bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interconnectivity between molecular subtypes and tumor stage in colorectal cancer
Authors: Coebergh van den Braak R. R. J. , ten Hoorn S. , Sieuwerts A. M. , Tuynman J. B. , Smid M. , Wilting S. M. , Martens J. W. M. , Punt C. J. A. , Foekens J. A. , Medema J. P. , IJzermans J. N. M. , Vermeulen L. 
Published: September 2020

Abstract
Background
There are profound individual differences in clinical outcomes between colorectal cancers (CRCs) presenting with identical stage of disease. Molecular stratification, in conjunction with the traditional TNM staging, is a promising way to predict patient outcomes. We investigated the interconnectivity between tumor stage and tumor biology reflected by the Consensus Molecular Subtypes (CMSs) in CRC, and explored the possible value of these insights in patients with stage II colon cancer.

Methods
We performed a retrospective analysis using clinical records and gene expression profiling in a meta-cohort of 1040 CRC patients. The interconnectivity of tumor biology and disease stage was assessed by investigating the association between CMSs and TNM classification. In order to validate the clinical applicability of our findings we employed a meta-cohort of 197 stage II colon cancers.

Results
CMS4 was significantly more prevalent in advanced stages of disease (stage I 9.8% versus stage IV 38.5%, p < 0.001). The observed differential gene expression between cancer stages is at least partly explained by the biological differences as reflected by CMS subtypes. Gene signatures for stage III-IV and CMS4 were highly correlated (r = 0.77, p < 0.001). CMS4 cancers showed an increased progression rate to more advanced stages (CMS4 compared to CMS2: 1.25, 95% CI: 1.08–1.46). Patients with a CMS4 cancer had worse survival in the high-risk stage II tumors compared to the total stage II cohort (5-year DFS 41.7% versus 100.0%, p = 0.008).

Conclusions
Considerable interconnectivity between tumor biology and tumor stage in CRC exists. This implies that the TNM stage, in addition to the stage of progression, might also reflect distinct biological disease entities. These insights can potentially be utilized to optimize identification of high-risk stage II colon cancers.
Predictors of mental health problems in formal and informal caregivers of patients with Alzheimer’s disease
Authors: Sołtys Anna , Tyburski Ernest 
Published: September 2020

Abstract
Background
Caring for a person with Alzheimer’s disease (AD) is associated with significant mental burden e.g., depression and anxiety, and difficulties with social, familial, and professional functioning. To date, few studies have examined variables which would allow for a comprehensive and detailed study of the relationship between personal resources and caregiver health status, with a majority of studies focusing on factors that contribute to increased caregiver’s burden. Moreover, the available evidence fails to address differences in the functioning of formal and informal carers. Paying proper attention to the problems of nursing home staff can help identify important risk factors. Therefore, this study compared mental health problems in informal and formal caregivers and examined the relationship between mental resources and mental health problems in both groups of caregivers.

Methods
This cross-sectional study examined 100 formal (n = 50) and informal (n = 50) caregivers of AD patients. Personal resources were measured with the Social Support Questionnaire (SSQ), the Generalized Self-Efficacy Scale (GSES), and the Sense of Coherence Questionnaire (SCQ), while mental health was assessed with the Depression Assessment Questionnaire (DAQ) and the General Health Questionnaire (GHQ). Multivariate stepwise regression was performed separately for both investigated groups.

Results
There were no significant differences between informal and formal caregivers in terms of psychological variables, i.e., sense of coherence, social support, self-efficacy, or mental health problems. In contrast, there were different significant predictors of mental health problems in both groups. Comprehensibility (SCQ) was a significant predictor of mental health problems measured by DAQ and self-efficacy (GSES) was a significant predictor of mental health problems measured by GHQ in informal caregivers. For formal caregivers, emotional support (SSQ) and comprehensibility (SCQ) were significant predictors of mental health problems measured by DAQ, while tangible support (SSQ) and meaningfulness (SCQ) were significant predictors of mental health problems measured by GHQ.

