bluuebunny/crossref_metadata_2025_split huggingface dataset:
School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines
Authors: Sangalang Stephanie O. , Lemence Allen Lemuel G. , Ottong Zheina J. , Valencia John Cedrick , Olaguera Mikaela , Canja Rovin James F. , Mariano Shyrill Mae F. , Prado Nelissa O. , Ocaña Roezel Mari Z. , Singson Patricia Andrea A. , Cumagun Ma. Lourdes , Liao Janine , Anglo Maria Vianca Jasmin C. , Borgemeister Christian , Kistemann Thomas 
Published: November 2022

Abstract
Background
The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children’s health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children’s malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines.

Methods
The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children’s physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects.

Results
None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal.

Conclusion
Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed.

Trial registration number
DRKS00021623.
Changes in self-reported and accelerometer-measured physical activity among pregnant TRICARE Beneficiaries
Authors: Pebley Kinsey , Farage Gregory , Hare Marion E. , Bursac Zoran , Andres Aline , Chowdhury Sultana Mubarika Rahman , Talcott G. Wayne , Krukowski Rebecca A. 
Published: November 2022

Abstract
Background
Physical activity is recommended for all pregnant individuals and can prevent excessive gestational weight gain. However, physical activity has not been assessed among military personnel and other TRICARE beneficiaries, who experience unique military lifestyles. The current study assessed physical activity among pregnant TRICARE beneficiaries, both active duty and non-active duty, as measured by accelerometry and self-report data to examine potential predictors of physical activity engagement in the third trimester, and if self-report data was consistent with accelerometry data. We expected having a lower BMI, being active-duty, and having higher baseline physical activity engagement to be associated with higher physical activity at 32-weeks. We also hypothesized that accelerometry data would show lower physical activity levels than the self-reported measure.

Methods
Participants were 430 TRICARE adult beneficiaries (204 Active Duty; 226 non-Active Duty) in San Antonio, TX who were part of a randomized controlled parent study that implemented a stepped-care behavioral intervention. Participants were recruited if they were less than 12-weeks gestation and did not have health conditions precluding dietary or physical activity changes (e.g., uncontrolled cardiovascular conditions) or would contribute to weight changes. Participants completed self-report measures and wore an Actical Activity Monitor accelerometer on their wrist to collect physical activity data at baseline and 32-weeks gestation.

Results
Based on the accelerometer data, 99% of participants were meeting moderate physical activity guidelines recommending 150 min of moderate activity per week at baseline, and 96% were meeting this recommendation at 32-weeks. Based on self-report data, 88% of participants at baseline and 92% at 32-weeks met moderate physical activity recommendations. Linear regression and zero-inflated negative binomial models indicated that baseline physical activity engagement predicted moderate physical activity later in pregnancy above and beyond BMI and military status. Surprisingly, self-reported data, but not accelerometer data, showed that higher baseline activity was associated with decreased vigorous activity at 32-weeks gestation. Additionally, self-report and accelerometry data had small correlations at baseline, but not at 32-weeks.

Conclusions
Future intervention efforts may benefit from intervening with individuals with lower pre-pregnancy activity levels, as those who are active seem to continue this habit.

Trial Registration
The trial is registered on clinicaltrials.gov (NCT 03057808).
Prognostic factors in the treatment of gastric mucosal atypical hyperplasia by endoscopic submucosal dissection
Authors: Hong Yongping , Chen Xingxing , Li Guofeng 
Published: November 2022

Abstract
Background
Endoscopic submucosal dissection (ESD) is becoming increasingly popular as a treatment for precancerous lesions and early cancers of the stomach. However, there have been few studies on the factors associated with the recurrence of precancerous lesions after ESD.

Methods
To investigate the prognostic factors of gastric intraepithelial neoplasia, we retrospectively analyzed 115 patients who were treated with ESD between February 2018 and January 2020. Chi-square test and Fisher’s extract test were used to select factors for further investigation, and prognostic analysis was carried out with the Kaplan–Meier method and a Cox regression model.

