bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania
Authors: Said Ali , Sirili Nathanael , Massawe Siriel , Pembe Andrea B , Hanson Claudia , Malqvist Mats 
Published: May 2021

BackgroundSince 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system.MethodsAn exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data.ResultsTwo main themes emerged from this study: ‘Accomplishing by ambitions’ and ‘A flawed system’. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation.ConclusionThe implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.
1 The adoption of an empowered physical training programme in a military population – the benefit in injury reduction. A retrospective cohort study
Authors: Downes Graeme , Doddington Luke 
Published: May 2021

IntroductionMusculoskeletal injuries (MSKI) represent a significant burden within the British Army, this has been extensively studied amongst recruits. It was decided to study the injury rates of a Light Cavalry Squadron who have adopted an empowered physical training program involving personal responsibility for physical training with periodic benchmark exercises.MethodsAnonymised data were collected between April and August 2020 during an operational tour. The number of presentations to the medical centre for MSKI as well as the number of days of restricted duties were collected. The data relating to the same operational tour, exactly one year previously, for another Light Cavalry squadron were collected as a control. Both units were deployed in the same location, in the same role, and with the same population, fluctuating around 138 personnel.ResultsBetween April and August 2020 there were 124 consultations for MSKI amongst the study population, this resulted in 241 days of restricted duties. In comparison for the control population (April to August 2019), there were 225 consultations for MSKI, and this resulted in 777 days of restricted duties.ConclusionsIt was found that the current unit has experienced a lower incidence of MSKI and fewer restricted duties days when compared to the control group. It is proposed that the greater emphasis on personal responsibility for physical fitness has allowed personnel to develop their fitness with a broader range of physical activity. This has resulted in a lesser burden of overuse injuries. It is also thought that the focus on personal responsibility has led to a greater desire to engage in physical training. Further work is needed to ensure that this trend continues throughout the operational tour and that the empowered training programme has a comparable benefit in physical fitness to the standard training program.
3 Clinical implications of the differential antibody response in mild-moderate SARS-CoV-2: a prospective multi-centre cross-sectional study
Authors: Pallett Scott , Jones Rachael , Rayment Michael , Pallett Mitchell A , Mughal Nabeela , Oliveira Carolina Rosadas de , Randell Paul , Davies Gary W , Tedder Richard , McClure Myra O , O’Shea Matthew K , Moore Luke SP 
Published: May 2021

IntroductionSerological testing can augment delayed case identification programmes for Severe Acute Respiratory Syndrome coronoravirus-2 (SARS-CoV-2). Immunoassays employ anti-nucleocapsid (anti-NP; the majority) or potentially neutralising anti-spike (including anti-receptor binding domain; anti-RBD) antibody targets, yet correlation between assays and variability arising from disease symptomatology remains unclear. We explore these possibly differential immune responses across the disease spectrum.MethodsA multicentre prospective study was undertaken via a SARS-CoV-2 delayed case identification programme (08 May-11 July 2020). Matched samples were tested for anti-NP and anti-RBD (utilising an ‘inhouse’ double-antigen bridged assay), reactivity expressed as test/cut-off binding ratios (BR) and results compared. A multivariate linear regression model analysed age, sex, symptomatology, PCR positivity, anti-NP, and anti-RBD BRs. Participants were followed up for possible reinfection.Results902 individuals underwent matched testing; 109 were SARS-CoV-2 PCR swab positive. Anti-NP, anti-RBD immunoassay agreement was 87.5% (95% CI 85.3–89.6), with BRs strongly correlated (R=0.75). PCR confirmed cases were more frequently identified by anti-RBD (sensitivity 108/109, 99.1%, 95% CI 95.0–100.0) than anti-NP (102/109, 93.6%, 95% CI 87.2–97.4). Anti-RBD identified an additional 83/325 (25.5%) cases in those seronegative for anti-NP. Presence of anti-NP (p<0.0001), fever (p=0.005), or anosmia (p=0.002) were all significantly associated with an increased anti-RBD BR. Age was associated with reduced anti-RBD BR (p=0.052). Three cases with evidence of seroconversion (anti-RBD seropositive) presented with subsequent reactive PCR results, two of which coincided with first time onset of Public Heath England SARS-CoV-2 symptoms.ConclusionsSARS-CoV-2 anti-RBD shows significant correlation with anti-NP for absolute seroconversion, and BRs. Higher BRs are seen in symptomatic individuals with significantly higher levels seen in those with fever and anosmia. The degree of discordant results (12.5%) limits the use of anti-NP as a stand-alone for delayed case finding programmes. Similarly, this discordance limits the utility of non-neutralising anti-NP assays in place of potentially neutralising anti-RBD to infer possible immunity.** this abstract presentation was awarded an Honourable Mention
4 Histamine, mast cell tryptase and post-exercise hypotension in healthy and collapsed marathon runners
Authors: Parsons Iain , Stacey Michael , Woods David 
Published: May 2021

