bluuebunny/crossref_metadata_2025 huggingface dataset:
DLK2 Acts as a Potential Prognostic Biomarker for Clear Cell Renal Cell Carcinoma Based on Bioinformatics Analysis
Authors: Lee Man-Gang , Lee Yung-Kuo , Huang Shih-Chung , Chang Chen-Lin , Ko Chou-Yuan , Lee Wen-Chin , Chen Tung-Yuan , Tzou Shiow-Jyu , Huang Cheng-Yi , Tai Ming-Hong , Lin Yu-Wei , Kung Mei-Lang , Tsai Ming-Chao , Chen Yung-Lung , Chang Yi-Chen , Wen Zhi-Hong , Huang Chao-Cheng , Chu Tian-Huei
Published: April 2022

Clear cell renal cell carcinoma (ccRCC) is the most common RCC subtype with a high mortality. It has been reported that delta-like 1 homologue (DLK1) participates in the tumor microenvironmental remodeling of ccRCC, but the relationship between delta-like 2 homologue (DLK2, a DLK1 homologue) and ccRCC is still unclear. Thus, this study aims to investigate the role of DLK2 in the biological function and disease prognosis of ccRCC using bioinformatics analysis. The TNMplot database showed that DLK2 was upregulated in ccRCC tissues. From the UALCAN analysis, the overexpression of DLK2 was associated with advanced stage and high grade in ccRCC. Moreover, the Kaplan-Meier plotter (KM Plotter) database showed that DLK2 upregulation was associated with poor survival outcome in ccRCC. By the LinkedOmics analysis, DLK2 signaling may participated in the modulation of ccRCC extracellular matrix (ECM), cell metabolism, ribosome biogenesis, TGF-β signaling and Notch pathway. Besides, Tumor Immune Estimation Resource (TIMER) analysis showed that the macrophage and CD8+ T cell infiltrations were associated with good prognosis in ccRCC patients. Finally, DLK2 overexpression was associated with the reduced macrophage recruitments and the M1–M2 polarization of macrophage in ccRCC tissues. Together, DLK2 may acts as a novel biomarker, even therapeutic target in ccRCC. However, this study lacks experimental validation, and further studies are required to support this viewpoint.
Technological Advances: CEBPA and FLT3 Internal Tandem Duplication Mutations Can be Reliably Detected by Next Generation Sequencing
Authors: Akabari Ratilal , Qin Dahui , Hussaini Mohammad
Published: April 2022

Background: The detection of CEBPA and FLT3 mutations by next generation sequencing (NGS) is challenging due to high GC content and Internal Tandem Duplications (ITDs). Recent advances have been made to surmount these challenges. In this study, we compare three commercial kits and evaluate the performance of these more advanced hybrid-capture and AMP-chemistry based methods. Methods: Amplicon-based TSM 54-Gene Panel (Illumina) was evaluated against hybridization-capture SOPHiA Genetics MSP, OGT SureSeq, and AMP chemistry-based VariantPlex (Archer) for wet-lab workflow and data-analysis pipelines. Standard kit directions and commercial analysis pipelines were followed. Seven CEBPA and 10 FLT3-positive cases were identified that previously were missed on an amplicon NGS assay. The average reads, coverage uniformity, and the detection of CEBPA or FLT3 mutations were compared. Results: All three panels detected all 10 CEBPA mutations and all 10 FLT3 ITDs with 100% sensitivity. In addition, there was high concordance (100%) between all three panels detecting 47/47 confirmed variants in a set of core myeloid genes. Conclusions: The results show that the NGS assays are now able to reliably detect CEBPA mutations and FLT3 ITDs. These assays may allow foregoing additional orthogonal testing for CEBPA and FLT3.
Methylenetetrahydrofolate Reductase Polymorphism (rs1801133) and the Risk of Hypertension among African Populations: A Narrative Synthesis of Literature
Authors: Mabhida Sihle E. , Muhamed Babu , Sharma Jyoti R. , Apalata Teke , Nomatshila Sibusiso , Mabasa Lawrence , Benjeddou Mongi , Masilela Charity , Ziqubu Khanyisani , Shabalala Samukelisiwe , Johnson Rabia
Published: April 2022

In this review, we have gathered and analyzed the available genetic evidence on the association between the methylenetetrahydrofolate reductase gene (MTHFR), rs1801133 and the risk of Hypertension (HTN) in African populations, which was further compared to the global data evidence. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and Human Genome Epidemiology Network (HuGENet) guidelines. Literature was retrieved through major search databases, including PubMed, Scopus, Web of Science, and African Journal Online. We identified 64 potential studies, of which 4 studies were from the African continent and 60 studies were reported globally. Among the studies conducted in Africa, only two (n = 2) reported a significant association between the MTHFR (rs1801133) and the risk of developing HTN. Only one (n = 1) study population was purely composed of black Africans, while others were of other ethnicities. Among studies conducted in other continents (n = 60), forty-seven (n = 47) studies reported a positive association between MTHFR (rs1801133) and the risk of developing HTN, whereas the remaining studies (n = 14) did not show a significant association. Available literature suggests an apparent association between rs1801133 and HTN in global regions; however, such information is still scarce in Africa, especially in the black African population.
The Roles of Obstetrics Training Skills and Utilisation of Maternity Unit Protocols in Reducing Perinatal Mortality in Limpopo Province, South Africa
Authors: Makhado Langanani C. , Mangena-Netshikweta Mutshinyalo L. , Mulondo Seani A. , Olaniyi Foluke C.
Published: April 2022

