bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation strategies: Lessons learned during an e-learning intervention to improve dietary behaviors and feeding practices in Early Childhood Education and Care
Authors: Lian Henrik , Øverby Nina Cecilie , Vik Frøydis Nordgård , Medin Anine Christine , Osorio Natalie Garzon , Helle Christine , Bjørkkjaer Tormod , Love Penelope , Rutter Harry , Barker Mary Elizabeth , Hillesund Elisabet Rudjord , Helland Sissel H. 
Published: October 2024

Abstract

Background:
Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0–2 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing Nutrition Now in ECEC centers in a municipality in Norway.
Methods:
The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Short phone interviews were conducted with the champions every three weeks over six months. The interviews were analysed using qualitative thematic analysis.
Results:
In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n = 37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion.
Conclusion:
This study’s findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. While the results can inform the scale-up of this and similar interventions, these findings are likely context-dependent, and further investigations are required.
Trial registration on June 6, 2022:ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967
Higher sperm H3K4me3 levels are associated with idiopathic recurrent pregnancy loss
Authors: Irani Delna , Tandon Deepti , Bansal Vandana , Patil Anushree , Singh Dipty 
Published: October 2024

Abstract

Background:
During fertilization, spermatozoa contribute genetic and epigenetic factors such as chromatin packaged with protamines and histones; DNA methylome, micro RNAs etc. Human sperm chromatin retains 5–15% nucleosomes which can play a key role in embryonic development. Recurrent Pregnancy loss (RPL) is a condition mainly attributed to defects in embryo and placenta development. Majority of the known RPL factors are of maternal contribution while ~ 50% RPL cases are termed idiopathic (iRPL). Besides paternal genetic factors, epigenetic factors via sperm could also be responsible for iRPL. Hence, we investigated alterations in retained nucleosome content of iRPL sperm (n = 46) as compared to fertile male population (n = 40).
Results:
We measured the relative abundance of core histone H4 and Protamine-2 content along with the modified histones H4Ac, H3K4me3, H3K27me3 and H3K9me3 by flow cytometry. Enrichment of these modified histones at regulatory loci have either transcription activating or repressing roles and Protamine-2 contributes to sperm chromatin compaction. H4 and Protamine-2 levels were comparable in both groups and showed significant negative correlation. The iRPL group was found to have significantly higher levels of sperm H3K4me3 as compared to the fertile control group. The other modified histones and protamine levels showed no alterations among the two groups. Furthermore, we analyzed possible correlation of sperm DNA fragmentation index (DFI) and 5-mC content with the relative sperm core histone H4 levels. Sperm DFI was found to be significantly positively correlated with H4 MFI in both control and iRPL sperm.
Conclusion:
A fraction of the H3K4me3 enrichment is now known to resist embryonic epigenetic reprogramming; and hence, such elevated levels in the sperm would question its developmental competence requiring its implications to be explored further in RPL pathology. Also, incidence of sperm DNA fragmentation is associated with increased histone retention in both fertile and iRPL cases.
Pregnancy, delivery, and neonatal outcomes among women with beta-thalassemia major: A population-based study of a large US database
Authors: St-Georges Juliette , Alnoman Abdullah , Badeghiesh Ahmad , Baghlaf Haitham 
Published: October 2024

Abstract

Purpose:
We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database.
Methods:
This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. Patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile and type of health insurance at a ratio of 1:20. Baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. Univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively.
Results:
Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. Patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03–1.63) and there was more than three-fold increased in rate of blood transfusion (aOR 4.69, 95% CI 3.02–7.28) among participants with beta-thalassemia major. Mothers with Beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07–2.62).
Conclusions:
Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.
Extreme heat and pediatric health in a warming world: a space-time stratified case-crossover investigation in Ontario, Canada
Authors: Kassem Hallah , Lavigne Eric , Weinberger Kate , Brauer Michael 
Published: October 2024

