bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitalization of unintentional fall injuries in Kuwait: a national database study
Authors: Ibrahim Islam Kamal , AlAsoomi Fatima 
Published: July 2021

Abstract
Background
Accidental falls are a major cause of morbidity placing pressure on hospital capacity and utilizing costly services. Evaluating the burden of falls is key for planning, implementation, and evaluation of prevention strategies. To date, no studies have been published on accidental falls at the population level in Kuwait. We studied the burden of accidental falls on public hospital inpatient capacity in Kuwait and identified the subgroups with the highest utilization of inpatient service days.

Methods
From the national database of inpatient hospitalizations, we selected hospitalizations of patients admitted to Kuwait’s public hospitals for unintentional injury caused by an accidental fall from 1 January through 31 December 2016. We studied the number of inpatient service days (bed days), length of stay (LOS), and number of hospitalizations by age group, gender, and nationality. Mann–Whitney, Kruskal-Wallis, and Chi square tests were used for comparison. Logistic regression was used to quantify the risk of prolonged LOS and fractures among fall-related hospitalizations.

Results
Accidental falls were responsible for 2.9% of inpatient hospitalizations, 3.7% of inpatient service days (61,140 days) with an ALOS of 9.1 days in Kuwait’s public hospitals in 2016. Accidental falls were responsible for 4.6% of older adult service days, and an even higher 5.6% of older women service days. In the age group 13–64, fall-related service days for non-Kuwaitis (5.7%) were more than triple those for Kuwaitis (1.8%) with a substantial percentage among male non-Kuwaitis (8.1%). The risk factors for exceeding the national ALOS for fall-related hospitalizations were female gender (OR 1.36), age 65 and older (OR 9.72), age 13–64 (OR 5.20), being non-Kuwaiti (OR 1.39), sustaining a femur fracture (OR 11.67), and undergoing surgery (OR 2.63). Fall-related hospitalizations associated with a higher risk of fractures were females (OR 1.22), patients 65 years and older (OR 5.09), patients aged 13–64 (OR 3.65), and non-Kuwaitis (OR 1.28).

Conclusions
Accidental falls impose a considerable burden on inpatient service utilization in Kuwait. This varies by age, gender, and nationality. To reduce this burden, prevention programs should target working-age non-Kuwaiti males and older females.
A qualitative assessment of the sexual-health education, training and service needs of young adults in Tehran
Authors: Sheikhansari Narges , Abraham Charles , Denford Sarah , Eftekhar Mehrdad 
Published: July 2021

Abstract
Background
Sexual Health and Relationships Education (SHRE) provides individuals with knowledge and skills to manage risky behaviors and take informed decisions to protect themselves against STIs, and unintended pregnancy. Only minimal SHRE is provided in Iranian schools and universities and previous research has highlighted needs and demands for improved SHRE and sexual services in Iran. This study explored young, Iranian adults’ experience of, and need for sexual health education, sexual skills training and sexual healthcare services, as well their views on how to augment and improve existing provision.

Design and methods
Semi-structured interviews were conducted with a sample of 25 young adults who lived in Tehran, Iran and had volunteered to participate in the study. Transcripts were analyzed using thematic analysis.

Results
Participants explained their needs and demands for sexual health education and sexual healthcare. They unanimously expressed their dissatisfaction with available SHRE and sexual health care provision. They highlighted barriers to gaining sexual health information and seeking advice and healthcare, including a lack of reliable resources, taboo and cultural barriers, lack of trust and protected confidentiality. This has resulted in ambiguities and misconceptions, including those regarding the cause and transmission of STIs and correct use of contraceptives. Participants recommended improvements, including holding mixed-gender extracurricular workshops with a comprehensive approach to sexual health and relationships education.

