bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term drought and risk of infant mortality in Africa: A cross-sectional study
Authors: Wang Pin , Rogne Tormod , Warren Joshua L. , Asare Ernest O. , Akum Robert A. , Toure N’datchoh E. , Ross Joseph S. , Chen Kai 
Published: January 2025

Background
As extreme events such as drought and flood are projected to increase in frequency and intensity under climate change, there is still large missing evidence on how drought exposure potentially impacts mortality among young children. This study aimed to investigate the association between drought and risk of infant mortality in Africa, a region highly vulnerable to climate change that bears the heaviest share of the global burden.

Methods and findings
In this cross-sectional study, we obtained data on infant mortality in 34 African countries during 1992–2019 from the Demographic and Health Surveys program. We measured drought by the standardized precipitation evapotranspiration index at a timescale of 24 months and a spatial resolution of 10 × 10 km, which was further dichotomized into mild and severe drought. The association between drought exposure and infant mortality risk was estimated using Cox regression models allowing time-dependent covariates. We further examined whether the association varied for neonatal and post-neonatal mortality and whether there was a delayed association with drought exposure during pregnancy or infancy.
The mean (standard deviation) number of months in which children experienced any drought during pregnancy and survival period (from birth through death before 1 year of age) was 4.6 (5.2) and 7.3 (7.4) among cases and non-cases, respectively. Compared to children who did not experience drought, we did not find evidence that any drought exposure was associated with an increased risk of infant mortality (hazard ratio [HR]: 1.02, 95% confidence interval [CI] [1.00, 1.04], p = 0.072). When stratified by drought severity, we found a statistically significant association with severe drought (HR: 1.04; 95% CI [1.01, 1.07], p = 0.015), but no significant association with mild drought (HR: 1.01; 95% CI [0.99, 1.03], p = 0.353), compared to non-exposure to any drought. However, when excluding drought exposure during pregnancy, the association with severe drought was found to be non-significant. In addition, an increased risk of neonatal mortality was associated with severe drought (HR: 1.05; 95% CI [1.01, 1.10], p = 0.019), but not with mild drought (HR: 0.99; 95% CI [0.96, 1.02], p = 0.657).

Conclusions
Exposure to long-term severe drought was associated with increased infant mortality risk in Africa. Our findings urge more effective adaptation measures and alleviation strategies against the adverse impact of drought on child health.
Protocol for evaluating the effects of integrating music with taekwondo training in children with autism spectrum disorder: A randomized controlled trial
Authors: Yu Clare C. W. , Mok Kam M. , Mak Emma , Au Chun T. , Chan Dorothy F. Y. , Wu Stanley , Chung Raymond C. K. , Ip Matthew C. K. , Wong Simpson W. L. 
Published: January 2025

Background
Children with autism spectrum disorder (ASD) are known to experience difficulties in coordinating fine- and gross-motor movement. Previous interventional studies have reported significant effect of exercise-based intervention programs on improving motor skills and alleviating symptoms in ASD; however, researchers are yet to know why some participants experienced less improvement than others. One plausible explanation for suboptimal treatment outcomes is insufficient engagement in the exercise programs due to the children’s difficulties in following instructions and performing the correct movements. In the proposed research, we will test the above speculation by manipulating the amount of music-therapy elements into a 10-week Taekwondo training program designed specifically for children with autism.

Methods
This is a randomized controlled trial. Seventy-two children aged 7 to 9 years who meet the diagnostic criteria of ASD will be recruited and randomized into either the “Taekwondo training with elements of music therapy” group or the “Taekwondo training alone” group. In both groups, the participating children will attend Taekwondo training sessions twice a week over 10 consecutive weeks. In the “Taekwondo training with elements of music therapy” group, elements of music therapy will be incorporated into the Taekwondo training. Assessment will be conducted before the program commences, immediately after the completion of the 10-week program, and 2 months after the post-test. The outcome domains to be evaluated include the immediate effects during the exercise sessions. These effects include the level of engagement in the exercise sessions (primary outcome), enjoyment, physical activity level, and rate of perceived exertion. Furthermore, the evaluation will also cover the overall effects of the training program on gross motor skills, Taekwondo skills performance, executive function, psychosocial functioning, and behavioral problems.

