bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial
Authors: Patterson Victoria C , Tibbo Philip G , Stewart Sherry H , Town Joel , Crocker Candice E , Ursuliak Zenovia , Lee Siranda , Morrison Jason , Abidi Sabina , Dempster Kara , Alexiadis Maria , Henderson Neal , Pencer Alissa 
Published: October 2024

Abstract
Background
Several adversity-focused treatment trials have reported improvements to adversity sequelae (e.g., PTSD symptoms) and decreases in psychotic symptoms among individuals with psychotic disorders. Yet, no trials have examined the impact of adversity-focused treatment on substance use or examined the outcomes among an early phase psychosis population. These gaps in both the research literature and clinical practice have resulted in less knowledge about the outcomes of adversity-focused treatment at this stage of illness, including the impact on substance use.

Methods
The outcomes of an adapted prolonged exposure protocol (PE+) among an early phase psychosis population were examined using a multiple-baseline design. Nineteen adults with a psychotic disorder, current substance misuse, and a history of adversity were recruited from an early psychosis program. Participants were randomized to treatment start time and participated in a 15-session course of PE + therapy. Ten assessments were completed focusing on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to establish whether there were clinically significant changes to primary or secondary outcomes.

Results
Half or more of treatment completers experienced clinically significant changes to most domains of adversity sequelae, no participants experienced improvements in negative psychotic symptoms, and substance misuse increased for several participants. In terms of secondary outcomes, functioning and experiential avoidance were improved for a number of participants, while hopelessness decreased for only one participant. Participants reported high satisfaction with the PE + treatment, and exposure and coping skills were rated as the most helpful elements of treatment.

Conclusions
Reductions in adversity sequelae were observed following PE + treatment, suggesting that adversity-focused treatment may be beneficial for an early psychosis population. Yet, few positive changes to psychotic symptoms or substance use were observed. Further integrating treatment strategies for psychosis and substance use into PE + may be required to effectively treat the links between psychosis, adversity sequelae, and substance use. Future studies should make efforts to integrate substance use strategies into adversity treatment trials for people with psychotic disorders.

Trial registration
Clinicaltrials.gov, NCT04546178; registration posted 11/09/2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1.
Gender differences in preferences for mental health apps in the general population – a choice-based conjoint analysis from Germany
Authors: Jagemann Inga , Stegemann Manuel , von Brachel Ruth , Hirschfeld Gerrit 
Published: October 2024

Abstract
Background
Men and women differ in the mental health issues they typically face. This study aims to describe gender differences in preferences for mental health treatment options and specifically tries to identify participants who prefer AI-based therapy over traditional face-to-face therapy.

Method
A nationally representative sample of 2,108 participants (53% female) aged 18 to 74 years completed a choice-based conjoint analysis (CBCA). Within the CBCA, participants evaluated twenty choice sets, each describing three treatment variants in terms of provider, content, costs, and waiting time.

Results
Costs (relative importance [RI] = 55%) emerged as the most critical factor when choosing between treatment options, followed by provider (RI = 31%), content (RI = 10%), and waiting time (RI = 4%). Small yet statistically significant differences were observed between women and men. Women placed greater importance on the provider, while men placed greater importance on cost and waiting time. Age and previous experience with psychotherapy and with mental health apps were systematically related to individual preferences but did not alter gender effects. Only a minority (approximately 8%) of participants preferred AI-based treatment to traditional therapy.

Conclusions
Overall, affordable mental health treatments performed by human therapists are consistently favored by both men and women. AI-driven mental health apps should align with user preferences to address psychologist shortages. However, it is uncertain whether they alone can meet the rising demand, highlighting the need for alternative solutions.
Health impact assessment in two planning projects in England: reflections on normative effectiveness
Authors: Fischer Thomas B. , Chang Michael , Muthoora Tara 
Published: October 2024

Abstract
Background
This article reports on research commissioned by (what was at the time) Public Health England (PHE). The objective is to reflect on the normative effectiveness of Health Impact Assessment (HIA) applied to two planning projects; (a) the new town at Cranbrook, Devon (HIA prepared in 2007), and (b) the regeneration of the Marsh farm area in Luton (HIA prepared in 2009). In this context, the focus is on the contribution of HIA to actions that are intended to lead to good or improved health and wellbeing.

