bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care unit among selected governmental hospitals in Addis Ababa, Ethiopia, 2022: an institution-based cross-sectional study
Authors: Tilahun Befkad Derese , Yilak Gizachew , Amena Nimona , Abate Biruk Beletew , Fantahun Addishiwet , Deribe Leul 
Published: February 2024

ObjectiveTo assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022.DesignA cross-sectional study conducted from 3 March 2022 to 30 March 2022.SettingThe research was conducted at a government hospital in Addis Ababa, Ethiopia.ParticipantsOut of 305 eligible participants, 303 were parents of preterm infants’ participants with complete data.Primary outcome measureLevels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables.ResultsThe mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (β=−4.65, 95% CI −9.32 to –0.025), length of neonatal intensive care unit (NICU) stay >10 days (β=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (β=−7.47, 95% CI −11.42 to –3.52), parents with college degrees and above (β=−14.15, 95% CI −22.94 to –5.34), parents with neonates who were preterm and had neonatal sepsis (β=10.42, 95% CI −17.57 to –3.27), parents without a history of neonatal NICU admission (β=−6.16, 95% CI −11.69 to –0.63) and parents who were housewives (β=6.51, 95% CI 1.83 to 12.19) all showed significant associations.ConclusionFactors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.
Evaluation of the effectiveness and safety of a novel substrate-based radiofrequency ablation for persistent atrial fibrillation: a prospective, randomised, parallel-controlled, single-blinded study protocol
Authors: Yang Jie , Song Yuanbin , Bian Shizhu , Zhang Bo , Zhang Yi , Wang Xia , Cheng Li , Fan Yu , Liu Changsong , Tan Hu 
Published: February 2024

IntroductionPulmonary vein isolation (PVI) is the cornerstone of radiofrequency (RF) ablation for atrial fibrillation (AF). However, a single ablation strategy does not always achieve the desired therapeutic effect in all patients with persistent AF, and individualised strategies are required for different clinical characteristics.Methods and analysisThis study aimed to determine the optimal catheter ablation strategy for persistent AF by comparing the efficacy of PVI and BCXL (BC: big circles encircling pulmonary vein isolation; XL: unfixed number of lines based on the left atrial substrate). The BCXL-AF study (clinical trial no. ChiCTR2200067081) was designed as a prospective, randomised, parallel-controlled, single-blinded clinical trial. Overall, 400 patients with persistent AF were randomised in a 1:1 ratio into PVI-only and BCXL-individualised ablation groups. Patients randomised to the individualised ablation group will be further categorised into risk strata according to their clinical condition using the actual ablation method determined by the strata. Seven postoperative visits were conducted from discharge to 24 months of age. The primary observation endpoint will be the incidence of atrial tachyarrhythmia (including AF, atrial flutter and atrial tachycardia with a duration of ≥30 s) without using antiarrhythmic drugs after a blank period of 3 months following a single ablation procedure. The BCXL-AF study will assess an optimal approach for persistent AF RF ablation and evaluate the effectiveness of individualised RF ablation strategies in reducing the recurrence rate of AF.Ethics and disseminationThe study protocol was reviewed, and ethical approval was obtained from the Army Medical University Human Ethics Committee (approval number: 2022-484-01). All the participants provided written informed consent. This study was conducted according to the principles of the Declaration of Helsinki and its amendments. The results of this study will be disseminated through manuscript publication and conference presentations.Trial registration numberChiCTR2200067081.
Predictors of perinatal mortality in Liberia’s post-civil unrest: A comparative analysis of the 2013 and 2019–2020 Liberia Demographic and Health Surveys
Authors: Koray Munawar Harun , Curry Tanya 
Published: February 2024

