bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preferences, educational messaging, and demand creation channels for multipurpose-prevention technologies (MPTs) among women in South Africa
Authors: Mataboge Paballo , Mthimkhulu Nqaba , Kutywayo Alison , Martin Catherine E. , Mazibuko Mbali , Kwatsha Khanyiswa , Makalela Nthabiseng , Briedenhann Elmari , Butler Vusile , Bothma Rutendo , Mullick Saiqa 
Published: October 2023

Abstract
Background
South African women, including female sex workers (FSWs), are disproportionately affected by HIV, experience a high unmet need for contraception and high rates of sexually transmitted infections (STIs). Products that address the interlinked risk between HIV, unplanned pregnancy, and other STIs are needed. There are several multipurpose-prevention technologies (MPTs) in development, aimed at preventing both HIV and pregnancy. This study aimed to explore educational messaging and demand creation channels to improve the potential uptake of a hypothetical MPT implant, using participatory action research. It also aimed to look at product and service provision attributes preferred by potential end users.

Methods
Between July and August 2022, 303 PrEP-eligible adolescent girls and young women (AGYW) (18–24 years), women > 24 years, and FSW’s (≥ 18 years) participated in 4-hour workshops, where they were asked about their ideal messaging and demand creation channels and their preferences for different attributes of an MPT implant. Quantitative descriptive analysis was conducted to determine the frequency and ranking for each demand creation message, channel, and each product and service provision attribute, by population group. A chi-square test was used to assess MPT implant characteristics associated with age. Qualitative data were analysed using deductive and thematic analysis.

Results
A total of 104 AGYW, 157 women > 24 years, and 42 FSWs participated in the PAR workshops. Participants preferred demand creation messages that were empowering, motivational and encouraged body autonomy. The use of slang was popular. Community radio stations and newspapers, social media, and information at hospitals and clinics were participants’ preferred MPT demand creation channels because they were easily accessible. Providing long-term and dual HIV and pregnancy protection, receiving implant services at the local clinic, manageable side effects, discreet and private implant, and numbing the area before insertion and removal, were the most preferred product and service provision attributes.

Conclusion
Early considerations for women’s product preferences are key to product development. Educational messaging around the MPT implant should be empowering and in local languages, this may motivate women to learn more about it and use it. Multiple demand creation channels should be used to engage both young and older populations, which may ensure better reach.
Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia
Authors: Muir Jonathan A. , Dheresa Merga , Madewell Zachary J. , Getachew Tamirat , Daraje Gamachis , Mengesha Gezahegn , Whitney Cynthia G. , Assefa Nega , Cunningham Solveig A. 
Published: October 2023

Abstract
Background
COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships.

Methods
We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia.

Results
Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships.

Conclusions
Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks.
Understanding covid-19 outcomes among people with intellectual disabilities in England
Authors: Sosenko Filip , Mackay Daniel , Pell Jill P. , Hatton Chris , Jani Bhautesh D. , Cairns Deborah , Ward Laura , Henderson Angela , Fleming Michael , Nijhof Dewy , Melville Craig ,   CVD-COVID-UK/COVID-IMPACT Consortium
Published: October 2023

Abstract
Background
Evidence from the UK from the early stages of the covid-19 pandemic showed that people with Intellectual Disabilities (ID) had higher rates of covid-19 mortality than people without ID. However, estimates of the magnitude of risk vary widely; different studies used different time periods; and only early stages of the pandemic have been analysed. Existing analyses of risk factors have also been limited. The objective of this study was to investigate covid-19 mortality rates, hospitalisation rates, and risk factors in people with ID in England up to the end of 2021.

Methods
Retrospective cohort study of all people with a laboratory-confirmed SARS-CoV-2 infection or death involving covid-19. Datasets covering primary care, secondary care, covid-19 tests and vaccinations, prescriptions, and deaths were linked at individual level.

Results
Covid-19 carries a disproportionately higher risk of death for people with ID, above their already higher risk of dying from other causes, in comparison to those without ID. Around 2,000 people with ID had a death involving covid-19 in England up to the end of 2021; approximately 1 in 180. The covid-19 standardized mortality ratio was 5.6 [95% CI 5.4, 5.9]. People with ID were also more likely to be hospitalised for covid-19 than people without ID. The main determinants of severe covid-19 outcomes (deaths and/or hospitalisations) in both populations were age, multimorbidity and vaccination status. The key factor responsible for the higher risk of severe covid-19 in the ID population was a much higher prevalence of multimorbidity in this population. AstraZeneca vaccine was slightly less effective in preventing severe covid-19 outcomes among people with ID than among people without ID.

