bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family physicians and menstrual care: An analysis of CERA 2023
Authors: Casola Allison R , Rea Olivia , Ho Tiffany 
Published: April 2024

Background: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations. Objectives: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care. Design/Methods: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included actively practicing US physicians who are members of the Council of Academic Family Medicine organizations. Descriptive demographic statistics were calculated; chi-square tests were generated for menstrual care-specific items; logistic regression models were fit to determine the association between receiving formal menstrual care training, importance of physician training in menstrual care, and demographic factors. Results: Eighty-five percent of respondents report frequently providing menstrual care. Participants of younger age, or who had earned their degree more recently, were significantly more likely to provide frequent menstrual care. Respondents who earned their medical degree at an earlier year were significantly more likely to believe that physician training in menstrual care was of limited importance (OR = 1.02, 95% CI = 1.00, 1.03). Conclusions: Our findings show that family physicians are providing menstrual care, despite non-uniform training, and recognize its importance to patients. By understanding physician profile and the care they provide, we can work toward comprehensive physician education in menstrual care and providing appropriate menstrual care to patients.
Glucagon-like peptide-1 receptor agonists and stroke: A systematic review and meta-analysis of cardiovascular outcome trials
Authors: Adamou Anastasia , Barkas Fotios , Milionis Haralampos , Ntaios George 
Published: April 2024

Background: In patients surviving stroke, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in patients surviving stroke with diabetes mellitus or obesity. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed MEDLINE and Scopus until 15 November 2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1. Results: Among 1369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77–0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs weekly). In addition, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79–0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence. Conclusion: In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity. Data access statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Knowledge of Non-Invasive Biomarkers of Breast Cancer, Risk Factors, and BSE Practices Among Nursing Undergraduates in Farasan Island, KSA
Authors: Sayed Shabihul Fatma , Dailah Hamad G. , Nagarajan Sumathi , Abdelwahab Siddig Ibrahim , Abadi Shaived S. Hasan , Akhtar Nida , Khuwaja Gulrana , Malham Wadeah Ali DA 
Published: April 2024

Background of the Study Mammograms are sometimes met with issues of overdiagnosis and underdiagnosis; therefore, they are less reliable in identifying cancer in women with dense breasts. As a result, it is critical to be aware of other sensitive screening techniques for the early diagnosis of breast cancer. Aim The ultimate objective of this study was to assess the knowledge of nursing undergraduates regarding non-invasive biomarkers, such as volatile organic compounds in breath, nipple aspirate fluid, sweat, urine, and tears, for the early detection of breast cancer to help improve patient care, determine the risk factors, and encourage practice of breast self-examination. Methods Cross-sectional research was done in the Department of Nursing at Farasan campus using a self-structured questionnaire as the study tool. A total of 260 students willingly participated. The study tool had evaluation questions focused on the non-invasive biomarkers of breast cancer, risk factors, and breast self-examination practices to collect data. The data were subjected to descriptive and inferential statistics. The statistical significance was calculated at P < .05. Data analyses were done using Microsoft Excel (2013). Results A significant knowledge gap existed among the study participants about the non-invasive biomarkers of breast cancer. A lesser percentage of students (25%) stated that they do breast self-examination on a monthly basis. The most common reasons for not doing the breast self-examination were “not knowing how to do the breast self-examination” (77.3%), fear of a positive diagnosis (53.9%), thinking that they are not at risk as all were in their teens and hence not required (44.7%), and lack of time (48.7%). Age and frequency of breast self-examination were significantly associated ( P < .05) as those few students (22.7%) who were doing breast self-examination practices every 2–4 months belonged to a higher study year. Furthermore, knowledge regarding incidence rates and health care expenditure by the government on breast cancer was also significantly low ( P < .05). Conclusions Outcomes would help prioritize actions to help future nurses better understand breast cancer, allowing them to extend patient care in the best way possible.
Challenges of Clinical Education: From the Perspective of Clinical Instructors and Clinical Staffs at Dire Dawa University, Dire Dawa, Ethiopia, Qualitative Study
Authors: Tadesse Daniel , Solomon Yonatan , Hailu Mickiale , Tigistu Feven 
Published: April 2024

