bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qualitative Study of Socio-Cultural Challenges in the Nursing Profession in Pakistan
Authors: Abbas Sidra , Zakar Rubeena , Fischer Florian 
Published: January 2020

Abstract
Background In a patriarchal social system, a women-dominated profession like nursing is mostly seen as a disempowered group due to its stereotypical image and negative connotations. The low social prestige of this profession is based on the roles typically assigned to men and women to maintain gender identity according to their performance and embodiment. The aim of this study was to explore the social and cultural challenges faced by nurses while creating their professional image within the regional context of Lahore (Punjab) in Pakistan.Methods A qualitative research design was chosen to conduct one-to-one, in-depth interviews with twelve nurses. Recruitment was based on purposive sampling from three large public hospitals in Lahore to learn about nurses’ perceptions of social and cultural challenges in the nursing profession. A thematic analysis was conducted using the data analysis software package NVIVO 12 Plus.Results Certain social and cultural stigmas attached to the nursing profession affect its status and changing perceptions of nurses, who either do not choose to remain or do not recommend nursing as a career option. This is still a major barrier that perpetuates the shortage of nurses in the healthcare system. Four major themes relating to the social and cultural challenges facing the nursing profession were identified: 1) it is a gender-segregated profession with less acceptance of male nurses; 2) inappropriate portrayal as low-profile professionals having little visibility in the media; 3) issues around finding a marriage partner or being refused when introduced as a nursing professional; 4) nurses’ identity from a religious perspective with the label of being impure due to touching male patients during caring work.Conclusion The present study solely highlights nurses’ perspectives on redefining gender roles and gender integration within the nursing profession. It argues that there is a need for positive portrayals in the media for the removal of public misperceptions related to nursing. This would reduce the shortage of nurses along with increasing retention and improving the quality of healthcare delivered to the public.
Management Outcome, Mortality and Factors Associated with Mortality Amongst Hospitalized Patients with Stroke. A Cross Sectional Study.
Authors: Weldegebreal Solomon , Gidey Kiday , Gidey Kidu , Nirayo Yirga Legesse , Desta Desilu Mahari , Atey Tesfay Mehari 
Published: January 2020

Abstract
Background Outcomes, mortality due to stroke and factors related with mortality are not profoundly known in the northern Ethiopia. Hence, the main purpose of the study was to assess management outcome, mortality and factors associated with mortality amongst stroke patients.Methods A cross sectional study design was used to conduct the study. Patients medical chart were utilized to collect patient information. Patients medical registries who were diagnosed with stroke and treated in Ayder Comprehensive Specialized Hospital over the years were retrospectively seen. Sample size was estimated using single population formula. Medical charts have been assigned a number and patients were selected using systematic random sampling technique. The findings were analyzed using SPSS version 22. Using logistic regression analysis factors associated with mortality in hospital were identified. A P value less than 0.05 were deemed to be significant in all types of analyses.Results About 216 patients with the diagnosis of stroke were studied. Of the total patients studied, 126(58.3%) were females. From the total stroke patients analyzed, 102(47.2%) were discharged with improvement, 44(20.4%) left against medical advice, and 22(10.2%) patients discharged with no change. Moreover, about 48(22.2%) patients died in the hospital. The median time to death was 3 days ranging from 1 to 48 days and the average mean time to death was 6.2±8.7 days. One hundred thirty-six (62.9%) patients had affirmed to have at least one complication during their hospital stay. The total frequency of complication detected was 234 in number and aspiration pneumonia (n=92, 39.4%) was the frequently identified complication. Sever (3-8) record of Glasgow coma scale (GCS) at admission (Adjusted Odds Ratio=15.33, 95%CI:3.77-62.40, p=0.001) and being unconscious (AOR=2.61, 95%CI:1.06-6.40, p=0.037) during admission were positively associated with mortality.Conclusion Substantially higher number of patients died at the hospital. Majority of the patients admitted to the hospital developed complication, aspiration pneumonia being the most frequently affirmed complication during their stay in the wards. Patients with severe GCS and who were unconscious during admission were more likely to die at the hospital. Sketching out strategies to solve the problem will be conducive for the patients with stroke.
Effect of bridging with intravenous thrombolysis on cognitive function in stroke thrombectomy – An analysis of the German Stroke Registry
Authors: Ettelt Philipp , Maier Ilko , Schnieder Marlena , Bähr Mathias , Behme Daniel , Psychogios Marios-Nikos , Liman Jan 
Published: January 2020

