bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of Different Media Activities With Behavioral Strengths and Difficulties and School Performance in Adolescents: a Cross-Sectional Analysis
Authors: Poulain Tanja , Meigen Christof , Grafe Nico , Kiess Wieland 
Published: August 2020

Abstract
Background: This study investigates the times adolescents engage in different media activities (including entertaining and educational activities) and explores associations with behavioral strengths and difficulties and school grades. Methods: This cross-sectional study included 664 10- to 18-year-old adolescents (350 boys, 314 girls) participating in the LIFE Child study in Germany. Participants completed questionnaires on their media use, on strengths and difficulties (using the Strengths and Difficulties Questionnaire), and on their school grades in mathematics and first language. Associations of the times engaged in different media activities via mobile phone or computer (traditional communication, social media use, gaming, playing learning games, watching videos, and searching for information) with behavioral strengths/difficulties and school grades were assessed using linear regression analyses (adjusting for age, gender, and socioeconomic status). Results: With the exception of playing learning games, each media activity was followed for almost one hour per day, with high inter-relations between the single activities. Gaming, watching videos, social networking, traditional communication, and playing learning games were significantly associated with more behavioral difficulties in at least one domain (emotional problems, conduct problems, hyperactivity/inattention, peer-relationship problems, prosocial behavior) and with lower school grades. Searching for information showed the weakest associations with behavioral difficulties and no association with school grades. In a multivariate analysis, searching for information was associated with fewer behavioral difficulties. Conclusions: Using media to search for information might weaken the adverse effects of other media activities on school performance and behavioral adjustment.
Improving Diagnostic Ability and Confidence In Otoscopy Through A Web Based Learning Platform: A Prospective Interventional Study
Authors: Azman Mawaddah , Rajasingam Devyadarsshni , Mokhtar Rahmi Hidayati Mohammad Mursal , Hamzah Amir Thaqiff , Iskandarrani Izzatul Ismah , Roslan Ainur Atikah , Besar Mohd Nasri Awang 
Published: August 2020

Abstract
Background

Otoscopy is an important clinical skill to master in the undergraduate medical curriculum. This study investigated the effect of a new web-based learning platform in improving diagnostic ability and confidence in otoscopy among final year medical undergraduates in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
Methods

A new web-based learning platform for otoscopy was introduced to final year medical undergraduates who have completed a three-week posting in otorhinolaryngology. A total of 45 subjects who participated in the learning platform were included in this prospective interventional study. All of them answered questionnaires on level of confidence (LC) and completed online questions on diagnostic ability (DA) at three different timelines during the study: prior to intervention (T1), after intervention (T2) and 4 months following the intervention (T3).
Results

LC scores were significantly higher in between T1 and other timelines measured: T1 vs T2 and T1 vs T3 respectively (p < 0.05). DA scores were significantly higher in between T1 and other timelines measured: T1 vs T2 and T1 vs T3 respectively (p < 0.05). LC and DA scores continued to improve at T3 with scores significantly higher when compared with scores at T2 (p < 0.05).
Conclusion

Subjects’ level of confidence in performing otoscopy and diagnostic ability showed sustained improvements at 4 months with this intervention. We conclude that otoscopy web based learning platform complements the teaching and learning of otoscopy among final year medical undergraduates.
The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: assessment of the psychometric properties of the Greek version of the BSES-SF tool.
Authors: Economou Mary , Kolokotroni Ourania , Paphiti-Demetriou Irene , Kouta Christiana , Lambrinou Ekaterini , Hadjigeorgiou Eleni , Hadjiona Vasiliki , Middleton Nicos 
Published: August 2020

