bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD)
Authors: Bleil Maria E. , Roisman Glenn I. , Hamilton Deven T. , Magro Sophia W. , Appelhans Bradley M. , Gregorich Steven E. , Booth-LaForce Cathryn , Pianta Robert C. 
Published: April 2024

Abstract
Background
Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood.

Methods
Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991–2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018–2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26–31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking).

Results
In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (β=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (β=-0.0014, p <.05) and diet quality (β=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05).

Conclusions
Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.
A first look at the reliability, validity and responsiveness of L-PF-35 dyspnea domain scores in fibrotic hypersensitivity pneumonitis
Authors: Swigris Jeffrey J. , Aronson Kerri , Fernández Pérez Evans R. 
Published: April 2024

Abstract
Background
Dyspnea impairs quality of life (QOL) in patients with fibrotic hypersensitivity pneumonitis (FHP). The Living with Pulmonary Fibrosis questionnaire (L-PF) assesses symptoms, their impacts and PF-related QOL in patients with any form of PF. Its scores have not undergone validation analyses in an FHP cohort.

Methods
We used data from the Pirfenidone in FHP trial to examine reliability, validity and responsiveness of the L-PF-35 Dyspnea domain score (Dyspnea) and to estimate its meaningful within-patient change (MWPC) threshold for worsening. Lack of suitable anchors precluded conducting analyses for other L-PF-35 scores.

Results
At baseline, Dyspnea’s internal consistency (Cronbach’s coefficient alpha) was 0.85; there were significant correlations with all four anchors (University of California San Diego Shortness of Breath Questionnaire scores r = 0.81, St. George’s Activity domain score r = 0.82, percent predicted forced vital capacity r = 0.37, and percent predicted diffusing capacity of the lung for carbon monoxide r = 0.37). Dyspnea was significantly different between anchor subgroups (e.g., lowest percent predicted forced vital capacity (FVC%) vs. highest, 33.5 ± 18.5 vs. 11.1 ± 9.8, p = 0.01). There were significant correlations between changes in Dyspnea and changes in anchor scores at all trial time points. Longitudinal models further confirmed responsiveness. The MWPC threshold estimate for worsening was 6.6 points (range 5–8).

Conclusion
The L-PF-35 Dyspnea domain appears to possess acceptable psychometric properties for assessing dyspnea in patients with FHP. Because instrument validation is never accomplished with one study, additional research is needed to build on the foundation these analyses provide.

Trial registration
The data for the analyses presented in this manuscript were generated in a trial registered on ClinicalTrials.gov; the identifier was NCT02958917.
Evaluation of open-face maxillary complete denture for patients with prominent premaxilla: a crossover study
Authors: Ismail Haitham A. , El-Danasory Muhammed B. , Abolgheit Salma , Soliman Ingy S. 
Published: April 2024

Abstract
Background
The establishment of good facial esthetics is one of the main objectives of complete denture construction. Unfortunately, it may be the caused issue for patients having a prominent premaxilla due to excessive lip support by the labial flange of the maxillary denture. Open-face dentures (OFD) may suggest suitable prosthetic management for these patients. However, clinical evidence regarding the efficiency of OFD is scarce.

Methods
A total of 38 completely edentulous participants having prominent premaxilla and skeletal class I Angle’s classification were enrolled in this study. Each participant received a mandibular complete denture and 2 opposing maxillary dentures; conventional (CD) and open-face (OFD). On the day of denture insertion, the participants were divided into 2 groups; CD-OFD and OFD-CD where CD-OFD group was instructed to use the mandibular denture and the maxillary CD for 3 months and then to use the maxillary OFD for another 3 months after a wash-out period of 2 weeks. While group OFD-CD was instructed to use the mandibular denture and the maxillary OFD for 3 months then to use the maxillary CD for another 3 months after a wash-out period of 2 weeks. The dislodging force of the maxillary dentures was evaluated using the universal testing machine and the patient perception of retention, esthetics, and comfort was evaluated using the Visual Analogue Scale (VAS). Evaluation was carried out 1 day, 1 month, and 3 months after denture insertion. The Student t-test was used to compare the 2 maxillary dentures and the intervals for each denture were compared by using the ANOVA test with repeated measures followed by a Post Hoc test (adjusted Bonferroni) for pairwise comparison.

