bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain perception following computer-controlled versus conventional dental anesthesia: randomized controlled trial
Authors: Attia Sameh , Austermann Thomas , May Andreas , Mekhemar Mohamed , Conrad Jonas , Knitschke Michael , Böttger Sebastian , Howaldt Hans-Peter , Riad Abanoub 
Published: September 2022

Abstract
Background
The administration of local anesthesia (LA) in dental practice requires an injection which is the leading cause of patients’ fear and anxiety. Computer-controlled local anesthetic injector, designed to reduce the pain of performing local anesthesia by controlling the speed of injection. This single-blind randomised control trial aimed to compare the pain perception after computer-controlled local anesthesia (CCLA) and conventional LA.

Methods
Dental students were both test and operator group versus an experienced dentist as additional operator of the LA. Data were collected regarding gender, age, medical condition, smoking habits. Additionally, operator feedback about the handling, pain at insertion and during infiltration, excitement (Dental Anxiety Scale), and complications were assessed.

Results
Out of the 60 included participants, the majority were females (n = 41; 68.3%), medically healthy (n = 54; 90%), and did not receive medications (n = 54; 90%). While the participating students administered 62 (51.7%) injections, the experienced dentist administered 58 (48.3%) injections. The difference in pain perception on puncture between CCLA and conventional injections was not statistically significant (Sig. = 0.285); however, pain perception during injection was significantly different (Sig. = 0.029) between CCLA (1.65 ± 1.93) and conventional injections (2.49 ± 2.31).

Conclusion
The professional experience influenced the pain perception while applying the LA. CCLA did not reduce pain on puncture significantly; however, pain perception during the injection was significantly reduced in the case of using CCLA devices compared to the conventional syringe.
Adolescents’ and young people’s needs and preferences for support when living with a parent with life-threatening cancer: a grounded theory study
Authors: Bergersen Emily , Larsson Maria , Lövgren Malin , Olsson Cecilia 
Published: September 2022

Abstract
Background
Living with a parent facing life-threatening illness and losing a mom or dad at a young age can cause both short- and long-term health problems. Without satisfactory support, adolescents’ and young people are at risk of developing low self-esteem, behavioural difficulties (e.g., anger and aggression), long-term illness or premature death caused by severe mental illness, substance abuse, self-harm and suicide attempts. The aim of this study was to explore adolescents’ and young people’s needs and preferences for support as they live with a parent with life-threatening cancer.

Methods
Qualitative interviews were conducted with 10 respondents (17–24 years) in Norway and Sweden. Data were analysed through grounded theory according to Charmaz.

Results
Adolescents’ and young peoples’ needs and preferences for support were described through the main category ‘To feel safe and secure and to be prepared’ and further broken down into five subcategories ‘Relationships in the immediate family—balancing support and protection’; ‘The social network—support and normalcy in a carefully selected group’; ‘Maintaining everyday life—challenges in school and working life’; ‘The right support at the right time—competence, trust and continuity in meeting health care professionals’; and ‘Support outside the home—an opportunity for full transparency’.

Conclusion
Adolescents’ and young peoples’ preferences for support when living with a parent facing life-threatening illness are individual and unique, but they share a common need to feel safe and secure and to be prepared.
Adolescents and young people express that they primarily want support from parents and friends, but they also want support from health care professionals, especially in situations when the ill parent becomes worse. Therefore, it is of the utmost importance for health care professionals to identify the most vulnerable adolescents and young people by mapping their social networks and paying extra attention to their needs for support when there is deterioration in the parent’s illness state. This study also highlights the importance for health care professionals to establish a good relationship with adolescents and young people to meet their needs and preferences for support. In addition, information and support are needed in a timely manner and adapted to the life-threatening ill parent’s illness state and individual’s needs and preferences to optimise preparedness.
Postpartum depression and its correlates: a cross-sectional study in southeast Iran
Authors: Zakeri Mohammad Ali , Khoram Somaye , Bazmandegan Gholamreza , Ghaedi-Heidari Fatemeh , Talebi Batol , Ramezani Najmeh , Ahmadi Fatemeh , Kamiab Zahra , Dehghan Mahlagha 
Published: September 2022

Abstract
Background
Postpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.

Methods
This cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.

Results
Postpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R2 = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R2 = 24.0%).

Conclusions
With an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.
Using drawing and situated learning to teach transitional care to post-graduate residents
Authors: Liaw Fang-Yih , Chang Yaw-Wen , Chang Yan-Di , Shih Li-Wen , Tsai Po-Fang 
Published: September 2022

Abstract
Background
The “draw-and-talk” technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan.

