bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associated factors of undernutrition in children with congenital heart disease: a cross-sectional study
Authors: Ruan Xiaorui , Ou Jun , Chen Yige , Diao Jingyi , Huang Peng , Song Xinli , Wei Jianhui , Sun Mengting , Shi Hongqiang , Li Liuxuan , Tang Jiapeng , Liu Hanjun , Qin Jiabi 
Published: January 2024

ObjectiveTo evaluate the prevalence and associated factors of undernutrition among children with congenital heart disease (CHD) who have not undergone surgeries in China.MethodsThis cross-sectional study included 734 CHD children along with their parents. The outcome of interest was undernutrition, including underweight, wasting, and stunting, defined as Z-scores (i.e., weight-for-age, weight-for-height, and height-for-age) ≤−2, according to the World Health Organization (WHO) growth standard. Exposures of interest, containing demographics, obstetric factors, maternal dietary factors, parents' life behaviors and habits, birth-related factors, cardiac-related factors, and preoperative factors, were analyzed using a multivariate logistic regression model to test their associations with undernutrition in CHD children.ResultsOverall, 36.1%, 29.7%, and 21.3% of cases were underweight, wasted, and stunted, respectively. Multivariate logistic regression indicated that underweight was associated with demographic factors (including parents' occupational status, family income, and maternal body mass index pre-pregnancy), low birth weight (OR = 4.60, 2.76–7.70), pulmonary hypertension (OR = 4.46, 3.09–6.43), and pneumonia (OR = 1.88, 1.28–2.76). Artificially-fed children were 2.34 (1.36–4.01) times more likely to be underweight. Occupied mothers (OR = 0.62, 0.44–0.88) and fathers (OR = 0.49, 0.26–0.92) served as protective factors, while mothers having gestational complications (OR = 1.56, 1.11–2.18) and exposed to noisy environment (OR = 1.64, 1.11–2.42) during this pregnancy, and pulmonary hypertension (OR = 3.21, 2.30–4.49) increased the chance of wasting in offspring. The odds of being stunted were greater in families with &gt;2 children (OR = 1.88, 1.13–3.14), placental abruption during this pregnancy (OR = 25.15, 2.55–247.89), preterm births (OR = 1.84, 1.02–3.31), low birth weight (OR = 3.78, 2.16–6.62), pulmonary hypertension (OR = 2.35, 1.56–3.53) and pneumonia (OR = 1.93, 1.28–2.90). In subgroup analyses, the associations differed between patients with different feeding patterns (breastfeeding vs. non-breastfeeding), CHD classifications (cyanotic vs. acyanotic), and prematurity (preterm vs. non-preterm).ConclusionUndernutrition is common in preoperative CHD children. Familial demographics, maternal factors (including having gestational complications and exposure to noisy environment during pregnancy), and patient-related factors (encompassing preterm births, low birth weight, pulmonary hypertension, pneumonia, and feeding pattern) were found to contribute to undernutrition in CHD cases. However, associated factors among the three subgroups of distinct feeding patterns, CHD categorization, and prematurity exhibited varied outcomes, suggesting the necessity for targeted interventions.
Ethics of access to newly approved expensive medical treatments: multi-stakeholder dialogues in a publicly funded healthcare system
Authors: Bomhof Charlotte H. C. , Smids Jilles , Sybesma Sybren , Schermer Maartje , Bunnik Eline M. 
Published: January 2024

