bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal, Foetal and Service-Related Risk Factors for Stillbirths During Conflict Situation, Yemen, 2015-2016
Authors: Al-Shahethi Ahmed Hamood , Zaki Rafdzah Ahmad , Serouri Abdullwahed Abdulgabar Al- , Mahmud Awang Bulgiba 
Published: August 2020

Abstract
Background: Stillbirth is a silent traumatic canker which is a major concern of various individuals, health institutions and the country as a whole. Stillbirth remains a Global major problem responsible for nearly three million deaths.Study objectives: To estimate the stillbirth rate (SBR) in Sana’a, Yemen and to identify potential risk factors for stillbirth.Methods: A community-based prospective cohort study was carried out between 8/2015 and 12/2016. Nine-hundred and eighty pregnant women were identified for the outcome of their pregnancy. We employed binomial regression together with generalised linear models.Results: The study included 952 pregnant women with 44 stillbirths. The stillbirth rate was 46.2 per 1000 and 45.2 per 1000. In multivariable analysis teenage mothers’ age at first childbirth (< 20 years) (RR 3.70), women with anemia (RR=2.23), smoking snuff (RR = 4.27), prolonged labour (> 24 hours) (RR = 2.02), prolonged rupture of membranes (≥ 24 hours) (RR = 2.22), foetal malposition (RR = 4.60), low birth weight (RR = 14.90) and foetal gestational age (weeks) (RR = 5.60) were significant factors associated with increased risk of stillbirths. Conclusions: This study identiﬁed many risk factors of stillbirth that are amenable to intervention. Encouraging women to deliver at health facilities, providing better management of obstetrical complications, proper antenatal care, and prompt referral services are essential for reduction of stillbirths in Yemen.
Developing Healthcare Team Observations for Patient Safety (HTOPS): Senior Medical Students Capture Everyday Clinical Moments
Authors: Anderson Elizabeth Susan , Griffiths Leyshon , Forey Teri , Wobi Fatima , Norman Robert , Martin Graham 
Published: August 2020

Abstract
Background
Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Seeking a patient-safety experiential learning method for final year medical students we embarked on a pilot study for similarly observing real-time clinical practice in context.
Methods
Using Participatory Action Research, we collected data on medical students’ observations of real time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed on-to-one interviews on their experiences. The interviews were analysed using thematic analysis.
Results
Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital Trust. They formed the themes of human factors, systems and environment. Aviation approaches were adapted to form an app capable of recording real time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their agreement of the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed.
Conclusion
The final product, an app called Healthcare Team Observations for Patient Safety (HTOPS), used by observing senior medical students can record both positive and negative clinical individual and team behaviours in acute-care practice. Early findings are promising as they highlight the totality of patient safety practice and can illuminate good and poor practice. The findings have been positively received and welcomed by the observed Hospital Trust. The next steps will further refine the app for use in all clinical areas for capturing light noise. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by staff and medical students.
Listen and learn: Using focus groups in program planning for a low-income population at cardiovascular risk
Authors: Kirzner Rachel S. , Robbins Inga , Privitello Meghan , Miserandino Marianne 
Published: August 2020

Abstract
Background: Poverty increases the risk of cardiac disease, while diminishing the resources available to mitigate that risk. Available prevention programs often require resources that low-income residents of urban areas do not possess, e.g. membership fees, resources to purchase healthy foods, and safe places for physical activity. The aim of this study is to obtain participant input in order to understand the health-related goals, barriers, and strengths as part of planning a program to reduce cardiovascular risk.Methods: In a mixed methods study, we used surveys and focus groups as part of planning an intervention specifically designed to meet the needs of lower income individuals. Based on prior research, we used Self-Determination Theory (SDT) and its core constructs of autonomy, competence, and relatedness as the theoretical framework for analysis. The study collected information on the perspectives of low-income urban residents on their risks of cardiovascular disease, their barriers to addressing health needs, and how they addressed those barriers. Focus group transcripts were analyzed using standard qualitative methods including paired coding and development of themes from identified codes.Results: Participants had health goals that aligned with accepted approaches to reducing their cardiovascular risks, however they lacked the resources to reach those goals. We found the need for support in the three SDT core constructs. The barriers that participants reported suggested that these basic psychological needs were often thwarted by their environments.Conclusions: Substantial disparities in both access to health-promoting resources and in support for autonomy, competence, and relatedness must be addressed in order to design an effective intervention for a low-income population at cardiac risk.
Reflection on the Reform of China's Emergency Medical Insurance System based on the Prevention and Control of COVID-19
Authors: Meng Luo , Cheng Hui , Li Shaohua 
Published: August 2020

