bluuebunny/crossref_metadata_2025_split huggingface dataset:
Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges
Authors: Kibira Simon P. S. , Karp Celia , Wood Shannon N. , Desta Selamawit , Galadanci Hadiza , Makumbi Fredrick E. , Omoluabi Elizabeth , Shiferaw Solomon , Seme Assefa , Tsui Amy , Moreau Caroline 
Published: June 2020

Abstract
Background
The balance between increasing men’s participation in family planning and rights-based initiatives favoring women’s empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- and middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women’s decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women’s choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries.

Methods
Women aged 15–49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women’s and girls’ empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes.

Results
Findings comprised three thematic areas: the practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure.

Conclusions
Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China
Authors: Zhou Huan , Wu Yuju , Liu Chengfang , Sun Chang , Shi Yaojiang , Zhang Linxiu , Medina Alexis , Rozelle Scott 
Published: June 2020

Abstract
Background
Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.

Methods
We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).

Results
Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.

Conclusions
The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.
Effects of short- and long-term glucocorticoid-induced osteoporosis on plasma metabolome and lipidome of ovariectomized sheep
Authors: Cabrera Diana , Kruger Marlena , Wolber Frances M. , Roy Nicole C. , Fraser Karl 
Published: June 2020

AbstractBackgroundUnderstanding the metabolic and lipidomic changes that accompany bone loss in osteoporosis might provide insights about the mechanisms behind molecular changes and facilitate developing new drugs or nutritional strategies for osteoporosis prevention. This study aimed to examine the effects of short- or long-term glucocorticoid-induced osteoporosis on plasma metabolites and lipids of ovariectomized (OVX) sheep.MethodsTwenty-eight aged ewes were divided randomly into four groups: an OVX group, OVX in combination with glucocorticoids for two months (OVXG2), and OVX in combination with five doses of glucocorticoids (OVXG5) to induce bone loss, and a control group. Liquid chromatography–mass spectrometry untargeted metabolomic analysis was applied to monthly plasma samples to follow the progression of osteoporosis over five months.ResultsThe metabolite profiles revealed significant differences in the plasma metabolome of OVX sheep and OVXG when compared with the control group by univariate analysis. Nine metabolites were altered, namely 5-methoxytryptophan, valine, methionine, tryptophan, glutaric acid, 2-pyrrolidone-5-carboxylic acid, indole-3-carboxaldehyde, 5-hydroxylysine and malic acid. Similarly, fifteen lipids were perturbed from multiple lipid classes such as lysophoslipids, phospholipids and ceramides.ConclusionThis study showed that OVX and glucocorticoid interventions altered the metabolite and lipid profiles of sheep, suggesting that amino acid and lipid metabolisms are potentially the main perturbed metabolic pathways regulating bone loss in OVX sheep.
Which disease-related factors influence patients’ and physicians’ willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data
Authors: Postler Anne , Goronzy Jens , Günther Klaus-Peter , Lange Toni , Redeker Imke , Schmitt Jochen , Zink Angela , Callhoff Johanna 
Published: June 2020

Abstract
Background
A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR. The purpose of this study therefore was to analyze potential cofactors which might influence the desire of patients to undergo TJR and physicians’ willingness to discuss surgery with their patients.

Methods
A total of 8995 patients in Germany with a claims data diagnosis of hip or knee OA or polyarthrosis were asked to complete a questionnaire for this cross-sectional study of sociodemographic factors, indicators of current joint function (WOMAC score), willingness to undergo TJR and whether they had already discussed TJR with a physician. The overall response rate was 40%. Responders with polyarthrosis and individuals without current or chronic symptoms in the corresponding joints, pain in already replaced joints or simultaneous symptomatic hip and knee OA were excluded. We linked the survey results to claims data. Separate logistic regression models were used to assess which parameters were associated with patients’ willingness to undergo TJR and physicians’ discussion of surgery.

Results
We analyzed 478 hip OA and 932 knee OA patients. Just 17% with hip OA and 14% with knee OA were willing to undergo TJR, although 44 and 45% had already discussed surgery with their physicians.
Patients’ willingness was associated with higher WOMAC scores, a deterioration of symptoms over the last 2 years, and previous TJR for another joint. The discussion with a physician was influenced by the impact on personal life and previous arthroplasty. Older age (odds Ratio (OR) 1.2 per 10 years), male sex (OR 0.69 vs female), longer symptom duration (OR 1.08 per 5 years), deterioration of symptoms (OR 2.0 vs no change/improvement), a higher WOMAC score (OR 1.3 per 10% deterioration) and reduced well-being (OR 1.1 per 10% deterioration) were associated with physician discussion in knee OA patients.

