bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnant Women’s Knowledge About Alcohol Consumption During Pregnancy and its Consequences: An Israeli Survey
Authors: Hen-Herbst Liat , Senecky Yehuda , Tenenbaum Ariel , Berger Andrea
Published: November 2020

Background. Alcohol consumption can negatively affect fetal development, resulting in a range of mental and physical disabilities clinically termed fetal alcohol spectrum disorders (FASD). Despite suspected rates of maternal drinking during pregnancy, the documented number of children diagnosed with FASD in Israel is extremely low. The aim of this study was to investigate alcohol-consumption behavior and knowledge about the consequences of such consumption among pregnant Israeli women.Methods. A sample of 802 pregnant women completed an anonymous online survey related to their backgrounds, recommendations and education on alcohol consumption during pregnancy, general knowledge regarding the consequences of alcohol consumption during pregnancy and FASD, and alcohol they consumed (frequency and amount) 2 mo prior to conception and during pregnancy. Descriptive statistics included means, standard deviations, ranges, and frequencies. Associations between demographic characteristics and alcohol consumption were assessed using chi-square tests, independent sample t tests, one-way analyses of variances, and Spearman correlations. Results. Of the 802 women sampled, 539 (67.2%) reported drinking alcohol in the 2 mo prior to learning they were pregnant, 96 (12%) reported drinking alcohol during their current pregnancy, and 28.1% reported knowing other women who had consumed alcohol during pregnancy. Higher alcohol consumption rates before pregnancy were found among women in their first pregnancies, women with advance education, Jews, and secular women. About 40% of the sample reported they had not received any education about the dangers of consuming alcohol during pregnancy.Conclusions. A high percentage of pregnant women in Israel drank alcohol close to conception and during pregnancy. Although most of the woman ceased drinking after realizing they were pregnant, a still-worrying percentage continued consuming alcohol and had low knowledge and awareness of the plausible dangers of this behavior. Formal dissemination of information on this topic by healthcare professionals treating pregnant woman did not reach many of them. The results emphasize an urgent need for better education of both professionals and the lay public to increase awareness of the consequences of consuming alcohol during pregnancy.
The Relationship Between Hypertriglyceridemic Waist Circumference Phenotype and Gestational Diabetes Mellitus
Authors: Jia Xiao-jiao , Wang Jia-xin , Bai Li-wei , Hua Tian-shu , Han Zhong-hou , Lu Qiang
Published: November 2020

Background: To investigate the correlation between hypertriglyceridemic waist circumference (HTWC) phenotype and gestational diabetes mellitus (GDM).Methods: A total of 1083 patients with gestational age ≤8 weeks were divided into four groups: normal triglyceride and waist circumference group (group A, n=575), simple abdominal obesity group (group B, n=317), simple high triglyceride group (group C, n=125), and HTWC group (group D, n=66). General information and serum biochemical indicators were measured and recorded. Analysis of variance (ANOVA) and logistic regression analysis were used to evaluate the relationship between HTWC with GDM.Results: The prevalence of GDM in the HTWC group was significantly greater than in the other three groups. After adjustment by multivariate logistic regression analysis, the proportion of GDM in the HTWC group was 1.753 times higher than in group A.Conclusion: These findings suggest that there is a significant correlation between HTWC phenotype and GDM, indicating that the HTWC phenotype could be applied as a simple marker for identifying GDM risk factors.
Self-medication practice, its causes and risk factors among people in Tehran, Iran: A descriptive-analytic study
Authors: Onsori Pariya , Esmaeli Faezeh , Abachi Saba , Miremami Mohammad Mahdi , Farahani Amir Mahdi , Nouroozi Pedram , Kazemi Ali , Varpaei Hesam Aldin
Published: November 2020

