bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with blood pressure check-up during pregnancy among women of reproductive age in Tanzania: an analysis of data from 2015—16 Tanzania Demographic and Health Survey and Malaria Indicators Survey
Authors: Moshi Fabiola V. , Tungaraza Maximilian 
Published: June 2021

AbstractBackgroundHypertensive Disorder of Pregnancy (HDP) is one of the leading causes of maternal mortality and morbidity amongst pregnant women in the world. Blood pressure check-ups during pregnancy are one of the strategies used to identify hypertensive disorders, hence timely management. Little is known about the factors associated with blood pressure check-ups in Tanzania.MethodThe study used data from 2015—16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015—16 TDHS—MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine the association between early antenatal booking and maternal services utilization.ResultsThe prevalence of blood pressure checkups during pregnancy was 72.17% at 95% confidence interval of 71.1–73.2%. Factors associated with uptake of blood pressure check-ups were; timely antenatal booking, AOR = 1.496, CI = 1.297–1.726,p < 0.001, late booking was a reference population, age group [> 34 years, (AOR = 1.518, CI = 1.149–2.006,p = 0.003)] with < 20 years used as a reference population, wealth index [middle income, (AOR = 1.215, CI = 1.053–1.468,p = 0.008) and rich, (AOR = 2.270, CI = 1.907–2.702,p < 0.001)] reference population being poor; education level [primary education, (AOR = 1.275, CI = 1.107–1.468,p = 0.001); secondary education, (AOR = 2.163, CI = 1.688–2.774,p < 0.001) and higher education, (AOR = 9.929, CI = 1.355–72.76,p = 0.024)] reference population being no formal education; parity [para 2–4, (AOR = 1.190, CI = 1.003–1.412,p = 0.046) with para one used as a reference population and zones [Unguja Island, (AOR = 3.934, CI = 1.568–9.871,p = 0.004), Pemba Island, (AOR = 5.308, CI = 1.808–15.58,p = 0.002)] and Mainland Urban being the reference population.ConclusionThe study revealed that rural dwelling pregnant women had higher chance of not getting their BP checked. It was also revealed that maternal age, education level, place of residence, wealth index and timing of ANC services were significantly associated with blood pressure check-ups. The study recommends the need to explore significant factors associated with utilization of available free reproductive health services across all public health facilities. It also recommends the need to address prioritized intensive awareness programs and behavioral change interventions on the significance of BP check-ups among pregnant women of reproductive age.
Diagnostic codes of cancer in Skåne healthcare register: a validation study using individual-level data in southern Sweden
Authors: Shen Qing , Schelin Maria E. C. , Fang Fang , Jöud Anna 
Published: June 2021

Abstract
Background
The Swedish healthcare is decentralised to 21 regions. Detailed information on all delivered care in the southernmost region, Skåne, is prospectively collected in the Skåne Healthcare Register (SHR). The data is updated daily and hence a good source for epidemiological studies. However, the diagnostic codes used to identify cancer patients in SHR have not yet been validated.

Methods
We conducted a validation study including 1,473,204 residents in Skåne region during 2005–2014, with at least one physical consultation in SHR. Newly diagnosed cancer from the Swedish Cancer Register was considered the ‘gold standard’ reference. We estimated the positive predictive value (PPV), sensitivity, and area under the curve (AUC) of a cancer diagnosis based on SHR by level of consultation, for any cancer, and for different cancer types.

Results
There were 61,693 cancers from the Swedish Cancer Register, and 87,650 cancers from SHR. The PPV of SHR-based diagnosis of any cancer was 63.76% (95% confidence interval (CI): 63.44–64.08%) with a sensitivity of 90.58% (95% CI: 90.35–90.81%). The AUC was 0.94, for any cancer. The measures of PPV, sensitivity and AUC varied across levels of care and were higher in specialized care than in primary care. The highest PPV was observed for specialist inpatient care in SHR (89.17, 95% CI 88.89–89.45%) whereas the highest sensitivity was observed for specialized outpatient care in SHR (86.39, 95%CI 86.12–86.66%). Robust validity was noted among most cancers, except for cancers of soft tissues, central nervous system and eye, and endocrine glands.

