bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stressors in hospitalized patients and their associations with mental health outcomes: testing perceived social support and spiritual well-being as moderators
Authors: Gerges Sarah , Hallit Rabih , Hallit Souheil 
Published: May 2023

Abstract
Background
Although hospitalization can be a burdensome experience for all patients, research into the sources of this distress and potential protective factors has so far been scattered, specifically among the broad hospitalized population across all disease types and inpatient units. The present study explores the frequency and nature of the foremost experienced hassles among a sample of Lebanese hospitalized patients, tracing their correlations with depression and anxiety while also investigating positive coping (i.e., perceived social support and spiritual well-being) as potential moderator of these relationships.

Methods
A total of 452 Lebanese inpatients from all medical units filled a survey composed of a list of 38 stressors experienced during hospitalization and other measures assessing depression, anxiety, perceived social support, and spiritual well-being.

Results
Pain was the most common stressor experienced by the patients (88.9%), followed by the feeling of being overwhelmed (80.3%). When conducting a factor analysis, 18 stressors loaded on 4 distinct factors, hence yielding 4 main stressor groups (i.e., Illness Apprehension, Hopelessness/Uselessness, Social Isolation, and Spiritual Concerns). The multivariable analysis showed that increased illness apprehension (Beta = 0.69) and hopelessness (Beta = 1.37), being married (Beta = 1.17) or divorced (Beta = 1.38) compared to single, being admitted in a two-bed room compared to one-bed (Beta = 1.59), higher financial burden (Beta = 0.24), and lower socio-economic status (Beta = 1.60) were significantly associated with higher anxiety. Additionally, increased hopelessness (Beta = 0.82) and being married (Beta = 0.79) compared to single were significantly associated with higher depression. However, among patients experiencing high levels of stressors, those with high spiritual well-being and perceived social support had lower depressive/anxiety symptoms.

Conclusion
Our study characterized the principal stressors encountered during hospitalization, underscoring their associations with Lebanese inpatients’ mental health. On the other hand, as perceived social support and spiritual well-being acted as negative moderators of these associations, intervention programs aimed at enhancing such adaptive coping techniques are strongly called upon to palliate the psychological distress of patients in hospital settings.
Recruitment and selection of community health workers in Iran; a thematic analysis
Authors: Shakerian Sareh , Gharanjik Gozal Shafeei 
Published: May 2023

Abstract
Background
In Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs.

Methods
This study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8.

Results
Data saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of “CHW effectiveness” and “CHW sustainability”, and three main themes of “criteria for employing competent people”, “barriers to employing competent people”, and “identifying the barriers to employing competent people”, according to the MOH instructions.

Conclusion
In the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.
The use of metformin, sulfonylurea compounds and insulin and the risk of hip fractures in diabetic patients: a systematic review and meta-analysis of observational studies
Authors: Bahardoust Mansour , Yarali Mohsen , Donyadideh Ghazaleh , Rahimi Elham , Naderi Delaram , Tehrani Farshid Monshizadeh , Delpisheh Ali 
Published: May 2023

Abstract
Background
Hip fracture is a major health problem that occurs more often in the elderly, especially in diabetic patients. Some studies have been conducted regarding the effect of anti- diabetic drugs on fractures. But so far, no meta-analysis study has been conducted to investigate the effect of diabetic drugs on hip fractures. Therefore, this study investigated the relationship between anti-diabetic drugs (Metformin, Sulfonylurea, and insulin) with hip fractures.

Methods
In this systematic review and meta analysis study, PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find relevant studies. Two researchers included related studies after screening based on the title and full text. Cochran’s Q and I2 tests were used to assess heterogeneity between studies. Publication bias between studies was evaluated for each drug using Egger’s test. A 95% confidence interval was used for effect size significance. Overall, 49 studies, including 6,631,297 participants, were reviewed.

Results
The results showed that metformin significantly reduced the risk of hip fracture (HR: 0.833, 95% CI: 0.759, 0.914, P:0.001). Consumption of sulfonylurea compounds was significantly associated with an increased risk of hip fracture. (HR: 1.175, 95% CI:1.068,1.293, P:0.001), The risk of hip fracture in patients receiving insulin was significantly higher than in diabetic patients who did not receive insulin. (HR:1.366, 95% CI:1.226,1.522, P:0.001).