Background: Self-medication practice unfortunately, is a current issue in different countries. Patterns of self-medication vary among different populations and are influenced by different characteristics. So, this study was aimed at the prevalence of self-medication practice in Tehran. Methods: This descriptive-analytic study was performed from Oct 2019 to March 2020 by a researcher-designed questionnaire among people. The main determinants of the questionnaire included personal information, diet pattern, physical activity, smoking, alcohol consumption, and self-medication habits. Chi-square and Tukey's post hoc tests were used for statistical analysis of data.Results: Eight hundred people participated in this study. The rate of self-medication was 78% among men and 88% among women. 35.75% of the participants had a chronic illness, and 90% of them had a history of self-medication. A significant correlation between gender and self-medication (P = 0.45, r = 0.55), also significant correlation between exercise and self-medication (P = 0.206, r = 0.75), alcohol consumption and self-medication (P= 0.37, r = 0.19) were not seen. Discussion and Conclusion: Education and income levels, chronic diseases, history of drug allergies, smoking, and fast-food consumption seem to create self-medication behavior. Having an old doctor's prescription, saving time, as well as advising family members, were the most important reasons for self-medication. The most commonly used medications were analgesics, common cold medicines, and gastrointestinal drugs. Self-medication was mostly used to treat headaches, migraines, and common cold symptoms such as cough and muscle pain.
Understanding mobile application development and implementation to monitor Posyandu data in Indonesia: a 3-year hybrid action research to build “a bridge” from the community to the national scale
Authors: Rinawan Fedri Ruluwedrata , Susanti Ari Indra , Amelia Indah , Ardisasmita Mulya Nurmansyah , - Widarti , Dewi Rima Kusumah , Ferdian Dani , Purnama Wanda Gusdya , Purbasari Ayi
Published: November 2020

Background. There is a small number of facts available to better understand how mobile health application technology on mother and child health (MCH) is developed. This study is aimed: (a) to explore the process of developing the mobile app in MCH community-based services in the Indonesian setting/ Posyandu ( Pos Pelayanan Terpadu ), (b) to perform feasibility assessment among the community health workers (CHWs), and (c) to see the scalability of the mobile app to the national level in Indonesia. Methods. A hybrid method in which the action research principles and the mixed method, which comprise qualitative and quantitative methods, were synergistically combined for the end-users. The study was conducted in Pasawahan sub-district, Purwakarta, Indonesia from 2017 to 2019. Content analysis, coding, and categorizing were carried out using NVivo 12 Pro for the transcribed data. Wilcoxon Test (2018 and 2019) was conducted using STATA 15 Special Edition. Results. (1) The use of a CHW notebook for data entry in the Posyandu information system book delayed the data reporting process, resulting in the need to develop a mobile app; (2) There are significant differences in CHWs’ knowledge ( p =0.000) and skills ( p =0.0097) on training (2018) and Posyandu phases (2019); (3) There have been 964 Posyandu registered to the Posyandu mobile app from almost all provinces in Indonesia. Conclusions. The 3-year hybrid approach suggests the crucial phases to develop a mobile app in a more user-friendly manner to substitute the use of CHWs’ old-fashion book use, hence its implementation is promising for national use.
“Side effects--part of the package”: A mixed methods approach to study adverse events among patients being programmatically treated for DR-TB in Gujarat, India
Authors: Jakasania Arjunkumar Hardas , shringarpure Kalpita , Kapadia Dixit , Sharma Radhika , Mehta Kedar , Prajapati Arpit , Soundappan Kathirvel
Published: November 2020

Background High rates of Adverse Events (AEs) during treatment is one of the leading causes of unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB). However, information related to AEs is not systematically collected and managed under programmatic setting. The present study assessed the a) incidence and pattern of adverse events in first three months of DR-TB treatment initiation; b) treatment seeking behaviour for AE management; and c) explore the challenges in seeking treatment and reporting AEs.Methods This mixed methods study included all patients diagnosed and initiated on treatment under RNTCP during July-September 2018 at Ahmedabad DR-TB centre. The patients were interviewed telephonically and assessed for all AEs experienced by them. In-depth interviews and key-informant interviews were conducted among patients, DOTS supervisors and programme staffs (treatment supervisors, medical officer and district program manager). Results Total 207 AEs were reported by the 74 DR-TB patients. All patients experienced at least one AE during initial treatment period. Incidence rate of AEs (experienced) was 3.11 (1st month-4.6, 2nd month-2.7, 3rd month-2.02) per 100 person days. Of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and sub-themes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, and past treatment experience; 2) Health system related- lack of guidelines and training for AE management, 3) Poor coordination between hospital and tuberculosis centre. Conclusion The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient and orientation of the health systems are the need of the hour. An efficient real-time reporting and management of AE should be developed and tested for effective DR-TB control.
A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa
Authors: Brijkumar Jaysingh , Johnson Brent , Zhao Yuan , Edwards Alex , Moodley Pravi , Pathan Khairoonisa , Pillay Selvan , Castro Kenneth , Sunpath Henry , Kuritzkes Dan , Moosa Yunus , Marconi Vincent
Published: November 2020