Background: Due to rising healthcare expenditures, countries with publicly funded healthcare systems face challenges when providing newly approved expensive anti-cancer treatments to all eligible patients. In the Netherlands in 2015, the so-called Coverage Lock (CL), was introduced to help safeguard the sustainability of the healthcare system. Since then, newly approved treatments are no longer automatically reimbursed. Previous work has shown that as policies for access to CL treatments are lacking, patient access to non-reimbursed treatments is limited and variable, which raises ethical issues. The ethics of access were discussed in a series of multi-stakeholder dialogues in the Netherlands.Methods: Three dialogues were held in early 2023 and included physicians, health insurers, hospital executives, policymakers, patients, citizens, and representatives of pharmaceutical companies, patient and professional organizations. In advance, participants had received an ‘argument scheme’ featuring three models: 1) access based on third-party payment (e.g., by pharmaceutical companies, health insurers or hospitals) 2) access based on out-of-pocket payments by patients 3) no access to CL treatments. During the dialogues, participants were asked to discuss the merits of the ethical arguments for and against these models together, and ultimately to weigh them. The discussions were audio-taped, transcribed, coded, and thematically analyzed.Results: Generally, most stakeholders were in favour of allowing access–at least when treatments are clearly beneficial–to treatments in the CL. When discussing third-party payment, stakeholders favoured payment by pharmaceutical companies over payment by health insurers or hospitals, not wanting to usurp collective funds while cost-effectiveness assessments are still pending. Largely, stakeholders were not in favour of out-of-pocket payments, emphasizing solidarity and equal access as important pillars of the Dutch healthcare system. Recurrent themes included the conflict between individual and collective interests, shifting attitudes, withholding access as a means to put pressure on the system, and the importance of transparency about access to CL-treatments.Conclusion: Policies for access to non-reimbursed treatments should address stakeholders’ concerns regarding transparency, equal access and solidarity, and loss of potential health benefits for patients. Multi-stakeholder dialogues are an important tool to help inform policy-making on access to newly approved (too) expensive treatments in countries facing challenges to the sustainability of healthcare systems.
Aloe-emodin exhibits growth-suppressive effects on androgen-independent human prostate cancer DU145 cells via inhibiting the Wnt/β-catenin signaling pathway: an in vitro and in silico study
Authors: Hussain Talib , Alafnan Ahmed , Almazni Ibrahim Abdullah , Helmi Nawal , Moin Afrasim , Baeissa Hanadi M. , Awadelkareem Amir Mahgoub , Elkhalifa AbdElmoneim O. , Bakhsh Tahani , Alzahrani Abdulrahman , Alghamdi Rashed Mohammed , Khalid Mohammad , Tiwari Rohit Kumar , Rizvi Syed Mohd Danish 
Published: January 2024

At the molecular level, several developmental signaling pathways, such as Wnt/β-catenin, have been associated with the initiation and subsequent progression of prostate carcinomas. The present report elucidated the anti-cancerous attributes of an anthraquinone, aloe-emodin (AE), against androgen-independent human prostate cancer DU145 cells. The cytotoxicity profiling of AE showed that it exerted significant cytotoxic effects and increased lactose dehydrogenase levels in DU145 cells (p &lt; 0.01 and p &lt; 0.001). AE also induced considerable reactive oxygen species (ROS)-mediated oxidative stress, which escalated at higher AE concentrations of 20 and 25 μM. AE also efficiently instigated nuclear fragmentation and condensation concomitantly, followed by the activation of caspase-3 and -9 within DU145 cells. AE further reduced the viability of mitochondria with increased cytosolic cytochrome-c levels (p &lt; 0.01 and p &lt; 0.001) in DU145 cells. Importantly, AE exposure was also correlated with reduced Wnt2 and β-catenin mRNA levels along with their target genes, including cyclin D1 and c-myc. Furthermore, the molecular mechanism of AE was evaluated by performing molecular docking studies with Wnt2 and β-catenin. Evidently, AE exhibited good binding energy scores toward Wnt2 and β-catenin comparable with their respective standards, CCT036477 (Wnt2 inhibitor) and FH535 (β-catenin inhibitor). Thus, it may be considered that AE was competent in exerting anti-growth effects against DU145 androgen-independent prostate cancer cells plausibly by modulating the expression of Wnt/β-catenin signaling.
Gastrointestinal symptoms in patients with postural orthostatic tachycardia syndrome in relation to hemodynamic findings and immunological factors
Authors: Tufvesson Hanna , Hamrefors Viktor , Fedorowski Artur , Hansson Monika , Ohlsson Bodil 
Published: January 2024

