bluuebunny/crossref_metadata_2025_split huggingface dataset:
Historical and regional particularities in the prevalence of traumatic events and posttraumatic stress disorder in East and West Germany
Authors: Kasinger Christoph , Schulz Ann-Christin , Ulke Christine , Maercker Andreas , Beutel Manfred , Brähler Elmar 
Published: August 2023

Abstract
Background
Epidemiological research on the prevalence of traumatic events and PTSD has shown that there are significant differences between countries, due to their different history and socialization processes. In the case of Germany, this is particularly relevant. Germany was divided into two states from 1949 to 1990. This study examines the prevalence of traumatic events and PTSD in the formerly divided East and West Germany.

Methods
For the prevalence of traumatic events, we used data from four representative surveys (years 2005, 2007, 2008, and 2016) with a total of N = 9,200 respondents. For the analyses of PTSD prevalence, we used data from three representative surveys (years 2005, 2007, 2008) with a total of N = 6676 respondents. We compared different birth cohorts, persons living in the former West vs. East Germany, and the application of different diagnostic criteria using a chi-square test.

Results
The overall one-month prevalence rate for PTSD was 3.4% (3.0% for men and 3.8% for women). We found significant differences in the occurrence of traumatic events between genders, different age cohorts as well as between people who live in East and West Germany. Significant differences in the prevalence of PTSD can only be observed for different age cohorts. Most of the age effects are due to traumatic events related to World War II (WWII). Prevalence rates for PTSD were higher when the diagnostic criterions of the DSM-V were applied compared to the criterions of the DSM-IV.

Conclusions
Our data suggests that socio-political factors may need to be considered when accounting for differences in occurrence rates of traumatic events, but not for prevalence rates of PTSD, between East and West Germany. People who have experienced WW II have a higher risk of suffering from PTSD. Future epidemiological trauma research should take historical and regional peculiarities of countries into account.
Serious game as oral histology learning strategy for undergraduate dental students; crossover randomized controlled trial
Authors: Amir Lisa R. , Leonardy Irene C. , Dewatmoko Salsabila N. , Yanuar Rezon , Suniarti Dewi F. , Idrus Erik , Sipiyaruk Kawin , Puspitawati Ria 
Published: August 2023

Abstract
Background
Oral histology is perceived by dental students as a challenging subject and often struggle to recognize the long-term relevance of understanding the cells and tissues at the microscopic level. Serious games have been reported to have a positive effect on student cognitive skills and learning motivation. However, there is still a limited amount of research supporting the effectiveness of serious games as a learning method in dentistry. The present study aimed to evaluate the impact of serious game of HistoRM as a complementary learning strategy for oral histology.

Methods
The study design was a crossover randomized controlled trial. A total of 74 first year dental students of Universitas Indonesia participated in the study and divided into 2 groups. Study intervention included HistoRM game for 3 days followed by a combination of HistoRM and script-based handouts for another 4 days. The groups represented different intervention sequences. Evaluation was performed using pre-test, post-test on day 3 and 7 and a questionnaire.

Results
The data showed significant improvement of student cognitive skills (p < 0.001) and it was influenced by the number of game missions completed. Students who completed the whole 15 missions have a higher day-7 post-tests scores (p = 0.03). Perception of dental students on HistoRM was positive in all domains tested, the learning content, games and learning experience domains. Immediate feedback given after each gameplay helped the students understand the subject matters.

