bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends and geospatial distribution of stillbirths in Uganda, 2014–2020
Authors: Nakamya Petranilla , Komakech Allan , Migamba Stella M. , Biribawa Claire , Kwesiga Benon , Bulage Lilian , Ario Alex R. , Ocom Felix 
Published: April 2024

Abstract
Introduction
Uganda with 17.8 stillbirths per 1,000 deliveries in 2021, is among the countries with a high burden of stillbirths globally. In 2014, Uganda adopted the World Health Organization Every New-born Action Plan (ENAP), which targets < 10 stillbirths per 1,000 deliveries by 2035. Little is known about the trends of stillbirth burden since ENAP was introduced. We assessed the temporal, and spatial distribution of stillbirths, in Uganda, 2014–2020, to inform programming for safe pregnancies and deliveries.

Methods
We obtained and analysed stillbirth surveillance data from the District Health Information System, 2014–2020. A stillbirth was defined as the death of a foetus > 28 weeks of pregnancy or weighing > 1000 g before or during birth and reported to a health facility. We calculated annual incidence rates of stillbirths per 1,000 deliveries at district, regional, and national levels. We used logistic regression to determine the significance of trends.

Results
The overall national annual incidence of stillbirths decreased from 24/1,000 deliveries in 2014 to 17/1,000 deliveries in 2020. During the same period, reporting rates declined from 71% in 2014 to 46% in 2020. The central region continuously had the highest incidence rate for the past 5 years despite the largest decline (OR = 0.79; CI = 0.77–0.83, P < 0.001) while the eastern region had the smallest decline (OR = 0.59; CI = 0.57–0.61, P < 0.001). Districts with persistently high annual incidence rates of stillbirths (> 30/1000) included Mubende, Kalangala, Hoima, and Nebbi. There was no difference in the reporting rates of the most- vs. least-affected districts.

Conclusion
Even with suboptimal reporting, the incidence of stillbirths remained above the national target. Specific areas in the country appear to have particularly high stillbirth rates. We recommend continuous capacity building in managing pregnant women with an emphasis on the most affected districts, and investigation into the reasons for low reporting.
Anti-tumor necrosis factor-α therapy may not be safe during pregnancy in women with inflammatory bowel disease: an updated meta-analysis and systematic review
Authors: Huang Wei , Zhang Xinxing , Zhang Li , Dai Xiaosong , Chen Heping , Xie Qin 
Published: April 2024

Abstract
Background
Inflammatory Bowel Disease (IBD) affects reproductive-aged women. Active disease can lead to decreased fertility. Although the vast majority of international guidelines recommend for the continuation of anti-TNF-α during pregnancy, recent studies have raised concerns about the safety of anti-tumor necrosis factor-α (TNF-α) therapy during pregnancy, both for patients and for physicians.

Methods
Studies that evaluate the safety of anti-TNF-α therapy in pregnant women with IBD were identified using bibliographical searches. An updated meta-analysis was performed for pregnancy outcomes, such as live birth, abortion, still birth, preterm birth, low birth weight, congenital abnormalities, and neonatal infection. Odds ratio (OR) with 95% confidence interval (CI) are reported. Data on disease activity, timing of anti-TNF-α therapy were collected for further analysis.

Results
Overall, 11 studies were screened from on-line databases and international meeting abstracts. An increased risk of abortion (OR, 1.33; 95% CI, 1.02–1.74; P = 0.04) and preterm birth (OR, 1.16; 95% CI, 1.05–1.28; P = 0.004), and a decreased risk of live birth (OR, 0.83; 95% CI, 0.74–0.94; P = 0.002]) were found in the anti-TNF-α therapy group compared with the control group (no use of anti-TNF-α therapy). The subgroup analyses based on the disease activity showed there is no significant association between the use of anti-TNF-α therapy during pregnancy on adverse pregnancy outcomes of abortion, preterm birth, and live birth. The rates of still birth, low birth weight, and congenital abnormalities in the anti-TNF-α therapy group were not significantly different from those in the control group.

Conclusions
Anti-TNF-α therapy does not increase the risks of still birth, low birth weight, and congenital abnormalities; however it may be assicated with increased risks of abortion and preterm birth, which are accompanied by a lower rate of live birth. Although these findings may be confounding by potential disease activity, they offer some opposite viewpoints with biologic agent use. Therefore, more studies are required to further confirm the safety of anti-TNF-α therapy in pregnancy with IBD.
Analysis of the obstetrician's posture and movements during a simulated forceps delivery
Authors: Sorel Manon , Gachon Bertrand , Coste-Mazeau Perrine , Aubard Yves , Pierre Fabrice , Fradet Laetitia 
Published: April 2024

Abstract
Background
The objective of this study was to identify and qualify, by means of a three-dimensional kinematic analysis, the postures and movements of obstetricians during a simulated forceps birth, and then to study the association of the obstetricians’ experience with the technique adopted.

