bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma metabolomic signature of healthy lifestyle, structural brain reserve and risk of dementia
Authors: Tian Fei , Wang Yuhua , Qian Zhengmin (Min) , Ran Shanshan , Zhang Zilong , Wang Chongjian , McMillin Stephen Edward , Chavan Niraj R , Lin Hualiang 
Published: September 2024

Abstract
Although the association between healthy lifestyle and dementia risk has been documented, the relationship between a metabolic signature indicative of healthy lifestyle and dementia risk and the mediating role of structural brain impairment remain unknown.
We retrieved 136 628 dementia-free participants from UK Biobank. Elastic net regression was used to obtain a metabolic signature that represented lifestyle behaviours. Cox proportional hazard models were fitted to explore the associations of lifestyle-associated metabolic signature with incident dementia. Causal associations between identified metabolites and dementia were investigated using Mendelian randomization. Mediation analysis was also conducted to uncover the potential mechanisms involving 19 imaging-derived phenotypes (brain volume, grey matter volume, white matter volume and regional grey matter volumes).
During a follow-up of 12.55 years, 1783 incident cases of all-cause dementia were identified, including 725 cases of Alzheimer's dementia and 418 cases of vascular dementia. We identified 83 metabolites that could represent healthy lifestyle behaviours using elastic net regression. The metabolic signature was associated with a lower dementia risk, and for each standard deviation increment in metabolic signature, the hazard ratio was 0.89 [95% confidence interval (CI): 0.85, 0.93] for all-cause dementia, 0.95 (95% CI: 0.88, 1.03) for Alzheimer's dementia and 0.84 (95% CI: 0.77, 0.91) for vascular dementia. Mendelian randomization revealed potential causal associations between the identified metabolites and risk of dementia. In addition, the specific structural brain reserve, including the hippocampus, grey matter in the hippocampus, parahippocampal gyrus and middle temporal gyrus, were detected to mediate the effects of metabolic signature on dementia risk (mediated proportion ranging from 6.21% to 11.98%).
The metabolic signature associated with a healthy lifestyle is inversely associated with dementia risk, and greater structural brain reserve plays an important role in mediating this relationship. These findings have significant implications for understanding the intricate connections between lifestyle, metabolism and brain health.
Executive Summary: State-of-the-Art Review: Evaluation and Management of Pelvic Osteomyelitis in Stage IV Pressure Injuries: A Multidisciplinary Collaborative Approach
Authors: El Zein Said , Melin Matthew M , Suh Gina A , Tran N V , Rose Peter S , Berbari Elie F 
Published: September 2024

Abstract
Managing pelvic osteomyelitis (POM) in the setting of stage IV pressure injuries requires multidisciplinary evaluation as well as patient and caregiver engagement and is complicated by the lack of high-evidence data to guide best practices. In this review, we describe our approach to pressure injury and POM evaluation and management through multidisciplinary collaboration and highlight areas of future research that are necessary to enhance patient outcomes, reduce healthcare costs, and improve the quality of life of those affected by POM.
Robotic-assisted versus video-assisted thoracoscopic surgery for thymic epithelial tumours, from the European Society of Thoracic Surgeons Database
Authors: Patel Akshay J , Smith Alexander ,   ESTS Thymus Collaborative Steering Group, Podobed Alexandr , Liberman Moishe , Pascal Thomas , Gabryel Piotr , Aigner Clemens , Aresu Giuseppe , Coonar Aman , Nizami Maria , Jimenez Marcelo , Van Schil Paul , Voltolini Luca , Casiraghi Monica , Spaggiari Lorenzo , Ampollini Luca , Carmargo Spencer , Londero Francesco , Schmitt-Opitz Isabelle , Scarci Marco , Turna Akif , Esch Mathhias , Venuta Federico , Mendogni Paolo , Moreno-Mata Nicolas , Martelo Fernando , Elkhayat Hussein , Fitzmaurice Gerald , Szanto Zalan , Moser Bernhard , Lyberis Paraskevas , Ruffini Enrico , Bille Andrea 
Published: September 2024

Abstract

OBJECTIVES
Minimally invasive thymectomy is an accepted approach for early-stage thymic epithelial neoplasia, reducing pain and length of stay compared with open surgery. In this study, we compare robotic and video-assisted thymectomy to assess pathological resection status, overall and disease-free survival.

METHODS
Data were retrieved from the European Society of Thoracic Surgeons prospectively maintained thymic database. Eighty-two international centres were invited to participate in the ESTS registry. Thirty-seven centres agreed to take part. We included all patients who had undergone complete thymectomy for malignancy through a minimally invasive approach and excluded patients in whom complete data were not available.

