bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards an implementation framework for governance in the Ghanaian securities trading industry
Authors: Marx Johan , Mynhardt Ronald Henry
Published: April 2021

Purpose

The purpose of this paper is to propose an implementation framework for governance in the Ghanaian securities trading industry.

Design/methodology/approach

A qualitative research approach was followed, using participatory action research (PAR) by involving stakeholders from the Ghanaian securities trading industry.

Findings

A governance framework for the Ghanaian securities trading industry is proposed, taking into account the regulatory environment of Ghana, the role of ethical leadership, boards of directors, audit committees, the governance of risk, information technology and internal audit.

Research limitations/implications

This study used PAR because it is a recognised research methodology aimed at problem resolution, knowledge creation and improving professional practice, through the involvement of the interest group. This paper provides a starting point – a practical solution for the securities industry of Ghana, but not generalisable results.

Practical implications

Applying the governance framework will create safeguards against corruption and mismanagement, promote transparency in economic life and assist Ghana in attracting investment, ultimately lowering its cost of capital and contributing to economic growth and development in the country.

Social implications

The implementation of the governance framework will benefit all stakeholders (employees, suppliers and the community at large) as a result of a culture conducive to influencing behaviour, strategy planning and implementation, as well as corporate results and financial sustainability.

Originality/value

The use of PAR assists the practitioners from the Ghanaian securities trading industry in improving their competencies (knowledge, skills, values and attributes) whilst generating a workable solution for their current governance challenges.
Increasing e-government adoption by emphasizing environmental sustainability: an extended case study in Peru
Authors: Pérez Chacón Sebastián Ramón , Rodriguez Vilchez Jose Luis , Cabrera Berrios Jorge Antonio , Raymundo Ibañez Carlos Arturo , Mauricio David Santos
Published: April 2021

Purpose

Low citizen adoption rates jeopardize the success and proliferation of e-government systems. This study aims to understand how the perception of environmental sustainability (ES) can influence a citizen’s intention to use e-government systems.

Design/methodology/approach

In a case study in Peru, the technology acceptance model (TAM) adoption model is extended with the construct of ES and evaluated with structural equation modeling. An 18-element, in-person survey was constructed and administered to citizens of Lima, Peru who had prior exposure to e-government systems.

Findings

The results show that citizens can be positively influenced to adopt e-government systems if they perceive that doing so will contribute to ES.

Research limitations/implications

As this was a preliminary study, further research should focus on specific, as opposed to general, e-government systems, as well as encompassing a broader cross section of the population.

Practical implications

Administrators of e-government initiatives can consider public-interest factors, alongside of the common self-interest factors, when looking to improve adoption rates of e-government systems.

Originality/value

This is the first time that TAM has been extended with the construct of ES.
Building a sustainable high-performance customer experience and product performance (CxPP): the JJV experience
Authors: Barre Vincent , Ramos David Orlando , Medovich Charles , Lovera Gabriela , Hoch Matthew
Published: April 2021

Purpose

The paper provides insight on the customer experience through product performance (CxPP) initiative; which was developed by Johnson & Johnson Vision to monitor and conduct product performance improvements to enhance the customer experience effort and protect sales. The piece explains the basic tenets for CxPP execution and upkeep. It also explains the methods used to create, evaluate and monitor the CxPP initiative while illustrating the ways in which the initiative functions and adds value to any firm implementing it.

Design/methodology/approach

The paper utilizes a descriptive approach to explain the basic tenants of the CxPP initiative. The paper utilizes the define, measure, analyze, improve and control (DMAIC) framework to explain the tenets of the CxPP initiative. Each section of the paper utilizes descriptions of internal processes and research to further explain and justify implementation of the CxPP imitative across firms. Moreover, the piece explains the methods used to create, evaluate and monitor the CxPP initiative while illustrating the ways in which the initiative functions and adds value to the firm.

Findings

According to JJV Quality Assurance experts, the CxPP initiative is a long-term approach that supports synergy across departments to enhance product quality, improve customer satisfaction and protect sales. By implementing the CxPP approach, JJV was able to uncover and solve four distinct defect categories that affect product quality and customer experience, thus demonstrating the importance and benefits of the CxPP initiative for any organization.

