bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between air quality satisfaction, family relationships, and depression symptoms among middle-aged and elderly chinese people: the mediation role of perceived health status
Authors: Niu Zhiping , Zhai Mengxi , Dong Yu , Wen Weihong , Xue Lina , Aosiman Maieryemuguli , Qin Weijun , Duan Zhizhou 
Published: December 2022

Abstract
Background
Population aging has led to depression becoming a serious public health problem both in China and worldwide. Marital relationships, relationships with their children, and air pollution might play an important role in the process of depressive disorders. In this study, we aimed to reveal the mechanism of the effects of these factors on depression.

Methods
Participants were recruited from The China Health and Retirement Longitudinal Study (CHARLS) (wave 4) from July 2018 to March 2019. Depression symptoms were evaluated using the 10-item Center for Epidemiologic Studies depression scale (CESD-10). Marital relationships, relationships with their children, air quality satisfaction, and perceived health status were analyzed using Likert 5-point evaluation methods. Structural equation modeling-path (SEM) models were used to explore these variables’ mediation effects on depression symptoms.

Results
Marital relationships, relationships with their children, air quality satisfaction, perceived health status, and depression symptoms were significantly associated with each other (P < 0.001). Mediation analysis showed that family relationships (standardized beta = −0.28 [−0.31, −0.26]) and quality satisfaction (standardized beta = −0.03 [−0.05, −0.01]) had negative effects on depression symptoms. The total indirect effects of family relationships and air quality satisfaction on depression symptoms were −0.06 (95% confidence interval (CI) = [−0.07, −0.05]) and −0.016 (95% CI = [−0.02, −0.01]), respectively.

Conclusion
Family relationships, air quality satisfaction, and perceived health status influenced depression symptoms. The effects of family relationships and air quality satisfaction on depression symptoms were significantly mediated by perceived health status. Therefore, perceived health status aspects should be considered when conducting targeted intervention toward depression symptoms among middle-aged and elderly adults.
Letter to the editor regarding “Covid-19 transmission in fitness centers in Norway - a randomized trial”
Authors: Valberg Morten , Gran Jon Michael , Rueegg Corina S. , LeBlanc Marissa 
Published: December 2022

AbstractIn a recently published paper in BMC Public Health we read about a randomized trial on Covid-19 transmission performed in five fitness centers in Oslo, Norway, during the spring of 2020. In our opinion, this study has major shortcomings in design and methodology, which have not been addressed by the authors.
Effects of a one-week vacation with various activity programs on well-being, heart rate variability, and sleep quality in healthy vacationers—an open comparative study
Authors: Hübner Markus , Lechleitner Peter , Neumayr Günther 
Published: December 2022

Abstract
Objectives
This open comparative study aimed to analyze the effects of a one-week vacation with various activity programs on well-being, heart rate variability (HRV) and sleep quality in healthy vacationers.

Methods
Fifty-two healthy untrained vacationers spent a one-week vacation with regular exercise in East Tyrol. Exercise was performed on six of seven days. The study participants were divided into a) Group 1, playing golf (G), and b) Group 2 performing Nordic walking or e-biking (NW&EB). Well-being was measured with the WHO-5 well-being-index; stress and recovery status was obtained with the EBF-24-questionnaire (recovery-stress questionnaire). HRV parameters in the time and frequency domain (SDNN, pNN50, r-MSSD, log LF/HF and total power) were measured with a 24-h-ECG (electrocardiogram). Sleep quality was derived from the EBF-24 questionnaire and sleep architecture from HRV-analysis. Examinations were performed one day before and after the vacation.

Results
Well-being significantly improved in the G group (+ 40%, p < 0.001) and NW&EB group (+ 19%, p = 0.019). The stress and recovery profile also improved significantly in both groups (stress-decrease: -43.7% G group; -44.7% NW&EB group; recovery-increase: + 23.6% G group; + 21.5% NW&EB group). Except for the SDNN (standard deviation of the NN interval), no significant change was noted in HRV-parameters. SDNN improved significantly only in the NW&EB group (+ 9%, p < 0.05). Sleep quality (+ 21% G group, p = 0.029; + 19% NW&EB group, p = 0.007) and architecture (-10% G group, p = 0.034; -23% NW&EB group, p = 0.012) significantly improved in both groups.