Results
The significance of the obtained results was judged at the 5% level (P value). The dislodging force and patient perception of retention did not show significant differences between the 2 dentures, while the perception of esthetics showed significant differences throughout the follow-up period. Perception of comfort showed an insignificant difference only at the 3-month interval.

Conclusions
Open-face maxillary dentures can be a suitable alternative for patients with prominent premaxilla to achieve satisfactory retention, aesthetics, and comfort.
Causes and outcomes of at-risk underperforming pharmacy students: implications for policy and practice
Authors: Campbell Alice , Hinton Tina , da Costa Narelle C. , O’Brian Sian E. , Liang Danielle R. , Wheate Nial J. 
Published: April 2024

Abstract
Objective
This study aimed to understand the key determinants for poor academic performance of students completing a Bachelor of Pharmacy (BPharm), Bachelor of Pharmacy and Management (BPharmMgmt), or Master of Pharmacy (MPharm) degree.

Methods
Data were collected on pharmacy students who had not met academic progression requirements between 2008 and 2018 at The University of Sydney, Australia. This included: age at the start of pharmacy degree; gender; whether they transferred from another university; whether they were a domestic or international student; Australian Tertiary Admissions Rank upon entry, previous studies in biology, chemistry, or mathematics; show cause triggers (units of study failed); number of show causes; students’ written show cause responses; weighted average mark at last show cause or graduation; whether they graduated and were a registered pharmacist; and, the number of years they spent studying the degree. Descriptive studies were used to analyse student characteristics using SPSS software, and student self-reported reasons for poor performance were analysed reflexively using thematic analysis procedures using NVivo.

Results
This study included 164 pharmacy students enrolled in a BPharm (79.3%, n = 130), BPharmMgmt (1.2%, n = 2), or MPharm (19.5%, n = 32). Of the students, 54% (n = 88) were men, 81% (n = 133) were domestic students, 15% (n = 24) transferred from another degree program, and 38% (n = 62) graduated from the course. Show cause students were less likely to graduate if they transferred from another degree program (P = 0.0002) or failed more than three units of study (UoS; P < 0.0001). The most commonly failed UoS were related to organic or pharmaceutical chemistry, and the top student self-reported reasons for poor performance was stress/anxiety, physical health, and depression.

Conclusion
Pharmacy schools should aim to address student foundational knowledge in chemistry, identify at-risk students early using pre-subject testing, and provide better services to address student mental health.
The feedback dilemma in medical education: insights from medical residents’ perspectives
Authors: Shafian Sara , Ilaghi Mehran , Shahsavani Yasamin , Okhovati Maryam , Soltanizadeh Adel , Aflatoonian Sarah , Karamoozian Ali 
Published: April 2024

Abstract
Background
Feedback is a critical component of the learning process in a clinical setting. This study aims to explore medical residents’ perspectives on feedback delivery and identify potential barriers to feedback-seeking in clinical training.

Methods
This cross-sectional study involved 180 medical residents across seventeen specialties. We employed the validated Residency Education Feedback Level Evaluation in Clinical Training (REFLECT) tool to assess residents’ perspectives on their attitude toward feedback, quality of feedback, perceived importance, and reaction to feedback. Additionally, we explored barriers to feedback-seeking behavior among medical residents.

Results
The majority of medical residents held positive attitudes toward feedback. They agreed that feedback improves their clinical performance (77.7%), professional behavior (67.2%), and academic motivation (56.7%), while also influencing them to become a better specialist in their future career (72.8%). However, the study revealed critical deficiencies in the feedback process. Only 25.6% of residents reported receiving regular feedback and less than half reported that feedback was consistently delivered at suitable times and locations, was sufficiently clear or included actionable plans for improvement. A minority (32.2%) agreed that faculty had sufficient skills to deliver feedback effectively. Moreover, peer-to-peer feedback appeared to be a primary source of feedback among residents. Negative feedback, though necessary, often triggered feelings of stress, embarrassment, or humiliation. Notably, there were no significant differences in feedback perceptions among different specialties. The absence of a feedback-seeking culture emerged as a central barrier to feedback-seeking behavior in the clinical setting.

