bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study
Authors: Kurtz Landy Christine , Sword Wendy , Kathnelson Jackie Cramp , McDonald Sarah , Biringer Anne , Heaman Maureen , Angle Pam 
Published: June 2020

Abstract
Background
Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women’s decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method.

Methods
A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis.

Results
Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women’s choice … with conditions, their assessment of women’s chances of a successful TOLAC, their perception of women’s risk tolerance, women’s preferred delivery method, and their perception of women’s beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers’ perspectives on risk of TOLAC.

Conclusion
The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease non-medically indicated PRCS.
Improving the mental wellbeing of Arabic speaking refugees: an evaluation of a mental health promotion program
Authors: Slewa-Younan Shameran , McKenzie Molly , Thomson Russell , Smith Mitchell , Mohammad Yaser , Mond Jonathan 
Published: June 2020

Abstract
Background
Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees’ knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees.

Methods
A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention.

Results
Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants’ levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up.

Conclusion
While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation.
Illness prevalence rate in Tibet, China: data from the 2018 National Health Service Survey
Authors: Deng Rendan , Labasangzhu  , Zhaxideji  , Wang Guihua , Hong Peiwei , Li Jiaqi , Li Qiwen , Wan Yang , Xiong Hai 
Published: June 2020

Abstract
Background
Tibet is located in the high-altitude area of Southwest China, where the health level is influenced by specific factors such as the natural environment and living habits. However, there has been little research that has focused on Tibetan health conditions. The two-week prevalence rate is an important indicator of the health level of residents. The purpose of this study was to understand the health status of the residents and the health service needs in Tibet.

Methods
The two-week prevalence rate was calculated using data from a population of 10,493 individuals aged 15 and above that was obtained from the 2018 Sixth National Health Service Survey of Tibet. We initially analysed the types and associated factors of two-week illnesses in Tibetan. The influencing factors for the two-week prevalence rate in Tibet were determined by multivariate logistic regression analysis. Subsequently, we assessed the severity of two-week illnesses by calculating the average days of the duration of the disease, the days of being bedridden and the days of being off work.

Results
The two-week illness prevalence rate was 20.1% in Tibet. Digestive system diseases were frequent, and hypertension was the most common disease. According to the multivariate logistic regression analysis, the two-week prevalence rate was associated with gender, age, residence, marital status, and employment status. In addition, the severity of two-week illnesses differed among the residents.

Conclusion
This study identified that health service needs have increased in Tibet and that the health status of the local residents needs to be improved. Moreover, hypertension has become a major health hazard for the residents and should be considered in the utilization of health services.
Coverage of tuberculosis and diabetes mellitus screening among household contacts of tuberculosis patients: a household-based cross-sectional survey from Southern Thailand
Authors: Oo Myo Minn , Tassanakijpanich Nattaporn , Phyu Moe Hnin , Safira Nanda , Kandel Shashi , Chumchuen Kemmapon , Zhang Li Mei , Kyu Hnin Aye , Sriwannawit Porraporn , Bilmumad Bintinee , Cao Li , Guo Yingwu , Sukmanee Jarawee , Cuong Vu Manh , Chongsuvivatwong Virasakdi , McNeil Edward B. 
Published: June 2020

Abstract
Background
The comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening.

Methods
A household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and individual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results
Of 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the individual level, contacts aged ≥35 years (AOR: 30.6, 95% CI: 2.0–466.0), being an employee (AOR: 0.1, 95% CI: 0.0–0.8) and those who had lived more than 5 years in the same household (AOR: 0.1, 95% CI: 0.0–0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened.

Conclusions
Compared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.
The association of healthy lifestyle behaviors with mental health indicators among adolescents of different family affluence in Belgium
Authors: Maenhout L. , Peuters C. , Cardon G. , Compernolle S. , Crombez G. , DeSmet A. 
Published: June 2020

Abstract
Background
Healthy lifestyles may contribute to better mental health, which is particularly important in adolescence, an age at which half of all mental health problems first occur. This association may be even more relevant in adolescents of low family affluence, who show more mental health problems, as well as more unhealthy lifestyles. This study investigated healthy lifestyle behaviors, namely sufficient sleep and physical activity, daily breakfast intake, low levels of alcohol use or smoking, in relation to mental health and symptoms of mental health problems (feelings of depression, anxiety, stress and self-esteem) among adolescents from different family affluence. Furthermore, the moderating role of family affluence was examined in those relations.

Methods
Adolescents aged 12-18y were recruited via a random sample of schools in Flanders, Belgium. A total of 1037 adolescents participated (mean age = 15.2, 49.8% female). Independent samples t-tests, Mann Whitney U-tests and χ2-tests determined the differences in healthy lifestyle behaviors and mental health indicators between adolescents of low-medium and high family affluence. Regression analyses assessed the association between healthy lifestyles and mental health outcomes and the moderating role of family affluence.

