bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sociocultural Relevance of Communication Strategies of Adolescent Sexual and Reproductive Health Programmes in Mozambique: A Study of Programa Geração Biz Activities in Nampula Province
Authors: Silva Lurdes da Balbina Vidigal Rodrigues 
Published: April 2021

Adolescent sexual and reproductive health (ASRH) challenges in Mozambique include early marriages, early pregnancies and HIV/AIDS. In 1999 the Programa Geração Biz (PGB) was created to address youths’ problems and improve their sexual and reproductive health (SRH). However, studies show Mozambican youths continue to be exposed to risks related to their SRH. Mozambique is a multicultural country but only 40% of Mozambicans speak Portuguese, the official language, while 93.5% of the population uses a Bantu language as their mother tongue. This raises an important issue – should PGB communication strategies (CS) take into account the country’s complex cultural reality? Studies recognise the role of culture in enhancing effective delivery of communication programmes. Concurrently, studies point to a lack of research analyzing CS of health campaigns.
This paper’s aims are: (i) to examine PGB communication strategies; (ii) identify cultural challenges to these strategies; and (iii) determine the implications of these impediments for the PGB.
Research methods included non-participant observation, in-depth interviews and focus group discussions. Research questions were based on the McGuire Communication/Persuasion Model, and data analyzed thematically using Nvivo Pro11.
Results revealed the following: (i) interpersonal methods are used to deliver preventive messages, with sociocultural approaches often ignored or not used to reduce cultural barriers; (ii) cultural chal¬lenges identified include initiation rites, taboos surrounding sexuality, language and health terminologies, and parents’ attitudes towards early marriages; and (iii) these factors hinder effective delivery of programme messages.
The conclusion is that the CS used by PGB does not sufficiently take into account the Mozambican sociocultural context. Taboos around sexuality have silenced open communication in this regard. Ideas of sexual abstinence, condom use and campaigns against early marriage stand in opposition to certain orientations of traditional initiations.
A Duty to Consult Foreign Investors When Changing the Regulatory Framework? Implications for Non-Communicable Disease Prevention and Beyond
Authors: Henckels Caroline 
Published: April 2021

Abstract
Several decisions of international investment tribunals can be read as suggesting that the fair and equitable treatment standard may oblige governments to consult foreign investors in the course of developing new laws and policies. This position would significantly expand the concept of fair and equitable treatment, and goes far beyond what most domestic legal systems require of governments. Generally speaking, there may be sound instrumental and normative reasons for engaging in consultation with affected stakeholders in the course of legislative and policy development. However, with the exception of treaty provisions that otherwise so provide, no duty of consultation in the lawmaking process arises from fair and equitable treatment clauses, customary international law or general principles of law. Therefore, industries such as the tobacco industry are unlikely to succeed in a claim of failure to properly engage in consultation in the process of lawmaking.
Manhaj al-Daraqutni dalam Menilai Periwayatan al-Tafarrud daripada Perawi Thiqa dalam Karya “Al-ʿIlal al-Warida fi al-Ahadith al-Nabawiyya”
Authors: Aizul bin Yaakob Mohd , Shamsudin Roshimah 
Published: April 2021

Abstract
The scholarship of al-Daraqutni in the discipline of hadith gains prominence through his work “al-ʿIlal al-Warida fi al-Ahadith al-Nabawiyya”. His evaluation of the al-tafarrud, narrated by a reliable transmitter, was alleged to be inconsistent, whereby some of the narrations were accepted by him, and some were not. As for the narration of al-tafarrud, which contained additional elements from a trustworthy transmitter, al-Daraqutni commented using the term “ziyada thiqa maqbula”. This lexicon implied that al-Daraqutni accepted the narrations in totality. However, Ibn Hajar objected by citing that al-Daraqutni did not accept ziyada thiqa unconditionally. There seemed to be a contradiction between al-Daraqutni’s usage of terminology in contrast to other scholars such as Ibn Hajar. Therefore, this article intends to analyze the methods employed by al-Daraqutni in evaluating al-tafarrud, transmitted by trustworthy transmitters as mentioned in his book “al-ʿIlal al-Warida”. This qualitative study was analyzed using content analysis by means of inductive and deductive methods. The research found that the method used by al-Daraqutni to evaluate the al-tafarrud transmission was consistent throughout and showed no contradiction. Not only did he emphasized the trustworthiness of the transmitters, he further scrutinized the reference to qarina, which accompanied the narration, before concluding his evaluation.
Decoding first complete chloroplast genome of toothbrush tree (Salvadora persica L.): insight into genome evolution, sequence divergence and phylogenetic relationship within Brassicales
Authors: Khan Abdul Latif , Asaf Sajjad , Lubna  , Al-Rawahi Ahmed , Al-Harrasi Ahmed 
Published: April 2021

