernchujit Bancha
Published: January 2023

Background:

The standard radiographic view for diagnosing acromioclavicular joint (ACJ) dislocations is the Zanca view of both shoulders to assess superior displacement of the distal clavicle by measuring the coracoclavicular distance (CCD) and comparing it with the uninjured shoulder; however, there is no consensus on a gold standard for diagnostic measures to classify acute ACJ injuries.

Purpose:

To compare the CCD from an upright chest radiograph with a standard Zanca view of both shoulders in patients with an ACJ dislocation.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

We reviewed the records of 70 patients with an ACJ dislocation between 2010 and 2021 who had both an upright chest radiograph and a Zanca view. An ACJ dislocation was classified as low grade (Rockwood types 1-3) or high grade (Rockwood type 5). The CCD was measured on the upright chest radiograph and the Zanca view by 2 independent reviewers, and the percentage of the CCD difference compared with the unaffected side (ΔCCD) was calculated and compared between the upright chest radiograph and the Zanca view. Interrater and intrarater reliability were determined using the intraclass correlation coefficient.

Results:

Included were 70 patients (55 male and 15 female; mean age, 46 years). There were 29 patients (41.43%) with a low-grade injury and 41 patients (58.57%) with a high-grade injury. In the overall analysis, the ΔCCD on the upright chest radiograph and Zanca view was significantly different (130.25% ± 88.42% vs 152.69% ± 106.56%, respectively; mean difference, 22.44% [95% CI, 2.40% to 42.48%]; P = .029). The subgroup analysis revealed that the ΔCCD on the upright chest radiograph and Zanca view was significantly different for patients with a low-grade injury (60.71% ± 25.79% vs 91.46% ± 68.54%, respectively; mean difference, 30.76% [95% CI, 7.18% to 54.33%]; P = .012) but not different for patients with a high-grade injury (179.45% ± 83.87% vs 196.00% ± 107.97%, respectively; mean difference, 16.56% [95% CI, –14.06% to 47.18%]; P = .281). The intraclass correlation coefficients for the ΔCCD measurements indicated good to excellent interrater and intrarater reliability.

Conclusion:

The study findings indicated that upright chest radiography can be used as a diagnostic screening tool for high-grade ACJ dislocations, but not for low-grade ACJ injuries, compared with the Zanca view.
Trends in the Parenthood Gap in Health and Well-Being among U.S. Women from 1996 to 2018
Authors: Nomaguchi Kei , Milkie Melissa A.
Published: January 2023

The notion that U.S. mothers with minor children are less happy and more depressed than nonmothers largely relies on data collected in the 1990s or earlier. Although the coronavirus disease 2019 pandemic brought much attention to the stressfulness of parenting, we lack knowledge of how mothers fared relative to nonmothers in the 2000s and 2010s, before the pandemic. The authors investigate trends in the parenthood gap in happiness, depression, and self-rated health among women aged 18 to 59 years, using the 1996 to 2018 General Social Survey ( n = 13,254) and the 1997 to 2018 National Health Interview Survey ( n = 263,110). Results indicate that twenty-first-century mothers with younger children were better off than nonmothers on two measures, reporting less depression and better health. Mothers’ “depression advantage” grew across this time. However, mothers with older children reported less happiness than nonmothers, a continued trend from the 1990s. The study underscores the importance of examining various well-being indicators across the changing contexts of parenting.
Idiopathic pulmonary fibrosis and lung cancer: future directions and challenges
Authors: Abu Qubo Ahmad , Numan Jamil , Snijder Juan , Padilla Maria , Austin John H.M. , Capaccione Kathleen M. , Pernia Monica , Bustamante Jean , O'Connor Timothy , Salvatore Mary M.
Published: January 2023

Idiopathic pulmonary fibrosis (IPF) is a progressive disease of pulmonary scarring. New treatments slow disease progression and allow pulmonary fibrosis patients to live longer. Persistent pulmonary fibrosis increases a patient's risk of developing lung cancer. Lung cancer in patients with IPF differs from cancers that develop in the non-fibrotic lung. Peripherally located adenocarcinoma is the most frequent cell type in smokers who develop lung cancer, while squamous cell carcinoma is the most frequent in pulmonary fibrosis. Increased fibroblast foci in IPF are associated with more aggressive cancer behaviour and shorter doubling times. Treatment of lung cancer in fibrosis is challenging because of the risk of inducing an exacerbation of fibrosis.