Results
Platelet counts (P = 0.027) and albumin levels (P = 0.011) were both lower in patients with recurrence than in patients without recurrence of gastric mucosal atypical hyperplasia after ESD.

Conclusions
This study reveals that low platelet counts and albumin levels were probably unfavorable prognostic factors in mucosal atypical hyperplasia of the stomach.
Challenges and opportunities for general practice specific CME in Europe – a narrative review of seven countries
Authors: Löffler Christin , Altiner Attila , Blumenthal Sandra , Bruno Pascale , De Sutter An , De Vos Bart J. , Dinant Geert-Jan , Duerden Martin , Dunais Brigitte , Egidi Günther , Gibis Bernhard , Melbye Hasse , Rouquier Frederic , Rosemann Thomas , Touboul-Lundgren Pia , Feldmeier Gregor 
Published: November 2022

AbstractBackgroundSeveral changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development.MethodsNarrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation.ResultsGeneral practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented.ConclusionsIndependent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.
What are the impacts of setting up new medical schools? A narrative review
Authors: Hashem Ferhana , Marchand Catherine , Peckham Stephen , Peckham Anna 
Published: November 2022

Abstract
Background
The growth of the UK’s population together with an aging society with increasingly complex health and social care needs has placed a greater demand on statutory care services. In view of this emerging landscape, the UK Government has sought to increase its medically trained workforce in order to better respond to the demands placed on the health service. Five universities were announced as homes to new medical schools offering undergraduate places to boost the numbers of doctors training in England. The aim of this narrative review was to explore how new medical schools could improve the health outcomes of the local population and evaluate the potential contribution it may make to the local economy, workforce and to research and innovation.

Methods
A narrative review was undertaken using a systematic approach for the search literature strategy. The articles were evaluated by undertaking a critical assessment evaluating the fitness of a paper for review according to results, methods used to test the hypothesis, conclusions and impact and limitations. Thematic analysis was employed to organise and summarise the findings across a heterogeneous body of literature included in the review. The analysis was developed in an inductive manner and there were not any predefined themes to guide data extraction and analysis.

Results
Thirty-six articles were selected for inclusion for this narrative review. The review identified six key themes: influence of prior rural exposure, medical school environment and rural enrichment programmes, workforce, health outcomes of local populations, social accountability, economic contribution of medical schools to communities and impact on rural research.

Conclusions
The studies included found a wealth of information on a wide-range of topics on the expansion of undergraduate education and its implications on the future medical workforce. It was shown that medical schools can have a positive effect on the health, social, economic and research activity of a region, but this literature tended to be heterogeneous in focus without consideration of the inter-connections between the wider societal and economic impacts arising from long-term sustainable change being brought to a region.
Effect analysis of a virtual simulation experimental platform in teaching pulpotomy
Authors: Lu Jiaxuan , Yang Xin , Zhao Wei , Lin Jiacheng 
Published: November 2022

AbstractBackgroundThe experimental teaching of pediatric dentistry is a bridge between theoretical study and clinical practice, and virtual simulation technology provides a new method of instruction.MethodsWe built an experimental teaching platform using virtual simulation technology for vital pulpotomy that includes learning and examination modes. A total of 199 students majoring in stomatology in the fourth year at Sun Yat-Sen University were randomly divided into a control group (conventional teaching mode) and an experimental group (virtual simulation experimental teaching model). The teaching effect was evaluated by theoretical and experimental examination.ResultsWe found that both the theoretical and experimental scores of the experimental group were higher than those of the control group, and the theoretical scores of the experimental group after exposure to the virtual simulation experimental teaching platform were also higher than those before the class, with significant differences (P < 0.05). Feedback from the experimental group after the class indicated that the platform reinforced their theoretical knowledge and greatly improved their mastery of operational skills.ConclusionsThe application of a virtual simulation experimental teaching platform can effectively improve the teaching of pulpotomy.
Speech silence character as a diagnostic biomarker of early cognitive decline and its functional mechanism: a multicenter cross-sectional cohort study
Authors: Wang Hua-Long , Tang Ran , Ren Ru-Jing , Dammer Eric B. , Guo Qi-Hao , Peng Guo-Ping , Cui Hai-Lun , Zhang You-Min , Wang Jin-Tao , Xie Xin-Yi , Huang Qiang , Li Jian-Ping , Yan Fu-Hua , Chen Sheng-Di , He Na-Ying , Wang Gang 
Published: November 2022

