bluuebunny/crossref_metadata_2025_split huggingface dataset:
Too young for Cannabis? Choice of minimum legal age for legalized non-medical Cannabis in Canada
Authors: Nguyen Hai V. , Bornstein Stephen , Gamble John-Michael , Mathews Maria , Bishop Lisa , Mital Shweta 
Published: May 2020

Abstract
Background
Choice of minimum legal age (MLA) for cannabis use is a critical and contentious issue in legalization of non-medical cannabis. In Canada where non-medical cannabis was recently legalized in October 2018, the federal government recommended age 18, the medical community argued for 21 or even 25, while public consultations led most Canadian provinces to adopt age 19. However, no research has compared later life outcomes of first using cannabis at these different ages to assess their merits as MLAs.

Methods
We used doubly robust regression techniques and data from nationally representative Canadian surveys to compare educational attainment, cigarette smoking, self-reported general and mental health associated with different ages of first cannabis use.

Results
We found different MLAs for different outcomes: 21 for educational attainment, 19 for cigarette smoking and mental health and 18 for general health. Assuming equal weight for these individual outcomes, the ‘overall’ MLA for cannabis use was estimated to be 19 years. Our results were robust to various robustness checks.

Conclusion
Our study indicated that there is merit in setting 19 years as MLA for non-medical cannabis.
Decreasing employees’ work stress by a participatory, organizational level work stress prevention approach: a multiple-case study in primary education
Authors: Bakhuys Roozeboom Maartje C. , Schelvis Roosmarijn M. C. , Houtman Irene L. D. , Wiezer Noortje M. , Bongers Paulien M. 
Published: May 2020

AbstractBackgroundWork stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education.MethodsThis study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors.ResultsMultilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands.ConclusionThe study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction.Trial registrationISRCTN registry, study ID:ISRCTN14697835, registration date: 11-10-2019 (retrospectively registered).
MicroRNA-532-5p is implicated in the regulation of osteoporosis by forkhead box O1 and osteoblast differentiation
Authors: Guo Xinyu , Wei Shijun , Xu Feng , Cai Xianhua , Wang Huasong , Ding Ran 
Published: May 2020

Abstract
Background
MicroRNAs (miRNAs) are critical regulators in osteogenesis and cartilage formation. This study was designed to investigate whether miR-532-5p plays a role in the regulation of osteoporosis.

Methods
Osteoporotic fractures (OP group, n = 10) or osteoarthritis without osteoporosis (control group, n = 10) were selected as subjects in this study. Quantitative analysis of gene expression was performed by RT-PCR. Western blot was used to determine the expression levels of protein forkhead O1 (FOXO1). Bioinformatics analyses and luciferase reporter assay were used to verify the downstream target of miR-532-5p.

Results
Compared with the non-osteoporotic controls, miR-532-5p was upregulated in osteoporotic samples, and expression of miR-532-5p was downregulated in the osteogenic C2C12 cell model. Overexpression of miR-532-5p resulted in decreased expression levels of key osteoblast markers, including alkaline phosphatase (ALP), osteocalcin (OC), and collagen type I alpha 1 (COL1A1). The inhibitory results of miR-532-5p were reversed. MiR-532-5p contained a putative FOXO1 binding site. Moreover, miR-532-5p inhibited the expression of FOXO1, and overexpression of FOXO1 inhibited the effect of miR-532-5p on osteoblast markers.

Conclusions
MiR-532-5p can provide references to osteoporosis by regulating the expression of FOXO1 and osteoblast differentiation. MiR-532-5p might serve as a therapeutic target for osteoporosis.
Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data
Authors: Herman Patricia M. , Edgington Sarah E. , Hurwitz Eric L. , Coulter Ian D. 
Published: May 2020

Abstract
Background
Chronic spinal pain is prevalent, expensive and long-lasting. Several provider-based nonpharmacologic therapies have now been recommended for chronic low-back pain (CLBP) and chronic neck pain (CNP). However, healthcare and coverage policies provide little guidance or evidence regarding the long-term use of this care. To provide one glimpse into the long-term use of nonpharmacologic provider-based care, this study examines the predictors of visit frequency in a large sample of patients with CLBP and CNP using ongoing chiropractic care.

Methods
Observational data were collected from a large national sample of chiropractic patients in the US with non-specific CLBP and CNP. Visit frequency was defined as average number of chiropractic visits per month over the 3-month study period. Potential baseline predictor variables were entered into two sets of multi-level models according to a defined causal theory—in this case, Anderson’s Behavioral Model of Health Services Use.

