bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-period-cohort analysis of lung cancer mortality inequalities in Southern Spain: missed opportunities for implementing equitable tobacco control policies
Authors: Córdoba-Doña Juan Antonio , Benítez-Rodríguez Encarnación , Escolar-Pujolar Antonio , Santos-Sánchez Vanessa 
Published: July 2023

AbstractBackgroundLung cancer mortality in European countries shows different epidemiological patterns according to sex and socioeconomic variables. Some countries show decreasing rates in both sexes, while others show a delayed profile, with increasing mortality in women, inconsistently influenced by socioeconomic status. Our aim was to evaluate the effect of age, period and birth cohort on lung cancer mortality inequalities in men and women in Andalusia, the southernmost region in Spain.MethodsWe used the Longitudinal Database of the Andalusian Population, which collects demographic and mortality data from the 2001 census cohort of more than 7.35 million Andalusians, followed up between 2002 and 2016. Mortality rates were calculated for men and women by educational level, and small-area deprivation. Poisson models were used to assess trends in socioeconomic inequalities in men and women. Finally, age-period-cohort (APC) models were used separately for each educational level and gender.ResultsThere were 39,408 lung cancer deaths in men and 5,511 in women, yielding crude mortality rates of 78.1 and 11.4 × 105person-years, respectively. In men higher mortality was found in less educated groups and inequalities increased during the study period: i.e. the rate ratio for primary studies compared to university studies increased from 1.30 (CI95:1.18–1.44) to 1.57 (CI95:1.43–1.73). For women, educational inequalities in favour of the less educated tended to decrease moderately. In APC analysis, a decreasing period effect in men and an increasing one in women were observed. Cohort effect differed significantly by educational level. In men, the lower the educational level, the earlier the peak effect was reached, with a 25-year difference between the least-educated and college-educated. Conversely, college-educated women reached the peak effect with a 12-year earlier cohort than the least-educated women. The decline of mortality followed the same pattern both in men and women, with the best-educated groups experiencing declining rates with earlier birth cohorts.ConclusionsOur study reveals that APC analysis by education helps to uncover changes in trends occurring in different socioeconomic and gender groups, which, combined with data on smoking prevalence, provide important clues for action. Despite its limitations, this approach to the study of lung cancer inequalities allows for the assessment of gaps in historical and current tobacco policies and the identification of population groups that need to be prioritised for public health interventions.
A case of acquired thrombotic thrombocytopenic purpura induced by acute severe hepatitis E: successfully treated by plasma exchange and rituximab
Authors: Ou Yingwei , Xu Yifan , Tan Zhaowang , Pang Lingxiao , Li Shengqin , Li Qian , Cai Wenwei , Nan Yong , Tu Jianfeng 
Published: July 2023

AbstractWith its low morbidity and high mortality rates, thrombotic thrombocytopenic purpura (TTP) has imposed a critical physical and economic burden on both society and individuals. Thrombocytopenia commonly occurs in severe liver failure, and a variety of hepatitis viruses are known to induce immune thrombocytopenic purpura. However, TTP is extremely rare in hepatitis E virus infection. We hereby report a case of a 53-year-old male who present with TTP caused by severe hepatitis E, and the patients achieved successful recovery after treatment. Therefore, we propose considering AMAMTS13 testing as an essential and beneficial approach for accurately diagnosing and treating patients with severe hepatitis or infection with notable platelet decline.
Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil
Authors: De Freitas Lopes Ana Carolina , Novaes Hillegonda Maria Dutilh , De Soárez Patrícia Coelho 
Published: July 2023

Abstract
Background
The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec’s recommendations following these PC.

Methods
This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec’s recommendations following PC.

Results
A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33–13.35, p = 0.02).