Method
Fifty-seven volunteer obstetricians, 20 from the Limoges and 37 from the Poitiers University hospitals, were included in this multi-centric study. They were classified into 3 groups: beginners, intermediates, and experts, beginners having performed fewer than 10 forceps deliveries in real conditions, intermediates between 10 and 100, and experts more than 100. The posture and movements of the obstetricians were recorded between December 2020 and March 2021 using an optoelectronic motion capture system during simulated forceps births. Joint angles qualifying these postures and movements were analysed between the three phases of the foetal traction. These phases were defined by the passage of a virtual point associated with the forceps blade through two anatomical planes: the mid-pelvis and the pelvic outlet. Then, a consolidated ascending hierarchical classification (AHC) was applied to these data in order to objectify the existence of groups of similar behaviours.

Results
The AHC distinguished four different postures adopted when crossing the first plane and three different traction techniques. 48% of the beginners adopted one of the two raised posture, 22% being raised without trunk flexion and 26% raised with trunk flexion. Conversely, 58% of the experts positioned themselves in a “chevalier servant” posture (going down on one knee) and 25% in a “squatting” posture before initiating traction. The results also show that the joint movement amplitude tends to reduce with the level of expertise.

Conclusion
Forceps delivery was performed in different ways, with the experienced obstetricians favouring postures that enabled observation at the level of the maternal perineum and techniques reducing movement amplitude. The first perspective of this work is to relate these different techniques to the traction force generated. The results of these studies have the potential to contribute to the training of obstetricians in forceps delivery, and to improve the safety of women and newborns.
Progesterone therapy for prevention of recurrent spontaneous preterm birth in a minority patient population: a retrospective study
Authors: Mazza Genevieve R. , Komatsu Emi , Ponzio Madeline , Bai Claire , Cortessis Victoria K. , Sasso Elizabeth B. 
Published: April 2024

Abstract
Background
Preterm birth is a leading cause of infant morbidity and mortality worldwide. The burden of prematurity underscores the need for effective risk reduction strategies. The purpose of this study is to evaluate the efficacy of progesterone therapy, both intramuscular 17-α-hydroxyprogesterone caproate (IM 17-OHPC) and vaginal progesterone, in the prevention of recurrent spontaneous preterm birth (sPTB). The co-primary outcomes included: recurrent spontaneous PTB < 37 and < 34 weeks’ gestation.

Methods
This retrospective cohort study included 637 pregnant patients that delivered at any of the three hospitals within the Los Angeles County healthcare system between October 2015 and June 2021. We compared frequencies of measured variables between each of the progesterone treated groups to no treatment using Pearson chi-squared tests and independent t-tests for categorical and continuous variables, respectively. We estimated crude and adjusted associations between each specific treatment (versus no treatment) and primary outcomes using logistic regression.

Results
Recurrent sPTB < 37 weeks’ gestation occurred in 22.3% (n = 64) of those in the no treatment group, 29.1% (n = 86, p = .077) in the 17-OHPC group, and 14.3% (n = 6, p = 0.325) in the vaginal progesterone group. Recurrent sPTB < 34 weeks’ gestation was 6.6% (n = 19) in the no treatment group, 11.8% (n = 35, p = .043) in the 17-OHPC group, and 7.1% (n = 3, p = 1) in the vaginal progesterone group. Among all participants, neither 17-OHPC nor vaginal progesterone was significantly associated with a reduction in recurrent sPTB at any time point. Among those with a short cervix, IM 17-OHPC was positively associated with recurrent sPTB < 37 weeks’ gestation (aOR 5.61; 95% CI 1.16, 42.9).

Conclusions
Progesterone therapy of any type did not reduce the risk of recurrent sPTB < 34 or < 37 weeks’ gestation compared to no progesterone therapy.
Association of the Advanced Lung Cancer Inflammation Index (ALI) and Gustave Roussy Immune (GRIm) score with immune checkpoint inhibitor efficacy in patients with gastrointestinal and lung cancer
Authors: Jiang Hao , Li Borui , Wu Min , Wang Qimei , Li Yijin 
Published: April 2024

Abstract
Objective
This study aimed to conduct a comprehensive analysis, evaluating the prognostic significance of the baseline Advanced Lung Cancer Inflammation Index (ALI) and Gustave Roussy Immune (GRIm) Score in patients undergoing immune checkpoint inhibitor (ICI) therapy.

Methods
A comprehensive search was performed across various databases, including PubMed, the Cochrane Library, EMBASE, and Google Scholar, until October 21, 2023, to compile relevant articles for analysis. The investigation encompassed diverse clinical outcomes, including overall survival (OS) and progression-free survival (PFS).