Research limitations/implications

Due to the chosen research approach, the study lacks specificity. As a result, it is recommended that future implementation of the proposed initiative opts for more testable propositions.

Practical implications

Due to competitive considerations, note that no empirical data will be shared in the findings. The scaling of the principles of this approach should be universal. But the execution; types of projects, type of customer need and feedback should be specific to each environment.

Originality/value

This paper fulfills an identified need to study the relationship between product quality, customer satisfaction and sales.
Cooperatives and economic growth in a developing country: The case of Nepal
Authors: Paudel Ramesh C. , Acharya Chakra Pani
Published: April 2021

Cooperatives play important role in economic development via multiple channels, particularly, in developing countries’ cases. Considering this fact, Nepal's constitution 2017 has incorporated the cooperative as one of the three pillars of her economy. This paper aims to analyze the role of cooperatives in the economic development of Nepal. For this, first, this paper documents the trend and pattern of Nepalese cooperatives’ evolving structure, then moves to the econometric estimation to analyze the role of cooperatives in economic growth employing an advanced methodology. Looking at the properties of time series data for the period of 49 years from 1970 to 2018, the autoregressive distributed lag (ARDL) approach of cointegration is employed. The major finding is that the development of the cooperatives has a long‐run relationship with economic growth. However, the focus should be seen as on the involvement of many people in the cooperatives’ activities rather than just on amassing the cooperatives’ capital. The results also suggest that there is a need for the attention of policymakers so ensure that share capital contributes to economic growth. Therefore, the areas of priorities and scope of work of cooperatives need to be reconsidered when formulating new policies related to cooperatives.
Developmental Pathways Between Infant Gestures and Symbolic Actions, and Children’s Communicative Skills at Age 5: Findings From the All Our Families Pregnancy Cohort
Authors: Morin‐Lessard Elizabeth , Hentges Rochelle F. , Tough Suzanne C. , Graham Susan A.
Published: April 2021

Using data from the All Our Families study, a longitudinal study of 1992 mother‐child dyads in Canada (47.7% female; 81.9% White), we examined the developmental pathways between infant gestures and symbolic actions and communicative skills at age 5. Communicative gestures at age 12 months (e.g., pointing, nodding head “yes”), obtained via parental report, predicted stronger general communicative skills at age 5 years. Moreover, greater use of symbolic actions (e.g., “feeding” a stuffed animal with a bottle) indirectly predicted increased communicative skills at age 5 via increased productive vocabulary at 24 months. These pathways support the hypothesis that children’s communicative skills during the transition to kindergarten emerge from a chain of developmental abilities starting with gestures and symbolic actions during infancy.
Viral gene therapy for paediatric neurological diseases: progress to clinical reality
Authors: Privolizzi Riccardo , Chu Wing Sum , Tijani Maha , Ng Joanne
Published: April 2021

In the era of genomic medicine, diagnoses of rare paediatric neurological diseases are increasing. Many are untreatable and life‐limiting, leading to an exceptional increase in gene therapy development. It is estimated that 20 gene therapy products will have received approval from the US Food and Drug Administration by 2025. With viral gene therapy considered a potential single‐dose cure for patients with spinal muscular atrophy type 1 as one example, and contemporaneously tragically resulting in the deaths of three male children with X‐linked myotubular myopathy receiving high‐dose gene therapy in 2020, what is the current state of gene therapy? What is behind the decades of hype around viral gene therapy and is it high impact, but high risk? In this review, we outline principles of viral gene therapy development and summarize the most recent clinical evidence for the therapeutic effect of gene therapy in paediatric neurological diseases. We discuss adeno‐associated virus and lentiviral vectors, antisense oligonucleotides, emerging genetic editing approaches, and current limitations that the field still faces.

What this paper adds

Viral gene therapy development and clinically used transgenes, regulatory elements, capsids, dosage, and delivery routes are summarized.

Viral gene therapy for 18 childhood neurological disorders involving over 600 children in 40 clinical trials are reviewed.
Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes
Authors: Slåtsve Kristina B. , Claudi Tor , Lappegård Knut T. , Jenum Anne K. , Larsen Marthe , Nøkleby Kjersti , Cooper John G. , Sandberg Sverre , Berg Tore J.
Published: April 2021

Aims

The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care.