Abstract

Background
Globally, climate change is causing frequent and severe extreme heat events (EHEs). A large body of literature links EHEs to multiple health endpoints. While children’s physiology and activity patterns differ from those of adults in ways that are hypothesized to increase susceptibility to such endpoints, research gaps remain regarding the specific impacts of EHEs on child health. This study evaluated pediatric emergency healthcare utilizations associated with EHEs in Ontario.
Methods
Applying a space-time stratified case-crossover design, associations between EHEs (same-day or lagged exposure to consecutive days of daily maximum temperatures above percentile thresholds) and 15 causes of pediatric emergency healthcare use in Ontario, Canada from 2005–2015 were analysed using conditional quasi-Poisson regression. In primary analyses, EHEs were defined as two or more consecutive days with temperatures above the 99th percentile of temperature within each respective forward sortation area (FSA). Healthcare use was measured using hospital admissions as an indicator of severe outcomes, and emergency department (ED) visits as a sensitive measure of outcomes.
Results
EHEs increased the risk of pediatric hospital admissions for respiratory illnesses by 26% (95% CI: 14%-40%), asthma by 29% (16%-44%); infectious and parasitic diseases by 36% (24%-50%), lower respiratory infections by 50% (36%-67%), and enteritis by 19% (7%-32%). EHEs also increased the risk of ED visits for lower respiratory infections by 10% (0%-21%), asthma by 18% (7%-29%), heat-related illnesses by 211% (193%-230%), heatstroke by 590% (550%-622%), and dehydration by 35% (25%-46%), but not for other causes. Admissions and ED visits due to injuries and transportation related injuries were negatively associated with EHEs. Neither all-cause hospital admissions nor ED visits were associated with EHEs.
Conclusions
In Ontario, EHEs decreased the risk of pediatric emergency healthcare utilization for injuries and increased the risk of respiratory illnesses, asthma, heat-related illnesses, heatstroke, dehydration, infectious and parasitic diseases, lower respiratory infections, and enteritis. Tailored policies and programs that reflect the specific heat-related vulnerabilities of children to respiratory and infectious illnesses are warranted in the face of a rapidly warming climate.
Validation of the Arabic versions of the long (15 items) and short (4 items) forms of the Distress Tolerance Scale (DTS)
Authors: Noureddine Amir , Malaeb Diana , Sawma Toni , Sakr Fouad , Dabbous Mariam , Obeid Sahar , Hallit Souheil , Fekih-Romdhane Feten 
Published: October 2024

Abstract

Background: Distress tolerance, defined as the capacity to endure and manage negative emotional states, is an important construct in comprehending various psychological conditions, including anxiety, depression, and substance use disorders. The Distress Tolerance Scale (DTS) and its Short Form (DTS-SF) are widely used tools for measuring distress tolerance. Still, their applicability in non-Western, Arabic-speaking populations has not been validated. Our study aims to examine the psychometric properties of an Arabic translation of the DTS and DTS-SF among Arabic-speaking general population adults.
Methods: A sample of 507 participants was recruited from diverse community settings. Participants completed the Arabic translations of the DTS and DTS-SF, alongside other relevant psychological measures, through an online survey. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of both scales, and their reliability was assessed using McDonald’s omega and Cronbach’s alpha. Sex invariance was tested, and correlations with other psychological constructs, such as anxiety and child abuse, were examined to establish concurrent validity.
Results: CFA supported the four-factor structure of the DTS, especially after removing one item with low factor loading. Both the DTS and DTS-SF demonstrated strong internal consistency (DTS: ω = .91, α = .91; DTS-SF: ω = .77, α = .77) and good fit indices, confirming their reliability. Sex Invariance was established at the configural, metric, and scalar levels for both long and short versions. The DTS and DTS-SF scores showed significant correlations with anxiety and child abuse, supporting the scales' concurrent validity, while no significant correlation was found with pain, suggesting a differentiation between emotional distress and physical pain tolerance.
Conclusion: The study indicates that the Arabic versions of the DTS and DTS-SF are reliable and valid tools for assessing distress tolerance in Arabic-speaking populations. These scales are valuable for both clinical and research applications, enabling the identification of individuals at risk for psychological distress and guiding the development of culturally relevant interventions. Future research should explore the use of these psychometric instrument in other cultural contexts.
Is the Family Doctor Contract Service Program widely and equitably known among Chinese community residents? A national cross-sectional survey
Authors: Wang Yang , Wu Yibo , Jin Hua , Yu Dehua 
Published: October 2024

