bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived implications of COVID-19 policy measures on food insecurity among urban residents in Blantyre Malawi
Authors: Dzimbiri Mastano N. , Mwanjawala Patrick , Chilanga Emmanuel , Munthali George N. Chidimbah 
Published: March 2022

Abstract
Background
Malawi is at the brink of experiencing food insecurity amidst the COVID-19 pandemic as the vast majority of its population lives in extreme poverty. While measures are being implemented to avert the spread of COVID-19, little is known about how COVID-19 policy measures have impacted food insecurity in urban Malawi. This study addresses this gap by exploring the implications of COVID-19 policy measures on food insecurity in low-income areas of Blantyre in Malawi.

Methods
We used Bronfenbrenner's ecological theory to explore the implications of COVID-19 policy measures on peoples’ access to food. In-depth interviews were conducted with fifteen participants comprising of private school teachers, street vendors, sex workers, and minibus drivers. Data were analyzed using thematic analysis in which emerging patterns and themes from the transcripts were identified.

Results
The COVID-19 lockdown measures undermined participants’ ability to maintain livelihoods. These measures have increased the vulnerability of the residents to food insecurity, forcing them to face severe challenges to accessing adequate food to support their families as a result of low incomes, job loss, and business disruptions.

Conclusion
Our study underscores the need for the Malawi government to seriously consider the provision of basic necessities such as food to the urban poor. We also suggest that the Malawi government should continue and expand the social cash transfer or relief funding packages by targeting the most vulnerable groups in the city. There is also a need for the government to engage all stakeholders and work collaboratively with people at local level in policymaking decisions in times of crisis.
Production loss and sick leave caused by antibiotic resistance: a register-based cohort study
Authors: Larsson Sofie , Svensson Mikael , Ternhag Anders 
Published: March 2022

AbstractBackgroundAdverse economic consequences of antibiotic resistance, both in health care systems and in society at large, have been estimated to emerge and significantly affect the global economy. To date, most studies of the societal costs of antibiotic resistance have had a macroeconomic perspective, using the number of attributable deaths as a quantifier for production loss. In contrast, there have been few studies of the consequences of antibiotic resistance in terms of the length of sick leave and hence the impact of morbidity on production loss. The aim of our study was to estimate the production loss from ill health caused by antibiotic resistance.MethodTo estimate additional production loss due to antibiotic resistance, we used Swedish register-based cohort data to determine days of long-term sick leave (LTSL) for episodes of infection caused by resistant and susceptible bacteria respectively. We collected patient data for four common infection types (bloodstream infection, urinary tract infection, skin and soft tissue infection, and pneumonia), as well as, antibiotic susceptibility test data, and total days of LTSL. We used a two-part model to estimate the number of LTSL days attributable to resistance, and controlled for comorbidities and demographic variables such as age and gender.ResultsThe results show that antibiotic resistance adds an additional 8.19 days of LTSL compared with a similar infection caused by susceptible bacteria, independent of infection type and resistance type. Furthermore, the results suggest that production loss due to temporary sick leave caused by antibiotic resistance in a working-age population amounts to about 7% of total health care costs attributable to antibiotic resistance in Sweden.ConclusionEstimating the effect of antibiotic resistance in terms of temporary production loss is important to gain a better understanding of the economic consequences of antibiotic resistance in society and, by extension, enable more effective resource allocation to combat further emergence of resistance. Society’s economic costs of antibiotic resistance are, however, probably much greater than those of sick leave due to disease alone.
Association of secondhand smoke exposure with cardiometabolic health in never-smoking adult cancer survivors: a population-based cross-sectional study
Authors: Kim Kyuwoong , Chang Yoonjung 
Published: March 2022

Abstract
Background
Little is known about the association of secondhand smoke (SHS) exposure with cardiometabolic health in adult cancer survivors, especially those who have never smoked. This study aimed to investigate the association of SHS exposure and cardiometabolic health in never-smoking adult cancer survivors.

Methods
Cross-sectional data of 830 adult cancer survivors aged more than 19 years who were never-smokers were identified from the Korea National Health and Nutrition Survey (KNHANES) 2013–2018, a nationally representative sample of the noninstitutionalized Korean population. SHS exposure was defined from self-reported survey and cardiometabolic outcomes (hypertension, general and abdominal obesity, hyperlipidemia, hypertriglyceridemia, reduced high-density lipoprotein, and impaired fasting glucose) were determined according to relevant criteria and data from the KNHANES. We used multiple logistic regression to compute odds ratio (OR) and 95% confidence intervals (95% CI) comparing those with and without SHS exposure for each outcome adjusted for potential confounders.