Conclusions
Personal resources are significant predictors of mental health outcomes in caregivers of AD patients. Preventive actions should therefore include assessment of factors affecting caregivers’ mental health in order to provide them with necessary care and create appropriate support groups.
Cold-related symptoms and performance degradation among Thai poultry industry workers with reference to vulnerable groups: a cross-sectional study
Authors: Auttanate Nipaporn , Chotiphan Chotirot , Maruo Suchinda Jarupat , Näyhä Simo , Jussila Kirsi , Rissanen Sirkka , Sripaiboonkij Penpatra , Ikäheimo Tiina M. , Jaakkola Jouni J. K. , Phanprasit Wantanee 
Published: September 2020

Abstract
Background
Few studies have examined cold-related symptoms among cold workplace workers in Thailand. This study aimed to determine the prevalence of cold-related cardiorespiratory, circulatory, and general symptoms and performance degradation among Thai chicken industry workers and identify vulnerable groups.

Methods
Overall, 422 workers aged from 18 to 57 years at four chicken meat factories in Thailand were interviewed for cold-related symptoms and complaints. The results were expressed in terms of model-based adjusted prevalence and prevalence differences (PDs) in percentage points (pp) with 95% confidence intervals (CIs).

Results
In total, 76.1% of the respondents reported cold-related respiratory symptoms, 24.6% reported cardiac symptoms, 68.6% reported circulatory symptoms, and 72.1% reported general symptoms. In addition, 82.7% of the respondents reported performance degradation. Cold-related respiratory symptoms increased by PD 29.0 pp. (95% CI 23.4–34.6) from the lowest to the highest educational group, with a similar pattern observed in performance degradation. Forklift drivers and storage and manufacturing workers complained of cold-related respiratory symptoms more than office staff (PD 22.1 pp., 95% CI 12.8–31.3; 12.0 pp., 95% CI 2.4–21.6; and 17.5 pp., 95% CI 11.5–23.6, respectively); they also reported more performance degradation (PD 24.1 pp., 95% CI 17.0–31.2; 19.8 pp., 95% CI 14.1–25.6; and 14.8 pp., 95% CI 8.0–22.6, respectively). Weekly alcohol consumers reported more performance problems owing to cold (PD 18.2 pp., 95% CI 13.9–22.6) than non-consumers of alcohol. Cardiac and circulation symptoms were more common in women than men (PD 10.0 pp., 95% CI 1.1–18.9; and 8.4 pp., 95% CI 0.5–16.4, respectively). The age trend in performance issues was curved, with the highest prevalence among those aged 35–44 years, while the oldest workers (45–57 years) perceived less cold-related symptoms, particularly thirst.

Conclusions
Cold-related symptoms and performance degradation were found to be common in this industry, with vulnerable groups comprising of highly educated workers, forklift drivers, storage and manufacturing workers, weekly alcohol consumers, aging workers, and women. The results demonstrate a need for further research on the adequacy of protection provided against the cold, particularly given that global warming will increase the contrast between cold workplaces and outdoor heat.
Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes
Authors: Wang Lijun , Chen Jianjiu , Ho Sai Yin , Leung Lok Tung , Wang Man Ping , Lam Tai Hing 
Published: September 2020

AbstractBackgroundTobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry.MethodsThe School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses.ResultsAmong 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (allp-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%).ConclusionsEven exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
Application of Freire’s adult education model in modifying the psychological constructs of health belief model in self-medication behaviors of older adults: a randomized controlled trial
Authors: Gharouni Kasra , Ardalan Arash , Araban Marzieh , Ebrahimzadeh Farzad , Bakhtiar Katayon , Almasian Mohammad , Bastami Fatemeh 
Published: September 2020

