bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 pandemic fears and obsessive-compulsive symptoms in adolescents with pre-existing mental disorders: An exploratory cross-sectional study
Authors: Khan Yasser Saeed , Jouda Muayad , Albobali Yahia , Osman Abouelseoud Manal , Souid Aouatef , AlMeraisi May Jasem , Alabdulla Majid 
Published: May 2021

Background: Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. Aim: To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. Methods: A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient ( r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. Results: A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant – { r = 0.405, Sig. (two-tailed) = 0.001}. Conclusion: Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.
A qualitative study of autism services and supports in Singapore: Perspectives of service providers, autistic adults and caregivers
Authors: Han Emeline , Tan Melisa Mei Jin , Crane Laura , Legido-Quigley Helena 
Published: May 2021

The lifelong and complex nature of autism necessitates an array of services and supports spanning across different sectors and providers at different life stages of an autistic individual. However, research has shown that autistic individuals and their families often experience barriers accessing the autism-related services and supports that they need. This is the first qualitative study to explore the provision and coordination of autism services and supports in Singapore from the perspectives of service providers, autistic adults and caregivers. Semi-structured interviews with 21 participants revealed three main themes: (1) improving access to autism-specific services, (2) creating flexible supports in an inclusive environment and (3) addressing stigma and changing societal attitudes. Our findings suggest that Singapore may have achieved rapid growth in autism services, but broader social structures may be slower to change. To better support autistic individuals in society, autistic voices need to be amplified and a collective effort is needed to achieve a paradigm shift from impairment to capability. Lay abstract Because autism is a lifelong and complex condition, autistic people may need a range of supports cutting across different sectors (e.g. health, education and social care) at different stages of their lives. Studies in some countries have shown that autistic people and their families face difficulties accessing the services they need, but no research has been done on this topic in Singapore. To start addressing this gap, we interviewed 21 service providers, autistic adults and caregivers/parents of autistic children to find out their perceptions and experiences of autism services and supports in Singapore. Our participants told us that beyond improving access to autism-specific services, they also hoped to see more flexible supports in an inclusive environment and a broader change in societal attitudes. This study highlights that autism service provision should be informed by autistic voices and not only focus on impairment but also recognise the strengths of autistic people alongside their very real needs. The whole of society – including policymakers, professionals, employers, educators, families and autistic people themselves – needs to work together to fight autism stigma and discrimination.
Am I bilingual? Reporting on the self-reflections of Japanese EFL learners
Authors: Turnbull Blake 
Published: May 2021

Aims and objectives/purpose/research questions: Through use of a written questionnaire, this article examines the personal opinions of tertiary-level Japanese intermediate EFL students regarding the definition and process of becoming bilingual. Design/methodology/approach: This article takes a critical applied linguistic approach to examining the perspectives of emergent bilingual Japanese EFL learners regarding their own status as bilingual speakers in Japan. Data and analysis: This study employed a questionnaire involving both Likert and open perspective questions. The subsequent data analysis involved quantitative analysis of the Likert questions and qualitative analysis of the open-ended questions, according to emerging themes. Findings/conclusions: The results suggest that most of the Japanese emergent bilingual participants did not view themselves as being bilingual, and instead considered the notion of bilingualism to be an out-of-reach goal at their current level. This article suggests the need to educate foreign language (FL) learners of their emergent bilingual status so they may dismiss the idea of attaining native-like competence and embrace their status as competent emergent bilinguals. Originality: Whereas many studies examine (emergent) bilingualism from the perspective of minorities learning a majority language, this article has expanded upon the current body of bilingualism literature by investigating the perspectives of bilingualism from speakers of a majority language learning a minority language, as is the case in all FL education environments. Significance/implications: This article provides an insight into the issue of FL learners’ lack of recognition of their own emergent bilingualism. It brings attention to the need for FL teachers to inform students of their emergent bilingual status to leverage their bilingual languaging strategies so that they can make meaning, express themselves, and learn in their ever-increasing bilingual worlds.
Aerobic Exercise Combined With Transcranial Direct Current Stimulation Over the Prefrontal Cortex in Parkinson Disease: Effects on Cortical Activity, Gait, and Cognition
Authors: Conceição Núbia Ribeiro , Gobbi Lilian Teresa Bucken , Nóbrega-Sousa Priscila , Orcioli-Silva Diego , Beretta Victor Spiandor , Lirani-Silva Ellen , Okano Alexandre Hideki , Vitório Rodrigo 
Published: May 2021

