bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gaming behavior disorder and its association with social phobia during COVID-19 pandemic: A cross-sectional study among the young Arabs
Authors: Shaheen Nour , Shaheen Ahmed , Elmasry Mohamed , Abdelwahab Omar Ahmed , Mohamed Abdelrahman , Swed Sarya , Rababah Ala’ Abdala , Meshref Mostafa , Zaki Ahmed , Shoib Sheikh 
Published: April 2023

BackgroundGaming addiction is a compulsive mental health condition that can have severe negative consequences on a person’s life. As online gaming has increased during the COVID-19 pandemic, studies have shown a heightened risk of mental health issues. This study aims to assess the prevalence of severe phobia and addiction to online gaming among Arab adolescents and identify risk factors associated with these disorders.MethodsThis cross-sectional study was conducted across 11 Arab nations. Participants were recruited using convenience sampling through an online survey distributed on social media platforms in 11 Arab countries. The survey included demographic questions, the Nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9) to measure participants’ online gaming addiction, the Social Phobia Scale (SPS), and questions assessing the impact of the COVID-19 pandemic on the prevalence of internet gaming addiction. The data were analyzed using SPSS win statistical package version 26.ResultsOut of 2,458 participants, 2,237 were included in the sample due to non-response and missing data. The average age of the participants was 19.9 ± 4.8 years, and the majority were Egyptian and unmarried. 69% of the participants reported playing more than usual since the COVID-19 pandemic, as they were confined to their homes. Higher social phobia scores were associated with being single, male, and Egyptian. Participants from Egypt and those who felt that the pandemic significantly increased their gaming time had higher scores for online gaming addiction. Several major criteria, such as playing hours per day and beginning gaming at an early age, were associated with a higher level of online gaming addiction with social phobia.ConclusionThe study’s findings suggest that there is a high prevalence of internet gaming addiction among Arab adolescents and young adults who play online games. The results also indicate a significant association between social phobia and several sociodemographic factors, which may inform future interventions and treatments for individuals with gaming addiction and social phobia.
First-episode mania after COVID-19: A case series in Iran
Authors: Saeidi Mahdieh , Rezvankhah Tara , Pereira-Sanchez Victor , Rafieian Maryam , Shariati Behnam , Esmaeeli Soode Tajik , Emamikhah Maziar , Alavi Kaveh , Shabani Amir , Soraya Shiva , Kashaninasab Fatemeh , Mirfazeli Fatemeh Sadat 
Published: April 2023

BackgroundIncreasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections.MethodsWe obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021.ResultsPatients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature.ConclusionOur case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.
Previous pregnancy loss and gestational cardiovascular health: A prospective cohort of nulliparous women
Authors: Ma Shuang-shuang , Yin Wan-jun , Wang Peng , Wang Hai-xia , Zhang Lei , Jiang Xiao-min , Zhang Ying , Tao Ruixue , Ge Jin-fang , Zhu Peng 
Published: April 2023

ObjectivesTo estimate the association of previous pregnancy loss with subsequent cardiovascular health during gestation and to examine the role of high-sensitivity C reactive protein (hs-CRP) in the association.MethodsA total of 2,778 nulliparous pregnant women were recruited between March 2015 and November 2020 in Hefei city, China. Their cardiovascular health (CVH) including prepregnancy body mass index (BMI), blood pressure, total cholesterol, fasting plasma glucose, and smoke status were recorded at 24–28 weeks’ gestation, as well as their reproductive history. Multivariate linear and logistic regression were performed to examine the association of pregnancy loss with cardiovascular health. And the role of hs-CRP between pregnancy loss and CVH was assessed by the mediation analysis.ResultsCompared with women who have no pregnancy loss, women with a history of spontaneous or induced abortions had higher BMI (β, 0.72, 95% CI, 0.50 to 0.94) and fasting plasma glucose (β, 0.04, 95% CI, 0.01 to 0.07), and had lower total CVH scores after adjusting for confounders (β, −0.09, 95% CI, −0.18 to −0.01). CVH scores were most significantly decreased among women with 3 or more induced abortions (β, −0.26, 95% CI, −0.49, −0.02). The contribution of pregnancy loss to poorer gestational CVH mediated by increased hs-CRP levels was 23.17%.ConclusionPrevious pregnancy loss was associated with poorer cardiovascular health during gestation, which may be mediated by their gestational inflammatory status. Exposure to miscarriage alone was not a significant predictor of poorer CVH.
Prediction of spherical equivalent difference before and after cycloplegia in school-age children with machine learning algorithms
Authors: Du Bei , Wang Qingxin , Luo Yuan , Jin Nan , Rong Hua , Wang Xilian , Nian Hong , Guo Li , Liang Meng , Wei Ruihua 
Published: April 2023