Perinatal mortality has been associated with poor maternal health during pregnancy and intrapartum periods. This study was conducted to determine the effects of obstetrics training programmes and the utilization of maternal unit protocols in the management of obstetric complications in reducing neonatal mortality rate in selected public hospitals in the Vhembe district of Limpopo province, South Africa. A quantitative, descriptive design was used and a non-probability purposive sampling method was used to select midwives with a minimum of two (2) years of working experience in maternity wards of selected public hospitals. A total of 105 completed questionnaires were analysed using SPSS version 23. Most of the respondents were within the age group of 40–59 years (74.3%) and with professional experience of more than 10 years (76.8%). More than half (63.8%) had qualified as midwives at a diploma level. Only 44.8% indicated that the protocols were always utilised, even though the majority (70.5%) believed that the protocols are helpful in managing obstetrics complications. The obstetric skills are helpful in reducing neonatal mortality, however, utilisation of the protocols is not encouraging in the studied health facilities. We recommend that efforts should be geared towards the enforcement of the protocol’s use, and all midwives should be encouraged to undergo the trainings.
Sleep Quality and Nutrient Intake in Japanese Female University Student-Athletes: A Cross-Sectional Study
Authors: Hoshino Fumi , Inaba Hiromi , Edama Mutsuaki , Natsui Saya , Maruyama Sae , Omori Go
Published: April 2022

Objectives: This study aimed to characterize the sleep quality and nutrient intake of Japanese female college athletes to provide specific conditioning support. Methods: A cross-sectional survey conducted between December 2019 and January 2020 during the regular training season in Niigata City, located at 139°02′ E longitude and 37°55′ N latitude. Overall, 120 female university student-athletes from eight clubs were selected. All sports were at the national level of competition. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality. Nutrient intake was assessed using Excel nutrition software through the Food Intake Frequency Questionnaire. Results: The mean PSQI score was 4.5 ± 2.5, with 29% of participants having a PSQI score ≥ 5.5. The sleep duration was 6.8 ± 1.1 h, with 45% of participants sleeping <7 h. The energy intake was 1800 ± 419 kcal, with no correlation between PSQI score and nutrient intake. Conclusions: PSQI scores were higher compared with other studies, but many participants had shorter sleep duration and lower nutrient intake, these data suggest that there is the possibility of improving the habits of Japanese athletes by increasing the subjects’ amount of sleep time and food intake.
The Relationship between Empowerment and Organizational Commitment from Nurse’s Perspective in the Ministry of Health Hospitals
Authors: Rawah Rehab , Banakhar Maram
Published: April 2022

(1) Background: The nurse structure is the largest proportion of the healthcare team in hospitals and Primary Healthcare Centers (PHCs). Empowerment is considered a vital component in strategic planning implementation and plays an important role in enhancing job commitment, motivation and employee satisfaction. (2) Aim: The aim of this study is to examine the relationship between the empowerment and organizational commitment from a nurse’s perspective in the MOH in Makkah city in Saudi Arabia. (3) Methods: A descriptive, correlational design was utilized. The study was conducted at three hospitals affiliated with the Ministry of Health in Makkah. A random stratified sampling of 318 nurses voluntarily participated. Data were collected using two tools; Conditions for Workplace Effectiveness Questionnaire-II (CWEQ-II) to measure nurses’ empowerment, and the Organizational Commitment Questionnaire (OCQ). (4) Results: This study revealed that the nurses in Makkah city have a moderate degree of empowerment. Moreover, the level of organizational commitment among nurses was moderate. In addition, this study showed that there is a significant positive relationship between nurses’ empowerment and their organizational commitment. (5) Conclusion: By conducting this study, it seems that nurse’s empowerment is considered an important healthcare organizational strategy and nurses feel empowered by several factors, such as having access to power through informal and formal means and having access to organizational opportunity, access to support, access to information and access to resources. Access to sources of empowerment influences a nurse’s organizational commitment.
Alterations in Cortisol Profiles among Mothers of Children with ASD Related to Poor Child Sleep Quality
Authors: Bin Eid Wasmiah , Lim Mengyu , Gabrieli Giulio , Kölbel Melanie , Halstead Elizabeth , Esposito Gianluca , Dimitriou Dagmara
Published: April 2022

Caregivers of children with autism spectrum disorder (ASD) experience poorer sleep, but studies have not yet used objective measures to investigate how child and caregiver sleep affect each other. In this study, 29 mothers and their child with ASD aged between 6 and 16 years were recruited. Questionnaires measuring child autism, maternal depression, and maternal and child sleep quality were administered. Cortisol salivary samples were also obtained from the mothers over the course of a day. Results revealed that maternal depression is significantly correlated with their subjective sleep quality, sleep latency and daytime dysfunction. Child sleep quality was also found to be significantly correlated with ASD severity. In terms of maternal cortisol profiles, a significant number of mothers showed a flattened diurnal cortisol expression, and children of mothers with a flattened cortisol profile had significantly more sleep problems. Overall, results suggest that maternal and child sleep are affected by the child’s disability but also are mutually related. Future studies may consider employing measures such as actigraphy or somnography to quantify sleep quality and establish causal pathways between sleep, cortisol expression and caregiver and child outcomes. The present study has clinical implications in examining family sleep when considering treatment for ASD.
Architectural Polychromy on the Athenian Acropolis: An In Situ Non-Invasive Analytical Investigation of the Colour Remains
Authors: Aggelakopoulou Eleni , Sotiropoulou Sophia , Karagiannis Georgios
Published: April 2022

