bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Travel Time on Hospital Utilization in the Islands Area: A Cross-Sectional Study in the Maluku Region, Indonesia, in 2018
Authors: Ipa Mara , Laksono Agung Dwi , Wulandari Ratna Dwi 
Published: April 2023

Background:
Maluku region is one of the vulnerable areas in Indonesia, and this region has extreme geographical conditions with thousands of islands. The study aims to analyze the role of travel time to a hospital in the Maluku region in Indonesia.

Material and Methods:
This cross-sectional study analyzed the 2018 Indonesian Basic Health Survey data. The research included 14,625 respondents by stratification and multistage random sampling. The study used hospital utilization as an outcome variable and the travel time to the hospital as an exposure variable. Moreover, the study employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and health insurance. The study performed binary logistic regression to interpret the data in the final analysis.

Results:
The result shows a relationship between travel time and hospital utilization. Someone with a travel time of 30 min or less to the hospital has a 1.792 (95% CI 1.756–1.828) higher probability than those with a travel time of more than 30 min. The results of this analysis find that shorter travel time to the hospital has a better possibility of hospital utilization. In addition, the study also found eight control variables to have a significant relationship with hospital utilization.

Conclusion:
Shorter travel time to the hospital is more likely to be utilized in the Maluku region.
Social Support Status of the Elderly Population in Selected Villages in a Central India District
Authors: Khandre Ruchita R. , Raut Abhishek , Mundra Anuj 
Published: April 2023

Background:
Social support has been considered an important social determinant of health because it assists individuals in reaching their physical and emotional needs. The current study was proposed to assess the social support status of the elderly in rural central India.

Material and Methods:
This observational cross-sectional study was conducted in selected four villages in central India on 460 elderly individuals for 5 months (Aug-Dec 2021) with the use of the MSPSS (Multi-dimensional Scale Perceived Social Support) questionnaire. Univariate analysis and multivariate analysis were carried out using R software.

Result:
Out of 460, 37 (8.04%) of the elderly were found to have low, 177 (38.47%) were moderate, and 246 (53.48%) were having high social support. The result showed age and education of the elderly were significantly associated with social support.

Conclusion:
Intergenerational activities, provision and strengthening of social platforms, and the addition social support components with comprehensive geriatric assessment can improve the current status.
Community Medicine in Ayushman Bharat Digital Mission: The Hidden Cornerstone
Authors: Samudyatha U.C , Kosambiya J.K. , Madhukumar Suwarna 
Published: April 2023

Background:
India has launched Ayushman Bharat Digital Mission (ABDM), to provide an integrated digital health infrastructure. The success of digital health systems lies in their ability to achieve universal healthcare and incorporate all levels of disease prevention. The objective of this study was to develop an expert consensus on how Community Medicine (Preventive and Social Medicine) can be integrated into ABDM.

Methods:
A total of 17 and 15 participants, who were Community Medicine professionals with more than 10 years experience in the Public Health Sector and/or Medical Education in various parts of India, participated in round 1 and 2 of this Delphi study respectively. The study explored three domains: 1. Advantages and challenges of ABDM, and possible solutions; 2. Intersectoral convergence in Unified Health Interface (UHI) and 3. Way ahead in medical education and research.

Results:
Participants envisaged improved accessibility, affordability, and quality of care due to ABDM. However, awareness generation, reaching out to marginalized populations, human resource constraints, financial sustainability, and data security issues were anticipated challenges. The study identified plausible solutions addressing six broad challenges of ABDM and classified them based on the priority of implementation. Participants listed out nine key roles of Community Medicine professionals in digital health. The Study identified about 95 stakeholders who play direct and indirect roles in public health and can be connected to the general public through the Unified Health Interface of ABDM. Further, the study explored the future of medical education and research in the digital era.

Conclusion:
The Study contributes to broadening the scope of India’s digital health mission, with elements of Community Medicine in its cornerstone.
Financial Cost of Hypertension in Urban and Rural Tertiary Health Facilities in Southwest, Nigeria: A Comparative Cross-Sectional Study
Authors: Ipinnimo Tope Michael , Emmanuel Eyitayo Ebenezer , Ipinnimo Motunrayo Temidayo , Agunbiade Kehinde Hassan , Ilesanmi Oladipupo Adekunle 
Published: April 2023

Background:
The financial cost of hypertension could result in serious economic hardship for patients, their households, and the community. To assess and compare the direct and indirect cost of care for hypertension in urban and rural tertiary health facilities.

