bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation
Authors: Kemp Joshua , Benito Kristen , Herren Jennifer , Brown Zoe , Frank Hannah E. , Freeman Jennifer 
Published: February 2023

BackgroundExposure therapy is a highly effective but underutilized treatment for anxiety disorders. A primary contributor to its underutilization is therapist-level negative beliefs about its safety and tolerability for patients. Given functional similarities between anxious beliefs among patients and negative beliefs among therapists, the present protocol describes how exposure principles can be leveraged during training to target and reduce therapist negative beliefs.MethodsThe study will take place in two phases. First, is a case-series analysis to fine-tune training procedures that is already complete, and the second is an ongoing randomized trial that tests the novel exposure to exposure (E2E) training condition against a passive didactic approach. A precision implementation framework will be applied to evaluate the mechanism(s) by which training influences aspects of therapist delivery following training.Anticipated resultsIt is hypothesized that the E2E training condition will produce greater reductions in therapists’ negative beliefs about exposure during training relative to the didactic condition, and that greater reduction in negative beliefs will be associated with higher quality exposure delivery as measured by coding of videotaped delivery with actual patients.ConclusionImplementation challenges encountered to date are discussed along with recommendations for future training interventions. Considerations for expansion of the E2E training approach are also discussed within the context of parallel treatment and training processes that may be tested in future training trials.
Art-based interventions for women’s mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials
Authors: Qian Jialu , Sun Shiwen , Wang Man , Sun Xiangyu , Yu Xiaoyan 
Published: February 2023

ObjectivePregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women.MethodsSystematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women’s mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality.ResultsTwenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = −0.75, 95% CI = −1.10 to −0.40) and depression symptoms (MD = −0.79, 95% CI = −1.30 to −0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety.ConclusionIn perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.
Associations between post-traumatic stress symptoms and quality of life among psychiatric healthcare personnel in China during the COVID-19 pandemic: A network approach
Authors: Zhao Yan-Jie , Zhang Cheng , Guo Tong , Sha Sha , Su Zhaohui , Cheung Teris , Jackson Todd , An Feng-Rong , Xiang Yu-Tao 
Published: February 2023

BackgroundPost-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic.MethodsThis cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist – Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method.ResultsAltogether, 10,516 psychiatric healthcare personnel completed the assessment. “Avoidance of thoughts” (PTSS-6), “Avoidance of reminders” (PTSS-7), and “emotionally numb” (PTSS-11) were the most central symptoms in the PTSS community, all of which were in theAvoidance and Numbingdomain. Key bridge symptoms connecting PTSS and QOL were “Sleep disturbances” (PTSS-13), “Irritability” (PTSS-14) and “Difficulty concentrating” (PTSS-15), all of which were within theHyperarousaldomain.ConclusionIn this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.
Clinical characteristics and outcomes of immunocompromised patients with severe community-acquired pneumonia: A single-center retrospective cohort study
Authors: Wu Xiaojing , Sun Ting , Cai Ying , Zhai Tianshu , Liu Yijie , Gu Sichao , Zhou Yun , Zhan Qingyuan 
Published: February 2023