The preservation of the Athenian Acropolis monuments constitutes an ongoing top-priority national project of global significance and impact. The project concerning the analytical investigation of the polychromy of the Acropolis monuments presented in this paper was part of the Acropolis Restoration Service (YSMA) program (2011–2015), regarding the restoration of the two corners of the west entablature of the Parthenon, which exhibited severe static damage, and a parallel restoration program of the Propylaea. The scope of this research was to investigate the materials in the paint decoration remains on the monuments by applying, entirely in situ, numerous non-invasive techniques on selected architectural members of the Parthenon and the Propylaea. The research focused, mainly, on surfaces where traces of colour or decoration patterns were visible to the naked eye. Furthermore, surfaces that are referred to in the literature as decorated but that are currently covered with weathering crusts (of white or black colour) and/or layers of patina (of yellowish and orange-brown hue), were also examined. The techniques applied in situ on the Acropolis monuments were X-ray fluorescence, micro-Raman, and Fourier Transform InfraRed (FTIR) spectroscopic techniques, conducted with the use of handheld or portable instruments. The scientific data gathered in situ are discussed in this paper to enhance our knowledge of the architectural polychromy of the classical period. Further investigation by applying analytical techniques on a few selected micro-samples would be highly complementary to this present work.
Repetitive Bathing and Skin Poultice with Hydrogen-Rich Water Improve Wrinkles and Blotches Together with Modulation of Skin Oiliness and Moisture
Authors: Tanaka Yoshiharu , Miwa Nobuhiko
Published: April 2022

Hydrogen-rich warm water (HW) has not been verified yet for skin anti-aging effects. Daily 10 min HW (dissolved hydrogen: 338–682 μg/mL, 41 °C) bathing and skin poultice with HW-impregnated towels for 11–98 days were demonstrated to improve wrinkle degrees (29 skin-loci) from 3.14 ± 0.52 to 1.52 ± 0.74 (p < 0.001) and blotch degrees (23 loci) from 3.48 ± 0.67 to 1.74 ± 0.92 (p < 0.001) in five healthy subjects (49–66 years old), by densito-/planimetrically evaluating with an Image-J software, and ranking into six hierarchies (0, 1–5). Meanwhile, skin oiliness was evaluated to increase for the oil-poor skins, but inversely decrease for excessively oily skins, suggesting the HW’s function as skin-oiliness modulation, with an appreciably negative correlation in prior oiliness contents versus change after HW application (r = −0.345, 23 loci). Skin moisture increased upon HW application, with a negative correlation (r = −0.090, 23 loci) in prior moisture contents versus post-HW-application moisture-changing rates, meaning that HW application compensated moisture for water-deficient skins (27.5–40% moisture), but not for wet skins (>41% moisture). Thus, the HW bath together with HW poultice exerted beneficial effects on skin appearances such as wrinkles, blotches and moisture/oiliness, some of which might ensue from enhanced antioxidant ability in blood, as was previously demonstrated for the HW bath.
Efficacy and Sustainability of Diabetes-Specific Meal Replacement on Obese and Overweight Type-2 Diabetes Mellitus Patients: Study Approaches for a Randomised Controlled Trial and Impact of COVID-19 on Trial Progress
Authors: Lew Leong Chen , Mat Ludin Arimi Fitri , Shahar Suzana , Abdul Manaf Zahara , Mohd Tohit Noorlaili
Published: April 2022

Meal replacement (MR) is widely used in weight and diabetes management programs due to its ease of compliance and handling. However, little is known about its impact on outcomes other than glycaemic control and weight loss. Furthermore, not many studies evaluate its cost-effectiveness and sustainability. This study aimed to evaluate the efficacy of a diabetes-specific MR for the weight reduction and glycaemic controls of overweight and obese T2DM patients, as compared to routine dietary consultation. Other health outcomes, the cost effectiveness, and the sustainability of the MR will also be evaluated. Materials and Methods: This randomised controlled clinical trial will involve 156 participants who have been randomised equally into the intervention and control groups. As a baseline, both groups will receive diet consultation. Additionally, the intervention group will receive an MR to replace one meal for 5 days a week. The duration of intervention will be 12 weeks, with 36 weeks of follow-up to monitor the sustainability of the MR. The primary endpoints are weight and Hemoglobin A1c (HbA1c) reduction, while the secondary endpoints are anthropometry, biochemical measurements, satiety, hormone changes, quality of life, and cost-effectiveness. The impact of the COVID-19 pandemic on study design is also discussed in this paper. This study has obtained human ethics approval from RECUKM (JEP-2019-566) and is registered at the Thai Clinical Trials Registry (TCTR ID: TCTR20210921004).
Perceptions of Pregnant Women on Traditional Health Practices in a Rural Setting in South Africa
Authors: Thipanyane Mvulakazi Patricia , Nomatshila Sibusiso Cyprian , Oladimeji Olanrewaju , Musarurwa Hannibal
Published: April 2022