OBJECTIVE To explore the challenges of clinical education from the perspective of clinical instructors and clinical staff at Dire Dawa University College of Health Science. METHODS An institutional-based phenomenological qualitative study was conducted. Clinical instructors and staff provided data through in-depth interviews and key informant discussions, which were facilitated by a semistructured tool and a voice recorder. A total of 17 participants, including 11 in-depth interviews (IDIs) with clinical instructors (including two key informants) and six IDIs with clinical staff were included in this study. A purposive sampling method was used to select study participants, and the data were analyzed thematically using the computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach involves six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing. RESULTS Clinical instructors and clinical staff noted a number of challenges in clinical education, including insufficient medical equipment, low incentives, clinical site repetition, unfavorable clinical practice sites, lack of communication from instructors, skill attrition, lack of orientation for instructors and students, client/patient unwelcomingness, uncooperative healthcare workers, and poor university cooperation. CONCLUSION The aforementioned issues contributed to the quality of clinical education and its desired impact, as outlined in this research. A multidisciplinary and collaborative effort is needed to address these challenges.
Association of 5-HTTLPR With Post-Traumatic Stress Disorder in US Service Members
Authors: Hu Xian-Zhang , Ursano Robert J. , Benedek David , Li Xiaoxia ,   Biomarker Study Group, Zhang Lei 
Published: April 2024

Objective Post-traumatic stress disorder (PTSD) is a mental disorder that manifests after exposure to a stressful traumatic event, such as combat experience. Accumulated evidence indicates an important genetic influence in the development of PTSD. The serotonin transporter (5-HTT) gene has been identified as a candidate for PTSD and a polymorphism of the serotonin transporter-linked promoter region (5-HTTLPR) is associated with the disorder in the general population. However, whether it is associated with PTSD in active military service members has not been investigated. This study aimed to investigate the relationship between 5-HTTLPR and PTSD in service members. Methods Leucocyte genomic DNA was extracted from service members, including those with PTSD (n = 134) or without PTSD (n = 639). The 5-HTTLPR polymorphism was detected by means of 2 stages of TaqMan fluorescent PCR assay. PTSD symptoms and symptom severity were assessed using the PTSD Checklist (PCL), a 17-item, DSM-based, self-report questionnaire with well-established validity and reliability. PTSD was determined based on endorsement of DSM-IV criteria and a PCL total score ≥ 44. Results Significant differences in biallele distribution were observed between PTSD and controls (χ2 = 7.497, P = .024). The frequency of SS, SL, and LL genotypes in the PTSD group was 0.17, 0.56, and 0.27 respectively, compared to the frequencies of 0.27, 0.43, and 0.29 in non-PTSD controls. Carriers of the L allele had higher scores for reexperiencing and arousal symptoms on the PCL, compared to SS homozygote carriers ( P < .05). The triallele genotypes showed no significant differences in distribution between the PTSD and control groups ( P > .05) and no relationship with PTSD symptom severity. The interaction of triallelic genotypes of 5-HTTLPR and traumatic life events was associated with re-experiencing, avoidance, and arousal ( P < .05 for all). Multiple regression analysis revealed significant correlations between both biallelic and triallelic genotypes of 5-HTTLPR, the interaction of the number of stressful lifetime events, and 5-HTTLPR genotypes with PCL total score ( P < .001). Conclusion Our findings suggested that 5-HTT might play a minor role in PTSD, and the interaction between 5-HTTLPR and the environment had effects on PCL score, complementing and emphasizing 5-HTT for PTSD, especially in the military population.
Mitochondrial (mt)DNA–cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING) signaling promotes pyroptosis of macrophages via interferon regulatory factor (IRF)7/IRF3 activation to aggravate lung injury during severe acute pancreatitis
Authors: Peng Yiqiu , Yang Yuxi , Li Yingying , Shi Tingjuan , Xu Ning , Liu Ruixia , Luan Yingyi , Yao Yongming , Yin Chenghong 
Published: April 2024

Abstract
Background
Macrophage proinflammatory activation contributes to the pathology of severe acute pancreatitis (SAP) and, simultaneously, macrophage functional changes, and increased pyroptosis/necrosis can further exacerbate the cellular immune suppression during the process of SAP, where cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING) plays an important role. However, the function and mechanism of cGAS–STING in SAP-induced lung injury (LI) remains unknown.