In order to improve patient outcomes, modifications of current lung cancer screening guidelines in patients with pulmonary fibrosis will be necessary to avoid delays in treatment. 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) computed tomography (CT) imaging can help identify cancer earlier and more reliably than CT alone. Increased use of wedge resections, proton therapy and immunotherapy may increase survival by decreasing the risk of exacerbation, but further research will be necessary.
Comparison of pulmonary function during interscalene block vs. supraclavicular block: a single-center, double-blind, randomized trial
Authors: Wang Jiajia , Hou Xinwei , Zhang Xiao , Wang Xueting , Qin Weiwei , Li Qiujie , Ma Fuguo , Sun Lixin
Published: January 2023

Backround

The supraclavicular plexus block (SCB) and interscalene plexus block (ISB) have the potential to pulmonary function, the duration of the potential remains uncertain. So, we compared the effect of SCB and ISB on pulmonary function, especially the duration time.

Methods

Ninety-six patients were finally allocated to group I and group S. The ISB and the SCB procedures were performed with ultrasound guidance before anesthesia induction. An investigator recorded the diaphragm mobility and respiratory function test indicators before the block (T0) and at 30 min (T30 min), 4 h (T4), 8 h (T8), and 12 h (T12) after the block. The diaphragmatic paralysis rate was calculated for above timepoint. The VAS, the recovery time for the sensory and motor block, and adverse reactions within 24 h of administering the block were also recorded.

Results

The recovery times of diaphragm mobility in group I were longer than those in group S. Compared with group I, group S had a significantly lower diaphragmatic paralysis rate during eupnea breathing at T30 min and T8 after the block. Similarly, group S had a significantly lower diaphragmatic paralysis rate at deep breathing at T30 min, T8, and T12 after the block. The recovery times of FEV1 and FVC in group I were longer than those in group S. The other results were not statistically significant.

Conclusions

Ultrasound-guided ISB resulted in a longer periods with a suppressive effect on pulmonary function than SCB.

Trials registration

17/12/2019, ChiCTR1900028286.
Uric acid promotes myocardial infarction injury via activating pyrin domain-containing 3 inflammasome and reactive oxygen species/transient receptor potential melastatin 2/Ca2+pathway
Authors: Wu Haiyun , Dai Ruozhu , Wang Min , Chen Chengbo
Published: January 2023

Cardiomyocytes injury has been considered as a key contributor for myocardial infarction (MI). Uric acid (UA) can induce cardiomyocytes injury, which is closely related to NLRP3 activation and inflammatory factor generation. However, the mechanism how UA modulates cardiomyocytes remains elusive. Western blotting and qRT-PCR were applied for measuring protein and mRNA expression, respectively. ROS production and Ca2+ influx were measured by flow cytometry. Patch clamp technique was used for measuring transient receptor potential melastatin 2 (TRPM2) channel. Ligation of left anterior descending for 2 h was performed to induce MI animal model. The rats were treated by different concentration of uric acid. The artery tissues were stained by HE and collected for measurement of NLRP3 and inflammatory factors. Supplementation of UA significantly promoted apoptosis, and augmented the expression of intercellular adhesion molecule-1, chemoattractant protein-1, vascular cell adhesion molecule-1, and NLRP3 inflammasome. Knockdown of NLRP3 reversed the influence of UA on MI by decreasing collagen deposition, fibrotic area, apoptosis. The expression of NLRP3 inflammasome increased markedly after treatment of UA. UA activated ROS/TRPM2/Ca2+ pathway through targeting NLRP3. UA activated NLRP3 inflammasome and augments inflammatory factor production, which in turn exacerbates cardiomyocytes injury. Knockdown of NLRP3 reversed the influence of UA on apoptosis and cell cycle. UA may promote cardiomyocytes injury through activating NLRP3 inflammasome and ROS/TRPM2 channel/Ca2+ pathway.
Establishing machine learning models to predict the early risk of gastric cancer based on lifestyle factors
Authors: Afrash Mohammad Reza , Shafiee Mohsen , Kazemi-Arpanahi Hadi
Published: January 2023

