bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients languishing in emergency departments: A descriptive analysis of mental health-related emergency department presentations in Australia between 2016-17 and 2020-21
Authors: Brazel Matthew , Allison Stephen , Bastiampillai Tarun , Kisely Stephen R , Looi Jeffrey CL 
Published: August 2023

Objective In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health–related ED episodes in Australian public hospitals between 2016-17 and 2020-21. Method We descriptively analysed Australian Institute of Health and Welfare data for mental health–related ED presentations, outcomes and 5-year trends for Australian public hospitals. Results There were more than 300,000 Australian mental health–related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health–related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14 h, which was longer than the 90th percentile for all ED presentations (up to 8 h). Conclusions Current mental health policies have not stemmed the rising tide of ED presentations. Mental health–related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access.
The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion
Authors: Khan Wafa B , Gallagher Harry M , Jayasimhan Dilip , Dray Michael , Chang Catherina L 
Published: August 2023

Background and objective Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD. Methods Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic. Results 36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47–0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624–0.935), in step 3 κ = 0.776 (95% CI 0.614–0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD. Conclusion We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.
Spiritual Care in Action for Oncology Patients in the uMgungundlovu and eThekwini Health Districts, KwaZulu-Natal, South Africa: A Qualitative Study
Authors: Sewkarran Vashni , Gumede Emelda Zandile 
Published: August 2023

Introduction Globally the inclusion of spiritual activities has been well adopted into nursing care. Empirical work related to the inclusion of spiritual activities in nursing within the South African context particularly within the oncology setting is sparse. Being diagnosed with cancer can be unsettling because of the severity and vigorous treatment that one has to endure. Spiritual activities could be used as one of the coping strategies for cancer patients in times of spiritual distress. Strengthening spiritual care by including spiritual activities into daily nursing care could be beneficial to the patient and the institution. Objective This study aimed to explore spiritual activities that could strengthen spiritual care in oncology nursing practice. Methods The research study followed a phenomenological qualitative descriptive design. The study population consisted of professional nurses working in the oncology units for more than 6 months. Four health care institutions were purposively selected. Data was collected through individual in-depth interviews and field notes. Ten professional nurses were recruited at the point of data saturation. Data analysis followed inductively using content analysis enrolling steps from Elo and Kyngas. Results The findings revealed the nurse's willingness to embrace spiritual care in action into their daily nursing care. Three subthemes: holding patient's hands, hospital policy for patient visits, and music therapy outline how patients are comforted by nurses. Conclusion Nurses are integral in the provision of spiritual care for cancer patients from diagnosis up until the end of life. The essence of spiritual activities gives patients a distraction and an escape from their pain and predicament thus improving their quality of life. The findings provide policy makers with an indication that patients do not only need medical and physical care but spiritual care in their nursing care plan.
Safety of geriatric patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration with deep sedation: a retrospective study
Authors: Tunç Mehtap , Sazak Hilal , Öztürk Ayperi , Yılmaz Aydın , Alagöz Ali 
Published: August 2023

Abstract
Background
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also associated with many pathological processes that further increase morbidity and mortality. The ideal sedation protocol for EBUS-TBNA has yet to be determined in geriatric patients. Deep sedation (DS) may increase the safety and performance of the procedure. There are limited studies evaluating the effectiveness and safety of EBUS-TBNA under DS in elderly patients.

Methods
280 patients who underwent EBUS-TBNA under DS were included in this retrospective study. 156 patients aged 65 years and over (Group 1) and 124 patients under 45 (Group 2) were compared. Demographic data, comorbidities, pulmonary function tests (PFTs), hemodynamic measurements, and peripheral oxygen saturation (SpO2) before the procedure were evaluated. In addition, the duration of the EBUS-TBNA procedure, sedation agents and dosages, recovery time, and complications related to the procedure in the 24 h and applied medications and treatments were recorded.

Results
There was no difference in body mass index, EBUS-TBNA procedure duration, and recovery time between geriatric and young patients(p > 0.05). The proportion of female patients, pre-anesthesia SpO2, and PFTs were found to be significantly lower in geriatric patients(p < 0.05). ASA classification, frequency of comorbidities, and initial mean arterial pressure were found to be significantly higher in the geriatric group(p < 0.05). The propofol-ketamine combination was the most preferred sedative in both groups. The dose of propofol used in the regimen in which propofol was administered alone was found to be lower in the elderly group (p < 0.05). The increase in the HR was significant in Group 2 in the T4 and T5 periods with respect to T1 when the differences were compared (p < 0.05). As a complication, the frequency of high blood pressure during the procedure was higher in the elderly group (p < 0.05).