IntroductionHeat stress exacerbates post-exercise hypotension and cardiovascular disturbances from elevated body temperature and may contribute to exertion-related incapacity. Mast cell degranulation and muscle mass are considered likely modifiers, though this hypothesis lacks practical evidence. This study had three aims: 1) to characterise pre-post responses in histamine and mast cell tryptase (MCT); 2) to investigate relationships between whole body muscle mass (WBMM) and changes in blood pressure post marathon; 3) to identify any differences in runners incapacitated from marathon running.Methods24 recreational runners were recruited and successfully completed the 2019 Brighton Marathon (COMPLETION). WBMM was measured by bioimpedance at rested baseline. A further eight participants were recruited from incapacitated runners diagnosed with heat illness (COLLAPSE). Histamine, MCT, blood pressure, heart rate, body temperature and echocardiographic measures were taken before and after exercise (COMPLETION) and upon hyperthermic incapacitation (COLLAPSE).ResultsIn COMPLETION, MCT increased by nearly 50% from baseline (p=0.001), whereas histamine and body temperature did not vary (P>0.9462). Systolic (sBP), diastolic (dBP) and mean (MAP) arterial blood pressures and systemic vascular resistance (SVR) declined (p<0.019). WBMM negatively correlated with ΔsBP (r=-0.43, p=0.046). For COLLAPSE versus COMPLETION there were significant elevations in MCT (1769±244 ng/L vs 1179±431, p=0.001) and body temperature (39.8±1.3 vs 36.2±0.8°C, p<0.0001) with a non-significant rise in histamine (9.6±17.9μg/L vs 13.7±33.9, p=0.1074) and significantly lower MAP, dBP and SVR (p<0.0327).ConclusionsThese data support the hypothesis that mast cell degranulation is a vasodilatory mechanism underlying PEH and exercise associated collapse. The magnitude of PEH is inversely proportional to the muscle mass and enhanced by concomitant body heating.
5 Cold stored platelets correct cardiac surgery induced platelet dysfunction
Authors: Scorer Tom , Mumford Andrew 
Published: May 2021

IntroductionPlatelet dysfunction (thrombocytopathy) is a major problem in the bleeding patient and increases morbidity and healthcare costs. The thrombocytopathy resulting from cardiopulmonary bypass (CPB) can be used to study therapies targeted to improve outcomes in other scenarios, such as trauma. Platelet transfusion is used widely to correct thrombocytopathy. However, the current standard, room temperature stored platelets (RTP) have several disadvantages including; short shelf life, risk of bacterial contamination and deterioration in platelet function during storage. Cold stored platelets (CSP) are a potential alternative product with longer shelf life, reduced contamination risk and better-preserved platelet function.MethodsUsingex vivomixing studies, we investigated whether CSP were better able to reverse the thrombocytopathy associated with cardiac surgery than RTP. Blood samples were collected from 20 cardiac surgery patients. Donor platelets were split into two bags and stored at either 4°C (CSP), or 22°C (RTP) for up to seven days. The donor platelets were mixed with the patient blood samples to simulate platelet transfusion. The mixed samples were analysed using the TEG 5000 and using a collagen coated flow chamber at arterial shear. Patient samples were analysed alongside healthy controls (n = 20).ResultsAfter mixing the patient samples with CSP, the TEG R times were shorter than in samples mixed with RTP (p<0.0001), indicating more rapid initiation of clot formation. In the flow chamber experiments, the clot volume was greater in the patient samples mixed with CSP compared with samples mixed with RTP (p<0.0001).ConclusionsThese findings suggest that CSP, but not RTP can partially reverse the thrombocytopathy associated with cardiac surgeryex vivo, at clinically relevant mixing volumes. Reversal of thrombocytopathy by mixing CSP was greatest in the arterial shear model, which may indicate superiorin vivoefficacy that requires confirmation in clinical trials.* this abstract presentation was awarded First Place.
Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis
Authors: Maina Beatrice W , Juma Kenneth , Igonya Emmy Kageha , Osindo Jane , Wao Hesborn , Kabiru Caroline W 
Published: May 2021