Background

Gastric cancer is one of the leading causes of death worldwide. Screening for gastric cancer greatly relies on endoscopy and pathology biopsy, which are invasive and pose financial burdens. Thus, the prevention of the disease by modifying lifestyle-related behaviors and dietary habits or even the prevention of risk factor formation is of great importance. This study aimed to construct an inexpensive, non-invasive, fast, and high-precision diagnostic model using six machine learning (ML) algorithms to classify patients at high or low risk of developing gastric cancer by analyzing individual lifestyle factors.

Methods

This retrospective study used the data of 2029 individuals from the gastric cancer database of Ayatollah Taleghani Hospital in Abadan City, Iran. The data were randomly separated into training and test sets (ratio 0.7:0.3). Six  ML methods, including multilayer perceptron (MLP), support vector machine (SVM) (linear kernel), SVM (RBF kernel), k-nearest neighbors (KNN) (K = 1, 3, 7, 9), random forest (RF), and eXtreme Gradient Boosting (XGBoost), were trained to construct prognostic models before and after performing the relief feature selection method. Finally, to evaluate the models’ performance, the metrics derived from the confusion matrix were calculated via a test split and cross-validation.

Results

This study found 11 important influence factors for the risk of gastric cancer, such as Helicobacter pylori infection, high salt intake, and chronic atrophic gastritis, among other factors. Comparisons indicated that the XGBoost had the best performance for the risk prediction of gastric cancer.

Conclusions

The results suggest that based on simple baseline patient data, the ML techniques have the potential to start the prescreening of gastric cancer and identify high-risk individuals who should proceed with invasive examinations. Our model could also considerably lessen the number of cases that need endoscopic surveillance. Future studies are required to validate the efficacy of the models in a larger and multicenter population.
Does illicit amphetamine seizures quantity associated with amphetamine use disorder related admissions in Saudi Arabia?
Authors: Ramadan Majed , Ghulam Enas , Alhusseini Noara
Published: January 2023

Background

Illicit amphetamine-type stimulants (ATS) trafficking activities have increased substantially in Saudi Arabia over the last 10 years. In the period 2013–2017 Saudi Arabia seized the largest quantities of amphetamine at the global level. The current study examines whether the increased quantity of ATS seizures has an impact on amphetamine use disorder admissions.

Method

This is an ecological study combining two datasets, the first dataset was obtained from United Nations Office on Drugs and Crime (UNODC), and the Al-Amal Hospital Electronic Health Record System in the city of Dammam, Eastern region of Saudi Arabia from 2005 to 2018. The annual incidence of patients diagnosed with amphetamine use was the dependent variable. The independent variable was the annual reported count of seized quantities of ATS in Saudi Arabia. We used a random intercept Negative Binomial model to predict the yearly count of amphetamine use disorder admission rates.

Results

A total of 910 amphetamine disorder admission patients in Al-Amal rehabilitation and addiction center, and the quantity equivalent to 200 tons of ATS was seized from 2005 to 2018. The amphetamine disorder admission rate has increased from 1.33% in 2005 to 18.27% in 2018. For each one-unit increase in the amphetamine confiscated quantities, the amphetamine use disorder admission rate increased by 49 to 88%.