Methods

Population‐based cross‐sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed‐effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables.

Results

Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c, use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners’ use of a structured form and a diabetes nurse were negatively associated with specialist care.

Conclusions

Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow‐up in primary care.
Exaggerated lower frontalis and glabella after Botox injection
Authors: Elghblawi Ebtisam
Published: April 2021

Botox is well known to be safe and effective; however, in some rare instances, there are unwanted side effects that every clinician should be aware of and can address to their clients. A rare encounter in the upper face is mild ptosis of the forehead along with mid‐horizontal line that divided and parted the forehead into two distinctive nearly equal horizontal portions. A woman experienced a deep furrow line across her forehead post‐Azzalure injection by a week, with noticeable glabella projection. This line should expect to resolve by itself within few weeks. This could be attributed to overactivity and overcompensation of the surrounding untreated muscles in the same vicinity. Also, it could be attributed to different forehead muscle patterns.
Entrustable professional activity assessment tool for clinical procedures: A psychometric study
Authors: Lau Siew Tiang , Ang Emily , Shorey Shefaly , Lau Ying
Published: April 2021

Aim and objective

To test the psychometric properties of the entrustable professional activity assessment tool for clinical procedures to be administered to clinical trainers and students.

Background

Students’ ability to perform clinical procedures professionally and safely is a key concern for healthcare educators. The assessment of professional activities, in which entrustment is a key outcome, is crucial for determining the level of training and supervision of work‐based assessments. The entrustable professional activities for clinical procedures (EPA‐CP) have been used among clinical trainers, but it needs more psychometric testing.

Design

The psychometric study used a cross‐sectional design.

Methods

Students’ self‐assessment (n = 302) and the supervisors’ ratings on the students’ performance in clinical procedures (n = 266) were used to evaluate the psychometric properties of the six‐item EPA‐CP assessment tool. Internal consistency and test–retest reliabilities of the assessment tool were examined. Convergent, known‐groups, analysis of structural validity were conducted to investigate the tool's construct and factorial structure. The STROBE checklist for cross‐sectional studies was followed.

Results

The EPA‐CP assessment tool demonstrated good reliability, satisfactory convergent validity and significant differences in the known‐group comparison. The exploratory factor and confirmatory factor analyses indicated the cogent constructs of the assessment tool when administered to students and their supervisors.

Conclusion

The EPA‐CP assessment tool is a valid, reliable and user‐friendly tool for evaluating healthcare students’ capability to perform clinical procedures. This tool makes it possible for the precise assessment of learners in performing procedures in busy and dynamic clinical settings.

Relevance to clinical practice

Reliable instruments are needed to effectively assess healthcare students’ ability to perform clinical procedures and enable trainers to entrust students with the tasks. The results indicate that the EPA‐CP assessment is promising and may be used in the healthcare settings.
Don't Take Their Word for It: The Misclassification of Bond Mutual Funds
Authors: CHEN HUAIZHI , COHEN LAUREN , GURUN UMIT G.
Published: April 2021

We provide evidence that bond fund managers misclassify their holdings, and that these misclassifications have a real and significant impact on investor capital flows. The problem is widespread, resulting in up to 31.4% of funds being misclassified with safer profiles, compared to their true, publicly reported holdings. “Misclassified funds”—those that hold risky bonds but claim to hold safer bonds—appear to on‐average outperform lower risk funds in their peer groups. Within category groups, misclassified funds receive more Morningstar stars and higher investor flows. However, when we correctly classify them based on actual risk, these funds are mediocre performers.
Efficient training of physics‐informed neural networks via importance sampling
Authors: Nabian Mohammad Amin , Gladstone Rini Jasmine , Meidani Hadi
Published: April 2021