Results
This analysis included a total of 15 articles, comprising 19 studies involving 3335 patients. Among the 19 studies, nine studies focused on NSCLC, and six studies were conducted on HCC. Pooled results revealed that patients with elevated ALI levels experienced prolonged OS (HR: 0.51, 95% CI: 0.37–0.70, p < 0.001) and extended PFS (HR: 0.61, 95% CI: 0.52–0.72, p < 0.001). Furthermore, a GRIm score > 1 was associated with reduced OS (HR: 2.07, 95% CI: 1.47–2.92, p < 0.001) and diminished PFS (HR: 1.78, 95% CI: 1.35–2.34, p < 0.001) in cancer patients receiving ICIs. Subgroup analysis indicated that ALI cutoff values of 18 exhibited enhanced predictive potential. Additionally, for HCC patients, those with HCC-GRIm score > 2 showed a substantially decreased risk of mortality compared to individuals with HCC-GRIm score ≤ 2 (HR: 2.63, 95% CI: 1.89–3.65, p < 0.001).

Conclusion
The ALI and GRIm score served as dependable prognostic indicators for patients undergoing ICI therapy in the context of cancer treatment.
The depth of perineural invasion is an independent prognostic factor for stage II colorectal cancer
Authors: Chen Hao , Wang Chao , Chen Zexian , Huang Tianze , Lin Yanyun , Chen Junguo , Zhang Bin , He Xiaosheng 
Published: April 2024

Abstract
Background
Perineural invasion (PNI) is the invasion of nerves by cancer cells and is associated with poor survival in stage II colorectal cancer. However, PNI can be further subdivided according to the depth of invasion, and the depth of PNI has not been clearly linked to prognosis.

Method
This study aimed to assess the prognostic value of different depths of PNI in stage II colorectal cancer. We defined PNI in the submucosal plexus and myenteric plexus as superficial perineural invasion (sup-PNI) and PNI in the subserous plexus as deep perineural invasion (deep-PNI). Patients were divided into three groups based on the depth of PNI: sup-PNI, deep-PNI and non-PNI. Then, univariate and multivariate Cox regression analyses were conducted to evaluate the role of PNI in the prognosis of stage II colorectal cancer.

Results
This study enrolled 3508 patients with stage II colorectal cancer who underwent resection for primary colorectal lesions between January 2013 and September 2019. Clinicopathological features, including elevated carcinoembryonic antigen (CEA) levels, T4 stage, poor differentiation, deficient DNA mismatch repair (dMMR), and vascular invasion, were correlated with deep-PNI. Multivariate analyses revealed that deep-PNI was associated with worse overall survival (OS; hazard ratio [HR], 3.546; 95% confidence interval [CI], 2.307–5.449; P < 0.001) and disease-free survival (DFS; HR, 2.921; 95% CI, 2.032–4.198; P < 0.001), compared with non-PNI. Conversely, no significant difference in OS or DFS was observed between the sup-PNI and non-PNI groups in multivariate analyses.

Conclusions
The study demonstrated that the depth of PNI was an independent prognostic factor for patients with stage II colorectal cancer, and patients with deep PNI had a worse prognosis. Thus, patients with PNI require further subdivision according to the depth of invasion.
What may encourage or deter health services utilization by people living with or at the risk of HIV/AIDS in special health centers? Qualitative evidence from a stigmatized community
Authors: Bazyar Mohammad , Ghorabi Samaneh Tahmasebi , Sadeghifar Jamil , Ranjbar Mohammad , Pakzad Reza , Bonyadi Fatemeh , Khasi Keyvan , Shakiba Ebrahim , Nourbakhsh Mahtab , Rezeghian Leila , Noshadi Boshra , Bavandpour Mehrdad , HasanBeigi Azim , Behzadi Anahita 
Published: April 2024

Abstract
Background
Behavioral Diseases Counseling Centers (BDCCs) and Vulnerable Women’s Counseling Centers (VWCCs) in Iran are the main peripheral centers that offer educational, counseling, diagnostic, preventive, curative and protective services to individuals living with or at high risk of contracting HIV/AIDS and female sex workers respectively. Due to the social stigma surrounding HIV in Iran, this study aims to identify the factors that may hinder or encourage HIV/AIDS patients and women with risky sexual behaviors from visiting these centers.

Methods
Conducted in 2023, this qualitative study involved individuals visiting BDCCs and VWCCs in two western provinces of Iran, Ilam and Kermanshah. The study participants included 21 health staff members working in BDCCs and VWCCs and 20 HIV/AIDS patients and vulnerable women with unsafe sexual behaviors referring to these centers. Purposive, snowball and maximum variation sampling techniques were applied to interview the participants. Interviews were conducted between January 5th and May 21st, 2023, using a semi-structure guideline. Interviews were transcribed and content analysis approach was applied to analyze data using MAXQDA20 software.

