bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obligation or getaway? A qualitative inquiry into medical professionalism under COVID-19 among medical students and new physicians in a Taiwan hospital
Authors: Chiu Chiung-Hsuan , Wei Chung-Jen , Sheu Mei-Ling , Liu Yueh-Ping , Chang Chun-Chao , Chen Chien-Yu 
Published: November 2022

ObjectivesDuring the COVID-19 outbreak, medical educators’ main concern has been how to prepare new physicians and medical students to meet their obligations as healthcare providers under novel circumstances. This study aims at exploring how trainees perceive their commitments as physicians under the threat of a pandemic.DesignA qualitative method was employed. Researchers interviewed medical students under clerkship training (fifth and sixth-year medical students) and new physicians undergoing postgraduate year (PGY) and specialty training.SettingA university hospital in Taipei, Taiwan.ParticipantsThe team conducted three focus groups for participants in three separate training stages: clerks, PGY students (PGYs), and residents. Researchers collected data from 31 March to 2 April 2020 and analysed the thematic analysis results.ResultsSeventeen medical students and new physicians took part in the focus groups, five of whom (31.25%) were female. Participants consisted of four residents, six PGYs, and seven medical students. Through their responses, the authors determined four major dimensions with corresponding subdimensions that significantly affected their sense of medical professionalism, including medical knowledge and clinical skills, sense of duty towards public health, teamwork and protection of patient rights.ConclusionsWe therefore concluded that participants grew to accept their roles after acquiring the knowledge and skills needed to care for patients with COVID-19. Alternative teaching arrangements and their impact on trainees’ clinical performance require further discussion.
Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study
Authors: Bischof Anja , Brandt Dominique , Schlossarek Samantha , Vens Maren , Rozgonjuk Dmitri , Wernicke Jennifer , Kannen Christopher , Wölfling Klaus , Dreier Michael , Salbach Harriet , Basenach Lara , Mößle Thomas , Olbrich Denise , König Inke , Borgwardt Stefan , Montag Christian , Rumpf Hans-Jürgen 
Published: November 2022

IntroductionExcessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs).Methods and analysisThe study ‘Stepped Care Approach for Problematic Internet use Treatment’ is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step—that is, the successful reduction of criteria—and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive–behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model.Ethics and disseminationThe study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD.Trial registration numberDRKS00025994.
Hyperbaric oxygen for treatment of long COVID-19 syndrome (HOT-LoCO): protocol for a randomised, placebo-controlled, double-blind, phase II clinical trial
Authors: Kjellberg Anders , Abdel-Halim Lina , Hassler Adrian , El Gharbi Sara , Al-Ezerjawi Sarah , Boström Emil , Sundberg Carl Johan , Pernow John , Medson Koshiar , Kowalski Jan H , Rodriguez-Wallberg Kenny A , Zheng Xiaowei , Catrina Sergiu , Runold Michael , Ståhlberg Marcus , Bruchfeld Judith , Nygren-Bonnier Malin , Lindholm Peter 
Published: November 2022

