bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complicated urachal cyst in two pediatric patients: a case report
Authors: Kamel Karol , Nasr Hadeer , Tawfik Sherifa , Azzam Ahmed , Elsaid Mohamed , Qinawy Mohamed , Kamal Ahmed , Taher Heba 
Published: April 2023

Abstract
Background
A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth.

Case presentation
We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder.

Conclusion
Complicated urachal cysts can present with acute abdominal pain.
The relative age effect on fundamental movement skills in Chinese children aged 3–5 years
Authors: Li Kai , Chen Sitong , Ma Jiani , Martins Clarice , Duncan Michael , Sheng Xinxin , Liu Shijie , Cai Yujun 
Published: April 2023

Abstract
Background
The cut-off date in the education system causes a relative age difference, with developmental advantages for children who are born on the “early side” of the cut-off date and disadvantages for those born later, which is known as the relative age effect (RAE). Very few studies have examined whether there is a RAE on the development of fundamental movement skills (FMSs) in preschool children, and no studies have been conducted in China. The purpose of this study is to identify whether a RAE exists on FMS in Chinese preschool children, comparing RAEs according to gender and age.

Methods
From a total of 378 invited preschool children regularly registered at one Chinese kindergarten, a total of 288 healthy and typically developing preschoolers (4.33 ± 0.84 years-old; 56.6% boys) were included in this study. All children were required to take part in anthropometry and FMS assessments. Analysis of covariance (ANCOVA) was applied to examine the difference in each of the FMS items across quarter categories, year and gender groups, controlling for body mass index (BMI).

Results
For the overall sample, the data show the significant main effects on the quarter of birth factor in locomotor skills (LC; F (3, 265) = 2.811, p = 0.04, ηp2 = 0.031), object control skills (OB; F (3, 265) = 6.319, p = 0.04, ηp2 = 0.031), and total test score (TTS; F (3, 265) = 5.988, p = 0.001, ηp2 = 0.063). There were also significant differences in the age effect on all the domains of FMS (FLC (2, 265) = 100.654, p < 0.001, ηp2 = 0.432; FOB (2, 265) = 108.430, p < 0.001, ηp2 = 0.450; FTTS (2, 265) = 147.234, p < 0.001, ηp2 = 0.526) but a gender effect only in LC (F (1, 265) = 20.858; p < 0.001; ηp2 = 0.073). For gender and quarter of birth groups, RAEs in LC only exists in girls. Moreover, regarding age and quarter of birth factors, RAEs are only found at younger ages.

Conclusions
This study suggests the existence of RAEs in the FMS of Chinese preschool children. Teachers need to be aware of the effect of RAEs on the FMS when approaching development, evaluation, and teaching approaches in preschools.
An intervention to promote positive homeworker health and wellbeing through effective home-working practices: a feasibility and acceptability study
Authors: Keightley Samuel , Duncan Myanna , Gardner Benjamin 
Published: April 2023

Abstract
Background

In the wake of Covid-19, the prevalence of working from home (‘home-working’) is expected to rise. Yet, working from home can have negative health and wellbeing impacts. Interventions are needed to promote effective ways of working that also protect workers’ health and wellbeing. This study explored the feasibility and acceptability of an intervention intended to promote home-working practices that would protect and promote health behaviour and wellbeing.

Methods
An uncontrolled, single-arm mixed-methods trial design was employed. Forty-two normally-office-based UK workers, working from home between January–February 2021 (during the Covid pandemic), consented to receive the intervention. The intervention: a digital document offering evidence-based recommendations for home-working in ways conducive to health behaviour and wellbeing. Feasibility and acceptability were quantitatively indexed by: expressions of interest within 1 week (target threshold ≥ 35); attrition across the one-week study period (threshold ≤ 20%); and the absence of any apparent detriments in self-reported physical activity, sedentary behaviour, snacking, and work-related wellbeing prior to and one week after receiving the intervention. Qualitative think-aloud data, obtained while participants read through the intervention, and analysed using reflexive thematic analysis, explored acceptability. Semi-structured interviews conducted one week after intervention exposure were content-analysed to identify whether and which behaviour changes were adopted.

