bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between gestational diabetes and fear of childbirth: a longitudinal register study
Authors: Savard Josephine , Pauck Bernhardsen Guro , Mykkänen Anu , Keski-Nisula Leea , Lehto Soili Marianne 
Published: December 2024

Abstract
Background
Gestational diabetes mellitus is a common condition known to be associated with pregnancy complications, larger fetus size and depression, and may therefore lead to increased concerns linked to childbirth. We sought to determine whether gestational diabetes mellitus is linked to fear of childbirth, and whether the possible association is mediated by depressive symptoms.

Methods
This study includes women who gave birth at the Kuopio University Hospital between 2019–2022 and had reported their level of fear of childbirth after gestational week 28 (n = 3293). Two outcome measures of fear of childbirth were used: self-rated intensity on a visual analogue scale, and obstetrician-confirmed diagnosis. Gestational diabetes mellitus was diagnosed based on plasma glucose concentrations in fasting state (≥ 5.3 mmol/l) and after a 75 g glucose load (one hour: ≥ 10.0 mmol/l, two hours: ≥ 8.6 mmol/l). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms in the third trimester. We performed logistic and linear regression analyses while adjusting for possible confounding factors and examined the controlled direct effect by including depressive symptoms in the model.

Results
Gestational diabetes mellitus was associated with increased risk of fear of childbirth diagnosis (OR = 1.42, 95% CI 1.11─1.73) and higher levels of fear of childbirth (B = 0.31, 95% CI 0.09─0.53), but the associations were attenuated and no longer significant after further adjustments for body mass index and health behaviors (OR = 1.22, 95% CI 0.91─1.5; B = 0.11, 95% CI -0.13─0.35). Inclusion of depressive symptoms in the model attenuated the non-significant estimates further.

Conclusions
The observed association between fear of childbirth and gestational diabetes mellitus in previous studies may result from the lack of adjustments for confounding factors.
Evaluating causal associations of chronotype with pregnancy and perinatal outcomes and its interactions with insomnia and sleep duration: a mendelian randomization study
Authors: Yang Qian , Magnus Maria C. , Kilpi Fanny , Santorelli Gillian , Soares Ana Goncalves , West Jane , Magnus Per , Håberg Siri E. , Tilling Kate , Lawlor Deborah A , Borges M Carolina , Sanderson Eleanor 
Published: December 2024

Abstract
Background
Observational studies suggested chronotype was associated with pregnancy and perinatal outcomes. Whether these associations are causal is unclear. Our aims are to use Mendelian randomization (MR) to explore (1) associations of evening preference with stillbirth, miscarriage, gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, preterm birth and offspring birthweight; and (2) differences in associations of insomnia and sleep duration with those outcomes between chronotype preferences.

Methods
We conducted two-sample MR using 105 genetic variants reported in a genome-wide association study (N = 248,100) to instrument for lifelong predisposition to evening- versus morning-preference. We generated variant-outcome associations in European ancestry women from UK Biobank (UKB, N = 176,897), Avon Longitudinal Study of Parents and Children (ALSPAC, N = 6826), Born in Bradford (BiB, N = 2940) and the Norwegian Mother, Father and Child Cohort Study (MoBa, N = 57,430), and extracted equivalent associations from FinnGen (N = 190,879). We used inverse variance weighted (IVW) as main analysis, with weighted median and MR-Egger as sensitivity analyses. Relying on the individual participant data from UKB, ALSPAC, BiB and MoBa, we also conducted IVW analyses of insomnia and sleep duration on the pregnancy and perinatal outcomes, stratified by genetically predicted chronotypes.

Results
In IVW and sensitivity analyses, we did not find robust evidence of associations of chronotype with the outcomes. Insomnia was associated with a higher risk of preterm birth among evening preference women (odds ratio 1.61, 95% confidence interval: 1.17, 2.21), but not among morning preference women (odds ratio 0.87, 95% confidence interval: 0.64, 1.18), with an interaction P-value = 0.01. There was no evidence of interactions between insomnia and chronotype on other outcomes, or between sleep duration and chronotype on any outcomes.

