bluuebunny/crossref_metadata_2025_split huggingface dataset:
The COVID-19 pandemic related stress and the associated factors among the healthcare workers in Kota Setar District Health Office, Malaysia
Authors: Itam Mohd Faiz , Minhat Halimatus Sakdiah , Abd Rahman Anita , Ibrahim Mohd Zukri , Shareh Ali Shareh Azizan , Shuhaimi Ahmad Hanis 
Published: May 2024

BackgroundThe COVID-19 pandemic is the most significant worldwide health catastrophe, with massive impacts observed particularly among the healthcare workers. Stress among healthcare workers is a significant and pervasive issue that can have profound implications for both the well-being of healthcare professionals and the quality of patient care. This study aimed to determine the prevalence of stress related to the COVID-19 pandemic and the associated factors among the healthcare workers (HCWs).MethodsA retrospective cross-sectional study was conducted involving 533 HCWs in Kota Setar District Health Office. Related data was collected between January and June 2021. Stress was measured using the Depression Anxiety Depression Scale 21 (DASS-21). Other variables included in this study were sociodemographic and employment factors. The associated factors and predictors were determined by employing chi-square test and multivariate logistic models.ResultsCOVID-19 related stress was reported at 10.5%. HCWs who work at the district health offices and those with degree or higher qualifications had 2.3 (AOR = 2.310, 95% CI: 1.177–4.535) and 3 (AOR = 2.899, 95% CI: 1.613–5.211) higher odds of experiencing stress compared to those working in the clinics and had lower qualifications (diploma or less).ConclusionsThe mental wellbeing of the HCWs participated in this study had been affected negatively by the COVID-19 pandemic, resulting in one in 10thof the HCWs were experiencing stress during the COVID-19 pandemic, with higher risk observed among those working at the district health office and HCWs with higher qualifications or ranking. This is expected since COVID-19 was a new and unprecedented outbreak associated with massive number of mortalities that requires active contact tracing and surveillance which commonly conducted at district health office level. Active intervention needed to cope with the overwhelming stress and working condition to ensure effective rehabilitation are in place and quality of work were not jeopardized.
Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis
Authors: Broshkevitch Cara J. , Barnabas Ruanne V. , Liu Gui , Palanee-Phillips Thesla , Rao Darcy White 
Published: May 2024

Introduction
Women living with HIV experience heightened risk of cervical cancer, and over 50% of cases in Southern Africa are attributed to HIV co-infection. Cervical cancer interventions tailored by HIV status delivered with HIV antiretroviral therapy (ART) for treatment can decrease cancer incidence, but impact on HIV-related disparities remains understudied.

Methods
Using a dynamic model calibrated to KwaZulu-Natal, South Africa, we projected HIV prevalence, cervical cancer incidence, and proportion of cancer cases among women living with HIV between 2021–2071. Relative to the status quo of moderate intervention coverage, we modeled three additive scenarios: 1) ART scale-up only; 2) expanded human papillomavirus (HPV) vaccination, screening, and treatment; and 3) catch-up HPV vaccination and enhanced screening for women living with HIV.

Results
Under the status quo, HIV prevalence among women aged 15+ decreased from a median of 35% [Uncertainty Range (UR): 26–42%] in 2021 to 25% [19–34%] in 2071. The proportion of cervical cancer cases that were women living with HIV declined from 73% [63–86%] to 58% [47–74%], but incidence remained 4.3-fold [3.3–5.7] that of women without HIV. ART scale-up reduced HIV prevalence in 2071, but increased the incidence rate ratio to 5.2 [3.7–7.3]. Disparities remained after expanding cancer interventions for all women (incidence rate ratio: 4.8 [3.6–7.6]), while additional catch-up HPV vaccination and screening for women living with HIV decreased the incidence rate ratio to 2.7 [1.9–3.4] in 2071.

Conclusions
Tailored cervical cancer interventions for women living with HIV can counteract rising cancer incidence incurred by extended life expectancy on ART and reduce disparate cancer burden.
Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage
Authors: Ruggles Phoebe R. , Pasch Keryn E. , Poulos Natalie S. , Thomas Jacob E. 
Published: May 2024

Introduction
Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth’s preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES.

Methods
Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower).

Results
Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17–69), vs Medianhigh = 10.5 (IQR 4–17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16–99) vs Medianhigh = 13.5 (IQR 6–25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8–19) vs Medianhigh = 6 (IQR 2–8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13–65) vs Medianhigh = 14 (IQR 4–29), p = 0.045).There were no significant differences by school type.

