bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programmes: the Mozambique experience
Authors: Ahoua Laurence , Tiendrebeogo Thierry , Arikawa Shino , Laheurta Maria , Aly Dario , Becquest Renaud , Dabis Francois 
Published: November 2019

Abstract
Background: Failure of retention of HIV-positive pregnant women on ART leads to increased mortality for the mother and her child. This study evaluated different retention measures intended to measure women’s engagement along the continuum of care for PMTCT option B+ services in Mozambique.
Methods: We compared ‘point’ retention (patient’s presence in care at 12-months post-ART initiation or any time thereafter) to the following definitions: alive and in care at 12 months post-ART initiation (Ministry of Health); attendance at a health facility up to 15 months post-ART initiation (World Health Organisation); alive and in treatment at 1, 2, 3, 6, 9, and 12 months post-ART initiation (Inter-Agency Task Team); and alive and in care at 12 months post-ART initiation with ≥75% appointment adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% appointment done on-time during follow-up (i.e. ‘on-time adherence’ retention). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as our reference to estimate sensitivity, specificity, and proportion of misclassified patients.
Results: Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12 months post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘ ≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively).
Conclusion: More stringent definitions indicated lower retention rates for PMTCT programmes. Policy makers and programme managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scaling up, and monitoring of interventions.
Manual therapy as a prophylactic treatment for migraine. Design of a randomized controlled trial.
Authors: Amons Andreas Leonard , Castien Rene Franciscus , Wouden Johannes van der , De Hertogh Willem , Dekker Joost , Horst Henriëtte Eveline van der 
Published: November 2019

Abstract
Background: People with migraine often experience disability with serious consequences for social life and work productivity. The pharmacological prophylactic management of migraine is effective in reducing migraine attacks. However, many people are reluctant to use daily prophylactic medication, leading to a demand for non-pharmacological treatment options. We present the design and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine.
Methods: Eligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises, and mobilization of the cervical and thoracic spine.
The trial will consist of a 12 weeks treatment period and follow-up measurements at 12, 26 and 52 weeks. The primary outcome measure is the number of migraine days per four weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect.
Discussion: The results of the trial will show if a multimodal MT intervention is an effective non-pharmacological treatment option for people with migraine.
Trial registration: 7 February 2019 Dutch Trial Register (NL7504)
Keywords: manual therapy, migraine, manual pressure techniques
Association between perceived environmental pollution and urban and rural residents’ health-A Chinese national study
Authors: Yang Ting 
Published: November 2019

Abstract
Background: China’s economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts’ attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents.
Methods: Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected.
Results: Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents’ good health (B=-0.14, p<0.05; B=-0.23, p<0.001). Perceived garbage pollution had a positive effect on urban residents’ poor health (B=0.33, p<0.01). Perceived water pollution had no significant effect on urban residents’ health. The four types of perceived environmental pollution all had insignificant effects on rural residents’ health.
Conclusions: Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.
Non-polio enteroviruses among healthy children in the Philippines
Authors: Jiao Maria Melissa Ann , Apostol Lea Necitas Necitas , de Quiroz-Castro Maricel , Jee Youngmee , Roque Vito , Mapue Manuel , Navarro Frances Marsha , Tabada Cleo Fe , Tandoc Amado III 
Published: November 2019

Abstract
Background
Enteroviruses are most commonly associated with either mild or asymptomatic infections, however, the presence of silent carriers in the community has been proven to play a crucial role in the spread of diseases such as HFMD that records high incidence in Asia Pacific region. In the Philippines, limited information is available on the etiology and prevalence of enterovirus outside the Acute Flaccid Paralysis (AFP) surveillance.
Methods
Duplicate stool sampleswere collected from 360 healthy children. Virus isolation and polymerase chain reaction were performed to identify enteroviruses present in the samples. To determine if the results of the study are comparable to the AFP surveillance data, the results of the study were compared to the prevalence and isolation rate among AFP cases of the similar cases collected the same year.
Results
Prevalence of enteroviruses among healthy children was found to be at 24.7%. Comparing the NPEV rates from the study and AFP surveillance of similar age and the same year of collection, there was no significant difference in NPEV case prevalence.The study identified a total of 19 different enterovirus serotypes with majority belonging to species Enterovirus B (EV-B).