Discussion/Findings
The findings of this study will inform strategies for the promotion of physical activity and engagement among children with ASD when participating in exercise training classes. The study will also suggest the importance of regular physical activity for the physical and mental well-being of children with ASD.

Trial registration
Clinical trial registration: URL: http://www.clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT06277778. Registered on 15 February 2024.
Screening attendance of breast or cervical cancers and its associated factors among 30–49 year old women in Gedeo zone, South Ethiopia: Cross-sectional study
Authors: Demeke Abel Desalegn , Deribe Bedilu , Girma Martha , Gizaw Muluken , Getachew Sefonias , Unverzagt Susanne , Kantelhardt Eva J. , Ferrell Betty , Kroeber Eric Sven , Taylor Lesley 
Published: January 2025

Introduction
Breast and cervical cancers are the most frequent and fatal cancers among women. Thus, early detection is necessary to improve the prognosis of affected women. However, in Ethiopia, the rates of screening remain alarmingly low.

Objective
To assess the magnitude of screening attendance for breast or cervical cancer, as well as the factors that predict it, among women aged 30–49 years old in Gedeo Zone, South Ethiopia, in 2023.

Method
A community-based cross-sectional study was conducted using a multi-stage cluster sampling technique. Data were collected using pretested, structured questionnaires by trained interviewers. Univariate and multivariate logistic regression models were employed to identify factors associated with screening attendance.

Results
A total of 554 women participated in the study. Of them, 132 (23.8%) were screened for breast or cervical cancer. Higher age of 40–44 versus 45–49 years (adjusted odds ratio [AOR] 4.18 [95% CI 1.59, 10.9]), higher education status ([AOR] 5.49 [95% CI 2.01, 13.1]), having family or a friend with history of breast or cervical cancer ([AOR] 5.55 [95% CI 2.47, 12.5]), short anticipated time to seek help ([AOR] 4.66 [1.31, 11.7]), adequate health literacy ([AOR] 6.98 [95% CI 2.82,13.3]) and high self-efficacy ([AOR] 2.32 [95% CI 1.08, 4.96]) were positive factors with higher screening attendance. High response cost ([AOR] 0.19 95% CI [0.08, 0.50]) was a negative factor and associated with lower screening attendance.

Conclusion and recommendation
The study found that only one in four women attended breast or cervical cancer screening. Screening uptake was better in women with higher education, health literacy, self-efficacy, and older age–similar to factors associated with other health seeking behavior. Interestingly, history of breast or cervical cancer in a friend or relative was also associated with higher uptake. This indicates that in addition to awareness campaigns, personal testimonials of survivors could encourage women to visit screening facilities.
A prospective model of the potential clinical and economic impact of cervical cancer screening supported by a mobile phone app
Authors: Asirwa Fredrick Chite , Bresnahan Brian W. , Yego Faith , Duncan Dana , Karichu James K. , Garrison Jr. Louis P. 
Published: January 2025

Introduction
Cervical cancer is a preventable and highly curable disease when detected early and adequately treated, yet it remains the leading cause of cancer-related death in women in Kenya due to low screening coverage and treatment. Implementing World Health Organization screening guidelines for human papillomavirus (HPV) is challenging due to the complex logistics of result return and follow-up requiring multiple clinic visits. Increasing the use of mobile technology can support follow-up care in cervical cancer screening programs.

Methods
We developed a prospective clinico-economic model to assess the potential impact of a mobile phone-based application (“app”) communicating laboratory results and recommendations to improve follow-up care for cervical cancer screening in Kenya. The model is structured to simulate a three-visit pathway for HPV-based screening used in a clinical trial of the app and based on epidemiological data, clinical guideline-based workflow, and patient-based behavioral pathways. Published literature, expert elicitation, and time-and-motion observations were used to estimate clinical data, care pathways, and visit-related costs. This analysis was conducted from a base-case healthcare system perspective with a scenario from a “limited” societal perspective.

