bluuebunny/crossref_metadata_2025_split huggingface dataset:
From active duty to activism: how moral injury and combat trauma drive political activism and societal reintegration among Israeli veterans
Authors: Levy Adi , Gross Michael L. 
Published: June 2024

Trigger warningThis article deals with combat experiences and their consequences and could be potentially disturbing.IntroductionMoral injury (MI) is a severe form of combat trauma that shatters soldiers’ moral bearings as the result of killing in war. Among the myriad ways that moral injury affects veterans’ reintegration into civilian life, its impact on political and societal reintegration remains largely unstudied but crucial for personal, community, and national health.Methods13 in-depth interviews examine combat soldiers’ exposure to potentially morally injurious events (PMIEs) that include killing enemy combatants, harming civilians, and betrayal by commanders, the military system, and society. Interviewees also described their political activities (e.g., voting, fundraising, advocacy, protest) and social activism (e.g., volunteering, teaching, charitable work). Interviewees also completed the Moral Injury Symptom Scale.ResultsTwo distinct narratives process PMIEs. In a humanitarian narrative, soldiers hold themselves or their in-group morally responsible for perpetrating, witnessing, or failing to prevent a morally transgressive act such as killing or injuring civilians or placing others at unnecessary risk. In contrast, a national security perspective blames an out-group for leaving soldiers with no choice but to act in ways that trigger moral distress. Associated with shame and guilt, the humanitarian perspective triggered amends-making and social activism after discharge. In contrast, a national security perspective associated with anger and frustration fostered protest and intense political activism.DiscussionDespite its harmful health effects, moral trauma and injury can drive intense political and social activism, depending upon the narrative veterans adopt to interpret PMIEs. Aside from moral injury’s personal, familial, and social effects, moral injury drives veterans’ return to the political arena of civil society. As such, veterans play a central role in politics and dramatically affect post-war policy in democratic nations following conflict.
Decoding Fujian’s cervical HPV landscape: unmasking dominance of non-16/18 HR-HPV and tailoring prevention strategies at a large scale
Authors: Zhang Yulong , Li Haibo , You Qianru , Chen Yusha , Zhao Ziyan , Chen Jiancui , Su Yanzhao , Zheng Xiangqin , Yi Huan , Song Jianrong 
Published: June 2024

BackgroundPersistent HR-HPV causes cervical cancer, exhibiting geographic variance. Europe/Americas have higher HPV16/18 rates, while Asia/Africa predominantly have non-16/18 HR-HPV. This study in Fujian, Asia, explores non-16/18 HR-HPV infections, assessing their epidemiology and cervical lesion association for targeted prevention.MethodsA total of 101,621 women undergoing HPV screening at a hospital in Fujian Province from 2013 to 2019 were included. HPV genotyping was performed. A subset of 11,666 HPV-positive women with available histopathology results were analyzed to characterize HPV genotype distribution across cervical diagnoses.ResultsIn 101,621 samples, 24.5% tested positive for HPV. Among these samples, 17.3% exhibited single infections, while 7.2% showed evidence of multiple infections. The predominant non-16/18 high-risk HPV types identified were HPV 52, 58, 53, 51, and 81. Single HPV infections accounted for 64.1% of all HPV-positive cases, with 71.4% of these being non-16/18 high-risk HPV infections. Age-related variations were observed in 11,666 HPV-positive patients with pathological results. Cancer patients were older. In the cancer group, HPV52 (21.8%) and HPV58 (18.6%) were the predominant types, followed by HPV33, HPV31, and HPV53. Compared to single HPV16/18 infection, non-16/18 HPV predominated in LSIL. Adjusted odds ratios (OR) for LSIL were elevated: multiple HPV16/18 (OR 2.18), multiple non-16/18 HR-HPV (OR 2.53), and multiple LR-HPV (OR 2.38). Notably, solitary HPV16/18 conferred higher odds for HSIL and cancer.ConclusionOur large-scale analysis in Fujian Province highlights HPV 52, 58, 53, 51, and 81 as predominant non-16/18 HR-HPV types. Multiple HPV poses increased LSIL risks, while solitary HPV16/18 elevates HSIL and cancer odds. These findings stress tailored cervical cancer prevention, highlighting specific HPV impacts on lesion severity and guiding region-specific strategies for optimal screening in Asia, emphasizing ongoing surveillance in the vaccination era.
Social transition, socioeconomic status and self-rated health in China: evidence from a national cross-sectional survey (CGSS)
Authors: Gao Yi , Zeng Jing , Liao Zangyi , Yang Jing 
Published: June 2024