Conclusions
The EBUS-TBNA procedure performed under DS was safe in elderly and young patients. Our study showed that the procedure and recovery times were similar in the elderly and young groups. The incidence of temporary high blood pressure during the procedure was higher in the elderly patients. The other complication rates during the procedure were similar in groups. Decreased propofol dose in the regimen using propofol alone has shown us that anesthetists are more sensitive to the administration of sedative agents in geriatric patients, taking into account comorbidities and drug interactions.
Sarcopenia is associated with non-motor symptoms in Han Chinese patients with Parkinson's Disease: a cross-sectional study
Authors: Liu Qiu-Wan , Mao Cheng-Jie , Lu Zhao-Hui , Shi Rong-Fang , Zhang Ying-Chun , Zhao Ping , Liu Chun-Feng 
Published: August 2023

Abstract
Background
Sarcopenia is commonly seen in the older adults and increases in incidence with age, also in Parkinson’s disease (PD). Although research has indicated that the development of sarcopenia in patients with PD may be related to both motor symptoms and non-motor symptoms (NMS), the precise relationship between the two conditions remains unclear. Therefore, we aimed to investigate the incidence of sarcopenia in patients with PD and its association with NMS.

Methods
The study included 123 patients with PD and 38 age- and sex-matched healthy controls (HC). All participants were evaluated for sarcopenia using the 2019 Asian Sarcopenia Diagnostic Criteria, and patients with PD underwent standard assessments of motor symptoms and NMS. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were used to examine the association between sarcopenia and NMS in patients with PD.

Results
The incidence of sarcopenia was significantly higher in patients with PD than in HC (26.8% vs. 10.4%, p = 0.046). Multiple logistic regression analysis revealed that poorer sleep quality (odds ratio [OR]: 1.245; 95% confidence interval [CI]: 1.011–1.533; p = 0.040) and fatigue (OR: 1.085, 95% CI: 1.006–1.170, p = 0.034) were independently associated with sarcopenia. ROC analysis indicated that the optimal cut-off value for Pittsburgh Sleep Quality Index (PSQI) scores was 10, with 72.7% sensitivity and 74.4% specificity (area under the curve [AUC] = 0.776, 95% CI: 0.683–0.868, p < 0.001). The optimal cut-off value for Fatigue Severity Scale (FSS) scores was 39, with 87% sensitivity and 50% specificity (AUC = 0.725, 95% CI: 0.629 –0.820, p < 0.001). Joint use of FSS and PSQI scores increased the predictive value for sarcopenia(AUC = 0.804, 95% CI: 0.724–0.885, p < 0.001).

Conclusion
Patients with PD are more susceptible to sarcopenia than healthy older adults, and fatigue and poorer sleep are positively associated with sarcopenia. Further longitudinal studies are needed to clarify the causal relationships.
Targeting sphingolipid metabolism with the sphingosine kinase inhibitor SKI-II overcomes hypoxia-induced chemotherapy resistance in glioblastoma cells: effects on cell death, self-renewal, and invasion
Authors: Sousa Nadia , Geiß Carsten , Bindila Laura , Lieberwirth Ingo , Kim Ella , Régnier-Vigouroux Anne 
Published: August 2023

Abstract
Background
Glioblastoma patients commonly develop resistance to temozolomide chemotherapy. Hypoxia, which supports chemotherapy resistance, favors the expansion of glioblastoma stem cells (GSC), contributing to tumor relapse. Because of a deregulated sphingolipid metabolism, glioblastoma tissues contain high levels of the pro-survival sphingosine-1-phosphate and low levels of the pro-apoptotic ceramide. The latter can be metabolized to sphingosine-1-phosphate by sphingosine kinase (SK) 1 that is overexpressed in glioblastoma. The small molecule SKI-II inhibits SK and dihydroceramide desaturase 1, which converts dihydroceramide to ceramide. We previously reported that SKI-II combined with temozolomide induces caspase-dependent cell death, preceded by dihydrosphingolipids accumulation and autophagy in normoxia. In the present study, we investigated the effects of a low-dose combination of temozolomide and SKI-II under normoxia and hypoxia in glioblastoma cells and patient-derived GCSs.