Abstract
Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initiation, duration and exclusivity. The use of valid measurement tools of BSES is important in clinical and community practice. Thus, we aimed to assess the properties of the Breastfeeding Self-Efficacy Scale (BSES-SF) to measure the self-efficacy of mothers in Cyprus and its association with BF and EBF up to the sixth month.Methods: A cross-sectional and longitudinal descriptive study with a nationwide consecutive sample of 586 mother-infant dyads, recruited from all state maternity wards and 24 (of 30) private clinics within 24-48 hours of birth and followed up by telephone up to the 6 th month postpartum. BSES was assessed at the clinic and at the first month with the Greek version of the 14-item 5-point Likert BSES-SF scale. Information on infant feeding practices was collected at all four time points. The association between self-efficacy and breastfeeding outcomes was estimated in logistic regression models. Results: With Mean=3.55 (SD=0.85), BSES was only moderate, and lower among Cypriot women, primiparas, those who delivered by C/S and did not intent to breastfeed exclusively. There was good internal consistency across the 14 items (alpha coefficient=0.94). While higherlevels of self-efficacy were not strongly associated with the likelihood of breastfeeding initiation, there was a stepwise association with exclusivity. The association between in-hospital assessment of self-efficacy and long-term EBF persisted in multivariable models adjusting for socio-demographic characteristics. Women in the upper quartile of BSES at 48 hours were more likely to breastfeed exclusively at the 1 stand at the 4 th month. Similar, if not stronger, associations were observed between self-efficacy at the 1 st month and BF outcomes at subsequent time-points. High BSES at the first month (>3.96) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months.Conclusions: The Greek version of the BSES-SF showed good metric properties. The generally low prevalence of breastfeeding among mothers in Cyprus, suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.
Association of Stress Management Skills and Stressful Life Events With Allergy Risk: a Case-control Study in Southern China
Authors: Cheng Jingru , Li Fei , Lai Yigui , Chen Jieyu , Sun Xiaomin , Xiang Lei , Jiang Pingping , Wu Shengwei , Xiao Ya , Zhou Lin , Luo Ren , Zhao Xiaoshan , Liu Yanyan 
Published: August 2020

Abstract
Background: Psychosocial stress and stressful life events are known to aggravate atopic diseases. Less is known about the impact of stress management skills on allergies. Here we sought to determine whether stress management skills are associated with the allergies and to assess the combined effects of stress management skills and stressful events on allergy risk. Methods: A survey on risk factors for self-reported allergic diseases was carried out among 28,144 southern Chinese people; 14 stressful life events and 8 stress management skills were retrospectively recorded in a case-control setting with multivariate logistic regression analysis. Multiplicative and additive interactions between stressful events and stress management skills were evaluated. Results: Stressful events significantly increased allergy risk. The odds ratio (OR) for allergies was 1.65 (95% confidence interval CI, 1.41–1.93) for those reporting one or two stressful events and 3.10 (95% CI, 2.55–3.79) for those reporting more than two stressful events. Stress management skills were adversely associated with allergic risk for people experiencing stressful events (OR, 0.71; 95% CI, 0.53–0.97) when adjusted demographically, particularly “concentrate on pleasant thoughts at bedtime” (OR, 0.67; 95% CI, 0.51–0.89), “pace myself to prevent tiredness” (OR, 0.67; 95% CI, 0.54–0.83), “get enough sleep” (OR, 0.48; 95% CI, 0.32–0.72) and “take some time for relaxation each day” (OR, 0.55; 95% CI, 0.37–0.80). There was a significant linear trend for allergy risk from good stress management skills with no stressful events to poor stress management skills with stressful events (P < 0.000), with significant interaction in additive models (P = 0.006). Conclusions: There are independent and antagonistic combined associations of stressful life events and stress management skills with allergy risk. This supports the use of stress management skills in managing allergic disease.
Beliefs and Barriers Associated with COVID-19 Vaccination Among the General Population in Saudi Arabia
Authors: Magadmi Rania M , Kamel Fatemah O. 
Published: August 2020

