bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological distress, oral health behaviour and related factors among adolescents: Finnish School Health Promotion Study
Authors: Pohjola Vesa , Nurkkala Meri , Virtanen Jorma I. 
Published: January 2021

Abstract
Background
Psychological distress may affect health behaviour. We examined how psychological distress, social phobia (SP) and anxiety associated with tooth brushing among Finnish adolescents with respect to gender, school grade, parents’ education, family structure, smoking and perceived general health.

Methods
This study is part of the Finnish national School Health Promotion Study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). Mini-Social Phobia Inventory (Mini-SPIN) and generalized anxiety disorder (GAD) served to assess SP and anxiety. A questionnaire enquired about the respondents’ oral health habits (tooth brushing, smoking), background factors (age, gender, family structure and parents’ education) and perceived general health. Chi-squared tests and logistic regression analyses served in the statistical analyses.

Results
About two-thirds of the girls (66.7%) and less than half of the boys (40.1%) followed the international recommendation of tooth brushing twice daily. Girls reported possible problems with SP and GAD more often than boys did. Those reporting possible problems with SP or moderate or severe anxiety brushed their teeth at least twice daily less often than did those reporting no possible problems with SP and those with no, slight or mild anxiety. Logistic regression analyses showed that male gender (OR = 3.2; 95% CI 3.1–3.4), parents’ basic education (OR = 1.5; 95% CI 1.4–1.5), and adolescents’ perception of their current state of health as moderate, fairly or very poor (OR = 1.8; 95% CI 1.5–2.0) associated with not brushing teeth twice daily. Gender-specific logistic regression analyses showed that boys who smoked (OR = 1.7; 95% CI 1.6–1.8) were less likely than non-smokers to brush their teeth twice daily.

Conclusion
Adolescents with psychological distress, such as possible SP or possible general anxiety, had less favourable oral health behaviour. Psychological distress indicates a greater risk for oral health problems already in adolescence.
Oral health status of children and young adults with maple syrup urine disease in Turkey
Authors: Ballikaya Elif , Yildiz Yılmaz , Koç Nagihan , Tokatli Ayşegül , Uzamis Tekcicek Meryem , Sivri Hatice Serap 
Published: January 2021

Abstract
Background
Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey.

Methods
A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients.

Results
Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD.

Conclusions
Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.
Effects of qigong on systolic and diastolic blood pressure lowering: a systematic review with meta-analysis and trial sequential analysis
Authors: Ching Siew Mooi , Mokshashri Naidu Ragubathi , Kannan Maharajan Mari , Lee Kai Wei , Sallahuddin Nurin Amalina , Ng Jun Xun , Wong Jie Lin , Devaraj Navin Kumar , Hoo Fan Kee , Loo Yee Shen , Veettil Sajesh K. 
Published: January 2021

Abstract
Background
The benefits of qigong for systolic and diastolic blood pressure (BP) reduction have been noted in previously published systematic reviews; however, the data on its effectiveness has been at best scarce. We aimed to update the evidence of qigong on blood pressure reduction after taking into consideration the risks of random error and reliability of data in the cumulative meta-analysis using trial sequential analysis (TSA).

Methods
Included trials were assessed using Cochrane risk of bias instrument. We performed meta-analysis with random-effects model and random errors were evaluated with TSA. We performed the search for the eligible randomized controlled trial (RCT) through Medline, Cinahl, Cochrane Central Register of Controlled Trials and also PubMed.

Results
A total of 370 subjects sourced from seven eligible RCTs were entered into the analysis. The pooled results demonstrated the significant reduction with the use of qigong of the systolic blood pressure [weighted mean difference (WMD), − 10.66 mmHg (95% confidence interval (CI) = − 17.69,-3.62, p < 0.001] and diastolic BP [WMD, − 6.76 mmHg, 95% CI = − 12.22, − 1.30, p < 0.001] as compared to the control group.

Conclusions
Significant reductions in BP is seen with the use of qigong as compared with the control group, suggesting that qigong may be used as a complementary therapy in the somewhat complicated management of hypertension.
Curcumin protects radiation-induced liver damage in rats through the NF-κB signaling pathway
Authors: Li Wei , Jiang Liangjun , Lu Xianzhou , Liu Xianrong , Ling Mingjiong 
Published: January 2021

Abstract
Background
Curcumin has been demonstrated to exert anti-oxidant, anti-fibrotic, anti-inflammatory, and anti-cancer activities. This study was conducted to observe the effect and inner mechanism of curcumin in rats with radiation-induced liver damage (RILD).

