bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge of the health personnel involved in the fluoride varnish therapy programs of primary schools in Tehran, Iran
Authors: Khami Mohammad Reza , Haghparast Ghomsheh Ali , Hessari Hossein , Shati Mohsen 
Published: June 2024

Abstract
Introduction
The World Health Organization (WHO) places great importance on oral health promotion programs in schools, given that approximately one billion people worldwide are students. This demographic not only includes the students themselves, but also extends to school staff, their families, and the broader community, all of whom are interconnected. The objectives of this study were firstly to assess the knowledge of health personnel conducting fluoride varnish treatment (FVT) in schools, and secondly to solicit their views on the effectiveness of their training methods.

Methods
Data was collected from health personnel involved in FVT in schools, supervised by medical universities in Tehran province, using a questionnaire. The questionnaire was divided into four sections: demographic information, methods of receiving FVT training, respondents’ knowledge regarding FVT, and opinions about the effectiveness of FVT training methods. The questionnaire was distributed via social media, phone conversations, and email. The collected data was analyzed using Mann-Whitney in SPSS Version 26. A regression model was also fitted to the data.

Results
The present study included 403 participants. Among various educational methods, it was found that participation in previous workshops (P = 0.001) and FVT workshops (P = 0.013) was significantly correlated with a higher FVT knowledge score. Additionally, participation in previous oral health promotion programs was significantly associated with a higher knowledge score (P < 0.05). Therefore, a history of participating in previous health promotion programs significantly contributed to the participants’ knowledge.

Conclusion
Participation in previous oral health programs was found to be significantly correlated with a higher knowledge score. The effectiveness of training programs can be attributed to participation in previous workshops and FVT workshops. This study provided insights into potential strategies for enhancing personnel training in national oral health programs.
Effect of margin designs and loading conditions on the stress distribution of endocrowns: a finite element analysis
Authors: Zeng Baijin , Luo Bin , Hu Jiangqi , Meng Dan , Zhang Jiebing , Cao Xu , Jiang Qingsong 
Published: June 2024

Abstract
Background
Margin designs and loading conditions can impact the mechanical characteristics and survival of endocrowns. Analyzing the stress distribution of endocrowns with various margin designs and loading conditions can provide evidence for their clinical application.

Methods
Three finite element analysis models were established based on the margin designs: endocrown with a butt-joint type margin (E0), endocrown with a 90° shoulder (E90), and endocrown with a 135° shoulder (E135). The E0 group involved lowering the occlusal surface and preparing the pulp chamber. The E90 group created a 90° shoulder on the margin of model E0, measuring 1.5 mm high and 1 mm wide. The E135 group featured a 135° shoulder. The solids of the models were in fixed contact with each other, and the materials of tooth tissue and restoration were uniform, continuous, isotropic linear elasticity. Nine static loads were applied, with a total load of 225 N, and the maximum von Mises stresses and stress distribution were calculated for teeth and endocrowns with different margin designs.

Results
Compared the stresses of different models under the same loading condition. In endocrowns, when the loading points were concentrated on the buccal side, the maximum von Mises stresses were E0 = E90 = E135, and when there was a lingual loading, they were E0 < E90 = E135. In enamel, the maximum von Mises stresses under all loading conditions were E0 > E90 > E135. In dentin, the maximum von Mises stresses of the three models were basically similar except for load2, load5 and load9. Compare the stresses of the same model under different loading conditions. In endocrowns, stresses were higher when lingual loading was present. In enamel and dentin, stresses were higher when loaded obliquely or unevenly. The stresses in the endocrowns were concentrated in the loading area. In enamel, stress concentration occurred at the cementoenamel junction. In particular, E90 and E135 also experienced stress concentration at the shoulder. In dentin, the stresses were mainly concentrated in the upper section of the tooth root.

Conclusion
Stress distribution is similar among the three margin designs of endocrowns, but the shoulder-type designs, especially the 135° shoulder, exhibit reduced stress concentration.
Association between serum vitamin E and bacterial vaginitis in women: a cross-sectional study
Authors: Liu En-Hui , Liao Wan-Zhe , Chen Hao-Kai , Huang Xiao-Ye , Li Rui-Xuan , Liang Hao-Wen , Guo Xu-Guang 
Published: June 2024

Abstract
Introduction
Bacterial vaginitis (BV) is a common vaginal disease. Vitamin E has been shown to reduce BV by enhancing immune function, but no studies have analyzed the relationship between vitamin E and BV at different BMIs and ages.

