bluuebunny/crossref_metadata_2025_split huggingface dataset:
An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi
Authors: Chirwa Ellen , Kapito Esnath , Jere Diana L. , Kafulafula Ursula , Chodzaza Elizabeth , Chorwe-Sungani Genesis , Gresh Ashley , Liu Li , Abrams Elizabeth T. , Klima Carrie S. , McCreary Linda L. , Norr Kathleen F. , Patil Crystal L. 
Published: February 2020

Abstract
Background
Sub-Saharan Africa has the world’s highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO’s call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes.

Methods
Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices.

Discussion
This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model.

Trial registration
ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.
Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar
Authors: Thike Thin Zar , Saw Yu Mon , Lin Htin , Chit Khin , Tun Aung Ba , Htet Hein , Cho Su Myat , Khine Aye Thazin , Saw Thu Nandar , Kariya Tetsuyoshi , Yamamoto Eiko , Hamajima Nobuyuki 
Published: February 2020

Abstract
Background
Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar.

Methods
A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI).

Results
This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44–15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82–8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54–31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63–7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22–9.03), and smoking (AOR = 5.62, 95% CI 1.06–29.90) were positively associated with overweight and obesity.

Conclusion
Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.
Associations between perceived and actual physical literacy level in Chinese primary school children
Authors: Li Ming Hui , Sum Raymond Kim Wai , Sit Cindy Hui Ping , Wong Stephen Heung Sang , Ha Amy Sau Ching 
Published: February 2020

Abstract
Background
The concept of physical literacy (PL) is gaining popularity within public health and physical education circles. However, little is known about the relationship between perceived and actual PL levels among school-aged children. The aim of this study is to explore the associations between perceived and actual levels of PL of primary school students in China.

Methods
A total of 327 children (153 boys and 174 girls) with a mean (SD) age of 10.0 (±1.0) years were included for analysis. PL perceptions were measured using the Perceived Physical Literacy Instrument. Children’s actual level of PL was objectively assessed by the Chinese version of the Canadian Assessment of Physical Literacy, 2nd edition, which consists of four domains: Daily Behavior, Physical Competence, Motivation and Confidence, and Knowledge and Understanding. Pearson’s correlation coefficients were calculated to examine the relationship between students’ perceived and actual PL levels, whereas Multivariate Analysis of Variance (MANOVA) was calculated to investigate the gender, relative age differences, and interaction effect (2 × 4) on perceived and actual PL levels respectively.

Results
Significant correlations were observed between the perceptions and actual PL scores in both boys (r = .46, p < .01) and girls (r = .41, p < .01). Low to moderate significances were shown between each domain of perceived PL and actual PL (from .16 to .49). Further MANOVA results revealed that there were significant gender differences in the Daily Behavior domain of actual PL (F (1, 319) = 30.15, p < .001, Wilks’ Λ = 540.88, η2partial = .09). Overall, boys had both higher actual PL scores (58.9) and PL perceptions (37.3) than girls. Neither relative age effect nor interaction effect (2 × 4) was observed for the current participants in all the variables.

Conclusions
This study is the first to examine the associations between the perceived and actual levels of PL in Chinese children. Additional studies should explore the importance of children’s perceptions of PL when assessing the actual level of PL in physical education and health settings. Girls should be more encouraged by PE teachers to participate actively in physical activities in the school environment.
Trabecular bone scores in young HIV-infected men: a matched case-control study
Authors: Kim Youn Jeong , Kang Kwi Young , Shin Juyoung , Jun Yoonhee , Kim Sang Il , Kim Yang Ree 
Published: February 2020

Abstract
Background
Screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) is recommended for male HIV-infected patients only above the age of 50. Recently, trabecular bone score (TBS) has been introduced as a novel tool to assess bone microarchitecture using DXA of the lumbar spine. Few studies have reported TBS values in HIV-infected individuals younger than 50 years of age. This study compared TBS values in young males infected with HIV and matched controls, and investigated the associations between TBS and demographic parameters, clinical parameters, and bone mineral density (BMD) scores.

Methods
A cross-sectional study of BMD and TBS in HIV-infected men (n = 80) aged between 18 and 50 years and age- and sex-matched controls (n = 80) was conducted.

Results
The proportion of patients with low BMD (Z-score ≤ − 2) was significantly greater among HIV-infected patients than among matched controls (21.3% [17/80] vs. 8.8% [7/80], p = 0.027). Mean TBS values were significantly lower in HIV-infected patients than in controls (1.41 ± 0.07 vs. 1.45 ± 0.07, p = 0.008). In both groups, TBS values were positively correlated with BMD at the lumbar spine, femoral neck, and total hip (p < 0.001); however, TBS was not correlated with body mass index. In the HIV group, TBS was negatively correlated with the duration of tenofovir disoproxil fumarate(TDF) exposure (p = 0.04).