BackgroundSocial transition is one of the multi-level mechanisms that influence health disparities. However, it has received less attention as one of the non-traditional social determinants of health. A few studies have examined China’s social transition and its impact on health inequality in self-rated health (SRH). Therefore, this study explores the impact of China’s market-oriented reforms—social transition and socioeconomic status (SES)—on residents’ SRH.MethodsUsing the cross-sectional data from the Chinese General Social Survey (CGSS) in 2017, we analyzed the effects of social transition and SES on the SRH of Chinese residents using the RIF (Recentered influence function) method. The RIF decomposition method investigated health differences among different populations and their determinants.ResultsSocial transition and SES have significant positive effects on the SRH of Chinese residents. The correlation between SES and the SRH of Chinese residents is moderated by social transition, implying that social transition can weaken the correlation between SES and the SRH of Chinese residents. The impacts of SES and social transition on SRH vary across populations.ConclusionPromoting social transition and favoring disadvantaged groups with more resources are urgently needed to promote equitable health outcomes.
Nudge theory and gambling: a scoping review
Authors: Fortier Marie-Ève , Audette-Chapdelaine Sophie , Auger Anne-Marie , Brodeur Magaly 
Published: June 2024

BackgroundGambling disorder (GD) is a pressing public health concern with significant societal costs. The recently developed nudge theory, which is rooted in behavioral economics, aims to influence the decision-making behaviors of individuals by implementing changes in the environment.AimThis scoping review aims to synthesize the literature on nudge theory as it relates to gambling.MethodsThis scoping review accords with the Arksey and O’Malley framework, as refined by Levac et al. It includes only articles from peer-reviewed journals that focus, as main themes, on both nudge theory and gambling. The final study selection includes six articles.ResultsThe scoping review process led to studies explaining how (1) nudges aim to prod people toward healthier gambling choices, fostering the adoption of more responsible gambling practices, and (2) some gambling features, called dark nudges (or sludges), exploit and harm the decision-making processes of people who gamble.ConclusionThis scoping review highlights the fact that many stakeholders are involved in the field of gambling, and that better cooperation between them would promote safer and more responsible gambling practices. Future research is also needed to empirically test nudges to develop a better understanding of their impact on those who gamble.
Evaluating the impact of distance learning on gender-affirming healthcare competence: knowledge acquisition and satisfaction among healthcare professionals in Italy
Authors: Favazzi Ughetta Maria , Marconi Matteo , Carbone Pietro , Guerrera Debora , Ruocco Angela , Manoli Martina , Molinaro Francesca , Regini Federica Maria , Vittozzi Andrea , Mazzaccara Alfonso , Pierdominici Marina 
Published: June 2024