Abstract
Background
Salvadora persica L. (Toothbrush tree – Miswak; family-Salvadoraceae) grows in the arid-land ecosystem and possesses economic and medicinal importance. The species, genus and the family have no genomic datasets available specifically on chloroplast (cp) genomics and taxonomic evolution. Herein, we have sequenced the complete chloroplast genome of S. persica for the first time and compared it with 11 related specie’s cp genomes from the order Brassicales.

Results
The S. persica cp genome was 153,379 bp in length containing a sizeable single-copy region (LSC) of 83,818 bp which separated from the small single-copy region (SSC) of 17,683 bp by two inverted repeats (IRs) each 25,939 bp. Among these genomes, the largest cp genome size (160,600 bp) was found in M. oleifera, while in S. persica it was the smallest (153,379 bp). The cp genome of S. persica encoded 131 genes, including 37 tRNA genes, eight rRNA genes and 86 protein-coding genes. Besides, S. persica contains 27 forward, 36 tandem and 19 palindromic repeats. The S. persica cp genome had 154 SSRs with the highest number in the LSC region. Complete cp genome comparisons showed an overall high degree of sequence resemblance between S. persica and related cp genomes. Some divergence was observed in the intergenic spaces of other species. Phylogenomic analyses of 60 shared genes indicated that S. persica formed a single clade with A. tetracantha with high bootstrap values. The family Salvadoraceae is closely related to Capparaceae and Petadiplandraceae rather than to Bataceae and Koberliniacaea.

Conclusion
The current genomic datasets provide pivotal genetic resources to determine the phylogenetic relationships, genome evolution and future genetic diversity-related studies of S. persica in complex angiosperm families.
Effects of empagliflozin in different phases of diabetes mellitus-related cardiomyopathy: a prospective observational study
Authors: Oka Satoshi , Kai Takahiko , Hoshino Katsuomi , Watanabe Kazunori , Nakamura Jun , Abe Makoto , Watanabe Akinori 
Published: April 2021

Abstract
Background
Diabetes mellitus-related cardiomyopathy (DMCMP), defined as left ventricular (LV) dysfunction caused by hyperglycemia in the absence of coronary artery disease, leads to heart failure (HF). Previous studies have shown that treatment with sodium-glucose co-transporter 2 inhibitor (SGLT2i) reduces the risk of exacerbation of HF. The beneficial effects of SGLT2i on HF depend not only on indirect actions such as osmotic diuresis but also on direct actions on the myocardium, leading to improvements in LV function. However, it remains unclear whether SGLT2i treatment is equally effective in any phase of DMCMP. The aim of this observational study was to compare the efficacy of SGLT2i treatment on LV dysfunction between early and advanced DMCMP.

Methods
Thirty-five symptomatic non-ischemic HF patients with LV ejection fraction > 40% and type 2 diabetes mellitus (T2DM) treated with empagliflozin (EMPA group) and 20 controls treated without SGLT2i were enrolled. According to the myocardial extracellular volume fraction (ECV), a reliable marker of cardiac fibrosis quantified by cardiac magnetic resonance, the EMPA group was further divided into early DMCMP (n = 16, ECV ≤ 30%) and advanced DMCMP (n = 19, ECV > 30%) groups and followed up prospectively. Echocardiography was performed at baseline and after 12 months. LV function assessed as LV global longitudinal strain (LVGLS) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e′) were compared.

Results
ECV was strongly correlated with T2DM duration (r2 = 0.65, p < 0.001). At baseline, each group had a similar background. After 12 months, the EMPA group, especially the early DMCMP group, showed remarkable improvements in LVGLS (ΔLVGLS: 2.9 ± 3.0% (EMPA) vs. 0.6 ± 2.2% (controls), p = 0.005, and 4.6 ± 1.5% (early DMCMP) vs. 1.6 ± 3.3% (advanced DMCMP), p = 0.003) and E/e′ (ΔE/e′: − 1.5 ± 4.7 vs. − 0.3 ± 3.0, p = 0.253, and − 3.4 ± 5.5 vs. − 0.1 ± 3.5, p = 0.043).

