bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional study: exploring knowledge and attitude of medical and nursing students to Care for Elders in the future
Authors: Alqahtani Rawan , Almuhaidib Shadan , Jradi Hoda 
Published: November 2022

Abstract
Background
All societies are going through a longevity revolution. Inflating the elderly’s age group will present many challenges to the healthcare system. A better health workforce is needed to meet this demand. Little is known about the knowledge and attitude of medical and nursing students toward geriatric care in Saudi Arabia. This study aims to explore medical and nursing students’ knowledge about aging, and their attitude toward caring for older adults.

Method
A cross-sectional study using two surveys: the fact on aging quiz to assess knowledge and the UCLA geriatric attitude scale to evaluate attitudes. A total of 494 medical and nursing students from three universities in Saudi Arabia were included.

Results
Knowledge and attitude scores were 13.57/23 and 3.37/5, respectively. Findings showed that even in a country where the elderly are respected and family bonds are valued there is still much room for improvement. Moreover, there was a significant statistical difference in the knowledge and attitude scores (p < .0001) regarding the participants’ specialty. The nursing participants had higher knowledge scores, while the medical participants had better attitude scores. Overall, Spearman’s correlation coefficient between ranked knowledge and attitude scores was −.339 with a significance of p < .0001, indicating a low negative correlation between the two scores.

Conclusion
Knowledge and attitude score were fair to moderate, these findings propose enhancing learners’ education and training experiences in the care of the elderly through curricular improvements.
The effect and relative importance of sleep disorders for all-cause mortality in middle-aged and older asthmatics
Authors: Hu Zhigang , Tian Yufeng , Song Xinyu , Zeng Fanjun , Hu Ke , Yang Ailan 
Published: November 2022

Abstract
Background
Previous studies observed that sleep disorders potentially increased the risk of asthma and asthmatic exacerbation. We aimed to examine whether excessive daytime sleepiness (EDS), probable insomnia, objective short sleep duration (OSSD), and obstructive sleep apnea (OSA) affect all-cause mortality (ACM) in individuals with or without asthma.

Methods
We extracted relevant data from the Sleep Heart Health Study established in 1995–1998 with an 11.4-year follow-up. Multivariate Cox regression analysis with a proportional hazards model was used to estimate the associations between ACM and four sleep disorders among asthmatic patients and individuals without asthma. Dose-response analysis and machine learning (random survival forest and CoxBoost) further evaluated the impact of sleep disorders on ACM in asthmatic patients.

Results
A total of 4538 individuals with 990 deaths were included in our study, including 357 asthmatic patients with 64 deaths. Three multivariate Cox regression analyses suggested that OSSD (adjusted HR = 2.67, 95% CI: 1.23–5.77) but not probable insomnia, EDS or OSA significantly increased the risk of ACM in asthmatic patients. Three dose-response analyses also indicated that the extension of objective sleep duration was associated with a reduction in ACM in asthmatic patients compared to very OSSD patients. Severe EDS potentially augmented the risk of ACM compared with asthmatics without EDS (adjusted HR = 3.08, 95% CI: 1.11–8.56). Machine learning demonstrated that OSSD of four sleep disorders had the largest relative importance for ACM in asthmatics, followed by EDS, OSA and probable insomnia.

Conclusions
This study observed that OSSD and severe EDS were positively associated with an increase in ACM in asthmatic patients. Periodic screening and effective intervention of sleep disorders are necessary for the management of asthma.
Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department
Authors: Polilli Ennio , Di Iorio Giancarlo , Silveri Claudio , Angelini Gilda , Anelli Maria Chiara , Esposito Jessica Elisabetta , D’Amato Milena , Parruti Giustino , Carinci Fabrizio 
Published: November 2022