IntroductionPerinatal mortality remains a pressing concern, especially in lower and middle-income nations. Globally, 1 in 72 babies are stillborn. Despite advancements, the 2030 targets are challenging, notably in sub-Saharan Africa. Post-war Liberia saw a 14% spike in perinatal mortality between 2013 and 2020, indicating the urgency for in-depth study.ObjectiveThe study aims to investigate the predictors of perinatal mortality in Liberia using 2013 and 2019–2020 Liberia Demographic and Health Survey datasets.MethodsIn a two-stage cluster design from the Liberia Demographic and Health Survey, 6572 and 5285 respondents were analysed for 2013 and 2019–2020, respectively. Data included women aged 15–49 with pregnancy histories. Descriptive statistics was used to analyse the sociodemographic characteristics, the exposure to media and the maternal health services. Bivariate and multivariate logistic regressions were used to examine the predictors of perinatal mortality at a significance level of p value ≤0.05 and 95% CI. The data analysis was conducted in STATA V.14.ResultsPerinatal mortality rates increased from 30.23 per 1000 births in 2013 to 42.05 in 2019–2020. In 2013, increasing age of respondents showed a reduced risk of perinatal mortality rate. In both years, having one to three children significantly reduced mortality risk (2013: adjusted OR (aOR) 0.30, 95% CI 0.14 to 0.64; 2019: aOR 0.24, 95% CI 0.11 to 0.54), compared with not having a child. Weekly radio listenership increased mortality risk (2013: aOR 1.36, 95% CI 0.99 to 1.89; 2019: aOR 1.86, 95% CI 1.35 to 2.57) compared with not listening at all. Longer pregnancy intervals (p<0.0001) and receiving 2+ tetanus injections (p=0.019) were protective across both periods. However, iron supplementation showed varied effects, reducing risk in 2013 (aOR 0.90, 95% CI 0.48 to 1.68) but increasing it in 2019 (aOR 2.10, 95% CI 0.90 to 4.92).ConclusionThe study reports an alarming increase in Liberia’s perinatal mortality from 2013 to 2019–2020. The findings show dynamic risk factors necessitating adaptable healthcare approaches, particularly during antenatal care. These adaptable approaches are crucial for refining health strategies in line with the Sustainable Development Goals, with emphasis on the integration of health, education, gender equality, sustainable livelihoods and global partnerships for effective health outcomes.
Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes: a nationwide registry-based study
Authors: Ghaith Abdul Karim , El-Hajj Victor Gabriel , Atallah Elias , Rios Zermeno Jorge , Ravindran Krishnan , Gharios Maria , Hoang Harry , Bydon Mohamad , Ohlsson Marcus , Elmi-Terander Adrian , Tawk Rabih G , Jabbour Pascal 
Published: February 2024

ObjectivesTo investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions.DesignRegistry-based study.SettingWe used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA.ParticipantsThe NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35 231 patients were included.Outcome measuresOutcome measures were postprocedural complications, length of stays (LOSs), in-hospital mortality and non-routine discharge. Propensity score matching using all available baseline variables was performed to reduce confounders when comparing patients with and without concomitant COVID-19.ResultsMechanical thrombectomy (MT) was performed in 48.4%, intravenous thrombolysis (IVT) in 38.2%, and both MT and IVT (MT+IVT) in 13.4% of patients. A gradual increase in the use of MT and an opposite decrease in the use of IVT (p<0.001) was detected during the study period. Overall, 25.0% of all patients were admitted for MCA strokes during the pandemic period (2020), of these 209 (2.4%) were concomitantly diagnosed with COVID-19. Patients with MCA strokes and concomitant COVID-19 were significantly younger (64.9 vs 70.0; p<0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p<0.001), in-hospital mortality (26.3% vs 9.8%; p<0.001) and non-routine discharge (84.2% vs 76.9%; p=0.013), as compared with those without COVID-19. After matching, only in-hospital mortality rates remained significantly higher in patients with COVID-19 (26.7% vs 8.5%; p<0.001). Additionally, patients with COVID-19 had higher rates of thromboembolic (12.3% vs 7.6%; p=0.035) and respiratory (11.3% vs 6.6%; p=0.029) complications.ConclusionsAmong patients with MCA stroke, those with concomitant COVID-19 were significantly younger and had higher stroke severity scores. They were more likely to experience thromboembolic and respiratory complications and in-hospital mortality compared with matched controls.
Fathers’ mental health and coping strategies: a qualitative study in Mwanza, Tanzania
Authors: Jeong Joshua , McCann Juliet K , Joachim Damas , Ahun Marilyn N , Kabati Mary , Kaaya Sylvia 
Published: February 2024

