bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia
Authors: Azraii Ahmad Baihaqi , Ramli Anis Safura , Ismail Zaliha , Abdul-Razak Suraya , Badlishah-Sham Siti Fatimah , Mohd-Kasim Noor Alicezah , Ali Norsiah , Watts Gerald F. , Nawawi Hapizah 
Published: January 2021

Abstract
Background
Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP.

Methods
This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test–retest reliability was tested on 26 PCP using kappa statistics.

Results
During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement).

Conclusion
This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.
The correlation between lipoprotein(a) and coronary atherosclerotic lesion is stronger than LDL-C, when LDL-C is less than 104 mg/dL
Authors: Li Chuang , Chen Qiwen , Zhang Mei , Liu Yin , Chu Yushun , Meng Fanpeng , Wang Jianyu , Tang Jie , Luo Jian , Niu Xiulong , Wei Maoti 
Published: January 2021

Abstract
Background
Lp(a) and LDL-C are both risk factors of atherosclerotic cardiovascular disease (ASCVD). But there was a contradiction point in LDL-C and Lp(a) control. The appropriate level of LDL-C and Lp(a) in the prevention of ASCVD is still pending.

Objective
To investigate the correlation of Lp(a) and coronary atherosclerotic lesion, and find out the balance point in LDL-C and Lp(a) control.

Method
3449 patients were divided to coronary atherosclerotic heart disease (CAHD) Group and Non-CAHD Group based on the result of coronary angiography. The clinical characteristics were compared, and Logistic regressions were applied to find the CAHD risk factors in total, High-LDL-C Group (LDL-C ≥ 100 mg/dL) and Low-LDL-C Group (LDL-C < 100 mg/dL) patients. Spearman correlation analysis of Lp(a), LDL-C and Gensini Score was performed in patients with different LDL-C concentration.

Results
Except male and diabetes, the traditional CAHD risk factors were well matched between two groups. But triglyceride, LDL-C and Lp(a) were higher, HDL-C and Apo-A1 were lower in CAHD group (2771). In the Logistic regression analysis, diabetes, LDL-C and Lp(a) are risk factors of CAHD in all patients, while in High-LDL-C Group, they were age, LDL-C, non-HDL-C and ApoB, in Low-LDL-C Group, they were age, Lp(a) and ApoB. Lp(a) correlated with Gensini with coefficient r = 0.41 in all patients, 0.67 in Low-LDL-C Group and 0.32 in High-LDL-C Group. The coefficient r for Lp(a) and Gensini decreased, while the r for LDL-C and Gensini increased with LDL-C concentration increasing. The two fitted lines of rs crossed at LDL-C = 2.7 mmol/L (104 mg/dL).

Conclusion
Lp(a) was the risk factor of CAHD in patients with LDL-C < 100 mg/dL. The correlation between Lp(a) and Gensini was influenced by LDL-C concentration, and the correlation was stronger than LDL-C when LDL-C < 104 mg/dl.
The association between caregiver burden, distress, psychiatric morbidity and healthcare utilization among persons with dementia in Singapore
Authors: Lau Jue Hua , Abdin Edimansyah , Jeyagurunathan Anitha , Seow Esmond , Ng Li Ling , Vaingankar Janhavi Ajit , Chong Siow Ann , Subramaniam Mythily 
Published: January 2021

AbstractBackgroundCaregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore.MethodsThe data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers’ sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits.ResultsAfter adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models.ConclusionThe study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.
Phenotype, molecular characterisation and risk factors for postoperative meningitis caused by ESBL-producing-Enterobacteriaceae: a six years multi-Centre comparative cohort study
Authors: Zheng Guanghui , Cao Yanfei , Liu Chunhong , Qian Lingye , Cai Yumeng , Cui Miaomiao , Sun Huiting , Hong Lv , Yuan Jun , Zhang Lina , Zhang Guojun 
Published: January 2021

Abstract
Background
To determine the phenotype, molecular characterisation and risk factors of postoperative meningitis induced by Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in China.

