bluuebunny/crossref_metadata_2025_split huggingface dataset:
Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma
Authors: Kaggwa Mark Mohan , Najjuka Sarah Maria , Mamun Mohammed A. , Griffiths Mark D. , Nyemara Novatus , Ashaba Scholastic 
Published: January 2023

Abstract
Background
The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers’ burden can lead to a reduction in caregivers’ involvement. There is a relationship between caregivers’ involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers’ burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.

Methods
A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers.

Results
The findings indicate that affiliated stigma serves as a full mediator between the caregiver’s roles and involvement (β=15.97, p<0.001). Being female increased the caregivers’ burden of caregiving (β= -0.23, p<0.001).

Conclusion
The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.
Clinical advantages of gradually reducing radius versus multi-radius total knee arthroplasty: a noninferiority randomized trial
Authors: Limmahakhun Sakkadech , Chaiamporn Anuchit , Klunklin Kasisin , Jingjit Warakorn 
Published: January 2023

Abstract
Background
The rationale for gradually reducing radius (GR) femoral component aims to prevent flexion instability by gradually change the center of femoral rotation, unlike a discrete change by the multi-radius (MR) which is more common for most of total knee arthroplasties (TKA). However, no strong evidence has been reported the clinical significance of the GR design.

Methods
This patient-blinded, parallel, non-inferiority trial conducted in September 2020. Patients with knee osteoarthritis consented for cruciate retaining TKA were randomly allocated to a GR or MR group. Primary outcome measures were knee functions at postoperative 6 and 12 months using the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were performance-based tests (30-s chair stand test, 40-m fast paced walk test, and 3-m timed up and go test), and knee motions.

Results
Sixty patients were enrolled and randomized; GR (n = 30) and MR (n = 30) group. The changes of KOOS at 6 and 12 months from baseline showed clinical meaningful for both GR and MR group. At 6 and 12 months postoperatively, there was no significant difference between both groups in all KOOS subscales. The length of stay was not different between GR and MR group (5.93 ± 1.44 vs 6.17 ± 1.86 days, p = 0.59). Patients on both groups presented similar performance-based tests. However, the improvement in degrees of knee motion for the GR group was significantly greater than the MR group (34.67 ± 12.52 vs 23.67 ± 12.59, p = 0.001).

Conclusion
GR was noninferiority to MR for the functional outcomes and performances after TKA.
The GR femoral component gave more knee motions than did the MR prostheses.

Level of evidence
Level I, therapeutic study.
Examiner perceptions of the MRCGP recorded consultation assessment for general practice licensing during COVID-19: cross-sectional study
Authors: Botan Vanessa , Laparidou Despina , Phung Viet-Hai , Cheung Peter , Freeman Adrian , Wakeford Richard , Denney Meiling , Law Graham R. , Siriwardena Aloysius Niroshan 
Published: January 2023

Abstract
Background
The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA.

Methods
We employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses.

Results
Overall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates’ data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates’ performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners’ difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment.

Conclusion
The RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.
Entity and relation extraction from clinical case reports of COVID-19: a natural language processing approach
Authors: Raza Shaina , Schwartz Brian 
Published: January 2023

AbstractBackgroundExtracting relevant information about infectious diseases is an essential task. However, a significant obstacle in supporting public health research is the lack of methods for effectively mining large amounts of health data.ObjectiveThis study aims to use natural language processing (NLP) to extract the key information (clinical factors, social determinants of health) from published cases in the literature.MethodsThe proposed framework integrates a data layer for preparing a data cohort from clinical case reports; an NLP layer to find the clinical and demographic-named entities and relations in the texts; and an evaluation layer for benchmarking performance and analysis. The focus of this study is to extract valuable information from COVID-19 case reports.ResultsThe named entity recognition implementation in the NLP layer achieves a performance gain of about 1–3% compared to benchmark methods. Furthermore, even without extensive data labeling, the relation extraction method outperforms benchmark methods in terms of accuracy (by 1–8% better). A thorough examination reveals the disease’s presence and symptoms prevalence in patients.ConclusionsA similar approach can be generalized to other infectious diseases. It is worthwhile to use prior knowledge acquired through transfer learning when researching other infectious diseases.
The Swiss Health Insurance Literacy Measure (HILM-CH): Measurement Properties and Cross-Cultural Validation
Authors: Bardy Tess L. C. 
Published: January 2023

