bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of functional genetic variants in TFF1 and nephrolithiasis risk in a Chinese population
Authors: Wang Qiangdong , Jiang Yan , Du Mulong , Yang Lei , Yuan Qinbo 
Published: August 2022

AbstractTrefoil Factor 1 (TFF1) is considered to be able to inhibit the formation of kidney stone. However, genetic variants in TFF1 and corresponding function in kidney stone development are still not well studied. In this study, the discovery set including 230 cases and 250 controls was used to analyze the association between seven tagSNPs of TFF1 gene and the nephrolithiasis risk. Further evaluation was confirmed by the validation set comprising 307 cases and 461 controls. The consequences of the two-stage case–control study indicated that individuals with the rs3761376 A allele have significantly increased nephrolithiasis risk than those with the GG genotypes [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.05–1.73]. Moreover, we also carried out a stratified analysis and found the increased nephrolithiasis risks at A allele among males, overweight individuals, no hypertensive individuals, nondiabetic individuals, smokers, and drinkers. In the following functional experiments, the notably lower expression of TFF1 was exhibited by the vectors carrying A allele compared with those carrying G allele in both luciferase (P = 0.022) and expression vectors (P = 0.041). In addition to tissue detection, we confirmed a significant inverse association of rs3761376 G > A and TFF1 gene expression (P < 0.001). These results suggest that TFF1 rs3761376 may serve as a potential biomarker to predict the risk of nephrolithiasis.
Dynamic changes of quality of life in muscle-invasive bladder cancer survivors
Authors: Tsai Yuh-Shyan , Wu Tzu-Yi , Ou Chien-Hui , Cheng Hong-Lin , Tzai Tzong-Shin , Yang Wen-Horng , Wang Jung-Der 
Published: August 2022

Abstract
Background
To explore the dynamic changes and effects of radical cystectomy on quality of life in muscle-invasive bladder cancer survivors.

Methods
Patients with muscle-invasive bladder cancer were randomly recruited in this study. We used the World Health Organization Quality of Life-Brief questionnaire to assess consecutive patients’ quality of life. We applied kernel smoothing to illustrate the dynamic changes of the domain and item scores after treatment. Mixed-effects models were constructed to determine the effects of radical cystectomy on the scores of each item and domain of the World Health Organization Quality of Life-Brief questionnaire after controlling demographic and clinical factors.

Results
We collected 397 repeated measurements of the World Health Organization Quality of Life-Brief questionnaire from 109 muscle-invasive bladder cancer patients. Forty-two of them received radical cystectomy. Patients with radical cystectomy exhibited higher levels of education, less co-morbidities (i.e., diabetes and heart diseases), but were associated with more malignancies. Construction of mixed-effects models showed patients with radical cystectomy and those with bladder sparing had similar scores in the three main domains and their items, except that of certain items of physical domain. By applying kernel smoothing method, we found that stage III–IV patients consistently showed higher scores on sleep and rest after radical cystectomy for more than 5 years. In contrast, stage II patients receiving radical cystectomy did not show a higher score on the “sleep and rest” item compared with those with bladder sparing operation.

Conclusions
Radical cystectomy may result in sound sleep and rest, especially in those with stage III–IV bladder cancer.
The impact of the evaluations made by Mini-CEX on the clinical competency of nursing students
Authors: Motefakker Sanaz , Shirinabadi Farahani Azam , Nourian Manijeh , Nasiri Maliheh , Heydari Fatemeh 
Published: August 2022

Abstract
Introduction
Clinical competency is defined as one’s capabilities in terms of knowledge, attitude and practice, and is a necessity for nursing practice. Evaluation is the inseparable part of the education process, without which the quality of education could not be measured. Considering the characteristics of clinical education and its impact on the clinical competency of students, as well as the importance of making precise evaluations of them using scientific, modern and efficient approaches, this study aims to investigate the impact of the evaluation made using Mini-Clinical Evaluation Exercise on the clinical competency of the nursing students of the School of Nursing and Midwifery Shahid Behesti University.

Methods
This is a quasi-experimental study with a control group conducted on students who were taking courses “Nursing care for a sick child”. The students were classified into the intervention and control groups using complete enumeration. The evaluations were made using Mini-Clinical Evaluation Exercise in the intervention group and the portfolio approach in the control group. The skills regarding patient (mother–child) education, IV therapy and medication were evaluated by checklists.

Findings
The results showed that the mean score of clinical competency in the intervention group was significantly higher than that of the control group.

Conclusion
Considering the improvement of clinical competency in the intervention group, it is recommended to use Mini-Clinical Evaluation Exercise for the evaluation of students.
What influences graduate medical students’ beliefs of lower back pain? A mixed methods cross sectional study
Authors: Inman John G. K. , Ellard David R. 
Published: August 2022

Abstract
Background
Low back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner’s management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student’s beliefs of LBP and what influences them.

