bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress level and associated factors among nurses working in the critical care unit and emergency rooms at comprehensive specialized hospitals in Southern Ethiopia, 2023: explanatory sequential mixed-method study
Authors: Bolado Getachew Nigussie , Ataro Bizuayehu Atinafu , Gadabo Christian Kebede , Ayana Agumas Shibabaw , Kebamo Tamirat Ersino , Minuta Worku Mimani 
Published: May 2024

Abstract
Background
Stress is a pervasive occurrence within certain professions, including nurses working in emergency and intensive care unit environments. Nurses in these settings often confront various stress-inducing factors, such as unsupportive management and distressing events like patient mortality, and experience notably higher levels of stress. Nevertheless, information is scarce regarding the precise level of stress in Ethiopia, particularly within southern hospitals.

Objective
To assess stress levels and associated factors among nurses working in the critical care unit and emergency rooms at comprehensive specialized hospitals in southern Ethiopia, 2023.

Methods
A facility-based cross-sectional explanatory sequential mixed-method study was undertaken, involving a total of 239 nurses. For the quantitative component, all nurses working in intensive care units and emergency rooms were included as participants, while a purposive sampling technique was employed to select participants for the qualitative aspect. Data for the quantitative study were gathered through the utilization of self-administered questionnaires, while interviews were conducted using a structured interview guide for the qualitative portion. Quantitative data entry and analysis were performed using EpiDataV4.6 and the Statistical Package for the Social Sciences software, respectively. Thematic analysis of the qualitative data was conducted using the OpenCode software.

Results
The level of stress among nurses in the emergency and intensive care units was low (19.3%), moderate (55.9%), and high (24.8%). Workload (Adjusted odds ratio (AOR) = 3.51, 95% confidence interval (CI) (1.17–10.56) and time constraints (AOR = 2.5, 95% CI (1.03–6.07) were significantly associated with moderate stress level, while duty demands (AOR = 3.03, 95% CI (1.17–7.14), availability of medical equipment and supplies (AOR = 1.42, 95% CI (1.18–4.97), and witnessing death and dying (AOR = 2.34, 95% CI (1.13–5.88) were significantly associated with high-stress level. The qualitative data analysis revealed that the participants underscored the significant impact of organizational factors, individual factors, and profession-related factors on the stress levels experienced by nurses in emergency and critical care settings.

Conclusion and recommendation
Based on the findings, the participants in this study experienced some level of stress, to varying degrees. Therefore, it is crucial to implement effective strategies such as optimizing staffing and workflow, improving communication and collaboration, providing adequate support and resources, leveraging technology and innovation, emphasizing patient-centered care, and implementing data-driven quality improvement to alleviate the burden.
Are recent health, welfare and care graduates part of a rural and remote workforce solution? Evidence from Tasmania, Australia
Authors: Jessup Belinda , Proudfoot Fiona , Cross Merylin , Barnett Tony 
Published: May 2024

Abstract
Background
Strong growth in graduate supply from health, welfare and care courses across Australia may bode well for easing rural workforce shortages. However, little is known about the employment opportunities available for recent graduates in non-metropolitan areas. This study aimed to quantify and describe advertised job vacancies for health, welfare and care professions in Tasmania, a largely rural and geographically isolated island state of Australia. Further, it aimed to examine those job vacancies specifying that recent graduates were suitable to apply.

Methods
Job advertisements for health, welfare and care professionals were collected weekly throughout 2018 from six online job vacancy websites. Data were extracted on 25 variables pertaining to type of profession, number of positions, location, and graduate suitability. Location of positions were recoded into a Modified Monash Model (MM) category, the Australian geographic standard used to classify rurality. Positions advertised in MM2 areas were considered regional and MM3-7 areas rural to very remote. Data were analysed using descriptive and inferential statistics.