Methods
Normative HIA effectiveness criteria derived from a literature review were used to guide the analysis. The two included HIA cases were previously identified as good practice examples with regards to procedure and report quality. Semi-structured interviews with public health, planning and other actors originally involved in the HIAs were conducted in 2021. This was followed up by web-searches for evidence on actual developments in 2023.

Results
Interviews indicated that normative effectiveness initially appeared to be high, but that the longer-term effects of the financial crash of 2008 reduced this. Delays in initially anticipated timelines and HIA actors moving elsewhere or retiring meant that HIAs were not followed-up and connections between developments and the HIAs were no longer made. However, web-based searches conducted in 2023 found that key HIA suggestions were eventually implemented, albeit with delay. There is also evidence for improved IMD (index of multiple deprivation) rankings in the Marsh farm regeneration case.

Conclusion
A mismatch is observed with regards to HIA exercises appearing to be largely ‘forgotten’ after over a decade of their publication, but recommendations still being implemented, possibly as a result of ‘institutional memory’. Making monitoring and follow-up of HIA binding rather than advisory would allow for direct linkages to be made.
How, why and when are delayed (back-up) antibiotic prescriptions used in primary care? A realist review integrating concepts of uncertainty in healthcare
Authors: Mcleod Monsey , Campbell Anne , Hayhoe Benedict , Borek Aleksandra J. , Tonkin-Crine Sarah , Moore Michael V. , Butler Christopher C. , Walker A. Sarah , Holmes Alison , Wong Geoff ,   on behalf of the STEP-UP study team, Anyanwu Philip E , Bright Nicole , Buchanan James , Costelloe Ceire , Hopkins Susan , Majeed Azeem , Morrell Liz , Pouwels Koen B , Robotham Julie V , Roope Laurence S J , Wordsworth Sarah , Wright Carla , Yadav Sara , Zalevski Anna 
Published: October 2024

Abstract
Background
Antimicrobial resistance is a global patient safety priority and inappropriate antimicrobial use is a key contributing factor. Evidence have shown that delayed (back-up) antibiotic prescriptions (DP) are an effective and safe strategy for reducing unnecessary antibiotic consumption but its use is controversial.

Methods
We conducted a realist review to ask why, how, and in what contexts general practitioners (GPs) use DP. We searched five electronic databases for relevant articles and included DP-related data from interviews with healthcare professionals in a related study. Data were analysed using a realist theory-driven approach – theorising which context(s) influenced (mechanisms) resultant outcome(s) (context-mechanism-outcome-configurations: CMOCs).

Results
Data were included from 76 articles and 41 interviews to develop a program theory comprising nine key and 56 related CMOCs. These explain the reasons for GPs’ tolerance of risk to different uncertainties and how these may interact with GPs’ work environment, self-efficacy and perceived patient concordance to make using DP as a safety-net or social tool more or less likely, at a given time-point. For example, when a GP uses clinical scores or diagnostic tests: a clearly high or low score/test result may mitigate scientific uncertainty and lead to an immediate or no antibiotic decision; an intermediary result may provoke hermeneutic (interpretation-related) uncertainty and lead to DP becoming preferred and used as a safety net. Our program theory explains how DP can be used to mitigate some uncertainties but also provoke or exacerbate others.

Conclusion
This review explains how, why and in what contexts GPs are more or less likely to use DP, as well as various uncertainties GPs face which DP may mitigate or provoke. We recommend that efforts to plan and implement interventions to optimise antibiotic prescribing in primary care consider these uncertainties and the contexts when DP may be (dis)preferred over other interventions to reduce antibiotic prescribing. We also recommend the following and have included example activities for: (i) reducing demand for immediate antibiotics; (ii) framing DP as an ‘active’ prescribing option; (iii) documenting the decision-making process around DP; and (iv) facilitating social and system support.
The roles of employment status and income in the mental health of informal caregivers in Germany
Authors: Scheuermann Julia-Sophia , Pendergrass Anna , Diehl Katharina , Herr Raphael M. 
Published: October 2024

Abstract
Background
Informal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers’ employment status and their mental health, as well as the moderating effect of net household income on this relationship.

