bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India
Authors: Datta Biplab K. , Husain Muhammad J. 
Published: April 2021

AbstractBackgroundUncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20–35) women in India.MethodsWe used the India National Family Health Survey (NFHS-4) 2015–2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20–35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.ResultsWe found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01–1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14–1.42) and with no education (1.22, 95% CI: 1.10–1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57–2.29) or obese (2.82, 95% CI: 1.88–4.24).ConclusionsOur findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.
Experiences of family violence and parental unavailability in childhood in relation to parental socioeconomic position and psychological problems: a cohort study of young Swedish women 1990–2013
Authors: Löve Jesper , Mehlig Kirsten , Källström Åsa , Hensing Gunnel , Gunnarsdottir Hrafnhildur 
Published: April 2021

Abstract
Background
Despite the high prevalence and severe consequences for health and wellbeing, epidemiological research of neglected emotional needs during childhood is scarce and little is known about its relation to parental socioeconomic position (SEP). This study investigates the prevalence of family violence and parental unavailability in childhood and its association with parental SEP and parental psychological problems in four strata of young Swedish women examined 1990, 1995, 2000, and 2013.

Method
The sample comprised 976 women (mean age 22, range 20–25) living in Sweden. Secular trends for family violence, parental rejection and unavailability were analyzed using logistic regression as a function of year of examination. The associations with parental SEP and parental psychological problems were assessed using logistic regression with results in terms of odds ratios (OR) and 95% confidence intervals.

Results
Gendered patterns were observed in the associations between parental psychological problems and family violence and parental unavailability. Maternal psychological problems were associated with maternal rejection OR 6.8 (3.5–13.0), maternal lack of time OR 2.4 (1.2–5.0), and paternal rejection OR 1.9 (1.1–3.5). Paternal psychological problems were associated with paternal rejection OR 4.0 (2.1–7.7), paternal lack of time OR 4.9 (2.3–10.6), and experiencing family violence OR 4.9 (2.1–11.6). Low and medium parental SEP were associated with experience of family violence in childhood OR 3.1 (CI 1.1–8.5) and OR 3.4 (1.7–6.9), respectively. No changes between 1990 and 2013 were observed for the prevalence of any of the outcomes.

Conclusions
A stable prevalence of family violence and parental unavailability was reported by young women examined between 1990 and 2013. Lower socioeconomic position was associated with family violence while the association with parental unavailability was non-significant. Gendered patterns were observed in the association between parental psychological problems and family violence, where paternal but not maternal psychological problems were associated with family violence. Further, maternal psychological problems were associated with paternal rejection while paternal psychological problems were not associated with maternal rejection. Gendered patterns of parental unavailability need further studies.
Under consent: participation of people with HIV in an Ebola vaccine trial in Canada
Authors: David Pierre-Marie , Mathiot Benjamin , Thiongane Oumy , Graham Janice E. 
Published: April 2021

Abstract
Background
Little is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity of an Ebola vaccine candidate.

Methods
Observation at the clinical study site and semi-structured interviews employing situational and discursive analysis were conducted with clinical trial participants and staff over one year. Interviews were recorded, transcribed and analysed using critical qualitative interpretivist thematic analytical techniques. Patterns were identified, clustered and sorted to generate distinct and comprehensive themes. We then reassembled events and contexts from the study participants’ stories to develop two ideal portraits based on "composite characters" based on study participants features. These provide ethnographically rich details of participants’ meaningful social worlds while protecting individual identities.

Results
Ten of the 14 clinical trial participants, and 3 study staff were interviewed. Participant demographics and socio-economic profiles expressed limited contextual diversity. Half were men who have sex with men, half were former injection drug users experiencing homelessness, one was female, none were racialized minorities and there were no people from HIV endemic countries. Fully 90% had previous involvement in other clinical studies. Their stories point to particular socio-economic situations that motivated their participation as clinical labor through trial participation.

Conclusions
Our findings support Fisher’s argument of “structural coercion” in clinical trial recruitment of vulnerable individuals experiencing precarious living conditions. Clinical trials should provide more detail of the structural socio-economic conditions and healthcare needs which lie “under consent” of study participants. Going well beyond an overly convenient narrative of altruism, ethical deliberation frameworks need to sufficiently address the structural conditions of clinical trials. We offer concrete possibilities for this and acknowledge that further research and clinical data should be made available underlying study participant contexts with regards to recruitment and participation in resource poor settings, in both the South and the North.
Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development
Authors: Kremer I. E. H. , Jongen P. J. , Evers S. M. A. A. , Hoogervorst E. L. J. , Verhagen W. I. M. , Hiligsmann M. 
Published: April 2021

