bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of workplace breastfeeding in a provincial government setting: A qualitative exploratory study among managers and mothers in South Africa
Authors: Mabaso Prudence Bongekile , Jaga Ameeta , Doherty Tanya 
Published: October 2020

Abstract
Background: Return to employment is a major barrier to breastfeeding continuation, globally and in the Southern African context. The Lancet breastfeeding series revealed an explicit need for research exploring breastfeeding as a workplace issue in low- and middle-income countries. A dearth of research on workplace breastfeeding in South Africa calls for attention to this topic. This study sought to explore breastfeeding at work experiences from the perspective of employed mothers and senior managers in a provincial government setting in South Africa. Methods: The study adopted an exploratory qualitative design with multi-perspective semi-structured interviews. Snowball sampling was employed to recruit twelve participants, senior managers (n = 4) and employed mothers (n = 8), from two provincial government departments in Cape Town, South Africa. Interviews were conducted between April and August 2018 to capture participants’ experiences with breastfeeding in the workplace. Thematic analysis was used to analyse data. Results: Four key themes that described experiences of workplace breastfeeding emerged which further traversed three critical maternity periods: pregnancy, maternity leave, and return to work. The prevalent themes were: 1) Knowledge about the legislation and breastfeeding support benefits. Most participants only knew about the legislated four months maternity leave and time off for prenatal visits but lacked knowledge about comprehensive maternity benefits; 2) Perceptions and experiences of breastfeeding in the workplace. Breastfeeding was perceived to be a mother’s responsibility and a private issue. As a result, most participants stopped breastfeeding prior to or immediately upon return to work after maternity leave; 3) Barriers to breastfeeding continuation, such as the absence of a conversation about infant feeding plans between managers and mothers; and 4) Recommendations to improve breastfeeding support at work from an individual, organisational and national level. Conclusion: Our study contributions emphasise that breastfeeding support from managers should begin prior to the mother taking maternity leave, and that in addition to providing supportive facilities (such as private space and breastmilk storage), immediate supervisor support may be critical in fostering breastfeeding-friendly workplaces for mothers. Management implications for advancing workplace breastfeeding support in the public sector are presented.
A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa
Authors: Brijkumar Jaysingh , Johnson Brent , Zhao Yuan , Edwards Alex , Moodley Pravi , Pathan Khairoonisa , Pillay Selvan , Castro Kenneth , Sunpath Henry , Kuritzkes Dan , Moosa Yunus , Marconi Vincent 
Published: October 2020

Abstract
Background: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. Methods: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.Results: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p<0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p<0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.Conclusions: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
The MD-PhD Program in Geneva: A 10-Year Analysis of Graduate Demographics and Outcomes
Authors: ROCHA ANDRE DOS SANTOS , Combescure Cristophe , Negro Francesco 
Published: October 2020

Abstract
Background: MD-PhD programs confer degrees that empower medical doctors with in-depth scientific skills to contribute to biomedical research and academic medicine, alongside clinical practice. Whilst the career options and research opportunities related to graduates following these programs in the US are well documented, little is known about their European counterparts. In this article, we studied graduates who had completed the MD-PhD program at the University of Geneva between 2010 and 2019.Methods: A cross-sectional survey was performed in April 2019, targeting all medical doctors who had obtained the MD-PhD degree from the University of Geneva since 2010. Demographics, opinions, and career outcomes of the MD-PhD graduates were assessed through an online anonymous questionnaire.Results: Twenty-one questionnaires were collected from 31 MD-PhD graduates (response rate 65.5%). Most respondents (57.1%) had performed an MD-PhD training in basic sciences; however, only 14.3% had pursued this type of research thereafter. Most of the respondents held a position at a University hospital (90.5%), although a significant number of them were no longer involved in research in their current position (28.6%). 85.7% mentioned obstacles and challenges in combining clinical duties with research. Despite this, the majority (85.7%) declared that the MD-PhD degree had given them advantages in their career path, granting access to clinical and academic positions, as well as funding. Conclusions: Graduates from the MD-PhD program in Geneva were for the most part, satisfied with their training. However, because of the challenges and obstacles in combining clinical duties with research, the implementation of research activities in their current position proved difficult.
Clinical features of a Chinese female nongestational choriocarcinoma cohort: a retrospective study of 37 patients
Authors: Shao Yuming , Xiang Yang , Jiang Fang , Pan Boju , Wan Xirun , Yang Junjun , Feng Fengzhi , Ren Tong , Zhao Jun 
Published: October 2020

