bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors
Authors: Hutchinson Paul L. , Anaba Udochisom , Abegunde Dele , Okoh Mathew , Hewett Paul C. , Johansson Emily White 
Published: June 2021

Abstract
Background
Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval.

Methods
Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants.

Results
Knowledge, approval of family planning, and social influences, particularly from husbands, were all associated with improved family planning outcomes. Approval of family planning was critical – women who personally approve of family planning were nearly three times more likely to be currently using modern contraception and nearly six times more likely to intend to start use in the next 6 m. Husband’s influence was also critical. Women who had ever talked about family planning with their husbands were three times more likely both to be currently using modern contraception and to intend to start in the next 6 m.

Conclusion
SBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use—even without large-scale changes in socio-economic and health services factors—by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Uncertainty about the time-order of influencers and outcomes however precludes inferences about the existence of causal relationships and the potential for impact from interventions.
Analysis of the current status and associated factors of tuberculosis knowledge, attitudes, and practices among elderly people in Shenzhen: a cross-sectional study
Authors: Wang Yunxia , Gan Yong , Zhang Juanjuan , Mei Jinzhou , Feng Jing , Lu Zuxun , Shen Xin , Zhao Meigui , Guo Yanfang , Yuan Qing 
Published: June 2021

Abstract
Background
The incidence and risk of tuberculosis (TB) among the elderly population have increased with the ageing population in China. This study aimed to assess the current status and associated factors of TB knowledge, attitudes, and practices among elderly people in Shenzhen City, China, which may provide references for the development of TB prevention and treatment policies targeting elderly people.

Methods
A multistage random sampling method was used to collect data with a self-designed questionnaire from 1078 elderly people (response rate, 90.66%) living in Bao’an District of Shenzhen between September and October 2019. Univariate and multiple linear regression analyses were used to analyse factors associated with TB knowledge, attitudes, and practices among elderly people.

Results
Among the respondents, 3.13% had previously been treated for TB, and 3.09% of respondents had family members or friends with a previous TB history. The percentages of elderly people who were aware of TB and had positive attitudes and practices regarding TB were 69.23%, 48.87%, and 42.62%, respectively. Multiple linear stepwise regression analysis showed that elderly people with a junior high school education or higher, a family annual income per capita of less than 100,000 RMB, a better self-perceived health status, and family members or friends with a previous TB history had higher TB knowledge scores (P < 0.05). Elderly people with medical insurance, a junior high school or higher education, a family annual income per capita of less than 100,000 RMB, and family members and friends with a previous TB history had higher TB attitude scores (P < 0.05). In addition, elderly people who were older, had medical insurance, had a junior high school education or higher, and had a family annual income per capita less than 100,000 RMB had higher TB practice scores (P < 0.05).

Conclusions
Elderly people were aware of TB, but their positive attitudes and practices were at a low level. Corresponding prevention and treatment policies should be developed according to these influencing factors to reduce the incidence of TB among elderly people and improve their quality of life.
Urogenital fascia anatomy study in the inguinal region of 10 formalin-fixed cadavers: new understanding for laparoscopic inguinal hernia repair
Authors: Li Yi , Qin Changfu , Yan Likun , Tong Cong , Qiu Jian , Zhao Yamin , Xiao Yang , Wang Xiaoqiang 
Published: June 2021

Abstract
Purpose
To investigate the urogenital fascia (UGF) anatomy in the inguinal region, to provide anatomical guidance for laparoscopic inguinal hernia repair (LIHR).

Methods
The anatomy was performed on 10 formalin-fixed cadavers. The peritoneum and its deeper fascial tissues were carefully dissected.

Results
The UGF’s bilateral superficial layer extended and ended in front of the abdominal aorta. At the posterior axillary line, the superficial layer medially reversed, with extension represented the UGF's deep layer. The UGF's bilateral deep layer medially extended beside the vertebral body and then continued with the transversalis fascia. The ureters, genital vessels, and superior hypogastric plexus moved between both layers. The vas deferens and spermatic vessels, ensheathed by both layers, moved through the deep inguinal ring. From the deep inguinal ring to the midline, the superficial layer extended to the urinary bladder’s posterior wall, whereas the deep layer extended to its anterior wall. Both layers ensheathed the urinary bladder and extended along the medial umbilical ligament to the umbilicus and in the sacral promontory, extended along the sacrum, forming the presacral fascia. The superficial layer formed the rectosacral fascia at S4 sacral vertebra, and the deep layer extended to the pelvic diaphragm, terminating at the levator ani muscle.

