bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship of nutritional behaviors and parent–child interactions with developmental domains of Iranian toddlers: a cross-sectional study
Authors: Faghani Parastoo , Nikpeyma Nasrin , Haghani Shima , Amrollah Majdabadi Zahra , Pashaeypoor Shahzad 
Published: July 2024

Abstract
Background
Health service providers closely monitor the developmental state of toddlers to identify the factors affecting this process because any defect during this period will cause irreversible damage. Therefore, this study investigated the relationship of nutritional behaviors and parent–child interactions with the developmental domains of Iranian toddlers.

Methods
This cross-sectional, descriptive-analytical study was conducted on 341 toddlers aged 12–36 months covered by comprehensive health centers in the south of Tehran in 2021–2022. The participants were selected through single-stage cluster sampling. To this end, 16 comprehensive health centers were randomly selected, and then some of the clients from each center were randomly selected as the sample. The required data were collected through the Ages and Stages Questionnaire (ASQ), the Children’s Eating Behavior Questionnaire (CEBQ), the Child-Parent Relationship Scale (CPRS), and a demographics form. They were then analyzed statistically using descriptive and inferential statistics in SPSS-21, considering a significance level of p < 0.05.

Results
The results showed that most participants were normal in all developmental domains (communication, gross motor, fine motor, personal-social, and problem-solving), with a mean developmental delay ranging from 1.8 to 7%. The most serious problem of participants requiring medical referral was related to gross motor (7%) with a mean of 54.35 ± 7.28 followed by communication (6.5%) with a mean of 49.41 ± 9.67. The mean nutritional behavior of participants was 77.9 ± 21.7. A significant relationship was found between the nutritional behaviors of participants and the problem-solving domain of development (p = 0.018). The results also indicated a mean parent-child interaction score of 94.26 ± 12.63. There was a significant relationship between parent-child interactions and the communication area of development (p = 0.04).

Conclusion
Since some areas of toddler development are influenced by children’s nutritional behavior and parent-child interactions, it is necessary to train families to identify, monitor, and correct the factors affecting the development of their children. Health system officials and planners are also recommended to develop interventions to improve the nutritional behaviors of children and parent-child interactions.
From not knowing, to knowing more needs to be done: health care providers describe the education they need to care for sex trafficked patients
Authors: Mason Robin , Recknor Frances , Bruder Rhonelle , Quayyum Fareeha , Montemurro Frances , Du Mont Janice 
Published: July 2024

Abstract
Background
Sex trafficking is highly prevalent, pernicious, and under-recognized. When an individual is trafficked for the purpose of sexual exploitation within the borders of a single country, it is termed domestic sex trafficking. Sex trafficked persons can experience severe physical and mental health outcomes requiring medical attention and treatment. However, health care providers often fail to identify sex trafficked patients, missing opportunities to provide needed care and support.

Methods
In this qualitative study, we interviewed 31 health care providers (physicians, nurses, and social workers) working in Ontario, Canada to learn what they identified as their specific education and training needs to recognize and care for sex trafficked persons. Interviews were conducted over Zoom, recorded, and transcribed. Coding of the transcripts followed a standard framework for qualitative studies. Codes related to the education and training needs of providers were identified as a core issue suited to further analysis.

Results
Three themes related to providers’ education and training needs emerged. These acknowledge basic (Foundational knowledge), as well as more specific learning needs (Navigating the encounter). The final theme, (“It just seems so much bigger than me”) suggests that even with some knowledge of domestic sex trafficking, participants still experienced considerable distress and multiple challenges due to gaps in the broader system impacting the provision of appropriate care.

