bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity prevalence, nutritional status, and physical activity levels in Turkish adults during the COVID-19 pandemic
Authors: Karaca Çelik Kezban Esen , Morales-Suárez-Varela María , Uçar Nazlı , Soriano Jose M. , İnce Palamutoğlu Merve , Baş Murat , Toprak Dilek , Hajhamidiasl Ladan , Erol Doğan Özge , Doğan Mert 
Published: August 2024

BackgroundAlthough nutritional status is influenced by multidimensional aspects encompassing physical factors, there is limited research on this complex relationship.ObjectivesThis study aimed to examine the interaction between physical activity level indicators and the nutritional status of adults in Türkiye.MethodsA total of 3,970 individuals aged 18 years or older, residing in Afyonkarahisar (Türkiye), participated in this study. Data were obtained through face-to-face interviews with a questionnaire, using simple random sampling among adults. One-day food consumption was recorded using a 24-h dietary recall (24HDR). Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ).ResultsThis study comprised 3,970 participants: 2,087 (52.57%) men and 1,883 (47.42%) women. Among them, 32.64% smoked cigarettes, and 8.72% consumed alcohol. About 40% of adults were overweight, and 16.33% were obese. All participants had inadequate intake levels of potassium, calcium, and iron when compared to the recommended amounts. Physical activity levels showed a weak positive correlation with dietary energy, carbohydrates, protein, fat, and cholesterol, and a weak negative correlation with age, waist-to-hip ratio, and BMI of participants.ConclusionThis study provides insights into the importance of addressing both physical activity and nutritional status. It was found that the weekly duration of physical activity for women was lower than for men. As a result of the nutritional status evaluation, it was found that the daily energy intake of men was higher than that of women.
Development and validation of a CT-based nomogram for accurate hepatocellular carcinoma detection in high risk patients
Authors: Liang Yingying , Wu Hongzhen , Wei Xinhua 
Published: August 2024

PurposeTo establish and validate a CT-based nomogram for accurately detecting HCC in patients at high risk for the disease.MethodsA total of 223 patients were divided into training (n=161) and validation (n=62) cohorts between January of 2017 and May of 2022. Logistic analysis was performed, and clinical model and radiological model were developed separately. Finally, a nomogram was established based on clinical and radiological features. All models were evaluated using the area under the curve (AUC). DeLong’s test was used to evaluate the differences among these models.ResultsIn the multivariate analysis, gender (p = 0.014), increased Alpha-fetoprotein (AFP) (p = 0.017), non-rim arterial phase hyperenhancement (APHE) (p = 0.011), washout (p = 0.011), and enhancing capsule (p = 0.001) were the independent differential predictors of HCC. A nomogram was formed with well-fitted calibration curves based on these five factors. The area under the curve (AUC) of the nomogram in the training and validation cohorts was 0.961(95%CI: 0.935~0.986) and 0.979 (95% CI: 0.949~1), respectively. The nomogram outperformed the clinical and the radiological models in training and validation cohorts.ConclusionThe nomogram incorporating clinical and CT features can be a simple and reliable tool for detecting HCC and achieving risk stratification in patients at high risk for HCC.
Comparison of endoscopic breast-conserving surgery versus conventional breast-conserving surgery for the treatment of early-stage breast cancer: a meta-analysis
Authors: Li Liwen , Liang Yiwen , Li Chunyan , Huang Miaoyan , Liang Weiming , Qin Tian 
Published: August 2024

IntroductionThis meta-analysis seeks to evaluate the efficacy and safety of endoscopic breast-conserving surgery (E-BCS) compared to conventional breast cancer surgery (C-BCS) in patients diagnosed with early-stage breast cancer.Materials and methodsFour databases (Medline, Embase, Web of Science and CENTRAL) were searched published from establishment of database to January 30,2024, for articles studying E-BCS compared to C-BCS in patients diagnosed with early-stage breast cancer. Meta-analyses of procedure time, blood loss, length of incision, drainage duration, total postoperative drainage volume, average duration of hospital stay, positive rate of margin, complication rate, recurrence rate, metastasis rate and cosmetic scoring were performed.ResultsTotally 11 studies were included for meta-analysis. Compared with C-BCS, E-BCS exhibited significantly reduced incision length (WMD = -6.44, 95%CI: -10.78 to -2.11, P=0.004, I2 = 99.0%) and superior cosmetic scoring (WMD = 2.69, 95%CI: 1.46 to 3.93, P=0.001, I2 = 93.2%), but had significantly longer operation time (WMD = 34.22, 95%CI: 20.89~47.55, P=0.000, I2 = 90.7%) and blood loss (WMD = 3.65, 95%CI: -3.12 to 10.43, P=0.291, I2 = 86.8%). There was no significant difference in terms of recurrence rate, metastasis rate, positive rate of tumor resection margins, drainage duration, drainage volume, complication rate and hospital days.ConclusionsOur research findings indicate that E-BCS is a viable and secure method for treating breast cancer in its early stages. E-BCS provides distinct advantages in terms of the length of the incision and the aesthetic result, without demonstrating an elevated recurrence rate or metastasis rate.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024535164, identifier CRD42024535164.
The effect of the antibiotic stewardship program (ASP) on community-acquired pneumonia (CAP): a before–after study
Authors: Fésüs Adina , Baluku Phiona , Sipos Éva , Somodi Sándor , Berczi-Kun Enikő , Lekli István , Bácskay Ildikó , Benkő Ria , Vaskó Attila 
Published: August 2024

