bluuebunny/crossref_metadata_2025_split huggingface dataset:
Misclassification Bias in the Assessment of Gene-by-Environment Interactions
Authors: Weisskopf Marc G. , Leung Michael 
Published: May 2023

Background:
Misclassification bias is a common concern in epidemiologic studies. Despite strong bias on main effects, gene–environment interactions have been shown to be biased towards the null under gene–environment independence. In the context of a recent article examining the interaction between nerve agent exposure and paraoxonase-1 gene on Gulf War Illness, we aimed to assess the impact of recall bias—a common misclassfication bias—on the identification of gene–environment interactions when the independence assumption is violated.

Methods:
We derive equations to quantify the bias of the interaction, and numerically illustrate these results by simulating a case–control study of 1000 cases and 1000 controls. Simulation input parameters included exposure prevalence, strength of gene–environment dependence, strength of the main effect, exposure specificity among cases, and strength of the gene–environment interaction.

Results:
We show that, even if gene–environment independence is violated, we can bound possible gene–environment interactions by knowing the strength and direction of the gene–environment dependence (

) and the observed gene–environment interaction (

)—thus often still allowing for the identification of such interactions. Depending on whether

is larger or smaller than the inverse of

,

is a lower (if

) or upper (if

) bound for the true interaction. In addition, the bias magnitude is somewhat predictable by examining other characteristics such as exposure prevalence, the strength of the exposure main effect, and directions of the recall bias and gene–environment dependence.

Conclusions:
Even if gene–environment dependence exists, we may still be able to identify gene–environment interactions even when misclassification bias is present.
Propeller posterior tibial artery perforator flap for reconstruction of the medial malleolar defect: A case report
Authors: Chiang Liang-Jui , Shieh Shyh-Jou 
Published: May 2023

Abstract
Traumatic injury to the distal third of the lower leg remains challenging and often requires free tissue transfer. Reconstructive options for lower leg soft-tissue defects require comprehensive evaluation. A 20-year-old man presented with a medial malleolar soft-tissue defect with exposure of the great saphenous vein, distal tibia, and ankle joint after a traffic accident. Negative pressure wound therapy provided only partial coverage of the exposed tissue. The defect was reconstructed using a local fasciocutaneous propeller flap based on a septocutaneous perforator from the posterior tibial artery. At 1-year follow-up, the patient resumed normal daily activities without functional deficits. We review the options of reconstructing the distal third of the lower leg and surgical pearls of propeller flaps. Propeller flaps provide adequate tissue-like and pliable soft tissue coverage with a short operation time. It can be a useful technique for the reconstruction of distal third lower-leg defects.
Delayed Lithium Reintoxication in a Case of Severe Multidrug Intoxication: A Case Study
Authors: Liang Jiayi , van den Bout Christiaan J. , Bosch Tessa M. , Mitrov-Winkelmolen Lieke 
Published: May 2023

Abstract:
The authors present a case of severe multidrug intoxication following massive ingestion of lithium, nortriptyline, aripiprazole, lorazepam, and temazepam. After initial treatment, serum lithium levels decreased significantly. However, 28 hours post ingestion, recurrent elevated lithium levels were observed, and serum lithium level increased 0.71 mmol/L in 12 hours. The intensivist consulted a hospital pharmacist about this. After administering clearance-inducing therapy using continuous venovenous hemodialysis, the lithium level was reduced to a long-lasting nontoxic level. The occurrence of secondary elevation in lithium levels exceeding the toxic limit in cases of massive ingestion of lithium tablets, whether in combination with anticholinergic drugs, should be anticipated. Close monitoring and prompt initiation of clearance-inducing therapy can improve clinical outcomes.
Patients’ views on HCC biospecimen research: Understanding the role of race and culture through interviews
Authors: Jones Patricia D. , Schooley Ryan C. , Hon Sophia , Castañeda Stephanie M. , McCauley Jacob L. , Lee Debbiesiu L. 
Published: May 2023

Background:
HCC is a leading cause of cancer-related mortality; there are significant racial and ethnic disparities in HCC risk and survival. Our knowledge regarding whether molecular and genetic factors contribute to these observed differences is limited by scarcity of biospecimens, which are especially scarce in minority populations. Because biospecimens are not needed for HCC diagnosis or treatment, patients are less likely to provide biospecimens solely for research purposes.

