bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in urine lead and associated mortality in US adults: NHANES 1999–2018
Authors: Wang Qiong , Wu Jing , Dong Xiaoqun , Niu Wenquan 
Published: May 2024

ObjectivesThis study aimed to describe the trends of urine lead among US adults aged ≥45 years and to explore its association with all-cause and disease-specific mortality.MethodsThis study enrolled 9,669 participants from the National Health and Nutrition Examination Survey, 1999–2018. Trends in urine lead were described by logistic regression analysis using the survey cycle as a continuous variable. Cox proportional hazard regression analyses were used to quantify the association between urine lead and mortality.ResultsThere was an obvious decline in urine lead concentrations from 1.203 μg/L (95% confidence interval [CI]: 1.083–1.322) in 1999–2000 to 0.478 μg/L (95% CI: 0.433–0.523) in 2017–2018, and this decline was statistically significant (P &lt; 0.001). Referring to the first tertile of urine lead concentrations, risk magnitude for all-cause mortality was significantly and linearly increased after adjustment (P = 0.026 and 0.020 for partially and fully adjusted models, respectively), and significance was attained for the comparison of the third vs. first tertile after full adjustment (hazard ratio [HR]: 1.17, 95% CI: 1.01 to 1.35). Treating urine lead continuously, the risk for all-cause mortality was statistically significant (HR: 1.18 and 1.19, 95% CI: 1.01 to 1.39 and 1.00 to 1.40 for partially and fully adjusted models). For cardiovascular disease-specific and cancer-specific mortality, there was no hint of statistical significance.ConclusionsOur findings indicated that urine lead exhibited a declining trend from 1999–2000 to 2017–2018 in US adults aged ≥45 years, and high urine lead was a significant and independent risk factor for all-cause mortality.
Juvenile dermatomyositis with central nervous system involvement: two case reports from a retrospective single-center cohort, with literature review
Authors: Yang Ling , Guan Wanzhen , Liu Haimei , Li Yifan , Gong Yinv , Lv Qianying , Zeng Qiaoqian , Wei Qijiao , Zhang Xiaomei , Chen Weiming , Chen Chao , Sun Li 
Published: May 2024

BackgroundJuvenile dermatomyositis (JDM) is a systemic autoimmune disease primarily involving the muscles and skin; it can also affect the central nervous system (CNS). The relevant literature provides limited information regarding the characteristics of JDM with CNS involvement.MethodWe reviewed patients with JDM who were hospitalized at our center between January 2016 and August 2023, with a focus on those with CNS involvement. The aim was to provide detailed case reports on these patients, and to summarize the relevant literature about the characteristics of similar cases.ResultsAmong 193 hospitalized patients with JDM, two (1.03%) had CNS involvement. Two patients, a 5.5-year-old girl and an 11-year-old boy, were admitted with severe proximal muscle weakness and seizures, and presented with active cutaneous vasculitis. Both were ultimately diagnosed with JDM, with CNS involvement. Both patients had confirmed presence of anti-NXP2 antibody through myositis-specific antibody analysis. Additionally, they all exhibited hyperferritinemia and thrombocytopenia. Salvage therapies like intravenous methylprednisolone (IVMP) pulse therapy and/or plasma exchange were administered successfully. At final follow-up, both patients had achieved complete clinical response and full neurological recovery. Our literature review identified nine similar case studies. CNS involvement usually occurred within the first 10 months of the disease course, and most of these patients had fatal outcomes, with a mortality rate of 66.6% (6/9). Including the two patients described herein, the median age for disease onset is 10.5 years (range 4–17 years), and the male: female ratio is 6:5. Seizures are the most common neurological symptom, accompanied by active cutaneous vasculitis. The brain biopsies showed two distinct pathological presentations: one was central nervous system vasculitis, and the other was cerebral macrophage activation syndrome.ConclusionsCNS involvement is a rare but life-threatening JDM complication. Herein, our cases and the literature indicate that it typically occurs within the first 10 months of the disease course and manifests as seizures, often accompanied by active cutaneous vasculitis, with fatal outcomes. Timely implementation of salvage therapies, like IVMP pulse therapy and plasma exchange, may significantly impact patient outcomes.
Pharmaceutical interventions for drug-related problems in the neonatal intensive care unit: incidence, types, and acceptability
Authors: Ahmed Norhan Attia , Fouad Ehab Ahmed , El-Asheer Osama M. , Ghanem A. S. M. 
Published: May 2024

