bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital tools to support mental health: a survey study in psychosis
Authors: Eisner Emily , Berry Natalie , Bucci Sandra 
Published: October 2023

Abstract
Background
There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation.

Methods
A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context.

Results
Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership.
Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support.
Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime.
Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood.

Conclusions
Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
Assessing sex differences in viral load suppression and reported deaths using routinely collected program data from PEPFAR-supported countries in sub-Saharan Africa
Authors: Fernandez Danielle , Ali Hammad , Pals Sherri , Alemnji George , Vasireddy Vamsi , Siberry George K. ,   PEPFAR MER Interagency Participants, Rebello Cardoso Yolanda , Vasquez Caroll , Bruno Emily , Kavungerwa Apollinaire , Kavabushi Franck , Ndayizeye Aime , Eno Laura T. , Akiy Zacheaus Zeh , Clotaire Billong Serge , Mukinda Elie , Ahmed Solomon , Fiseha Daniel , Hika Zerihun , Waruru Anthony , Asiimwe Fred , Luhanga Misheck , Matchere Faustin , McOwen Jordan , Mutandi Gram , Bikinesi Leonard , Ashipala Laimi , Dalhatu Ibrahim T. , Bolo Alex , Katoro Joel Sua , Balinda Mushubira M. , Rosenthal Matthew , Nguhuni Boniface , Magesa Alex S. , Oboho Ikwo , Godfrey Catherine 
Published: October 2023

Abstract
Background
In sub-Saharan Africa, more women than men access HIV testing and treatment and may have better viral load suppression (VLS). We utilized routinely reported aggregated HIV program data from 21 sub-Saharan African countries to examine sex differences in VLS and death rates within antiretroviral therapy (ART) programs supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).

Methods
We included VLS and reported death data for persons aged 15 + years on ART from October–December 2020 disaggregated by sex and age for each subnational unit (SNU). We used linear mixed-model regression to estimate VLS proportion and negative binomial mixed-model regression to estimate the rates of death and death plus interruptions in treatment (IIT). All models were weighted for SNU-level ART population size and adjusted for sex, age, HIV/tuberculosis coinfection, country, and SNU; models for reported deaths and deaths plus IIT were also adjusted for SNU-level VLS.

Results
Mean VLS proportion was higher among women than men (93.0% vs. 92.0%, p-value < 0.0001) and 50 + than 15–49 age group (93.7% vs. 91.2%, p-value < 0.0001). The mean rate of reported deaths was higher among men than women (2.37 vs. 1.51 per 1000 persons, p-value < 0.0001) and 50 + than 15–49 age group (2.39 vs. 1.50 per 1000, p-value < 0.0001); the mean rate of reported deaths plus IIT was higher among men (30.1 in men vs. 26.0 in women per 1000, p-value < 0.0001) and higher among 15–49 than 50 + age group (34.7 vs. 22.6 per 1000, p-value < 0.0001).

Conclusions
The mean rate of reported deaths was higher among men in most models despite adjusting for VLS. Further exploration into differences in care-seeking behaviors; coverage of screening, prophylaxis, and/or treatment of opportunistic infections; and more extensive testing options for men to include CD4 is recommended.
A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers’ sustained implementation of classroom physical activity breaks (energisers): study protocol
Authors: Nathan Nicole , Hall Alix , Shoesmith Adam , Bauman Adrian E. , Peden Belinda , Duggan Bernadette , Gardner Carly , Lane Cassandra , Lecathelinais Christophe , Oldmeadow Christopher , Duncan Craig , Groombridge Daniel , Riley-Gibson Edward , Pollock Emma , Boyer James , Wiggers John , Gillham Karen , Pattinson Martina , Mattingly Megan , McCarthy Nicole , Naylor Patti-Jean , Reeves Penny , Budgen Philippa , Sutherland Rachel , Jackson Rebecca , Croft Thomas , Pascoe William , Wolfenden Luke 
Published: October 2023

Abstract
Background
Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers’ sustainment of energisers (short 3–5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up.

Methods
A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods.

Discussion
This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools’ sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally.