Physics‐informed neural networks (PINNs) are a class of deep neural networks that are trained, using automatic differentiation, to compute the response of systems governed by partial differential equations (PDEs). The training of PINNs is simulation free, and does not require any training data set to be obtained from numerical PDE solvers. Instead, it only requires the physical problem description, including the governing laws of physics, domain geometry, initial/boundary conditions, and the material properties. This training usually involves solving a nonconvex optimization problem using variants of the stochastic gradient descent method, with the gradient of the loss function approximated on a batch of collocation points, selected randomly in each iteration according to a uniform distribution. Despite the success of PINNs in accurately solving a wide variety of PDEs, the method still requires improvements in terms of computational efficiency. To this end, in this paper, we study the performance of an importance sampling approach for efficient training of PINNs. Using numerical examples together with theoretical evidences, we show that in each training iteration, sampling the collocation points according to a distribution proportional to the loss function will improve the convergence behavior of the PINNs training. Additionally, we show that providing a piecewise constant approximation to the loss function for faster importance sampling can further improve the training efficiency. This importance sampling approach is straightforward and easy to implement in the existing PINN codes, and also does not introduce any new hyperparameter to calibrate. The numerical examples include elasticity, diffusion, and plane stress problems, through which we numerically verify the accuracy and efficiency of the importance sampling approach compared to the predominant uniform sampling approach.
Mindset regarding mathematical ability in K‐12 teachers
Authors: Willingham James C. , Barlow Angela T. , Stephens D. Christopher , Lischka Alyson E. , Hartland Kristin S.
Published: April 2021

Two potentially impactful conceptions of mathematics and mathematics teaching, teachers’ implicit theories (i.e., mindset) toward intelligence and mathematical ability, have not been well examined in the literature. This study established baseline characteristics for these constructs across grades K‐12 teachers through a survey of background and mindset characteristics of 583 classroom teachers. Analyses regarding the uniqueness of these constructs, their proportions in the sample of teachers, and differences in mindset by subject and grade level taught are provided. Mindset regarding mathematical ability was found to be distinguished from mindset regarding general intelligence, and as a whole, teachers displayed drastically different distributions of mindset than the population, with growth‐oriented mindset characteristics for intelligence and mathematical ability greatest among elementary teachers and mathematics teachers. Additionally, teachers’ mindsets regarding these constructs appeared to be strongly oriented toward growth. Mindset constructs, which are potentially impactful to mathematical teaching practices, should be further examined in relation to effective classroom teaching, particularly at the elementary level, and differences in the distribution of these constructs by grade level taught should be further explored.
“How Come You Sent Me the Canadian One?” Application and Uptake of the Canadian Physical Activity Guidelines for Adults With Multiple Sclerosis in the United States
Authors: Neal Whitney N. , Richardson Emma , Motl Robert W.
Published: April 2021

The uptake and benefits of the Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis (PAGs) have been validated, but there is limited understanding regarding the knowledge, needs, and preferences of people with multiple sclerosis (MS) for implementing the PAGs outside of clinical research. The authors conducted online, semistructured interviews with 40 persons with MS from across the United States seeking information on awareness of and potential approaches for increasing the uptake of the PAGs. They identified first impressions and potential approaches for increasing the uptake of the PAGs through inductive, semantic thematic analysis. Participants perceived the PAGs as a good introduction for structured exercise but desired more information on how to meet the PAGs. Participants further believed that modifying the PAGs for inclusivity and applying a multifaceted approach for dissemination and implementation may increase uptake of exercise behavior. Physical activity research in MS should include both analyzing the effects of exercise and the unique challenges faced by persons with MS in putting the PAGs into practice.
Associated Sociodemographic and Facility Patterning of Uptake, Attendance, and Session Count Within a Scottish Exercise Referral Scheme
Authors: Shore Colin B. , Hubbard Gill , Gorely Trish , Hunter Angus M. , Galloway Stuart D.R.
Published: April 2021

Background: Exercise referral schemes (ERS) aim to tackle noncommunicable disease via increasing levels of physical activity. Health benefits are reliant on uptake and attending ERS sessions. Hence, it is important to understand which characteristics may influence these parameters to target interventions to improve uptake and attendance to those who need it most. Method: Secondary analysis of one ERS database was conducted to (1) profile participants’ nonuptake of exercise referral; (2) describe any differences between nonattenders and attenders; and (3) report session count of attenders, exploring any relationship between attender demographics and session count. Results: The study showed that (1) sociodemographic profile of nonattenders was very similar to that of those who attended; (2) there was a high, early withdrawal rate of attenders wherein 68% exited the scheme at 5 exercise sessions or less; and (3) session count did not appear to differ by demographic characteristics. Conclusions: Nonattendance and session count did not appear to differ by demographic characteristics. Attendance at ERS was low. Nonuptake and reduced attendance may limit any associated health benefits that may be achieved from ERS. Therefore, it is important to identify additional factors that may influence participants’ choice to uptake and attend ERS.
How Jupiter’s unusual magnetospheric topology structures its aurora
Authors: Zhang Binzheng , Delamere Peter A. , Yao Zhonghua , Bonfond Bertrand , Lin D. , Sorathia Kareem A. , Brambles Oliver J. , Lotko William , Garretson Jeff S. , Merkin Viacheslav G. , Grodent Denis , Dunn William R. , Lyon John G.
Published: April 2021

