bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Birth Weight-for-age and Length-for-age Z-scores in Infants With in-utero HIV and ART Exposure: A Prospective Study in Cape Town, South Africa
Authors: Nyemba Dorothy Chiwoniso , Kalk Emma , Madlala Hlengiwe P. , Malaba Thokozile R. , Slogrove Amy L. , Davies Mary-Ann , Boulle Andrew , Myer Landon , Powis Kathleen M. 
Published: August 2020

Abstract
Background: Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy. Methods: We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics. Results: Among 888 infants, 49% (n=431) were HEU and 51% (n=457) HU. Of 431 HEU infants, 62% (n=268) were exposed to HIV and antiretroviral (ARVs) from conception and 38% (n=163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17-26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β= -0.15 (95% Confidence Interval (CI): -0.28, -0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β -0.14 (95%CI: -0.28, -0.01]. Similar differences were noted for mean LAZ in univariable [β -0.20 (95%CI: -0.42, -0.01] but not multivariable analyses [adjusted β -0.18 (95%CI: -0.41, +0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU. Conclusion: In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.
Objective Structural Clinical Examinations can be Used to Assess Clinical Nursing Cultural Competence Abilities.
Authors: Lee Yu-Hsia , Lin Shu-Chuan , Wang Pao-Yu , Lin Mei-Hsiang 
Published: August 2020

Abstract
Background: Culture is the adhesive that binds people's lives. However, there is a lack of an objective and useful tool for assessing cultural competence and practice. The purpose of this study were to assess the learning efficacy of nurses after completing the Cultural Competence Cultivation Program using an Objective Structured Clinical Examination (OSCE).Methods: A quasi-experimental research design was used to evaluate nurses working at a medical center in Taiwan. The nurses were randomly allocated into an experimental group (N = 47), which underwent the Cultural Competence Cultivation Program, and a control group (N = 50), which did not partake in an educational program. After the intervention, the nurses’ learning efficacy was assessed using an OSCE. The research data were statistically analyzed using SPSS 22.0 software for Windows. Results: The average score of the experimental group was significantly higher in the “communication ability and skill” category. Furthermore, the OSCE scores, Standardized Patient Survey (SPS) scores and overall SPS scores were significantly and positively correlated.Conclusion: The findings of this study can serve as a reference for the design of future clinical education programs.
Irrational use of antibiotics in Iran from the Perspective of Complex Adaptive Systems: redefining the challenge
Authors: Sharif Zahra , Peiravian Farzad , Salamzadeh Jamshid , Mohammadi Nastaran Keshavarz , Jalalimanesh Ammar 
Published: August 2020

Abstract
Background: Irrational use of antibiotics proves major concerns to the health systems globally. It results in antibiotics resistance and increases health care costs. In Iran, many years of research, appreciable efforts and policy making have been of little avail and indicators still show suboptimal use of antibiotics, pointing out an urgent need to alternative approach to understand the problem and generate new solutions. Applying the Complex Adaptive Systems theory, to explore and research in health systems and their challenges and has become popular. Therefore, this study was aimed to better understand the complexity of irrational use of antibiotic use in Iran and the potential solutions. Method: This research utilized a CAS observatory tool to qualitatively collect and analysis data. Many interviews with key informants were conducted. The data was enriched with documents reviews in order to fully understand the system. MAXQDA software was applied to organize and analyze the data. Result: We could identify several diverse and heterogeneous, yet highly interdependent agents in the antibiotic consumption system in Iran, operating at different levels. The network structure and its adaptive emergent behaviour, information flow, governing rules, feedbacks and values of the system and the way they interact were identified. The gaps and weakness of the system which needs redesigning or modification were recognized as well. Findings describe antibiotic use as an emerge behavior of the system which is formed by interplay of many factors and actors over time.Conclusion: The study suggests re-engineering the system by implementing several system level changes including establishing strong, timely and effective interactions between identified stakeholders which facilitate information flow and provision of on time feedbacks, create win-win rules in participatory manner with stakeholders and distributed control system.
Perspectives of Syrian Refugees on Antibiotic Use and Prescribing in Dutch Primary Care: A Qualitative Study
Authors: Alkirawan Rima , Kawous Ramin , Bloemen Evert , Muijsenbergh Maria E.T.C. van den , Goosen Simone , de Boer Fijgje 
Published: August 2020

