bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes care knowledge and practice among primary care physicians in Southeast Nigeria: a cross-sectional study
Authors: Ugwu Ejiofor , Young Ekenechukwu , Nkpozi Marcellinus 
Published: July 2020

Abstract
Background
Due to the perennial shortage of diabetes specialists, primary care physicians (PCPs) constitute the largest diabetes care manpower in Nigeria. However, the competence of the PCPs to undertake this task is not known. This study was aimed at evaluating diabetes care knowledge and practice among PCPs in Southeastern part of Nigeria.

Methods
This was a cross-sectional study among PCPs in Southeastern Nigeria. Diabetes care knowledge and practices were evaluated using a structured self administered questionnaire.

Results
A total of 64 PCPs with mean duration of practice of 17.3 ± 11.6 years completed the study. 65.6% were in private practice and 50% attended to between 11 and 20 persons living with diabetes (PLWD) weekly. Majority (78.1%) had not participated in any diabetes training since graduation from medical school and 79.9% were not aware of any diabetes clinical practice guideline.
The PCPs had adequate knowledge of classical symptoms of diabetes. However, they had very poor knowledge of glycemic thresholds for diagnosis of diabetes which was 26.6, 45.3 and 10.9% for fasting blood glucose (FBG), random blood glucose (RBG) and glycated hemoglobin (A1c) respectively.
We observed serious gaps in diabetes care practice such that only 18.8% of the respondents performed foot examination on newly diagnosed PLWD while 28.1 and 39.1% provided counseling on foot care and hypoglycemia respectively. Annual comprehensive foot examination was conducted by only 12.5%, none of the physicians ever screened for microalbuminuria and only 21.9% conducted annual dilated eye examination. Majority (57.8%) rated their confidence in prescribing insulin as “low” and only 23.4% had ever prescribed outpatient insulin for type 2 diabetes in their practice. Glycemic monitoring was largely limited to FBG and only 17.2% monitored A1c. Duration of practice more than 10 years (OR 10.1; P 0.034) and non participation in diabetes training (OR 6.5; P 0.027) were significant predictors of poor diabetes care knowledge.

Conclusion
Diabetes care knowledge and practice were poor among PCPs in Southeast Nigeria. There is an urgent need to improve their capacity to provide diabetes care through periodic training.
The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland
Authors: Touhami Dima , Merlo Christoph , Hohmann Joachim , Essig Stefan 
Published: July 2020

Abstract
Background
Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice.

Methods
This is a quantitative study, analyzing 15 years of billing data from 213 GPs in Central Switzerland, and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM).

Results
According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients < 65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with abdominal indications being most frequent among them.

Conclusions
The use of ultrasound is high among general practitioners and it covers a wide range of clinical indications. Ultrasound is utilized primarily in the diagnosis of clinical indications of the abdomen, and more often for female than male patients.
The geno-spatio analysis of Mycobacterium tuberculosis complex in hot and cold spots of Guangxi, China
Authors: Lin Dingwen , Cui Zhezhe , Chongsuvivatwong Virasakdi , Palittapongarnpim Prasit , Chaiprasert Angkana , Ruangchai Wuthiwat , Ou Jing , Huang Liwen 
Published: July 2020

Abstract
Background
At present, there are few studies on polymorphism of Mycobacterium tuberculosis (Mtb) gene and how it affects the TB epidemic. This study aimed to document the differences of polymorphisms between tuberculosis hot and cold spot areas of Guangxi Zhuang Autonomous Region, China.

Methods
The cold and hot spot areas, each with 3 counties, had been pre-identified by TB incidence for 5 years from the surveillance database. Whole genome sequencing analysis was performed on all sputum Mtb isolates from the detected cases during January and June 2018. Single nucleotide polymorphism (SNP) of each isolate compared to the H37Rv strain were called and used for lineage and sub-lineage identification. Pairwise SNP differences between every pair of isolates were computed. Analyses of Molecular Variance (AMOVA) across counties of the same hot or cold spot area and between the two areas were performed.

Results
As a whole, 59.8% (57.7% sub-lineage 2.2 and 2.1% sub-lineage 2.1) and 39.8% (17.8% sub-lineage 4.4, 6.5% sub-lineage 4.2 and 15.5% sub-lineage 4.5) of the Mtb strains were Lineage 2 and Lineage 4 respectively. The percentages of sub-lineage 2.2 (Beijing family strains) are significantly higher in hot spots. Through the MDS dimension reduction, the genomic population structure in the three hot spot counties is significantly different from those three cold spot counties (T-test p = 0.05). The median of SNPs distances among Mtb isolates in cold spots was greater than that in hot spots (897 vs 746, Rank-sum test p < 0.001). Three genomic clusters, each with genomic distance ≤12 SNPs, were identified with 2, 3 and 4 consanguineous strains. Two clusters were from hot spots and one was from cold spots.