Abstract
Background The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear. Methods We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS≤2 pts) and excellent (mRS=0 pts) functional outcome receiving combined EVT and IVT (EVT+IVT) vs. EVT alone (EVT-IVT). Results Of the 2636 GSR patients, we included 166 patients with mRS≤2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT+IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI≥2b in both groups at 95%, p=0.65). Median MoCA score in the EVT+IVT group was 20 pts (18-25 IQR) vs. 18 pts (16-21 IQR) in the EVT-IVT group (p=0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT+IVT group (78 patients (76%)). EVT+IVT was associated with a higher MoCA score at 90 days (mRS≤2: p=0.033, B=2.39; mRS=0: p=0.021, B=4.38). Conclusions In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.
How is breastfeeding perceived in the informal work environment? A qualitative study among working mothers in India and South Africa
Authors: Horwood Christiane , Surie Aditi , Haskins Lyn , Luthuli Silondile , Hinton Rachael , Chowdhury Antara , Rollins Nigel 
Published: January 2020

Abstract
Background Worldwide, over 740 million women make their living in the informal economy. These women do not benefit from formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding but little is known about how informal work impacts on infant feeding.Methods The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in the informal sector in India and South Africa. Data was analysed using a thematic approach and the framework method.Findings Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations often forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about breastmilk becoming ‘spoilt’. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding and childcare. Mothers also described being unable to complete their work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of child care and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as good for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected the ability of working mothers to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.Conclusion Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support optimal feeding and child care if global nutrition and development goals are to be met.
Harnessing mobile health technology to support long-term chronic illness management: Exploring family caregiver support needs in the outpatient setting
Authors: Shin Ji Youn , Chaar Dima , Kedroske Jacob , Vue Rebecca , Chappell Grant , Mazzoli Amanda , Hassett Afton L. , Hanauer David A. , Park Sun Young , Barton Deb , Choi Sung Won 
Published: January 2020

Abstract
BACKGROUND Family caregiving is an important public health issue, particularly with the aging population. In recent years, mobile health (mHealth) technology has emerged as a potential low-cost, scalable platform to address caregiver support needs, and thereby alleviate caregiver burden. This study sought to examine the support needs of family caregivers in their lived experiences of outpatient care in an effort to inform the development of a future mHealth intervention. METHODS The current study is a part of a larger study in a population of family caregivers to patients undergoing blood and marrow transplant (BMT), consisting of three phases: i) tablet-based caregiver-facing intervention design (Phase I); ii) usability testing in an inpatient healthcare setting (Phase II); and iii) randomized trial to expand the user group to an outpatient setting (Phase III). In an earlier pilot study (Phases I and II), a tablet-based caregiver-facing application was developed and tested for supporting inpatient care. As part of Phase III, we conducted 20 semi-structured interviews in two outpatient BMT clinics at a large academic medical center in the Midwestern United States. A thematic analysis was performed to define emerging themes. RESULTS Our data analysis identified five primary themes that BMT caregivers faced: I. lifestyle restrictions due to the patient’s immunocompromised state; II. unfamiliar medical tasks required on behalf of patients; III. unmet needs based on existing resources; IV. adopting strategies due to the new roles; and V. reformation of social relationships with family and friends. Based on these findings, we observed three design considerations to guide the development of a future mHealth intervention: i) connecting caregivers with other caregivers through Chat Forums; ii) enabling video conferencing with healthcare providers; and iii) using readily accessible activities (e.g., journaling) to help express emotions. CONCLUSION The findings herein captured the family caregiver’s lived experiences during outpatient care. There was broad agreement that caregiving was challenging and stressful. Thus, effective and scalable interventions to support caregivers are needed. This study provided data to guide the content and design of a future mHealth intervention in the outpatient setting.
Predictors of tuberculosis incidence and the effects of multiple deprivation indices on tuberculosis management in OR Tambo district over a 5-year period
Authors: Dlatu Ntandazo , Longo-Mbenza Benjamin , Apalata Teke 
Published: January 2020