Background Since people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait. Objective We investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD. Methods A total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session. Results Compared with the pre-assessment, participants decreased step time variability (effect size: −0.4), shortened simple and choice reaction times (effect sizes: −0.73 and −0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS. Conclusion The addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD.
Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)
Authors: Cadilhac Dominique A , Cameron Jan , Kilkenny Monique F , Andrew Nadine E , Harris Dawn , Ellery Fiona , Thrift Amanda G. , Purvis Tara , Kneebone Ian , Dewey Helen , Drummond Avril , Hackett Maree , Grimley Rohan , Middleton Sandy , Thijs Vincent , Cloud Geoffrey , Carey Mariko , Butler Ernest , Ma Henry , Churilov Leonid , Hankey Graeme J , English Coralie , Lannin Natasha A 
Published: May 2021

Rationale To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Hypothesis Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Methods and design Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. Outcomes Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. Discussion We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study
Authors: Sparapani Valéria de Cássia , Fels Sidney , Kamal Noreen , Ortiz La Banca Rebecca , Nascimento Lucila Castanheira 
Published: May 2021

Background: Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors. Methods: This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children’s learning needs and behaviors, that were considered to design The Heroes of Diabetes—the power of knowledge. Results: The results presented the process of designing 4 mini games with its description and theory foundation to reach children’s lack of understanding about T1D, insulin’s role, SMBG requirements, food groups and physical activity’s role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features. Conclusions: The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.
The Relationships Between Sport Specialization, Sleep, and Quality of Life in Female Youth Volleyball Athletes
Authors: Watson Andrew , McGuine Timothy , Lang Pamela , Post Eric , Biese Kevin , Kliethermes Stephanie , Brooks M. Alison , Bell David 
Published: May 2021

Background: Although sport specialization may be associated with stress and burnout among youth athletes, the relationship with quality of life (QOL) remains unknown. The purpose of this study was to evaluate the relationship between sport specialization, sleep, and QOL in female youth athletes. Hypothesis: Higher levels of specialization are associated with increased daytime sleepiness and worse QOL. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Female high school volleyball players completed preseason surveys to determine sport specialization (low, moderate, high), injury history, QOL, sleep duration, and daytime sleepiness. QOL and sleep variables were compared across specialization groups. Multivariable linear regression models were developed to evaluate the associations between sleepiness, QOL, specialization, grade in school, and injury history. Results: Of 1482 participants, 591 (40%), 436 (29%), and 455 (31%) were categorized as low, moderate, and high specialization, respectively. Highly specialized athletes demonstrated worse QOL (median 91.3 [interquartile range 86-96]) than low (92.4 [88-97], P = 0.05) and moderate (93.5 [88-99], P = 0.05) specialization groups and greater daytime sleepiness (11 [7-15]) than low (10 [6-14], P < 0.001) and moderate (10 [6-14], P < 0.001) specialization groups. In the multivariable model, QOL was negatively associated with prior injury occurrence (β = −1.1 ± 0.5, P = 0.02), but not grade in school (β = −0.08 ± 0.2, P = 0.71) or specialization (moderate: β = 0.08 ± 0.5, P = 0.88; high: β = −0.70 ± 0.5, P = 0.18). Daytime sleepiness increased with high specialization (β = 1.12 ± 0.3, P < 0.001) and grade (β = 0.76 ± 0.1, P < 0.001), but not prior injury (β = 0.51 ±0.3, P = 0.10). Conclusion: Highly specialized female volleyball athletes demonstrate decreased QOL, perhaps because of higher rates of prior injury. Specialization is also associated with increased daytime sleepiness. Clinical Relevance: Sport participation patterns and injury may have implications for QOL in youth athletes.
Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study
Authors: Duguma Negesso , Tesfaye Kiya Girum , Adissu Maleko Wondimagegn , Bimerew Lealem Gedefaw 
Published: May 2021

