bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Multimorbidity During Pregnancy and After Childbirth in Women in Low- and Middle-Income Countries: A Systematic Literature Review
Authors: McCauley Mary , Zafar Shamsa , Broek Nynke van den 
Published: June 2020

Abstract
Background For every maternal death, 20 to 30 women are estimated to have morbidity related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological, and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth.Methods We systematically reviewed published literature, in English, describing measurement of two or more types of maternal morbidity, and/or associations between morbidities, during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007-2018. Outcomes were descriptions, occurrence of all maternal morbidities, and associations between these morbidities. Narrative analysis was conducted. Results 38 papers reporting about 36 studies were included (71,229 women; 60,911 during and 10,318 after pregnancy from 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidity was included in 28 studies; psychological morbidity in 32 studies and social morbidity in 27 studies; with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidity were reported in four studies and between psychological and social morbidity in six. Domestic violence increased risks of physical ill-health in two studies. Conclusions Lack of standardised, comprehensive and routine measurements and tools exist to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity.
Barriers to accessing health care services: A qualitative study of migrant construction workers in a Southwestern Indian city
Authors: Santalahti Maija , Sumit Kumar , Perkiö Mikko 
Published: June 2020

Abstract
Background: This study examined access to health care in an occupational context in an urban city of India. Many people migrate from rural areas to cities, often across Indian states, for employment prospects. The purpose of the study is to explore the barriers to accessing health care among a vulnerable group – internal migrants working in the construction sector in Manipal, Karnataka. Understanding the lay workers’ accounts of access to health services can help to comprehend the diversity of factors that hinder access to health care. Methods: Individual semi-structured interviews involving 15 migrant construction workers were conducted. The study applied theory-guided content analysis to investigate access to health services among the construction workers. The adductive analysis combined deductive and inductive approaches with the aim of verifying the existing barrier theory in a vulnerable context and further developing the health care access barrier theory. Results: This study’s result is a revised version of the health care access barriers model, including the dimension of trust. Three known health care access barriers – financial, cognitive and structural, as well as the new barrier (distrust in public health care services), were identified among migrant construction workers in a city context in Karnataka, India. Conclusions: Further qualitative research on vulnerable groups would produce a more comprehensive account of access to health care. The socioeconomic status behind access to health care, as well as distrust in public health services, forms focal challenges for any policymaker hoping to improve health services to match people’s needs.
Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection
Authors: yang xinwei , Jun-yi Chen , Zhi-jian Wen , Yu-long Li , Fei-yu Wang , Liang Li , Jue Yang , Ping-hua Yang , zhang baohua , shen feng 
Published: June 2020

Abstract
Purposes: This study was designed to evaluate the long-term prognostic value of preoperative jaundice and explore which clinicopathological factor significantly influencing the long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods: A total of 267 GBC patients who underwent R0 resection between January 2004 and December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results: Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. In terms of the 54 GBC patients with preoperative jaundice, univariate and multivariate analysis showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survival for more than 3 years) and those who died within 3 years (P<0.05). Conclusion: Preoperative jaundice was not the independent factor affecting the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients with and without preoperative jaundice.
Risk factors for malaria infection prevalence and household vector density between mass distribution campaigns of long-lasting insecticidal nets in Northern Tanzania
Authors: Mosha Jacklin Franklin , Lukole Eliud , Charlwood J Derek , Wright Alexandra , Bullock Olivia , Manjurano Alphaxard , Kisinza William , Mosha Franklin W , Kleinschmidt Immo , Rowland Mark , Protopopoff Natacha 
Published: June 2020

