bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal and perinatal outcomes of delivery after previous one or two cesarean section
Authors: Yadav Gunjan , Vishwakarma Kshama , Waddar Parasuram 
Published: September 2020

The prevalence of cesarean deliveries is high in many parts of world. Vaginal birth after cesarean section (VBAC) is a trial of vaginal delivery in selected cases of a previous CS in a well equipped hospital. It offers distinct advantages over a repeat caesarean section, since the operative risks are completely eliminated, the hospital stay is much shorter and expenses involved are much less.To study the maternal and perinatal outcomes among women with previous Cesarean section at a tertiary care centre.This prospective study was carried out over a period of 12 months. 979 pregnant women with previous caesarean section were recruited in study. A detailed history was taken and mode of delivery decided as per the standard protocol. 636 patients underwent elective repeat LCSC.343 patients were given trial of labour out of which 226 delivered vaginally. Maternal and neonatal outcomes were notedThe rate of successful VBAC was 65.89%. Most common indications of repeat caesarean section were fetal distress and failure to progress. Post op maternal and neonatal complications were significantly more in repeat caesarean section group. Incidence of infectious morbidity was also higher in repeat cesarean group than VBAC group.Fetal morbidity and mortality due to trial of labor is comparable with the women laboring without a scar, trial of labour may be encouraged. women given trial of labour with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one or two CS.
Prevalence of meconium stained amniotic fluid and meconium aspiration syndrome according to gestational age and parity of mother
Authors: Patel Smeet , Patel Babulal , Shah Akshay , Jani Shashwat , Jani Chinmay 
Published: September 2020

The first demonstrable meconium is found around the third month of the gestational age in the intestines of the fetus as black green color, odorless mass. Multiple conditions of intrauterine fetal distress is said to be causative reason for intrauterine passage of meconium in the amniotic fluid by the fetus. Aspiration of meconium stained amniotic fluid may lead to a gasping breathing pattern which induces hypoxia via airway obstruction, surfactant dysfunction, chemical pneumonitis, and pulmonary hypertension.The aim of the present study was to find the prevalence of various grades of meconium stained amniotic fluid as well as meconium aspiration syndrome according to gestational age and parity.The present study was a prospective observational study. It was conducted in the Obstetrics and Gynecology department of Tertiary Hospital & Medical Collage & Research Centre, Ahmedabad, Gujarat, India during May 2016 to May 2018 on 200 laboring mothers with meconium stained amniotic fluid who delivered or underwent cesarean section in the institute were included in the study. MSAF grade 1 cases were maximum 40/82(48.78%) in mothers having previous vaginal delivery. MSAF grade 2 cases were maximum 51/63(80.95%) in primigravid mothers. MSAF grade 3 cases were maximum 24/55(43.64%) in primigravid mothers. 3.96% of the primigravida patients were found to have MAS whereas 15.38% of the patients with previous vaginal delivery were having MAS. Maximum cases of grade 1 MSAF 64/82(78.05%), grade 2 MSAF 40/63(63.49%) as well as grade 3 MSAF 26/55(47.27%) were in mothers having gestational age between 37-40 weeks at the time of delivery of baby. 45.45% patients having gestational age less than 37 weeks, 4.62% of the patients having gestational age between 37-40 weeks, and 6.78% patients having gestational age greater than 40 weeks were having MAS.
Non-normative corporalities and transgender identity in English as a Foreign Language student teachers
Authors: Ubaque-Casallas Diego , Castañeda-Peña Harold 
Published: September 2020

Little international research exists on EFL (English as a Foreign Language) student teachers regarding transgender identity and non-normative corporalities. Similarly, few studies in Colombia have investigated the concept of teacher identity of transgender EFL student teachers to understand this dimension of identity. This study explores the transgender/blind identity of an EFL student teacher. The study took on identity as multiple and fluid to understand how transgender identity serves a lens to shape the process of becoming a teacher. Findings suggest that transgender identity is made from either experiences that modify or re-construct the self. The study revealed that the notion of gender is contested when the idea of transgender works as a personal mechanism to question the existing normativity of one’s own body and the self. Identity is then presented as a series of choices and performances situated in time that are validated in the transgender and blind condition.
Strategi Komunikasi Pemasaran Politik Pada Pemilu Legislatif
Authors: Batara Primus Adeodatur Latu , Prisanto Guntur Freddy , Ernungtyas Niken Febrina , Irwansyah Irwansyah , Hasna Safira 
Published: September 2020