Methods
Before the conventional lecture on discharge planning, trainees were invited to draw their “home” and “life as older adults” and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected.

Results
Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of “home” and “elderly life” led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable.

Conclusions
Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients’ lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants’ real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents’ knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.
Predicting the level of anemia among Ethiopian pregnant women using homogeneous ensemble machine learning algorithm
Authors: Dejene Belayneh Endalamaw , Abuhay Tesfamariam M. , Bogale Dawit Shibabaw 
Published: September 2022

Abstract
Background
More than 115,000 maternal deaths and 591,000 prenatal deaths occurred in the world per year with anemia, the reduction of red blood cells or hemoglobin in the blood. The world health organization divides anemia in pregnancy into mild anemia (Hb 10–10.9 g/dl), moderate anemia (Hb 7.0–9.9 g/dl), and severe anemia (Hb < 7 g/dl). This study aims to predict the level of anemia among pregnant women in the case of Ethiopia using homogeneous ensemble machine learning algorithms.

Methods
This study was conducted following a design science approach. The data were gathered from the Ethiopian demographic health survey and preprocessed to get quality data that are suitable for the machine learning algorithm to develop a model that predicts the levels of anemia among pregnant. Decision tree, random forest, cat boost, and extreme gradient boosting with class decomposition (one versus one and one versus rest) and without class decomposition were employed to build the predictive model. For constructing the proposed model, twelve experiments were conducted with a total of 29,104 instances with 23 features, and a training and testing dataset split ratio of 80/20.

Results
The overall accuracy of random forest, extreme gradient boosting, and cat boost without class decompositions is 91.34%, 94.26%, and 97.08.90%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus one is 94.4%, 95.21%, and 97.44%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus the rest are 94.4%, 94.54%, and 97.6%, respectively.

Conclusion
Finally, the researcher decided to use cat boost algorithms with one versus the rest for further use in the development of artifacts, model deployment, risk factor analysis, and generating rules because it has registered better performance with 97.6% accuracy. The most determinant risk factors of anemia among pregnant women were identified using feature importance. Some of them are the duration of the current pregnancy, age, source of drinking water, respondent’s (pregnant women) occupation, number of household members, wealth index, husband/partner's education level, and birth history.
Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals
Authors: Bouma Adrie , van Nassau Femke , Nauta Joske , Krops Leonie , van der Ploeg Hidde , Verhagen Evert , van der Woude Lucas , van Keeken Helco , Dekker Rienk ,   PIE = M consortium, van Mechelen Willem , de Groot Vincent , van der Leeden Marike , Zwerver Johannes , Fluit Martin , van den Akker-Scheek Inge , Stevens Martin , Diercks Ronald , Bossers Willem , Buffart Laurien , de Jong Johan , Kampshoff Caroline , Leutscher Hans , van Twillert Sacha 
Published: September 2022

Abstract
Background
There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as ‘Exercise is Medicine’ (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care.

Methods
A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide.

Results
An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients’ electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care.

Conclusions
This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.
Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study
Authors: Gong Xue , Hou Mengchi , Guo Rui , Feng Xing Lin 
Published: September 2022

Abstract
Background
Consultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services.

Methods
We defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider’s responses, total words of provider’s all responses, and average words of provider’s each response. We appraised E-consults services quality using five indicators building on China’s clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality.

Results
Providers who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well.

Conclusions
The times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better.
Factors impacting—stillbirth and neonatal death audit in Malawi: a qualitative study
Authors: Gondwe Mtisunge Joshua , Joshua Emily , Kaliati Hendrina , Aminu Mamuda , Allen Stephen , Desmond Nicola 
Published: September 2022

Abstract
Background
Over one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained countries. Death audit may be a valuable tool for improving quality of care and decreasing mortality. However, challenges in implementing audit and their subsequent action plans have been reported, with few successfully implemented and sustained. This study aimed to identify factors that affect stillbirth and neonatal death audit at the facility level in the southern region of Malawi.

Methods
Thirty-eight semi-structured interviews and seven focus group discussions with death audit committee members were conducted. Thematic analysis was guided by a conceptual framework applied deductively, combined with inductive line-by-line coding to identify additional emerging themes.