Methods
Lipopolysaccharide (LPS) was combined with caerulein-induced SAP in wild type, cGAS −/− and sting −/− mice. Primary macrophages were extracted via bronchoalveolar lavage and peritoneal lavage. Ana-1 cells were pretreated with LPS and stimulated with nigericin sodium salt to induce pyroptosis in vitro.

Results
SAP triggered NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome activation-mediated pyroptosis of alveolar and peritoneal macrophages in mouse model. Knockout of cGAS/STING could ameliorate NLRP3 activation and macrophage pyroptosis. In addition, mitochondrial (mt)DNA released from damaged mitochondria further induced macrophage STING activation in a cGAS- and dose-dependent manner. Upregulated STING signal can promote NLRP3 inflammasome-mediated macrophage pyroptosis and increase serum interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α levels and, thus, exacerbate SAP-associated LI (SAP-ALI). Downstream molecules of STING, IRF7, and IRF3 connect the mtDNA–cGAS–STING axis and the NLRP3–pyroptosis axis.

Conclusions
Negative regulation of any molecule in the mtDNA–cGAS–STING–IRF7/IRF3 pathway can affect the activation of NLRP3 inflammasomes, thereby reducing macrophage pyroptosis and improving SAP-ALI in mouse model.
Supplementation of Jasmonic acid Mitigates the Damaging Effects of Arsenic Stress on Growth, Photosynthesis and Nitrogen Metabolism in Rice
Authors: Attia Houneida , Alamer Khalid H. 
Published: April 2024

AbstractExperiments were conducted to evaluate the role of exogenously applied jasmonic acid (JA; 0.1 and 0.5 µM) in alleviating the toxic effects of arsenic (As; 5 and 10 µM) stress in rice. Plants treated with As showed considerable decline in growth attributes like height, fresh and dry weight of plant. Arsenic stress reduced the content of δ-amino livulenic acid (δ-ALA), glutamate 1-semialdehyde (GSA), total chlorophylls and carotenoids, with more reduction evident at higher (10 µM) As concentrations, however exogenously supplied JA alleviated the decline to considerable extent. Arsenic stress mediated decline in photosynthetic gas exchange parameters, Fv/Fm (PSII activity) and Rubisco activity was alleviated by the exogenous treatment of JA. Arsenic stress caused oxidative damage which was evident as increased lipid peroxidation, lipoxygenase activity and hydrogen peroxide concentrations however, JA treatment declined these parameters. Treatment of JA improved the activity of nitrate reductase and glutamate synthase under unstressed conditions and also alleviated the decline triggered by As stress. Activity of antioxidant enzymes assayed increased due to As stress, and the supplementation of JA caused further increase in their activities. Moreover, the content of proline, free amino acids and total phenols increased significantly due to JA application under stressed and unstressed conditions. Treatment of JA increased the content of nitrogen and potassium while as reduced As accumulation significantly.
Update on prostate cancer epidemiology in Morocco
Authors: Samtal Chaimae , Bouguenouch Laila , Ismaili Nabil , El Baldi Marwa , El Makhzen Badreddine , El Rhazi Karima , Mzyiene Mohammed , Farih Moulay Hassan , Ouldim Karim , Ghazal Hassan , Bekkari Hicham 
Published: April 2024

Abstract
Background
Prostate cancer stands as the most frequently diagnosed cancer among men globally, with over 600,000 new cases annually. In-depth epidemiological studies play a pivotal role in delineating the unique characteristics of specific populations. This study endeavors to comprehensively document the histopathological pattern of Moroccan prostate cancer patients while assessing the extent of underdiagnosis risk within the Moroccan population.

Methods
A retrospective cross-sectional study, encompassing 141 cases of prostate cancer, was conducted. Prostate cancer-confirming biopsies were executed at both the University Hospital Hassan II in Fez and the University Hospital Mohammed VI in Oujda between 2015 and 2021. Statistical analysis employed SPSS version 21 software.

