bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perpetuation of gender discrimination in Pakistani society: results from a scoping review and qualitative study conducted in three provinces of Pakistan
Authors: Ali Tazeen Saeed , Ali Shahnaz Shahid , Nadeem Sanober , Memon Zahid , Soofi Sajid , Madhani Falak , Karim Yasmin , Mohammad Shah , Bhutta Zulfiqar Ahmed 
Published: December 2022

AbstractBackgroundGender discrimination is any unequal treatment of a person based on their sex. Women and girls are most likely to experience the negative impact of gender discrimination. The aim of this study is to assess the factors that influence gender discrimination in Pakistan, and its impact on women’s life.MethodsA mixed method approach was used in the study in which a systematic review was done in phase one to explore the themes on gender discrimination, and qualitative interviews were conducted in phase two to explore the perception of people regarding gender discrimination. The qualitative interviews (in-depth interviews and focus group discussions) were conducted from married men and women, adolescent boys and girls, Healthcare Professionals (HCPs), Lady Health Visitors (LHVs) and Community Midwives (CMWs). The qualitative interviews were analyzed both manually and electronically through QSR NVivo 10. The triangulation of data from the systematic review and qualitative interviews were done to explore the gender discrimination related issues in Pakistan.ResultsThe six major themes have emerged from the systematic review and qualitative interviews. It includes (1) Status of a woman in the society (2) Gender inequality in health (3) Gender inequality in education (4) Gender inequality in employment (5) Gender biased social norms and cultural practices and (6) Micro and macro level recommendations. In addition, a woman is often viewed as a sexual object and dependent being who lacks self identity unless being married. Furthermore, women are restricted to household and child rearing responsibilities and are often neglected and forced to suppress self-expression. Likewise, men are viewed as dominant figures in lives of women who usually makes all family decisions. They are considered as financial providers and source of protection. Moreover, women face gender discrimination in many aspects of life including education and access to health care.ConclusionGender discrimination is deeply rooted in the Pakistani society. To prevent gender discrimination, the entire society, especially women should be educated and gendered sensitized to improve the status of women in Pakistan.
Statistics for undergraduate medical students in Sudan: associated factors for using statistical analysis software and attitude toward statistics among undergraduate medical students in Sudan
Authors: Hasabo Elfatih A. , Ahmed Ghassan E. Mustafa , Alkhalifa Raed M. , Mahmoud Mai D. , Emad Sara , Albashir Roaa B. , Mansour Mohamed E. , Hsabo Elmuiz A. 
Published: December 2022

Abstract
Introduction
Statistics helps medical students understand research. Without understanding statistics, students can’t choose the proper analysis in their research. We aimed to assess the attitude toward statistics, usage of statical software and associated factors for using statistical analysis software in Sudan.

Method
A cross-sectional online survey was distributed among undergraduate medical students across ten Sudanese universities. The study aimed to measure their attitude towards statistics using Survey of Attitudes Toward Statistics (SATS-36) scale.

Results
In total, 489 students were participated with a mean age of 21.94 ± 1.61 and a slight female preponderance (52%, n = 256). The overall attitude towards statistics was 4.64 ± 0.91. The mean attitude scores for the components of SATS-36 scale was higher for students who were using statistical analysis software demonstrating significant difference in affect (p = 0.002), cognitive competence (p = 0.002), value (p = 0.002), Interest (p = 0.004) and Effort (p = 0.029). Almost half of the students (47%) had attended a biostatistics workshop with only 26% of them reported using statistical analysis software. Of the latter group, 72% (n = 91) used SPSS while 50% (n = 64) used excel. Univariate logistic regression showed students who had previously used an statistical software were more likely to be studying in their sixth year compared with second year (OR: 12.652, CI 95% 4.803– 33.332; p < 0.001), older age (OR: 1.224, CI 95% 1.079– 1.388; p = 0.002), attended a course in research methodology (OR: 3.383, CI 95% 2.120– 5.398; p < 0.001) or biostatistics (OR: 1.886, CI 95% 1.252– 2.841; p = 0.002), initiated or participated in a research project (OR:4.349, CI 95% 2.839 – 6.661;p < 0.001) or published a paper (OR: 8.271, CI 95% 3.542 – 19.312; p < 0.001).