RESULTS
Between October 2001 and May 2021, a total of 899 patients with thymic malignancy underwent minimal access surgical resection and were included in the study. A propensity matched analysis was conducted with interrogation of 732 patients. Median age was 55 years, and 408 (56%) patients were female. Propensity matched was performed with 1:1 matching for surgical approach (video assisted = 366, robot assisted = 366). Robot-assisted surgery conferred significantly lower odds of incomplete resection (R1; 0.203 95% CI 0.13–0.317; P &lt; 0.001). However, there was no difference in terms of overall and disease-free survival between the 2 techniques.

CONCLUSIONS
In this analysis, after adjusting for thymoma stage, the odds of incomplete surgical resection were higher in patients undergoing video-assisted surgery than robotic. However, there was no difference in overall or disease-free survival. With data maturation and increased follow-up, this would need repeat analysis and perhaps may provide more credence to the concept of a prospective randomized study to compare outcomes in thymic epithelial neoplasia by surgical approach with a standardized pathological work-up.
Heart rate response and recovery in cycle exercise testing: normal values and association with mortality
Authors: Jou Jordi , Zhou Xingwu , Lindow Thomas , Brudin Lars , Hedman Kristofer , Ekström Magnus , Malinovschi Andrei 
Published: September 2024

Abstract

Aims
Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk.

Methods and results
We included 9917 subjects (45% females) aged 18–85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (&lt;5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR1, hazard ratio 1.70 (95% confidence interval, 1.49–1.94), and HRR2, 1.57 (1.37–1.79)] and in subjects with normal exercise capacity [HRR1, 1.96 (1.61–2.39), and HRR2, 1.76 (1.46–2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR1 and HRR2, 1.96 (1.68–2.29), and peak HR and HRR1, 1.87 (1.56–2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality.

Conclusion
All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.
143 National strategy of physical activity in Georgia - process and results supporting sustainable development
Authors: Gvinianidze Kakha 
Published: September 2024

Abstract

Purpose
National strategy for promoting physical activity (PA) in Georgia aims to decrease insufficient PA in whole population, including children and adults. It is comprehensive document addressing key issues related with physical inactivity and covering all relevant sectors on central and municipal levels. Currently draft of the document is submitted to the government for official approval.
The document considers specific activities for the groups of population, such as pregnant women, children and youth, adults, people with disabilities and elderlies.

Project description
Process has been initiated in 2021 by creating multisectoral group of PA under the National Center for Disease Control and Public Health with support of WHO and funding of EU. The group consists of state, municipal and nonstate representatives of health, education, sport, urban planning, transport and environment. First step was wide scale desk review and situation analysis. This was followed by brainstormings, drafting of the policy document and large-scale policy dialogue with diverse sectors.
Draft of the National Strategy and Action Plan of PA 2024-2030 includes improving PA programs and other opportunities in kindergartens and schools, workplaces, universities; services and opportunities for pregnant women, elderlies, people with disabilities; strengthening active mobility, tourism; increasing scale and attractiveness of green spaces, access to sport infrastructure and programs; integration of PA in health services; building institutional capacity, systematization of surveillance and national communication campaign.

Conclusion
As a practical result of this work it is expected Georgia to have comprehensive national policy for health promoting physical activity with all associated benefits for health and economy of the country.
Nature of comprehensive PA policy requires relevant sustainable development elements to be widely considered in reforms of diverse sectors and therefore document development process includes large scale dialogue. Accordingly, PA on policy development stage became interconnecting issue and platform for policy dialogues regarding specific sustainable development issue of diverse sectors and it is expected to be continued and strengthened in course of its implementation. It may add to the experience and knowledge both from PA and sustainable development discourses especially for developing societies.
149 Accelerometer-based measurement of physical activity and sleep duration in Denmark: A Large Population-Based Study
Authors: Ahrensberg Hannah , Eghøj Martin , Ekholm Ola , Christensen Anne Illemann , Petersen Christina Bjørk , Rasmussen Mette 
Published: September 2024

Abstract

Purpose
Public health surveillance involves regular assessment of health indicators, including physical activity, sedentary behavior, and sleep. Traditionally, self-reported measures have been used, but recent advancements in accelerometer technology and administration offer a new approach. The aim of this study is to monitor and explore accelerometer-based measurements of physical activity and sleep duration in in the adult Danish population.

Methods
Data were obtained from the Danish National Health Survey conducted in 2023. From participants delivering a web-based response, 6,993 individuals (age 16 to 92 years) were invited to participate in an accelerometer-based measurement of physical activity, sedentary behavior, and sleep. A total of 1,595 individuals accepted (22,8%). Each participant received a SENS motion® accelerometer in the post, an instruction letter (with a QR-code to access a mobile-application), a mounting patch, and a pre-paid return envelope. Data were analyzed using the MOTUS algorithm, which is a refined version of the Acti4-algoritmen.