Background: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. Methods: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.Results: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p<0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p<0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.Conclusions: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi
Authors: Sakala Doreen , Kumwenda Moses K. , Conserve Donaldson F. , Ebenso Bassey , Choko Augustine Talumba
Published: November 2020

Background: Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods: Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results: The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion: Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.
Determinants of Anxiety and Depression in Patients with Cubital Tunnel Syndrome
Authors: jia siming , Shi Xiaoying , Liu Guanglian , Wang Li , Zhang Xiaoran , Ma Xuelin , li jia , shao xinzhong
Published: November 2020

Background:: The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features.Methods: From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. Results: The proportions of depression and anxiety were 17.8% (n=44) and 14.2% (n=35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. Conclusions: In patients with CuTS, the proportions of depression and anxiety were 18% and 14%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.
Efficacy of prophylactic methylprednisolone on reducing the risk of post-extubation stridor in patients after an emergency intubation: study protocol for a randomized controlled trial
Authors: Wang Jingyi , Walline Joseph Harold , Yin Lu , Dai Yili , Dai Jiayuan , Zhu Huadong , Yu Xuezhong , Xu Jun
Published: November 2020

Background: Post-extubation stridor (PES) is one of the most common complications of invasive respiratory support, with severe cases leading to possible extubation failure (reintubation within 48 hours) and increased mortality. Previous studies confirmed that prophylactic corticosteroids play an important role in reducing the risk of PES and extubation failure. However, few studies have looked at the efficacy of corticosteroids on preventing PES in patients after an emergency intubation.Aim: To evaluate whether a single dose of methylprednisolone given over a set timeframe before extubation is effective in preventing PES in patients after an emergency intubation.Methods: A multicenter, randomized, placebo-controlled trial will be performed in an emergency department (ED) setting. The trial will include 132 patients who fail a cuff-leak test (CLT) prior to the intervention. Patients will be randomly assigned to either intravenous methylprednisolone (40mg) or placebo four hours prior to extubation. Other eligible patients who pass the CLT will be included in a non-intervention (observation) group. The primary endpoint is the incidence of PES within 48 hours after extubation. Secondary endpoints include oxygen therapy, respiratory support requirements, reintubation secondary to PES, adverse effects within 48 hours after extubation, hospital length of stay and hospital mortality.Discussion: Patients who are intubated on an emergency basis have a higher risk of intubation-related complications. Previous studies have examined treatment regimens involving more than 10 different variations on corticosteroid treatments for PES prevention, while for ED therapy only a simple and effective treatment would be appropriate. Corticosteroid administration is usually accompanied by adverse effects, thus this study will be important for further risk stratification among intubated ED patients. Trial registration: Chictr.org.cn, ChiCTR2000030349. Registered on 29 Feb 2020.
The accuracy and safety of CT-guided iodine-125 seeds implantation assisted by 3D non-coplanar template for retroperitoneal recurrent carcinoma.
Authors: Jiang Weijuan , Jiang Ping , Wei Shuhua , Jiang Yuliang , Ji Zhe , Sun Haitao , Fan Jinghong , Li Weiyan , Shao Yuxia , Wang Junjie
Published: November 2020

