bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile nudges and financial incentives to improve coverage of timely neonatal vaccination in rural areas (GEVaP trial): A 3-armed cluster randomized controlled trial in Northern Ghana
Authors: Levine Gillian , Salifu Amadu , Mohammed Issah , Fink Günther 
Published: May 2021

Background
Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting.

Methods
We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life.

Results
Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage.

Conclusion
Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination “nudges” via voice calls may be constrained in settings where network coverage and phone ownership are limited.

Trial registration
This trial was registered at ClinicalTrials.gov; NCT03797950.
Vitreous expression of cytokines and growth factors in patients with diabetic retinopathy—An investigation of their expression based on clinical diabetic retinopathy grade
Authors: Deuchler Svenja , Schubert Ralf , Singh Pankaj , Chedid Adonis , Brui Natallia , Kenikstul Ninel , Kohnen Thomas , Ackermann Hanns , Koch Frank 
Published: May 2021

Diabetic retinopathy (DR) is an inflammatory condition that affects the posterior of the eye; yet, there are limited published data on techniques measuring the expression of growth and inflammatory factors (GIF) from the posterior segment. The purpose of the current study was two-fold: to sample the vitreous fluid from the eyes of patients with DR and assess the expression of GIF. As DR is an inflammatory disease, the second objective of this study was to determine the relationship between the status of DR and the expression of vitreous GIF. This non-randomized clinical trial was approved by BfARM for the analysis and evaluation of 12 eyes from patients with diabetic macular edema. Vitreous sampling was performed before treatment with fluocinolone acetonide and the extracted vitreous material was examined for the determination of GIF including interleukins 6 (IL-6) and 8 (IL-8), interferon gamma-inducible protein (IP-10), monocyte chemoattractant protein-1 (MCP-1), placental growth factor (PIGF), pigment epithelium-derived factor (PEDF), VEGF (vascular endothelial growth factor) and intercellular adhesion molecule (CD54). These were linearly compared with the grade of inflammation in the vitreous assessed via DR score and ART. Additionally, all eyes were grouped based on their diabetic retinopathy status. All cytokine levels, except MCP-1 and PEDF, were numerically higher in DME patients with proliferative DR than those with non-proliferative DR. DR grade was found to linearly correlate with the expression of CD54 (p = 0.02, rho = 0.64), IL-8 (p = 0.03, rho = 0.64) and PIGF (p = 0.007, rho = 0.76). A correlation was found between ART and CD54 (p = 0.02, rho = 0.66) and also between ART and IL-8 (p = 0.04, rho = 0.60). A trend was found between ART and PIGF (p = 0.08, rho 0.52). For IL-6, there appeared to be a trend with DR grade (p = 0.14, rho = 0.45) and ART (p = 0.09, rho = 0.51). Proliferative DR was shown to be associated with a significant higher expression of CD54, IL-8 and PIGF, thus suggesting that they are potentially important in defining and monitoring the effectiveness of a patients’ therapy. Vitreous probes may be helpful in deciding which therapy to administer (i.e. anti-VEGF or corticosteroid or both) based on the expression of GIF.RegistryEudraCT number:2016-004488-38; DRKS-ID: DRKS00014915.
The impact of textual elements on the comprehensibility of drug label instructions (DLIs): A systematic review
Authors: Maghroudi Ekram , van Hooijdonk Charlotte Miriam Joyce , van de Bruinhorst Heidi , van Dijk Liset , Rademakers Jany , Borgsteede Sander Diederik 
Published: May 2021

Introduction
Correct interpretation of drug labels instructions (DLIs) is needed for safe use and better adherence to prescribed drugs. DLIs are often too difficult for patients, especially for those with limited health literacy. What is yet unknown, is how specific textual elements in DLIs (e.g., the presentation of numbers, or use of medical jargon) and patients’ health literacy skills are related to the comprehension of DLIs. In order to provide concrete directions for health professionals on how to optimize drug prescriptions, we performed a systematic review to summarize the available research findings on which textual elements facilitate or hinder the correct interpretation of DLIs in relation to patients’ health literacy.

Method
A systematic search was performed in PubMed, EMBASE, PsychINFO, and Smartcat (until April 2019) to identify studies investigating textual elements that facilitate or hinder the correct interpretation of DLIs in relation to patients’ health literacy.

