bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women’s knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context
Authors: Borrull‐Guardeño Jessica , Sebastiá‐Laguarda Cruz , Donat‐Colomer Francisco , Sánchez‐Martínez Vanessa 
Published: February 2021

AbstractAims and objectivesTo explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain.BackgroundWorldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored.DesignQualitative descriptive study.MethodsThree focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used.ResultsWomen expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results.ConclusionsThere was a self‐perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness.Relevance to clinical practiceMidwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.
Excretory dysfunction and quality of life after a spinal cord injury: A cross‐sectional study
Authors: Gong De , Wang Yingmin , Zhong Lirong , Jia Mengmeng , Liu Ting , Li Kun 
Published: February 2021

AbstractAims and ObjectivesTo determine the aspects of excretory dysfunction most influential in determining the quality of life of survivors of spinal cord injury.BackgroundExcretory dysfunction is one of the most common and troublesome sequelae of spinal cord injury. Previous studies have shown that it can restrict social participation restriction, cause readmission and generally influence quality of life substantially.DesignA cross‐sectional survey of hospital inpatients following STOBE guidelines.MethodsA convenience sample of 101 patients with traumatic or non‐traumatic spinal cord injury were asked about their experiences of excretory dysfunction, and management and their self‐perceived quality of life. Univariate analysis and multiple linear regression were performed to isolate the most important relationships.ResultsOnly 2 of the 101 subjects professed to be unaffected by excretion dysfunction. Bladder‐related dysfunction was the most frequently mentioned type of problem. Quality of life impairment was found to be most often associated with bladder accidents, bowel accidents and having more than one bladder complications.ConclusionsExcretory dysfunction substantially impacts quality of life after a spinal cord injury. Bladder accidents, bowel accidents and more than one bladder complication are factors independently influencing the quality of life of spinal cord injury survivors.Relevance to Clinical PracticeTo improve excretion‐related QOL, patients’ bladder and bowel self‐management training should be strengthened seeking to prevent complications and reduce the risk of bladder and bowel accidents.
Effect of Impression Technique and Operator Experience on Impression Time and Operator‐Reported Outcomes
Authors: Yilmaz Hakan , Eglenen Merve Nur , Cakmak Gulce , Yilmaz Burak 
Published: February 2021

AbstractPurposeTo investigate the effect of impression technique (conventional preliminary alginate and digital scan) and operator experience in impression making (experienced in digital and conventional, experienced in conventional and inexperienced in digital, and inexperienced in conventional and digital) on impression time, satisfaction and stress levels, and the preference of the operators.Material and MethodsOne patient was assigned for each of the 60 operators, who were experienced in impression techniques at different levels (Group 1: experienced in conventional and digital, Group 2: experienced in conventional and inexperienced in digital, Group 3: inexperienced in conventional and digital). They made conventional impressions (irreversible hydrocolloid) and digital scans (Trios 3) from the same patient. The impression times were recorded at each step (patient registration, maxillary arch, mandibular arch, and bite registration) and in total. A visual analog scale (VAS) was used for the operator satisfaction for applicability, comfort, and hygiene; the State‐Trait Anxiety Inventory form (STAI‐TX1) was used for stress, and a questionnaire was completed to measure the operator's impression preference. The data were analyzed with a 2‐way ANOVA and Chi‐square test (α = 0.05).ResultsA significant interaction was found between the operator experience in impression making and the impression technique on time for maxillary and mandibular arch impressions and total time (p ≤ 0.002). Operator experience and impression technique interaction had a significant effect on comfort and average VAS scores (p ≤ 0.016). Whereas, no significant effect of this interaction was found on stress (p ≥ 0.195). Operator experience in impression making had a significant effect on applicability (p < 0.001), and the impression technique had a significant effect on hygiene VAS scores (p < 0.001). Operators in Group 1 and Group 3 preferred the digital scans, however, operators in Group 2 had no preference (p = 0.022).ConclusionOperator experience in impression making and impression technique had varying effects on clinician's impression time, comfort, applicability, hygiene, and preference. Operators needed less time for the impressions they were experienced with. Operator stress level was not affected by the operator experience in impression making and the impression technique. Dental students and operators experienced in both techniques were satisfied with the digital scans and they preferred digital scans. Operators experienced with conventional impressions were satisfied with conventional impressions but didn't have a preference for the impression type.
Evaluating the Effect of Ambient and Scanning Lights on the Trueness of the Intraoral Scanner
Authors: Koseoglu Merve , Kahramanoglu Erkut , Akin Hakan 
Published: February 2021