BackgroundImmunocompromised patients with severe community-acquired pneumonia (SCAP) warrant special attention because they comprise a growing proportion of patients and tend to have poor clinical outcomes. The objective of this study was to compare the characteristics and outcomes of immunocompromised and immunocompetent patients with SCAP, and to investigate the risk factors for mortality in these patients.MethodsWe conducted retrospective observational cohort study of patients aged ≥18 years admitted to the intensive care unit (ICU) of an academic tertiary hospital with SCAP between January 2017 and December 2019 and compared the clinical characteristics and outcomes of immunocompromised and immunocompetent patients.ResultsAmong the 393 patients, 119 (30.3%) were immunocompromised. Corticosteroid (51.2%) and immunosuppressive drug (23.5%) therapies were the most common causes. Compared to immunocompetent patients, immunocompromised patients had a higher frequency of polymicrobial infection (56.6 vs. 27.5%, P &lt; 0.001), early mortality (within 7 days) (26.1 vs. 13.1%, P = 0.002), and ICU mortality (49.6 vs. 37.6%, P = 0.027). The pathogen distributions differed between immunocompromised and immunocompetent patients. Among immunocompromised patients, Pneumocystis jirovecii and cytomegalovirus were the most common pathogens. Immunocompromised status (OR: 2.043, 95% CI: 1.114–3.748, P = 0.021) was an independent risk factor for ICU mortality. Independent risk factors for ICU mortality in immunocompromised patients included age ≥ 65 years (odds ratio [OR]: 9.098, 95% confidence interval [CI]: 1.472–56.234, P = 0.018), SOFA score [OR: 1.338, 95% CI: 1.048–1.708, P = 0.019), lymphocyte count &lt; 0.8 × 109/L (OR: 6.640, 95% CI: 1.463–30.141, P = 0.014), D-dimer level (OR: 1.160, 95% CI: 1.013–1.329, P = 0.032), FiO2 &gt; 0.7 (OR: 10.228, 95% CI: 1.992–52.531, P = 0.005), and lactate level (OR: 4.849, 95% CI: 1.701–13.825, P = 0.003).ConclusionsImmunocompromised patients with SCAP have distinct clinical characteristics and risk factors that should be considered in their clinical evaluation and management.
Incidence of cognitive impairment after hypothetical interventions on depression, nighttime sleep duration, and leisure activity engagement among older Chinese adults: An application of the parametric g-formula
Authors: Zhang Nan , Chen Fenghui , Wang Cui , Yan Ping 
Published: February 2023

BackgroundCognitive impairment is an age-relevant intermediate stage where cognition declines to a state between the normal aging process and dementia. Earlier studies reported that depression, inappropriate nighttime sleep duration (NSD), and limited leisure activity engagement are cognitive impairment risk factors among older adults. Thus, we postulated that interventions on depression, sleep duration, and leisure activity engagement can reduce cognitive impairment risk. However, no earlier research ever explored this.MethodsThe data of 4,819 respondents aged 60 years and above, without cognitive impairment at baseline and with no prior history of memory-related diseases, including Alzheimer's disease, Parkinson's disease, and encephalatrophy, were obtained from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. The parametric g-formula, an analytic tool for estimating standardized outcome distributions using covariate (exposure and confounders)-specific estimates of the outcome distribution, was used to estimate 7-year cumulative cognitive impairment risks among older Chinese adults, under independent hypothetical interventions on depression, NSD, and leisure activity engagement, which was subdivided into social activity (SA) and intellectual activity (IA) for the different intervention combinations.ResultsThe observed cognitive impairment risk was 37.52%. Independent intervention on IA was the most effective factor in reducing incident cognitive impairment, with a risk ratio (RR) of 0.75 (95% confidence interval [CI]: 0.67–0.82), followed by depression (RR: 0.89, 95% CI: 0.85–0.93) and NSD (RR: 0.88, 95% CI: 0.80–0.95). The joint intervention combining depression, NSD, and IA interventions could reduce the risk by 17.11%, with an RR of 0.56 (95% CI: 0.48–0.65). In subgroup analyses, independent interventions on depression and IA had analogously significant effects on men and women. However, interventions on depression and IA had stronger effects on literate than illiterate individuals.ConclusionsHypothetical interventions on depression, NSD, and IA reduced cognitive impairment risks among older Chinese adults, both independently and jointly. The findings of the present study suggest that the intervention measures on depression, inappropriate NSD, limited intellectual activities, and their combination may prove to be effective strategies for preventing cognitive impairment among older adults.
Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis
Authors: Zhang Xiaoqian , Wang Chun , Zuo Xiaoli , Aertgeerts Bert , Buntinx Frank , Li Tang , Vermandere Mieke 
Published: February 2023