The large number of parties in the 2019 legislative elections made political parties have to compete for political power in their constituencies. Political marketing communication strategies are needed to get the most votes and win in the democratic event every 5 years in Indonesia. East Nusa Tenggara I became one of the electoral districts that experienced fierce competition among the political parties, due to the large number of elite legislative members and political activists in this area. However, Nasdem as a new party was able to gain the most votes and won the 2019 legislative elections. Therefore, the objective of this study is to understand how the political marketing communication strategy used by Nasdem in East Nusa Tenggara Province, especially in the NTT electoral district I to win the 2019 legislative elections. The research used the concept of political parties, political campaigns, and political marketing communication using a qualitative approach and in-depth interview techniques. As a result, sales oriented political party marketing communication strategies used by Nasdem in the 2019 elections in the electoral district of East Nusa Tenggara Province I won the most votes. This strategy aims to get the number of votes from potential voters, and the representation of parties and personal figures that are 'sold' by political parties. Personal figures of the candidates have more impact for winning legislative elections than political party ideologies.
Assessment of infection in newly diagnosed multiple myeloma patients: Risk factors and main characteristics
Authors: Lin Chenyao , Shen Hui , Zhou Shuimei , Liu Minghui , Xu Anjie , Huang Shuang , Shen Changxin , Zhou Fuling 
Published: September 2020

Abstract
Background:
Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time.

Methods:
Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis.

Results:
Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P =0.040), more severe anaemia (Hb<90 g/L, P =0.044) and elevated CRP (>10 mg/L, P =0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM ( P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis ( P = 0.011), especially ISS stage III ( P =0.008) and lower haemoglobin level ( P =0.039).

Conclusions:
Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.
Interviews with experts in Rare Diseases for the development of Clinical Decision Support System software - a qualitative study
Authors: Schaaf Jannik , Prokosch Hans-Ulrich , Boeker Martin , Schaefer Johanna , Vasseur Jessica , Storf Holger , Sedlmayr Martin 
Published: September 2020

Abstract
Background Patients with rare diseases (RDs) are often diagnosed too late or not at all. Clinical decision support systems (CDSSs) could support the diagnosis in RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium, which is one of four funded consortia in the German Medical Informatics Initiative, will develop a CDSS for RDs based on distributed clinical data from ten university hospitals. This qualitative study aims to investigate (1) the relevant organizational conditions for the operation of a CDSS for RDs when diagnose patients (e.g. the diagnosis workflow), (2) which data is necessary for decision support, and (3) the appropriate user group for such a CDSS.Methods Interviews were carried out with RDs experts. Participants were recruited from staff physicians at the Rare Disease Centers (RDCs) at the MIRACUM locations, which offer diagnosis and treatment of RDs.An interview guide was developed with a category-guided deductive approach. The interviews were recorded on an audio device and then transcribed into written form. We continued data collection until all interviews were completed. Afterwards, data analysis was performed using Mayring’s qualitative content analysis approach.Results A total of seven experts were included in the study. The results show that medical center guides and physicians from RDC B-centers (with a focus on different RDs) are involved in the diagnostic process. Furthermore, interdisciplinary case discussions between physicians are conducted. The experts explained that RDs exist which cannot be fully differentiated, but rather described only by their overall symptoms or findings: diagnosis is dependent on the disease or disease group. At the end of the diagnostic process, most centers prepare a summary of the patient case. Furthermore, the experts considered both physicians and experts from the B-centers to be potential users of a CDSS. The experts also have different experiences with CDSS for RDs.Conclusions This qualitative study is a first step towards establishing the requirements for the development of a CDSS for RDs. Further research is necessary to create solutions by also including the experts on RDs.
Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study
Authors: Kim Min Kyoung , Choi Jae-Won 
Published: September 2020