PurposeTo predict the need for cycloplegic assessment, as well as refractive state under cycloplegia, based on non-cycloplegic ocular parameters in school-age children.DesignRandom cluster sampling.MethodsThe cross-sectional study was conducted from December 2018 to January 2019. Random cluster sampling was used to select 2,467 students aged 6–18 years. All participants were from primary school, middle school and high school. Visual acuity, optical biometry, intraocular pressure, accommodation lag, gaze deviation in primary position, non-cycloplegic and cycloplegic autorefraction were conducted. A binary classification model and a three-way classification model were established to predict the necessity of cycloplegia and the refractive status, respectively. A regression model was also developed to predict the refractive error using machine learning algorithms.ResultsThe accuracy of the model recognizing requirement of cycloplegia was 68.5–77.0% and the AUC was 0.762–0.833. The model for prediction of SE had performances of R^2 0.889–0.927, MSE 0.250–0.380, MAE 0.372–0.436 and r 0.943–0.963. As the prediction of refractive error status, the accuracy and F1 score was 80.3–81.7% and 0.757–0.775, respectively. There was no statistical difference between the distribution of refractive status predicted by the machine learning models and the one obtained under cycloplegic conditions in school-age students.ConclusionBased on big data acquisition and machine learning techniques, the difference before and after cycloplegia can be effectively predicted in school-age children. This study provides a theoretical basis and supporting evidence for the epidemiological study of myopia and the accurate analysis of vision screening data and optometry services.
Digital literacy level and associated factors among health professionals in a referral and teaching hospital: An implication for future digital health systems implementation
Authors: Tegegne Masresha Derese , Tilahun Binyam , Mamuye Adane , Kerie Hailemariam , Nurhussien Fedlu , Zemen Endalkachew , Mebratu Aragaw , Sisay Girma , Getachew Redet , Gebeyehu Henok , Seyoum Abiy , Tesfaye Selamsew , Yilma Tesfahun Melese 
Published: April 2023