Methods
Drug synergism was analyzed with the Chou-Talalay Combination Index method. Dose–effect curves of each drug were determined with the Sulforhodamine B colorimetric assay. Cell death mechanisms and autophagy were analyzed by immunofluorescence, flow cytometry and western blot; sphingolipid metabolism alterations by mass spectrometry and gene expression analysis. GSCs self-renewal capacity was determined using extreme limiting dilution assays and invasion of glioblastoma cells using a 3D spheroid model.

Results
Temozolomide resistance of glioblastoma cells was increased under hypoxia. However, combination of temozolomide (48 µM) with SKI-II (2.66 µM) synergistically inhibited glioblastoma cell growth and potentiated glioblastoma cell death relative to single treatments under hypoxia. This low-dose combination did not induce dihydrosphingolipids accumulation, but a decrease in ceramide and its metabolites. It induced oxidative and endoplasmic reticulum stress and triggered caspase-independent cell death. It impaired the self-renewal capacity of temozolomide-resistant GSCs, especially under hypoxia. Furthermore, it decreased invasion of glioblastoma cell spheroids.

Conclusions
This in vitro study provides novel insights on the links between sphingolipid metabolism and invasion, a hallmark of cancer, and cancer stem cells, key drivers of cancer. It demonstrates the therapeutic potential of approaches that combine modulation of sphingolipid metabolism with first-line agent temozolomide in overcoming tumor growth and relapse by reducing hypoxia-induced resistance to chemotherapy and by targeting both differentiated and stem glioblastoma cells.
Factors affecting students’ attitudes towards reproductive health in the north of Iran: Designing an educational program
Authors: Bakhtiari Afsaneh , Pasha Hajar , Kashefi Fatemeh , Nasiri-Amiri Fatemeh , Bakouei Fatemeh 
Published: August 2023

Abstract
Background
It is essential to empower young people to promote reproductive health (RH) and develop effective educational programs to prevent risky behaviors. This study aimed to investigate the factors affecting students’ attitudes towards RH based on the ecological model and then design an educational program.

Methods
This cross-sectional study was conducted on 461 female students aged 18–29 in the north of Iran. This study was done in two stages. In the first stage, factors affecting the attitude towards RH including demographic questionnaire, interpersonal communication skills, family communication pattern, depression, stress and anxiety, body self-image, and self-confidence were determined. In the second stage, an educational program was designed based on the most effective factors. Independent t-test, ANOVA, and multiple linear regression were employed using SPSS version 20 software. Also, STATA version 15 software was utilized for statistical modeling to predict the best predictive model of attitude towards RH.

Results
47.7% of students had a good attitude toward RH. The majority of students had problems with interpersonal communication skills (60.7%). Also, 28.5% experienced depression, 35.8% anxiety, and 12.8% stress at different levels. More than a quarter of the students (26.5%) had poor body self-image and 18.7% had Undesirable self-esteem. Interpersonal skills (P = 0.002), family communication pattern (P = 0.004), stress (p = 0.019), anxiety (P = 0.001), and body self-image (P = 0.034) have a significant relationship with the attitude towards RH. The multiple regression showed that the most important effective factor on RH is the dialogue orientation of family communication pattern (P = 0.041), stress (P = 0.002), and anxiety (P = 0.001).

Conclusion
Stress and anxiety management training and the use of dialogue orientation in the family communication pattern for young female students are recommended based on the scientific model.
Are exposure to health information and media health literacy associated with fruit and vegetable consumption?
Authors: Jindarattanaporn Nongnuch , Rittirong Jongjit , Phulkerd Sirinya , Thapsuwan Sasinee , Thongcharoenchupong Natjera 
Published: August 2023

Abstract
Background
Health information promotes a healthy lifestyle; however, media health literacy (MHL) is essential to personal intake, especially fruit and vegetables (F&V). This study aimed to determine how exposure to health information and MHL affect F&V consumption among Thai youth aged 10–14 years. Health behavior at this age can be an important determinant of consumption habits when transitioning into adulthood.

Methods
A stratified two-stage sample survey was conducted to recruit 1,871 youth across regions to be nationally representative. Qualtrics offline survey application was used for data collection face-to-face with all respondents. Multiple linear regression was used to analyze the explanatory variables on fruit consumption and vegetable consumption.