Conclusion
Narrower genotype diversity in the hot area may indicate higher transmissibility of the Mtb strains in the area compared to those in the cold spot area.
miR-10a overexpression aggravates renal ischemia–reperfusion injury associated with decreased PIK3CA expression
Authors: Xu Dongsheng , Li Wenjun , Zhang Tao , Wang Gang 
Published: July 2020

Abstract
Background
To investigate the effect of miR-10a on renal tissues with ischemia reperfusion (I/R) injury in rats and to explore the underlying mechanisms of the effect of miR-10a on hypoxia–reoxygenation in HK-2 cells.

Methods
MiR-10a level was measured in the renal tissues of rats with I/R rats using RT-PCR. In order to research the role of miR-10a in renal tissues, an miR-10 agonist and an miR-10a antagonist were used to treat I/R-injured rats. Levels of serum creatinine and blood urea nitrogen, renal histopathology, and levels of cell apoptosis were analyzed separately in renal tissues from the rats. Phosphatidylinositol 3-kinase (PI3K)/Akt pathway related proteins were measured by Western blotting. In addition, HK-2 cells were cultured in order to study the mechanism of action of miR-10a in the hypoxia-reoxygenation model being studied. Finally, the dual luciferase reporter gene assay was used to confirm that the PI3K p100 catalytic subunit α (PIK3CA) gene was targeted by miR-10a.

Results
After renal I/R injury in rats, miR-10a expression increased significantly (p < 0.05). Injection of miR-10a agonist significantly aggravated the renal injury and raised the level of cell apoptosis in the renal tissues of I/R-injured rats (p < 0.05). However, administration of miR-10a antagonist led to obvious improvement of the renal injury, decreased renal cell apoptosis, and inhibited PI3K/Akt pathway activity (p < 0.05). In in vitro experiments, the negative relationship between PIK3CA and miR-10a levels was confirmed. Furthermore, overexpression of miR-10a significantly decreased the proliferation of HK-2 cells, and increased cell apoptosis via up-regulation of the PI3K/Akt pathway (p < 0.05).

Conclusion
The aggravation of renal I/R injury by miR-10a was associated with a decrease in the activity of PIK3CA/PI3K/Akt pathway.
Associations of physical partner violence and sexual violence victimization on health risk behaviours and mental health among university students from 25 countries
Authors: Pengpid Supa , Peltzer Karl 
Published: July 2020

Abstract
Background
The study aimed to investigate the associations between physical partner violence victimization (IPV) and/or sexual violence victimization and various health risk behaviours and mental health in university students in 25 countries.

Methods
Using a cross-sectional study design, 18,335 university students with a median age of 20 years from 25 countries in Africa, the Americas and Asia, replied to self-reported measures of interpersonal violence, health compromising behaviours, mental health measures and protective factors.

Results
In adjusted logistic regression analysis, physical IPV and/or sexual violence victimization was associated, among men and/or among women, with sexual risk behaviours (multiple sexual partners, alcohol use in the context of sex, diagnosed with HIV and pregnancy), violence related behaviour (in a physical fight and carrying a weapon), poor mental health (depression, loneliness, post-traumatic stress disorder, sleeping problem and short sleep), addictive behaviour (binge drinking, tobacco and drug use), and other health risk behaviour (skipping breakfast and frequent salt intake).

Conclusions
We found evidence that physical IPV and/or sexual violence victimization among female and/or male university students was associated with 4 of 5 sexual risk behaviours, 2 violence related behaviours, 5 of 5 poor mental health indicators, 3 of 3 addictive behaviours and 2 of 7 other health risk behaviours.
Secular trends in cardiovascular risk factors among women aged 45–54 years in Gothenburg, Sweden, from 1980 to 2014
Authors: Persson Carina U. , Collén Anna-Clara , Rosengren Annika , Mandalenakis Zacharias , Zverkova Sandström Tatiana , Fu Michael , Dellborg Mikael , Johansson Saga , Hansson Per-Olof 
Published: July 2020

Abstract
Background
A declining trend in mean cholesterol levels and smoking has been observed in high-income western countries during the last few decades, whereas obesity rates have increased. Simultaneously, mortality from coronary heart disease has decreased. The aim of the present study was to determine whether the trends in cardiovascular risk factors have continued in successive cohorts of middle-aged women over a period of 34 years.

