bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal, South Africa
Authors: Hlongwa Mbuzeleni , Peltzer Karl , Hlongwana Khumbulani 
Published: March 2020

Abstract
Background: Despite several intervention programmes in South Africa, risky sexual behaviours among women of reproductive age remain a public health concern, thereby making them prone to unintended pregnancies, human immunodeficiency virus (HIV) infection and/or sexually transmitted infections (STIs). This study investigated the predictors of risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal (KZN), South Africa.Methods: This was a cross-sectional study conducted among 471 women of reproductive age (18-49 years, mean: 25.83) in 10 public health clinics in Umlazi township, using a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson Chi-square test and logistic regression models (bivariate and multivariate) were employed to assess the level of the association between the predictor and outcome variables and the p-value 0.05 or lower was considered statistically significant.Results: More than half (51.80%) of women were aged 18-24 years and only a handful (18.26%) had tertiary qualification. The majority were single (88.96%) and the unemployed accounted for 53.50%. This study found that women who talked about condoms with their partners in the past 12 months were more likely (p=<0.0001) to have used condoms during their last sexual experience. Older women (p=0.035) were more likely to use a condom at last sex, compared to younger women. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had ever been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use during last sexual experience.Conclusion: Exposure to physical partner violence and poor partner discussions about condoms are key deterrents to condom usage. Holistic interventions are required in order to address the risky behaviours, and consequently reduce sexually transmitted infections and/or unintended pregnancies.
A comparison, for older people with diabetes, of health and health care utilisation in two different health systems on the island of Ireland
Authors: Pierse Tom , Barry Luke , Glynn Liam , Murphy Andrew , Cruise Sharon , O’Neill Ciaran 
Published: March 2020

Abstract
Background Primary care policies for diabetes have differed between Northern Ireland (NI) and the Republic of Ireland (ROI). In NI, the Quality and Outcomes Framework (QOF) system was adopted in 2004. In ROI, prior to the Cycle of Care programme being established in 2015 specific financial support for GPs providing diabetic primary care was not available. The aims of this study are to compare health and healthcare utilisation among people with diabetes in the NI and ROI.Methods Large scale comparable surveys of people over 50 years of age in Northern Ireland (NICOLA) and the Republic of Ireland (TILDA) are used to compare people with diabetes (Type I and Type II) in the two jurisdictions. The combined data set comprises 1,536 people with diabetes. A coarsened exact matching approach is used to compare health care utilisation among people with diabetes in NI and ROI with equivalent demographic, lifestyle and illness characteristics.Results The overall prevalence in the 50 to 84 years old age group is 3.4 percentage points higher in NI (11.1% in NI, 7.7% ROI, p-value < 0.01). The diabetic population in NI also appear sicker – with more diabetic complications and more chronic illnesses. Comparing people with diabetes in the two jurisdictions with similar levels of illness we find that there are no statistically significant differences in GP, outpatient or A&E utilisation.Conclusion There are a range of factors that influence the quality of primary care for people with diabetes. While the QOF system in Northern Ireland is likely to have improved some aspects of care by providing financial incentives for identification and management, unless accompanied by improved access to care their ability to impact on outcomes may be compromised.
Identification and Validation of an Individualized Autophagy-Clinical Prognostic Index in Gastric Cancer Patients
Authors: Qiu Jieping , Sun Mengyu , Wang Yaoqun , Chen Bo 
Published: March 2020