Methods
We performed a multi-centre comparative cohort study of postoperative meningitis patients infected with Enterobacteriaceae in 4 neurosurgical centres in China from January 2014 to December 2019. Phenotype and molecular characteristics of the isolates were reviewed and tested, and independent risk factors of the EPE meningitis were evaluated by binary logistic regression.

Results
In total, 220 Enterobacteriaceae include 78 EPE were available in this study. 85.6% (67/78) ESBL-related genes were tested, and blaSHV (14.9%) and blaSHV + blaTEM + blaCTX-M-9 (20.9%) were found to be the most frequent mono and combined ESBL-related genes harboured by Enterobacteriaceae. On binary logistic analysis, craniotomy (OR. 2.583, 95% C.I. 1.274–5.235, P = 0.008) and malignancy (OR. 2.406, 95% C.I. 1.299–4.456, P = 0.005) were the associated independent risk factors to meningitis induced by EPE.

Conclusions
To the best of our knowledge, this is the largest series focusing on risk factors of EPE meningitis which has been conducted in China. Craniotomy and malignancy were independent risk factors for EPE meningitis. The risk factors identified may be further utilized in clinical practice and research to avoid and reduce the mortality in future.
A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma
Authors: Bantan Najwa Abdalkabeer A. , Abouissa Ahmed H. , Saeed Muhammad , Alwalily Mustafa Hassan , Balkhoyour Kamal Bakour , Ashour Khalid Mohammad , Hassan Amal Ali , Falemban Afnan Hisham , Taher Mohiuddin M. 
Published: January 2021

Abstract
Background
Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region.

Case presentation
A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment.
The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up.

Conclusions
Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.
Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey
Authors: van der Geest Berthe A. M. , Theeuwen Imke M. , Reiss Irwin K. M. , Steegers Eric A. P. , Been Jasper V. 
Published: January 2021

Abstract
Background
Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia.

Methods
All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training.

Results
One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001).

Conclusions
Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.
Early visual quality outcomes after small-incision lenticule extraction surgery for correcting high myopic astigmatism
Authors: Hou Xiangtao , Du Kaixuan , Wen Dan , Hu Shengfa , Hu Tu , Li Chenling , Tang Yanhui , Wu Xiaoying 
Published: January 2021

Abstract
Background
To evaluate early optical quality outcomes after small-incision lenticule extraction (SMILE) surgery for correcting high myopic astigmatism.

Methods
This retrospective study enrolled 55 eyes from 37 patients who had preoperative myopic astigmatism of ≥2.00 diopters (D) who had been treated with SMILE surgery. Preoperatively, the mean cylinder was − 2.41 ± 0.54 D (range, − 2.00 D to − 4.50 D). The preoperative and postoperative visual outcomes, refraction, and higher-order aberration (HOA) at 1 and 3 months were compared. Refractive astigmatism changes were analyzed by the Alpins vector method.

Results
Three months after SMILE surgery, the average cylinder was − 0.14 ± 0.31 D, and the average astigmatism vector was − 0.09 D × 6.34°. The angle of error (AofE) was limited to within ±10°, and the magnitude of error was limited to within ±1.0 D in all patients. The correction index (CI) was 0.98 ± 0.07, the index of success (IOS) was 0.08 ± 0.13, and the flattening index (FI) was 0.97 ± 0.07. Significant positive correlations were found between IOS and |AofE| (P = 0.000); negative correlations were found between FI and |AofE| (P = 0.000). The postoperative total HOA, spherical aberration, vertical coma aberration, and trefoil 30° were increased significantly compared with preoperative measurements, and the increase in HOA was closely related to preoperative astigmatism (P < 0.05).