Method
This study used 2242 participants from four cycles of NHANES 1999–2006 in American. Participants' vitamin E levels were divided into four groups, and analyses such as study population description, stratified analysis, multiple logistic regression analysis, and curve fitting were performed. To perform data processing, the researchers used the statistical package R (The R Foundation; http://www.r-project.org; version 3.6.3) and Empower Stats software (www.empowerstats.net, X&Y solutions, Inc. Boston, Massachusetts).

Result
The concentrations of serum vitamin E were negatively correlated with the risk of BV, especially when vitamin E were at 1198-5459ug/dL with (OR = -0.443, 95%CI = 0.447–0.923, P = 0.032) or without (OR = -0.521, 95%CI = 0.421–0.837, P = 0.006) adjustment for variables. At the same time, at lower levels, there was no significant association. Vitamin E supplementation may significantly reduce the risk of BV (p < 0.001). In addition, the risk of having BV decreased and then increased with increasing vitamin E concentrations at high BMI levels (p < 0.01).

Conclusion
Vitamin E at moderate to high concentrations may significantly reduce BV risk, says the study, providing clinical evidence for the prevention and the treatment of BV.
Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context
Authors: Ibrahim Hawkar , Goessmann Katharina , Neuner Frank , Iffland Benjamin 
Published: June 2024

Abstract
Background
Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement.

Methods
This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years.

Results
Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis.

Conclusion
The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.
Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review
Authors: Sarikhani Yaser , Najibi Seyede Maryam , Razavi Zahra 
Published: June 2024

Abstract
Background
The preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs).

Methods
In this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O’Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method.

Results
The main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services.

Conclusions
The evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.
Frontline assessors’ opinions about grading committees in a medicine clerkship
Authors: Lewis Sophia K. , Nolan Nathanial S. , Zickuhr Lisa 
Published: June 2024

Abstract
Background
Collective decision-making by grading committees has been proposed as a strategy to improve the fairness and consistency of grading and summative assessment compared to individual evaluations. In the 2020–2021 academic year, Washington University School of Medicine in St. Louis (WUSM) instituted grading committees in the assessment of third-year medical students on core clerkships, including the Internal Medicine clerkship. We explored how frontline assessors perceive the role of grading committees in the Internal Medicine core clerkship at WUSM and sought to identify challenges that could be addressed in assessor development initiatives.

Methods
We conducted four semi-structured focus group interviews with resident (n = 6) and faculty (n = 17) volunteers from inpatient and outpatient Internal Medicine clerkship rotations. Transcripts were analyzed using thematic analysis.

Results
Participants felt that the transition to a grading committee had benefits and drawbacks for both assessors and students. Grading committees were thought to improve grading fairness and reduce pressure on assessors. However, some participants perceived a loss of responsibility in students’ grading. Furthermore, assessors recognized persistent challenges in communicating students’ performance via assessment forms and misunderstandings about the new grading process. Interviewees identified a need for more training in formal assessment; however, there was no universally preferred training modality.

Conclusions
Frontline assessors view the switch from individual graders to a grading committee as beneficial due to a perceived reduction of bias and improvement in grading fairness; however, they report ongoing challenges in the utilization of assessment tools and incomplete understanding of the grading and assessment process.
Compliance with oral nutritional supplements and its influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study
Authors: Su Liqing , Zhang Jie , Jia Lei , Dou Wenyue , Li Mengxue , Zhang Yumeng , Chang Jian 
Published: June 2024

Abstract
Background
Oral nutritional supplements are one of the preferred methods of nutritional support for postoperative patients. This study aims to investigate the current status of oral nutritional supplements compliance in postoperative patients with digestive tract tumors and its influencing factors.

Methods
Convenience sampling was employed to select 242 patients who underwent surgery for digestive tract tumors at a tertiary hospital in Shanghai from October 2022 to July 2023 as the study subjects. Data following a normal distribution were analyzed using independent sample t-tests, ANOVA single-factor analysis, Pearson correlation analysis, and multiple linear regression analysis to determine the factors influencing compliance with oral nutritional supplements.

