bluuebunny/crossref_metadata_2025_split huggingface dataset:
The sore throat: a clinical approach to tonsillopharyngitis
Authors: Marais A. , Leuschner M. 
Published: April 2020

Acute sore throat is a common complaint encountered by medical practitioners and health care workers routinely. The disease is mostly caused by viral infections of the upper respiratory tract and is usually self-limiting. Symptoms rarely exceed two weeks, irrespective of the cause. Group A beta-haemolytic streptococci accounts for the majority of bacterial instances of tonsillopharyngitis. Clinical examination is not always adequate to diagnose bacterial infections, resulting in the irrational and over-prescribing of antibiotics, especially in upper respiratory tract infections, contributing to communal antimicrobial bacterial resistance. A few scoring systems are available to assist physicians in deciding on the aetiology without resorting to unnecessary laboratory investigations. This article briefly reviews the scoring systems and antimicrobial management of streptococcal throat infections.
Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa
Authors: Nyalunga S. L.N. , Ndimande J. V. , Ogunbanjo G. A. , Masango-Makgobela A. , Bogongo T. 
Published: April 2020

Background: In 2011, South Africa established ward-based outreach teams (WBOTs) comprising Community Health Workers as part of strategies to strengthen primary healthcare. The new community health workers (CHWs) lacked experience of the programme. This study aimed at assessing perceptions of community health workers on their training, teamwork and practice.Methods: This was a cross-sectional study conducted among CHWs in the seven regions of Tshwane health district between October and November 2015. Data were collected from 431 CHWs in eight Community Health Centres and 11 clinics using a pre-tested, self-administered questionnaire. Outcome measures were CHWs’ perceptions on training, teamwork and practice regarding WBOT programme.Results: A total of 431 CHWs formed the study sample. Participants had a mean age of 36 years (SD ± 9.46). The majority (88.2%) were female. Some 77% had completed secondary school. Overall, most CHWs perceived their training (86.4%), teamwork(87.6%) and practices (67.7%) to be good (p = 0.001). The majority were able to provide efficient health care despite the challenges experienced, which were lack of equipment, walking long distances, and safety on the streets and in households with patients who had mental health problems among others. Fisher’s exact test showed a significant association between training and work challenges (p = 0.006).Conclusion: The study findings showed that most CHWs had good perceptions regarding their training, teamwork and practice. Several concerns raised by CHWs suggest the need for stakeholders to ensure availability of resources for optimal functioning of CHWs.
An assessment of erectile dysfunction among male diabetics attending Temba Community Health Centre, Pretoria
Authors: Bongongo T. , Ndimande J. V. , Tumbo J. 
Published: April 2020

Introduction: Erectile dysfunction is common among men with diabetic mellitus and has a negative effect on their quality of life. The proportion of male diabetics who disclosed their problematic sexual performance was increasing at Temba Community Health Centre (CHC), which motivated a survey that was conducted from April 2015 till April 2016.Aim: Assessment of erectile dysfunction among male diabetics attending Temba Community Health Centre.Setting: Temba Community Health Centre, Pretoria, South Africa.Method: A cross-sectional survey was conducted using a piloted, structured questionnaire adapted from the International Index of Erectile dysfunction (IIRF-5) questionnaire. Convenience sampling was used to select 191 participants.Result: From the selected sample, 97.3% of male diabetics were suffering from erectile dysfunction. Among them, 120 (62.8%) were between 41 and 60 years of age, 96 (50.2%) were employed, 81 (42.4%) had a secondary level of education and 84 (44.4%) were married. The duration of diagnosed diabetes varied between 2 months and 564 months (42 years). Hypertension and HIV, as co-morbidities, affected 12.7% of the participants and 56% of participants consulted primarily for erectile dysfunction, not knowing that it was a complication of diabetes mellitus.Conclusion: The assessment of erectile dysfunction among male diabetics attending Temba CHC in Pretoria showed that more than two-thirds of the selected sample of patients suffered from erectile dysfunction, from a mild to a severe form of the condition. Most of those participating were between 41 and 60 years old, half of them were married, have a secondary level of education and were unaware that erectile dysfunction is a complication of diabetes mellitus.
Factors associated with physical activity amongst patients with hypertension in two community health centres in uMgungundlovu health district, KwaZulu-Natal, 2018
Authors: Mbambo S. W. , Tlou B. , Dlungwane T. P. 
Published: April 2020