IntroductionLong COVID-19, where symptoms persist 12 weeks after the initial SARS-CoV-2-infection, is a substantial problem for individuals and society in the surge of the pandemic. Common symptoms are fatigue, postexertional malaise and cognitive dysfunction. There is currently no effective treatment and the underlying mechanisms are unknown, although several hypotheses exist, with chronic inflammation as a common denominator. In prospective studies, hyperbaric oxygen therapy (HBOT) has been suggested to be effective for the treatment of similar syndromes such as chronic fatigue syndrome and fibromyalgia. A case series has suggested positive effects of HBOT in long COVID-19. This randomised, placebo-controlled clinical trial will explore HBOT as a potential treatment for long COVID-19. The primary objective is to evaluate if HBOT improves health-related quality of life (HRQoL) for patients with long COVID-19 compared with placebo/sham. The main secondary objective is to evaluate whether HBOT improves endothelial function, objective physical performance and short-term HRQoL.Methods and analysisA randomised, placebo-controlled, double-blind, phase II clinical trial in 80 previously healthy subjects debilitated due to long COVID-19, with low HRQoL. Clinical data, HRQoL questionnaires, blood samples, objective tests and activity metre data will be collected at baseline. Subjects will be randomised to a maximum of 10 treatments with hyperbaric oxygen or sham treatment over 6 weeks. Assessments for safety and efficacy will be performed at 6, 13, 26 and 52 weeks, with the primary endpoint (physical domains in RAND 36-Item Health Survey) and main secondary endpoints defined at 13 weeks after baseline. Data will be reviewed by an independent data safety monitoring board.Ethics and disseminationThe trial is approved by the Swedish National Institutional Review Board (2021–02634) and the Swedish Medical Products Agency (5.1-2020-36673). Positive, negative and inconclusive results will be published in peer-reviewed scientific journals with open access.Trial registration numberNCT04842448.
Trends in prevalence and incidence of registered dementia and trends in multimorbidity among patients with dementia in general practice in Flanders, Belgium, 2000–2021: a registry-based, retrospective, longitudinal cohort study
Authors: Beerten Simon Gabriël , Helsen Antje , De Lepeleire Jan , Waldorff Frans Boch , Vaes Bert 
Published: November 2022

ObjectivesWith the ageing of our population, it seems plausible that the prevalence of both dementia and multimorbidity will increase in the following decades. The aim of this study is to examine the trends in prevalence and incidence of registered dementia and trends in multimorbidity in patients with dementia in general practice in Flanders.DesignRetrospective, longitudinal cohort study.SettingPrimary care practices across Flanders, Belgium.ParticipantsPatients included in the Intego database.MethodsData were collected from the Intego database, a Belgian general practice registration network, from 1 January 2000 to 31 December 2021. Joinpoint regression, the Cochran-Armitage test and Jonckheere-Terpstra test were used for the trend analysis.ResultsData from 149 492 unique patients aged 65 years and older were available. From 2000 to 2021, 3835 incident cases of dementia were found. The age-adjusted prevalence of registered dementia significantly increased during this study period, from 1.19% to 2.43% (average annual percentage change (AAPC) 3.3; 95% CI 2.7 to 4.0). Incidence increased from 3.68 to 5.86 per 1000 patient years overall (AAPC 1.8, 95% CI −2.0 to 5.7), but declined in recent years (annual percentage change −8.1, 95% CI −14.8 to −0.8). Almost three-quarters of the patients with dementia (74.8%) suffered from multimorbidity (three or more comorbidities) and this increased significantly during the study period (p=0.0031). By 2021, 86.7% and 74.8% of the patients with dementia suffered from two or more or three or more chronic conditions, respectively. Hypertension (47.9%), osteoarthritis (29.7%) and lipid metabolism disorders (25.7%) were the most prevalent conditions.ConclusionsThe prevalence of registered dementia doubled over a 22-year time period, mirroring the increasing health burden by this disease globally. Furthermore, three-quarters of the patients with dementia suffered from multimorbidity, underlining the urgent need to implement comorbidity management and patient-centred care in dementia.
Does binge drinking mediate the relationship between four adverse childhood experiences and adult traumatic brain injury? Results from the National Longitudinal Survey of Youth 1979 Cohort
Authors: Daugherty Jill , Treves-Kagan Sarah , Gottfredson Nisha C , Miedema Stephanie , Haarbauer-Krupa Juliet 
Published: November 2022

