bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and Facilitators to Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study
Authors: Yitbarek Kiddus , Birhanu Zewdie , Terefe Gudina , Anand Susan , Agenagnew Liyew , Ahmed Gutema , Getnet Masrie , Tesfaye Yonas 
Published: July 2020

Abstract
Background: Mental health problem is the major health problem globally and nationally in Ethiopia. To address this problem the Ministry of health of Ethiopia integrated mental health services in to the community health service. However, the preliminary reports showed the service has not been implemented yet. Therefore, the aim of this study was to explore the barriers and facilitators of mental health service implementation in to the Ethiopian health extension program.Methods: A qualitative case study was conducted in the Ethiopian primary health care system from 12 August to 25 September 2019. We have conducted about ten purposively selected key informant interviews from the Ministry of Health and community level workers (i.e. health extension workers). All interviews were recorded using voice recorder and transcribed verbatim and translated for analysis. The data then analyzed manually in relevant themes. Results: Mental health problem currently is a major health issue in Ethiopia. However, the service is not ready to respond for the existing health service need. The recently designed integration of mental health services in to health extension program was not implemented so far. The basic identified barriers were, low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, the lack of reporting system for mental health problems. On the contrary, there are also facilitators for the service like well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community.Conclusion: Although mental health problems are widely spread and increasing in alarming rate, in Ethiopia, the existing health system is not capable enough to respond. This problem is complex and intertwined. A series of activities to solve the major barriers are expected especially from the health system leaders to implement follow up and evaluate mental health services at the health extension programs.
COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran
Authors: Sabetian Golnar , Moghadami Mohsen , Haghighi Leila Hashemizadeh Fard , Fallahi Mohammad Javad , Shahriarirad Reza , Asmarian Naeimehossadat , Moeini Yalda Sadat 
Published: July 2020

Abstract
Objective: With the novel coronavirus pandemic, the impact on the healthcare system and workers cannot be overlooked. However, studies on the infection status of medical personnel are still lacking. It is imperative to ensure the safety of health-care workers (HCWs) not only to safeguard continuous patient care but also to ensure they do not transmit the virus, therefore evaluation infection rates in these groups are indicated.Methods: Demographic and clinical data regarding infected cases among HCWs of Fars, Iran with positive SARS‐CoV‐2 PCR tests were obtained from 10th March to 16th May.Results: Our data demonstrated a rate of 5.62% (273 out of 4854 cases) infection among HCW, with a mean age of 35 years and a dominance of female cases (146 cases: 53.5%). The majority of infected cases were among nurses (51.3%) while the most case infection rate (CIR) was among physicians (27 out of 842 performed test (3.2%)). Also, the highest rate of infection was in the emergency rooms (30.6%). Also, 35.5% of the patients were asymptomatic and the most frequent clinical features among symptomatic patients were myalgia (46%) and cough (45.5%). Although 5.5% were admitted to hospitals, there were no reports of ICU admission. Furthermore, 10.3% of the cases reported transmitting the infection to family and friends. Regarding safety precautions, 1.6% didn't wear masks and 18.7% didn't use gloves in work environments. Conclusion: HCWs are among the highest groups at risk of infection during the COVID-19 pandemic; therefore, analysis of the infection status of these groups is vital to maintain enough attention from the public, provide effective suggestions for government agencies and expanding protective measures is essential to decrease infection rates.
Measuring body condition of lizards: a comparison between non-invasive dual-energy X-ray absorptiometry, chemical fat extraction and calculated indices
Authors: Sion Guy , Watson Maggie J. , Bouskila Amos 
Published: July 2020