Conclusion
Young men infected with HIV had abnormal bone trabecular microarchitecture, as assessed by both TBS and BMD. TBS values were correlated with both BMD and the duration of TDF exposure.
Effect of reconstruction parameters on cone beam CT trabecular bone microstructure quantification in sheep
Authors: Muhammad Aso Muhammad Ali , Ibrahim Norliza , Ahmad Rohana , Asif Muhammad Khan , Radzi Zamri , Zaini Zuraiza Mohamad , Razak Hairil Rashmizal Abdul 
Published: February 2020

Abstract
Background
Cone Beam Computed Tomography (CBCT) is a reliable radiographic modality to assess trabecular bone microarchitecture. The aim of this study was to determine the effect of CBCT image reconstruction parameters, namely, the threshold value and reconstruction voxel size, on trabecular bone microstructure assessment.

Methods
Five sectioned maxilla of adult Dorper male sheep were scanned using a CBCT system with a resolution of 76 μm3 (Kodak 9000). The CBCT images were reconstructed using different reconstruction parameters and analysed. The effect of reconstruction voxel size (76, 100 and 200 μm3) and threshold values (±15% from the global threshold value) on trabecular bone microstructure measurement was assessed using image analysis software (CT analyser version 1.15).

Results
There was no significant difference in trabecular bone microstructure measurement between the reconstruction voxel sizes, but a significant difference (Tb.N = 0.03, Tb.Sp = 0.04, Tb.Th = 0.01, BV/TV = 0.00) was apparent when the global threshold value was decreased by 15%.

Conclusions
Trabecular bone microstructure measurements are not compromised by changing the CBCT reconstruction voxel size. However, measurements can be affected when applying a threshold value of less than 15% of the recommended global value.
Who needs and continues to need paediatric palliative care? An evaluation of utility and feasibility of the Paediatric Palliative Screening scale (PaPaS)
Authors: Chong Poh Heng , Soo Janice , Yeo Zhi Zheng , Ang Raymond Qishun , Ting Celene 
Published: February 2020

AbstractBackgroundWhile the populations of children who can benefit from paediatric palliative care (PPC) have been broadly defined, identifying individual patients to receive PPC has been problematic in practice. The Paediatric Palliative Screening scale (PaPaS) is a multi-dimensional tool that assesses palliative care needs in children and families to facilitate timely referrals. This study evaluates its use to manage new referrals and ongoing review of patients receiving home-based PPC in Singapore.MethodsUsing a retrospective cohort study design, 199 patients admitted to receive PPC via clinician screening were scored using PaPaS. Eighty-four patients in two groups were scored again at one of two following milestones: one-year service continuation mark or point of discharge before a year. Accuracy measures were compared against clinical assessment.Results96.98% of patients scored 15 and above on admission (indicating need for PPC). Patients assessed at following milestones were effectively stratified; those who continued to receive service after 1 year scored significantly higher (M = 19.23) compared to those who were discharged within a year (M = 7.86). Sensitivity and specificity for PaPaS were calculated at 82.54 and 100% respectively. Overall congruence with clinician-based decisions supports the utility of PaPaS as a screening tool in PPC. Recommendations to improve the scale further are proposed.ConclusionThe PaPaS is a practical screening tool that signposts PPC needs within the clinical setting. This facilitates early referrals to PPC, without having to specify individual prognoses that are often uncertain. Other benefits include optimised continuity of care and implications for resource allocation.
Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review
Authors: Magnay Julia L. , O’Brien Shaughn , Gerlinger Christoph , Seitz Christian 
Published: February 2020

AbstractBackgroundPictorial blood loss assessment charts (PBACs) represent the most widely used method to assess menstrual blood loss (MBL) in clinical trials. The aims of this review were to: (1) determine the diagnostic accuracy of PBACs that have been validated against the reference alkaline hematin technique; (2) categorize the pitfalls of using obsolete and nonvalidated charts; (3) provide guidelines for development of a new PBAC or use of an existing chart to measure MBL in clinical trials; and (4) consider the feasibility of using pictorial charts in primary care.MethodsA literature review was conducted using Embase and MEDLINE databases. The review identified reports of women with self-perceived or actual heavy menstrual bleeding (HMB), bleeding disorders, abnormal uterine bleeding, leiomyomata (uterine fibroids) or endometriosis, and women undergoing treatment for HMB, as well as those with normal menstrual periods. Data were reviewed from studies that focused on the development and validation of PBACs and from those that used derivative noncertified charts to assess HMB.ResultsNine studies reported validation of PBAC scoring systems against the alkaline hematin technique. Across these studies, the sensitivity was 58–97%, the specificity was 7.5–95.5%, the positive and negative likelihood ratios were 1.1–13.8 and 0.14–0.56, respectively, and the diagnostic odds ratio was 2.6–52.4. The cut-off score above which the diagnosis of HMB was made ranged from 50 to 185. Several modifications of these PBACs were used in other studies; however, objective confirmation of their validity was not reported. Overall, there was widespread inconsistency of chart design, scoring systems, diagnostic cut-off limits and post-treatment outcome measures.ConclusionsPBACs are best suited to the controlled and specific environment of clinical studies, where clinical outcome parameters are defined. The current lack of standardization precludes widespread use of the PBAC in primary care.Review registration numberPROSPERO international prospective register of systematic reviews: CRD42016030083.
A theory-based study of doctors’ intentions to engage in professional behaviours
Authors: Rich Antonia , Medisauskaite Asta , Potts Henry W. W. , Griffin Ann 
Published: February 2020

