bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional study of mother-child agreement on PTSD symptoms in a south Indian post-tsunami sample
Authors: Exenberger Silvia , Riedl David , Rangaramanujam Kumuthavalli , Amirtharaj Vijai , Juen Florian 
Published: December 2019

Abstract
Background
Few studies examine caregiver-child agreement on posttraumatic stress disorder (PTSD) symptoms in non-Western cultures. The present study investigated mother-child agreement for PTSD symptoms in a South Indian sample, which was affected by the Indian Ocean Tsunami in 2004.

Methods
Data was collected four years post-disaster. In total, 80 mothers rated PTSD symptoms for their 164 children and gave information about their own trauma symptoms. In addition, the children aged 8 to 17 reported about their own PTSD symptoms.

Results
Results showed that mother-child agreement on posttraumatic stress symptoms was poor, and a child’s age, gender and living situation (fishing village vs. family-based out-of-home care) did not positively influence this concordance. Moreover, mothers’ own posttraumatic symptoms were strongly related to maternal reports of the child’s PTSD symptoms. Multivariate analyses showed that mothers’ PTSD symptoms were the only significant predictor for discrepancies in the rating of the child’s PTSD symptoms. That means, if mothers reported clinically relevant PTSD symptoms, the likelihood for disagreement on the child’s PTSD ratings more than doubled. Neither age, nor gender nor the living situation had an influence on children’s self-rated posttraumatic stress reactions.

Conclusions
In general, long-term monitoring of posttraumatic stress symptoms of mothers and children should be planned by relief actions as recovery processes are decelerated through lacking resources in developing countries such as India. Specifically, the assessment of mothers’ trauma symptoms is inevitable because the mothers’ own responses to disaster highly influence their assessment of their children’s symptoms. Mother-child agreement is discussed against the background of socio-cultural aspects.
Current prevalence pattern of tobacco smoking in Nigeria: a systematic review and meta-analysis
Authors: Adeloye Davies , Auta Asa , Fawibe Ademola , Gadanya Muktar , Ezeigwe Nnenna , Mpazanje Rex G. , Dewan Mary T. , Omoyele Chiamaka , Alemu Wondimagegnehu , Harhay Michael O. , Adewole Isaac F. 
Published: December 2019

AbstractBackgroundNational smoking cessation strategies in Nigeria are hindered by lack of up-to-date epidemiologic data. We aimed to estimate prevalence of tobacco smoking in Nigeria to guide relevant interventions.MethodsWe conducted systematic search of publicly available evidence from 1990 through 2018. A random-effects meta-analysis and meta-regression epidemiologic model were employed to determine prevalence and number of smokers in Nigeria in 1995 and 2015.ResultsAcross 64 studies (n = 54,755), the pooled crude prevalence of current smokers in Nigeria was 10.4% (9.0–11.7) and 17.7% (15.2–20.2) for ever smokers. This was higher among men compared to women in both groups. There was considerable variation across geopolitical zones, ranging from 5.4% (North-west) to 32.1% (North-east) for current smokers, and 10.5% (South-east) to 43.6% (North-east) for ever smokers. Urban and rural dwellers had relatively similar rates of current smokers (10.7 and 9.1%), and ever smokers (18.1 and 17.0%). Estimated median age at initiation of smoking was 16.8 years (IQR: 13.5–18.0). From 1995 to 2015, we estimated an increase in number of current smokers from 8 to 11 million (or a decline from 13 to 10.6% of the population). The pooled mean cigarettes consumption per person per day was 10.1 (6.1–14.2), accounting for 110 million cigarettes per day and over 40 billion cigarettes consumed in Nigeria in 2015.ConclusionsWhile the prevalence of smokers may be declining in Nigeria, one out of ten Nigerians still smokes daily. There is need for comprehensive measures and strict anti-tobacco laws targeting tobacco production and marketing.
Cluster randomised controlled trial of behavioural intervention program: a study protocol for control of hypertension among teachers in schools in Kerala (CHATS-K), India
Authors: Mini G. K. , Sarma P. S. , Thankappan K. R. 
Published: December 2019

Abstract
Background
Control of blood pressure among hypertensives is a major challenge around the world. Interventions for improving hypertension control in India are very limited. This paper describes the protocol for a cluster randomized controlled trial of efficacy of behavioural intervention on control of hypertension among school teachers in Kerala.