Results
The mean age at presentation was 72 years. Prostatic adenocarcinoma emerged as the only histopathological type observed in our patients. Clinically staged diseases (T2, T3, and T4) were manifested in 71.1% of patients. Poorly differentiated tumors (Gleason grades 8, 9, and 10) were identified in 29.2% of cases. The majority of enrolled patients exhibited an intermediate to high-risk disease state.

Conclusions
Our findings underscore the significance of prostate cancer as a substantial public health burden, given the severity of this pathology and the limited accessibility to diagnosis within the population. These results substantiate the necessity for further research into the epidemiology of prostate cancer in Morocco.
Intergenerational transmission of unemployment after apprenticeship graduation: does parental socioeconomic background still matter?
Authors: Dummert Sandra 
Published: April 2024

AbstractA smooth transition from apprenticeship to standard employment is a key step in the professional biographies of apprenticeship graduates. In this study, the transition of apprenticeship graduates from households that receive unemployment benefits are considered. These graduates are thought to be disadvantaged because their parents’ socioeconomic background is assumed to influence their employment outcomes through processes of intergenerational transmission and cumulative disadvantage. Based on administrative data from the Sample of Integrated Welfare Benefit Biographies (SIG) provided by the Institute for Employment Research (IAB), this analysis offers deeper insights into parental socioeconomic background and the individual factors that affect the risk of unemployment following the completion of an apprenticeship. In the case of an unsuccessful direct transition to standard employment, the factors influencing the duration of the first unemployment are also assessed. The results show that, as with individual characteristics, parents’ education level has a significant effect on the graduates’ risk of unemployment. The duration of the household’s benefit receipt, on the other hand, significantly influences the duration of the first unemployment in the case of an unsuccessful transition following an apprenticeship.
Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York
Authors: Fiori Kevin P. , Levano Samantha , Haughton Jessica , Whiskey-LaLanne Renee , Telzak Andrew , Muleta Hemen , Vani Kavita , Chambers Earle C. , Racine Andrew 
Published: April 2024

Abstract
Background
In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system’s 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY.

Methods
We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023.

Results
There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3–39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2–26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 – $202.12).

Conclusions
We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.
Association between TB delay and TB treatment outcomes in HIV-TB co-infected patients: a study based on the multilevel propensity score method
Authors: Liao Rujun , Hu Lin , Yu Jie , Chen Ying , Chen Miaoshuang , Yan Jingmin , Li Xin , Han Xinyue , Jike Chunnong , Yu Gang , Wang Ju , Liao Qiang , Xia Lan , Bai Xuefei , Shi Jinhong , Jiang Tian , Du Liang , Zhang Tao 
Published: April 2024

Abstract
Background
HIV-tuberculosis (HIV-TB) co-infection is a significant public health concern worldwide. TB delay, consisting of patient delay, diagnostic delay, treatment delay, increases the risk of adverse anti-TB treatment (ATT) outcomes. Except for individual level variables, differences in regional levels have been shown to impact the ATT outcomes. However, few studies appropriately considered possible individual and regional level confounding variables. In this study, we aimed to assess the association of TB delay on treatment outcomes in HIV-TB co-infected patients in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) of China, using a causal inference framework while taking into account individual and regional level factors.

Methods
We conducted a study to analyze data from 2068 patients with HIV-TB co-infection in Liangshan Prefecture from 2019 to 2022. To address potential confounding bias, we used a causal directed acyclic graph (DAG) to select appropriate confounding variables. Further, we controlled for these confounders through multilevel propensity score and inverse probability weighting (IPW).

Results
The successful rate of ATT for patients with HIV-TB co-infection in Liangshan Prefecture was 91.2%. Total delay (OR = 1.411, 95% CI: 1.015, 1.962), diagnostic delay (OR = 1.778, 95% CI: 1.261, 2.508), treatment delay (OR = 1.749, 95% CI: 1.146, 2.668) and health system delay (OR = 1.480 95% CI: (1.035, 2.118) were identified as risk factors for successful ATT outcome. Sensitivity analysis demonstrated the robustness of these findings.

Conclusions
HIV-TB co-infection prevention and control policy in Liangshan Prefecture should prioritize early treatment for diagnosed HIV-TB co-infected patients. It is urgent to improve the health system in Liangshan Prefecture to reduce delays in diagnosis and treatment.