bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia
Authors: Mulyanto Joko , Wibowo Yudhi , Kringos Dionne S. 
Published: January 2021

Abstract
Background
In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors.

Methods
We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers.

Results
GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score.

Conclusion
GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.
Variation in Mycobacterium tuberculosis population structure in Iran: a systemic review and meta-analysis
Authors: Hadifar Shima , Fateh Abolfazl , Pourbarkhordar Vahid , Siadat Seyed Davar , Mostafaei Shayan , Vaziri Farzam 
Published: January 2021

Abstract
Background
Acquiring comprehensive insight into the dynamics of Mycobacterium tuberculosis (Mtb) population structure is an essential step to adopt effective tuberculosis (TB) control strategies and improve therapeutic methods and vaccines. Accordingly, we performed this systematic review and meta-analysis to determine the overall prevalence of Mtb genotypes/ sublineages in Iran.

Methods
We carried out a comprehensive literature search using the international databases of MEDLINE and Scopus as well as Iranian databases. Articles published until April 2020 were selected based on the PRISMA flow diagram. The overall prevalence of the Mtb genotypes/sublineage in Iran was determined using the random effects or fixed effect model. The metafor R package and MedCalc software were employed for performing this meta-analysis.

Results
We identified 34 studies for inclusion in this study, containing 8329 clinical samples. Based on the pooled prevalence of the Mtb genotypes, NEW1 (21.94, 95% CI: 16.41–28.05%), CAS (19.21, 95% CI: 14.95–23.86%), EAI (12.95, 95% CI: 7.58–19.47%), and T (12.16, 95% CI: 9.18–15.50%) were characterized as the dominant circulating genotypes in Iran. West African (L 5/6), Cameroon, TUR and H37Rv were identified as genotypes with the lowest prevalence in Iran (< 2%). The highest pooled prevalence rates of multidrug-resistant strains were related to Beijing (2.52, 95% CI) and CAS (1.21, 95% CI).

Conclusions
This systematic review showed that Mtb populations are genetically diverse in Iran, and further studies are needed to gain a better insight into the national diversity of Mtb populations and their drug resistance pattern.
Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: a prospective analysis of 601 cases
Authors: Yang Xinting , Zhang Jing , Liang Qingtao , Pan Liping , Duan Hongfei , Yang Yang , Li Hua , Guo Chao , Sun Qi , Jia Hongyan , Du Boping , Wei Rongrong , Xing Aiying , Zhang Zongde , Chen Xiaoyou 
Published: January 2021

Abstract
Background
Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics.

Methods
We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.

Results
A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59–8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75–2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30–2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370).

Conclusions
In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.
Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey
Authors: Ryvlin Philippe , Skorobogatykh Kirill , Negro Andrea , Sanchez-De La Rosa Rainel , Israel-Willner Heike , Sundal Christina , MacGregor E. Anne , Guerrero Angel L. 
Published: January 2021

Abstract
Background
Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients.

Methods
My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients’ management in the primary care setting.

Results
In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care.

Conclusions
There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.
RETRACTED ARTICLE: MiR-200c/FUT4 axis prevents the proliferation of colon cancer cells by downregulating the Wnt/β-catenin pathway
Authors: Cong Jinchun , Gong Jian , Yang Chuanjia , Xia Zhixiu , Zhang Hong 
Published: January 2021

Abstract
Background
MicroRNA (miR)-200c has been widely reported to be involved in colon cancer progress. However, the mechanisms of miR-200c in regulating tumor metastasis and growth remain to be fully elucidated. This study aimed to investigate the mechanism of miR-200c targets fucosyltransferase 4 (FUT4) on the proliferation of colon cancer.

Methods
The miR-200c and FUT4 mRNA levels in LoVo and SW480 cells were measured by real-time quantitative polymerase chain reaction. Further, miR-200c mimic, FUT4 siRNA and FUT4 mimic were transfected into cells, separately. Cell counting kit-8, plate colony formation and transwell assays were used to analyse the cells biological behaviour.. Immunofluorescence was used to analyse the Ki-67 expression Moreover, the Wnt/β-catenin pathway-related proteins were detected by western blots. A double luciferase experiment was performed to confirm the relationship between miR-200c and FUT4. In vivo, tumour growth and Wnt/β-catenin pathway-related proteins were also analysed.