Purpose: To investigate the accuracy, dosimetric parameters and safety of 3D-printing non co-planar template (3D-PNCT) assisted CT-guidance for radioactive iodine-125 (125I) seed implantation brachytherapy (RSI-BT) for retroperitoneal recurrent carcinomas.Methods and materials: We enrolled 15 patients with 17 retroperitoneal recurrent carcinomas after external beam radiotherapy (EBRT). All patients received CT-guided 125I RSI-BT assisted by 3D-PNCT successfully. We compared the original needles insertion position, angular and the needle tips distance deviations of preoperative plan with that of intra-operative in brachytherapy treatment-planning system (B-TPS). The dosimetric parameters of RSI-BT were evaluated on preoperative plan, intra-operative real-time plan and postoperative plan, including D90, D100 (the dose to 90% and 100% of the target volume), V100, V150 and V200 (the volume receives 100%, 150% and 200% of the prescribed doses). The quality assurance of RSI-BT evaluated on conformal index (CI), external index (EI), homogeneity index (HI) of the targets were compared among preoperative plan, intra-operative real-time plan and postoperative plan. The peri-operation complications and RSI-BT related toxicity were assessed.Results: The median follow-up was 8.2 months (range 1-18.5months). One patient lost follow-up after RSI-BT. 14 patients were assessed for response rate and toxicity. The mean entrance point distance deviation for all 165 needles was 4.50 ± 4.10 mm (range, 0-30). The mean angular deviation was 2.70 ± 3.00 degrees (range, 0-20). The needles tip distances deviation was 6.90 ± 6.00 mm (range, -30-28). D90 for preoperative plan, intra-operative plan and postoperative plan were 140.55 ± 23.93, 124.25 ± 28.04,128.98 ± 22.75. There was significant difference between D90 of preoperative plan with that of intraoperative plan (p=0.036). Four lesions reached CR, six lesions reached PR, three lesions were SD and three lesions was PD. Four patients with moderate pain became mild, two with mild pain relived completely after RSI-BT. The others parameters showed no differences among preoperative plan, intraoperative plan and postoperative plan. The perioperative complications were observed in four patients, including three patients of grade 1 and one patient of grade 2. No ≥ grade 3 side-effects were observed.Conclusion: CT-guided 125I RSI-BT assisted by 3D-PNCT was a safe, accurate and feasible strategy for recurrent carcinomas located in retroperitoneal regions.
Contraceptive use among sexually active female adolescent in Ethiopia: Trends and determinants insight from national demographic and health survey
Authors: Olika Alemi Kebede , Kitila Sena Belina , Terfa Yonas Biratu , Olika Ayantu Kebede
Published: November 2020

Background: Sexual and reproductive health and right of young people is a global priority as the reproductive choices made by them have a massive impact on their health and wellbeing, education and economy. Teenage pregnancy is a burning public health issue and a demographic challenge in Ethiopia. The use of contraceptive method is a most effective way for sexually active adolescent to prevent pregnancy and its related complication. However, little is known about the trends in contraceptive use and its determinant among girls aged 15 to 19 in Ethiopia. Therefore, this study was designed to examine the trends and correlates of contraceptive use among sexually active adolescents in Ethiopia by using Ethiopian demographic and health survey data.Methods: Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use among sexually active adolescent girls. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data were used. The data was accessed from the demographic and health survey program data base and data for sexually active adolescent girls were extracted. Data analysis was done using SPSS version 21. Data were weighted for analysis. Descriptive analysis was used to describe independent variables of the study. Multivariable logistic regression model was used to identify factors associated with contraceptive use.Results: Contraceptive method use was increased significantly from 6.9% in 2000 to 39.6% in 2016 among sexually active adolescent girls in Ethiopia. The odds of contraceptive use were lower among female adolescent who had no formal education (AOR= 0.044; 95% CI= 0.008–0.231) and attended primary education (AOR= 0.101; 95% CI= 0.024–0.414). But the odds of contraceptive methods use were higher among adolescents in rich wealth status (AOR= 3.662; 95% CI =1.353–9.913) and those who were told about family planning during their health facility visits (AOR= 3.115; 95% CI= 1.385–7.007)Conclusion: Contraceptive method use was increased significantly among sexually active adolescent girls in Ethiopia in the year 2000 to 2016. Wealth status, educational status and information about family planning during their health facility visits were factors associated with contraceptive use. Improving economic and educational status of young women may help in improving contraceptive use in Ethiopia.
A conceptual model of functional health literacy to improve chronic airway disease outcomes
Authors: Poureslami Iraj , Tregobov Noah , Shum Jessica , McMillan Austin , Akhtar Alizeh , Kassay Saron , Starnes Kassandra , Mahjoob Maryam , Fitzgerald Mark John
Published: November 2020