Abstract
Background: The purpose of this study is to perform bioinformatics analysis of autophagy-related genes in gastric cancer, and to construct a multi-gene joint signature for predicting the prognosis of gastric cancer.Methods: GO and KEGG analysis were applied for differentially expressed autophagy-related genes in gastric cancer, and PPI network was constructed in Cytoscpae software. In order to optimize the prognosis evaluation system of gastric cancer, we established a prognosis model integrating autophagy-related genes. We used single factor Cox proportional risk regression analysis to screen genes related to prognosis from 222 autophagy-related genes in The Atlas Cancer Genome (TCGA) gastric cancer cohort. Then, the generated genes were applied to the Least Absolute Shrinkage and Selection Operator (LASSO). Finally, the selected genes were further included in the multivariate Cox proportional hazard regression analysis to establish the prognosis model. According to the median risk score, patients were divided into high-risk group and low-risk group, and survival analysis was conducted to evaluate the prognostic value of risk score. Finally, by combining clinical features and prognostic gene signatures, a nomogram was established to predict individual survival probability.Results: GO analysis showed that the 38 differently expressed autophagy-related genes was enriched in cell growth, neuron death, and regulation of cell growth. KEGG analysis showed that the 38 differently expressed autophagy-related genes were related to platinum drug resistance, apoptosis and p53 signaling pathway. The risk score was constructed based on 4 genes (GRID2, ATG4D,GABARAPL2, CXCR4), and gastric cancer patients were significantly divided into high-risk and low-risk groups according to overall survival. In multivariate Cox regression analysis, risk score was still an independent prognostic factor (HR = 1.922, 95% CI = 1.573-2.349, P < 0.001). Cumulative curve showed that the survival time of patients with low-risk score was significantly longer than that of patients with high-risk score (P < 0.001). The external data GSE62254 proved that nomograph had a great ability to evaluate the prognosis of individual gastric cancer patients.Conclusions: This study provides a potential prognostic marker for predicting the prognosis of GC patients and the molecular biology of GC autophagy.
Clinical significance of extranodal extension in sentinel lymph node positive breast cancers
Authors: Yang Xia , Ma Xiaoxi , Yang Wentao , Shui Ruohong 
Published: March 2020

Abstract
Background The precise stage of lymph node (LN) metastasis is a strong prognostic factor in breast cancer, and sentinel lymph node (SLN) is the first station of nodal metastasis, whereas the clinical value of extranodal extension (ENE) in SLN are still in exploration.Objective Our study aimed to evaluate the predictive and prognostic values of ENE in SLN and to investigate the feasibility of ENE to predict non-SLN metastasis, disease free survival (DFS) and overall survival (OS) in clinical practice.Methods 183 cases of primary invasive breast cancer (cT1-2N0 breast cancer with 1-2 positive SLNs) underwent SLN biopsy and axillary lymph node dissection (ALND) between 2008 and 2015 were extracted from the pathology database of Fudan University Shanghai Cancer Center. Sections were reviewed for the microscopic features of SLN, including the number and pattern of SLN metastasis, SLNs positive ratio, nodal vascular invasion (NVI), and ENE. The associations between tumor features including ENE and non-SLN metastasis, DFS and OS were analyzed. Moreover, ENE was subclassified into circumferential (CD-ENE) and perpendicular (PD-ENE) and set a threshold as 2mm or 3mm to evaluate the prognostic value of ENE.Results 73/183 (39.9 %) cases were positive for ENE in SLN. Logistic regression analysis indicated that ENE, the number and pattern of SLN involvement, SLN positive ratio, and NVI were significantly associated with the presence of non-SLN metastasis in univariate analysis. ENE, higher number of SLN involvement, SLN macrometastasis, and NVI were significantly associated with a higher rate of non-SLN metastasis in multivariate analysis. Cox regression analysis showed ENE in SLN was associated with DFS and OS in univariable analysis, but not in multivariable analysis. Whereas the size of ENE (CD-ENE and PD-ENE) subdivided by 3mm (or 2mm) cutoff values were not found as strongly prognostic factors of DFS and OS as well.Conclusions Our study indicated that ENE in SLN was a predictor for non-SLN metastasis in breast cancers, patients with ENE in SLN had a higher rate of non-SLN metastasis. ENE in SLN was associated with DFS and OS in univariable analysis, but not in multivariable analysis. The size of ENE (CD-ENE and PD-ENE) which was classified by a 3mm (or 2mm) cutoff value had no significant prognostic values in this study. The prognostic value of ENE in SLN and the cutoff values of ENE in SLN in breast cancers need further investigation.
Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients
Authors: Hata Taigo , Mise Yoshihiro , Ono Yoshihiro , Sato Takafumi , Inoue Yosuke , Ito Hiromichi , Takahashi Yu , Yanaga Katsuhiko , Saiura Akio 
Published: March 2020