Though there are prenatal and perinatal protocols across the African continent, traditional practices are commonly used. Improving maternal health requires an understanding of local cultural approaches and traditional health systems. The purpose of this study was to determine the perceptions of pregnant mothers of various ages and gravidities towards traditional maternal health practices during pregnancy. A descriptive phenomenological study was carried out with 27 purposively selected pregnant women from the King Sabatha Dalindyebo health sub-district. Discussion from three focus groups yielded three major themes and eight sub-themes. Content analysis revealed strong opinions and support for traditional practices. Although specialist practitioners were mentioned, family members were the primary source of information on traditional perinatal health practices. African mahogany bark, herbal decoctions, and holy water were allegedly used to treat labor pains, postnatal care, and the warding off of evil spirits. During pregnancy, these were thought to be beneficial and necessary. Nonetheless, the protection of some traditional practices’ know-how prevents integration of the traditional health system into the national health system. Consequently, there is a need for dialogue to facilitate the exchange of ideas on maternal health between the two health systems in order to facilitate more efficient policy formulation and implementation.
Factors Influencing the Waste Separation Behaviors of Urban Residents in Shaanxi Province during the 14th National Games of China
Authors: Guo Daoyan , Wang Xinping , Feng Taozhu , Han Shuai
Published: April 2022

The behaviors of urban residents in terms of waste separation at source are crucial to achieve the reduction and recycling of waste in urban governance. In this study, the data were collected from 1008 respondents in Shaanxi province, the host of China’s 14th National Games; theoretical and empirical analyses were conducted to determine the factors influencing waste separation behaviors, and specific policy suggestions are proposed. The results show that the waste separation behaviors of urban residents are positively influenced by their cognition of waste pollution, ecological values, sense of social responsibility, perceived knowledge, and perceived utilities of waste separation. Moreover, the residents’ waste separation intentions partially mediate the relationships between their cognition of waste pollution, ecological values, perceived utilities, and waste separation behaviors, which almost totally mediate the relationship between their sense of social responsibility and waste separation behaviors. In addition, it was shown that the cost of waste separation can weaken the effect of waste separation intention on behavior, while waste separation facilities, social norms, and the publicity for China’s 14th National Games have the opposite effect. Finally, policy suggestions are proposed to encourage urban residents to adopt waste separation behaviors, contributing to transforming Shaanxi into a zero-waste province.
Effect of Peer Victimization on the Long-Term Mental Health Status among Adults Users of Intellectual Disability Services: A Longitudinal Follow-Up Study
Authors: Yang Dai-Rong , Tzeng Nian-Sheng , Lin Fu-Gong
Published: April 2022

Caregiving for mental health among people with intellectual disabilities (IDs) in the ID services was reported as insufficient. The purposes of this study were to investigate five types of peer victimization (PV) experiences among adults with ID using ID services, and to gain a deeper understanding of the influence of PV experience on adults with ID’s long-term mental health status. A one-year longitudinal follow-up study was conducted from eight long-term care ID services (n = 176). Logistic regression analysis was applied to variables comprising personal characteristics, various types of PV experience and polyvictimization to predict period prevalence of psychiatric symptoms. The data indicated that nearly one-third of individuals with ID experienced at least one psychiatric symptom. The three most common psychiatric symptoms prevalent after one year were adjustment disorder, anxiety disorder, and somatoform disorder. Over the 1-year study period, approximately 40% of adults with ID reported experiencing PV. The most frequently reported types of PV were physical force (26%) and verbal victimization (22%). Polyvictimization was experienced by approximately a quarter of adults with ID. The findings suggest that PV is a common experience among adults in ID services. Thus, for a clearer understanding of mental health risks, caregivers should pay attention to adults with ID who experienced PV.
The Role of Walking in the Relationship between Catastrophizing and Fatigue in Women with Fibromyalgia
Authors: Sanromán Lucía , Catalá Patricia , Écija Carmen , Suso-Ribera Carlos , San Román Jesús , Peñacoba Cecilia
Published: April 2022

Walking is one of the most beneficial treatments for fibromyalgia patients. However, adherence to walking behavior is low due to the initially associated symptoms (including pain and fatigue). Although the association of catastrophism with greater symptoms is known, the results regarding fatigue have not always been consistent. Nevertheless, it is unknown whether the association between catastrophism and fatigue could, in turn, be conditioned by whether the patients walk or not. Therefore, our goal was to explore the moderating effect of walking on the association between catastrophizing and fatigue in patients with fibromyalgia. A cross-sectional study was carried out with 203 women with fibromyalgia. We used the Multidimensional Fatigue Inventory to assess fatigue and the Pain Catastrophizing Scale to assess pain catastrophizing (differentiating between its three dimensions). An ad hoc item was used to evaluate walking (moderator). Lower scores for fatigue and pain catastrophizing were found among patients who walked versus those who did not. Walking moderated the relationship between rumination and fatigue (Beta = 0.16, t = 1.96, p = 0.049) and between magnification and fatigue (Beta = 0.22, t = 21.83, p = 0.047). Helplessness showed no direct or interaction effect for fatigue. Nevertheless, higher rumination and magnification were associated with higher fatigue only in patients who walked. Therefore, to promote adherence to walking and reduce the effects of catastrophizing on fatigue, it seems necessary to manage rumination and magnification among patients who walk.
Practical Opportunities to Improve the Impact of Health Risk Assessment on Environmental and Public Health Decisions
Authors: Bizjak Tine , Kontić Davor , Kontić Branko
Published: April 2022