Results
Our sample included 852 patients with CLBP and 705 with CNP. Visit frequency varied significantly by chiropractor/clinic, so our models controlled for this clustering. Patients with either condition used an average of 2.3 visits per month. In the final models visit frequency increased (0.44 visits per month, p = .008) for those with CLBP and some coverage for chiropractic, but coverage had little effect on visits for patients with CNP. Patients with worse function or just starting care also had more visits and those near to ending care had fewer visits. However, visit frequency was also determined by the chiropractor/clinic where treatment was received. Chiropractors who reported seeing more patients per day also had patients with higher visit frequency, and the patients of chiropractors with 20 to 30 years of experience had fewer visits per month. In addition, after controlling for both patient and chiropractor characteristics, the state in which care was received made a difference, likely through state-level policies and regulations.

Conclusions
Chiropractic patients with CLBP and CNP use a range of visit frequencies for their ongoing care. The predictors of these frequencies could be useful for understanding and developing policies for ongoing provider-based care.
Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer
Authors: Su Hao , Wu Hongliang , Bao Mandula , Luo Shou , Wang Xuewei , Zhao Chuanduo , Liu Qian , Wang Xishan , Zhou Zhixiang , Zhou Haitao 
Published: May 2020

Abstract
Background
To retrospectively evaluate the feasibility and safety of intraoperative assessment of bowel perfusion in totally laparoscopic surgery for colon cancer using indocyanine green fluorescence imaging (IGFI).

Methods
From October 2017 to June 2019, consecutive patients with colon cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the IGFI group (n = 84) and control group (n = 105). In the IGFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.

Results
The two groups were demographically comparable. The IGFI group exhibited a significantly shorter operative time (p = 0.0374) while intraoperative blood loss did not significantly differ among the groups (p = 0.062). In the IGFI group, average time to perfusion fluorescence was 48.4 ± 14.0 s after ICG injection, and four patients (4.8%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected. There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (p>0.05).

Conclusion
IGFI shows promise as a safe and feasible tool to assess bowel perfusion during a totally laparoscopic surgery for colon cancer and may reduce the operative time.
Successful surgical treatment of Cronkhite-Canada Syndrome with bilateral flail chest: a case report
Authors: Lv Guang-chao , Li Zhi-hong , Duan Zong-sheng , Niu Chun-bo , Li Ming-he , Wang Kai-zhong , Jiang Jin-dong 
Published: May 2020

AbstractBackgroundDevelopment of multiple rib fractures leading to bilateral flail chest in Cronkhite–Canada Syndrome (CCS) has not been reported.Case presentationA 59-year-old man presented with complaints of fatigue, chest pain, respiratory distress and orthopnea requiring ventilatory support to maintain oxygenation. CCS with bilateral anterior and posterior flail chest due to multiple rib fractures (2nd-10th on the right side and 2nd-11th on the left side). He underwent open reduction and anterior and posterior internal fixation using a titanium alloy fixator and a nickel-titanium memory alloy embracing fixator for chest wall reconstruction. He recovered gradually from the ventilator and showed improvement in his symptoms. He gained about 20 kg of weight in the follow up period (6 months after discharge from the hospital).ConclusionCCS is a rare, complex disease that increases the risk of developing multiple rib fractures, which can be successfully treated with open reduction and internal fixation.
Role of nurses in medication management at the end of life: a qualitative interview study
Authors: Huisman Bregje A. A. , Geijteman Eric C. T. , Dees Marianne K. , Schonewille Noralie N. , Wieles Margriet , van Zuylen Lia , Szadek Karolina M. , van der Heide Agnes 
Published: May 2020

AbstractBackgroundPatients in the last phase of their lives often use many medications. Physicians tend to lack awareness that reviewing the usefulness of medication at the end of patients’ lives is important. The aim of this study is to gain insight into the perspectives of patients, informal caregivers, nurses and physicians on the role of nurses in medication management at the end of life.MethodsSemi-structured interviews were conducted with patients in the last phase of their lives, in hospitals, hospices and at home; and with their informal caregivers, nurses and physicians. Data were qualitatively analyzed using the constant comparative method.ResultsSeventy-six interviews were conducted, with 17 patients, 12 informal caregivers, 15 nurses, 20 (trainee) medical specialists and 12 family physicians. Participants agreed that the role of the nurse in medication management includes: 1) informing, 2) supporting, 3) representing and 4) involving the patient, their informal caregivers and physicians in medication management. Nurses have a particular role in continuity of care and proximity to the patient. They are expected to contribute to a multidimensional assessment and approach, which is important for promoting patients’ interest in medication management at the end of life.ConclusionsWe found that nurses can and should play an important role in medication management at the end of life by informing, supporting, representing and involving all relevant parties. Physicians should appreciate nurses’ input to optimize medication management in patients at the end of life. Health care professionals should recognize the role the nurses can have in promoting patients’ interest in medication management at the end of life. Nurses should be reinforced by education and training to take up this role.
General and reproductive health outcomes among female greenhouse workers: a comparative study
Authors: Rahimi Tahereh , Rafati Foozieh , Sharifi Hamid , Seyedi Fatemeh 
Published: May 2020

Abstract
Background
Agricultural activities as well as exposure to pesticides could have many adverse effects on health status and reproductive outcomes especially in reproductive aged greenhouse workers. The present study aimed to compare the general and reproductive health outcomes between female greenhouse workers and housewives.