Abstract
BackgroundThis study investigated the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. MethodsSecondary data analysis was performed on data obtained from various sources including governmental, non-governmental and research institutions. Indicators for TB treatment outcomes included rates of TB deaths, TB case finding index, TB treatment failure, HIV associated TB deaths, TB defaulter rate, and new TB smear positive cases. Analysis of variance (ANOVA) and Post-Hoc Bonferroni pairwise tests were used to compare means of variables of interest considering a type I error rate of 0.05. Regression models and canonical discriminant analysis (CDA) were used to explore the associations between trends in TB incidence and independent TB predictors. During CDA, Fischer’s linear functions, Eigen values, and Mahalanobis distances were determined with values of Wilk’s Lambda closer to zero being the evidence for well discriminated patient groups. Data analysis was performed using SPSS® statistical software version 23.0 (Chicago, IL).ResultsIn total, 62 400 records of TB notification were analyzed for the period 2009-2013. The TB incidence rate reduced by 80% at the end of the evaluation. After adjusting for confounders, expenditure per patient day equivalent (PDE) and PHC expenditure per capita were significantly and independently associated with the decline of incident TB cases (adjusted R2 = 60%; ρ = 0.002) following the equation: Y= (- 209× Expenditure per PDE) + (- 0.191 × PHC expenditure per capita). CDA showed that TB cases in the most socio-economically deprived communities (quintile 1) were significantly more likely to have high HIV and TB co-infection death rates as compared to the least socio-economically deprived group (quintile 5) [Eigen value (12.95), function coefficient (1.49) > (.77); Wilk’s Lambda = .019, p < .0001]. ConclusionsAlthough TB control programs in OR Tambo district have averted thousands of TB incident cases, their effects on HIV associated TB deaths among the most deprived communities remain insignificant. There is an urgent need for strengthening integration of TB/HIV services in most deprived settings.
Population Attributable fraction Estimation of the Cardiovascular Diseases–related factors: An Evidence from western part of Iran
Authors: Javani Zhila , Salimi Yahya , Moradinazar Mahdi , Najafi Farid 
Published: January 2020

Abstract
Background: Cardiovascular diseases are the first cause of deaths and years of lost life due to disability, worldwide. The population attributable fraction has been widely used in literature to quantify an impact of removing risk factors in occurrence of diseases. This study was designed to estimate the population attributable fraction of prevalent cases of cardiovascular diseases associated with different risk factors, using data from people aged 35-65 years old in Ravansar County.Methods: Data of this study came from 9825 adults aged 35-65 years that were included in the study of Ravansar Non-Communicable disease (RaNCD). First, to identify the confounding variables, we did a comprehensive review of the available resources and then presented the relationship between different risk factors with directed acyclic graphs and for any risk factor. Sequential and average adjusted attributable fractions were used. To calculate 95% confidence intervals, the Monte Carlo simulation was conducted. All statistical analyses were performed using the ’averisk’ package in R version 3.4.4.Results: The age adjusted prevalence for cardiovascular diseases was 12.6% (95% CI: 11.9, 13.2%). Among the modifiable predictors of cardiovascular diseases, the highest amount of population attributable fraction after adjusting for age, sex, and other factors associated with cardiovascular diseases, in men were for hypertension 35.7% (95% CI: 30.2, 40.6%), dyslipidemia 12.2% (95% CI: 7.5, 17.6%), general obesity 5.7% (95% CI: -0.7, 11.9%) and for cigarette smoking 4.0% (95% CI: -6.3, 14.6%), and in women were hypertension 42.8% (95% CI: 36.5, 47.3%), general obesity 10.7% (95% CI: 6.2, 15.3%), central obesity 10.1% (95% CI: -7.0, 23.8%) and for dyslipidemia 9.7% (95% CI: 5.1, 14.5%).Conclusion: Due to the difference in the population attributable fraction of cardiovascular diseases- related factors in men and women, it is advisable to prioritize preventive cardiovascular diseases interventions by sex segregation. Special attention should be paid to control hypertension, dyslipidemia in men, and hypertension, general obesity and dyslipidemia in women, and priority should be given to strategies for preventing cardiovascular diseases.
Magnitude of Home Delivery and Associated Factors Among Child Bearing Age Mothers in Sherkole District, Benishangul Gumuz Regional State-Western-Ethiopia
Authors: Gebremariam Resom Berhe , Nigusie Adane 
Published: January 2020