Abstract
Background: Developing a vaccine against COVID-19 is considered a key strategy to end the pandemic. However, public acceptance is reliant on beliefs and perception toward the vaccine. Therefore, the study aimed to assess the beliefs and barriers associated with COVID-19 vaccination among the Saudi population. Methods: An online self-administered questionnaire was distributed across the main regions of Saudi Arabia on May 2020. The questionnaire addressed the socio-demographic variables, beliefs toward COVID-19 vaccination, and potential barriers that may prevent participants from being vaccinated. The association between COVID-19 vaccine acceptance and sociodemographic variables were analyzed. Logistic regression analysis was used to identify the predicting variables of vaccine acceptance.Results: Out of 3,101 participants, 44.7% are accepting of COVID-19 vaccination if available, whereas 55.3% admitted hesitancy. Younger, male, with secondary education, history of taking previous seasonal influenza vaccine, and positive belief toward COVID-19 vaccination are more likely to accept. The study found that concerns about side effects were the key barrier for vaccine acceptance. Furthermore, the majority of refusers will accept the vaccine if additional studies confirmed safety and effectiveness. Conclusion: Results can be utilized in planning vaccination campaigns while waiting for vaccine development.
COVID-19 and Epilepsy
Authors: Sidig Amira , Alhusseini Radi Tofaha , Abbasher Khabab , Elsayed Mohamed , Abbasher Hussien , Abbasher Mohammed , N Sufian Khalid M. , Hajnoor Khalid , Malekaldar Mohammed , Hussien Abbasher , Hamid Omer Eladil A. , Digna Mutaz F. 
Published: August 2020

Abstract
Introduction: COVID-19 caused by SARS-CoV-2 acquired via respiratory droplets. It can present with many systemic disorders, includingA 45-year-old Sudanese male known to have well-controlled generalized tonic-clonic epilepsy, He presented to the Accident and Emergency (A&E) department complaining of refractory status epilepticus. Despite immediate initial stabilization, the seizure attacks were still refractory to intravenous loading doses of antiepileptic drugs AEDs. Hence the patient was intubated and mechanically ventilated. Brain MRI and EEG were normal. The chest X-ray was normal. The screening of COVID-19 was positive.Epilepsy is one of the most common neurological disorders. Since the beginning of the Coronavirus outbreak in December 2019, no available research data is suggesting that the patients with epilepsy are at more risk than others. As no available data relating epilepsy to severe COVID-19 infection (6). Moreover, no data studied COVID-19 and the sudden unexpected death among epileptic patients (SUDEP).Conclusion: This case might report the effect of SARS-CoV-2 on provoking the refractory seizures in a previously well-controlled patient with epilepsy. More researches are needed to explain the relation between COVID and seizure threshold.
An Interdisciplinary Oral Health Program for Children in Kindergartens of Northern Italy
Authors: Orlando Antonina , Arisido Maeregu Woldeyes , Brioschi Stefano , Maccà Luca , Graci Stephanie , Panzeri Maria Cristina , Mecatti Fulvia , Palestini Paola , Cazzaniga Emanuela 
Published: August 2020

Abstract
Background: The aim of the study was to investigate if a parents’ training program on nutritional and oral health behaviours held by health professionals can influence children habits in a sample of kindergartens in Northern Italy.Methods: The study designed was a longitudinal study. The study population were children aged 6–36 months attending four kindergartens. Parents were invited to participate filling out a self-administered questionnaire, and after having returned the informed consent form they were asked to participate to a training meeting. Parents had to fill out a questionnaire at baseline and after 3 months from the training meeting. The questionnaire included information on socio-demographics about parents, oral hygiene habits of parents and child, and eating habits of child. Wald test was used to analyse data collected. Results: After the training program, almost all children were able to use a toothbrush suitable for kids (from 91% at the baseline to 99% after the 3-months). The analysis shows that the given training significantly increased the number of children who use toothpaste from 86% at baseline (95%CI: 85%-88%) to 96% (95%CI: 94%-98%). The use of fluoride toothpaste significantly increased after the training intervention as the baseline measure of 59% proportion increased to 80%. The intervention study showed a positive impact on the number of pupils who wash their tooth more than twice per week and on the timing of oral hygiene as both night and morning time proportion increased after the 3-month. Regarding the feeding habits the given consultation resulted in a statistically significant increase regarding the importance of morning snack from 94% at baseline (95%CI: 92%-96%) to 97% after 3-month (95%CI: 94%-99%). Another promising effect of the education is the decrease from 47% at baseline (95%CI: 46%-49%) to 42% after the study (95%CI:41%-43%) of the bad habit of having a snack after dinner.Conclusions: Results of our study have shown that a parents training intervention can have good results on the oral hygiene and eating habits of children of this age group. To underline the importance of several professional figures who work together with a common purpose.
Association of HMGB1, S100A12 and IL-17A Expression with IVIG-Resistant Kawasaki Disease and Treatment Options
Authors: Liu Deying , Liu Pan , Liu Fan , Yin Wei , Ding Yan 
Published: August 2020