Results
A total of 434 studies were identified of which 28 studies met our inclusion criteria. We found that textual elements contributing to the correct interpretation of DLIs were: using explicit time periods in dosage instructions, using plain language, presenting numbers in a numerical format, and providing DLIs in patients’ native language. Multistep instructions per instruction line, using abbreviations and medical jargon seem to hinder the correct interpretation of DLIs. Although health literacy was taken into account in a majority of the studies, none of them assessed the effectiveness of specific textual elements on patients’ comprehensibility of DLIs.

Conclusion
Based on our findings, we provide an overview of textual elements that contribute to the correct interpretation of DLIs. Optimizing the textual instruction on drug labels may increase the safety and adherence to prescribed drugs, taking into account that a significant proportion of patients has low health literacy.
Dynamics of data availability in disease modeling: An example evaluating the trade-offs of ultra-fine-scale factors applied to human West Nile virus disease models in the Chicago area, USA
Authors: Uelmen J. A. , Irwin P. , Brown W. M. , Karki S. , Ruiz M. O. , Li B. , Smith R. L. 
Published: May 2021

Background
Since 1999, West Nile virus (WNV) has moved rapidly across the United States, resulting in tens of thousands of human cases. Both the number of human cases and the minimum infection rate (MIR) in vector mosquitoes vary across time and space and are driven by numerous abiotic and biotic forces, ranging from differences in microclimates to socio-demographic factors. Because the interactions among these multiple factors affect the locally variable risk of WNV illness, it has been especially difficult to model human disease risk across varying spatial and temporal scales. Cook and DuPage Counties, comprising the city of Chicago and surrounding suburbs, experience some of the highest numbers of human neuroinvasive cases of WNV in the United States. Despite active mosquito control efforts, there is consistent annual WNV presence, resulting in more than 285 confirmed WNV human cases and 20 deaths from the years 2014–2018 in Cook County alone.

Methods
A previous Chicago-area WNV model identified the fifty-five most high and low risk locations in the Northwest Mosquito Abatement District (NWMAD), an enclave ¼ the size of the combined Cook and DuPage county area. In these locations, human WNV risk was stratified by model performance, as indicated by differences in studentized residuals. Within these areas, an additional two-years of field collections and data processing was added to a 12-year WNV dataset that includes human cases, MIR, vector abundance, and land-use, historical climate, and socio-economic and demographic variables, and was assessed by an ultra-fine-scale (1 km spatial x 1 week temporal resolution) multivariate logistic regression model.

Results
Multivariate statistical methods applied to the ultra-fine-scale model identified fewer explanatory variables while improving upon the fit of the previous model. Beyond MIR and climatic factors, efforts to acquire additional covariates only slightly improved model predictive performance.

Conclusions
These results suggest human WNV illness in the Chicago area may be associated with fewer, but increasingly critical, key variables at finer scales. Given limited resources, these findings suggest large variations in model performance occur, depending on covariate availability, and provide guidance in variable selection for optimal WNV human illness modeling.
Religious affiliation and suicidality among college students in China: A cross-sectional study across six provinces
Authors: Lew Bob , Kõlves Kairi , Zhang Jie , Zhizhong Wang , Koenig Harold G. , Yip Paul S. F. , Abu Talib Mansor , Osman Augustine , Siau Ching Sin , Chan Caryn Mei Hsien 
Published: May 2021

Background
Several past studies indicated that religious beliefs, orientation, and practice are protective of suicide. Findings from recent studies in China suggest that religiosity may contribute to increased suicidality. However, few studies have examined the associations between religious affiliation across different faiths and suicidality in China.

Objective
The current study examines the association between religious affiliation and suicidality among college students in six provinces in China.

Methods
We conducted a cross-sectional study involving 11,407 college students from six universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, and Shaanxi. We collected the data between October 2017 and March 2018 using self-report questionnaires. They included self-report measures of depression, psychache, hopelessness, self-esteem, social support, and life purpose.

Results
Participants with a Christian affiliation had 1.5 times (95% CI: 1.14, 1.99, p = 0.004) higher odds of indicating an elevated suicide risk, 3.1 times (95% CI: 1.90, 5.04, p<0.001) higher odds of indicating a previous suicide attempt, and increased overall suicidality (B = 0.105, p < 0.001) after accounting for demographic and risk/protective factors. Christians also scored the highest in depression, psychache, hopelessness, and the lowest social support, self-esteem, and purpose in life. Muslims reported decreased suicidality (B = -0.034, p = 0.031). Buddhism/Daoism yielded non-significant results in the multivariate analyses.