Conclusion
The UGF ensheaths the kidneys, ureters, vas deferens, genital vessels, superior hypogastric plexus, seminal vesicles, prostate, and urinary bladder. This knowledge of the UGF’s anatomy in the inguinal region will help find correct LIHR targets and reduce bleeding and other complications.
A nomogram for predicting feasibility of laparoscopic anterior resection with trans-rectal specimen extraction (NOSES) in patients with upper rectal cancer
Authors: Zhang Zhen-Yu , Zhu Zhe , Zhang Yuanyuan , Ni Li , Lu Bing 
Published: June 2021

Abstract
Background
Laparoscopic anterior resection with trans-rectal specimen extraction (NOSES) has been demonstrated as a safe and effective technique in appropriate patients with upper rectal cancer (RC). However, improper selection of RC candidates for NOSES may lead to potential surgical and oncological unsafety as well as complications such as bacteria contamination and anastomotic leak. Unfortunately, no tools are available for evaluating the risk and excluding improper cases before surgery. This study aims to estimate its clinical relevancy and to investigate independent clinical-pathological predictors for identifying candidates for NOSES in patients with upper RC and to develop a validated scoring nomogram to facilitate clinical decision making.

Methods
The study was performed at Shanghai East hospital, a tertiary medical center and teaching hospital. 111 eligible patients with upper RC who underwent elective laparoscopic anterior resection between February and October of 2017 were included in the final analysis. Univariate and multivariate analyses were performed to compare characteristics between the two surgical techniques. Odds ratios (OR) were determined by logistic regression analyses to identify and quantify the clinical relevancy and ability of predictors for identifying NOSES candidate. The nomogram was constructed and characterized by c-index, calibration, bootstrapping validation, ROC curve analysis, and decision curve analysis.

Results
Upper RC patients with successful NOSES tended to be featured with female gender, negative preoperative CEA/CA19-9, decreased mesorectum length (MRL), ratio of diameter (ROD) and ratio of area (ROA) values, while no significant statistical correlations were observed with age, body mass index (BMI), tumor location, and tumor-related biological characteristics (ie., vascular invasion, lymph node count, TNM stages). Furthermore, the two techniques exhibited comparably low incidence of perioperative complications and achieved similar functional results under the standard procedures. The nomogram incorporating three independent preoperative predictors including gender, CEA status and ROD showed a high c-index of 0.814 and considerable reliability, accuracy and clinical net benefit.

Conclusions
NOSES for patients with upper RC is multifactorial; while it is a safe and efficient technique if used properly. The nomogram is useful for patient evaluation in the future.
Consent for withholding life-sustaining treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law
Authors: Chung Yu Jin , Park Incheol , Cho Junho , Beom Jin Ho , Lee Ji Eun 
Published: June 2021

Abstract
Background
The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.

Methods
This retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.

Results
The length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).

Conclusion
After the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased.
Relationship between sleep habits and academic performance in university Nursing students
Authors: Gallego-Gómez Juana Inés , González-Moro María Teresa Rodríguez , González-Moro José Miguel Rodríguez , Vera-Catalán Tomás , Balanza Serafín , Simonelli-Muñoz Agustín Javier , Rivera-Caravaca José Miguel 
Published: June 2021

Abstract
Background
Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students.

Methods
This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the ‘Morningness and Eveningness scale’, an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the ‘sleep habits questionnaire’ was assessed with the Cronbach’s alpha test.

Results
Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the ‘sleep habits questionnaire’ was appropriate (Cronbach’s alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01–2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11–2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30–3.98) were independently associated with a higher probability of poor academic performance.

Conclusions
Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.
Impact of replacing sedentary behaviour with other movement behaviours on depression and anxiety symptoms: a prospective cohort study in the UK Biobank
Authors: Kandola A. A. , del Pozo Cruz B. , Osborn D. P. J. , Stubbs B. , Choi K. W. , Hayes J. F. 
Published: June 2021

AbstractBackgroundSedentary behaviour is potentially a modifiable risk factor for depression and anxiety disorders, but findings have been inconsistent. To assess the associations of sedentary behaviour with depression and anxiety symptoms and estimate the impact of replacing daily time spent in sedentary behaviours with sleep, light, or moderate to vigorous physical activity, using compositional data analysis methods.MethodsWe conducted a prospective cohort study in 60,235 UK Biobank participants (mean age: 56; 56% female). Exposure was baseline daily movement behaviours (accelerometer-assessed sedentary behaviour and physical activity, and self-reported total sleep). Outcomes were depression and anxiety symptoms (Patient Health Questionnaire-9 and Generalised Anxiety Disorders-7) at follow-up.ResultsReplacing 60 min of sedentary behaviour with light activity, moderate-to-vigorous activity, and sleep was associated with lower depression symptom scores by 1.3% (95% CI, 0.4–2.1%), 12.5% (95% CI, 11.4–13.5%), and 7.6% (95% CI, 6.9–8.4%), and lower odds of possible depression by 0.95 (95% CI, 0.94–0.96), 0.75 (95% CI, 0.74–0.76), and 0.90 (95% CI, 0.90–0.91) at follow-up.Replacing 60 min of sedentary behaviour with moderate-to-vigorous activity and sleep was associated with lower anxiety symptom scores by 6.6% (95% CI, 5.5–7.6%) and 4.5% (95% CI, 3.7–5.2%), and lower odds of meeting the threshold for a possible anxiety disorder by 0.90 (95% CI, 0.89–0.90) and 0.97 (95%CI, 0.96–0.97) at follow-up. However, replacing 60 min of sedentary behaviour with light activity was associated with higher anxiety symptom scores by 4.5% (95% CI, 3.7–5.3%) and higher odds of a possible anxiety disorder by 1.07 (95% CI, 1.06–1.08).ConclusionsSedentary behaviour is a risk factor for increased depression and anxiety symptoms in adults. Replacing sedentary behaviour with moderate-to-vigorous activity may reduce mental health risks, but more work is necessary to clarify the role of light activity.
Long non-coding RNA MEG3 mediates the miR-149-3p/FOXP3 axis by reducing p53 ubiquitination to exert a suppressive effect on regulatory T cell differentiation and immune escape in esophageal cancer
Authors: Xu Qi-Rong , Tang Jian , Liao Hong-Ying , Yu Ben-Tong , He Xiang-Yuan , Zheng Yu-Zhen , Liu Sheng 
Published: June 2021