Abstract
Background: Kawasaki disease (KD) is a medium vessel vasculitis of unknown aetiology that predominantly affecting coronary arteries. The damage-associated molecular pattern molecules (DAMPs) such as HMGB1, S100A12 and IL-17A have been reported to predict poor response to IVIG. Here, we explored the the role of HMGB1, S100A12 and IL-17A in the detection of intravenous immunoglobulin (IVIG)-resistant in KD patients, and to investigate the value of different adjunctive therapy.Method: 126 KD patients and as well as age- and sex-matched 16 febrile control subjects were enrolled in our study. The fresh peripheral blood were collected from KD patients and febrile controls, analyzed the demographic or clinical data and various laboratory parameters. We also measured changes in serum levels of IL-17A and mRNA expression levels of HMGB1 and S100A12 were tested in IVIG-resistant KD patients. Further we explored the association between coronary arteries lesions and different treatment options about IVIG retreatment, methylprednisolone and infliximab for IVIG-resistant KD patients. Result: Regarding laboratory parameters, KD individuals were found to have lower levels of lymphocyte(L)%, prealbumin, CD4+, CD8+ and higher levels of WBC, neutrophil (N)%, CRP, ESR, NT-proBNP, ALT, CD4+/CD8+ (P<0.05 or P<0.01). For KD group, the 53 IVIG-resistant patients had significantly higher levels of S100A12, HMGB1, serum IL-17A, N%, CRP, NT-proBNP, TBIL, ALT, AST and lower levels of L%, PLT (P<0.05 or P<0.01) in comparison to the IVIG-responsive patients. For patients with IVIG-resistant, IVIG retreatment, methylprednisolone or infliximab were used. Methylprednisolone showed better in improving clinical symptoms and CRP than the IVIG retreatment and infliximab (P> 0.05).Conclusion: IVIG-resistant was associated with overreaction of inflammation.The levels of HMGB1,S100A12 and IL-17A suggested to be reliable predictors for IVIG-resistant in KD. In addition, the adjunctive therapy of methylprednisolone and infliximab showed more effective in relieving clinical symptoms than IVIG retreatment.
Evaluation of Biochemical, Hematological and Oxidative Parameters in Mice exposed to the Binapacryl
Authors: Sowunmi Kehinde , Adebayo Sofiyah Modupeola , Lawal Ayobami Adesiyan , Kade Ayomikun Emmanuel , Kaur Gurpreet 
Published: August 2020