Results
According to the findings, the barriers and facilitators of visiting specialized centers for HIV/AIDS patients and vulnerable women were categorized into three main categories, 10 subcategories and 35 sub-subcategories including: Medical and operational processes (4 subcategories and 12 sub-subcategories), mutual interactions between the personnel and visitors (people living with and at the risk of getting HIV/AIDS) (3 subcategory and 13 sub-subcategories), and physical characteristics of the centers (3 subcategories and 10 sub-subcategories).

Conclusions
To improve the performance of BDCCs and VWCCs and encourage people living with and at the risk of contracting HIV/AIDS to visit these centers regularly, health policy makers should consider modifying clinical processes, physical features, personnel behaviors and visitors’ concerns raised by the interviewees and the issues identified in this study.
Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone
Authors: Osborne Augustus , James Peter Bai , Olorunsaiye Comfort Z. , Bangura Camilla , Lebbie Aiah 
Published: April 2024

Abstract
Background
In Sierra Leone, adolescents are increasingly engaging in risky activities, including cannabis use, which can lead to substance abuse, poor academic performance, and psychotic symptoms. This study aims to investigate the prevalence and associated factors of cannabis use among school-going adolescents in the country.

Method
Data for the study was sourced from the 2017 Sierra Leone Global School-based Student Health Survey (GSHS), a nationally representative survey conducted among adolescents aged 10-19 years using a multistage sampling methodology. A weighted sample of 1,467 adolescents in Sierra Leone was included in the study. The study utilised bivariate and multivariable logistic regression analysis to identify factors linked to cannabis use, presenting results using adjusted odds ratios and 95% confidence intervals.

Results
The prevalence of cannabis use was 5.1% [3.0,8.6] among school-going adolescents in Sierra Leone. School-going adolescents who attempted suicide [aOR = 6.34, 95% CI = 1.71–23.45], used amphetamine [aOR = 15.84, 95% CI = 7.94–31.62] and were involved in sexual risk behaviour [aOR = 5.56, 95% CI = 2.18–14.20] were more likely to be associated with cannabis use.

Conclusion
In Sierra Leone, a small but non-trivial minority of students use cannabis. Ever-used amphetamines or methamphetamines, suicidal attempts, and sexual risk behaviour were the factors associated with cannabis use in Sierra Leone. The development of school-based health intervention programmes is crucial to address the risk factors associated with cannabis use among school-going adolescents.
Food safety knowledge and practices among raw meat handlers and the microbial content of raw meat sold at Kumasi Abattoir Butchery Shops in Kumasi, Ghana
Authors: Asati Desmond Azeko , Abdulai Prosper Manu , Boateng Kofi Sekyere , Appau Abigail Abena Anokyewaa , Ofori Linda Aurelia , Agyekum Thomas Peprah 
Published: April 2024

Abstract
Background
Foodborne diseases affect nearly 600 million people each year, that is, one in every ten people, and their outbreaks are most common in low- and middle-income countries, particularly in Africa. This study investigated the food safety practices among raw meat handlers and the microbial quality of the meat from the butchery shops in Kumasi Abattoir, Ghana.

Methods
This study employed a descriptive cross-sectional study and collected quantitative data on factors associated with food safety and hygienic practices among raw meat handlers and the microbial quality of the raw meat using a structured questionnaire and standard laboratory methods, respectively. The study used all 50 beef vending shops in the butchery for questionnaire aspect and fresh beef samples were obtained from 10 vendors in the butchery shop. Appropriate methods were followed to analyse questionnaire data and meat samples.

Results
Most of the butchers (72%) were between the ages of 31 and 45, and they were predominantly Muslims (68%). Most of the respondents (48%) had basic education. All the respondents had food safety certificates from the local authority but needed adequate knowledge of meat safety. Most respondents (90%) handled meat and money with the same bare hands, thus contaminating the meat. The study showed that the maximum Total Viable Count (TVC), Total Staphylococcus Count (TSC), and Total Escherichia coli Count (TEC) were 5.60, 4.39 and 5.13 cfu/g, respectively. The study also revealed that all the meat samples were Salmonella species-free.

Conclusions
Microorganisms in raw beef indicate a public health hazard. It gives a signal of a possible occurrence of food-borne intoxication and infection if not controlled. Environmental health officers in the Greater Kumasi area should organize food safety training and educate raw meat handlers on the importance of food safety and its consequences.
Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study
Authors: Dolonbaeva Zuura , Inthaphatha Souphalak , Dzhangaziev Bakyt , Ismailov Mederbek , Nishino Kimihiro , Hamajima Nobuyuki , Yamamoto Eiko 
Published: April 2024

Abstract
Background
Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic.

Methods
This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15–49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant.

Results
The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women’s age, area of residence, mother tongue of household head, age of husband, and number of children ever born.

Conclusion
The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.