bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inherited privilege? First vs. continuing-generation medical students in Egypt, academic performance, extracurricular training and expectations: a cross-sectional study
Authors: Aboudeif Ayten , Elaraby Youssef , Hany Mohamed , Nasser Sara , Refaat Nadine , Mohamed Yara Gamal , Khalil Reem Youssry , Khabiry Hashim , Raafat Fatma Hussein , Ghazy Nour , Boulos Dina N.K. , Yosef Mostafa 
Published: November 2024

Abstract
Background
The transition to college life is a highly demanding period for all students, especially when enrolling into an academically-challenging field as that of medicine. First-generation medical students represent an overlooked demographic and are thought to be more vulnerable to the stressors of college. This study’s aim is to explore the differences between first and continuing-generation medical students in Egypt regarding their academic performance, extracurricular training opportunities and future expectations.

Methods
Two identical 24-item online questionnaires, in English and Arabic were distributed with five main themes: general demographics, academic performance, extracurricular training opportunities (outpatient clinics, hospitals and operating rooms), future expectations and if participants have relatives in the medical field.

Results
Responses from 1652 eligible respondents from all 36 medical universities in Egypt were received. Continuing-generation medical students achieved a higher cumulative grade, with 46.1% getting an “Excellent” grade compared to only 38.4% in the first-generation. The gap between the two groups was best noted in Year 1 (p-value < 0.001), as continuing-generation medical students were almost twice more likely to score an “Excellent” grade [Odds Ratio = 1.85 (1.48–2.31)]. First-generation group had less training opportunities in clinics (p < 0.001) and operating rooms (p < 0.001). There was a significant difference (p < 0.001) across all three clinical settings in regard to how the training opportunity was acquired. The majority of continuing-generation medical students credited their family members for it. Amongst those who wish to travel, the majority of the first-generation medical students plan to pursue their career in the United States; whereas, most of continuing-generation medical students aimed for the Middle East and Western Europe.

Conclusion
First-generation medical students had lower grades at first mainly due to their lack of awareness of proper resources that were provided by the families of continuing-generation medical students. However, the challenges posed to first-generation medical students prompted the development of higher resilience, enabling them to catch up and even surpass their continuing-generation counterparts. Continuing-generation medical students obtained further extracurricular training (outpatient clinics and operating rooms), accessed mainly through their family members and connections; whereas, first-generation medical students received most of their training by searching for it themselves.
A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure
Authors: Yang Lawrence H. , Bass Judy K. , Le PhuongThao D , Singh Ritika , Gurung Dristy , Velasco Paola R. , Grivel Margaux M. , Susser Ezra , Cleland Charles M. , Alvarado Rubén , Kohrt Brandon A. , Bhana Arvin 
Published: November 2024

Abstract
Background
Few implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility.

Methods
We summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure’s construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility.

Results
Continuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure’s structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as “program,” “provider type,” and “type of service” were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers’ conceptions of utility regarding the measure’s acceptability, appropriateness, and feasibility clustered across several common categories.

Conclusions
This case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers’ preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.
Adoption and perception of prescribable digital health applications (DiGA) and the advancing digitalization among German internal medicine physicians: a cross-sectional survey study
Authors: Cirkel Lasse , Lechner Fabian , Schlicker Nadine , Leipe Jan , Mühlensiepen Felix , Grgic Ivica , Hirsch Martin C. , Kuhn Sebastian , Knitza Johannes 
Published: November 2024

Abstract
Background
Therapeutic digital health applications (DiGAs) are expected to significantly enhance access to evidence-based care. Since 2020, German physicians and psychotherapists have been able to prescribe approved DiGAs, which are reimbursed by statutory health insurance. This study investigates the usage, knowledge and perception of DiGAs as well as the growing digitalization among internal medicine physicians in Germany.