Conclusions
There is a clear need and demand for provision of relevant and reliable sexual health and relationships education for young adults in Tehran. This should be addressed to empower young people to make informed choices and avoid risky sexual behavior.
Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa
Authors: Shahmanesh Maryam , Okesola Nonhlanhla , Chimbindi Natsayi , Zuma Thembelihle , Mdluli Sakhile , Mthiyane Nondumiso , Adeagbo Oluwafemi , Dreyer Jaco , Herbst Carina , McGrath Nuala , Harling Guy , Sherr Lorraine , Seeley Janet 
Published: July 2021

AbstractBackgroundDespite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN).MethodsBetween March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapta biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307).ResultsFollowing written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create theThetha Nami(`talk to me’). The intervention includedpeer-led health promotionto improve self-efficacy and demand for HIV prevention,referrals to social and educational resources,andaaccessible youth-friendly clinical servicesto improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined theThetha Namiintervention to add three components:structured assessment toolto tailor health promotion and referrals,safe spaces and community advocacyto create an enabling environment, andpeer-mentorship and navigationof resources to improve retention in HIV prevention.ConclusionLocal youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.
Development of an online curriculum for California early care and education providers on healthy beverages
Authors: Hazard Kimberly , Lee Danielle , Ritchie Lorrene , Rose Roberta , Rios L. Karina Díaz , Plank Kaela , Alkon Abbey 
Published: July 2021

Abstract
Background
Children’s consumption of sugar-sweetened beverages is associated with obesity, diabetes, and dental decay. California’s Healthy Beverages in Child Care Act (AB 2084) requires all licensed child care centers and family child care homes to comply with healthy beverages standards, however many licensed providers in California are unaware of the law and few are fully compliant with the law’s requirements. The aim of the current project is to describe the development of a self-paced online training on best practices and implementation of AB 2084 in English and Spanish for family child care home and child care center providers; and to evaluate the feasibility, defined as being accessible, acceptable, and satisfactory to providers, of this new online course.

Methods
The project was broken into two main stages: (1) development of the online course; and (2) evaluation of the final online course. The first stage was completed in five phases: (1) identify relevant course content and develop narration script; (2) conduct in-person focus groups with child care providers to review and edit the content; (3) adapt course content and translate for Spanish-speaking providers; (4) build the online course and resources; and (5) pilot online course and evaluate accessibility. The second stage, evaluation of the acceptability and satisfaction of the final course was rated on a Likert scale from 1 to 4; the evaluation was completed as part of a larger randomized control trial with 43 child care providers. The course features four key requirements of AB 2084 as the main sections of the course (milk, sweetened beverages, juice, and water), plus background information about beverages and children’s health, special topics including caring for children with special needs, family engagement, written policies, and child engagement.

Results
The child care providers who completed the evaluation found the online training was easily understandable (median(Q1,Q3,IQR) = 4 (4,4,0)), included new information (3 (1, 3, 4)), provided useful resources (4(4,4,0)), and was rated with high overall satisfaction (3 (1, 3, 4)).

Conclusion
Online training in English and Spanish designed for child care providers is a feasible medium to deliver important health messages to child care providers in an accessible, acceptable, and satisfactory manner.
Do perceived social neighborhood factors explain the association between neighborhood age composition and mental health among Dutch older adults?
Authors: Verspoor Eline , Beenackers Mariëlle A. , Oude Groeniger Joost , van Lenthe Frank J. 
Published: July 2021

Abstract
Background
In the light of urbanization and aging, a crucially relevant policy question is how to shape neighborhoods to foster healthy aging. An important debate is whether older adults should group in neighborhoods, or whether a more mixed neighborhood age composition is more beneficial to health and well-being. We therefore assessed the association between neighborhood age structure and mental health and the mediating role of individual perceptions of neighborhood social factors.

Methods
We conducted multivariable linear regression models and causal mediation analyses in 1255 older adults of the Dutch Globe study. The neighborhood age structure was measured in 2011 as the homogeneity of the age composition (using the Herfindahl-Hirschman index, range from 0 to 100, a higher score indicating more homogeneity) and the percentage of specific age groups in a neighborhood. Mental health was measured in 2014 by the Mental Health Inventory-5 score (range 0 to 100, a higher score indicating better mental health). Potential mediators were assessed in 2011 and included perceptions of neighborhood social cohesion, feeling at home in a neighborhood, and social participation.