Methods
A total of 92 schools are randomised to intervention and control group in Kerala. A baseline survey was conducted in all schools to assess the prevalence of hypertension and its risk factors among school teachers in Thiruvananthapuram district of Kerala state, India. Teachers in both sets of schools will receive a leaflet containing details on the importance of controlling hypertension. With the objective of improving control of hypertension, the intervention schools will additionally receive self-management education and behavioural intervention programs delivered by trained intervention managers along with measurement of weight, waist circumference and blood pressure. This intervention program will be developed based on the findings of the baseline survey and selected components of successful models of hypertension control from previous research done in similar settings. The intervention will be given for 3 months after which a post-survey will be conducted among teachers of both control and intervention schools. The primary outcome is change in control of hypertension and secondary outcome is the change in behavioural risk factors of hypertension both in the control and intervention groups.

Discussion
This is the first comprehensive study looking at the efficacy of behavioural intervention on hypertension control among school teachers in Kerala, India. This study is likely to provide an upper estimate of behavioural intervention on hypertension control since teachers are reported to have one of the highest compliance rates of behavioural intervention.

Trial registration
This trial was prospectively registered with the Clinical Trials Registry of India [CTRI/2018/01/011402] on 18 January 2018.
Pattern of physical exercise practice among university students in the Kingdom of Saudi Arabia (before beginning and during college): a cross-sectional study
Authors: Alkhateeb Sarah Ahmed , Alkhameesi Najwa Fahad , Lamfon Ghadeer Nazeh , Khawandanh Shahad Zuhair , Kurdi Lujain Khalid , Faran Murooj Yaseen , Khoja Alya Abdullah , Bukhari Lujain Muhammed , Aljahdali Hadeel Rajeh , Ashour Nuha Abdullah , Bagasi Hessan Turki , Delli Raghdah Adel , Khoja Ohood Abdullah , Safdar Osama Yousof 
Published: December 2019

AbstractBackgroundTransition to college is characterized by change, ambiguity, and adjustment compared to the previous lifestyle before entering college. Our study aimed was to determine the pattern of students’ physical exercise practices in the Kingdom of Saudi Arabia in the period before and during college attendance.MethodsA cross-sectional study was conducted among university students from fifteen universities in the Kingdom of Saudi Arabia on August 2017. The data were collected using an electronic questionnaire that was modified from questionnaires used in previous studies. Statistical analysis and data entry was performed with SPSS version 21. This study was approved by the Research Ethics Committee at King Abdulaziz University.Results417 college students completed the questionnaire and 77.2% were female. Slightly more than half of the participants (55.9%) were from King Abdulaziz University, and 59.7% were from healthcare specialties from different institutions. The mean age of the participants was 21.80 years old (SD = 2.75). The pattern of practicing physical exercise showed a significant decrease after enrollment in college (p = 0.000). The most common reason for not practicing exercise was time restrictions, accounting for 18.5% of all the reasons, while the most common reason for practicing exercise was to improve body shape, accounting for 48% of all the reasons.ConclusionsOur research found that there was a significant decrease in doing regular exercise during one’s college years in comparison to the school years prior to college. To address the decrease in physical exercise, we recommend organizing and promoting more awareness campaigns and providing suitable sports facilities and infrastructure.
Loading capacity of dynamic knee spacers: a comparison between hand-moulded and COPAL spacers
Authors: Chong Sook-Yee , Shen Lu , Frantz Sandra 
Published: December 2019

AbstractBackgroundThe two-stage revision protocol represents the current gold standard for treating infected total knee replacement implants. Allowing early mobility with weight-bearing between staged procedures will enable early restoration to knee function. So, the mechanical performance of knee spacers is a key issue. Commercially available moulds are often used as they are easy to prepare and produce smoother surfaces of the articulating parts. However, they are costly, and only for single use. A cost-effective alternative is the surgeon-made hand-moulded spacers. In this study, we wanted to determine how the hand-moulded spacers will compare biomechanically with the commercially available COPAL spacers.MethodsSeven cadaveric knees were implanted with knee spacers fabricated using COPAL knee moulds. The same surgeon implanted eight cadaveric knees with hand-moulded spacers. In the first test protocol, an axial load was applied at 200 mm/min till failure. In the second test protocol, the knees were cyclically loaded in five steps of 1000 cycles each from 30-400 N, 30-600 N, 30-800 N, 30-1000 N, 30-1200 N at 1.5 Hz.ResultsCOPAL knee spacers demonstrated a maximum load and mean stiffness of 5202 (± 486.9) N and 1098 (± 201.5) N/mm respectively. The hand-moulded knee spacers demonstrated a mean stiffness of 4509 (± 1092.6) N and 1008.7 (± 275.4) N/mm respectively. The maximum axial displacement was 1.19 ± 0.57 mm and 0.89 ± 0.30 mm for specimens implanted with COPAL knee spacers and hand-moulded spacers respectively. The differences between COPAL and hand-moulded knee spacers were not statistically different.ConclusionsOur study demonstrated that dynamic knee spacers may be able to withstand more than the touch-down load permitted in previous studies, and this may allow more weight-bearing during ambulation. Previous studies have demonstrated that hand-moulded knee spacers have similar advantages to commercially available dynamic spacers with respect to mobility, pain, bone loss, and reinfection rate. Given that ambulation with weight-bearing up to 1200 N is permitted during rehabilitation, it may be more cost-effective to fabricate hand-moulded spacers in revision total knee arthroplasty.
A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review
Authors: Walter Jennifer K. , Hill Douglas L. , DiDomenico Concetta , Parikh Shefali , Feudtner Chris 
Published: December 2019