Results
Over the twelve-month period, 3967 advertisements were identified, recruiting for more than 4700 positions across 49 different health, welfare and care professions in Tasmania. Most vacancies were in the non-government sector (58.5%) and located in regional areas (71.7%) of the state. Professions most frequently advertised were registered nurse (24.4%) and welfare worker (11.4%). Eleven professions, including physiotherapist and occupational therapist, recorded a disproportionate number of advertisements relative to workforce size, suggesting discipline specific workforce shortages. Only 4.6% of collected advertisements specified that a recent graduate would be suitable to apply. Of these, most were for the non-government sector (70.1%) and located in regional areas (73.4%). The professions of physiotherapist (26.6%) and occupational therapist (11.4%) were most frequently represented in advertised graduate suitable positions.

Conclusions
Despite a range of advertised employment opportunities for health, welfare and care professionals across Tasmania, few specified vacancies as suitable for recent graduates and most were located in regional areas of the state. Health, welfare and care services in non-metropolitan locations may need to develop more employment opportunities for recent graduates and explicitly advertise these to job-seeking graduates to help grow and sustain the rural and remote health workforce into the future.
Measuring intersectional HIV, sexual diversity, and gender non-conformity stigma among healthcare workers in Ghana: scale validation and correlates of stigma
Authors: Oga Emmanuel A. , Stockton Melissa A. , Abu-Ba’are Gamji R. , Vormawor Richard , Mankattah Emmanuel , Endres-Dighe Stacy , Richmond Ryan , Jeon Sangchoon , Logie Carmen H. , Baning Emma , Saalim Khalida , Torpey Kwasi , Nelson Laron E. , Nyblade Laura 
Published: May 2024

Abstract
Background
Men who have sex with men (MSM) are at heightened risk for HIV acquisition, yet they may delay or avoid HIV testing due to intersectional stigma experienced at the healthcare facility (HCF). Few validated scales exist to measure intersectional stigma, particularly amongst HCF staff. We developed the Healthcare Facility Staff Intersectional Stigma Scale (HCF-ISS) and assessed factors associated with stigma in Ghana.

Methods
We analyzed baseline data from HCF staff involved in a study testing a multi-level intervention to reduce intersectional stigma experienced by MSM. Data are from eight HCFs in Ghana (HCF Staff n = 200). The HCF-ISS assesses attitudes and beliefs towards same-sex relationships, people living with HIV (PLWH) and gender non-conformity. Exploratory factor analysis assessed HCF-ISS construct validity and Cronbach’s alphas assessed the reliability of the scale. Multivariable regression analyses assessed factors associated with intersectional stigma.

Results
Factor analysis suggested an 18-item 3-factor scale including: Comfort with Intersectional Identities in the Workplace (6 items, Cronbach’s alpha = 0.71); Beliefs about Gender and Sexuality Norms (7 items, Cronbach’s alpha = 0.72); and Beliefs about PLWH (5 items, Cronbach’s alpha = 0.68). Having recent clients who engage in same-gender sex was associated with greater comfort with intersectional identities but more stigmatizing beliefs about PLWH. Greater religiosity was associated with stigmatizing beliefs. Infection control training was associated with less stigma towards PLWH and greater comfort with intersectional identities.

Conclusions
Achieving the goal of ending AIDS by 2030 requires eliminating barriers that undermine access to HIV prevention and treatment for MSM, including HCF intersectional stigma. The HCF-ISS provides a measurement tool to support intersectional stigma-reduction interventions.
Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province
Authors: Horn Carla , Bam Nokwanda Edith , Matsipane Molekodi Jacob 
Published: May 2024

Abstract
Background
Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses’ knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses’ knowledge and attitudes.

Methods
This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder.

Results
The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit.

Conclusion
The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.
Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study
Authors: Øien-Ødegaard Carine , Christiansen Solveig Tobie Glestad , Hauge Lars Johan , Stene-Larsen Kim , Bélanger Sissel Marguerite , Bjertness Espen , Reneflot Anne 
Published: May 2024

Abstract
Background
Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20–64 from 2009 to 2021, emphasizing disparities related to SES.

Methods
This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions.

Results
Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women.