Conclusions
SMILE has preferable outcomes for correcting high myopic astigmatism. Axis rotation during the surgery might influence the undercorrection of astigmatism. The increase of HOA after surgery is related to preoperative astigmatism.
Barriers to using HIV pre-exposure prophylaxis (PrEP) and sexual behaviour after stopping PrEP: a cross-sectional study in Germany
Authors: Koppe Uwe , Marcus Ulrich , Albrecht Stefan , Jansen Klaus , Jessen Heiko , Gunsenheimer-Bartmeyer Barbara , Bremer Viviane 
Published: January 2021

AbstractBackgroundPersistence of individuals at risk of HIV with Pre-Exposure Prophylaxis (PrEP) is critical for its impact on the HIV epidemic. We analysed factors associated with stopping PrEP, barriers that may deter people from continuing PrEP and investigated sexual behaviour after stopping PrEP.MethodsCurrent and former PrEP users in Germany were recruited to complete an anonymous online survey on PrEP use and sexual behaviour. Participants were recruited through dating apps, a PrEP community website, anonymous testing sites and peers. The results were analysed using descriptive methods and logistic regression.ResultsWe recruited 4848 current and 609 former PrEP users in two study waves (July–October 2018, April–June 2019). Former PrEP users were more likely 18–29 years old than current users (adjusted OR = 1.6, 95% confidence interval (CI) 1.1–2.3). Moreover, they were more often unhappy with their sex life, which was more pronounced in former daily PrEP users (aOR = 4.5, 95% CI 2.9–7.1) compared to former on-demand users (aOR = 1.8, 95% CI 1.1–2.9, pinteraction = 0.005). The most common reason for stopping PrEP was a reduced need for PrEP (49.1%). However, 31.4% of former users identified logistic reasons and 17.5% stopped due to side effects. Former PrEP users using PrEP < 3 months were more likely to stop PrEP due to concerns over long-term side effects (32.0% vs. 22.5%,p = 0.015) and not wanting to take a chemical substance (33.2% vs. 24.0%,p = 0.020) compared to former PrEP users who used PrEP for longer. After stopping PrEP, 18.7% of former PrEP users indicated inconsistent condom use while having ≥4 sex partners within the previous 6 months. Former PrEP users with many partners and inconsistent condom use more often indicated logistic reasons for stopping (46.5% vs. 27.9%,p < 0.001) than did other former PrEP users.ConclusionsTo maximise persistence with PrEP we need to develop strategies for younger PrEP users, reduce logistic barriers to access PrEP, and to develop effective communication on side-effect management. Moreover, prevention strategies for people stopping PrEP are required, since some remain at high risk for HIV.
“My right to walk, my right to live”: pedestrian fatalities, roads and environmental features in Benin
Authors: Glèlè-Ahanhanzo Yolaine , Kpozèhouen Alphonse , Sossa-Jerôme Charles , Sopoh Ghislain E. , Tedji Huguette , Yete Koovy , Levêque Alain 
Published: January 2021

Abstract
Background
The implementation of road safety interventions in many developing countries usually focuses on the behavior of users. In order to draw more attention on the role of road infrastructure and physical environment in road safety interventions, this study aims to analyze the environmental and road factors associated with the pedestrians involved in traffic crashes in Benin.

Method
The method used was an analysis of national road crash statistics for the period 2008 to 2015. The information available included the circumstances surrounding the collision, the road infrastructure, the vehicles and the individuals involved. A multiple logistic regression was used to identify predictors of pedestrian mortality in traffic crashes.

Results
During the period studied, 3760 crashes involved at least one pedestrian. The death rate among these pedestrians was 27.74% (CI 95%: 26.31–29.20). The mortality predictors were the area in which the crash occurred (OR = 4.94; CI 95%: 4.10–5.94), the day of the crash (OR = 2.17; CI 95%:1.34–3.52), light levels (OR = 1.30; CI 95%: 1.06–1.59), road classification (OR = 1.79; CI 95%: 1.46–2.20), the condition of the road surface (2.04, CI 95%: 1.41–2.95) and the position of the pedestrian during the crash (OR = 1.69; CI 95%: 1.19–2.38).