Abstract
Objective: Based on the Prevention and Control of COVID-19, this paper points out the shortcomings of China's current medical insurance system, and puts forward the concept of establishing emergency medical insurance system.Methods: This paper analyzes the characteristics of the modern epidemic and its special requirements for medical insurance. Putting forward the idea of mechanism construction.Results:The operation of China's national medical insurance system is mainly operated by the insured, the government, medical institutions and medical institutions. However, the rapid spread of the epidemic has caused great disasters to the society. In the face of major public health events, medical insurance should have four characteristics: the "normalization" of the emergency medical insurance system, the fairness of guarantees, the public quality of treatment and positive externalities. China should establish an emergency system in line with these four characteristics from the four parties. Therefore, this paper analyzes the characteristics of modern epidemic risk, its development process and the requirements for the insurance industry in combination with the situation of China's response to dealing with COVID-19, and puts forward that China should further improve the universal medical insurance system and establish an emergency medical security system to better deal with all kinds of sudden public health events, which will still happen in the future.Conclusions:China's national medical insurance system should not be limited to meet people's conventional medical needs. When public health emergencies occur, it is also necessary to establish a sound medical insurance system to operate.The establishment of emergency medical security system is one of the important development directions of our country in the future.
An ingredients-based approach to costing integrated malaria elimination strategies: an example from Myanmar
Authors: Kyaw Shwe Sin , Delmas Gilles , Drake Tom L , Celhay Olivier , Pan-ngum Wirichada , Pukrittayakameee Sasithon , Lubell Yoel , Aguas Ricardo J , Maude Richard , White Lisa J , Nosten Francois 
Published: August 2020

Abstract
Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA is to be included in elimination packages beyond existing malaria interventions. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for MDA, and conducting mass treatment in target villages) were evaluated. We then estimate the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses.Results The cost of delivering MDA within an integrated malaria elimination initiative in Eastern Kayin State was approximately US$ 910 000. The cost per person reached for MDA was US$ 2·5. Conclusion This cost analysis can assist policy makers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of MDA in different numbers of target villages.
Ultra-Processed Foods Are the Major Sources of Total Fat, Saturated and Trans-Fatty Acids Among Tunisian Preschool and School Children: A Cross-Sectional Study
Authors: Dogui Darine , Ati-Hellal Myriam El , Doggui Radhouene , Ati Jalila El 
Published: August 2020

Abstract

Background: Excessive intake of fat and fatty acids is associated with major health hazards such as obesity or chronic diseases. The aim of this study is to provide the first data on total fat, SFA and TFA intakes and their major food sources in Tunisian children. Methods: A total of 1200 children, aged 3 to 9 years old, were randomly selected from primary schools and kindergarten under a cross-sectional design. The 24hour recall method and food frequency questionnaire were used to assess dietary intake over a period of one week.Results: The energy percentages of total fat, SFA and TFA in Tunisian children were respectively 29.6, 11.4 and 0.15. No sex differences were found. The WHO recommendations for total fat, SFA and TFA were adopted by 58 %, 39 % and 89 % of the study population, respectively. The leading food groups of fat and fatty acids were ultra-processed foods, bread and cereals and dairy products. The meat, fish, eggs and fish alternatives were the fifth main contributors to the total fat and SFA intakes in Tunisian children.Conclusions: The implementation of a relevant strategy for fat reduction, especially from ultra-processed foods, considered as low nutrient energy-dense products, is needed to promote health among children and prevent diet-related chronic diseases.
Factors Influencing Adolescent Girls and Young Women’s Participation in a Combination Hiv Prevention Intervention in South Africa
Authors: Appollis Tracy McClinton , Duby Zoe , Jonas Kim , Dietrich Janan , Maruping Kealeboga , Abdullah Fareed , Slingers Nevilene , Mathews Catherine 
Published: August 2020