Methods
A web-based survey was distributed at the 2024 annual congress of the German Society for Internal Medicine. Participants could respond by scanning a QR code or directly on a tablet.

Results
A total of 100 physicians completed the survey, with a mean age of 43.4 years. The majority were internal medicine physicians (85%). Of the respondents, 31% had already prescribed DiGAs, and 29% had tested one. Self-rated knowledge of DiGAs was low (median score 3.17/10). The main barriers identified were lack of knowledge about effective implementation (60%), lack of time for patient onboarding (27%), and concerns about patient adherence (21%). However, 92% believed that DiGAs could improve care, and 88% expressed interest in specific digital health training. The majority (64%) stated that digitalization had a positive impact on medical care and 39% of physicians expected their daily workload to decrease due to digitalization. In addition, 38% believed that the physician-patient relationship would improve as a result of digitalization.

Conclusions
While physicians widely acknowledged the potential benefits of DiGAs, adoption and understanding remain limited. Specific training in digital health is crucial to accelerate digitalization in internal medicine.
Sex-specific dietary habits and their association with weight change in healthy adults
Authors: Rein Michal , Elkan Matan , Godneva Anastasia , Dolev Noa Cohen , Segal Eran 
Published: November 2024

Abstract
Background
Dietary intake plays a pivotal role in the prevalence and management of obesity. While women and men exhibit differences in dietary habits and food-related behaviors, sex-based weight loss recommendations are lacking. This study aims to examine the impact of specific foods and food categories on weight reduction in men and women over a two-year period.

Methods
A total of 8,548 participants from the 10K cohort, from 2019 to 2023, were included in the analysis (53.1% women, mean age 51.7 years). Anthropometric measurements and laboratory results were collected at baseline and at the two-year follow-up visit. Dietary assessment was based on daily food intake digitally logged through an application for at least 3 consecutive days at both timepoints. We compared intake of macronutrients, micronutrients, food groups and daily energy consumption between sex and body mass index (BMI) categories at baseline and weight change categories at follow-up. Using linear regression, we assessed the associations between food categories or specific foods and BMI at baseline as well as weight change percentage at follow-up.

Results
Dietary habits varied by BMI and sex. Women and men living with obesity (BMI > 30 kg/m2) reported a greater intake of animal-based protein and lower intake of plant-based proteins and fats at baseline, as compared to participants with normal weight. In linear regression models predicting two-year weight change, including age, income, and baseline weight, the explained variance was 5.6% for men and 5.8% for women. Adding food categories and specific foods increased the explained variance to 20.6% for men and 17.5% for women. Weight reduction in men was linked to daily consumption of an egg (1.2% decrease) and beef (1.5% decrease), while in women, the most pronounced reductions were associated with an apple (1.2% decrease) and cashew nuts (3.4% decrease). Notably, total energy intake changes significantly impacted weight outcomes only in women.

Conclusions
Sex-specific dietary habits significantly influence weight change over time. In men, weight loss was primarily associated with the addition of animal-based protein, while in women, it was linked to caloric deficit and plant-based fat, suggesting that sex-based nutritional interventions may demonstrate greater efficacy.

Trial registration
NCT05817734 (retrospectively registered January 31, 2023).
Societal costs of older adults with low back pain seeking chiropractic care: findings from the BACE-C cohort study
Authors: Maas Esther T. , van der Vossen Brenda L. , van Dongen Johanna M. , Jenks Alan D. , Rubinstein Sidney M. 
Published: November 2024

Abstract
Background
To describe the societal costs during one year of follow-up among older adults seeking chiropractic care due to a new episode of low back pain (LBP), and to determine what factors predict high societal costs in this population.

Methods
Prospective cohort study, within chiropractic private practices (n = 38) in the Netherlands. 223 people ≥ 55 years of age with a new episode of LBP seeking chiropractic care participated. The primary outcome was total societal costs. High societal costs were defined as patients with costs in the top 20th percentile. The final prediction models were obtained using forward selection. Results were presented for the total population and stratified for retirement status. The model’s prognostic accuracy (Hosmer–Lemeshow X2, Nagelkerke’s R2) and discriminative ability [area under the receiver operating curve (AUC)] were assessed, and the models were internally validated using bootstrapping.

