bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship between marital status and cognitive impairment in Chinese older adults: the multiple mediating effects of social support and depression
Authors: Zhang Donghang , Zheng Wenhao , Li Keyang 
Published: April 2024

Abstract
Background
Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people.

Methods
This study involved a secondary analysis of data from the 2014–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted.

Results
The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found.

Conclusions
The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.
Determinants of early antenatal care visits among women of reproductive age in Ghana: evidence from the recent Maternal Health Survey
Authors: Abuosi Aaron Asibi , Anaba Emmanuel Anongeba , Daniels Anita Anima , Baku Anita Asiwome Adzo , Akazili James 
Published: April 2024

Abstract
Background
Antenatal care services play a crucial role in promoting positive pregnancy outcomes by facilitating the early identification of pregnancy risk factors and early diagnosis of pregnancy-related complications. This study aimed to assess the frequency and timing of ANC attendance of mothers in Ghana as well as determine the predictors of early ANC attendance.

Methods
The data for this study was extracted from the 2017 Ghana Maternal Health Survey (GMHS). The study population was women aged 15–49 years with a live birth or stillbirth in the 5 years preceding the survey. Data was analysed using STATA/SE version 17, using descriptive statistics and multiple binary logistic regression analysis.

Results
It was found that 44.4% of the women obtained eight (8) + ANC visits. A majority of the women (66%) initiated ANC visits in the first trimester of pregnancy. Early ANC visit was significantly associated with age of the respondent, education, wealth index, religion, region and reason for first ANC visit. For instance, women between the ages of 25–29 years (aOR = 1.75, 95% CI: 1.31–2.33) had increased odds of early ANC visit compared to those aged 15–19 years. Women with higher education (aOR = 1.83, 95% CI: 1.27–2.64) were about twice as likely to initiate early ANC visits compared to those with no education. Also, women in the highest wealth index (aOR = 2.43, 95% CI: 1.83–3.23) were two times more likely to initiate early ANC visits compared to those in the lowest wealth index.

Conclusion
This study has shown that a majority of women in Ghana start their first ANC visit during the first trimester of pregnancy. A considerable proportion of the women failed to meet the WHO’s recommendation of having a minimum of eight ANC visits throughout pregnancy. Early ANC visit was determined by socio-demographic factors. Going forward, it should be a priority for stakeholders to ensure that ANC services are accessible to all mothers in a timely manner.
Effects of a single subanesthetic dose of esketamine on postoperative subthreshold depressive symptoms in patients undergoing unilateral modified radical mastectomy: a randomised, controlled, double-blind trial
Authors: Wang Huanwei , Te Rigen , Zhang Jianxing , Su Yanbing , Zhou Hongxia , Guo Na , Chi Dongmei , Huang Wan 
Published: April 2024

Abstract
Background
Breast cancer is the most common malignant tumor in females worldwide. During disease development, breast cancer patients suffer anxious and depressed, which may lead to worse quality of life or even higher mortality. Esketamine has been regarded as an antidepressant in breast cancer patients with mild or moderate depression. Here, we wonder whether the administration of esketamine could reduce the postoperative depressive symptom score of breast cancer patients who have no preoperative depression.

Methods
A total of 64 patients treated with unilateral modified radical mastectomy were randomly divided into an experimental group (esketamine group, Group E) and a control group (Group C), with 32 cases in each one. After anesthesia induction, Group C received 0.2 ml/kg of normal saline intravenously and Group E was administered 0.2 mg/kg intravenous esketamine. The primary outcome was the Patient Health Questionnaire-9 (PHQ-9) scores. The secondary outcomes included the Visual Analogue Scale (VAS) scores for pain, inflammatory markers, perioperative-related indicators, and the incidence of postoperative delirium, nausea and vomiting.

Results
The PHQ-9 score on postoperative day (POD) 1 in Group E declined from the preoperative level, while the score in Group C was higher than before, and the former was far lower than the latter (P = 0.047). There is no statistically significant difference in PHQ-9 scores between Group E and Group C on POD 3, 7, and 30. Moreover, the postoperative leukocyte level of Group E was higher than that of Group C, and the difference was statistically significant (P = 0.030).

Conclusions
A single subanesthetic dose of esketamine can result in lower postoperative score on subthreshold depressive symptoms compared to the Group C on POD 1, without increasing the occurrence of postoperative adverse reactions.