Results
Two feasibility criteria were met: 85 expressions of interest indicated satisfactory intervention demand, and no detriments were observed in health behaviours or wellbeing. Forty-two participants (i.e., maximum capacity for the study; 26 females, 16 males, aged 22–63) consented to take part. 31% dropped out over the one-week study period leaving a final sample of 29 (18 females, 11 males, aged 22–63), exceeding identified attrition thresholds. Think-aloud data showed that participants concurred with intervention guidance, but felt it lacked novelty and practicality. Follow-up interviews produced 18 (62%) participant reports of intervention adherence, where nine recommendations reportedly prompted behaviour change in at least one participant.

Conclusions
Mixed evidence was found for intervention feasibility and acceptability. Whilst the information was deemed relevant and of value, further development is required to increase its novelty. It may also be more fruitful to provide this information via employers, to encourage and emphasise employer endorsement.
Understanding risk factors for musculoskeletal disorders in Iranian housewives: Development of a comprehensive health promotion behavior model
Authors: Norouzi Samaneh , Tavafian Sedigheh Sadat , Cousins Rosanna , Mokarami Hamidreza 
Published: April 2023

Abstract
Background
Chronic musculoskeletal problems are a major source of disability, reduced productivity and poor quality of life. Prevalence of musculoskeletal disorders among Iranian housewives is particularly high. Understanding how housework causes the injuries, mobility restrictions and pain associated with musculoskeletal disorders is vital to developing health promotion behavior models to support intervention. The aim of this qualitative study was to explore the experiences of housewives with musculoskeletal disorders and, according to the risk factors identified, to develop a comprehensive behavior change framework to facilitate implementing a musculoskeletal health-promoting training intervention for women.

Methods
Twenty-four in-depth interviews were conducted with Iranian housewives aged 20–65 years experiencing musculoskeletal pain over a 13-month period from September 2020 to October 2021. The conventional content analysis approach was used to interrogate the data. The transcript of each interview was considered a unit of analysis, and data analysis was performed using MAXQDA2018 software.

Results
The analysis of the interview data provided 1432 meaning units. From these codes, a conceptual framework was developed. This comprehensive model is comprised of 24 subcategories, eight categories and three themes: Individual and social predictors of MSDs and their control, Risk factors for MSDs, and Prevention and treatment of MSDs. Altogether the developed conceptual framework specified the multiple risk factors for MSDs in housewives. The findings were aligned to various health promotion models, and it was seen that ecological models, especially the Theory of Triadic Influence, can be very helpful as a supportive roadmap to implementing multilateral interventions to improve the quality of life of housewives.

Conclusions
This study developed an evidence based comprehensive model that identifies the individual, psychosocial, and cultural factors that influence the status of MSDs in women’s domestic work to support the development and implementation of effective ergonomic interventions to manage potentials for MSDs.
Low human beta-defensin-2 levels in the sputum of COPD patients are associated with the risk of exacerbations
Authors: Feng Shengchuan , Yang Yuqiong , Wang Fengyan , Shi Weijuan , Xu Jiaxuan , Tang Guoyan , Xie Jiaxing , Zhong Nanshan , Liang Zhenyu , Chen Rongchang 
Published: April 2023

Abstract
Rationale
Chronic obstructive pulmonary disease (COPD) is a complicated chronic inflammatory disease. It is important to investigate the characteristics of acute exacerbation of COPD to develop new therapeutic strategies.

Objective
This study aimed to determine the relationship between the human beta-defensin-2 (hBD-2) levels and aggravation of COPD.

Methods
We detected the sputum hBD-2 level of 254 patients from Guangzhou, China, for 2 years. The study participants were categorized into the COPD group (n = 203, GOLD 0–4) and the control group (n = 51, 40–79 years old). At baseline, 12th month, and 24th month, we detected the sputum hBD-2 level and levels of cytokines, such as CXCL10, CXCL11, and IFN.