Abstract
Background: For interventions to reach those they are intended for, an understanding of the factors that influence their participation, as well as the facilitators and barriers of participation are needed. This study explores factors associated with participation in a combination HIV prevention intervention targeting adolescent girls and young women (AGYW) aged 15–24-years-old, as well as the experiences of AGYW, intervention implementers, and facilitators who participated in this intervention. Methods: This study used mixed-methods approach with quantitative household survey data from 4399 AGYW aged 15-24-years-old in six of the ten districts in which the intervention was implemented. In addition, qualitative methods included semi-structured in-depth interviews and focus group discussions in five of the ten intervention districts with 185 AGYW who participated in one or more of the key components of the intervention, and 13 intervention implementers and 13 facilitators. Results: Findings reveal that almost half of AGYW (48.4%) living in the districts where the intervention took place, participated in at least one of the components of the intervention. For both 15-19-year-olds and 20-24-year-olds, factors associated with increased participation in the intervention included being HIV negative, in school, never been pregnant, and having had a boyfriend. Experiencing intimate partner violence (IPV) and/or sexual violence in the past 12 months was associated with increased levels of participation in the intervention for 20-24-year-olds only. In our analysis of the qualitative data, facilitators to participation included motivating participants to join the interventions through explaining the benefits of the programme. Barriers included misguided expectations about financial rewards or job opportunities; competing responsibilities, interests or activities; family responsibilities including childcare; inappropriate incentives; inability to disrupt the school curriculum and difficulties with conducting interventions after school hours due to safety concerns; miscommunication about meetings; as well as struggles to reach out-of-school AGYW.Conclusion: Designers of combination HIV prevention interventions need to address the structural barriers to participation so that AGYW can attend without risking their safety and compromising their family, childcare and schooling responsibilities. Strategies to create demand need to include clear communication about the nature and potential benefits of such interventions, and the inclusion of valued incentives.
The Effectiveness of Moxibustion for Treating of Lumbar Disc Herniation(LDH): A Protocol for Systematic Review and Meta-ananlysis
Authors: Wu Zenan , Xiong Jun , Xu Guixing , Zuo Zhengyun , Yang Yi , Xie Qiongshan 
Published: August 2020

Abstract
Background: Lumbar disc herniation (LDH) refers to lumbar disc degeneration or external pressure, resulting in annulus fibrosus rupture, nucleus pulposus protrusion or bulging, compression of nerve roots, cauda equina nerve, and then some clinical symptoms of a clinical syndrome, clinical symptoms are often manifested as unilateral or bilateral lumbar pain, leg numbness. L3/L4,L4/L5, and L5/S1 intervertebral disc herniations are common in the lesion sites of lumbar disc herniations, and the incidence rate is as high as 90%. Typical manifestations are tenderness at the corresponding surface of the body. This disease is a common and frequently-occurring disease in the department of rehabilitation and acupuncture of the hospital, and is a common cause of lumbago and leg pain. At present, the common external treatment for LDH includes many methods,mostly acupuncture and moxibustionMethods: We're going to use systematic electronic search, including PubMed,MEDLINE, Cochrane library, SinoMed,CNKI,WF,VIPand checked references of retrieved articles. Randomized controlled trials (RCTs) on acupotomy treatment in LDH patients will be searched for independently by 2 reviewers in the databases from their inception to August 2020. We will combine data from clinically homogenous studies in a fixed effect meta-analysis using RevManV.5.3.5, and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Discussion: The results of this review will provide reliable evidence for effectiveness and safety of moxibustion for treating LDH.Systematic review registration: CRD42020187626
Bloodstream infections caused by ST2 Acinetobacter baumannii&nbsp;over 6 years in China: risk factors, antibiotic regimens and virulence
Authors: Yu Kaihang , Zeng Weiliang , Xu Ye , Liao Wenli , Xu Wenya , Zhou Tieli , Cao Jianming , Chen Lijiang 
Published: August 2020

Abstract
Background
Acinetobacter baumannii (Ab) is an important pathogen of medical-related infections, A.baumannii sequence type 2 (ST2) has spread all over the world. To the best of our knowledge, this is the first study to analyze the clinical and microbiological characteristics of patients with bloodstream infection (BSI) due to ST2 A.baumannii.
Methods
A retrospective study was conducted in a large tertiary hospital in China. From January 2013 to December 2018, the clinical and microbiological data of all consecutive hospitalized patients with bacteremia due to multidrug-resistant A.baumannii (MDR-AB) were included and analyzed comprehensively.
Results
A total of 108 episodes of BSI due to MDR-AB cases were enrolled during the study period. Overall, 30-day mortality was 69.4% (75/108). The use of mechanical ventilation, intensive care unit (ICU) stay and thrombocytopenia may cause higher mortality (P = 0.048, P < 0.001, and P < 0.001, respectively). Change antimicrobial within 48 h after isolating from blood, use of antibacterial combination and more inpatient days were significantly associated with survival (P < 0.001, P = 0.037, and P = 0.007, respectively). All MDR isolates belong to ST2, and have strong biofilm formation ability and high pathogenicity.
Conclusions
BSI caused by ST2 A.baumannii represents a difficult challenge for physicians, considering the high mortality associated with this infection. The combination of cefoperazone/sulbactam and tigecycline may be a meaningful treatment option.
Early Prediction of the Carbapenem Resistance Gram-negative Bacteria Carriage in Intensive Care Unit using Machine-Learning
Authors: Liang Qiqiang , Zhao Qinyu , Xu Xin , Zhou Yu , Huang Man 
Published: August 2020