BackgroundTransgender and gender diverse (TGD) individuals face significant healthcare barriers, with one of the most critical being the inadequate knowledge and skills of healthcare professionals (HCPs) in TGD health. To address this issue, we undertook a project to develop a distance learning course for all healthcare professions, encompassing a comprehensive range of topics related to TGD health issues.ObjectivesThis study aimed to evaluate the impact of a course on gender-affirming healthcare competence, with a focus on knowledge acquisition and satisfaction levels. The hypothesis was that participating in the course would enhance the participants' knowledge on the covered topics.MethodsA distance learning course, designed for all Continuing Medical Education professions, was conducted between March and September 2023. The course was structured according to the Problem-Based Learning methodology. We implemented a pre-test vs. post-test study design to evaluate the enhancement of knowledge, based on a set of Multiple Choice Questions (MCQs), and investigated users' satisfaction through the administration of a semi-structured questionnaire. We examined the pre- and post-course proportions of correct responses to questions, along with the mean score difference, categorized by learners' sex, age, and geographical area. Eventually, a Satisfaction Training Index was created.ResultsThe maximum capacity was reached, with 29,998 out of 30,000 available spots filled. Of those enrolled, 18,282 HCPs successfully completed the training. Post-test results revealed an increase in correct answers across all MCQs, with overall mean score rising from 48.8 to 68.0 (p &lt; 0.001). Stratified analysis indicated improvements across all participant categories. A higher average increase among female (19.87) compared to male enrollees (17.06) was detected (p &lt; 0.001). Both “over 55” and “46–55” age groups showed the greatest score increases compared to “35–46” and “under 35” groups, despite no significant differences in pre-test scores. Course satisfaction was high, averaging 4.38 out of 5. Top-rated aspects included “learning new concepts” (4.49), “accessibility” (4.46), and “platform functionality” (4.46).ConclusionOur research hypothesis was confirmed by the significant increase in knowledge going from pre-test to post-test and by the high level of user satisfaction. The obtained results serve as a foundation for planning additional professional education in TGD health.
Relationship between quadriceps muscle architecture and lower limb strength and physical function in older adults community-dwelling individuals: a cross-sectional study
Authors: Cinarli Fahri Safa , Ulubaba Hilal Er , Ucar Ozan , Kilinc Deniz Can , Ciftci Rukiye , Karayigit Raci , Aldhahi Monira I , Al-Mhanna Sameer Badri , Gülü Mehmet 
Published: June 2024

Background and objectiveFactors related to muscle architecture may lead to functional limitations in activities of daily living in the older adults. This study aimed to investigate the relationship between quadriceps femoris (QF) architecture and physical function in older adults community-dwelling people.MethodsThe study included 25 community-dwelling older adults participants aged over 60 years (14 women and 11 men) who were not engaged in regular physical activity. The rectus femoris (RF) and vastus intermedius (VI) muscle thicknesses as well as the RF cross-sectional area (CSA) were assessed using 2D ultrasonography. The 30 Seconds Chair Stand test (30sCST) and Timed Up and Go Test (TUG) were used to assess lower body muscle power and functional mobility, respectively.ResultsThe QF muscle architecture showed moderate and large correlations with the 30sCST (r range = 0.45–0.67, p &lt; 0.05) and TUG (r range = 0.480–0.60, p &lt; 0.05). RF thickness was a significant (p &lt; 0.01) independent predictor of 30sCST (R2 = 0.45) and TUG (R2 = 0.36). VI thickness was a significant (p &lt; 0.05) independent predictor of 30sCST (R2 = 0.20) and TUG (R2 = 0.231). RF CSA was a significant independent predictor of the 30sCST (R2 = 0.250, p &lt; 0.05) and TUG (R2 = 0.27, p &lt; 0.01). Multiple linear regression models explained 38% of the 30sCST variance and 30% of the TUG variance in the older adults group.ConclusionQuadriceps muscle group directly affects basic activities of daily living in the older adults. Ultrasound measurements, which are non-invasive tools, are extremely valuable for understanding the limitations of activities of daily living in the older adults.
Supporting pension decisions with value clarification methods or testimonials: two studies showing mixed effects on activation and feeling of preparation
Authors: Strikwerda Jelle , Holleman Bregje , Hoeken Hans 
Published: June 2024

IntroductionPension participants need appropriate support when making (complex) pension decisions. Grounded in Fuzzy-Trace Theory, we argue that suitable decisions require participants to (accurately) understand meaningful differences between decision alternatives. Based on this, we investigated the effectiveness of different types of decision support for the decision when to retire.MethodsWe conducted two experiments among participants of four Dutch pension funds (Study 1: N = 2,328, Study 2: N = 500) on the effectiveness of three different types of decision support: (a) a traditional pros and cons text, (b) a Value Clarification Method (VCM), and (c) testimonials.ResultsThe studies showed mixed results. In the first study, we found an activating effect of the VCM and the testimonials: participants who received one of these two types of decision support were more likely to visit a web page with additional information. In the second study, we found no differences between the three types of decision support.ConclusionWe discuss possible explanations for the effects found, as well as implications for future (research on) pension decision support.
Towards evidence-based practice 2.0: leveraging artificial intelligence in healthcare
Authors: Nilsen Per , Sundemo David , Heintz Fredrik , Neher Margit , Nygren Jens , Svedberg Petra , Petersson Lena 
Published: June 2024