Abstract
Background Limited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs. Methods We reviewed treatment and outcomes for patients in different age groups who underwent initial hepatectomy for CRLMs from 2004 through 2012. Results We studied 462 patients who were divided into three groups by age: ≤ 64 years (n = 265), 65–74 years (n = 151), and ≥ 75 years (n = 46). The rate of major hepatectomy and incidence of postoperative complications did not differ between groups. Adjuvant chemotherapy was used less in the ≥ 75 -year group (19.6%) than that in the ≤ 64 (54.3%) or 65–74 age group (43.5%). Repeat hepatectomy for liver recurrence was performed less in the ≥ 75 -year group (35%) than in the ≤ 64 (57%) or 65–74 (66%) age group. The 5-year disease-specific survival (DSS) rate of 44.2% in the ≥ 75 -year group was lower than in the ≤ 64 (59.0%) or 65–74 (64.7%) age group. Multivariate analysis revealed age ≥ 75 years was an independent predictor of poor DSS. Conclusions Liver resection for CRLMs can be performed safely in elderly patients. However, repeat resection for recurrence are performed less frequently in the elderly, which may lead to the poorer disease-specific prognosis.
Meta-analysis and trial sequential analysis of LncRNA H19 polymorphic variants on susceptibility to cancer
Authors: Wang Kunpeng , Zhu Zheng , Wang Yiqiu , Zong Dayuan , Xue Peng , Gu Jinbao , Lu Daoyuan , Tu Chuanquan 
Published: March 2020

Abstract
Background: Although myriad researches upon the associations between LncRNA H19 polymorphic variants (rs2839698 G﹥A, rs3024270 C﹥G, rs2107425 C﹥T, rs2735971 A﹥G and rs217727 G﹥A) and the susceptibility to cancer have been conducted, these results remained contradictory and perplexing. Basing on that, a systematic review and updated meta-analysis was conducted to anticipate a fairly precise assessment about these associations. Methods: We retrieved the electronic databases EMBASE, PubMed and Web of Science for valuable academic studies before October 1st, 2019. Ultimately, 24 of which were encompassed after screening, and the available data was extracted and integrated. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) was adopted to evaluate the strength of these associations. For multi-level investigation, subgroup analysis derived from source of controls together with genotypic method was preformed. Eventually, 24 articles altogether embodying 52 studies were included. Results: The results illuminated that LncRNA H19 SNPs mentioned above were all irrelevant to cancer susceptibility. Nevertheless, crucial results were found concentrated in population-based control group when subgroup analysis by source of controls were performed in H19 mutation rs2839698 and rs2735971. Meanwhile, in the stratification analysis by genotypic method, apparent cancer risks were discovered by TaqMan method in H19 mutation rs2107425 and rs3024270. Then, trial sequential analysis (TSA) demonstrated that the results about such associations were firm evidence of effect, except rs2735971 polymorphism. Conclusion: Therefore, this meta-analysis indicated that LncRNA H19 SNPs were not associated with the susceptibility to human cancer. However, after the stratification analysis, inconsistent results still existed in different genotypic method and source of control. Thus, more high-quality studies on cancer patients of different factors were needed to confirm these findings.
Drug sensitivity of Plasmodium falciparum field isolates to selected antimalarial drugs in Ghana using the in-vitro DAPI assay
Authors: Ofori Michael Fokuo , Kploanyi Emma E. , Mensah Benedicta A. , Dickson Emmanuel K. , Baafour Eric Kyei , Gyabaa Sampson , Tetteh Mary , Koram Kwadwo A. , Abuaku Benjamin K. , Ghansah Anita 
Published: March 2020