Conclusions
Christian college students reported increased suicidality levels, perhaps due to public policies on religion. The decreased suicidality levels among Muslims may be attributed to higher perceived social support. The associations between religious affiliation and suicidality, depression, and hopelessness contrast sharply with US samples. This finding may be influenced by interactions between the religious denomination, individual, and social/political factors. This conclusion includes the possibility of anti-religious discrimination, which this paper did not investigate as a possible mediator and therefore remains a conjecture worthy of future investigation.
The impact of urinary incontinence on falls: A systematic review and meta-analysis
Authors: Moon Shinje , Chung Hye Soo , Kim Yoon Jung , Kim Sung Jin , Kwon Ohseong , Lee Young Goo , Yu Jae Myung , Cho Sung Tae 
Published: May 2021

Objective
Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies.

Methods
We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel–Haenszel method.

Results
This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45–1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31–1.93), and in both men (OR, 1.88; 95% CI, 1.57–2.25) and women (OR, 1.41; 95% CI, 1.29–1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42–1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49–1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15–1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39–2.15).

Conclusions
This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.
Vaccine hesitancy among paediatric nurses: Prevalence and associated factors
Authors: Elizondo-Alzola Usue , G. Carrasco Mireia , Pinós Laia , Picchio Camila Andrea , Rius Cristina , Diez Elia 
Published: May 2021

ObjectiveThis study describes the prevalence of vaccine hesitancy associated with the Catalan systematic childhood vaccination calendar and some related psychosocial determinants among paediatric primary care nurses in Barcelona (Spain).MethodsCross-sectional descriptive study. In 2017 we invited the paediatric nurses (N = 165) working in Barcelona public primary health centres with paediatric departments (N = 41) to participate. They answered a questionnaire with sociodemographic and behavioural variables: severity and perceived probability of contracting the diseases of the vaccines in the vaccination schedule; safety and protection offered by each vaccine; and beliefs, social norms, and knowledge about vaccines. Outcome variable was vaccine hesitancy, dichotomized into not hesitant (nurses who would vaccinate their own offspring), and hesitant (including those who would not vaccinate them, those who had doubts and those who would delay the administration of one or more vaccines). We performed bivariate analysis and adjusted logistic regression models.Results83% of paediatric nurses (N = 137) agreed to participate. 67.9% had the intention to vaccinate their children of all the vaccines in the systematic schedule. 32.1% of nurses experienced vaccine hesitancy, especially about the HPV (21.9%) and varicella (17.5%) vaccines. The multivariate analysis suggests associations between hesitancy and low perception of the severity of whooping cough (aOR: 3.88; 95%CI:1.32–11.4), low perception of safety of the HPV vaccine (aOR:8.5;95%CI:1.24–57.8), the belief that vaccines are administered too early (aOR:6.09;95%CI:1.98–18.8), and not having children (aOR:4.05;95%CI:1.22–13.3).ConclusionsAlthough most paediatric nurses had the intention to vaccinate their own children, almost one-third reported some kind of vaccine hesitancy, mainly related to doubts about HPV and varicella vaccines, as well as some misconceptions. These factors should be addressed to enhance nurses’ fundamental role in promoting vaccination to families.
Social networks and infectious diseases prevention behavior: A cross-sectional study in people aged 40 years and older
Authors: Steijvers Lisanne C. J. , Brinkhues Stephanie , Hoebe Christian J. P. A. , van Tilburg Theo G. , Claessen Vivian , Bouwmeester-Vincken Noortje , Hamers Femke , Vranken Petra , Dukers-Muijrers Nicole H. T. M. 
Published: May 2021