ObjectivesTo investigate the nature of paternal mental health problems, their causes and the coping strategies used by fathers of young children under the age of 2 years.Design and settingWe conducted in-depth interviews with fathers, mothers, community leaders and community health workers as well as focus group discussions with fathers-only, mothers-only and mixed groups of fathers and mothers. Respondents provided their perspectives on the psychosocial challenges affecting fathers and how fathers responded to their mental health problems. Data were triangulated across stakeholders and analysed using thematic content analysis.SettingThe study was conducted in four communities in Mwanza, Tanzania.ParticipantsThe total sample included 56 fathers, 56 mothers and 8 community stakeholders that were equally distributed across the four communities.ResultsRespondents highlighted a spectrum of mental health concerns affecting fathers, including elevated parenting stress, depressive symptoms, and anxiety. Causes of paternal mental health problems included poverty, child-related concerns, marital problems and family illness. When asked about paternal coping strategies, both fathers and mothers shared that fathers mostly turned to negative coping strategies to manage their distress, such as paternal alcohol use and poor conflict resolution strategies. However, respondents also shared how some fathers used positive coping strategies, such as seeking out social support from their family and friends, engaging in exercise and leisure activities and relying on their faith.ConclusionsOverall, this study highlights the importance of supporting positive mental health among fathers. Our findings can inform the design of psychosocial programme components that can be integrated within parenting interventions to promote the well-being of specifically fathers and ultimately improve the family caregiving environment.
Assessment of the role of gut health in childhood stunting in a multisite, longitudinal study in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol
Authors: Momo Kadia Benjamin , Ramsteijn Anouschka S , Dasi Teena , Fahmida Umi , Kulkarni Bharati , Faye Babacar , Htet Min Kyaw , Sow Doudou , Kalashikam Rajender Rao , Sharma Ritu , Sudibya Arienta R P , Kusuma Sari , Angelin Tiffany C , Nurfadilah Mifa , Jobarteh Modou Lamin , Diop Ndeye Sokhna , Gabain Isobel , Calvo-Urbano Beatriz , Ferguson Elaine , Haggarty Paul , Heffernan Claire , Webster Joanne P , Walker Alan W , Allen Stephen 
Published: February 2024

IntroductionChildhood stunting has a complex aetiology, with poor gut health being an important contributor. This study will assess inter-relationships between maternal and infant gut health indices and infant linear growth. Inter-relationships between gut health indices, systemic inflammation and growth hormones in early childhood will also be assessed.Methods and analysisA longitudinal observational study of cohorts of 600 newborns and their mothers in India, Indonesia and Senegal will be conducted. Women will be recruited during pregnancy and their children followed up to age 24 months. Stool, urine and blood samples will be collected from the women and children for assessments of helminthic and protozoal parasites, bacterial pathogens, faecal microbiota taxa, biomarkers of environmental enteric dysfunction, systemic inflammation and growth hormones. Child anthropometric measurements will be collected at birth and at ages 3, 6, 9, 12, 18 and 24 months. The gut health indices will be integrated with cohort data from other Action Against Stunting Hub (AASH) workstreams for interdisciplinary analyses of childhood stunting and the development of a new typology of stunting.DiscussionThis study will advance scientific understanding of the role of gut health in childhood stunting and will contribute to a broader knowledge of the complex aetiology of this condition as part of the interdisciplinary AASH research to reduce the global burden of childhood stunting.Ethics and disseminationThis study has been approved by the relevant Ethics Committees in Senegal, India, and Indonesia and LSHTM. The results will be submitted for publication in peer-reviewed journals.
Measurement of cognition and profiling early learning environments in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper
Authors: Dockrell Julie , Massonnié Jessica , Ang Lynn , Munoz-Chereau Bernardita , Fernandez Rao Sylvia , Kolopaking Risatianti , Ndiaye Moustapha , Heffernan Claire 
Published: February 2024

IntroductionChildhood stunting is associated with poorer child health, growth and development including diminished cognitive abilities. Mapping out the links between child stunting and Early Childhood Education and Development is critical to increasing understanding of the causes and effects of childhood stunting, and for programme and policy development. The aim of this study is to investigate and compare the development and educational environments across India, Indonesia and Senegal, and to identify the multifactorial drivers and impacts of childhood stunting to inform a new typology.Methods and analysisThis current study is part of an interdisciplinary observational research study, where women are recruited during pregnancy and mother–infant pairs followed prospectively, up to 24 months after birth. Eight measures will be used to profile children’s early development and learning environments in two sample cohorts: (A) children aged 12 and 24 months born to the women recruited during pregnancy (ie, 500 pregnant mothers per country) and (B) a preschool case–control cohort of siblings from the main cohort aged between 3:6 and 5:6 years of age where anthropomorphic measures will be collected to assess degrees of stunting. Profiling of the development and learning environments in the countries will include both parent/caregiver self-reported and local staff (enumerators) direct assessments of children and settings.Ethics and disseminationThis study was approved by the institutional ethics committees of all partner institutions. In India, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad; In Indonesia, Ethics Committee of the Faculty of Medicine, University of Indonesia; and in Senegal, National Ethics Committee for Scientific Research in Senegal.The findings of the study will be disseminated in national and international meetings, seminars, conferences and peer-reviewed journals.
Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper
Authors: Jobarteh Modou Lamin , Saxena Deepak B , Kulkarni Bharati , Shah Komal , Banjara Santosh Kumar , Shah Priyanka Akshay , Memon Farjana , Chilumula Monica , Palepu Dharani Pratyusha , Selvaraj Kiruthika , Dasi Teena , Madhari Radhika , Calvo-Urbano Beatriz , Dockrell Julie , Antalek Catherine , Davies-Kershaw Hilary , Ferguson Elaine , Heffernan Claire 
Published: February 2024

