bluuebunny/crossref_metadata_2025_split huggingface dataset:
The suitability of outing frequency as a definition of hikikomori (prolonged social withdrawal)
Authors: Nonaka Shunsuke , Sakai Motohiro 
Published: March 2023

Recent research has employed outing frequency, referred to in this study as one’s frequency of going out of the home, as a condition to define and determine the severity of hikikomori (prolonged social withdrawal). However, there is little definitive evidence on this topic. Furthermore, compared to the previous definition, it is unclear how the scope of hikikomori included in the proposed condition differs. This study aimed to clarify the relationship between hikikomori tendencies and the frequency and quality of outings to bridge this gap in research.MethodsData included 397 self-rated online samples, 72 self-rated offline samples, and 784 parent-rated samples. Quantitative and qualitative indicators of outings and subjective social functioning impairment were used in the analysis.ResultsThe cut-off points supported the criteria for the number of days outside the home proposed in previous studies. The results revealed that the outing frequency condition excluded about 14.5–20.6% of those previously considered to have hikikomori. Logistic regression analysis showed that low outings with interpersonal interaction, low frequency of outings, and high subjective social functioning impairment consistently predicted hikikomori. However, outings without interpersonal interaction did not predict hikikomori.ConclusionThese results indicate that outing frequency tends to be suitable as one of the conditions for hikikomori. However, they indicate that we should also focus on the quality of outings, that is, outings with or without interpersonal interaction, to evaluate hikikomori consistently with previous findings. Further research is needed to clarify the appropriate frequency of outings to define hikikomori and determine its severity.
Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting
Authors: Tokumitsu Keita , Yasui-Furukori Norio , Adachi Naoto , Kubota Yukihisa , Watanabe Yoichiro , Miki Kazuhira , Azekawa Takaharu , Edagawa Koji , Katsumoto Eiichi , Hongo Seiji , Goto Eiichiro , Ueda Hitoshi , Kato Masaki , Nakagawa Atsuo , Kikuchi Toshiaki , Tsuboi Takashi , Watanabe Koichiro , Shimoda Kazutaka , Yoshimura Reiji 
Published: March 2023

BackgroundBipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to prevent hospitalization. On the other hand, there is a lack of evidence regarding predictors of hospitalization in real-world clinical practice.MethodsThe multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was an observational study conducted to provide evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked, as part of a retrospective medical record survey, to fill out a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. Our study extracted baseline patient characteristics from records dated between September and October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. The incidence and predictors of hospitalization among patients with bipolar disorder over a 1-year period extending from that baseline to September–October 2017 were examined.ResultsIn total, 2,389 participants were included in our study, 3.06% of whom experienced psychiatric hospitalization over the course of 1 year from baseline. Binomial logistic regression analysis revealed that the presence of psychiatric hospitalization was correlated with bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and manic state.ConclusionsOur study revealed that 3.06% of outpatients with bipolar disorder were subjected to psychiatric hospitalization during a 1-year period that extended to September–October 2017. Our study suggested that bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and baseline mood state could be predictors of psychiatric hospitalization. These results may be useful for clinicians seeking to prevent psychiatric hospitalization for bipolar disorder.
Study protocol: Hypersexual and hyposexual behavior among adults diagnosed with alcohol- and substance use disorders—Associations between traumatic experiences and problematic sexual behavior
Authors: Jepsen Dennis , Luck Tobias , Bernard Marie , Moor Irene , Watzke Stefan 
Published: March 2023