Jupiter’s slow dayside magnetic merging and fast rotation produce an unusual magnetic topology that can explain its polar aurora.
A Novel Antigenic Site Spanning Domains I and III of the Zika Virus Envelope Glycoprotein Is the Target of Strongly Neutralizing Human Monoclonal Antibodies
Authors: Graham Stephen D. , Tu Huy A. , McElvany Benjamin D. , Graham Nancy R. , Grinyo Ariadna , Davidson Edgar , Doranz Benjamin J. , Diehl Sean A. , de Silva Aravinda M. , Markmann Alena Janda
Published: April 2021

People infected with Zika virus develop durable neutralizing antibodies that prevent repeat infections. In the current study, we characterize a ZIKV-neutralizing human monoclonal antibody isolated from a patient after recovery. Our studies establish a novel site on the viral envelope that is targeted by human neutralizing antibodies. Our results are relevant to understanding how antibodies block infection and to guiding the design and evaluation of candidate vaccines.
Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia
Authors: Pohontsch Nadine Janis , Meyer Thorsten , Eisenmann Yvonne , Metzendorf Maria-Inti , Leve Verena , Lentsch Veronika
Published: April 2021

Introduction

Stroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients’ needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used.

Methods and analysis

We will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).

We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist.

Ethics and dissemination

Ethical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.
Birthweight features of the infants of mothers diagnosed with diabetes at different gestational ages in South China from 2014 to 2018: a retrospective study
Authors: Huang Xin-xin , Jiang Xiu-Min , Zheng Qing-Xiang , Chen Xiao-Qing , Pan Yu-Qing
Published: April 2021

Objectives

The primary purpose was to measure the birth weight of infants of mothers with gestational diabetes (IMGDs) at different gestational ages to develop new reference charts and curves for them. A further purpose was to compare them with those of 159 334 infants in China to provide more accurate reference charts for the diagnosis of suspected abnormal birth weight of IMGDs. The final purpose was to evaluate the key periods for such mothers to control their weight in line with the difference of fetal weight of each two neighbouring gestational ages.

Setting

A specialised hospital in South China

Participants

IMGDs born here from January 2014 to December 2018.

Primary and secondary outcome variables

Birth weight, gestational ages of IMGDs, gender and year of birth.

Results

Data of 14 311 singleton live births at the gestational weeks 25–42 here were collected. The proportions of low birth weight, normal birth weight and macrosomia were 7.26%, 87.04%, and 5.70%, respectively. The proportions of small for gestational age, appropriate for gestational age and large for gestational age were 5.69%, 84.42% and 9.89%, respectively. In the macrosomia group, the mean of all birth weight in 2017 decreased for the first time since 2014. Both the means of birth weight of male infants at gestational weeks 36–41 and of female at weeks 38–40 were greater than that of the 159 334 infants. The increase of each weekly mean of IMGDs at gestational weeks 27–31 and 33–35 was >10% compared with the former. Based on this, new reference charts of birth weight for IMGDs in terms of different gestational age and gender were formulated.

Conclusion

These charts may be applied as reference for more accurate diagnosis and quick treatment of abnormal birth weight. This study showed that the identification of key periods for fetal weight gain was helpful for the management of the weight of women with gestational diabetes.
Efficacy and safety of inulin supplementation for functional constipation: a systematic review protocol
Authors: Liu Xinyuan , Yang Qing , He Zhongning , Yao Shukun
Published: April 2021

Introduction

Functional constipation (FC) is a common digestive system disease, with an uptrend in morbidity and mortality, resulting in huge social and economic losses. Although the guidelines recommend lifestyle intervention as a first-line treatment, lifestyle intervention is not widely used in clinic. Inulin can be used as the basic material of functional food. Clinical studies have shown that inulin supplementation is associated with increased frequency of bowel movements, but has certain side effects. Therefore, the efficacy and safety of inulin in the treatment of FC need to be further evaluated.