Conclusion
This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.
Nonlinear dose-response association of moderate-to-vigorous physical activity with hyperuricemia in US adults: NHANES 2007–2018
Authors: Zeng Xia , Huang Jitian , Shen Tianran , Xu Yingxia , Yan Xiaofang , Li Qian , Li Yanmei , Xing Xiaohui , Chen Qingsong , Yang Wenhan 
Published: May 2024

Background
The relationship between physical activity and hyperuricemia (HUA) remains inconsistent, and the dose-response association between moderate-to- vigorous physical activity (MVPA) level and HUA still unclear. In this study, we aimed to investigate the dose-response association of MVPA with HUA, and to explore an appropriate range of MVPA level for preventing HUA.

Methods
Data from the US National Health and Nutrition Examination Survey (NHANES) 2007–2018 were used, including 28740 non-gout adult Americans. MVPA level was self-reported using the Global Physical Activity Questionnaire and serum uric acid was measured using timed endpoint method. The dose-response relationship between MVPA level and HUA was modeled with restricted cubic spline analysis. Logistic regression analysis were applied to estimate odd ratios (ORs) and 95% confidence intervals (CIs) of the relationships between MVPA level and HUA.

Results
A total of 28740 adults were included in the study (weighted mean age, 47.3 years; 46.5% men), with a prevalence rate of HUA was 17.6%. The restricted cubic spline functions depicted a general U-shaped relationship between MVPA level and HUA. The MVPA level of 933 and 3423 metabolic equivalent (MET) -min/wk were the cut-off discriminating for the risk of HUA. Participants with MVPA levels in the range of 933–3423 MET-min/wk had lower risk of HUA and they had the lowest risk when MVPA levels at around 1556 MET-min/wk. Compared with the moderate-activity group (600–2999 Met-min/wk), the low-activity group (< 600 Met-min/wk) had a greater risk of HUA (OR, 1.13 [95%CI, 1.02–1.26]) after fully adjusting for potential confounders.

Conclusions
Compared with the moderate MVPA level, the low MVPA level was associated with the higher risk of HUA. And there may be a U-shaped dose-response relationship between MVPA level and HUA. When MVPA level was approximately 933–3423 MET-min/wk, the risk of HUA may at a lower level and the risk reached the lowest when MVPA level at around 1556 MET-min/wk.
Spectrum of infection and outcomes in individuals with Candida auris infection in Qatar
Authors: Al Ajmi Jameela A. , B. Malik Aimon , Nafady-Hego Hanaa , Hanana Fathima , Abraham Joji , G. Garcell Humberto , Hudaib Ghada , Al-Wali Walid , Eltayeb Faiha , Shams Sherin , G. Thomas Anil , Saleem Samah , Abou-Samra Abdul-Badi , Butt Adeel A. 
Published: May 2024

Background
We investigated the spectrum of infection and risk factors for invasive fungal disease due to Candida auris (CA) in Qatar.

Methods
We performed structured chart reviews on individuals with any positive CA culture between May 2019 and December 2022 at three tertiary care hospitals in Qatar. Invasive CA disease (ICAD) was defined as a positive sterile site culture, or any positive culture for CA with appropriate antifungal prescription. Main outcomes included proportion of individuals who developed ICAD among those with positive cultures, and 30-day/in-hospital mortality.

Results
Among 331 eligible individuals, median age was 56 years, 83.1% were male, 70.7% were non-Qataris, and 37.5% had ≥ 3 comorbidities at baseline. Overall, 86.4% were deemed to have colonization and 13.6% developed ICAD. Those with ICAD were more likely to have invasive central venous or urinary catheterization and mechanical ventilation. Individuals with ICAD had longer prior ICU stay (16 vs 26 days, P = 0.002), and longer hospital length of stay (63 vs. 43 days; P = 0.003), and higher 30-day mortality (38% vs. 14%; P<0.001). In multivariable regression analysis, only mechanical ventilation was associated with a higher risk of ICAD (OR 3.33, 95% CI 1.09–10.17).

Conclusion
Invasive Candida auris Disease is associated with longer hospital stay and higher mortality. Severely ill persons on mechanical ventilation should be especially monitored for development of ICAD.
Maternal COVID-19 exposure and placental characteristics
Authors: Allo Ghassan , Sitarik Alexandra R. , Redding Ashley , Coleman Chad M. , Cassidy-Bushrow Andrea E. , Gaba Arthur , Straughen Jennifer K. 
Published: May 2024

Introduction
The impact of COVID-19 on the placenta is poorly described, particularly among minority women.