Methods
This cross-sectional study was conducted on 645 females of reproductive age. They were categorized into two groups according to occupation in greenhouse (308 female greenhouse workers as exposed group and 337 housewives as control group). Participants were interviewed using a questionnaire about reproductive outcomes and occupational status. Clinical measures include blood pressure (BP), pulse and respiratory rate (PR and RR), body mass index (BMI) and hematological parameters. Mann-Whitney U test was used to assess differences between two groups in quantitative variables. Chi-square or Fisher’s exact tests was used to determine the differences in the distribution of categorical variables. Data was analyzed using SPSS software version 16.

Results
The average daily working hours of the greenhouse workers were 6.94 ± 1.99 h. Only 44.3% of them used personal protective equipment. Data revealed that the rate of spontaneous abortion, infertility, low birth weight (LBW), abnormal births and preterm birth were significantly higher among the greenhouse workers compared to the control group (p ≤ 0.05). The average number of female infants in greenhouse workers was significantly higher than the control group (p ≤ 0.05). Clinical measurements indicated an increase in RR of greenhouse workers and mean of BMI was decreased in them. Hematological parameters demonstrated that there was a significant increase in white blood cells (WBC) and significant decrease in hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) among the female greenhouse workers compared to the control (p ≤ 0.05).

Conclusion
Local government efforts is needed to address associated issues including acute effects on health and long-term health risks, resulting from pesticide exposure to greenhouse workers, and gender differences should be considered. Also, occupational health and safety training is necessary and can be helpful in reducing adverse reproductive outcomes.
Predictive validity of the National Benchmark Test and National Senior Certificate for the academic success of first-year medical students at one South African university
Authors: Mabizela Sfiso Emmanuel , George Ann Zeta 
Published: May 2020

AbstractBackgroundSouth African medical schools use the results of the National Senior Certificate (NSC) examination for selecting students. Five of the nine medical schools also use the National Benchmark Test (NBT). The University of the Witwatersrand weights the NSC and NBT results equally in the selection process. This study addresses the predictive validity of the NBT and NSC for academic success. The association between the NBT proficiency levels and students’ progression outcomes was also investigated.MethodsData obtained from the University’s Business Intelligence Services for 1652 first-year medical students from 2011 to 2017 were analysed using hierarchical regression models and chi-square tests. The three NBT domains and four of the NSC subjects were the independent variables in the regression models, with the first-year grade point average for students who passed the first year as the dependant variable. The NBT performance levels and first-year progression outcome (passed, failed, or cancelled) were used in the chi-square analysis. Frequency tables were used to describe the cohort’s demographic details and NBT results. Crosstabs were used to analyse student performance according to the school quintile system.ResultsThe three NBT domains explained 26% of the variance, which was statistically significant,R2 = 0.263,F(3, 1232) = 146.78,p < 0.000. When the NSC subjects (Life Sciences, English, Mathematics, and Physical Science) were added to the regression equation, they accounted for an additional 19% of the variance,R2 = 0.188,F(3, 1229) = 137.14,p < 0.000. All independent variables contributed 45% of the variance,R2 = 0.451,F(6, 1229) = 166.29,p < 0.000. A strong association between the NBT proficiency levels and first-year students’ progression outcomes was observed.ConclusionThe NBT results, when weighted equally to the NSC results, explained more variance than the NSC alone in predicting academic success in the first year of the medical degree. The NBT should not only be used for selecting medical students but should also be used to place students with lower entry-level skills in appropriate foundation programmes and to identify students who are admitted to regular programmes who may need additional support.
Concept analysis of community health outreach
Authors: Shin Hye Young , Kim Ka Young , Kang Purum 
Published: May 2020

Abstract
Background
The definition of community health outreach to promote the health of vulnerable populations depends heavily on the particulars of the given health project and community. There is no consistency in the definitions attached to the concept itself. Our study aimed to clarify the general definition of community health outreach to facilitate its understanding and use.

Methods
Walker and Avant’s (2010) method of concept analysis was used to understand community health outreach. A total of 45 articles were included in the analysis after having searched for text on database portals like PubMed, Scopus, CINAHL complete and EMBASE published between 2010 and 2018.