Abstract
Background
Language deficits frequently occur during the prodromal stages of Alzheimer’s disease (AD). However, the characteristics of linguistic impairment and its underlying mechanism(s) remain to be explored for the early diagnosis of AD.

Methods
The percentage of silence duration (PSD) of 324 subjects was analyzed, including patients with AD, amnestic mild cognitive impairment (aMCI), and normal controls (NC) recruited from the China multi-center cohort, and the diagnostic efficiency was replicated from the Pitt center cohort. Furthermore, the specific language network involved in the fragmented speech was analyzed using task-based functional magnetic resonance.

Results
In the China cohort, PSD increased significantly in aMCI and AD patients. The area under the curve of the receiver operating characteristic curves is 0.74, 0.84, and 0.80 in the classification of NC/aMCI, NC/AD, and NC/aMCI+AD. In the Pitt center cohort, PSD was verified as a reliable diagnosis biomarker to differentiate mild AD patients from NC. Next, in response to fluency tasks, clusters in the bilateral inferior frontal gyrus, precentral gyrus, left inferior temporal gyrus, and inferior parietal lobule deactivated markedly in the aMCI/AD group (cluster-level P < 0.05, family-wise error (FWE) corrected). In the patient group (AD+aMCI), higher activation level of the right pars triangularis was associated with higher PSD in in both semantic and phonemic tasks.

Conclusions
PSD is a reliable diagnostic biomarker for the early stage of AD and aMCI. At as early as aMCI phase, the brain response to fluency tasks was inhibited markedly, partly explaining why PSD was elevated simultaneously.
The expression changes of transcription factors including ANKZF1, LEF1, CASZ1, and ATOH1 as a predictor of survival rate in colorectal cancer: a large-scale analysis
Authors: Sajadi Manizheh , Fazilti Mohammad , Nazem Habibollah , Mahdevar Mohammad , Ghaedi Kamran 
Published: November 2022

Abstract
Introduction
Transcription factors (TFs) are essential for many biological processes and regulate the expression of several genes. This study’s objective was to analyze the abnormalities in TF expression, their impact on patient prognosis, and related pathways in colorectal cancer (CRC).

Method
The expression alterations of all TFs were investigated using the cancer genome atlas and GSE39582 data. Clinical data were also used to study the association between TFs expression and patient prognosis through the Cox regression test, and a predictive model of CRC patient survival was constructed based on TFs expression. Co-expression network was used to discover TF-related pathways. To validate the findings, the RT-qPCR method was applied to CRC samples and adjacent normal tissue.

Results
The findings revealed that ANKZF1, SALL4, SNAI1, TIGD1, LEF1, FOXS1, SIX4, and ETV5 expression levels increased in both cohorts and were linked to the poor prognosis. NR3C2, KLF4, CASZ1, FOXD2, ATOH1, SALL1, and RORC expression, on the other hand, exhibited a significant decrease, and their increase was related to the good prognosis of patients. The patient mortality risk model based on expression of mentioned TFs revealed that, independent of clinical characteristics, the expression of ANKZF1, LEF1, CASZ1, and ATOH1 could accurately predict patient survival rates. According to the co-expression network, increased transcription factors were linked to metastatic pathways, while decreasing TFs were involved to apoptotic pathways. RT-qPCR findings showed that FOXS1 expression was markedly overexpressed in CRC samples. However, in CRC samples, the expression of CASZ1 decreased.