Conclusion
The results of this study showed that taking metformin reduces the risk of hip fracture, and insulin and Sulfonylurea increase the risk of hip fracture.
Analysis of risk factors for duodenal leak after repair of a duodenal perforation
Authors: Liu Jianping , Zhou Song , Wang Shaoyi , Xue Xiaojun 
Published: May 2023

Abstract
Background
Repairing of a duodenal perforation is a well accepted procedure, but clinically, approximately 4% of patients develop duodenal leaks after perforation repair, increasing the risk of death. We retrospectively analyzed clinical data from 168 patients at our hospital to explore risk factors for duodenal leak after perforation repair and developed a nomogram for predicting postoperative duodenal leak.

Methods
This retrospective case–control study totalled 168 patients undergoing repair of a duodenal perforation with omentopexy at the General Surgery Department, Dongnan Hospital of Xiamen University, from January 2012 to January 2022. The patients were divided into the non-leak group and the leak group. Risk factors were evaluated by analyzing the patient’s sex, shock, diameter and anatomic position of the ulcer, use of NSAIDS and Glucocorticoid, history of drinking, diabetes, chronic diseases, age, time of onset of symptoms and lab tests.

Result
One hundred fifty-six patients (92.9%) who did not develop leaks after repair of a duodenal perforation were included in the non-leak group, and 12 (7.1%) developed leaks were included in the leak group. In univariate analysis, there were significant differences between the two groups referring to age, shock, NSAIDs, albumin, and perforation size (P < 0.05). The area under the ROC curve for perforation diameter was 0.737, the p-value was 0.006, the optimal cutoff point was 11.5, sensitivity was 58.3%, and specificity was 93.6%, the positive predictive value is 41.1%, and the negative predictive value is 98.0%. In the internal validation of the performance of the nomogram, the C-index and AUC of the model were 0.896(95%CI 0.81–0.98), demonstrating that the nomogram model was well calibrated.

Conclusion
The study discussed the risk factors for postoperative duodenal leak in patients undergoing repair of a duodenal perforation, and a nomogram was constructed to predict the leak. Future prospective studies with large sample sizes and multiple centres are needed to further elucidate the risk of duodenal leak after repair of a duodenal perforation.
Influence of TPH2 and HTR1A polymorphisms on lifelong premature ejaculation risk among the chinese Han population
Authors: Wang Fei , Luo Defan , Chen Jianxiang , Pan Cuiqing , Wang Zhongyao , Fu Housheng , Xu Jianbing , Yang Meng , Mo Shaowei , Zhuang Liying , Wang Weifu 
Published: May 2023

Abstract
Background
Lifelong premature ejaculation (LPE) is one of the most common ejaculatory dysfunctions in men. The serotonin (5-HT) synthesis rate-limiting enzyme (TPH2) and receptor (HTR1A) in the 5-HT regulatory system may play a key role in the pathogenesis of LPE. However, there are few studies on the effects of TPH2 and HTR1A polymorphisms on LPE risk. We speculated that TPH2 and HTR1A polymorphisms may affect the occurrence and development of LPE in the Chinese Han population.

Methods
In this study, 91 patients with LPE and 362 normal controls aged 18 to 64 years were enrolled in the male urology department of Hainan General Hospital in China from January 2016 to December 2018. The SNPs in HTR1A and TPH2, which are related to 5-HT regulation, were selected as indexes to genotype the collected blood samples of participants. Logistic regression was used to analyze the correlation between SNPs of HTR1A and TPH2 with LPE susceptibility, as well as the relationship with leptin, 5-HT and folic acid levels.

Results
The results revealed that HTR1A-rs6295 increased LPE risk in recessive model. Rs11178996 in TPH2 significantly reduced susceptibility to LPE in allelic (odds ratio (OR) = 0.68, 95% confidence interval (95% CI) = 0.49–0.96, p = 0.027), codominant (OR = 0.58, 95% CI = 0.35–0.98, p = 0.040), dominant (OR = 0.58, 95% CI = 0.36–0.92, p = 0.020), and additive (OR = 0.71, 95% CI = 0.52–0.98, p = 0.039) models. Grs11179041Trs10879352 could reduce the risk of LPE (OR = 0.44, 95% CI = 0.22–0.90, p = 0.024) by haplotype analysis.