Background: Drug-related problems (DRPs) are widespread in hospitalized neonates, but studies on the prevalence of DRPs in this population are limited. The presence of clinical pharmacists on multidisciplinary teams helps prevent and reduce DRPs.Aim: This investigation aimed to identify and classify the incidence of DRPs in the neonatal intensive care unit (NICU), to determine the determining factors associated with DRPs and to document clinical pharmacists’ interventions, outcomes, acceptance rates and clinical significance.Method: A prospective descriptive hospital study was conducted from August to November 2023 at the NICU of Children’s University Hospital, Assiut University, Egypt. DRPs were classified using the Pharmaceutical Care Network of Europe (PCNE) classification V9.1.Results: Three hundred sixteen neonates were included in the study, with a mean gestational age of 34 ± 4 weeks and a mean birth weight of 2.03 ± 0.85 kg. A total of 1723 DRPs occurred among 283 neonates (89.6%), an average of 5.5 ± 5.1 DRPs per patient. The main types were treatment effectiveness (P1) (799, 46.4%), followed by others (P3) (469, 27.2%), and treatment safety (P2) (455, 26.4%). The leading causes were dose selection (C3) (1264, 61.9%) and “other domain” (C9) (543, 26.6%). Of the 2149 interventions introduced by pharmacists, 98.8% were accepted and 93% were accepted, and fully implemented. As a result, 92% of the DRPs were resolved. Both length of hospital stay and number of medications were significantly associated with DRPs.Conclusion: DRPs are common in the NICU; this study demonstrated the crucial role of clinical pharmacists in identifying and resolving DRPs.
Limbal stem cells carried by a four-dimensional -printed chitosan-based scaffold for corneal epithelium injury in diabetic rabbits
Authors: Wang Mengyuan , Liu Kaibin , Wang Xiaomin , Shang Zhen , Liu Yiming , Pan Nailong , Sun Xueqing , Xu Wenhua 
Published: June 2024

Methods: Herein, we obtained and characterized deltaN p63- and adenosine triphosphate-binding cassette subfamily G member 2-expressing limbal stem cells (LSCs). Chitosan and carboxymethyl chitosan (CTH) were cross-linked to be an in situ thermosensitive hydrogel (ACH), which was printed through four-dimensional (4D) printing to obtain a porous carrier with uniform pore diameter (4D-CTH). Rabbits were injected with alloxan to induce diabetes mellitus (DM). Following this, the LSC-carrying hydrogel was spread on the surface of the cornea of the diabetic rabbits to cure corneal epithelium injury.Results: Compared with the control group (LSCs only), rapid wound healing was observed in rabbits treated with LSC-carrying 4D-CTH. Furthermore, the test group also showed better corneal nerve repair ability. The results indicated the potential of LSC-carrying 4D-CTH in curing corneal epithelium injury.Conclusion: 4D-CTH holds potential as a useful tool for studying regenerative processes occurring during the treatment of various diabetic corneal epithelium pathologies with the use of stem cell-based technologies.
Effect of blueberry intervention on endothelial function: a systematic review and meta-analysis
Authors: Deng Bixin , Lei Yupeng , Zhou Ruixi , Ruan Tiechao , Lu Wenting , Ying Junjie , Yue Yan , Mu Dezhi 
Published: June 2024