BackgroundEvidence-based practice (EBP) involves making clinical decisions based on three sources of information: evidence, clinical experience and patient preferences. Despite popularization of EBP, research has shown that there are many barriers to achieving the goals of the EBP model. The use of artificial intelligence (AI) in healthcare has been proposed as a means to improve clinical decision-making. The aim of this paper was to pinpoint key challenges pertaining to the three pillars of EBP and to investigate the potential of AI in surmounting these challenges and contributing to a more evidence-based healthcare practice. We conducted a selective review of the literature on EBP and the integration of AI in healthcare to achieve this.Challenges with the three components of EBPClinical decision-making in line with the EBP model presents several challenges. The availability and existence of robust evidence sometimes pose limitations due to slow generation and dissemination processes, as well as the scarcity of high-quality evidence. Direct application of evidence is not always viable because studies often involve patient groups distinct from those encountered in routine healthcare. Clinicians need to rely on their clinical experience to interpret the relevance of evidence and contextualize it within the unique needs of their patients. Moreover, clinical decision-making might be influenced by cognitive and implicit biases. Achieving patient involvement and shared decision-making between clinicians and patients remains challenging in routine healthcare practice due to factors such as low levels of health literacy among patients and their reluctance to actively participate, barriers rooted in clinicians' attitudes, scepticism towards patient knowledge and ineffective communication strategies, busy healthcare environments and limited resources.AI assistance for the three components of EBPAI presents a promising solution to address several challenges inherent in the research process, from conducting studies, generating evidence, synthesizing findings, and disseminating crucial information to clinicians to implementing these findings into routine practice. AI systems have a distinct advantage over human clinicians in processing specific types of data and information. The use of AI has shown great promise in areas such as image analysis. AI presents promising avenues to enhance patient engagement by saving time for clinicians and has the potential to increase patient autonomy although there is a lack of research on this issue.ConclusionThis review underscores AI's potential to augment evidence-based healthcare practices, potentially marking the emergence of EBP 2.0. However, there are also uncertainties regarding how AI will contribute to a more evidence-based healthcare. Hence, empirical research is essential to validate and substantiate various aspects of AI use in healthcare.
Achieving sustainable, environmentally viable, solarized vaccine cold chain system and vaccination program—an effort to move towards clean and green energy-driven primary healthcare in Lebanon
Authors: Kapuria Bhrigu , Sami Hamadeh Randa , Mazloum Farah , Korbane Joe Akl , Aung Kyaw , Kamal Doaa , Chamoun Nariman , Syed Sabin 
Published: June 2024

IntroductionLebanon faces severe economic and energy crises, impacting its healthcare system, particularly vaccine storage. Traditional gas or kerosene-powered refrigerators often fail to maintain necessary temperatures for vaccine efficacy. This study explores transitioning to solar direct-drive (SDD) refrigerators to ensure reliable vaccine storage.MethodsA multi-phase methodology was employed, beginning with an inventory assessment of existing cold chain equipment. The implementation involved stepwise replacement of identified refrigerators across health facilities, including Primary Health Care Centers (PHCCs) and dispensaries. Feasibility, cost-effectiveness, and environmental impact were evaluated.ResultsFindings indicate that solarization significantly reduces vaccine wastage, ensures stable temperatures, and cuts operational costs by decreasing dependence on non-renewable energy sources. Over 1,000 SDD units were installed across more than 800 health facilities. Additionally, PHCC solarization improved vaccine preservation and enhanced the resilience of health services overall.DiscussionThe solarization initiative demonstrates the critical role of renewable energy in strengthening healthcare infrastructure, especially in crisis-hit regions. Solar-powered systems provide a reliable and sustainable solution for vaccine storage, reduce carbon footprints, and build public trust in the immunization system. Challenges included geographical and structural limitations, which were addressed through comprehensive planning and collaboration with local stakeholders. Solarization of Lebanon's vaccine cold chain and PHCCs marks a significant step towards sustainable and resilient healthcare infrastructure. The model offers a robust framework for other regions facing similar economic and energy challenges, highlighting the importance of renewable energy solutions in healthcare.
Visual perception and user satisfaction in video see-through head-mounted displays: a mixed-methods evaluation
Authors: de Souza Jessica , Tartz Robert 
Published: June 2024

