bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania
Authors: Dominico Sunday , Kasanga Mkambu , Mwakatundu Nguke , Chaote Paul , Lobis Samantha , Bailey Patricia E. 
Published: April 2021

Abstract
Background
Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors.

Methods
A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months.

Results
Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, but only 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive association with recent practice was observed; the single most promising factor was hands-on solo practice during in-service training (66% of providers with this experience had conducted vacuum extraction in the last 3 months). The logistic regression model showed that providers exposed to 7–9 training modalities were 7.8 times more likely to have performed vacuum extraction than those exposed to fewer training opportunities (AOR = 7.78, 95% CI: 4.169–14.524). Providers who worked in administrative councils other than Kigoma Municipality were 2.7 times more likely to have conducted vacuum extraction than their colleagues in Kigoma Municipality (AOR = 2.67, 95% CI: 1.023–6.976). Similarly, providers posted in a health center compared to those in a hospital were twice as likely to have conducted a recent vacuum extraction (AOR = 2.11, 95% CI: 1.153–3.850), and finally, male providers were twice as likely as their female colleagues to have performed this procedure recently (AOR = 1.95, 95% CI: 1.072–3.55).

Conclusions
Training and location of posting were associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components.
The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis
Authors: Qeadan Fares , Mensah Nana A. , Tingey Benjamin , Stanford Joseph B. 
Published: April 2021

AbstractBackgroundPregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity.MethodsWe used retrospective data from January through June 2020 on female patients aged 18–44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions.ResultsOut of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%,P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day,P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days,P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%,P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups.ConclusionsAmong women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.
Cystic fibrosis in disguise – the wolf in sheep’s clothing, a case report
Authors: Wilbert Friederike , Grünert Sarah C. , Heinzmann Andrea , Bode Sebastian F. N. 
Published: April 2021

Abstract
Background
Childhood hypoglycemia in combination with hepatomegaly is suspicious for inborn errors of metabolism. Cystic fibrosis typically presents with failure to thrive, pulmonary and gastrointestinal symptoms. Hepatic involvement and hypoglycemia can occur in a significant number of patients, although hepatomegaly is uncommon.

Case presentation
A 28 months old boy was presented with recurrent upper airways infections, progressive lethargy and weight loss. Clinically hepatomegaly was the main presenting feature and hypoglycemia (minimum 1.4 mmol/l) was noted as were elevated transaminases. The patient did not produce enough sweat to analyze it. Infectious causes for hepatitis were excluded and a broad metabolic work-up initiated. A therapy with starch was initiated to control hypoglycemia. In further course loose stools were reported and pancreatic elastase was found to be reduced. A further sweat test yielded pathological chloride concentration and genetic testing confirmed the diagnosis of cystic fibrosis.

Conclusions
Cystic fibrosis is a systemic disease and less common presentations need to be considered. Even in the age of CF-newborn screening in many countries CF needs to be ruled out in typical and atypical clinical presentations and diagnostics need to be repeated if inconclusive.
Occupational lifting and risk of hypertension, stratified by use of anti-hypertensives and age - a cross-sectional and prospective cohort study
Authors: Korshøj Mette , Hannerz Harald , Frikke-Schmidt Ruth , Marott Jacob L. , Schnohr Peter , Clays Els , Holtermann Andreas 
Published: April 2021

Abstract
Background
Heavy occupational lifting is prevalent in the general working population and is sparsely reported to associate with hypertension, especially among older and hypertensive workers. We investigated if heavy occupational lifting is associated with hypertension and blood pressure (BP) in both cross-sectional and prospective study designs in the Copenhagen General Population Study, stratified by age, and use of anti-hypertensives.

Methods
Participation was conducted following the declaration of Helsinki and approved by the ethical committee (H-KF-01-144/01). By multivariable logistic and linear regression models, we investigated the association between heavy occupational lifting and hypertension, in a cross-sectional design (n = 67,363), using anti-hypertensives or BP ≥140/≥90 mmHg as outcome, and in a prospective design (n = 7020) with an above-median change in systolic BP (SBP) from baseline to follow-up and/or a shift from no use to use of anti-hypertensives as outcome, with and without stratification by age and use of anti-hypertensives.