Trial registration
ACTRN12620000372987 version 1 registered 17th March 2020. Version 3 (current version) updated 4th August 2023.
A mixed-methods process evaluation of the feasibility and acceptability of involving community and peer role models within a physical activity intervention for primary-school-aged girls (the CHARMING study)
Authors: Morgan Kelly , Van Godwin Jordan , Cannings-John Rebecca , Hallingberg Britt , Moore Graham , Pell Bethan , Whiteley Holly , Hawkins Jemma 
Published: October 2023

Abstract
Background
Role models have been identified as a potential means to tackle the persisting low levels of physical activity among young girls. The aim of this research was to explore the involvement of community- and peer role models within the CHARMING (CHoosing Active Role Models to INspire Girls) intervention, an intervention which aims to increase and sustain physical activity among 9–10-year-old girls. The research questions were, is it feasible and acceptable to recruit role models? and what are the perceived barriers and facilitators to the inclusion of peer role models within the intervention?

Methods
A mixed methods process evaluation was embedded within a larger feasibility study, involving three secondary schools and four adjoining primary schools in South Wales, United Kingdom. One-to-one interviews were conducted with teachers (N = 10) across the seven schools and community role models (N = 10). Focus groups were conducted with 18 peer role models (older girls from adjoining secondary schools) and 18 girls aged 9–10-years who had participated in the intervention. Primary school teachers kept observation logs of each intervention session. A researcher completed observation logs of two random sessions per school. Qualitative data were analysed using thematic analysis with a combined deductive and inductive coding approach. Observation data were analysed using descriptive statistics. Data were triangulated and comparative analyses conducted across schools.

Results
Twenty-three peer role models (aged 12–16-years) and 16 community role models participated in intervention delivery. Overall, the inclusion of both types of role models was shown as acceptable and feasible within the CHARMING intervention. Observation data highlighted key areas (i.e., intervention components delivered inconsistently) for further qualitative exploration. Six themes were identified during analyses; reach and access, communication, logistics, existing systems, interpersonal relationships, and perceived impacts. Themes were intertwined across the barriers and facilitators of recruitment and implementation. Areas for future improvement were highlighted.

Conclusions
Findings can be used to optimise the CHARMING intervention and inform wider interventions or policies employing several role models across settings to promote physical activity among children.
Nutrition facts labels: who is actually reading them and does it help in meeting intake recommendations for nutrients of public health concern?
Authors: Storz Maximilian Andreas 
Published: October 2023

Abstract
Background
Fiber, potassium and calcium are nutrients of public health concern and their intakes in the United States are alarmingly low. The usage of nutrition facts labels has been reported to increase the odds for dietary reference intake of fiber in some studies. The overall evidence, however, is mixed, as some studies suggested that nutrition facts panels have little to no effect on average measures of diet quality. Here, we investigated whether the usage of nutrition facts labels was associated with meeting U.S. intake recommendations for three nutrients of public health concern: fiber, potassium and calcium.

Methods
We used cross-sectional multistage, stratified, clustered and probability sampling design data from the U.S. National Health and Nutrition Examination Surveys 2017–2020 cycle. The sample included 5,416 individuals aged 20 years or older, which may be extrapolated to represent 146,841,866 US Americans. Nutrient intakes were compared among individuals reading nutrition facts panels “frequently”, “sometimes” or “rarely” using applied survey data analyses techniques (including multivariate logistic regression and marginsplots).

Results
We observed substantial sociodemographic differences between the three groups. Frequent readers were significantly more likely to be female and had higher educational levels. On average, they were also significantly older as compared to rare readers. Fiber intake in g/d was highest in frequent readers (17.09) and lowest in rare readers (14.64). The proportion of participants that met dietary fiber intake recommendations was almost four times higher in the frequent readers group (12.69%) as compared to the rare readers group (3.69%). In a bivariate logistic regression model, frequent label reading significantly increased the odds for meeting the fiber recommendations in Dietary Guidelines for Americans (OR: 2.15, p < 0.001). Rarely reading labels decreased the odds (OR: 0.57, p = 0.003). These odds remained essentially unchanged after adjusting for sociodemographic covariates, diabetes status and body mass index (OR: 1.84, p = 0.004; and OR: 0.62, p = 0.022).

