bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model
Authors: Dewau Reta , Mekonnen Fantahun Ayenew , Seretew Wullo Sisay 
Published: December 2020

Abstract
Background: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival. Methods: A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey (EDHS), 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier (KM) method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value<0.05. Results: The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR=2.33,95% CI:2.08-2.63),secondary education level (AHR=0.84,95% CI:0.78-0.96), higher education level (AHR=0.75, 95% CI:0.65-0.85), intercourse before 15 years in the married stratum (AHR=23.81, 95% CI:22.22-25.64), intercourse 15-17 years in married stratum (AHR=5.56, 95% CI:5.26-5.88),spousal age difference (AHR=1.11, 95% CI:1.05-1.16),and use of contraceptives (AHR=0.91, 95% CI: 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR=1.16, 95% CI: 1.13-1.20) than low risk clusters adjusting for other factors.Conclusion:In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.
A preoperative mortality risk assessment model for Stanford type A acute aortic dissection
Authors: Kuang Juntao , Yang Jue , Wang Qiuji , Yu Changjiang , Li Ying , Fan Ruixin 
Published: December 2020

Abstract
BACKGROUNDAcute aortic dissection type A is a life-threatening disease required emergency surgery during acute phase. Different clinical manifestations, laboratory tests, and imaging features of patients with acute aortic dissection type A are the risk factors of preoperative mortality. This study aims to establish a simple and effective preoperative mortality risk assessment model for patients with acute aortic dissection type A.METHODSA total of 673 Chinese patients with acute aortic dissection type A who were admitted to our hospital were retrospectively included. All patients were unable to receive surgically treatment within 3 days from the onset of disease. The patients included were divided into the survivor and deceased groups, and the endpoint event was preoperative death. Multivariable analysis was used to investigate predictors of preoperative mortality and to develop a prediction model.RESULTSAmong the 673 patients, 527 patients survived (78.31%) and 146 patients died (21.69%). The developmental dataset had 505 patients, calibration by Hosmer Lemeshow was significant (χ2 = 3.260, df = 8, P = 0.917) and discrimination by area under ROC curve was 0.8448 (95% CI, 0.8007-0.8888). The validation dataset had 168 patients, calibration was significant (χ2 = 5.500, df = 8, P = 0.703) and the area under the ROC curve was 0.8086 (95% CI, 0.7291-0.8881). The following independent variables increased preoperative mortality: age (OR = 1.008, P = 0.510), abrupt chest pain (OR = 3.534, P < 0.001), lactic in arterial blood gas ≥ 3 mmol/L (OR = 3.636, P < 0.001), inotropic support (OR = 8.615, P < 0.001), electrocardiographic myocardial ischemia (OR = 3.300, P = 0.001), innominate artery involvement (OR = 1.625, P = 0.104), right common carotid artery involvement (OR = 3.487, P = 0.001), superior mesenteric artery involvement (OR = 2.651, P = 0.001), false lumen / true lumen of ascending aorta ≥ 0.75 (OR = 2.221, P = 0.007) . Our data suggest that a simple and effective preoperative death risk assessment model has been established.CONCLUSIONSUsing a simple and effective risk assessment model can help clinicians quickly identify high-risk patients and make appropriate medical decisions.
External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study
Authors: Sun DongDong , Lv Dan , Zhou Kun , Chen Jian , Gao Li-Lan , Sun Ming-Lin 
Published: December 2020

Abstract
Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n=35), plate-screw (group B, n=30) and Kirschner wire(group C, n=26).The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C(114.92±36.09min) was shorter than that of group A (142.27±47.05min) and group B(184.00±48.56min) (P<0.05). There was no difference in intraoperative blood loss among the three groups (P>0.05). The surgical and implants costs in group C (5.24±1.21, thousand dollars) is lower than that in group A (6.48±1.11, thousand dollars) and group B (9.37±2.16, thousand dollars) (P < 0.05).The fracture healing time of group C(5.67±1.42months) was significantly less than that of group A (6.90±1.33months) and group B(6.70±1.12months) (P<0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P<0.05). The wound infection and needle-tract infection did not differ among the three groups (P>0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P>0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.Fund program: National Natural Science Foundation of China (11572222)
Exploring the Effect of Problem Based Facilitatory Teaching Approach on Motivation to Learn: A Quasi-Experimental Study of Nursing Students in Tanzania
Authors: Millanzi Walter Cleophace , Kibusi Stephen M. 
Published: December 2020