AbstractBackgroundDespite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents.DiscussionBuilding on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral.Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition “clinician regoaling”. Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians’ willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility.ConclusionsRecognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.
Predictive factors of success at the French National Ranking Examination (NRE): a retrospective study of the student performance from a French medical school
Authors: Lhuaire Martin , Dramé Moustapha , Hivelin Mikael , Levasseur Thomas , Maestraggi Quentin , Hunsinger Vincent , Abrahams Peter , Lantieri Laurent , Sommacale Daniele 
Published: December 2019

Abstract
Background
The national ranking examination (NRE) marks the end of the second cycle (6th university year) of French medical studies and ranks students allowing them to choose their specialty and city of residency. We studied the potential predictive factors of success at the 2015 NRE by students attending a French School of Medicine.

Methods
From March 2016 to March 2017, a retrospective study of factors associated with the 2015 NRE success was conducted and enrolled 242 students who attended their sixth year at the school of medicine of Reims. Demographic and academic data collected by a home-made survey was studied using univariate and then multivariate analysis by generalized linear regression with a threshold of p <  0.05 deemed significant.

Results
The factors independently associated with a better ranking at the NRE were the motivation for the preparation of the NRE (gain of 3327 ± 527 places, p <  0.0001); to have participated in the NRE white test organized by la Revue du Praticien in November 2014 (gain of 869 ± 426 places, p <  0.04), to have participated in the NRE white test organized by la conférence Hippocrate in March 2015 (+ 613 places ±297, p <  0.04). The factors independently associated with poor NRE ranking were repeating the first year (loss of 1410 places ±286, p <  0.0001), repeating a year during university course (loss of 1092 places ±385, p <  0.005), attendance of hospital internships in 6th year (loss of 706 places ±298, p <  0.02).

Conclusions
The student motivation and their white tests completion were significantly associated with success at the NRE. Conversely, repeating a university year during their course and attendance of 6th year hospital internships were associated with a lower ranking.
Does a Mobile app improve patients’ knowledge of stroke risk factors and health-related quality of life in patients with stroke? A randomized controlled trial
Authors: Kang Yi-No , Shen Hsiu-Nien , Lin Chia-Yun , Elwyn Glyn , Huang Szu-Chi , Wu Tsung-Fu , Hou Wen-Hsuan 
Published: December 2019

Abstract
Background
Developing a stroke health-education mobile app (SHEMA) and examining its effectiveness on improvement of knowledge of stroke risk factors and health-related quality of life (HRQOL) in patients with stroke.

Methods
We recruited 76 stroke patients and randomly assigned them to either the SHEMA intervention (n = 38) or usual care where a stroke health-education booklet was provided (n = 38). Knowledge of stroke risk factors and HRQOL were assessed using the stroke-knowledge questionnaire and European Quality of Life–Five Dimensions (EQ-5D) questionnaire, respectively.

Results
Sixty-three patients completed a post-test survey (the SHEMA intervention, n = 30; traditional stroke health-education, n = 33). Our trial found that patients’ mean knowledge score of stroke risk factors was improved after the SHEMA intervention (Mean difference = 2.83; t = 3.44; p = .002), and patients’ knowledge was also improved in the after traditional stroke health-education (Mean difference = 2.79; t = 3.68; p = .001). However, patients after the SHEMA intervention did not have significantly higher changes of the stroke knowledge or HRQOL than those after traditional stroke health-education.

Conclusions
Both the SHEMA intervention and traditional stroke health-education can improve patients’ knowledge of stroke risk factors, but the SHEMA was not superior to traditional stroke health-education.

Trial registration
NCT02591511 Verification Date 2015-10-01.
Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation
Authors: Aggarwal V. R. , Pavitt S. , Wu J. , Nattress B. , Franklin P. , Owen J. , Wood D. , Vinall-Collier K. 
Published: December 2019

Abstract
Background
Data from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services.

Methods
A mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities.