Abstract
Background: Despite evidences of breastfeeding for preventing acute physical illnesses in infants, the evidence for the association between breastfeeding and long-term cognitive development is not yet convincing.Methods: The data of nationwide representative sample of 1,752 children born between 2008 and 2009 in Korea were prospectively assessed from the fetal period to examine the benefits of breastfeeding and cognitive development. Breastfeeding duration was prospectively assessed by parents. The Korean Ages and Stages Questionnaire and the Korean version of Denver II were used to assess early development annually from 5.5 to 26.2 months of age. Language development at 3 years of age was assessed with Receptive and Expressive Vocabulary Tests. Cognitive function at 8 years of age was assessed using multifactorial intelligence test.Results: In the analysis of categorical variables, children who were breastfed for >1 and ≤3 months displayed significantly higher odds ratios for delayed development assessed with Korean Ages and Stages Questionnaire at 14.1 months than those breastfed for >3 and ≤6 months (OR=2.21; 95% CI: 1.08, 4.50), but no significant differences in other rounds of assessments. In the analysis with continuous variables, there were significant differences among six groups of breastfeeding duration in communication (F=3.72; p<0.002) and problem solving (F=3.09; p<0.009) at 14.1 months, expressive language (F=3.74; p=0.002) at 3 years, and calculation (F=2.43; p<0.033) at 8 years. When analyzed by two groups, children breastfed for >3 months scored significantly higher on the communication (F = 17.71; p < 0.001) and problem-solving (F = 11.26; p < 0.001) subscales at 14.1 months, and expressive language (F=12.85; p<0.001) at 3 years, and vocabulary (F=6.78; p=0.009) and language inference (F=5.62; p=0.018) at 8 years, compared to children breastfed for 3 months or less. Conclusion: We found that cognitive development was improved in children that were breastfed for >3 months. Although these results are supported by previous studies, it is important to note that other factors were reported as larger determinants of cognitive development than breastfeeding. Future studies that examine the underlying mechanism for the association between breastfeeding and cognitive development are warranted.
Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.
Authors: Viamonte Katherine Romero , Tames Adrian Salvent , Correa Rosa Sepùlveda , Manteca María Victoria Rojo , Suárez Ana Martín 
Published: September 2020

Abstract
Background

Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences.

Methods

A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25.

Results

The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations.

Conclusions

Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.
Managerial features and outcome in neonatal intensive care units: results from a cluster analysis
Authors: Fanelli Simone , Bellù Roberto , Zangrandi Antonello , Gagliardi Luigi , Zanini Rinaldo 
Published: September 2020

Abstract
Background Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes. Methods The research was conducted in Italy, within the SONAR project. SONAR’s aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1,601 from nurses. A cluster analysis was performed to identify managerial models of NICUs. Results Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the “traditional” model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The “collaborative” model has as key elements professional specialisation and functional coordination. The “individualistic” model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model.Conclusions Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.
Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Mixed Method Study of Client Experiences
Authors: Pijl Em M. , Oosterbroek Tracy , Motz Takara , Mason Erin , Hamilton Keltie 
Published: September 2020

Abstract
Background: Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, BC, clients were prohibited from injecting their peers; only recently has this practice been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injector and recipient; the roles of ritual and pragmatism; trust and assessment of expertise; and gender relations.Methods: In this explanatory sequential mixed-methods study, participants were interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Quantitative administrative data was used to provide context and to describe the study sample in comparison to all PAIP participants. Results: PAIP clients made up only 17.4% of all SCS clients; however, 71% of all SCS visits and 83% of all overdoses occurred among PAIP clients indicating their high service utilization. The PAIP program was utilized infrequently (0.4% of all SCS visits) but was a valuable service as expressed by Program participants. Participants expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP. Conclusions: These findings reveal the humanity within a cohort of at-risk individuals, often dehumanized at the societal level. Relational equity and mutuality were evident, in contrast to other studies. Regular use of the SCS, and access to its resources, enabled participants to make healthier choices and practise lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.