Abstract

Background:
The Family Doctor Contract Service Program in China aims to enhance the accessibility and continuity of primary care by fostering ongoing, patient-centered relationships between residents and primary care physicians. This study examines nationwide awareness levels of the program in 2023, with a focus on disparities across different economic development levels, socioeconomic strata, and urban versus rural areas.
Methods:
A stratified, quota-sampled national survey was conducted from June to August 2023, targeting Chinese residents aged 18 and older across 800 communities in 32 provinces. The survey assessed awareness of the Family Doctor Contract Service Program along with related sociodemographic and health characteristics. Statistical analysis included estimating awareness rates, adjusted for age and gender weighting, and examining the association between sociodemographic factors and awareness using multilevel modeling, with provinces as the first level and residents as the second.
Results:
The survey included 12,403 respondents, with an overall awareness rate of 49.75%. Awareness rates were 63.7%, 53.24%, and 48.28% in high-, middle-, and low-income provinces, respectively, and 57.23%, 49.42%, and 44.69% across high-, middle-, and low-socioeconomic status (SES) groups. Urban residents had a higher awareness rate (56.78%) compared to rural residents (45.50%). Residents in provinces where the average annual income is less than 40,000 yuan were significantly less likely to be aware of the program (OR=1.70, 95% CI: 1.24-2.31, P=0.001) compared to those in provinces with an average annual income of 60,000 yuan or more. Similarly, individuals in SES levels 1-2 were more likely to be unaware of the program compared to those in SES levels 6-7 (OR=1.47, 95% CI: 1.27-1.71, P≤0.001). Rural residency was also associated with a higher likelihood of being unaware of the program (OR=1.13, 95% CI: 1.03-1.22, P=0.006).
Conclusion:
Nine years after its implementation, only about half of mainland China's community residents are aware of the Family Doctor Contract Service Program, with particularly low awareness among economically disadvantaged provinces, lower socioeconomic groups, and rural areas. There is a critical need to enhance the dissemination of information about the program and enhance primary care to meet the health service needs of these vulnerable populations.
Aberrant bcl6 protein expression in patients with EMZL following recurrence or progression: case report of two cases
Authors: Zhang Ming , Qu Jianli , Guo Weiwei , Liu Yi , Zhang Wei 
Published: October 2024

Abstract

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL) is an indolent B-cell lymphoma that can involve various anatomic sites. EMZL is derived from post-germinal center marginal zone B cells and typically lacks bcl-6 expression. Herein, we report two post-treatment cases of EMZL where unexpected bcl-6 protein expression was observed in specimens obtained following recurrence or progression. This contrasts with the primary specimens, which were negative for the bcl-6. Additionally, we confirm that the altered bcl6 expression observed in relapsed EMZL cases is independent of BCL6 gene rearrangement, as demonstrated by fluorescence in situ hybridization analysis. Relevant literature was reviewed and summarized to enhance the understanding of this phenomenon, particularly for pathologists.
18F-FDG PET for the differential diagnosis of Alzheimer's disease and Frontotemporal lobar degeneration: a multicenter prospective study in Japan
Authors: Ito Kengo , Washimi Yukihiko , Kato Takashi , Suzuki Keisuke , Ouchi Yasuomi , Watanabe Chigusa , Sunada Yoshihide , Kutoku Yumiko , Ishii Kazunari , Ishii Kenji , Kitayama Michio , Matsubara Etsuro , Kimura Noriyuki , Takano Harumasa , Adachi Hiroaki , Hara Kazuhiro , Kawarabayashi Takeshi , Shoji Mikio , Sugimoto Norio 
Published: October 2024

Abstract

Background: 18F-fluoro-2-deoxy-2-D-glucose positron emission tomography (18F-FDG PET) is a biomarker of neuronal injury, according to the revised National Institute on Aging-Alzheimer's Association criteria. This multicenter prospective cohort study aimed to evaluate the value of 18F-FDG PET for differential diagnosis of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) in comparison with phosphorylated tau protein (p-tau181) in cerebrospinal fluid (CSF).
Methods: In total, 138 patients (AD, 119; FTLD, 19) from 11 participating institutions underwent clinical and neuropsychological examinations, magnetic resonance imaging (MRI), CSF examination, and 18F-FDG PET at baseline. The cases were visually classified into predefined dementia patterns using 18F-FDG PET by three experts. A region-of-interest (ROI)-based automated analysis of 18F-FDG PET was also performed. The participants were followed up for 12 months, and the clinical diagnosis of dementia was re-evaluated.
Results: The sensitivity, specificity, and accuracy of the visual reading of 18F-FDG PET were 94%, 78%, and 92%, respectively. In contrast, those of p-tau181 in CSF were 62%, 79%, and 65%, respectively. The sensitivity, the primary endpoint, was 32% higher for 18F-FDG PET than for p-tau181 in CSF. Additionally, the accuracy, the secondary endpoint, was 27% higher for 18F-FDG PET than for p-tau181 in CSF. In addition to the visual reading of 18F-FDG PET, the Z-score summation analysis method (ZSAM) showed a sensitivity, specificity, and accuracy of 81%, 79%, and 81%, respectively. Regarding adverse events during the study, of the 135 patients who underwent 18F-FDG PET, 19 had 22 adverse events; however, there was no causal relationship with the 18F-FDG PET study, except for one case of unknown cause. In addition, two patients experienced two serious adverse events; however, both were due to CSF sampling and were judged to have no causal relationship with the 18F-FDG PET study.
Conclusion: This study showed that the diagnostic performance of 18F-FDG PET in differential diagnosis of AD and FTLD was higher than that of p-tau181 in CSF, and there were no safety concerns with 18F-FDG PET.
Trial registration: UMIN-CTR (UMIN 000016427) and Japan Registry of Clinical Trials (jRCTs041180098)
Influence of sedentary behavior and physical activity in leisure and work on sleep duration: Data from NHANES 2017-2018
Authors: Paixão Luciene Teixeira , Neves Layana Amaral , Danese Marina Viana , de Menezes-Júnior Luiz Antônio Alves 
Published: October 2024