Abstract
Background
Most consumers face difficulties when choosing and navigating health insurance plans. Health insurance literacy (HIL) has been discussed as a critical lever to ensure efficient choices and navigation in choice-based health insurance systems. Still, existing evidence about HIL mainly comes from the US, and the only validated scale, the Health Insurance Literacy Measure (HILM), may not be adequate to measure HIL outside US samples. This paper describes the measurement properties of the Swiss Health Insurance Literacy Measure (HILM-CH), the first scale to measure HIL in Switzerland.

Methods
The items of the HILM-CH were adapted from the HILM in German, French, and Italian. A panel of experts refined it to ensure its suitability for the Swiss context. The final version of the HILM-CH contains 21 items, and other relevant measures were administered in the Swiss Health Insurance Literacy Survey to a sample of 6036 insurees. Measurement properties were investigated overall and per linguistic group. Internal reliability was determined using Cronbach’s alphas. Criterion validity was examined through convergent and concurrent validity of the HILM-CH. The construct validity was assessed using factor analysis. Measurement invariance of the HILM-CH between linguistic regions was further evaluated using multiple-group confirmatory factor analyses.

Results
The HILM-CH had acceptable to good reliability (alphas between 0.70 and 0.91). Concurrent and convergent validity showed that HILM-CH is a good measurement of HIL. Factor analysis revealed a four-factor model and showed an acceptable fit to the data (CFI= 0.977; TLI = 0.974; RMSEA = 0.061; SRMR = 0.032). Using the established four-factor model, measurement invariance was established across Switzerland’s German, French, and Italian-speaking regions.

Conclusions
The HILM-CH is a reliable and valid measure of HIL across Switzerland’s German, French, and Italian-speaking regions. It can be used in future research to find associations between HIL and individual characteristics.
Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study
Authors: Chang Ji Eun , Cronin Cory E. , Lindenfeld Zoe , Pagán José A. , Franz Berkeley 
Published: January 2023

AbstractIntroductionOpioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs.MethodsWe conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018).ResultsControlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities.ConclusionsMedicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.
Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study
Authors: Jaramillo Elise Trott , Willging Cathleen E , Saldana Lisa , Self-Brown Shannon , Weeks Erin A. , Whitaker Daniel J. 
Published: January 2023

Abstract
Background
Evidence-based interventions, which are typically supported by data from randomized controlled trials (RCTs), are highly valued by providers of human services like child welfare. However, implementing such interventions in the context of a randomized clinical trial is a complex process, as conducting an RCT adds extra tasks for providers and complicating factors for provider organizations. Utilizing the Exploration, Preparation, Implementation, and Sustainment Framework, this study examines factors that facilitate or impede success in the implementation of evidence-based interventions in the context of a largescale trial of SafeCare,® a child maltreatment intervention.

Methods
Qualitative data were obtained as part of a larger mixed-methods study involving a cluster randomized trial comparing SafeCare to usual services for caregivers within nine child welfare agencies across four states. Between May and October 2017, individual interviews were conducted with a purposive sample of 21 child welfare administrators and 24 supervisors, and 19 focus groups were conducted with 84 providers. Data were coded iteratively and grouped into themes.