Conclusions
Nutrition facts panel reading associates with fiber intake. Our findings have potential implications for public health nutrition strategies that may center around educational work.
Managing persistent physical symptoms when being social and active is the norm: a qualitative study among young people in Denmark
Authors: Andersen Julie Høgsgaard , Risør Mette Bech , Frostholm Lisbeth , Rask Mette Trøllund , Rosendal Marianne , Rask Charlotte Ulrikka 
Published: October 2023

Abstract
Background
An increasing number of young people in Western countries report persistent physical symptoms (PPS). PPS may disturb everyday activities and they may have negative consequences for later adult mental and physical health. Still little is known about how young people handle PPS in their everyday lives. This study examines how young people with PPS attempt to manage their symptoms while staying engaged in their daily activities and what is at stake in these attempts.

Methods
This qualitative study involved semi-structured interviews with 11 young people with PPS. Photo-elicitation was used to capture the participants’ experiences as they occurred in their everyday lives. The data material was analysed using a thematic analysis approach, as well as theory on subjectivity and social acceleration.

Results
The participants employed alleviating measures and tried to find patterns between their activities and the severity of their symptoms in order to adjust their activity level. Decisions not to participate in social activities were accompanied by feelings of missing out. The participants’ attempts at adjusting their activity level was challenged by norms of being social and active, and they experienced difficulty prioritizing their activities and explaining their symptoms to others.

Conclusion
PPS shaped the participants’ sense of how to act towards their bodies and social relationships in interaction with societal norms. The participants’ subject formation and symptom experiences should thus be seen as a biosocial process.
Oral health status and hygiene practices among visually impaired adolescents from a school in Kenya
Authors: Macharia Maureen , Masiga Mary , Psiwa Nathan , Bermudez Janella , Seminario Ana Lucia , Kemoli Arthur Musakulu 
Published: October 2023

Abstract
Background
Visual impairment affects a significant population globally. The aim of this study was to determine the oral health status and oral hygiene practices among visually impaired adolescents from a school in Kenya.

Methods
A descriptive cross-sectional study was carried out among 159 adolescents aged 10–19 years attending the largest public primary boarding school for the blind in Kenya. A questionnaire was used to record participants’ socio-demographic variables and oral hygiene practices. Clinical examination was undertaken to assess oral health status which consisted of oral hygiene, gingival health, and dental caries. Bivariate analyses were conducted to compare dental health outcomes across socio-demographic characteristics.

Results
There were 69 (43.4%) and 90 (56.6%) participants in Category I and II visual impairment respectively, 85 (53.5%) were male and 74 (46.5%) were female. Study participants were divided into three age categories: 10–12 years 48 (30.2%), 13–15 years 67 (42.1%), and 16- 19 years 44 (27.7%), with an overall mean age of 13.9 ± 2.3. All participants brushed their teeth, majority 107 (67.3%) brushed two or more times daily. Only 66 (41.5%) of the participants replaced their toothbrushes at 3 months. Sex (p =< 0.001) and age (p = 0.04) influenced frequency of toothbrush replacement. The average plaque score and gingival score index was 0.95 ± 0.45 and 0.28 ± 0.25 respectively, with gingivitis prevalence of 88.1%. Overall dental caries prevalence was 44.7%, [42.1%)] permanent dentition and [8.2%] deciduous dentition. Mean DMFT and dmft were 0.44 ± 0.60 and 0.12 ± 0.32 respectively. DMFT had a statistically significant association with sex (t = 1.82, p = 0.03). Oral hygiene practices did not influence oral hygiene and dental caries status. However, a statistically significant association was reported between frequency of toothbrush replacement and gingival score index (“p” =< 0.001).

