bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for marginal food security in young children in primary care
Authors: Bayoumi Imaan , Birken Catherine S. , Nurse Kimberly M. , Parkin Patricia C. , Maguire Jonathon L. , Macarthur Colin , Randall Simpson Janis A. , Borkhoff Cornelia M. 
Published: April 2021

Abstract
Background
Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years.

Results
The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question “I have difficulty buying food I want to feed my child because food is expensive” had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™.

Conclusion
The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits.

Trial registration
TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov; NCT01869530); www.targetkids.ca
An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt
Authors: Russell Abigail Emma , Hemani Gibran , Jones Hannah J , Ford Tamsin , Gunnell David , Heron Jon , Joinson Carol , Moran Paul , Relton Caroline , Suderman Matthew , Watkins Sarah , Mars Becky 
Published: April 2021

AbstractBackgroundEmpirical evidence supporting the distinction between suicide attempt (SA) and non-suicidal self-harm (NSSH) is lacking. Although NSSH is a risk factor for SA, we do not currently know whether these behaviours lie on a continuum of severity, or whether they are discrete outcomes with different aetiologies. We conducted this exploratory genetic epidemiology study to investigate this issue further.MethodsWe explored the extent of genetic overlap between NSSH and SA in a large, richly-phenotyped cohort (the Avon Longitudinal Study of Parents and Children;N = 4959), utilising individual-level genetic and phenotypic data to conduct analyses of genome-wide complex traits and polygenic risk scores (PRS).ResultsThe single nucleotide polymorphism heritability of NSSH was estimated to be 13% (SE 0.07) and that of SA to be 0% (SE 0.07). Of the traits investigated, NSSH was most strongly correlated with higher IQ (rG = 0.31, SE = 0.22), there was little evidence of high genetic correlation between NSSH and SA (rG = − 0.1, SE = 0.54), likely due to the low heritability estimate for SA. The PRS for depression differentiated between those with NSSH and SA in multinomial regression. The optimal PRS prediction model for SA (NagelkerkeR20.022,p < 0.001) included ADHD, depression, income, anorexia and neuroticism and explained more variance than the optimal prediction model for NSSH (Nagelkerke R20.010,p < 0.001) which included ADHD, alcohol consumption, autism spectrum conditions, depression, IQ, neuroticism and suicide attempt.ConclusionsOur findings suggest that SA does not have a large genetic component, and that although NSSH and SA are not discrete outcomes there appears to be little genetic overlap between the two. The relatively small sample size and resulting low heritability estimate for SA was a limitation of the study. Combined with low heritability estimates, this implies that family or population structures in SA GWASs may contribute to signals detected.
Sports activities of 60 above Hungarian elderly-explaining and predicting impact of exercise on health
Authors: Lampek Kinga , Csóka László , Hegedüs Réka , Zrínyi Miklós , Törőcsik Mária 
Published: April 2021

AbstractBackgroundThe proportion of elderly is on the rise both in Europe and in Hungary. The challenge is to increase the number of years spent in good health as well as to improve quality of life of those 60 years and above. This study focuses on the impact of physical activity on this age group.MethodsA nationally representative sample of 2000 respondents were surveyed in an age range of 15–74. Our data concerns those being 60–74 years of age. The focus of our investigation was level and impact of physical activity in the group above. First, we used Chi-squared tests and correspondence analysis to identify the deviation in the answers of different groups in our sample. After we built a hierarchical linear regression model to get a deeper understanding of the impact of physical activity for elderly.ResultsThose reporting no physical/sports activity at all have to do with the negative culture of exercising. Only 9.3% reported being engaged with any sports; 72% reported no regular exercising throughout their lives. The relationship between sport activity and self-reported health was significant (p = 0.009, Cramer’s V = 0.2). Elderly were characterized by walking, hiking and less intense sports.ConclusionsThose who actively exercised in this research reported better health outcomes than those who stopped or had never been engaged in any sports. We conclude that of all variables tested, physical activity was most effective to improve personal health of the elderly in this sample. Compared to European data on physical activity of elderly populations, Hungary seems to fall behind and needs to consider concentrated efforts to improve the future health of its senior populace.
Factors associated with crack-cocaine early initiation: a Brazilian multicenter study
Authors: Perrenoud Luciane Ogata , Oikawa Koki Fernando , Williams Anna Virginia , Laranjeira Ronaldo , Fischer Benedikt , Strang John , Ribeiro Marcelo 
Published: April 2021

AbstractBackgroundCrack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs.MethodsThis cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure.ResultsPresence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana:p = 0.028, 95% CI = − 3.81, − 0.22; crack-cocaine:p < 0.001, 95% CI = − 7.40, − 4.90), and deviant behavior (threatening someone with a gun:p = 0.028, 95% CI = − 2.57, − 0.14) remained independent predictors of early age of crack-cocaine initiation.ConclusionsEarly onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.
Knowledge, attitude and practices on cervical cancer screening among undergraduate female students in University of Gondar, Northwest Ethiopia: an institution based cross sectional study
Authors: Getaneh Alem , Tegene Birhanemeskel , Belachew Teshome 
Published: April 2021