IntroductionThe COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where insults acting on maternal environment have far-reaching consequences, the pandemic has had a significant impact on prenatal outcomes, intrauterine and postnatal development of infants. This research will investigate both the direct and indirect impacts of the COVID-19 pandemic during pregnancy on prenatal outcomes, growth and development in early childhood.Methods and analysisCommunity and hospital data in Hyderabad and Gujarat, India will be used to recruit women who were pregnant during the COVID-19 pandemic and contracted SARS-CoV-2 infection. In comparison with women who were pregnant around the same time and did not contract the virus, the study will investigate the impact of the pandemic on access to healthcare, diet, nutrition, mental health and prenatal outcomes in 712 women (356 per study arm). Children born to the women will be followed prospectively for an 18-month period to investigate the impact of the pandemic on nutrition, health, growth and neurocognition in early childhood.Ethics and disseminationEthics approval was granted from the institutional ethics committees of the Indian Institute of Public Health Gandhinagar (SHSRC/2021/2185), Indian Council of Medical Research-National Institute of Nutrition (EC/NEW/INST/2021/1206), and London School of Hygiene and Tropical Medicine (72848). The findings of the study will be disseminated to policy and research communities through engagements, scientific conferences, seminars, and open-access, peer-reviewed publication.
Advancement, barriers and collaboration: the ABC’s of addressing challenges and designing solutions between front-line physicians and business-oriented leaders
Authors: Ramedani Shayann , Miller Jeffery , Gonzalo Jed D 
Published: February 2024

BackgroundThe complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education.MethodsThe ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper.ResultsThrough this process, we identified four challenges: (1) the difference in thinking styles, which we term, ‘mental model differences’; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or ‘the chess game of stakeholder engagement’; (3) the language and precise methodology, or ‘consistency of language and need for administrative resilience’ and (4) the issue of teaching these concepts or bridging the learning gap.’ConclusionIn an increasingly complex healthcare landscape, physicians and trainee’s need to bridge gaps between the mental models of administrative and clinical workflow.
Faculty retention at a young medical school in crisis times and beyond: prospects, challenges and propositions from a mixed-methods study
Authors: Yazbeck Karam Vanda G , Bahous Sola , Awada Ghada M , Youssef Nazih 
Published: February 2024

BackgroundRetention of faculty constitutes a significant challenge for higher education institutions, especially in times of crisis. Lebanon has been experiencing economic recession since the end of its civil war in 1990 until its complete collapse in 2019. This resulted in a massive faculty exodus, escaping the daily struggle with the sinking economy.PurposeThe purpose of this study was to empirically investigate the factors that precipitate faculty attrition and the measures that foster long-term commitment to the institution in a time of unprecedented crisis.MethodsAn online anonymous survey, using a Likert scale, gathered responses from 92 faculty members. Quantitative findings were complemented by a qualitative exploration of emergent themes in comments. A team of three certified researchers conducted the analysis. Inductive analysis identified recurring themes, with steps like intercoder reliability checks and member-checking enhancing data validity. The researchers ensured methodological rigour, subject expertise, and overall reliability and validity of the thematic analysis.ResultsA total of 78 faculty participated in the survey (84.8%), with 79.5% reporting overall satisfaction, but a varying degree of satisfaction was noted across items. Faculty satisfaction was highest in areas such as respectful interactions (91.0%), belonging to the workplace (85.9%), communication from the Dean’s office (85.9%), supportive environment and medical school leadership’s commitment to retaining faculty (82.1%). Financial assistance, support for research and professional assistance were identified as important retention measures. Effective, transparent communication from leadership was highlighted as a critical factor during times of crisis.ConclusionThis study provides strategies for faculty retention in times of crisis that include ensuring timely salary payments, supporting research and professional development, fostering a positive work environment and implementing bonding programmes. Transparent communication from leadership is vital for faculty satisfaction and retention. These findings can aid medical schools and other institutions facing faculty attrition during crises.