BackgroundIn Ethiopia and other developing countries, electronic medical record systems and other health information technology are being introduced. However, a small proportion of low-income countries have successfully implemented national health information systems. One cause for this can be the lack of digital literacy among medical practitioners. As a result, this study aimed to assess health professionals’ digital literacy level and associated factors in Northwest Ethiopia.MethodA quantitative cross-sectional study was employed among 423 health professionals working in a teaching and referral hospital in Northwest Ethiopia. We modified and applied the European commission’s framework for digital competency to assess the level of digital literacy among health professionals. We used stratified random sampling with proportional allocation to the size of the departments in the hospital to select study participants. Data were collected using a semi-structured, self-administered, and pretested questionnaire. Descriptive and binary logistic regression analysis techniques were used to describe respondents’ digital literacy level and identify its associated factor, respectively. The odds ratio with 95% CI and value of p were used to assess the strength of the association and statistical significance, respectively.ResultsOut of 411 participants, 51.8% (95% CI, 46.9–56.6%) of health professionals had adequate digital literacy. Holding a master’s degree (Adjusted OR = 2.13, 95% CI: 1.18–3.85), access to digital technology (AOR = 1.89, 95% CI: 1.12–3.17), having training in digital technology (AOR = 1.65, 95% CI: 1.05–2.59), and having a positive attitude towards digital health technology (AOR = 1.64, 95% CI: 1.02–2.68) were found to be significant factors associated with health professionals digital literacy level of health professionals.ConclusionLow level of digital literacy among health professionals was observed, with nearly half (48.2%) of them having poor digital literacy levels. Access to digital technology, training on digital technology, and attitude toward digital health technology were significant factors associated with digital literacy. It is suggested to increase computer accessibility, provide a training program on digital health technology, and promote a positive attitude toward this technology to improve the deployment of health information systems.
Association of nocturnal sleep duration and midday napping with subjective poor hearing among middle-aged and older adults in China
Authors: Cui Xiaorui , Lu Zixuan , Guo Xinyue , Dai Neng , Huang Chen , Liu Yahang , Lin Ruilang , Yu Yongfu , Qin Guoyou , Chen Jiaohua 
Published: April 2023

BackgroundHearing loss has occurred as a critical concern for aging and health. However, it remains unknown whether nocturnal sleep and midday napping duration are associated with hearing loss in middle-aged and older adults.MethodsThe study comprised 9,573 adults from China Health and Retirement Longitudinal Study, who have completed the survey for sleep characteristics and subjective functional hearing. We collected self-reported nocturnal sleep duration (&lt;5, 5 to &lt;6, 6 to &lt;7, 7 to &lt;9, ≥9 h/night) and midday napping duration (≤5, 5 to ≤30, and &gt;30 min). The sleep information was classified into different sleep patterns. The primary outcome was self-reported hearing loss events. Multivariate Cox regression models and restricted cubic splines were used to investigate the longitudinal association of sleep characteristics with hearing loss. We applied Cox generalized additive models and bivariate exposure-response surface diagrams to visualize the effects of different sleep patterns on hearing loss.ResultsWe confirmed 1,073 cases of hearing loss (55.1% female) during the follow-up. After adjusting for demographic characteristics, lifestyle factors and health condition, nocturnal sleep with &lt; 5 h was positively associated with hearing loss [hazard ratio (HR): 1.45, 95% confidence interval [CI]: 1.20, 1.75]. Individuals with napping for 5 to ≤30 min had a 20% (HR: 0.80, 95%CI: 0.63, 1.00) lower risk of hearing loss compared with those with napping ≤ 5 min. Restrictive cubic splines showed the reverse J-shaped association between nocturnal sleep and hearing loss. Moreover, we found significant joint effects of sleeping &lt; 7 h/night and midday napping ≤ 5 min (HR: 1.27, 95% CI: 1.06, 1.52) on hearing loss. Bivariate exposure-response surface diagrams also reflected the finding that short sleep without napping existed the highest risk of hearing loss. Compared with persistently sleeping moderately (7–9 h/night), those who persistently slept &lt; 7 h/night or shifted from &lt; 7 h/night to moderate or &gt; 9 h/night had higher risks of hearing loss.ConclusionInadequate nocturnal sleep was associated with an elevated risk of poor subjective hearing in middle-aged and older adults, while moderate napping decreased the risk of hearing loss. Keeping sleep stable within recommendation duration may be a useful strategy for preventing poor hearing loss.
The impact of adolescents’ health motivation on the relationship among mental stress, physical exercise, and stress symptoms during COVID-19: A dual moderation model
Authors: Lou Hu , Chen Jin , Liu Ping 
Published: April 2023