Following alerts about the diminishing role of health risk assessment (HRA) in informing public health decisions, this study examines specific HRA topics with the aim of identifying possible solutions for addressing this compelling situation. The study administered a survey among different groups of stakeholders involved in HRA or decision-making, or both. The responses show various understandings of HRA in the decision-making context—including confusion with the health impact assessment (HIA)—and confirm recurring foundational issues within the risk analysis field that contribute to the growth of inconsistency in the HRA praxis. This inconsistency lowers the effectiveness of HRA to perform its primary purpose of informing public health decisions. Opportunities for improving this situation come at the beginning of the assessment process, where greater attention should be given to defining the assessment and decision-making contexts. Both must reflect the concerns and expectations of the stakeholders regarding the needs and purpose of an HRA on one side, and the methodological and procedural topics relevant for the decision case at hand on the other. The HRA process should end with a decision follow-up step with targeted auditing and the participation of stakeholders to measure its success.
Dynamic Interactive Model of Sport Motivation
Authors: Tušak Matej , Corrado Donatella Di , Coco Marinella , Tušak Maks , Žilavec Iztok , Masten Robert
Published: April 2022

Motivation variables in 11 motivational instruments of 357 Slovenian male athletes (168 elite and 189 young athletes from age 12–14) in nine different sport disciplines (basketball, football, handball, water polo, ice hockey, ski jumping, alpine skiing, sport climbing, and judo) were obtained. Different concepts of motivation were researched, such as achievement motivation, incentive motivation, participation motivation, goal orientation, satisfaction and enjoyment in sport, self-efficacy, effort, and ability attributions. The most popular framework for motivation in sport lately has been social cognitive perspective. The aim of this study was to form a dynamic interactive model of sport motivation. We tried to upgrade different models of motivation to one unique meta model of sport motivation, which would explain possible behaviours and motivation in sport situations. Different statistic methods were used to define differences among young and elite athletes and between athletes in group and individual sports. The results show important differences among those groups and suggest that specific sport discipline also has a specific footprint inside motivation. Factor analysis and discriminant analysis were used to explore sport motivation space. The results also suggest that it is possible to define some main determinants of sport motivation that can be connected to previous models of sport motivation.
Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory
Authors: Wei Wenshuang , Zhang Miao , Zuo Dan , Li Qinmei , Zhang Min , Chen Xinguang , Yu Bin , Liu Qing
Published: April 2022

Colorectal cancer poses a serious threat worldwide. Although early screening has been proved to be the most effective way to prevent and control colorectal cancer, the current situation of colorectal cancer screening remains not optimistic. The aim of this article is to apply the protection motivation theory (PMT) to examine the influencing factors on screening intention of colorectal cancer (CRC). This cross-sectional survey was launched in five communities in Wuhan, China. All the eligible urban Chinese were recruited and interviewed using paper-and-pencil questionnaires. The intention of colorectal cancer screening (CRCS) was measured using six PMT subconstructs, including perceived risk, perceived severity, fear arousal, response efficacy, response cost, and self-efficacy. Data on sociodemographic variables and knowledge of CRC were also collected. The structural equation modeling (SEM) method was used for data analysis. Among all the 569 respondents, 83.66% expressed willingness to participate in CRCS. Data of the research fit the proposed SEM model well (Chi-square/df = 2.04, GFI = 0.93, AGFI = 0.91, CFI = 0.91, IFI = 0.91, RMSEA = 0.04). Two subconstructs of PMT (response efficacy and self-efficacy) and CRC knowledge were directly and positively associated with screening intention. Age, social status, medical history, physical activity, and CRC knowledge were indirectly related to the screening intention through at least one of the two PMT subconstructs (response efficacy and self-efficacy). The findings of this study suggest the significance of enhancing response efficacy and self-efficacy in motivating urban Chinese adults to participate in CRC screening. Knowledge of CRC is significantly associated with screening intention. This study can provide useful information for the formulation and improvement of colorectal cancer screening strategies and plans.
How Implicit Attitudes toward Vaccination Affect Vaccine Hesitancy and Behaviour: Developing and Validating the V-IRAP
Authors: Simione Luca , Vagni Monia , Maiorano Tiziana , Giostra Valeria , Pajardi Daniela
Published: April 2022