Abstract
Background
Long non-coding RNA (lncRNA) maternally expressed gene 3 (MEG3) has been implicated in the progression of esophageal cancer (EC). However, the specific mechanism of the involvement of MEG3 in EC development in relation to the regulation of immune escape remains uncertain. Thus, the aim of the current study was to investigate the effect of MEG3 on EC via microRNA-149-3p (miR-149-3p).

Methods
Gain- and loss-of-function experiments were initially performed in EC cells in addition to the establishment of a 4-nitroquinoline 1-oxide-induced EC mouse model aimed at evaluating the respective roles of forkhead box P3 (FOXP3), MEG3, miR-149-3p, mouse double minute 2 homolog (MDM2) and p53 in T cell differentiation and immune escape observed in EC.

Results
EC tissues were found to exhibit upregulated FOXP3 and MDM2 while MEG3, p53 and miR-149-3p were all downregulated. FOXP3 was confirmed to be a target gene of miR-149-3p with our data suggesting it reduced p53 ubiquitination and degradation by means of inhibiting MDM2. P53 was enriched in the promoter of miR-149-3p to upregulate miR-149-3p. The overexpression of MEG3, p53 or miR-149-3p or silencing FOXP3 was associated with a decline in CD25+FOXP3+CD4+ T cells, IL-10+CD4+ T cells and IL-4+CD4+ T cells in spleen tissues, IL-4, and IL-10 levels as well as C-myc, N-myc and Ki-67 expression in EC mice.

Conclusion
Collectively, MEG3 decreased FOXP3 expression and resulted in repressed regulatory T cell differentiation and immune escape in EC mice by upregulating miR-149-3p via MDM2-mediated p53.
Fathers’ experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study
Authors: Mӧrelius Evalotte , Brogren Sofia , Andersson Sandra , Alehagen Siw 
Published: June 2021

Abstract
Background
Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers’ perspectives.

Methods
The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24–27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013–2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021.

Results
Six sub-categories and two generic categories formed the main category: “a team striving towards the same goal”. The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful.

Conclusions
The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.
Confidence level, challenges, and obstacles faced by orthopedic residents in obtaining informed consent
Authors: Alomar Abdulaziz Z. 
Published: June 2021

AbstractObjectivesThe objective is to evaluate the opinions of orthopedic residents on current practices, experiences, training, confidence level, difficulties, and challenges faced when obtaining informed consent.DesignThis is a cross-sectional, multi-center, and questionnaire-based study.SettingThe study was done in forty-four training centers across Saudi Arabia.ParticipantsIn total, 313 orthopedic residents participated.Material and methodsThe web-based questionnaire examined the perceptions of residents regarding practices, experience, training, difficulties, and challenges surrounding the obtention of informed consent, as well as residents’ confidence in obtaining informed consent for different orthopedic situations and eight common orthopedic procedures.ResultsMost residents were allowed to obtain consent independently for all emergency, trauma, primary, and revision cases at their institution (92.7%). Only 33.5% of the residents received formal training and teaching on obtaining informed consent, with 67.1% having believed that they needed more training. Only 4.2% of the residents routinely disclosed all essential information of informed consent to patients. Inadequate knowledge (86.3%) and communication barriers (84.7%) were the most reported difficulties. Generally, 77.3% of the residents described their confidence level in obtaining informed consent as good or adequate, and 33.9% were confident to discuss all key components of the informed consent. Residents’ confidence level to independently obtain informed consent decreased with procedure complexity. Receiving formal training, senior level (postgraduate year (PGY) 4 and 5), and being frequently involved in obtaining informed consent correlated with increased confidence level.ConclusionMany residents incompletely disclosed key information upon obtaining informed consent and reported lacking confidence in their ability to perform the procedure in their daily practices. To improve patient care and residents’ performance and overcome these difficulties and challenges, institutions should develop effective strategies to standardize the informed consent process, provide formal training for obtaining informed consent, and provide supervision for residents during obtention of informed consent.