Results
This study found that almost 70% of Thai youth were exposed to health-related content via the Internet, and had low analytical skills to process that information. Grade Point Average (GPA), exposure to health information, various media types, frequency of exposure to health information, and MHL influenced the frequency of F&V intake. Health status related to fruit intake, age, place of residence, amount of pocket money, and body mass index (BMI) were associated with F&V consumption.

Conclusion
Exposure to health information and MHL are associated with F&V intake. Therefore, exposure to health information and MHL should be addressed for policy formulation in Thai schools and the health system.
Social isolation in COVID-19: a comparative study between Korea and Vietnam
Authors: Jo Hyeon , Baek Eun-Mi 
Published: August 2023

AbstractAmidst the ongoing COVID-19 pandemic, social isolation has become a pressing issue worldwide, deeply affecting individuals’ mental and physical well-being. This study introduces a theoretical model to understand the factors influencing social isolation in the context of this global health crisis. We employed a survey methodology, collecting data from Korean and Vietnamese university students through a Google survey form. The theoretical model was evaluated using structural equation modeling (SEM), and multi-group analysis (MGA) was used to assess differences between the Korean and Vietnamese student groups. The investigation centered on affective risk perception, cognitive risk perception, social distancing attitude, social distancing intention, and demographic factors like age and gender. Our findings revealed that affective and cognitive risk perceptions have significant positive impacts on attitudes toward social distancing. Furthermore, attitudes towards social distancing were found to significantly influence social distancing intentions. Interestingly, social distancing intention was found to have a significant positive correlation with social isolation. Lastly, demographic factors such as gender and age were found to be significant factors influencing social isolation. Specifically, gender had a positive association, while age showed a negative correlation with social isolation. Moreover, our MGA results showed that the relationship between social distancing intention and social isolation significantly differed between the Korean and Vietnamese student groups, indicating potential cultural or societal influences on this relationship. Such understanding could inform policies and strategies aimed at mitigating the adverse effects of social isolation in the wake of global health crises.
Regional perspectives on the coordination and delivery of paediatric end-of-life care in the UK: a qualitative study
Authors: Papworth Andrew , Hackett Julia , Beresford Bryony , Murtagh Fliss , Weatherly Helen , Hinde Sebastian , Bedendo Andre , Walker Gabriella , Noyes Jane , Oddie Sam , Vasudevan Chakrapani , Feltbower Richard G. , Phillips Bob , Hain Richard , Subramanian Gayathri , Haynes Andrew , Fraser Lorna K. 
Published: August 2023

Abstract
Background
Provision of and access to paediatric end-of-life care is inequitable, but previous research on this area has focused on perspectives of health professionals in specific settings or children with specific conditions.
This qualitative study aimed to explore regional perspectives of the successes, and challenges to the equitable coordination and delivery of end-of-life care for children in the UK.
The study provides an overarching perspective on the challenges of delivering and coordinating end-of-life care for children in the UK, and the impact of these on health professionals and organisations. Previous research has not highlighted the successes in the sector, such as the formal and informal coordination of care between different services and sectors.

Methods
Semi-structured interviews with Chairs of the regional Palliative Care Networks across the UK. Chairs or co-Chairs (n = 19) of 15/16 Networks were interviewed between October-December 2021. Data were analysed using thematic analysis.

Results
Three main themes were identified: one standalone theme (“Communication during end-of-life care”); and two overarching themes (“Getting end-of-life services and staff in the right place”, with two themes: “Access to, and staffing of end-of-life care” and “Inconsistent and insufficient funding for end-of-life care services”; and “Linking up healthcare provision”, with three sub-themes: “Coordination successes”, “Role of the networks”, and “Coordination challenges”). Good end-of-life care was facilitated through collaborative and network approaches to service provision, and effective communication with families. The implementation of 24/7 advice lines and the formalisation of joint-working arrangements were highlighted as a way to address the current challenges in the specialism.

Conclusions
Findings demonstrate how informal and formal relationships between organisations and individuals, enabled early communication with families, and collaborative working with specialist services. Formalising these could increase knowledge and awareness of end of life care, improve staff confidence, and overall improve professionals’ experiences of delivering care, and families’ experiences of receiving it.
There are considerable positives that come from collaborative working between different organisations and sectors, and care could be improved if these approaches are funded and formalised. There needs to be consistent funding for paediatric palliative care and there is a clear need for education and training to improve staff knowledge and confidence.