ObjectiveAdverse childhood experiences (ACEs) are associated with increased risk of sustaining a traumatic brain injury (TBI). Alcohol use may play an important role in this relationship. This study examines whether binge drinking mediates the relationship between four ACEs and TBIs sustained in adulthood.MethodsUsing the National Longitudinal Survey of Youth, 1979 cohort, we conducted longitudinal mediation analyses (n=6317). Interviews occurred annually from 1979 to 1994 and biennially until 2016. We evaluated the direct and indirect effects of individual ACEs (ie, experiencing physical violence, low parental warmth, familial alcoholism and familial mental illness; reported retrospectively) and a cumulative ACEs score on mean level of binge drinking (calculated across waves) and having a TBI in adulthood. To establish temporality, we included binge drinking that was measured at age 18 or older and before any reported TBI.ResultsCumulative ACEs, familial alcoholism and physical abuse exposure were significantly associated with having a TBI through binge drinking, although this only explained a small part of the association between ACEs and TBI. Other ACEs were not significantly associated with binge drinking or TBI.ConclusionThe results indicate that while ACEs and adult TBI risk were significantly associated, lifetime binge drinking explains only a small part of the association. Future research could examine alternative social, biological and behavioural mechanisms along the pathway between ACEs and TBI. Determining this mechanism will allow public health practitioners to design and implement effective TBI prevention programmes for those at higher risk of injury due to ACE exposure.
Socioeconomic position over the life course and impaired lung function of older adults in Central and Eastern Europe: the HAPIEE study
Authors: Quispe-Haro Consuelo , Pająk Andrzej , Tamosiunas Abdonas , Capkova Nadezda , Bobak Martin , Pikhart Hynek 
Published: November 2022

BackgroundSocial differences in lung functioning have been reported, but the role of socioeconomic position (SEP) at different stages of life is less well understood, particularly in Central and Eastern Europe. This study addressed this question.MethodsThe analysis included 10 160 individuals aged 45–70 years from the Czech Republic, Poland and Lithuania. Lung function was either normal if values of forced expiratory volume in the first second divided by forced vital capacity (FEV1/FVC) and FVC were higher than the lower limit of normality or impaired if otherwise. SEP at three stages of life was assessed using maternal education (childhood), participant’s education (young adulthood), and current ability to pay for food, clothes and bills (late adulthood). SEP measures were dichotomised as advantaged versus disadvantaged. The associations between impaired lung function and life-course SEP were estimated by logistic regression.ResultsDisadvantaged SEP in young and late adulthood had higher odds of impaired lung function. In young adulthood, age-adjusted ORs were 1.26 (95% CI 1.06 to 1.49) in men and 1.56 (95% CI 1.29 to 1.88) in women, while in late adulthood, the ORs were 1.15 (95% CI 0.99 to 1.34) in men and 1.26 (95% CI 1.09 to 1.46) in women. Men and women disadvantaged at all three stages of life had ORs of 1.42 (95% CI 1.06 to 1.91) and 1.83 (95% CI 1.32 to 2.52), respectively, compared with those always advantaged. Smoking substantially attenuated the ORs in men but not in women.ConclusionReducing socioeconomic inequalities in young and late adulthood may contribute to reducing the risk of impaired lung function in late adulthood.
Investigating the association between income inequality in youth and deaths of despair in Canada: a population-based cohort study from 2006 to 2019
Authors: Benny Claire , Smith Brendan T , Hyshka Elaine , Senthilselvan Ambikaipakan , Veugelers Paul J , Pabayo Roman 
Published: November 2022