BackgroundHypersexual and hyposexual behaviors are common concomitant of substance use disorders (SUD). On the one hand, the regular consumption of alcohol or illegal drugs can lead to hypersexual or hyposexual behavior due to its effects on the organism; on the other hand, the use of psychotropic substances is also used as a coping strategy concerning already existing sexual impairments. The aforementioned disorders show similarities in terms of their etiology, as traumatic experiences get special attention as potential risk factors for the development of addictions, hypersexual, and hyposexual behavior.ObjectivesThe study aims to explore the association between SUD characteristics and hypersexual/hyposexual behavior, and a potential moderating effect of early traumatic life events by answering the following research questions: (1) Do people with SUD differ from a sample of people with other psychiatric disorders regarding hypersexual and hyposexual behavior? (2) What are the associations between the presence of sexual problems and different characteristics of the SUD (e.g., mono vs. polysubstance use, type of addictive substance, intensity of the disorder)? (3) What influence do traumatic experiences in childhood and adolescence have on the existence of sexual disorders among adults with a diagnosed SUD?MethodThe target group of this cross-sectional ex-post-facto study comprises adults diagnosed with an alcohol- and/or substance use disorder. Data will be collected with an online survey, which will be promoted via several support and networking services for people diagnosed with SUD. Two control groups will be surveyed, one consisting of people with other psychiatric disorders than SUD and traumatic experiences, and one healthy group. Relations between the dependent variables (hypersexual and hyposexual behavior) and independent variables (sociodemographic information, medical and psychiatric status, intensity of the prevalent SUD, traumatic experiences, and symptoms of posttraumatic stress disorder) will be initially calculated via correlations and linear regression. Risk factors will be identified via multivariate regression.DiscussionGaining relevant knowledge promises new perspectives for prevention, diagnosis, case conception, and therapy of SUDs as well as problematic sexual behaviors. The results can provide more information about the importance of psychosexual impairments regarding the development and maintenance of SUDs.
Serum brain-derived neurotrophic factor as diagnosis clue for Alzheimer's disease: A cross-sectional observational study in the elderly
Authors: Li Yuanyuan , Chen Jiao , Yu Hui , Ye Jiayu , Wang Chunxia , Kong Lingli 
Published: March 2023

ObjectiveBrain-derived neurotrophic factor (BDNF) has not been validated as a diagnostic marker for Alzheimer's disease (AD). To provide a different perspective, this study aimed to evaluate the relationship between serum levels of mature BDNF (mBDNF) and precursor BDNF (proBDNF) in AD and to investigate whether serum BDNF levels or the ratio of mBDNF levels to proBDNF levels (M/P) could be a valuable biomarker for determining the risk of AD in elderly individuals.MethodA total of 126 subjects who met the inclusion criteria were assigned to either the AD group (n = 62) or the healthy control group (HC, n = 64) in this cross-sectional observationl study. Serum levels of mBDNF and proBDNF were measured using enzyme immunoassay kits. We analyzed the Mini-Mental State Examination (MMSE) scores from the two groups and examined the associations between AD and BDNF metabolism.ResultsThe serum concentration of proBDNF was significantly higher in ADs (4140.937 pg/ml) than in HCs (2606.943 pg/ml; p &lt; 0.01). The MMSE significantly correlated with proBDNF (p &lt; 0.01, r = −0.686) and M/P (p &lt; 0.01, r = 0.595) in all subjects. To determine the risk for AD, the area under the receiver operating characteristic curve was calculated, which was 0.896 (95% confidence interval 0.844–0.949) for proBDNF and 0.901 (95% 0.850–0.953) for proBDNF and M/P combined.ConclusionWe observed a correlation between low serum proBDNF levels and higher MMSE scores in AD. The most effective diagnostic strategy was the combination of proBDNF and M/P, whereas mBDNF levels performed poorly when we evaluated the predictive model.
Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults
Authors: Chen Jiaying , Mittendorfer-Rutz Ellenor , Berg Lisa , Nørredam Marie , Sijbrandij Marit , Klimek Peter 
Published: March 2023

BackgroundCommon mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.ObjectiveWe aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.MethodsThis longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or &gt; 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.ResultsIn total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p &lt; 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).ConclusionTo combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.
Understanding influencing attributes of COVID-19 vaccine preference and willingness-to-pay among Chinese and American middle-aged and elderly adults: A discrete choice experiment and propensity score matching study
Authors: Li Xialei , Yang Liujun , Tian Guanghua , Feng Bojunhao , Jia Xiaocen , He Zonglin , Liu Taoran , Zhao Xianqi , Huang Mengjie , Yu Wenli , Yu Lian , Ming Wai-Kit 
Published: March 2023