Results
The mean total annual societal cost per patient was €5297 [95% confidence interval (CI): 4191–6403]. The biggest cost driver was presenteeism (65% of total costs), and costs were higher among non-retired participants (€7759; 95% CI 6047–9470) than retired participants (€1892; 95% CI 1088–2695). In the total population, younger age [odds ratio (OR): 0.87 for each additional year; 95% CI 0.80–0.95], being male instead of female (OR 2.96; 95% CI 1.19–7.44), less alcohol intake (OR 0.49; 95% CI 0.20–1.19), working instead of retirement (OR 9.37; 95% CI 1.83–48.04), and more disability at baseline (OR 1.08; 95% CI 1.00–1.16) were found to be predictive of high societal costs. Working was found to be the strongest predictor for high societal costs. After internal validation, the model’s fit was good, it’s explained variance was moderate (28%) and their AUCs could be interpreted as moderate (0.85). For non-pensioners, the same predictive factors were identified as for the entire population. The costs for the retired participants showed too little variation to be able to predict high costs.

Conclusions
This study estimated the mean total annual societal cost of older adults seeking chiropractic care due to a new episode of LBP at €5297 (95% CI 4191–6403).These costs were mainly due to high levels of presenteeism, and extensively differed based upon work status.
Applying an osteopathic intervention to improve mild to moderate mental health symptoms: a mixed-methods feasibility randomised trial
Authors: Hope-Bell Josh , Draper-Rodi Jerry , Edwards Darren J. 
Published: November 2024

Abstract
Background
The increasing prevalence of mental health disorders in the United Kingdom necessitates the exploration of novel treatment modalities. This study aimed to assess the feasibility and acceptability of conducting a randomised controlled trial (RCT) evaluating the efficacy of four osteopathic interventions on psychophysiological and mental health outcomes.

Methods
A mixed-methods feasibility study with an explanatory sequential design was implemented. The quantitative phase involved randomising 42 participants into four intervention groups: (1) high-velocity and articulation techniques (HVAT), (2) soft-tissue massage (STM), (3) craniosacral therapy (CST), and (4) a combination approach. Primary outcome measures encompassed recruitment rate, assessment duration, questionnaire completion, intervention attrition, and adverse events. Secondary outcomes included validated assessments of depression, anxiety, stress, psychological flexibility, heart rate variability (HRV), and interoception, administered pre- and post-intervention. Analysis of variance (ANOVA) was employed to evaluate pre-post intervention changes. The qualitative phase comprised semi-structured interviews analysed using thematic analysis.

Results
The study achieved a recruitment rate of 21 eligible participants per month, with 54.8% of respondents meeting eligibility criteria. All 33 participants who completed the study underwent interventions and assessments within the allocated one-hour timeframe, with full questionnaire completion. The attrition rate was 21%. No adverse events were reported. Qualitative analysis revealed positive participant experiences, with themes highlighting good practitioner communication, intervention accessibility, and increased bodily awareness. Some participants found the questionnaire battery burdensome. Exploratory quantitative analyses showed variations in effects across interventions for heart rate variability, interoceptive accuracy, and mental health measures, but these results should be interpreted cautiously due to the small sample size.

Conclusions
This study provides evidence supporting the feasibility and acceptability of a larger-scale RCT investigating osteopathic interventions for individuals presenting with mild psychological symptoms. The preliminary findings suggest potential efficacy in improving mental health outcomes, warranting further investigation.
Trial registration NCT05674071, registered 06/01/2023.
Racing against time: Emergency ambulance dispatches and response times, a register-based study in Region Zealand, Denmark, 2013–2022
Authors: Jensen Josefine Tangen , Møller Thea Palsgaard , Blomberg Stig Nikolaj Fasmer , Ersbøll Annette Kjær , Christensen Helle Collatz 
Published: November 2024

Abstract
Background
The global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times.
This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities.