Abstract
Background
Cervical cancer is a major public health problem. In the world, cervical cancer is the fourth most common cancer among women and it is one of the leading causes of cancer mortality in females. It is the second most common women cancer in Ethiopia with almost 6300 new cases and 4884 deaths annually. Despite the high burden of new cases and deaths, there is a scarcity of data on knowledge, attitude and practices (KAP) towards cervical cancer screening among female university students in Ethiopia particularly in the study area. Therefore, the present study was aimed to assess the KAP of undergraduate female students towards cervical cancer screening.

Methods
An institution based cross-sectional study was conducted in April 2018 at the University of Gondar, College of Medicine and Health Sciences undergraduate female students. Pretested, self-administered questionnaire was used for data collection. Four hundred and three female students were recruited by a simple random sampling method and the data were entered and analyzed using SPSS version 20 statistical packages. Descriptive data analysis was used to report the results.

Results
More than half of the respondents (59.3.3%) had good knowledge, whereas nearly 67.7% of the respondents had favorable attitude towards cervical cancer. However, less than 1% of the respondents had been screened for cervical cancer.

Conclusion
Although undergraduate female students had apparently good knowledge and favorable attitude, their practices on cervical cancer screening were quite low. Therefore, the health sectors and the gender streaming office of the university mobilize students to strengthen the uptake the cervical cancer screening practice.
The effects of professional continuous glucose monitoring as an adjuvant educational tool for improving glycemic control in patients with type 2 diabetes
Authors: Rivera-Ávila Dulce Adelaida , Esquivel-Lu Alejandro Iván , Salazar-Lozano Carlos Rafael , Jones Kyla , Doubova Svetlana V. 
Published: April 2021

Abstract
Background
The study objective was to evaluate the effects of professional continuous glucose monitoring (CGM) as an adjuvant educational tool for improving glycemic control in patients with type 2 diabetes (T2D).

Methods
We conducted a three-month quasi-experimental study with an intervention (IGr) and control group (CGr) and ex-ante and ex-post evaluations in one family medicine clinic in Mexico City. Participants were T2D patients with HbA1c > 8% attending a comprehensive diabetes care program. In addition to the program, the IGr wore a professional CGM sensor (iPro™2) during the first 7 days of the study. Following this period, IGr participants had a medical consultation for the CGM results and treatment adjustments. Additionally, they received an educational session and personalized diet plan from a dietitian. After 3 months, the IGr again wore the CGM sensor for 1 week. The primary outcome variable was HbA1c level measured at baseline and 3 months after the CGM intervention. We analyzed the effect of the intervention on HbA1c levels by estimating the differences-in-differences treatment effect (Diff-in-Diff). Additionally, baseline and three-month CGM and dietary information were recorded for the IGr and analyzed using the Student’s paired t-test and mixed-effects generalized linear models to control for patients’ baseline characteristics.

Results
Overall, 302 T2D patients participated in the study (IGr, n = 150; control, n = 152). At the end of the three-month follow-up, we observed 0.439 mean HbA1C difference between groups (p = 0.004), with an additional decrease in HbA1c levels in the IGr compared with the CGr (Diff-in-Diff HbA1c mean of − 0.481% points, p = 0.023). Moreover, compared with the baseline, the three-month CGM patterns showed a significant increase in the percentage of time in glucose range (+ 7.25; p = 0.011); a reduction in the percentage of time above 180 mg/dl (− 6.01; p = 0.045), a decrease in glycemic variability (− 3.94, p = 0.034); and improvements in dietary patterns, shown by a reduction in total caloric intake (− 197.66 Kcal/day; p = 0.0001).

Conclusion
Professional CGM contributes to reducing HbA1c levels and is an adjuvant educational tool that can improve glycemic control in patients with T2D.

Trial registration
ClinicalTrials.gov: NCT04667728. Registered 16/12/2020
An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant
Authors: Román-Quesada Nieves , González-Navarro Beatriz , Izquierdo-Gómez Keila , Jané-Salas Enric , Marí-Roig Antonio , Estrugo-Devesa Albert , López-López José 
Published: April 2021

Abstract
Background
The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It’s important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants.

Methods
An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic” AND "Dental implants" OR "Oral implants”.

Results
After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67).

Conclusions
The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.
Association between intimate partner violence and the use of maternal health care services among married Malawian women
Authors: Magombo Praise W. , Ntenda Peter A. M. , Nkoka Owen 
Published: April 2021

Abstract
Background
Maternal and child health care (MCH) services aim at improving the overall health outcomes of both the mother and newborn. Intimate partner violence (IPV) has been linked with poor health outcomes and under usage of MCH services. In Malawi, IPV is a persistent problem, while MCH services’ uptake remains a constant challenge. However, there is limited information on the association between IPV and MCH services in Malawi. The study examined the association between IPV and the use of MCH services among married Malawian women.