Conclusions
Our study supports that SHR is a valid and robust healthcare register for cancer diagnosis, with varying validities across levels of care and cancer types. This makes SHR a useful data source for cancer epidemiological studies, especially because the data covers the entire cancer care pathways without time lags for further linkage.
Dense hyperthermic intraperitoneal chemotherapy with cisplatin in patients with stage III serous epithelial ovarian cancer: a retrospective study
Authors: He Xiaoli , Wei Li , Li Rui , Jing Shuang , Jia Linlin , Ji Danwei , Li Yali , Wang Yue , Zhu Yongxia 
Published: June 2021

Abstract
Background
To investigate the efficacy and safety of interval debulking surgery (IDS) combined with dense hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in Chinese patients with FIGO stage III serous epithelial ovarian cancer (EOC).

Methods
This retrospective single-center study reviewed the demographic and clinical data of 197 patients with primary FIGO stage III serous EOC who were treated with IDS with (n = 121) or without (n = 76, control group) dense HIPEC between January 2012 and April 2017. The co-primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoint was the occurrence of adverse events.

Results
The median PFS was 24 months in the IDS plus dense HIPEC group, whereas it was 19 months in the IDS alone group (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.33–0.65, p = 0.000). The median OS in patients treated with IDS plus dense HIPEC (51 months) was significantly longer than that in patients treated with IDS alone (40 months, HR 0.52, 95% CI: 0.35–0.78, p = 0.001). The demographic and preoperative clinical characteristics of these two groups were comparable (p > 0.05). In the IDS alone group, no adverse events were recorded in 42 (55.3%) of the 76 patients, and 14 (18.4%) patients were reported to have grade III/IV adverse events. In the IDS plus dense HIPEC group, no adverse events were recorded in 55 (45.5%) of the 121 patients, and 23 (19.0%) patients were reported to have grade III/IV adverse events. No postoperative deaths occurred within 30 days in either group and neither did severe fatal complications in the IDS plus dense HIPEC group.

Conclusions
IDS plus dense HIPEC with cisplatin in Chinese patients with FIGO stage III serous EOC is associated with improved survival and is reasonably well tolerated by patients.
A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders
Authors: Peterson Bradley S. , West Amy E. , Weisz John R. , Mack Wendy J. , Kipke Michele D. , Findling Robert L. , Mittman Brian S. , Bansal Ravi , Piantadosi Steven , Takata Glenn , Koebnick Corinna , Ashen Ceth , Snowdy Christopher , Poulsen Marie , Arora Bhavana Kumar , Allem Courtney M. , Perez Marisa , Marcy Stephanie N. , Hudson Bradley O. , Chan Stephanie H. , Weersing Robin 
Published: June 2021

AbstractBackgroundTreatment of a child who has an anxiety disorder usually begins with the question of which treatment to start first, medication or psychotherapy. Both have strong empirical support, but few studies have compared their effectiveness head-to-head, and none has investigated what to do if the treatment tried first isn’t working well—whether to optimize the treatment already begun or to add the other treatment.MethodsThis is a single-blind Sequential Multiple Assignment Randomized Trial (SMART) of 24 weeks duration with two levels of randomization, one in each of two 12-week stages. In Stage 1, children will be randomized to fluoxetine or Coping Cat Cognitive Behavioral Therapy (CBT). In Stage 2, remitters will continue maintenance-level therapy with the single-modality treatment received in Stage 1. Non-remitters during the first 12 weeks of treatment will be randomized to either [1] optimization of their Stage 1 treatment, or [2] optimization of Stage 1 treatment and addition of the other intervention. After the 24-week trial, we will follow participants during open, naturalistic treatment to assess the durability of study treatment effects. Patients, 8–17 years of age who are diagnosed with an anxiety disorder, will be recruited and treated within 9 large clinical sites throughout greater Los Angeles. They will be predominantly underserved, ethnic minorities. The primary outcome measure will be the self-report score on the 41-item youth SCARED (Screen for Child Anxiety Related Disorders). An intent-to-treat analysis will compare youth randomized to fluoxetine first versus those randomized to CBT first (“Main Effect 1”). Then, among Stage 1 non-remitters, we will compare non-remitters randomized to optimization of their Stage 1 monotherapy versus non-remitters randomized to combination treatment (“Main Effect 2”). The interaction of these main effects will assess whether one of the 4 treatment sequences (CBT➔CBT; CBT➔med; med➔med; med➔CBT) in non-remitters is significantly better or worse than predicted from main effects alone.DiscussionFindings from this SMART study will identify treatment sequences that optimize outcomes in ethnically diverse pediatric patients from underserved low- and middle-income households who have anxiety disorders.Trial registrationThis protocol, version 1.0, was registered in ClinicalTrials.gov on February 17, 2021 with Identifier:NCT04760275.
Maternal investment, life-history trajectory of the off-spring and cardiovascular disease risk in Emirati females in the United Arab Emirates
Authors: Al Ghali Rola , Smail Linda , Muqbel Maryam , Haroun Dalia 
Published: June 2021