Conclusions
Increased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.
Exercise mitigates Dapagliflozin-induced skeletal muscle atrophy in STZ-induced diabetic rats
Authors: Yang Xudong , Wang Lifeng , Zhang Liangzhi , Zhai Xia , Sheng Xiusheng , Quan Helong , Lin Hengjun 
Published: July 2023

Abstract
Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are commonly used in the management of type 2 diabetes mellitus (T2DM) and have been found to worsen the reduction of skeletal muscle mass in individuals with T2DM. This study aims to examine the potential of exercise in mitigating the skeletal muscle atrophy induced by SGLT2i treatment.

Methods
A rat model of T2DM (40 male Sprague-Dawley rats; T2DM induced by a combination of high-fat diet and streptozotocin) was used to examine the effects of six-week treatment with Dapagliflozin (DAPA, SGLT2i) in combination with either aerobic exercise (AE) or resistance training (RT) on skeletal muscle. T2DM-eligible rats were randomized into the T2DM control group (CON, n = 6), DAPA treatment group (DAPA, n = 6), DAPA combined with aerobic exercise intervention group (DAPA + AE, n = 6), and DAPA combined with resistance training intervention group (DAPA + RT, n = 6). To assess the morphological changes in skeletal muscle, myosin ATPase and HE staining were performed. mRNA expression levels of Atrogin-1, MuRF1, and Myostatin were determined using quantitative PCR. Furthermore, protein expression levels of AKT, p70S6K, mTOR, FoXO1/3A, NF-κB, and MuRF1 were examined through western blotting.

Results
Both the administration of DAPA alone and the combined exercise intervention with DAPA resulted in significant reductions in blood glucose levels and body weight in rats. However, DAPA alone administration led to a decrease in skeletal muscle mass, whereas RT significantly increased skeletal muscle mass and muscle fiber cross-sectional area. The DAPA + RT group exhibited notable increases in both total protein levels and phosphorylation levels of AKT and p70S6K in skeletal muscle. Moreover, the DAPA, DAPA + AE, and DAPA + RT groups demonstrated downregulation of protein expression (FoXO1/3A) and mRNA levels (Atrogin-1, MuRF1, and Myostatin) associated with muscle atrophy.

Conclusions
Our findings provide support for the notion that dapagliflozin may induce skeletal muscle atrophy through mechanisms unrelated to protein metabolism impairment in skeletal muscle, as it does not hinder protein metabolic pathways while reduces muscle atrophy-related genes. Additionally, our observations reveal that RT proves more effective than AE in enhancing skeletal muscle mass and muscle fiber cross-sectional area in rats with T2DM by stimulating protein anabolism within the skeletal muscle.
An analysis of the effect of fiscal expenditure on the income distribution of Chilean households
Authors: Garrido Nicolas , Morales Jeffrey 
Published: July 2023

AbstractThis study analyzes the effect of government spending on income distribution in Chile for 2016 using a multiplier model with the Social Accounting Matrix. The results indicate that increasing fiscal expenditure has a regressive effect on the income share of households in the richest quintile and widens the income gap between the two poorest quintiles and the third and fourth quintiles. When the effect of fiscal expenditure is measured by its nominal impact, households with the highest income receive approximately ten times more income than those with the lowest income. Thus, the regressivity of the income share of the richest households conceals an unequal distribution of the nominal income generated by the fiscal expenditure. Using counterfactual simulations, we suggested that fiscal expenditures could become more equalitarian through policies affecting the distribution of labor payments.
Parenting profiles: motivation toward health-oriented physical activity and intention to be physically active
Authors: Vega-Díaz Marta , González-García Higinio , De Labra Carmen 
Published: July 2023

Abstract
Introduction
Parents influence their sons’ and daughters’ interest in practicing and maintaining physical activity through parenting patterns.

Objective
To identify perceived parenting style profiles and examine whether the participants differed in their motivation toward health-oriented physical activity and the intention to be physically active.

Method
A sample of 296 participants completed a series of self-report measures and a latent profile analysis (LPA) was performed.