Conclusion

The current study found that reported amphetamine seized quantities were significantly and positively associated with the increase of amphetamine use disorder-related admission rates. In 2018, both ATS seized quantities and admission rates significantly increased, nearly doubling from the previous year. Rigorous, and multidisciplinary interventional studies to evaluate factors associated with increasing abuse of ATS should be a priority for policymakers and researchers in Saudi.
Long-term exposure to low-level arsenic in drinking water is associated with cause-specific mortality and hospitalization in the Mt. Amiata area (Tuscany, Italy)
Authors: Nuvolone Daniela , Stoppa Giorgia , Petri Davide , Voller Fabio
Published: January 2023

Background

Arsenic in drinking water is a global public health concern. This study aims to investigate the association between chronic low-level exposure to arsenic in drinking water and health outcomes in the volcanic area of Mt. Amiata in Italy, using a residential cohort study design.

Methods

Chronic exposure to arsenic in drinking water was evaluated using monitoring data collected by the water supplier. A time-weighted average arsenic exposure was estimated for the period 2005–2010. The population-based cohort included people living in five municipalities in the Mt. Amiata area between 01/01/1998 and 31/12/2019. Residence addresses were georeferenced and each subject was matched with arsenic exposure and socio-economic status. Mortality and hospital discharge data were selected from administrative health databases. Cox proportional hazard models were used to test the associations between arsenic exposure and outcomes, with age as the temporal axis and adjusting for gender, socio-economic status and calendar period.

Results

The residential cohort was composed of 30,910 subjects for a total of 407,213 person-years. Analyses reported risk increases associated with exposure to arsenic concentrations in drinking water > 10 µg/l for non-accidental mortality (HR = 1.07 95%CI:1.01–1.13) and malignant neoplasms in women (HR = 1.14 95%CI:0.97–1.35). Long-term exposure to arsenic concentrations > 10 µg/l resulted positively associated with several hospitalization outcomes: non-accidental causes (HR = 1.06 95%CI:1.03–1.09), malignant neoplasms (HR = 1.10 95%CI:1.02–1.19), lung cancer (HR = 1.85 95%CI:1.14–3.02) and breast cancer (HR = 1.23 95%CI:0.99–1.51), endocrine disorders (HR = 1.13 95%CI:1.02–1.26), cardiovascular (HR = 1.12 95%CI:1.06–1.18) and respiratory diseases (HR = 1.10 95%CI:1.03–1.18). Some risk excesses were also observed for an exposure to arsenic levels below the regulatory standard, with evidence of exposure-related trends.

Conclusions

Our population-based cohort study in the volcanic area of Mt. Amiata showed that chronic exposure to arsenic concentrations in drinking water above the current regulatory limit was associated with a plurality of outcomes, in terms of both mortality and hospitalization. Moreover, some signs of associations emerge even at very low levels of exposure, ​​below the current regulatory limit, highlighting the need to monitor arsenic concentrations continuously and implement policies to reduce concentrations in the environment as far as possible.
The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations
Authors: McLaren Thomas , Peter Lina-Jolien , Tomczyk Samuel , Muehlan Holger , Schomerus Georg , Schmidt Silke
Published: January 2023

Background

Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).

Method

All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).

Results

Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).

Conclusion

The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.

Trial registration

German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
Willingness to receive the COVID-19 vaccine among HIV positive men who have sex with men in China: a cross-sectional study
Authors: Wu Songjie , Zhu Shanhui , Yan Xumeng , Xu Yongshi , Xu Huifang , Yang Fang , Han Zhigang , Gu Yuzhou , Zhou Yi , Yang Zhengrong , Yang Huake , Shu Bo , Tang Weiming , Liang Ke
Published: January 2023

Background

People living with HIV(PLWH) are deemed more vulnerable to the SARS-CoV-2 infection than the uninfected population. Vaccination is an effective measure for COVID-19 control, yet, little knowledge exists about the willingness of men who have sex with men (MSM) living with HIV in China to be vaccinated.