Methods
The 2015–16 Malawi demographic and health survey was used to analyze the association of IPV and the use of MCH services among 2712 married Malawian women. Multivariable logistic regression models were used to estimate the strength of association.

Results
Approximately 41.4% of the women reported experiencing IPV. Specifically, 27.8%, 19.3%, and 23.6% reported experiencing physical, sexual, and emotional violence, respectively. Women who reported experiencing any form of IPV had a 34% reduced likelihood of delivering at a health facility [adjusted odds ratio (aOR): 0.66; 95% confidence interval (CI) 0.46–0.96] or were 36% less likely [aOR: 0.64; 95% CI 0.46–0.90] to have had skilled assistance during delivery compared to those who never experienced IPV.

Conclusion
IPV was associated with MCH services use, specifically delivery at a health facility and skilled birth attendants. The high prevalence of IPV underscores the need to design effective programs to raise awareness regarding IPV and reduce IPV. Reducing IPV may be a promising means to support a more integrated and sustainable approach to improve the use of MCH services.
Trichomonas vaginalis as a risk factor for human papillomavirus: a study with women undergoing cervical cancer screening in a northeast region of Brazil
Authors: Belfort Ilka Kassandra Pereira , Cunha Ana Paula Almeida , Mendes Francisco Pedro Belfort , Galvão-Moreira Leonardo Victor , Lemos Renata Gaspar , de Lima Costa Lucas Henrique , Monteiro Pablo , Ferreira Mariele Borges , dos Santos Gerusinete Rodrigues Bastos , Costa Joyce Leal , de Sá Ferreira Alice , Brito Luiz Gustavo Oliveira , Brito Luciane Maria Oliveira , Vidal Flávia Castello Branco , Monteiro Sally Cristina Moutinho 
Published: April 2021

Abstract
Background
Human papillomavirus (HPV) and Trichomonas vaginalis (TV) infections are the most common sexually transmitted infections (STIs) globally. The latter has contributed to a variety of adverse outcomes for both sexes. Moreover, in Brazil, epidemiological studies on patients with STIs are limited. Therefore, this study aimed to determine the prevalence of TV and its association with HPV in women undergoing cervical cancer screening.

Methods
Women with a normal cervix were recruited from a community-based cervical cancer screening program. Gynecological examinations were conducted, and questionnaires were provided. Vaginal canal and uterine cervix samples were collected for cytological examinations (reported using the 2001 Bethesda System) and tested for the presence of TV and HPV DNA.

Results
In total, 562 women who attended public primary healthcare were included in the study. The T. vaginalis was present in 19.0% (107) and HPV DNA was present in 46.8% (263) of women. Among the women of TV 73.8% (79) had a co-infection with HPV (p = 0.001).

Conclusions
We concluded that a TV infection is associated with an HPV infection of the cervix as well as with the cervical cytological abnormalities. Further studies could reveal the mechanisms by which these two organisms interact at the cellular level, with control for shared behavioral risk factors.
Exploring the practice, confidence and educational needs of hospital pharmacists in reviewing antimicrobial prescribing: a cross-sectional, nationwide survey
Authors: Khumra Sharmila , Mahony Andrew A. , Bergen Phillip J. , Page Amy T. , Elliott Rohan A. 
Published: April 2021

Abstract
Background
Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions.

Methods
We conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models.

Results
There were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription; p < 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5–7); key gaps were noted in antimicrobials’ anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3–5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes; p ≤ 0.01.

Conclusion
Gaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.
“I would do something if I could!”: experiences and reflections from ethics teachers on how to respond when hearing alarming cases from medical students
Authors: Muhaimin Amalia , Hoogsteyns Maartje , Wicaksono Raditya Bagas , Utarini Adi , Willems Derk Ludolf 
Published: April 2021

Abstract
Background
Previous studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves.

Methods
This study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples.

Results
Four teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient’s rights and autonomy, and sexual harassment. Regarding teachers’ responses in general, we found three main themes: (1) being assertive, (2) being careful, (3) barriers and facilitators. Most teachers were convinced of the need to take action despite numerous barriers, which they identified, leading to doubts and concerns in taking action. Our study shows that formal education in ethics might not necessarily influence how teachers respond to alarming cases, and that their responses are mainly influenced by how they perceive their role and responsibility as teachers.

Conclusions
Our study suggests that teachers should carefully consider the risks and consequences before taking action upon alarming cases to prevent further harm, and that support from higher authorities might be crucial, especially in the Indonesian context. Our study also shows that taking action as a group might be appropriate in certain cases, while personal approaches might be more appropriate in other cases. Most importantly, school leaders and administrators should develop effective organisational culture and support students and teachers for their ethical responsibility commitment.