Conclusions
Participants voiced their need for specialized sex trafficking education as well as role specific training to combat their sense of inadequacy and provide better care for their patients. Participants’ education needs ranged from requiring the definition of domestic sex trafficking and the frequency of its occurrence, to the various circumstances associated with increased risk of recruitment into sex trafficking. In terms of desired training and specific skills, participants wanted to learn how to identify a person being sex trafficked, broach the subject with a patient, know what to do next including access to local resources and referrals, as well as connections to other critical services, such as legal and housing. The results can be used to inform the design and content of education and training on sex trafficking for health care providers.
Nurse-led web-based self-management program to improve patient activation and health outcomes in patients with chronic low back pain: an acceptability and feasibility pilot study
Authors: Skolasky Richard L. , Nolan Sarah , Pierre Raven , Vinch Paige , Taylor Janiece L. 
Published: July 2024

Abstract
Background
Patients with chronic low back (cLBP) pain report reduced physical function and ability to participate in social roles and are more likely to use opioid pain medications. While self-management interventions have been shown to support these patients, their effectiveness has been limited due to poor patient engagement. “Patient activation” encompasses the skills, knowledge, and motivation that a person has to manage their health. Supporting patient activation may improve the effectiveness of self-management for cLBP.

Methods
In this single-masked pilot study of adults with cLBP, patients were randomized to receive either no intervention (control) or 6 weekly sessions of an evidence-based web-based self-management program (SMP) with or without health behavior change counseling (HBCC) using motivational interviewing. Participants were assessed at baseline and at 12 and 26 weeks using the Patient Activation Measure, Oswestry Disability Index and PROMIS physical function, social role participation, and pain interference. We assessed acceptability and feasibility based on recruitment, session attendance, and follow-up.

Results
Of 187 individuals screened, 105 were eligible and 34 were randomized to control (n = 12), SMP (n = 4), or SMP + HBCC (n = 18). The population had 19 women, 22 patients married or living with significant other, 13 Black or African American patients, and 4 Hispanic or Latino patients. Participants had a mean (SD) Oswestry Disability Index score of 42 (12), moderate impairments in physical function (40 (6.6)) and social roles (45 (10)), and moderately severe pain interference (61 (6.7)). Of 22 participants receiving SMP sessions, 20 participated in at least 1, 15 participated in at least 3, and 7 participated in all 6 sessions. Loss to follow-up was 6 over the 26-week study. Participants in the SMP and SMP + HBCC groups had at least medium effect size improvements in Patient Activation Measures and small-to-medium effect size improvements in Oswestry Disability Index scores and physical function and large effect size improvement in social roles at 12 weeks. Improvements persisted in the SMP + HBCC group at 26 weeks.

Conclusions
A web-based SMP is acceptable and feasible in this population. Participants who received augmentation with HBCC had persistent improvements in health outcomes at 26 weeks.

Trial Registration
ClinicalTrials.gov Identifier NCT06236529 (2/1/2024 – retrospectively registered).

Level of Evidence
3.
Utilization and affordability of health insurance coverage for rare disease drugs in a first-tier city in Northeast China from 2018 to 2021: a study based on the health insurance claims database
Authors: Wang Yaqun , Zhou Na , Li Baoxin , Lv Zixuan , Duan Shengnan , Li Xin , Yuan Ni 
Published: July 2024

Abstract
Objective
The accessibility issue of orphan drugs in China is prominent. Based on real-world data from a tier-one city in Northeast China, this study aims to analyze the current usage and affordability of orphan drugs for rare diseases.

Methods
The data was sourced from the health insurance claims data of a certain city from 2018 to 2021, including a total of 16 orphan drugs. The utilization of orphan drugs is assessed using four indicators: frequency of medical insurance claims, medication cost, defined daily doses (DDDs), and defined daily drug cost (DDDc). Affordability is measured using the concept of catastrophic health expenditure (CHE).

Results
Between January 2018 and December 2021, there were a total of 2,851 medical insurance claims in the city, with a total medication costs of $3.08 million. Overall, during the study, there was a year-on-year increase in the utilization frequency of individual rare disease drugs in the city, with DDDs rising from 140.22 in 2018 to 3983.63 in 2021. Additionally, the annual medication costs of individual drugs showed a consistent upward trend, increasing from $10,953.53 in 2018 to $120,491.36 in 2021. However, the DDDc of individual drugs decreased from $398.12 in 2018 to $96.65 in 2021.The number of sales and the amount of sales for orphan drugs in community pharmacies have significantly increased. Prior to medical insurance coverage, out of the 16 orphan drugs, 9 drugs had annual treatment costs exceeding CHE for urban residents, and 15 drugs had annual treatment costs exceeding CHE for rural residents. After medical insurance coverage, there were no drugs with out-of-pocket costs exceeding CHE for urban residents, while 8 drugs had out-of-pocket costs exceeding CHE for rural residents. Furthermore, both before and after medical insurance coverage, the four treatment drugs for idiopathic pulmonary arterial hypertension were more affordable compared to the four treatment drugs for multiple sclerosis.