Conclusion
A short-term vacation with regular exercise was well tolerated by the study participants and improved well-being, sleep quality, HRV and autonomic regulation.

Trial registration
Registry and the registration no. of the study/trial: Approval was received from the ethics committee of the Leopold Franzens University of Innsbruck (AN2013-0059 332/4.8).
How to establishing an indicators framework for evaluating the performances in primary TB control institutions under the new TB control model? Based on a Delphi study conducted in Guangxi, China
Authors: Wu Tengyan , He Huimin , Wei Suosu , Zhu Pinghua , Feng Qiming , Tang Zhong 
Published: December 2022

AbstractBackgroundIn China, the new TB control model of trinity form had been implemented in all parts, and the comprehensively evaluation to the performances in primary TB control institutions were closely related to the working capacity and quality of TB service, but there was still no an unified evaluation indicators framework in practice and few relevant studies. The purpose of this study was to establish an indicators framework for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form in Guangxi, China.MethodsThe Delphi method was used to establish an indicators framework for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form, and the analytic hierarchy process(AHP) was used to determine the weights of all levels of indicators, from September 2021 to December 2021 in Guangxi, China.ResultsA total of 14 experts who had at least 10 years working experience and engaged in TB prevention and control and public health management from health committee, CDC, TB designated hospitals and university of Guangxi were consulted in two rounds. The average age of the experts were (43.3 ± 7.549) years old, and the effective recovery rate of the questionnaire was 100.0%. The average value of authority coefficient of experts (Cr) in the two rounds of consultation was above 0.800. The Kendall’s harmony coefficient (W) of experts’ opinions on the first-level indicators, the second-level indicators and the third-level indicators were 0.786, 0.201 and 0.169, respectively, which were statistically significant (P < 0.05). Finally, an indicators framework was established, which included 2 first-level indicators, 10 second-level indicators and 37 third-level indicators. The results of analytic hierarchy process (AHP) showed that the consistency test of all levels of indicators were CI < 0.10, which indicating that the weight of each indicator was acceptable.ConclusionThe indicators framework established in this study was in line with the reality, had reasonable weights, and could provide a scientific evaluation tool for comprehensively evaluating the performances in primary TB control institutions under the new TB control model of trinity form in Guangxi, China.
Associations of excessive screen time and early screen exposure with health-related quality of life and behavioral problems among children attending preschools
Authors: Xiang Hongyu , Lin Li , Chen Weiqing , Li Chunrong , Liu Xinxia , Li Jinghua , Ren Yan , Guo Vivian Yawei 
Published: December 2022

Abstract
Background
Both excessive screen time and early screen exposure have been linked to children’s health outcomes, but few studies considered these two exposures simultaneously. The aim of this study was to explore the independent and interactive associations of excessive screen time and early screen exposure with health-related quality of life (HRQOL) and behavioral problems among Chinese children attending preschools.

Methods
A cross-sectional study of 4985 children aged between 3 and 6 years was conducted in Chengdu, China. Each parent has finished an online questionnaire regarding their children’s screen use, HRQOL, and behavioral problems. Children with screen time over 1 h/day were considered as having excessive screen time. Early screen exposure was defined if the children had started using screen-based media before the age of 2 years. HRQOL was assessed by the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0), while behavioral problems were confirmed with the 48-item Conners’ Parent Rating Scale (CPRS-48).