Results
Compared with the never-smoking adult cancer survivors without SHS exposure, those with SHS exposure had significantly higher odds for hypertriglyceridemia (OR = 1.63; 95% CI: 1.07–2.48). However, the other outcomes showed nonsignificant associations with SHS exposure (hypertension [OR = 1.33; 95% CI: 0.90–1.96]. general obesity [OR = 1.47; 95% CI: 1.47: 0.97–2.22], abdominal obesity [OR = 1.20; 95% CI: 0.82–1.75], hyperlipidemia [OR = 1.03; 95% CI: 0.68–1.55], reduced HDL-cholesterol [OR = 1.01; 95% CI: 0.70–1.45], and impaired fasting glucose [OR = 1.07; 95% CI: 0.72–1.58].

Conclusion
This cross-sectional study suggests the association of SHS exposure with hypertriglyceridemia and provides evidence for marginal associations with other cardiometabolic risk factors in never-smoking adult cancer survivors. More studies are needed to develop evidence-based public health policies to minimize SHS exposure in adult cancer survivors.
Obesity is negatively associated with dental caries among children and adolescents in Huizhou: a cross-sectional study
Authors: Shi Rou , Lin Chunwen , Li Shu , Deng Linling , Lin Zhan , Xiu Liangchang 
Published: March 2022

Abstract
Background
Obesity and dental caries among children and adolescents are growing worldwide public health problems. They share some common and modifiable influences. The objective of this study was to evaluate the prevalence of obesity and dental caries among children and adolescents in Huizhou and explore the association between Body Mass Index (BMI) category and dental caries.

Methods
This cross-sectional study enrolled 105,181 students (55,500 males and 49,681 females) from 87 schools in Huizhou. Height and weight were measured, and BMI was calculated. Based on Chinese BMI standards, students were classified into underweight, normal weight, overweight, and obesity groups. Dental caries was diagnosed according to criteria recommended by World Health Organization (WHO). We used the Chi-square test to compare proportions of groups and performed Association Rules Mining to identify patterns and combinations of BMI categories and dental caries. Finally, a multilevel logistic regression model was applied to analyze the association between BMI category and dental caries when confounders were considered.

Results
The prevalence of underweight, overweight, and obesity among children and adolescents was 7.56%, 8.85%, and 2.95%, respectively. The overall prevalence of dental caries was 58.10%, with a lower prevalence among boys than girls. Students from primary schools and remote towns more easily suffer from dental caries. Caries prevalence of students belonged to underweight, normal, overweight, and obesity was 65.6%, 58.8%, 49.6%, and 46.1% individually. With increasing BMI levels, the prevalence of dental caries decreased. Further, this trend still exists in each subgroup of gender, educational stage, school type, and area. Association rules indicate underweight has a positive effect on the occurrence of dental caries, while overweight or obesity has a negative impact on the occurrence of dental caries. The three-level logistic regression model results show that BMI category is inversely associated with dental caries after adjusting confounders.

Conclusion
Obesity is negatively associated with dental caries among children and adolescents in Huizhou. Further research is required to investigate how dietary habits, oral hygiene habits, and parental socioeconomic status mediate the association between BMI and dental caries.
Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic
Authors: Yusefi Ali Reza , Barfar Eshagh , Daneshi Salman , Bayati Mohsen , Mehralian Gholamhossein , Bastani Peivand 
Published: March 2022

AbstractBackgroundOne of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020.MethodsThis descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods.ResultsThe mean scores of the participants’ "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P < 0.001, r = 0.471). Furthermore, all health literacy dimensions of comprehension (P < 0.001), accessibility (P < 0.001), reading skills (P < 0.001), evaluation (P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r =  − 0.327,P = 0.007), level of education (F = 3.119,P = 0.002), and place of residence (t = 2.416,P = 0.004) and between health-promoting behaviors with level of education (F = 3.341,P = 0.001) and marital status (F = 2.868,P = 0.02).ConclusionAccording to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.
Primary ovarian carcinoid arising in associated mature cystic teratoma
Authors: Zhang Wanyu , Chen Qiongrong 
Published: March 2022

Abstract
Background
Primary ovarian carcinoid is a very rare ovarian low-grade neuroendocrine tumor, accounting for about 0.1% of all ovarian neoplasms.