Materials and methods
This is a retrospective case-control study. Micro- and macroscopic placental pathologic findings were compared for 15 COVID-19 positive and 36 negative mothers. Cases and controls were frequency matched on gestational age, race, maternal comorbidities, and delivery type. Data from the electronic medical record were supplemented with independent review of microscopic slides.

Results
Placentas from cases and controls were similar except the median distance from the site of the cord insertion to the nearest disk margin was statistically significantly shorter among placentas from COVID-19 positive cases (3.5 versus 6.0 cm, p = 0.006). Case status was not associated with an increased risk of placental pathologies.

Conclusion
There are few pathologic differences between placentas of COVID-19 positive and negative mothers. Additional studies are needed to investigate the role of timing of infection.
Fat quantification in dual-layer detector spectral CT: How to handle iron overload, varying tube voltage and radiation dose Indices
Authors: Molwitz Isabel , Campbell Graeme Michael , Knopp Tobias , Schubert Niklas , Erley Jennifer , Löser Anastassia , Adam Gerhard , Yamamura Jin , Fischer Roland , Ozga Ann-Kathrin , Szwargulski Patryk 
Published: May 2024

Objectives
Opposed to other spectral CT techniques, fat quantification in dual-layer detector CT (dlCT) has only recently been developed. The impact of concomitant iron overload and dlCT-specific protocol settings such as the dose right index (DRI), a measure of image noise and tube current, on dlCT fat quantification was unclear. Further, spectral information became newly available <120 kV. Therefore, this study’s objective was to evaluate the impact of iron, changing tube voltage, and DRI on dlCT fat quantification.

Material and methods
Phantoms with 0 and 8mg/cm3 iron; 0 and 5mg/cm3 iodine; 0, 10, 20, 35, 50, and 100% fat and liver equivalent, respectively, were scanned with a dlCT (CT7500, Philips, the Netherlands) at 100kV/20DRI, 120kV/20DRI, 140kV/20DRI, and at 120kV/16DRI, 120kV/24DRI.
Material decomposition was done for fat, liver, and iodine (A1); for fat, liver, and iron (A2); and for fat, liver, and combined reference values of iodine and iron (A3). All scans were analyzed with reference values from 120kV/20DRI. For statistics, the intraclass correlation coefficient (ICC) and Bland-Altman analyses were used.

Results
In phantoms with iron and iodine, results were best for A3 with a mean deviation to phantom fat of 1.3±2.6% (ICC 0.999 [95%-confidence interval 0.996–1]). The standard approach A1 yielded a deviation of -2.5±3.0% (0.998[0.994–0.999]), A2 of 6.1±4.8% (0.991[0.974–0.997]). With A3 and changing tube voltage, the maximal difference between quantified fat and the phantom ground truth occurred at 100kV with 4.6±2.1%. Differences between scans were largest between 100kV and 140kV (2.0%[-7.1–11.2]). The maximal difference of changing DRI occurred between 16 and 24 DRI with 0.4%[-2.2–3.0].

Conclusion
For dlCT fat quantification in the presence of iron, material decomposition with combined reference values for iodine and iron delivers the most accurate results. Tube voltage-specific calibration of reference values is advisable while the impact of the DRI on dlCT fat quantification is neglectable.
“It’s like your days are empty and yet there’s life all around”: A mixed methods, multi-site study exploring boredom during and following homelessness
Authors: Marshall Carrie Anne , Cooke Abrial , Holmes Julia , Bengall Jordana , Aryobi Suliman , Phillips Brooke , Lysaght Rosemary , Gewurtz Rebecca 
Published: May 2024

Purpose
To identify experiences of boredom and associations with psychosocial well-being during and following homelessness.

Methods
Using a convergent, mixed-methods explanatory design, we conducted quantitative interviews with 164 participants) (n = 102 unhoused; n = 62 housed following homelessness) using a 92-item protocol involving demographic components and seven standardized measures of psychosocial well-being. A sub-sample (n = 32) was approached to participate in qualitative interviews. Data were analyzed by group (unhoused; housed). Quantitative data were analyzed using descriptive statistics designed to generate insights into boredom, meaningful activity engagement, and their associations with psychosocial well-being during and following homelessness. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative findings were integrated at the stage of discussion.

Results
Quantitative analyses revealed small to moderate correlations between boredom and increased hopelessness (rs = .376, p < .01), increased drug use (rs = .194, p < .05), and lowered mental well-being (rs = -.366, p < .01). There were no statistically significant differences between unhoused and housed participants on any standardized measures. Hierarchical regression analyses revealed that housing status was not a significant predictor of boredom or meaningful activity engagement (p>.05). Qualitative interviews revealed profound boredom during and following homelessness imposing negative influences on mental well-being and driving substance use.

