bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health status and use of medication and their association with migration related exposures among Syrian refugees in Lebanon and Norway: a cross-sectional study
Authors: Strømme Elisabeth Marie , Haj-Younes Jasmin , Hasha Wegdan , Fadnes Lars T. , Kumar Bernadette , Igland Jannicke , Diaz Esperanza 
Published: March 2020

Abstract
Background
The health of forcibly displaced individuals changes along their migration path and estimates of disease burden are essential to develop health care policies and practices adequately corresponding to their health care needs. This study aims to describe the health status and use of medication among Syrian refugees in two different migration phases: in a transit setting and in a recipient country. Further, we aim to investigate the associations between migration related exposures and both chronic pain and mental health among Syrian refugees.

Methods
This is a cross-sectional study based on survey data collected among 827 adult Syrian refugees in Lebanon and Norway during 2017–2018. The survey instrument included items measuring somatic status (including chronic pain), mental health (using the HSCL-10 and HTQ items), use of medication and migration related exposures. We used descriptive statistics to calculate standardised prevalence proportions and regression analyses to study associations between migration related exposures and health outcomes.

Results
The response rate was 85%. The mean age in the sample was 33 years and 41% were women. Half of the participants reported that they had never had any health problems. The prevalence of non-communicable diseases was 12%. Headache and musculoskeletal complaints were the most prevalent conditions reported, with 30% reporting chronic pain lasting for more than six months. Symptoms indicating anxiety and/or depression were presented by 35%, while 7% revealed symptoms compatible with post-traumatic stress disorder. Among those reporting non-communicable diseases a substantial share did not seem to receive adequate treatment. Trauma experiences were associated with both chronic pain and anxiety/depression symptoms, and the latter were also associated with migrating without family members.

Conclusions
Migrant-friendly public health policies and practises should acknowledge migration related risks, address discontinuity in care of chronic conditions and target common complaints such as chronic pain and mental health problems among forcibly displaced individuals.
The application of metagenomic next-generation sequencing in diagnosing Chlamydia psittaci pneumonia: a report of five cases
Authors: Gu Lei , Liu Wei , Ru Meng , Lin Jing , Yu Guoqing , Ye Jia , Zhu Zheng-an , Liu Yuebin , Chen Jian , Lai Guoxiang , Wen Wen 
Published: March 2020

Abstract
Background
Chlamydia psittaci pneumonia is a zoonotic infectious disease caused by Chlamydia psittaci. Diagnostic tools, including culture, serologic test and PCR-based methods, are available but prone to false negative results.

Case presentation
This report included five cases of Chlamydia psittaci pneumonia. Symptoms and signs common to all 5 cases included fever, coughing, generalized muscle ache, and most notably, inflammatory infiltration of the lungs upon chest CT and X-ray. Metagenomic next-generation sequencing (mNGS) revealed the presence of Chlamydia psittaci in biopsy lung tissue in 3 cases and bronchoalveolar lavage fluid in the remaining 2 cases. Three patients responded to doxycycline plus moxifloxacin; two patients responded to moxifloxacin alone.

Conclusions
mNGS could be used to diagnose Chlamydia psittaci pneumonia.
Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population
Authors: Glans Martin , Humble Mats B. , Elwin Marie , Bejerot Susanne 
Published: March 2020

AbstractBackgroundThe conventional way to identify generalised joint hypermobility is by a physical examination according to the Beighton Score. However, a physical examination is time-consuming in clinical practise and may be unfeasible in population-based studies. The self-assessment five-part questionnaire on hypermobility (5PQ) offers a more practicable way to identify GJH. The aim of this study was to test validity and reliability of the five-part questionnaire on hypermobility (5PQ) translated into Swedish on a non-clinical adult population.MethodsA structured procedure was used for the translation of the 5PQ into Swedish. The Beighton Score was used as reference standard for generalised joint hypermobility. Test-retest reliability was tested in a separate group who filled in the questionnaire twice with a ten-week interval. Participants consisted of a convenience sample recruited in Stockholm, Sweden (2017).ResultsA total of 328 participants were included in the study, 297 participants in the validity group and 31 participants in the reliability group. When evaluated against a present Beighton Score with an age-dependent cut-off, the Swedish 5PQ attained a sensitivity of 91%, a specificity of 75% and an area under the curve of 0.87. The Swedish 5PQ showed substantial to almost perfect test-retest reliability.ConclusionsThe Swedish 5PQ is a valid and reliable instrument to screen for or to identify generalised joint hypermobility.
Contextual and individual determinants of tooth loss in adults: a multilevel study
Authors: Roberto Luana Leal , Silveira Marise Fagundes , de Paula Alfredo Mauricio Batista , Ferreira e Ferreira Efigênia , Martins Andréa Maria Eleutério de Barros Li , Haikal Desirée Sant’ana 
Published: March 2020

Abstract
Background
Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35–44 years of age), in accordance with individual and contextual social characteristics.