Results
A more homogeneous age composition (not specified for age) and a higher percentage of children living in a neighborhood were associated with better mental health, the other age categories were not. Social cohesion, feeling at home and social participation did not mediate the associations.

Conclusions
The neighborhood age composition may be an interesting but currently insufficiently understood entry point for policies to improve older adult’s mental health status.
Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial
Authors: Hashemi Zahra Sadat , Khorsandi Mahboobeh , Shamsi Mohsen , Moradzadeh Rahmatollah 
Published: July 2021

Abstract
Background
In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6–12-aged students.

Methods
In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.

Results
Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p  > 0.05).

Conclusion
The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy.
IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017–05-17 https://en.irct.ir/trial/25851
Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication
Authors: Chen Yi-Hsuan , Chen Marcelo , Chen Yu-Hsin 
Published: July 2021

Abstract
Background
Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy.

Case presentation
A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place.

Conclusions
A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.
Pushing poverty off limits: quality improvement and the architecture of healthcare values
Authors: Mitchell Polly , Cribb Alan , Entwistle Vikki , Singh Guddi 
Published: July 2021

Abstract
Background
Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI).

Discussion
Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health.

Conclusions
We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.
Non-medical risk factors associated with postponing elective surgery: a prospective observational study
Authors: Becker Julia , Huschak Gerald , Petzold Hannes-Caspar , Thieme Volker , Stehr Sebastian , Bercker Sven 
Published: July 2021

AbstractBackgroundOperation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons.MethodsIn this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–WhitneyUtest and Fisher's exact test/χ2-test.ResultsSignificantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer.ConclusionsElderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery.Trial registrationDRKS00015836. Retrospectively registered.
Comparison of alternative integration sites in the chromosome and the native plasmids of the cyanobacterium Synechocystis sp. PCC 6803 in respect to expression efficiency and copy number
Authors: Nagy Csaba , Thiel Kati , Mulaku Edita , Mustila Henna , Tamagnini Paula , Aro Eva-Mari , Pacheco Catarina C. , Kallio Pauli 
Published: July 2021

Abstract
Background
Synechocystis sp. PCC 6803 provides a well-established reference point to cyanobacterial metabolic engineering as part of basic photosynthesis research, as well as in the development of next-generation biotechnological production systems. This study focused on expanding the current knowledge on genomic integration of expression constructs in Synechocystis, targeting a range of novel sites in the chromosome and in the native plasmids, together with established loci used in literature. The key objective was to obtain quantitative information on site-specific expression in reference to replicon copy numbers, which has been speculated but never compared side by side in this host.

Results
An optimized sYFP2 expression cassette was successfully integrated in two novel sites in Synechocystis chromosome (slr0944; sll0058) and in all four endogenous megaplasmids (pSYSM/slr5037-slr5038; pSYSX/slr6037; pSYSA/slr7023; pSYSG/slr8030) that have not been previously evaluated for the purpose. Fluorescent analysis of the segregated strains revealed that the expression levels between the megaplasmids and chromosomal constructs were very similar, and reinforced the view that highest expression in Synechocystis can be obtained using RSF1010-derived replicative vectors or the native small plasmid pCA2.4 evaluated in comparison. Parallel replicon copy number analysis by RT-qPCR showed that the expression from the alternative loci is largely determined by the gene dosage in Synechocystis, thereby confirming the dependence formerly proposed based on literature.

Conclusions
This study brings together nine different integrative loci in the genome of Synechocystis to demonstrate quantitative differences between target sites in the chromosome, the native plasmids, and a RSF1010-based replicative expression vector. To date, this is the most comprehensive comparison of alternative integrative sites in Synechocystis, and provides the first direct reference between expression efficiency and replicon gene dosage in the context. In the light of existing literature, the findings support the view that the small native plasmids can be notably more difficult to target than the chromosome or the megaplasmids, and that the RSF1010-derived vectors may be surprisingly well maintained under non-selective culture conditions in this cyanobacterial host. Altogether, the work broadens our views on genomic integration and the rational use of different integrative loci versus replicative plasmids, when aiming at expressing heterologous genes in Synechocystis.