Methods
Using administrative data from the Region Zealand emergency medical dispatch center, a register-based study spanning from January 1, 2013, to December 31, 2022, was conducted. Data were linked with nationwide registries and priority A (emergency), or B (urgent) ambulance dispatches were included.
Trends were examined overall and stratified by catchment areas corresponding to the hospitals with emergency departments in the region. Poisson and ordinal logistic regressions were used to analyze data.

Results
The study encompassed 678,789 emergency ambulance dispatches, with 55.0% priority A and 45.0% priority B. Among these, 667,788 had a valid personal identification number allowing for further analysis. Within the study population, females comprised 48.5%, while 49.1% of patients were 65 years or more. Overall, 47.5% of patients had no comorbidities, while 7.7% and 44.8% had mild and severe comorbidities, respectively.
Emergency ambulance dispatches increased from 56,867 in 2013 to 81,080 in 2022 (143%). Correspondingly, the dispatch incidence rate per 1,000 residents per year increased from 69.2 to 95.5. Stratification by catchment areas revealed significant disparities.
The median response time for priority A dispatches increased from 7 min:14 s in 2013 to 8 min:20 s in 2022 and for priority B dispatches from 12 min:23 s to 15 min:6 s.

Conclusions
From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards.
Pre and post diagnostic dementia care in four Scottish prisons
Authors: MacRae Rhoda , Chalmers Natalie , Tolson Debbie , Taylor James , Anderson Kirstin , Thomson Lindsay , Russ Tom 
Published: November 2024

Abstract
Background and purpose
The number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.

Results
At the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a ‘case by case’ approach to their pre- and post-diagnostic care. Meeting these prisoner’s needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.

Conclusion
This research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.
The impact of co-occurring chronic pain and mental health symptoms on adolescent functioning, a cross-sectional survey
Authors: Bateman Sharon , Jordan Abbie , Noel Melanie , Loades Maria , Caes Line 
Published: November 2024

AbstractAdolescents who experience poor mental health may develop chronic pain. Similarly, those with chronic pain may develop mental health symptoms. Little is known concerning how these co-occurring symptoms are associated with adolescent functioning. Our online cross-sectional quantitative study compared the specific nature of challenges to psychosocial functioning, across 4 groups: (1) adolescents with co-occurring chronic pain and mental health symptoms; (2) adolescents who only experience chronic pain symptoms; (3) adolescents who only experience mental health symptoms, and (4) adolescents who do not report either symptom. Participants completed self-report questionnaires assessing pain experiences, mental health symptoms and psychosocial functioning. After controlling for pain intensity, findings revealed significant differences, in physical, social, and family functioning across all groups. Significantly worse physical functioning was reported by adolescents with co-occurring pain and mental health symptoms and those with pain-only symptoms compared with adolescents with mental health-only symptoms and those without symptoms. Social functioning was significantly worse for adolescents who experienced co-occurring chronic pain and mental health symptoms compared with adolescents who experienced pain-only symptoms, and those with no symptoms. Significantly worse family functioning was reported by adolescents with mental health-only symptoms compared with adolescents reporting pain-only symptoms and no symptoms. Results suggest the combined impact of pain and mental health symptoms mainly influences adolescent social functioning. Future research is needed to develop standardised assessment and treatment plans to facilitate a thorough understanding of symptoms presented by adolescents who experience co-occurring pain and mental health symptoms.This study identifies that the combined impact of pain and mental health symptoms influences adolescent social functioning when compared to adolescents who experience pain-only or those without symptoms. Research is needed to develop standardised assessment and treatment plans to fully understand the symptoms presented by adolescents with co-occurring symptoms.