Conclusions
This study raises the possibility of a higher risk of preterm birth among women with insomnia who also have an evening preference. Our findings warrant replications due to imprecise estimates.
Changes in essential cancer medicines and association with cancer outcomes: an observational study of 158 countries
Authors: Ul Haq Moizza Zia , Heredia Camila , Buadu Adelaide , Rizvi Amal , Workentin Aine , Persaud Nav 
Published: December 2024

Abstract
Background
Cancer is a major cause of mortality worldwide, and differences in cancer mortality rates between countries are, in part, due to differences in access to cancer care, including medicines. National essential medicines lists (NEMLs) play a role in prioritization of healthcare expenditure and access to medicines. We examined the association between amenable cancer mortality and listing medicines used in the management of eight cancers (non-melanoma skin, uterine, breast, Hodgkin lymphoma, colon, leukemia, cervical, and testicular) in national essential medicines lists of 158 countries and summarized changes to the inclusion of cancer treatments in NEMLs.

Methods
We conducted a cross-sectional examination of NEMLs for 158 countries, which were obtained in May 2023. We identified medicines used to treat each of the eight cancers and determined the number of medicines listed by NEMLs for each cancer. We conducted multiple linear regressions to examine the association between the number of medicines listed on the NEMLs and cancer mortality.

Results
We found associations between cancer medicine listing and outcomes for six of the eight examined cancers (non-melanoma skin cancer (p = 0.001), uterine cancer (p = 0.006), breast cancer (p = 0.001), Hodgkin lymphoma (p = 0.021), colon cancer (p = 0.006), and leukemia (p = 0.002)), when adjusting for healthcare expenditure and population size.

Conclusion
There was an association between listing cancer medicines on NEMLs and cancer mortality. Further research is required to explore how cancer mortality may be impacted by other cancer interventions, as well as policies to improve equitable access to cancer care.
Cancer and Syria in conflict: a systematic review
Authors: Basha Lena , Ahmed Hamza , Hamze Mohamed , Ali Amaar Awais , Alahdab Fares , Marzouk Manar , Sullivan Richard , Abbara Aula 
Published: December 2024

Abstract
Background
Armed conflict can disrupt oncology care profoundly, resulting in worsened health outcomes for cancer patients. Syria has endured armed conflict for over a decade, resulting in a severe breakdown of its healthcare services. The aim of this systematic review was to assess the available evidence on the burden of cancer and oncology services in Syria and how they have been affected during the conflict.

Methods
Eight academic and six grey literature databases were searched for English- and Arabic-language studies published from March 2011 until February 2024. Studies reporting any outcomes relating to the burden of cancer or the state of oncology services in wartime Syria were considered for inclusion, although case reports and scoping reviews were excluded. A narrative synthesis of findings was performed.

Results
Of 5,801 studies identified, 28 studies from academic (23) and grey literature (5) were eligible. Papers which reported on the burden of cancer showed an overall increase in cancer incidence and mortality between 2012 and 2022 (most recent data available). Most services were noted to be concentrated in Syria’s capital, Damascus. The main identified themes related to the challenges of providing oncology services with staff shortages, chemotherapeutic drug shortages, insufficient radiotherapy services, and a lack of screening and palliative care noted.

Conclusion
There is insufficient high-quality exploration of the burden of cancer and the state of oncology services across Syria in academic and grey literature. Syria’s health system is divided, creating disparities in access to oncology services, most of which are concentrated in Damascus, exacerbating pre-existing inequalities. The sparsity of robust data reinforces the need for high-quality data, including the use of national or other cancer registries with data from all regions of Syria, including those under opposition control. As the country rebuilds its healthcare systems, policymakers should focus on addressing inequities in oncology service availability to support equity of services.
Comparison between clinician and machine learning prediction in a randomized controlled trial for nonsuicidal self-injury
Authors: Pontén Moa , Flygare Oskar , Bellander Martin , Karemyr Moa , Nilbrink Jannike , Hellner Clara , Ojala Olivia , Bjureberg Johan 
Published: December 2024

Abstract
Background
Nonsuicidal self-injury is a common health problem in adolescents and associated with future suicidal behavior. Predicting who will benefit from treatment is an urgent and a critical first step towards personalized treatment approaches. Machine-learning algorithms have been proposed as techniques that might outperform clinicians’ judgment. The aim of this study was to explore clinician predictions of which adolescents would abstain from nonsuicidal self-injury after treatment as well as how these predictions match machine-learning algorithm predictions.

Methods
Data from a recent trial evaluating an internet-delivered emotion regulation therapy for adolescents with nonsuicidal self-injury was used. Clinician predictions of which patients would abstain from nonsuicidal self-injury (measured using the youth version of Deliberate Self-harm Inventory) were compared to a random forest model trained on the same available data from baseline assessments.