AbstractBackgroundSince decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options.ResultsAfter determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid.ConclusionThis paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.
A comparison of three interactive examination designs in active learning classrooms for nursing students
Authors: Ahlstrom Linda , Holmberg Christopher 
Published: April 2021

AbstractBackgroundDespite the advantages of using active learning strategies in nursing education, researchers have rarely investigated how such pedagogic approaches can be used to assess students or how interactive examinations can be modified depending on circumstances of practice (e.g., in online education).AimsThe aim was to compare three interactive examination designs, all based on active learning pedagogy, in terms of nursing students’ engagement and preparedness, their learning achievement, and instructional aspects.MethodsA comparative research design was used including final-year undergraduate nursing students. All students were enrolled in a quality improvement course at a metropolitan university in Sweden. In this comparative study to evaluate three course layouts, participants (Cohort 1,n = 89; Cohort 2,n = 97; Cohort 3,n = 60) completed different examinations assessing the same course content and learning objectives, after which they evaluated the examinations on a questionnaire in numerical and free-text responses. Chi-squared tests were conducted to compare background variables between the cohorts and Kruskal–Wallis H tests to assess numerical differences in experiences between cohorts. Following the guidelines of the Good Reporting of a Mixed Methods Study (GRAMMS), a sequential mixed-methods analysis was performed on the quantitative findings, and the qualitative findings were used complementary to support the interpretation of the quantitative results.ResultsThe 246 students who completed the questionnaire generally appreciated the interactive examination in active learning classrooms. Among significant differences in the results, Cohort 2 (e.g., conducted the examination on campus) scored highest for overall positive experience and engagement, whereas Cohort 3 (e.g., conducted the examination online) scored the lowest. Students in Cohort 3 generally commended the online examination’s chat function available for use during the examination.ConclusionsInteractive examinations for nursing students succeed when they are campus-based, focus on student preparation, and provide the necessary time to be completed.
Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine
Authors: de Ruijter Ursula W. , Lingsma Hester F. , Bax Willem A. , Legemaate Johan 
Published: April 2021

AbstractBackgroundHealthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice.MethodsCross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics.ResultsThe survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8).ConclusionHidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.
A concept mobility device with multi-positional configurations and child-kind restraint for safe perioperative transfer and induction of anaesthesia in children with autistic spectrum disorder – a cross sectional study
Authors: Hee Hwan Ing , Lim Ying Ching , Tan Tracy , Wan Sharon , Wijeweera Olivia , Lee Sumin , Raghavan Kavitha 
Published: April 2021

Abstract
Background
Transfer into the operating room, onto the operating table and mask induction of anaesthesia are major challenges faced by children with Autistic Spectrum Disorder (ASD). In a pilot study, parents observed that perioperative transfer becomes unsafe and difficult when children with ASD becomes uncooperative.

Method
A CHILD-KIND CONCEPT mobility system comprising of multi-positioning seat configurations and restraining module was developed with inputs from multi-disciplinary healthcare professionals and parents with children with ASD. To appeal to children and motivate child-machine interaction, the seat configurations and restraining module are designed to take the form of child-friendly, non-threatening, fun and familiar items. The sitting configuration, sitting to supine transformation, the restraint modules resemble racing-car seat, reclining motion of a home massage chair, safety restraints found in airplanes and amusement rides respectively. Healthcare professionals (HCPs) involved in the perioperative patient care, parents of ASD children and children (neurotypical and ASD) experience the use of the system in a non-clinical environment and participated in a survey study. The acceptance of its functionality (HCPs, parents) for perioperative transfer and induction of anaesthesia, rating of the user experience and likes and dislikes of (parents and children) were obtained.

Results
Thirty-two HCPs, 30 parents and 23 children participated. Majority of parents and HCPs opined the use of the system enables improvement in the management of perioperative movement (90.0% parents, 100% HCPs), safe perioperative movement (86.7% parents, 96.9% HCPs) and promotes ease of anaesthesia induction (76.7% parents, 90.6% HCPs) for uncooperative combative ASD children. Overall, 93.8% HCPs and 86.7% parents would recommend its frequent use in their own practice and their ASD children respectively. Attractiveness and multi-functionality are attributes endorsed by parents and children. Children endorse its use for induction of anaesthesia (73.9%), dental chair (82.6%), intra-hospital transfer (95.7%).

Conclusion
A child-kind mobility device that integrates appeal with functionality of restraint and multi-positional transformation has a potential to promote safe perioperative movement and ease of induction of anaesthesia in anxious uncooperative ASD children.
Modeling the interplay between demography, social contact patterns, and SARS-CoV-2 transmission in the South West Shewa Zone of Oromia Region, Ethiopia
Authors: Trentini Filippo , Guzzetta Giorgio , Galli Margherita , Zardini Agnese , Manenti Fabio , Putoto Giovanni , Marziano Valentina , Gamshie Worku Nigussa , Tsegaye Ademe , Greblo Alessandro , Melegaro Alessia , Ajelli Marco , Merler Stefano , Poletti Piero 
Published: April 2021

Abstract
Background
COVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures. However, in sub-Saharan Africa, a low prevalence and mortality have been observed so far.

