bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia
Authors: Yasuoka Junko , Yi Siyan , Okawa Sumiyo , Tuot Sovannary , Murayama Makoto , Huot Chantheany , Chhoun Pheak , Yem Sokunthea , Yuzuriha Kazuki , Mizutani Tetsuya , Kikuchi Kimiyo 
Published: May 2020

Abstract
Background: HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children’s nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration. Methods: This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children’s nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting. Results: Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 hours was 4.6 out of 7 groups. Factors associated with children’s stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past one year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728). Conclusions: Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children’s nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.
Presentation Intervals and the Impact of Delay on Breast Cancer Progression in a Black African Population
Authors: Agodirin Olayide , Olatoke Samuel , Rahman Ganiyu , Olaogun Julius , Olasehinde Olalekan , Katung Aba , Kolawole Oladapo , Ayandipo Omobolaji , Etonyeaku Amarachukwu , Habeeb Olufemi , Adeyeye Ademola , Agboola John , Akande Halimat , Oguntola Adetunji , Akanbi Olusola , Fatudimu Oluwafemi 
Published: May 2020

Abstract
BACKGROUND: The help-seeking interval and primary-care interval are points of delays in breast cancer presentation. To inform future intervention targeting early diagnosis of breast cancer, we described the contribution of each interval to the delay and the impact of delay on tumor progression. METHOD: We conducted a multicentered survey from June 2017 to May 2018 hypothesizing that most patients visited the first healthcare provider within 60 days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression. RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230 (60%, 95% CI 53-63). Most had long primary-care (237 of 377 (64% 95% CI 59-68) and detection-to-specialist (293 (73% (95% CI 68-77)) intervals. The primary care interval (median 106 days, IQR 13-337 ) was longer than the help-seeking interval ( median 42 days, IQR 7-150 ) Wilcoxon signed-rank test p= 0.001. There was a strong correlation between the length of primary care interval and the detection-to-specialist interval (r= 0.9, 95% CI 0.88- 0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor (>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm (95% CI 4.0-5.0). The hazard of progressing from early to locally advanced disease was least in the first 30 days (3%). The hazard was 31% in 90 days. CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.
Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection
Authors: Wang Zhigang , Ge Min , Chen Tao , Chen Cheng , Zong Qiuyan , Lu Lichong , Wang Dongjin 
Published: May 2020

Abstract
Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement therapy (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed postoperative CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Results: Before propensity score matching, univariate analysis showed that there were significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (P <0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr and CPB time were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P <0.001) and long-term overall cumulative survival (P <0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003). Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.
Allowing more time to ILCOR Step A of neonatal resuscitation leads to better residents’ task completion in simulated scenarios. A problem of time pressure?
Authors: Boithias Claire , Jule Laure , Foulgoc Stephanie Le , Jourdain Gilles , Benhamou Dan 
Published: May 2020

Abstract
Background: Roughly 10% of newborns need help to complete the transition of birth. For these infants, international guidelines recommend supporting them using a 4-step procedure (A to D). Step A is an assessment time, which includes eight tasks and finishes by starting the positive pressure ventilation (PPV), if necessary (step B). The guidelines changed in 2015 and the allotted time was raised from 30 to 60 seconds for step A completion. Objectives: This study aimed to assess if the reduced time constraint in step A could have an impact on 1st-year pediatric residents' performance to complete step A and if could lead to later initiation of step A. Methods: Using video recordings of standardized neonatal scenarios over 6 years (3 before the change and 3 after), we assessed the ability of 1st-year pediatric residents of the Paris region to complete step A and initiate PPV in the allotted time in each period. Among the sessions, including at least five scenarios we evaluated all the PPV required scenarios executed for the first time by a dyad of 1st-year pediatric residents.Results: Among 52 sessions, we included 104 scenarios (25 sessions and 50 scenarios before the change and 27 sessions and 54 scenarios after). PPV started roughly at 1-minute resuscitation in both periods, but completion of the tasks before PPV-start was significant. Only 12% of the dyad of residents executed the eight tasks before PPV initiation in the first period versus 56% in the second period (p < 0.0001). Additionally, the completion of the eight tasks of step A was significantly better during the second period (6 [6-7] vs. 8 [7-8] p < 0.001).Conclusions: These results could suggest that a reduced time constraint for step A imposed by the new Guidelines was associated with better performance.
Nurses Practice and Influencing Factors regarding Physical Restraint use in the Intensive Care Units in Northwest Ethiopia
Authors: Kassew Tilahun , Tilahun Ambaye Dejen , Liyew Bikis 
Published: May 2020