AbstractBackgroundMonocyte Distribution Width (MDW), a simple cellular marker of innate monocyte activation, can be used for the early recognition of sepsis. We performed an observational prospective monocentric study to assess the predictive role of MDW in detecting sepsis in a sample of consecutive patients presenting at the Emergency Department.MethodsProspective observational study using demographic and clinical characteristics, past medical history and other laboratory measurements to predict confirmed sepsis using multivariate logistic regression.ResultsA total of 2724 patients were included in the study, of which 272 (10%) had sepsis or septic shock. After adjusting for known and potential risk factors, logistic regression found the following independent predictors of sepsis: SIRS equal to 1 (OR: 2.32, 1.16–4.89) and 2 or more (OR: 27.8, 14.8–56.4), MDW > 22 (OR: 3.73, 2.46–5.70), smoking (OR: 3.0, 1.22–7.31), end stage renal function (OR: 2.3, 1.25–4.22), neurodegenerative disease (OR: 2.2, 1.31–3.68), Neutrophils ≥ 8.9 × 103/µL (OR: 2.73, 1.82–4.11), Lymphocytes < 1.3 × 103/µL (OR: 1.72, 1.17–2.53) and CRP ≥ 19.1 mg/L (OR: 2.57, 1.63–4.08). A risk score derived from predictive models achieved high accuracy by using an optimal threshold (AUC: 95%; 93–97%).ConclusionsThe study suggests that incorporating MDW in the clinical decision process may improve the early identification of sepsis, with minimal additional effort on the standard procedures adopted during emergency care.
Causes and outcome of acute kidney injury amongst adults patients in two hospitals of different category in Cameroon; a 5 year retrospective comparative study
Authors: Georges Teuwafeu Denis , Marie-Patrice Halle , Ingrid Tonou Sorel , Mbua Ronald Gobina , Hermine Fouda Menye , Gloria Ashuntantang 
Published: November 2022

Abstract
Background
Acute kidney injury (AKI) is an under-recognized disorder, which is associated with a high risk for mortality, development of chronic kidney disease (CKD).

Objective
We sought to describe and compare the causes and outcomes of AKI amongst adult patients in Douala general hospital (DGH) and Buea regional hospital (BRH).

Methods
A hospital-based retrospective cohort analytic study was carried from February to April 2021. Convenience sampling was used. We included Patient’s files admitted from January 2016 to December 2020 aged > 18 years, with AKI diagnosed by a nephrologist and recorded values of serum creatinine (sCr) on admission and discharge. Data were analysed using SPSSv26. Chi-square, fisher, median mood’s and regression logistic test were used, values were considered significant at p < 0.05.

Results
Of the 349 files included 217 was from DGH and 132 from BRH. Community acquired AKI were more present in BRH 87.12% (n = 115) than DGH 84.79% (n = 184) (p = 0.001). Stage III AKI was the most common presentation in both hospital. Pre-renal AKI was more common (p = 0.013) in DGH (65.44%, n = 142) than BRH (46.97%, n = 62). Sepsis and volume depletion were more prevalent in urban area with (64.51 and 30.41% vs. 46.21 and 25.75%) while severe malaria was more present in Semi-urban area (8.33% vs. 1.84%, p = 0.011). Complete and partial renal recovery was 64.97% (n = 141) in DGH and 69.69% (n = 92) in BRH (p = 0.061). More patients had dialysis in BRH 73.07% (n = 57) than in DGH 23.33% (n = 21). More patient died in DGH 33.18% (n = 72) died than in BRH 19.70% (n = 26) (p = 0.007). Stage III was significantly associated with non-renal recovery in both DGH (p = 0.036) and BRH (p = 0.009) while acute tubular necrosis was associated with non-renal outcome in DGH (p = 0.037).

Conclusions
AKI was mainly due to sepsis, volume depletion and nephrotoxicity. Complete and partial recovery of kidney function were high in both settings. Patient outcome was poorer in DGH.
Kennedy’s disease presented with mastication fatigue combined with positive titin antibody: a case report
Authors: Ji Guang , Huang Rui , Zhou Xiaomeng , Cao Cuifang , Wu Qiong , Li Zhenfei , Dong Hui , Song Xueqin , Liu Yaling 
Published: November 2022