BackgroundDeaths due to suicide, drug overdose and alcohol-related liver disease, collectively known as ‘deaths of despair’, have been markedly increasing since the early 2000s and are especially prominent in young Canadians. Income inequality has been linked to this rise in deaths of despair; however, this association has not yet been examined in a Canadian context, nor at the individual level or in youth. The study objective was to examine the association between income inequality in youth and deaths of despair among youth over time.MethodsWe conducted a population-based longitudinal study of Canadians aged 20 years or younger using data from the Canadian Census Health and Environment Cohorts. Baseline data from the 2006 Canadian Census were linked to the Canadian Vital Statistics Database up to 2019. We employed multilevel survival analysis models to quantify the association between income inequality in youth and time-to deaths of despair.ResultsThe study sample included 1.5 million Canadians, representing 7.7 million Canadians between the ages of 0 and 19 at baseline. Results from the weighted, adjusted multilevel survival models demonstrated that income inequality was associated with an increased hazard of deaths of despair (adjusted HR (AHR) 1.35; 95% CI 1.04 to 1.75), drug overdose (AHR 2.38; 95% CI 1.63 to 3.48) and all-cause deaths (AHR 1.10; 95% CI 1.04 to 1.18). Income inequality was not significantly associated with suicide deaths (AHR 1.23, 95% CI 0.93 to 1.63).ConclusionThe results show that higher levels of income inequality in youth are associated with an increased hazard of all-cause death, deaths of despair and drug overdose in young Canadians. This study is the first to reveal the association between income inequality and deaths of despair in youth and does so using a population-based longitudinal cohort involving multilevel data. The results of this study can inform policies related to income inequality and deaths of despair in Canada.
Virtual clinical trials of anti-PD-1 and anti-CTLA-4 immunotherapy in advanced hepatocellular carcinoma using a quantitative systems pharmacology model
Authors: Sové Richard J , Verma Babita K , Wang Hanwen , Ho Won Jin , Yarchoan Mark , Popel Aleksander S 
Published: November 2022

BackgroundHepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is the third-leading cause of cancer-related death worldwide. Most patients with HCC are diagnosed at an advanced stage, and the median survival for patients with advanced HCC treated with modern systemic therapy is less than 2 years. This leaves the advanced stage patients with limited treatment options. Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) or its ligand, are widely used in the treatment of HCC and are associated with durable responses in a subset of patients. ICIs targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) also have clinical activity in HCC. Combination therapy of nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4) is the first treatment option for HCC to be approved by Food and Drug Administration that targets more than one immune checkpoints.MethodsIn this study, we used the framework of quantitative systems pharmacology (QSP) to perform a virtual clinical trial for nivolumab and ipilimumab in HCC patients. Our model incorporates detailed biological mechanisms of interactions of immune cells and cancer cells leading to antitumor response. To conduct virtual clinical trial, we generate virtual patient from a cohort of 5,000 proposed patients by extending recent algorithms from literature. The model was calibrated using the data of the clinical trial CheckMate 040 (ClinicalTrials.gov number,NCT01658878).ResultsRetrospective analyses were performed for different immune checkpoint therapies as performed in CheckMate 040. Using machine learning approach, we predict the importance of potential biomarkers for immune blockade therapies.ConclusionsThis is the first QSP model for HCC with ICIs and the predictions are consistent with clinically observed outcomes. This study demonstrates that using a mechanistic understanding of the underlying pathophysiology, QSP models can facilitate patient selection and design clinical trials with improved success.
Evaluation of the Disease Activity index for PSoriatic Arthritis (DAPSA) with a quick quantitative C reactive protein assay (Q-DAPSA) in patients with psoriatic arthritis: a prospective multicentre cross-sectional study
Authors: Proft Fabian , Schally Julia , Brandt Henning Christian , Brandt-Juergens Jan , Burmester Gerd Rüdiger , Haibel Hildrun , Käding Henriette , Karberg Kirsten , Lüders Susanne , Muche Burkhard , Protopopov Mikhail , Rademacher Judith , Rios Rodriguez Valeria , Torgutalp Murat , Verba Maryna , Zinke Silke , Poddubnyy Denis 
Published: November 2022