Methods
The research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender.

Results
Informal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (β = 0.077, p < 0.001). The significant interaction term for full-time (β=-0.066, p = 0.001) and part-time workers (β=-0.066, p = 0.003) indicated a moderating effect of net household income on the association between employment status and mental health. This finding was especially evident in women.

Conclusions
Employment appears to be a relevant protective factor for informal caregivers’ mental health. However, if informal caregivers are not employed, a low net household income might additionally restrict their mental health. Therefore, welfare policy structures must be created to reduce the negative financial consequences for informal caregivers and enable them to achieve work-life-care balance.
Persistent deficits in knee joint kinematics and kinetics during gait following tibial plateau fractures – a longitudinal study
Authors: Fändriks Anna , Zügner Roland , Karlsson Jón , Möller Michael , Tranberg Roy 
Published: October 2024

AbstractThe recovery process after tibial plateau fractures varies, with some patients experiencing persistent gait asymmetries for a long period of time. The aim of this study is to analyse knee joint kinematics and kinetics post-fracture using a linear mixed-effects model, assessing 26 participants over 24 months (aged 45, range 26–63), and an age-matched control group (aged 47, range 26–62). Participants underwent three-dimensional gait analysis at 6-, 12- and 24-months post-injury. Controls participated in the gait analysis on one occasion. Six gait variables related to knee joint kinematics and kinetics were analysed with a linear mixed-effects model. The model was constructed to determine if there was a differential improvement over time between the injured and the non-injured legs across the six variables, referred to as an interaction effect. If no interaction effect was observed, the model assessed whether there was a side difference between the legs and if there was any improvement over time in both legs. Additionally, non-parametric tests were performed to assess differences between the non-injured leg and the control group across the six variables 24 months after injury. The findings revealed an interaction effect in terms of cumulative absorbed power (p = 0.02, side difference p = 0.06). Other variables showed no interaction effects. Although a side difference between legs was observed for all variables (p < 0.001), only the variables regarding generated power exhibited improvements over time (p = 0.02 respectively). Minimal knee flexion, range of motion, and maximal extending knee joint moment showed no improvements over time. At the 24-month follow-up, the maximal extending knee joint moment was the only variable that differed between the non-injured leg and controls, with increased moment observed for the non-injured leg compared with the controls (p = 0.03). Taken together, two years post-fracture, patients demonstrated pronounced side differences between the injured and non-injured legs with worse ability to extend the knee joint and to generate power in the injured leg. While the kinetic variables improved over time, there were no improvements observed in kinematic variables. Moreover, the non-injured leg performed similarly to healthy controls in terms of minimal knee flexion, range of motion, and generated and absorbed power.
Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access
Authors: Noh Dave Haeyun , Darwar Roopa , Uba Belinda V. , Gab-deedam Shiva , Yani Stella , Jimoh Akolade , Waziri Ndadilnasiya , David Joshua , Amoo Babatunde , Atobatele Sunday , Dimas Janada , Fadahunsi Rhoda , Sampson Sidney , Simple Edwin , Ugbenyo Gideon , Wisdom Margeret , Asekun Adeyelu , Pallas Sarah W. , Ikwe Hadley 
Published: October 2024

Abstract
Background
In 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.

Methods
This retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).

Results
The estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).

