bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viable Mycobacterium tuberculosis in sputum after pulmonary tuberculosis cure
Authors: Ambreen Atiqa , Jamil Muhammad , Rahman Muhammad Aqeelur , Mustafa Tehmina 
Published: September 2019

Abstract
Background

Pulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it.

Methods

New sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for six months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured.

Results

Among 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of six months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase.

Conclusion

Viable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.
Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence
Authors: Lucherini Mark , Smith Katherine , Hill Sarah 
Published: September 2019

Abstract
Background: While some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact . We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic.
Methods: Ten electronic databases were searched in February 2017 using terms relating to e-cigarettes, smokeless tobacco and nicotine replacement therapy (NRT); and SES. We included studies published since 1980 that were available in English and examined product use by SES indicators such as income and education. Data synthesis was based on those studies judged to be of medium- to high-quality using guidelines adapted from the Critical Appraisal Skills Programme.
Results: We identified 54 studies describing NCNP use by SES across 12 countries, of which 27 were judged of sufficient quality to include in data synthesis. We found mixed patterns of e-cigarette current use by SES, with evidence of higher use among low-income adults but unclear or mixed findings by education and occupation. In contrast, smokeless tobacco current use was consistently higher among low SES adults. There was very limited evidence on the SES distribution of NRT in adults and of all NCNPs in young people.
Conclusions: The only NCNP for which there are clear patterns of use by SES is smokeless tobacco, where prevalence is higher among low SES groups. While this suggests a potentially positive impact on inequalities in smoking (if NCNP use displaces smoked tobacco use), this has not been seen in practice. These findings do not support the suggestion that e-cigarettes have the potential to reduce social inequalities in smoking, since i) current evidence does not show a clear trend of higher e-cigarette use in population groups with higher tobacco consumption, and ii) the experience of smokeless tobacco suggests that – even where NCNP use is higher among low SES groups – this does not necessarily replace smoked tobacco use in these groups.
Relevance and usefulness of head CT-scan requests in the management of adult headaches: A cross-sectional study in two referral hospitals in Cameroon
Authors: Mbede Maggy , Tegueu Callixte Kuate , Kengne Ulrich Igor Mbessoh , Zogo Pierre Ongolo , Moifo Boniface 
Published: September 2019

Abstract
Background: In developing sub-Saharan Africa countries such as Cameroon, the head CT-scan, which is more available and accessible than magnetic resonance imaging, gold standard, exposes to a high irradiation dose level and is still expensive. In those countries, head CT-scan has become a routine exploration in patients with headache. In front of this inflation, it is necessary to assess CT-scan requests and their profitability in the patient management. Objective: To assess the relevance and the usefulness of head computerized tomography scanner (CT-scan) requests in the management of adult headache in two referral teaching hospitals of Cameroon, in order to improve their appropriateness. Methods: This was a prospective cross-sectional study conducted in medical imaging units of the Central Hospital of Yaounde and the Laquintinie Hospital of Douala on five months period. We confronted indication mentioned on head CT-scan requests to the recommendation grades and indication’s mentions of the referral imaging guidelines of the French Society of Radiology in order to assess the relevance on the one hand. We also confronted head CT-scan results to the expectations of the requesting physicians in order to assess the usefulness on the other hand. Data analysis: Non-parametric statistical analysis. Results: During the study period, 169 examinations requests for headaches were collected. Symptom was the main clinical data mentioned on CT-scan requests (60.4%), followed by the suspected clinical diagnosis (40.2%). Requesting physicians were general practitioners (50.3%), followed by neurologists in 14.2%. Overall, 92.3% of requests were judged appropriate while 2.4% were non-indicated. The general practitioner’s requests were non-indicated in 75% of the cases. Inappropriate requests multiplied by two the risk of having no significant abnormality on the head CT-scan. Of all the head CT-scan requests, 73.2% were useful and 100% of relevant CT-scans were also useful. 45.5% of useless head CT-scans were requested by a general practitioner. Conclusion: Physicians need to follow the guidelines and justify the use of head CT-scans in patients suffering from headache in order to improve the relevance and usefulness of head CT-scans requests.
Combination of isoflurane and propofol, a means for general anesthesia in the surgery of perioperative cerebral hypoperfusion rats to avoid cognitive impairment
Authors: Bu Xinyue , Li Tang , Wang Haiyun , Xia Zhengyuan , Guo Di , Wang Jinxin , Sun Yi , Yang Chenyi , Liu Guoqiang , Ma Ji , Yang Zhuo , Wang Guolin 
Published: September 2019

Abstract
Background: Perioperative cerebral hypoperfusion often occurs. However, the underlying mechanism and targeted interventions remain mostly to be determined. Anesthetic isoflurane induces neuronal injury via endoplasmic reticulum (ER) stress, whereas sub-anesthetic dose of propofol improves postoperative cognitive function. However, the effects of the combination of isoflurane plus propofol, which is a common combination of anesthesia for patient, on ER stress and the associated cognitive function remain unknown.

