bluuebunny/crossref_metadata_2025_split huggingface dataset:
Client perceived quality of the postnatal care provided by public sector specialized care institutions following a normal vaginal delivery in Sri Lanka: A cross sectional study
Authors: Wickramasinghe Sashimali , Gunathunga Wasantha , Hemachandra Nilmini 
Published: October 2019

Abstract
Background:
Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes.
Methods:
A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions.
Results:
The median score obtained for the questionnaire was 108, (Inter Quartile Range 96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38-45), 33 (IQR 30-35) and 32 (IQR 28-35) respectively. Attending teaching/ specialized hospitals (1.6, p<0.001), 20-35 age group (aOR=1.8, p=0.024), and services such as initiation of breast feeding within one hour of delivery (2.1, p=0.009), pain relief during episiotomy suturing (2.2, p<0.001), practicing Kangaroo Mother Care (1.4, p=0.035), receiving health advices by doctors or midwives (2.1, p<0.001) were significant correlates of positive perceptions.
Conclusions:
Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.

Key words:
Client perceptions, Postnatal care, Quality of care, Client perceived care, institutional postnatal care
Association between ovarian reserve and preeclampsia: a cohort study
Authors: Erfani Hadi , Rahmati Maryam , Mansournia Mohammad Ali , Azizi Fereidoun , Montazeri Seyed Ali , Shamshirsaz Alireza A. , Tehrani Fahimeh Ramezani 
Published: October 2019

Abstract
Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998-2014). Out of 2412 women aged 20-50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.Results PE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36 – 2.2) mg/L in women who experienced PE compared with 0.85 (0.28 – 2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4))Conclusions Age-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies is highly recommended for precise interpretation of the association between ovarian reserve status and PE.
Transformation of internal head structures during the metamorphosis of Chrysopa pallens (Neuroptera: Chrysopidae)
Authors: Zhao Chenjing , Ang Yuchen , Wang Mengqing , Gao Caixia , Zhang Kuiyan , Tang Chufei , Liu Xingyue , Li Min , Yang Ding , Meier Rudolf 
Published: October 2019

Abstract
Background The metamorphosis is a complicated but very interesting process because of the highly dynamic transformation in sheath. Very few studies had coverage on the head muscles of larvae, pupae, and adults. Most of these studies were focusing on the model organisms about the rough changes of the external and internal tissues or the time of metamorphosis based on the traditional methods. In our study,the skeleto-muscular system of head, as well as the brain of Chrysopa pallens (Rambur, 1838) from larvae to adults are described in detail for the first time by the technology of micro computed tomography (µ-CT). The transformations of these systems during pupal stage are studied for the first time.Results The morphological differences and functional adaptations between the stages are assessed. Muscles are distinctly slender in larvae than in adults with a significantly larger quantity. A larger brain with improved sensory perception is suggested to be essential for dispersal, mating and flying for adults. For the pupae, the results show that the histolysis of the muscles happens in first third of the pupal period and their reconstruction happens in the following days. The brain exists all along.Conclusion We suggest the transformations of the skeleton occur earlier than the musculature. Most of the transformations are related to tasks they play in the developmental stages.
Treatment adherence and associated factors among glaucoma patients attending ophthalmic unit of Debre Markos Referral and Felege Hiwot Comprehensive Specialized Hospitals
Authors: Ayenew setarg , Alem Girma , Tesfa Mulugeta , Mulugeta Henok , Gedefaw Mihretie 
Published: October 2019