Gastrointestinal (GI) symptoms are common in postural orthostatic tachycardia syndrome (POTS). We aimed to explore the prevalence and severity of GI symptoms in POTS, and to investigate immunological factors, hemodynamic findings, and their possible association with GI symptoms in POTS. Forty-three patients (93% female, median age 30.6 (26.0–41.0) years), previously diagnosed with POTS and 74 healthy controls (78% female, median age 35.6 (28.8–41.7) years) were included. The participants completed a questionnaire including prevalence of GI symptoms, the irritable bowel syndrome severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). All POTS patients were previously examined by tilt test (2010–2021) and the vast majority with more recent active standing test (2017–2021), which included monitoring of heart rate (HR). ΔHR was calculated as difference between supine and upright position. Continuous variables from IBS-SSS and VAS-IBS were correlated to ΔHR. A microarray containing several autoantigens commonly targeted in systemic autoimmune disorders was used to assess prevalent autoantibodies in POTS and controls. Total IgE and S-tryptase were analyzed. GI symptoms were more prevalent and severe in POTS than in controls; nausea being the most prevalent (79.1% vs 4.9%, p &lt; 0.001) and bloating and flatulence being the most severe (median 65 (25–88) vs 0 (0–14), p &lt; 0.001). The median total IBS-SSS was 213 (135–319) in POTS vs 13 (0–54) in controls (p &lt; 0.001). Total IBS-SSS was associated with low psychological wellbeing (r = 0.539, p &lt; 0.001) in POTS. ΔHRmax correlated inversely with abdominal pain (r = −0.406, p = 0.007). After adjustments for psychological wellbeing, total IBS-SSS still associated inversely with ΔHR10min (β: 4.748; 95% CI: −9.172 to −0.324; p = 0.036). Similar results were seen with active standing test. The prevalence of autoantibodies did not differ between POTS and controls (29.4% vs 33.3%, p = 0.803). There was no association between GI symptoms and autoantibody status. Total IgE and tryptase were elevated in a few cases. This study confirms the high prevalence of GI symptoms in POTS. More pronounced tachycardia upon tilt table testing seems to be inversely correlated with severity of chronic GI symptoms in POTS. This study did not support the hypothesis that POTS is associated with immunological factors.
Design and experiments with a SLAM system for low-density canopy environments in greenhouses based on an improved Cartographer framework
Authors: Tan Haoran , Zhao Xueguan , Zhai Changyuan , Fu Hao , Chen Liping , Yang Minli 
Published: January 2024

To address the problem that the low-density canopy of greenhouse crops affects the robustness and accuracy of simultaneous localization and mapping (SLAM) algorithms, a greenhouse map construction method for agricultural robots based on multiline LiDAR was investigated. Based on the Cartographer framework, this paper proposes a map construction and localization method based on spatial downsampling. Taking suspended tomato plants planted in greenhouses as the research object, an adaptive filtering point cloud projection (AF-PCP) SLAM algorithm was designed. Using a wheel odometer, 16-line LiDAR point cloud data based on adaptive vertical projections were linearly interpolated to construct a map and perform high-precision pose estimation in a greenhouse with a low-density canopy environment. Experiments were carried out in canopy environments with leaf area densities (LADs) of 2.945–5.301 m2/m3. The results showed that the AF-PCP SLAM algorithm increased the average mapping area of the crop rows by 155.7% compared with that of the Cartographer algorithm. The mean error and coefficient of variation of the crop row length were 0.019 m and 0.217%, respectively, which were 77.9% and 87.5% lower than those of the Cartographer algorithm. The average maximum void length was 0.124 m, which was 72.8% lower than that of the Cartographer algorithm. The localization experiments were carried out at speeds of 0.2 m/s, 0.4 m/s, and 0.6 m/s. The average relative localization errors at these speeds were respectively 0.026 m, 0.029 m, and 0.046 m, and the standard deviation was less than 0.06 m. Compared with that of the track deduction algorithm, the average localization error was reduced by 79.9% with the proposed algorithm. The results show that our proposed framework can map and localize robots with precision even in low-density canopy environments in greenhouses, demonstrating the satisfactory capability of the proposed approach and highlighting its promising applications in the autonomous navigation of agricultural robots.
Integrating intrapreneurial self-capital, cultural intelligence, and gender in Chinese international education: pathways to flourishing
Authors: Dong Tianran , Li Xuetao 
Published: January 2024