Conclusion
Serious game of HistoRM effectively improved students’ understanding of oral histology learning outcome and provided more interesting learning experiences. This innovative learning can be recommended as a complementary learning strategy of oral histology for dental students.
Development of a conceptual framework to scale up co-managed care for older patients with hip fracture in China: a qualitative study
Authors: Zhang Jing , Ye Pengpeng , Yang Minghui , Wu Xinbao , Webster Ruth , Ivers Rebecca , Tian Maoyi 
Published: August 2023

AbstractBackgroundHip fracture creates a major burden on society due to high mortality, loss of independence and excess medical costs for older people. A multidisciplinary co-managed model of care is widely considered as the best practice for the management of older patients with hip fracture. The study aims to develop a conceptual framework to inform the future scale-up of this model of care through the identification of barriers and enablers that may influence successful uptake.MethodsThis qualitative study was conducted within an interventional study, which aimed to test the effectiveness of co-managed model of care for older patients with hip fracture. Health providers and health administrators from three hospitals were purposively selected and interviewed in-depth. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview guides, collect and analyse data. Inductive and deductive approaches were used to generate enablers or barriers, aligned with the CFIR constructs. All barriers or enablers were inductively summarised to a conceptual framework with essential components to guide the implementation of co-managed model of care in other hospitals.ResultsA total of 13 health providers and 3 health administrators were recruited. The main barriers to co-managed care implementation included perceived complexity of implementation, insufficient international collaboration and incentives, the absence of national guideline support and lack of digital health applications for communication between health providers, insufficient number of health providers and beds, and poor understanding about the effectiveness of this care model. A conceptual framework for future scale-up was then developed, consisting of the following essential components: hospital authority support, enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation and feedback, and external collaborations.ConclusionsDespite the complexity of the intervention, the co-managed model of care has the potential to be implemented and promoted in China and in similar settings, although there is a need to demonstrate feasibility in different settings.
Sexually dimorphic methylation patterns characterize the placenta and blood from extremely preterm newborns
Authors: Santos Hudson P. , Enggasser Adam E. , Clark Jeliyah , Roell Kyle , Zhabotynsky Vasyl , Gower William Adam , Yanni Diana , Yang Nou Gao , Washburn Lisa , Gogcu Semsa , Marsit Carmen J. , Kuban Karl , O’Shea T. Michael , Fry Rebecca C. 
Published: August 2023

Abstract
Background
Health outcomes among children born prematurely are known to be sexually dimorphic, with male infants often more affected, yet the mechanism behind this observation is not clear. CpG methylation levels in the placenta and blood also differ by sex and are associated with adverse health outcomes. We contrasted CpG methylation levels in the placenta and neonatal blood (n = 358) from the Extremely Low Gestational Age Newborn (ELGAN) cohort based on the EPIC array, which assays over 850,000 CpG sites across the epigenome. Sex-specific epigenome-wide association analyses were conducted for the placenta and neonatal blood samples independently, and the results were compared to determine tissue-specific differences between the methylation patterns in males and females. All models were adjusted for cell type heterogeneity. Enrichment pathway analysis was performed to identify the biological functions of genes related to the sexually dimorphic CpG sites.

Results
Approximately 11,500 CpG sites were differentially methylated in relation to sex. Of these, 5949 were placenta-specific and 5361 were blood-specific, with only 233 CpG sites overlapping in both tissues. For placenta-specific CpG sites, 90% were hypermethylated in males. For blood-specific CpG sites, 95% were hypermethylated in females. In the placenta, keratinocyte differentiation biological pathways were enriched among the differentially methylated genes. No enrichment pathways were observed for blood.

Conclusions
Distinct methylation patterns were observed between male and female children born extremely premature, and keratinocyte differentiation pathways were enriched in the placenta. These findings provide new insights into the epigenetic mechanisms underlying sexually dimorphic health outcomes among extremely premature infants.
Gene losses, parallel evolution and heightened expression confer adaptations to dedicated cleaning behaviour
Authors: Kang Jingliang , Ramirez-Calero Sandra , Paula José Ricardo , Chen Yifang , Schunter Celia 
Published: August 2023

Abstract
Background
Cleaning symbioses are captivating interspecific interactions in which a cleaner fish removes ectoparasites from its client, contributing to the health and diversity of natural fish communities and aquaculture systems. However, the genetic signatures underlying this specialized behaviour remain poorly explored. To shed light on this, we generated a high-quality chromosome-scale genome of the bluestreak cleaner wrasse Labroides dimidiatus, a dedicated cleaner with cleaning as primary feeding mechanism throughout its life.