Results
Time-trends for amalgam placement showed that there was a significant (p < 0.05) reduction in amalgam use compared with composites and glass ionomers. However dental amalgam still represented a large proportion (42%) of the restorations (circa 1.8 million) placed in the 2016–2017 financial year.
Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations.

Conclusion
Amalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.
Prevalence and genotyping of Toxoplasma gondii in stray cats in Mashhad area, Iran
Authors: Khodaverdi Majid , Razmi Gholamreza 
Published: December 2019

Abstract
Background
Cats as a definitive host have an important role in the epidemiology of toxoplasmosis in humans and animals. The aim of the study was to determine the frequency of Toxoplasma gondii infection and isolate and identify the genotypes of T. gondii in stray cats in the Mashhad suburb.

Methods
From April 2016 to August 2017, 175 fecal samples from stray cats and 31 brain samples from cats killed in driving accidents were collected. The fecal samples were examined by fecal flotation technique and T. gondii-specific PCR. The brain samples were investigated by T. gondii-specific PCR and consequently examined by mice bioassay. The DNA of T. gondii isolated was genotyped using SAG1, SAG2, SAG3, BTUB and GRA6 as PCR-restriction fragment length polymorphism (PCR-RFLP) markers.

Results
In the present study, Toxoplasma-like oocysts were microscopically observed in 2.2% (4/175) fecal samples. The presence of Toxoplasma oocysts was confirmed in one microscopy-positive sample by PCR. In addition, T. gondii DNA was detected in 4% (7/175) microscopy-negative samples using PCR. T. gondii was isolated from one brain PCR-positive sample by mice bioassay. The isolate was avirulent and many T. gondii cysts were observed in mice brain. The isolate was successfully genotyped by PCR-RLFP analysis. The isolated genotyped was type II. Besides, eight Toxoplasma-positive fecal samples contained insufficient DNA and only amplified at SAG-3 locus in PCR. These samples were also showed type II pattern at this locus.

Conclusions
Parasitological and molecular results showed low frequency of Toxoplasma infection in the stray cats, and identified the genotype of T. gondii isolate as type II, for the first time in Mashhad area, Khorasan Razavi Province.
Antimicrobial resistance in fecal Escherichia coli and Salmonella enterica isolates: a two-year prospective study of small poultry flocks in Ontario, Canada
Authors: Varga Csaba , Guerin Michele T. , Brash Marina L. , Slavic Durda , Boerlin Patrick , Susta Leonardo 
Published: December 2019

Abstract
Background
Although keeping small poultry flocks is increasingly popular in Ontario, information on the antimicrobial susceptibility of enteric bacteria of such flocks is lacking. The current study was conducted on small poultry flocks in Ontario between October 2015 and September 2017, and samples were submitted on a voluntary basis to Ontario’s Animal Health Laboratory. From each submission, a pooled cecal sample was obtained from all the birds of the same species from the same flock and tested for the presence of two common enteric pathogens, E. coli and Salmonella. Three different isolates from each E. coli-positive sample and one isolate from each Salmonella-positive sample were selected and tested for susceptibility to 14 antimicrobials using a broth microdilution technique.

Results
A total of 433 fecal E. coli isolates (358 chicken, 27 turkey, 24 duck, and 24 game bird) and 5 Salmonella isolates (3 chicken, 1 turkey, and 1 duck) were recovered. One hundred and sixty-seven chicken, 5 turkey, 14 duck, and 15 game bird E. coli isolates were pan-susceptible. For E. coli, a moderate to high proportion of isolates were resistant to tetracycline (43% chicken, 81% turkey, 42% duck, and 38% game bird isolates), streptomycin (29% chicken, 37% turkey, and 33% game bird isolates), sulfonamides (17% chicken, 37% turkey, and 21% duck isolates), and ampicillin (16% chicken and 41% turkey isolates). Multidrug resistance was found in 37% of turkey, 20% of chicken, 13% of duck, and 8% of game bird E. coli isolates. Salmonella isolates were most frequently resistant to streptomycin, tetracycline, and sulfonamides. Resistance to cephalosporins, carbapenems, macrolides, and quinolones was infrequent in both E. coli and Salmonella isolates. Cluster and correlation analyses identified streptomycin-tetracycline-sulfisoxazole-trimethoprim-sulfamethoxazole as the most common resistance pattern in chicken E. coli isolates. Turkey E. coli isolates compared to all the other poultry species had higher odds of resistance to tetracycline and ampicillin, and a higher multidrug resistance rate.

Conclusions
Escherichia coli isolates were frequently resistant to antimicrobials commonly used to treat poultry bacterial infections, which highlights the necessity of judicious antimicrobial use to limit the emergence of multidrug resistant bacteria.