Conclusion
HTR1A-rs6295 and TPH2-rs11178996 are associated with LPE risk in the Chinese Han population based on the finding of this study.
A rare presentation of central pontine myelinolysis secondary to hyperglycaemia
Authors: Sun Wen-Ping , Wang Ying-Di , Gao Song , Wang Yi-Fan , Li Da-Wei 
Published: May 2023

Abstract
Background
Central pontine myelinolysis (CPM) is a rare demyelinating disorder caused by the loss of myelin in the center of the basis pontis. CPM typically occurs with rapid correction of severe chronic hyponatremia and subsequent disturbances in serum osmolality. Although hyperglycaemia is recognized as a pathogenetic factor in serum osmolality fluctuations, CPM is rarely seen in the context of diabetes.

Case presentation
A 66-year-old Chinese male presented with a history of gait imbalance, mild slurred speech and dysphagia for two weeks. MRI showed the mass lesions in the brainstem, and laboratory examinations showed high blood glucose and HbA1c, as well as increased serum osmolality. The patient was diagnosed with CPM secondary to hyperosmolar hyperglyceamia and received insulin treatment as well as supportive therapy. After six weeks of followup, the patient had fully recovered to a normal state.

Conclusion
CPM is a potentially fatal neurological condition and can occur in uncontrolled diabetes mellitus. Early diagnosis and timely treatment are crucial for improving the prognosis.
Influence of growth structures and fixed appliances on automated cephalometric landmark recognition with a customized convolutional neural network
Authors: Popova Teodora , Stocker Thomas , Khazaei Yeganeh , Malenova Yoana , Wichelhaus Andrea , Sabbagh Hisham 
Published: May 2023

Abstract
Background
One of the main uses of artificial intelligence in the field of orthodontics is automated cephalometric analysis. Aim of the present study was to evaluate whether developmental stages of a dentition, fixed orthodontic appliances or other dental appliances may affect detection of cephalometric landmarks.

Methods
For the purposes of this study a Convolutional Neural Network (CNN) for automated detection of cephalometric landmarks was developed. The model was trained on 430 cephalometric radiographs and its performance was then tested on 460 new radiographs. The accuracy of landmark detection in patients with permanent dentition was compared with that in patients with mixed dentition. Furthermore, the influence of fixed orthodontic appliances and orthodontic brackets and/or bands was investigated only in patients with permanent dentition. A t-test was performed to evaluate the mean radial errors (MREs) against the corresponding SDs for each landmark in the two categories, of which the significance was set at p < 0.05.

Results
The study showed significant differences in the recognition accuracy of the Ap-Inferior point and the Is-Superior point between patients with permanent dentition and mixed dentition, and no significant differences in the recognition process between patients without fixed orthodontic appliances and patients with orthodontic brackets and/or bands and other fixed orthodontic appliances.

Conclusions
The results indicated that growth structures and developmental stages of a dentition had an impact on the performance of the customized CNN model by dental cephalometric landmarks. Fixed orthodontic appliances such as brackets, bands, and other fixed orthodontic appliances, had no significant effect on the performance of the CNN model.
Intravaginal lactic acid gel versus oral metronidazole for treating women with recurrent bacterial vaginosis: the VITA randomised controlled trial
Authors: Ross Jonathan D. C. , Brittain Clare , Anstey Watkins Jocelyn , Kai Joe , David Miruna , Ozolins Mara , Jackson Louise , Abdali Zainab , Hepburn Trish M. , Griffiths Frances , Montgomery Alan , Daniels Jane , Manley Alice , Dean Gillian , Armstrong-Buisseret Lindsay K. 
Published: May 2023

Abstract
Background
Bacterial vaginosis is a common and distressing condition for women. Short-term antibiotic treatment is usually clinically effective, but recurrence is common. We assessed the effectiveness of intravaginal lactic acid gel versus oral metronidazole for treating recurrent bacterial vaginosis.