Conclusions
The proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery. While previous TJR seems to enhance patients’ and surgeons’ willingness, the influence of other cofactors is heterogeneous.
Performance in dynamic movement tasks and occurrence of low back pain in youth floorball and basketball players
Authors: Rossi M. K. , Pasanen K. , Heinonen A. , Äyrämö S. , Räisänen A. M. , Leppänen M. , Myklebust G. , Vasankari T. , Kannus P. , Parkkari J. 
Published: June 2020

Abstract
Background
Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players.

Methods
Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox’s proportional hazard models with mixed effects and time-varying risk factors were used for analysis.

Results
We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks.

Conclusions
Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation.

Level of evidence
Prognosis, level 1b.
Treatment of open ankle dislocation without associated fractures in a young athlete using external fixation and ligament repair with suture tape augmentation
Authors: Kawai Ryosuke , Kawashima Itaru , Tsukada Makoto , Tsukahara Takashi , Aoshiba Hideyuki 
Published: June 2020

AbstractBackgroundAnkle dislocation without fracture is an extremely rare injury because it is usually accompanied by concomitant malleolar fractures from the anatomical and mechanical viewpoints.Case presentationWe report the case of a 17-year-old woman who was injured while playing basketball. Her ankle was swollen and deformed. Plain X-ray revealed tibiotalar dislocation in the medial direction without any fractures.Immediate reduction and ligament repair using suture tape augmentation were performed.ConclusionsAt 5 months postoperatively, the patient returned to playing basketball without any complaints. After an additional 2 months, the patient participated and played in the Winter Cup 2019 (the national high school basketball tournament in Japan) at the previous performance level.
Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature
Authors: van Veelen Nicole M. , Fischli Stefan , Beeres Frank J.P. , Eisenhut Timo , Babst Reto , Henzen Christoph , Link Björn-Christian 
Published: June 2020

Abstract
Background
Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown.

Case presentations
A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto’s thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments.

Conclusion
Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.
The relationship between obesity, diabetes, hypertension and vitamin D deficiency among Saudi Arabians aged 15 and over: results from the Saudi health interview survey
Authors: Al-Sumaih Ibrahim , Johnston Brian , Donnelly Michael , O’Neill Ciaran 
Published: June 2020

Abstract
Background
Obesity and diabetes are related conditions, the prevalence of which has increased globally in recent years. These conditions have been linked to hypertension and vitamin D deficiency though the nature of the relationship remains unclear and is likely to vary between identifiable groups and specific contexts. The aim of this paper is to examine the relationships between obesity, type 2 diabetes, hypertension and vitamin D, among Saudis citizens aged 15 and over.

Methods
Self-reported and measured data were taken from the 2013 Saudi Health Interview Survey and analysed using a series of seemingly unrelated bivariate probit regression (SURBVP) analyses. Sensitivity analyses were undertaken in which the selection and specification of covariates and outcomes were varied.

Results
In the main analysis data on 957 women and 1127 men were analysed. Differences were evident between men and women in the prevalence of type 2 diabetes, obesity, central obesity, hypertension and vitamin D deficiency. While men were more likely to experience diabetes and hypertension, women were more likely to experience obesity, central obesity and vitamin D deficiency. In multivariable analyses obesity and age were found to significantly predict hypertension risk in women; central obesity to predict diabetes risk in men and women, as well as hypertension risk in men. Vitamin D was not found to predict diabetes risk nor hypertension risk in either sex. Milk consumption and sun exposure were found to predict vitamin D deficiency in women but not men. While there was evidence of unobserved heterogeneity in models predicting diabetes and hypertension, there was no evidence of unobserved heterogeneity between these and those predicting vitamin D deficiency. Results did not materially change over a range of sensitivity analyses.