ObjectiveOur study addresses the challenges limiting the adoption of Extended Reality (XR) Head-Mounted Displays (HMDs), mainly focusing on device quality and cybersickness. We aim to investigate the impact of hardware and software on user experience and task performance while wearing Video See-Through (VST) HMDs. We employ a novel methodology designed to bridge the gaps identified in previous research.MethodsThis study uses a convergent mixed-methods approach, combining qualitative and quantitative data in a within-subjects evaluation involving 20 participants. This comprehensive evaluation examines visual perception, visual quality, and user experience through a range of tasks. Usability, comfort, and cybersickness are assessed, with insights derived from both user performance metrics and subjective measures collected through in-depth interviews and comments. The study includes three distinct HMDs—two prototypes (PD1 and PD2) and one commercial device (CD1)—to provide a broad analysis of the technology.FindingsOur findings reveal that while participants were generally satisfied with VST mode, their preferences varied across devices. CD1 was preferred for its realistic color representation and superior reading task performance due to its high-resolution display and camera. However, visual disturbances and temporal issues differed across devices, with CD1 exhibiting fewer artifacts when stationary but showing more disturbances when participants were moving. Participants found PD1 and PD2 more comfortable for extended use and fewer cybersickness symptoms, but they highlighted color and display resolution issues. These variations underscore the importance of considering both qualitative and quantitative measures in HMD evaluations.ConclusionThis mixed-methods evaluation emphasizes the limitations of relying solely on visual perception performance measures for VST HMDs. By integrating both quantitative and qualitative insights, we offer a more detailed evaluation framework to identify design flaws and user experience issues that quantitative metrics alone might miss. This methodology contributes to the field by illustrating how a mixed-methods approach provides a broader perspective on XR technology, guiding future improvements and enhancing VST adoption in future applications.
Pre and post-competitive anxiety and self-confidence and their relationship with technical-tactical performance in high-level men's padel players
Authors: Conde-Ripoll Rafael , Escudero-Tena Adrián , Bustamante-Sánchez Álvaro 
Published: June 2024

IntroductionThis study aimed to analyze the variations in pre- and post-competitive anxiety and self-confidence considering match outcomes, the performance according to the result and the correlation among performance and psychological variables.MethodsThe sample consisted on 12 matches in which 11 high-level padel players from Finland (top 24) voluntarily participated. CSAI-2R and STAI-S were used to assess psychological variables and technical-tactical performance was evaluated by a certified padel coach.ResultsLosing players presented higher cognitive (p = .004), somatic (p = .020) and state (p = .001) anxiety and lower selfconfidence (p = .014), and winning players showed higher state anxiety (p = .022), after than before the matches. Post-match, winning players exhibited higher self-confidence (p = .015) than losing players. Winning players made more winners (p = .010) than losing players. There are direct correlations between unforced errors and post-state anxiety (p = .015), unforced errors and state anxiety (p = .009) and winners and cognitive anxiety (p = .033), in winning players; between generators of forced error and post-cognitive anxiety (p = .034), forced errors and cognitive anxiety in losing players (p = .001). There are indirect correlations between forced errors and pre-cognitive anxiety (p = .009), winners and somatic anxiety (p = .046), unforced errors and state anxiety (p = .042) in losing players.DiscussionThe outcomes imply the need for intervention programs to equip players, especially those facing defeat, with tools for anxiety management and self-confidence enhancement. Likewise, coaches are advised to incorporate exercises that promote the occurrence of winners.