Vaccination is one of the most important ways of fighting infectious diseases, such as COVID-19. However, vaccine hesitancy and refusal can reduce adherence to vaccination campaigns, and therefore undermine their effectiveness. Although the scientific community has made great efforts to understand the psychological causes of vaccine hesitancy, studies on vaccine intention have usually relied on traditional detection techniques, such as questionnaires. Probing these constructs explicitly could be problematic due to defense mechanisms or social desirability. Thus, a measure capable of detecting implicit attitudes towards vaccination is needed. To achieve this aim, we designed and validated a new test called the Vaccine-IRAP, or V-IRAP, which is a modified version of the original Implicit Relational Assessment Procedure, or IRAP, task. The V-IRAP allows the unspoken reasons behind vaccine hesitancy to be investigated, and is able to distinguish between positive and negative beliefs on vaccination. The test was assessed in a sample of 151 participants. The V-IRAP showed good internal reliability and convergent validity, with meaningful correlational patterns with explicit measures. Moreover, it revealed incremental validity over such explicit measures. Lastly, the V-IRAP was able to shed light on the implicit attitudes involved in vaccine refusal, revealing negative attitudes relative to vaccine-related risks in non-vaccinated participants. Overall, these results support V-IRAP as a sensitive and reliable tool that could be used in future studies on implicit attitudes toward vaccination.
Modelling Maternal Depression: An Agent-Based Model to Examine the Complex Relationship between Relative Income and Depression
Authors: Benny Claire , Yamamoto Shelby , McDonald Sheila , Chari Radha , Pabayo Roman
Published: April 2022

Depression is a major public health concern among expectant mothers in Canada. Income inequality has been linked to depression, so interventions for reducing income inequality may reduce the prevalence of maternal depression. The current study aims to simulate the effects of government transfers and increases to minimum wage on depression in mothers. We used agent-based modelling techniques to identify the predicted effects of income inequality reducing programs on maternal depression. Model parameters were identified using the All Our Families cohort dataset and the existing literature. The mean age of our sample was 30 years. The sample was also predominantly white (78.6%) and had at least some post-secondary education (89.1%). When income was increased by just simulating an increase in minimum wage, the proportion of depressed mothers decreased by 2.9% (p < 0.005). Likewise, simulating the Canada Child Benefit resulted in a 5.0% decrease in the prevalence of depression (p < 0.001) and Ontario’s Universal Basic Income pilot project resulted in a simulated 5.6% decrease in the prevalence of depression (p < 0.001). We also assessed simulated changes to the mother’s social networks. Progressive income policies and increasing social networks are predicted to decrease the probability of depression.
Exploring Health Trends Prior to State Pension Age for The Netherlands up to 2040
Authors: van der Noordt Maaike , Polder Johan J. , Plasmans Marjanne H. D. , Hilderink Henk B. M. , Deeg Dorly J. H. , van Tilburg Theo G. , van der Pas Suzan , van der Lucht Fons
Published: April 2022

Background: In many Western countries, the state pension age is being raised to stimulate the extension of working lives. It is not yet well understood whether the health of older adults supports this increase. In this study, future health of Dutch adults aged 60 to 68 (i.e., the expected state pension age) is explored up to 2040. Methods: Data are from the Dutch Health Interview Survey 1990–2017 (N ≈ 10,000 yearly) and the Dutch Public Health Monitor 2016 (N = 205,151). Health is operationalized using combined scores of self-reported health and limitations in mobility, hearing or seeing. Categories are: good, moderate and poor health. Based on historical health trends, two scenarios are explored: a stable health trend (neither improving nor declining) and an improving health trend. Results: In 2040, the health distribution among men aged 60–68 is estimated to be 63–71% in good, 17–28% in moderate and 9–12% in poor health. Among women, this is estimated to be 64–69%, 17–24% and 12–14%, respectively. Conclusions: This study’s explorations suggest that a substantial share of people will be in moderate or poor health and, thus, may have difficulty continuing working. Policy aiming at sustainable employability will, therefore, remain important, even in the case of the most favorable scenario.
Adolescent COVID-19 Vaccine Decision-Making among Parents in Southern California
Authors: Hopfer Suellen , Fields Emilia J. , Ramirez Magdalen , Long Sorina Neang , Huszti Heather C. , Gombosev Adrijana , Boden-Albala Bernadette , Sorkin Dara H. , Cooper Dan M.
Published: April 2022

Adolescent COVID-19 vaccination has stalled at 53% in the United States. Vaccinating adolescents remains critical to preventing the continued transmission of COVID-19, the emergence of variants, and rare but serious disease in children, and it is the best preventive measure available to return to in-person schooling. We investigated parent–adolescent COVID-19 vaccine decision-making. Between 24 February and 15 March 2021, we conducted surveys and 12 focus groups with 46 parent–adolescent dyads in Southern California. Parents and adolescents completed a survey prior to participation in a focus group discussion, which focused on exploring COVID-19 vaccine acceptance or uncertainty and was guided by the 5C vaccine hesitancy model. Parents uncertain about vaccinating adolescents expressed low vaccine confidence and high COVID-19 disease risk complacency. Parents who accepted COVID-19 vaccination for adolescents expressed high confidence in health authority vaccine recommendations, high perceived COVID-19 risk, and collective responsibility to vaccinate children. Additionally, unique pandemic-related factors of vaccine acceptance included vaccinating for emotional health, resuming social activities, and vaccine mandates. Among parents, 46% were willing to vaccinate their adolescent, 11% were not, and 43% were unsure. Among adolescents, 63% were willing to vaccinate. Despite vaccine availability, 47% of adolescents remain unvaccinated against COVID-19. Factors associated with vaccine uncertainty and acceptability inform health care practitioner, school, community, and public health messaging to reach parents and adolescents.
Scope of Nursing Practice as Perceived by Nurses Working in Saudi Arabia
Authors: Aljohani Khalid A. , Alamri Majed S. , AL-Dossary Reem , Albaqawi Hamdan , Hosis Khaled Al , Aljohani Mohammed S. , Almadani Noura , Alrasheadi Bader , Falatah Rawaih , Almazan Joseph , Alharbi Jalal
Published: April 2022