Conclusions
People with ID should be considered a priority group in future pandemics, such as shielding and vaccinations.
Changes in fitness and fatness in Australian schoolchildren during the summer holidays: fitness lost, fatness regained? A cohort study
Authors: Olds Tim , Dumuid Dorothea , Eglitis Emily , Golley Rebecca , Fraysse François , Miatke Aaron , Tomkinson Grant R. , Watson Amanda , Munzberg Mason , Maher Carol 
Published: October 2023

Abstract
Background
Emerging evidence suggests that children’s fatness increases and fitness declines at a greater rate during the summer holiday period, compared with the school year. The aim of this study was to compare rates of change in fitness and fatness over the in-term and summer holiday periods among Australian schoolchildren. A secondary aim was to explore whether rates of change differed according to the child’s sex, socio-economic status (SES), pubertal status and weight status.

Methods
Children (n = 381) initially in Grade 4 (age 9) were recruited for this 2-year longitudinal study. Fatness (% body fat, BMI z-score, waist-to-height ratio) and fitness (20-m shuttle run and standing broad jump) were measured at the start and end of two consecutive years. Rates of change were calculated for the two in-school periods (Grades 4 and 5) and for the summer holiday period. Rates of change in fatness and fitness between in-school and holiday periods were compared, and differences in rates of change according to sex, socio-economic status, and weight status were explored.

Results
During the holidays, percentage body fat increased at a greater rate (annualised rate of change [RoC]: +3.9 vs. Grade 4 and + 4.7 vs. Grade 5), and aerobic fitness declined at a greater rate (RoC − 4.7 vs. Grade 4 and − 4.4 vs. Grade 5), than during the in-school periods. There were no differences in rates of change for BMI z-score, waist-to-height ratio or standing broad jump. Body fatness increased faster in the holidays (relative to the in-school period) in children who are overweight and from low-SES families. Aerobic fitness declined more rapidly in the holidays in children who are overweight.

Conclusion
This study highlights that during the summer holiday period, children experience greater increases in fatness and declines in fitness, with children who live with low-SES families and are overweight being more affected. The findings suggest the need for targeted interventions during this period to address these negative health trends.

Trial registration
Australia New Zealand Clinical Trials Registry, identifier ACTRN12618002008202. Retrospectively registered on 14 December 2018.
Changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates – HBSC study
Authors: Sigmund Erik , Sigmundová Dagmar , Pavelka Jan , Kalman Michal , Voráčová Jaroslava , Meier Zdeněk , Kopčáková Jaroslava , Badura Petr 
Published: October 2023

Abstract
Background
The main aim of the study is to examine changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates with respect to the adolescents’ families’socioeconomic status (SES) in 2022.

Methods
The sample of 24,535 adolescents (n = 11,629/12,9062018/2022; boys: 50.4/50.6%2018/2022) aged 10.5–16.5 years that was analysed was drawn from two nationally representative cohorts of Czech youngsters from the last two cycles of the Health Behaviour in School-aged Children (HBSC) online questionnaire survey from 2018 to 2022. Obesity is represented by the > 97th percentile interval on the World Health Organization Body Mass Index percentile chart, with distinctions by sex and the age of adolescents. The differences in the prevalence of obesity between boys and girls from all SES family categories in 2018 and 2022 were tested using a chi-square test (χ2). Multiple logistic regression analysis with repeated measures was used to analyse correlates of obesity in 2022.

Results
Between 2018 and 2022, there was no significant difference in the prevalence of obesity in girls or boys in any of the SES categories of families. Adolescents from low-SES families have the highest prevalence of obesity, 11% for boys and 5.8% for girls, significantly higher (p < .001) than its prevalence among adolescents from high-SES families, by + 4.8% points for boys and + 3.9% points for girls. Among adolescents from low-SES families, individuals who engaged in moderate-to-vigorous physical activity (PA) daily (p < .005) or vigorous PA three times per week (p < .05) were significantly less likely to be obese than their less active peers. Skipping breakfast significantly (p < .05) increased the odds of obesity, but only among adolescents from low-SES families. Shorter screen time (ST) significantly (p < .05) reduced the odds of obesity for all categories of adolescent SES.

Conclusions
Obesity is most pronounced in adolescents from low-SES families as a result of a long-term positive energy balance mediated by unbalanced behaviour. Significantly lower odds of obesity in adolescents from low-SES families were confirmed to be associated with regular practice of the recommended PA, shorter ST, and not skipping breakfast.
Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program
Authors: Young James J. , Kongsted Alice , Hartvigsen Jan , Ammendolia Carlo , Jensen Rikke Krüger 
Published: October 2023

Abstract
Background
People with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program for NSLBP patients with and without comorbid LSS symptoms.

