bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of scrub typhus with incidence of dementia: a nationwide population-based cohort study in Korea
Authors: Kim Jooyun , Seok Hyeri , Jeon Ji Hoon , Choi Won Suk , Seo Gi Hyeon , Park Dae Won 
Published: March 2023

Abstract
Background
Scrub typhus is a mite-borne infectious rickettsial disease that can occur in rural and urban areas, with an especially high prevalence in older populations. This disease causes systemic vasculitis that can invade the central nervous system. Considering these characteristics, here we examined whether scrub typhus was associated with the occurrence of dementia, using large population-based cohort data.

Method
This population-based cohort study enrolled patients aged 60–89 years using data from the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. We defined scrub typhus and dementia using International Classification of Diseases, Tenth Edition diagnostic codes. The control group was stratified according to age and sex at a ratio of 1:5 to the case group in the study population. The index date was set after 90 days beyond the date of the scrub typhus diagnosis, while the observation period was from the time of the index appointment to December 31, 2020. The primary outcome was newly diagnosed dementia. The secondary outcome was dementia classification, such as Alzheimer’s disease, vascular dementia, and other. All analyses were conducted by matching age, gender, and comorbidity.

Results
During the observation period, 10,460 of 71,047 (14.7%) people who had a history of scrub typhus versus 42,965 of 355,235 (12.1%) people in the control group, that is, with no history of scrub typhus, were diagnosed with dementia (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10–1.15, p < 0.001). The Kaplan–Meier curves for time to cumulative incidence of dementia showed that the dementia incidence in both groups increased over time, while individuals with a past history of scrub typhus had a higher incidence of dementia than the control group. Second, the risk of Alzheimer’s disease was significantly higher among patients with a history of scrub typhus (adjusted hazard ratio, 1.15; 95% confidence interval 1.13–1.18, p < 0.001).

Conclusion
In conclusion, a history of scrub typhus infection in old age is significantly associated with an increase in dementia, especially Alzheimer’s disease. Our results suggest that prevention and appropriate treatment of scrub typhus should be emphasized as a dementia prevention measure.
Adopting international recommendations to design a model for maternal health service to cope with pandemic disruption for Indonesian primary care
Authors: Ekawati Fitriana Murriya , Muchlis Mumtihana , Tuteja Amita 
Published: March 2023

Abstract
Background
Limited evidence is available as the reference for the model of care on providing maternity care in low-and-middle-income countries (LMICs) to cope with pandemic disruption. This study aimed to adopt international recommendations to develop the model of care with the context of Indonesian settings.

Methods
Four codesign workshops and substitute interviews with stakeholders, covering the (i) exploration of service provision during the pandemic, (ii) adoption of international recommendations, (iii) designing and (iv) finalising model of care for maternal health services in primary care under the COVID-19 pandemic. The study took place in Yogyakarta Province Indonesia from July-November 2021. The participants were general practitioners, midwives, nurses, patients, and obstetricians. The data were analysed thematically.

Results
Twenty-three participants were recruited. As many as 23, 16, 14 and 16 participants participated in the first to fourth codesign workshops or substitute interviews. Key recommendations agreed upon in the workshop were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, using telemedicine, and creating a multidisciplinary team to provide the care. A model of care for improving maternal service was also agreed and received suggestions from the participants. Identified barriers to the recommendation implementation, such as the available clinical resources and negotiating providers’ authority in practice.

Conclusion
Recommendations and the model of care for improving maternity care in Indonesia are beneficial to be implemented in Indonesian primary care during the COVID-19 pandemic. Further research includes pilot studies to explore the acceptability of the model and recommendation implementation in practice.
Psychiatric symptoms in a female with subacute combined degeneration of the spinal cord (SCD): a case report
Authors: Zhang Yinlin , Luo Huirong , Wang Xueqian , Qiu Haitang , Ren Hao , Zheng Anhai , Luo Qinghua 
Published: March 2023

Abstract
Background
Subacute combined degeneration of the spinal cord (SCD) is mainly caused by deficiency of Vitamin B12 and characterized by deep hypoesthesia, sensory ataxia and spasmodic paralysis of lower limbs. SCD often accompanies with megaloblastic anemia. Psychiatric symptoms could be the initial manifestations of SCD by lack of Vitamin B12, but are rarely considered secondary to physical discomfort and psychological factors in SCD. Additionally, treatment experience for psychiatric symptoms in SCD remains little reported.