AbstractPurposeTo determine the influence of different scanning and ambient light conditions on the trueness values of an intraoral scanning (IOS) device.Material and methodsThe present study was conducted among 20 complete dentate volunteers. After making complete maxillary arch impressions with vinyl polysiloxane material, type IV dental stone was poured, and working casts were obtained. Then, the models were digitized using a dental laboratory scanner (LS) and standard tessellation language (STL) files were acquired. Full arch digital scans of the volunteers were also performed using an IOS device with 2 ambient light conditions (RL: room light, 1003 lux, and ZL: zero light, 0 lux) and 2 scanning light modes (blue [B] and white [W]). Twenty digital scans per group at each light condition were consecutively obtained. Discrepancy between the digital scans and digitized working casts was analyzed using a 3D inspection software. The obtained data were analyzed using one‐way ANOVA and Tukey tests (α = 0.05).ResultsSignificant differences were obtained among different light conditions for the IOS device (p ˂ 0.0001, F = 42.958 for positive deviations and F = 29.278, for negative deviations). The room light and blue mode (RLB) condition had the lowest deviation values compared with the other light conditions, followed by room light and white mode (RLW), zero light and blue mode (ZLB), and zero light and white mode (ZLW; p = 0.008, p ˂ 0.0001, and p ˂ 0.0001, respectively).ConclusionLighting conditions are effective in assessing the trueness of the digital impressions made with an IOS device. RLB conditions are recommended for taking a digital impression.
Understanding the place of punishment: Disadvantage, politics, and the geography of imprisonment in 21st century America
Authors: Beckett Katherine , Beach Lindsey 
Published: February 2021

AbstractStudies suggest that the spatial distribution of punishment in the United States is shifting. This article analyzes variation in prison admissions across U.S. counties to deepen our understanding of the contemporary geography of punishment. While research on punishment generally treats economic and political theories of punishment as distinct, we draw on recent studies of penal attitudes to develop a theoretical argument regarding their possible interconnection. We then use Hierarchical Linear Modeling to test the hypothesis that conservatism, race, and disadvantage are associated with the use of prison and that these factors help to explain why prison admission rates are higher in rural and suburban counties than in urban ones, despite notably higher crime rates in the latter. The results indicate that nonurban counties send more people to prison than urban counties and that socioeconomic disadvantage, the size of the Black population, and conservatism are significant predictors of prison admissions after controlling for crime‐related problems. These findings suggest that poverty, race, and politics work in concert to shape the distribution of punishment across 21st century America.
The impact of direct acting antivirals on hepatitis C virus disease burden and associated costs in four european countries
Authors: Mennini Francesco S. , Marcellusi Andrea , Robbins Scott Sarah , Montilla Simona , Craxi Antonio , Buti Maria , Gheorghe Liana , Ryder Stephen , Kondili Loreta A. 
Published: February 2021

AbstractBackground and AimsWe assessed the clinical and economic impact of direct‐acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain.MethodsAn HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015‐2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID‐19) was also developed.ResultsThe estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20‐year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015‐2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017‐2019. The cost‐savings ranged from € 45 to € 275 million. The investment needed to expand access to DAAs in 2015‐2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID‐19 will increase liver mortality in all countries.ConclusionDirect‐acting antivirals have significant clinical benefits and can bring substantial cost‐savings over the next 20 years, reaching a Break‐even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID‐19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts.
Diet during pregnancy: Influence of social characteristics and migration in the ELFE cohort
Authors: Kadawathagedara Manik , Ahluwalia Namanjeet , Dufourg Marie‐Noelle , Forhan Anne , Charles Marie Aline , Lioret Sandrine , de Lauzon‐Guillain Blandine 
Published: February 2021