Abstract
Background Globally, more than 536,000 maternal and 8 million perinatal deaths occur every year. Ethiopian Demographic and Health Survey stated that maternal death was 412 per 100,000 in 2016.This still indicate that maternal health remains a major public health problem in Ethiopia irrespective of the government’s measure to institutional delivery.MethodsCommunity based cross sectional study was conducted among women aged 15-49 years in Sherkole district, Benishangul Gumuz region from January to Jun 2018. A total of 451 randomly selected women were included in the study. Stratified sampling followed by simple random sampling technique was used to select the study participants. Data were collected using pretested and structured questionnaire. Bivariate and multivariate logistic regression model was fitted to identify factors associated with home delivery among women’s in the child bearing age. An adjusted odds ratio with 95% confidence interval was computed to determine the level of significance.Results The magnitude of home delivery was 353 (80%) and were assisted by non-skilled birth attendants. Mothers whose husband choose the place of delivery [AOR: 5.6, 95% CI (2.1-15.2), Mothers’ occupation ([AOR: 0.21 95% C I (0.08-0.57), ANC visit [AOR: 95 CI: 5.1(1.6-15.8), decision making [AOR: 95 CI: 0.3(0.01-0.7)] and traditional remedies [AOR: 95%CI: 0.03(0.01-0.09)] were significantly associated with home delivery.Conclusions Based on the findings of the survey, it was concluded that the overall magnitude of home delivery was found to be high. ANC visit, mother’s occupation, traditional remedies and decision making were significantly associated with home delivery.
Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive Impairment and Frailty in Elderly Inpatients With Cardiovascular Diseases
Authors: Yao Simin , Zheng Peipei , Liang Yaodan , Wan Yuhao , Sun Ning , Luo Yao , Yang Jiefu , Wang Hua 
Published: January 2020

Abstract
Background: No prior studies have assessed the role of cognitive impairment and physical frailty in elderly inpatients with cardiovascular disease (CVD). We aimed to assess the utility of a combination developed using the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD. Methods : A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death. Results : A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]:1.73, 95% confidence intervals [CI]:1.06-2.82, P=0.028) and impaired cognition (HR:2.50, 95% CI:1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke. Conclusions : The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time. Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.
Early detection of postpartum depression (PPD) for women suffering high-risk pregnancy: An explorative study on self-perceived burden and other prenatal risk factors of immediate PPD among women hospitalized with threatened preterm labour1
Authors: Ni Qianqian , Cheng GuiZhi , Chen An , Heinonen Seppo 
Published: January 2020

Abstract
Background: The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed mental health of pregnant women with threatened preterm labour (TPL). In the present study, we investigated self-perceived burden (SPB) and postpartum depression (PPD) among hospitalized pregnant women with TPL, exploring the association of SPB with PPD, and identifying other potential risk factors of early PPD. Methods: A self- reported survey conducted in the Obstetrics Department of Anhui Provincial Hospital, People’s Republic of China. Women hospitalized with TPL were approached one week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. Self-Perceived Burden Scale (SPBS), Edinburgh Postnatal Depression Scale (EPDS), and Multidimensional Scale of Perceived Social Support (MSPSS) were the main measures. Descriptive statistics, Spearman's correlation, and multiple logistic regression were employed for data analysis.Results: SPB and PPD were commonly experienced by women hospitalized with TPL, and SPB was positively and significantly correlated with PPD. A multiple logistic regression analysis revealed that, for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.473, 95% CI = 1.141–1.903, p = 0.003), age (OR = 1.178, 95%CI = 1.056–1.314, p = 0.003), occupation (OR = 0.282, 95%CI = 0.095–0.023, p = 0.023), history of scarred uterus (OR = 0.163, 95%CI = 0.034–0.769, p = 0.022), delivery mode (OR = 5.974, 95%CI = 1.750–20.396, p = 0.004), and family support to women hospitalized with TPL during pregnancy (OR = 0.665, 95% CI = 0.498–0.887, p = 0.006) were the significant factors predicting early signs of PPD. Conclusion: This study indicated that SPB and PPD were prevalent mental issues among hospitalized women with TPL, and SPB, especially perceived emotional burden, is a strong predictor of PPD. Our study suggests the necessity of paying attention to mental health issues—especially SPB and PPD—among hospitalized women with TPL, as well as providing appropriate interventions at the prenatal stage to prevent adverse consequences. Perceiving support from family during pregnancy with high risk can help women in reducing the risk of PPD.