Methods

This cross-sectional study evaluated the willingness of MSM living with HIV to receive COVID-19 vaccination in six cities of Guangdong, China, from July to September 2020. Factors associated with willingness to receive COVID-19 vaccination using multivariable logistic regression.

Results

In total, we recruited 944 HIV-positive MSM with a mean age of 29.2 ± 7.7 years. Of all participants, 92.4% of them were willing to receive the COVID-19 vaccine. Participants who were separated, divorced, or widowed (adjusted OR: 5.29, 95%CI: 1.02–27.48), had an annual income higher than 9,000 USD (adjusted OR: 1.70, 95%CI: 1.01–2.86), had ever taken an HIV self-test (adjusted OR: 1.78, 95%CI: 1.07–2.95), had ever disclosed sexual orientation to a doctor/nurse (adjusted OR: 3.16, 95%CI: 1.33–7.50), had ever disclosed sexual orientation to others besides their male partners (adjusted OR: 2.18, 95%CI: 1.29–3.69) were more willing to receive the vaccine. Sex with a female partner in the past six months decreased the likelihood of willingness to receive the vaccine (adjusted OR: 0.40, 95%CI: 0.17–0.95). Economic burden, worry that my health condition could not bear the risk of receiving COVID-19 vaccines, and concern that the vaccination would affect the immune status and antiretroviral therapy were the main reasons for unwillingness to receive vaccination.

Conclusion

Our study showed that HIV-positive MSM had a high willingness to receive the COVID-19 vaccination. Targeted interventions such as health education should be conducted among MSM with HIV infection to enhance COVID-19 vaccine uptake.
Application of computer-aided design and 3D-printed template for accurate bone augmentation in the aesthetic region of anterior teeth
Authors: Liu Xin , Fang Zhou , Feng Jin , Yang Se-fei , Ren Yi-peng
Published: January 2023

Purpose

To explore the outcomes of bone augmentation in the aesthetic zone of the anterior teeth using computer-aided design and a 3D-printed template.

Methods

Ten patients with severe bone defects in the aesthetic zone of anterior teeth were included in the study; CT data were collected before surgery. The design of the osteotomy line in the bone defect area was determined under computer simulation. The position parameters and osteotomy line of the free bone were determined via virtual surgery. A 3D-printed template was prepared to guide the accurate placement of the bone graft. Reexamination was conducted to evaluate the position of the bone graft immediately after the operation and the resorbed capacity of the bone graft before implant restoration.

Results

The position of the bone graft was consistent with the preoperative design. The amount of bone graft resorbed was within the acceptable range three months after the operation, and the effect of implant restoration was satisfactory.

Clinical significance

Use of computer-aided design and a 3D-printed template can be an effective approach for accurate bone augmentation in the aesthetic zone of the anterior teeth.
Trajectories of quality of life in breast cancer survivors during the first year after treatment: a longitudinal study
Authors: Park Jin-Hee , Jung Yong Sik , Kim Ji Young , Bae Sun Hyoung
Published: January 2023

Background

Although quality of life (QOL) improves over time for most breast cancer patients after their treatment, some patients may show different patterns of QOL. Beyond determining distinct QOL trajectories, identifying characteristics of patients who have different trajectories can help identify breast cancer patients who may benefit from intervention. We aimed to identify trajectories of QOL in breast cancer patients for one year after the end of primary treatment, to determine the factors influencing these changes.

Methods

This longitudinal study recruited 140 breast cancer patients. Patients' QOL, symptom experience, self-efficacy, and social support were assessed using the Functional Assessment of Cancer Therapy Scale-G, Memorial Symptom Assessment Scale-Short Form, Self-Efficacy Scale for Self-Management of Breast Cancer, and Interpersonal Support Evaluation List-12. Data were collected immediately after the end of primary treatment (T1) and at three (T2), six (T3), and 12 months (T4) after primary treatment. Group-based trajectory modeling was used to identify distinct subgroups of patients with similar patterns of QOL change after treatment. A one-way analysis of variance was used to determine which variables were associated with trajectory membership. A multinomial logistic regression was performed to identify factors associated with trajectory group membership.