BackgroundThis study investigates the complex interplay between Intrapreneurial Self Capital, Cultural Intelligence, and gender, and their collective influence on the flourishing of Chinese international students in foreign academic settings. As global interconnectivity intensifies, the increasing number of Chinese students seeking education abroad presents a unique opportunity to examine the psychological and sociocultural dynamics of this demographic.AimCentral to our investigation is the role of Cultural Intelligence, a crucial competency for navigating diverse environments, and Intrapreneurial Self Capital, a composite of psychological resources instrumental in educational and career success. The study also explores the mediating role of Cultural Intelligence in the relationship between Intrapreneurial Self Capital and student flourishing, and examines how gender moderates this dynamic.MethodThe research engaged 508 Chinese international students, utilizing a variety of social networks for participant recruitment. The survey, conducted via Qualtrics, focused on a diverse range of students across different educational levels and disciplines. A moderated mediation model was tested to examine the mediation effect of cultural intelligence on the relationship between intrapreneurial self-capital and flourishing, with gender serving as a moderating variable.ResultsOur findings reveal significant insights into how Intrapreneurial Self Capital and Cultural Intelligence contribute to the personal and professional development of Chinese international students. Overall, the results suggest that the impact of Intrapreneurial Self Capital on various cognitive qualities (Metacognitive Cultural Intelligence, Cognitive Cultural Intelligence, Motivational Cultural Intelligence and Behavioral Cultural Intelligence) is moderated by gender, highlighting the importance of considering gender differences in this context. Related to the prediction of Flourishing, the direct effect of Intrapreneurial Self Capital on flourishing is notably strong. However, the mediating roles of Metacognitive, Cognitive, and Behavioral aspects of Cultural Intelligence show different levels of influence.ImplicationsThe study underscores the need for educational institutions to adopt holistic approaches in fostering student well-being and success, accounting for the nuanced effects of cultural and gender dynamics. These results have significant implications for the development of targeted educational programs and training, aimed at enhancing the international educational experience for students and professionals.
The mediating role of impulsivity between sleep quality and suicidal ideation in adolescent population: a multicenter cross-sectional study in the northeastern Sichuan, China
Authors: Zhong Yunling , He Jinlong , Luo Jing , Zhao Jiayu , Cen Yu , Wu Yuhang , Song Yuqin , Lin Cen , Pan Lu , Luo Jiaming 
Published: January 2024

IntroductionSuicidal ideation is a critical early stage in the progression towards suicidal be havior. Prior research has established links between sleep quality, impulsivity, and suicidal tendencies, yet the interaction among these factors has been less explored. This study aims to explore the mediating role of impulsivity in the relationship between sleep quality and suicidal ideation in adolescents.MethodsEmploying a cross-sectional study design, 6,974 questionnaires were distributed,including the Socio-demographic Characteristics Questionnaire, Barratt Impulsiveness Scale, the Positive and Negative Suicide Ideation Inventory,and the Pittsburgh Sleep Quality Index Scale. The participants were high school and middle school students from 33 schools in northeastern Sichuan, China, selected through random cluster sampling.ResultsOf these 6,786 questionnaires were analyzed. The participant distribution included 47.2% male and 52.8% female students, with 68.3% from junior schools and 31.7% from senior schools. The prevalence of suicidal ideation was found to be 13.6%. The analysis, which involved correlation analysis and the construction of a structural equation model, revealed that sleep quality had a significant positive effect on impulsivity (β:0.289,p &lt; 0.05), and impulsivity, in turn, had a positive impact on suicidal ideation (β:0.355,p &lt; 0.05).Moreover, sleep quality was directly linked to suicidal ideation (β:0.208,p &lt; 0.05). Thus, sleep quality affects suicidal ideation both directly and indirectly through impulsivity.DiscussionThe results of this study suggest that both sleep quality and impulsivity are significant direct influencers of suicidal ideation among adolescents in the region studied, with impulsivity also playing an indirect role in the relationship between sleep quality and suicidal ideation.
The influence of lifestyle habits on levels of depression among rural middle school students in Northeastern China
Authors: Zhao JunCheng , Wang Xiaoyin , Xu Shiliang , Yan Wenjing , Wang Jingzhe , Wang Ende , Liu Tao , Hao Ming 
Published: January 2024