Results
A total of 252 questionnaires were distributed, with 10 invalid questionnaires excluded, resulting in an effective questionnaire rate of 96.03%. The compliance score for oral nutritional supplements in postoperative patients with digestive tract tumors was (2.40 ± 1.45), General Self-efficacy Scale (GSES) score was (24.72 ± 4.86), Multidimensional Scale of Perceived Social Support Scale (MSPSS) score was (58.67 ± 11.09), and Belief about Medicines Questionnaire Scale (BMQ) score was (0.17 ± 2.78). Multiple linear regression analysis revealed that age, adverse reactions, educational level, self-efficacy, medication beliefs, and social support were factors influencing compliance with oral nutritional supplements in postoperative patients with digestive tract tumors (P < 0.05).

Conclusion
Our study revealed that the compliance to oral nutritional supplements among postoperative patients with digestive tract tumors was at a moderate level and was closely associated with age, educational level, adverse reactions to oral nutritional supplements, medication beliefs, social support, and self-efficacy. Nursing staff should conduct nursing assessments based on the specific circumstances of patients and their families, provide personalized health education management plans based on the patients’ educational level, enhance patients’ nutrition knowledge, improve patient self-efficacy, and enhance social support for patients, while further improving patient nutrition management.
Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study
Authors: Kim Chaehee , Han Kihye , Trinkoff Alison M. , Baek Hyang 
Published: June 2024

Abstract
Background
Prescription drug misuse has been identified as a global issue of concern. Nurses’ prescription drug misuse is linked to personal health problems and impaired nursing care. This study explored the level of South Korean hospital nurses’ prescription drug misuse and examined associations with workplace access and burnout.

Methods
This cross-sectional study used data from 1142 nurses working in South Korean hospital settings. Nurses completed the online survey anonymously. Descriptive analysis, logistic regression, and Shapley value assessment were conducted.

Results
Pain relievers (44.2%), IV drips (26.8%), and antibiotics (13.5%) were the most commonly misused drugs among hospital nurses. Accessibility in the workplace was high, with nurses reporting frequent administration of IV drips, pain relievers, and antibiotics and perceiving these drugs as easily accessible. Logistic regression demonstrated that perceived availability was significantly related to misuse across all drug types. Burnout was associated with IV drips, sleeping pills, and steroids, increasing the likelihood of misuse. Shapley feature importance analysis highlighted perceived availability as the most influential factor for IV drips, pain relievers, and steroids, while burnout emerged as crucial for antibiotics and sleeping pills. Notably, age played a significant role in appetite suppressant misuse, distinguishing it from other drugs.

Conclusion
Our results revealed that workplace access and burnout are associated with nurses’ prescription drug misuse. Effective educational strategies are essential for enhancing nurses’ willingness to seek help for personal health issues. Hospital organizations play a crucial role in facilitating access to healthcare and fostering a supportive environment for nurses to seek treatment when necessary. Additionally, governmental policies should prioritize the implementation of active surveillance systems to monitor medication usage in healthcare settings, thereby mitigating drug misuse among healthcare professionals. By addressing these issues, we can ensure the well-being of nurses and promote a safer healthcare environment.
Spatiotemporal dynamics and determinants of medical service efficiency in China
Authors: Yang Ting , Li Yiyi , Sun Mingzhen , Meng Jingjing 
Published: June 2024

Abstract
Background
Medical service efficiency is an important indicator for measuring the equity of medical services. Therefore, this study primarily focuses on investigating the spatiotemporal domain to explore both spatial and temporal characteristics, as well as influencing factors that affect medical service efficiency across diverse provinces in China.

Methods
The super Epsilon-based Measure (EBM) unexpected model has previously been utilized to quantify energy eco-efficiency, carbon emission efficiency, and green development efficiency. However, limited studies have applied this method to assess the efficiency of healthcare services. Therefore, this study investigates the application of the super-EBM-unexpected model in evaluating medical service efficiency, and further integrates spatial econometric models to explore the influencing factors of medical service efficiency and aims to identify potential avenues for improvement.

Results
The average efficiency of medical services in the 31 provinces of China ranges from 0.6 to 0.7, indicating predominantly low efficiency values. However, economically developed coastal areas exhibit relatively high efficiency levels above 1. Conversely, regions with relatively lower levels of economic development demonstrate lower efficiency rates at approximately 0.3. Evidently, substantial regional disparities exist. For the influencing factors, the enhancement of residents' living standards can effectively foster the medical service efficiency, while residential living standards of nearby areas can also exert an impact in this region. The influence of educational attainment on medical service efficiency exhibits a significant inhibitory effect.