Results

We analyzed 124 patients (mean age: 48.75 years). Latent class analysis of the QOL identified three trajectory groups: the low QOL group (n = 27; 21.1%), moderate QOL group (n = 57; 45.3%), and high QOL group (n = 40; 33.6%). The low QOL group showed consistently low QOL after the end of primary treatment, and the moderate QOL group showed a slight decrease in QOL from T1 to T3, which returned to the T1 level at T4. The high QOL group maintained a consistently high QOL. By multinomial logistic regression, psychological symptoms (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.22–0.99) predicted a moderate QOL, and both psychological symptoms (OR 0.19, 95% CI 0.07–0.51) and belonging support (OR 1.60, 95% CI 1.06–2.39) predicted a high QOL.

Conclusion

Identifying high-risk groups for reduced QOL after the end of primary treatment is necessary. Moreover, psychosocial interventions should be provided to alleviate psychological symptoms and increase belonging support to enhance patients' QOL.

Trial registration Not registered.
Clinician and computer: a study on doctors’ perceptions of artificial intelligence in skeletal radiography
Authors: York Thomas James , Raj Siddarth , Ashdown Thomas , Jones Gareth
Published: January 2023

Background

Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography.

Methods

A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review.

Results

The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice.

Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20).

Conclusions

This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.
The effect of blended task-oriented flipped classroom on the core competencies of undergraduate nursing students: a quasi-experimental study
Authors: Ke Li , Xu Lanlan , Sun Li , Xiao Juan , Tao Lingxuan , Luo Yixue , Cao Qiongya , Li Yan
Published: January 2023

Background

The flipped classroom (FC) method is becoming increasingly popular in China's nursing education. It is an important breakthrough improvement in the quality of learning in nursing education reforms.

Purpose

This study aimed to determine the effects of blended task-oriented flipped classroom (TFC) on nursing students undertaking the Fundamentals of Nursing course.

Methods

A pre-and post-test quasi-experimental design was adopted. This study was conducted in the Autumn semester, 2021 academic year in a Chinese university. Using cluster sampling technique, this study enrolled second-year undergraduate nursing students from six classess who were studying Fundamentals of Nursing course. A blended TFC was developed and implemented with three classes (experimental group: n = 152). In-class traditional lectures were applied to the other three classes (control group: n = 151). The Self-Directed Learning Instrument, Problem-Solving Inventory, and California Critical Thinking Disposition Inventory were used to evaluate students’ learning outcomes, and final examinations were conducted at the end of after course. In addition, students in the flipped classroom group were required to answer five open-ended questions concerning their flipped classroom learning experiences.

Results

Students in the experimental group showed significant improvement in academic performance compared to those in the control group (p = 0.001). Considering total scale and factors, students in the experimental grouped recorded significantly higher scores in self-directed learning ability, problem-solving skills, and critical thinking ability compared to those in the control group (p < 0.05). Furthermore, improved abilities and skills such as team cooperation, communication, presentation, identifying /solving clinical problems, and accountability were reported.

Conclusion

A blended TFC teaching approach positively impacted students' core competencies and improved learning outcomes in the Fundamentals of Nursing course.
Regional disparities and influencing factors of high quality medical resources distribution in China
Authors: Yuan Lei , Cao Jing , Wang Dong , Yu Dan , Liu Ge , Qian Zhaoxin
Published: January 2023

Background

With the gradual increase of residents’ income and the continuous improvement of medical security system, people’s demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on China's high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China.

Methods

The study selected Class III level A hospitals (the highest level medical institutions in China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR.

Results

The total amount of HQMR in China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors.

Conclusions

China's total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.