Conclusion
The study was able to establish a baseline NPEV case prevalence of 24.7% among healthy children aged under 6 years old in three major urban sites in the Philippines. The high isolation of NPEV among healthy children signifies continuous fecal-oral transmission of enteroviruses in the community. Surveillance of other diseases caused by EVs, such as HFMD and meningitis is necessary in order to complete the picture of EV circulation in the Philippines.
Assessment Of The Reproducibility And Precision For Milling And 3d Printing Surgical Guides
Authors: Mukai Sueli , Mukai Eduardo , DDS Jamil Awad Shibli , GIRO GABRIELA 
Published: November 2019

Abstract
Objective: The aim of the present study was to evaluate the reproducibility and precision of two types of surgical guides, obtained by using 3D printing and milling methods.
Methods: A virtual model was developed, which allowed the virtual design of surgical guide project that were milled (n = 10) or 3D printing (n = 10). Surgical guides were digitally oriented and overlapped on the virtual model that had generated them. For milling guides, it was used the Sirona Dentsply system, while 3D printing guides were produced at the Perfactory P4K Life Series, the EnvisionTEC's E-Guide Tint. In this way, average mismatches from the master model were determined. Moreover, coefficients of variation, root mean square deviations, and mismatches during an overlap were evaluated after obtaining individual misalignments for each guide, in order to verify the reproducibility of the guides and the precision of the methods for obtaining the guides
Results: The evaluations showed that both groups presented the same degree of mismatch during overlap, with no statistically significant differences between the groups. However, the intragroup evaluation for misalignment, 3D printing surgical guides had a higher coefficient of variation than the milled guides, since a statistically significant difference was observed between groups in the RMS of the guide from the master model.
Conclusions: Milling of the guides resulted in smaller misalignments from the master model.
With a grain of salt? Supervisor credibility and other factors influencing trainee decisions to seek in-consultation assistance: a focus group study of Australian general practice trainees.
Authors: Sturman Nancy Jennifer , Jorm Christine , Parker Malcolm 
Published: November 2019

Abstract
Background
‘Ad hoc’ help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses).
Methods
Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes.
Results
Early in their general practice placements trainees needed information about practice facilities, and the “complex maze” of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as “having a chat” or “getting a second opinion” so as not to “miss anything” when trainees were “not 100% sure”. Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor’s advice on occasions.
Conclusion
A trainee’s subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee ‘face’ in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
Cost of inappropriate antimicrobial use for upper respiratory infection in Japan
Authors: Tsuzuki Shinya , Kimura Yuki , Ishikane Masahiro , Kusama Yoshiki , Ohamagari Norio 
Published: November 2019

Abstract

Background: Antibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan.
Methods: We conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from JMDC Claims Database, which contains data from 5·1 million corporate employees and family members aged <65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data
Results: The total annual cost of antibiotic prescription for URI was estimated at 423·6 (95% CI: 416·8–430·5) million USD in 2013, 340·9 (95% CI: 335·7–346·2) million USD in 2014, 349·9 (95% CI: 344·5–355·3) million USD in 2015, and 297·1 (95% CI: 292·4–301·9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for >90% of the total annual cost.
Conclusions: Although a decreasing trend was observed, annual costs of antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.
Clinical value of histologic dating of the endometrium for personalized frozen-thawed embryo transfer (pFET) in patients with repeated implantation failure (RIF) in natural cycles
Authors: Li Yuan , Li Xiaofeng , liao Jingnan , Fan Xiangxiu , Hu Yongbin , Gan Runxin , Lu Guangxiu , Lin Ge , Gong Fei 
Published: November 2019

Abstract
Background: Displacement of the window of implantation (WOI) has been proposed as an important factor contributing to RIF. However, histologic dating of the endometrium as a diagnostic tool of endometrial receptivity has been questioned.
Methods: This is a prospective intervention trial that entailed 205 infertile patients from July 2017 to December 2017. Endometrial biopsies from 50 good-prognosis patients were conducted on day 3 (n=6), 5 (n=6), 7 (n=26), 9 (n=6) or 11 (n=6) post-ovulation (PO+3/5/7/9/11) of the previous natural cycle before their conventional frozen-thawed embryo transfer (FET) cycle. We conducted endometrial biopsies of 155 RIF patients on day PO +7.
Results: The verification of the Noyes criteria for endometrial dating was conducted at different times (PO +3/+5/+7/+9/+11) on 41 good-prognosis patients who achieved an ongoing pregnancy in their first conventional FET cycle after endometrial biopsy. The agreement between two pathologists for endometrial biopsy dating in infertile patients was determined to be acceptable (weighted kappa = 0.672, P < 0.001). The rate of out-of-phase dating on day PO+7 was significantly higher in RIF patients than good- prognosis patients (31.6% vs . 3.8%, P=0.003). pFET was performed in 47 RIF patients diagnosed to be out of phase, and the cumulative live-birth rate was 55.7%.
Conclusions: Histologic endometrial dating of RIF patients in natural cycles may be a biomarker for a receptive endometrium in diagnosing the displacement of WOI.
Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan
Authors: Moin Safia , Farooqi Joveria , Jabeen Kauser , Laiq Sidra , Zafar Afia 
Published: November 2019