AbstractBetter adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aim to characterize the diets of pregnant women by hypothesis‐driven and exploratory approaches and describe potential social determinants. Analyses included 12 048 mothers from the French nationwide ELFE birth cohort. Dietary intake over the last three months of the pregnancy was assessed by a food frequency questionnaire. Two hypothesis‐driven scores (the Diet Quality score, based on benchmarks derived from the National Health and Nutrition Program Guidelines, and the PANDiet score, based on nutrient intake) were calculated. Exploratory dietary patterns were also identified by principal component analysis. Multiple linear regressions were used to assess associations of maternal social characteristics with dietary patterns, accounting for the possible effect modification by their migration status. Five dietary patterns were identified: the Western, Balanced, Bread and toppings, Processed products, and Milk and breakfast cereals. Younger maternal age, single motherhood, unemployment and the presence of older children in the household were related to a suboptimal diet during pregnancy. The less acculturated the women were, the healthier and less processed their diets were, independent of their socio‐economic position. Several social determinants of the quality of women's diets were however moderated by their migration status. These findings shed light on the relations between indicators of social vulnerability, such as single motherhood and unemployment, and poorer diet quality. Given the reduced diet quality that accompanies the acculturation process, it is of paramount importance to identify the specific factors or obstacles that affect migrant women in maintaining their diet quality advantage over the majority population.
Effectiveness of the baby‐friendly community initiative on exclusive breastfeeding in Kenya
Authors: Kimani‐Murage Elizabeth W. , Kimiywe Judith , Mutoro Antonina N. , Wilunda Calistus , Wekesah Frederick Murunga , Muriuki Peter , Mwangi Bonaventure M. , Samburu Betty Mogesi , Madise Nyovani Janet , McGarvey Stephen T. , Griffiths Paula L. 
Published: February 2021

AbstractThe baby‐friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby‐friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub‐county. Pregnant women aged 15–49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention groupn= 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%;P< .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85;P< .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.
Professional identity formation within longitudinal integrated clerkships: A scoping review
Authors: Brown Megan E. L. , Whybrow Paul , Kirwan Gavin , Finn Gabrielle M. 
Published: February 2021

AbstractContextAlthough the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research.MethodIn 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis.Results849 articles were identified following an extensive search. 131 articles were selected for full‐text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity.ConclusionsThis scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co‐providers of patient care. There are suggestions that LICs encourage the development of an ‘ethic of caring’. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
Admissions experiences of aspiring physicians from low‐income backgrounds
Authors: De Freitas Chanté , Buckley Rya , Klimo Rebecca , Daniel Juliet M. , Mountjoy Margo , Vanstone Meredith 
Published: February 2021

AbstractIntroductionStudents from low‐income backgrounds (LIB) have been under‐represented in Canadian medical schools for over fifty years. Despite our awareness of this problem, little is known about the experiences of aspiring physicians from LIB in Canada who are working towards medical school admission. Consequently, we have little insight into the barriers and facilitators that may be used to increase the representation of students from LIB in Canadian medical schools.MethodsThis paper describes a qualitative description interview study aimed at understanding the experiences of aspiring physicians from LIB as they attempt to gain entry to medical school. We conducted semi‐structured interviews with 21 participants at different stages of their undergraduate, master's, and non‐medical professional education, and used the theories of intersectionality and identity capital as a theoretical framework for identifying barriers and facilitators to a career in medicine.ResultsParticipants experienced social, identity‐related, economic, structural and informational barriers to a career in medicine. Intrinsic facilitators included motivation, self‐confidence, attitude, strategy, information‐seeking and sorting, and financial literacy and increasing income. Extrinsic facilitators were social, informational, financial and institutional in nature.ConclusionThis study fills existing knowledge gaps in the literature by identifying the pre‐admissions barriers and facilitators encountered by aspiring physicians from LIB in Canada. The barriers and facilitators outlined in this study offer a framework for identifying target areas in developing support for admitting medical students from LIB. Given that medical students from LIB are more likely to serve underserved populations, our study is relevant to Canadian medical schools’ social accountability commitment to producing physicians that meet the health needs of marginalised and vulnerable patients.
Qualitative analysis of medical student reflections on the implicit association test
Authors: Gonzalez Cristina M. , Noah Yuliana S. , Correa Nereida , Archer‐Dyer Heather , Weingarten‐Arams Jacqueline , Sukhera Javeed 
Published: February 2021

AbstractIntroductionHealth professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback.MethodsMedical students in Bronx, NY, USA, participated in one 90‐minute session on implicit bias. The focus of analysis for this study is the post‐session narrative assignment inviting them to take the race‐based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de‐identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology.ResultsMedical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced.ConclusionDespite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students’ acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.