Methods:
We identified participants, n = 32, from an ongoing prospective cohort study. Using semi-structured interviews, we examined perceptions of providing biospecimens for research to identify factors that motivate and hinder their willingness to donate.

Results:
Directed content analysis resulted in 6 themes, including reported experiences of (1) support or suspicion in donating biospecimens; (2) desire to help others or themselves; (3) inconvenience, discomfort, and concerns about privacy or recovery as hindrances to donating; (4) recommendations for health care researchers; (5) preferences for biospecimen donation; and (6) the influence of race, culture, and religion in donating biospecimens. Patients reported being least willing to donate specimens that required more invasive procedures and recovery, namely, liver tissue. Patients reported being more likely to donate if the data collection was convenient, resulted from discarded tissue, or was instituted as part of a broad opt-in consent approach, with assurances as to confidentiality and prosocial benefit. Participants expressed mixed views about whether race and culture influence people’s willingness to donate biospecimens.

Conclusions:
Specific recommendations to increase the likelihood of donation include providing patients with educational materials addressing the benefits of donation and the concerns about confidentiality and data usage, making donation convenient, and adopting a broad consent bio-banking policy.
Professional Nursing Practice Environment and Work Engagement: The Mediating Roles of Self-Efficacy and Achievement Motivation
Authors: DAN Xin , HUANG Yan , REN Jian-Hua , TIAN Ya-Lin , HE Ya-Lin 
Published: May 2023

ABSTRACTBackgroundThe shortage of nurses is a global problem. Increasing the level of work engagement is known to effectively reduce turnover rate among nursing staff. Strategies to improve work engagement based on the job demands–resources model may effectively improve nurses' job satisfaction and reduce staff turnover.PurposeA job demands–resources model was used in this study to test the hypothesis that work engagement is affected by both external resources (professional nursing practice environment) and internal resources (self-efficacy and achievement motivation). In addition, the mediating role of self-efficacy and achievement motivation in the relationship between professional nursing practice environment and work engagement was also verified.MethodsA cross-sectional survey employing a convenience sampling design was implemented. Five hundred fifteen registered nurses were recruited from four tertiary hospitals in Chengdu, China, from January to June 2020. The Practice Environment Scale of the Nursing Work Index, General Self-Efficacy Scale, Achievement Motive Scale, and Utrecht Work Engagement Scale were used to measure the four variables.ResultsThe results of the structural equation model showed that the degree of fit for each index model was good, indicating that all of the three variables, including professional nursing practice environment, self-efficacy, and achievement motivation, directly affected work engagement. In addition, the variable professional nursing practice environment was found to indirectly influence work engagement through the partial mediation of self-efficacy and achievement motivation.ConclusionsThe results may be used to guide health policymakers and nurse managers attempting to enhance the work engagement of nurses by providing a supportive working environment, improving the welfare mechanism, formulating a talent training plan, and fostering appropriate empowerment to improve the working environment, self-efficacy, and motivation in nurses.
A contemporary approach to the musculoskeletal problems associated with hemophilia
Authors: Martín Fuentes Angel , Salas Gaude María Elena 
Published: May 2023

Abstract
It is essential that joint bleeds be treated in a hematologically and orthopedically optimal manner so as to arrest the bleeding as soon as possible and prevent potentially irreversible joint damage from setting in. The main goal of rehabilitation in the context of hemophilia is above all prevention and treatment of the consequences of musculoskeletal bleeding. Rehabilitation of acute joint bleeding episodes, that is, hemarthrosis, is based on three fundamental pillars: arthrocentesis, PRICE measures, and rehabilitation protocols.
Prevalence and Factors Associated with Mycoplasma genitalium Infection in At-risk Female Adolescents in Bronx County, New York
Authors: Menezes Melissa E. , Silver Ellen J. , Goldstein D. Yitzchak , Collins-Ogle Michelle D. , Fox Amy S. , Coupey Susan M. 
Published: May 2023

ABSTRACT

Background

Mycoplasma genitalium infection can adversely affect female reproductive health, but data are limited about prevalence and characteristics of the infection in female adolescents. We employed a sensitive assay to detect M.genitalium infection and we describe its characteristics in a clinical sample of females aged <21 years.

