bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the reasons why women prefer to give birth at home in rural northern Ghana: A qualitative study
Authors: Adatara Peter , Strumpher Johanita , Ricks Esmeralda 
Published: August 2020

Abstract
Background: Skilled birth care during childbirth is reported in the literature as one critical strategy for reducing maternal morbidity and mortality. Despite the importance of birth care provided by skilled birth attendants, women in rural areas of northern Ghana still give birth utilising the birth services provided by Traditional Birth Attendants. The aim of this study, therefore, was to explore and describe the factors and experiences of a small group of rural women choosing homebirth in rural northern Ghana. Methods: A qualitative approach was adopted to explore the reasons why women prefer to deliver at home in rural areas of northern Ghana. Individual interviews were used to obtain a full description of factors and experiences of women associated with home births in rural areas in Ghana. The research population consisted of 10 women who utilised birth care services provided by Traditional Birth Attendants in a rural community of northern Ghana. Data collected from the interviews were transcribed verbatim and analysed to identify themes. Results: This study, which was conducted amonga small group of women, yielded interesting results on why these women still give birth at home in rural northern Ghana. It was found out that perceived poor quality of care and conduct of skilled birth attendants; the perception that women received better care from Traditional Birth Attendants; financial constraints and lack of access to healthcare facilities in the rural areas by these women accounted for majority of the reasons why women in rural northern Ghana still give birth at home. Conclusion : The study highlighted some barriers experienced by participants to the utilisation of birth care services provided by skilled birth attendants in rural northern Ghana. Management of healthcare facilities should facilitate the implementation of supportive supervision in the maternity units to improve the quality of care and attitude delivered by skilled birth attendants in maternity care in rural communities.
Recognition of stroke-related knowledge among community residents and the improvement after intensive health education: A cross-sectional study
Authors: Zhong Xuemin , Wang Jian , He Lanying , Xu Ronghua 
Published: August 2020

Abstract
Background: The high morbidity, mortality, and disability rates of stroke constitute a heavy burden to the society. The level of understanding about stroke warning symptoms and first aid systems among community residents was generally low. The aim of our work is to investigate stroke-related knowledge in community residents of Jinjiang district of Chengdu and to raise public awareness about stroke through an intensive educational program. Methods: Nine communities in Jinjiang district were sampled and a questionnaire about stroke-related knowledge was applied before and after stroke educational activities. We analyzed the impact of such activities in stroke recognition and management. Results: We collected 1685 valid questionnaires. The awareness about stroke risk before educational activities was 11.4%. The recognition of stroke warning signs among community residents was 29.8-59.5%. Among them, the recognition of major signs, such as limb weakness, language disorder, and imbalance was more than 50%. When faced with five stroke warning signs, the proportion of participants who chose to make an emergency call was 41.5%. Less than 10% of the participants chose to consult a doctor, take medicine, or wait. After strengthening publicity and educational activities regarding stroke, there was a significant improvement in the identification of stroke risk factors, warning signs, and stroke management. The percentage of participants who chose to make an emergency call increased from 53.2% to 82.7%. Conclusions: The knowledge about stroke among community residents in Jinjiang District of Chengdu was low. Strengthening publicity and educational activities may raise awareness about stroke prioritizing call emergency after the onset of stroke signs.
Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in Northeast Japan: comparisons with the general population
Authors: Kawakami Norito , Fukasawa Maiko , Sakata Kiyomi , Suzuki Ruriko , Tomita Hiroaki , Nemoto Harumi , Yasumura Seiji , Yabe Hirooki , Horikoshi Naoko , Umeda Maki , Suzuki Yuriko , Shimoda Haruki , Tachimori Hisateru , Takeshima Tadashi , Bromet Evelyn J 
Published: August 2020

Abstract
Background

People living in temporary housing for long periods after a disaster are at risk of poor mental health. This study investigated the post-disaster incidence and remission of common mental disorders among adults living in temporary housing for the three years following the 2011 Great East Japan Earthquake.

Methods

Three years after the disaster, face-to-face interviews were conducted with 1,089 adult residents living in temporary housing in the disaster area, i.e., the shelter group, and a random sample of 852 community residents from non-disaster areas of East Japan. The World Health Organization Composite International Diagnostic Interview was used to diagnose DSM-IV mood, anxiety, and alcohol use disorders. Information on demographic variables and disaster experiences was also collected.

Results

Response rates were 49% and 46% for the shelter group and the community residents, respectively. The incidence of mood/anxiety disorder in the shelter group was elevated only in the first year post-disaster compared to that of the general population. The rate of remission for mood and anxiety disorders was significantly lower in the shelter group than in the community residents. The proportion seeking medical treatment was higher in the shelter group.