Method
A cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis.

Results
Fifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements.

Conclusions
The HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex.
Impact of Managed Entry Agreements on availability of and timely access to medicines: an ex-post evaluation of agreements implemented for oncology therapies in four countries
Authors: Efthymiadou Olina , Kanavos Panos 
Published: August 2022

Abstract
Background
Despite the increased utilisation of Managed Entry Agreements (MEAs), empirical studies assessing their impact on achieving better access to medicines remains scarce. In this study we evaluated the role of MEAs on enhancing availability of and timely access to a sample of oncology medicines that had received at least one prior rejection from reimbursement.

Methods
Funding decisions and their respective timelines for all oncology medicines approved between 2009 and 2018 in Australia, England, Scotland and Sweden were studied. A number of binary logit models captured the probability (Odds ratio (OR)) of a previous coverage rejection being reversed to positive after resubmission with vs. without a MEA. Gamma generalised linear models were used to understand if there is any association between time to final funding decision and the presence of MEA, among other decision-making variables, and if so, the strength and direction of this association (Beta coefficient (B)).

Results
Of the 59 previously rejected medicine-indication pairs studied, 88.2% (n = 45) received a favourable decision after resubmission with MEA vs. 11.8% (n = 6) without. Average time from original submission to final funding decision was 404 (± 254) and 452 (± 364) days for submissions without vs. with MEA respectively. Resubmissions with a MEA had a higher likelihood of receiving a favourable funding decision compared to those without MEA (43.36 < OR < 202, p < 0.05), although approval specifically with an outcomes-based agreement was associated with an increase in the time to final funding decision (B = 0.89, p < 0.01). A statistically significant decrease in time to final funding decision was observed for resubmissions in Australia and Scotland compared to England and Sweden, and for resubmissions with a clinically relevant instead of a surrogate endpoint.

Conclusions
MEAs can improve availability of medicines by increasing the likelihood of reimbursement for medicines that would have otherwise remained rejected from reimbursement due to their evidentiary uncertainties. Nevertheless, approval with a MEA can increase the time to final funding decision, while the true, added value for patients and healthcare systems of the interventions approved with MEAs in comparison to other available interventions remains unknown.
A nationwide survey exploring physicians’ and pharmacists’ knowledge, awareness and perceptions regarding generic medicines in China
Authors: Qu Jinghan , Zuo Wei , Took Roxane L. , Schafermeyer Kenneth W. , Lukas Stephanie , Wang Shaohong , Du Liping , Liu Xin , Gao Yang , Li Jiantao , Pan Hui , Du Xiaoli , Mei Dan , Zhang Bo 
Published: August 2022

Abstract
Background
Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China.

Methods
We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant.

Results
A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution.

Conclusions
Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution.
Scaling-up community-based rehabilitation programs in rural Thailand: the development of a capacity building program
Authors: Tongsiri Sirinart 
Published: August 2022

Abstract
Background
Approximately 15% of the world population have some forms of disability and their quality of life is compromised. According to Thailand Persons with Disabilities (PWDs) Empowerment Act, B.E. 2550 (2007), PWDs are entitled for benefits ranging from medical care to social support services. The CBR framework and the International Classification of Functioning, Disability and Health (ICF) can be used to promote the interdisciplinary approach across staff from different organizations. This study aimed to demonstrate the capacity building strategy for user organizations and resource teams, the key components in environment of scale-up as described in “WHO/ExpandNet Scaling-up Framework” to promote the implementation process of CBR interventions in Thailand.

Methods
The study was conducted with a network of representative from five sub-districts in Thailand. A set of capacity building training courses was designed. Fieldworkers were trained to administer the ICF questionnaire to collect data of PWDs in community. A qualitative interview was conducted to investigate the changes of the interdisciplinary teams.

Results
The total of 1,783 PWDs data were collected during 1 April 2018–30 December 2019. All of them have, at least, one type of impairment and one type of difficulty in activity of daily living (ADL). Needs of assistive devices and home modifications were also recognized. Individual ICF profiles can also developed to monitor change of their functioning after receiving services. After the discussions in the qualitative interviews, it is indicated that their perceptions towards work with PWDs were changed. The six steps in capacity building include: dialogue, team building, disability role-play; ICF data collection and analysis; developing individual care plans for PWDs; home and environmental modifications for PWDs; training to promote employment opportunities; and evaluation of the care plan.

Conclusions
The study highlighted the innovative training methodology for building up the capacity of staff to work as a team and to become agents of change to set up a strategic plan for delivering CBR interventions in their own settings.
Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana
Authors: Akinnawo Ayodele , Seyram Kaali , Kaali Ellen Boamah , Harrison Samuel , Dosoo David , Cairns Matthew , Asante Kwaku Poku 
Published: August 2022

Abstract
Background
Malaria infection during pregnancy can cause significant morbidity and mortality to a pregnant woman, her fetus and newborn. In areas of high endemic transmission, gravidity is an important risk factor for infection, but there is a complex relationship with other exposure-related factors, and use of protective measures. This study investigated the association between gravidity and placental malaria (PM), among pregnant women aged 14–49 in Kintampo, a high transmission area of Ghana.