Results
Compared with facultative and non-cleaner wrasses, L. dimidiatus was found with notable contractions in olfactory receptors implying their limited importance in dedicated cleaning. Instead, given its distinct tactile pre-conflict strategies, L. dimidiatus may rely more heavily on touch sensory perception, with heightened gene expression in the brain in anticipation of cleaning. Additionally, a reduction in NLR family CARD domain-containing protein 3 might enhance innate immunity of L. dimidiatus, probably assisting to reduce the impacts from parasite infections. In addition, convergent substitutions for a taste receptor and bone development genes across cleaners (L. dimidiatus and facultative cleaners) may provide them with evolved food discrimination abilities and jaw morphology that differentiate them from non-cleaners. Moreover, L. dimidiatus may exhibit specialized neural signal transductions for cleaning, as evidenced by positive selection in genes related to the glutamatergic synapse pathway. Interestingly, numerous glutamate receptors also demonstrated significantly higher expression in L. dimidiatus not engaged in cleaning, as compared to those involved in cleaning. Besides, apparent contractions in L. dimidiatus for protocadherins, which are responsible for neuronal development, may further promote specialized neural signal transductions in this species.

Conclusions
This study reveals that L. dimidiatus harbours substantial losses in specific gene families, convergent evolutions across cleaners and a large-scale high gene expression in preparation for cleaning, allowing for adaptation to the dedicated cleaning behaviour.
Genetic and ultrasonographic analyses of fetuses with 1q21.1q21.2 microdeletion/microduplication: a retrospective study
Authors: Guo Nan , Xue Huili , Liang Bin , Huang Hailong , Cai Meiying , Xu Liangpu 
Published: August 2023

Abstract
Background
1q21.1q21.2 microdeletions/microduplications are rare and incompletely penetrant genetic mutations, and only a few reports regarding their prenatal diagnosis are currently available. Here, we analyzed the ultrasonographic phenotypic characteristics of fetuses with these mutations to improve the understanding, diagnosis, and screening of these mutations during gestation.

Methods
We retrospectively analyzed 8700 cases of pregnant women who underwent invasive prenatal screening by karyotyping and chromosomal microarray analysis (CMA) between November 2016 and November 2021.

Results
CMA revealed copy number changes in the 1q21.1q21.2 region of eleven fetuses, of which five had microdeletions and six had microduplications. These eleven fetuses exhibited variable ultrasonographic phenotypes. Of the five fetuses with the microdeletion, one exhibited a right-dominant heart, permanent right umbilical vein, and mild tricuspid regurgitation, another showed thickened nuchal translucency, and the remaining three had normal ultrasound phenotypes. Two of the six cases with 1q21.1q21.2 microduplication had structural malformations; one of them had a bilateral subependymal cyst, neck mass, and enlarged cardiothoracic ratio, while the other had right ventricular hypoplasia. Of the remaining four cases, two exhibited nasal bone dysplasia, one showed measurement slower than that during menopause and mild tricuspid regurgitation, and another did not show any notable abnormality in ultrasound examination. Among the eleven cases of 1q21.1q21.2 microdeletion/microduplication, only the parents of two fetuses underwent pedigree verification. The parents of these two fetuses with 1q21.1q21.2 microdeletion syndrome chose to continue the pregnancy, and all aspects of postnatal follow-up were normal. The parents of the other nine fetuses refused pedigree verification; of these cases, four cases terminated, and five cases continued the pregnancies. The five continued pregnancies were followed up after birth; no abnormalities were found.

