bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of social support on oral health behavior: Serial multiple‐mediator model
Authors: Jiang Nan , Shi Hongyan , Zhao Jie , Zhang Yuxin , Wang Ting , Cao He , Wang Quqing , Wang Jiwei , Xu Xiaoming 
Published: December 2022

AbstractObjectiveThis study investigates the serial multiple mediation of job stress and perceived behavioral control (PBC) in the relationship between social support and oral health behavior (OHB).Materials and MethodsThis cross‐sectional study was conducted in Minhang District, Shanghai, China, between July and November 2021. 559 Employees from 10 community health centers were recruited. A five‐part survey was used to collect data on demographic characteristics, social support, job stress, PBC and OHB. Descriptive statistics, independent‐sample t‐test, Pearson's correlation analysis, ordinary least‐squares regression and the bootstrap method were used to analyze data.ResultsSocial support was found to impact OHB through three significant mediation pathways: the pathway through job stress (point estimate = 0.033; 95%BC CI [0.004, 0.089]), the pathway through PBC (point estimate = 0.283; 95%BC CI [0.174, 0.416]), and the serial multiple mediating pathway through first job stress and then PBC (point estimate = 0.006; 95%BC CI [0.001, 0.019]).ConclusionThis study indicates that job stress and PBC play a serial multiple‐mediator role in the relationship between social support and OHB. To ensure the effectiveness of social support intervention on OHB, workplace managers and employees should strengthen the motivators that could promote the reduction of job stress and the improvement of PBC.
What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta‐Analysis
Authors: Gao Yu‐Cheng , Zhang Yuan‐Wei , Shi Liu , Gao Wang , Li Ying‐Juan , Chen Hui , Rui Yun‐Feng 
Published: December 2022

Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta‐analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled, and a meta‐analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22–6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02–1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87–6.47), dependent functional status (OR = 5.23, 95% CI: 2.18–12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07–1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07–6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01–1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23–2.46), arrhythmia (OR = 1.47, 95% CI: 1.01–2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56–2.27), dementia (OR = 2.36, 95% CI: 1.04–5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29–2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08–1.56), delayed surgery (OR = 6.40, 95% CI: 3.00–13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55–10.08), and preoperative serum albumin (MD = −3.01, 95% CI: −4.21 – −1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above‐mentioned risk factors to prevent POP after hip fracture surgery.
Education as a tool of social equality?
Authors: Gingrich Jane , Giudici Anja 
Published: December 2022

AbstractDo political parties approach education with different social policy aims? We argue that while parties have adopted a common language of equality as an aim of education, they draw on different conceptions of it linked to diverging social projects. To make this argument, we first normatively distinguish education as a tool for creating equal opportunity, equal outcomes, and representational diversity. We then draw on an original dataset coding the educational content in the political manifestos of the largest center‐left and center‐right party across 19 Western democracies from 1950 to present. The analysis shows that left parties emphasise more equality of outcome than rightwing parties and pay less attention to equality of opportunity, and that they associate equality‐related aims more extensively with promises of resources. These findings suggest that there remain critical differences in parties' understanding of education as a tool of social policy.
Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand
Authors: Yu Dahai , Wang Zheng , Cai Yamei , Osuagwu Uchechukwu Levi , Pickering Karen , Baker John , Cutfield Richard , Orr-Walker Brandon J , Sundborn Gerhard , Jayanatha Kalpa , Zhao Zhanzheng , Simmons David 
Published: December 2022

IntroductionInsights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II–V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared.Research design and methodsAs a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II–V were ruled out. To balance potential confounders, we applied a tapered matching method . ‘Quasi-trial’-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994–2018 were examined by weighted Cox regression model.ResultsThe HRs for developing any CKD, CKD stages II–V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II–V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively.ConclusionsAmong people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT
Authors: Robberegt Suzanne J , Kooiman Bas E A M , Albers Casper J , Nauta Maaike H , Bockting Claudi , Stikkelbroek Yvonne 
Published: December 2022

IntroductionYouth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience.Method and analysisIn this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13–21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes.Ethics, funding and disseminationThe study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences.Trial registration numberNCT05551468; NL8237.
Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data
Authors: Vedsted Peter , Weller David , Zalounina Falborg Alina , Jensen Henry , Kalsi Jatinderpal , Brewster David , Lin Yulan , Gavin Anna , Barisic Andriana , Grunfeld Eva , Lambe Mats , Malmberg Martin , Turner Donna , Harland Elizabeth , Hawryluk Breann , Law Rebecca-Jane , Neal Richard D , White Victoria , Bergin Rebecca , Harrison Samantha , Menon Usha ,   The ICBP Module 4 Working Group
Published: December 2022