Abstract
Background: Academic motivation is most important as a key determinant of competent and motivated nurses who are often considered as frontline healthcare providers who devote most of their time taking care of clients and patients. However, most of them demonstrate remarkable differences in their academic performances during their schooling that might be due to the differences in their academic motivation and achievement motivation. There appears a growing concern to rethink the approaches on how nurses are prepared, explore, and test novel approaches for delivering the nursing curricula. This study tested the effect of Problem Based Facilitatory Teaching pedagogy on academic motivation among nursing students in Tanzania, higher learning institutions.Methods: A pre-post-test controlled quasi-experimental study of 401 purposively selected participants was conducted between February and June 2018. The study was not a clinical randomized controlled trial and thus it has not been identified in the title and no summary of trial design, its methods, results, and conclusion. The Auditing Inventory developed by the researcher measured the intervention and a Questionnaire titled “Academic Motivation Scale,” was adopted to measure academic motivation. Statistical Product for Service Solutions software program version 23 was used to perform descriptive analysis to establish participants’ sociodemographic profiles. Regression analysis was performed to determine the association between variables.Results: Findings revealed that 65.8% of participants were males. Post-test findings showed 70.3% of participants demonstrated the motive to learn contrary to 34.9% at baseline. The odds of an intervention to influence academic motivation among participants was higher than the control (AOR = 1.720; p<0.05; 95%CI: 1.122, 2.635). However, the intervention demonstrated little influence on the extrinsic motivation to learn (AOR = 0.676, p>0.05, 95%CI: 0.405, 1.129) and Amotivation to learn (AOR = 0.538, p>0.05; 95%CI: 0.283, 1.022) compared to the control.Conclusion: The Problem Based Facilitatory Teaching pedagogy was a predictive factor to intrinsic academic motivation among nursing students. The approach demonstrated educational potentials to change the spectrum of nursing competency and quality of care to patients or clients. This study suggests problem-based facilitatory teaching pedagogy be integrated into the nursing curriculum in Tanzania as it is feasible.
Gender differences in self-harm and drinking behaviors among high school students in Beijing, China
Authors: LI Chai-Quan , ZHANG Jing-Shu , MA Shang , Ruo-Ran LV , DUAN Jia-Li , LUO Dong-Mei , YAN Xiao-Jin , MA Ning , SONG Yi 
Published: December 2020

Abstract
BackgroundSelf-harm and drinking are both serious problems in adolescents and many studies presented evidence of their association. However, gender differences in this association are seldom deeply discussed. Our study aimed to evaluate the prevalence of self-harm and explore its association with drinking behaviors by gender and investigate the extent to which the gender differences exist in the association between self-harm and drinking.MethodsA total of 32,362 students in grades 7 to 12 in Beijing, China were anonymously surveyed and included in our study using two-stage, stratified probability proportion sampling. Self-harm, drinking behaviors and other basic information were obtained from an anonymous questionnaire. Demographic variables, self-harm and drinking behaviors were analyzed using the Chi-square test and the Gamma test between genders and the gender differences in this association were analyzed by log-binomial regression. ResultsThe total prevalence of self-harm was 13.7% with no significant gender difference (B=0.352, P=0.553). The prevalence of self-harm in girls decreased with age (G=-0.163, P<0.001). Self-harm was associated with drinking behaviors in both boys and girls. The Log-binomial regression demonstrated that girls in the 16-19 years old category were at lower risk of self-harm than girls in the 12-15 years old group while this association was weaker in boys (1.493 vs 1.128). The higher OR for self-harm was found among girls with early drinking experiences compared with boys (2.565 vs 1.863). Girls who had previously drunk (i.e. drunk at least once) (2.211 vs 1.636), were currently drinking (3.400 vs 2.122) and performed binge drinking (6.357 vs 3.924) were at greater risk of self-harm than boys. ConclusionAmong high school students, self-harm has a significant positive association with drinking and girls with drinking behaviors are at higher risk of suffering self-harm. Identifying adolescents’ drinking behaviors is of vital importance to self-harm prevention and special attention should be focused on younger girls.
A Canadian-wide Perspective on the Essential Conditions for Taking a Comprehensive School Health Approach
Authors: Neely Kacey C , Montemurro Genevieve R. , Storey Kate E. 
Published: December 2020