Abstract
Background Glaucoma is one of the common eye disorders resulting from optic neuropathy which leads to irreversible blindness if left untreated. Poor adherence to glaucoma medical treatments leads to serious consequences such as progressive visual impairment and blindness. Despite its serious consequences, the level of glaucoma treatment adherence and associated factors have been poorly explored in Ethiopia particularly in the selected study areas. Hence, the objective of this study was to assess the level of adherence to treatment and associated factors among glaucoma patients attending at Debre Markos referral and Felege Hiwot comprehensive specialized Hospitals.Methods Institution based cross-sectional study was conducted from March 1st 2019 to April 30th 2019 among 414 consecutive glaucoma patients attending at ophthalmic units of Debre Markos Referral and Felege Hiwot Comprehensive Specialized hospitals. Data about adherence to glaucoma treatment was collected by using Morisky Medication adherence scale-8. Each collected data were coded and entered into Epi-Data version 4.2 and analysis was done using STATA version 14.0 statistical software. Descriptive analysis was done and binary logistic regression model was fitted to assess the effect of independent variable on the dependent variable. This was done using odds ratio within 95% confidence limits. A p-value < 0.05 was considered to declare statistically significant association.Results this study revealed that 189 (49.5%) of participants were adherent to glaucoma medical treatment. The result of multivariate logistic regression analysis showed that factors such as occupation (farmer), good knowledge, favorable attitude, a short distance from patients’ home to hospitals, and schedule problems for glaucoma medical follow-up visits were significantly associated with adherence to glaucoma medical treatments.Conclusion In this study almost one in two patients were adherent to glaucoma medical treatment which is low. Patient-related and health care system-related factors were significantly associated with adherence to glaucoma treatments. Policy-makers need to give attention to patient education and develop strategies to improve patients’ adherence to glaucoma medical treatment.
Estimation of LOS level in hospitalization with multiple attributes: taking patients with kidney disease as an example
Authors: Zhang Xinli , Shen Xue 
Published: October 2019

Abstract
Abstract: Aim: Thinking of the relationship between Multiple attributes and length of stay(LOS).This paper provide LOS level prediction method with applying a classification estimation of multi-avariables statistic,also provides suggestions of diversion management for kidney disease patients. Methods: We use three steps to finish the estimation. Firstly, Using the correlation-coefficient between the variable and LOS to find some sensitive factors; secondly,using projection pursuit clustering analysis to find the weight of each factor, then calculation the weighting value to discriminant the LOS level.thirdly, using mean test to give the multi-level classification of LOS based on the most sensitive factor. Results: We use 12547 kidney disease patients’ data in the year 2016 from a large hospital in the Department of Nephrology to applying the estimation method. The correlations results shows that the influence of variables on LOS are ranked as disease types>age>cost.The means test results demonstrate that patients with kidney disease are divided into 3 levels between 2-20 days of los. Short-term patients (los=2-9) are mainly treated with regular treatment; medium-term patients (los=10-15) are accompanied by emergency and acute attacks; long-term patients (los=16-20) need more treatments and long hospital observation period.Tested by multi-attribute multi-level discriminant model, Indicated that the kidney patients sample data can be modeled well by the builded models. Conclusion: We build the multi-variable multi-level discriminant model for LOS estimation, which is successively applied in kidney disease. The research offers a new way for LOS estimation through the Multi-variables. Key words:LOS; Multi-variable multi-level; Projection pursuit; Clustering and discriminant
Level of Awareness, Perception And Uptake Of Interventions For Computer Vision Syndrome Among University Students, Maseno, Western Kenya
Authors: Muma Shadrack , Aduda Dickens Omondi , Onyango Patrick 
Published: October 2019