Results
In a simulated cohort of women using the app-based intervention compared to conventional care, with 10,000 women in each arm, use of the app is projected to increase healthcare costs by $12.53 per enrolled woman during the trial period and to detect and treat an additional 247 women—229 with precancerous cervical lesions and 18 with cervical cancer. The incremental cost-effectiveness ratio of the app versus conventional care was $174 per case detected and treated. This would be cost-saving given the average lifetime cost per cervical cancer case of $1,000–$3,000.

Conclusion
Use of a mobile phone-based app is costlier than conventional screening but by improving visit compliance, it can be a cost-effective and cost-saving strategy to enhance detection and treatment in cervical cancer screening programs.
HIV viral load suppression rates among adults and children living with HIV in the North West Region of Cameroon: A call for action!
Authors: Tayong Gladys Fosah E. , Sander Melissa , Vuchas Comfort , Samje Moses , Kum Vera , Enokbonong Pascal , Yeika Eugene , Bekombo Ndanga , Nyibio Paul , Ngwani Vanessa B. , Ndié Justin , Yembe Njamnshi wepnyu , Ashuntangtang Gloria 
Published: January 2025

Introduction
HIV continues to be a major public health problem in Cameroon where 2.7% of the population aged 15 to 49 are living with HIV. The prevalence remains higher in females, 3.4% versus 1.9% in males. The North West region of Cameroon has a higher prevalence than the national average; 4% in the general population, 5.8% in females and 1.6% in males. Despite the availability of pediatric HIV treatment, gaps in outcomes of children living with HIV (CLHIV) persists. This study aimed to compare the HIV viral suppression rates among adults and children living with HIV receiving antiretroviral therapy (ART) in the North West Region of Cameroon. In this study we hypothesized that the virologic outcome of children living with HIV is unfavorable compared to adults.

Methodology
This study was a comparative cross-sectional analytical study with secondary analysis of Viral load laboratory database. Data was collected in June 2023. We systematically collected deidentified data on viral load test of all PLHIV with HIV viral load results in the Bamenda TB reference laboratory database for the period January 1, 2022 to December 31, 2022. Data was analyzed using Stata SE 14.2. Categorical variables were described using absolute and relative frequencies. These were compared using Pearson’s chi-squared test. Quantitative variables were described using mean as a characteristic of central tendency and standard deviation (SD) as a characteristic of dispersion.

Results
Analysis revealed that of the 23,814 PLHIV whose viral load test was done at the Bamenda TB reference laboratory during the year 2022, 17,364(73%) were female and 1436 (6%) were children. The level of HIV viral suppression (viral load<1000 copies/ml) in children was lower compared to that of adults (80% vs. 95%; p<0.001). Females had lower viral suppression than males (94% vs. 91%; p<0.001).

Conclusion
The results revealed a significant lower HIV viral suppression rate in children than in adults. Women also had a significantly higher HIV viral suppression than males. Findings indicated that HIV viral suppression rate is significantly higher for routine viral load testing than for targeted testing after enhanced adherence counselling, thus the need to systematically offer enhanced adherence counselling and other evidence-based support interventions in routine care to all PLHIV to avoid persistent high viral non-suppression. Action is needed to tackle all known factors contributing to high viral non-suppression in children living with HIV and to help achieve 95% viral suppression rate in CLHIV in the North West region of Cameron.
Prevalence, outcome and conduct of in-hospital cardiopulmonary resuscitation in government hospitals of Nepal
Authors: Hamal Pawan Kumar , Kunwar Surendra , Gautam Kapil , Bhattarai Ramesh , Yadav Rupesh Kumar , Lamsal Ritesh , Singh Radeep , Pathak Sonam , Pokhrel Nabin 
Published: January 2025

Introduction
Cardiopulmonary resuscitation (CPR) is an evidence-based intervention that saves lives. In low- and middle-income countries like Nepal, the occurrence of the problem and its outcome are seldom studied. The study aims to highlight the prevalence, performance, and outcome of CPR in government hospitals of Nepal.