IntroductionEarly sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10–19 years.Methods and analysisWe will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature.Ethics and disseminationEthical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
Study protocol for the Healthier Wealthier Families (HWF) pilot randomised controlled trial: testing the feasibility of delivering financial counselling to families with young children who are identified as experiencing financial hardship by community-based nurses
Authors: Price Anna M H , Zhu Anna , Nguyen Huu N J , Contreras-Suárez Diana , Schreurs Natalie , Burley Jade , Lawson Kenny D , Kelaher Margaret , Lingam Raghu , Grace Rebekah , Raman Shanti , Kemp Lynn , Woolfenden Susan , Goldfeld Sharon 
Published: May 2021

IntroductionPoverty and deprivation can harm children’s future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish ‘Healthier Wealthier Children’ model, the objectives of this Australian pilot are to test the (1)feasibilityof systematising the referral pathway, and (2) short-termimpactson household finances, caregiver health, parenting efficacy and financial service use.Methods and analysisThis pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms.Ethics and disseminationEthics committees of the Royal Children’s Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications.Trial registration numberACTRN12620000154909; prospectively registered. Pre-results.
Role of parents in fatigue of children with a chronic disease: a cross-sectional study
Authors: Kramer Niels , Nijhof Sanne L , van de Putte Elise M , Ketelaar Marjolijn , Grootenhuis Martha A , van der Ent Kors , Swart Joost F , van Grotel Martine , Dalmeijer Geertje W , Nap-van der Vlist Merel M 
Published: May 2021

ObjectiveAs parents majorly impact their child’s well-being, and as fatigue is a highly prevalent threat to the well-being of children with a chronic disease, we aimed to explore the association between parental factors and fatigue in children with a chronic disease.DesignCross-sectional studySettingTwo Dutch children’s hospitals.PopulationChildren 2–18 years of age with either an autoimmune disease, cystic fibrosis or post-cancer treatment, and one of their parents.Main outcome measuresPaediatric fatigue was measured using the PedsQL Multidimensional Fatigue Scale. Parental factors included parental pain, fatigue and physical symptoms, parental distress, catastrophising thoughts about their child’s pain and family empowerment. Multiple linear regressions were used to study associations with paediatric fatigue. A multivariable regression model was used to assess the effect of the different parental factors on paediatric fatigue. All analyses were adjusted for the age and sex of the child.Results204 families participated (mean age 11.0±4.3 and 43.5±6.3 years for children and parents, respectively; 69% participation rate). More parental pain, fatigue and physical symptoms, and more parental distress and pain catastrophising were associated with more paediatric fatigue. More parental empowerment was associated with less paediatric fatigue on both subscales. In the multivariable model, only paediatric age remained significantly associated with fatigue. In a separate multivariable model for children 8–18 years old, more parental distress (β=−1.9, 95% CI −3.7 to −0.1) was also significantly associated with more paediatric fatigue.ConclusionsIn a population of children with a chronic disease, parental factors, both physical and psychosocial, were associated with paediatric fatigue. Our study provides evidence that more family empowerment is associated with less paediatric fatigue. This exploratory study adds to our knowledge of associated factors with fatigue in paediatric chronic disease, providing starting points for targeted interventions.
Feasibility of investigating methylphenidate for the treatment of sarcoidosis-associated fatigue (the FaST-MP study): a double-blind, parallel-arm randomised feasibility trial
Authors: Atkins Christopher , Jones Andy , Clark Allan B , Stockl Andrea , Fordham Richard , Wilson Andrew M 
Published: May 2021