Material and Methods:
A comparative cross-sectional study was carried out in two tertiary health facilities which are located in urban and rural communities of the southwest, Nigeria. Four hundred and six (204 urban, 202 rural) hypertensive patients were selected from the health facilities using a systematic sampling technique. A pretested semi-structured, interviewer-administered questionnaire adapted from that used in a previous study was used for data collection. Information on biodata, and direct and indirect costs was collected. Data entry and analysis were done using IBM SPSS Statistics for Windows, Version 22.0.

Results:
More than half of the respondents were females (urban, 54.4%; rural, 53.5%) and in their middle age (45-64 years) (urban, 50.5%; rural, 51.0%). The monthly cost of care for hypertension was significantly higher in urban than in rural tertiary health facilities (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

19,703.26 [$54.73]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

18,448.58 [$51.25]) (P < 0.001). There was a significant difference in the direct cost (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

15,835.54 [$43.99]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

14,531.68 [$40.37]) (P < 0.001), although the indirect cost (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

3,867.72 [$10.74]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

3,916.91 [$10.88]) (P = 0.540) did not show much difference between the groups. The cost of drugs/consumables and investigations contributed more than half (urban, 56.8%; rural, 58.8%) of the cost in both health facilities.

Conclusion:
The financial cost of hypertension was higher in the urban tertiary health facility; therefore, more government support is needed in this health facility to close the financial gap.
Epidemiological Profile and Spatio-Temporal Pattern of Infant Deaths in a District of North India during 2016-2019
Authors: Sachdeva Aman , Verma Ramesh , Agrawal Ginni , Vinay  , Satija Jitesh 
Published: April 2023

Background:
Infant mortality is an important health indicator of a population given its strong link to socioeconomic status, health service access, and quality and maternal health. The declining trend of Infant Mortality Rate has been observed in India where it reduced from 89 deaths per 1000 live births in 1990 to 28 deaths per 1000d live births in 2019. Most of the studies regarding the trend of infant mortality are state-based, however, state-level infant mortality has masked the intradistrict clustering of individual infant deaths. Hence, this study was planned with an objective to study the trend of infant mortality at the district level.

Material and Methods:
A retrospective study was conducted in the district Rohtak of Haryana using the data collected regarding infant deaths. The collected data regarding addresses were geocoded. The resulting layer was then analyzed using QGIS v3.10. The descriptive data was analyzed using SPSS v20.0.

Result:
In total, 1336 infant deaths during the study period were included. A declining trend of infant mortality was observed over the study period. The number of grids (25 km2) reduced from 18 in 2016 to 10 in 2019 depicting a reduction in the areas with more than expected count.

Conclusion:
This study emphasizes on the importance of using the geographic information science technique in identifying local hotspots within the district so as to find areas that need more support and observation.
The Influence of Digitalized Examination of the Histology Laboratory Course on Medical and Dental Students
Authors: Chiang Ming-Hsien , Lan Hsin-Chieh , Cheng Chia-Pi , Chen Jang-Yi , Yin Fon-Yi , Lin Gu-Jiun 
Published: April 2023

Background:
Histology laboratory courses comprise the study of cell structures, tissues, and body organs, which are mainly examined using a microscope. Two types of examinations assess learning outcomes in these courses in Taiwan: the traditional, light microscope station (LMS) examination and the Microsoft PowerPoint (MS PPT) examination. Whether these examinations exhibit different influences on students' grade performances remains to be examined.

Aim:
The aim is to compare the grade performance and opinion of students in a medical center for the LMS and MS PPT examinations.

Methods:
We compared the grade performances of students who completed LMS (3 cohorts) or MS PPT (2 cohorts) examinations retrospectively and conducted a survey to investigate the students' learning attitude between these two types of examinations.

Results:
Grade performances in the MS PPT group were not significantly higher than those in the LMS group. The average scores of students who failed the LMS examination were significantly lower than those of students who failed the MS PPT examination. Questionnaire survey results showed that the MS PPT examination was easier for students and that they may spend less time studying for it. The LMS examination positively influenced learning attitudes among students with a rather low self-demand.

Conclusion:
Examination type may affect learning attitude, especially among students with a rather low self-demand. The MS PPT examination seems to be easier for students and was connected to remarks about less study time in the histology laboratory course, and for students with low self-demands, the traditional LMS examination may be a better option. We believe that with the advance of digital whole histology slide imaging, there is an opportunity to revolutionize both learning and evaluating for all medical school students.
Effect of Betahistine on Isolated Rats' Tracheal Smooth Muscles
Authors: Chou Ying-Liang , Wang Hsing-Won 
Published: April 2023

Background:
Betahistine is used as an H3 antagonist. It has been used to treat balance disorders. During the administration of the drug, the trachea may be affected through oral intake.

Aim:
This study aimed to determine the effects of betahistine on the tracheal smooth muscle of rats in vitro.