AbstractBackgroundSelf-medication by older adults has been always a public health concern. The present study aimed to modify the psychological constructs of Health Belief Model (HBM) in relation to self-medication behaviors using Freire’s Adult Education Model (FAEM) among older adults in Khorramabad, Iran, from 2017 to 2018.MethodsThe mean age of the older adults was 66.28 ± 7.18 years. This was a randomized controlled trial study conducted on 132 individuals older than 60 who were referred from different health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phase of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significant level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for the purpose of analyzing data.ResultsThere was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important reason for self-medication (p = 0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p > 0.05). However, they came up to be considerably different for the above variables after the intervention was implemented (p <  0.05). When the findings were adjusted for the effects of confounding variables, there were significant differences between the two groups in almost all constructs of HBM and their behaviors (p <  0.05). However, the perceived barrier modality of HBM did not reach to a significant level of difference between two groups.ConclusionThe educational intervention, which was based on Freire’s AEM, had positive effects on the constructs of HBM and consequently on self-medication behaviors. The psychological constructs of HBM were affected at the phases of listening to problems. Self-medication was tempered at the action-reflection phase with shared creation and evaluation of the action plan geared toward the achievement of the behavioral objectives. The results might be of importance to healthcare professionals involved in care of older patients.Trial registrationCurrent Controlled TrialsIRCT2013091814512N2. Registered on January 2 - prospectively registered, the trial was registered in the Iranian Clinical Trials Registryhttp://www.irct.ir.
Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
Authors: Dunton Genevieve F. , Do Bridgette , Wang Shirlene D. 
Published: September 2020

Abstract
Background
COVID-19 restrictions such as the closure of schools and parks, and the cancellation of youth sports and activity classes around the United States may prevent children from achieving recommended levels of physical activity (PA). This study examined the effects of the COVID-19 pandemic on PA and sedentary behavior (SB) in U.S. children.

Method
Parents and legal guardians of U.S. children (ages 5–13) were recruited through convenience sampling and completed an online survey between April 25–May 16, 2020. Measures included an assessment of their child’s previous day PA and SB by indicating time spent in 11 common types of PA and 12 common types of SB for children. Parents also reported perceived changes in levels of PA and SB between the pre-COVID-19 (February 2020) and early-COVID-19 (April–May 2020) periods. Additionally, parents reported locations (e.g., home/garage, parks/trails, gyms/fitness centers) where their children had performed PA and their children’s use of remote/streaming services for PA.

Results
From parent reports, children (N = 211) (53% female, 13% Hispanic, Mage = 8.73 [SD = 2.58] years) represented 35 states and the District of Columbia. The most common physical activities during the early-COVID-19 period were free play/unstructured activity (e.g., running around, tag) (90% of children) and going for a walk (55% of children). Children engaged in about 90 min of school-related sitting and over 8 h of leisure-related sitting a day. Parents of older children (ages 9–13) vs. younger children (ages 5–8) perceived greater decreases in PA and greater increases in SB from the pre- to early-COVID-19 periods. Children were more likely to perform PA at home indoors or on neighborhood streets during the early- vs. pre-COVID-19 periods. About a third of children used remote/streaming services for activity classes and lessons during the early-COVID-19 period.

Conclusion
Short-term changes in PA and SB in reaction to COVID-19 may become permanently entrenched, leading to increased risk of obesity, diabetes, and cardiovascular disease in children. Programmatic and policy strategies should be geared towards promoting PA and reducing SB over the next 12 months.
Working conditions mediate the association between social class and physical function in older age in Sweden: a prospective cohort study
Authors: Pandey Nikita , Darin-Mattsson Alexander , Nilsen Charlotta 
Published: September 2020

Abstract
Background
Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age.

Methods
Two Swedish surveys, linked at the individual level, were used (n = 676–814 depending on the outcome). Follow-up time was 20–24 years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions.

Results
Working conditions seem to mediate 35–74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age.