Methods
This was a longitudinal analysis of 655 Danish participants in the GLA:D® Back program; an education and exercise therapy program for people with persistent NSLBP. Participants were classified as having comorbid LSS symptoms based on self-report. Linear mixed models were used to assess differences in change in disability (Oswestry Disability Index [0-100]) and back and leg pain intensity (Numeric Rating Scale [0–10]) at 3-, 6-, and 12-months between those with and without LSS symptoms.

Results
28% of participants reported LSS symptoms. No certain differences in change in disability or back pain intensity improvement were observed at any time-point between those with and without LSS symptoms. Participants with LSS symptoms had slightly greater improvement in leg pain intensity at 6- (-0.7, 95% CI -1.2 to -0.2) and 12-months (-0.6, 95% CI -1.2 to -0.1).

Conclusion
Compared to those without LSS symptoms, patients with persistent NSLBP and LSS symptoms can expect similar improvements in disability and back pain intensity, and slightly greater improvements in leg pain intensity with treatment. Therefore, education and exercise therapy programs designed for NSLBP are likely helpful for those also experiencing LSS symptoms.
Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study
Authors: Palola Vili , Hevonkorpi Teemu P. , Ponkilainen Ville T. , Launonen Antti P. , Mattila Ville M. 
Published: October 2023

Abstract
Background
Among the working population, a transient loss of working ability due to distal radius fracture (DRF) has a societal impact in terms of sick leave. Non-operative cast immobilization is the most common treatment option for DRF. However, these fractures are increasingly treated operatively. This retrospective cohort study of patients aged 20–64 with DRF compares the effects of different treatment strategies on sick leave length and overall cost of treatment.

Methods
Multivariable regression analysis was used with treatment modality as an exposure and sick leave length as an outcome. Sick leave data were obtained from a national register. Costs were evaluated by adding the direct cost of the treatment modality to the mean cost of sick leave per patient in different treatment groups.

Results
Of 614 working-age patients with a DRF who were treated at a tertiary hospital in Finland between January 2013 and December 2014, 521 were primarily treated non-operatively with cast immobilization and 93 were primarily operated. Of the primarily non-operatively treated patients, 48 were operated during follow-up. The mean follow-up was 5 years. The median time lost from work after DRF was 55 days (7.9 weeks), and the separated medians by treatment modality were 49 (7 weeks) and 70 days (10 weeks) for conservative and operative treatment, respectively. Multivariable linear regression analyses were performed for those patients who had sick leave (n = 292). Regression analysis also showed that operative treatment correlates with longer sick leave.

Conclusions
Operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. Moreover, due to longer sick leave and the costs of the operation itself, operative treatment is over two times more expensive than conservative treatment.

Trial registration
retrospectively registered.
Musculoskeletal disorders among dental students: a survey from Saudi Arabia
Authors: AlSahiem Jood , Alghamdi Sarah , AlQahtani Raghad , Bin-Jardan Leena , AlMadani Dalal , Farooqi Faraz Ahmed , Gaffar Balgis 
Published: October 2023

AbstractBackgroundWork-related musculoskeletal disorders (WMSD) are injuries affecting bones, joints, muscles, and tendons due to improper working conditions with serious consequences on health and career. Dentists were found to be at greater risk of developing WMSD compared to other healthcare providers. This study aimed to investigate the prevalence and risk factors of WMSD among dental students in Saudi Arabia.MethodsThis cross-sectional survey-based study recruited dental students across the kingdom using respondent-driven sampling technique. Data was collected using the Nordic Musculoskeletal scale and a validated, self- administered, close-ended questionnaire which assessed WMSDs predisposing factors, enabling factors and musculoskeletal disorders consequences and management. The questionnaire was administered in both Arabic and English languages and was distributed online using google forms. Data analysis was performed using SPSS, Chi-square test or Fisher Exact test was used where appropriate and Multivariate Logistic regression analysis was performed to identify predictors of developing WMSDs.ResultsThe prevalence of WMSD was 87% (95% CL; 83.9% to 90.3%) among the 462 respondents. Gender, study year, type of practice, having clinics for left-handed, hours of clinical practice, sitting in the proper position while working, use of coping strategies were significantly associated with WMSD prevalence (P < 0.05). Males were OR = 10 times at higher risk of WMSD compared to females (P = 0.0001). Those with daily clinical practice were OR = 5 times at higher risk of WMSD than those who have weekly practice. Those practicing walking, workout, and yoga showed lower prevalence of WMSD (OR = 0.377 & 0.323,p = 0.015, 0.010 respectively).ConclusionsThe prevalence of WMSD among dental students in KSA was high. Males and those with prolonged clinical sessions were at greater risk of WMSD. There is a need for awareness campaigns to educate dental students about risk factors of WMSD. Collegesy, dental colleges should adopt policies in reducing WMSD among their students.
Impact of manual toothbrush design on plaque removal efficacy
Authors: Axe Alyson , Mueller Wolf Dieter , Rafferty Helen , Lang Tomas , Gaengler Peter 
Published: October 2023