Results
At baseline, there were no significant differences in the sputum and serum hBD-2 levels between the patients and the controls. However, the sputum hBD-2 levels of patients who had at least one symptom aggravation over the next 2 years were significantly lower than those of patients without any exacerbations (1130.9 ± 858.4 pg/mL vs. 2103.7 ± 1294.2 pg/mL, respectively; p = 0.001). Nevertheless, there were no statistically significant differences in the sputum hBD-2 levels between patients (no aggravation history) and controls (2084.9 ± 1317.6 pg/mL vs. 2152.5 ± 1251.6 pg/mL, respectively; p = 0.626). We used a logistic regression model to assess the relationship between aggravation and sputum hBD-2 levels. Interestingly, we found that low hBD-2 level (< 1000 pg/mL) was significantly associated with exacerbations. Specifically, patients with low hBD-2 levels were more likely to experience exacerbations in the next 12 months (0.333 vs. 0.117; p = 0.001). Moreover, we compared the hBD-2 levels between controls and patients with GOLD 3–4 and found that participants with bacteria (+) and/or viruses (+) had an association between hBD-2 level and disease severity (p = 0.02).

Conclusion
Patients at risk of exacerbations are more likely to have lower sputum hBD-2 levels. These results have important implications for future therapies for COPD.
Spanish menstrual literacy and experiences of menstruation
Authors: Sánchez López Sara , Barrington Dani Jennifer , Poveda Bautista Rocio , Moll López Santiago 
Published: April 2023

AbstractThere is growing recognition of the important role menstrual health plays in achieving health, education, and gender equity. Yet, stigmatisation and taboo remain present and negative emotions like fear and shame dominate the narrative when speaking about periods. This paper analyses how formal and informal menstrual education is received in Spain, to understand the role of menstrual health literacy in the way menstruation is experienced, and to identify what information would be useful to integrate into formal menstrual education. An online survey with more than 4000 participants (aged between 14 and 80, both people who will/do/have previously menstruate/d and those who do not menstruate) was conducted. Data was gathered using the digital platform Typeform, descriptive and inferential statistical analyses were performed with SPSS software and qualitative data was thematically analysed using Nvivo. Many participants declared not having received sufficient information on menstruation prior to menarche, particularly about how to physically manage it. Furthermore, negative emotions like shame, worry, and fear were recurrently reported to describe menarche; this has not changed between generations. Interestingly, we saw an increase in stress and sadness with an increase in perceived knowledge of the reproductive role of menstruation. We did observe a reduction in negative emotions when people who menstruate perceived they had sufficient information on how to manage their first bleeding. It is recommended that menstrual education beyond reproductive biology, particularly including how to physically manage periods, is integrated into school curricula. Menstrual education of everyone – including those who do not menstruate—can improve how periods are experienced in Spain.
Decreasing the options’ number in multiple choice questions in the assessment of senior medical students and its effect on exam psychometrics and distractors’ function
Authors: Al-lawama Manar , Kumwenda Ben 
Published: April 2023

Abstract
Background
Studies that have investigated the effect options’ number in MCQ tests used in the assessments of senior medical students are scarce. This study aims to compare exam psychometrics between three- and five-option MCQ tests in final-year assessments.

Methods
A cluster randomized study was applied. Participants were classified into three groups, according to their academic levels. Students in each of those levels were randomized into either the three- or five-option test groups.

Results
Mean time to finish the five-option test was 45 min, versus 32 min for the three-option group. Cronbach’s alpha was 0.89 for the three-option group, versus 0.81 for the five-options, p-value = 0.19. The mean difficulty index for the three-option group was 0.75, compared to 0.73 for the five-option group, p-value = 0.57. The mean discriminating index was 0.53 for the three-option group, and 0.45 for the five-options, p-value = 0.07. The frequency of non-functioning distractors was higher in the five-option test, 111 (56%), versus 39 (39%) in the three-options, with p-value < 0.01.