Methods
Six population-based, cross-sectional samples of women (n = 2294) mean age: 49.8 years (range: 45–54), living in Gothenburg, Sweden, were investigated between 1980 and 2014.

Results
Body mass index (BMI) increased over time, with a mean BMI of 24.7 kg/m2 in 1980 to 25.7 kg/m2 in 2013–2014, corresponding to a weight gain of 4.5 kg, together with an increase in the proportion of obese individuals (BMI ≥ 30 kg/m2) from 10.4 to 16.6% (p = 0.0012). The proportion of smokers and women with hypertension decreased from 34.5 to 12.8% (p = 0.0006) and from 37.7 to 24.5% (p < 0.0001) respectively. Mean total serum cholesterol levels decreased from 6.23 (SD 1.09) mmol/L in 1980 to 5.43 (SD 0.98) mmol/L in 2013–2014 (p < 0.0001). Self-reported leisure time regular exercise increased from 7.8% in 1980 to 35.6% in 2013–2014 (p < 0.0001). For women born in 1963, the prevalence ratio of not having any of five major cardiovascular risk factors was 1.82 (95% confidence interval (CI) 1.38–2.41), compared with women born in 1925–1934.

Conclusion
The trend towards increasing obesity, more leisure-time physical activity and less smoking remains, while the decrease in serum cholesterol appears to have abated.
Nobody says to you “come back in six months and we’ll see how you’re doing”: a qualitative interview study exploring young adults’ experiences of sport-related knee injury
Authors: Watkins Ross , Young Georgina , Western Max , Stokes Keith , McKay Carly 
Published: July 2020

Abstract
Background
Regular exercise is vital for overall health, and key to the maintenance of joint health. However, whilst people are encouraged to participate in sport and exercise, many are unaware that they could be at risk of developing post-traumatic osteoarthritis (PTOA) in the years following sport-related injury. Younger adults (< 40 years) with PTOA can experience declining quality of life, comorbid health conditions, and symptoms that place a chronic burden on health services. Conserving knee health through careful self-management in the latency period between injury and the onset of PTOA may help to delay disease progression. In this regard, the development of self-management interventions can be facilitated by understanding the post-injury experiences of young adults and their attitudes towards joint health.

Methods
Semi-structured interviews were conducted with 13 young adults following a sport-related knee injury to explore their experiences of injury, and their attitudes and perceptions of self-managing knee health. The interviews were audio-recorded, transcribed and analysed systematically using an inductive approach.

Results
Four themes pertaining to participants’ experiences were identified: [1] perceptions of current care provision; [2] long-term impact of knee injury; [3] motivation to conserve knee health; and [4] opportunities for supplementary support. The expression “Nobody says to you ‘come back in six months and we’ll see how you’re doing’” personifies the long-term impact of knee injury on young adults and a paucity of care provision.

Conclusion
Participants did not perceive that they had adequate care in the aftermath of knee injury, leading to a sense of frustration and uncertainty. This had implications for continued participation in sport and exercise, negatively impacting their athletic identity and sense of wellbeing. Activity tracking, symptom monitoring, advice provision and peer support were identified as tools to enable individuals to self-manage knee health.
A rare case of herniated duplex collecting system causing obstructive uropathy
Authors: El Mouhayyar Christopher , Wang Haoyang , Hattar Laith , Liu Fang-Yu , Feghali Karen , Balakrishnan Vaidyanathapuram 
Published: July 2020

Abstract
Background
An inguinal hernia is the protrusion of intraabdominal organs through an opening in the abdominal wall. Structures such as small and large intestines are commonly contained within inguinal hernias. However, uretero-inguinal hernia of the native collecting system is an extremely rarely reported entity. If unrecognized, acute kidney injury due to obstructive uropathy or serious intraprocedural ureteral injuries during hernia repair can occur. A duplex collecting system is a congenital kidney anomaly with an incidence of 0.8%. A uretero-inguinal hernia involving duplicated ureters has not been previously described in literature. Here we report a case of obstructive uropathy secondary to uretero-inguinal hernia involving duplicated ureters.

Case presentation
A 78-year-old male known to have a left sided inguinal hernia presented to the Emergency department with two weeks of intermittent suprapubic tenderness, dysuria, frequency, urgency, frothy urine as well as nausea and vomiting. Workup on admission revealed an elevated creatinine of 2.8 mg/dl. CT imaging revealed duplicated left sided ureters with left inguinal hernia containing the ureters. There was cystic ureteral dilation within the herniation sac as well as moderate left hydroureteronephrosis. Patient had an elective inguinal hernia repair with left ureteral stent placement. Following the surgery, he had recovery of kidney function to the previous baseline serum creatinine of 1.5 mg/dl.