Conclusions
The positive effects of empagliflozin on LV dysfunction were more remarkable in early than in advanced DMCMP. Early intervention of SGLT2i for DMCMP may be preferable.
Five-year microevolution of a multidrug-resistant Mycobacterium tuberculosis strain within a patient with inadequate compliance to treatment
Authors: Fernandez Do Porto Darío A. , Monteserin Johana , Campos Josefina , Sosa Ezequiel J. , Matteo Mario , Serral Federico , Yokobori Noemí , Benevento Andrés Fernández , Poklepovich Tomás , Pardo Agustín , Wainmayer Ingrid , Simboli Norberto , Castello Florencia , Paul Roxana , Martí Marcelo , López Beatriz , Turjanski Adrián , Ritacco Viviana 
Published: April 2021

Abstract
Background
Whole-genome sequencing has shown that the Mycobacterium tuberculosis infection process can be more heterogeneous than previously thought. Compartmentalized infections, exogenous reinfections, and microevolution are manifestations of this clonal complexity. The analysis of the mechanisms causing the microevolution —the genetic variability of M. tuberculosis at short time scales— of a parental strain into clonal variants with a patient is a relevant issue that has not been yet completely addressed. To our knowledge, a whole genome sequence microevolution analysis in a single patient with inadequate adherence to treatment has not been previously reported.

Case presentation
In this work, we applied whole genome sequencing analysis for a more in-depth analysis of the microevolution of a parental Mycobacterium tuberculosis strain into clonal variants within a patient with poor treatment compliance in Argentina. We analyzed the whole-genome sequence of 8 consecutive Mycobacterium tuberculosis isolates obtained from a patient within 57-months of intermittent therapy. Nineteen mutations (9 short-term, 10 fixed variants) emerged, most of them associated with drug resistance. The first isolate was already resistant to isoniazid, rifampicin, and streptomycin, thereafter the strain developed resistance to fluoroquinolones and pyrazinamide. Surprisingly, isolates remained susceptible to the pro-drug ethionamide after acquiring a frameshift mutation in ethA, a gene required for its activation. We also found a novel variant, (T-54G), in the 5′ untranslated region of whiB7 (T-54G), a region allegedly related to kanamycin resistance. Notably, discrepancies between canonical and phage-based susceptibility testing to kanamycin were previously found for the isolate harboring this mutation. In our patient, microevolution was mainly driven by drug selective pressure. Rare short-term mutations fixed together with resistance-conferring mutations during therapy.

Conclusions
This report highlights the relevance of whole-genome sequencing analysis in the clinic for characterization of pre-XDR and MDR resistance profile, particularly in patients with incomplete and/or intermittent treatment.
Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients
Authors: Meng Mei , Chen Limin , Zhang Sheng , Dong Xuan , Li Wenzhe , Li Ranran , Deng Yunxin , Wang Tao , Xu Yan , Liu Jiao , Huang Yanxia , Chen Yizhu , Huang Sisi , Wen Zhenliang , Zhang Lidi , Du Hangxiang , Liu Yongan , Annane Djillali , Qu Jieming , Chen Dechang 
Published: April 2021

Abstract
Background
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors.

Method
Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data.

Results
In 408 patients, 41 (10.04%) had an HScore ≥169 and were characterized as “suspected sHLH positive”. Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 × 109/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19.

Conclusions
HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.
What do Germans really think about health-nudges?
Authors: Krisam Mathias , Maier Mona , Janßen Rebecca , Krisam Johannes 
Published: April 2021