Case report
We presented a case of a 37-year-old female who complained of being persecuted and controlled for one week and thus was admitted to the psychiatry department. Before that, she had went through persistent paresthesia and numbness of her lower extremities for two-month. Low Vitamin B12 level and hemoglobin concentration, neurologic symptoms and bone marrow smear results supported the clinical diagnosis of SCD and megaloblastic anemia. With supplementation of Vitamin B12 and blood transfusion and short-term prescription of antipsychotics and antidepressants, physical symptoms were improved and psychological symptoms disappeared within 2 weeks.

Conclusions
Psychiatric symptoms of SCD could be generated from lack of Vitamin B12, anemia and neurologic symptoms, where short-term use of antipsychotics and antidepressants may be effective.
Measuring social desirability bias in a multi-ethnic cohort sample: its relationship with self-reported physical activity, dietary habits, and factor structure
Authors: Teh Wen Lin , Abdin Edimansyah , P.V. Asharani , Siva Kumar Fiona Devi , Roystonn Kumarasan , Wang Peizhi , Shafie Saleha , Chang Sherilyn , Jeyagurunathan Anitha , Vaingankar Janhavi Ajit , Sum Chee Fang , Lee Eng Sing , van Dam Rob M. , Subramaniam Mythily 
Published: March 2023

Abstract
Background
Social desirability bias is one of the oldest forms of response bias studied in social sciences. While individuals may feel the need to fake good or bad answers in response to sensitive or intrusive questions, it remains unclear how rampant such a bias is in epidemiological research pertaining to self-reported lifestyle indicators in a multicultural Asian context. The main purpose of the current study is, therefore, to examine the sociodemographic correlates and impact of social desirability responding on self-reported physical activity and dietary habits at an epidemiological scale in a non-western multi-cultural Asian setting.

Methods
Prior to the main analyses, confirmatory and exploratory factor analyses were conducted to determine the factorial validity of a western derived concept of social desirability. Multiple regression analyses were conducted on cross-sectional data (n = 2995) extracted from a nationwide survey conducted between 2019 and 2020.

Results
A unique factor structure of social desirability was found and was therefore used for subsequent analyses. Multiple regression analyses revealed older age groups, the Indian ethnic group, those with past or present marriages, and having no income, had a significantly greater tendency to act on the bias.

Conclusion
The construct of social desirability bias was fundamentally different in a multicultural context than previously understood. Only a small proportion of variance of self-report lifestyle scores was explained by social desirability, thus providing support for data integrity.
Evaluation and guide for embedding opioid use disorder education in health professions’ curricula
Authors: Salvador Julie G. , Bolaños-Sacoman Sindy L. , Katzman Joanna G. , Morrison Ann E. , Fox Lindsay E. , Schneider Jennifer S. , Bhatt Snehal R. , Kincaid Tyler W. , Waldorf V. Ann 
Published: March 2023

Abstract
Background
Morbidity and mortality from Opioid Use Disorder is a health crisis in the United States. During the COVID-19 pandemic, there was a devastating increase of 38.4% in overdose deaths from the 12-month period leading up to June 2019 compared with the 12-month period leading up to May 2020, primarily driven by synthetic opioids. Buprenorphine is an effective medication for opioid use disorder but uptake is slow due in part to lack of provider knowledge, confidence, and negative attitudes/stigma toward patients with OUD. Addressing these barriers in academic training is a promising approach to building workforce able to effectively treat opioid use disorder.

Methods
Our university developed a training for pre-licensure physicians, physician assistants and psychiatric nurse practitioners that included the DATA Waiver training and a shadowing experience. Expected outcomes included improved knowledge, skills and attitudes about persons with OUD and buprenorphine treatment, plans to provide this treatment post-graduation, for pre-licensure learners to have completed all requirements to prescribe buprenorphine post-graduation, and for the training to be embedded into school’s curricula.