Abstract
Background Long Lasting Insecticidal nets (LLINs) are the most widely deployed vector control intervention in Sub-Saharan Africa to prevent malaria. Recent reports indicate selection of pyrethroid insecticide resistance is widespread in mosquito vectors. This paper explores net coverage indicators and other risk factors associated with malaria infection prevalence and vector density three years after a mass distribution campaigns of LLINs in Northwest Tanzania. Methods A cross sectional malaria survey of 3,456 children was undertaken in 2014 in Muleba district in the Lake Zone. Vector density was assessed using indoor light traps and outdoor tent traps. Anophelines were identified to species using PCR and tested for falciparum circumsporozoite protein. Logistic regression was used to identify household and environmental factors associated with malaria infection and vector density. Results LLINs use was 27.7%. Only 16.9% of households had sufficient nets to cover all sleeping places. Malaria infection was independently associated with access to LLINs (OR: 0.57; 95%CI 0.34 – 0.98). LLINs less than 2 years old were more protective than older LLINs (53% vs 65% prevalence of infection); however, there was no evidence that LLINs in good condition (hole index <65) were more protective than LLINs which were more holed. Other risk factors for malaria infection were age group, altitude and house construction quality. Independent risk factors for vector density were consistent with malaria outcomes and included altitude, wind, livestock, house quality, open eaves and LLINs usage. Indoor collections comprised 4.6% Anopheles funestus and 95.4% An. gambiae of which 4.5% were An. arabiensis and 93.5% were An. gambiae s.s.Conclusion Three years after the mass distribution campaign and despite top-ups, LLINs usage had declined considerably. While children living in households with access to LLINs were at lower risk of malaria, infection prevalence remained high even among users of LLINs in good condition. While effort should be made to maintain high coverage between campaigns, distribution of standard pyrethroid-only LLINs appears insufficient to prevent malaria transmission in this area of intense pyrethroid resistance.
Correlation of Resting Heart Rate with Anthropometric factors and serum biomarkers in a population-based study: Fasa PERSIAN Cohort study
Authors: Goorakani Yashar , Rahimabadi Massih Sedigh , Dehghan Azizallah , Kazemi Maryam , Chijan Mahsa Rostami , Asl Mostafa Bizhani , Shahraki Hadi Raeisi , Davoodi Ali , Farjam Mojtaba , Homayounfar Reza 
Published: June 2020

Abstract
Background There is a positive association between raised resting heart rate (RHR), and all causes of mortality and shorter life expectancy. Several serum biomarkers and some anthropometric factors can affect the resting heart rate. This study aimed to investigate the determinants of resting heart rate in a large random sample of the Iranian population. Material and Methods It is a standardized, retrospective study and the subjects were chosen from the baseline survey of the Prospective Epidemiological Research Study in IrAN (PERSIAN) Fasa non-communicable disease cohort study. It was conducted from winter 2014 to summer 2019 and after obtaining informed consent from a random sample, all the eligible subjects were enrolled. All anthropometric factors and biologic laboratory factors were collected and analyzed by implement smoothly clipped absolute deviation (SCAD) linear regression and SCAD quantile regression. The comparisons between males and females were done via independent T-test. Results & Conclusion A total number of 9975 persons were included. The overall median resting heart rate was 74 (interquartile range:66-80). Mean age has no important difference between males and females (P=0.79) but, resting heart rate was significantly higher in females (76.6 versus 71.4, P<0.001). All anthropometric factors except wrist circumference were higher in females (P<0.05). Age has an adverse effect on resting heart rate and also, there was direct association between resting heart rate and systolic blood pressure and blood glucose. Alpha-blockers (coefficient=5.2) and Beta1-blockers (coefficient=-2.2) were the most effective drugs with positive and negative effects on resting heart rate respectively. Lower hemoglobin, obesity and more body mass index, and more low-density lipoprotein were associated with more resting heart rate. Continuing the monitoring of this sample via our cohort study and put to action multinational prospective researches with large sample sizes and long follow-ups can lead to more precise results and better scientific judgments.
Clinicopathological and Prognostic Significance of Platelet-Lymphocyte Ratio (PLR) in Gastric Cancer: An Updated Meta-Analysis
Authors: Zhang Xunlei , Zhao Wenjing , Yu Yang , Qi Xue , Song Li , Zhang Chenfei , Li Guoxing , Yang Lei 
Published: June 2020