Conclusion
The usage frequency of orphan drugs in a certain city increased gradually, but the disease burden remained heavy. More policy support should be provided to the priority rare disease populations, and the rare disease medical security and diagnosis and treatment systems should be improved.
Association between tea, coffee and caffeine consumption and risk of female infertility: a cross-sectional study
Authors: Zhang Hanzhi , Qian Sixu , Chen Jianlin , Chen Jingfei 
Published: July 2024

Abstract
Objectives
To explore the association between tea, coffee, and caffeine consumption and the risk of female infertility.

Methods
We analyzed data from 2099 females aged 18 to 44 years, participating in the National Health and Nutrition Examination Survey (NHANES) 2013–2018. We used generalized linear models (GLM) and generalized additive model (GAM) to investigate the dose-response relationship between the tea, coffee, and caffeine consumption and infertility, adjusting for potential confounders.

Results
A non-linear relationship was detected between tea consumption and infertility and the inflection point was 2 cups/day. On the right side of the inflection point, we did not detect a significant association. However, on the left side, we found a negative relationship between tea consumption and infertility (OR: 0.73; 95% CI: 0.57 to 0.93; P = 0.0122). Meanwhile, our study found no significant association between coffee (0.96, 0.81 to 1.13, P = 0.6189) or caffeine consumption (1.15, 0.93 to 1.42, P = 0.2148) and female infertility.

Conclusions
Tea consumption was non-linearly associated with infertility, whereas no significant associations were found between coffee, caffeine consumption and infertility.
DAHEAN: A Danish nationwide study ensuring quality assurance through real-world data for suspected hereditary anemia patients
Authors: Glenthøj Andreas , Rasmussen Andreas Ørslev , Bendtsen Selma Kofoed , Hasle Henrik , Hoffmann Marianne , Rieneck Klaus , Dziegiel Morten Hanefeld , Sjö Lene Dissing , Frederiksen Henrik , Hansen Dennis Lund , Fassi Daniel El , Rathe Mathias , Jensen Peter-Diedrich Matthias , Winther-Larsen Anne , Nielsen Christian , Olsen Marianne , Toft Nina , Lorenzen Mads Okkels Birk , Jensen Lise Heilmann , Gudbrandsdottir Sif , Helby Jens , Rossing Maria , van Wijk Richard , Petersen Jesper 
Published: July 2024

Abstract
Background
Hereditary anemias are a group of genetic diseases prevalent worldwide and pose a significant health burden on patients and societies. The clinical phenotype of hereditary anemias varies from compensated hemolysis to life-threatening anemia. They can be roughly categorized into three broad categories: hemoglobinopathies, membranopathies, and enzymopathies. Traditional therapeutic approaches like blood transfusions, iron chelation, and splenectomy are witnessing a paradigm shift with the advent of targeted treatments. However, access to these treatments remains limited due to lacking or imprecise diagnoses. The primary objective of the study is to establish accurate diagnoses for patients with hereditary anemias, enabling optimal management. As a secondary objective, the study aims to enhance our diagnostic capabilities.

Results
The DAHEAN study is a nationwide cohort study that collects advanced phenotypic and genotypic data from patients suspected of having hereditary anemias from all pediatric and hematological departments in Denmark. The study deliberates monthly by a multidisciplinary anemia board involving experts from across Denmark. So far, fifty-seven patients have been thoroughly evaluated, and several have been given diagnoses not before seen in Denmark.

Conclusions
The DAHEAN study and infrastructure harness recent advancements in diagnostic tools to offer precise diagnoses and improved management strategies for patients with hereditary anemias.
Inhibiting interferon-γ induced cancer intrinsic TNFRSF14 elevation restrains the malignant progression of glioblastoma
Authors: Han Yunhe , Zou Cunyi , Liu Tianqi , Cheng Wen , Cheng Peng , Wu Anhua 
Published: July 2024

Abstract
Background
Prolonged interferon-γ signaling activation induces cancer resistance to therapeutics, especially immunotherapy. However, the detailed mechanisms are not well characterized. In present study, we explored cancer intrinsic resistant mechanisms employing for evading immune checkpoint blockade (ICB) and searched for key immune checkpoints contributing to the constitution of suppressive immune microenvironment of glioblastoma (GBM).