Results
Of the 4985 children (2593 boys and 2392 girls) included, the mean age was 4.6 (SD: 1.0) years. After adjustment for confounders and early screen exposure, excessive screen time was significantly associated with worse HRQOL scores in all dimensions and summary scales, as well as each type of behavioral problems (all p values < 0.05). We also found that compared to children with later initiation of screen exposure, those with screen use before the age of 2 years had significantly lower emotional functioning score (β: − 2.13, 95%CI: − 3.17, − 1.09) and psychosocial health summary score (β: − 0.82, 95%CI: − 1.54, − 0.10) of HRQOL, as well as higher risks of conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, and hyperactivity index, which were independent of excessive screen use. Furthermore, there were significant interactive effects of excessive screen time and early screen exposure on emotional functioning domain of HRQOL scores and conduct problems.

Conclusion
Excessive screen time and early screen exposure are two independent and interactive factors to children’s HRQOL and behavioral problems. Our findings support current guidelines to limit screen exposure in children. Appropriate screen use may represent an important intervention target to improve children’s HRQOL and reduce their behavioral problems.
Is spinal sagittal alignment of diffuse idiopathic skeletal hyperostosis relevant to thoracolumbar pain? A controlled study
Authors: Ruan Shengyu , Song Xiaoting , Xu Xianquan , Lu Fangying , Yuan Chiting , Zhang Binhao , Tung Tao-Hsin , Hong Dun 
Published: December 2022

Abstract
Objectives
The extension of diffuse idiopathic skeletal hyperostosis (DISH) from the low thoracic spine to the lumbar spine result in adjustment of spinal sagittal alignment in surgical patients. The aim of this study was to investigate changes in sagittal alignment and back pain in the thoracolumbar spine in nonsurgical DISH and control participants selected from a radiological database.

Methods
Participants in the DISH and the control group were selected by searching for “DISH or degenerative changes in the thoracic spine” in the radiology database of Taizhou Hospital between 2018 and 2021 using Resnick and Niwayama’s criteria. The subjects with spinal tumors, previous spinal surgery, vertebral fractures, inflammatory diseases, poor-quality radiographs, or loss of follow-up were excluded. Demographic and clinical characteristics were recorded retrospectively via the hospital information system and telephone follow-up. Segmental disc angles (SDAs), lumbar lordosis (LL), and bridge scores were analyzed using images of three-dimensional CT.

Results
The final participants consisted of 51 individuals with DISH (DISH group) and 102 individuals without DISH (control group). Depending on the presence of thoracolumbar pain, the DISH group was divided into the DISH group with thoracolumbar pain (DISH+Pain) and the DISH group without thoracolumbar pain (DISH-Pain). The LL and SDAs of T11-T12 and T12-L1 were significantly greater in the DISH group than in the control group. In addition, the SDA of L1-L2 was significantly smaller in the DISH+Pain group than in the DISH-Pain group, whereas there was no significant difference in lumbar lordosis between the DISH+Pain group and the DISH-Pain group. The bridge scores in DISH+Pain group was larger in T10-T11 (p = 0.01) and L1-L2 (p < 0.01) spine segments than those in DISH-Pain group.

Conclusion
The extension of DISH from thoracic to lumbar spine may increase lumbar lordosis and SDAs in the thoracolumbar spine. The DISH patients with more bony bridging and small L1-L2 SDA may be more likely have thoracolumbar pain. Adjustment of sagittal alignment of the spine in the development of DISH may be of clinical importance.
A cross-sectional study of women’s autonomy and modern contraception use in Zambia
Authors: Mangimela-Mulundano Abigail , Black Kirsten I. , Cheney Kate 
Published: December 2022

Abstract
Background
Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women’s autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women’s autonomy and modern contraception use among partnered women in Zambia.

Methods
This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women’s autonomy using three indices: women’s participation in decision-making, women’s attitude towards wife-beating and women’s household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR).

Results
The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women’s autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048–1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013–1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091–1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105–1.766) and age, 15–24 (AOR = 1.266, P value = 0.007, 95% CI 1.182–2.113,) and 25–34 (AOR = 1.163, P value = 0.002, 95% CI 1.052–1.273).