Results
In vitro, the expression of miR-200c and FUT4 were negatively correlated in LoVo and SW480 cells (correlation coefficients were − 0.9046 and − 0.9236, respectively). MiR-200c overexpression inhibited the proliferation, migration and invasion of LoVo and SW480 cells by downregulating FUT4. The Ki67-positive cells and Wnt/β-catenin signalling pathway-related proteins were reduced in the miR-200c overexpression and FUT4 silencing groups. A dual luciferase reporting system identified FUT4 as the target of miR-200c. The results in vivo were further confirmed the foundation of cells study.

Conclusions
In summary, miR-200c overexpression inhibits proliferation of colon cancer targeting FUT4 to downregulate the Wnt/β-catenin pathway, which promises molecular targets to inhibit metastasis for colon cancer therapy.
Designing an exercise intervention for adult survivors of childhood cancers
Authors: Rokitka Denise , Heffler Jennifer , Zevon Michael , Kitcho Caleb , Schweitzer Jennifer , Rodriguez Elisa M. , Mahoney Martin C. 
Published: January 2021

Abstract
Background
This study examined current physical activity levels and preferences for exercise settings and activities among adult survivors of childhood cancers as a strategy to inform the feasibility and design of such programs.

Methods
A mixed-methods design was used to investigate current activity levels as well as barriers to and preferences for physical activity among 20 adult survivors of pediatric cancer.

Results
One-half of participants reported engaging in regular physical activity, although the frequency, intensity, and duration varied. Overall, 17 of the 20 participants (85%) stated they would be interested in participating in a structured exercise intervention, and they expressed a strong interest in walking (76%), bicycling (53%), and weight training (53%). Common barriers to participation in a potential structured exercise program were insufficient time, current health issues, and program location/distance. Nearly all participants agreed that information on nutrition and diet should be included as part of an exercise intervention.

Conclusions
These findings will help inform the design and implementation of future exercise programs to enhance physical activity among this high-risk group of cancer survivors.
The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study
Authors: Zhuo Deyi , Chen Si , Ren Xiaofang , Wang Bingsong , Liu Linbo , Xiao Lin 
Published: January 2021

Abstract
Background
To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors.

Methods
In this population-based, cross-sectional study, a total of 3170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis.

Results
The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6, 28.0, 15.0, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20–1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68–4.33)), myopia (OR = 3.55; 95% CI, (1.86–6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18–1.99)).

Conclusions
There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.
Choroidal and peripapillary changes in high myopic eyes with Stickler syndrome
Authors: Xerri Olivia , Bernabei Federico , Philippakis Elise , Burin-Des-Roziers Cyril , Barale Pierre-Olivier , Laplace Olivier , Monin Claire , Bremond-Gignac Dominique , Guerrier Gilles , Valleix Sophie , Brezin Antoine , Rothschild Pierre-Raphaël 
Published: January 2021

Abstract
Background
To compare different clinical and Spectral-Domain Optical Coherence Tomography (SD-OCT) features of high myopic eyes with Stickler syndrome (STL) with matched controls.

Methods
Patients with genetically confirmed STL with axial length ≥ 26 mm and controls matched for axial length were included. The following data were obtained from SD-OCT scans and fundus photography: choroidal and retinal thickness (respectively, CT and RT), peripapillary atrophy area (PAA), presence of posterior staphyloma (PS).

Results
Twenty-six eyes of 17 patients with STL and 25 eyes of 19 controls were evaluated. Compared with controls, patients with STL showed a greater CT subfoveally, at 1000 μm from the fovea at both nasal and temporal location, and at 2000 and 3000 μm from the fovea in nasal location (respectively, 188.7±72.8 vs 126.0±88.7 μm, 172.5±77.7 vs 119.3±80.6 μm, 190.1±71.9 vs 134.9±79.7 μm, 141.3±56.0 vs 98.1±68.5 μm, and 110.9±51.0 vs 67.6±50.7 μm, always P< 0.05). Furthermore, patients with STL showed a lower prevalence of PS (11.5% vs 68%, P< 0.001) and a lower PAA (2.2±2.1 vs 5.4±5.8 mm2, P=0.03), compared with controls.