Abstract
Background: Malaria continues to be a major health issue globally with nine out of ten cases reported in Africa. Although the current artemisinin derived combination therapies in Ghana are still efficacious against the Plasmodium falciparum parasite, compounding evidence of artemisinin and amodiaquine resistance in the African region establish the need for a full, up-to-date understanding and monitoring of antimalarial resistance to provide evidence for planning control strategies.Methods: The study was cross-sectional and was conducted during the peak transmission seasons of 2015, 2016, and 2017 in two study sites located in different ecological zones of Ghana involving children aged 0.5-14 years presenting with symptomatic uncomplicated Plasmodium falciparum (Pf) malaria with parasitaemia greater than 1000 parasites/µl of blood. Using in vitro 4-,6-diamidino-2-phenylindole (DAPI) drug sensitivity assays, 328 Pf parasites collected were used to investigate susceptibility to five selected antimalarial drugs: chloroquine, amodiaquine, dihydroartemisinin, artesunate and mefloquine.Results: The geometric mean B (GMIC50) of five drugs against the parasites collected from Cape Coast were 9.6, 23.6, 9.1, 3.5 and 8.1nM for chloroquine, amodiaquine, artemisinin, artesunate, and mefloquine respectively in 2015. There was a 2 fold increase in the GMIC50 levels of all the drugs against the isolates collected in 2016 as compared to the 2015 data from Cape Coast .The a of the five drugs against the parasites collected from Cape Coast were significantly higher than those isolates collected from Begoro in 2016 and 2017 (P<0.001) . The chloroquine resistance ranged between 1.9% and 9.1% among isolates collected from Cape Coast but remained 0% in Begoro over the period. High amodiaquine resistance levels were recorded at both sites whilst that of artesunate resistance ranged between 4 and 10% over the study period.Conclusions: The study has assessed the antimalarial drug sensitivities of Ghanaian Pf isolates collected over 3 consecutive years. The parasites showed variable resistance levels to all the drugs used over the period. The study has demonstrated the continual return of chloroquine-sensitive parasites. The in vitro DAPI assay is a useful method for monitoring individual drugs used in combinations in Ghana for the generation of data on their sensitivities over time.
Knowledge, Awareness and Practices of Malaria in Western Area Rural District, Sierra Leone: A Household-based Cross-sectional Survey in the Middle of National Malaria Strategic Plan (2016-2020)
Authors: WANG Lili , Yin Jianhai , Zheng Canjun , Smith Samuel Juana , Ngegba Esther , Huang Xiaoxia , Kamara Anitta , Chen Xia , Wang Xu , Luo Wei , Kan Biao 
Published: March 2020

Abstract
BackgroundThe malaria epidemic is high in Sierra Leone, and the implementation of the National Malaria Strategic Plan (2016-2020) has reached its middle stage. In order to guide the interventions more specifically in future, a household-based cross-sectional survey was conducted to understand the public perception of knowledge, attitudes and practices of malaria and its control.MethodsThree communities (Grafton, Jui and Kossoh) in Western Area Rural District within close proximity to Sierra Leone’s capital city of Freetown were included. Households were randomly selected and interviewed with a structural questionnaire covering malaria infection, diagnosis, treatment and prevention, as well as the knowledge of malaria prevention, in collaboration with the National Malaria Control Program of the Ministry of Health and Sanitation, Sierra Leone.ResultsA total of 262 qualified questionnaires were included. The average cost for meals per day is around 30000 Leones in each household. The awareness rate of having heard of malaria is 98.1% (257/262) and knowing mosquito biting as its main route of transmission is 86.6% (227/262) respectively. And 80.9% (212/262) of the respondents sought health advice or treatment for the illness, and similar percentage of them could be tested for malaria, mostly through RDTs. A great demand of long-lasting insecticidal nets (72.1%) was raised to fulfill the high shortage (61.8%, 162/262) in households, and of them there were 66 families having children under five years old.Conclusion﻿Malaria burden is still high. Although public awareness of malaria prevention sounds well in this survey, the fact that the use of preventive measures against malaria is low in households within the three communities. It is suggested that an advanced campaign should be carried out to scale up not only the knowledge on malaria but also the actual usage of malaria prevention measures.
Supply of and demand for radiologic technologist personnel in Taiwan: an analysis of 20 years
Authors: Tyan Yeu-Sheng , Chou Ying-Hsiang , Tsai Hui-Yu , Chen Tou-Rong 
Published: March 2020