Methods
We recruited females aged 13-20 years in children’s hospital clinics whose clinicians were testing for chlamydia/gonorrhea. Participants completed a questionnaire providing demographics, sexual history, and current symptoms. Urine/endocervical samples were tested for chlamydia/gonorrhea and partitioned for M.genitalium testing using Aptima M.genitalium assay. We reviewed records for the clinic visit to document examination, diagnosis, and results of STI testing. We compared prevalence of M.genitalium infection by demographics, sexual history, symptoms, and signs.

Results
Of 153 participants mean age 18.07 ± 1.68 years, 58% self-identified as Hispanic, 27% Black, 64% straight/heterosexual, 27% bisexual, 1% gay/lesbian, 29% reported a prior STI diagnosis. Prevalence of M.genitalium was 11.1% (17/153), 13/17 were asymptomatic, 2/17 had PID, 3/17 co-infected with chlamydia or gonorrhea. Prevalence of chlamydia was 6.6%, and of gonorrhea 2.6%. A logistic regression model indicated independent associations of bisexual orientation vs all other orientations (aOR = 4.80; 95%CI = 1.38-16-67), self-reported prior STI (aOR = 3.83; 95%CI = 1.10-13.37) and self-reported prior PID (aOR = 9.12; 95%CI = 1.02-81.72) with higher odds of M.genitalium infection.

Conclusions
Findings suggest that in at-risk female populations aged <21 years, M.genitalium is a prevalent STI and symptomatic adolescents may warrant testing and treatment. Further study of harms and benefits of testing asymptomatic bisexual female adolescents or those with prior STI/PID is needed.
Polygenic risk associations with clinical characteristics and recurrence of Dupuytren’s disease
Authors: Riesmeijer Sophie A. , Nolte Ilja M. , Olde Loohuis Loes M. , Reus Lianne M. , Boltz Toni , Ng Michael , Furniss Dominic , Werker Paul M.N. , Ophoff Roel A. 
Published: May 2023

Background:
Dupuytren’s disease (DD) is a common complex trait, with varying severity and incompletely understood etiology. Genome-wide association studies (GWAS) have identified risk loci. Here, we examine whether genetic risk profiles of DD in patients are associated with clinical variation and disease severity as well as with patient genetic risk profiles of genetically correlated traits, including body mass index (BMI), triglycerides (TG), high-density lipoproteins (HDL), type 2 diabetes mellitus (T2D), and endophenotypes fasting glucose (FG), and glycated hemoglobin (HbA1c).

Methods:
We used a well-characterized cohort of 1,461 DD patients with available phenotypic and genetic data. Phenotype data include age of onset, recurrence, and family history of disease. Polygenic risk scores (PRSs) of DD, BMI, TG, HDL, T2D, FG, and HbA1c using various significance thresholds were calculated with PRSice using the most recent GWAS summary statistics. Control data from LifeLines were used to determine p-value cut-offs for PRSs generation explaining most variance.

Results:
The PRS for DD was significantly associated with a positive family history for DD, age of onset, disease onset before the age of 50, and recurrence. We also found a significant negative correlation between the PRSs for DD and BMI.

Conclusions:
While GWAS studies of DD are designed to identify genetic risk factors distinguishing case/control status, we show that the genetic risk profile for DD also explains part of its clinical variation and disease severity. The PRS may therefore aid in accurate prognostication, choosing initial treatment and in personalized medicine in future.
Changes in HIV Prevention and Sexual Experiences During the COVID-19 Pandemic: A Mixed-Methods Study
Authors: Pyra Maria , Kline J. , Taylor O. , Rusie L. , Schafer T. , Motley D. , Johnson A. K. 
Published: May 2023

Background:
STI and HIV services and infection rates were affected during the COVID-19 pandemic, because of changes in access to health care and individual behavior. Understanding how individuals made decisions around prevention and sexual activities during different phases of the pandemic is useful to addressing the rising rates of STIs and HIV.