Abstract
Background
Variations in cardiovascular disease risk (CVD) are suggested to be partly influenced by factors that affect prenatal growth patterns and outcomes, namely degree of maternal investment (proxied by birth weight and gestational age). Using the life history trajectory model, this study investigates whether maternal investment in early prenatal life associates with menarcheal age and whether maternal investment affects CVD risk in adulthood and predicts adult size and adiposity levels.

Methods
A cross-sectional study was conducted among 94 healthy Emirati females. Birth weight, gestational age and menarcheal age were obtained. Anthropometrical measurements, body composition analysis, and blood pressure values were collected. Regression analyses were conducted to establish associations.

Results
There was no association between birth weight standard deviation score (SDS) and age at menarche. When investigating the associations of birth weight SDS and age at menarche with growth indices, it was found that only birth weight was positively and significantly associated with both height (β = 1.342 cm, 95% CI (0.12, 2.57), p = 0.032) and leg length (β = 0.968 cm, 95% CI (0.08, 1.86), p = 0.034). Menarcheal age was significantly and inversely associated with fat mass index (FMI) (β = − 0.080 cm, 95% CI (− 0.13, − 0.03), p = 0.002), but not with waist circumference and fat free mass index (FFMI) (p > 0.05). Birth weight SDS was positively and significantly associated with waist circumference (β = 0.035 cm, 95% CI (0.01, 0.06), p = 0.009), FMI (β = 0.087 cm, 95% CI (0.01, 0.16), p = 0.027), and FFMI (β = 0.485 cm, 95% CI (0.17, 0.80), p = 0.003). Birth weight SDS was not significantly associated with either systolic blood pressure (SBP) or diastolic blood pressure (DBP) (p > 0.05). However, FMI, waist circumference, and FFMI were positively and significantly associated with SBP. Regarding DBP, the relationship was negatively and significantly associated with only FFMI (β = − 1.6111 kg/m2, 95% CI (− 2.63, − 0.60), p = 0.002).

Conclusion
Although the results do not fully support that Emirati females fast-life history is associated with increased chronic disease risk, the data does suggest a link between restricted fetal growth in response to low maternal investment and metabolic and reproductive health.
Lateral herniation during treatment with collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s disease
Authors: Gannon Margaret K. , Pearlman Amy M. 
Published: June 2021

Abstract
Background
Collagenase Clostridium histolyticum (CCH), also know as Xiaflex, with penile modeling is considered to be the gold standard non-surgical option for management of Peyronie’s disease and is known to be safe and efficacious. Corporal rupture is a rare but known adverse event of CCH treatment, however there are limited studies describing corporal herniation without rupture. Here we present a patient who experienced a rare complication following CCH injections for Peyronie’s disease: lateral herniation of the tunica albuginea in the setting of a dorsal penile plaque.

Case presentation
A 58-year-old male presented to our clinic seeking treatment for Peyronie’s disease. On exam, he was found to have a palpable dorsal plaque and > 30 degrees leftward curvature of the penis. He was deemed an appropriate candidate for and patient decided to proceed with CCH and modeling. He received 2 cycles of CCH injections (4 total CCH injections) with in-office and at-home penile modeling, per manufacturer’s protocol. Two weeks following in-office modeling during his second CCH cycle, the patient reported a painless, soft swelling involving the left side of his penile shaft only occurring with erection. Exam and history were suggestive of lateral herniation rather than corporal rupture. CCH was discontinued. Patient declined further evaluation with penile ultrasound.