Results
Two profiles emerged as the most suitable: profile (a) with average scores in parenting variables, and profile (b) with high scores in parenting variables. The results revealed significant differences in integrated regulation and in amotivation, reporting higher scores for profile (b) in the parenting variables love/affection, hostility/aggression, and indifference/neglect, and average in undifferentiated/rejection and control.

Conclusion
The combination of perceived parenting style variables in the profiles seems to influence people’s motivation toward health-oriented physical activity. As such, it is crucial to understand parenting from a multivariate approach, mostly in interventions to adjust parenting styles to the most suitable combination.
The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women
Authors: Godoy-Izquierdo Débora , Lara-Moreno Raquel , Ogallar-Blanco Adelaida , González Juan , de Teresa Carlos , Mendoza Nicolás 
Published: July 2023

AbstractBackgroundThe postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.Methods/designThis study was approved by the authors’ Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.DiscussionThis paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women’s adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.Trial registrationISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).
Modules in robust but low-efficiency phyllosphere fungal networks drive saponin accumulation in leaves of different Panax species
Authors: Zhang Guozhuang , Shi Liping , Liu Congsheng , Mao Renjun , Xia Bing , Huang Zhixin , Wei Xiuye , Wu Lixuan , Zheng Yuqing , Wei Guangfei , Xu Jia , Gao Shuangrong , Chen Shilin , Dong Linlin 
Published: July 2023

Abstract
Background
The phyllosphere mycobiome plays a crucial role in plant fitness and ecosystem functions. The complex microbial ecological networks (MEN) formed by these fungi remain poorly understood, particularly with regard to their organization strategy and their contributions to plant secondary metabolites such as saponin.

Results
In this study, we constructed six MENs from leaf epiphytic and endophytic mycobiomes of three Panax species distributed in the northeast and southwest ends of mainland China. Hub nodes were absent in these MENs, which were significantly more complex, robust, and less efficient compared to random graphs (P < 0.05), indicating a hub-independent high-robustness strategy to maintain structural homeostasis. The important roles of specific MEN modules in shaping leaf saponin profiles of each Panax species were proved by multiple machine learning algorithms. Positive regulation modules (PRMs) of total saponin content were further identified, which exhibited more deterministic ecological assembly and comprised of highly connected nodes as well as higher proportion of plant-associated fungal guilds compared to other network members, indicating their tight links with host plant. The significant and direct effects (P < 0.05) of PRMs on total saponin accumulation were validated by well-fitted structural equation models (χ2 < 0.3, P > 0.5). Taxonomic analysis revealed that Pleosporales and Chaetothyriales were significantly overrepresented by positive regulation taxa (PRT) of total saponin content (FDR < 0.05). Across PRT identified in three Panax species, Epicoccum and Coniothyrium were conservatively present, while species-specific taxa such as Agaricales were also found, indicating the conservatism and specificity of plant-fungi interactions associated with leaf saponin accumulation in Panax genus.

Conclusions
These findings provide a foundation for understanding mechanisms maintaining the steady state of phyllosphere mycobiome in healthy plant, and offer clues for engineering phyllosphere mycobiome to improve the accumulation of bioactive secondary metabolites on the basis of network modules.
Prevalence and trends of polypharmacy in U.S. adults, 1999–2018
Authors: Wang Xiaowen , Liu Keyang , Shirai Kokoro , Tang Chengyao , Hu Yonghua , Wang Ying , Hao Yuantao , Dong Jia-Yi 
Published: July 2023

Abstract
Background
Polypharmacy is one of the most important health issues for its potential impacts on disease burden and healthcare costs. The aim of this study was to update a comprehensive picture of prevalence and trends in polypharmacy over 20 years in U.S. adults.

Methods
Participants included 55,081 adults aged ≥ 20 from the National Health and Nutrition Examination Survey, January 1, 1999, through December 31, 2018. The simultaneously use of ≥ 5 drugs in one individual was defined as polypharmacy. National prevalence and trends in polypharmacy were evaluated among U.S. adults within different demo-socioeconomic status and pre-existing diseases.