Abstract
Background: Pretreatment PLR (platelet-lymphocyte ratio), was reported to be associated with the prognosis in gastric cancer (GC), but the results remain inconclusive. This meta-analysis aimed to investigate the prognostic potential of the pre-treatment PLR in gastric cancer.Methods: We performed a systematic literature search in PubMed, Embase and the Cochrane Library to identify eligible publications. The hazard ratio (HR) /Odds Ratio (OR) and its 95% confidence (CI) of survival outcomes and clinicopathological parameters were calculated.Results: A total of 49 studies (51 cohorts), collectting data from 28,929 GC patients, were included in the final analysis. The pooled results demonstrated that the elevated pre-treatment PLR was significantly associated with poor overall survival (OS) (HR: 1.37, 95% CI: 1.26-1.49, p < 0.001; I2= 79.90%, Ph < 0.001) and disease-free survival (DFS) (HR 1.52, 95%CI 1.22–1.90, P< 0.001, I2= 88.6%, Ph< 0.001). Furthermore, the patients with the elevated PLR had a higher risk of lymph node metastasis (OR = 1.17, 95% CI: 1.02–1.33, p=0.023), serosal invasion (T3 +T4) (OR = 1.34, 95% CI: 1.10–1.64, p=0.003) and increased advanced stage (III+IV) (OR = 1.20, 95% CI: 1.06–1.37, p=0.004).Conclusions: An elevated pre-treatment PLR was a prognostic factor for poor OS and DFS, and associated with poor clinicopathological parameters in GC patients .
Nutritional support for lactating women with or without Azithromycin for infants compared to breast-feeding counselling alone, to improve six-month growth outcomes among infants of peri-urban slums of Karachi, Pakistan – a protocol of multi-arm assessor blinded randomized controlled trial (Mumta LW trial)
Authors: Muhammad Ameer , Shafiq Yasir , Nisar M Imran , Baloch Benazir , Yazdani Amna Tanweer , Yazdani Nida , Jehan Fyezah 
Published: June 2020

Abstract
BackgroundGlobally, 45% of under-five deaths are, directly or indirectly, attributable to malnutrition, most of these deaths are in low- and middle-income countries (LMICs). Children in the first 6 months of life are particularly vulnerable. An estimated 4.7 million infants under the age of 6 months are moderately wasted whereas 3.8 million are severely wasted. Despite the increased risk to a child of a mother with nutritional decompensation, there are discrepancies in guidance in this area. MethodsThis is a community-based, open-label factorial randomized controlled trial, using parallel assignment with 1:1:1 allocation ratio, in low-income squatter settlements of urban Karachi, Pakistan. In the control group (Arm A), women are randomized to standard counseling only; whereas in the first intervention group (Arm B), lactating women receive two sachets of balanced energy-protein (BEP) supplementation per day from enrollment till the infant reaches six months of age, in the second intervention group (Arm C), lactating women receive same BEP as in intervention Arm B while their babies also receive a single stat dose (20mg/kg orally) of azithromycin at 42 days. The primary outcome is relative length velocity from 0 to 6 months by the limb of allocation. The primary analysis will be Intention-to-treat analysisTrial registrationRegistration of the trial is done at ClinicalTrials.gov. NCT03564652, registered on June 21, 2018. Trial registration data is available through https://clinicaltrials.gov/ct2/show/NCT03564652
The role of periodontal disease in preterm labor: A prospective cohort study (A path analysis)
Authors: Farshad Mohammad MAHDI , Khorsand Afshin , kheirkhah Masoomeh , Shamshiri Ahmad Reza 
Published: June 2020

Abstract
Background: Periodontal infections are the most common oral diseases in pregnancy. This condition can cause complications during pregnancy. Therefore, this study was designed to determine the factors affecting preterm birth and their relationship with periodontal diseases. Methods: This was a prospective cohort study and the population, consisted of women 18-45 years attending prenatal care centers in their second trimester of pregnancy. After obtaining informed and free consent from the female parent, a periodontal examination was performed and her medical information was recorded. Examination of Rumford’s teeth was performed to assess the severity of gingivitis, plaque, calculus, and attachment loss, and AMOS software was used to investigate the association between preterm labor and delivery and to provide a conceptual model. Results: The consequences showed a direct association between preterm labor and factors, such as attachment loss, calculus , bleeding on probing (BOP), age, current diabetes, gestational diabetes, gestational hypertension, lack of Calcium, Folic acid, and Fe supplementation, mothers’ depression, polyhy dramnios, smoking severity and history of premature rupture of the membrane. The results also indicated an indirect relationship between an irregular tooth brushing and preterm birth. Conclusion: Attachment loss, calculus, bleeding on probing are directly related to premature labor and irregular tooth brushing is indirectly associated with early birth. Due to the direct relationship between periodontal diseases and preterm delivery, regular brushing, oral hygiene, oral examinations during pregnancy and follow-up treatment of periodontal disease during pregnancy are recommended. Keywords: Periodontal disease, Preterm labor, Cohort study, Path analysis, Pregnancy
A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial
Authors: Loy See Ling , - Thilagamangai , Teo Joyce , Chan Sze Wern , Razak Nurul Khairani Abdul , Chay Oh Moh , Ng Kee Chong 
Published: June 2020