Conclusions
The study reported general good oral hygiene, prevalent gingivitis 140 (88.1%), and almost half of the study population affected by dental caries 71 (44.7%). Most participants were unaware of using fluoridated toothpaste and of needing to change toothbrushes within 3 months. Frequency of toothbrush replacement was reported to influence gingival score index.
Evaluation of the proximal contact tightness in class II resin composite restorations using different contact forming instruments: a 1-year randomized controlled clinical trial
Authors: Abbassy Karim M. , Elmahy Waleed A. , Holiel Ahmed A. 
Published: October 2023

Abstract
Background
Proper proximal contact in direct composite restorations is crucial for periodontal health. Over a one-year period, this study was conducted to assess successive biological changes in proximal contact tightness PCT in class II direct composite restorations and the adjacent teeth by applying sectional matrix system along with different contact forming instruments.

Methods
72 direct compound class II composite restorations were performed in patients aged 18–40 years and divided into 4 groups: Group I (n = 18): proximal contact was restored with Palodent plus sectional matrix system, Group II (n = 18): Trimax as contact forming instrument, Group III (n = 18): Perform as contact forming instrument and Group IV (n = 18): Contact pro as contact forming instrument. All contact forming instruments were used along with Palodent plus matrix system. PCT was measured using a digital force gauge before (T0), immediate post operative (T1) and at 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after restorative treatment. Using One-Way ANOVA, Tukey’s post hoc test, and Bonferroni correction, PCT values were compared between groups before and after the intervention restoration. Meanwhile, for comparisons within groups, a paired t-test was conducted (p ≤ 0.05).

Results
Contact forming instruments combined with Palodent plus sectional matrix system achieved better PCT. Trimax led to a statistically considerable tighter proximal contacts than the other groups (p < 0.05). No statistically significant difference was found in PCT between Contact pro-2, Perform and Palodent plus sectional matrix system. By means of multivariate analysis, the PCT between both T0 and T1 were increased (p < 0.001) and then it decreased till T5.

Conclusions
The use of transparent contact forming instruments achieved greater PCT compared to Palodent sectional matrix system alone that gradually decreased throughout 12 months and reached the PCT between the natural teeth. Using Trimax system provided the tightest proximal contacts. Additionally, digital force gauge was confirmed as an inclusive and accurate method to quantify PCT.

Trial registration
ClinicalTrials.gov NCT05749640: 24/5/2022.
Economic inequalities in decayed, missing, and filled first permanent molars among 8–12 years old Iranian schoolchildren
Authors: Khoramrooz Maryam , Mirrezaie Seyed Mohammad , Emamian Mohammad Hassan , Golbabaei Pasandi Hajar , Dadgari Ali , Hashemi Hassan , Fotouhi Akbar 
Published: October 2023

Abstract
Background
First permanent molars (FPM) play an important role in the masticatory function and oral health. This study aimed to assess the economic inequalities of FPM health indices among schoolchildren in the northeast of Iran.

Methods
A total of 4051 children aged 8–12 years old were included in the analyses of this cross-sectional study in 2015. Economic status was measured using the principal component analysis on home assets. Concentration index (C) was used to measure economic inequality in FPM health indices, and its contributing factors determined by Wagstaff decomposition technique.

Results
The prevalence of having decayed, missing, and filled FPMs among children was 40.9% (95% CI: 38.8–43.0), 1.2% (95% CI: 0.8–1.6%), and 7.8% (95% CI: 6.7–8.9%), respectively. Missing FPM was generally more concentrated among low-economic children (C=-0.158), whereas, filled FPM was more concentrated on high-economic children (C = 0.223). Economic status, mother education, having a housekeeper mother, and overweight/obesity, contributed to the measured inequality in missing FPM by 98.7%, 97.5%, 64.4%, and 11.2%, respectively. Furthermore, 88.9%, 24.1%, 14.5%, and 13.2% of filled FPM inequality was attributable to children’s economic status, father education, residence in rural areas, and age, respectively.

Conclusion
There is a significant economic inequality in both missing and filled FPM. This inequality can be attributed to the economic status of individuals. To reduce FPM extraction, it is important to target low-income and rural children and provide them with FPM restoration services. Additionally, it is necessary to provide training to less-educated parents and housekeeper mothers to address the observed inequalities.