The absence of scope of practice guidelines may lead to role ambiguity and legal consequences in nursing practice. This study measures the scope of practice of nurses in Saudi Arabia. The study utilized a descriptive cross-sectional design using an electronic version of the Arabic Actual Scope of Nursing Practice (A-ASCOP) questionnaire among 928 nurses. Descriptive analysis was followed by a t-test and an analysis of variance (ANOVA). Significance was assured through the Bonferroni test; the effect size was measured through partial η2 when appropriate. The A-ASCOP mean score of each dimension ranged from 4.29 to 4.72 (overall mean = 4.59). Significant overall ASCOP score variations were evident, with higher ASCOP among expatriate nurses, females, Hospital Operation Program (HOP) nurses, and nurses with postgraduate qualifications. Partial η2 showed a small effect of <0.016. Low-complexity nursing tasks showed insignificant differences no matter the nurse’s position, but were less practiced by Bachelor of Science in Nursing (BSN) and advanced-degree nurses than by those with a diploma education. High complexity of ASCOP was practiced significantly more often by postgraduate-prepared nurses than by diploma-educated nurses. The study showed that there is a range of variation in nursing practice, but that the lack of internal regulations (nursing scope of practice) has no effect on nursing duties. In a country such as Saudi Arabia, where massive national improvement initiatives are frequent, clearly defining the scope of practice for nurses is essential and needs to be done through government mandates. Further studies are essential to define what the scope of practice should include.
Fine Particulate Matter Exposure Levels in Patients with Normal-Tension Glaucoma and Primary Open-Angle Glaucoma: A Population-Based Study from Taiwan
Authors: Luo Ci-Wen , Chiang Yun-Wei , Sun Han-Yin , Yeh Kun-Lin , Lee Min-Wei , Wu Wen-Jun , Kuan Yu-Hsiang
Published: April 2022

Patients with NTG or POAG with more than one outpatient or discharge diagnosis from the ophthalmology department were included in the study. These data were merged with the PM2.5 data from the Air Quality Monitoring Network for analysis. This was a case–control study, with 1006 participants in the NTG group and 2533 in the POAG group. To investigate fine particulate matter (PM2.5) exposure levels in patients with normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG), patient data were obtained from Taiwan’s Longitudinal Health Insurance Database 2000 for the 2008 to 2013 period. We used a multivariate logic regression model to assess the risk for each participant. The PM2.5 exposure levels were divided into four groups: <25th percentile (Q1), <617 μg/mm3; 25th to 50th percentile (Q2), 617 to 1297 μg/mm3; 50th to 75th percentile (Q3), 1297 to 2113 μg/mm3; and >75th percentile (Q4), >2113 μg/mm3. The results are expressed in terms of odds ratio (OR) and 95% CI. A multiple logistic regression was used to compare the results of the NTG group with those of the POAG group. Compared with the PM2.5 Q1 level, the OR of the PM2.5 Q2 level was 1.009 (95% CI 0.812–1.254), the PM2.5 Q3 level was 1.241 (95% CI 1.241–1.537, p < 0.05), and the PM2.5 Q4 level was 1.246 (95% CI 1.008–1.539, p < 0.05). Our research reveals that compared with POAG, the risk of developing NTG is more closely related with PM2.5 exposure, and PM2.5 has a concentration–dose effect. It is hoped that in the future, in the clinical judgment of NTG and POAG, the level of PM2.5 in the environment can be taken as a risk factor.
Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019–2021
Authors: Arriaga Miguel , Francisco Rita , Nogueira Paulo , Oliveira Jorge , Silva Carlota , Câmara Gisele , Sørensen Kristine , Dietscher Christina , Costa Andreia
Published: April 2022

Health literacy entails the knowledge, motivation, and competencies to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life throughout the life course. It has become an essential concept in public health. It is considered a modifiable determinant of health decisions, health behaviors, health, and healthcare outcomes. Prior studies suggest highly variable levels of health literacy across European countries. Assessing and monitoring health literacy is critical to support interventions and policies to improve health literacy. This study aimed to describe the process of adaptation to Portugal of the short-form version of the Health Literacy Survey (HLS19-Q12) from the Health Literacy Population Survey Project 2019–2021, also establishing the health literacy levels in the Portuguese population. The sample comprised 1247 valid cases. The survey consisted of a brief questionnaire on the determinants of health literacy, plus the HLS19-Q12 questionnaire and the specific health literacies packages on digital health literacy, navigational health literacy, and vaccination health literacy. The results suggest that 7 out of 10 people in Portugal (mainland) have high health literacy levels and support the results of other studies concerning the main socioeconomic determinants of general health literacy. Furthermore, the results suggest that “navigation in the health system” tasks are the most challenging tasks regarding specific health literacies. The overall data suggest the HLS19-Q12 as a feasible measure to assess health literacy in the Portuguese population. Thus, it can be used in Portugal to assess the population’s needs and monitor and evaluate policies and initiatives to promote health literacy by addressing its societal, environmental, personal, and situational modifiable determinant factors.
The Challenge: Equal Availability to Palliative Care According to Individual Need Regardless of Age, Diagnosis, Geographical Location, and Care Level
Authors: Axelsson Bertil
Published: April 2022