Trial registration
Registration number: Chinese Clinical Trial Registry ChiCTR2200057028. Date of registration: 26/02/2022.
Association of cognitive impairment with the interaction between chronic kidney disease and depression: findings from NHANES 2011–2014
Authors: Zhou Tong , Zhao Jiayu , Ma Yimei , He Linqian , Ren Zhouting , Yang Kun , Tang Jincheng , Liu Jiali , Luo Jiaming , Zhang Heping 
Published: April 2024

Abstract
Background
Cognitive impairment (CoI), chronic kidney disease (CKD), and depression are prevalent among older adults and are interrelated, imposing a significant disease burden. This study evaluates the association of CKD and depression with CoI and explores their potential interactions.

Method
Data for this study were sourced from the 2011–2014 National Health and Nutritional Examination Survey (NHANES). Multiple binary logistic regression models assessed the relationship between CKD, depression, and CoI while controlling for confounders. The interactions were measured using the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S).

Results
A total of 2,666 participants (weighted n = 49,251,515) were included in the study, of which 700 (16.00%) had CoI. After adjusting for confounding factors, the risk of CoI was higher in patients with CKD compared to non-CKD participants (odds ratio [OR] = 1.49, 95% confidence interval [CI]:1.12–1.99). The risk of CoI was significantly increased in patients with depression compared to those without (OR = 2.29, 95% CI: 1.73–3.03). Furthermore, there was a significant additive interaction between CKD and depression in terms of the increased risk of CoI (adjusted RERI = 2.01, [95% CI: 0.31–3.71], adjusted AP = 0.50 [95% CI: 0.25–0.75], adjusted S = 2.97 [95% CI: 1.27–6.92]).

Conclusion
CKD and depression synergistically affect CoI, particularly when moderate-to-severe depression co-occurs with CKD. Clinicians should be mindful of the combined impact on patients with CoI. Further research is needed to elucidate the underlying mechanisms and assess the effects specific to different CKD stages.
1 plus 1 is more than 2: mental health problems, financial difficulties, and social exclusion in a cross-sectional study of 28,047 general-population adults
Authors: Haugland Siri Håvås , Topor Alain , Friesinger Jan Georg 
Published: April 2024

Abstract
Background
Mental health problems and financial difficulties each increase the risk of social exclusion. However, few large studies representing a broad age range have investigated the combined social effect of having both difficulties. The purpose of this cross-sectional study was to examine associations of mental health problems, financial difficulties, and the combination of both with social exclusion.

Methods
This analysis was based on responses from 28,047 adults (age > 18 years) from the general population participating in The Norwegian Counties Public Health Survey 2019. Respondents answered questions about their financial situation, mental health problems, and social exclusion. Social exclusion was measured as a lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded, and feeling isolated. Adjustments for sex and age were made in multivariable logistic regression analyses.

Results
Having mental health problems or financial difficulties was associated with various measures of social exclusion (odds ratios [ORs] with 95% confidence intervals [CIs]: 1.33 [1.23–1.43] to 12.63 [10.90–14.64]). However, the odds of social exclusion strongly increased for respondents who reported a combination of mental health problems and financial difficulties compared with those who did not report either (ORs [CIs]: 2.08 [1.90–2.27] to 29.46 [25.32–34.27]).

Conclusions
Having the combination of mental health problems and financial difficulties is strongly associated with increased risk for social exclusion, far beyond the effect of either factor alone.
Retrospective analysis of the incidence of appendiceal neoplasm and malignancy in patients treated for suspected acute appendicitis
Authors: Dohner Eliane , Kierdorf Fiona Joséphine , Langer Rupert , Zuber Markus , Fahrner René 
Published: April 2024

Abstract
Background
Nonoperative management of uncomplicated appendicitis is currently being promoted as treatment option, albeit 0.7–2.5% of appendectomies performed due to suspected acute appendicitis show histologically malignant findings. The purpose of this study was to investigate the incidence of neoplasm and malignancy of the appendix in patients presenting with suspected acute appendicitis in real world setting.

Methods
This is a retrospective single-centre investigation of 457 patients undergoing appendectomy between the years 2017–2020. The patients’ demographics, symptoms and diagnosis, intraoperative findings, and histopathological results were analysed.

Results
In 3.7% (n = 17) histological analysis revealed neoplasms or malignancies. Median age was 48 years (20–90 years), without sex predominance. Leukocytes (11.3 ± 3.7 G/l) and C-reactive protein (54.2 ± 69.0 mg/l) were elevated. Histological analysis revealed low-grade mucinous appendiceal neoplasia (n = 3), sessile serrated adenoma of the appendix (n = 3), neuroendocrine tumours (n = 7), appendiceal adenocarcinoma of intestinal type (n = 3), and goblet cell carcinoma (n = 1). Additional treatment varied between no treatment or follow-up due to early tumour stage (n = 4), follow-up care (n = 3), additional surgical treatment (n = 8), or best supportive care (n = 2).