Abstract
Background
The Theory of Planned Behaviour (TPB) has been proposed as an appropriate model for creating a theory-driven approach to teaching medical professionalism. However, there is a lack of empirical evidence into its efficacy. This study explores if the TPB can assess UK medical doctors’ professional behaviours and explores if there are differences in the TPB’s efficacy depending on doctors’ primary medical qualification (UK or outside).

Methods
Three hundred fourteen doctors in England at 21 NHS Trusts completed a questionnaire about reflective practice, using the General Medical Council’s confidentiality guidance, and raising a patient safety concern. The majority of participants were male (52%), white (68%), consultants (62%), and UK medical graduates (UKGs) (71%).

Results
The TPB variables of attitudes, subjective norms, and perceived behavioural control were predictive of intention to engage in raising concerns (R2 = 35%), reflection (R2 = 52%), and use of confidentiality guidance (R2 = 45%). Perceived behavioural control was the strongest predictor of intentions to raise a concern (β = 0.44), while attitude was the strongest predictor of intentions to engage in reflective practice (β = 0.61) and using confidentiality guidance (β = 0.38). The TBP constructs predicted intention for raising concerns and reflecting for both UKGs and non-UKGs (Fs ≥ 2.3; ps ≤ .023, βs ≥ 0.12). However, only perceived behaviour control was predictive of intentions to use guidance for both UKGs and non-UKGs (β = 0.24) while attitudes and norms were just predictive for UKGs (βs ≥ 0.26).

Conclusions
This study demonstrates the efficacy of the TPB for three professional behaviours. The implications for medical educators are to use the variables of the TPB (attitudes, subjective norms, and perceived behavioural control) in the education of professionalism, and for medical education researchers to further our understanding by employing the TPB in more empirical studies of non-clinical behaviours.
A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour
Authors: O’Donovan Róisín , McAuliffe Eilish 
Published: February 2020

Abstract
Background
Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions.

Methods
A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.

Results
Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions’ ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours.

Conclusion
To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams.

Prospero registration number
CRD42018100659.
What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence
Authors: Nic Giolla Easpaig Bróna , Tran Yvonne , Bierbaum Mia , Arnolda Gaston , Delaney Geoff P. , Liauw Winston , Ward Robyn L. , Olver Ian , Currow David , Girgis Afaf , Durcinoska Ivana , Braithwaite Jeffrey 
Published: February 2020

Abstract
Background
The adoption of Patient Reported Outcome Measures (PROMs) in cancer care has been widely advocated, but little is known about the evidence for the implementation of PROMs in practice. Qualitative research captures the perspectives of health professionals as end-users of PROMs and can be used to inform adoption efforts. This paper presents a systematic review and synthesis of qualitative research conducted to address the question: What are the attitudes of health professionals towards PROMs in oncology, including any barriers and facilitators to the adoption of PROMS, reported in qualitative evidence?

Methods
Systematic searches of qualitative evidence were undertaken in four databases and reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English between 1998 and 2018, which reported qualitative findings about the attitudes of health professionals working in oncology towards PROMs were eligible. Studies were assessed using the Critical Appraisal Skills Programme’s Qualitative Research Checklist. A sentiment analysis was conducted on primary text to examine the polarity (neutral, positive or negative) of health professionals’ views of PROMs. Qualitative meta-synthesis was conducted using a constant comparative analysis.

Results
From 1227 articles after duplicates were removed, with 1014 excluded against the screening criteria, 213 full text articles remained and were assessed; 34 studies met the inclusion criteria and were included. The majority of studies were of good quality. Sentiment analysis on primary text demonstrated an overall positive polarity from the expressed opinions of health professionals. The meta-synthesis showed health professionals’ attitudes in four domains: identifying patient issues and needs using PROMs; managing and addressing patient issues; the care experience; and the integration of PROMs into clinical practice.

Conclusions
From the accounts of health professionals, the fit of PROMs with existing practice, how PROMs are valued, capacity to respond to PROMs and the supports in place, formed the key factors which may impede or promote adoption of PROMs in routine practice. To assist policy-makers and services involved in implementing these initiatives, further evidence is required about the relationship between PROMs data collection and corresponding clinical actions.

Trial registration
International Prospective Register of Systematic Reviews (PROSPERO) CRD42019119447, 6th March, 2019.