Background: Hypertension (HPT) is a global public health challenge. It predisposes to cardiovascular diseases, kidney diseases and disability as well as contributing to high death rates. HPT is increasing tremendously in sub-Saharan Africa with HPT-related mortality risk having increased by 25% in less than 10 years in South Africa. Physical activity is a cost-effective way of reducing, controlling and preventing hypertension. The aim of the study was to establish the level of physical activity, and factors associated with physical activity, amongst patients with hypertension, in two community health centres in uMgungundlovu Health District, KwaZulu-Natal, 2018.Methods: An observational, cross-sectional descriptive study with an analytic component was implemented. Data were collected utilising an interviewer-administered questionnaire. Frequency distribution tables and the chi-square test were used in the analysis of data. A p-value less than 0.05 was deemed statistically significant.Results: A total of 374 questionnaires were administered of which 373 were adequately completed, yielding a response rate of 99.7%. The results showed that 39.1% were highly physical active, 32.4% were moderately physical active and 28.4% had low physical activity. Age, marital status, employment status and level of education were significantly associated with physical activity. Major barriers to physical activity included health problems and having no time to exercise. Health-related reasons were reported to be the major motivator towards physical activity.Conclusion: Over a third of the participants presented with high levels of physical activity. Health education should focus on promoting physical activity for HPT clients.
The quality of feedback from outpatient departments at referral hospitals to the primary care providers in the Western Cape: a descriptive survey
Authors: Mash Robert , Steyn Herma , Bello Muideen , Von Pressentin Klaus , Rossouw Liezel , Hendricks Gavin , Fouche Germarie , Stapar Dusica 
Published: April 2020

Background: Coordinating care for patients is a key characteristic of effective primary care. Family physicians in the Western Cape formed a research network to enable them to perform practical research on key questions from clinical practice. The initial question selected by the network focused on evaluating the quality of referrals to and feedback from outpatient departments at referral hospitals to primary care providers in the Western Cape.Methods: A descriptive survey combined quantitative data collected from the medical records with quantitative and qualitative data collected from the patients by questionnaire. Family physicians collected data on consecutive patients who had attended outpatient appointments in the last three months. Data were analysed using the Statistical Package for the Social Sciences.Results: Seven family physicians submitted data on 141 patients (41% male, 59% female; 46% metropolitan, 54% rural). Referrals were to district (18%), regional (28%) and tertiary hospitals (51%). Referral letters were predominantly biomedical. Written feedback was available in 39% of patients. In 32% of patients, doctors spent time obtaining feedback; the patient was the main source of information in 53% of cases, although many patients did not know what the hospital doctor thought was wrong (36%). The quality of referrals differed significantly by district and type of practitioner, while feedback differed significantly by level of hospital.Conclusion: Primary care providers did not obtain reliable feedback on specialist consultations at referral hospital outpatients. Attention must be given to barriers to care as well as communication, coordination and relationships across the primary–secondary interface.
Flash floods versus river floods – a comparison of psychological impacts and implications for precautionary behaviour
Authors: Laudan Jonas , Zöller Gert , Thieken Annegret H. 
Published: April 2020