Results
The odds ratio for hypertension was estimated at 0.97 (99% CI: 0.93–1.00) in the cross-sectional analysis, and at 1.08 (99% CI: 0.98–1.19) in the prospective analysis. The difference in SBP among workers with versus without heavy occupational lifting was estimated at − 0.29 mmHg (99% CI -0.82 – 0.25) in the cross-sectional and at 1.02 mmHg (99% CI -0.41 – 2.45) in the prospective analysis. No significant interaction between heavy occupational lifting and age, nor use of anti-hypertensives were shown.

Conclusions
Only the prospective analysis indicated heavy occupational lifting to increase the risk of hypertension. Further research on the association between occupational lifting and hypertension are needed.
Modeling of suppression and mitigation interventions in the COVID-19 epidemics
Authors: Han Yuexing , Xie Zeyang , Guo Yike , Wang Bing 
Published: April 2021

AbstractBackgroundThe global spread of the COVID-19 pandemic has become the most fundamental threat to human health. In the absence of vaccines and effective therapeutical solutions, non-pharmaceutic intervention has become a major way for controlling the epidemic. Gentle mitigation interventions are able to slow down the epidemic but not to halt it well. While strict suppression interventions are efficient for controlling the epidemic, long-term measures are likely to have negative impacts on economics and people’s daily live. Hence, dynamically balancing suppression and mitigation interventions plays a fundamental role in manipulating the epidemic curve.MethodsWe collected data of the number of infections for several countries during the COVID-19 pandemics and found a clear phenomenon of periodic waves of infection. Based on the observation, by connecting the infection level with the medical resources and a tolerance parameter, we propose a mathematical model to understand impacts of combining intervention measures on the epidemic dynamics.ResultsDepending on the parameters of the medical resources, tolerance level, and the starting time of interventions, the combined intervention measure dynamically changes with the infection level, resulting in a periodic wave of infections controlled below an accepted level. The study reveals that, (a) with an immediate, strict suppression, the numbers of infections and deaths are well controlled with a significant reduction in a very short time period; (b) an appropriate, dynamical combination of suppression and mitigation may find a feasible way in reducing the impacts of epidemic on people’s live and economics.ConclusionsWhile the assumption of interventions deployed with a cycle of period in the model is limited and unrealistic, the phenomenon of periodic waves of infections in reality is captured by our model. These results provide helpful insights for policy-makers to dynamically deploy an appropriate intervention strategy to effectively battle against the COVID-19.
Higher maternal BMI early in pregnancy is associated with overweight and obesity in young adult offspring in Thailand
Authors: Ounjaijean Sakaewan , Wongthanee Antika , Kulprachakarn Kanokwan , Rerkasem Amaraporn , Pruenglampoo Sakda , Mangklabruks Ampica , Rerkasem Kittipan , Derraik José G. B. 
Published: April 2021

Abstract
Background
Rates of overweight and obesity among women of reproductive age have been steadily increasing worldwide and in Thailand. There is mounting evidence that maternal obesity during pregnancy is associated with an increased risk of obesity and other adverse health outcomes in the offspring, but such data are lacking for Thailand. We examined the associations between maternal body mass index (BMI) and anthropometry (particularly the likelihood of obesity) and cardiometabolic parameters in young adult offspring.

Methods
This was a prospective follow-up study of a birth cohort in Chiang Mai (Thailand). Pregnant women carrying singletons were recruited at their first antenatal visit (< 24 weeks of gestation) and followed until delivery in 1989–1990. Participants were their young adult offspring followed up in 2010. Maternal BMI was recorded at the first antenatal visit. The offspring underwent clinical assessments, including anthropometry, lipid profile, insulin sensitivity (HOMA-IR), blood pressure, and carotid intima-media thickness. The primary outcome of interest was the likelihood of obesity in the offspring.