Abstract
Background: Physical restraint is a common clinical practice in intensive care units. Even though physical restraint is used to prevent the removal of life support tubes and risk of a patient’s falling injure; complications such as edema, laceration, and pain at the restrained site, restricted circulation, worsening of agitation or delirium that may end with death are frequently encountered. Despite the sensitivity of the problem, there are gaps in nurses’ evidence-based practice in Ethiopia. Before developing protocols and guidelines relevant evidence-based practices of nurses are required. So, this study aimed to assess the practice and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from July to August 2019 at Amhara regional state referral hospitals, Northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff Regarding Physical Restraints Questionnaire was used to assess the nurses’ knowledge, attitude, and practice. Linear regression analysis was computed to examine the influencing factors of nurses' practice. An adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association. Statistical significance was declared at p-value<0.05. Result: The mean score of the nurses’ practice regarding physical restraint use among critically ill patients was 30.94±5.44. This mean score is above the scale midpoint nearer to the higher range that implies the majority of nurses have a satisfactory practice regarding physical restraint. Less than or equal to 2 years of work experience [β= -1.34, 95% CI (-2.47, -0.21)] was significantly associated with poor nurses practice; received training regarding restraints [β= 1.49, 95% CI (0.16, 2.82)], higher level of knowledge [β=0.40, 95% CI (0.03, 0.78)] and better attitude scores [β=0.37, 95% CI (0.27, 0.47)] were associated with good nurses practice regarding physical restraint use.Conclusion: Nurses working in the intensive care units had a satisfactory practice regarding physical restraint use on critically ill patients. So developing and providing educational and in-service training to the nurses on the alternative strategies, complications, and risks of physical restraint are important to strengthening the quality of nursing care for critically ill patients.
Micromorphology analysis and compare bond strength of two adhesives to different degrees of dental fluorosis
Authors: Liu Shuangfeng , Zhu Yanxia , Gegen Tana 
Published: May 2020

Abstract
Objectives: The aim of this study was to evaluate bond strength and morphological analysis of the all-etching bonding system and self-etching bonding system to different degrees of fluorosed enamel. Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. The collected teeth were mainly extracted due to orthodontic or periodontal disease. According to the Dean’s index and the Thylstrup and Fejerskov (TF) index, 180 extracted teeth were divided into three groups of mild, moderate and severe dental fluorosis, 60 teeth in each group. The teeth in each group were randomly divided into 2 subgroups (n=30) that were subjected to the all-etching bonding system (Prime & Bond NT) and self-etching bonding system (SE-Bond). Each group of adhesives was used to bond Z350 universal resin (3M) to the etched dental enamel. Tensile and shear testing were used to determine the bond strength. After the tensile testing, the fractured specimens were examined under scanning electron microscopy (SEM) and confocal laser scanning microscopic(CLSM). Results: The Prime & Bond NT had statistically significant on tensile and shear strength for mild fluorosis enamel (P<0.05), but it had no significant difference for moderate and severe dental fluorosis (P>0.05). Self-etching bonding system (SE-Bond) had no statistical significance on the tensile and shear strength for mild, moderate and severe dental fluorosis (P>0.05). SEM and CLSM showed that the mild fluorosis enamel crystals were relatively dense and a small amount of resin remained. The moderate fluorosis enamel crystals were loosely arranged and the gaps were widened. The severe fluorosis enamel crystals were irregularly arranged. The disorder was aggravated, and the dentinal orifice exposed by partial enamel exfoliation can be seen. Conclusions The bonding strength of mild fluorosis enamel to Prime & Bond NT was better than that of SE-Bond, cohesive failure is the most common failure method in this study. And there is no difference in the bonding strength of SE-Bond to different degrees of DF. Therefore, we suggested that the all -etching adhesive system was used to treat mild fluorosis teeth in the clinic. For moderate to severe fluorosis teeth, we may prolong the application time of self-etching adhesion to enhance enamel-etching pattern and promoted similar results in terms of adhesive enamel bond strength.
Low Cost Simulator for Cardiopulmonary Resuscitation in Infants: a Proof-of-Concept Study.
Authors: Targino Ailton do Nascimento , Patricio Alan , de Oliveira Adriana Gonçalves , Echeimberg Jorge de Oliveira , de Abreu Luiz Carlos , Raimundo Rodrigo Daminello 
Published: May 2020