Methods
We screened key immune checkpoint (IC) associated with IFN signaling activation in GBM according to integrated transcriptomic profiling on the ICs. Expression analysis and functional assays revealed that malignant cells elevated the key IC, TNFRSF14 expression under IFN-γ stimulation, which enhanced their proliferation and in vivo tumorigenicity. Therapeutic efficiency of TNFRSF14 disruption in GBM was evaluated with in vitro and in vivo functional assays, including immunofluorescence, transwell, RT-qPCR, flow cytometry, mass cytometry, and mice preclinical GBM models. Moreover, the improvement of TNFRSF14 blockade on the efficacy of PD-L1 treatment was examined in mice intracranial xenograft bearing models.

Results
TNFRSF14, a previously poorly characterized IC, was disclosed as a checkpoint with malignant intrinsic elevation closely associated with type II not type I IFN signaling activation in GBM. Anti-PD-L1 treatment induces compensatory TNFRSF14 elevation, while enhancing IFN-γ production. TNFRSF14 phosphorylates FAK at Y397 and consequently activates NF-κB, which not only strengthens the tumorigenicity of GBM cells, but also enhances TAMs recruitment through elevating CXCL1/CXCL5 secretion from GBM cells. TNFRSF14 ablation reduces the tumorigenicity of GBM cells, reshapes the immunosuppressive microenvironment, and enhances therapeutic efficacy of anti-PD-L1 in mouse orthotopic GBM model.

Conclusion
Our findings highlight a malignant TNFRSF14/FAK axis as a potential target to blunt cancer-intrinsic resistance to ICB treatment, which may help improve the therapeutic efficiency of immunotherapy in malignancies.
Socio-economic inequalities in the use of flu vaccination in Europe: a multilevel approach
Authors: Jemna Dănuț-Vasile , David Mihaela , Bonnal Liliane , Oros Cornel 
Published: July 2024

Abstract
Background
The European-wide statistics show that the use of flu vaccination remains low and the differences between countries are significant, as are those between different population groups within each country. Considerable research has focused on explaining vaccination uptake in relation to socio-economic and demographic characteristics, health promotion and health behavior factors. Nevertheless, few studies have aimed to analyze between-country differences in the use of flu vaccination for the EU population. To address this gap, this study examines the socio-economic inequalities in the use of influenza vaccination for the population aged 15 years and over in all 27 EU Member States and two other non-EU countries (Iceland and Norway).

Methods
Using data from the third wave of European Health Interview Survey (EHIS) 2019, we employed a multilevel logistic model with a random intercept for country, which allows controlling simultaneously the variations in individuals’ characteristics and macro-contextual factors which could influence the use of flu vaccination. In addition, the analysis considers the population stratified into four age groups, namely adolescents, young adults, adults and elderly, to better capture heterogeneities in flu vaccination uptake.

Results
The main findings confirm the existence of socio-economic inequalities between individuals in different age groups, but also of significant variation between European countries, particularly for older people, in the use of influenza vaccination. In this respect, income and education are strong proxy of socio-economic status associated with flu vaccination uptake. Moreover, these disparities within each population group are also explained by area of residence and occupational status. Particularly for the elderly, the differences between individuals in vaccine utilization are also explained by country-level factors, such as the type of healthcare system adopted in each country, public funding, personal health expenditure burden, or the availability of generalist practitioners.

Conclusions
Overall, our findings reveal that vaccination against seasonal influenza remains a critical public health intervention and bring attention to the relevance of conceiving and implementing context-specific strategies to ensure equitable access to vaccines for all EU citizens.
The validity of clinical guidelines and nasal endoscopy in the diagnosis of chronic rhinosinusitis—a prospective observational study
Authors: Sheikh Mohd Abass , Patigaroo Suhail Amin , Showkat Showkat A. , Latoo Manzoor A. , Rather Rauf Hussain 
Published: July 2024

Abstract
Background
Chronic rhinosinusitis is a common disease entity seen by ENT surgeons as well as general practitioners all over the world. This study is aimed to evaluate and validate whether the clinical guideline symptoms (set by AAO-HNS 2015) alone and/or nasal endoscopic findings can predict the diagnosis of CRS, taking CT as the gold standard.