Conclusions
Fetuses with 1q21.1q21.2 microdeletion/microduplication show different ultrasound characteristics and may have congenital heart disease, thickened nuchal translucency, and nasal bone dysplasia or show no notable abnormalities in an ultrasound examination. Our study highlights that CMA as a powerful diagnostic tool for these diseases can provide an accurate genetic diagnosis, while improving prenatal diagnosis standards.
Years of life lost due to deaths of despair and COVID-19 in the United States in 2020: patterns of excess mortality by gender, race and ethnicity
Authors: Entrup Parker , Brodsky Leon , Trimble Candice , Garcia Stephanie , Mohamed Nasra , Deaner Megan , Martell J. P. , Teater Julie , Jordan Ayana , Tetrault Jeanette M. , Hall O. Trent 
Published: August 2023

Abstract
Background
In 2020 COVID-19 was the third leading cause of death in the United States. Increases in suicides, overdoses, and alcohol related deaths were seen—which make up deaths of despair. How deaths of despair compare to COVID-19 across racial, ethnic, and gender subpopulations is relatively unknown. Preliminary studies showed inequalities in COVID-19 mortality for Black and Hispanic Americans in the pandemic's onset. This study analyzes the racial, ethnic and gender disparities in years of life lost due to COVID-19 and deaths of despair (suicide, overdose, and alcohol deaths) in 2020.

Methods
This cross-sectional study calculated and compared years of life lost (YLL) due to Deaths of Despair and COVID-19 by gender, race, and ethnicity. YLL was calculated using the CDC WONDER database to pull death records based on ICD-10 codes and the Social Security Administration Period Life Table was used to get estimated life expectancy for each subpopulation.

Results
In 2020, COVID-19 caused 350,831 deaths and 4,405,699 YLL. By contrast, deaths of despair contributed to 178,598 deaths and 6,045,819 YLL. Men had more deaths and YLL than women due to COVID-19 and deaths of despair. Among White Americans and more than one race identification both had greater burden of deaths of despair YLL than COVID-19 YLL. However, for all other racial categories (Native American/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander) COVID-19 caused more YLL than deaths of despair. Also, Hispanic or Latino persons had disproportionately higher mortality across all causes: COVID-19 and all deaths of despair causes.

Conclusions
This study found greater deaths of despair mortality burden and differences in burden across gender, race, and ethnicity in 2020. The results indicate the need to bolster behavioral health research, support mental health workforce development and education, increase access to evidence-based substance use treatment, and address systemic inequities and social determinants of deaths of despair and COVID-19.
Are “additional cuts” effective for positive margins in cervical conization? It varies according to the doctor
Authors: Sun Yujie , He Yingying , Zhuoma Mima , Hua Zhengyu , Sun Zhigang , Jiang Nan , Kong Fandou , Xiao Zhen 
Published: August 2023

Abstract
Background
High-grade squamous intraepithelial lesion (HSIL) is a disease that is closely related to the development of cervical cancer. In clinical work, cold knife conization and a loop electrosurgical excision procedure (LEEP) are often selected for diagnosis and treatment.

Objective
In this paper, we aimed to discuss additional cuts, a common practice in cervical conization, and determine whether the doctor’s choice to use additional cuts in conization can reduce the occurrence of a positive cone margin.

Methods
From January 2018 to October 2019, 965 patients underwent cervical conization at the First Affiliated Hospital of Dalian Medical University (Dalian, China). Of these, 174 were in the positive cone margin group, and 791 were in the negative cone margin group. Age, preoperative pathology, pathological results of conization, additional cuts, cone depth, and cone volume were studied. Additionally, the additional cut rate and the efficiency of doctors with a habit of additional cuts were analyzed.

Results
Of the 965 patients included in the study, the median age was 41 years (range 35–50). Multivariable logistic regression analysis suggested that additional cuts (OR, 2.480; 95% CI 1.608 to 3.826; p = 0.01) and smaller cone depth (OR, 0.591; 95% CI, 0.362 to 0.965, p = 0.036) were independent risk factors for positive margins. Six of the 64 doctors who performed conizations had a habit of making additional cuts, and there was no positive correlation between their additional cut rate and their effective additional cut rate.