Abstract
Background: Realistic simulation methodology is used in various learning scenarios, allowing students to participate directly in problematic situations that require immediate professional action. The objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants.Findings: The prototype was developed successfully with accessories to simulate cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the Basic Life Support guidelines of the American Heart Association to test the instrument. The prototype was used as a learning object for the teaching-learning process as a low-cost resource.Conclusion: A low-cost prototype was developed, and its application was obtained from the simulation of the training activity in Basic Life Support and from the performance of procedures in the positioning and simulation of cardiopulmonary resuscitation.
Multiple HPV 16 infection with two strains: a possible marker of neoplastic progression
Authors: Bruno Maria Teresa , Scalia Guido , Cassaro Nazario , Boemi Sara 
Published: May 2020

Abstract
Background. We studied the cases of single and multiple HPV infection and analyzed the correlation with negative cases, and preneoplastic and neoplastic lesions of the uterine cervix with the aim of making a contribution to the prognostic factor under discussionMethods: 909 women undergoing second level screening because they had been positive at cervical cytology were enrolled. All the patients underwent colposcopy and cervical biopsy with viral genotyping. We divided mHPV infection based on the number of genotypes present: infections with 2 strains, 3 strains, 4 strains and 5 or more strains. Statistical analysis The analysis of the data was made using the χ2 test. Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p <0.05 were considered statistically significant.Results: The presence of genotype HPV16 in our study was associated with a 12 times greater risk of developing a high-grade lesion, OR = 12.70. The patients with single infections had the highest incidence of CIN2+ (34.1 %) with respect to those with multiple infections (10.6%).When we studied in the mHPV infection the prevalence of the combinations between the genotypes, we found that in mHPV16 infections, the combinations HPV16, 18 and HPV16, 31 were the most frequent (55.5%) in CIN3 lesion.ConclusionsOur results suggest that single HPV infections have a greater risk of developing SCC with respect to multiple infections. Multiple HPV infections are relevant only in the first phase of the lesion (CIN1-CIN2), while they are absent in carcinomas, where infections are of a single genotype. In particular, among multiple infections, HPV16 infection with 2 HR genotypes is associated significantly with CIN2 / CIN3 (21/30) and has 4 times greater risk of developing a high-grade lesion. Thus, it is probable that only specific combinations of HPV (HPV16,18 - HPV 16,31) can be associated with a clinically significant impact, while other combinations can simply be correlated because of a common infection or diagnostic method used. Therefore, multiple HPV16 infections with two high-risk genotypes is a major risk of CIN2/CIN3.
Contextual Effects of Social Integration and Disintegration on Health Status: Evidence from South Korea
Authors: Jo Eun-Bi , Kwon Rang Hee , Jung Minsoo 
Published: May 2020

Abstract
Background: Many studies have shown that various social integration variables represented by social capital are beneficial to communities, including collective health. However, the rapid decline in fertility rates and the breakup of familyism in developed countries require a new approach to social disintegration, but the literature is insufficient. Here, we explored the contextual effects of social integration and social disintegration on the health of individuals.Methods: The research data consist of merged datasets of 6909 respondents who were quota-sampled by approximately 30 people from 229 local governments in Korea. The individual-level independent variable is a social integration measure consisting of 26 questions in four areas. The community-level independent variables are five integral and aggregate variables extracted from 81 indicators. The dependent variable is self-rated health status. Potential confounders are gender, age, annual income, educational attainment, district type, and the number of beds in medical institutions per 1,000 people.Results: The results showed that at the individual level, the higher the inclusive attitude of in- and out-of-networks, after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p <0.001). At the community level, the higher the proportion of single-person households in a community after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p <0.05). The effect size was 0.22.Conclusion: Thus far, social integration has been preferred, with the positive aspects of social capital being emphasized. However, this study shows that in some cases, social disintegration can instead positively influence an individual's health. Therefore, further studies of the various conditions of social context effects on health are necessary.Keywords: Social integration, Social disintegration, Contextual
General and Tuberculosis-Specific Service Readiness in two states in Nigeria
Authors: Oluwasanu Mojisola , Hassan Abiodun , Adebayo Ayodeji , Ogbuji Queen Chidinma , Adeniyi Bamidele Olaiya , Adewole David , Ladipo Oladapo Alabi , Ajuwon Grace , Ajuwon Ademola 
Published: May 2020

Abstract
Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary and tertiary healthcare facilities in two TB high burden states. Data was collected using key informant interviews, facility assessment using a semi-structured tool adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. The domain score for basic amenities in both states is 48.8% (SE:2.8); 47.0% (SE:4.0) in Anambra and 50.8% (SE:3.9) in Oyo state. In Oyo, only half of the facilities (50%) have access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states is 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (P = 0.56). The domain score for availability of staff and TB guidelines is 57.1% (SE:3.4) for both states. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states is 75%; this is higher in Oyo state (P = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing and gaps with continuing education on TB management. The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.