Conclusions

The onset of common mental disorders increased in the first year, but then levelled off in the following years among residents in temporary housing after the disaster. Remission from incident post-disaster mental disorders was slower in the shelter group than in the general population. Post-disaster mental health service could consider the greater incidence in the first year and prolonged remission of mental disorders among survivors with a long-term stay in temporary housing after a disaster.
Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer
Authors: Zhang Yiyi , Xu Meifang , Wu Yong , Li Shoufeng , Liu Xing , Guan Guoxian 
Published: August 2020

Abstract
Background: To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).Method: LARC patients undergoing NCRT and radical surgery from 2011 to 2018 were divided into young (<40 years) and old (≥40 years) groups. Multivariate analyses were performed to identify predictive factors for pathological complete response (pCR). Predictive nomograms and decision curve analysis were used to compare the models including/excluding age groups. Immunohistochemical analysis was performed to detect CD133 expression in LARC patients.Result: A total of 901 LARC patients were analyzed. The young group was associated with poorly differentiated tumors, more metastatic lymph nodes, higher perineural invasion, and a lower tumor regression grade (P = 0.008; P < 0.001; P < 0.001; P = 0.003). Logistic regression analysis demonstrated that age <40 years (HR = 2.190, P = 0.044), tumor size (HR = 0.538, P < 0.001), pre-NCRT cN stage (HR = 0.570, P = 0.036), and post-NCRT CEA level (HR = 0.877, P = 0.001) were significantly associated with pCR. Predictive nomograms and decision curve analysis demonstrated that the predictive ability of models including the age group was superior to that of models excluding the age group. Higher CD133 expression was more common in young LARC patients.Conclusion: Young patients with LARC were associated with lower pCR rates following NCRT. The ability of the predictive model was greater when based on the age group. Young LARC patients were associated with a higher CD133+ tumor stem cell burden, which contributed to the lower pCR rates.
Quality of Life and mortality in the general population: a systematic review and meta-analysis
Authors: Phyo Aung Zaw Zaw , Freak-Poli Rosanne , Craig Heather , Gasevic Danijela , Stocks Nigel , Gonzalez-Chica David A. , Ryan Joanne 
Published: August 2020

Abstract
Background: Quality of life (QoL) is multi-dimensional concept of an individual’ general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population.Methods: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed.Results: Of 4,184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992).Conclusion: These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.
Split household and smoking behavior of rural migrants in China
Authors: Wang Zicheng , Wu Qiushi , Ming Juan 
Published: August 2020

Abstract
Background: With Hukou constraints, a large proportion of rural migrants have to leave part of their family members stay at hometown, the split household may induce smoking behavior among rural migrants in destination cites.Objective: This study aims to address association between split household and smoking behavior, while the main discussion is to explore the differences between the three forms of split households---involving sole migration, couple migration, and family migration.Method: A unique and comprehensive database named Rural Urban Migration in China (RUMiC-2009) is applied to explore the association between split household and the smoking behavior; Analyses are conducted using the Chi-square tests and Logit regression.Results: The prevalence of smoking among family migrants (23.54%) is less than those sole migrants (25.46%) and couple migrants (35.13%). The family migrants (OR= 0.7445; 95% CI= 0.5955, 0.930) and couple migrants (OR= 0.8785; 95% CI= 0.6939, 1.1121) are less prone to smoke than the sole migrants counterparts. The family migrants (Coefficient= -0.0787; CI= -0.1229,-0.0346) and couple migrants (Coefficient= -0.0726; CI= -0.1188,-0.0264) show lower lever of depression compared with the sole migration groups.Conclusions: Split household is positively associated with the smoking behavior of rural migrants. While the depression may play as the potential transmission channel linked the spit household and smoking prevalence.
The Impact of Irregular Corneal Shape Parameters on Visual Acuity and Contrast Sensitivity
Authors: Liduma Sanita , Luguzis Artis , Krumina Gunta 
Published: August 2020