Results
Both clinician (accuracy = 0.63) and model-based (accuracy = 0.67) predictions achieved significantly better accuracy than a model that classified all patients as reaching NSSI remission (accuracy = 0.49 [95% CI 0.41 to 0.58]), however there was no statistically significant difference between them. Adding clinician predictions to the random forest model did not improve accuracy. Emotion dysregulation was identified as the most important predictor of nonsuicidal self-injury absence.

Conclusions
Preliminary findings indicate comparable prediction accuracy between clinicians and a machine-learning algorithm in the psychological treatment of nonsuicidal self-injury in youth. As both prediction approaches achieved modest accuracy, the current results indicate the need for further research to enhance the predictive power of machine-learning algorithms. Machine learning model indicated that emotion dysregulation may be of importance in treatment planning, information that was not available from clinician predictions.

Trial Registration
NCT03353961||https://www.clinicaltrials.gov/, registered 2017–11-21.
Preregistration at Open Science Framework: https://osf.io/vym96/.
The impact of a coach-guided personalized depression risk communication program on the risk of major depressive episode: study protocol for a randomized controlled trial
Authors: Wang JianLi , Feng Cindy , Hajizadeh Mohammad , Lesage Alain 
Published: December 2024

Abstract
Background
Depression is a highly prevalent and disabling mental health problem. Self-help has been strongly advocated for dealing with depression. Built upon the research on risk prediction modeling and risk communication, we developed a coach-guided, personalized depression risk communication tool (PDRC) for sharing information about individualized depression risk and evidence-based self-help strategies. The primary objective of this project is to evaluate the impact of the PDRC on the 12-month risk of major depressive episode (MDE) in Canadians who are at high risk of MDE.

Methods
This is an assessor-blinded randomized controlled trial (RCT) with two arms. We will recruit 500 males and 500 females in the communities across the country. Individuals are eligible, if they: (1) are 18 years or older, (2) have not had a depressive episode in the past two months, (3) are at high risk of MDE based on the sex-specific risk predictive algorithms for MDE (predicted risk of 6.5% + for men and of 11.2% + for women), (4) can communicate in either English or French, and (5) agree to be contacted for follow-up interviews. After screening and baseline assessment, participants will be randomized by sex into intervention and control group in a 1:1 ratio. Participants in the intervention group will receive the coach-guided PDRC. The participants are assessed at baseline, 3 and 12 months via computer assisted telephone interview system, regarding the presence of MDE, depressive and anxiety symptoms, use of self-help strategies, mental health services use and self-efficacy.

Discussion
The coach-guided PDRC may empower users to actively engage in self-management, leading to reduced risk of MDE. If successful, the coach-guided PDRC will lead to a novel selective prevention program that is closely aligned with the tiered mental health services model, contributing to early prevention of depression and better mental health wellbeing.

Date of trial registration
: 2024-10-02.

Protocol version and date
December 6, 2024. Version #1.

Trial registration
: NCT06619366.
How could 20-minute neighbourhoods impact health and health inequalities? A policy scoping review
Authors: Pollack Roxana , Olsen Jonathan R , Heppenstall Alison , Hoehn Andreas , Boyd Jennifer , Hardy Vicki Ponce , Littlejohn Jennifer , Stevenson Amy , Mitchell Richard , Meier Petra , Stokes Jonathan 
Published: December 2024

Abstract
Background
‘Twenty-minute neighbourhoods’ (or variations, such as 15-minute cities) are receiving increasing policy attention with anticipated impacts on population health (inequalities) outcomes alongside sustainability improvements. Yet, factors contributing to possible health impacts are not well understood. This scoping review aimed to identify proposed and evidenced pathways to health (inequality) outcomes from international policy plans.

Methods
We first identified relevant academic literature, searching Scopus, (Ovid) Medline and Embase databases. A second search aimed to identify local or national planning or policy documents on government websites and related organisations. We followed a snowball search strategy to retrieve examples identified from the academic literature search and from the C40 cities network. These policy documents were our primary target for extraction, and we extracted and analysed by individual place. Pathways to health and health inequality outcomes identified in these documents were inductively coded thematically. We used Sankey diagrams to visually aggregate the thematic codes for each place relating to pathways to health outcomes and social determinants (mechanisms).

Results
In total, 36 places across 17 countries were included, described across 96 academic articles, policy plans and reports. While different health improvement outcomes were included as a goal in nearly all policy plans, most frequently references were to health in general rather than specific health outcomes. Pathways to health were discussed in numerous policy plans across three overarching themes: proximity, place redesign, and environmental action. Proximity pathways were most frequently outlined as the means to achieve health outcomes, with active travel acting through increased physical activity/reduced obesity as the most frequent individual pathway. However, few plans specified what would actually be implemented in practice to achieve the increased proximity to services. Health inequalities were only mentioned by six places specifically, although nearly half of all places mentioned broader inequality aims (e.g., poverty reduction). Possible unintended consequences to health inequalities also received some attention, for example through displacement of residents.