ObjectivesA growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.SettingPrimary care in 10 jurisdictions.ParticipantData were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.Primary and secondary outcome measuresPatient, primary care, diagnostic and treatment intervals.ResultsOverall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).ConclusionsLarge international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants
Authors: Omale Ugwu I , Iyare Osarhiemen , Ewah Richard L , Amuzie Chidinma I , Oka Onyinyechukwu U , Uduma Victor U , Adeke Azuka S , Ikegwuonu Cordis O , Nnachi Olaedo O , Ukpabi Okechukwu O , Okeke Ifeyinwa M , Nkwo Glory E , Nwali Ugochi IA 
Published: December 2022

IntroductionThe COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria.Methods and analysesThe study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach.Ethics and disseminationEthical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022–02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021–17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate.Trial registration numberISRCTN16735844.
Incremental medical cost of delirium in elderly patients with cognitive impairment: analysis of a nationwide administrative database in Japan
Authors: Igarashi Masakazu , Okuyama Kotoba , Ueda Naoya , Sano Hideki , Takahashi Kanae , P Qureshi Zaina , Tokita Shigeru , Ogawa Asao , Okumura Yasuyuki , Okuda Shoki 
Published: December 2022

ObjectivesDelirium is a neuropsychiatric disorder that commonly occurs in elderly patients with cognitive impairment. The economic burden of delirium in Japan has not been well characterised. In this study, we assessed incremental medical costs of delirium in hospitalised elderly Japanese patients with cognitive impairment.DesignRetrospective, cross-sectional, observational study.SettingAdministrative data collected from acute care hospitals in Japan between April 2012 and September 2020.ParticipantsHospitalised patients ≥65 years old with cognitive impairment were categorised into groups—with and without delirium. Delirium was identified using a delirium identification algorithm based on the International Classification of Diseases 10thRevision codes or antipsychotic prescriptions.Outcome measuresTotal medical costs during hospitalisation were compared between the groups using a generalised linear model.ResultsThe study identified 297 600 hospitalised patients ≥65 years of age with cognitive impairment: 39 836 had delirium and 257 764 did not. Patient characteristics such as age, sex, inpatient department and comorbidities were similar between groups. Mean (SD) unadjusted total medical cost during hospitalisation was 979 907.7 (871 366.4) yen for patients with delirium and 816 137.0 (794 745.9) yen for patients without delirium. Adjusted total medical cost was significantly greater for patients with delirium compared with those without delirium (cost ratio=1.09, 95% CI: 1.09 to 1.10; p<0.001). Subgroup analyses revealed significantly higher total medical costs for patients with delirium compared with those without delirium in most subgroups except patients with hemiplegia or paraplegia.ConclusionsMedical costs during hospitalisation were significantly higher for patients with delirium compared with those without delirium in elderly Japanese patients with cognitive impairment, regardless of patient subgroups such as age, sex, intensive care unit admission and most comorbidities. These findings suggest that delirium prevention strategies are critical to reducing the economic burden as well as psychological/physiological burden in cognitively impaired elderly patients in Japan.
Association of oral health knowledge, self-efficacy and behaviours with oral health-related quality of life in Chinese primary school children: a cross-sectional study
Authors: Zhao Jie , Shi Hongyan , Wang Jingya , Huang Rui , Liu Yongyi , Zhang Yuxin , Jiang Nan , Wang Ting , Wang Jiwei , Xu Xiaoming 
Published: December 2022