Abstract
Background: Burden of aspergillosis is reported to be significant from developing countries including those in South Asia. The estimated burden in Pakistan is also high on the background of tuberculosis and chronic lung diseases. There is concern for management of aspergillosis with the emergence of azole resistant Aspergillus species in neighbouring countries in Central and South Asia. Hence the aim of this study was to screen significant Aspergillus species isolates at the Microbiology Section of Aga Khan Clinical Laboratories, Pakistan, for triazole resistance. Methods: A descriptive cross-sectional study, conducted at the Aga Khan University Laboratories, Karachi, from September 2016-May 2019. One hundred and fourteen, clinically significant Aspergillus isolates [A. fumigatus (38; 33.3%), A. flavus (64; 56.1%), A. niger (9; 7.9%) A. terreus (3; 2.6%)] were included. The clinical spectrum ranged from invasive aspergillosis (IA) (n=25; 21.9%), chronic pulmonary aspergillosis (CPA) (n=58; 50.9%), allergic bronchopulmonary aspergillosis (ABPA) (n=4; 3.5%), severe asthma with fungal sensitization (SAFS) (n=4; 3.5%), saprophytic tracheobronchial aspergillosis (n=23; 20.2%). Screening for triazole resistance was performed by antifungal agar screening method. The minimum inhibitory concentration (MIC) of 41 representative isolates were tested and interpreted according to the Clinical and Laboratory Standards Institute broth microdilution method. Results: All the isolates were triazole-susceptible on agar screening. MICs of three azole antifungals for 41 tested isolates were found to be ≤1 ml/L; all isolates tested were categorized as triazole-susceptible, including 4 isolates from patients previously on triazole therapy for more than two weeks. The minimum inhibitory concentration required to inhibit the growth of 90% organisms (MIC90) of itraconazole, voriconazole and posaconazole of the representative Aspergillus isolates was 1 mg/L, 1 mg/L and 0.5 mg/L, respectively. Conclusion: Triazole resistance could not be detected amongst clinical Aspergillus isolates from the South of Pakistan. However, environmental strains remain to be tested for a holistic assessment of the situation. This study will set precedence for future periodic antifungal resistance surveillance in our region on Aspergillus isolates. Keywords: Aspergillosis, Aspergullus flavus, Aspergullus fumigatus, Aspergullus niger, Aspergullus terreus, itraconazole, voriconazole and posaconazole.
Evaluation of the Effect of Items’ Format and Type on Psychometric Properties of Sixth Year Pharmacy Students Clinical Clerkship Assessment Tools
Authors: Muhaissen Suha Al , AlKhatib Hatim S. , Brazeau Gayle , Akour Amal 
Published: November 2019

AbstractBackground Examination is the traditional assessment tool, and are used to guide the improvement of academic programs. Accreditation committees’ emphasis on the implementation of standardized examinations. The aims of the current study are to evaluate the quality of assessment tools of sixth year PharmD students as a function of assessment item format and type/structure and to assess the effect of the number of response choices on the characteristics of MCQs as assessment items. Methods. A total of 173 assessment items used in the examinations of sixth year rotations of PharmD program were included. Items were classified as case based or non-case based and as MCQs or open-ended. The psychometric characteristics of examinations were studied as a function of the level of the Bloom’s levels addressed by an item, item format, and number of choices in MCQs. Results. Items addressing intellectual and analysis skills were more difficult, while items associated with multiple cognitive levels were more discriminative. No differences were found between case based and noncase based items in terms of their difficulty, with a slightly better discrimination in the letter. Open-ended items were easier, yet more discriminative. MCQs with higher number of options were easier and more discriminative. Open-ended questions were significantly easier and more discriminative in comparison to MCQs as case based items while they were more difficult and more discriminative as non-case based items. Conclusion. Item formats, structure, and number of options in MCQs, affected students’ performance and overall examination quality. The discrimination of items associated with multiple Bloom’s levels was significantly higher than those associated with a single level. Noncase based items and open-ended items were easier and more discriminative than case based items and MCQs, respectively.