BackgroundSocial networks, i.e., our in-person and online social relations, are key to lifestyle behavior and health, via mechanisms of influence and support from our relations. We assessed associations between various social network aspects and practicing behavior to prevent respiratory infectious diseases.MethodsWe analyzed baseline-data (2019) from the SaNAE-cohort on social networks and health, collected by an online questionnaire in Dutch community-dwelling people aged 40–99 years. Outcome was the number of preventive behaviors in past two months [range 0–4]. Associations between network aspects were tested using ordinal regression analyses, adjusting for confounders.ResultsOf 5,128 participants (mean age 63; 54% male), 94% regularly washed hands with water and soap, 55% used only paper (not cloth) handkerchiefs/tissues; 19% touched their face as little as possible; 39% kept distance from people with respiratory infectious disease symptoms; median score of behaviors was 2. Mean network size was 11 (46% family; 27% friends); six network members were contacted exclusively in-person and two exclusively via phone/internet. Participants received informational, emotional, and practical support from four, six, and two network members, respectively. Independently associated with more preventive behaviors were: ‘strong relationships’, i.e., large share of friends and aspects related to so called ‘weak relationships’, a larger share of distant living network members, higher number of members with whom there was exclusively phone/internet contact, and more network members providing informational support. Club membership and a larger share of same-aged network members were inversely associated.ConclusionFriends (‘strong’ relationships) may play an important role in the adoption of infection-preventive behaviors. So may ‘weak relationships’, e.g. geographically more distant network members, who may provide informational support as via non-physical modes of contact. Further steps are to explore employment of these types of relationships when designing infectious diseases control programs aiming to promote infection-preventive behavior in middle aged-and older individuals.
The impact of glucosamine on age-related macular degeneration in patients: A nationwide, population-based cohort study
Authors: Feng Kathy Ming , Chien Wu-Chien , Chen Jiann-Torng , Chen Yi-Hao , Chung Chi-Hsiang , Sun Chien-An , Chen Ching-Long 
Published: May 2021

Purpose
To analyze the association between glucosamine (GlcN) use and the risk of age-related macular degeneration (AMD) using claims data from the National Health Insurance Research Database (NHIRD).

Methods
A retrospective, population-based study was conducted with NHIRD data from a 14-year period (2000–2013). Chi-squared and Student’s t-tests were used to evaluate differences between the study and comparison cohorts for categorical and continuous variables, respectively. Risk factors for disease development were examined by the adjusted hazard ratio (aHR) with 95% confidence interval. Kaplan-Meier analysis was performed to compare the cumulative risk of AMD between the two cohorts.

Results
In total, 1,344 patients with GlcN treatment were enrolled in the study cohort and 5,376 patients without GlcN use were enrolled in the comparison cohort. The incidence rate of AMD was lower with GlcN use (3.65%) than without GlcN use (5.26%) (P = 0.014). GlcN use was associated with a lower risk of developing AMD among patients with hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, stroke, other neurological disorders, or degenerative arthritis. Although the incidence of wet type AMD did not significantly differ (P = 0.91), the incidence of dry type AMD was lower in patients with GlcN use (2.9%) than those without GlcN use (4.84%) (P = 0.003). Kaplan-Meier analysis similarly revealed a lower rate of dry type AMD in patients with GlcN use compared to those without GlcN use (log-rank P = 0.004).

Conclusions
GlcN treatment can decrease the risk of developing dry type AMD. Further prospective controlled studies are needed to determine the effectiveness of GlcN treatment in patients with AMD and the associated mechanism.
A longitudinal study at an English medium instruction university in Turkey: the interplay between English language improvement and academic success
Authors: Yuksel Doğan , Soruç Adem , Altay Mehmet , Curle Samantha 
Published: May 2021

AbstractThis article reports a quantitative empirical study that investigated whether English language proficiency increases over time when studying academic content through English Medium Instruction (EMI). It was also investigated whether an increase in proficiency predicts EMI academic achievement. Student English language test score data and Grade Point Average (GPA) data were collected from a public university in Turkey. Two academic subjects were compared: Business Administration (a Social Science subject,n = 81) and Mechatronics Engineering (a Mathematics, Physical and Life Sciences subject,n = 84). Results showed that in both subjects, English language proficiency statistically significantly improved over a four-year period of studying through English. Furthermore, this improvement predicted EMI academic achievement; meaning that the more proficient students became in English, the higher they achieved in their EMI academic studies. This provides evidence for policymakers, EMI practitioners, and language professionals around the world that English does improve when studying academic content through English, and that this improvement has a positive effect on content learning outcomes. Implications of these findings, and suggestions for further research are discussed.