bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi
Authors: Twizelimana Donatien , Muula Adamson S 
Published: November 2020

Abstract
Background: Research has paid limited attention to understanding factors that are associated with unmet contraceptives needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptives needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods:. We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results: Out of the 290 study participants 102 (35.2%) reported unmet needs for contraceptives. The following factors were significantly associated with unmet contraceptives needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p<0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p<0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p<0.001. Conclusion: Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptives needs among female sex workers in semi-urban Blantyre.
Evaluating the efficacy and safety of the myrtle (Myrtus Communis) in treatment and prognosis of patients suspected to novel coronavirus disease (COVID-19): study protocol for a randomized controlled trial
Authors: Azimi Maryam , Hasheminasab Fatemeh Sadat 
Published: November 2020

Abstract
Background: Since December 2019, the outbreak of corona virus pneumonia was observed in China and quickly propagate in all of the world. Nowadays many trials are underway on this disease in which the efficacy of various therapeutic remedies including chemical or natural agents as well as different non pharmacological methods such as acupuncture are evaluated. This study aims at investigating the effect of M. communis fruit for treatment of COVID-19 disease.Methods: We are performing an open label randomized controlled trial on outpatients clinically suspected to COVID-19 disease in the age range of 18-65 years old with mild to moderate symptoms and without respiratory distress. Patients in both groups (M. communis and control) receive conventional therapy, but those in M. communis group get M. communis preparation in addition to conventional therapy. Intervention will continue for 5 days and the study outcomes including clinical statues as well as mortality rate and adverse effects will be measured up to 14 days.Discussion: The protocol describes the design of an ongoing randomized controlled trial to establish the evidence for the usage of water extract of M. communis fruit in clinically suspected COVID-19 disease and identify any safety concerns.Trial registration: The trial has been registered at the Iranian Registry of Clinical Trials website under the code IRCT20180923041093N3 on March 28th, 2020 (https://www.irct.ir/trial/46721). The results will be disseminated through manuscript publications, and presentations to scientific meetings.
Prognostic Impact of Tumor Length in Esophageal Cancer: A Systematic Review and Meta-analysis
Authors: Wang Zhao Yang , Jiang Yuanzhu , Xiao Wen , Xue Xianbiao , Zhang Xiangwei , Zhang Lin 
Published: November 2020

Abstract
Background: In clinical work, it has been increasingly found that the prognosis is still very different even for esophageal cancer (EC) patients with the same TNM stage. Tumor length has been analysed as a possible independent prognostic factor in many studies, but no unanimous conclusion has been reached. Therefore, this review used a meta-analysis to evaluate the association between tumor length and prognosis in EC patients.Methods: A systematic search for relevant articles was performed in PubMed, Web of Science, and Embase. Hazard ratios (HRs) and 95% conﬁdence intervals (CIs) were used as effective measures to estimate the correlation between tumor length and prognosis, including overall survival, disease-free survival, progression-free survival, disease-specific survival, and cancer-speciﬁc survival. STATA 15.0 software was used to perform the meta-analysis and the data synthesis.Results: Finally, 41 articles with 28,973 patients were included in our study. The comprehensive statistical results showed that long tumors are an independent prognostic parameter associated with poor overall survival (OS) (HR=1.30; 95% CI: 1.21-1.40, p<.001) and disease-free survival (DFS) (HR=1.38; 95% CI: 1.18-1.61, p<.001) in EC patients. Subgroup analyses also suggested a significant correlation between long tumors and poor OS. Sensitivity analysis and publication bias evaluation confirmed the reliability and stability of the results. Similar results were obtained in the analyses of progression-free survival (PFS), disease-specific survival (DSS), and cancer-specific survival (CSS).Conclusion: The results of this meta-analysis showed that long tumors were related to poor OS, DFS, PFS, DSS and CSS in EC patients. Tumor length might be an important predictor of prognosis in EC patients, and it can be used as an independent staging index. Further well-designed and large-scale prospective clinical studies are needed to confirm these findings.
Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey
Authors: Tiwari Ishwar , Acharya Kiran , Paudel Yuba Raj , Sapkota Bhim Prasad , Kafle Ramesh Babu 
Published: November 2020

Abstract
Background: Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.Methods: We used the Nepal Demographic and Health Survey 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p<0.001.Results: The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under five years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order >3 and <2 years of the interval between birth and subsequent birth (IBBSB). The association between the children’s birth order and the prevalence of undernutrition had strong statistical significance. Mother’s age at marriage (p=0.001), underweight mother, mother’s education, father’s education, wealth quintile, no exposure to mass media, children’s age, and place of residence(p=0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and <12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9). Conclusion: The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.
Association of subchondral bone marrow lesion localisation with weight bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative
Authors: Aso Koji , Shahtaheri Seyed Mohsen , McWilliams Daniel F. , Walsh David A. 
Published: November 2020