Abstract
Background
Spinal and bulbar muscular atrophy (SBMA) is an X-linked recessive hereditary neuromuscular disorder caused by the expanded trinucleotide repeat in the androgen receptors gene. The major clinical manifestations of SBMA consist of weakness in the bulbar and limb muscles, fasciculations, tremors, cramps, sensory impairment, and gynecomastia. However, atypical SBMA cases may lead to misdiagnosis. Muscular fatigue and decremental responses to repetitive nerve stimulation (RNS), despite being observed in some SBMA patients, are usually occurred in MG patients, and patient with the symptom of mastication fatigue was rarely reported. In addition, cardiological investigations have been performed in SBMA patients and several ECG alterations were identified. Here we report an SBMA patient presenting with a rare onset symptom of mastication fatigue, who has been detected with a positive titin antibody in the serum and showed a WPW pattern electrocardiogram.

Case presentation
The patient showed mildly progressive fatigue in the muscles of mastication over 3 years. Neurological examination showed facial muscle weakness and a wasting tongue with fasciculations, but the weakness, wasting, or fasciculations were not obvious in the limbs. 3-Hz RNS showed a decremental response in bilateral orbicularis oculi. The test of titin antibody was positive in the serum, and the electrocardiogram showed a WPW pattern ECG. Genetic analysis revealed an increased number (39 repeats) of tandem CAG repeats in the AR gene, which confirmed the diagnosis of SBMA. The fatigue symptom was significantly improved after oral pyridostigmine bromide treatment.

Conclusion
This case calls for more attention to muscular fatigue as the onset symptoms of Kennedy’s disease. ECG screening is of importance in SBMA patients and further studies are needed to investigate the titin antibody in SBMA patients as well as other neurogenic disorders.
Early onset monocular hydroxychloroquine maculopathy in a systemic lupus erythematosus patient with history of central retinal artery occlusion: a case report
Authors: Ameen Ismail Ahmed , Sadek Sherin Hassan , Hatata Ragai Magdy 
Published: November 2022

Abstract
Background
Hydroxychloroquine is a widely used medication for various clinical conditions mainly rheumatological and dermatological autoimmune diseases e.g. systemic lupus erythematosus, rheumatoid arthritis and psoriasis. While it is considered a safe medication, it is well-established that it can cause retinal toxicity i.e. HCQ maculopathy. Guidelines for HCQ retinal toxicity screening include factors like body weight, daily dose, duration, systemic diseases and retinal diseases. In this case study, we report a specific association between CRAO as a retinal disease and early onset HCQ maculopathy in a SLE patient.

Case presentation
A 42-year-old Caucasian female SLE patient presented with a complaint of gradual progressive painless diminution of vision in the left eye that started 16 months earlier. Clinical evaluation of the patient revealed a history of sudden profound painless diminution of vision in the same eye 18 months earlier after which the patient experienced only partial improvement of vision. That episode of sudden diminution of vision was attributed to left CRAO, complicating SLE-related thrombophilia, confirmed by fundus fluorescein angiography. Based on that diagnosis, the patient had been prescribed HCQ. At the time of presentation, fundus examination revealed left bull's eye maculopathy and right normal fundus. Therefore, a diagnosis of HCQ maculopathy in the left eye was made after exclusion of other causes of unilateral bull's eye maculopathy.

Conclusion
Our case study is the first to report an association between CRAO as a specific retinal disease and early onset of HCQ maculopathy in a SLE patient. The unilateral bull's eye presentation which occurred in the eye with CRAO after only 16 months of HCQ treatment highly suggests that CRAO is probably the cause of such unusually early maculopathy. This case report highlights the importance of retinal diseases as risk factors for HCQ maculopathy. It also points out the lack of specific evidence concerning the association between specific retinal diseases and HCQ maculopathy.
Prevalence of pharmacological and non-pharmacological coping mechanisms for anxiety management during the COVID-19 pandemic: investigating the transition to online learning among medical students
Authors: Almarri Firas K. , Alaseem Ali M. , Alanazi Muteb S. , Alyahya Salman I. , Alsanad Naif H. , Alswayed Khalid E. , Alanazi Jowaher S. , Alharby Tareq N. , Alghamdi Saleh A. 
Published: November 2022

Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic had a devastating effect on college students worldwide. Here, the authors aimed to determine the prevalence of anxiety and its related coping strategies, provide a theoretical basis for understanding self-prescription, and identify the factors contributing to stress and anxiety in medical students during the pandemic.