Abstract. River floods are among the most damaging natural hazards that frequently occur in Germany. Flooding causes high economic losses and impacts many residents. In 2016, several southern German municipalities were hit by flash floods after unexpectedly severe heavy rainfall, while in 2013
widespread river flooding had occurred. This study investigates and compares the psychological impacts of river floods and flash floods and potential consequences for precautionary behaviour. Data were collected using computer-aided telephone interviews that were conducted among flood-affected households around 9 months after each damaging event. This study applies Bayesian statistics and negative binomial regressions to test the
suitability of psychological indicators to predict the precaution motivation of individuals. The results show that it is not the particular flood type but rather the severity and local impacts of the event that are crucial for the different, and potentially negative, impacts on mental health. According to the used data, however, predictions of the individual precaution motivation should not be based on the derived psychological indicators – i.e. coping appraisal, threat appraisal, burden and evasion – since their explanatory power was generally low and results are, for the most part, non-significant. Only burden reveals a significant positive relation to planned precaution regarding weak flash floods. In contrast to weak flash floods and river floods, the perceived threat of strong flash floods is significantly lower although feelings of burden and lower coping appraisals are more pronounced. Further research is needed to better include psychological assessment procedures and to focus on alternative data sources regarding floods and the connected precaution motivation of affected residents.
Opioid Prescribing Patterns in Orthopaedic Surgery Patients: the Effect of New York State Regulations and Institutional Initiatives
Authors: Lott Ariana , Hutzler Lorraine H. , Bosco Joseph A. , Lajam Claudette M. 
Published: April 2020

Background:
The opioid epidemic in the United States is a public health crisis. As a result, regulatory agencies, including state governments, have enacted initiatives to decrease the use of opioids in the perioperative setting. The purpose of this study was to compare opioid utilization in orthopaedic surgery patients at discrete points after implementation of State regulatory and institution/physician-led initiatives to decrease opioid utilization in the perioperative period.

Methods:
We reviewed the electronic medication orders for all patients who underwent orthopaedic surgery procedures between September 2015 and June 2018 at our urban academic medical center. The outcome measures were the number of patients who were prescribed opioid medications, duration of prescription (days), and average milligram morphine equivalents prescribed. Patients were divided into three time cohorts to assess the effect of the NY State (NYS) policy and institutional initiatives to decrease opioid utilization.

Results:
A total of 20,483 patients met the inclusion criteria over all three time cohorts. After the initiation of the NYS 7-day supply legislation, there was a decrease in the average supply of opioids prescribed from 10.1 to 7.6 days and the average daily milligram morphine equivalent decreased from 67.9 to 56.7 mg (P < 0.0001). However, with the combination of physician education and surgeon-led institutional initiatives, the percentage of patients who were prescribed opioids decreased by over 10% (96% to 84%), with continued decrease in duration of prescription by 1.0 to 6.4 days (P < 0.0001).

Conclusions:
The addition of institution-led initiatives and education programs to previously established government-led prescription limits produced a substantial reduction in the amount of opioids prescribed to orthopaedic surgery patients in the perioperative period. Although mandatory limits set by the state government resulted in a decreased amount of opioid medications being prescribed per patient, it was only after the introduction of educational programs and institution- and physician-led programs that perioperative patient exposure to opioids decreased.

Level of Evidence:
Level III
Regular Mindful Yoga Practice as a Method to Improve Androgen Levels in Women With Polycystic Ovary Syndrome: A Randomized, Controlled Trial
Authors: Patel Vishesha , Menezes Heather , Menezes Christian , Bouwer Stephanie , Bostick-Smith Chevelta A. , Speelman Diana L. 
Published: April 2020