Results
We assessed 628 young adults (54% were females) at 20.6 ± 0.5 years of age (range 19.1–22.1 years). The young adult offspring of mothers with overweight/obesity was 14.1 kg (95%CI 9.7, 18.5; p < 0.0001) and 9.4 kg (95% CI 6.1, 12.8; p < 0.0001) heavier than those born to mothers with underweight or normal weight, respectively, and had BMI 3.46 kg/m2 (95%CI 2.26, 4.67; p < 0.0001) and 5.27 kg/m2 (95%CI 3.67, 8.68; p < 0.0001) greater, respectively. For every 1-kg/m2 increase in maternal BMI, the adjusted odds ratio (aOR) of offspring obesity was 25% greater (95%CI 1.10, 1.42; p < 0.001). Thus, the aOR of obesity in offspring of mothers with overweight/obesity was 4.6 times greater (95%CI 1.86, 11.26; p < 0.001) and nearly 17-fold greater (95%CI 1.96, 146.4; p = 0.010) compared to young adults born to mothers with normal weight or underweight, respectively. There were no observed associations between maternal BMI status and offspring metabolism or blood pressure.

Discussion
Maternal overweight/obesity early in pregnancy was associated with increased BMI and greater odds of obesity in their young adult offspring in Thailand. These findings highlight the public health importance of fostering healthier lifestyle choices among women of reproductive age.
Analysis of work-related accidents and ill-health in Brazil since the introduction of the accident prevention factor
Authors: Shimizu Helena Eri , Bezerra Josierton Cruz , Arantes Luciano José , Merchán-Hamann Edgar , Ramalho Walter 
Published: April 2021

Abstract
Background
Since 2004, Brazil has had a national policy for occupational health and safety. This policy means companies’ tax burden is altered according to the numbers of work-related accidents and ill-health amongst their workers. In 2010, a multiplication factor was introduced to this policy, called the Accident Prevention Factor. The idea of this new multiplication factor is to encourage individual employers to take initiatives to prevent accidents and ill health in the workplace. This study was designed to investigate the incidence of work-related accidents and ill-health in Brazil according to their causes, their severity, and the economic activity in which they occur, and to compare the data before and after the introduction of the Accident Prevention Factor.

Methods
An ecological study was conducted by analyzing the time series of work-related accidents/ill-health between 2008 and 2014 from the Brazilian social security system (Previdência Social) statistical yearbooks. Incidences were calculated per cause, economic activity, and severity of the accident/ill-health. Data from before and after the introduction of the Accident Prevention Factor were compared using the Mann-Whitney test per cause and per economic activity. Statistical analyses were made using the SPSS software, with significance set at 5%.

Results
A reduction in the incidence of work-related accidents/ill-health was found across all the groups of causes analyzed, except for the groups “external causes of morbidity and mortality” and “factors influencing health status and contact with health services.” Greater reductions were found for diseases of the musculoskeletal system and connective tissue and diseases of the nervous system. Reductions in work-related accidents/ill-health were found in the different economic activities and in the different severity groups. The highest reduction after the introduction of the Accident Prevention Factor was in manufacturing and production (p < 0.05).

Conclusions
Overall, the incidence of accidents/ill-health was found to be on decline, except those with external causes of morbidity and mortality and those involving factors influencing health status and contact with health services. The biggest reduction was found in manufacturing and production. However, generally speaking progress still needs to be made in accident prevention and occupational health across a whole range of work environments.
Prevalence and factors associated with alcohol consumption among persons with diabetes in Kampala, Uganda: a cross sectional study
Authors: Salama Maki Sifa , Isunju Jonh Bosco , David Salama Kaishusha , Muneza Fiston , Ssemanda Sylvester , Tumwesigye Nazarius Mbona 
Published: April 2021

Abstract
Background
The prevalence of diabetes has been rising increasing rapidly in middle- and low-income countries. In Africa, the World Health Organization projections anticipate diabetes mellitus to be the seventh leading cause of death in by 2030. Alcohol consumption influences diabetes evolution, in such a way that it can interfere with self-care behaviours which are important determinants of diabetes prognosis. In this study, we evaluated factors associated with alcohol consumption among persons with diabetes in Kampala to inform management policies and improve comprehensive diabetes care.