Conclusions
Preoperative diagnosis of appendiceal tumours is difficult. Nonoperative management of patients with acute, uncomplicated appendicitis potentially prevents the correct diagnosis of malignant appendiceal pathologies. Therefore, close follow-up or surgical removal of the appendix is mandatory.
Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis
Authors: Zheng XiaoGang , Wang Fan , Su Yong Cheng , Xu Chao Yang , Wang Ming Zheng 
Published: April 2024

AbstractVarious studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of “seroma formation that required invasive treatment” indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.
A novel surgical treatment approach for the vertical root fracture of posterior teeth: a case report with 24-month review
Authors: Sun Qing , Han Furong , Fan Wei 
Published: April 2024

Abstract
Background
Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth.

Methods
a maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation.

Results
At the 24-month review, the tooth showed desirable periodontal healing and normal function.

Conclusions
This case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result.
Perceptions of lecturers and students regarding discriminatory experiences and sexual harassment in academic medicine – results from a faculty-wide quantitative study
Authors: Ludwig Sabine , Jenner Sabine , Berger Ralph , Tappert Sylvie , Kurmeyer Christine , Oertelt-Prigione Sabine , Petzold Mandy 
Published: April 2024

Abstract
Background
Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences.

Methods
In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité—Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators.

Results
The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment.

Conclusions
Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace.
Motivations of undergraduate student medical interpreters: Exposure and experience
Authors: Wechsler Julie R. , Tamasi Susan 
Published: April 2024

Abstract
Background
When patients do not speak the same language as their doctors, they face poorer medical outcomes, decreased doctor-patient trust, and a diminished desire to seek medical care. It has been well established that interpretation is an essential part of an accessible healthcare system, but effective use of such language services relies on both the interpreters themselves and the healthcare teams working with them. This study presents an interdisciplinary examination of the motivations of undergraduate student medical interpreters, a group which serves as a bridge between these roles. While not full-time interpreters, they receive official training and spend time serving patients in local clinics. Further, for those who aspire to careers in medicine, interpreting provides invaluable exposure to the medical field and early professional know-how.

Methods
Semi-structured individual interviews with undergraduate student interpreters were conducted to describe this multifaceted educational experience. A thematic analysis framework was employed to understand how and why they volunteer their time to interpret.

Results
Motivations of student interpreters were found to fall under three general categories: (1) personal identity, or connection to family, language, and their career aspirations; (2) community engagement, or the opportunity to make a direct impact on patients at an early stage; and (3) pre-professional experience, both in general and specifically in healthcare. Each of these contributes to the view of a student medical interpreter as a unique contributor to language equity in medicine, as they provide language services in the short-term as well as set themselves up to be linguistically and culturally competent providers in the long-term.

Conclusions
A greater understanding of student motivations adds to knowledge about language mediation and validates the utility of students in this role, encouraging the development of more student interpreter programs. Particularly in communities with high proportions of non-English speakers, these students can contribute to making medical care as inclusive and accessible as possible.
Current status and issues regarding surgical education in the region: a questionnaire survey in Oita prefecture in Japan
Authors: Ueda Yoshitake , Kawasaki Takahide , Inomata Masafumi , Shiraishi Norio 
Published: April 2024

Abstract
Background
The shortage and aging of surgeons in regional surgical care has been remarkable, and the importance of surgical education for young surgeons in the region is only increasing. However, there are very few reports about regional surgical education. This study aimed to clarify the current status and issues regarding surgical education in regional surgical care and to examine the ideal way to provide surgical education in the region.

Methods
Two questionnaire surveys were carried out. (1) “Survey on the awareness regarding the education of young surgeons” was conducted by mail in institutions where surgeons worked. (2) “Survey on the current status of surgical education for young surgeons” was conducted via the Internet with surgeons under 40 years old and mentors at the same facility.

Results
There were 175 respondents to survey (1), among whom 131 (75%) surgeons were interested in educating young surgeons, and 112 (64%) were actively participating in this educating. Regarding the best evaluation methods for mentors who are educating young surgeons, the most frequent answer was “I don’t know (51%)”. The number of respondents in survey (2) was 87, including 27 (31%) young surgeons and 60 (69%) mentors. Although there was no difference between young surgeons and mentors in the level of satisfaction with the current status of young surgeons, 37% of young surgeons in urban areas were dissatisfied with their current status, compared to 0% in the regional area (p < 0.05).

Conclusions
Although surgeons did not have confidence in their own education, the level of satisfaction among young surgeons was high even in those providing regional surgical care. Development of an evaluation system for surgical education is necessary for young surgeons to receive more effective surgical education in the region.