Abstract
Background: To understand which irregular corneal parameters determine the visual quality in keratoconus subjects. Methods: The cross-sectional study examined the eyes of 44 subjects, graded from the first to third keratoconus stages by Amsler-Krumeich classification. We obtained measurements in two ways: (a) by projecting two perpendicular axes onto a cornea (first, through the central point of the cornea and keratoconus apex; second, as the perpendicular axis) to read the elevation values at points on these axes as parameters characterising the corneal surface; (b) by projecting circles with different diameters around the central part of the cornea (1, 2, and 3 mm) and reading elevation values at points equally displaced on these circles as parameters characterising an anterior surface slope. Irregular corneal shape parameters’ correlations with visual acuity and contrast sensitivity were determined in order to understand which corneal slope parameter has the strongest correlation with visual acuity and contrast sensitivity.Results: .Parameters characterising the corneal surface’s correlations with contrast sensitivity were from r=0.25 (p=0.03) at 3 cpd to r=0.47 (p<0.01) at 9 cpd for the highest elevation and from r=0.33 (p=0.09) at 5 cpd to r=0.40 (p<0.01) at 11 cpd for the lowest elevation in all subjects together, while for visual acuity the parameters were r=0.30 (p<0.01) for the highest elevation and r=0.21 (p=0.06) for the lowest elevation in all subjects together. The correlation between contrast sensitivity and the highest and lowest corneal point in all measured cornea was stronger for subjects with a peripheral corneal apex than for those with a central apex. In keratoconus subjects, contrast sensitivity displayed a strong correlation with slope in the central part of the cornea (with a radius of 1 mm) ranging from 0.48 (p<0.01) at 3 cpd to 0.61 (p<0.01) at 9 cpd.Conclusion: Contrast sensitivity has a higher correlation with corneal shape parameters than with visual acuity. Subjects with a peripheral corneal apex had stronger correlations with visual acuity and contrast sensitivity than did subjects with a central apex. In keratoconus subjects, the strongest correlation was for contrast sensitivity and elevation (slope) in the region within a 1 mm radius of the corneal centre in the opposite direction of the keratoconus apex (direction (ax) CB).
Energy efficiency in an integrated agro-ecosystem within an acidic soil area of the Mekong delta, Vietnam
Authors: Thao Nguyen Thi Thu , Tung Tra Van , Thao Nguyen Thi Phuong , Thanh Son Le , Braunegg Sibylle , Braunegg Gerhart , Schnitzer Hans , Le Hai Thanh 
Published: August 2020

Abstract
Background: Both exergy and energy analysis methodologies are used for analysing energy efficiencies in various processes, including agriculture. This study focuses on the connection of three main process components (husbandry-crop-fishpond) in a typical farming household located within an acid soil region of rural Vietnam. The concept of exergy analysis is used to underline the potential for resource efficiency in alternative processes in the agricultural system. For development of an integrated ecological system aiming towards zero-emissions, the analytical methods of material cycles and energy flows utilized a set of indicators of resource efficiency in a sustainable agriculture.Results: The design of the ideal integrated farming system “Agro-Industrial Zero Emissions Systems” (AIZES) can increase the system efficiency by making use of indigenous natural materials and waste reuse/recycling. Recycling waste produce energy, fish feed and fertilizer can result in a decreased environmental load of approximately half. Using exergy analysis to calculate an indicator non-renewable yield ratio (NRYR), the systems verified sustainability of agriculture production.Conclusions: The farming household will be able to subsidize their fuel and electricity consumption by utilizing biogas.. Surplus biogas will be distributed to proximate households, further creating sustainable goals. Biochar, created by mixing the biomass residues with local plants, will improve soil quality and pig sludge, mixed with biomass residue, will create high-quality fertilizer.
Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac disease
Authors: Leonard Maureen M , Karathia Hiren , Pujolassos Meritxell , Troisi Jacopo , Valitutti Francesco , Subramanian Poorani , Camhi Stephanie , Kenyon Victoria , Colucci Angelo , Serena Gloria , Cucchiara Salvatore , Montuori Monica , Malamisura Basilio , Francavilla Ruggiero , Elli Luca , Fanelli Brian , Colwell Rita , Hasan Nur , Zomorrodi Ali R , Fasano Alessio , Team CDGEMM Study 
Published: August 2020

Abstract
Background: Celiac disease (CD) is an autoimmune digestive disorder that occurs in genetically susceptible individuals in response to ingesting gluten, a protein found in wheat, rye, and barley. Research shows that genetic predisposition and exposure to gluten are necessary but not sufficient to trigger the development of CD. This suggests that exposure to other environmental stimuli early in life, e.g., cesarean section delivery, exposure to antibiotics or formula feeding, may also play a key role in CD pathogenesis through yet unknown mechanisms. Here, we use multi-omics analysis to investigate how genetic and early environmental risk factors alter the development of the gut microbiota in infants at risk of CD. Results: Toward this end, we selected 31 infants from a large-scale prospective birth cohort study of infants with a first-degree relative with CD. We then performed rigorous multivariate association, cross-sectional and longitudinal analyses using metagenomic and metabolomic data collected at birth, three months and six months of age to explore the impact of genetic predisposition and environmental risk factors on the gut microbiota composition, function and metabolome prior to the introduction of trigger (gluten). These analyses revealed several microbial species, functional pathways and metabolites that are associated with each genetic and environmental risk factor or that are differentially abundant between environmentally exposed and non-exposed infants or between time points. Among our significant findings, we found that cesarean section delivery is associated with a decreased abundance of Bacteroides vulgatus and Bacteroides dorei and of folate biosynthesis pathway, and with an increased abundance of hydroxyphenylacetic acid, alterations that are implicated in immune system dysfunction and inflammatory conditions. Additionally, longitudinal analysis revealed that, in infants not exposed to any environmental risk factor, the abundances of Bacteroides uniformis and of metabolite 3-3-hydroxyphenylproprionic acid increase over time while those for lipoic acid and methane metabolism pathways decrease, patterns that are linked to beneficial immunomodulatory and anti-inflammatory effects. Conclusions: Overall, our study provides unprecedented insights into major taxonomic and functional shifts in the developing gut microbiota of infants at risk of CD linking genetic and environmental risk factors to detrimental immunomodulatory and inflammatory effects.
Impact of sample size on the stability of risk scores from clinical prediction models: a case study in cardiovascular disease
Authors: Pate Alexander , Emsley Richard , Sperrin Matthew , Martin Glen P. , Staa Tjeerd van 
Published: August 2020