Conclusion
Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.
Juvenile dermatomyositis with Anti-SAE antibodies in a Moroccan child associated with pseudo-angioedema: a case report
Authors: Nainia Khalila , Aouzal Mohamed Amine , Ouafik Imane , Charhbili Mariyam , Bouchhab Amal , Daoudi Abdellatif , Tizki Samira , Chakiri Radia 
Published: May 2024

Abstract
Background
Juvenile Dermatomyositis (JDM) is the leading cause of non-infectious inflammatory myopathy in children. It is a heterogeneous group of autoimmune diseases characterized by a variable combination of muscular, dermatological, and visceral involvement. Myositis-specific autoantibodies help define homogeneous subgroups with common clinical characteristics and prognoses. Anti-SAE (small ubiquitin-like modifier 1 (SUMO-1) activating enzyme) antibodies are among the most recently discovered specific autoantibodies. The presence of these antibodies is very rare, making it challenging to define clinical features and prognosis in the juvenile form. We report the first case of an African patient with juvenile dermatomyositis and positive anti-SAE antibodies.

Case Report
A 5-year-3-month-old Moroccan boy presented to the pediatric emergency department with dysphagia that had been evolving for two days, preceded two months earlier by facial erythema associated with fatigue, lower limb pain, difficulty walking, and progressive inflammatory polyarthralgia. On admission, the child had a heliotrope rash with predominant pseudo-angioedema on the lips, periungual telangiectasia, and Gottron’s papules over the bilateral interphalangeal and metatarsophalangeal joints. The patient had a more pronounced proximal muscle weakness in the lower limbs. He had no urticaria, fever, arthritis, calcinosis, cutaneous ulcers, or lipodystrophy. The Joint examination was normal, as was the pleuropulmonary examination. The electroneuromyography showed myogenic changes in all four limbs. Laboratory findings showed elevated levels of creatine phosphokinase and lactate dehydrogenase and a mild inflammatory syndrome. The electrocardiogram was normal. The anti-SAE antibodies were positive. The boy was diagnosed with juvenile dermatomyositis. He received methylprednisolone bolus therapy followed by oral prednisone. The latter was gradually tapered in combination with weekly intramuscular methotrexate. As a result, dysphagia disappeared within 48 h. After two weeks, there was an improvement in the muscular score and a significant regression of facial pseudo-angioedema.

Conclusion
We report the first African patient with anti-SAE autoantibody-positive JDM. He had a typical dermatological manifestation of JDM associated with pseudo-angioedema predominant on the lips; a rarely reported sign in DM and JDM patients. The patient responded well to corticosteroid therapy and methotrexate.
Intracranial pressure following surgery of an unruptured intracranial aneurysm—a model for normal intracranial pressure in humans
Authors: Norager Nicolas Hernandez , Lilja-Cyron Alexander , Riedel Casper Schwartz , Holst Anders Vedel , Pedersen Sarah Hornshoej , Juhler Marianne 
Published: May 2024

Abstract
Objective
Optimizing the treatment of several neurosurgical and neurological disorders relies on knowledge of the intracranial pressure (ICP). However, exploration of normal ICP and intracranial pressure pulse wave amplitude (PWA) values in healthy individuals poses ethical challenges, and thus the current documentation remains scarce. This study explores ICP and PWA values for healthy adults without intracranial pathology expected to influence ICP.

Methods
Adult patients (age > 18 years) undergoing surgery for an unruptured intracranial aneurysm without any other neurological co-morbidities were included. Patients had a telemetric ICP sensor inserted, and ICP was measured in four different positions: supine, lateral recumbent, standing upright, and 45-degree sitting, at day 1, 14, 30, and 90 following the surgery.

Results
ICP in each position did not change with time after surgery. Median ICP was 6.7 mmHg and median PWA 2.1 mmHg in the supine position, while in the upright standing position median ICP was − 3.4 mmHg and median PWA was 1.9 mmHg. After standardization of the measurements from the transducer site to the external acoustic meatus, the median ICPmidbrain was 8.3 mmHg in the supine position and 1.2 mmHg in the upright standing position.