Methods
Between 2008 and 2011, as part of a study investigating the association between PM and malaria in infancy, pregnant women attending antenatal care (ANC) clinics in the study area were enrolled and followed up until delivery. The outcome of PM was assessed at delivery by placental histopathology. Multivariable logistic regression analyses were used to investigate the association between gravidity and PM, identify other key risk factors, and control for potential confounders. Pre-specified effect modifiers including area of residence, socio-economic score (SES), ITN use and IPTp-SP use were explored.

Results
The prevalence of PM was 65.9% in primigravidae, and 26.5% in multigravidae. After adjusting for age, SES and relationship status, primigravidae were shown to have over three times the odds of PM compared to multigravidae, defined as women with 2 or more previous pregnancies [adjusted OR = 3.36 (95% CI 2.39–4.71), N = 1808, P < 0.001]. The association appeared stronger in rural areas [OR for PG vs. MG was 3.79 (95% CI 3.61–5.51) in rural areas; 2.09 (95% CI 1.17–3.71) in urban areas; P for interaction = 0.07], and among women with lower socio-economic scores [OR for PG vs. MG was 4.73 (95% CI 3.08–7.25) amongst women with lower SES; OR = 2.14 (95% CI 1.38–3.35) among women with higher SES; P for interaction = 0.008]. There was also evidence of lower risk among primigravidae with better use of the current preventive measures IPTp and LLIN.

Conclusions
The burden of PM is most heavily focused on primigravidae of low SES living in rural areas of high transmission. Programmes should prioritize primigravidae and young women of child-bearing age for interventions such as LLIN distribution, educational initiatives and treatment to reduce the burden of malaria in first pregnancy.
Spatial analysis to evaluate risk of malaria in Northern Sumatera, Indonesia
Authors: Fahmi Fahmi , Pasaribu Ayodhia Pitaloka , Theodora Minerva , Wangdi Kinley 
Published: August 2022

Abstract
Background
As Indonesia aims for malaria elimination by 2030, provisional malaria epidemiology and risk factors evaluation are important in pursue of this national goal. Therefore, this study aimed to understand the risk factor of malaria in Northern Sumatera.

Methods
Malaria cases from 2019 to 2020 were obtained from the Indonesian Ministry of Health Electronic Database. Climatic variables were provided by the Center for Meteorology and Geophysics Medan branch office. Multivariable logistic regression was undertaken to understand the risk factors of imported malaria. A zero-inflated Poisson multivariable regression model was used to study the climatic drivers of indigenous malaria.

Results
A total of 2208 (indigenous: 76.0% [1679] and imported: 17.8% [392]) were reported during the study period. Risk factors of imported malaria were: ages 19–30 (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] 1.67, 2.56), 31–45 (AOR = 5.69; 95% CI 2.65, 12.20), and > 45 years (AOR = 5.11; 95% CI 2.41, 10.84). Military personnel and forest workers and miners were 1,154 times (AOR = 197.03; 95% CI 145.93, 9,131.56) and 44 times (AOR = 44.16; 95% CI 4.08, 477,93) more likely to be imported cases as compared to those working as employees and traders. Indigenous Plasmodium falciparum increased by 12.1% (95% CrI 5.1%, 20.1%) for 1% increase in relative humidity and by 21.0% (95% CrI 9.0%, 36.2%) for 1 °C increase in maximum temperature. Plasmodium vivax decreased by 0.8% (95% CrI 0.2%, 1.3%) and 16.7% (95% CrI 13.7%, 19.9%) for one meter and 1 °C increase of altitude and minimum temperature. Indigenous hotspot was reported by Kota Tanjung Balai city and Asahan regency, respectively. Imported malaria hotspots were reported in Batu Bara, Kota Tebing Tinggi, Serdang Bedagai and Simalungun.

Conclusion
Both indigenous and imported malaria is limited to a few regencies and cities in Northern Sumatera. The control measures should focus on these risk factors to achieve elimination in Indonesia.
Optimising a multi-strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial
Authors: Lane Cassandra , Wolfenden Luke , Hall Alix , Sutherland Rachel , Naylor Patti-Jean , Oldmeadow Chris , Leigh Lucy , Shoesmith Adam , Bauman Adrian , McCarthy Nicole , Nathan Nicole 
Published: August 2022

Abstract
Background
To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools’ implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was “as good as” the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers.

Methods
A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers’ scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at − 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).

Results
The posterior estimate for the between group difference at follow-up was − 2.3 minutes (95% credible interval = − 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of − 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.

Conclusions
It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.

Trial registration
Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).