Abstract
Background
Condition indices (CIs) are used in ecological studies as a way of measuring an individual animal’s health and fitness. Noninvasive CIs are estimations of a relative score of fat content or rely on a ratio of body mass compared to some measure of size, usually a linear dimension such as tarsus or snout-vent length. CIs are generally measured invasively by lethal fat extraction as in a seasonal sample of individuals in a population. Many alternatives to lethal fat extraction are costly or time consuming. As an alternative, dual-energy X-ray absorptiometry (DXA) allows for non-destructive analysis of body composition and enables multiple measurements during an animal's life time. DXA has never been used for ecological studies in a small, free-ranging lizard before, therefore we calibrated this method against a chemical extraction of fat from a sample of 6 geckos (Israeli fan toed gecko Ptyodactylus guttatus) ranging in body mass between 4.2–11.5 g.
Results
We found that fat mass measured with DXA was significantly correlated with the mass of chemically extracted fat for specimens more than 4.8 g (N = 5, R2 = 0.995, P < 0.001). Fat percentage regressed with body mass significantly predicted the DXA fat percentage (N = 30, R2adj.=0.875, P < 0.001). Live wet mass was significantly correlated with calculated fat mass (N = 30, R2 = 0.984, P < 0.001) for specimens more than 4.8 g. Among the other calculated non-invasive CIs that we tested, the best was mass/SVL (provide N, correlation coeff and p value).
Conclusions
We recommend that in situations where DXA cannot be used, that the most accurate of the body condition estimators for both males and females in this species is mass/SVL (snout-vent length) for both sexes.
Welfare and Productivity Impact of Adoption of Biofortified Cassava by Smallholder Farmers in Nigeria
Authors: KOLAPO ADETOMIWA , Kolapo Adeyera James 
Published: July 2020

Abstract
In the bid to improve the productivity, welfare and vitamin-A intake of SSA farmers, Biofortified cassava was bred. This study examined the welfare and productivity impact of adoption of biofortified cassava using a household-level data from smallholder farmers in Nigeria. We used instrumental variable regression to control for endogeneity. The results obtained from the study showed that adoption of biofortified cassava increased farm yield, farmers income and welfare outcomes of adopters of biofortified cassava. In addition, the distributional impact of the adoption of the biofortified cassava showed heterogeneity effect based on gender and farm size. Overall, the study suggests that since the largest proportion of the cassava farmers in Nigeria are mostly smallholder farmers, distribution and circulation of biofortified cassava stem cuttings should be targeted towards the smallholder farmers so as to improve their productivity, income and welfare and subsequently reduce their poverty status and ensure food security.
Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya
Authors: Dong Rae , Leung Claudia , Naert Mackenzie N. , Naanyu Violet , Kiptoo Peninah , Matelong Winnie , Matini Esther , Orango Vitalis , Bloomfield Gerald S. , Edelman David , Fuster Valentin , Manyara Simon , Menya Diana , Pastakia Sonak D. , Valente Tom , Kamano Jemima , Horowitz Carol R. , Vedanthan Rajesh 
Published: July 2020

Abstract
Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery that has demonstrated beneficial impact in previous pilot studies. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known.Methods: Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes.Results: We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. Participants expressed interest in participating in microfinance and group medical visits, but cited several key challenges: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility.Conclusions: Our qualitative study revealed and illuminated actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also felt that planned interventions could address and mitigate the impact of these dynamic factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.Trial Registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015
Multi-locus sequence analyses reveal a clonal L. borgpetersenii genotype in a heterogeneous invasive Rattus spp. community across the City of Johannesburg, South Africa
Authors: Moseley Mark Hamish , Naidoo Kovashnee , Bastos Armanda , Retief Liezl , Frean John , Telfer Sandra , Rossouw Jennifer 
Published: July 2020

Abstract
Background Rattus spp. are frequently implicated as key reservoir hosts for leptospirosis, one of the most common, but neglected, bacterial zoonoses in the world. Although leptospirosis is predicted to be a significant public health threat in Africa, studies from the continent are limited. Methods Rattus spp. (n=171) were sampled (January-May 2016) across the City of Johannesburg, South Africa’s largest inland metropole. Rattus spp. genetic diversity was evaluated by full length (1140 bp) cyt b sequencing of 42 samples. For comparison, a further 12 R. norvegicus samples collected in Cape Town, South Africa’s largest coastal metropole, were also genotyped. Leptospira infections were identified and genotyped using real-time PCR and multi-locus (lfb1, secY, lipL41) DNA sequencing. Results Five R. norvegicus haplotypes were identified across Johannesburg, four of which have not previously been detected in South Africa, and one in Cape Town. Across Johannesburg we identified a Leptospira spp. infection prevalence of 44% (75/171) and noted significant differences in the prevalence between administrative regions within the metropole. Multi-locus sequence analyses identified a clonal genotype consistent with L. borgpetersenii serogroup Javanica (serovar Ceylonica).Discussion The prevalence of infection identified in this study is amongst the highest detected in Rattus spp. in similar contexts across Africa. Despite the complex invasion history suggested by the heterogeneity in R. norvegicus haplotypes identified in Johannesburg, a single L. borgpetersenii genotype was identified in all infected rodents. The lack of L. interrogans in a rodent community dominated by R. norvegicus is notable given the widely recognised host-pathogen association between these species and evidence for L. interrogans infection in R. norvegicus in Cape Town. It is likely that environmental conditions (cold, dry winters) in Johannesburg may limit the transmission of L. interrogans. Spatial heterogeneity in prevalence suggest that local factors, such as land use, influence disease risk in the metropole. Conclusion In South Africa, as in other African countries, leptospirosis is likely underdiagnosed. The high prevalence of infection in urban rodents in Johannesburg suggest that further work is urgently needed to understand the potential public health risk posed by this neglected zoonotic pathogen.
Functional Outcome in Cats with Acute Severe Injuries of the Thoracolumbar Spinal Cord Following Intensive Rehabilitative Physiotherapy
Authors: Gallucci Antonella , Dragone Ludovica , Kafaji Tania Al , Menchetti Marika , Magno Sara Del , Gandini Gualtiero 
Published: July 2020