Conclusion
While there is strong evidence of distinct patterns in the relationship between diabetes, hypertension and obesity among men and women in Saudi Arabia and in the risk of vitamin D deficiency, we found no evidence of a relationship between vitamin D levels and risk of either diabetes or hypertension.
A bioinformatics investigation into the pharmacological mechanisms of javanica oil emulsion injection in non-small cell lung cancer based on network pharmacology methodologies
Authors: Ni Mengwei , Liu Xinkui , Meng Ziqi , Liu Shuyu , Jia Shanshan , Liu Yingying , Zhou Wei , Wu Jiarui , Zhang Jingyuan , Guo Siyu , Li Jialin , Wang Haojia , Zhang Xiaomeng 
Published: June 2020

AbstractBackgroundJavanica oil emulsion injection (JOEI) is an effective therapeutic option for patients with non-small cell lung cancer (NSCLC), but its mechanisms have not been fully elucidated.MethodsIn this study, we utilized network pharmacology to systematically investigate the bioactive components and targets of JOEI, identify common targets in NSCLC, and understand and evaluate the underlying mechanism of JOEI in the treatment of NSCLC through expression level, correlation, enrichment, Cox, survival and molecular docking analyses. The results indicated that five compounds of JOEI interact with five pivotal targets (LDLR, FABP4, ABCB1, PTGS2, and SDC4) that might be strongly correlated with the JOEI-mediated treatment of NSCLC.ResultsThe expression level analysis demonstrated that NSCLC tissues exhibit low expression of FABP4, ABCB1, LDLR and PTGS2 and high SDC4 expression. According to the correlation analysis, a decrease in FABP4 expression was strongly correlated with decreases in LDLR and ABCB1, and a decrease in LDLR was strongly correlated with decreased PTGS2 and increased in SDC4 expression. Cox and survival analyses showed that the survival rate of the high-risk group was significantly lower than that of the low-risk group (p = 0.00388). In the survival analysis, the area under the curve (AUC) showed that the pivotal gene model exhibited the best predictive capacity over 4 years (AUC = 0.613). Moreover, the molecular docking analysis indicated that LDLR, FABP4, ABCB1, PTGS2 and SDC4 exhibit good binding activity with the corresponding compounds.ConclusionIn conclusion, this study predicted and verified that the mechanism of JOEI against NSCLC involves multiple targets and signaling pathways. Furthermore, this study provides candidate targets for the treatment of NSCLC, lays a good foundation for further experimental research and promotes the reasonable application of JOEI in clinical treatment.
Our first review: an evaluation of effectiveness of root cause analysis recommendations in Hong Kong public hospitals
Authors: Kwok Yick Ting A , Mah Alastair PY , Pang Katherine MC 
Published: June 2020

AbstractBackgroundTo evaluate the effectiveness of root cause analysis (RCA) recommendations and propose possible ways to enhance its quality in Hong Kong public hospitals.MethodsA retrospective cross-sectional study was performed across 43 public hospitals and institutes in Hong Kong, reviewing RCA reports of all Sentinel Events and Serious Untoward Events within a two-year period. The incident nature, types of root causes and strengths of recommendations were analysed. The RCA recommendations were categorised as ‘strong’, ‘medium’ or ‘weak’ strengths utilizing the US’s Veteran Affairs National Center for Patient Safety action hierarchy.ResultsA total of 214 reports from October 2016 to September 2018 were reviewed. These reports generated 504 root causes, averaging 2.4 per RCA report, and comprising 249 (49%) system, 233 (46%) staff behavioural and 22 (4%) patient factors. There were 760 recommendations identified in the RCA reports with an average of 3.6 per RCA. Of these, 18 (2%) recommendations were rated strong, 116 (15%) medium and 626 (82%) weak. Most recommendations were related to ‘training and education’ (466, 61%), ‘additional study/review’ (104, 14%) and ‘review/enhancement of policy/guideline’ (39, 5%).ConclusionsThis study provided insights about the effectiveness of RCA recommendations across all public hospitals in Hong Kong. The results showed a high proportion of root causes were attributed to staff behavioural factors and most of the recommendations were weak. The reasons include the lack of training, tools and expertise, appropriateness of panel composition, and complicated processes in carrying out large scale improvements. The Review Team suggested conducting regular RCA training, adopting easy-to-use tools, enhancing panel composition with human factors expertise, promoting an organization-wide safety culture to staff and aggregating analysis of incidents as possible improvement actions.
Reorganising dermatology care: predictors of the substitution of secondary care with primary care
Authors: van den Bogaart Esther H. A. , Kroese Mariëlle E. A. L. , Spreeuwenberg Marieke D. , Martens Herm , Steijlen Peter M. , Ruwaard Dirk 
Published: June 2020

Abstract
Background
The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision.

Methods
This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors.

Results
A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+.

Conclusion
The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.