Methods
This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated.

Results
Brazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males.

Conclusions
The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.
An integrative review on the information and communication needs of parents of children with cancer regarding the use of complementary and alternative medicine
Authors: Stub Trine , Kristoffersen Agnete E. , Overvåg Grete , Jong Miek C. 
Published: March 2020

AbstractBackgroundParents often choose Complementary and Alternative Medicine (CAM) as a supportive agent with the aim to reduce cancer treatment-related symptoms in their children. Therefore, it is necessary to understand parents´ information and communication needs regarding CAM. The aim of the present study was to review the research literature as to identify the information and communication needs of parents of children with cancer, and the children themselves, regarding the use of CAM.MethodsAn integrative systematic review design was chosen. Searches were performed in AMED, CAMbase, CINAHL (Ebsco), EMBASE, PubMed and PsycInfo, Theme eJournals and Karger. The search was limited to studies published in English, German, Dutch, and the Scandinavian languages. Using predefined inclusion and exclusion criteria, two reviewers independently screened the title and abstracts of the relevant papers. A data extraction form and critical appraisal checklists were used to extract data for analysis, and a mixed methods synthesis was applied.ResultsOut of 24 studies included, 67% were of quantitative and 33% of qualitative study design. Five main themes emerged from the analysis of 21 studies: Information on CAM, sources of CAM information, communication about CAM, informed decision-making on CAM, and Risk/benefit of CAM. The majority of the parents did not disclose the CAM use of their children because they feared negative reactions from the attending oncologist. To make informed treatment decisions for their children, parents wanted unbiased information about CAM and would act accordingly. They demand open communication about these modalities and respect for the family’s autonomy when choosing CAM for their children.ConclusionThere is an urgent need for parents of children with cancer for high quality information on CAM from reliable and scientific sources. Development of authoritative evidence-based decision tools is thus warranted to enable health care professionals and parents of children with cancer to make well informed, individual decisions concerning CAM.
Existing contradictions and suggestions: flipped classroom in radiology courses of musculoskeletal disease under Chinese medical educational mode from medical imaging student perspective
Authors: Wu Su , Pan Shinong , Ren Ying , Yu Hong , Chen Qi , Liu Zhaoyu , Guo Qiyong 
Published: March 2020

Abstract
Background
Flipped classrooms have already begun to be used in many universities aboard, and they now make up for some of the short comings of the traditional classroom. We introduced the concept of flipped classrooms into a radiology class in China and evaluated the students’ performance to find out whether it was a better learning method. Furthermore, we have attempted to identify the problems of application of flipped classrooms (as practiced under the Chinese education system) and make suggestions.

Methods
Facilities made videos and prepared clinical cases and short lectures for the flipped classroom. A total of 55 undergraduate radiology students were asked to finish pre-class learning and pre-learning assessment, participate in a flipped classroom about bone malignant tumours, and complete questionnaires. Teachers were also need to finish the survey.

Results

The students showed good performances in the pre-learning assessment. The mean scores for three pre-learning assessment were 89.77, 96.54, and 93.71, respectively; the median scores were 90, 97.5, and 94, respectively.

After they attended the flipped classroom, their mastery of knowledge (case-solving skills, basic feature command, comparison ability, and overall knowledge command) showed improvements; after flipped classroom, the scores for these knowledge factors improved to 81.25, 85.42, 85.42, and 85.42%, respectively, compared to the scores they obtained before taking the flipped classroom (1.25, 68.75, 64.58, and 72.92% respectively).

The students’ discussion time and student-teacher-communication time increased, and the students’ questions were solved satisfactorily.

CTDI-CV showed no improvement in critical thinking skills after taking the course.

The time spent in previewing (pre-class video watching, material reading, and pre-learning assessment) increased significantly.

Conclusions
Flipped classrooms, when tested in a radiology classroom setting, show many advantages, making up for some inadequacies of didactic classrooms. They provide students with better learning experiences. We can continue to practice flipped classroom methods under the curriculum, but we still need to make improvements to make it more suitable for the Chinese medical education mode.
Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data
Authors: Kim Yunmi , Kim Hyun-Young , Cho Eunyoung 
Published: March 2020

Abstract
Background
The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. However, less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Therefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery using national administrative data.

Methods
The study analyzed data from 129,923 patients who underwent surgery between January 2014 and December 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5–3.4), level 3 (3.5–4.4), and level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the association between the bed-to-nurse ratio and 30-day post-discharge mortality.

Results
1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in hospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8% in hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower at hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference.