Case presentation
We reported a case of primary ovarian carcinoid arising from a mature cystic teratoma in a 50-year-old woman. Intraoperative frozen section of left ovarian mass was assessed and a malignant epithelial tumor was considered. Morphologically, the main tumor was composed of cells forming trabeculae, and mature cystic teratoma was observed adjacent to the main part. Immunohistochemistry revealed that the trabecular cells were diffuse positive for pan Cytokeratin, CD56 and synaptophysin with low Ki-67 index (about 1%).

Conclusions
Careful morphological observation combined with appropriate accessory examination are essential for the diagnosis of primary ovarian carcinoid arising from mature cystic teratoma. In addition, the classification criteria of the primary ovarian neuroendocrine tumor are discussed.
Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective
Authors: Ladha Feria A. , Pettinato Anthony M. , Perrin Adam E. 
Published: March 2022

Abstract
Background
A high proportion of medical school graduates pursue specialties different from those declared at matriculation. While these choices influence the career paths, satisfaction, and potential regret students will experience, they also impact the supply and demand ratio of the shorthanded physician workforce across many specialties. In this study, we investigate how the choice of medical specialty and the factors motivating those choices change between the beginning and end of medical school training.

Methods
A questionnaire was administered annually from 2017 to 2020 to a cohort of medical students at the University of Connecticut to determine longitudinal preferences regarding residency choice, motivational factors influencing residency choice, future career path, and demographic information.

Results
The questionnaire respondent totals were as follows: n = 76 (Year 1), n = 54 (Year 2), n = 31 (Year 3), and n = 65 (Year 4). Amongst newly matriculated students, 25.0% were interested in primary care, which increased ~ 1.4-fold to 35.4% in the final year of medical school. In contrast, 38.2% of matriculated students expressed interest in surgical specialties, which decreased ~ 2.5-fold to 15.4% in the final year. Specialty choices in the final year that exhibited the largest absolute change from matriculation were orthopedic surgery (− 9.9%), family medicine (+ 8.1%), radiology (+ 7.9%), general surgery (− 7.2%), and anesthesiology (+ 6.2%). Newly matriculated students interested in primary care demonstrated no differences in their ranking of motivational factors compared to students interested in surgery, but many of these factors significantly deviated between the two career paths in the final year. Specifically, students interested in surgical specialties were more motivated by the rewards of salary and prestige compared to primary care students, who more highly ranked match confidence and family/location factors.

Conclusions
We identified how residency choices change from the beginning to the end of medical school, how certain motivational factors change with time, how these results diverge between primary care and surgery specialty choice, and propose a new theory based on risk-reward balance regarding residency choice. Our study promotes awareness of student preferences and may help guide school curricula in developing more student-tailored training approaches. This could foster positive long-term changes regarding career satisfaction and the physician workforce.
HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study
Authors: Langi Gaby G. , Rahadi Arie , Praptoraharjo Ignatius , Ahmad Riris A. 
Published: March 2022

Abstract
Background
Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of HIV-related SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia.

Methods
We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one district hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression to identify the correlates of these SAD indicators.

Results
The prevalence of SAD among HCWs was similarly high between hospital and PHC HCWs for fear of HIV transmission (~71%) and perceived negative image of PHIV (~75%). Hospital HCWs exhibited somewhat lower avoidance of service duties (52.6% vs. 63.7%; p = 0.088) with weak evidence of a difference and significantly higher levels of discriminatory practice (96.1% vs. 85.6%; p = 0.009) than those working in PHCs. Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p<0.021). However, the odds of avoiding care duties increased with receipt of training (p =0.003) and decreased for hospital HCWs (p = 0.030). HIV knowledge lowered the odds of discriminatory practice (p = 0.002), but hospital facility and nurse/midwife cadres were associated with increased odds of discriminatory practices (p<0.021). No significant correlate was found for perceived negative image of PLHIV.

Conclusion
HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.
A new lineage of non-photosynthetic green algae with extreme organellar genomes
Authors: Pánek Tomáš , Barcytė Dovilė , Treitli Sebastian C. , Záhonová Kristína , Sokol Martin , Ševčíková Tereza , Zadrobílková Eliška , Jaške Karin , Yubuki Naoji , Čepička Ivan , Eliáš Marek 
Published: March 2022

Abstract
Background
The plastid genomes of the green algal order Chlamydomonadales tend to expand their non-coding regions, but this phenomenon is poorly understood. Here we shed new light on organellar genome evolution in Chlamydomonadales by studying a previously unknown non-photosynthetic lineage. We established cultures of two new Polytoma-like flagellates, defined their basic characteristics and phylogenetic position, and obtained complete organellar genome sequences and a transcriptome assembly for one of them.