Background: Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework.Methods: Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients.Results: Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains. Conclusions: We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients. Trial Registration Number: NCT01474928- Date of registration: 11/26/2017
Perception and belief in oral health among Karen ethnic group living along Thai-Myanmar border, Thailand
Authors: Thu Sai Wai Yan Myint , Ngeonwiwatkul Yaowaluk , Maneekan Pannamas , Phuanukoonnon Suparat
Published: November 2020

Background: Utilization of oral health services has been low among rural populations in Thailand, especially for minority ethnicity populations living along the borders. The aim of this study was to increase understanding of the determinants of the underutilization of oral health services among these populations.Methods: A qualitative study using in-depth interview and semi-structured interview was conducted among participants of Karen ethnicity living in Mae Tan Sub-district, Thasongyang District, Tak Province, Thailand. The interviews focused on exploring the participants’ perceptions of oral health problems, oral health and hygiene, and oral health-seeking behaviors. The verbatim-transcribed interviews were analyzed using thematic analysis.Results: A total of 101 participants (50 adults and 51 children) with a Karen ethnic background took part in the interviews. Most participants could not identify oral health problems and did not perceive dental disease as a problem unless there was severe pain that could not be relieved by painkillers. The Karen ethnic community worked as subsistence farmers, and their busy daily activities consisted of farming, going to the forest to hunt and gather, performing housework, and taking care of their children. Dental health was given a lower priority compared with general health. The perceived value of primary teeth was low, which was identified as an underlying factor resulting in delayed oral health care seeking among this population. The participants had relied on self-care throughout their lifetimes, using either traditional medicines or modern painkillers to relieve toothaches. Fear of dental procedures among children was also described as a barrier to seeking dental health care.Conclusions: This study found that the lifestyle and traditions of Karen people living in this area influence their oral health care and hygiene activities as well as their health-seeking behaviors. Further research should emphasize how to improve oral health promotion by providing necessary services and health education appropriately to Karen ethnic populations living along the Thai-Myanmar border.
Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Harare, Zimbabwe
Authors: Tinago Chiwoneso B. , Frongillo Edward A. , Warren Andrea , Chitiyo Vivian , Cifarelli Ashley K. , Fyalkowski Shannon , Pauline Victoria
Published: November 2020

Background Adolescent mothers in Zimbabwe often experience stigma, isolation and lack coping skills and resources to successfully navigate motherhood. Social isolation and stigma are linked to poor mental health outcomes. No interventions currently address mental health of adolescent mothers in Zimbabwe. Peer support groups in other contexts have been effective at increasing social connectedness, self-esteem, and self-efficacy, providing coping mechanisms to manage stigma experiences, in addition to empowering and improving mental health or adolescents and adolescent mothers. To develop a community-based peer support intervention, we need to understand the unique needs of adolescent mothers and how peer support groups could address those needs. Methods Focus group discussions were conducted with 85 adolescent mothers aged 14-18 years, 24 community health workers, and 25 key community stakeholders in a low-income high-density community in Harare. Data were analyzed thematically using NVivo 12 software.Results Participants described adolescent mother experiences with stigma and social isolation, in addition to challenges including gossip, lack of employment and educational opportunities and gaps in services and programming. Peer support groups for adolescent mothers were welcomed to improve mental health, social support, knowledge sharing and skills building. Participants identified varying preferred frequency and duration of group sessions addressing topics including income generation, mental health, and gossip, facilitated by community health workers at health and community centers. Use of WhatsApp Messenger to support intervention efforts was welcomed as an affordable and user-friendly platform to share information.Conclusions Participants supported peer support groups to empower, meet needs, and improve the health of adolescent mothers.
To do or not to do – A survey study on factors associated with participating in the Danish screening program for colorectal cancer
Authors: Nielsen Jesper Bo , Berg-Beckhoff Gabriela , Leppin Anja
Published: November 2020

Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6,807 Danish citizens aged 50-80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling.Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. gender, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.
Increased mRNA expression of key cytokines among suspected cases of Pneumocystis jirovecii infection
Authors: Alshahrani Mohammad Y. , Alfaifi Mohammed , Shahrani Mesfer Al , Alshahrani Abdulaziz S. , Alkhathami Ali G. , Dera Ayed A. , Ahmad Irfan , Wahab Shadma , Beg Mirza M. A. , Hakamy Ali , Hamid Mohamed E
Published: November 2020

Background: Pneumocystis pneumonia (PCP) is a fatal infectious disease caused by Pneumocystis jirovecii (PJP). The major factor relevant to morbidity and mortality seems to be the host inflammatory reaction. The objective of this study was to evaluate the role of IL-2, IL-4, IL-10, and IL-13 cytokines mRNA expression among suspected P. jirovecii infection.Methods: This was a cross-sectional analytic study undertaken in Aseer region, Saudi Arabia. A 100 suspected PCP cases and a 100 healthy controls were included in the study. Basic clinical manifestations, radiological findings, microbiological and immunological findings were extracted from the hospital records from January 2019 to August 2019, Pneumocystis detection was done by the immune-fluorescent staining (IFAT, Gomorimethanamine silver staining (GMSS), Giemsa staining, Toluidine blue O (TBO), and Pneumocystis RT-PCR. Results: Increased more than 5 fold, 3 fold, 4 fold, and 7 fold of IL-2, IL-4, IL-10, and IL-13 mRNA expression were observed in PCP cases compared to control. Higher expression of IL-2 mRNA was connected with crept, wheezing and chest X-ray findings like central perihilar infiltrates, patchy infiltrates, consolidation, hilar lymphadenopathy, pneumothorax, pleural effusion which showed higher expression compared to counterpart (p<0.0001). Higher expression of IL-4 mRNA was found to be significantly associated with the weight loss (p=0.002), dyspnea (p=0.003), crept (p=0.01), and chest X-ray findings (p<0.0001). Significantly increased expression of IL-10 mRNA was observed to be associated with weight loss, dyspnea, night sweats, wheezing, and different findings of chest X-ray compared to their counterparts, whereas, IL-13 mRNA was observed with cases with fever. Suspected cases of PCP confirmed positive by IFTA with higher IL-2, IL-4 and IL-10 mRNA expression compared to negative cases. RT-PCR confirmed PCP cases had significantly higher expression of IL-2, IL-4 and IL-10 as well as IL-13 mRNA compared to negative cases. Positive detected cases by GMSS showed higher IL-2, IL-10 mRNA expression, while Giemsa showed only higher IL-4 mRNA expression compared to negatives cases. Conclusion: Confirmed cases of P. jirovecii showed higher IL-2, IL-4, IL-10, and IL-13 mRNA expression comparatively to negative cases. Increased expression of cytokines may be indicative of infection severity and could help in patients’ management.
High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study
Authors: Cheng Ran , Tan Ning , Kang Qian , Luo Hao , Chen Hongyu , Pan Jiali , Han Yifan , Yang Yuqing , Xu Xiaoyuan
Published: November 2020

Background: Lipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.Methods: From January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and randomly divided into the derivation (n=629) and validation (n=314) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.Results: Among study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (total bilirubin (TBIL), HDL-C, International normalized ratio (INR), and hemoglobin), allowing accurate discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 12.3% (intermediate risk), and 56.9% (high risk) mortality. Its accuracy was significantly better than that of Child–Pugh, model of end-stage liver disease (MELD), albumin-bilirubin score (ALBI), D’Amico model, Augustin model, AIMS65 score and Glasgow-Blatchford score. Baseline HDL-C values ≤0.54 mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set. Conclusion: HDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.
Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis
Authors: Wang Gang , Luo Feng Ming , Liu Dan , Liu Jia Shen , Wang Ye , Chen Hong , Tian Pan Wen , Fan Tao , Tang Li , Yu He , Wang Lan , Feng Mei , Ni Zhong , Wang Bo , Song Zhi Fang , Wu Xiao Lin , Wang Hong Jun , Tong Xiang , Xue Miao , Lei Xian Ying , Long Bo , Jia Chao , Xiao Jun , Shang Juan , Xiong Nian , Luo Jian Fei , Liang Zong An , Li Wei Min
Published: November 2020