Conclusion
Our study provides insights into normal ICP dynamics in healthy adults following a uncomplicated surgery for an unruptured aneurysm. These results suggest a slightly wider normal reference range for invasive intracranial pressure than previously suggested, and present the first normal values for PWA in different positions. Further studies are, however, essential to enhance our understanding of normal ICP.
Trial registration The study was preregistered at www.clinicaltrials.gov (NCT03594136) (11 July 2018)
Effect of adjuvant radiotherapy on overall survival and breast cancer-specific survival of patients with malignant phyllodes tumor of the breast in different age groups: a retrospective observational study based on SEER
Authors: Yang Ping , Zhang Gongyin , Zhang Yu , Zhao Wanying , Tang Jinhai , Zeng Siyuan , Lv Xiupeng , Lv Li 
Published: May 2024

Abstract
Purpose
Malignant phyllodes tumor of the breast (MPTB) is a rare type of breast cancer, with an incidence of less than 1%. The value of adjuvant radiotherapy (RT) for MPTB has been controversial. The aim of the study was to explore the effect of radiotherapy on the long-term survival of female patients with MPTB at different ages.

Methods
Female MPTB patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2020. A Kaplan–Meier survival analysis was conducted to investigate the value of RT for the long-term survival of MPTB patients in different age groups. Additionally, univariate and multivariate Cox regression analyses were performed for overall survival (OS) and breast cancer-specific survival (BCSS) of MPTB patients. Furthermore, propensity score matching (PSM) was also performed to balance the differences in baseline characteristics.

Results
2261 MPTB patients were included in this study, including 455 patients (20.12%) with RT and 1806 patients (79.88%) without RT. These patients were divided into four cohorts based on their ages: 18–45, 46–55, 56–65, and 65–80. Before adjustment, there was a statistically significant difference in long-term survival between RT-treated and non-RT-treated patients in the younger age groups (age group of 18–45 years: OS P = 0.019, BCSS P = 0.016; age group of 46–55 years: OS P < 0.001, BCSS P < 0.001). After PSM, no difference was found in long-term survival of patients in both younger and older groups regardless of whether they received RT (age group of 18–45 years: OS P = 0.473, BCSS P = 0.750; age group of 46–55 years: OS P = 0.380, BCSS P = 0.816, age group of 56–65 years: OS P = 0.484, BCSS P = 0.290; age group of 66–80 years: OS P = 0.997, BCSS P = 0.763). In multivariate COX regression analysis, RT did not affect long-term survival in patients with MPTB.

Conclusion
There is no evidence that long-term survival of MPTB patients in specific age groups can benefit from RT.
Bone marrow lesion and 5-year incident joint surgery in patients with knee osteoarthritis: a retrospective cohort study
Authors: Lin Liang , Zhang Jinshan , Zhu Hongyi , Wang Zefeng , Liu Xiaofeng , Xu Yongquan , Fang Yangzhen , Lin Zhenyu , Zheng Yongqiang 
Published: May 2024

Abstract
Background
It is beneficial for society to discover the risk factors associated with surgery and to carry out some early interventions for patients with these risk factors. Few studies specifically explored the relationship between bone marrow lesions (BMLs) and long-term incident joint surgery.

Objective
To investigate the association between BML severity observed in knee osteoarthritis (OA) patients’ first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of BMLs for the incident knee surgery.

Design
Retrospective cohort study.

Methods
We identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine the Max BML grades, BML burden grades and Presence BML grades for the medial, lateral, patellofemoral, and total compartments, respectively. Multi-variable logistic regression models examined the association of the BML grades with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined for BML grades referring to 5-year incident knee surgery.

Results
Totally, 1011 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 74 knees. Max BML grade 2 and grade 3 of medial, patellofemoral and total compartments were strongly and significantly associated with incident surgery. None of the BML grades from lateral compartment was associated with incident surgery. The PPV was low and NPV was high for BMLs.

Conclusions
BMLs found in the first MRI examination were associated with 5-year incident joint surgery, except for those allocated in lateral compartments. The high NPVs imply that patients without BMLs have a low risk of requiring surgery within 5 years.