Methods
The authors conducted a cross-sectional study among medical students in Saudi Arabia from September to November 2020. They assessed anxiety using the GAD-7 scale based on seven core symptoms. The authors also examined perceived psychological stress using a single-item measure of stress, the factors contributing to stress during the transition to online learning and examinations, and related coping strategies. The Statistical Package for Social Sciences (SPSS) version 26.0 was used to examine the data for both descriptive and inferential analyses. Chi-square test, one-way ANOVA, and univariate linear regression were used to test the research hypotheses.

Results
The authors collected and analyzed data from 7116 medical students distributed across 38 medical colleges. Among them, 40% reported moderate to severe anxiety symptoms. Pre-clinical and female students experienced more stress than clinical and male students. 12.19% (n = 868) of respondents reported using medication during their college years. Among those, 58.9% (n = 512) had moderate to severe anxiety, and the most commonly used drug was propranolol (45.4%, n = 394). Among the studied sample, 40.4% (n = 351) decreased their medication use after switching to online teaching. Most students used these medications during the final exam (35.8%, n = 311) and before the oral exam (35.5%, n = 308). In terms of coping strategies, males were much more likely to use substances than females, who mainly resorted to other strategies.

Conclusions
This study provides a national overview of the impact of COVID-19 on the mental health of medical students. The results indicated that the pandemic is associated with highly significant levels of anxiety. These findings can provide theoretical evidence for the need for supportive psychological assistance from academic leaders in this regard.
The effect of family structure on physical activity levels among children and adolescents in Western China in the era of COVID-19
Authors: Shi Mengyao , Shi Yuqing , Zhao Zuhang , Zhai Xiangyu , Fan Xiang 
Published: November 2022

Abstract
Purpose
This study aimed to examine the levels of physical activity (PA) among children and adolescents in western China, and the influence of parents on their PA, in the era of coronavirus disease 2019 (COVID-19).

Methods
This cross-sectional study used a multistage questionnaire to evaluate 4800 children and adolescents of grades 4–12 (9–17 years old) from 48 primary and secondary schools across 16 districts and counties in western China. In addition to PA, questionnaires collected data on demography, family structure, and exercise habits. Data were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and analyzed using chi-square tests, t-tests, Spearman’s correlation, and logistic regression models in SPSS.

Results
In this study, a minority (42.1%, n = 1553) of children and adolescents met the daily exercise target (60 min) recommended by the World Health Organization (WHO). Moderate- to vigorous-intensity physical activity (MVPA) level of boys was significantly higher than that of girls. Regardless of sex, children with the highest MVPA levels were those in grades 4–6, and PA levels decreased with increasing age. Furthermore, for every hour of increase in the daily MVPA of parents, the MVPA also increased by 6.1–13.9 min in children and adolescents. Moreover, areas of higher economic development were associated with lower levels of MVPA.

Conclusions
Overall, this study found a low level of MVPA in children and adolescents of western China; both family structure and parental activity have a significant influence on the children's PA levels. Besides, the impact of COVID-19 on PA levels has not been entirely negative.
Evaluation of the health promotion effect of hepatitis B prevention and treatment in the Zhejiang demonstration area, China
Authors: Qin Hongli , Qiu Yan , Ying Meike , Ren Jingjing 
Published: November 2022

Abstract
Background
To investigate the health literacy level and health promotion effect of hepatitis B prevention and treatment in the demonstration area of Zhejiang Province.

Methods
The National Science and Technology Major Health Education Group took 6 demonstration areas in Zhejiang Province as the whole research site. After the sample size (N=2160 people) was determined, a multistage stratified cluster sampling method was used to conduct a questionnaire survey in 2018 (before health education) and 2019 (after health education). Stata 12 statistical software was used to analyse the status and improvement rate of hepatitis B health literacy of residents in the demonstration area before and after health education and compare the health promotion effects of different health intervention methods.