Discussion
Pathways to assumed health (inequality) outcomes require better specification and evidence. Health inequalities are particularly under-explored, and scenario modelling might provide a means to explore the dynamic aspects necessary to examine these important outcomes pre-implementation.
Digital learning of clinical skills and its impact on medical students’ academic performance: a systematic review
Authors: McGee Richard G. , Wark Stuart , Mwangi Felista , Drovandi Aaron , Alele Faith , Malau-Aduli Bunmi S. ,   The ACHIEVE Collaboration
Published: December 2024

Abstract
Background
The constraints imposed by the COVID-19 pandemic has led to the rapid development and implementation of digital methods for teaching clinical skills in medical education. This systematic review presents both the benefits, challenges, and effectiveness of this transition.

Methods
A systematic search of six electronic databases (SCOPUS, Medline, CINAHL, PsycINFO, ERIC & Informit) was conducted on 1st October 2023 and updated on 1st April 2024 to identify peer- reviewed articles, from 2019 onwards, which used any type of digital tool (online or otherwise) to teach clinical skills to medical trainees (undergraduate or postgraduate) and were published in English language. The primary outcome synthesised was the reported effectiveness of these digital tools in the development of clinical skills. Risk of bias of included studies was assessed using the Quality Assessment With Diverse Studies (QuADS) tool.

Results
Twenty-seven studies involving 3,895 participants were eligible for inclusion in this review. The QuADS quality assessment scores ranged from 22 to 35, indicating medium quality and thirteen of the studies were randomized trials. Overall, digital teaching of clinical skills demonstrated improved or comparable outcomes to in-person teaching. There was a beneficial effect of digital learning tools on assessment outcomes, with meta-analysis showing a mean difference increase of 1.93 (95% CI 1.22 to 2.64), albeit with a high amount of statistical heterogeneity I2 97%, P < 0.001. Digital clinical skills teaching also resulted in improved student satisfaction scores in many situations and was also shown in one study to be cost effective.

Conclusion
Teaching of clinical skills using digital tools is an important alternative to the traditional format of face-to-face delivery, which is resource intensive and difficult to implement during a pandemic. This review demonstrates their potential efficacy in improving education outcomes, student satisfaction and potentially reducing costs. However, the integration of traditional and innovative digital teaching methods appeared to provide the most comprehensive learning experience. Future research could focus on longitudinal studies to assess the long-term impact and efficacy of different digital and blended learning modalities on the acquisition of clinical skills and professional competencies.
Social anxiety, loneliness, and mobile phone addiction among nursing students: latent profile and moderated mediation analyses
Authors: Jiang Yingting , Shen Zhenrong , Zeng Yihao , Li Shuhan , Li Hongman , Xiong Ying , Ye Zengjie 
Published: December 2024

Abstract
Background
The overutilization of mobile devices by nursing students has been found to adversely affect their physical and cognitive health, potentially impeding the cultivation of a proficient nursing workforce. Previous research has identified social anxiety and loneliness as influential contributors to mobile phone addiction, but the relationship between these three factors has not been extensively examined. The objective of this research was to investigate the role of loneliness in mediating the relationship between social anxiety and mobile phone addiction, as well as the moderating influence of sleep duration on the relationship between social anxiety, loneliness, and mobile phone addiction among nursing students.

Methods
We enrolled 437 students from the Be Resilient to Nursing Career program (BRNC) between October and December 2023. Surveys were employed to evaluate the levels of social anxiety, loneliness, and mobile phone addiction among nursing students. Three types of analyses were performed: latent profile analysis, mediation analysis, and moderation analysis.

Results
The following three profiles of social anxiety were identified: low social anxiety (23.8%), middle social anxiety (42.8%), and high social anxiety (33.4%). The significant mediating effect of loneliness in the relationship between social anxiety based on latent profile analysis and mobile phone addiction was observed (SE = 0.709, 95%CI = 1.821, 4.618; SE = 0.561, 95%CI = 1.161, 3.345, respectively). The moderating role of sleep duration between social anxiety, loneliness, and mobile phone addiction was not significant (P > 0.05).

Conclusion
Heterogeneity exists in social anxiety among nursing students. Loneliness serves as a significant mediating factor between social anxiety and mobile phone addiction. The moderating influence of sleep duration should be validated in future research.