Results
We discovered a novel deeply diverged chlamydomonadalean lineage that has no close photosynthetic relatives and represents an independent case of photosynthesis loss. To accommodate these organisms, we establish the new genus Leontynka, with two species (L. pallida and L. elongata) distinguishable through both their morphological and molecular characteristics. Notable features of the colourless plastid of L. pallida deduced from the plastid genome (plastome) sequence and transcriptome assembly include the retention of ATP synthase, thylakoid-associated proteins, the carotenoid biosynthesis pathway, and a plastoquinone-based electron transport chain, the latter two modules having an obvious functional link to the eyespot present in Leontynka. Most strikingly, the ~362 kbp plastome of L. pallida is by far the largest among the non-photosynthetic eukaryotes investigated to date due to an extreme proliferation of sequence repeats. These repeats are also present in coding sequences, with one repeat type found in the exons of 11 out of 34 protein-coding genes, with up to 36 copies per gene, thus affecting the encoded proteins. The mitochondrial genome of L. pallida is likewise exceptionally large, with its >104 kbp surpassed only by the mitogenome of Haematococcus lacustris among all members of Chlamydomonadales hitherto studied. It is also bloated with repeats, though entirely different from those in the L. pallida plastome, which contrasts with the situation in H. lacustris where both the organellar genomes have accumulated related repeats. Furthermore, the L. pallida mitogenome exhibits an extremely high GC content in both coding and non-coding regions and, strikingly, a high number of predicted G-quadruplexes.

Conclusions
With its unprecedented combination of plastid and mitochondrial genome characteristics, Leontynka pushes the frontiers of organellar genome diversity and is an interesting model for studying organellar genome evolution.
Impact of a delayed second dose of mRNA vaccine (BNT162b2) and inactivated SARS-CoV-2 vaccine (CoronaVac) on risks of all-cause mortality, emergency department visit, and unscheduled hospitalization
Authors: Wong Carlos King Ho , Xiong Xi , Lau Kristy Tsz Kwan , Chui Celine Sze Ling , Lai Francisco Tsz Tsun , Li Xue , Chan Esther Wai Yin , Wan Eric Yuk Fai , Au Ivan Chi Ho , Cowling Benjamin John , Lee Cheuk Kwong , Wong Ian Chi Kei 
Published: March 2022

Abstract
Background
Safety after the second dose of the SARS-CoV-2 vaccine remains to be elucidated, especially among individuals reporting adverse events after their first dose. This study aims to evaluate the impact of a delayed second dose on all-cause mortality and emergency services.

Methods
A territory-wide, retrospective cohort of people who had completed two doses of mRNA (BNT162b2) or inactivated SARS-CoV-2 (CoronaVac) vaccine between February 23 and July 3, 2021, in Hong Kong was analyzed, with linkage to electronic health records retrieved from the Hong Kong Hospital Authority. Vaccine recipients were classified as receiving a second dose within recommended intervals (21–28 days for BNT162b2; 14–28 days for CoronaVac) or delayed. Study outcomes were all-cause mortality, emergency department (ED) visits, and unscheduled hospitalizations within 28 days after the second dose of vaccination.

Results
Among 417,497 BNT162b2 and 354,283 CoronaVac second dose recipients, 3.8% and 28.5% received the second dose beyond the recommended intervals (mean 34.4 and 31.8 days), respectively. During the study period, there were < 5 daily new cases of COVID-19 infections in the community. Delaying the second dose was not associated with all-cause mortality (hazard ratio [HR] = 1.185, 95% CI 0.478–2.937, P = 0.714), risk of ED visit (HR = 0.966, 95% CI 0.926–1.008, P = 0.113), and risk of unscheduled hospitalization (HR = 0.956, 95% CI 0.878–1.040, P = 0.294) compared to that within the recommended interval for CoronaVac recipients. No statistically significant differences in all-cause mortality (HR = 4.438, 95% CI 0.951–20.701, P = 0.058), ED visit (HR = 1.037, 95% CI 0.951–1.130, P = 0.411), and unscheduled hospitalization (HR = 1.054, 95% CI 0.867–1.281, P = 0.597) were identified between people who received a second dose of BNT162b2 within and beyond the recommended intervals.

Conclusions
No significant association between delayed second dose of BNT162b2 or CoronaVac and all-cause mortality, ED visit, and unscheduled hospitalization was observed in the present cohort. Regardless of the recommended or delayed schedule for SARS-CoV-2 vaccination, a second dose of both vaccines should be administered to obtain better protection against infection and serious disease. The second dose should be administered within the recommended interval following the manufacturer’s product information, until further studies support the benefits of delaying vaccination outweighing the risks.