Abstract
Background: Enhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore. Methods: This three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women’s and Children’s Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving home visits, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first trimester, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using linear regression mixed models to test the effects of interventions across time-point. Recruitment is projected to begin in June 2020 and end in May 2021.Discussion: This study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes. Trial registration: ClinicalTrials.gov, NCT 04275765. Registered on 19 February 2020, https://clinicaltrials.gov/ct2/show/NCT04275765?term=NCT+04275765&draw=2&rank=1.
Clinical Trial Protocol to Evaluate the Efficacy of Cefixime in the Treatment of Early Syphilis
Authors: Mehta Shivani N. , Stafylis Chrysovalantis , Tellalian David M. , Burian Pamela L. , Okada Cliff M. , Millner Carl E. , Mejia Christopher M. , Klausner Jeffrey D. 
Published: June 2020

Abstract
Background: Syphilis rates have been increasing both in the US and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. Methods: We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, California. Eligible participants are ≥18 years old, with primary, secondary or early latent syphilis (Rapid Plasma Reagin [RPR] titer ≥1:8). Patients with HIV infection must have a viral load ≤200 copies/mL and CD4+ T cell count ≥350 cells/μl during the past 6 months. Participants are randomized to receive either 2.4M IU benzathine penicillin G intramuscularly once or cefixime 400mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥4-fold RPR titer decrease at 3- or 6-months post-treatment.Discussion: Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. Trial Registration: Clinicaltrials.gov, NCT03660488. Registered September 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03660488
Patterns of Fish and Whale Consumption in Relation to Methylmercury in Hair among Residents of Western Canadian Arctic Communities
Authors: Walker Emily Victoria , Yuan Yuan , Girgis Safwat , Goodman Karen J. 
Published: June 2020

Abstract
Background: Methylmercury contamination of the environment represents a substantial environmental health concern. Human exposure to methylmercury occurs primarily through consumption of fish and marine mammals. Heavily exposed subgroups include sport or subsistence fishers residing in Arctic communities. We aimed to estimate the association of fish/whale consumption patterns of Canadian Arctic subsistence fishers with the internal dose of methylmercury as measured in hair. Methods: This research was conducted within ongoing community projects led by the CAN Help Working Group in Aklavik and Fort McPherson, Northwest Territories and Old Crow, Yukon. We interviewed each participant using a fish-focused food-frequency questionnaire during September-November 2016 and collected hair samples concurrently. Methylmercury was measured in the full-length of each hair sample using gas chromatography inductively-coupled plasma-mass spectrometry. Multivariable linear regression estimated beta-coefficients and 95% confidence intervals (CIs) for the effect of fish/whale consumption on hair-methylmercury concentrations. Results: Among 101 participants who provided hair samples and diet data, the mean number of fish/whale species eaten was 3.5 (SD:1.9). The mean hair-methylmercury concentration was 0.60μg/g (SD:0.47). Fish/whale consumption was positively associated with hair-methylmercury concentration, after adjusting for sex, hair length and use of permanent hair treatments. Hair-methylmercury concentrations among participants who consumed the most fish/whale in each season ranged from 0.30- 0.50μg/g higher than those who consumed <1 meal/week. Conclusions: In this population of Canadian Arctic subsistence fishers, hair-methylmercury concentration increased with fish/whale consumption, but the maximum concentrations were below Health Canada’s 6.0μg/g threshold for safe exposure.