Results
All healthy lifestyle behaviors were associated with at least one mental health outcome, with the exception of alcohol consumption. Adolescents from low-medium family affluence had lower levels of physical activity, less often took breakfast, had lower levels of alcohol consumption and reported lower self-esteem than adolescents from high family affluence. The results showed no moderating effect of family affluence for the association between healthy lifestyle and mental health.

Conclusion
These findings support the value of integrating healthy lifestyle behaviors in interventions for mental health promotion, for both youth of low-medium and high family affluence.
Early warning score validation methodologies and performance metrics: a systematic review
Authors: Fang Andrew Hao Sen , Lim Wan Tin , Balakrishnan Tharmmambal 
Published: June 2020

Abstract
Background
Early warning scores (EWS) have been developed as clinical prognostication tools to identify acutely deteriorating patients. In the past few years, there has been a proliferation of studies that describe the development and validation of novel machine learning-based EWS. Systematic reviews of published studies which focus on evaluating performance of both well-established and novel EWS have shown conflicting conclusions. A possible reason is the heterogeneity in validation methods applied. In this review, we aim to examine the methodologies and metrics used in studies which perform EWS validation.

Methods
A systematic review of all eligible studies from the MEDLINE database and other sources, was performed. Studies were eligible if they performed validation on at least one EWS and reported associations between EWS scores and inpatient mortality, intensive care unit (ICU) transfers, or cardiac arrest (CA) of adults. Two reviewers independently did a full-text review and performed data abstraction by using standardized data-worksheet based on the TRIPOD (Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) checklist. Meta-analysis was not performed due to heterogeneity.

Results
The key differences in validation methodologies identified were (1) validation dataset used, (2) outcomes of interest, (3) case definition, time of EWS use and aggregation methods, and (4) handling of missing values. In terms of case definition, among the 48 eligible studies, 34 used the patient episode case definition while 12 used the observation set case definition, and 2 did the validation using both case definitions. Of those that used the patient episode case definition, 18 studies validated the EWS at a single point of time, mostly using the first recorded observation. The review also found more than 10 different performance metrics reported among the studies.

Conclusions
Methodologies and performance metrics used in studies performing validation on EWS were heterogeneous hence making it difficult to interpret and compare EWS performance. Standardizing EWS validation methodology and reporting can potentially address this issue.
Cerebrospinal fluid and plasma biomarkers in individuals at risk for genetic prion disease
Authors: Vallabh Sonia M. , Minikel Eric Vallabh , Williams Victoria J. , Carlyle Becky C. , McManus Alison J. , Wennick Chase D. , Bolling Anna , Trombetta Bianca A. , Urick David , Nobuhara Chloe K. , Gerber Jessica , Duddy Holly , Lachmann Ingolf , Stehmann Christiane , Collins Steven J. , Blennow Kaj , Zetterberg Henrik , Arnold Steven E. 
Published: June 2020

Abstract
Background
Prion disease is neurodegenerative disease that is typically fatal within months of first symptoms. Clinical trials in this rapidly declining symptomatic patient population have proven challenging. Individuals at high lifetime risk for genetic prion disease can be identified decades before symptom onset and provide an opportunity for early therapeutic intervention. However, randomizing pre-symptomatic carriers to a clinical endpoint is not numerically feasible. We therefore launched a cohort study in pre-symptomatic genetic prion disease mutation carriers and controls with the goal of evaluating biomarker endpoints that may enable informative trials in this population.

Methods
We collected cerebrospinal fluid (CSF) and blood from pre-symptomatic individuals with prion protein gene (PRNP) mutations (N = 27) and matched controls (N = 16), in a cohort study at Massachusetts General Hospital. We quantified total prion protein (PrP) and real-time quaking-induced conversion (RT-QuIC) prion seeding activity in CSF and neuronal damage markers total tau (T-tau) and neurofilament light chain (NfL) in CSF and plasma. We compared these markers cross-sectionally, evaluated short-term test-retest reliability over 2–4 months, and conducted a pilot longitudinal study over 10–20 months.

Results
CSF PrP levels were stable on test-retest with a mean coefficient of variation of 7% for both over 2–4 months in N = 29 participants and over 10–20 months in N = 10 participants. RT-QuIC was negative in 22/23 mutation carriers. The sole individual with positive RT-QuIC seeding activity at two study visits had steady CSF PrP levels and slightly increased tau and NfL concentrations compared with the others, though still within the normal range, and remained asymptomatic 1 year later. T-tau and NfL showed no significant differences between mutation carriers and controls in either CSF or plasma.