Conclusions
The majority of China's 31 provinces exhibit suboptimal medical service efficiency, with notable regional disparities. Future policy initiatives should be tailored to address the unique challenges faced by regions with lower levels of economic development, prioritizing enhancements in both the efficacy and quality of their healthcare systems.
ZEB family is a prognostic biomarker and correlates with anoikis and immune infiltration in kidney renal clear cell carcinoma
Authors: Lin Sheng , Chen Qi , Tan Canliang , Su Manyi , Min Ling , Ling Lv , Zhou Junhao , Zhu Ting 
Published: June 2024

Abstract
Background
Zinc finger E-box binding homEeobox 1 (ZEB1) and ZEB2 are two anoikis-related transcription factors. The mRNA expressions of these two genes are significantly increased in kidney renal clear cell carcinoma (KIRC), which are associated with poor survival. Meanwhile, the mechanisms and clinical significance of ZEB1 and ZEB2 upregulation in KIRC remain unknown.

Methods
Through the Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO) database, expression profiles, prognostic value and receiver operating characteristic curves (ROCs) of ZEB1 and ZEB2 were evaluated. The correlations of ZEB1 and ZEB2 with anoikis were further assessed in TCGA-KIRC database. Next, miRTarBase, miRDB, and TargetScan were used to predict microRNAs targeting ZEB1 and ZEB2, and TCGA-KIRC database was utilized to discern differences in microRNAs and establish the association between microRNAs and ZEBs. TCGA, TIMER, TISIDB, and TISCH were used to analyze tumor immune infiltration.

Results
It was found that ZEB1 and ZEB2 expression were related with histologic grade in KIRC patient. Kaplan-Meier survival analyses showed that KIRC patients with low ZEB1 or ZEB2 levels had a significantly lower survival rate. Meanwhile, ZEB1 and ZEB2 are closely related to anoikis and are regulated by microRNAs. We constructed a risk model using univariate Cox and LASSO regression analyses to identify two microRNAs (hsa-miR-130b-3p and hsa-miR-138-5p). Furthermore, ZEB1 and ZEB2 regulate immune cell invasion in KIRC tumor microenvironments.

Conclusions
Anoikis, cytotoxic immune cell infiltration, and patient survival outcomes were correlated with ZEB1 and ZEB2 mRNA upregulation in KIRC. ZEB1 and ZEB2 are regulated by microRNAs.
Engineering cascade biocatalysis in whole cells for syringic acid bioproduction
Authors: Liu Xin , An Yi , Gao Haijun 
Published: June 2024

Abstract
Background
Syringic acid (SA) is a high-value natural compound with diverse biological activities and wide applications, commonly found in fruits, vegetables, and herbs. SA is primarily produced through chemical synthesis, nonetheless, these chemical methods have many drawbacks, such as considerable equipment requirements, harsh reaction conditions, expensive catalysts, and numerous by-products. Therefore, in this study, a novel biotransformation route for SA production was designed and developed by using engineered whole cells.

Results
An O-methyltransferase from Desulfuromonas acetoxidans (DesAOMT), which preferentially catalyzes a methyl transfer reaction on the meta-hydroxyl group of catechol analogues, was identified. The whole cells expressing DesAOMT can transform gallic acid (GA) into SA when S-adenosyl methionine (SAM) is used as a methyl donor. We constructed a multi-enzyme cascade reaction in Escherichia coli, containing an endogenous shikimate kinase (AroL) and a chorismate lyase (UbiC), along with a p-hydroxybenzoate hydroxylase mutant (PobA**) from Pseudomonas fluorescens, and DesAOMT; SA was biosynthesized from shikimic acid (SHA) by using whole cells catalysis. The metabolic system of chassis cells also affected the efficiency of SA biosynthesis, blocking the chorismate metabolism pathway improved SA production. When the supply of the cofactor NADPH was optimized, the titer of SA reached 133 μM (26.2 mg/L).

Conclusion
Overall, we designed a multi-enzyme cascade in E. coli for SA biosynthesis by using resting or growing whole cells. This work identified an O-methyltransferase (DesAOMT), which can catalyze the methylation of GA to produce SA. The multi-enzyme cascade containing four enzymes expressed in an engineered E. coli for synthesizing of SA from SHA. The metabolic system of the strain and biotransformation conditions influenced catalytic efficiency. This study provides a new green route for SA biosynthesis.

Graphical Abstract