ObjectiveAchieving good oral health-related quality of life (OHRQOL) is of particular concern in children. The inter-relations among oral health knowledge, self-efficacy, behaviours and OHRQOL in children groups remain unclear. This study aimed to explore the inter-relations between these oral health behaviour-related factors and OHRQOL in primary school children.MethodsIn this cross-sectional study, 651 children in grades 2 and 3 were recruited in October 2020 from two primary schools in Minhang District, Shanghai, China. Data were collected through self-reported questionnaires, consisting of demographic characteristics, oral health knowledge, self-efficacy, oral health behaviours and OHRQOL. Pearson’s correlation analyses were used to analyse the relationship between study variables. Structural equation models were used to test the inter-relations between OHRQOL and oral health behaviour-related factors.ResultsFour hypothetical structural equation models were tested and one of them was selected as the most appropriate model, which explained 15.0% of the variance in OHRQOL. This selected model showed that oral health behaviours were directly related to OHRQOL. Oral health knowledge was indirectly associated with OHRQOL through both self-efficacy and oral health behaviours. Self-efficacy was directly associated with OHRQOL or was indirectly associated with OHRQOL through oral health behaviours.ConclusionThis study revealed a pathway of association between children’s oral health knowledge and their OHRQOL, in which children’s oral health self-efficacy and behaviours had indirect effects. This provides a basis for understanding the mechanism of oral health promotion interventions to improve children’s OHRQOL and helps to identify direct or indirect intervention targets.
When and why do medical students drop out of extracurricular longitudinal general practice tracks? A cross-sectional study from two German medical faculties
Authors: Nafziger Melanie , Geier Anne-Kathrin , Bauch Felix Johannes , Deutsch Tobias , Frese Thomas 
Published: December 2022

ObjectivesTo explore when and why undergraduate medical students drop out of longitudinal extracurricular general practice (GP) tracks and to describe their future career plans.DesignCross-sectional online survey and descriptive analysis of routine data.SettingGP tracks at two German medical faculties, data collection took place between September 2020 and April 2021.ParticipantsOf 111 students who had taken part in one of the two GP tracks and dropped out prematurely, 101 were contactable via email. Overall, the response rate was 72.3% with 73 completed questionnaires and 75.3% of the participants were female.Primary and secondary outcome measuresReasons for leaving the GP track (closed and free-text answers), attitudes towards a career in GP and future career plans.ResultsStudents left the tracks predominantly during the first 2 years of study. Students most frequently stated that structural reasons such as the distance to the GP teaching practice (74.2%), interest in another medical discipline (66.1%), private reasons (58.1%) and the GP mentor (53.1%) influenced their decision to drop out. However, 87.1% of the students indicated that their exit could not have been prevented by the project administration.ConclusionsReasons for dropping out differ between GP tracks and not all reasons are within reach of programme design and staff. Addressable issues include student selection with regard to career plans, support and strengthening of student–mentor relationships, the location of GP practices, and/or travel and accommodation support.
Efficacy and safety of radiotherapy combined with atezolizumab plus bevacizumab in treating hepatocellular carcinoma with portal vein tumour thrombus: a study protocol
Authors: Wang Kang , Yu Hong-Ming , Xiang Yan-Jun , Cheng Yu-Qiang , Ni Qian-Zhi , Guo Wei-Xing , Shi Jie , Feng Shuang , Zhai Jian , Cheng Shu-Qun 
Published: December 2022

IntroductionVascular invasion and metastasis are poor prognostic factors in patients with hepatocellular carcinoma (HCC). The efficacy of available therapeutic regimens for unresectable HCC is not satisfactory in HCC with portal vein tumour thrombosis (PVTT). Therefore, this open-label, single-arm phase II clinical trial aims to investigate the efficacy and safety of radiotherapy combined with atezolizumab plus bevacizumab in treating HCC patients with PVTT.Methods and analysisWe plan to enrol patients diagnosed with unresectable HCC complicated by PVTT. Intensity-modulated radiotherapy (IMRT) combined with atezolizumab plus bevacizumab will be administered for treatment. Patients will initially receive radiotherapy, with each IMRT cycle lasting for 28 days and the total dose of tumour (DT) of 40 Gy/20 f/26 d. CT scan will be performed again, and the treatment plan will be reformulated after field constriction. The treatment will continue until the total DT is up to 54–56 Gy/27–28 f. The treatment with atezolizumab plus bevacizumab will be started at 3±1 days after the initiation of radiotherapy and will continue until unacceptable toxicity or disease progression. The primary endpoint is objective response rate (ORR), while the secondary endpoints include overall survival, disease control rate, progression-free survival, time to progression, duration of response and the rate of surgical conversions. Assuming an ORR of 47%, with a one-sided alpha error of 0.1, 90% power, and a 10% drop-out rate, the required number of evaluable patients is 42.Ethics and disseminationThis study will be conducted according to the standards of Good Clinical Practice and in compliance with the principles of the Declaration of Helsinki. The Ethics Committee of our Hospital has approved the protocol (EHBHKY2021-K-017). All participants are required to provide written informed consent. The results of the trial will be published in peer-reviewed journals and presented at international conferences.Trial registration numberChiCTR2100049831.