Objectives: Hematological abnormalities of the major blood cell lines are frequently reported in patients with HIV-1 infection, in patients without antiretroviral therapy, and during the advanced stages of the disease. Chronic immune activation and inflammation results in the progressive depletion of CD4+ T-cells play a significant role in the clinical progression and pathogenesis of this infection. This study was aimed at assessing the prevalence of hematological abnormalities and their associated factors before and after the initiation of antiretroviral therapy in adults with HIV-1 infection in a referral hospital. Methods: The study was conducted from 1 April to 30 June 2018, at Goba Referral Hospital. A total of 308 HIV-positive adults on treatment were enrolled during the study period. Socio-demographic and clinical data were collected using a structured questionnaire, with pre-highly active antiretroviral therapy data were extracted from medical records while post-treatment immuno-hematological measurements were done on blood samples collected at the time of enrollment. Results: The prevalence of anemia, leukopenia, and thrombocytopenia before initiation of antiretroviral treatment was higher, although anemia and thrombocytopenia decreased correspondingly after initiation of treatment leukopenia increased by 4%. Mean values of immuno-hematological parameters before and after treatment initiation were significant ( p < 0.05). CD4+ T-cell count <200 cells/µL was the only independent risk factor for anemia and leukopenia before highly active antiretroviral therapy, while stage IV disease, female sex, zidovudine, lamivudine, and nevirapine treatment, and intestinal parasite infection were predictors of anemia after treatment initiation. Conclusion: The study revealed that hematological abnormalities are common in HIV infection, while the occurrence of abnormalities after highly active antiretroviral therapy initiation. Different risk factors are associated with hematological abnormalities at pre- and post-highly active antiretroviral therapy with regular monitoring of risk factors, adherence to the early initiation of highly active antiretroviral therapy, and conduct of further longitudinal studies are recommended.
The relationship between the stone-free status after extracorporeal shockwave lithotripsy (ESWL) treatment in different patient and kidney stone characteristics: A single center experience in Saudi Arabia
Authors: Katib Atif , Al-Wafi Osama , Dakkak Basem , Bawa Abdallah , Basheer Mansur , Al-Bilal Izzeldin 
Published: May 2021

Purpose: The objective was to unveil the relationship between different relevant patient and kidney stone characteristics and the stone-free status post extracorporeal shockwave lithotripsy (ESWL) treatment. Materials and methods: Kidney stones cases referred for ESWL from October 2019 to January 2020 were collected. A total of 225 adult patients who met the criteria of being new cases of single radio-opaque kidney stones measuring 5 to 20 mm were included. We were looking for disintegrated stones down to 4 mm or less as a marker for stone-free (SF) status. The studied parameters were gender, laterality (right or left kidney), location of the stone within the kidney, stone’s density measured in Hounsfield units (HU), stone’s size, and stone-to-skin distance (SSD). Results: Out of the 225 cases treated, only 175 (77.8%) became SF after or during the study timeframe. SF status was achieved after the first session in 131 cases (58.2%). The bivariate analysis of the factors associated with higher SF rates found to be statistically significant were left kidney ( p-value of < 0.01), low stone density ( p-value of < 0.01), short stone–skin distance ( p-value of < 0.01), and small stone size ( p-value of < 0.01). On the other hand, gender and stone location within the kidney showed no association with ESWL outcomes. Conclusion: Kidney laterality, SSD, stone density, and size are influencing parameters on ESWL outcomes and achievement of stone-free status.
A Case Report of Recurrent Hypokalemia During Pregnancies Associated With Nonaldosterone-Mediated Renal Potassium Loss
Authors: Pintavorn Pairach , Munie Stephanie 
Published: May 2021

Rationale: Geller et al reported a rare mutation in the mineralocorticoid receptor (MR) resulting in constitutive MR activity. Progesterone, normally an MR antagonist, acts as a potent agonist with this mutation. Progesterone levels can increase 100-fold during pregnancy and thus lead to increased MR activity in this setting, resulting in hypertension (HTN) and hypokalemia during pregnancy and resolution of hypokalemia after delivery. Presenting concerns: Our patient was a 33-year-old African American female with a history of pregnancy-induced HTN associated with hypokalemia during her last pregnancy. She presented with muscle weakness from profound hypokalemia complicated by nephrogenic diabetes insipidus (DI) and rhabdomyolysis. Diagnosis: Her admission potassium was 1.9 mmol/L (3.5-5.1 mmol/L) with a 24-hour urine potassium of 35 mmol per day and an unmeasurable serum aldosterone level. Her potassium normalized 1 day after delivery off potassium supplementation and amiloride, which were last given 1 day prior to her delivery. Recurrent hypokalemia from nonaldosterone-mediated renal potassium wasting during pregnancy (with normal potassium in a nongestational state) is consistent with the cases of gain-of-function mutation in MR that Geller et al report. A definite diagnosis requires genetic analysis. Interventions: Her hypokalemia was refractory to potassium replacement but quickly responded to an inhibitor of the epithelial sodium channel (ENaC), amiloride. Outcomes: Her potassium normalized on amiloride 10 mg per day and KCL 40 mEq daily during the remainder of her pregnancy, and her nephrogenic DI resolved after this correction of hypokalemia. After her delivery, her potassium remained normal off the potassium supplements and amiloride. Novel findings: Pregnancy-induced hypokalemia from an activating MR mutation has rarely been reported. Pregnancy-induced HTN is often the first differential diagnosis in a patient who develops worsening in her HTN during pregnancy. We should also consider the possibility of a gain-of-function mutation in MR in these patients who also have associated hypokalemia.