Background and objectiveCOVID-19 has imposed burdens on public health systems globally. Owing to the urgency of vaccination, this study aimed at comparing the differences in preference and willingness to pay of COVID-19 vaccine among Chinese and American middle-aged and elderly adults.MethodsA cross-sectional survey containing demographic questions, rating their acceptance of COVID-19 vaccination with and without recommendations from friends, family members or employers (the social cues referred to in our study), and a discrete choice experiment understanding COVID-19 vaccine preference and willingness to pay was conducted to collect data. Propensity score matching was utilized to adjust confounding factors of baseline characteristics and the relative importance of respondents' preference for each attribute and its level was estimated using a conditional logit model. Then, willingness to pay was calculated.ResultsIn total, 3,494 (2,311 and 1,183 from China and the United States, respectively) completed the questionnaire, among which 3,444 questionnaires were effective. After propensity score matching, 1,604 respondents with 802 from the US and 802 from China were included. Under the influence of the social cues, Chinese respondents' vaccine acceptance decreased from 71.70 to 70.70%, while American respondents' vaccine acceptance increased from 74.69 to 75.81%. The discrete choice experiment showed that American respondents regarded the efficacy of COVID-19 vaccine as the most important attribute, whereas Chinese respondents attached the highest importance to the cost of vaccination. But overall, the COVID-19 vaccine with the higher efficacy, the milder adverse effect, the lower cost, and the longer duration will promote the preference of the public in both countries. Additionally, the public were willing to spend the most money for a reduction in COVID-19 vaccine adverse effect from moderate to very mild (37.476USD for the United States, 140.503USD for China), followed by paying for the 1% improvement in its efficacy and paying for the one-month extension of its duration.ConclusionGiven the impact of social cues on vaccine acceptance, Chinese government should promote reasonable vaccine-related information to improve national vaccination acceptance. Meanwhile, considering the influence of COVID-19 attributes on public preference and willingness to pay, regulating the vaccine pricing, improving the efficacy of the vaccine, reducing its adverse effect, and prolonging the duration of the vaccine works will contribute to vaccine uptake.
Combined effects of EMP and RF field on emotional behavior in mice
Authors: Qin Tongzhou , Liu Liyuan , Wang Xing , Guo Ling , Lin Jiajin , Du Junze , Xue Yizhe , Lai Panpan , Jing Yuntao , Ding Guirong 
Published: March 2023

BackgroundRecently, concerns about the combined effects of electromagnetic field (EMF) in daily living and occupational environment are rapidly growing.MethodsIn this study, we investigated the combined effects of 1-week exposure to electromagnetic pulse (EMP) at 650 kV/m for 1,000 pulses and 4.9 GHz radiofrequency (RF) at 50 W/m2 for 1 h/d in male mice. Open field test, tail suspension test and Y-maze were applied to evaluate anxiety, depression-like behaviors and spatial memory ability, respectively.ResultsIt was found that compared with Sham group, combined exposure to EMP and RF induced anxiety-like behavior, increased the level of serum S100B and decreased the level of serum 5-HT. The results of quantitative proteomic and KEGG analysis showed that the differentially expressed proteins in hippocampus were enriched in Glutamatergic and GABAergic synapse after combined exposure group, which were verified by western blot. In addition, an obvious histological alteration and autophagy-associated cell death were observed in amygdala instead of hippocampus after combined exposure to EMP and 4.9 GHz RF.ConclusionCombined exposure to EMP and 4.9 GHz RF could induce emotional behavior alteration, which might be associated with Glutamatergic and GABAergic synapse system of hippocampus and autophagy in amygdala.
Sensory impairments and subjective well-being status in middle-aged and older Chinese population: Cross-sectional and longitudinal analyses of a nationally representative survey
Authors: Zhou Yifan , Lu Yan , Liu Ye , Hou Yanan , Qian Xinyi , Abuduxukuer Kaiweisa , Xiang Minhong , Peng Qing , Luo Jianfeng 
Published: March 2023

PurposeTo investigate the impacts of sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI) and dual sensory impairment (DSI) on subjective wellbeing measurements including life expectancy (LE), life satisfaction (LS) and self-rated health (SRH) in middle-aged and older Chinese population.MethodsWe obtained data from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 9,293 Chinese middle-aged and older adults aging over 45 were included at baseline 2011 in this study, and 3,932 participants who accomplished all 4 interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and subjective wellbeing measurements were collected. Other covariates included socio-demographic characteristics, medical condition and lifestyle-related factors. The impacts of baseline sensory status on LE, LS and SRH were assessed using univariate and multivariate logistic regression analyses. A linear regression analysis with generalized estimating equations (GEE) was used to assess the association between time-varying sensory statuses with LE, LS and SRH over 8 years after being adjusted with multi-confounding factors.ResultsParticipants with SIs had significantly lower level of LE, LS, and SRH, compared to those who were free of SI. All kinds of SIs were significantly associated with LE, LS, and SRH according to cross-sectional data. The correlations between SIs and LE or SRH over 8 years were also noticed. However, only SHI and DSI were found to be significantly associated with LS according to longitudinal data (all p values &lt; 0.05).ConclusionSensory impairments had explicitly detrimental effects on subjective wellbeing status over time among middle-aged and older Chinese population.
A community-based study of dental fluorosis in rural children (6–12 years) from an aspirational district in Karnataka, India
Authors: Prasad U. Venkateswara , Vastrad Phaniraj , N. Chandan , Barvaliya Manish J. , Kirte Rahul , R. Sabarinath , Ray Suman K. , B. Ravichandran , Chakma Tapas , Murhekar Manoj V. , Roy Subarna 
Published: March 2023