Conclusions
These results support the need for a holistic approach to interventions aiming to tackle deaths on roads. Interventions should integrate environmental factors for greater pedestrian safety around roads with appropriate signs, roads in good condition and awareness campaigns for a proper use of road infrastructures.
Determinants and effects or consequences of internal HIV-related stigma among people living with HIV in Morocco
Authors: Moussa Amal Ben , Delabre Rosemary M. , Villes Virginie , Elkhammas Mohammed , Bennani Aziza , Ouarsas Lahoucine , Filali Hind , Alami Kamal , Karkouri Mehdi , Castro Daniela Rojas 
Published: January 2021

Abstract
Background
HIV-related stigma and discrimination constitute a barrier to different intervention programs. Unlike external stigma, internal stigma is not well explored in in the Middle East and North African countries, while grasping this particular form of stigma is essential to limit its effects. The present study aims to measure internal stigma effects and to identify factors associated with this kind of stigma not yet documented among people living with HIV (PLHIV) in Morocco.

Methods
The PLHIV Stigma Index questionnaire (adapted and translated into French and Moroccan Arabic dialect “darija”) was used to collect information regarding the stigma and discrimination experienced by PLHIV across 8 cities in Morocco (September–October 2016). A randomly drawn cluster of 10 PLHIV, consisting of 5 men and 5 women, was drawn at each participating medical care center to achieve a nationally representative sample of PLHIV. Fifteen interviewers living with HIV and five supervisors were selected and trained to administer the questionnaire. An internal stigma score (range: 0–7), was calculated based on seven negative feelings/ beliefs. Negative binomial regression was used to identify characteristics associated with the internal stigma score.

Results
Among 626 PLHIV, internal stigma was reported by 88.2%. The median [IQR] internal stigma score was 4 [2–5]. Regarding internal stigma, 51% avoided going to the local clinic when needed and 44% chose not to attend social gatherings. Belonging to at least one key population (aIRR [95%CI] = 1.15 [1.03; 1.28]), experiencing discriminatory reactions from family following HIV status disclosure (1.28 [1.11; 1.49]), avoiding HIV services for fear of stigmatization by staff (1.16 [1.05; 1.28]) and being denied health services because of HIV status (1.16 [1.03;1.32]), are among the factors significantly associated with an increase of the internal stigma score.

Conclusions
Internal stigma is high among Moroccan PLHIV and significantly impacting their life decisions and their healthcare access. Multi-level interventions are needed to address internal stigma experienced by PLHIV in Morocco.
Excessive intake of iodine and low prevalence of goiter in school age children five years after implementation of national salt iodization in Shebedino woreda, southern Ethiopia
Authors: Elias Elilta , Tsegaye Workneh , Stoecker Barbara J. , Gebreegziabher Tafere 
Published: January 2021

AbstractBackgroundIodine is a trace element required for the synthesis of thyroid hormones. The multiple effects of iodine deficiency on human health are called iodine deficiency disorders (IDDs). IDDs have been common nutritional problems in Ethiopia. In 2012, Ethiopia launched a national salt iodization program to address IDDs. The objective of this study was to assess the effects of this program after 5 years by measuring urinary iodine concentration (UIC) and prevalence of goiter in school age children as well as household salt iodine concentration (SIC).MethodsA school-based cross-sectional design was employed. After ethical approval, 408 children from eight randomly selected primary schools provided urine samples. UIC was analyzed by inductively coupled plasma mass spectrophotometry (ICP-MS). A 10 g salt sample was collected from each household of a sampled child. SIC was analyzed with a digital electronic iodine checker (WYD, UNICEF) and goiter was assessed by palpation.ResultsThe mean (±SD) age of the children was 9 ± 2 years. The prevalence of goiter was 4.2% and no child had grade 2 goiter. The median (IQR) UIC was 518 (327, 704) μg/L and UIC ranged from 3.1 to 2530 μg/L. Of the salt samples, 15.6% were not adequately iodized (< 15 ppm), 39.3% were adequately iodized (≥15 to ≤40 ppm), and 45.1% were > 40 ppm. SIC ranged from 4.2 to 195 ppm. Of the mothers, 92% said iodized salt prevents goiter and 8% mentioned prevents mental retardation.ConclusionsIn 2017 iodine deficiency was no longer a public health problem in the study area. However, the high variability in UIC and SIC and excessive iodine intake are of great concern. It is vital to ensure that salt is homogenously iodized at the production site before being distributed to consumers.