Setting:
Federally-qualified health center focused on sexual and gender minority health, Chicago IL, 2021.

Methods:
Patients with a history of PrEP use who were contacted by the PrEP retention team as part of standard care were invited to complete an online survey. A subset of survey participants were then contacted to complete one-on-one interviews. Participants were asked about two distinct periods: November 2020 to January 2021 and February to June 2021.

Results:
From the 356 survey participants (mostly young, insured, and experienced with PrEP), more than half maintained their number of sex partners during the early pandemic and most also maintained PrEP use; during the later pandemic; most reported more or the same number of sex partners and almost all maintained PrEP use. From interviews, we identified diverse and changing experiences regarding sexual practices throughout the pandemic; whereas many participants changed PrEP use in accordance with sexual practices, many others maintained PrEP use as a habit. COVID-19 prevention was also a factor in sexual activities, particularly prevaccination.

Conclusion:
Many PrEP users try to align their HIV prevention with their sexual exposures and establish PrEP as a long-term habit. Removing financial and access barriers is important to improve PrEP use and STI testing.
Development and Validation of a Short Form of Suboptimal Health Status Questionnaire
Authors: Sun Shuyu , Liu Hongzhi , Guo Zheng , Guan Qihua , Wang Yinghao , Wang Jie , Qi Yan , Yan Yuxiang , Wang Youxin , Wen Jun , Hou Haifeng 
Published: May 2023

AbstractBackgroundSuboptimal health status (SHS) is a reversible borderline condition between optimal health and diseases. Although the definition of SHS is widely understood, the questionnaires of SHS are needed to be further developed, by which individual with SHS can be identified from a variety of population in the context of predictive, preventive and personalized medicine (PPPM/3PM). This study aimed to develop a short form of suboptimal health status questionnaire (SHSQ-SF) by reference to suboptimal health status questionnaire-25 (SHSQ-25).MethodsA total of 6,183 participants enrolled from southern China were included in a training set, while 4,113 from northern China were included in an external validation set. SHSQ-SF included nine key items from SHSQ-25, a questionnaire that has been applied in Caucasians, Asians, and Africans. Item analysis, reliability and validity tests were carried out to validate SHSQ-SF. Receiver operating characteristic (ROC) curve was used to identify the optimal cutoff value for diagnosis of SHS.ResultsIn the training dataset, the Cronbach’s α coefficient was 0.902, and the split-half reliability was 0.863. The Kaiser-Meyer-Olkin (KMO) statistic was 0.880, and the Bartlett’s test of sphericity was significant (χ2= 32,929.680,P<0.05). Both Kaiser’s criteria (eigenvalues >1) and scree plot revealed one factor which explained 57.008% of the total variance. Standardized factor loadings of confirmatory factor analysis (CFA) indices were between 0.59 to 0.74, with χ2/dƒ= 4.972, (GFI) = 0.996, CFI = 0.996, RFI = 0.989 and RMSEA = 0.031. The area under ROC curve (AUC) was 0.985 (95%CI: 0.983 – 0.988) in training dataset, by which the cutoff value (≥ 11) was identified for diagnosis of SHS. In the external validation dataset, this questionnaire showed good discriminatory power (AUC = 0.975, 95%CI: 0.971 – 0.979), with a sensitivity of 96.2% and specificity of 87.4%.ConclusionsWe developed a short form of SHS questionnaire, which has good reliability and validity in measurement of SHS in Chinese residents. From the perspective of PPPM/3PM, SHSQ-SF is recommended to be used for quickly screening individuals with SHS from a large-scale population.
Simplifying and personalising health information with mobile apps: translating complex models into understandable visuals
Authors: Waaler Per Niklas , Bongo Lars Ailo , Rolandsen Christina , Lorem Geir F. 
Published: May 2023