Abstract
We evaluated the toxicity of hepatic, hematological, and oxidative effects of binapacryl on female albino mice. The animals were treated orally with 50, 100, 150 and 200 mg/kg body weight of the binapacryl, on a daily basis for a period of 15 days. Distilled water was used as control treatment. Samples of blood and hepatic tissue were collected at the end of the treatment. Hepatotoxicity was monitored by quantitative analysis of the serum enzymes ALT, AST, γ-GT, urea and creatinine. We also investigated liver tissues histopathologically. Alterations of hematological parameters were monitored by RBC, WBC, hemoglobin, hematocrit, MCV, MCH, and MCHC. Significant increases in the levels of hepatic enzymes (ALT, AST, and γ-GT) were observed for both binapacryl treatments, but no considerable differences were found by histological analysis. The hematological parameters showed significant alterations (200mg/kg body weight) with reductions of RBC, hematocrit, and hemoglobin, together with a significant increase of MCV. There was an important increase in lipid peroxidation at both dosage levels, together with an NPSH decrease in the hepatic tissue, and significant changes in these parameters were observed only at the higher dose rate. The results of this study indicate that binapacryl can promote hematological and hepatic alterations, even at subacute exposure, which could be related to the induction of reactive oxygen species.
An&nbsp;Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone
Authors: Youkee Daniel , Bangura Thaimu , O’Neill Kwame , Hartshorn Lucy , Samura Sorie 
Published: August 2020

Abstract
Background Referral systems are critical to a well-functioning health system. In 2017, a special cadre of referral coordinators were trained and deployed at every district and tertiary hospital in Sierra Leone. We analyse the referrals coordinated by the network to understand health service utilisation, referral pathways and outcomes.Methods A retrospective observational study of incoming referrals to all district and tertiary hospitals in Sierra Leone from 1st November 2017 until 31st October 2018. Multivariate analysis was performed on all referrals and a subgroup analysis of urgent referrals (n=10,865). Hospital preparedness and readiness scores were sourced from the Service Availability and Readiness Assessment 2017.Results 14,266 referrals were captured over the 12 months. Referral indices ranged from 0·51-5·97, with the highest indices found in Freetown and Pujehun. Bed occupancy ranged from 36·8-83·3%. 606 deaths were recorded, mortality rate per referral was 4.25%, with the majority of deaths, 446 (73.60%) occurring in the U5 population. Higher OR for mortality are seen from referrals originating from higher levels of the health system. The OR for mortality for a referral from the lowest level, MCHP, was 0.77, whilst from tertiary level was 2.40 (MCHP 0·77, CHP 0·90, CHC 1·40, district 2·06 and tertiary 2·40). For urgent referrals, factors associated with mortality were U5s, adult non-maternity cases and being seen by a clinician within one hour. Referrals from district hospitals to tertiary hospitals only accounted for 0·5% of all referrals. No correlation was found between referral index, bed occupancy and hospital service availability and readiness scores. The study did not detect any difference in total number of national referrals during the rainy season.Conclusions Wide variations in bed occupancy and referrals by district highlight disparities in health service utilisation. Low rates of referral from district hospitals to tertiary care should be further investigated. Referral indices and referral mortality rates are useful to monitor over time and to make inter district comparisons. Referral systems and pathways are useful indicators of health service utilisation and further research should be undertaken to standardise definitions and identify performance indicators for referral systems in low resource settings.
Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas
Authors: Li Yuchan , Wang Zhigang , Chen Mu , Cai Haoqi 
Published: August 2020

Abstract
Background

Gradual ulnar lengthening is the most commonly used procedure in treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children and only slightly handicapped of daily life activities in untreated adult patients. The aim of this study was to evaluate mid-term clinical and radiological outcomes of ulnar gradual lengthening in our clinic.
Methods

We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. Patients with less than two years of follow-up were excluded. The surgical procedures consisted of ulnar lengthening by external fixator and/or excision of the osteochondroma at the distal ulna. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, two months after external frame removal, and at the last follow-up.
Results

The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37.3 ± 7.9° to 29.8 ± 6.5° initially (P = 0.003) and relapsed to 34.4 ± 7.6° at the last follow-up (p = 0.234). There was minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). The elbow flexion and forearm pronation were improved significantly at last follow-up (p < 0.001 and p = 0.024, respectively). The mean carrying angle improved significantly from − 6.3 ± 7.4 ° preoperatively to 7.4 ± 11.1° at last follow-up (p < 0.001).
Conclusions

Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function; it is recommended for patients with Masada type I/IIb deformity. Therefore, we advocated aggressive individual treatment protocol for patients with Masada type I/IIb deformities.