Conclusions
Boredom and meaningful activity are important outcomes that require focused attention in services designed to support individuals during and following homelessness. Attention to this construct in future research, practice, and policy has the potential to support the well-being of individuals who experience homelessness, and to contribute to efforts aimed at homelessness prevention.
Assessment of the Arabic patient-centered online information about orthodontic pain: A quality and readability assessment
Authors: Alassaf Muath Saad , Hamadallah Hatem Hazzaa , Almuzaini Abdulrahman , Aloufi Aseel M. , Al-Turki Khalid N. , Khoshhal Ahmed S. , Alsulaimani Mahmoud A. , Eshky Rawah 
Published: May 2024

Background
This study assesses the quality and readability of Arabic online information about orthodontic pain. With the increasing reliance on the internet for health information, especially among Arabic speakers, it’s critical to ensure the accuracy and comprehensiveness of available content. Our methodology involved a systematic search using the Arabic term for (Orthodontic Pain) in Google, Bing, and Yahoo. This search yielded 193,856 results, from which 74 websites were selected based on predefined criteria, excluding duplicates, scientific papers, and non-Arabic content.

Materials and methods
For quality assessment, we used the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net (HON) code. Readability was evaluated using the Simplified Measure of Gobbledygook (SMOG), Flesch Reading Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL) scores.

Results
Results indicated that none of the websites received the HONcode seal. The DISCERN assessment showed median total scores of 14.96 (± 5.65), with low overall quality ratings. In JAMA benchmarks, currency was the most achieved aspect, observed in 45 websites (60.81%), but none met all four criteria simultaneously. Readability scores suggested that the content was generally understandable, with a median FKGL score of 6.98 and a median SMOG score of 3.98, indicating middle school-level readability.

Conclusion
This study reveals a significant gap in the quality of Arabic online resources on orthodontic pain, highlighting the need for improved standards and reliability. Most websites failed to meet established quality criteria, underscoring the necessity for more accurate and trustworthy health information for Arabic-speaking patients.
FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin
Authors: Taru Madalina-Gabriela , Tefas Cristian , Neamti Lidia , Minciuna Iulia , Taru Vlad , Maniu Anca , Rusu Ioana , Petrushev Bobe , Procopciuc Lucia Maria , Leucuta Dan Corneliu , Procopet Bogdan , Ferri Silvia , Lupsor-Platon Monica , Stefanescu Horia 
Published: May 2024

Background
MASLD is a prevalent chronic liver condition with substantial clinical implications. This study aimed to assess the effectiveness of three new, elastography-based, scoring systems for advanced fibrosis ≥F3 (Agile 3+), cirrhosis F4 (Agile 4), and fibrotic NASH: NASH + NAS ≥4 + F≥2 (FAST score), in a cohort of biopsy-proven NAFLD meeting MASLD criteria. Our secondary aim was to compare their diagnostic performances with those of other fibrosis prediction tools: LSM-VCTE alone, and common, easily available scores (FIB-4 or APRI).

Methods
Single-center, retrospective study, on consecutive patients with baseline laboratory tests, liver biopsy, and reliable LSM-VCTE measurements. The discrimination between tests was evaluated by analyzing the AUROCs. Dual cut-off approaches were applied to rule-out and rule-in ≥F3, F4 and fibrotic NASH. We tested previously reported cut-off values and provided our best thresholds to achieve Se ≥85%, Se ≥90%, and Sp ≥90%, Sp ≥95%.

Results
Among 246 patients, 113 (45.9%) were women, and 75 (30.5%) presented diabetes. Agile 3+ and Agile 4 demonstrated excellent performance in identifying ≥F3 and F4, achieving AUROCs of 0.909 and 0.968, while the FAST score yielded acceptable results in distinguishing fibrotic NASH. When compared to FIB-4 and LSM-VCTE, both Agile 3+ and Agile 4 performed better than FIB-4 and had a similar performance to LSM-VCTE, but with higher diagnostic accuracy, hence reducing the grey zone.

Conclusion
Agile 3+ and Agile 4 are reliable, non-invasive tests for identifying advanced fibrosis or cirrhosis in MASLD patients, while FAST score demonstrates moderate performance in identifying fibrotic NASH.
Factors associated with the enrollment of commercial medical insurance in China: Results from China General Social Survey
Authors: Xue Songyue , Zeng Wu , Yang Xiaocong , Li Jianguo , Zhu Lei , Zou Guanyang 
Published: May 2024

Background
The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage.

Objective
This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China.

Methods
Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI.

Results
Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI.

Conclusions
We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.