Conclusion
In CRC, TFs expression of ANKZF1, LEF1, CASZ1 and ATOH1 are deregulated, which are associated with prognosis in patients. According to our findings, changes in the expression of the mentioned TFs have the potential to be considered diagnostic and prognostic biomarkers for CRC patients.
Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem
Authors: Unger Shifra , Orr Zvika , Alpert Evan Avraham , Davidovitch Nadav , Shoham-Vardi Ilana 
Published: November 2022

Abstract
Background
A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.

Methods
A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.

Results
There were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.

Conclusion
The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
Disruptions to U.S. local public health’s role in population-based substance use prevention and response during COVID-19
Authors: Hall Kellie , Higgins Francis , Beach Karla Feeser , Diriba Kabaye , Sladky Mandy , McCall Timothy C. 
Published: November 2022

Abstract
Background
COVID-19 dramatically limited the scale and scope of local health department (LHD) work, redirecting resources to the response. However, the need for essential public health services—including substance use prevention—was not reduced.

Methods
We examined six quantitative data sources, collected between 2016 and 2021, to explore the impact of the COVID-19 pandemic on LHD substance use-related services.

Results
Before the pandemic, the proportion of LHDs providing some level of substance use prevention services was increasing, and many were expanding their level of provision. During the pandemic, 65% of LHDs reduced their level of substance use-related service provision, but the proportion of LHDs providing some level of services remained steady from prior to COVID-19.

Conclusion
We discuss policy recommendations to mitigate the risk of service disruptions during future public health emergencies, including direct and flexible funding for LHDs and federal directives declaring substance use prevention services as essential.
Comprehensive clinical evaluation of TomoEQA for patient-specific pre-treatment quality assurance in helical tomotherapy
Authors: Kim Changhwan , Han Min Cheol , Lee Young Kyu , Shin Han-Back , Kim Hojin , Kim Jin Sung 
Published: November 2022

AbstractBackgroundBased on a previous study on the feasibility of TomoEQA, an exit detector-based patient-specific pre-treatment quality assurance (QA) method for helical tomotherapy, an in-depth clinical evaluation was conducted.MethodsData of one hundred patients were analyzed to evaluate the clinical usefulness of TomoEQA for patient-specific pre-treatment QA in comparison with the conventional phantom-based method. Additional investigations were also performed under unusual measurement conditions to validate the off-axis region. In addition to the clinical evaluation of TomoEQA, a statistical analysis was conducted to determine the plan parameters that affect the pass/failure results of pre-treatment QA.ResultsThe average and standard deviations of the gamma passing rate and point dose error for TomoEQA were comparable to those of the conventional QA method. For TomoEQA, the average values of the gamma passing rate and point dose error were 96.32% (standard deviation (1 sigma) = 3.94; 95% confidence interval (CI), 95.55 to 97.09) and − 1.12% (standard deviation (1 sigma) = 1.04; CI, − 1.32 to − 0.92), respectively. For the conventional QA method, the average values of the gamma passing rate and point dose error were 95.95% (standard deviation (1 sigma) = 4.35; 95% confidence interval (CI), 95.10 to 96.80) and − 1.20% (standard deviation (1 sigma) = 1.61; CI, − 1.52 to − 0.88), respectively. Further experiments on the off-axis region demonstrated that TomoEQA can provide accurate results for 3D dose analysis, which is inherently difficult in the conventional QA method. Through a statistical analysis based on the results of TomoEQA, it was validated that the total fraction (Total Fx), monitor units, beam-on-time, leaf-of-time below 100 ms, and planning target volume diameter were statistically significant for the pass/failure of the pre-treatment QA results.ConclusionsTomoEQA is a clinically beneficial alternative to the conventional phantom-based QA method.