Results
Results were positive overall including improved knowledge and attitudes toward persons with OUD, better understanding of the benefits of this treatment for patients, increased confidence and motivation to provide this treatment post-graduation. The training is now embedded in each program’s graduation requirements.

Conclusion
Developing a didactic and experiential training on buprenorphine treatment for opioid use disorder and embedding it into medical, physician assistant, and psychiatric nurse practitioner licensure programs can help prepare future providers to treat opioid use disorder in a range of settings. Key to replicating this program in other university settings is to engage faculty members who actively provide treatment to persons with OUD to ensure shadowing opportunities and serve as role models for learners.
Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis
Authors: Rajaram Nadia , Jaganathan Maheswari , Muniandy Kavitha , Rajoo Yamuna , Zainal Hani , Rahim Norlia , Tajudeen Nurul Ain , Zainal Nur Hidayati , Mohd Khairy Azuddin , Abdul Wahab Mohamed Yusof , Teo Soo Hwang 
Published: March 2023

Abstract
Background
Improving help-seeking behaviour is a key component of down-staging breast cancer and improving survival, but the specific challenges faced by low-income women in an Asian setting remain poorly characterized. Here, we determined the extent of help-seeking delay among Malaysian breast cancer patients who presented at late stages and explored sub-groups of women who may face specific barriers.

Methods
Time to help-seeking was assessed in 303 women diagnosed with advanced breast cancer between January 2015 and March 2020 at a suburban tertiary hospital in Malaysia. Two-step cluster analysis was conducted to identify subgroups of women who share similar characteristics and barriers. Barriers to help-seeking were identified from nurse interviews and were analyzed using behavioural frameworks.

Results
The average time to help-seeking was 65 days (IQR = 250 days), and up to 44.5% of women delayed by at least 3 months. Three equal-sized clusters emerged with good separation by time to help-seeking (p < 0.001). The most reported barrier across clusters was poor knowledge about breast health or breast cancer symptoms (36.3%), regardless of help-seeking behaviour (p = 0.931). Unexpectedly, women with no delay (9 days average) and great delay (259 days average) were more similar to each other than to women with mild delays (58 days average), but, women who experienced great delay reported poor motivation due to fear and embarrassment (p = 0.066) and a lack of social support (p = 0.374) to seek help.

Conclusions
Down-staging of breast cancer in Malaysia will require a multi-pronged approach aimed at modifying culturally specific social and emotional barriers, eliminating misinformation, and instilling motivation to seek help for breast health for the women most vulnerable to help-seeking delays.
m6A methylation: a process reshaping the tumour immune microenvironment and regulating immune evasion
Authors: Cao Xiaoxue , Geng Qishun , Fan Danping , Wang Qiong , Wang Xing , Zhang Mengxiao , Zhao Lu , Jiao Yi , Deng Tingting , Liu Honglin , Zhou Jing , Jia Liqun , Xiao Cheng 
Published: March 2023

AbstractN6-methyladenosine (m6A) methylation is the most universal internal modification in eukaryotic mRNA. With elaborate functions executed by m6A writers, erasers, and readers, m6A modulation is involved in myriad physiological and pathological processes. Extensive studies have demonstrated m6A modulation in diverse tumours, with effects on tumorigenesis, metastasis, and resistance. Recent evidence has revealed an emerging role of m6A modulation in tumour immunoregulation, and divergent m6A methylation patterns have been revealed in the tumour microenvironment. To depict the regulatory role of m6A methylation in the tumour immune microenvironment (TIME) and its effect on immune evasion, this review focuses on the TIME, which is characterized by hypoxia, metabolic reprogramming, acidity, and immunosuppression, and outlines the m6A-regulated TIME and immune evasion under divergent stimuli. Furthermore, m6A modulation patterns in anti-tumour immune cells are summarized.
Excess healthcare costs of mental disorders in children, adolescents and young adults in the Basque population registry adjusted for socioeconomic status and sex
Authors: Larrañaga Igor , Ibarrondo Oliver , Mar-Barrutia Lorea , Soto-Gordoa Myriam , Mar Javier 
Published: March 2023