Abstract
Background: Antibiotic resistance is an international public health concern. Medical culture influences antibiotic use. Migrants, like Syrian refugees, are confronted with a different health care system in their new country and also with different culture regarding antibiotic prescription. The aim of this study is to get insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.Methods: A qualitative study using semi-structured interviews with 12 Syrian refugees living in the Netherlands was conducted. Results: participants stressed the easy access to antibiotics in Syria and reported storing antibiotics at home for emergencies. In the Netherlands, some of them still self-prescribed antibiotics while others adhered to the Dutch GP’s advice. Syrian refugees believed in having a weaker immunity compared to the Dutch inhabitants. For their young children, they adhered to the new health care system which resulted in not giving the children antibiotics without a prescription. Several complaints about the Dutch health care system were identified such as difficult access to the desired medication and lack of medical care for their complaints. Most respondents preferred the Syrian health care system.Conclusion: Syrian refugees experienced restricted access to antibiotics in Dutch primary care which was contrary to their experiences in Syria. As a reaction, they continued self-medicating with antibiotics. However, some of them adapted to the Dutch health care culture and accepted the alternative treatment proposal. For their children most participants adhered to the prescription policy of antibiotics in the Netherlands.
The Association Between Obstructive Sleep Apnea and Periodontitis in Chinese Male Adults: A Cross-Sectional Study
Authors: Chen Yanlong , Duan Ying , Li Yan , Han Xiaoxia , Gao He , Gao Xuemei 
Published: August 2020

Abstract
Background: Obstructive sleep apnea (OSA) is characterized by complete or partial upper airway obstruction during sleep. Periodontitis is an infectious and inflammatory disease of periodontal tissues. Recent studies suggested that both diseases could alter the host response synergistically by sharing same inflammatory pathways. The study aimed to investigate the association between OSA and periodontitis in Chinese male adults.Methods: This was a cross-sectional study of 93 male adults recruited from a dormitory compound and examined between June and September 2019. All participants were diagnosed OSA using the apnea–hypopnea index (AHI) with a portable, overnight polysomnography (PSG). Periodontal examinations were conducted the same day before PSG measuring: 1) mean probing depth (PD); 2) mean clinical attachment level (CAL); and 3) percentage of sites with bleeding on probing (BOP). An objective nasal airway resistance assessment was also practiced before PSG to reflect on the mouth breathing during sleep.Results: In all, 43.0% participants had periodontitis, 20.4% had OSA and 32.5% of those diagnosed with periodontitis were in combination with OSA. OSA was positively associated with periodontitis (odds ratio (OR) = 3.77, 95% confidence interval (CI) = 1.29 ~ 11.07). The OSA group showed a significantly higher BOP (p = 0.034) and CAL (p = 0.046), but there was no statistically significant difference of PD (p = 0.090) between the two groups. Correlation analysis showed a low but positive correlation between OSA severity and periodontitis severity classifications and periodontal parameters. Further regression analysis identified Lowest oxygen saturation (SaO2) (OR = 0.894, 95% CI = 0.842 ~ 0.949) to be significantly associated with the prevalence of periodontitis.Conclusions: A significant association was observed between OSA and periodontitis. And increasingly severe OSA might increase the severity of periodontitis. Hypoxia parameters might have a predicting effect of periodontitis, suggesting hypoxia related systematic inflammation may be the possible explanation of the association.
A Novel Autophagy-Related lncRNA Gene Signature to Improve the Prognosis of Patients with Melanoma
Authors: Ding Yi , Li Tian , Li Min , Tayier Tuersong , Zhang MeiLin , Chen Long , Feng ShuMei 
Published: August 2020

Abstract
Background: Autophagy and long non-coding RNAs (lncRNAs) have been the focus of research on the pathogenesis of melanoma. However, the autophagy network of lncRNAs in melanoma has not been reported. The purpose of this study was to investigate the lncRNA prognostic markers related to melanoma autophagy and predict the prognosis of patients with melanoma.Methods: We downloaded RNA-sequencing data and clinical information of melanoma from The Cancer Genome Atlas. The co-expression of autophagy-related genes (ARGs) and lncRNAs was analyzed. The risk model of autophagy-related lncRNAs was established by univariate and multivariate COX regression analyses, and the best prognostic index was evaluated combined with clinical data. Finally, gene set enrichment analysis was performed on patients in the high- and low-risk groups.Results: According to the results of the univariate COX analysis, only the overexpression of LINC00520 was associated with poor overall survival, unlike HLA-DQB1-AS1, USP30-AS1, AL645929, AL365361, LINC00324, and AC055822. The results of the multivariate COX analysis showed that the overall survival of patients in the high-risk group was shorter than that recorded in the low-risk group (p<0.001). Moreover, in the receiver operating characteristic curve of the risk model we constructed, the area under the curve (AUC) was 0.734, while the AUC of T and N was 0.707 and 0.658, respectively. The Gene Ontology was mainly enriched with the positive regulation of autophagy and the activation of the immune system. The results of the Kyoto Encyclopedia of Genes and Genomes enrichment were mostly related to autophagy, immunity, and melanin metabolism.Conclusion: The positive regulation of autophagy may slow the transition from low-risk patients to high-risk patients in melanoma. Furthermore, compared with clinical information, the autophagy-related lncRNAs risk model may better predict the prognosis of patients with melanoma and provide new treatment ideas.
Fall Risk Prediction via Classification of Lower Extremity Strength in Older Adults with Exergame-Collected Data
Authors: Becker Hagen , Garcia-Agundez Augusto , Müller Philipp Niklas , Tregel Thomas , Miede André , Göbel Stefan 
Published: August 2020