Abstract
Background: Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA. Methods: We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analysed with the MRI Osteoarthritis Knee Score for 4 subchondral region s (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline, and changes in the BML scores and changes in pain after 24-month follow up. Results: Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex and Body Mass Index (BMI) (medial femorotibial; B=0.08, p=0.02. patellofemoral; B=0.13, p=0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B=0.11, p=0.01, and B=0.10, p=0.04, respectively ). Lateral patellofemoral BML scores were associated with pain on climbing, respectively B=0.14, p=0.02. Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B=0.10, p=0.01). Conclusions: Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically-induced OA pain.
A qualitative meta-synthesis of facilitators and barriers to tuberculosis diagnosis and treatment in Nigeria
Authors: Oga-Omenka Charity , Wakdet Lawrence , Menzies Dick , Zarowsky Christina 
Published: November 2020

Abstract
BackgroundDespite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most of these numbers.Nigeria ranks 6th in the world for TB burden, with an estimated 4.3% multi-drug resistance in new cases. However, the country had one of the lowest case detection rates, estimated at 24% of incident cases in 2018 - well below the WHO STOP TB target of 84%. This rate highlights the need to understand contextual issues influencing tuberculosis management in Nigeria. Our synthesis was aimed at synthesizing qualitative evidence on factors influencing TB care in Nigeria. MethodsA three-stage thematic meta-synthesis of qualitative studies was used to identify barriers and facilitators to tuberculosis case finding and treatment in Nigeria. A search of eleven databases was conducted. The date of publication was limited to 2006 to June 2020. We analyzed articles using a three-stage process, resulting in coding, descriptive subthemes and analytical themes.ResultsOur final synthesis of 10 articles resulted in several categories including community and family involvement, education and knowledge, attitudes and stigma, alternative care options, health system factors (including coverage and human resource), gender, and direct and indirect cost of care. These were grouped into three major themes: individual factors; interpersonal influences; and health system factors.ConclusionCase finding and treatment for TB in Nigeria currently depends more on individual patients presenting voluntarily to the hospital for care, necessitating an understanding of patient behaviors towards TB diagnosis and treatment. Our synthesis has identified several related factors that shape patients’ behavior towards TB management at individual, community and health system levels that can inform future interventions.
Characteristics and outcomes of frail patients with suspected infection in intensive care units: a descriptive analysis from a multicenter cohort study
Authors: Komori Akira , Abe Toshikazu , Yamakawa Kazuma , Ogura Hiroshi , Kushimoto Shigeki , Saitoh Daizoh , Fujishima Seitaro , Otomo Yasuhiro , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiino Yasukazu , Takeyama Naoshi , Tarui Takehiko , Tsuruta Ryosuke , Nakada Taka-aki , Hifumi Toru , Iriyama Hiroki , Naito Toshio , Gando Satoshi 
Published: November 2020

Abstract
Background: Frailty is associated with morbidity and mortality in patients admitted to intensive care units (ICUs). However, the characteristics of frail patients with suspected infection remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study, including 22 ICUs in Japan. Adult patients (aged ≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes among three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score, 1–3), vulnerable (score, 4), and frail (score, 5–9). We conducted subgroup analysis of patients with sepsis defined as per Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median CFS score of 3 (interquartile range [IQR] 3–5) were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 (31.4%) were frail. The median patient age was 72 years (IQR 60−81). The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (IQR 4–10), 8 (IQR 5–11), and 7 (IQR 5–10), respectively (p = 0.59). The median body temperatures of fit, vulnerable, and frail patients were 37.5°C (IQR 36.5°C–38.5°C), 37.5°C (IQR 36.4°C–38.6°C), and 37.0°C (IQR 36.3°C–38.1°C), respectively (p < 0.01). The median C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (IQR 4.6–24.5), 12.1 (IQR 3.9–24.9), 10.5 (IQR 3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ among the patients according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during short-term follow-up. However, more vulnerable and frail patients died after 30-day than fit patients; this difference was not statistically significant (p = 0.25). Compared with the fit and vulnerable groups, the rate of home discharge was lower in the frail group.Conclusion: Frail and vulnerable patients with suspected infection tend to have poor disease outcomes. However, they did not show a statistically significant increase in the 90-day mortality risk.
Social Media Perceptions of Clubfoot Treatment: A Global Observational Study
Authors: Keil Evan J , Shaikh Hashim , Navarro Sergio M , Dube Andile , Yao Lilian E , Sheik-Ali Sharaf , Ncube Thando , Lavy Chris 
Published: November 2020