AbstractBackgroundMental illnesses account for a considerable proportion of the global burden of disease. Economic evaluation of public policies and interventions aimed at mental health is crucial to inform decisions and improve the provision of healthcare services, but experts highlight that nowadays the cost implications of mental illness are not properly quantified. The objective was to measure the costs of excess use of all healthcare services by 1- to 30-year-olds in the Basque population as a function of whether or not they had a mental disorder diagnosis.MethodsA real-world data study was used to identify diagnoses of mental disorders and to measure resource use in the Basque Health Service Registry in 2018. Diagnoses were aggregated into eight diagnostic clusters: anxiety, attention deficit hyperactivity disorder, conduct disorders, mood disorders, substance use, psychosis and personality disorders, eating disorders, and self-harm. We calculated the costs incurred by each individual by multiplying the resource use by the unit costs. Annual costs for each cluster were compared with those for individuals with no diagnosed mental disorders through entropy balancing and two-part models which adjusted for socioeconomic status (SES).ResultsOf the 609,381 individuals included, 96,671 (15.9%) had ≥ 1 mental disorder diagnosis. The annual cost per person was two-fold higher in the group diagnosed with mental disorders (€699.7) than that with no diagnoses (€274.6). For all clusters, annual excess costs associated with mental disorders were significant. The adjustment also evidenced a social gradient in healthcare costs, individuals with lower SES consuming more resources than those with medium and higher SES across all clusters. Nonetheless, the effect of being diagnosed with a mental disorder had a greater impact on the mean and excess costs than SES.ConclusionsResults were consistent in showing that young people with mental disorders place a greater burden on healthcare services. Excess costs were higher for severe mental disorders like self-harm and psychoses, and lower SES individuals incurred, overall, more than twice the costs per person with no diagnoses. A socioeconomic gradient was notable, excess costs being higher in low SES individuals than those with a high-to-medium SES. Differences by sex were also statistically significant but their sizes were smaller than those related to SES.
How do 24-h movement behaviours change during and after vacation? A cohort study
Authors: Ferguson Ty , Curtis Rachel , Fraysse Francois , Olds Timothy , Dumuid Dorothea , Brown Wendy , Esterman Adrian , Maher Carol 
Published: March 2023

Abstract
Background
For adults, vacations represent a break from daily responsibilities of work – offering the opportunity to re-distribute time between sleep, sedentary behaviour, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) across the 24-h day. To date, there has been minimal research into how activity behaviour patterns change on vacation, and whether any changes linger after the vacation. This study examined how daily movement behaviours change from before, to during and after vacations, and whether these varied based on the type of vacation and vacation duration.

Methods
Data collected during the Annual Rhythms In Adults’ lifestyle and health (ARIA) study were used. 308 adults (mean age 40.4 years, SD 5.6) wore Fitbit Charge 3 fitness trackers 24 h a day for 13 months. Minute-by-minute movement behaviour data were aggregated into daily totals. Multi-level mixed-effects linear regressions were used to compare movement behaviours during and post-vacation (4 weeks) to pre-vacation levels (14 days), and to examine the associations with vacation type and duration.

Results
Participants took an average of 2.6 (SD = 1.7) vacations of 12 (SD = 14) days’ (N = 9778 days) duration. The most common vacation type was outdoor recreation (35%) followed by family/social events (31%), rest (17%) and non-leisure (17%).
Daily sleep, LPA and MVPA all increased (+ 21 min [95% CI = 19,24] p < 0.001, + 3 min [95% CI = 0.4,5] p < 0.02, and + 5 min [95% CI = 3,6] p < 0.001 respectively) and sedentary behaviour decreased (-29 min [95% CI = -32,-25] p < 0.001) during vacation. Post-vacation, sleep remained elevated for two weeks; MVPA returned to pre-vacation levels; and LPA and sedentary behaviour over-corrected, with LPA significantly lower for 4 weeks, and sedentary behaviour significantly higher for one week. The largest changes were seen for “rest” and “outdoor” vacations. The magnitude of changes was smallest for short vacations (< 3 days).