Introduction: Endothelial dysfunction indicates blood vessel injury and is a risk factor for cardiovascular diseases. Blueberry has been approved for its benefits on human health, especially on cardiovascular function. However, its effect on endothelial function remains unclear. We conducted a systematic review and meta-analysis to explore the impact of blueberries on endothelial function in adults.Methods: We searched PubMed, Web of Science, Embase, and the Cochrane Library, 16 studies were included in the systematic review, and 11 were used for the meta-analysis. Data associated with endothelial function were extracted and pooled as mean differences (MD) with 95% confidence intervals (CI).Results: Blueberry consumption significantly improved flow-mediated dilation (FMD) by 1.50% (95% CI: 0.81, 2.20; I2 = 87%) and reactive hyperemia index (RHI) by 0.26 (95% CI: 0.09, 0.42; I2 = 72%). A significant decrease in diastolic blood pressure (DBP) was also observed (MD: −2.20 mm Hg; 95% CI: −4.13, −0.27; I2 = 11%). Subgroup analysis indicated a significant decrease in blood pressure (Systolic blood pressure [SBP]: −3.92 mmHg; 95% CI: −6.88, −0.97; I2 = 20% and DBP: −2.20 mmHg; 95% CI: −4.13, −0.27; I2 = 11%) in the smoking population. However, SBP levels (MD: −1.43 mm Hg; 95% CI: −3.11, 0.26; I2 = 20%) and lipid status (high-density lipoprotein cholesterol [HDL-C]: 0.06; 95% CI: −0.04, 0.16; I2 = 77%; low-density lipoprotein cholesterol [LDL-C]: 0.05; 95% CI: −0.14, 0.24; I2 = 0%) did not significantly improve.Conclusion: Blueberry intervention improved endothelial function and DBP. Subgroup analysis revealed a notable improvement in blood pressure among the smoking population. However, no significant effects were observed on SBP, HDL-C, and LDL-C levels. Future research should delve into the mechanisms of endothelial improvement and verify blood pressure reduction in specific subpopulations through large-scale trials.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/, Identifier CRD42023491277.
Profile of gym-goers who do not use performance-enhancement substances
Authors: Tavares Ana Sofia R. , Carolino Elisabete , Teques Pedro , Calmeiro Luis , Serpa Sidonio 
Published: May 2024

IntroductionCurrently the use of prohibited performance-enhancing substances (PES) in fitness and gym settings is a public health concern as adverse health consequences are emerging. Understanding the characteristics of gym-goers who do not use these substances could lead to an important complement to the ongoing research about risk factors for PES use. The aim of this study was to identify the profile of PES non-use in gym-goers.MethodsIn total, 453 gym-goers (mean age = 35.64 years; SD = 13.08 – measure of central tendency location and measure of absolute dispersion, respectively) completed an online survey assessing sociodemographic factors, exercise characteristics, gym modalities, peers, social influence, attitudes, subjective norms, beliefs, intentions, and self-reported use of PES.ResultsDecision Trees showed that being a woman, training less frequently, not practicing bodybuilding and having a negative intention to consume PES were identified as characteristics of non-users of PES.DiscussionThese results may support evidence-based anti-doping interventions to prevent abusive use of PES in the fitness context.
Influence of socio-family variables on parental assessment of the pragmatic development of children under 4 years of age
Authors: Botana Iria , Peralbo Manuel 
Published: May 2024

IntroductionInterest in pragmatic development and its assessment has increased in recent years, not only because of the predictive value of pragmatic impairments as warning signs in the detection of multiple developmental disorders, but also because of the consideration that pragmatics has received in the field of mental disorders. Current contexts of child development assessment require pragmatic assessment instruments that accurately define profiles and take into account the immediate context in which they develop. Parents' knowledge of their children's abilities is supported by exhaustive observation over time of regularities in their behavior. But it is true that the way a caregiver interprets behavior is mediated by multiple variables. The aim of the present study, therefore, is to shed light on the possible influence of parental belief systems on the assessment of children's pragmatic development by analyzing the relationship between sociofamilial variables and the assessment of pragmatic competence.MethodA total of 215 educational centers across Spain participated in the study. The final sample was of 262 parents of boys and girls between 6 and 48 months of age. The parental questionnaire for the evaluation of pragmatic development, The Pragmatics Profile, in an adapted Spanish version, was applied along with a number of items for the evaluation of parental beliefs.ResultsAnalyses confirm the existence of an effect of child development conceptions and other socio-familial variables on the assessment of pragmatic development between 6 and 48 months of age. Furthermore, the results indicate that better scores on pragmatic development are associated with parents with higher socioeconomic and educational levels, greater number of children and more interactionist conceptions and realistic.ConclusionThe effect of parental conceptions on the evaluation of pragmatics points to the need to obtain convergent measures in an area as complex as that of communicative development in early childhood, especially taking into account that an evaluation which is neutral and free from context is not possible or indeed desirable. Pragmatic development must be evaluated within this contextual framework and should take into account each of the variables present therein. Hence the complementarity between parental reports and performance-based test.
Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood
Authors: Emke Helga , Altenburg Teatske , Dijkstra Coosje , Pinzon Angie Luna , Stronks Karien , Waterlander Wilma , Kremers Stef , Chinapaw Mai 
Published: June 2024

PurposeChildhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system’s dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents.MethodsFour PAR groups comprising of 6–8 adolescent co-researchers (10–14 years) and 1–2 adult facilitators met weekly during 3–4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions.ResultsOur approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers.ConclusionWe experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents’ EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.
A study on the physical aging characteristics of the older people over 70 years old in China
Authors: Shen Jin-Bo , Ma Yuan-Yuan , Niu Qian 
Published: June 2024

AimIn China, with the increase of life expectancy and the decrease of fertility rate, the aging problem has become increasingly prominent, and the physical problems of the older people over 70 years are the key and difficult problems.MethodBased on the interactive logic between the aging problem and the older people health, in the study, a questionnaire survey and a nationwide physical fitness test were carried out on the older people over 70, to divide into different age groups (70–74 years old, 75–79 years old, 80–84 years old, 85 years old and older) and different genders. There were 8,400 valid samples, and 1,050 persons in each group. One-way ANOVA was used to compare the differences among groups of different ages, and a broken line chart was drawn to discuss the aging characteristics of various physical indexes of the older people over 70 in China.Result(1) Body morphology: male waist circumference, male waist-to-height ratio and female BMI showed a gradual downward trend with the increase of age; (2) Physiological function: male and female vital capacity showed a decreasing trend with the increase of age, while female pulse pressure showed a gradual upward trend. (3) Physical quality: the indicators of male and female muscle strength, flexibility quality, aerobic endurance and balance showed a downward trend with the increase of age.ConclusionVital capacity, flexibility quality, muscle strength, aerobic endurance, balance ability and so on, decreased significantly with the growth of age. 80 years old is the inflection point of the rapid decline of various indicators. Blood pressure, silent pulse, BMI, waist-to-hip ratio, waist-to-height ratio and other indicators did not change regularly with age. Indicators such as blood pressure, BMI, waist-to-hip ratio and waist-to-height ratio were in the high-risk range of metabolic diseases and cardiovascular and cerebrovascular diseases. The study conducted physical fitness test on the older people over 70 years old in 7 geographical regions of China, which is the first nationwide physical fitness test for the older people, which is an extension and expansion of the national physical fitness monitoring system, and also shows that the test indicators involved in the “Health fitness scale” are simple and feasible. And the study added a series of test data over 70 years old, which is the basis for scientific and reasonable formulation of physical fitness evaluation standards for the older people, and is of great significance for improving the national physical fitness database and grasping the dynamic changes of national physical health status, and providing data support for scientific guidance of physical exercise for the older people.
Core health system measures response to COVID-19 among East Asian countries
Authors: Jiao Jun , Chen Wei 
Published: June 2024

ObjectiveThe purpose of this study is to summarize the health system response to COVID-19 in four East Asian countries, analyze the effectiveness of their health system response, and provide lessons for other countries to control the epidemic and optimize their health system response.MethodsThis study investigated and summarized COVID-19 data and health system response in four East Asian countries, China, Japan, Mongolia, and South Korea from national governments and ministries of health, WHO country offices, and official websites of international organizations, to assess the effectiveness of health system measures.ResultAs of June 30, 2022, all four countries are in a declining portion of COVID-19. China has two waves, and new cases increased slowly, with the total cases per million remaining within 4, indicating a low level. Japan has experienced six waves, with case growth at an all-time high, total cases per million of 250.994. Mongolia started the epidemic later, but also experienced four waves, with total cases per million of 632.658, the highest of the four countries. South Korea has seen an increasing number of new cases per wave, with a total case per million of 473.759.ConclusionIn containment strategies adopted by China and Mongolia, and mitigation strategies adopted by Japan and South Korea, health systems have played important roles in COVID-19 prevention and control. While promoting vaccination, countries should pay attention to non-pharmaceutical health system measures, as evidenced by: focusing on public information campaigns to lead public minds; strengthening detection capabilities for early detection and identification; using technical ways to participate in contact tracing, and promoting precise judging isolation.
An examination of social relations and concussion management via the blue card
Authors: Jorgensen Michael P. , Safai Parissa , Mainwaring Lynda 
Published: June 2024

IntroductionInitially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials' experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being.MethodsUsing Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials' perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol.ResultsFour themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport.DiscussionOur findings emphasize the need to attend to social relations in concussion management and provide insight into match officials' fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card.