Abstract
Objective: The goal of this article is to present and evaluate a sensor-based falling risk estimation system. The system consists of an array of Wii Balance Boards (WBB) and an exergame that estimates if the player is at an increased falling risk by predicting the result of the 30 Second Sit-To-Stand Test (30CST).Methods: 16 participants recruited at a nursing home performed the 30CST and then played the exergame as often as desired during a period of two weeks. For each session, features related to how they walk and stand on the WBBs while playing the exergame were collected. Different classifier algorithms were used to predict the result of the 30CST on a binary basis (able or unable to maintain physical independence). Results: We achieved a maximum accuracy of 91% when attempting to estimate if the player’s 30CST score will be over or under a threshold of 12 points using a Logistic Model Tree. We also believe it is feasible to predict age- and sex-adjusted cutoff scores. Conclusion: An array of WBBs seems to be a viable solution to estimate lower extremity strength and with it the falling risk. In addition, data extracted while playing may form a basis to perform a general screening to identify elderly at an increased falling risk.
Expression of FAP-1 Correlates with Glioblastoma Proliferation, Migration and Treatment Resistance
Authors: Li Bo , Liu Yang , Mahati Shaya , Qin Hu , Maimaitili Aisha , Wang Zengliang , Wang Yongxin 
Published: August 2020

Abstract
Background: Glioblastoma (GBM) is the most severe type of brain cancer, with an extremely high mortality rate and the average survival time less than 15 months. Almost in all GBM cases, the residual tumor cells continue to divide uncontrollably, leading to tumor re-establishment, i.e., tumor recurrence, and ultimately death. Therefore, there is an urgent need to identify critical mediators of GBM progression and resistance to therapy. Fas-associated Phosphatase-1 (FAP-1, also known as PTPN13 or PTPL1) is a member of a large protein tyrosine phosphatase family. It has been shown that FAP-1 expression is downregulated in many types of cancers, which leads to unabated signaling and tumor progression and metastasis. The aim of this study is to evaluate the role of FAP-1 in GBM progression and resistance to therapy.Methods: Cell viability assays, radiotherapy and temozolomide response assays, and Western blot were used to analysis of FAP-1 in GBM based on Oncomine.Results: Our results showed that knockdown of FAP-1 enhanced viability and migration of GBM cell lines, and importantly, increased GBM cell resistance to radiotherapy and temozolomide. Conclusions: FAP-1 is important for GBM cells, and may account for GBM resistance to therapy.
Relationship Between Forest Strata Structure and Regeneration in Subtropical Evergreen Broad-Leaved Forest
Authors: Long Junsong , Tang Mengping 
Published: August 2020