Results
The factors that affected audit at individual, facility and national level were related to training, staff motivation, power dynamics and autonomy, audit organisation and data support. We found that factors were linked because they informed each other. Inadequate staff training was caused by a lack of financial allocation at the facility level and donor-driven approaches to training at the national level, with training taking place only with support from funders. Staff motivation was affected by the institutional norms of reliance on monetary incentives during meetings, gazetted at the national level so that audits happened only if such incentives were available. This overshadowed other benefits and non-monetary incentives which were not promoted at the facility level. Inadequate resources to support audit were informed by limited facility-level autonomy and decision-making powers which remained controlled at the national level despite decentralisation. Action plan implementation challenges after audit meetings resulted from inadequate support at the facility level and inadequate audit policy and guidelines at the national level. Poor documentation affected audit processes informed by inadequate supervision and promotion of data usage at both facility and national levels.

Conclusions
Given that the factors that facilitate or inhibit audits are interconnected, implementers, policymakers and managers need to be aware that addressing barriers is likely to require a whole health systems approach targeting all system levels. This will require behavioural and complex intervention approaches.
A method based on non-ionizing microwave radiation for ancillary diagnosis of osteoporosis: a pilot study
Authors: Albuquerque Gabriela , Cruz Agnaldo , Carvalho Dionísio , Mayrink Nadja , Pinheiro Bruno , Campos Antonio , Lima Josivan Gomes , Henriques Jorge , Valentim Ricardo 
Published: September 2022

Abstract
Background
Osteoporosis is a condition characterized by low bone mineral density, which typically leads to fractures and reduced quality of life. Currently, diagnostic devices used to assess this condition (e.g., dual-energy X-ray absorptiometry) are very costly, making it infeasible to meet the demand for testing in most countries. Therefore, we proposed a preclinical validation of a prototype called Osseus in an attempt to enhance osteoporosis screening tests and alleviate their costs. Osseus is a device developed to assist bone mineral density classification. It integrates a microcontroller into other peripheral devices to measure the attenuation at the middle phalanx of the middle finger, with two antennas operating at the 2.45 GHz frequency.

Results
We conducted tests with plaster, poultry, and porcine bones. A comparison of the measurements of the original and mechanically altered samples demonstrated that the device can handle the complexity of the tissues within the bone structure and characterize its microarchitecture.

Conclusions
Osseus is a device that has been preliminarily validated. Ionising radiation needed for DXA tests is replaced by non-ionising microwave electromagnetic radiation. Osseus enables early detection of osteoporosis, reduces costs, and optimizes high-complexity testing referrals. There is a lack of validation studies with the reference/gold standard that are currently under development.
The impact of different endometrial preparation protocols on obstetric and neonatal complications in frozen-thawed embryo transfer: a retrospective cohort study of 3,458 singleton deliveries
Authors: Xu Junting , Zhou Hong , Zhou Tianfan , Guo Yi , Liang Shanshan , Jia Yanping , Li Kunming , Teng Xiaoming 
Published: September 2022

Abstract
Background
Frozen-thawed embryo transfer (FET) is thought to be associated with obstetric and neonatal complications after in vitro fertilization/intracytoplasmic single sperm injection (IVF/ICSI) treatment. The study aimed to determine whether the endometrial preparation protocol is an influencing factor for these complications.

Methods
We conducted a retrospective cohort study of 3,458 women who had singleton deliveries after IVF/ICSI–FET treatment at the Centre for Reproductive Medicine of Shanghai First Maternity and Infant Hospital between July 2016 and April 2021. The women were divided into three groups according to the endometrial preparation protocols: 2,029 women with programmed cycles, 959 with natural cycles, and 470 with minimal ovarian stimulation cycles. The primary outcomes were the incidence rates of obstetric and neonatal complications, namely, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), placenta previa, preterm rupture of membranes (PROM), preterm delivery, postpartum haemorrhage, large for gestational age (LGA), small for gestational age (SGA), and macrosomia.

Results
After adjustments for confounding variables by multivariate logistic regression analysis, the results showed that programmed cycles had an increased risk of HDP (aOR = 1.743; 95% CI, 1.110–2.735; P = 0.016) and LGA (aOR = 1.269; 95% CI, 1.011–1.592; P = 0.040) compared with natural cycles. Moreover, programmed cycles also increased the risk of LGA (aOR = 1.459; 95% CI, 1.083–1.965; P = 0.013) but reduced the risk of SGA (aOR = 0.529; 95% CI, 0.348–0.805; P = 0.003) compared with minimal ovarian stimulation cycles. There were no significant differences between natural cycles and minimal ovarian stimulation cycles.

Conclusions
During IVF/ICSI–FET treatment, the risk of HDP and LGA was increased in women with programmed cycles. Therefore, for patients with thin endometrium, irregular menstruation or no spontaneous ovulation, minimal ovarian stimulation cycles may be a relatively safer option than programmed cycles.