Results
Several interconnected themes centered on facilitators and barriers to SafeCare implementation in the context of a randomized clinical trial. Facilitators included: (1) Benefits afforded through RCT participation; (2) Shared vision and sustained buy-in across system and organizational levels; and (3) Ongoing leadership support for SafeCare and the RCT. Barriers that hindered SafeCare were: (1) Insufficient preparation to incorporate SafeCare into services; (2) Perceived lack of fit, leading to mixed support for SafeCare and the RCT; and (3) Requirements of RCT participation at the provider level.

Conclusions
These data yield insight into an array of stakeholder perspectives on the experience of implementing a new intervention in the context of a largescale trial. This research also sheds light on how the dynamics of conducting an RCT may affect efforts to implement interventions in complex and high-pressure contexts. Findings highlight the importance of aligning knowledge and expectations among researchers, administrators of organizations, and supervisors and providers. Researchers should work to alleviate the burdens of study involvement and promote buy-in among frontline staff not only for the program but also for the research itself.
Whole-exome sequencing identified recurrent and novel variants in benzene-induced leukemia
Authors: Lin Dafeng , Wang Dianpeng , Li Peimao , Deng Lihua , Zhang Zhimin , Zhang Yanfang , Zhang Ming , Zhang Naixing 
Published: January 2023

Abstract
Background
Genome-wide sequencing may extensively identify potential pathogenic variants, which helps to understand mechanisms of tumorigenesis, but such study has not been reported in benzene-induced leukemia (BIL).

Methods
We recruited 10 BIL patients and conducted the whole-exome sequencing on their peripheral blood samples. The obtained sequencing data were screened for potential pathogenic and novel variants, then the variants-located genes were clustered to identify cancer-related pathways. Shared or recurrent variants among the BIL cases were also identified and evaluated for their potential functional impact.

Results
We identified 48,802 variants in exons in total, 97.3% of which were single nucleotide variants. After filtering out variants with minor allele frequency ≥ 1%, we obtained 8667 potentially pathogenic variants, of which 174 were shared by all the BIL cases. The identified variants located in genes that could be significantly enriched into certain cancer-related pathways such as PI3K-AKT signaling pathway and Ras signaling pathway. We also identified 1010 novel variants with no record in the Genome Aggregation Database and in dbSNP, and one of them was shared by 90% cases. The recurrent and novel variant caused a missense mutation in SESN3.

Conclusions
We examined variations of the whole exome in BIL patients for the first time. The commonly shared variants implied a relation with BIL, and the recurrent and novel variant might be specifically related to BIL. The related variants may help unravel the carcinogenic mechanisms of BIL.
Population-based physical activity promotion with a focus on health equity: a review of reviews
Authors: Kohler Simone , Dippon Lea , Helsper Natalie , Rütten Alfred , Abu-Omar Karim , Birkholz Leonie , Pfeifer Klaus , Weber Philipp , Semrau Jana 
Published: January 2023

Abstract
Background
The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews was therefore to identify successful population-based PA promotion approaches with a particular focus on health equity.

Methods
Six electronic databases were examined for systematic reviews on population-based PA promotion for the period 2015 to 2021. A reference list and grey literature search were also conducted. Two independent reviewers used inclusion/exclusion criteria to screen titles and abstracts of the potentially relevant literature and conducted a quality assessment for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations and/or health equity were narratively summarized.

Results
Our search resulted in 4,411 hits. After a systematic review process, six reviews met the inclusion criteria and were included after they were all rated as high quality. We identified that mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective as long as they are tailored. Regarding environmental approaches, the results are inconsistent. None of the reviews on community-based multi-component approaches provided evidence on health equity.