AbstractBackgroundHolistic approaches are needed to complement existing therapies for polycystic ovary syndrome (PCOS), a common disorder affecting the health of reproductive-aged females.ObjectiveTo determine whether thrice-weekly mindful yoga practice improves endocrine, cardiometabolic, or psychological parameters in women with PCOS.MethodsThirty-one women with PCOS between the ages of 23 and 42 years and living in Erie County, Pennsylvania, were recruited for this randomized, controlled study arm, which was part of a larger 3-part investigation. Women were randomly assigned to either a mindful yoga intervention group or no intervention (control) group. Group classes were 1 hour, thrice weekly. Initial endocrine, cardiometabolic, and psychological measurements were compared with measurements taken after the 3-month intervention period. Measurements included free testosterone, dehydroepiandrosterone, androstenedione, body mass index, waist-to-hip ratio, fasting blood glucose and insulin levels, and anxiety and depression scores.ResultsTwenty-two women completed the 3-month intervention period, 13 in the mindful yoga group and 9 in the control group. Paired comparisons of pre- and postintervention parameters indicated that women who completed the mindful yoga intervention had significantly lower free testosterone levels (5.96 vs 4.24 pg/mL;P<.05) and dehydroepiandrosterone levels that trended lower. Improved testosterone may persist for several months after completion of a 3-month, thrice-weekly mindful yoga intervention. Additionally, improvements were seen in measures of anxiety and depression.ConclusionThe improvements observed suggest that regular mindful yoga practice can be a useful complementary therapeutic option for women with PCOS, particularly for improving serum androgen levels, a hallmark feature of PCOS. This improvement occurred in the absence of weight loss and may persist even if there is a lapse in practice. (ClinicalTrials.gov No. NCT03383484)
Accumulation of sequence variants in genes of Wnt signaling and focal adhesion pathways in human corneas further explains their involvement in keratoconus
Authors: Karolak Justyna A. , Gambin Tomasz , Rydzanicz Malgorzata , Polakowski Piotr , Ploski Rafal , Szaflik Jacek P. , Gajecka Marzena 
Published: April 2020

Background
Keratoconus (KTCN) is a protrusion and thinning of the cornea, resulting in loss of visual acuity. The etiology of KTCN remains unclear. The purpose of this study was to assess the potential involvement of new genetic variants in KTCN etiology based on both the genomic and transcriptomic findings recognized in the same corneal tissues.

Methods
Corneal tissues derived from five unrelated Polish individuals with KTCN were examined using exome sequencing (ES), followed by enrichment analyses. For comparison purposes, the datasets comprising ES data of five randomly selected Polish individuals without ocular abnormalities and five Polish patients with high myopia were used. Expression levels of selected genes from the overrepresented pathways were obtained from the previous RNA-Seq study.

Results
Exome capture discovered 117 potentially relevant variants that were further narrowed by gene overrepresentation analyses. In each of five patients, the assessment of functional interactions revealed rare (MAF ≤ 0.01) DNA variants in at least one gene from Wnt signaling (VANGL1, WNT1, PPP3CC, LRP6, FZD2) and focal adhesion (BIRC2, PAK6, COL4A4, PPP1R12A, PTK6) pathways. No genes involved in pathways enriched in KTCN corneas were overrepresented in our control sample sets.

Conclusions
The results of this first pilot ES profiling of human KTCN corneas emphasized that accumulation of sequence variants in several genes from Wnt signaling and/or focal adhesion pathways might cause the phenotypic effect and further points to a complex etiology of KTCN.
Assessment of Technical Vocational Education Programs of Davao Del Sur School of Fisheries
Authors: Zamora-Sereguine Roname 
Published: April 2020

Aims: The study generally assessed the Technical Vocational Education Program of Davao del Sur School of Fisheries.
Study Design: Quantitative-descriptive correlation.
Place and Duration of Study: The study was conducted at the Davao del Sur School of Fisheries in Davao del Sur, The Philippines. The study was conducted for 10 months.
Methodology: This study used the universal sampling for both sets of respondents; the teachers of TVE program and the Grade 10 students. There were 32 teachers and 322 students participated in the study. The Technical Vocational Education program was assessed in terms of library facilities and internet connectivity, Science laboratory facilities, TVE laboratory facilities and the use of information and communication technology. These were correlated to the academic performances of the students.
Results: The findings of the study showed that in terms of population, 322 students were enrolled in the TVE program; majority of these students took the food processing technology course that comprised 39.45%. In terms of teachers’ qualification, 32 were Bachelor of Art or Bachelor of Secondary Education graduates. There were 18 out of 32 teachers who were teaching in TVE programs and the rest taught in other related courses. For qualification to teach in the Program, one- third of the total faculty was handling fish culture, while two third was teaching outside the flagship courses. In the assessment of the support learning facilities, the library, internet connectivity, science and laboratory facilities were described as “moderately adequate”; the TVE laboratory facilities was described as “very adequate”. In the assessment of the ICT in instruction, it was described as “very effective”. The study found significant relationship between the academic performance of the TVE students and the support learning facilities and between the academic performance of the TVE students and the used of information and communication technology (ICT) in learning.
Conclusion: The school needs to maintain its support learning facilities and information and communication technology so that it can produce more competent TVE students. However, the school may look into industry partners so that actual application of students’ theoretical knowledge may be put into action. Moreover, tracer study may also be conducted to find the competitiveness and employability of the graduates.
Mortality in Patients With Gout Treated With Allopurinol: A Systematic Review and Meta‐Analysis
Authors: Hay Charles A. , Prior James A. , Belcher John , Mallen Christian D. , Roddy Edward 
Published: April 2020