Methods and analysis

We will search Medline, Web of Science, Embase, China National Knowledge Infrastructure Database, Wanfang Database and China Biomedical Literature Database. We will also search the China Clinical Trial Registry, the Cochrane Central Register of Controlled Trials and related conference summaries. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RevMan V.5.3.5 will be used for analysis.

Ethics and dissemination

This systematic review will evaluate the efficacy and safety of inulin supplementation for the treatment of FC. All included data will be obtained from published articles, there is no need for the ethical approval, and it will be published in a peer-reviewed journal. Due to lack of a new systematic review in this field, this study will combine relevant randomised controlled trials to better explore the evidence of inulin supplementation in the treatment of FC and guide clinical practice and clinical research.

PROSPERO registration number

CRD42020189234.
Does mothers’ pregnancy intention affect their children’s preventive and curative care in India? Evidence from a longitudinal survey
Authors: Chowdhury Poulomi , Garg Mausam Kumar , Kanchan Sk Md Illias
Published: April 2021

Objective

To assess the effect of unintended births on preventive and curative care of children and their nutritional status.

Design

The study uses a cross-sectional prospective design.

Setting

Indian Human Development Survey (IHDS) data of two rounds were used in this study. Women data file was used to draw a representative sample of 3905 children who belong to under 5 years of age group.

Statistical analyses

We categorised birth as an unintended birth if the mother did not want to have an additional child at IHDS-I but gave birth during the intersurvey. Furthermore, all births exceeding to the desired number of children reported by mothers in the IHDS-II were also included in unintended births. Multivariate logistic regression models were applied to analyse the effect of unintended births on child immunisation and exclusive breast feeding, while multivariate linear regression models were used to assess the effect of childbearing intention on child nutritional status.

Results

The study shows that by controlling other factors, children from unintended births were less likely to be exclusively breast fed (OR 0.885, 95% CI 0.792 to 0.990, p<0.05) and receive full immunisation (OR 0.830, 95% CI 0.739 to 0.931, p<0.001). Moreover, poor nutrition was more prevalent among children from unintended births as they were more likely to be stunted and underweight.

Conclusions

The study confirmed the adverse effects of unintended pregnancy on children’s preventive and curative care. The findings of the study underscore the importance of formulating policies on more affordable, accessible and available means of family planning to reduce the unintended births.
Cross-sectional seroprevalence study of antibody to Bordetella pertussis toxin in western Saudi Arabia: is there a need for a vaccine booster dose for adolescents and young adults?
Authors: Farahat Fayssal , Althaqafi Abdulhakeem , Al-Amri Abdulfattah , Alsaedi Asim , Abouremsh Mohammad , Alshamrani Majid
Published: April 2021

Objectives

The present study was conducted to estimate the seroprevalence of antibody to pertussis toxin among adult populations in western Saudi Arabia.

Design

A cross-sectional study.

Setting

King Abdulaziz Medical City, Jeddah, western Saudi Arabia. A tertiary care teaching hospital.

Participants

A total of 1200 participants (400 healthcare workers, 400 military recruits and 400 blood donors) were included. The majority were male (79.3%), and the mean (±SD) age was 27.2 (±6.7) years old.

Interventions

The study included the analysis of serum blood samples using commercial ELISA. A consecutive sampling technique was applied.

Primary outcome measures

Seropositivity of antipertussis toxin immunoglobulin G (anti-PT IgG) ≥62.5 IU/mL.

Results

Antibody titres ≥62.5 IU/mL, indicating exposure to Bordetella pertussis infection within the last year, were identified in 12.0% (95% CI 10.2% to 14.0%) of the participants. Titres ≥125 IU/mL, suggesting recent infection, were detected in 3.5% (95% CI 2.5% to 4.7%). Seroprevalence of positive IgG antibody titres (≥62.5 IU/mL) was highest among the healthcare workers (HCWs) (14%), then the military recruits (13.5%) and blood donors (8.5%; p=0.03). The multivariate regression analysis showed association between participants group (HCWs and military), male gender and younger age (<25 years old) and higher antibody to pertussis toxin.