Methods:
On a rat trachea that had been isolated and immersed in Krebs solution in a muscle bath, we evaluated the efficacy of betahistine. We examined how the application of parasympathetic mimetic agents altered tracheal contractility. The betahistine was evaluated using the following criteria: the drug's effects on tracheal smooth muscle contractions triggered by parasympathetic mimetic 10− 6 M methacholine, electrically induced tracheal smooth muscle contractions, and resting tracheal smooth muscle tension were listed below.

Results:
At preparation concentrations as high as 10− 4 M, betahistine produced a substantial relaxing response. The medication also prevented spike contraction brought by electrical field stimulation. However, betahistine alone had a negligible effect on the basal tension of the trachea at increasing concentrations.

Conclusion:
According to this study, excessive levels of betahistine might actually oppose cholinergic receptors and prevented the tracheal smooth muscles parasympathetic activity.
Extracorporeal Shockwave Therapy on Spasticity after Central Nervous System Injury
Authors: Chen Po-Huang , Ho Ching-Liang , Lee Cho-Hao 
Published: April 2023

Background::
Spasticity is a disorder characterized by velocity dependently increasing in the tonic stretch reflexes (muscle tone). There were variable managements for spasticity. Treatment of spasticity depends on the severity, involved part, and patient's and families' preference. However, there were more trials completed in studying the efficacy of extracorporeal shockwave therapy (ESWT) in treating spasticity in different disease.

Aim:
The goal of our study is to evaluate the efficacy of ESWT in treating of spasticity after central nervous system lesions and to analyze the influences of related factors; we performed a systemic review to survey the effect.

Methods:
We performed a thoroughly systematic review and meta-analysis.

Results:
Totally 9 studies were included 4 studies examined the spasticity in stroke group, 4 studies were in cerebral palsy, and 1 study in multiple sclerosis. Regarding the effect of spasticity reduction in overall populations, the pooled effect showed that the modified Ashworth scale grade reduction compared with the baseline values were standardized mean difference (SMD): −4.07 (95% confidence interval (CI), −5.37– −2.76; P < 0.001) immediately after ESWT, SMD: −2.51 (95% CI, −3.40– −1.62; P < 0.001) after 4 weeks, and SMD: −1.44 (95% CI, −1.92– −0.95; P < 0.001) after 12 weeks. In terms of the disease types, the SMD in stroke patients was SMD: −4.03 (95% CI, −5.44– −2.61; Z = 5.57; P < 0.001) immediately after ESWT, SMD: −2.34 (95% CI, −3.01– −1.66; Z = 6.80; P < 0.001) after 4 weeks and SMD: −1.50 (95% CI, −2.06– −0.93; Z = 5.20; P < 0.001) after 12 weeks. No significant adverse events were found.

Conclusion:
The present meta-analysis revealed that ESWT effectively alleviates spasticity in patients after upper motor neuron lesions, regardless of disease type and parts treated. Both radial and focus ESWTs could decrease spasticity, regardless of the treatment session. The result could last for 12 weeks after treatment. Moreover, no serious side effects were observed after ESWT. Further studies with randomization and more parameters of ESWT were advised to setup to improve the clinical effectiveness.
Increased Cerebral Blood Flow Following L110 Acupuncture in Healthy Volunteers Observed with 99mTc-Ethyl Cysteine Dimer Single-Photon Emission Computed Tomography
Authors: Yeh Skye Hsin-Hsien , Lin Ching-Heng , Chang Ping-Ying , Lin Li-Fan , Tang Shin-En , Chiu Chuang-Hsin 
Published: April 2023

Background::
Ischemic stroke is the second most common cause of death and a major cause of disability worldwide. Acupuncture is frequently advocated as an alternative treatment during stroke rehabilitation.

Aim:
The purpose of this study was to measure regional cerebral blood flow (rCBF) following acupuncture at LI-10 Shousanli in healthy volunteers using 99mTc-ethyl cysteine dimer (99mTc-ECD) single-photon emission computed tomography (SPECT).

Methods:
Fourteen healthy volunteers were enrolled in this study. A baseline brain SPECT was taken, and 3 months later, acupuncture was performed at LI-10 for 20 min, followed by a second SPECT. Statistical parametric mapping was used to analyze the changes in rCBF before and after acupuncture through a paired t-test.

Results:
Perfusion increased in the caudate, thalamus, hippocampus, and precuneus (P < 0.05) regions after acupuncture at LI-10 compared to baseline and decreased rCBF was observed in the frontal cortex, occipital cortex, and parietal regions compared to baseline. Differences between baseline and postacupuncture (PA) perfusion levels showed were highest in the hippocampus region, followed by the striatum, thalamus, and cerebellum regions.