Results
From 1999–2000 to 2017–2018, the overall percentages of adults with polypharmacy remained on the rise, increasing from 8.2% (7.2–9.2%) to 17.1% (15.7–18.5%) (average annual percentage change [AAPC] = 2.9%, P = .001). The polypharmacy prevalence was considerably higher in the elderly (from 23.5% to 44.1%), in adults with heart disease (from 40.6% to 61.7%), and in adults with diabetes (from 36.3% to 57.7%). Also, we observed a greater increase rate of polypharmacy in men (AAPC = 4.1%, P < .001), in the Mexican American (AAPC = 6.3%, P < .001), and in the non-Hispanic Black (AAPC = 4.4%, P < .001).

Conclusions
From 1999–2000 to 2017–2018, the prevalence of polypharmacy is continually increasing in U.S. adults. The polypharmacy was especially higher in the older, in patients with heart disease, or diabetes. The high prevalence urges the healthcare providers and health policymakers to manage polypharmacy among specific population groups.
The frequency and impact of tramadol addiction on acute aneurysmal subarachnoid hemorrhage: cross-sectional multicenter study
Authors: Elbassiony Ahmed , Khedr Eman M. , Hegazy Ahmed , Ragab Omar Abdelaleem , Al-Shami Hieder , Soliman Radwa K. , Shoyb Ahmed , Aly Ahmed 
Published: July 2023

Abstract
Background
Arterial hypertension, cigarette smoking, excessive alcohol abuse and drug addiction such as cocaine all are known risk factors for aneurysmal subarachnoid hemorrhage (SAH). However, there is little information on whether tramadol addiction should also be considered as a risk factor for SAH. The purpose of this study was to investigate the prevalence and the impact of tramadol addiction on the symptomatology of intracranial aneurysmal SAH. We recruited 237 cases with acute aneurysmal ASH with a mean age of 52.3 ± 11.8 ranging from 17 to 86 years old.

Results
There were 124 males and 113 females; 43 cases had a history of tramadol addiction (18.1%). Tramadol addicts were significantly younger, more likely to be male (97.7%), and more commonly associated with seizure onset compared with non-addicts. Multiple aneurysms, wide neck, and sizable aneurysms were significantly more common in tramadol than non-tramadol addicts as were dissecting aneurysms. There is a high association of acute aneurysmal SAH with tramadol addiction, especially in young patients.

Conclusions
Tramadol addiction might be regarded as modifiable risk factor of aneurysmal ASH and tramadol addicts had a worse presentation than non-tramadol addicts. If this finding is proved, it will be of great importance in managing patients with ruptured and un-ruptured intracranial aneurysms. Tramadol is available over-counter in some countries, more studies are needed.
New connections between brand and environmentally sustainable businesses in the Amazon forest and local business owner’s perception
Authors: Vidal Santos Luiz Diego , Rodrigues Holanda Francisco Sandro , de Menezes Pedro Vinícius Bertulino , de Santana Oliveira Catuxe Varjão , Schervinski Villwock Ana Paula , Pedrotti Alceu 
Published: July 2023

AbstractThe debate surrounding entrepreneurship in the Amazon rainforest region highlights the importance of sustainable actions developed by local brands. However, limited attention has been given to entrepreneur's perspectives regarding the outcome of their applied practices. The objective of this study was to understand the entrepreneurs’ perception based on their business models concerning the connection to the Amazon brand and the aspects of sustainable use of its natural resources. The study was performed through semi-structured interviews with seven Amazonian product brands entrepreneurs utilizing Grounded Theory. The results demonstrate that entrepreneurs understand that reaching the social dimension relies on the articulation of three main factors: entrepreneurs, the native people, and the shared traditional knowledge and culture. It is observed that the political dimension is still underdeveloped in the region with limited application of its effects on products. Additionally, the economic dimension is not significantly favored by the utilization of environmentally sustainable brands. Lastly, the territorial dimension depends on the establishment of permanent protection areas, as well as agroforestry systems.