Conclusion
The results of this study are highly meaningful in that they underscore the necessity of in-hospital discharge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk. Furthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need for a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea, and thereby to enhance patient outcomes.
IMPlementation of An online Relatives’ Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use
Authors: Lobban Fiona , Appelbe Duncan , Appleton Victoria , Billsborough Julie , Fisher Naomi Ruth , Foster Sheena , Gill Bethany , Glentworth David , Harrop Chris , Johnson Sonia , Jones Steven H. , Kovacs Tibor Zoltan , Lewis Elizabeth , Mezes Barbara , Morton Charlotte , Murray Elizabeth , O’Hanlon Puffin , Pinfold Vanessa , Rycroft-Malone Jo , Siddle Ronald , Smith Jo , Sutton Chris J. , Viglienghi Pietro , Walker Andrew 
Published: March 2020

Abstract
Background
Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.

Methods
A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.

Results
In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT’s long-term availability.

Conclusions
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.

Trial registration
Study registration: ISCTRN 16267685.
A citizen science study of short physical activity breaks at school: improvements in cognition and wellbeing with self-paced activity
Authors: Booth Josephine N. , Chesham Ross A. , Brooks Naomi E. , Gorely Trish , Moran Colin N. 
Published: March 2020

Abstract
Background
School-based physical activity and running programmes, such as The Daily Mile™, are increasing in popularity globally. The aim of this research was to examine the acute impact of such classroom physical activity breaks on cognition and affective wellbeing.

Methods
A total of 5463 school pupils from 332 schools took part in a citizen science project with a repeated measures design. They completed tasks of cognition (inhibition, verbal, and visuo-spatial working memory) and the Children’s Feeling Scale and Felt Arousal Scale before and after three different outdoor activities: a classroom break of 15 min of self-paced activity, a near maximal exhaustion activity (the bleep test), and a no-exercise control group where pupils sat or stood outside. Wellbeing and fitness were examined as mediators of the relationship between outdoor activity and cognition.

Results
Fifteen minutes of self-paced outdoor activity was beneficial for pupils’ cognition and wellbeing in comparison to both other activities (Cohen’s d effect sizes ranging from 0.04 to 0.22; small). The relationship with cognition was not mediated by participants’ fitness level and was only partially mediated by wellbeing. Change scores for alertness were higher after the bleep test compared to the control activity but similar for all other outcomes.

Conclusions
Taking a break from the classroom to complete 15 min of self-paced physical activity should be considered a worthwhile activity by class teachers, school management, and policymakers. Additionally, more intense physical activity should not be considered to be detrimental.
Functions and properties of nuclear lncRNAs—from systematically mapping the interactomes of lncRNAs
Authors: Guh Chia-Yu , Hsieh Yu-Hung , Chu Hsueh-Ping 
Published: March 2020

AbstractProtein and DNA have been considered as the major components of chromatin. But beyond that, an increasing number of studies show that RNA occupies a large amount of chromatin and acts as a regulator of nuclear architecture. A significant fraction of long non-coding RNAs (lncRNAs) prefers to stay in the nucleus and cooperate with protein complexes to modulate epigenetic regulation, phase separation, compartment formation, and nuclear organization. An RNA strand also can invade into double-stranded DNA to form RNA:DNA hybrids (R-loops) in living cells, contributing to the regulation of gene expression and genomic instability. In this review, we discuss how nuclear lncRNAs orchestrate cellular processes through their interactions with proteins and DNA and summarize the recent genome-wide techniques to study the functions of lncRNAs by revealing their interactomes in vivo.
Health, income and poverty: evidence from China’s rural household survey
Authors: Zhou Yang , Guo Yuanzhi , Liu Yansui 
Published: March 2020

AbstractBackgroundUnderstanding the health status of the poor households and the influence of unhealthy on their income can provide some vital insights into the effectiveness and appropriateness of poverty reduction solutions.MethodsBased on a nationwide cross-sectional survey of 29,712 rural poor households, this study systematically investigated the causes of poverty and health status of Chinese rural poor households, and revealed the relationship between health, income and poverty.ResultsThe health status of the rural poor in China is not optimistic, with 51.63% attributing their poverty to the illness of household members. NCDs are the biggest health threat to the rural poor in China. Over 60% of all the households have at least one patient and more than a quarter of the households with patients cannot afford expensive medical expenses. Although 98% of all the households participate in China’s a rural health insurance system - the New Rural Cooperative Medical Scheme - 16% are still unable to bear their medical expenses after reimbursement from the scheme. Further, high altitude, ill-health and low-income are interlinked and mutually reinforcing. The per capita net income of poor households was inversely proportional to the altitude of their places of residence, family aging and unhealthy status, but was positively correlated with the number of workforces in their families.ConclusionsPoverty due to illness is one of the root causes of rural poverty in China. With the backward medical infrastructure in high altitude areas, people are more prone to fall into the vicious circle of poverty-unhealthy-low income-poverty. The establishment of effective long-term mechanism of disease prevention and intervention is an important prerequisite to enhance the endogenous development power of the poor and reduce poverty.