Results
The average time spent on physical activity with moderate to vigorous intensity was 31 min/day (Range: 0.5-178). Overall, 58% were sufficiently physically active according to WHO recommendations. The average total sedentary time was 527 min/day (equivalent to 8 hours and 47 minutes). Men were more sedentary than women. Participants took an average of 10,577 steps/day and cycled for 19 min/day (median: 13 minutes; range: 3-103 min/day). Within the primary sleep period, the average sleep time was 7 hours and 13 minutes/day and 33% of participants slept less than 7 hours/day.

Conclusion
The use of accelerometers has the potential to contribute significantly to monitoring of physical activity, sedentary behavior, and sleep at the population level in Denmark. However, this should be combined with questionnaire-based information as self-report and accelerometer measurements does not seem to capture the same facets of physical activity. Nevertheless, further development is necessary to enhance administration and user experiences.
92 Enhancing Self-Efficacy for and Adherence to Resistance Training in Older Adults: A Multi-Stakeholder Perspective of a Supervised-to-Unsupervised Step-Down Model
Authors: Mulhare Brian , O’Hagan Ciara , Harrison Michael , Fagan Sarah , Kehoe Bróna 
Published: September 2024

Abstract

Background
With the ageing population, it is increasingly important to support older adults in maintaining good health and independence. Resistance exercise has been proven to have physical, physiological, and cognitive benefits. However, only a small percentage of older adults participate in sufficient muscle-strengthening activities. Community or home-based programs may offer the best mode to address this, but lack long-term sustainability. A model combining both approaches could reinforce meaningful behavioural change. Expert consultation is necessary to identify potential challenges in this approach.

Methods
A multi-stakeholder expert panel (n = 11) of academics, facilitators, and older adults was consulted to critically evaluate a step-down exercise model using a multi-stage framework. Initially, the panel was briefed with an executive summary of a behavioural analysis of resistance training in older adults based on formative qualitative research (n = 27). In the first stage, the panel engaged in a structured process to outline the intervention’s key components, identify potential difficulties, and develop solutions through voting. The second stage focused on determining necessary content and resources, employing a silent generation technique for devising solutions, followed by group discussions and round-robin sharing to address implementation challenges. This was audio-recorded, transcribed and thematically analysed to identify the barriers and facilitators to the implementation of a step-down model.

Results
The primary themes were: Messaging, Health Autonomy, Education, Tiers/Levels, Individual Exerciser, and Equity and Scalability. Challenges include poor messaging to older adults about resistance training, leading to a lack of awareness, misconceptions and poor engagement. The approach to healthcare and social welfare fosters dependency, hindering self-responsibility and health literacy. Starting with a supervised group setting supports education and behavioural change, and allows intensive guidance with unfamiliar exercise to build self-efficacy, eventually transitioning to more independent, remotely-supported exercise. The tiered approach was perceived to gradually reduce dependency whilst providing benchmarks for progress. However, there were concerns about the suitability for unsupervised high-intensity exercise and acceptance of independent exercise among older adults.

Conclusion
Multi-stakeholder perspectives in the development of complex interventions are valuable to exploring potential implementation challenges and solutions, thereby enhancing the feasibility, acceptance, and, hence, potential success of the intervention.
80 Improving policy and practice for cyclists with a disability in The Netherlands
Authors: Rauws Robin , Noordzij Mark , van Lindert Caroline 
Published: September 2024

Abstract

Purpose
Cycling is known to have great health benefits and to contribute to the autonomy and independence in mobility of people with a disability. However, Dutch streets and cycling lanes are not designed for adapted bicycles, and other traffic users often do not know how to react to cyclists with an adapted bicycle. Furthermore, there is a lack of cycling policy that accounts for disabled cyclists. This raises the following questions:
- Why, when, and where do people with a disability cycle?
- What challenges do cyclists with a disability experience when cycling?
- How can these challenges be addressed, according to people with a disability themselves and professionals in the field?
This study will help to gain insight into the practice of cycling among Dutch adults with a disability, in order to better understand their challenges and needs. A better understanding of these challenges and needs is necessary to make cycling more accessible. We also aim to raise awareness amongst designers and policy officials of the great diversity within cyclists’ needs and the types of bicycles used. We ultimately hope to contribute to greater cycling participation among people with a disability.

Methods
We conducted ten interviews with Dutch adults with different disabilities who shared their experiences of cycling in their neighborhood environment and beyond. The interview transcripts were coded and analyzed based on main themes we identified: characteristics of general cycling behavior, motivation(s) to cycle, challenges in cycling and possibilities to improve the cycling experience. We discussed these results for improvement in a workshop with professionals in spatial and traffic design.