Conclusions

High pertussis seropositivity was associated with participants’ occupation (ie, healthcare workers and military recruits), and anti-PT IgG titre was negatively correlated with age. A substantial deficiency in pertussis reporting in Saudi Arabia has been suggested, with potential increased risk to the most vulnerable populations (ie, infants and elderly). Enhancing the booster dose of pertussis vaccine for adolescents and adults is crucial to minimise the burden of pertussis.
Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis
Authors: Alem Adugnaw Zeleke , Agegnehu Chilot Desta
Published: April 2021

Objective

This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia.

Design

Cross-sectional study.

Setting

Ethiopia.

Participants

Reproductive age group women.

Primary outcome

Unmet need for family planning.

Methods

This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15–49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables.

Results

The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning.

Conclusion

Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women’s education, age at first marriage, household wealth, distance to a health facility, community women’s education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.
CoCo20 protocol: a pilot longitudinal follow-up study about the psychiatric outcomes in a paediatric population and their families during and after the stay-at-home related to coronavirus pandemic (COVID-19)
Authors: Gindt Morgane , Fernandez Arnaud , Richez Aurelien , Nachon Ophelie , Battista Michele , Askenazy Florence
Published: April 2021

Introduction

In the context of a viral outbreak and the stay-at-home measures, a significant increase in psychological distress, such as stress or fear behaviours, has previously been reported in adult and paediatric population. Children and adolescents seem to be particularly at risk of developing psychiatric disorders during and after the stay-at-home but evidences are lacking. The main objective of this article is to present the methodology of Coronavirus Confinement 2020 (CoCo20) Study, which aims to assess the impact of the coronavirus pandemic (COVID-19) and stay-at-home on the development of psychiatric disorders, including post-traumatic stress disorder (PTSD), in children and adolescents.

Methods and analysis

We describe a longitudinal and multicentre study in the paediatric population during and after stay-at-home related to COVID-19 pandemic. Inclusions started on 30 March 2020 for 6 months. This study is proposed to all consecutive paediatric outpatients consulting during and after stay-at-home related to COVID-19 pandemic in medical–psychological centres and in a paediatric psychotrauma centre and/or calling the emergency COVID-19 hotline. We perform standardised and internationally validated psychiatric assessments (Diagnosis Infant and Preschool Assessment, Kiddie Schedule for Affective Disorders and Schizophrenia—Present and Lifetime Version) together with anxiety, attention deficit hyperactivity disorder, PTSD, parenting stress and somatic symptoms scales during five visits (baseline, 1 week after baseline, 1 month after baseline, 1 week after the end of the containment and 1 month after the end of the containment) in patients and their families enrolled during the containment and during three visits in case of enrolment after the containment. The inclusion period will end in 30 November 2020.

Ethics and dissemination

The protocol has been approved by the Ethics Committee of Cote d’Azur University « CERNI » (number 2020-59). All patients and their legal caregivers provide a written informed consent on enrolment in the study. We will submit the results of the study to relevant journals and offer national and international presentations. This study will enable better characterisation of the impact of the stay-at-home (related to COVID-19 pandemic) on the mental health of children and adolescents.

Trial registration number

NCT04498416.
Algorithmic surveillance ofICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy
Authors: Marx Gernot , Bickenbach Johannes , Fritsch Sebastian Johannes , Kunze Julian Benedict , Maassen Oliver , Deffge Saskia , Kistermann Jennifer , Haferkamp Silke , Lutz Irina , Voellm Nora Kristiana , Lowitsch Volker , Polzin Richard , Sharafutdinov Konstantin , Mayer Hannah , Kuepfer Lars , Burghaus Rolf , Schmitt Walter , Lippert Joerg , Riedel Morris , Barakat Chadi , Stollenwerk André , Fonck Simon , Putensen Christian , Zenker Sven , Erdfelder Felix , Grigutsch Daniel , Kram Rainer , Beyer Susanne , Kampe Knut , Gewehr Jan Erik , Salman Friederike , Juers Patrick , Kluge Stefan , Tiller Daniel , Wisotzki Emilia , Gross Sebastian , Homeister Lorenz , Bloos Frank , Scherag André , Ammon Danny , Mueller Susanne , Palm Julia , Simon Philipp , Jahn Nora , Loeffler Markus , Wendt Thomas , Schuerholz Tobias , Groeber Petra , Schuppert Andreas
Published: April 2021

Introduction

The acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure.