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death worldwide. Antibiotic stewardship program (ASP) has been implemented to improve rational and responsible antibiotic use by encouraging guideline adherence.Objective: This retrospective observational before–after study aimed to evaluate whether the ASP may improve guideline adherence, antibiotic exposure, and clinical outcomes in patients hospitalized due to CAP in Hungary.Methods: The study was conducted at a pulmonology department of a tertiary care medical center in Hungary. The ASP implementation consisted of written and published guidelines available to all professionals, continuous supervision, and counseling services on antibiotic therapies at an individual level, with the aim of ensuring compliance with CAP guidelines. Overall guideline adherence (agent selection, route of administration, and dose), clinical outcomes (length of stay and 30-day mortality), antibiotic exposure, and direct costs were compared between the two periods. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. P-values below 0.05 were defined as significant.Results: Significant improvement in overall CAP guideline adherence (30.2%), sequential therapy (10.5%), and a significant reduction in the total duration of antibiotic therapy (13.5%) were observed. Guideline non-adherent combination therapies with metronidazole decreased significantly by 28.1%. Antibiotic exposure decreased by 7.2%, leading to a significant decrease in direct costs (23.6%). Moreover, the ASP had benefits for clinical outcomes, and length of stay decreased by 13.5%.Conclusion: The ASP may play an important role in optimizing empirical antibiotic therapy in CAP having a sustained long-term effect.
Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis
Authors: Peng Jing , Liu Linhui , Li Qiaoling , Liu Maochang , Zhou Rong , Chen Li , Liu Zhisheng 
Published: August 2024

BackgroundLevetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV’s efficacy and safety for pediatric migraine prophylaxis.MethodsWe reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate.ResultsEight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: −5.19, 95% CI: −7.11 to −3.27, p &lt; 0.00001) and improved headache-free rates to 28% (95% CI: 0.17–0.41). More than 83% experienced a &gt;50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: −33.51, 95% CI: −38.46 to −28.55, p &lt; 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13–0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05–0.30).ConclusionLEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs.Systematic Review RegistrationIdentifier PROSPERO CRD42024497643.
Women have a higher risk of hospital admission associated with hyponatremia than men while using diuretics
Authors: Hendriksen L. C. , Mouissie M. S. , Herings R. M. C. , van der Linden P. D. , Visser L. E. 
Published: August 2024

BackgroundHyponatremia is a common electrolyte disturbance and known adverse drug reaction of diuretics. Women tend to be more susceptible for diuretic associated hyponatremia. The aim of this study was to find more evidence whether women have a higher risk of diuretic associated hyponatremia than men measured at hospital admission for specific diuretic groups and whether there is a sex difference in risk of severity of hyponatremia.MethodsAll patients using a diuretic and admitted for any reason to Tergooi MC and Haga Teaching hospital in the Netherlands between the 1st of January 2017 and the 31st of December 2021, with recorded sodium levels at admission were included in this study. Cases were defined as patients with a sodium level &lt;135 mmol/L, while control patients had a sodium level ≥135 mmol/L at admission. Logistic regression analysis was used to calculate odds ratios (OR) with 95% CIs for women versus men and adjusted for potential confounding covariables (age, body mass index, potassium serum level, systolic and diastolic blood pressure, estimated glomerular filtration rate, number of diuretics, comedications and comorbidities). Stratified analyses were conducted for specific diuretic groups (thiazides, loop diuretics and aldosterone antagonists), and adjusted for dose. Furthermore, stratified analyses were performed by severity of hyponatremia (severe: &lt;125 mmol/L), mild: 125–134 mmol/L).ResultsA total of 2,506 patients (50.0% women) were included, of which 516 had hyponatremia at admission (20.6%, 56.2% women). Women had a statistically significantly higher risk for hyponatremia at admission than men (OR 1.37; 95% CI 1.12–1.66) and after adjustment for potential risk factors (ORadj 1.55; 95% CI 1.22–1.98). Stratified analyses showed increased odds ratios for thiazides (ORadj 1.35; 95% CI 1.00–1.83) and loop diuretics (ORadj 1.62; 95% CI 1.19–2.19) among women. Use of aldosterone antagonists was also increased but not statistically significant (ORadj 1.15; 95% CI 0.73–1.81). Women had a statistically higher risk to develop mild and severe hyponatremia than men (ORadj 1.36; 95% CI 1.10–1.68 and ORadj 1.96; 95%CI 1.04–3.68, respectively).ConclusionWomen have a higher risk of a hospital admission associated with hyponatremia while using diuretics than men. Further research is necessary to provide sex-specific recommendations.
Update: factors influencing heart rate variability–a narrative review
Authors: Sammito Stefan , Thielmann Beatrice , Böckelmann Irina 
Published: August 2024