Methods
A mixed method study was done for two months in central and provincial government hospitals of Nepal. A total of 80 resuscitations were evaluated using a questionnaire based on the American Heart Association 2020 guidelines for cardiopulmonary resuscitation. An in-depth interview was conducted with 15 active participants of the resuscitation in different sites. Thematic analysis was done using the framework of the chain of survival of arrest victims.

Results
The overall prevalence of CPR was found to be 1.92% [95% CI: 0.01,0.02] with 5.4% in central hospitals and 0.65% in provincial hospitals with 60% cardiac arrests occurring in the intensive care unit. Estimated time from recognition of the arrest to initiating CPR was 1.9 ±1.4 minutes. Asystole 66.25% was the commonest arrest rhythm and 21.25% had difficulty interpreting rhythm. Only 11.25% of the victims had return of spontaneous circulation and were subsequently transferred for post-arrest care. The qualitative analysis highlighted the lack of trained staff, a dedicated system, feedback mechanism, and provision of post-arrest care.

Conclusion
Across various level of Nepal’s healthcare system, cardiopulmonary resuscitation is prevalent with poor performance and outcome. To improve outcomes, it is essential to implement standardized procedures and ensure high quality resuscitation delivery before and after the event supported by well-trained healthcare personnel and adequate infrastructure.
A data pipeline for secure extraction and sharing of social determinants of health
Authors: Schappe Tyler , McElroy Lisa M. , Ogundolie Moronke , Matsouaka Roland , Rogers Ursula , Bhavsar Nrupen A. 
Published: January 2025

Objectives
Linking neighborhood- and patient-level data provides valuable information about the influence of upstream social determinants of health (SDOH). However, sharing of these data across health systems presents challenges. We set out to develop a pipeline to acquire, deidentify, and share neighborhood-level SDOH data across multiple health systems.

Methods
We created a pipeline centered around Decentralized Geomarker Assessment for Multi-Site Studies (DeGAUSS) that utilizes containerization to geocode patient addresses and obtain neighborhood-level SDOH variables. We compared DeGAUSS to a third-party vendor geocoding tool available at Duke Health using a cohort of adult patients referred for abdominal transplant from January 1, 2016, to December 31, 2022. We calculated Cohen’s Kappa and percent disagreement at census block group and tract levels, and by Area Deprivation Index, urbanicity, and year.

Results
The pipeline successfully generated SDOH data for 97.8% of addresses. There was high concordance between DeGAUSS and the vendor tool at the census block group (0.93) and tract levels (0.95). At the block group level, disagreement proportion differed by year and urbanicity, with larger disagreement in the rural category than in micropolitan and metropolitan categories (13%, 7%, 6.2%, respectively).

Discussion and conclusion
We describe a novel pipeline that can facilitate the secure acquisition and sharing of neighborhood-level SDOH without sharing PHI. The pipeline can be scaled to include additional social, climate, and environmental variables, and can be extended to an unlimited number of health systems.
Serum lipids mediate the association of per- and polyfluoroalkyl substances exposure and age-related macular degeneration
Authors: Chen Xiaodong , Li Jiaqi , Xu Ningda , Li Xuewei , Li Jiarui , Guo Qianwen , Zhang Jia , Miao Heng , Huang Lvzhen 
Published: January 2025

Background
This study aims to investigate the connection between serum lipids, per- and polyfluoroalkyl substances (PFAS), and age-related macular degeneration (AMD) risk and assess whether serum lipids mediate the association between PFAS and AMD.

Methods
1605 participants were enrolled from NHANES 2005–2008. Four serum PFAS levels with high detective rates, including perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) were examined. Restricted cubic spline analysis (RCS) and weighted quantile sum (WQS) analysis were employed to detect nonlinear and mixed exposure effects.