Results
The defining attributes of the concept of community health outreach were purposive, temporary, mobile and collaboration with community. The antecedents were population facing health risks and awareness of health risks. The consequences were increased accessibility and health promotion.

Conclusion
This study proposed the definition of community health outreach as a temporary, mobile project that involves the collaboration of a community to undertake its purposeful health intervention of reaching a population facing health risks. This definition provides a general understanding of the outreach undertaken by health workers and enables the strong connection between health professionals and community residents.
Development of a complex community pharmacy intervention package using theory-based behaviour change techniques to improve older adults’ medication adherence
Authors: Patton D. E. , Ryan C. , Hughes C. M. 
Published: May 2020

Abstract
Background
To improve the effectiveness of interventions targeting non-adherence in older adults, a systematic approach to intervention design is required. The content of complex interventions and design decisions are often poorly described in published reports which makes it difficult to explore why they are ineffective. This intervention development study reports on the design of a community pharmacy-based adherence intervention using 11 Behaviour Change Techniques (BCTs) which were identified from previous qualitative research with older patients using the Theoretical Domains Framework.

Methods
Using a group consensus approach, a five-step design process was employed. This focused on decisions regarding: (1) the overall delivery format, (2) formats for delivering each BCT; (3) methods for tailoring BCTs to individual patients; (4) intervention structure; and (5) materials to support intervention delivery. The APEASE (Affordability; Practicability; Effectiveness/cost-effectiveness; Acceptability; Side effects/safety; Equity) criteria guided the selection of BCT delivery formats.

Results
Formats for delivering the 11 BCTs were agreed upon, for example, a paper medicines diary was selected to deliver the BCT ‘Self-monitoring of behaviour’. To help tailor the intervention, BCTs were categorised into ‘Core’ and ‘Optional’ BCTs. For example, ‘Feedback on behaviour’ and ‘Action planning’ were selected as ‘Core’ BCTs (delivered to all patients), whereas ‘Prompts and cues’ and ‘Health consequences’ were selected as ‘Optional’ BCTs. A paper-based adherence assessment tool was designed to guide intervention tailoring by mapping from identified adherence problems to BCTs. The intervention was designed for delivery over three appointments in the pharmacy including an adherence assessment at Appointment 1 and BCT delivery at Appointments 2 and 3.

Conclusions
This paper details key decision-making processes involved in moving from a list of BCTs through to a complex intervention package which aims to improve older patients’ medication adherence. A novel approach to tailoring the content of a complex adherence intervention using ‘Core’ and ‘Optional’ BCT categories is also presented. The intervention is now ready for testing in a feasibility study with community pharmacists and patients to refine the content. It is hoped that this detailed report of the intervention content/design process will allow others to better interpret the future findings of this work.
Seroprevalence and risk factors of canine distemper virus in the pet and stray dogs in Haa, western Bhutan
Authors: Dorji Tshering , Tenzin Tenzin , Tenzin Kuenga , Tshering Dawa , Rinzin Karma , Phimpraphai Waraphon , de Garine-Wichatitsky Michel 
Published: May 2020

Abstract
Background
Canine Distemper Virus (CDV) is a highly contagious virus belonging to family Paramyxovirade, genus Morbillivirus and responsible for high morbidity and mortality in dogs worldwide. Infected domestic dogs can cause spillover infections to wild carnivores that are in contact. We conducted a seroprevalence survey of CDV in domestic dogs in two areas of western Bhutan (Haa district) located at the periphery of the Jigme Khesar Strict Nature Reserve, which is home to several endangered wildlife. A total of 238 serum samples, 119 each from the pet and stray dog, were collected during summer and winter seasons. Samples were tested for CDV antibodies using a sandwich enzyme-linked immune-sorbent assay (ELISA) test.

Results
The seroprevalence of CDV was found to be 11.3% (95% CI 6.7–14.2). Dogs sampled during winter were less likely to test seropositive against CDV antibodies than those sampled during summer (adjusted odds ratio: -2.6; 95% CI: − 1.2–6.1). Dogs in good body condition were found to be more likely to test seropositive against CDV than dogs in poor condition and obese dogs (adjusted odds ratio: 2.2; 95% CI: 0.1–5.9). There were no significant differences in the seroprevalence of CDV among different sexes, breeds and age classes, pet and stray dogs and between the two study sites.

Conclusions
Our study indicates that CDV seroprevalence was equally distributed among pet and stray dogs. We suggest strengthening the management practices of dogs through responsible dog ownership, dog population management and waste management to minimize the transmission risk of infectious diseases to wildlife.