Abstract
Background Choriocarcinoma is a rare malignant neoplasm, which is classified as either gestational choriocarcinoma or nongestational choriocarcinoma. The purpose of this study was to examine the clinical characteristics of Chinese female nongestational choriocarcinoma patients and discuss our experience in treating this rare disease. Results We conducted a single-center retrospective study on a sample of 37 nongestational choriocarcinoma patients who were diagnosed and treated at Peking Union Medical College Hospital from March 1982 to March 2020. Their demographic, clinical, laboratory, and therapeutic data were collected. Detailed information was available for all 37 individuals in our sample. The primary lesions included 34 in the ovaries, 2 in the pituitary and 1 in the stomach. The median age of onset was 22 years, and the median follow-up period spanned 41 months. The lungs (40.5%) were the most commonly observed metastatic site. All subjects were treated with surgery and multidrug chemotherapies, and a median of 4.0 courses was required to achieve complete remission. The overall complete response rate, relapse rate, and 3-year and 5-year survival rates were 81.1%, 16.7%, 80.0%, and 75.5%, respectively. Conclusions Nongestational choriocarcinoma can be managed well using surgery and multidrug chemotherapies, but the overall outcome of nongestational choriocarcinoma is still worse than that of gestational choriocarcinoma. Mixed nongestational choriocarcinoma seems to have similar therapeutic outcomes as pure tumors.
Investigating the effect of social networking site use on mental health in an 18-34 year-old general population. A cross-sectional study using the 2016 Scania Public Health Survey.&nbsp;
Authors: Scott Emily Stella , Canivet Catarina A. , Östergren Per-Olof 
Published: October 2020

Abstract
Background: Social Networking Sites (SNS) are commonly used, especially by young adults. Their impact on mental health is unclear. Moreover, little is known about how social factors, e.g. Perceived Emotional Support (PES), may affect this association. Mental health issues are increasingly burdening the young generation and society as a whole. This study aims to investigate the association between frequency of SNS use and number of SNS contacts with the mental health of a young, Swedish population. Additionally, the potential effect modification of PES will be analysed in regard to these relationships.Method: This cross-sectional study applied logistic regression analyses to data on 1,341 participants (aged 18-34), retrieved from the Scania Public Health Survey (2016). Analyses were stratified by gender and the GHQ-12 scale assessed poor mental health. A 2-way interaction model was used to test for effect modification by PES regarding the association between SNS use and mental health.Results: Increased risk for poor mental health were found in women only. Using SNS almost hourly vs. less often resulted in an odds ratio (OR) of 1.66 (95% confidence interval (CI) = 1.16–2.38). The corresponding figures for having ≥600 contacts vs. ≤599 were (1.89; 1.21–2.97). Having low PES and using SNS almost hourly was associated with an OR of 3.12 (CI = 1.69–5.76; synergy index (SI) = 1.25). Low PES and ≥600 contacts resulted in an OR of 6.07 (CI = 1.73–21.33), whereby interaction was detected (SI = 2.88).Conclusion: Women, but not men, with frequent SNS use and a high number of SNS contacts were more likely to have poor mental health, which was exacerbated in women with low PES. Facilitating PES could be an approach for improving mental health among young adults. Future studies on the use of SNS should focus more on gender analyses.
Effects of Unweighting on Gait Kinematics During Walking on a Lower-Body Positive-Pressure Treadmill in Patients with Hip Osteoarthritis
Authors: Kataoka Yoshiaki , Shimizu Tomohiro , Takeda Ryo , Tadano Shigeru , Saito Yuki , Osuka Satoshi , Ishida Tomoya , Samukawa Mina , Irie Tohru , Takahashi Daisuke , Iwasaki Norimasa , Tohyama Harukazu 
Published: October 2020

Abstract
Background: Hip osteoarthritis (OA) is a musculoskeletal condition that makes walking difficult due to pain induced by weight-bearing activities. Treadmills that support the body weight (BW) reduce the load on the lower limbs, and those equipped with a lower-body positive-pressure (LBPP) device, developed as a new method for unweighting, significantly reduce pain in patients with knee OA. However, the effects of unweighting on gait kinematics remain unclear in patients with hip OA. Therefore, we investigated the effects of unweighting on kinematics in patients with hip OA during walking on a treadmill equipped with an LBPP device.Methods: A total of 15 women with hip OA and 15 age-matched female controls wore a three-dimensional (3-D) motion analysis system and walked at a self-selected speed on the LBPP treadmill. Data regarding self-reported hip pain using a numeric rating scale (NRS) in which the scores 0 and 10 represented no pain and the worst pain, respectively, under three different BW conditions (100%, 75%, and 50%) were collected. Moreover, 3-D peak joint angles during gait under each condition were calculated and compared.Results: In the hip OA group, the NRS pain scores at 50% and 75% BW conditions significantly decreased compared with that at 100% BW condition (50%, P=0.002; 75%, P=0.026), and the peak hip extension angle decreased compared with that in the healthy controls (P=0.044). In both groups, unweighting significantly decreased the peak hip (P<0.001) and knee (P<0.001) flexion angles and increased the peak ankle plantar flexion angle (P<0.001) during walking.Conclusions: Unweighting by the LBPP treadmill decreased pain in the hip OA group but did not drastically alter the gait kinematics compared with that in the control group. Therefore, regarding the use of the LBPP treadmill for patients with hip OA, clinicians should consider the benefits of pain reduction rather than the kinematic changes.
Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)
Authors: Okello Samson , Muhihi Alfa , Mohamed Shukri F , Ameh Soter , Ochimana Caleb , Oluwasanu Abayomi Olabayo , Bolarinwa Oladimeji Akeem , Sewankambo Nelson , Danaei Goodarz 
Published: October 2020