Methods
Thirty SD rats were classified into Control, Radiation group and Curcumin (Cur) + Radiation group (n = 10 in each group). The changes in body weight of the rats were observed on the 3rd, 7th and 14th days after the treatment with curcumin. On the 14th day post treatment, the heart blood of the rats was drawn for measurement of liver function indices including total protein (TP), alanine aminotransfetase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) as well as aspartate aminotransfetase (AST). Subsequently, the rats were euthanized and liver tissues were taken to observe liver morphological changes using hematoxylin-eosin (HE), and to analyze apoptosis condition using transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assays. Meanwhile, the oxidative stress level in liver tissue homogenate was determined by biochemical analysis. The expression of nuclear factor kappa B (NF-κB) pathway-associated and apoptosis-associated proteins was detected using Western blot analysis, and the expression levels of inflammatory factors were measured by Enzyme-linked immunosorbent assay (ELISA).

Results
The reduced body weight was observed in rats of the Radiation group compared to the Control and Cur + Radiation groups on day 14. In the Radiation group, hepatic cell edema and inflammatory cell infiltration could be visible under the light microscope, and the hepatocytes presented with vacuolar degeneration. In the Cur + Radiation group, the hepatocytes swelled under the microscope, but the pathological changes were alleviated in comparison with the Radiation group. RILD rats with curcumin treatment presented with decreased ALT, AST, ALP, LDH, and maleicdialdehyde (MDA) levels, and elevated TP, superoxide dismutase (SOD), caspase activated DNase (CAD) and glutathione (GSH) levels. Apoptosis and inflammation in rats with RILD were up-regulated, and the NF-κB pathway was activated, but they were reversed after continuously intragastric administration of curcumin for 14 days.

Conclusion
Our study highlights that curcumin treatment reduces the liver damage caused by radiation through the inhibition of the NF-κB pathway.
Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study
Authors: Shamim Muhammad Shahid , Torda Adrienne , Baig Lubna A. , Zubairi Nadeem , Balasooriya Chinthaka 
Published: January 2021

AbstractBackgroundDelivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia.MethodsThe study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy.ResultsThe analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context.ConclusionThe study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.
Using medical reality television as a technology-enhanced learning strategy to provide authentic patient care experiences during clinical placements: a case study research investigation
Authors: Osborne Fiona , Harrison Miles , Fisher James , Bateman Belinda 
Published: January 2021

Abstract
Background
Over the last decade, the use of technology-enhanced learning (TEL) has rapidly expanded and diversified. Since the COVID-19 pandemic, there is a growing demand for distance and online learning strategies to support and even replace learning experiences previously afforded by clinical placements and clerkships. An intriguing but under-researched modality is the use of medical reality television to provide authentic experiences of patient care. This strategy does not feature in published medical educational literature, though promising research is emerging from other disciplines.

Methodology
A programme of learning using medical reality television clips to facilitate case-based learning was developed according to the principles of ‘anchored instruction’, a technology-based educational theory. Clips were taken from the UK television show ’24 hours in A&E’. Medical students’ learning experiences were investigated using a qualitative approach addressing the following research questions:
- What is the perceived emotional experience of medical students when watching reality television in an educational context?
- How do medical students relate their experience of watching reality television in a formal educational setting to their perceived learning needs in the clinical environment?
A case study research methodology was adopted within the interpretivist paradigm. Data were triangulated from semi-structured interviews with students and non-participant observation of the teaching session. Field notes and transcripts were analysed through an inductive thematic analysis.

Results
In response to the medical reality television, a diverse range of emotions were expressed including: excitement, amusement, concern, nervousness, sadness and joy. Students identified gaps in their clinical knowledge such as interpreting results, practical aspects of prescribing and end of life care. Key themes were increased student engagement and a promotion of holistic care practices.

Discussion
Students perceived reality television as a highly realistic and relatable medium and an enjoyable, memorable way to contextualise learning from the classroom to real life, a finding mirrored in previous studies in other fields. The high degree of emotion expressed may explain the improved subjective memorability of the cases.

Conclusion
Medical reality television offers a unique means of engaging students by providing authentic experiences of patient care and should be valued alongside other technology-enhanced learning strategies.
Work-life balance in medical students: self-care in a culture of self-sacrifice
Authors: Picton Aled 
Published: January 2021

Abstract
Background
Work-life balance is a key contributor to doctors’ wellbeing and consequently is a central factor in their career decisions. General Medical Council guidance outlines the importance of work-life balance as part of compassionate self-care. Learning self-care should begin as an undergraduate, when academic and clinical workload can contribute to stress, anxiety and burnout.

Methods
Sequential mixed methods study of medical students in Years 3–5 at the University of Birmingham, UK. Students (n = 145) defined work-life balance in free-text answers and self-assessed their current work-life balance via questionnaires. Following this, a sub-sample of students (n = 44) participated in exploratory individual mini-interviews.