Conclusions
This study shows that high myopic patients with STL show a greater CT, a lower PAA and a lower prevalence of PS, compared with controls matched for axial length. These findings could be relevant for the development and progression of myopic maculopathy in patients with STL.
Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial
Authors: Adane Mesafint Molla , Alene Getu Degu , Mereta Seid Tiku , Wanyonyi Kristina L. 
Published: January 2021

Abstract
Background
Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove.

Methods
A cluster-randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within 1 year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population.

Results
A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89–1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline.

Conclusions
We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI.

Trial registration
The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).
Subcutaneous abscess caused by Streptococcus pneumoniae serotype 28F in an infant: a case report
Authors: Hirade Tomohiro , Harada Ai , Koike Daisuke , Abe Yasuhiro , Higuchi Tsuyoshi , Kato Fumihide , Chang Bin , Nariai Akiyoshi 
Published: January 2021

Abstract
Background
Invasive pneumococcal disease (IPD) is defined by the detection of Streptococcus pneumoniae on culture from samples obtained from a normally sterile site. Pneumococcal conjugate vaccines (PCV) have been developed for the prevention of IPD that is caused by highly virulent serotypes. Despite the effective reduction of IPD caused by vaccine serotypes after the introduction of PCV, there has been a rapid increase in the incidence of IPD caused by non-vaccine serotypes, and serotype replacement has become a global issue.

Case presentation
We report a previously healthy 4-month-old girl presenting with a large subcutaneous abscess caused by S. pneumoniae, identified as non-vaccine serotype 28F. The patient had received routine vaccination, including PCV vaccination. After the incision and drainage of the subcutaneous abscess, the patient was treated with antibiotics. She was discharged on Day 7 of hospitalization without any residual sequelae.

Conclusions
Subcutaneous abscess is a common pediatric skin and soft tissue infection, whereas pneumococcal subcutaneous abscesses are quite rare. As the pneumococcal serotype 28F caused a subcutaneous abscess, this serotype possibly has a high virulence. The incidence of IPD caused by non-vaccine serotypes, such as 28F, is expected to increase in the future. The consolidation of international data on pneumococcal serotypes is important for the development of novel PCV.
University students’ perceptions of airborne infection control: exploratory study using Q methodology
Authors: Lee Seonhye , Kim Hyun Jin , Cheong Chang Heon 
Published: January 2021

Abstract
Background
International cooperation for infection control is important to prevent global pandemics. University students were difficult groups to manage of infection control measures. They often had overconfidence to their health, ineffective personal hygiene, and active social activities. Their misperceptions and inappropriate preventive behaviors increase the infection risks to university and community. Understanding university students’ perceptions of airborne infection management will contribute to the establishment of relevant policies and health education programs.

Method
This study explored subjective perceptions of airborne infection among university students in South Korea using Q-methodology. Forty university students representing different majors ranked a set of 33 statements reflecting their perceptions of airborne infection. They sorted the statements into a distribution on seven scales ranging from “strongly disagree” to “strongly agree.” Collected data were analyzed by the PC-QUANL program. The subjective perception types were extracted by using the principal component analysis.

Results
Four type are derived regardingperception of airborne infection: Type I (Government responsibility), Type II (Personal responsibility in self-management), Type III (Strict external management) and Type IV (Comprehensive countermeasures management). Thesefour types accounted for 45.6% of the total variance, and the individual contributions of Types I, II, III, and IV were 27.7, 7.6, 6.2, and 4.1%, respectively.

Conclusion
The major contribution of this study is to clarify university students’ perceptions of airborne infection. These findings can be used in formulating effective strategies for health education, media reporting, and public health policy to improve airborne infection management.