BackgroundWhile the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors.MethodsThis systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included.ResultsOf 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I2 = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I2 = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I2 = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I2 = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I2 = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I2 = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I2 = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I2 = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I2 = 0%) showed an increase of PPDS during the COVID-19 period.ConclusionsThe COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.
The use of medications approved for alcohol use disorders in Italy
Authors: Fortinguerra Filomena , Pierantozzi Andrea , Trotta Francesco 
Published: February 2023

BackgroundItaly has the highest per capita alcohol consumption among European countries. Several pharmacological treatments for alcohol use disorders (AUDs) are currently available in Italy, but no consumption data are available. A first analysis of national drug consumption, comprising the whole Italian population over a long-term period covering the COVID-19 pandemic, was performed.MethodsTo analyze the consumption of medications indicated for therapy of alcohol dependence, different national data sources were used. Consumption was measured as a defined daily dose (DDD) per 1,000,000 inhabitants per day.ResultsIn 2020, the total consumption of medicines used in the treatment of AUDs amounted to 310.3 DDD per 1 million inhabitants per day (0.018% of the overall drug consumption in Italy) with a decreasing gradient from the north (373.9 DDD) to the south (250.7 DDD). 53.2% of the overall doses were dispensed by public healthcare facilities and 23.5% by community pharmacies, while the remaining 23.3% were purchased privately. The temporal trend of consumption seemed to be stable across the last few years, although an impact of the COVID-19 pandemic was observed. Disulfiram was the most consumed medicine over years.ConclusionAll Italian regions offer pharmacological treatments to patients with AUDs, but differences in the number of dispensed doses suggest a different local organization of patient care, which can be partly explained by the different severity of the clinical condition of residing patients. Pharmacotherapy of alcoholism should be deeply investigated to describe the clinical characteristics of treated patients (i.e., comorbidities) and evaluate the appropriateness of prescribed medications.
Management of cesarean scar pregnancy: Importance of gestational age at diagnosis and disease type—A single center’s 5 years of experience involving 223 cases
Authors: Yang Xinrui , Zheng Weiran , Wei Xiaoyu , Ma Jingmei , Yan Jie , Poon Liona C. , Yang Huixia 
Published: February 2023

ObjectiveThis study aims to evaluate the importance of the gestational age at diagnosis and the types of cesarean scar pregnancy (CSP) for treatment outcomes and to identify the optimal treatment based on both the gestational age at diagnosis and the CSP type.MethodsA retrospective cohort study included 223 pregnant women diagnosed with CSP at Peking University First Hospital, Beijing, China, between 2014 and 2018. All CSP cases underwent ultrasound-guided vacuum aspiration followed by supplementary curettage. Adjuvant treatment modalities included intramuscular injection of systemic methotrexate, uterine artery embolization, and hysteroscopy before ultrasound-guided vacuum aspiration. Linear regression was used to determine the relationship between intraoperative blood loss and gestational age at diagnosis, CSP type, highest β-human chorionic gonadotropin level, and management procedures.ResultsNone of the patients required blood transfusions or hysterectomies. Patients presenting at &lt;8, 8–10, and &gt;10 weeks had median estimated blood loss of 5, 10, and 35 ml, respectively. Patients with type I CSP, type II CSP, and type III CSP had median blood loss of 5, 5 and 10 ml, respectively. Multivariate linear regression analysis demonstrated that the gestational age at diagnosis (p &lt; 0.001) and type of CSP (p = 0.023) were independent predictors of intraoperative estimated blood loss. For type I CSP patients, ultrasound-guided vacuum aspiration followed by supplementary curettage alone was performed in 15 of 34 (44.1%) patients, including 12/27 (44.4%) diagnosed at &lt;8 weeks, 2/6 (33.3%) at 8–10 weeks, and 1/1 for &gt;10 weeks. In type II CSP patients, fewer cases were managed by ultrasound-guided vacuum aspiration followed by supplementary curettage alone as the gestational age at diagnosis increased [18/96 (18.8%) for &lt;8 weeks, 7/41 (17.1%) for 8–10 weeks, none for &gt;10 weeks]. Most type III CSP patients (41/45, 91.1%) needed treatments in addition to the ultrasound-guided vacuum aspiration regardless of the gestational age at diagnosis. All CSP patients were treated successfully and did not require readmission or further medical interventions.ConclusionGestational age at diagnosis of CSP and its type show a strong correlation with estimated blood loss during ultrasound-guided vacuum aspiration. With careful management, CSPs may be treated at any gestational week, regardless of their type, with minimal intraoperative bleeding.
Engage and enjoy–investigating predictors of employee engagement and work satisfaction in equine veterinary professionals
Authors: Elte Yteke , Acton Kate , Martin Jessica , Nielen Mirjam , van Weeren René , Wolframm Inga 
Published: February 2023