Abstract
Background: The primary purpose of this research was to explore Comprehensive School Health (CSH) stakeholders’ perceptions of the essential conditions for taking a CSH approach in other contexts across Canada. The secondary purpose was to examine the need for and development of an evaluative tool or resource to assess the implementation of the essential conditions.Methods: Data were generated through individual semi-structured interviews (n = 38) and small group interviews (n = 3) with 45 participants across Canada involved in implementing policies or programs which take a CSH approach. Interviews were subjected to content analysis. Results: There was positive support for the essential conditions and results indicated the essential conditions are relevant across Canada. Findings revealed the necessity for a new essential condition that reflected support and leadership from the school district and/or provincial/territorial governing bodies. Modifications to the description of each of the essential conditions were also suggested to provide clarity. Results also indicated that an evaluative tool that was concise, meaningful, and provided immediate feedback would be useful to school communities to establish readiness, assess, and improve ongoing implementation of CSH approaches. Conclusions: This research contributes to the evidence-base of CSH by providing school communities across Canada with a set of refined and understandable essential conditions that support successful implementation. Further, the development of an evaluation tool will support school health champions, researchers, and policymakers in the optimization and implementation of policies or programs which take a CSH approach, ultimately supporting healthier school communities across the country.
Pattern of Crimean-Congo hemorrhagic fever related high risk behaviors among Iranian butchers and its relation to perceived self-efficacy
Authors: Adham Davoud , Abazari Malek , Moradi-Asl Eslam , Abbasi-Ghahramanloo Abbas 
Published: December 2020

Abstract
Background: Crimean-Congo hemorrhagic fever (CCHF) is highly fatal to humans and an acute viral disease. The CCHF disease has been reported in occupations such as butchers, slaughterhouse butchers and workers. The aim of this study was to investigate the pattern of CCHF related high risk behaviors among butchers and determine the effects of perceived self-efficacy of the participants on their membership in latent classes. Methods: The participants of this cross-sectional study were recruited from all the meat distribution centers in Ardabil Province in 2019-2020. The LCA approach was used to observe the CCFH related high risk behaviors patterns.Results: The statistical significance level was assigned at P-value ˂ 0.05 in all the analyses. Three latent classes were identified; namely, 1) low risk (16.1%), 2) high risk (53.6%), and 3) very high risk (30.2%). After adjusting for other possible confounders higher score of perceived self-efficacy significantly decrease the odds of membership in high risk class (OR=0.74) and very high risk class (OR=0.62) compared to the low risk class. Also, age (OR=1.07) and experience (OR=0.91) associate with very high risk class.Conclusions: This study revealed the co-occurrence of CCHF related high risk behaviors in the majority of workers in the livestock and meat industry. It is necessary to provide butchers and slaughterhouse workers with general education, force them to use protective equipment and investigate the rate of tick bites in risky occupations.
The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study
Authors: Zhuo Deyi , Chen Si , Ren Xiaofang , Wang Bingsong , Liu Linbo , Xiao Lin 
Published: December 2020

Abstract
Background: To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors.Methods: In this population-based, cross-sectional study, a total of 3,170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis.Results: The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6%, 28.0%, 15.0%, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20-1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95% CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). Conclusions: There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.
Knowledge of PEP and PrEP among people living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil
Authors: Sousa Laelson Rochelle Milanês , Elias Henrique Ciabotti , Fernandes Nilo Martinez , Gir Elucir , Reis Renata Karina 
Published: December 2020

Abstract
Background: Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV.We aimed to determine the factors associated with PrEP and PEP's knowledge as secondary prevention among people living with HIV/AIDS.Method: Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP.Results: Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13-0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09-0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09- 0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59-5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0-2.8) were more likely to know about the PEP.Conclusions: The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.
FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: A prospective study with comparison to FDG-PET
Authors: Martineau Patrick , Pelletier-Galarneau Matthieu , Juneau Daniel , Leung Eugene , Nery Pablo , deKemp Rob , Beanlands Rob , Birnie David 
Published: December 2020

Abstract
BACKGROUND:2-deoxy-2-[18F]fluoro-D-glucose’s (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3’-deoxy-3’-[18F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.MATERIALS AND METHODS:14 subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed. RESULTS:12 subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p<0.001) higher for FDG than FLT (5.8 ± 3.0 vs 2.3 ± 1.1, respectively), but not (p=0.90) after adjusting for blood pool activity (2.8 ± 1.4 vs 2.8 ± 1.1, respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG.CONCLUSIONS:FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.