BackgroundDepression rates among adolescents have risen dramatically over the past decade. Therefore, preventing depression among adolescents is particularly important. Differences in lifestyle habits may play a role in depression.PurposeThis study aimed to explore the influence of living habits on depression levels among rural middle school students in Northeast China and to provide a theoretical basis for developing interventions to reduce depression levels in middle school students.MethodsA total of 296 middle school students aged 13–15 years from Benxi City, Northeast China completed the anthropometric measurements, Physical Activity Scale-3 (PARS-3), and the Self-Rating Depression Scale (SDS). Their average screen time in the most recent week, parents' education level, and monthly family income were collected through a questionnaire.ResultsFemales had higher depression scores than males (41.0 ± 6.9 vs. 37.9 ± 8.0). Physical activity (β = −0.38, t = −7.06, P &lt; 0.01), family income (β = −0.20, t = −4.07, P &lt; 0.01), screen time (β = 0.16, t = 3.34, P &lt; 0.01), age (β = 0.15, t = 3.16, P &lt; 0.01), sex (β = −0.13, t = −2.74, P &lt; 0.01), and sleep quality (β = −0.08, t = −1.87, P &lt; 0.01) are important factors related to depression levels.ConclusionThe preliminary analysis results showed that among middle school students in rural Northeast China, the depression level of females was significantly higher than that of males. Poor quality sleep, low levels of physical activity, low household income, and long screen time were positively associated with depression. Therefore, strengthening physical activity, improving sleep quality, and reducing screen time are of clinical relevance in preventing and reducing depression.
Exploring refugees’ health care access in times of COVID-19: a quantitative study in the Lisbon region, Portugal
Authors: Portela Vanessa , Hamwi Sousan , Oliveira Martins Maria R. 
Published: January 2024

BackgroundTo address the health needs of refugees, health services must be culturally competent and facilitate this population’s access to health care, especially in a context prone to the amplification of social inequities, such as the COVID-19 pandemic. However, few quantitative studies exist in the European Union, and to the extent of our knowledge, there are no published quantitative studies exploring refugees’ access to health care during the pandemic in Portugal. The objective of this study is to describe the demographic and socioeconomic characteristics of refugees living in Lisbon and to explore their healthcare access patterns during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, descriptive, and quantitative study from May to November 2022. Using Levesque’ s theory on health care access, we designed and applied a 38-item questionnaire through face-to-face interviews with refugees living in Lisbon for at least 12 months, and used descriptive statistics to characterize sociodemographic and healthcare access profiles during the pandemic.ResultsThe mean age of the 36 recruited refugees was 35 years (SD = 10.24), the majority were male (56%), married (72%), had at least a secondary education (69%), were unemployed (77.8%), and had a median length of stay in Portugal of 17 months (IQR = 45). All were registered in a primary care center, and 94% used healthcare services during the pandemic. The majority never tested positive for the coronavirus (58%) and one out of the positive was admitted to hospital due to severe COVID-19. A total of 97% received COVID-19 vaccination, of which 69% had an incomplete schedule. A quarter of the participants did not have access to information about COVID-19 in a language they understood, and although 97% needed health care during the pandemic, more than half (63%) did not seek it because of structural and cultural barriers. Half of the respondents had difficulty getting medical advice by phone or email, and 39.4% could not afford a medical examination or treatment. Only 18.2% sought counseling services. A total of 58.8% of the participants felt like healthcare professionals did not always show respect towards their culture, and 64.7% reported that healthcare professionals did not always discuss treatment options with them.ConclusionThis study’s findings highlight the need to endow inclusive communication, cultural competency, and patient involvement in health care, alongside improving the socioeconomic condition of refugees. Identified population characteristics and barriers to health care access by refugees in this study may inform future research on the health care needs of refugees in Portugal and ultimately assist in the devising of strategies to reduce inequalities in health care access.