Abstract
Background: Stability of risk estimates from prediction models may be highly dependent on the sample size of the dataset available for model derivation. In this paper, we evaluate the stability of cardiovascular disease risk scores for individual patients when using different sample sizes for model derivation; such sample sizes include those similar to models recommended in national guidelines, and those based on recently published sample size formula for prediction models.Methods: We mimicked the process of sampling N patients from a population to develop a risk prediction model by sampling patients from the Clinical Practice Research Datalink. A cardiovascular disease risk prediction model was developed on this sample and used to generate risk scores for an independent cohort of patients. This process was repeated 1000 times, giving a distribution of risks for each patient. N = 100 000, 50 000, 10 000, Nmin (derived from sample size formula) and Nepv10 (meets 10 events per predictor rule) were considered. The 5 – 95 percentile range of risks across these models was used to evaluate instability. Patients were grouped by a risk derived from a model developed on the entire population (population derived risk) to summarise results.Results: For a sample size of 100 000, the median 5 – 95 percentile range of risks for patients across the 1000 models was 0.77%, 1.60%, 2.42% and 3.22% for patients with population derived risks of 4-5%, 9-10%, 14-15% and 19-20% respectively, for N = 10 000 it was 2.49%, 5.23%, 7.92% and 10.59%, and for N using the formula derived sample size, it was 6.79%, 14.41%, 21.89% and 29.21%. Restricting this analysis to models with high discrimination, good calibration or small mean absolute prediction error reduced the percentile range, but high levels of instability remained.Conclusions: Widely used cardiovascular disease risk prediction models suffer from high levels of instability induced by sampling variation. Many models will also suffer from overfitting (a closely linked concept), but at acceptable levels of overfitting there may still be high levels of instability in individual risk. Stability of risk estimates should be a criterion when determining the minimum sample size to develop models.
Sagittal Abdominal Diameter and its Socioeconomic Correlates: Perspective of Sex Differences
Authors: Li Chang , Harris Marcelline , Tsilimingras Dennis , Liu Sophia , Sheng Ying , Liu Xuefeng 
Published: August 2020

Abstract
Background Sagittal abdominal diameter (SAD) is an anthropometric index associated with visceral adiposity. It remains unclear whether SAD and its socio-economic correlates differ in women and men, which limits the epidemiological and clinical applications of the SAD measurement. The aims of this study are to examine the sex differences in SAD and its socio-economic correlates. Methods A complex stratified multistage clustered sampling design was used to select 6,975 men and 7,079 women aged 18 years or more from the National Health Nutrition and Examination Survey 2011-2016, representative of the US civilian non-institutionalized population. SAD was measured in accordance to the standard protocols using a two-arm abdominal caliper. The sex differences in SAD and its socio-economic correlates were evaluated by performing weighted independent t tests and weighted multiple regression. Results SAD was lower in women than in men in the entire sample, as well as in all subgroups characterized by age, race, body mass index, birth place, and household income except for non-Hispanic blacks and those with household income < $20,000. Adjusted for other characteristics, SAD increased with age and body mass index for both women and men (p<.0001). Compared to white women, Asian women were associated with lower SAD (p=.018), and black women with higher SAD (p<.0001). Compared to white men, Hispanic and Asian men were associated with lower SAD (both p<.0001). Women born in other countries were more likely to have lower SAD than women born in the US (p<.0001), and so were men (p=.0118). Both women and men with a household income of <$75,000 had higher SAD than those with an income of over $75,000. Conclusion SAD is lower in women than in men, in the general population as well as in the most socio-economic subgroups. Socio-economic correlates of SAD were similar in women and men.