ObjectiveHeart rate variability (HRV) is an important non-invasive marker for the assessment of an organism’s autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation.MethodsThe narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors).ResultsThe review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances).ConclusionIn order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.
Soil drought sets site specific limits to stem radial growth and sap flow of Douglas-fir across Germany
Authors: Niessner Armin , Ehekircher Stefan , Zimmermann Reiner , Horna Viviana , Reichle Daniel , Land Alexander , Spangenberg Göran , Hein Sebastian 
Published: August 2024

IntroductionSoil drought during summer in Central Europe has become more frequent and severe over the last decades. European forests are suffering increasing damage, particularly Norway spruce. Douglas-fir (Pseudotsuga menziesii (Mirbel) Franco), a non-native tree species, is considered as a promising alternative to build drought-resilient forests. The main goal of this study was to investigate the intraannual radial stem growth and sap flow performance of Douglas-fir along a precipitation gradient across Germany under severe drought.Material and methodsSap flow and stem radial changes of up to ten trees each at four sites with different precipitation regimes were measured in combination with volumetric soil water content during the growing season of 2022. Measurements of stem radial changes were used to calculate the trees’ stem water deficit, a proxy for tree water status and drought stress.ResultsThe severe summer drought of 2022 led to an early growth cessation and a significant reduction in daily sap flow at all four sites monitored. We could identify a site-specific threshold in soil water availability ranging between 21.7 and 29.6% of relative extractable water (REW) under which stem water reserves cannot be replenished and thereby inhibiting radial growth. We could also demonstrate that at this threshold, sap flow is heavily reduced to between 43.5 and 53.3%, and for a REW below 50%, sap flow linearly decreases by 1.1–2.0% per 1% reduction in REW. This reduction tends to follow the humidity gradient, being more pronounced at the most oceanic characterized site and suggesting an adaptation to site conditions. Even though Douglas-fir is considered to be more drought stress resistant than Norway spruce, growth and sap flow are greatly reduced by severe summer drought, which became more frequent in recent years and their frequency and intensity is likely to increase.ConclusionsOur results suggest that timber production of Douglas-fir in Central Europe will decline considerably under projected climate change, and thus pointing to site specific growth constraints for a so far promising non-native tree species in Europe.
Initiation of rest-grazing during soil thawing improves interspecific relationships and stability of plant communities on alpine grassland
Authors: Ma Kaikai , Hou Qingqing , Xu Changlin , Chen Yanzhu , Yang Hang , Xu Jingjing , Yu Xiaojun 
Published: August 2024

IntroductionGrazing management is essential to maintain the stability of grassland ecosystems.MethodsTo determine the optimal rest-grazing period of alpine meadow, five rest-grazing periods were set based on soil thawing and plant re-greening in this study. The niche, interspecific relationships, and stability of plant communities at different rest-grazing periods were investigated.ResultsRest-grazing during soil thawing resulted in a small niche width and niche overlap of plants, overall positive interspecific associations, and a high stability of plant communities. Delayed rest-grazing time to plant re-greening resulted in a large niche width and niche overlap of plants, overall negative interspecific associations, and a low stability of plant communities.DiscussionRest-grazing in alpine meadows should begin as soon as possible to promote healthy and sustainable utilization of grasslands.
The impact of teachers’ perceived competence in information and communication technology usage, and workplace anxiety on well-being, as mediated by emotional exhaustion
Authors: Chen Bo-Ching , Wu Yu-Tai , Chuang Ya-Ting 
Published: August 2024