Abstract

Objective
To evaluate the association between sedentary behavior (SB), moderate to vigorous physical activity (MVPA), and sleep duration.
Methods
Data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) was analyzed. SB was assessed based on the average daily sitting time, while MVPA was estimated by the frequency and duration of leisure and work-related activities. The ratio of time spent in MVPA to time in SB was analyzed, and a threshold of ≥ 2.5 minutes of MVPA per sedentary hour was used to determine sufficiency for mitigating the effects of a sedentary lifestyle. Sleep duration was measured by the average hours slept on weekdays and weekends, classified according to National Sleep Foundation guidelines. Descriptive statistics were used to characterize the sample, and multivariate logistic regression was applied to assess the associations between movement behaviors and sleep duration.
Results
The study included 5,533 participants, with 51.7% women, predominantly aged 26–64 years (61.8%). Insufficient physical activity was reported by 59.6% at work and 62.5% during leisure time. Sleep duration was considered recommended or acceptable in 84.4% of the sample. Adjusted multivariate analysis revealed that individuals engaging in ≥ 2.5 minutes of MVPA during leisure-time for each sedentary hour were 37.0% less likely to experience short sleep duration. Conversely, those who performed the same amount of MVPA at work were 32% more likely to have short sleep spells.
Conclusion
Meeting the MVPA threshold during leisure-time reduces the likelihood of short-term sleep, while higher MVPA levels at work increase the likelihood of short-term sleep.
High incidence of radiation-induced brain necrosis in the periventricular deep white matter: Stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy
Authors: Ohguri Takayuki , Itamura Hirohide , Tani Subaru , Shiba Eiji , Yamamoto Junkoh 
Published: October 2024

Abstract

Purpose
In this retrospective study, we aimed to evaluate the efficacy and incidence of radiation-induced brain necrosis (RBN) after volumetric modulated arc therapy (VMAT)-based stereotactic irradiation (STI) for brain metastases.
Methods
In the 220 brain metastatic lesions included between January 2020 and June 2022, there were 1–9 concurrently treated lesions (median 1). A biologically effective dose (BED10) of 80 Gy and a reduced BED10 of 50 Gy were prescribed to the gross tumor volume (GTV) and planning target volume (PTV = GTV + 3 mm) margins, respectively. The number of fractions was adjusted from 3–15 to accommodate different GTV sizes; for larger tumor volumes, this was increased while maintaining the BED10 values comparable to those for GTV and PTV margins.
Results
Of the total patients, 16 (7%) exhibited locally progressive lesions; local tumor recurrence was observed in 2 (1%) patients, while RBN was noted in 14 (6%) patients. RBN was significantly more prevalent in the deep white matter around the lateral ventricles (DWM-LV) than in other sites, occurring in 9/22 (41%) lesions of metastases in the DWM-LV. The 2-year actuarial incidence risk of developing RBN was significantly higher in the DWM-LV (69%) than at other sites (5%).
Conclusion
The recurrence rate of brain metastases was low, and the incidence of RBN was lower in tumor sites other than the DWM-LV. However, the frequency of RBN was significantly higher in the DWM-LV region. Additional VMAT-STI-prescribed dose protocols are necessary to reduce RBN incidence in DWM-LVs.