AbstractBackgroundIn recent years, policymakers have increasingly used behaviourally informed policies, including ‘nudges’. They have been implemented to produce desirable social outcomes such as healthier eating and physical activity. In Germany, a small research team at the Federal Chancellery acts as the central unit to promote the introduction of nudges in the design of public life. Despite this, the nudging concept itself as well as the understanding around it has not spread widely among German citizens. When reporting about the concept, German media is often very critical of the concept.MethodsUsing a for age, sex and educational level nationally representative online survey with 1000 participants, we investigate whether German citizens know about the concept of nudging. We also explore if they approve of the theoretical concept as well as a list of seven specific interventions regarding healthy eating and physical activity. A particular focus is placed on whether the level of approval is dependent on the target group of the intervention, as well as different intervention-initiators.ResultsWe find that nearly 80% of the respondents have never heard of nudging. However when being provided with a definition, we find that a strong majority (90%) supports the concept of nudging as well as all the specific interventions. Acceptance rates are higher if interventions are targeted at the general population compared to only children. All initiators – statutory health insurers, the government, private companies, and independent experts – are accepted as nudge initiators.ConclusionAmongst Germans nudges are an accepted method to promote health behaviours. Policy makers from various fields in Germany should take that into account to improve future health policy.
Testing a multicomponent lifestyle intervention for combatting childhood obesity
Authors: Vlaev Ivo , Taylor Michael J. , Taylor David , Gately Paul , Gunn Laura H. , Abeles Aliza , Kerkadi Abdelhamid , Lothian Jackie , Jreige Sahar Karim , Alsaadi Aziza , Al-Kuwari Mohamed G. , Ghuloum Suhaila , Al-Kuwari Hanan , Darzi Ara , Ahmedna Mohamed 
Published: April 2021

Abstract
Background
Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity.

Methods
Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8–14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in.

Results
Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively).

Conclusions
Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions.

Trial registration
ClinicalTrials.gov NCT02972164, November 23, 2016.
Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar
Authors: Kyaw Shwe Sin , Delmas Gilles , Drake Tom L. , Celhay Olivier , Pan-ngum Wirichada , Pukrittayakamee Sasithon , Lubell Yoel , Aguas Ricardo J. , Maude Richard James , White Lisa J. , Nosten Francois 
Published: April 2021

Abstract
Background
Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar.

Methods
We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses.

Results
The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5.

Conclusion
This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.
Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis
Authors: Du Jielin , Xie Jiajia , Qian Yan , Wu Mingyue , Huang Wenjing , Yin Jin , Peng Xin , Deng Dan 
Published: April 2021

Abstract
Background
China proposed the Zero Markup Drug Policy (ZMDP), which popularized in tertiary hospitals across the country in 2017, to control drug expenditures’ rapid growth further and reduce the public’s medical burden. This study aims to evaluate the impact of ZMDP on the drug cost of chronic disease outpatients in the tertiary hospital in Chongqing.

Methods
We collected and described the drug-cost data for outpatients with chronic diseases in a Chongqing’s tertiary hospital from 2015 to 2019. The instantaneous and long-term changes of the outpatient volume and average drug cost after the ZMDP were evaluated using interrupted time series (ITS). We also analyzed the policy’s impact under the stratification of gender, age, and basic medical insurance types.

Results
A total of 350,848 outpatients were collected from January 2015 to February 2019. After the ZMDP, the outpatient volume for diabetes, hypertension, and coronary heart disease (CHD) all showed a downward trend, with a decrease of 53.04 (P = 0.012), 142.19 (P < 0.01) and 12.16 (P < 0.001) per month. Simultaneously, the average drug cost decreased by 4.44 yuan (P = 0.029), 5.87 yuan (P < 0.001) and 10.23 yuan (P = 0.036) per month, respectively. By gender, the average drug cost of diabetes in males had the most considerable instantaneous change, reducing by 51.21 yuan (P = 0.017); the decline of CHD in women is the most obvious, with an average monthly decrease of 12.51 yuan (P < 0.001). By age, the instantaneous change of CHD was the greatest for those older than 65 years old, with a decrease of 102.61 yuan (P = 0.030). CHD in 46–65 years old showed the most significant reduction, with an average monthly decline of 11.70 yuan (P < 0.01). BMIUE’s hypertension had the most considerable instantaneous change, which decreased 59.63 yuan (P = 0.010). BMIUE’s CHD showed the most apparent downward trend, with an average monthly decrease of 10.02 yuan (P = 0.010).

Conclusion
The ITS analysis is an effective method of health policy evaluation. The implementation of the ZMDP can reduce the drug cost for chronic disease outpatients in the tertiary hospital and their economic burden. Follow-up policies still require targeted price adjustments in the health service system to adjust the drug cost-effectively.