Methods and analysis

In this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested.

Ethics and dissemination

Ethical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals.

Trial registration number

DRKS00014330.
Epidemiological trends in COVID-19 pandemic: prospective critical appraisal of observations from six countries in Europe and the USA
Authors: Velicu Maria Alexandra , Furlanetti Luciano , Jung Josephine , Ashkan Keyoumars
Published: April 2021

Introduction

Europe was the epicentre of the COVID-19 pandemic in March 2020, with the highest number of cases and deaths between March and April. In May, the infection numbers registered a fall followed by a second new rise, not proportionally reflected by an increase in the number of deaths. We aimed to investigate the relationship between disease prevalence and infection fatality rate (IFR), and the number of intensive care unit (ICU) and hospital admissions over time, to develop a predictive model, as well as appraising the potential contributing factors underpinning this complex relationship.

Methods

A prospective epidemiological study using data from six countries collected between 10 March and 4 September 2020. Data on the number of daily hospital and ICU admissions with COVID-19 were gathered, and the IFR and the prevalence were calculated. Trends over time were analysed. A linear regression model was used to determine the association between the fatality rates and the number of admissions.

Findings

The prediction model confirmed the linear association between the fatality rates and the numbers of ICU and hospital admissions. The exception was during the peak of the COVID-19 pandemic when the model underestimated the fatalities indicating that a substantial number of deaths occurred outside of the hospitals. The fatality rates decreased in all countries from May until September regardless of the trends in prevalence, differences in healthcare systems or strategic variations in handling the pandemic.

Interpretation

The observed gradual reduction in COVID-19 fatality rates over time despite varying disease prevalence and public health measures across multiple countries warrants search for a biological explanation. While our understanding of this novel virus grows, hospital and ICU admission rates remain effective predictors of patient outcomes which can be used as early warning signs for escalation of public health measures.
Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study
Authors: Hamada Shota , Kojima Taro , Hattori Yukari , Maruoka Hiroshi , Ishii Shinya , Okochi Jiro , Akishita Masahiro
Published: April 2021

Objectives

To evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility in Japan.

Design

Cohort study.

Setting

A nationwide questionnaire survey across 3598 Roken in Japan in 2015 (up to five randomly selected residents per facility).

Participants

This study included 1201 residents from 343 Roken (response rate: 10%). We determined the presence and severity of dementia using a nationally standardised measure.

Primary and secondary outcome measures

Prescriptions of PD and DAP at admission and 2 months after admission were evaluated. Multivariable logistic regression was used to evaluate the associations of residents’ baseline characteristics with prescriptions or discontinuation.

Results

Prescription rates decreased for antidementia drugs (19.4% to 13.0%), hypnotics (25.1% to 22.6%) and anxiolytics (12.3% to 10.7%), whereas those for other PD, such as antipsychotics (13.2% to 13.6%), antidepressants (7.4% to 6.7%), antiepileptic drugs (7.1% to 7.8%) and DAP (35.2% to 36.6%) did not statistically significantly decrease. Some factors were associated with the prescriptions, for example, for antipsychotics, older age (≥85 years) (adjusted OR (aOR), 0.60; 95% CI 0.43 to 0.85) and being bedridden (aOR 0.67; 95% CI 0.47 to 0.97) were associated with a lower use of antipsychotics, whereas severe dementia was associated with a higher use of antipsychotics (aOR 3.26; 95% CI 2.26 to 4.70). At an individual level, a quarter of residents prescribed PD or DAP at admission had discontinued at least one PD or DAP, respectively, 2 months after admission. Antidementia drug use in severe dementia (aOR 1.86; 95% CI 1.04 to 3.31) and PD use in older age (aOR 1.61; 95% CI 1.00 to 2.60; in residents with disabling dementia) were associated with discontinuation.

Conclusions

There is possible scope for deprescribing PD and DAP in Roken residents with dementia to mitigate the risks of adverse events.