bluuebunny/crossref_metadata_2025_split huggingface dataset:
The new future perspective in corneal tissue utilisation – methods of preparation and preservation
Authors: Polachova Martina , Netukova Magdalena , Benada Oldrich , Kucera Tomas , Kolin Vojtech , Baxant Alina-Dana , Sirolova Zuzana , Studeny Pavel 
Published: June 2023

Abstract
Purpose
The goal of our study is to find an optimal approach to the preparation and preservation of corneal stromal tissue. We want to compare different methods of corneal stromal tissue creation and storage to optimize the efficacy of this process under the conditions of an eye bank. After we find the most suitable method to create a safe high quality product, we want to prove the possibility of using a single donor cornea for more than one patient. We would also like to verify the feasibility of making more corneal lenticules after the removal of a corneal endothelium for DMEK transplantation.

Methods
We provided morphological (histology, scanning electron microscope) and microbiological analysis in order to compare different methods of corneal lenticule and corneal stromal lamellae preparation and preservation. We also tested the surgical handling of the tissue to secure a safe manipulation of the tissue for clinical use. We compared two methods of corneal lenticule preparation: microkeratome dissection and femtosecond laser. As methods of preservation, we tested hypothermia, cryopreservation at -80 degrees Celsius in DMSO (dimethyl sulfoxide) and storage at room temperature with glycerol. Some intrastromal lenticules and lamellae in each group were previously irradiated with gamma radiation of 25 kGy (KiloGray).

Results
Corneal stromal lamellae prepared with a microkeratome have a smoother cut – side surface compared to lamellae prepared with a femtosecond laser. Femtosecond laser preparation caused more irregularities on the surface and we detected more conglomerates of the fibrils, while lamellae made with microkeratome had more sparse network. Using femtosecond laser, we were able to make more than five lenticules from a single donor cornea.
Gamma irradiation led to damage of collagen fibrils in corneal stroma and a loss of their regular arrangement. Corneal tissue stored in glycerol showed collagen fibril aggregates and empty spaces between fibrils caused by dehydration. Cryopreserved tissue without previous gamma irradiation showed the most regular structure of the fibrils comparable to storage in hypothermia.

Conclusion
Our results suggest that formation of a corneal lenticule lamellae by microkeratome results in smoother corneal lenticules, while being much cheaper than formation by femtosecond laser.
Gamma irradiation of 25 kGy caused damage of the collagen fibres as well as their network arrangement, which correlated with loss of transparency and stiffer structure. These changes impair possible surgical utilisation of gamma irradiated corneas.
Storage in glycerol at room temperature and cryopreservation had similar outcomes and we believe that both methods are appropriate and safe for further clinical use .
Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial—a stepped wedge cluster randomized trial protocol
Authors: Zhu Yunying , Li Sisi , Zhang Ruotong , Bao Lei , Zhang Jin , Xiao Xiaohua , Jiang Dongdong , Chen Wenxiao , Hu Chenying , Zou Changli , Zhang Jingna , Zhu Yong , Wang Jianqiu , Liang Jinchun , Yang Qian 
Published: June 2023

Abstract
Background
The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.

Methods
A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of “usual care” as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.

Discussion
Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.

Trial registration
AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW
Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study
Authors: Vold Jørn Henrik , Halmøy Anne , Chalabianloo Fatemeh , Pierron Marianne Cook , Løberg Else-Marie , Johansson Kjell Arne , Fadnes Lars Thore 
Published: June 2023

AbstractBackgroundAttention-deficit/hyperactivity disorder (ADHD) symptoms may challenge sufficient treatment of substance use and mental disorders. The literature on the extent of such symptoms among patients receiving opioid agonist therapy (OAT) is scarce. This study examined ADHD symptoms using the ADHD self-report scale (ASRS) and the association between the ‘ASRS–memory’ and ‘ASRS–attention’ scores and substance use and sociodemographic characteristics among patients receiving OAT.MethodsWe used data from assessment visits of a cohort of patients in Norway. In total, 701 patients were included from May 2017 to March 2022. All patients responded at least once to two ASRS questions assessing memory and attention, respectively. Ordinal regression analyses were performed to investigate whether the two obtained scores were associated with age, sex, frequent substance use, injecting use, housing status, and educational attainment at baseline, i.e., the first assessment, and over time. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). Additionally, a subsample of 225 patients completed an extended interview, including the ASRS–screener and collection of registered mental disorder diagnoses from the medical records. Standard cutoffs were used to define the presence of each ASRS symptom or a positive ASRS–screener (‘ASRS–positive’).ResultsAt baseline, 428 (61%) and 307 (53%) patients scored over the cutoffs on the ‘ASRS–memory’ and ‘ASRS–attention,’ respectively. Frequent cannabis use was associated with higher ‘ASRS–memory’ (OR: 1.7, 95% CI: 1.1–2.6) and ‘ASRS–attention’ (1.7, 1.1–2.5) scores compared with less or no use at baseline, though reduced score on the ‘ASRS–memory’ over time (0.7, 0.6–1.0). At baseline, frequent stimulant use (1.8, 1.0–3.2) and low educational attainment (0.1, 0.0–0.8) were associated with higher ‘ASRS–memory’ scores. In the subsample fulfilling the ASRS–screener, 45% of the patients were ‘ASRS–positive,’ of whom 13% with a registered ADHD diagnosis.ConclusionsOur findings illustrate a relationship between the ASRS–memory and –attention scores and frequent cannabis and stimulant use. Furthermore, nearly half of the subsample was ‘ASRS–positive.’ Patients receiving OAT might benefit from being further assessed for ADHD, but improved diagnostic methods are required.
Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial
Authors: Stabell L.A , Johnsen E. , Kroken R. A , Løberg E.M. , Blindheim A. , Joa I. , Reitan S.K. , Rettenbacher M. , Munk-Jørgensen P. , Gjestad R. 
Published: June 2023