Abstract
Background Computer vision syndrome is a multi-factorial condition of the eye that results in symptoms of stress and discomfort among computer users. It causes chronic vision-related morbidity and reduced work productivity. Ninety percent and 75% of computer users globally and in Africa respectively suffer from CVS. It is an insidious chronic condition that however, has hitherto received little attention, both by health providers as well as computer users. Also, it is likely to be under diagnosed as it mimics other eye conditions. The risk factors for CVS include prolonged period of electronic device use and glare. In Kenya, lack of awareness of the disease is a key barrier to early detection, health seeking and use of interventions. The burden of CVS and how much computer users in learning institutions are aware of and perceive CVS remains unknown.Methods This study adopted cross-sectional study design to determine the level of awareness, perception of CVS, uptake of preventive measures by students at Maseno University. In total, we administered questionnaires to 384 randomly selected students.Results The mean age was 19.5 years (SD= 0.747) with 18-24 years as the modal age group. Females comprised 51.3% (n=197) and males 48.7%. Participants who had at least 5 symptoms of CVS were 60.4% (n= 232). Awareness level was classified as low in 47.8%; medium level in 38.2% and high level in 13.8% of respondents . Sixty percent of respondents did not perceive CVS as an issue of public health concern compared to 39.8% who perceived CVS as an issue of public health concern ( p=0.001). In terms of precautionary measures, only duration of computer use (46.2%, p = 0.001 ) were practiced. The study results show that at least 3 out of 5 students have at least five symptoms of CVS, whereas awareness of the disease and related risks remain low.Conclusion The results of the present study indicate that CVS is a less recognized health concern among university students. Consequently, screening for the disease sensitization of students on CVS and awareness campaigns to improve early recognition and diagnosis of disease as well as uptake of interventions is recommended.
Active Learning Through Discussion: ICAP Framework for Education in Health Professions
Authors: Lim Jaeseo , Ko Hyunwoong , Yang Jiwon , Kim Songeui , Lee Seunghee , Chun Myungsun , Ihm Jungjoon , Park Jooyong 
Published: October 2019

Abstract
Background

The ICAP framework based on Cognitive Science posits four modes of cognitive engagement: Interactive, Constructive, Active, and Passive. Focusing on the wider applicability of discussion as interactive engagement in medical education, we investigated the effect of discussion when self-study preceded it and further investigated the effect of generating questions before discussions.

Methods

This study was conducted in the second semester of 2018, and 129 students majoring in health professions, including medicine, dentistry, veterinary medicine, and nursing, participated. The students were assigned into four different trial groups, who were asked to fill out a Subjective Mental Effort Questionnaire after completing each session. Their performance in post-test scores and their mental efforts were analyzed.

Results

A Bonferroni test for group comparison indicated that the self-study and question-generated group had the highest performance and that the lecture and question-received group had the lowest performance when comparing the total score. By using a mediation model, it was confirmed that the participants who showed a higher level of testing mental effort also showed higher levels of studying and discussion mental effort.

Conclusions

Our findings support the ICAP framework and provide practical implications for medical education, representing the fact that students learn more when they are involved in active learning activities, such as self-study and question generation, prior to discussions.
Surgical site infection and predictors among adults in specialized hospital: prospective observational study
Authors: kebede bezie , asredaw biset 
Published: October 2019

Abstract
Introduction: Health-care-associated infection (HAI) is a major global safety issue for patients, health care managers and health-care professionals. One of HAI is surgical site infection (SSI). SSI is refers to an infection that occurs after surgery in the part of the body where surgery took place. It arises following surgery and is specifically related to the surgical site. It is estimated that SSIs account between 10-30% of all HAIs. Objective: The objectives of this study was to quantify the rate of wound infection and identify determinant factors Method: Prospective observational study was conducted from January to June 05/2019. All adult patients who met inclusion criteria were included in the study. The data was obtained either directly from the patient, or by observations or from the patient’s file. All patients were followed daily before, during and after operation for 30 days starting from the date of operation. Wound infection was detected at bedside and post-discharge surveillance. Chi-square test was computed to evaluate adequacy of cells for regression analysis. Independent predictors identified using binary logistic regression analysis and statistical significance was considered at p<0.05. Results: Two hundred eighty patients were included with mean age of 42.5±11 and 157(56.1%) patients were females. Caesarean section is the most common type of surgery. The rate of wound infection was found to be 80 (28.57%). The highest SSI rate was observed in gastrointestinal surgery 28(35.0). More than half of the cases were developed in health institution and patients having clean contaminated wound share the highest number. Majority of patients were undergoing emergency surgery with mean duration of surgery 1.8±0.65 hours. Multivariate analysis revealed that seven variables were significantly associated with the prevalence of wound infection; namely patient’s body mass index (P=0.037), age (P=0.046), history of previous surgery (P=0.04), preoperative hospital stay (p=0.0091), wound class (p=0.01) and history of steroid use (p= 0.027). Conclusion: In this study the rate of wound infection was high with patient’s physical status, duration of surgery, previous steroid use being strong predictor of infection. Life style modification is important to reduce body mass index and health professionals should counsel them.
Systematic analysis of the basic/helix-loop-helix (bHLH) transcription factor family in pummelo (Citrus grandis) and identification of the key members involved in the response to iron deficiency
Authors: Zhang Xiao-Yong , Qiu Jie-Ya , Hui Qiu-Ling , Xu Yuan-Yuan , He Yi-Zhong , Peng Liang-Zhi , Fu Xing-zheng 
Published: October 2019