ObjectivesThis study aimed to evaluate the Disease Activity index for PSoriatic Arthritis (DAPSA) based on a quick quantitative C reactive protein (qCRP) assay (Q-DAPSA) in a multicentre, prospective, cross-sectional study in patients with psoriatic arthritis (PsA).MethodsThe assessment of prospectively recruited study patients included joint examination and patient reported outcome (PRO) measures (patient global assessment, patient pain assessment). Following, the DAPSA based on a routine laboratory CRP measurement, Q-DAPSA and clinical DAPSA (cDAPSA) were calculated. Cross-tabulations and weighted Cohen’s kappa were performed to analyse the agreement of disease activity categories. Bland-Altman plots and intraclass correlation coefficients were used to determine the agreement of numerical values regarding CRP and qCRP as well as different disease activity scores.ResultsAltogether, 104 patients with PsA could be included in the statistical analysis. With Q-DAPSA, 102 of 104 (98.1%) patients achieved identical disease activity categories in comparison to DAPSA with a weighted Cohen’s kappa of 0.980 (95% CI: 0.952 to 1.000). The agreement between DAPSA and cDAPSA was slightly lower with identical disease activity categories seen in 97 of 104 (93.3%) of patients and with a weighted Cohen’s kappa of 0.932 (95% CI 0.885 to 0.980).ConclusionsThe Q-DAPSA showed an almost perfect agreement with the conventional DAPSA regarding identical disease activity categories. Thus, the Q-DAPSA can be used as a timely available disease activity score in patients with PsA with the additional benefit of CRP involvement. Consequently, the Q-DAPSA could facilitate the implementation of the treat-to-target concept in clinical routine and clinical trials.
Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases
Authors: Fragoulis George E , Dey Mrinalini , Zhao Sizheng , Schoones Jan , Courvoisier Delphine , Galloway James , Hyrich Kimme L , Nikiphorou Elena 
Published: November 2022

ObjectiveTo conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD).MethodsSLR (inception-12/2021) based on the following search domains: (1) infectious agents, (2) AIIRD, (3) immunosuppressives/immunomodulators used in rheumatology, (4) screening terms and (5) prophylaxis terms. Articles were retrieved having the terms from (1) AND (2) AND (3) plus terms from (4) OR(5). Databases searched: PubMed, Embase and Cochrane Library. Exclusion criteria: studies on postoperative infections, paediatric AIIRD, COVID-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs.ResultsFrom 5641 studies were retrieved, 568 full-text articles were assessed for eligibility, with 194 articles finally included. For tuberculosis, tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. For hepatitis B virus (HBV): risk of reactivation is increased in patients positive for hepatitis B surface antigen. Anti-HBcore positive patients are at low risk for reactivation but should be monitored periodically with liver function tests and/or HBV-viral load. Risk for Hepatitis C reactivation is existing but low in patients treated with biological DMARDs. ForPneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15–30 mg/day for >2–4 weeks.ConclusionsDifferent screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
Some Bianchi Type Viscous Holographic Dark Energy Cosmological Models in the Brans–Dicke Theory
Authors: Santhi M. Vijaya , Chinnappalanaidu T. , Madhu S. Srivani , Gusu Daba Meshesha 
Published: November 2022

In this article, we analyze Bianchi type–II, VIII, and IX spatially homogeneous and anisotropic space-times in the background of the Brans–Dicke theory of gravity within the framework of viscous holographic dark energy. To solve the field equations, we have used the relation between the metric potentials as

R
=

S

n

and the relation between the scalar field

ϕ

and the scale factor

a

as

ϕ
=

a

m

. Also, we have discussed some of the dynamical parameters of the obtained models, such as the deceleration parameter

q

, the jerk parameter

j

, the EoS parameter

ω

v
h
d
e

, the density parameter

Ω

vhde

, Om-diagnostic, squared speed of sound

v
s
2

, EoS plane

ω

v
h
d
e

−

ω

v
h
d
e

′

, and statefinder plane

r

−

s

through graphical representation, which are significant in the discussion of cosmology. Furthermore, all the models obtained and graphically presented shown an expanding and accelerating Universe, which is in better agreement with the latest experimental data. The viscous holographic dark energy models are compatible with explaining the present cosmic accelerated expansion.