Abstract
Background: Currently, nine universities and one junior college offer radiologic technologist (RT) programs (RTPs) in Taiwan. The curriculum, certificate examination, and licensing of RTs in RTPs in Taiwan are similar to those for RTPs in Japan and Korea. The present study explored the supply of and demand for RTs over the past 20 years and identified predictive indicators of trends affecting the numbers of RTs supplied and demanded.Methods: The present study involved web-based research. The analyzed data were publicly available information downloaded from the websites of relevant statistical departments in Taiwan. The study employed specific medical devices or examinations used in hospitals to determine the demand for RTs. Long-term (1999–2018) and short-term (2014–2018) trends were analyzed. The change rates were calculated using compound annual growth rate (CAGR). Pearson’s product–moment correlation coefficient or Spearman’s rank correlation coefficient was used to evaluate two groups of continuous variables. Kolmogorov–Smirnov and Shapiro–Wilk tests were used to test normally distributed data.Results: During 1999–2018, the annual numbers of students and graduates in RTPs were 2654 ± 350 and 516 ± 109, respectively, with corresponding CAGRs of 2.2% and 3.7%. During 2014–2018, the annual numbers of students and graduates in the RTPs were 2908 ± 67 and 605 ± 55, respectively, with corresponding CAGRs of −0.7% and 2.4%. During 1999–2018, the annual numbers of examinees and qualified personnel were 1228 ± 174 and 372 ± 62, respectively. The CAGRs for the number of qualified personnel were −1.5% and −4.7% during 1999–2018 and 2014–2018, respectively. The number of specific medical devices increased from 599 in 2000 to 1057 in 2018, whereas that of specific medical examinations increased from 1.7 million in 2000 to 5.3 million in 2018.Conclusion: During 2014–2018, 605 students graduated from RTPs annually, with approximately 375 annually becoming qualified personnel in Taiwan. The increase in the numbers of specific medical devices and examinations resulted in an annual increase of 204 new positions for RTs.
Osteotomies combined with soft tissue procedures for symptomatic flexible flatfoot deformity in children
Authors: WEN Xiaodong , Nie Guanghua , Zhao Hongmou , Lu Jun , Liang Xiaojun , Wang Xinwen , Liang Jingqi , Zhang Yan , Guo Rui , Li Yi 
Published: March 2020

Abstract
Background: The indications for surgery, timing, and procedure in children with flexible flatfoot deformity remain controversial. For marked deformities, combined procedures are preferred to correct multiple plane deformities. Thus, this study aimed to evaluate the outcomes of osteotomies combined with soft tissue procedures in children with flexible flatfoot aged 9-14 years.Methods: From July 2014 to October 2017, 28 children (47 feet) with flexible flatfoot with an average age of 11.7±2.1 (range 9-14) years underwent osteotomy combined with soft tissue surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Foot and Ankle Outcome Score (FAOS) were used to evaluate the preoperative and postoperative clinical outcomes. The talo-navicular coverage angle (TNCA) and talar–first metatarsal angle (T1MA) on the foot anteroposterior view, calcaneal pitch angle and Meary’s angle on the foot lateral view, and calcaneus valgus angle (CVA) on the Saltzman view were also observed.Results: All patients were followed up for an average duration of 29.7±8.6 months. Mean AOFAS and FAOS significantly improved from 56.6±8.0 and 47.4±9.5 preoperatively to 88.4±3.9 and 83.2±6.8 at final follow-up (P<0.001). respectively. There were statistically significant differences between preoperative and postoperative scores in all FAOS subscales (P<0.001). Radiographic parameters, such as TNCA (P<0.001) and T1MT (P<0.001) on foot AP views, calcaneal pitch angle (P=0.014) and Meary,s angle (P<0.001) on foot lateral views, and CVA (P<0.001) on Saltzman views, were significantly improved. All patients and their parents were satisfied with the functional outcomes.Conclusion: Osteotomies combined with soft tissue procedures are an effective strategy for flexible flatfoot deformity in children, as it results in favorable radiographic and functional outcomes.