Methods
We collected data on individuals’ social contacts in the South West Shewa Zone (SWSZ) of Ethiopia across geographical contexts characterized by heterogeneous population density, work and travel opportunities, and access to primary care. We assessed how socio-demographic factors and observed mixing patterns can influence the COVID-19 disease burden, by simulating SARS-CoV-2 transmission in remote settlements, rural villages, and urban neighborhoods, under school closure mandate.

Results
From national surveillance data, we estimated a net reproduction number of 1.62 (95% CI 1.55–1.70). We found that, at the end of an epidemic mitigated by school closure alone, 10–15% of the population residing in the SWSZ would have been symptomatic and 0.3–0.4% of the population would require mechanical ventilation and/or possibly result in a fatal outcome. Higher infection attack rates are expected in more urbanized areas, but the highest incidence of critical disease is expected in remote subsistence farming settlements. School closure contributed to reduce the reproduction number by 49% and the attack rate of infections by 28–34%.

Conclusions
Our results suggest that the relatively low burden of COVID-19 in Ethiopia observed so far may depend on social mixing patterns, underlying demography, and the enacted school closures. Our findings highlight that socio-demographic factors can also determine marked heterogeneities across different geographical contexts within the same region, and they contribute to understand why sub-Saharan Africa is experiencing a relatively lower attack rate of severe cases compared to high-income countries.
Development of an indirect ELISA for detection of anti-Mycoplasma hyopneumoniae IgG in naturally infected pathogen-induced convalescent sera
Authors: Tian Yaqin , Xu Zuobo , Wen Yukang , Yang Mei , Ning Yaru , Wang Zhaodi , Ding Honglei 
Published: April 2021

AbstractBackgroundImmunization of pigs with an inactivatedMycoplasma hyopneumoniaevaccine (bacterin) generates hyperimmune serum that contains high concentrations of anti-M. hyopneumoniaeIgG. Commercially available IgG-ELISA kits cannot distinguish between anti-M. hyopneumoniaeIgG in inactivated bacterin-induced hyperimmune sera and convalescent sera resulting from naturalM. hyopneumoniaeinfection. Establishment of an ELISA to detect anti-M. hyopneumoniaeIgG in convalescent sera will facilitate the evaluation of theM. hyopneumoniaestatus of pig farms.ResultsIn this study, we expressed and purified recombinant Mhp366-N protein, which contains an epitope recognized byM. hyopneumoniaeconvalescent sera but not hyperimmune sera, for use as a coating antigen. For theM. hyopneumoniaeconvalescent serum IgG-ELISA, the optimal antigen concentration, blocking buffer, blocking time, dilution of serum, incubation time with serum, secondary antibody dilution, secondary antibody incubation time and colorimetric reaction time were 0.25 µg/mL, 2.5 % skim milk, 1 h, 1:500, 0.5 h, 1:10,000, 1 h and 15 min, respectively. Validation of theM. hyopneumoniaeconvalescent serum IgG-ELISA showed a cut-off value of 0.323, the intra-assay CV ranged from 3.27 to 7.26 %, the inter-assay CV ranged from 3.46 to 5.93 %, and the assay was able to differentiate convalescent sera from antibodies to 7 other porcine respiratory pathogens. The convalescent serum IgG-ELISA detected no anti-M. hyopneumoniaeIgG in hyperimmune serum samples while a commercial IgG-ELISA identified 95/145 of these sera as positive. The accuracy of theM. hyopneumoniaeconvalescent serum IgG-ELISA was comparable to the sIgA-ELISA but better than the commercial IgG-ELISA.ConclusionsThe convalescent serum IgG-ELISA is a reproducible, sensitive, and specific indirect ELISA to detect anti-M. hyopneumoniaeIgG in naturally infected pathogen-induced convalescent sera. This ELISA could be used to carry out large scale surveillance ofM. hyopneumoniaeinfection in pig farms regardless of vaccination status.
Trends in oral corticosteroids use in severe asthma: a 14-year population-based study
Authors: Sadatsafavi Mohsen , Khakban Amir , Tavakoli Hamid , Ehteshami-Afshar Solmaz , Lynd Larry D. , FitzGerald J. Mark 
Published: April 2021

Abstract
Background
Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort.

Methods
We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥ 2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression.

Results
21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p < 0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p < 0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis.

Conclusions
This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.