Conclusion::

99mTC-ECD SPECT revealed significant increases in rCBF for specific region PA at LI-10. These results provide reference control group data for future longitudinal studies of stroke patients receiving acupuncture therapy as an alternative treatment to improve motor function and aid intensive rehabilitation.
Electronic medical records-based retrospective, longitudinal, observational study to understand the patient management of benign prostatic hyperplasia with alpha-blockers monotherapy in Indian population
Authors: Gupta Rahul , Trivedi Sameer , Vaddi Surya Prakash , Borgohain Mrinal , Mittal Rajan , Pandit Sucheta , Mane Amey 
Published: April 2023

Objective:
The present retrospective study evaluates the effectiveness and tolerability of alpha-blockers as monotherapy in patients with benign prostatic hyperplasia associated with lower urinary tract symptoms (LUTS).

Materials and Methods:
A total of 335 male patients >50 years were categorized into four groups (Alfuzosin: 166, Silodosin: 67, Tamsulosin: 70, Prazosin: 32). The efficacy evaluated as a change in International Prostate Symptom Score (IPSS), peak flow rate (Qmax), residual urine volume, and relief from LUTS, and tolerability of the various alpha-blockers was assessed across the study group.

Results:
At baseline, most of the patients in alfuzosin (60%), silodosin (77%), and tamsulosin (90%) groups presented with severe IPSS (20–35), whereas patients in the prazosin group (69%) presented with a moderate score. At the end of the study, the mean IPSS gradually improved to moderate (41%, 62%, 66%, and 28%) and mild (59%, 38%, 28%, and 72%) in the alfuzosin, silodosin, tamsulosin, and prazosin groups, respectively (P = 0.004), with improvement in mean change in residual urine volume and complete relief from LUTS symptoms with no surgical or radiological interventions. Overall, 194 adverse events (AEs) were observed in 38.8% of patients. Of the total AEs, patients in the alfuzosin, silodosin, tamsulosin, and prazosin groups experienced 21%, 22%, 39%, and 18% of AEs, respectively.

Conclusion:
The nonselective alpha-adrenergic receptor antagonist, alfuzosin, emerged as noninferior in effectiveness and superior in tolerability than other selective alpha-blockers, silodosin, tamsulosin, and prazosin.
The effect of percutaneous tract dilation technique on renal parenchymal trauma
Authors: Tsaturyan Arman , Adamou Constantinos , Pantazis Lampros , Kalogeropoulou Christina , Tzelepi Vasiliki , Apostolopoulos Dimitris , Pagonis Konstantinos , Peteinaris Angelis , Natsos Anastasios , Vrettos Theofanis , Al-Aown Abdulrahman , Liatsikos Evangelos , Kallidonis Panagiotis 
Published: April 2023

Purpose:
The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model.

Materials and Methods:
A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography–computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination.

Results:
The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method.

Conclusions:
Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.
Recreational use of oral erectile dysfunction medications among male physicians - A cross-sectional study
Authors: Almannie Raed , Alzahrani Meshari A , Almuhaideb Mana , Abunohaiah Ibrahim , Habous Mohamad , Binsaleh Saleh 
Published: April 2023

Introduction:
Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Bypassing health-care providers and obtaining ED medications (EDM) without a prescription are an issue that is faced globally.

Aim:
We attempt to assess erectile function (EF) among a local sample of physicians, the psychological effects of recreational EDM use, and compare EF among different user groups.

Methods:
This is a cross-sectional study done solely on physicians in Saudi Arabia. A self-designed questionnaire including demographics, sexual characteristics, use of ED medication, sexual satisfaction, and the validated international index of EF (IIEF).

Outcome:
Physicians misused EDM.

Results:
A total of 503 physicians completed the questionnaire. Among participants reporting sexual problems, only 23% received counseling and 3.4% were professionally diagnosed with ED. Among users, 71.2% were using EDM recreationally, 14.4% prophylactically, and 14.4% were prescribed. Participants aged 20–29 IIEF-5 score was significantly lower than participants aged 30–39 years. Prescribed users had a lower IIEF-5 score compared to both recreational users and nonusers.

Clinical Implications:
Many healthy sexually active men use EDMs recreationally to increase sexual performance.

Strengths and Limitations:
One of the limitations of our study is that we did not use standardized tools to determine the diagnosis of some important disorders like premature ejaculation. Our study strengths include the very high response rate, with our results truly showing a nationwide self-assessment of sexual dysfunction.

Conclusion:
Recreational use of oral EDMs may adversely impact the psychological aspects of sexual function. In our study, physicians misused EDM. We recommend labeling EDMs as restricted medication that requires a prescription to use by a licensed physician.