Background: There is limited information on difference of epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic.Methods: The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes.Results: The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64). Conclusions: The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.
Correlation between Preoperative Ultrasonic Features of Medullary Thyroid Carcinoma and Postoperative Recurrence
Authors: Zhu Qiaodan , Xu Dong
Published: November 2020

Background: To investigate the factors that affect postoperative recurrence in medullary thyroid carcinoma (MTC) patients, including preoperative ultrasonic characteristics and other factors.Method: A retrospective analysis of 74 MTC patients who underwent first thyroid surgery from 2009 to 2018 and who had complete follow-up data was conducted. According to the follow-up results, these patients were divided into the recurrence group (17 cases) and non-recurrence group (57 cases). The preoperative ultrasound characteristics, preoperative and postoperative calcitonin level, and general information on the two groups were recorded, respectively. Univariate and multivariate analyses were performed.Results: Single factor Kaplan-Meier (KM) analysis showed that: ① Preoperative ultrasonic characteristics including tumor size > 40.0 mm, capsular invasion, and metastatic cervical lymph nodes, as well as preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin (within one week) level > 45.0 pg/ml were positively correlated with the risk of postoperative recurrence of MTC (P <0.05); ② There was no evidence to show that gender and age had a statistically significant effect on postoperative recurrence of MTC (P> 0.05). Multivariate Cox regression analysis showed that metastatic lymph nodes shown by ultrasound (HR=5.368, 95%CI 1.063-27.104, P=0.042) were an independent risk factor for postoperative recurrence of MTC.Conclusions: MTC patients with metastatic lymph nodes as shown by ultrasound are prone to postoperative recurrence of MTC. In addition, MTC patients with a tumor > 40.0 mm, capsular invasion, preoperative calcitonin level > 565.8 pg/ml, and postoperative calcitonin level > 45.0 pg/ml are more likely to have postoperative recurrence.
Learning from COVID-19: a systems approach for public health governance
Authors: Liu Jieling , Wu Yurong , Huang Cunrui
Published: November 2020

The COVID-19 rapidly evolved into a global pandemic. Countries have taken measures widely to prevent and control the epidemic. China for example, has control the spread effectively, while many countries are still striving to cope with the increasing COVID-19 confirmed cases. The epidemic revealed serious problems of public health governance in many countries with long lasting social and economic consequences. This commentary reviews the pandemic response measures in five selected countries: China, Italy, the United States, Brazil and India. Building on critical reflections on the problems incurred in each country's pandemic responses, we provide a theoretical framework to reconceptualize public health as multiple types of economic goods. We further couple this reconceptualization with a systems approach to public health and wellbeing to offer new thinking on health governance. Finally, we propose suggestions for better, preventative and comprehensive epidemic prevention and health governance in an increasing urban future.
Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews
Authors: Said Ali , Pembe Andrea B. , Massawe Siriel , Hanson Claudia , Malqvist Mats
Published: November 2020

Background Maternal deaths in Tanzania and other low and middle income countries occur both in and outside health facilities. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of summaries and action plans using a prepared checklist from Tanzania MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only 1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points 242(85%) recommended strategies to be implemented at health facilities and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans in MDSR system are mostly recommended to sub standard care in health facilities but are not specific on the issues to be addressed.
Unilateral Lateral Rectus Recession is an Effective Surgery for Intermittent Exotropia in Young Children
Authors: Spierer Oriel , Spierer Abraham
Published: November 2020

Background: Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤25 PD (prism diopters)) in children.Methods: The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006-2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented.Results: Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusion: In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.