Conclusions
Findings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.
Differing effectiveness of transcranial random noise stimulation and transcranial direct current stimulation for enhancing working memory in healthy individuals: a randomized controlled trial
Authors: Tokikuni Yukina , Watanabe Akihiro , Nakazono Hisato , Miura Hiroshi , Saito Ryuji , Miaowen Duan , Fuyama Kanako , Takahashi Keita , Okada Kazufumi , Sugawara Kazuhiro , Tohyama Harukazu , Yoshida Susumu , Fong Kenneth N. K. , Sawamura Daisuke 
Published: October 2024

Abstract
Background
Transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (DLPFC) is a promising technique for enhancing working memory (WM) performance in healthy and psychiatric populations. However, limited information is available about the effectiveness of transcranial random noise stimulation (tRNS) applied to the left DLPFC on WM. This study investigated the effectiveness of tRNS on WM compared with that of tDCS, which has established functional evidence.

Methods
This randomized, double-blind, sham-controlled trial enrolled 120 healthy right-handed adults who were randomly allocated to four stimulation groups: tRNS + direct current (DC) offset, tRNS, tDCS, or sham. Each stimulus was placed over the left DLPFC and had a current intensity of 2 mA applied for 20 min during the dual n-back task. The dual n-back task was repeated thrice: pre-stimulation, during stimulation, and post-stimulation. The d-prime scores, and response times were calculated as the main outcome measures. A linear mixed model was created to identify the main effects and interactions between the groups and times, with the group and time as fixed effects, and baseline performance and the subject as a covariate and random effect, respectively. The relationships between the benefit of each stimulus and baseline WM performance were also examined.

Results
For the d-prime score during stimulation, the tRNS group significantly performed better than the sham group at online assessment (β = 0.310, p = 0.001). In the relationships between the benefit of each stimulus and baseline WM performance, the tRNS group had significantly larger negative line slopes than the sham group for the d-prime score (β = −0.233, p = 0.038).

Conclusions
tRNS applied to the left DLPFC significantly improved WM performance and generated greater benefits for healthy individuals with lower WM performance. These findings highlight the potential utility of tRNS for enhancing WM performance in individuals with lower WM performance and contribute evidence for clinical application to patients with cognitive decline.

Trial Registration
This study was registered in the University Hospital Medical Information Network Clinical Trial Registry in Japan (UMIN000047365) on April 1, 2022; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000054021.
Frequent callers contacting the Norwegian national emergency medical number 113: a retrospective study
Authors: Viken Sara Naess , Myrmel Lars , Brattebø Guttorm 
Published: October 2024

Abstract
Background
Calling for help is the first link in the chain of survival; however, few studies have investigated the challenges faced by frequent callers (FCs) to emergency medical communication centres (EMCCs). This study aimed to explore the characteristics of FCs and the nature of their calls to the Bergen EMCC, Norway.

Methods
This was a retrospective analysis of all emergency calls to the Bergen EMCC over three consecutive years (2019–2021). Bergen is the second-largest city in Norway, and the Bergen EMCC and ambulance services are part of the specialist medical service, covering a population of 460,000. The Bergen EMCC receives approximately 60,000 emergency calls per year. The study population comprised all adults identified during emergency medical calls. FCs were defined as individuals who registered five or more calls over 12 consecutive months during the three-year period.

Results
The analysis included approximately 50,000 individuals, who made > 90,000 calls during the study period. Of those, 1,594 (3.2%) were FCs, accounting for approximately one in four (21,339 of 90,085, 23.7%) calls. The FCs included more men (882 of 1,594 (55.3%) vs. 24,204 of 47,564 (50.9%)) and registered a lower proportion of calls with an acute degree of urgency (6,051 of 21,339 calls (28.4%) vs. 30,276 of 68,746 calls (44.0%)). Calls from FCs showed an even occurrence throughout the week, peaking between 19:00 h and 20:00 h. Compared with calls from non-FCs, calls from FCs had a higher proportion of ‘no response/verbal referral to local emergency medical department’ and involved a lower proportion of hospital transfers. The EMCC most frequently used the medical criterion ‘Mental health problems/suicide’ for calls from FCs.

Conclusions
FCs were common, and more often men. The EMCC dispatched ambulances or admitted patients to hospitals less frequently following these calls. Many of these situations could be handled in other parts of the healthcare system, reducing the burden on EMCCs, and providing more suitable services for FCs. Thus, EMCCs should identify and adjust patient management to match their actual needs.