Conclusion
There are several effective approaches to promote PA in the general population but evidence regarding health equity is still sparse. Future studies should therefore pay more attention to this missing focus. Furthermore, there is a lack of evidence regarding the type of tailoring and the long-term impact of population-based approaches to PA promotion. However, this requires appropriate funding programmes, complex study designs and evaluation methods.
Response to Toshihide Tsuda, Yumiko Miyano and Eiji Yamamoto [1]
Authors: Schüz Joachim , Ostroumova Evgenia , Kesminiene Ausrele , Davies Louise , Ahn Hyeong Sik , Togawa Kayo , Vaccarella Salvatore 
Published: January 2023

Abstract
Background
Using a toolkit approach, Tsuda et al. critiqued work carried out by or in collaboration with the International Agency for Research on Cancer (IARC/WHO), including the IARC technical publication No. 46 on “Thyroid health monitoring after nuclear accidents” (TM-NUC), the project on nuclear emergency situations and improvement on medical and health surveillance (SHAMISEN), and the IARC-led work on global thyroid cancer incidence patterns as per IARC core mandate.

Main body
We respond on the criticism of the recommendations of the IARC technical publication No. 46, and of global thyroid cancer incidence evaluation.

Conclusion
After nuclear accidents, overdiagnosis can still happen and must be included in informed decision making when providing a system of optimal help for cases of radiation-induced thyroid cancer, to minimize harm to people by helping them avoid diagnostics and treatment they may not need.
Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP
Authors: Dipasquale Valeria , Deganello Saccomani Marco , Di Giorgio Angelo , Oliva Salvatore , Salvatore Silvia , Strisciuglio Caterina , Tambucci Renato , Lionetti Paolo , Romano Claudio 
Published: January 2023

Abstract﻿Around the world, the 2019 Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised serious public health problems and major medical challenges. The Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) published several papers on ﻿the impact of COVID-19 on the current management, diagnosis, and treatment of acute and chronic gastrointestinal, hepatic, immune-mediated, and functional disorders. The present article summarizes the most relevant SIGENP reports and consensus during and after the peak of the COVID-19 outbreak, including the diagnosis and treatment of inflammatory bowel disease (IBD), indications and timing of digestive endoscopy, and insights into the novel hepatitis.
Tumor necroptosis-mediated shedding of cell surface proteins promotes metastasis of breast cancer by suppressing anti-tumor immunity
Authors: Liu Zhaoshan , Choksi Swati , Kwon Hyung-Joon , Jiao Delong , Liu Chengyu , Liu Zheng-gang 
Published: January 2023

AbstractNecroptosis is a form of regulated necrosis and is executed by MLKL when MLKL is engaged in triggering the rupture of cell plasma membrane. MLKL activation also leads to the protease, ADAMs-mediated ectodomain shedding of cell surface proteins of necroptotic cells. Tumor necroptosis often happens in advanced solid tumors, and blocking necroptosis by MLKL deletion in breast cancer dramatically reduces tumor metastasis. It has been suggested that tumor necroptosis affects tumor progression through modulating the tumor microenvironment. However, the exact mechanism by which tumor necroptosis promotes tumor metastasis remains elusive. Here, we report that the ectodomain shedding of cell surface proteins of necroptotic cells is critical for the promoting effect of tumor necroptosis in tumor metastasis through inhibiting the anti-tumor activity of T cells. We found that blocking tumor necroptosis by MLKL deletion led to the dramatic reduction of tumor metastasis and significantly elevated anti-tumor activity of tumor-infiltrating and peripheral blood T cells. Importantly, the increased anti-tumor activity of T cells is a key cause for the reduced metastasis as the depletion of CD8+ T cells completely restored the level of metastasis in the Mlkl KO mice. Interestingly, the levels of some soluble cell surface proteins including sE-cadherin that are known to promote metastasis are also dramatically reduced in MLKL null tumors/mice. Administration of ADAMs pan inhibitor reduces the levels of soluble cell surface proteins in WT tumors/mice and leads to the dramatic decrease in metastasis. Finally, we showed the sE-cadherin/KLRG1 inhibitory receptor is the major pathway for necroptosis-mediated suppression of the anti-tumor activity of T cells and the promotion of metastasis. Hence, our study reveals a novel mechanism of tumor necroptosis-mediated promotion of metastasis and suggests that tumor necroptosis and necroptosis-activated ADAMs are potential targets for controlling metastasis.