Conclusions
The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction.
Prevalence of motor impairment in residents of New South Wales, Australia aged 55 years and over: cross-sectional survey of the 45 and Up cohort
Authors: Herbert R. D. , Taylor J. L. , Lord S. R. , Gandevia S. C. 
Published: September 2020

Abstract
Background
The population prevalence of many diseases is known. However, little is known of the population prevalence of motor impairments.

Methods
The aim of this study was to determine the point prevalence of specific motor impairments (weakness, fatigue, contracture, impaired balance and impaired coordination) in the population aged 55 years and older resident in New South Wales, Australia in 2018. 55,210 members of the 45 and Up cohort were invited to participate in a follow-up survey that included questions on motor impairment. Responses were received from 20,141 people (36%). Calibrated estimates of prevalence of specific motor impairments, and of having at least one motor impairment, were obtained using survey weights based on the known multivariate distributions of age, gender and geographical location (28 regions) in the population.

Results
More than one-third of adults aged over 55 residing in New South Wales have difficulty using their hands, arms or legs. The prevalence of each motor impairment (muscle weakness, fatigue, contracture, impaired balance or impaired coordination) in this population is between 4 and 12%. The prevalence of at least one of these impairments is 21%. The prevalence of at least one impairment in people aged 85 and over is 42%. Women consistently had more difficulty using hands, arms and legs, and more motor impairment, than men. Difficulty using hands, arms and legs and the prevalence of all motor impairments, especially poor balance, greatly increased with age.

Conclusion
The prevalence of specific motor impairments in older Australian adults is high - comparable to that of the most prevalent diseases. There may be merit in considering motor impairment as a significant public health problem in its own right.
Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group
Authors: Khlat Myriam , Van Cleemput Océane , Bricard Damien , Legleye Stéphane 
Published: September 2020

Abstract
Background
France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group.

Methods
The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression.

Results
Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55–1.84), 1.29 (1.14–1.45) and 2.31 (1.95–2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22–1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64–0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use.

Conclusion
Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.
Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study
Authors: Das Manoja Kumar , Arora Narendra Kumar , Rasaily Reeta , Kaur Gurkirat , Malik Prikanksha , Kumari Mahisha , Joshi Shipra , Chellani Harish , Gaekwad Harsha , Debata Pradeep , Meena K. R. 
Published: September 2020

Abstract
Background
India contributes the highest share of under-five and neonatal deaths and stillbirths globally. Diagnostic autopsy, although useful for cause of death identification, have limited acceptance. Minimally invasive tissue sampling (MITS) is an alternative to autopsy for identification of the cause of death (CoD). A formative research linked to pilot MITS implementation was conducted to document the perceptions and attitudes of the healthcare professionals and the barriers for implementation.

Methods
This exploratory qualitative study conducted at a tertiary care hospital in New Delhi, India included the hospital staffs. In-depth interviews were conducted with the doctors, nurses and support staffs from pediatrics, neonatology, obstetrics and forensic medicine departments. Inductive data analysis was done to identify the emerging themes and codes.

Results
A total of 26 interviews (doctors, n = 10; nurses, n = 9 and support staffs, n = 7) were conducted. Almost all professional and support staffs were positive about the MITS and its advantage for CoD identification including co-existing and underlying illnesses. Some opined conduct of MITS for the cases without clear diagnosis. All participants perceived that MITS would be acceptable for parents due to the non-disfigurement and preferred by those who had unexplained child deaths or stillbirths in past. The key factors for MITS acceptance were appropriate communication, trust building, involvement of senior doctors, and engagement of the counselor prior to deaths and training of the personnel. For implementation and sustenance of MITS, involvement of the institute authority and government stakeholders would be essential.

Conclusions
MITS was acceptable for the doctors, nurses and support staffs and critical for better identification of the causes of death and stillbirths. The key facilitating factors and challenges for implementing MITS at the hospital in Indian context were identified. It emphasized on appropriate skill building, counseling, system organization and buy-in from institution and health authorities for sustenance of MITS.