Results
We will present the experiences of cyclists with a disability, the challenges they face and suggestions for improvements.

Conclusions
With this study, we hope to contribute to a better understanding of the needs and experiences of cyclists with a disability. Applying these insights will help policy officers and other professionals in the field in making their policies and designs more effective and improve road designs for cyclists with a disability.

Funding
This research project is funded by the Dutch Ministry of Health, Welfare and Sport (VWS).
43 Involvement in active transport is related to organizational factors and physical environment infrastructure
Authors: Motiejunaite Kristina , Mieziene Brigita , Gasiuniene Laima 
Published: September 2024

Abstract

Purpose
Active transport (AT) is considered the most sustainable and accessible mode for travel purposes. AT (walking and cycling) contributes to health-enhancing physical activity as it is a convenient and accessible way to increase physical activity levels. Convenient infrastructure promotion and support are important factors in shift from motor transport towards active travel. The purpose of this study was to determine how organizational factors and neighbourhood physical environment differ between using and not using AT among the Lithuanian young adult population.

Methods
This cross-sectional study included 250 Lithuanian young adults aged 18-39 years, with a mean age of 20.38 years. Of these, 80% were women. AT was measured using the Stages of Change Model-based Questionnaire. Infrastructure was measured by ALPHA Questionnaire–REVISED (Spittals et al., 2010). Organization-related items were developed by study researchers.

Results
Young Lithuanian people preferred cars and/or public transport (62.4%) instead of active transportation (AT) (27.6%) when choosing mobility. The results support a strong link between AT and organizational aspects. AT is more often chosen by people who belong to an organization where environmentally friendly behaviour is encouraged (waste sorting, using AT (p = 0.018); conditions are created to safely store a bicycle or scooter (p = 0.024); that talks about sustainable development, environmentally friendly behaviour, sustainability, etc. (p = 0.034). Quality of the neighbourhood physical environment, such as maintained bicycle paths (p = 0.011), maintained sidewalks (p = 0.049), maintained parks, and other open spaces (p = 0.050) significantly associated with the choice of AT. However, the choice of active transport was not significantly related to the infrastructure of pedestrian zones or paths, infrastructure of special lanes, routes for bicycles, or separation of bicycle paths from car traffic.

Conclusions
Young people’s involvement in AT is influenced by the attitude of the organization in which they work or study towards environmentally friendly behaviour, AT, and sustainable development. The quality of the neighbourhood physical environment also determines the involvement of young people in AT.
57 Nature based social prescribing for enhancing mental health and well-being
Authors: Lynch Mary , Whiteley Holly , Hartfiel Ned , Edwards Rhiannon Tudor , Cuthbert Andrew 
Published: September 2024

Abstract

Objectives
Nature Based Social Prescribing (NBSP) is a means of connecting people with non-clinical, nature-based community-led interventions delivered by 3rd sector organisations using local community assets. This research used a mixed-method Social Return on Investment (SROI) of a six-month pilot ‘Making Well’ NBSP programme to support individuals with chronic mental health conditions in Wales.

Methods
The ‘Making Well’ programme costs were estimated by means of SROI along projected 20% overheads, were incorporated to reflect sustainable costs as the charity develops and more accurately estimate the future social value expected to be generated. The ‘Making Well’ project delivered two separate programmes between October 2021 and April 2022. Data was collected from participants (n = 12) at baseline and eight-week follow-up along with interviews to collect in-depth data on individuals lived experience of participating in the programme. The ‘Making Well’ programme costs were estimated and financial proxies from the HACT Social Value (SV) bank were applied to identified benefits.

Results
The estimated cost of ‘Making Well’ programme inputs were £1,312 per participant and the net value of well-being benefits were £4,313 to £6,130 per participant, giving a range of SVR’s between £3.30 to £4.70 for every £1 invested in this NBSP intervention. The SROI forecast provides a three-year projection of the annual social value created and the estimated forecast cost of programme inputs was £797 per participant. The net value of well-being benefits was £4,313 to £6,130 per participant, giving a range of social value ratios between £5.40 to £7.70 for every £1 invested.

Conclusions
The SROI results demonstrate that the ‘Making Well’ programme is an effective NBSP intervention for supporting people with enduring mild to moderate mental health conditions. This SROI contributes to emerging evidence on the use of community assets and NBSP in generating a return on investment and positive social value. SROI forecasting for socially prescribed interventions delivered by local community assets, such as The Fathom Trust, can help organisations demonstrate transparent and effective investment of public funds and support optimal future social value creation and long-term public health outcomes.