AbstractBackgroundIf patients could utilise scientific research about modifiable risk factors there is a potential to prevent disease and promote health. Mobile applications can automatically adjust what and how information is presented based on a user’s profile, creating opportunities for conveying scientific health information in a simpler and more intuitive way. We aimed to demonstrate this principle by developing a complex statistical model of the relationship between self-rated-health (SRH) and lifestyle-related factors, and designing an app that utilises user data to translate the statistical model into a user-centred visualisation that is easy to understand.MethodsUsing data from the 6th (n=12 981, 53.4% women and 46.6% men) and 7th (n=21 083, 52.5% women and 47.5% men) iteration of the Tromsø population survey, we modelled the association between SRH on a 4-point scale and self-reported intensity and frequency of physical activity, BMI, mental health symptoms (HSCL-10), smoking, support from friends, and diabetes (HbA1c≥6.5%) using a mixed-effects linear-regression model (SRH was treated as a continuous variable) adjusted for socio-economic factors and comorbidity. The app registers relevant user information, and inputs the information into the SRH-model to translate present status into suggestions for lifestyle changes with estimated health effects.ResultsSRH was strongly related to modifiable health factors. The strongest modifiable predictors of SRH were HSCL-10 and physical activity levels. In the fully adjusted model, on a scale ranging from 1 to 4, a 10-HSCL index≥3 was associated with a reduction in SRH of 0.948 (CI: 0.89, 1.00), and vigorous physical activity (exercising to exhaustion ≥4 days/week vs sedentary) was associated with an SRH increase of 0.643 (0.56-0.73). Physical activity intensity and frequency interacted positively in their effect on SRH, with large PA-volume (frequency ⨯ intensity) being particularly predictive of high SRH.ConclusionsApps that adjust the presentation of information based on the user’s profile can simplify and potentially improve communication of research-based scientific models, and could play an important role in making health research more accessible to the general public. Such technology could improve health education if implemented in websites or mobile apps that focus on improving health behaviours.
Diffusive mediator feedback explains the health-to-disease transition of skin inflammation
Authors: Sudo Maki , Fujimoto Koichi 
Published: May 2023

AbstractThe spatiotemporal dynamics of inflammation provide vital insights into the understanding of skin inflammation. Skin inflammation primarily depends on the regulatory feedback between pro- and anti-inflammatory mediators. Healthy skin exhibits faded erythema. In contrast, diseased skin exhibits expanding erythema with diverse patterns, clinically classified into five types: circular, annular, arcuate, gyrate, and polycyclic. Inflammatory diseases with expanding erythema are speculated to result from the overproduction of pro-inflammatory mediators. However, the mechanism by which feedback selectively drives the switch from a healthy fading erythema to each of the five types of diseased expanding erythema remains unclear. This study theoretically elucidates the imbalanced production between pro- and anti-inflammatory mediators and prospective treatment strategies for each expansion pattern. Our literature survey showed that eleven diseases exhibit some of the five expanding erythema, suggesting a common spatiotemporal regulation underlying different patterns and diseases. Accordingly, a reaction-diffusion model incorporating mediator feedback reproduced the five observed types of diseased expanding and healthy fading patterns. Importantly, the fading pattern transitioned to the arcuate, gyrate, and polycyclic patterns when the productions of anti-inflammatory and pro-inflammatory mediators were lower and higher, respectively, than in the healthy condition. Further depletion of anti-inflammatory mediators caused a circular pattern, whereas further overproduction of pro-inflammatory mediators caused an annular pattern. Mechanistically, the bistability due to stabilization of the diseased state exhibits circular and annular patterns, whereas the excitability exhibits the gyrate, polycyclic, arcuate, and fading patterns as the threshold of pro-inflammatory mediator concentration relative to the healthy state increases. These dynamic regulations of diffusive mediator feedback provide effective treatment strategies for mediator production wherein skins recover from each expanding pattern toward a fading pattern. Thus, these strategies can estimate disease severity and risk based on erythema patterns, paving the way for developing noninvasive and personalized treatments for inflammatory skin diseases.