IntroductionSarcoidosis-associated fatigue (SAF) is a common clinical problem with limited treatment options. This study was undertaken to determine the feasibility of performing a definitive trial to determine the clinical efficacy methylphenidate in SAF.MethodsThis was a parallel-arm, double-blind, placebo-controlled randomised controlled feasibility trial enrolling sarcoidosis patients reporting significant fatigue. Patients with a Fatigue Assessment Scale score of more than 21 were randomised to receive up to either 10 mg two times per day methylphenidate or identical placebo capsules two times per day, in a dose escalation fashion, for up to 24 weeks. Outcomes included number of participants eligible and willing to participate, withdrawal rates, adherence rates and ability to maintain blinding.ResultsOf 385 patients screened, 56 (14.5%) were eligible and 23 (41% of eligible patients) were randomised. No withdrawals occurred. One participant in the methylphenidate arm discontinued study medications due to chest pain. The side effect profile was not different between the groups. Median medication adherence rates were 98% and 99% in the methylphenidate and placebo arms, respectively. A greater proportion of participants receiving methylphenidate predicted their allocated treatment while blinded compared with those receiving placebo (93.3% vs 57.1%). The investigator could not predict the treatment allocation. Both groups showed clinically meaningful improvements in fatigue from baseline, although no between-group difference was seen.ConclusionsThe data support the feasibility of performing a double-blind parallel trial powered to determine the clinical efficacy of methylphenidate for SAF, however, a multicentre study will be required.Trial registration numberNCT02643732.
Self-care practice among hypertensive patients in Ethiopia: systematic review and meta-analysis
Authors: Tadesse Degena Bahrey , Gerensea Hadgu 
Published: May 2021

BackgroundIn high-income and low-income countries, including Ethiopia, hypertension (HTN) is a serious public health concern. As a consequence, a massive self-care practice (SCP) is necessary, and the domains of SCP, including adherence to medication, physical activity, weight management, low-salt diet, non-smoking, moderate alcohol usage, and dietary management, are required. However, there is no nationwide study on HTN SCPs in Ethiopia. This meta-analysis, therefore, aimed to estimate the pooled level of HCP among individuals living with HTN in Ethiopia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to report this systematic review and meta-analysis. We systematically searched the databases PubMed/MEDLINE, Embase, Google Scholar and Science Direct for studies conducted in Ethiopia. All observational studies published until July 2020 were included. Data were analysed using R V.3.5.3 software, and the pooled prevalence with 95% CIs was presented using tables and forest plots. The presence of statistical heterogeneity (I2) within the included studies was evaluated. We used a funnel plot to identify evidence of publication bias. The random-effects meta-analysis model was employed to estimate the pooled proportion of good HTN SCPs.This was submitted for registration with the International Prospective Register of Systematic Reviews in March 2020 and accepted with the registration number CRD42020175743 (https://www.crd.york.ac.uk/PROSPERO).ResultsOur search databases produced 356 papers. Twelve of these papers fulfilled the inclusion and were found suitable for the review. The total population in this study was 3938. Off these hypertensive populations, 44% (95% CI 34 to 53) had good SCP. The subgroup analysis for each component of SCP was done. The subgroup analysis of good adherence to low-salt diet, alcohol abstinence, medication adherence, non-smoking, physical exercise and weight management was 52% (95% CI 39% to 66%), 77% (95% CI 69% to 88%), 65% (95% CI 45% to 85%), 92% (95% CI 88% to 95%), 43% (95% CI 30% to 56%) and 51% (95% CI 32% to 69%), respectively. In conclusion, nearly half of patients with HTN had good SCPs.