Results
Work-life balance emerged as a broad and multifactorial concept. Questionnaire respondents most frequently referenced enjoyment, meeting work requirements and time management in their definitions. Interview participants highlighted additional influencing factors such as peer groups, study skills, family and professional culture. Students expect a significant shift towards work after graduating and expressed concerns about the stresses of delivering patient care. 42% (n = 60) of students felt they had received support with their work-life balance during their training, mostly from family and friends. Most students had not received support or advice on their work-life balance from University or hospital staff.

Conclusion
Self-care and work-life balance are essential for medical students and doctors to cope with lifelong learning and deliver effective care. Medical school staff should be pro-active in supporting students to develop these skills, particularly during critical transition periods. Early interventions targeting study skills and time management may be beneficial. Further research should include students in Years 1–2 and compare different institutions.
Consensual qualitative research on the internship experience and development of career identity of Korean doctors
Authors: Lee Hye-Jin , Ahn Moonsang 
Published: January 2021

AbstractBackgroundCareer identity is defined as the ability to substantialise career goals and results from the social learning process achieved through interactions with others.This study aimed to understand how the internship experience in Korea affects career identity, which provides a foundation for developing professional values while promoting personal goals and aspirations.MethodsWe conducted eleven semi-structured interviews with interns at a university hospital in Korea who had completed internships and chosen a speciality. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised from three domains for the year-long internship experience: personal cognitive, social interaction, and system domains.ResultsResearchers derived seven categories and 20 subcategories from the transcripts: (1) self-reflection throughout internship training, (2) practical awareness of the internship programme’s operation, (3) perception of individual competence, (4) recognition of mentor importance, (5) situational awareness in the clinical department, (6) relationship experience, and (7) experience of institutional limitations. The internship experience, during which the individual is in charge and core values drive career decisions, is important for the formation of career identity and career orientation.The internship programme provides information about the clinical department to applicants seeking residency and serves a mediating role, providing information about applicants to the clinical departments. Internship is an important period during which career identity is formed.ConclusionThe internship programme provides information about clinical departments to applicants seeking residency; it is an important period during which career identity is formed. This study helps provide an in-depth understanding of interns and a base for developing institutional and policy support for students during an uncertain time when specialties should be selected.
Faculty retention in regional medical schools in Iran: a qualitative content analysis
Authors: Shaterjalali Maria , Gholampoor Yousef , Jeihooni Ali Khani , Mansoori Yaser , Homayounfar Reza , Ehrampoush Elham , Karimi Shahnaz 
Published: January 2021

AbstractBackground and purposeRecruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members’ views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran.MethodsIn this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members who had applied for transfer, four with more than 10 years of experience and working in the type 3 universities with no intention to be transferred. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. The interview was developed for this study (Supplementary file). To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and conformability, as proposed by Lincoln and Guba.ResultsThe findings were classified into three categories and 14 subcategories. The first category was “retention facilitators” including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was “retention threats” including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was “retention strategies” which included four subcategories of recruitment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs.ConclusionSeveral factors play a role in the faculty members’ retention in regional medical schools in Iran. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of faculty autonomy practically to develop a sense of belonging among them and reduce the intention to be transferred among their human resources.
Predicting cardiovascular health trajectories in time-series electronic health records with LSTM models
Authors: Guo Aixia , Beheshti Rahmatollah , Khan Yosef M. , Langabeer James R. , Foraker Randi E. 
Published: January 2021

Abstract
Background
Cardiovascular disease (CVD) is the leading cause of death in the United States (US). Better cardiovascular health (CVH) is associated with CVD prevention. Predicting future CVH levels may help providers better manage patients’ CVH. We hypothesized that CVH measures can be predicted based on previous measurements from longitudinal electronic health record (EHR) data.

Methods
The Guideline Advantage (TGA) dataset was used and contained EHR data from 70 outpatient clinics across the United States (US). We studied predictions of 5 CVH submetrics: smoking status (SMK), body mass index (BMI), blood pressure (BP), hemoglobin A1c (A1C), and low-density lipoprotein (LDL). We applied embedding techniques and long short-term memory (LSTM) networks – to predict future CVH category levels from all the previous CVH measurements of 216,445 unique patients for each CVH submetric.

Results
The LSTM model performance was evaluated by the area under the receiver operator curve (AUROC): the micro-average AUROC was 0.99 for SMK prediction; 0.97 for BMI; 0.84 for BP; 0.91 for A1C; and 0.93 for LDL prediction. Model performance was not improved by using all 5 submetric measures compared with using single submetric measures.

Conclusions
We suggest that future CVH levels can be predicted using previous CVH measurements for each submetric, which has implications for population cardiovascular health management. Predicting patients’ future CVH levels might directly increase patient CVH health and thus quality of life, while also indirectly decreasing the burden and cost for clinical health system caused by CVD and cancers.