Conclusions
Vacations are associated with favourable changes in daily movement behaviours. These data provide preliminary evidence of the health benefits of vacations.

Trial registration
The study was prospectively registered on the Australian New Zealand Clinical Trial Registry (Trial ID: ACTRN12619001430123).
Clinical significance of the anteromedial talus osteophyte in anteromedial ankle impingement in chronic lateral ankle instability
Authors: Zhang Jieyuan , Li Xueqian , Fu Shaoling , Yang Kai , Shi Zhongmin 
Published: March 2023

AbstractPurposeThe aim of this study was to evaluate the relation between anteromedial ankle osteophytes (AMAO) and anteromedial ankle impingement (AMAI) in chronic lateral ankle instability (CLAI) through visualization and quantification.MethodsForty-three patients with unilateral CLAI between September 2018 and March 2020 accepted arthroscopic repair of an anterior talofibular ligament (ATFL) and were split into two groups: AMAI (AMAI including intraoperative AMAO resection) and pure CLAI (with AMAO but without AMAI, no AMAO resection). The AMAO protrusion lengths in each direction were measured and compared after all of the ankles were reconstructed. All patients were assessed preoperatively and at 2-year follow-up with ankle dorsiflexion, the American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, and visual analog scale (VAS) score.ResultsIntelligent analysis showed that a large extent of osteophytes was found at the dorsomedial surface of the talar neck in AMAI group. The upper and inner bound protrusion distances of AMAO in AMAI group were greater than in the pure CLAI group. There was no significant difference in anterior bound protrusion distance of AMAO between the two groups. Preoperatively, the ankle dorsiflexion of AMAI group (7.6 ± 1.4°) was considerably lower than that of pure CLAI group (22.4 ± 1.9°) (p < 0.001). When compared to the pure CLAI group, the AMAI group had a substantially worse AOFAS score (62.2 ± 6.7 vs 71.1 ± 9.1;p < 0.001) and VAS score (6.0 ± 1.0 vs 4.9 ± 0.8;p < 0.05). However, there was no significant difference in postoperative ankle dorsiflexion, AOFAS score, or VAS score between the two groups.ConclusionAMAO is formed mostly on the dorsomedial surface of the talar neck in CLAI with AMAI, and the upper and inner bound protrusion lengths of AMAO were shown to be significantly correlated with the existence of AMAI in CLAI.Level of evidence IV.
L-kynurenine induces NK cell loss in gastric cancer microenvironment via promoting ferroptosis
Authors: Cui Jian-Xin , Xu Xian-Hui , He Tao , Liu Jia-Jia , Xie Tian-Yu , Tian Wen , Liu Jun-Yan 
Published: March 2023

Abstract
Background
Natural killer (NK) cells play a major role in body’s fighting against various types of cancers. Their infiltration in the tumor microenvironment (TME) of gastric cancer (GC) are significantly decreased, which has been reported as a robust prognostic marker. However, the causes leading to NK cells loss in GC TME remains poorly understood.

Methods
We constructed a non-contact co-culturing system and humanized xenograft tumor mice model to detect the influence of GC microenvironment on NK-92 or primary human NK cells viability by flow cytometry. Then through using the specific inhibitors for different types of cell death and examining the surrogate markers, we confirmed ferroptosis in NK cells. Inspired by the accidental discoveries, we constructed a NK-92 cell strain with high expression of GPX4 and treated the humanized xenograft tumor mice model with the NK-92 cells.

Results
We found L-KYN, mainly generated through indoleamine 2, 3-dioxygenase (IDO) from GC cells, impaired NK cells viability in TME. Further analysis revealed L-KYN induced ferroptosis in NK cells via an AHR-independent way. Moreover, we found NK cells with higher GPX4 expression showed resistance to L-KYN induced ferroptosis. Based on this, we generated GPX4 over-expressed NK-92 cells, and found these cells showed therapeutic potential towards GC.

Conclusions
Our study revealed a novel mechanism to explain the decline of NK cell number in GC TME. Notably, we also developed a potential immunotherapy strategy, which might be beneficial in clinical treatment in the future.