Methods: We therefore set out to determine the effects of isoflurane plus propofol on the ER stress and cognitive function in the rats insulted by cerebral hypoperfusion. The rats received isoflurane alone (1.9%), propofol alone (40 mg·kg -1 ·h -1 ) or a combination of isoflurane and propofol (1% and 20 mg·kg -1 ·h -1 or 1.4% and 10 mg·kg -1 ·h -1 ). Behavior studies (Fear Conditioning test) and biochemical analyses (Nissl staining and western blotting for the harvested rat brain tissues) were employed in the studies.

Results: We found that the combination of 1% isoflurane plus 20 mg·kg -1 ·h -1 propofol attenuated the cerebral hypoperfusion-induced cognitive impairment and the ER stress.

Conclusions: These data suggest that ER stress contributes to the underlying mechanism of cognitive impairment and the combination of isoflurane and propofol was able to preserve cognitive function in the rats after cerebral hypoperfusion via prevention of ER stress. These findings have established a system to study the strategy in preventing and treating perioperative cerebral hypoperfusion, leading to promotion of the future larger scale studies.
The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon
Authors: DOHBIT Julius Sama , WOKS Namanou Ines Emma , KOUDJINE Carlin Héméry , TAFEN Willy , FOUMANE Pascal , ASSUMPTA Lucienne BELLA , OGU Rosemary Nkemdilim , III Fru Fobuzshi ANGWAFO 
Published: September 2019

Abstract
Background: Safe childbirth remains a daunting challenge, particularly in low-resource settings where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 782 per 100,000 live births in 2011 is significantly high. Adherence to good practice standards by birth attendants is key to improving pregnancy outcomes. The WHO Safe Childbirth checklist was designed as a tool to improve the quality of care provided to women giving birth. This checklist was implemented at the Yaounde Gyneco-Obsteric and Pediatric Hospital. Quantitative and qualitative assessment of its utilization is essential to secure a change in attitudes and practice and engender improvement in maternal health.
Objective: Evaluate the change in attitudes and practice of nurses and compare outcomes in cases where it was and was not used, 6 months after introduction of the safe childbirth checklist in a maternity setting.
Methods: A cross sectional and retrospective study was conducted over a 6 month period (January – June 2018). Predesigned questionnaires were used to collect qualitative data from personnel of the Gynecology and Obstetrics unit who used the safe childbirth checklist and quantitative data from patient delivery records. Data analysis was done using SPSS version 23.0. Chi square test was used to compare categorical variables, while the student test was used to compare continuous variables.
Results: Of the 1001 files retrieved from the archives, 25 were excluded. The checklist was used in 828/976 (84.8%) files. We observed an increasing trend in the usage rate, with a peak at 93.9% recorded during the last 2 months. Pages 2 and 3 were least completed, in <10% of cases during the first 5 months. A significant reduction in the onset of pre-eclampsia and eclampsia was noted with the use of the checklist (2·1% Vs 5·4%, p = 0·017). Fifty percent of the staff reported that the checklist increased workload while 37.5% mentioned laziness and absence of checklists in some files as a hindrance to its proper use.
Conclusion: The use of the safe childbirth checklist improved progressively with a simultaneous reduction in obstetrical and neonatal complications overtime.
Keywords: Checklist, childbirth, Obstetrical complications
Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments
Authors: Campeau Aimée , Tonmyr Lil , Gulbransen Erik , Hébert Martine , McFaull Steven , Skinner Robin 
Published: September 2019

Abstract
Background: The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields.

Methods: We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender.

Results: A total of 2 200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home.

Conclusions: The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.
Increasing questionnaire response: evidence from a nested RCT within a longitudinal birth cohort study
Authors: Goodwin Michaela , Walsh Tanya , Whittaker William , Emsley Richard , Sutton Matthew , Tickle Martin , Kelly Michael , Pretty Iain 
Published: September 2019