Methodology
A cross-sectional study was conducted systematically among 290 adults with diabetes, attending diabetic clinics at Mulago National Referral Hospital and St Francis Hospital Nsambya. Data were entered and analysed in Epi-Info version 7 and STATA 13 software. Modified Poisson regression was used to identify factors associated with alcohol consumption among persons with diabetes. All tests were two-sided and the significance level for all analyses was set to p < 0.05.

Results
The prevalence of alcohol consumption among persons with diabetes was 23.45% [95% CI: 18.9–28.7%]. Divorced, separated and widowed patients (Adj PR: 0.42, 95% CI: 0.21–0.83); and Protestant (Adj PR: 0.44, 95% CI: 0.24–0.82); Muslim (Adj PR: 0.30, 95% CI: 0.14–0.62); and Pentecostal (Adj PR: 0.32, 95% CI: 0.15–0.65) patients were less likely to consume alcohol. Diabetic patients who had a diabetes duration greater than 5 years were more likely to consume alcohol (Adj PR: 1.90, 95% CI: 1.25–2.88).

Conclusion
Approximately one-quarter of participants consumed alcohol. However being catholic, never being married and having diabetes for more than 5 years predisposed persons with diabetes to alcohol consumption. Sensitization messages regarding alcohol consumption among persons with diabetes should be target patients who have never been married and those who have spent more than 5 years with diabetes; religion should also be considered as an important venue for health education in the community.
The effect of cognition and affect on preventive behaviors during the COVID-19 pandemic: a cross-sectional study in China
Authors: Shen Fei , Min Chen , Lu Ye , Chu Yajie 
Published: April 2021

Abstract
Background
The global outbreak of COVID-19 has become an international public health crisis. Specific antiviral treatments for COVID-19 are not yet available, and prevention is of particular importance to fight the virus. This study tends to explore and compare the roles of cognitive and affective factors in predicting preventive behavior adoption during the COVID-19 pandemic in China.

Methods
An online survey using a quota sampling method to collect responses from 3000 Chinese adults was conducted from March 2, 2020 to March 23, 2020. Questions included sociodemographic features, coronavirus knowledge, negative emotion, risk perception, and behavioral responses. Multiple regression analyses were conducted to examine the predictors of behavioral responses toward COVID-19.

Results
On average, respondents had low levels of knowledge about COVID-19 (the overall correct response rate was 7.5%). Most respondents reported moderate to strong negative emotions towards the virus (3.47 out of 5). The average reported perceived chance of infection was 23.89%. For behavioral responses, respondents reported low frequencies of going out for activities (1.98 out of 4) and high frequencies of taking preventive measures (3.22 out of 4). Behavioral responses toward COVID-19 were found to be determined by cognitive and affective variables. Knowledge was negatively related to frequency of going out for activities (β = − 0.11, p < .001). Negative emotion (β = 0.34, p < .001), and risk perception (β = 0.05, p = .007) were positively associated with going out for activities. The explanatory power of affective variables (ΔR2 = 12.1%) was greater than cognitive variables (ΔR2 = 1.0%). For preventive behaviors, knowledge was positively associated with preventive behaviors (β = 0.22, p < .001). Negative emotion (β = − 0.28, p < .001) and risk perception (β = − 0.05, p = .002) were all negatively associated with preventive measures. Affective variables still showed stronger explanatory power (ΔR2 = 8%) than cognitive variables (ΔR2 = 4.4%) in predicting preventive behaviors.

Conclusions
After the rising period of the COVID-19 outbreak in mainland China, cognitive and affective variables still played important roles in predicting behavioral responses. Compared with cognitive factors, affective factors demonstrated stronger explanatory power in predicting behavioral responses toward COVID-19. The findings may have implications for enhancing individual compliance with guidelines of adopting preventive behaviors in response to COVID-19.