Abstract
Background
Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement.

Methods
Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight.

Results
Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0–6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6–52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics.

Conclusions
Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain.

Trial registration
ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
Adolescent determinants of life-course leisure-time vigorous physical activity trajectories: a 27-Year longitudinal study
Authors: Mathisen Frida Kathrine Sofie , Kristensen Sara Madeleine , Falco Coral , Wold Bente 
Published: June 2023

Abstract
Background
Adolescence is regarded as formative years for building the foundations for life-long health and well-being, and adolescent determinants of physical activity (PA) development is particularly interesting. Novel approaches for the study of PA development, such as group-based trajectory modelling, opens for the possibility of identifying different patterns in the relationship among several known determinants of PA. This study aimed to explore how demographic, psychological and social factors in early adolescence determine membership in four distinct leisure-time vigorous physical activity (LVPA) trajectories from 13 to 40 years.

Methods
This study is based on data from the Norwegian Longitudinal Health Behaviour Study, following a cohort born in 1977 from Western Norway. Four trajectories identified using latent class growth analysis, based on self-reposted LVPA (n = 1103, 45.5% women) measured ten times from age 13 to age 40 and 17 different adolescent determinants, were used in a multivariate multinomial logistic regression.

Results
We found that gender (male), VPA intentions the next year and athletic identity associated with belonging to the two trajectories reporting the highest levels of LVPA in adolescence, while VPA intentions in ten years were associated with belonging to the active trajectory compared to the decreasingly active and low active trajectories Enjoyment increased the odds of belonging to the increasingly and decreasingly active trajectories compared to the low active trajectory. In addition, two of the social determinants, mother’s PA and emotional support from father, were associated with belonging to the increasingly active trajectory when compared to the low active trajectory. Higher family income increased the odds of belonging to the increasingly active compared to the decreasingly active trajectory.

Conclusions
Both demographic, psychological, and social factors were identified as determinants of LVPA trajectory membership, and the findings support previous research related to the importance of intentions, but also indicate that enjoyment, role modelling and emotional support in PA can be of great importance to LVPA promotion among adolescents.
Does the implementation of an incentive scheme increase adherence to diabetes guidelines? A retrospective cohort study of managed care enrollees
Authors: Farcher Renato , Graber Sereina M. , Thüring Nicole , Blozik Eva , Huber Carola A. 
Published: June 2023

Abstract
Background
A novel incentive scheme based on a joint agreement of a large Swiss health insurance with 56 physician networks was implemented in 2018. This study evaluated the effect of its implementation on adherence to evidence-based guidelines among patients with diabetes in managed care models.

Methods
We performed a retrospective cohort study, using health care claims data from patients with diabetes enrolled in a managed care plan (2016–2019). Guideline adherence was assessed by four evidence-based performance measures and four hierarchically constructed adherence levels. Generalized multilevel models were used to examine the effect of the incentive scheme on guideline adherence.

Results
A total of 6′273 patients with diabetes were included in this study. The raw descriptive statistics showed minor improvements in guideline adherence after the implementation. After adjusting for underlying patient characteristics and potential differences between physician networks, the likelihood of receiving a test was moderately but consistently higher after the implementation of the incentive scheme for most performance measures, ranging from 18% (albuminuria: OR, 1.18; 95%-CI, 1.05–1.33) to 58% (HDL cholesterol: OR, 1.58; 95%-CI, 1.40–1.78). Full adherence was more likely after implementation of the incentive scheme (OR, 1.37; 95%-CI, 1.20–1.55), whereas level 1 significantly decreased (OR, 0.74; 95%-CI, 0.65 – 0.85). The proportions of the other adherence levels were stable.