Abstract
Background: literature is lacking data concerning the prognosis in cat suffering from acute thoracolumbar spinal cord lesions on field condition either with or without physiotherapy treatment. We investigated the role of intensive physical rehabilitation training in cats suffering from acute thoracolumbar (TL) spinal cord injury and compared their outcome to the presence/absence of pelvic limb pain perception (PP) under field conditions. A further aim was the evaluation of the outcome of cats under intensive physiotherapy when compared to a control group.Methods: Retrospective study. The medical records of 29 feline patients with acute TL spinal cord injury, with and without PP, selected for intensive rehabilitation treatment were reviewed. Those cats that satisfied the same criteria, but performed at home physiotherapy exercises with the owner, were enrolled as control group.Results: 7 cats had pelvic limb PP, which resulted significantly associated with functional recovery of voluntary locomotion (p=0.01) and voluntary micturition (p= 0.00006). Twenty-two cats (76%) had the absence of pelvic limb PP and the acquisition of spinal walking (SW) was achieved in ten cats (45%). None of these patients regained a voluntary micturition at the end of the treatment. The presence of the crossed extensor reflex on admission was significantly associated with the acquisition of SW (p= 0.008). At 15 days, improvement in assisted walking/UWTM was found to be significantly associated with higher possibility to achieve SW at the end of the treatment (p=0.04). The control group included seven cats. None of the cats had regained voluntary micturition or ambulatory condition. Comparing to the control group, the intensive rehabilitation program was significantly associated with a higher possibility to regain functional locomotion (p= 0.005). Recovery of voluntary micturition did not show significant differences among the control group and the cats that underwent physical therapy.Conclusions: cats with severe acute TL lesion recovery can benefit from physiotherapy and, also in case of loss of PP, the acquisition of SW is possible under field condition.
The Feeding Practices and Structure Questionnaire: development and validation of age appropriate versions for infants and toddlers
Authors: Jansen Elena , Russell Georgie , Appleton Jessica , Byrne Rebecca , Daniels Lynne , Fowler Catherine , Rossiter Chris , Mallan Kimberley 
Published: July 2020

Abstract
Background: A large range of questionnaires is available to assess parental feeding practices. Most have been developed for and are used with children aged two years and older. To measure and better understand trajectories of feeding and their relationship with child eating behaviours and weight in the long term, assessment from infancy is desirable. While questionnaires also exist to measure feeding practices of parents with infants, no questionnaire is available that allows tracking of feeding practices across time, from infancy through childhood. The aim of the study was to develop a version of the Feeding Practices and Structure Questionnaire (FPSQ) for parents with infants and toddlers.Methods: Constructs and items for the FPSQ for infants and toddlers were derived from the existing and validated FPSQ for older children and supplemented by a review of the literature on infant feeding questionnaires. Following expert review, two versions of the questionnaire were developed, one for milk feeding parents and one for solid feeding parents. Data from two studies were combined (child ages 0-24 months) to test the derived constructs with Confirmatory Factor Analysis for the milk feeding (N=731) and solid feeding (N=611) versions. Results: The milk feeding version consisted of four factors (18 items) and showed acceptable model fit and good internal reliability: ‘feeding on demand vs. feeding routine’ (α= 0.87), ‘using food to calm’ (α= 0.87), ‘persuasive feeding’ (α= 0.71), ‘parent-led feeding’ (α= 0.79). The same four factors showed acceptable model fit for the solid feeding version (21 items), likewise with good internal reliability (α= 0.74, 0.86, 0.85, 0.84 respectively). Two additional factors (13 items) were developed for the solid feeding version that appeared developmentally appropriate only for children aged 12 months or older: ‘family meal environment’ (α= 0.81) and ‘using (non-)food rewards’ (α= 0.92). The majority of factor-factor correlations were in line with those of the original FPSQ.Conclusions: The FPSQ milk and solid feeding versions are the first measures specifically developed as precursors to the FPSQ to measure parental feeding practices in children <2 years, particularly those related to non-responsiveness and structure. Further validation in more diverse samples is required.MeSH terms:Infant, Feeding behaviour, Parents, Body weight
How do patient feedback systems work in low- and middle-income countries? Insights from a realist evaluation in Bangladesh.
Authors: Mirzoev Tolib , Kane Sumit , Azdi Zunayed Al , Ebenso Bassey , Chowdhury Ayesha Afroz , Huque Rumana 
Published: July 2020