The European Council, the World Health Organization, the International Association of Hospice and Palliative Care, and various other national guidelines emphasize equal provision of palliative care. To fulfill this vision, all involved need to be aware of the existing situation even in western European countries. Data from the European Atlas of Palliative Care and the Swedish Registry of Palliative Care are used to illustrate the present inequalities. The data illustrate the unequal provision of palliative care relating to level of care, place of residence, diagnoses, and age. The challenge of providing equal palliative care remains, even in Western European countries, in spite of all positive developments. Different approaches that may contribute to successful implementation of equal palliative care are discussed. The challenge is still there and will require some effort to resolve.
Risk Factors Based on Analysis of Injury Mechanism and Protective Equipment for Ice Hockey Amateur Players
Authors: Jin Heejae , Lee Hyojeong
Published: April 2022

Considering the increasing popularity of ice hockey in South Korea, types of injuries and protective equipment for amateur club members need to be further studied. The purpose of the study is to investigate various injuries and protective equipment used by amateur players and to analyze different risk factors by collecting information on areas of injury and their mechanisms. The online survey for 102 participants was designed to address the general information of participants, types of injuries, information about ice hockey equipment, and open-ended questions about injuries and equipment. We conducted in-depth face-to-face interviews with five players about their experiences with injury and opinions about the protective equipment. In total, 60% of the survey participants had experienced injuries, including to the knee (22.6%), shoulder (21.6%), ankle (20.6%), and wrist (14.7%), in order of frequency. Types of injury included sprain (33.3%), contusion (31.4%), fracture (17.7%), abrasion (10.8%), and concussion (0.9%). Injury mechanisms included instances in which those with less proficiency in skating would be injured initially from player-to-player contact, and from landing on the ice or crashing into the fence afterward. We acknowledged how important wearing correctly sized equipment is for protection, and we highlighted the need to develop protective gear that accommodates Asian body measurements.
Perspectives and Views of Primary Care Professionals Regarding DiabeText, a New mHealth Intervention to Support Adherence to Antidiabetic Medication in Spain: A Qualitative Study
Authors: Zamanillo-Campos Rocío , Serrano-Ripoll Maria Jesús , Taltavull-Aparicio Joana Maria , Gervilla-García Elena , Ripoll Joana , Fiol-deRoque Maria Antonia , Boylan Anne-Marie , Ricci-Cabello Ignacio
Published: April 2022

Background: Antidiabetic medication is effective in preventing diabetes-related complications. However, 40% of type 2 diabetic patients do not adhere to their medication regimes adequately. Brief text messages represent a promising approach to support medication adherence. The aim of this study was to explore the perspectives of primary care professionals (PCPs) concerning the DiabeText intervention, a new text messaging intervention to be developed to support medication adherence in people with type 2 diabetes (T2D) in Mallorca, Spain. Methods: We conducted four focus groups (n = 28) and eight semi-structured interviews with doctors and nurses. Data collection and analysis were carried out by researchers independently following Braun and Clark’s methodology. Results: Three main themes were identified: (1) text messaging interventions have the potential to effectively support diabetes self-management; (2) involving PCPs in the intervention would facilitate its design and implementation; (3) obtaining evidence supporting the cost-effectiveness is a key prerequisite for large-scale implementation of the intervention. PCPs identified barriers and enablers of the design and implementation of the intervention and made suggestions about the content and format of the text messages. Conclusion: The DiabeText intervention is perceived as useful and acceptable by PCPs provided its cost-effectiveness.
Body Fat Percentage and Normal-Weight Obesity in the Chinese Population: Development of a Simple Evaluation Indicator Using Anthropometric Measurements
Authors: Zhu Yuetong , Wang Zimin , Maruyama Hitoshi , Onoda Ko , Huang Qiuchen
Published: April 2022

Few studies explore the associations between body fat percentage (BFP) prediction and evaluation indicators for Chinese with normal-weight obesity. We aimed to explore convenient and cost-free BFP evaluation indicators to routinely monitor BFP status in Chinese patients with normal-weight obesity. Participants (N = 164) were divided into three groups according to body mass index (BMI) and BFP: normal-weight lean, normal-weight obese, and overweight and obese. Differences in body composition and circumference were compared to examine the relationship between BFP and circumference, determine a simple evaluation indicator reflecting BFP, and identify cutoff values for normal-weight obesity circumference. Significant differences in body composition and circumference were observed among the three groups. The correlation between thigh/height, hip/height, (hip + waist)/height, and BFP was stronger than that with BMI. The (hip + waist)/height ratio was the indicator most reflective of BFP (95% confidence interval: 3.004–9.018, p = 0.013), and a ratio above 1.115 (95% confidence interval: 0.936–0.992, p < 0.001) was predictive of normal-weight obesity. Furthermore, we suggest that the upper value for a normal BMI in Chinese individuals be lowered to 23.4 kg/m2 (95% confidence interval: 0.984–0.999, p < 0.001). The (hip + waist)/height ratio can be used with body mass index for a more accurate evaluations of BFP abnormalities and health risks.