Abstract
Background

The prevention and control of carbapenem-resistance gram-negative bacteria (CR-GNB) is the difficulty and focus for clinicians in the intensive care unit (ICU). This study construct a CR-GNB carriage prediction model in order to predict the CR-GNB incidence in one week.
Methods

The database is comprised of nearly 10,000 patients. the model is constructed by the multivariate logistic regression model and three machine learning algorithms. Then we choose the optimal model and verify the accuracy by daily predicted and recorded the occurrence of CR-GNB of all patients admitted for 4 months.
Results

There are 1385 patients with positive CR-GNB cultures and 1535 negative patients in this study. Forty-five variables have statistical significant differences. We include the 17 variables in the multivariate logistic regression model and build three machine learning models for all variables. In terms of accuracy and the area under the receiver operating characteristic (AUROC) curve, the random forest is better than XGBoost and multivariate logistic regression model, and better than decision tree model (accuracy: 84% >82%>81%>72%), (AUROC: 0.9089 > 0.8947 ≈ 0.8987 > 0.7845). In the 4-month prospective study, 81 cases were predicted to be positive in CR-GNB culture within 7 days, 146 cases were predicted to be negative, 86 cases were positive, and 120 cases were negative, with an overall accuracy of 84% and AUROC of 91.98%.
Conclusions

Prediction models by machine learning can predict the occurrence of CR-GNB colonization or infection within a week period, and can real-time predict and guide medical staff to identify high-risk groups more accurately.
Effect of Timely Lactate Measurement on In-hospital Mortality among Adults with Hypotension and Hyperlactatemia: An Observational Study on Two Cohorts
Authors: Chen Hui , Bao Xiebing , Xu Ying , Guo Yanxia , Zhou Mingqin , Zhao Chenyan , Wei Yao , Jin Jun 
Published: August 2020

Abstract
Background: Whether patients presented with hypotension and hyperlactatemia can benefit from timely lactate measurement and further lactate-guide resuscitation were not fully understood.Methods: This was a retrospective observational study based on the data from the Medical Information Mart for Intensive Care (MIMIC)-III Database and the eICU Collaborative Research Database (eICU). Patients with hypotension (defined as a minimal systolic blood pressure ≤90 mm Hg or minimal mean arterial pressure ≤65 mm Hg or requiring any vasopressors support during the first 24 h after ICU admission) and hyperlactatemia (defined as an initial lactate level > 2.0 mmol/L after ICU admission) were eligible.The primary exposure was the timely lactate measurement, which was defined as an initial lactate level measured within 1 h after ICU admission. The primary outcome was in-hospital mortality. The statistical approaches included multivariate regression, propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) and causal mediation analysis (CMA) were utilized to elucidate the relationship between timely lactate measurement and in-hospital mortality. Results: A total of 9978 patients were identified, of which 4257 in MIMIC-III and 5721 in eICU. Timely lactate measurement was associated with lower risk-adjusted in-hospital mortality both in MIMIC (OR 0.70 (95%CI 0.58-0.85; p<0.001)) and eICU (OR 0.75 (95%CI 0.64-0.88; p<0.001)). Time to initial intravenous fluid (IVF) in MIMIC mediated 6.7% (95%CI 1.4%-38%; p<0.001) of the beneficial effect of timely lactate measurement (p<0.001 for average causal mediation effect (ACME)) in terms of in-hospital mortality. Finally, delayed initial lactate measurements are also associated an increased in-hospital mortality in MIMIC and eICU.Conclusions: Timely lactate measurement is associated with a lower risk-adjusted in-hospital mortality among patients with hypotension and hyperlactatemia, which was proportional mediated through shortening the time to IVF. Delay in initial lactate measurement showed a positive association with in-hospital mortality.