Conclusions
This is the first case report detailing lateral herniation with CCH injections. Symptoms and exam that should raise suspicion of corporal herniation are a soft, painless mass with erection.
Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation
Authors: Zachariou Athanasios , Paschopoulos Minas , Kaltsas Aris , Dimitriadis Fotios , Zikopoulos Athanasios , Mamoulakis Charalampos , Takenaka Atsushi , Sofikitis Nikolaos 
Published: June 2021

Abstract
Background
Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter.

Case presentation
We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery.

Conclusion
This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.
Perceptions of healthcare professionals towards palliative care in internal medicine wards: a cross-sectional survey
Authors: Tay Jason , Compton Scott , Phua Gillian , Zhuang Qingyuan , Neo Shirlyn , Lee Guozhang , Wijaya Limin , Chiam Min , Woong Natalie , Krishna Lalit 
Published: June 2021

AbstractBackgroundThe extension of palliative care services to meet the needs of patients with chronic non-malignant life-limiting conditions faces misconceptions amongst healthcare professionals. A study of prevailing perceptions of healthcare professionals on this wider palliative care service was thus conducted to identify current obstacles, guide the education of local healthcare professionals and improve service accessibility.MethodsA cross-sectional study was carried out at the Singapore General Hospital. An anonymised and close-ended online questionnaire was disseminated to 120 physicians and 500 nurses in the Department of Internal Medicine. The online survey tool focused on participant demographics; perceptions of palliative care and its perceived benefits; roles and indications; and attitudes and behaviours towards palliative care referrals.ResultsForty four physicians and 156 nurses suggested that care of terminally ill patients with chronic non-malignant life-limiting conditions are compromised by concerns over the role of palliative care in non-cancer care and lapses in their prognostication and communication skills. Respondents also raised concerns about their ability to confront sociocultural issues and introduce palliative care services to patients and their families.ConclusionsGaps in understanding and the ability of nurses and physicians to communicate end of life issues, introduce palliative care services to patients and their families and confront sociocultural issues suggest the need for a longitudinal training program. With similar concerns likely prevalent in other clinical settings within this island nation, a concerted national education program targeting obstacles surrounding effective palliative care should be considered.
Psychometric validation of the Laval developmental benchmarks scale for family medicine
Authors: Renaud Jean-Sébastien , Lacasse Miriam , Côté Luc , Théorêt Johanne , Rheault Christian , Simard Caroline 
Published: June 2021

Abstract
Background
With the implementation of competency-based education in family medicine, there is a need for summative end-of-rotation assessments that are criterion-referenced rather than normative. Laval University’s family residency program therefore developed the Laval Developmental Benchmarks Scale for Family Medicine (DBS-FM), based on competency milestones. This psychometric validation study investigates its internal structure and its relation to another variable, two sources of validity evidence.

Methods
We used assessment data from a cohort of residents (n = 1432 assessments) and the Rasch Rating Scale Model to investigate its reliability, dimensionality, rating scale functioning, targeting of items to residents’ competency levels, biases (differential item functioning), items hierarchy (adequacy of milestones ordering), and score responsiveness. Convergent validity was estimated by its correlation with the clinical rotation decision (pass, in difficulty/fail).

Results
The DBS-FM can be considered as a unidimensional scale with good reliability for non-extreme scores (.83). The correlation between expected and empirical items hierarchies was of .78, p < .0001.Year 2 residents achieved higher scores than year 1 residents. It was associated with the clinical rotation decision.

Conclusion
Advancing its validation, this study found that the DBS-FM has a sound internal structure and demonstrates convergent validity.
Why should HCWs receive priority access to vaccines in a pandemic?
Authors: Symons Xavier , Matthews Steve , Tobin Bernadette 
Published: June 2021

AbstractBackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers (HCWs) should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs.
Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial
Authors: MacKinnon Kinnon R , Grewal Ramandip , Tan Darrell HS , Rousseau Rodney , Maxwell John , Walmsley Sharon , MacPherson Paul A , Rachlis Anita , Andany Nisha , Mishra Sharmistha , Allen Vanessa G , Burchell Ann N. 
Published: June 2021

Abstract
Background
Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake.

Methods
Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing.

Results
A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing.

Conclusions
Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing.

Trial registration
ClinicalTrials.gov NCT02019043; registered December 23, 2013.