IntroductionThe 2030 Sustainable Development Goals (SDGs) were adopted by the United Nations in 2015, emphasizing the importance of achieving peace, prosperity, and well-being for all people. With the outbreak of the COVID-19 pandemic, sustainable health has become an important issue. Teachers were forced to adopt distance teaching, necessitating rapid upgrading of their ICT skills and integration into e-learning, which caused tangible and intangible pressures on teachers and impacted their well-being. This study examined the effects of ICT competence on teachers’ workplace anxiety, emotional exhaustion, and well-being during the pandemic from the perspective of Social Cognitive Theory (SCT).MethodsA quantitative research methodology and a questionnaire survey with a total of 21 questions were used as the primary research design. The snowball method was employed as a sampling method for online questionnaires from September to October 2021. A total of 216 questionnaires were collected, of which four incomplete questionnaires were excluded, leaving 212 valid questionnaires, with a valid questionnaire recovery rate of 98.1%. The valid questionnaires were analyzed using Smart Pls 4.0 Partial Least Square Method Structural Equation Modeling (PLS-SEM).ResultsThe study found that teachers’ ICT competence could significantly reduce emotional exhaustion and enhance teachers’ well-being. However, there was no significant effect on workplace anxiety. Additionally, well-being was not directly affected by workplace anxiety, and teachers’ well-being needs to be mediated by emotional exhaustion to be indirectly affected. Emotional exhaustion plays an important mediating role between teachers’ ICT competence and workplace stress, both of which are important mediators of well-being.DiscussionFrom a practical point of view, to achieve the Sustainable Development Goals (SDGs) 2030, it is ideal to have good health and well-being for the whole person. This study facilitates the development of strategies to improve the well-being of teachers, which provides an empirical basis for the enhancement of mental health and well-being of educators.
An advanced Artificial Intelligence platform for a personalised treatment of Eating Disorders
Authors: Monaco Francesco , Vignapiano Annarita , Piacente Martina , Pagano Claudio , Mancuso Carlo , Steardo Luca , Marenna Alessandra , Farina Federica , Petrillo Gianvito , Leo Stefano , Ferrara Emanuela , Palermo Stefania , Martiadis Vassilis , Solmi Marco , Monteleone Alessio Maria , Fasano Alessio , Corrivetti Giulio 
Published: August 2024

IntroductionEating Disorders (EDs) affect individuals globally and are associated with significant physical and mental health challenges. However, access to adequate treatment is often hindered by societal stigma, limited awareness, and resource constraints.MethodsThe project aims to utilize the power of Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), to improve EDs diagnosis and treatment. The Master Data Plan (MDP) will collect and analyze data from diverse sources, utilize AI algorithms for risk factor identificat io n, treatment planning, and relapse prediction, and provide a patient-facing chatbot for information and support. This platform will integrate patient data, support healthcare professionals, and empower patients, thereby enhancing care accessibility, personalizing treatment plans, and optimizing care pathways. Robust data governance measures will ensure ethical and secure data management.ResultsAnticipated outcomes include enhanced care accessibility and efficiency, personalized treatment plans leading to improved patient outcomes, reduced waiting lists, heightened patient engagement, and increased awareness of EDs with improved resource allocation.DiscussionThis project signifies a pivotal shift towards data-driven, patient-centered ED care in Italy. By integrat ing AI and promoting collaboration, it seeks to redefine mental healthcare standards and foster better well- being among individuals with EDs.
Head circumference growth in children with Autism Spectrum Disorder: trend and clinical correlates in the first five years of life
Authors: Cirnigliaro Lara , Clericò Luisa , Russo Lorenza Chiara , Prato Adriana , Caruso Manuela , Rizzo Renata , Barone Rita 
Published: August 2024

BackgroundMacrocephaly is described in almost 15% of children with Autism Spectrum Disorder (ASD). Relationships between head growth trajectories and clinical findings in ASD children show a high degree of variability, highlighting the complex heterogeneity of the disorder.ObjectivesThe aim of this study was to measure differences of the early growth trajectory of head circumference (HC) in children with ASD and macrocephaly compared to ASD normocephalic children, examining clinical correlates in the two groups of patients.MethodsHC data were collected from birth to 5 years of age in a sample of children with a confirmed diagnosis of ASD. Participants were classified into two groups: ASD macrocephaly (ASD-M, Z-scores ≥1.88 in at least two consecutive HC measurements), and ASD non-macrocephaly (ASD-N). Based on the distribution of HC measurements (Z-scores), five age groups were identified for the longitudinal study. Developmental and behavioral characteristics of the ASD-M children compared to the ASD-N group were compared by using standardized scores.Results20,8% of the children sample met criteria for macrocephaly. HC values became indicative of macrocephaly in the ASD-M group at the age range from 1 to 6 months, and persisted thereafter throughout the first five years of age. ASD-M children showed significantly higher developmental quotients of Griffiths III B and D subscales compared to ASD-N group. No significant differences in the severity of ASD symptoms assessed by ADOS-2 were observed between ASD-M and ASD-N groups.ConclusionIn this study HC size from birth to 5 years links to accelerated HC growth rate as early as the first 6 months of age in children with ASD and macrocephaly, preceding the onset and diagnosis of ASD. We found that in early childhood, children with ASD-M may exhibit some advantages in language and social communication and emotional skills without differences in autism severity, when compared with age-matched normocephalic ASD children. Longitudinal analyses are required to catch-up prospectively possible relationships between head size as proxy measure of brain development and neuro-developmental and behavioral features in children with ASD.