Conclusions
CSF PrP will be interpretable as a pharmacodynamic readout for PrP-lowering therapeutics in pre-symptomatic individuals and may serve as an informative surrogate biomarker in this population. In contrast, markers of prion seeding activity and neuronal damage do not reliably cross-sectionally distinguish mutation carriers from controls. Thus, as PrP-lowering therapeutics for prion disease advance, “secondary prevention” based on prodromal pathology may prove challenging; instead, “primary prevention” trials appear to offer a tractable paradigm for trials in pre-symptomatic individuals.
A novel chalcone derivative suppresses melanoma cell growth through targeting Fyn/Stat3 pathway
Authors: Tang Ling , Long Jing , Li Keke , Zhang Xu , Chen Xiang , Peng Cong 
Published: June 2020

Abstract
Background
Fyn has been documented to have oncogenic features in multiple tumors, which might be a potential therapeutic target, however, few studies on the function role of Fyn and its specific inhibitors in melanoma.

Methods
We investigated the impacts of Fyn and its inhibitor Lj-1-60 on melanoma through bioinformatics analysis, western blot, cell viability, cell cycle and apoptosis and xenograft tumor model as well as immunohistochemical staining. Pull-down and in vitro kinase assay were used to demonstrate Lj-1-60 targeting Fyn. Transcriptome sequencing and RT-PCR were adopted to confirm the potential mechanisms of Lj-1-60 in melanoma.

Results
Our findings showed that Fyn was overexpressed in melanoma cells and knocked down of Fyn suppressed the proliferation of melanoma cells. To identify the potential inhibitors of Fyn, our in-house library including total of 111,277 chemicals was conducted to vitro screening, among those compounds, 83 inhibitors were further detected to explore the effect on melanoma cells growth and discovered a novel chalcone derivative Lj-1-60 that exhibited low cellular toxicity and high anti-tumor efficacy. Lj-1-60 directly was associated with Fyn and inhibited the Fyn kinase activity with Stat3 as substrate. What’s more, Lj-1-60 suppressed the proliferation of melanoma in vitro and in vivo through inducing cell cycle arrest and apoptosis. Moreover, the activation of Stat3 had also been abrogated both in Lj-1-60 treated melanoma cells or Fyn knocked down cells.

Conclusion
Our study revealed a novel Fyn inhibitor that could significantly suppress melanoma growth, which is a promising potential inhibitor for melanoma treatment.
Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study
Authors: Tu Hua , Wan Ting , Zhang Xinke , Gu Haifeng , Feng Yanling , Huang He , Liu Jihong 
Published: June 2020

Abstract
Background
Sentinel lymph node (SLN) biopsy is an attractive technique that is widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear.

Methods
Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered successful. Patients’ clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed.

Results
Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in the obturator area (52 of 69 patients, 75.4%) and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion, and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed a significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P < 0.001) and lymph node metastasis (40.9% versus 3.8%, P < 0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis. The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also have a high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected.

Conclusions
In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection. The risk of having undetected metastasis is high when SLN is positive; therefore, further lymphadenectomy may be necessary for these patients.
Explaining the experience of prenatal care and investigating the association between psychological factors with self-care in pregnant women during COVID-19 pandemic: a mixed method study protocol
Authors: Masjoudi Marzieh , Aslani Armin , Khazaeian Somayyeh , Fathnezhad-Kazemi Azita 
Published: June 2020

Abstract
Background
Coronavirus disease 2019 (COVID-19) is a novel global public health emergency. Prenatal care (PNC) providing institutes should identify the needs and demands of pregnant women by optimizing the means of PNC services during the COVID-19 pandemic. The present study aims to: a) explain prenatal care experiences; b) assess the factors affecting self-care, and c) present a prenatal care guideline and Strategies to improve the PNC.

Methods
This mixed-methods study with a sequential explanatory design consists of three phases. The first phase is a qualitative study exploring the prenatal care experiences among pregnant women. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Finally, the conventional content analysis approach will be employed for data analysis. The second phase is quantitative and will be used as a cross-sectional approach for assessing the association between psychological factors of self-care. In this regard, a multistage cluster sampling method will be used to select 215 subjects who will be visited in health care centers of Tabriz, Iran. The third phase will be focusing on developing a prenatal care guideline and Strategies, using the qualitative and quantitative results of the previous phases, a review of the related literature, and the nominal group technique will be performed among experts.

Discussion
The present research is the first study to investigate the prenatal care experiences and factors influencing self-care among pregnant women during COVID-19 pandemic. For the purposes of the study, a mixed-methods approach will be used which aims to develop strategies for improving health care services. It is hoped that the strategy proposed in the current study could lead to improvements in this regard.

Ethical code
IR.TBZMED.REC.1399.003.