Abstract
Background: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4 %) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.
Resveratrol attenuates cigarette smoke induced endothelial apoptosis by activating Notch1 signaling mediated autophagy
Authors: Zong Dandan , Liu Xiang-ming , Li Jin-hua , Ouyang Ruo-yun , Long Ying-jiao , Chen Ping , Chen Yan 
Published: October 2020

Abstract
Background: Increasing evidences have showed that endothelial apoptosis contributes to cigarette smoke (CS)-induced disease progression, such as chronic obstructive pulmonary disease (COPD). Our previous studies have validated Notch1 as an anti-apoptotic signaling in cigarette smoke (CS)-induced endothelial apoptosis. Resveratrol (RESV) is a naturally occurring polyphenol that exhibits an anti-apoptotic activity in endothelial cells that exposed to many kinds of destructive stimulus. However, the effects of resveratrol on Notch1 signaling in CS-induced endothelial apoptosis have not yet been fully elucidated. Therefore, the aim of this study was to examine whether RESV can protect endothelial cells from cigarette smoke induced apoptosis via regulating Notch1 signaling. Methods: Human umbilical vein endothelial cells (HUVECs) were pretreated with RESV for 2 h, followed by cotreatment with 2.5%CSE for 24h to explore the role of RESV in CSE induced endothelial apoptosis. 3-methyladenine (3-MA) or rapamycin was used to alter autophagic levels. Lentivirus Notch1 intracellular domain (LV-N1ICD) or γ-secretase inhibitor (DAPT) were used to change Notch1 expression. The expression of Notch1, autophagic and apoptotic markers were examined by Western blot and the apoptosis rate was detected by Flow cytometry analysis. Results: Our results showed that activating autophagy reduced CSE-induced endothelial apoptosis, while blocking autophagy promoted cell apoptosis in HUVECs. RESV pretreatment attenuated the CSE-induced endothelial apoptosis and activated Notch1 signaling. RESV pretreatment also increased LC3b-II and Beclin1 production, decreased p62 and mTOR expression. 3-MA treatment inhibited autophagy and aggravated CSE induced apoptosis, while rapamycin promoted autophagy, led to a decrease in cell apoptosis. LV-N1ICD transfection upregulated autophagy and reduced apoptosis. However, this protective effect was abolished by 3-MA treatment. In cells treated with DAPT, autophagy was decreased, while apoptosis was increased. RESV partly rescued the DAPT induced apoptosis by activating Notch1 signaling. Conclusion: In HUVECs, RESV attenuates CSE induced endothelial apoptosis by inducing autophagy in a Notch1-dependent manner.
On the move: Exploring Inuit and non-Inuit health service providers’ perspectives about family participation in care in Nunavik, a qualitative study.
Authors: Fraser Sarah Louise , Moulin Louise , Gaulin Dominique , Thompson Jennifer 
Published: October 2020

Abstract
Background Literature on participation in health and social services suggests that youth, and more specifically Indigenous youth, are difficult to engage within health and social services. They are less likely to access services or to actively participate in decision-making regarding their personal care. Service providers play a crucial role in engaging youth based on the ways in which they seek, establish, and maintain relationships with them and their families. The way in which they do so will depend on various factors including their own perceptions of roles and relationships of the various people involved in the life of youth. This article analyzes health and social service providers’ perspectives, experiences and expectations regarding the roles of a particular group of Indigenous youth, families and community in care settings in Nunavik, Quebec.Methods: A snowball sampling method was used to recruit participants. A total of 58 participants were interviewed including psychiatrists, general practitioners, nurses, social workers, school principals, teachers, student counsellors, representatives of local committees (education committee, health committee), and police officers. Of the 58 participants, 39 were non-Inuit and 19 were Inuit. All interviews focused on three broad areas: 1) participants’ current and past positions/roles; 2) participants’ perceptions of the clientele (youth and their families) they work with; and 3) participants’ understanding of collaborations taking place within and between services (who works with whom) and community. Inductive applied thematic analyses were conducted on the entirety of relevant data and then verbatim of Inuit and non-Inuit were analyzed separately to explore similarities and differences in perceptions based on positionality.Results: We organized findings around three themes: I) The most commonly described interventions, II) different types of challenges to and within participation; and III) what successful participation can look like according to service providers. Participants speak of the challenges for families to go towards services as well as the challenges for services providers to go towards youth and families, including personal, organisational and historical factors.Conclusion: We adopt a critical lens to reflect on the key findings in order to tease out points of tension and paradoxes that might hinder the participation of youth and families and more specifically in a social context of decolonization and self-governance of services.
Validation of the Palliative Prognostic Index, Performance Status–Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China
Authors: Zhou Jun , Xu Sitao , Cao Ziye , Tang Jing , Fang Xiang , Qin Ling , Zhou Fangping , He Yuzhen , Zhong Xueren , Hu Mingcai , Wang Yan , Lu Fengjuan , Bao Yongzheng , Dai Xiangheng , Wu Qiang 
Published: October 2020

Abstract
Background: The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status–Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China.Methods: Patients with advanced cancer admitted to the hospice center of Yuebei People’s Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. Results: A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P <0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P >0.05).Conclusions: The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.