Results
Before and after health education, there was no significant difference in the basic information of the subjects (P>0.05). After the health education intervention, the level of hepatitis B health literacy of residents in the demonstration area increased by 11.8%, and the difference was statistically significant (P < 0.001). The awareness rate of hepatitis B transmission was low before health education but increased after health education. The form of "Internet +" health education may better improve the residents' health literacy level about hepatitis B prevention and treatment.

Conclusion
After health education, the level of health literacy of residents in the Zhejiang demonstration area about hepatitis B prevention and control significantly improved, but there is room for further improvement. In the future, targeted health education intervention should be carried out, and the health education mode of "Internet +" can achieve better results to effectively prevent and control hepatitis B.
The efficacy of 3D personalized insoles in moderate adolescent idiopathic scoliosis: a randomized controlled trial
Authors: Wang Bin , Sun Yue , Guo Xiaoqi , Cao Jiangang , Lu Haoyuan , Chen Wei , Chen Jie , Zhu Qian , Zhang Chong , Zhang Ming , Zhu Feilong 
Published: November 2022

Abstract
Background
Bracing and exercise methods were used in scoliosis rehabilitation and proven effective. There was little evidence about the efficacy of insoles on scoliosis.

Objective
This study aimed to investigate the effects of 3D personalized insoles on curve magnitude, postural stability, and quality of life (QOL) in moderate adolescent idiopathic scoliosis (AIS) patients.

Methods
Thirty-six volunteers with adolescent idiopathic scoliosis, who had moderate curves (20°-45°), were randomly divided into the experimental and control groups. The control group received traditional rehabilitation with bracing and exercises, and the experimental group received the insole interventions in addition to traditional rehabilitation. The outcome measures were Cobb angle, angle of trunk rotation (ATR), postural stability, and quality of life (Scoliosis Research Society-22 questionnaire). Measurements were conducted at baseline examination, two months and six months.

Results
After two and six months of treatment, the Cobb angle and ATR in both groups were significantly decreased as compared with the baseline (p < 0.05), but no significant group difference in Cobb angle and ATR was found in the study (p > 0.05). There was a significant difference in the sagittal balance index at six months compared to the control group (p < 0.05), and a significant difference in the coronal balance index was observed at six months compared to baseline in the experimental group (p < 0.05). Quality of life did not change in either group (p > 0.05).

Conclusion
Combining bracing with exercise in patients with moderate AIS is effective. 3D personalized insoles cannot reduce the Cobb angle and angle of trunk rotation of patients with moderate AIS but might have the potential to improve postural stability.
Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases
Authors: Shi Wensong , Hu Yuzhui , Chang Guotao , Zheng Huiyu , Yang Zhiqiang , Zhao Xiaogang , Yang Yulun , Li Xiangnan 
Published: November 2022

Abstract
Objective
To discuss the application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules in both lungs.

Methods
A retrospective analysis of 10 patients in Zhengzhou People’s Hospital who underwent single-incision thoracoscopic surgery to treat multiple nodules in both lungs at the same time from September 2019 to January 2021, and analyze the perioperative indicators (general condition, smoking history, family history, follow-up time of pulmonary nodules, size, location, height and weight, pulmonary function, intraoperative blood loss, operation time, color and volume of drainage fluid, catheterization time, perioperative complications, length of stay, pathology, patient satisfaction, etc.).

Results
All 10 patients used single-incision thoracoscopy to complete bilateral simultaneous sequential operations, aged 32 to 70 years, 8 female patients, 2 male patients, preoperative follow-up time ranging from 1 day to 2 years, a total of 23 lung nodules were removed except for the benign lesions in one nodule in the 2 patients, the other nodules were tumorous lesions (91.3%). The average total hospital stay was 10.5 days (8–14 days), and the average operation time was 194.5 min (145–292 min). The blood loss ranged from 10 to 280 ml, all patients had no serious complications during the perioperative period, and they recovered well and were discharged smoothly, and the satisfaction reached 100%.

Conclusion
Single-incision bilateral simultaneous sequential thoracoscopy have certain advantages in the treatment of patients with multiple nodules in both lungs, conforms to the concept of rapid recovery, and is a feasible choice in the shared decision making of doctors and patients.