ObjectiveMany Chinese teenagers are experiencing high mental stress levels due to epidemic-related restrictions and closures. Mental stress can induce numerous associated symptoms, and physical exercise is considered to buffer mental stress. However, it remains unclear whether health motivation regulates the relationships among mental stress, physical exercise, and stress symptoms. This study examined whether mental stress events during the epidemic can predict stress symptoms, whether physical exercise can buffer mental stress, and whether the mental stress buffer effect is enhanced when health motivation regarding physical exercise is high.MethodsIn total, 2,420 junior high school students (1,190 boys and 1,230 girls; 826 seventh-grade students, 913 eighth-grade students, and 681 ninth-grade students) from nine provinces nationwide were selected to investigate mental stress events, symptoms, health motivation, and physical exercise in adolescents. The hypothesis was tested with a multiple regression analysis.ResultsA positive relationship between adolescent mental stress events and stress symptoms was observed, and an interactive relationship was found among health motivation, physical exercise, and mental stress factors. Specifically, the mental stress-buffering effect of physical exercise was significant only when health motivation was high.ConclusionIn the post-epidemic period, the influence of mental stress events on stress symptoms in adolescents was found to be buffered by physical exercise only in terms of high health motivation. This result highlighted the role of health motivation in the buffering effect of physical exercise on mental stress during an epidemic.
Higher thyroid hormone has a negative association with lower limb lean body mass in euthyroid older adults: Analysis from the Baltimore Longitudinal study of aging
Authors: Ibad Hamza Ahmed , Mammen Jennifer S. , Simonsick Eleanor M. , Kwoh C. Kent , Guermazi Ali , Demehri Shadpour 
Published: April 2023

Background: Hyperthyroidism is associated with lower lean body mass, as a result of catabolic actions of thyroid hormone. Therefore, higher thyroid hormone levels could be a factor in the development of sarcopenia and age associated functional decline. The relationship between thyroid hormone and muscle mass in ambulatory, euthyroid older adults is not known.Method: We used mixed-effects models to estimate the cross-sectional relationships (accounting for inter-person variability) between thyroid axis hormone measures and lower limb composition or sarcopenia at visits in the Baltimore Longitudinal Study of Aging (BLSA) at which DEXA scans were available and both thyrotropin (TSH) and free thyroxine (FT4) were in the reference range. Analyses were adjusted for levothyroxine use, age, race, sex, BMI, smoking, alcohol intake, cholesterol, and systolic blood pressure.Results: 1442 euthyroid participants (median age 68, 50% female, and 69% white) contributed to 5306 visits from 2003 to 2019. FT4 was negatively associated with lower limb lean mass (beta: 88.49; 95% Confidence Interval (CI): 122.78, −54.20; p &lt; 0.001) and positively associated with sarcopenia (OR: 1.11%, 95% CI: 1.01, 1.22) in the whole cohort. Additionally, higher FT4 was associated with lower leg lean mass (beta: 66.79; 95% CI: 102.24, −31.33; p &lt; 0.001) and sarcopenia (OR:1.09%, 95% CI:1.01, 1.18) in older adults, but not in younger adults alone.Conclusion: In euthyroid older adults, higher FT4 is associated with lower leg lean mass and higher odds of sarcopenia. Understanding the relationship between thyroid hormone and sarcopenia is needed to improve clinical decision-making and avoid functional decline from excess thyroid hormone use in older adults.
The promotion of sleep wellness: Resilience as a protective factor
Authors: Allan Alexa C. , Gamaldo Alyssa A. , Gamaldo Charlene E. , Gunia Brian C. , Al Abdul Razzak Iyiad Mohamed , Ighodaro Edoghogho , Salas Rachel Marie E. 
Published: April 2023