Abstract
Background
Effective dental plaque removal is essential for oral health. Different toothbrush parameters including head-size, filament-diameter and interdent-height and different brushing movements like horizontal, rotating and vertical may affect plaque removal efficacy. The purpose of the study was to examine plaque removal efficacy of different design parameters of manual toothbrushes.

Methods
Eight manual toothbrushes were tested using a validated robot test to examine efficacy of toothbrush on replicated human teeth. Characteristics tested were: (i) head-size, (ii) filament-diameter, (iii) cutting-height, (iv) hardness, (v) interdental-height. Each test ran five times in horizontal, rotating, vertical movements. Simulated Plaque removal was evaluated using automated plaque planimetry: 30 fields/tooth, 13 areas representing buccal, lingual, proximal tooth sites. The Kolmogorov-Smirnov-test was applied to test tooth surface variables for normal distribution of plaque removal values. Parameters were analysed by independent two-sample t-test to assess mean differences. Where null hypothesis of normality was rejected, the Wilcoxon-Mann-Whitney-U-test was used.

Results
Plaque removal was significantly better with toothbrush having smaller head-size (compact vs. full-size); smaller filament-diameter (0.12 mm vs. 0.15 mm); larger cutting-height (12 mm vs. 9 mm); softer filaments (0.15 or 0.18 mm vs. 0.23 mm) and greater interdent-height difference (8.5/11 mm vs. 10/11 mm).

Conclusions
Manual brushes allowing filaments free to flex with longer, softer and/or having a difference in filament length overall removed significantly more simulated plaque as compared to more standard flat trim, stiff brushes with shorter, harder bristles and a larger head size. While limited by the in vitro nature of the study design, this indicates that the advances in toothbrush design can further enhance plaque removal.
Obstetric operating room staffing and operating efficiency using queueing theory
Authors: Lim Grace , Lim Annamarie J. , Quinn Beth , Carvalho Brendan , Zakowski Mark , Lynde Grant C. 
Published: October 2023

Abstract
Introduction
Strategies to achieve efficiency in non-operating room locations have been described, but emergencies and competing priorities in a birth unit can make setting optimal staffing and operation benchmarks challenging. This study used Queuing Theory Analysis (QTA) to identify optimal birth center operating room (OR) and staffing resources using real-world data.

Methods
Data from a Level 4 Maternity Center (9,626 births/year, cesarean delivery (CD) rate 32%) were abstracted for all labor and delivery operating room activity from July 2019—June 2020. QTA has two variables: Mean Arrival Rate, λ and Mean Service Rate µ. QTA formulas computed probabilities: P0 = 1-(λ/ µ) and Pn = P0 (λ/µ)n where n = number of patients. P0…n is the probability there are zero patients in the queue at a given time. Multiphase multichannel analysis was used to gain insights on optimal staff and space utilization assuming a priori safety parameters (i.e., 30 min decision to incision in unscheduled CD; ≤ 5 min for emergent CD; no greater than 8 h for nil per os time). To achieve these safety targets, a < 0.5% probability that a patient would need to wait was assumed.

Results
There were 4,017 total activities in the operating room and 3,092 CD in the study period. Arrival rate λ was 0.45 (patients per hour) at peak hours 07:00–19:00 while λ was 0.34 over all 24 h. The service rate per OR team (µ) was 0.87 (patients per hour) regardless of peak or overall hours. The number of server teams (s) dedicated to OR activity was varied between two and five. Over 24 h, the probability of no patients in the system was P0 = 0.61, while the probability of 1 patient in the system was P1 = 0.23, and the probability of 2 or more patients in the system was P≥2 = 0.05 (P3 = 0.006). However, between peak hours 07:00–19:00, λ was 0.45, µ was 0.87, s was 3, P0 was 0.48; P1 was 0.25; and P≥2 was 0.07 (P3 = 0.01, P4 = 0.002, P5 = 0.0003).

Conclusion
QTA is a useful tool to inform birth center OR efficiency while upholding assumed safety standards and factoring peaks and troughs of daily activity. Our findings suggest QTA is feasible to guide staffing for maternity centers of all volumes through varying model parameters. QTA can inform individual hospital-level decisions in setting staffing and space requirements to achieve safe and efficient maternity perioperative care.