Abstract
Background: Clubfoot is a debilitating congenital anomaly that is often under treated in lower- and middle-income countries. There exists an active social media community with regards to clubfoot on both Instagram and Twitter. The purpose of this observational study was to investigate shared content related to clubfoot on social media.Methods: A search for public posts on social media regarding clubfoot was performed from October 31st, 2018 to October 31st, 2019. Three hashtags on Instagram and Twitter were analyzed: #clubfootsurgery, #clubfoot, and #clubfootmommas. Data was analyzed using Chi-squared tests with significance set to p<0.05.Results: Overall, 2050 posts with clubfoot-related hashtags were identified as publicly shared on these social media platforms over the 12-month period. 1992 met the inclusion criteria. Pictures consisted of 93.9% of posts which overwhelmingly had a positive tone, while only 16 posts were explicitly negative. On Instagram, personal accounts authored 95.5% of posts and on Twitter, organizations shared 99.4% of posts. Content related to active treatment was shared 32.7% of the time - of these posts, 94.8% showed Ponseti casting or Ponseti bracing. Chi-squared analysis was performed comparing Instagram with Twitter for media format, timing, tone, author, content, visibility, and topic reference. Statistically significant differences between the two (p<0.001) groups were found in each of these categories.Conclusions: Clubfoot treatment has a large social media presence with contributions from patients, treatment organizations, and physicians. Personal accounts on Instagram emphasize the patient experience, whereas organizations on Twitter focus primarily on education and increasing overall awareness.
Predicting COVID-19 Disease Progression and Patient Outcomes based on Temporal Deep Learning
Authors: Sun Chenxi , Hong Shenda , Song Moxian , Wang Zhenjie , Li Hongyan 
Published: November 2020

Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused health concerns worldwide since December 2019. From the beginning of infection, patients will progress through different symptom stages, such as fever, dyspnea or even death. Identifying disease progression and predicting patient outcome at an early stage helps target treatment and resource allocation. However, there is no clear COVID-19 stage definition, and few studies have addressed characterizing COVID-19 progression, making the need for this study evident. Methods: We proposed a temporal deep learning method, based on a time-aware long short-term memory (T-LSTM) neural network and used an online open dataset, including blood samples of 485 patients from Wuhan, China, to train the model. Our method can grasp the dynamic relations in irregularly sampled time series, which is ignored by existing works. Specifically, our method predicted the outcome of COVID-19 patients by considering both the biomarkers and the irregular time intervals. Then, we used the patient representations, extracted from T-LSTM units, to subtype the patient stages and describe the disease progression of COVID-19. Results: Using our method, the accuracy of the outcome of prediction results was more than 90% at 12 days and 98%, 95% and 93% at 3, 6, and 9 days, respectively. Most importantly, we found 4 stages of COVID-19 progression with different patient statuses and mortality risks. We ranked 40 biomarkers related to disease and gave the reference values of them for each stage. Top 5 is Lymph, LDH, hs-CRP, Indirect Bilirubin, Creatinine. Besides, we have found 3 complications - myocardial injury, liver function injury and renal function injury. Predicting which of the 4 stages the patient is currently in can help doctors better assess and cure the patient. Conclusions: To combat the COVID-19 epidemic, this paper aims to help clinicians better assess and treat infected patients, provide relevant researchers with potential disease progression patterns, and enable more effective use of medical resources. Our method predicted patient outcomes with high accuracy and identified a four-stage disease progression. We hope that the obtained results and patterns will aid in fighting the disease.
Association of gestational diabetes mellitus with offspring weight status across infancy: a prospective birth cohort study in China
Authors: Hu Jiajin , Liu Yilin , Wei Xiaotong , Li Lin , Gao Ming , Liu Yang , Ma Yanan , Wen Deliang 
Published: November 2020

Abstract
Background: The association between gestational diabetes mellitus (GDM) and childhood body weight remains controversial, and additional study is needed, especially in Asian populations.Methods: This prospective study investigated the association between maternal glucose concentration, and GDM status and infant body weight from birth to 12 months of age. Linear mixed effects (LME) models and multiple linear regression were used to assess the longitudinal association of GDM with infant growth measured by weight-for-length z-scores (WFLZ), weight-for-age z-scores (WFAZ), and length-for-age z-scores (LFAZ) at birth, 1, 3, 6, 8, and 12 months of age.Results: Offspring born to mothers with GDM had higher WFLZ [β: 0.26 SD units (95% CI: 0.13–0.40)] across infancy than those of mothers without GDM. When stratified analysis by maternal pre-pregnancy body mass index (BMI) status, the association was pronounced in normal-weight [β:0.28 SD units (95% CI: 0.11–0.45)] and overweight/obese women [β: 0.34 SD units (95% CI: 0.09–0.58)] but not in underweight women (P for interaction <0.05). Multiple linear regression found that the effect estimate of GDM on infant WFLZ was highest at birth [β: 0.36 SD units (95% CI: 0.11– 0.61)], remained significant at 1 [β: 0.22 SD units (95% CI: 0.03–0.41)] and 3 [β:0.19 SD units (95% CI: 0.01–0.37)] months of age and decreased across infancy. Maternal GDM status was not associated with infant WFAZ or LFAZ.Conclusions: Maternal GDM status was associated with infant WFLZ, but not WFAZ or LFAZ. The association between GDM status and offspring WFLZ was more pronounced in early infancy or in normal-weight and overweight/obese women. Increased public health efforts to prevent GDM in normal-weight and overweight/obese pre-pregnancy mothers are recommended to control offspring overweight or obesity.