Abstract
Background: Adequate response rates are essential when using questionnaires in research, as these can affect the validity of studies and the ability to generalise the findings to a wider population. Aims: The study measured the response rate to questionnaires in a large longitudinal epidemiological study and sought to determine if any of the changes made throughout data collection had a positive impact on the response to questionnaires and readdressed any imbalance seen in response by participants level of deprivation. Methods: Data were taken from a prospective, comparative study, designed to examine the effects of the reintroduction of water fluoridation on children’s oral health over a five-year period. Response rates were analysed for the first year of data collection from this sample. During this year changes were made to the questionnaire layout and cover letter to attempt to increase response rates. Additionally a nested randomised control trial compared the effect on response rates of three different participant reminders to complete questionnaires were trialled. Results: Data were available for 1824 individuals. The assessment of different reminders indicated that while sending the whole questionnaire again to non responders, resulted in the highest level of response (25%), calling participants was the only method that appeared to address the imbalance in IMD between responders (29.5, 95%CI 16.9-42.0) and non-responders (26.8, 95%CI 23.5-30.2) t(12.994) -0.446, p=0.663. Conclusions: Low response rates were recorded within this large, longitudinal study giving rise to concerns about response bias. In order to address these biases, data can be weighted in order to compensate for the skew in those taking part compared to the population. Resending the entire questionnaire again is the most effective way of reminding participants to complete the questionnaire. As this is a less labour intensive method than for example, calling participants more time can then be spent targeting groups who are underrepresented in the study such as those most deprived.
Roles and Expectations of Male Partners from PMTCT services in Chiradzulu Malawi: A Qualitative Study
Authors: Kansinjiro Beatrice M'baya , Nyondo-Mipando Alinane Linda 
Published: September 2019

Abstract
Introduction: Prevention of mother to child transmission of HIV (PMTCT) is the main measure for curbing HIV infection in children. Male involvement (MI) greatly influences uptake and adherence to PMTCT services yet the level remain low in Sub Saharan Africa. Lack of well stipulated roles for men in PMTCT is one of the main barriers to MI. Studies on MI have focused on women and Health care workers (HCW), thereby making men silent partners. The main aim of the study was to explore the roles and expectations of male partners in PMTCT services in Malawi. Methods: This was a descriptive qualitative study that involved men whose partners were either pregnant or breastfeeding a child, health care workers working in PMTCT services for over six months and traditional leaders. We conducted 9 in-depth interviews and 12 key informant interviews from January to March 2018. All interviews were audio-recorded, transcribed and translated. Thematic analysis was employed to analyze data. Results: Male partners play supportive, HIV prevention behaviour change and decision-making roles in PMTCT services. Health assessment and health promotion activities are the male specific services required in PMTCT services and these should be delivered at both health facility and community levels. Conclusion: Male partners in PMTCT have expectations that need to be met at both health facility and community levels. There is need to have male-tailored package of health services that are directly provided to men along with PMTCT services at different levels in order to promote MI. The services should be provided in an atmosphere that allows and accepts male partners to exercise their roles in PMTCT services.
Clinician perspectives on models of care for pediatric weight management services in Australia: A mixed-methods study
Authors: Cohen Jennifer , Alexander Shirley , Signorelli Christina , Williams Kathryn , Sim Kyra A , Chennariyil Lenina , Baur Louise A 
Published: September 2019

Abstract
Introduction For children with moderate to severe obesity, secondary and tertiary level services provide a platform for a more intensive approach toward weight management. Clinician and health care managers’ (HCM) views are imperative for informing the nature of future services to treat such children. Methods This concurrent mixed-methods study utilized questionnaires and semi-structured focus groups with clinicians, and one-on-one semi-structured interviews with HCMs, who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. The Theoretical Domains Framework was employed to underpin the development of the interview guides. The recorded interviews were transcribed verbatim and coded line-by-line, noting the key emerging themes. The results from the questionnaire were analyzed using descriptive statistics. Results Clinicians (n=27) provided multiple approaches to weight management, tailored to families and patients. Clinicians more often provided general healthy eating advice over a specific diet approach. Four-fifths used body mass index percentile change as a measure of success, as well as behavioral outcomes such as improvements in physical activity levels, screen time and sleep quality. Use of a combination of group and individual sessions were thought to improve engagement and reduce attrition rates. Clinicians and HCMs recommended integrating clinics into community centres and providing specific programs for sub-groups such as children from culturally and linguistically diverse communities or children with development delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. Research into clinical outcomes for services was recommended to enable the development of a business case for further funding of pediatric weight management services. Conclusion Addressing common barriers to current pediatric weight management services, and designing future models of care based on key stakeholders’ preferences, are critical to achieving optimal care provision for this high risk population.
“INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes”
Authors: Alba Juan Jesus Fernández , Pazos Estefania Soto , Cortes Rocio Moreno , Sanchez Angel Vilar , Macias Carmen Gonzalez , Lara Maria Castillo , Corral Luis Moreno , Bueno Jose Antonio Sainz 
Published: September 2019

Abstract
Background Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polihydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to limit fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers.Methods This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios.Results 231 pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWT21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st.(RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%).Conclusions In pregnant women with GDM, the ability of customized fetal growth curves to identify the newborns with alterations in nutritional status exceeds that of INTERGROWTH21st.