ObjectivesThe present study was planned to estimate the prevalence of dental fluorosis in 6–12 years of children and its association with various drinking water sources, water, and urine fluoride levels among the subset of children under the umbrella of a larger study to address iodine deficiency disorders and iron deficiency anemia in 17 villages of Manvi and Devadurga talukas of Raichur district of Karnataka.MethodsAnalysis of subset of data and urine samples of children under the umbrella of a larger cross-sectional community-based study was conducted in 17 villages of Manvi and Devadurga taluks of Raichur district. House to house survey was carried out to collect data using a semi-structured questionnaire in ODK software. Demographic details, source of drinking water, clinical assessment of dental fluorosis, and height and weight measurements were performed by trained staff. Urine and water samples were collected for fluoride level estimation. The overall prevalence of dental fluorosis and its severity-wise prevalence were estimated. Association between dental fluorosis and age, gender, type of diet, source of drinking water, height for age, BMI for age, water fluoride level, and urine fluoride level were carried out using logistic regression analysis.ResultsThe prevalence of dental fluorosis was 46.0%. Mild, moderate, and severe dental fluorosis was found in 37.9, 7.8, and 0.3% of children. With the increasing age of participants, the odds of dental fluorosis were found to increase by 2–4 folds. The odds of having dental fluorosis were significantly increased with increasing water fluoride levels of 3 to 5 ppm [AOR = 3.147 (1.585–6.248); P = 0.001] in comparison with water fluoride levels of &lt; 1 ppm. The similar trend was found with urine fluoride level &gt; 4 ppm [AOR = 3.607 (1.861–6.990); P &lt; 0.001]. As compared to river water, other sources of drinking water were significantly associated with higher odds of dental fluorosis.ConclusionsPrevalence of dental fluorosis was high in 6 to 12 years due to overexposure of fluoride from drinking water. High water and urine fluoride levels in children indicate the chronic exposure to fluoride and suggest that the population is at high risk of developing chronic fluorosis.
Impact of post stroke depression and anxiety on health-related quality of life in young Filipino adults
Authors: Ignacio Katrina Hannah D. , Medrano Jose Miguel M. , Salabi Sitti Khadija U. , Logronio Alvin J. , Factor Sedric John V. , Ignacio Sharon D. , Pascual Jose Leonard R. , Pineda-Franks Maria Carissa , Diestro Jose Danilo B. 
Published: March 2023

BackgroundHealth-related quality of life (HRQoL) is important to assess in young adults who suffer from various physical and mental consequences after stroke. We aimed to evaluate the HRQoL of young adults after ischemic or hemorrhagic stroke and to determine the association of anxiety and depression with poor HRQoL in this special population.MethodsWe administered the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) to assess the HRQoL in our study population. This tool describes health outcomes in five dimensions. Socio-demographic and clinical data including modified Rankin scale (mRS), Barthel Index and Hospital Anxiety and Depression Scale scores were available from our previous cross-sectional study on young adults with stroke. We performed bivariate analyses to assess the association of psychiatric comorbidities with categorical characteristics and determined risk factors for poor HRQoL using multivariable logistic regression analysis.ResultsWe evaluated HRQoL, psychiatric and functional outcomes in 114 young adult stroke patients. CVD infarct was more common than hemorrhage (58.8 vs. 41.2%). Patients with both anxiety and depression were found to have the lowest ratings on the HRQoL scales, with an EQ VAS of 60 vs. 90 (p = 0.01) and an EQ Index of 0.64 vs. 0.89 (p &lt; 0.01) when compared to those without both conditions. Anxiety and depression were significantly correlated with poor quality of life on all dimensions of the EQ-5D-5L. Similarly, Barthel Index was a significant predictor for problems in HRQoL (OR 0.17, 95% CI 0.03–1.02 on the mobility dimension and OR 0.08, 95% CI 0.01–0.55 on the self-care dimension). Cerebral hemorrhage was an independent predictor for poorer self-care dimension scores (OR 4.99, 95% CI 1.42–17.56).ConclusionsOur study showed that anxiety, depression and poor functional status are associated with poorer HRQoL in young adult Filipinos after stroke. Screening for psychiatric conditions and evaluating mobility are crucial in the management of this special population after stroke.