Conclusion
Incentive schemes including transparency of the achieved performance may be able to improve guideline adherence in patients with diabetes and are promising to increase quality of care in this patient population.
Disparities in the level of COVID-19 health literacy and the associated factors among employees in long-term care facilities in Taiwan
Authors: Lin Lan-Ping , Yu Jia-Rong , Lin Jin-Ding 
Published: June 2023

Abstract
Background
Coronavirus disease 2019 (COVID-19) poses a significant threat to the safety of residents in long-term care facilities, and the staff of long-term care facilities are essential in the care and prevention of major infectious diseases and therefore require good health literacy to ensure the health of residents. The main objective of this study was to examine the health literacy of staff in long-term care facilities and analyze the factors associated with their COVID-19 health literacy in Taiwan to provide a basis for the response mechanism to emerging infectious diseases.

Methods
A cross-sectional survey with a structured questionnaire by a convenience sample method and to assess the COVID-19 health literacy of caregivers working in long-term care facilities in this study. The COVID-19 health literacy scale was a self-administered scale designed to combine the concept of “health literacy” with the 3 levels and 5 stages of preventive medicine. A total of 385 workers from 10 long-term care facilities were surveyed as the study sample, and the validated questionnaires were statistically analyzed using SPSS version 22.0 statistical software. A multivariate logistic regression model was used to establish the associated factors of the COVID-19 health literacy level.

Results
Overall, the mean COVID-19 health literacy score was 88.7 ± 10.4 (range: 58–105). Using a quartile scale, 92 (23.9%) of the study participants had low health literacy (health literacy score < 82), 190 (49.3%) had average health literacy (health literacy score 82–98), and the remaining 103 (26.8%) had good health literacy (health literacy score 99–105). Statistical analysis revealed significant differences (p < 0.05) in the COVID-19 health literacy score by demographic variables (education, job category, number of daily service users, and training related to infectious disease prevention and control) of the study population. The logistic regression analysis of the COVID-19 health literacy level (> 82 vs. ≤82) showed a significant difference in the study sample by gender (male vs. female, OR = 2.46, 95% CI = 1.15–5.26), job category (nurse practitioner vs. caregiver, OR = 7.25, 95% CI = 2.46–21.44), monthly service hours (> 160 h vs. 40–79 h, OR = 0.044, 95% CI = 0.07–0.97), experience caring for confirmed COVID-19 patients (yes vs. no, OR = 0.13, 95% CI = 0.02–0.98), and training related to infectious disease prevention and control (yes vs. no, OR = 2.8, 95% CI = 1.52–5.15).

Conclusions
This study recommends that facilities provide immediate updated COVID-19 information to staff, especially frontline caregivers, and specifically enhance COVID-19 infection control education training for all facility staff to eliminate health literacy disparities.
Impact of Watson’s human caring-based health promotion program on caregivers of individuals with schizophrenia
Authors: Bagheri Shahpar , Zarshenas Ladan , Rakhshan Mahnaz , Sharif Farkhondeh , Sarani Ebrahim Moghimi , Shirazi Zahra Hadian , Sitzman Kathleen 
Published: June 2023

Abstract
Background
Caring for people with schizophrenia is accompanied by challenges that impact caregiver health. We conducted this study to explore the effect of a Caring Science-Based health promotion program on the sense of coherence and well-being among caregivers of persons with schizophrenia.

Methods
This randomized clinical trial with the Solomon four-group design was conducted on 72 caregivers randomly allocated into two intervention and two control groups. A health promotion program based on Watson’s theory was performed individually through five face-to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected using a demographic information form, the Sense of Coherence Scale, and the Caregiver Well-Being Scale. One-way ANOVA, chi-square, Kruskal–Wallis, and independent t-test were used to determine the homogeneity at baseline. In the post-test, multiple between-groups and pairwise comparisons were assessed by One-way ANOVA and Tukey’s post-hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed, and the statistical level was considered 0.05.

Results
Data analysis showed that the mean scores of caregiver sense of coherence and well-being from pre-intervention to post-intervention were significantly increased in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups.

Conclusion
The health promotion program based on Watson’s human caring theory facilitated ongoing intrapersonal, and holistic caring and improved the sense of coherence and well-being in caregivers of persons with schizophrenia. Hence, this intervention is recommended for developing healing care programs.

Trial registration
https://www.irct.ir/trial/55040: IRCT20111105008011N2 (11/04/2021).
The effects of digitalisation on health and social care work: a qualitative descriptive study of the perceptions of professionals and managers
Authors: Kaihlanen Anu-Marja , Laukka Elina , Nadav Janna , Närvänen Johanna , Saukkonen Petra , Koivisto Juha , Heponiemi Tarja 
Published: June 2023

Abstract
Background
Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work.
Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals.

Methods
We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach.

Results
Digitalisation was perceived to have changed professionals’ 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems.

Conclusions
The findings suggest that some of the effects of digitalisation on professionals’ work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals’ well-being and adaptation to changes, as well as the provision of quality health and social services.