Conclusions
Establishing shared expectations and promoting a culture of feedback-seeking could bridge the gap between residents’ perceptions and faculty feedback delivery. Furthermore, recognizing the role of senior and peer residents as valuable feedback sources can contribute to more effective feedback processes in clinical training, ultimately benefiting resident development and patient care.
Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes
Authors: Reed Richard L. , Roeger Leigh , Kaambwa Billingsley 
Published: April 2024

Abstract
Background
This study was a two-year follow-up evaluation of health service use and the cost-effectiveness of a multicomponent general practice intervention targeted at people at high risk of poor health outcomes.

Methods
A two-year follow-up study of a clustered randomised controlled trial was conducted in South Australia during 2018–19, recruiting 1044 patients from three cohorts: children; adults (aged 18–64 years with two or more chronic diseases); and older adults (aged ≥ 65 years). Intervention group practices (n = 10) provided a multicomponent general practice intervention for 12 months. The intervention comprised patient enrolment to a preferred general practitioner (GP), access to longer GP appointments and timely general practice follow-up after episodes of hospital care. Health service outcomes included hospital use, specialist services and pharmaceuticals. The economic evaluation was based on quality-adjusted life years (QALYs) calculated from EuroQoL 5 dimensions, 5 level utility scores and used an A$50,000 per QALY gained threshold for determining cost-effectiveness.

Results
Over the two years, there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which is lower than the A$50,000 per QALY gained threshold used in Australia. However, the intervention's cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care.

Conclusions
The positive cost-effectiveness results from the 24-month follow-up warrant replication in a study appropriately powered for outcomes such as hospital use, with an intervention period of at least two years, and targeted to older people at high risk of poor health outcomes.
A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact
Authors: Endalamaw Aklilu , Khatri Resham B , Mengistu Tesfaye Setegn , Erku Daniel , Wolka Eskinder , Zewdie Anteneh , Assefa Yibeltal 
Published: April 2024

AbstractBackgroundThe growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.MethodsThis qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.ResultsA total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.ConclusionsImplementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.
A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study
Authors: Ibsen Tanja Louise , Strand Bjørn Heine , Bergh Sverre , Livingston Gill , Lurås Hilde , Mamelund Svenn-Erik , Voshaar Richard Oude , Rokstad Anne Marie Mork , Thingstad Pernille , Gerritsen Debby , Selbæk Geir 
Published: April 2024

Abstract
Background
Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts.

Methods
Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017–2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown.

Results
The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68–102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown.

Conclusion
Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics.

Trial registration
The study is registered at ClinicalTrials.gov, with the identification number NCT 04792086.
“It’s hard to say anything definitive about what severity really is”: lay conceptualisations of severity in a healthcare context
Authors: Stenmarck Mille Sofie , Whitehurst David GT , Lurås Hilde , Rugkåsa Jorun 
Published: April 2024

AbstractBackgroundDemand for healthcare outweighs available resources, making priority setting a critical issue. ‘Severity’ is a priority-setting criterion in many healthcare systems, including in Norway, Sweden, the Netherlands, and the United Kingdom. However, there is a lack of consensus on what severity means in a healthcare context, both in the academic literature and in policy. Further, while public preference elicitation studies demonstrate support for severity as a relevant concern in priority setting, there is a paucity of research on what severity is taken to mean for the public. The purpose of this study is to explore how severity is conceptualised by members of the general public.MethodsSemi-structured group interviews were conducted from February to July 2021 with members of the Norwegian adult public (n = 59). These were transcribed verbatim and subjected to thematic analysis, incorporating inductive and deductive elements.ResultsThrough the analysis we arrived at three interrelated main themes.Severity as subjective experienceincluded perceptions of severity as inherently subjective and personal. Emphasis was on the individual’s unique insight into their illness, and there was a concern that the assessment of severity should be fair for the individual. The second theme,Severity as objective fact, included perceptions of severity as something determined by objective criteria, so that a severe condition is equally severe for any person. Here, there was a concern for determining severity fairly within and across patient groups. The third theme,Severity as situation dependent, included perceptions of severity centered on second-order effects of illness. These included effects on the individual, such as their ability to work and enjoy their hobbies, effects on those surrounding the patient, such as next of kin, and effects at a societal level, such as production loss. We also identified a concern for determining severity fairly at a societal level.ConclusionsOur findings suggest that severity is a polyvalent notion with different meanings attached to it. There seems to be a dissonance between lay conceptualisations of severity and policy operationalisations of the term, which may lead to miscommunications between members of the public and policymakers.