Methods
We undertook an open-label, multicentre, parallel group, randomised controlled trial in nineteen UK sexual health clinics and a university health centre. Women aged ≥ 16 years, with current bacterial vaginosis symptoms and a preceding history of bacterial vaginosis, were randomised in a 1:1 ratio using a web-based minimisation algorithm, to 400 mg twice daily oral metronidazole tablets or 5 ml once daily intravaginal lactic acid gel, for 7 days. Masking of participants was not possible. The primary outcome was participant-reported resolution of symptoms within 2 weeks. Secondary outcomes included time to first recurrence of symptoms, number of recurrences and repeat treatments over 6 months and side effects.

Results
Five hundred and eighteen participants were randomised before the trial was advised to stop recruiting by the Data Monitoring Committee. Primary outcome data were available for 79% (204/259) allocated to metronidazole and 79% (205/259) allocated to lactic acid gel. Resolution of bacterial vaginosis symptoms within 2 weeks was reported in 70% (143/204) receiving metronidazole versus 47% (97/205) receiving lactic acid gel (adjusted risk difference -23·2%; 95% confidence interval -32.3 to -14·0%). In those participants who had initial resolution and for whom 6 month data were available, 51 of 72 (71%) women in the metronidazole group and 32 of 46 women (70%) in the lactic acid gel group had recurrence of symptoms, with median times to first recurrence of 92 and 126 days, respectively. Reported side effects were more common following metronidazole than lactic acid gel (nausea 32% vs. 8%; taste changes 18% vs. 1%; diarrhoea 20% vs. 6%, respectively).

Conclusions
Metronidazole was more effective than lactic acid gel for short-term resolution of bacterial vaginosis symptoms, but recurrence is common following both treatments. Lactic acid gel was associated with fewer reported side effects.

Trial registration
ISRCTN14161293, prospectively registered on 18th September 2017.
Survey on cervical cancer knowledge and its influencing factors among 2,578 women in Shache county, Kashi, China
Authors: Mijiti Yilidana , Yusupu Hainiguli , Liu Haixia , Zhang Xuefeng , Maimaiti Gulikezi , Kawuli Reyilaimu , Ma Cailing 
Published: May 2023

Abstract
Background
In the southern part of Xinjiang, the incidence and mortality rates of the cervical cancer among Uyghurs are significantly higher than those of other ethnic groups living in the same environment, and their mortality rate takes the first place among ethnic minorities in China.

Objective
To assess the level of cervical cancer knowledge by Questionnaire survey using the scoring system and its influencing factors among women in Shache county, Kashi, China.

Method
Based on the cervical cancer health education carried out by the medical team of the county hospital to the residents in the urban and rural areas of Shache County from September 1st, 2022, to September 30th, 2022, a cluster sampling was conducted at the same time and a total of 2578 women were included. The questionnaire survey includes resident basic information, and their knowledge about cervical cancer which was evaluated by the scoring system. The scoring system of the knowledge about cervical cancer includes 4 items, the total score was 8 point and scored more than 4 points was used as knowledge knowing, the knowledge of cervical cancer (unknown = 0; known = 1) was used as the dependent variable. Six factors include residence area (urban or rural), age, ethnic group, educational level, occupation, and the ways to acquire knowledge access were used as independent variables. The retrieved questionnaire was entered by the medical staff, and the Excel software was used for duplicate verification. Chi-square test and unconditional logistic regression analysis were used for statistical analysis.

Results
Of the 2578 study subjects, 1591 were from rural areas and 987 were from the urban areas, and the differences were statistically significant (P < 0.001). Based on the scoring system of the knowledge about cervical cancer, the knowledge knowing accounts for only 34.1%. Multivariate logistic regression analysis showed that living in the urban(AOR = 1.358,95% CI:1.111–1.659), occupation of non-farming and non-housewife(AOR = 2.680,95%CI:2.126–3.377), education level of high school and above(AOR = 1.388,95%CI:1.125–1.712), and four or more access to knowledge(AOR = 1.446,95%CI:1.099–1.903) were protective factors for cervical cancer knowledge knowing.