Conclusions
This study has shown that three-option MCQs are comparable to five-option MCQs, in terms of exam psychometrics. Three-option MCQs are superior to five-option tests regarding distractors’ effectiveness and saving administrative time.
Maternal vaccination against pertussis as part of the national immunization program: a qualitative evaluation among obstetric care providers one year after the implementation in December 2019
Authors: Immink Maarten M. , van Zoonen Kim , Jager Nina M. , Pluijmaekers Anne J.M. , de Melker Hester E. , van der Maas Nicoline A.T. , Bekker Mireille N. 
Published: April 2023

Abstract
Background
Immunization of pregnant women with a tetanus-diphtheria-and-acellular-pertussis (Tdap) vaccine is an effective and safe way to protect infants from pertussis before their primary vaccinations. Vaccine uptake among pregnant women is influenced by their care providers’ attitudes toward maternal vaccination. This qualitative study aimed to evaluate the implementation of the maternal Tdap vaccination under the National Immunization Program of the Netherlands from the perspective of obstetric care providers.

Methods
In this qualitative and explorative study, we conducted in-depth interviews by telephone with obstetric care providers who were selected from a pool of respondents (convenience sampling) to a questionnaire in a previous study. The interviews were based on a semi-structured interview guide that covered three aspects of the implementation strategy: providers’ overall experience with the implementation of maternal Tdap vaccination in the Netherlands; implementation logistics and counseling, and pregnant women referrals to municipal Youth Healthcare Centers. The interviews were recorded, pseudonymized and transcribed verbatim. Transcripts were analyzed according to the Thematic Analysis approach by two researchers independently in two phases of iterative coding, categorizing, reviewing and redefining until ultimately, emergent themes regarding maternal Tdap vaccination implementation were identified.

Results
Interviews with 11 midwives and 5 OB-GYN physicians yielded 5 major themes regarding the Tdap vaccination implementation strategy: challenges throughout the implementation process, views on maternal Tdap vaccination, general versus tailored counseling, provider responsibilities in vaccine promotion, and impact of materials for information delivery. Participants indicated that to improve provider attitudes toward Tdap vaccination, its implementation requires clear and transparent information about what is entailed, i.e., what is expected from obstetric care providers, how they can obtain information, and when their actions must be initiated. Participants demanded involvement throughout the implementation planning process. They preferred tailored communication with pregnant women over a generalized approach.

Conclusion
This study emphasized the importance of involving all relevant healthcare professionals in planning the implementation of maternal Tdap vaccination. Possible barriers perceived by these professionals should be taken into account in order to improve their attitudes toward vaccination, thus to increase uptake among pregnant women.
Estimating the cost of HIV services for key populations provided by the LINKAGES program in Kenya and Malawi
Authors: Opuni Marjorie , Sanchez-Morales Jorge Eduardo , Figueroa Jose Luis , Salas-Ortiz Andrea , Banda Louis Masankha , Olawo Alice , Munthali Spy , Korir Julius , DiCarlo Meghan , Bautista-Arredondo Sergio 
Published: April 2023