Conclusion
This study showed that a certain proportion of additional cuts can be effectively excised from the positive margin that cannot be removed in the initial conization. The practice of additional cuts in conization tends to be the personal habit of a small number of doctors.

Graphical Abstract
The optimal surgery timing after stenting in colorectal cancer patients with malignant obstruction: additionally compared with emergency surgery
Authors: Na Ji Eun , Kim Eun Ran , Kim Ji Eun , Hong Sung Noh , Kim Young Ho , Chang Dong Kyung 
Published: August 2023

Abstract
Background
This study aimed to determine short-term and long-term outcomes according to time intervals after stenting and compared them with those of emergency surgery (ES) in colorectal cancer (CRC) with malignant obstruction.

Methods
CRC with malignant obstructions was reviewed retrospectively between January 2008 and July 2018. Of a total of 539 patients who visited the emergency room and underwent ES, 133 were enrolled in the ES group. Of a total of 567 patients who initially received stenting and subsequently underwent elective surgery, 220 were enrolled in the SEMS group. The interval between SEMS placement and elective surgery was classified as < 11 days, 11–17 days, and > 17 days.

Results
For those who received SEMS (n = 220), those with a time interval of 11–17 days (n = 97) had fewer hospital days than those with a time interval of < 11 days (n = 68) (8 days vs. 15 days) and less stoma formation than those with a time interval of > 17 days (n = 55) (1.0% vs. 14.6%). Multivariable analysis revealed a decreased risk of death for the group with a time interval of 11–17 days (20.6%) compared to the ES group (31.6%) (hazard ratio: 0.48; 95% confidence interval: 0.24–0.97). Disease-free survival was comparable between the SEMS and ES groups regardless of the time interval (log-rank p = 0.52).

Conclusions
The time interval of 11–17 days after stenting to elective surgery appeared to be associated with the most favorable outcomes.
Assessing the impact of grief on quality of life, work productivity, and health outcomes for parents bereaved from SMA: A study protocol
Authors: Riley Abigail G. , Mulé Christina M. , Lerner Debra , Belter Lisa , O’Toole Colleen McCarthy , Kowal Stacey , Fox David , Shapouri Sheila , Vesel Tamara , Lavelle Tara A. 
Published: August 2023

Abstract
Background
U.S. cost-effectiveness recommendations suggest that analyses should include all costs and effects relevant to the decision problem [1]. However, in many diseases, including spinal muscular atrophy (SMA), few studies have evaluated bereaved family outcomes after a child has died, neglecting potential impacts on their health-related quality of life (HRQoL), work productivity, and mental health. Additionally, grief-related outcomes are rarely included in economic evaluations. This manuscript outlines the protocol of a study that will estimate the HRQoL, work functioning, and mental health of bereaved parents of children with SMA type 1 to determine how outcomes vary based on parent’s sex and the time since a child’s death.

Methods
This study will involve two phases. In Phase 1, we will conduct a literature review to identify prior research that has measured how parental grief impacts HRQoL, work productivity, and mental health. We will also interview four bereaved parents of children with SMA type 1, stratified by parent sex and time since their child’s death, and analyze findings using a thematic analysis. In Phase 2, we will develop a survey draft based on Phase 1 findings. Parents bereaved from SMA type 1 will review our survey draft and we will revise the survey based on their feedback. We will send a cross-sectional survey to approximately 880 parents bereaved from SMA type 1. We will analyze findings from the survey to investigate whether the severity of grief symptoms is correlated with HRQoL, productivity, depression and anxiety symptom severity. We will also evaluate whether the mean scores of grief and each of the outcomes vary significantly when stratified by parent sex and the time since the child’s death.

Discussion
Our results will provide preliminary information on how parental grief can impact HRQoL, productivity, and mental health outcomes over time. Increasing the availability of family outcomes data will potentially assist organizations performing health economic evaluations, such as the Institute of Clinical and Economic Review (ICER) in the U.S. This research will also help to inform the development of future economic guidelines on this topic.