Conclusion
A duplex collecting system arises when two ureteral buds are formed during fetal development. However, diagnosis can be made in rare instances during adulthood when duplex collecting systems are usually found incidentally. Uretero-inguinal hernias have been reported as a common complication of renal transplant. However, uretero-inguinal hernias in native kidneys are considered an uncommon finding, especially with a duplex collecting system. When patients present with herniation and acute kidney injury, it is important to rule out the possibility of uretero-inguinal hernia to minimize complications such as obstructive uropathy and kidney failure. CT scan providing cross-sectional imaging is the ideal modality for identification of the site and etiology of urinary tract obstruction and site of herniation. If during imaging, an obstructive uropathy is observed, a nephroureteral stent or nephrostomy tube can be inserted to protect the ureter as well as relieve the obstruction, respectively.
Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation
Authors: Thompson James E. , Sridhar Ashwin N. , Shaw Greg , Rajan Prabhakar , Mohammed Anna , Briggs Timothy P. , Nathan Senthil , Kelly John D. , Sooriakumaran Prasanna 
Published: July 2020

Abstract
Background
Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP..
The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA.

Methods
Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed.

Results
45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2.
Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications < 90 days occurred in 8.9, 6.7 and 2.2%; late (>90d) complications occurred in 13.2%.
At sRARP pathology, ISUP 3–5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3).
Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months.
Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP. Median IIEF-5 scores pre-HIFU, post-HIFU, 3- and 12-months post-sRARP were 23.5, 16, 5 and 5, respectively. Potency rates were 81.8, 65.5, 0 and 0%, respectively. Bilateral/unilateral nerve sparing were feasible in 7%/22%.

Conclusion
Salvage RARP was safe with acceptable but sub-optimal continence and poor sexual-function and poor oncologic outcomes. One in three men required additional treatment within 12-months. This information may aid men and urologists with treatment selection and counselling regarding primary HIFU-PA vs primary RARP and when considering salvage RARP.
“The way I am treated is as if I am under my mother’s care”: qualitative study of patients’ experiences of receiving hospice care services in South Africa
Authors: Vasileiou Konstantina , Smith Paula , Kagee Ashraf 
Published: July 2020

Abstract
Background
Research on the patient experience of receiving palliative care across a number of settings is increasing, but the majority of these investigations are situated within the context of developed countries. There is limited research from resource-limited countries, especially with regard to patients with cancer who receive hospice care. The present study explored the lived experience of attending hospice care facilities in South Africa to develop a bottom-up understanding from the perspectives of patients themselves.

Methods
A qualitative cross-sectional study was designed to examine how patients experienced receiving hospice care We conducted in-depth, semi-structured interviews with thirteen, purposively selected patients living with terminal cancer and receiving in-patient or day care palliative services from a hospice organisation in South Africa. We used inductive thematic analysis to analyse the data.

Results
We identified three themes that reflected a process of transformation that was experienced by participants during their engagement with the hospice services. The first theme describes participants’ initial reluctance to be linked to the hospice as a result of the stereotypic perceptions of hospice as being associated with death and dying. The second theme presents the perceived positive impact on patients’ physical and psychosocial wellbeing which resulted from the highly valued interactions with staff and other patients as well as patients’ engagement with creative activities. The final theme delineates the transformation of hospice into a second ‘family’ and ‘home’ and the restoration of an identity that expands beyond the ‘sick’ role.

Conclusions
Receiving hospice care that sensitively attends to patients’ psychosocial and physical needs helps people to re-create a sense of homeliness within the world, re-orient themselves toward a meaningful life and re-configure their relationship with self. Patient experience of receiving hospice care in South Africa does not appear dissimilar to that reported by patients in resource-rich countries, suggesting underlying commonalities. There is a need for raising awareness and educating the public about what palliative care can offer to those in need. Public health campaigns could help reduce the stigma attached to palliative care, deflect negative perceptions, and communicate the benefits for patients, families and communities in culturally sensitive ways.
Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study
Authors: Seo Min-Seok , Hwang In Cheol , Jung Jaehun , Lee Hwanhee , Choi Jae Hee , Shim Jae-Yong 
Published: July 2020

Abstract
Background
Although palliative care providers, patients, and their families rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention.

Methods
As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to a single hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independent prognostic factors.

Results
Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. The median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatremia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR = 1.45, 95% CI: 1.09–1.94), leukocytosis (HR = 1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR = 2.06, 95% CI: 1.49–2.73), and hypernatremia (HR = 1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis.

Conclusion
Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further large-scale prospective studies are needed to corroborate this finding.