IntroductionIndividuals working in the field of veterinary care are regularly affected by their profession. High levels of responsibility to often provide life-saving health care to animals combined with having to manage owners' expectations and irregular working hours can cause considerable levels of work-related stress among professionals in equine veterinary practice. On the positive side, research also shows that working in the veterinary profession can have a positive impact on personal wellbeing and feelings of fulfillment. A limited number of studies has investigated work satisfaction and engagement among veterinarians across the globe, and none specifically in the equine veterinary work field. The aim of the current study was to identify relevant predictors of employee engagement and work satisfaction in relation to demographic and work environment related factors in the equine veterinary profession.MethodsA cross-sectional study design was used to investigate work satisfaction and employee engagement among equine veterinary professionals from the UK, the US and the Netherlands using an online survey.ResultsResults suggest that levels of work engagement and satisfaction in the veterinary profession may be gauged using four factors. These factors encompass Pride and purpose (the extent to which personal core values align with the mission of the employer, i.e., the veterinary practice), Company culture and relationship with management (the manner in which staff members interact with each other and the management), Working conditions and compensation (formal employment conditions relating to responsibilities and rewards and levels of collegiality) and Team culture and learning possibilities (encouragement to pursue personal and professional growth).DiscussionFindings underline the importance of being particularly mindful of inexperienced colleagues, those with demanding family commitments and, where feasible, of providing employees with a modicum of autonomy in order to ensure a satisfied equine veterinary workforce.
Impact of Multiple Sclerosis on Foot Health and Quality of Life: A Prospective Case-Control Investigation
Authors: Ruiz-Sánchez Francisco Javier , Martins Maria do Rosário , Losa-Iglesias Marta Elena , Becerro-de-Bengoa-Vallejo Ricardo , Gómez-Salgado Juan , Romero-Morales Carlos , Jiménez-Cebrián Ana María , López-López Daniel 
Published: February 2023

Objectives: To assess quality of life or factors related to the foot and general health and to determine the impact taking into account foot health status in people with multiple sclerosis (MS).Methods: 50 subjects with MS and 50 healthy subjects were studied using the Foot Health Status Questionnaire, that is a validated and is reliable tool was used to assess foot health and quality of life. This instrument comprise four domains for evaluate the foot health (foot function, foot pain, footwear and general foot health) in the first section and for measure the general health comprise four domains (general health, physical activity, social capacity and vigor) for second section and was use for all participants.Results: In both groups of the sample, 50% (n = 15) were men and 50% (n = 35) women, and the mean age in the case group was 48.04 ± 10.49 and the control group was 48.04 ± 10.45 were recruited. A statistically significant difference (p &lt; 0.05) was shown for foot function, general foot health, general health, physical activity and vigor domains, stating that people with MS have a lower related to foot health (lower FHSQ scores) compared to healthy subjects who have higher FHSQ scores. There were no statistically significant differences (p &gt; 0.05) for the scores of the other domains of the FHSQ (foot pain, footwear and social capacity).Conclusion: Patients with MS suffer a negative impact on the quality of life related to foot health, which appears to be associated with the chronic disease.