Conclusion
Based on the questionnaire survey, the level of cervical cancer knowledge among women in Shache county was inadequate. Considering above mention influencing factors, it is necessary for the medical and health institutions to take various measures to carry out targeted health education on cervical knowledge for women in Shache county.
Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)
Authors: Kim Catherine , Schreiner Pamela J. , Siscovick David , Wang Ange , Wellons Melissa F. , Ebong Imo , Vu Thanh-Huyen , Appiah Duke , Catov Janet , Schisterman Enrique F. , Yin Zhe , Lewis Cora E. 
Published: May 2023

Abstract
Background
Polycystic ovary syndrome (PCOS) is underdiagnosed, but factors associated with women’s report of diagnosis are not well-understood, particularly social determinants of health. Therefore, in a population-based cohort, we compared the characteristics of women with self-reported PCOS vs. women who have unrecognized PCOS vs. women without PCOS.

Methods
We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a population-based, prospective cohort of Black and White women. Participants were women (n = 2028) who responded to the question, “Did a doctor or nurse ever tell you that you had polycystic ovarian syndrome or polycystic ovarian disease?” at the year 15 examination. Women who answered “yes” were defined as having self-reported PCOS. Women who answered “no or not sure” were defined as having unrecognized PCOS if they also had irregular menses and hyperandrogenemia between 20 and 30 years of age. Exposures of interest included social determinants of health, symptoms including irregular menses and hirsutism, and comorbid conditions.

Results
Forty-three (2.1%) of women had self-reported PCOS, 135 (6.7%) had unrecognized PCOS, and 1850 (91%) women were without PCOS. In logistic regression models adjusting for age, race, and center, women with self-reported PCOS were more likely to have obesity (OR 1.83, 95% CI 1.22, 2.75) and diabetes (OR 2.37, 95% CI 1.05, 5.33) compared to women without PCOS. Women with unrecognized PCOS were more likely to have hypertension (OR 1.68, 95% CI 1.03, 2.74) and food insecurity (OR 1.94, 95% CI 1.25, 3.01) compared to women without PCOS.

Conclusions
Unrecognized PCOS is common. Self-report of PCOS is not associated with access to healthcare. Women who report PCOS are more often obese and comorbidities may contribute to recognition of PCOS.
Big knowledge visualization of the COVID-19 CIDO ontology evolution
Authors: Zheng Ling , Perl Yehoshua , He Yongqun 
Published: May 2023

Abstract
Background
The extensive international research for medications and vaccines for the devastating COVID-19 pandemic requires a standard reference ontology. Among the current COVID-19 ontologies, the Coronavirus Infectious Disease Ontology (CIDO) is the largest one. Furthermore, it keeps growing very frequently. Researchers using CIDO as a reference ontology, need a quick update about the content added in a recent release to know how relevant the new concepts are to their research needs. Although CIDO is only a medium size ontology, it is still a large knowledge base posing a challenge for a user interested in obtaining the “big picture” of content changes between releases. Both a theoretical framework and a proper visualization are required to provide such a “big picture”.

Methods
The child-of-based layout of the weighted aggregate partial-area taxonomy summarization network (WAT) provides a “big picture” convenient visualization of the content of an ontology. In this paper we address the “big picture” of content changes between two releases of an ontology. We introduce a new DIFF framework named Diff Weighted Aggregate Taxonomy (DWAT) to display the differences between the WATs of two releases of an ontology. We use a layered approach which consists first of a DWAT of major subjects in CIDO, and then drill down a major subject of interest in the top-level DWAT to obtain a DWAT of secondary subjects and even further refined layers.

Results
A visualization of the Diff Weighted Aggregate Taxonomy is demonstrated on the CIDO ontology. The evolution of CIDO between 2020 and 2022 is demonstrated in two perspectives. Drilling down for a DWAT of secondary subject networks is also demonstrated. We illustrate how the DWAT of CIDO provides insight into its evolution.

Conclusions
The new Diff Weighted Aggregate Taxonomy enables a layered approach to view the “big picture” of the changes in the content between two releases of an ontology.