Methods
A total of 118 patients with symptoms of chronic rhinosinusitis were taken. They were divided into two groups on the basis of whether they fulfilled the Guideline symptom criteria laid down by AAO-HNS in 2015 for diagnosing chronic rhinosinusitis. Each group underwent diagnostic nasal endoscopy (DNE), and patients with either purulence, edema in the middle meatus or ethmoid, and polyps in the nasal cavity or middle meatus were considered positive for DNE. A Lund-Mackay CT score of > 4 was considered diagnostic of CRS. Each group was analyzed separately. Sensitivity, specificity, and positive predictive value of guideline symptom with and without the addition of nasal endoscopy was recorded taking CT as the gold standard.

Results
Nasal obstruction was the most common seen in all cases (100%) followed by headache in 45 (38.1%), facial pain in 32 (27.1%), anterior nasal discharge in 28 (23.7%), decreased sense of smell in 22 (18.6%), and posterior nasal discharge in 19 (16.1%). Two-thirds of patients (78, 66.1%) fulfilled the clinical guideline symptoms criteria, and one-third of patients (40, 33.9%) did not fulfill the clinical guideline symptoms criteria. A positive finding on DNE was found in 59.3% (n = 70) of patients. More than half of patients (62, 52.5%) had mild grade on endoscopic examination, while only 8 (6.8%) had moderate grade, and none had severe grade. Guideline symptoms have a high sensitivity (80%) but a low specificity (50.94%) in the diagnosis of CRS, with a fair level of agreement with CT diagnosis (Kappa = 0.32). DNE has a moderate sensitivity (72.31%) but a low specificity (56.60%) in the diagnosis of CRS, with a fair level of agreement with CT diagnosis (Kappa = 0.29). Sensitivity and specificity were 80.77% and 57.69% respectively when guideline symptoms and DNE findings are taken in series.

Conclusion
We conclude that neither Guideline Symptom Criteria nor DNE is independently sufficient enough to have a high diagnostic accuracy for CRS. Comparing the diagnostic efficiency among various modalities, we report that in patients who meet guideline symptom criteria for CRS, the addition of nasal endoscopy turned out to be a cost-effective diagnostic approach and improves the diagnostic accuracy of DNE for CRS reasonably, hence should be emphasized as a diagnostic tool in the evaluation of patients for CRS.
Six-month post-stroke review provision across southwest England: a service evaluation
Authors: Freeman Jennifer , Chatfield Sarah , Cork Emma , Schmitt Janet , Dennett Rachel 
Published: July 2024

Background/Aims Six-month post-stroke reviews are advocated for all stroke survivors. There is no recommended service model, with many variations in practice. The aim of this service evaluation was to describe and evaluate the 6-month post-stroke review service provision across the South West England Integrated Stroke Delivery Networks. Methods A mixed-methods service evaluation for 10 services was undertaken, consisting of: a stakeholder meeting to define the scope and review criteria; a mapping exercise to define core service features and activity data; a 12-month retrospective Sentinel Stroke National Audit Programme clinical data audit plus a 1-month prospective audit detailing identified unmet needs, actions to address needs and patient satisfaction; service provider and user guided discussions; and options appraisal synthesising data from all sources to inform service development. Results Considerable variations in service configuration, processes and outcomes existed across services. Guided discussions with 40 service users and 20 service providers revealed predominantly positive experiences. There was perceived value in the review, a key ingredient being its person-centred nature. However, some felt that the review was generic and more of a tick-box exercise. Many staff appeared unaware of differing 6-month post-stroke review models across the region and rarely used Sentinel Stroke National Audit Programme data to reflect on service outcomes or inform service development. Sharing of good practice across services appeared limited. Conclusions Data did not support a specific preferred service model. Findings suggested 6-month post-stroke reviews should not be a ‘one size fits all’ model, with flexibility in format and timing to optimise value. A knowledge sharing and evidence-based culture should be encouraged to nurture service development.