Conclusion
This study argues that increasing women’s assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women’s autonomy, which in turn would support gender equality and reproductive health.
True hermaphroditism with sex cord tumor with annular tubules (SCTAT): a rare case report and review of the literature
Authors: Shi Suhua , Tang Ming , Li Wuan , Wu Haixing , Liu Yinhua , Luo Yonghong , Ding Huafeng 
Published: December 2022

AbstractBackgroundTrue hermaphroditism is a rare condition. It is defined as the presence of both testicular and ovarian tissues in the same individual. Sex cord tumour with annular tubules (SCTAT) is a rare stromal tumour of the sex cord that occurs mostly in the ovaries.Case presentationA 16-year-old girl presented to the gynaecology department with primary amenorrhea. Gynaecological examination revealed an enlarged clitoris that looked like a small penis. The chromosome karyotype was chimaera. The postoperative pathology confirmed true hermaphroditism with SCTAT. The patient underwent hormonal replacement after an operation and had no evidence of recurrence for 6 months.ConclusionCases of true hermaphroditism with SCTAT are extremely rare conditions. Surgery and hormonal replacement are important for improving the prognosis of such patients.
Identifying the challenges of online education from the perspective of University of Medical Sciences Students in the COVID-19 pandemic: a Q-methodology-based study
Authors: Gheshlagh Reza Ghanei , Ahsan Mehrdad , Jafari Mojtaba , Mahmoodi Hassan 
Published: December 2022

Abstract
Background
Challenges of online education among students of the University of Medical Sciences during the COVID-19 disease pandemic have often gone unrecognized. This study aimed to identify online education’s challenges from the perspective of students of the University of Medical Sciences during the COVID-19 pandemic in Iran.

Method
The six-step Q method was used to systematically predict the different perspectives of 31 students at the Kurdistan University of Medical Sciences, Iran.

Results
Four distinct patterns of Challenges of Online Education from the Perspective of participants in the COVID-19 Pandemic were identified. Four factors, which explained 69% of the total variance, included: 1) inadequacy for practical learning (26%) 2) inadequacy of Internet and website services (17%), 3) barriers related to educational content and interaction between teacher and student (8%), and 4) lack of motivation (18%).

Conclusion
The identified challenges reflect the spheres that need to be focused on in interventions to facilitate the successful implementation of the challenges of online education from the perspective of the University of Medical Sciences Students in Iran and other developing countries.
Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals’ ethical challenges and norms regarding decision-making in gender-affirming medical care
Authors: Gerritse Karl , Martens Casper , Bremmer Marijke A. , Kreukels Baudewijntje P. C. , de Boer Fijgje , Molewijk Bert C. 
Published: December 2022

AbstractBackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise.
A rise-assisting robot extends life space and improves facial expressions of nursing home residents
Authors: Kato Kenji , Yoshimi Tatsuya , Aimoto Keita , Sato Kenji , Itoh Naoki , Kondo Izumi 
Published: December 2022

AbstractBackgroundThe introduction of nursing care-support devices using robotic technology is expected to reduce the task burden in long-term care facilities.ObjectiveTo investigate the use of the rise-assisting robot, Resyone, in extending and improving the life space of nursing home residents with severe care needs.MethodsWe performed a feasibility study in which Resyone was used to facilitate visits to additional sites in and around the nursing home as part of the care package of three residents. Two weeks before and four weeks after implementation of the new arrangements, the 30 caregivers involved were asked to record transfer times and destinations, while also checking the residents’ facial expressions.ResultsBefore implementation, participants had limited life spaces, but afterwards they regularly visited additional destinations including the garden, home entrance and corridors, which previously they had not visited frequently. The residents' facial expressions became more positive and less negative. This study demonstrates that Resyone can enrich care activities in severely disabled individuals.ConclusionThese findings suggest that the sustainable use of Resyone would improve the quality of care at care facilities. Moreover, the extension of otherwise limited life space has the potential to improve care receivers’ quality of life.Trial registrationUMIN Clinical Trials Registry No. UMIN000039204 (20/01/2020); retrospectively registered; interventional study; parallel, non-randomized, single blinded. URL of trial registry records:https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044709.