ObjectiveUrate‐lowering therapy (predominantly allopurinol) is highly effective as a treatment for gout, but its wider long‐term effects remain unclear. This systematic review and meta‐analysis aimed to ascertain the association between mortality and the use of allopurinol in patients with gout.MethodMedline, Embase, CINAHL, and the Cochrane Library were searched from inception to August 2018. Articles eligible for inclusion used a cohort design and examined cardiovascular or all‐cause mortality in patients diagnosed with gout and prescribed allopurinol. Information on study characteristics, design, sample size, and mortality risk estimates were extracted. Article quality was assessed using the Newcastle‐Ottawa Scale. Included articles were described in a narrative synthesis and, where possible, risk estimate data were pooled.ResultsFour articles reported a hazard ratio (HR) risk estimate for all‐cause mortality in patients with gout using allopurinol, and 2 of these also reported cardiovascular mortality. Two articles found allopurinol to be protective in patients with gout, 1 found no statistically significant association, and 1 found no statistically significant effect of escalation of allopurinol dosage on all‐cause or cardiovascular‐related mortality. Data pooling was possible for all‐cause mortality and found no association between allopurinol use in patients with gout and all‐cause mortality compared to patients with gout not using allopurinol (adjusted HR 0.80 [95% confidence interval 0.60–1.05]).ConclusionThere was no significant association between all‐cause mortality and allopurinol use in people with gout. However, the number of included studies was small, suggesting that further studies are needed.
Collagen Stiffness and Architecture Regulate Fibrotic Gene Expression in Engineered Adipose Tissue
Authors: Di Caprio Nikolas , Bellas Evangelia 
Published: April 2020

AbstractAdipose tissue (AT) has a dynamic extracellular matrix (ECM) surrounding adipocytes that allows for remodeling during metabolic fluctuations. During the progression of obesity, AT has increased ECM deposition, stiffening, and remodeling, resulting in a pro‐fibrotic dysfunctional state. Here, the incorporation of ethylene glycol‐bis‐succinic acid N‐hydroxysuccinimide ester (PEGDS) allows for control over 3D collagen hydrogel stiffness and architecture to investigate its influence on adipocyte metabolic and fibrotic function. Upon stiffening and altering ECM architecture, adipocytes did not alter their expression of key adipokines, leptin, and adiponectin. However, they do increase actin cytoskeletal fiber formation, pro‐fibrotic gene expression, ECM deposition, and remodeling within a stiffer, 3D collagen hydrogel. For example, COL6A3 gene expression is upregulated approximately twofold, resulting in increased deposition of pericellular collagen VI alpha 3 surrounding adipocytes. Furthermore, inhibition of actin contractility results in a reversal of pro‐fibrotic gene expression and ECM deposition, indicating that adipocytes are mediating mechanical cues through actin cytoskeletal networks. This study demonstrates that ECM stiffness and architecture plays a critical regulatory role in adipocyte fibrotic function and contributes to the overall pro‐fibrotic dysfunctional state of AT during the progression of obesity and AT fibrosis.