Abstract
Background As the second largest superfamily of transcription factors (TFs), the basic/helix-loop-helix (bHLH) proteins participate in regulating of a series of biological and developmental processes in plants. Although several bHLH genes of citrus have been identified and previously characterized, a large number of bHLH members are still unknown.Results In this study, we genome-widely identified a total of 128 CgbHLHs from pummelo (Citrus grandis) that were classified into 18 subfamilies by phylogenetic comparison with Arabidopsis thaliana bHLH proteins. All of these CgbHLHs were randomly distributed on nine known (125 genes) and one unknown (3 genes) chromosomes, and 12 and 47 of them were identified to be tandem and segmental duplicated genes, respectively. Sequence analysis showed detailed characteristics of their intron-exon structures, bHLH domain and conserved motifs. Gene ontology (GO) analysis suggested that most of CgbHLHs were annotated to the nucleus, DNA-binding transcription factor activity, response to abiotic stimulus, reproduction, post-embryonic development, flower development and photosynthesis. In addition, 37 CgbHLH proteins were predicted to have direct or indirect protein-protein interactions. Based on GO annotation, RNA sequencing data in public database and qRT-PCR results, 22 of CgbHLHs were identified as the key candidates that respond to iron deficiency.Conclusions In total, 128 CgbHLH proteins were identified from pummelo, and their detailed sequence and structure characteristics and putative functions were analyzed. This study provides comprehensive information for further functional elucidation of CgbHLH genes in citrus.
Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan
Authors: Liang Kai-Shun , Chen Chieh-Chang , Liao Wei-Chih , Kuo Yu-ting , Tseng Liang-Wei , He Wen-Tsung , Wang Hsiu-Po 
Published: October 2019

Abstract
Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF. Aims To investigate the success rate and complications of NKF and TPS in patients with difficult biliary access. Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, succesfs rate of biliary cannulation, and the rate of adverse events were assessed. Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred. Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.
Description of the targeted WASH response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC
Authors: Bompangue Didier , Moore Sandra , Taty Nadège , Impouma Benido , Sudre Bertrand , Manda Richard , Balde Thierno , Mboussou Franck , Vandevelde Thierry 
Published: October 2019

Abstract
Background
Rapid control of cholera outbreaks is a significant challenge in overpopulated urban settings, and documented results on field interventions are scarce. During the 2017-2018 period, Kinshasa, the capital ofDemocratic Republic of the Congo, experienced a sharp increase in cholera cases that showed potential to quickly spread throughout the city. A novel targeted WASH (Water, Sanitation and Hygiene) strategy was implemented to quickly stem the cholera outbreak.
Methods
We carried out a descriptive study of the cholera outbreak in Kinshasa from 2017 to 2018. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the cholera outbreak using epidemic curves and cartography. Weekly precipitation levels in Kinshasa were also assessed. We also described the targeted cluster grid WASH strategy, which was implemented to quickly target case clusters at the household and community level, carrying out interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also examined the evolution of the outbreak following implementation of the response strategy.
Results
From January 2017 to November 2018, a total of 1,712 suspected cholera cases were reported in Kinshasa. During this period, the health zones most affected included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% in two weeks and 86% in four weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% at four weeks after the outbreak peak.
Conclusion
During the 2017-2018 period, Kinshasa experienced a sharp increase in cholera cases that showed potential to quickly spread throughout the city. To contain the outbreak, WASH response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the WASH response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be useful to quickly interrupt cholera transmission in other urban settings.