Results
PFOS level was associated with any AMD (OR, 1.54; 95% CI, 1.12 to 2.11; P = 0.011), early AMD (OR, 1.43; 95% CI, 1.06 to 1.95; P = 0.024), and late AMD (OR, 3.35; 95% CI, 1.55 to 7.23; P = 0.004) risk. PFHxS (OR, 1.72; 95% CI, 1.01 to 2.93; P = 0.045) and PFOA (OR, 2.10; 95% CI, 1.21 to 3.63; P = 0.011) levels were associated with late AMD risk. The RCS showed a nonlinear connection between PFOS exposure and AMD risk (P nonlinear = 0.006). WQS analysis indicated a positive relationship between mixed PFAS exposure and AMD risk (OR, 1.34; 95% CI, 1.03 to 1.75; P = 0.030). Serum total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol were associated with AMD risk (ORTC, 1.005; 95% CI, 1.001 to 1.009; P = 0.026. ORHDL, 1.028; 95% CI, 1.014 to 1.042; P<0.001), and mediated the relationship of PFOS exposure and AMD risk, with mediation proportions of 5.73% (P = 0.020) and 7.27% (P = 0.032), respectively.

Conclusions
PFOS exposure was connected with AMD risk and serum TC and HDL mediated this relationship.
The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction
Authors: Zhang Zixi , Wang Cancan , Liu Qiming , Xiao Yichao , Zhou Jiabao , Wu Keke , Huang Yunying , Zhang Zeying , Liu Shiping , Lin Qiuzhen 
Published: January 2025

Background
Malnutrition presents a significant challenge in managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), yet its impact on AF recurrence after catheter ablation in this population remains unclear.

Methods
We conducted a retrospective analysis of 204 patients with paroxysmal non-valvular AF and HFpEF who underwent radiofrequency or cryoballoon ablation. Risk of malnutrition as assessed using three screening tools: the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)]. We examined the relationship between risk of malnutrition and AF recurrence post-ablation.

Results
After a mean follow-up period of 11.2 ±  1.8 months, 43 patients (21.1%) experienced AF recurrence. Despite being classified as overweight or obese based on body mass index, many patients were at risk of malnutrition according to the CONUT score, NRI, and PNI. Adjusted analyses showed that higher CONUT scores (HR: 10.132; 95% CI: 2.545–40.336; P =  0.001), lower NRI (HR: 22.734; 95% CI: 6.399–80.776; P <  0.001), or lower PNI (HR: 9.469; 95% CI: 3.232–27.739; P <  0.001) were significantly associated with increased risk of AF recurrence. Restricted cubic spline regression revealed an inverted U-shaped relationship between the CONUT score and AF recurrence, and L-shaped relationships for both NRI and PNI with AF recurrence.

Conclusions
Systematic nutritional assessment is crucial in patients with paroxysmal non-valvular AF and HFpEF. High CONUT scores, low NRI, or low PNI serve as independent predictors for AF recurrence. Further large-scale randomized controlled trials are required to validate these findings.
The combined impacts of toxic drug use and the 2021 Heat Dome in Canada: A thematic analysis of online news media articles
Authors: Tetzlaff Emily J. , Goulet Nicholas , Gorman Melissa , Kenny Glen P. 
Published: January 2025

Introduction
During the summer of 2021, western Canada experienced a historic and deadly extreme heat event. Simultaneously, toxic drug use and overdoses related to high-risk use of opioids and polysubstance use continued to rise across the country. However, the combined impacts of these intersecting public health crises remain poorly understood as relevant data sources are limited in Canada.

Methods
We explored news media articles (n = 86, 3%) discussing toxic drug use, overdose-related deaths and the 2021 Heat Dome which were identified in a systematic review of Canadian online news media (e.g., newspaper articles, radio broadcasts) from five subscription news databases and an extensive grey literature search (n = 2909). The analyzed articles were published before, during and after the 2021 Heat Dome, and were qualitatively coded and thematically analyzed in NVivo to identify patterns of meaning across the dataset.

Results
Four main themes were identified within our media-based analysis: (I) the reported impact of toxic drug use on human thermoregulation and behavioural adaptation; (II) the reported demand of intersecting crises on the health system; (III) barriers and stigma reported to influence an individual’s access to or use of heat mitigation behaviours and services; and (IV) the reported impact of extreme heat on the public health response to drug poisoning emergencies.

Conclusion
With increasing temperature extremes and a rising tide of toxic drug use and overdoses, our findings illustrate that there is a need for further research to better understand the combined impacts when toxic drug use, overdose-related deaths, and extreme heat coincide.