Abstract
Background: Regeneration is an extremely important and complex ecological process, which is disturbed by many factors. The current stand structure has an important influence on regeneration. The aim of this study is to provide theoretical reference for improving the regeneration capacity subtropical evergreen broad-leaved forest and formulating management measures of regeneration restoration.Methods: A permanent plot of 100m × 100m was set up in the evergreen broad-leaved forest of Tianmu Mountain National Nature Reserve, Zhejiang Province, China. The plot was divided into 25 survey units of 20m × 20m by the adjacent grid survey method, and all the trees in the plot were investigated. The tree height, DBH, crown width, density, species richness index, aggregation index, competition index and mingling of each forest stratum were used as the stand structure index. The tree height, DBH, crown width, density and species richness index of regeneration trees were used as regeneration indicators. Redundancy analysis (RDA) was used to explore the relationship between forest strata structure and regeneration of evergreen broad-leaved forest. Results: In the whole stand, DBH, tree species richness index and crown width were the main structure factors affecting regeneration. In the upper forest stratum, the tree height was the main structure factor affecting regeneration. In the middle forest stratum, the tree species richness index and crown width were the main factors affecting regeneration. In the lower forest stratum, crown width, competition index, tree height and tree species richness index were the main factors affecting regeneration. The effects of tree species richness index and crown width on regeneration in the whole stand were mainly reflected in the middle and lower forest strata in each forest stratum. Conclusions: The influencing order of each forest stratum structure on regeneration was: lower forest stratum > middle forest stratum > upper forest stratum. Different regeneration indicators had different responses to the main stand structure indices, while the young tree height and DBH, and the tree species diversity and density of regeneration trees were most affected by the main stand structure indices. In order to promote the regeneration of evergreen broad-leaved forest in the future, different management measures should be taken for different forest strata, and the threshold value of each index should be controlled.
Drivers of differential views of health equity in the U.S.: Is the U.S. ready to make progress? Results from the 2018 National Survey of Health Attitudes
Authors: Towe Vivian , May Linnea Warren , Huang Wenjing , Martin Laurie T. , Carman Katherine , Miller Carolyn E. , Chandra Anita 
Published: August 2020

Abstract
Objectives: The public health sector has long recognized the role of the social determinants of health in health disparities and the importance of achieving health equity. We now appear to be at an inflection point, as we hear increasing demands to dismantle structures that have perpetuated inequalities. Assessing prevailing mindsets about what causes health inequalities and the value of health equity is critical to the addressing larger, racial inequity issues. Using data from a nationally representative sample of adults in the United States, we examined the factors that Americans think drive health outcomes and their beliefs about the importance of health equity.Methods: Using data from the 2018 National Survey of Health Attitudes, we conducted factor analyses of 21 survey items identified three factors out of the items relating to health drivers—traditional health influencers (THI), social determinants of health (SDoH), and sense of community health (SoC). Beliefs about health equity were measured with three questions about opportunities to be healthy. Latent class analysis identified four groups with similar patterns of response. Factor mixture modeling combined factor structure and latent class analysis into one model. We conducted three separate logistic regressions using latent classes and demographics as predictors and the three equity beliefs as dependent variables. Results: Nearly 90% of respondents comprised one class that was characterized by high endorsement (i.e., rating the driver as having strong effect on health) of THI, but lower endorsement of SDoH and SoC. Logistic regressions showed that respondents endorsing (i.e., rated it as a top priority) all three health equity outcomes tended to be female, older, Black or Hispanic, more educated, and have lower incomes. The class of respondents that endorsed SDoH the most was more likely to endorse all three equity beliefs.Conclusions: Results suggested that people historically most impacted by inequity, e.g., people of color and people with low incomes, had the most comprehensive understanding of the drivers of health and the value of equity. Prevailing beliefs about SDoH and health equity are still generally not aligned with scientific consensus and the prevailing narrative in the public health community.Trial Registration: Not applicable
Premature pap test screening, under 25 years old, a link with the mode of contraception? Analysis of data from the CONSTANCES cohort study
Authors: Mignot Stephanie , Ringa Virginie , Vigoureux Solène , Zins Marie , Panjo Henri , Saulnier Pierre-Jean , Fritel Xavier 
Published: August 2020

Abstract
Background Many countries currently recommend that screening for cervical cancer begin at the age of 25 years. Premature screening (before that age) could lead to unnecessary follow-up examinations and procedures that turn out to be useless. Our objective is to ascertain if the use of particular contraceptive methods are associated with premature screening.Methods This cross-sectional study based on the CONSTANCES cohort enabled us to include 4297 women younger than 25 years. The factors associated with premature screening were modeled by logistic regression. Missing data were handled by multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status.Results Nearly half (48.5%) the women younger than 25 years had already undergone premature screening. Women not using contraceptives (aOR 0.3, 95% CI 0.3–0.5) and those using nonmedicalized contraceptives (condom, spermicide, etc.) (aOR 0.5, 95% CI 0.4–0.6) had premature screening less often than women using birth control pills. Higher risks of premature screening were observed in 20-year-old women (aOR 2.7, 95% CI 2.2–3.3) and in those with more than 5 lifetime partners (aOR 2.5, 95% CI 2.0-3.1), compared respectively with those of women who were younger and those with 5 or fewer lifetime partners.Conclusion Young women using contraceptives that require a doctor's prescription are exposed to premature screening more often than both those not using contraception and those with nonmedicalized contraceptives.