Abstract
Background
Well-functioning patient feedback systems can contribute to improved quality of healthcare and ultimately make health systems more accountable. We used realist evaluation to understand the functioning of patient feedback systems at frontline health facilities in Bangladesh.
Methods
We collected and analysed data in two stages using: document review; secondary analysis of data from publicly-available web-portals; in-depth interviews with patients, health workers and managers; non-participant observations of feedback environments; and stakeholder workshops. Stage 1 focused on identifying and articulating the initial program theory of patient feedback systems. In Stage 2, we iteratively tested and refined this initial theory, through analysing data and grounding emerging findings within substantive theories and empirical literature, to arrive at a refined program theory.
Results
Multiple patient feedback systems operate in Bangladesh, essentially comprising stages of collection, analysis and actions on feedback. Key contextual enablers include political commitment to accountability, whereas key constraints include limited patient awareness of feedback channels, lack of guidelines and documented processes, local political dynamics and priorities, institutional hierarchies and accountability relationships. Findings highlight that relational trust may be important for many people to exercise citizenship and providing feedback, and that appropriate policy and regulatory frameworks with clear lines of accountability are critical for ensuring effective patient feedback management within frontline healthcare facilities.
Conclusion
Tolib Information, Mirzoev*, Sumit Kanea, Bassey Ebenso1,b
Evaluation of Platinum-catalyzed Silicones for Fabrication of Biocompatible Patient-specific Elastic Bolus
Authors: Son Jaeman , Jung Seongmoon , Park Jong Min , Wu Hong-Gyun , Kim Jung-in 
Published: July 2020

Abstract
Purpose

We investigated the properties of platinum-catalyzed silicones with suitable characteristics for a biocompatible patient-specific elastic bolus.
Materials & Methods

We applied a platinum-catalyzed silicone (Ecoflex™ 0030) and a platinum cure liquid silicone (Dragon Skin™ 10 MEDIUM) to fabricate a biocompatible bolus using a mold and casting method with a 3D printer. We conducted physical evaluations including the shore hardness, cure time, transparency, and mixed viscosity. The dosimetric characteristics were basically investigated with surface dose and beam quality. For dosimetric evaluations using humanoid phantom, the dose differences between calculated dose and measured dose were compared with those of Dragon skin. To evaluate which boluses fit best, the volume of unwanted air gaps between the bolus and phantom was obtained from CT images. Biological evaluations were conducted on the skin sensitization, skin irritation, and cytotoxicity to ensure safe patient application.
Results

Ecoflex were biologically evaluated as safety materials. In addition, Ecoflex shows excellent physical properties with respect to a low shore hardness (00–30), short curing time (4 h), and low mixed viscosity (3,000). For the dosimetric properties using humanoid phantom, the average dose difference between the calculated dose and measured dose for Ecoflex is about 0.5% better than that of Dragon skin. In addition, a relatively smaller volume of unwanted air gaps for Ecoflex also showed than for Dragon skin, which these results tended to be the same as the dosimetric results.
Conclusion

The physical properties of Ecoflex including excellent adhesive strength, lower shore hardness reduces unwanted air gaps and ensures an accurate dose distribution. Therefore, it is a suitable material for fabricating biocompatible patient-specific elastic bolus. It would be an alternative to other materials of bolus and thus improve the efficiency for clinical use.