ObjectivesTo evaluate the association between resilience, sleep quality, and health.MethodsThis cross-sectional study included 190 patients (Mean age = 51, SD = 15.57) recruited from the Johns Hopkins Center for Sleep and Wellness. Patients completed a modified version of the brief resilience scale (BRS) to assess characteristics of resilience and questions to assess aspects of mental health, physical health, sleep quality, and daytime functioning.ResultsParticipants' average score on the BRS was 4.67 (SD = 1.32, range = 1.17–7), reflecting a high level of resilience. There was a significant gender difference in resilience levels for men (Mean = 5.04, SD = 1.14) and women (Mean = 4.30, SD = 1.38), such that men reported significantly higher levels of resilience compared to women (t (188) = 4.02, p &lt; 0.001) [lower levels of resilience were significantly associated with higher levels of (current) fatigue and tiredness after adjusting for demographic, physical, and mental covariates. In those reporting between one and three mental health symptoms, high levels of resilience minimized the negative influence that these symptoms had on sleep quality. This minimizing effect was no longer evident in those experiencing &gt;3 mental health symptoms, who also reported significantly higher symptoms of fatigue despite their high resilience scores.ConclusionsThis study emphasizes how resilience may affect the relationship between mental health and sleep quality in sleep patients. Resilience may further our understanding of the inter-relationships between sleep and the manifestation of physical health symptoms, a relationship that will likely heighten in relevance during personal and global crisis. An awareness of this interaction could be used as a proactive prevention and treatment strategy. In other words, incorporating methods to evaluate resilience in patients with mental illnesses regularly can be useful for predicting the potential manifestation and severity of sleep disturbance. Therefore, strategies that focus on promoting resilience could improve health and wellness.
Anterior shift of the ventral dura mater: A novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine
Authors: Takahashi Kohei , Hashimoto Ko , Onoki Takahiro , Kanno Haruo , Ozawa Hiroshi , Aizawa Toshimi 
Published: April 2023

BackgroundThoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult disorders to treat. The Ohtsuka procedure, extirpation, or anterior floating of the OPLL through a posterior approach, has shown great surgical outcomes after several modifications. However, these procedures are technically demanding and pose a significant risk of neurological deterioration. We have developed a novel modified Ohtsuka procedure in which removal or minimization of the OPLL mass is unnecessary; instead, the ventral dura mater is shifted anteriorly with the posterior part of the vertebral bodies and targeted OPLL.Surgical ProcedureFirst, pedicle screws were inserted at more than three spinal levels above and below the spinal level where pediculectomies were performed. After laminectomies and total pediculectomies, partial osteotomy of the posterior vertebra adjacent to the targeted OPLL was performed by using a curved air drill. Then, the PLL is completely resected at the cranial and caudal sites of the OPLL using special rongeurs or a threadwire saw with a diameter of 0.36 mm. The nerve roots were not resected during surgery.MethodsEighteen patients (follow-up ≥1 year) treated with our modified Ohtsuka procedure were assessed clinically, including the Japanese Orthopaedic Association (JOA) score for thoracic myelopathy and radiographically.ResultsThe average follow-up period was 3.2 years (range, 1.3–6.1 years). The preoperative JOA score was 2.7 ± 1.7, which improved to 8.2 ± 1.8 at 1 year postoperatively; therefore, the recovery rate was 65.8 ± 19.8%. The CT scan at 1 year after surgery revealed the anterior shift of the OPLL averaged 3.1 ± 1.7 mm and the ossification-kyphosis angle of the anterior decompression site decreased at an average of 7.2 ± 6.8 degrees. Three patients demonstrated temporary neurological deterioration, all of whom completely recovered within 4 weeks postoperatively.DiscussionThe concept of our modified Ohtsuka procedure is 1) not OPLL extirpation or minimization but only the creation of space between the OPLL and spinal cord by an anterior shift of the ventral dura mater, which is achieved by complete resection of the PLL at the cranial and caudal sites of the OPLL; and 2) no nerve roots are sacrificed to prevent ischemic spinal cord injury. This procedure is not technically demanding and safe and provides secure decompression for thoracic OPLL. The anterior shift of the OPLL was smaller than expected, but it resulted in a relatively good surgical outcome with a recovery rate ≥65%.ConclusionOur modified Ohtsuka procedure is quite secure and is not technically demanding, with a recovery rate of 65.8%.