AbstractBackgroundData remain scarce on the costs of HIV services for key populations (KPs). The objective of this study was to bridge this gap in the literature by estimating the unit costs of HIV services delivered to KPs in the LINKAGES program in Kenya and Malawi. We estimated the mean total unit costs of seven clinical services: post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), HIV testing services (HTS), antiretroviral therapy (ART), sexually transmitted infection (STI) services, sexual and reproductive health (SRH) services, and management of sexual violence (MSV). These costs take into account the costs of non-clinical services delivered alongside clinical services and the pre-service and above-service program management integral to the LINKAGES program.MethodsData were collected at all implementation levels of the LINKAGES program including 30 drop-in-centers (DICs) in Kenya and 15 in Malawi. This study was conducted from the provider’s perspective. We estimated economic costs for FY 2019 and cost estimates include start-up costs. Start-up and capital costs were annualized using a discount rate of 3%. We used a combination of top-down and bottom-up costing approaches. Top-down methods were used to estimate the costs of headquarters, country offices, and implementing partners. Bottom-up micro-costing methods were used to measure the quantities and prices of inputs used to produce services in DICs. Volume-weighted mean unit costs were calculated for each clinical service. Costs are presented in 2019 United States dollars (US$).ResultsThe mean total unit costs per service ranged from US$18 (95% CI: 16, 21) for STI services to US$635 (95% CI: 484, 785) for PrEP in Kenya and from US$41 (95% CI: 37, 44) for STI services to US$1,240 (95% CI 1156, 1324) for MSV in Malawi. Clinical costs accounted for between 21 and 59% of total mean unit costs in Kenya, and between 25 and 38% in Malawi. Indirect costs—including start-up activities, the costs of KP interventions implemented alongside clinical services, and program management and data monitoring—made up the remaining costs incurred.ConclusionsA better understanding of the cost of HIV services is highly relevant for budgeting and planning purposes and for optimizing HIV services. When considering all service delivery costs of a comprehensive HIV service package for KPs, costs of services can be significantly higher than when considering direct clinical service costs alone. These estimates can inform investment cases, strategic plans and other budgeting exercises.
Judicial and legislative practice and related suggestions on off-label drug use in China
Authors: Si Wenjie , Ma Panpan 
Published: April 2023

Abstract
Background
Off-label drug use exists widely in medical practice and is also an area which easily triggers controversy between patients and medical institutions. Previous studies have identified the reasons why off-label drug use long exists. However, there is no multidimensional analysis on real judicial precedents about off-label drug use. This study aimed to investigate the dispute points on off-label drug use based on real cases in China, and proposed suggestions based on newly-leased Physicians Law.

Methods
Our study is a retrospective study with all the 35 judicial precedents on off-label drug use extracted from China Judgments Online from 2014 to 2019. This study mainly used the methods of statistical analysis, inferential analysis, exemplification, literature summarization and comparative analysis.

Results
According to the analysis of the 35 precedents of jurisdictions from 11 different aspects, it can be seen that the second-instance and retrial rates of this kind of cases are high, and the disputes between patients and medical institutions are fierce. In judicial practice of off-label drug use, medical institutions are determined whether to bear civil liability according to the constituent elements of medical tort liability: the rate of medical institutions’ bearing liability for off-label drug use is not high, and medical institutions are not directly identified as infringing acts and they don’t bear tort liability. The clear provisions about off-label drug use in Law of the People’s Republic of China on Physicians which was implemented in March 2022 confirm this at the legislative level.

Conclusions
By analyzing the current judicial practice of China’s off-label drug use cases, and summarizing the dispute points between medical institution and patients, the constituent elements of tort liability, and the rules of evidence etc., suggestions are proposed to further regulate off-label drug use and promote safe and rational drug use.
DNAJB7 is dispensable for male fertility in mice
Authors: Bai Shun , Hu Meihong , Yu Lina , Chen Linjun , Zhou Jidong , Wu Limin , Xu Bo , Jiang Xiaohua , Zhang Xindong , Tong Xianhong , Yue Qiuling 
Published: April 2023

Abstract
Background
DNAJBs are highly conserved proteins that are involved in various biological processes. Although several DNAJBs are highly expressed in the testis, the function of DNAJB7 in spermatogenesis and male fertility remains unclear.

Methods
To identify the role of DNAJB7 in the male reproduction process, Dnajb7-deficient mice were generated by the CRISPR/Cas9-mediated genome editing system. Histological and immunofluorescence assays were performed to analyze the phenotype of the Dnajb7 mutants.

Results
DNAJB7 is specifically expressed in haploid germ cells. Dnajb7 knockout mice are fertile and do not have any detectable defects in Sertoli cells, spermatogonia, meiotic and postmeiotic cells, indicating that DNAJB7 is not essential for spermatogenesis.

Conclusions
Our findings suggest that DNAJB7 is dispensable for male fertility in mice, which could prevent duplicative work by other groups.