Conclusions
The study showed an average attitude towards statistics among medical students. Being at higher years, participating or publishing research and attending research workshop are associated with the usage of statistical software. Also, few students were using statistical software.
Measurement of provider fidelity to immunization guidelines: a mixed-methods study on the feasibility of documenting patient refusals of the human papillomavirus vaccine
Authors: Chang Rachel S. , Shing Jaimie Z. , Erves Jennifer C. , Du Liping , Koyama Tatsuki , Deppen Stephen , Rentuza Alyssa B. , McAfee Caree , Stroebel Christine , Cates Janet , Harnack Lora , Andrews David , Bramblett Robert , Hull Pamela C. 
Published: December 2022

Abstract
Background
Assessment and feedback is a common implementation strategy to improve healthcare provider fidelity to clinical guidelines. For immunization guidelines, fidelity is often measured with doses administered during eligible visits. Adding a patient refusal measure captures provider fidelity more completely (i.e., all instances of a provider recommending a vaccine, resulting in vaccination or refusal) and enables providers to track patient vaccine hesitancy patterns. However, many electronic health record (EHR) systems have no structured field to document multiple instances of refusals for specific vaccines, and existing billing codes for refusal are not vaccine specific. This study assessed the feasibility of a novel method for refusal documentation used in a study focused on human papillomavirus (HPV) vaccine.

Methods
An observational, descriptive-comparative, mixed-methods study design was used to conduct secondary data analysis from an implementation-effectiveness trial. The parent trial compared coach-based versus web-based practice facilitation, including assessment and feedback, to increase HPV vaccination in 21 community-based private pediatric practices. Providers were instructed to document initial HPV vaccine refusals in the EHR's immunization forms and subsequent refusals using dummy procedure codes, for use in assessment and feedback reports. This analysis examined adoption and maintenance of the refusal documentation method during eligible well visits, identified barriers and facilitators to documentation and described demographic patterns in patient refusals.

Results
Seven practices adopted the refusal documentation method. Among adopter practices, documented refusals started at 2.4% of eligible well visits at baseline, increased to 14.2% at the start of implementation, peaked at 24.0%, then declined to 18.8%. Barriers to refusal documentation included low prioritization, workflow integration and complication of the billing process. Facilitators included high motivation, documentation instructions and coach support. Among adopter practices, odds of refusing HPV vaccine were 25% higher for patients aged 15–17 years versus 11–12 years, and 18% lower for males versus females.

Conclusions
We demonstrated the value of patient refusal documentation for measuring HPV vaccination guideline fidelity and ways that it can be improved in future research. Creation of vaccine-specific refusal billing codes or EHR adaptations to enable documenting multiple instances of specific vaccine refusals would facilitate consistent refusal documentation.
Trial Registration NCT03399396 Registered in ClinicalTrials.gov on 1/16/2018.
Assessment of maternal services in China based on WHO’s comprehensive evaluation model
Authors: Liu Yalan , Yan Li , Xia Yulin 
Published: December 2022

Abstract
Background
To understand the trend of equalization in maternal services and to guide policy-makers regarding resource allocation and public health policy in China.

Methods
Twelve indicators, including maternal services needs, utilization, and resource allocation, were collected from China Health Statistical Year Book 2010 and 2020. WHO’s comprehensive evaluation model and the non-integral Rank Sum Ratio (RSR) method were used to analyze, rank, and categorize maternal services of 31 provinces (cities, autonomous regions) in China.

Results
All provinces (cities, autonomous regions) are grouped into relative balance areas, low input areas, resource shortage areas, overutilization areas, and resource waste areas. In 2019, there were 18 provinces (cities, autonomous regions) in the relative balanced area, and more than one-half had achieved equal development. Compared to 2009, the resource shortage area decreased from three to zero, and the resource waste area increased from four to six. Among the provinces (cities, autonomous regions) with a type change compared with 2009, eight changed to a relative balance areas, and four showed an improvement.

Conclusion
Under the policy guidance of promoting the equalization of public health services, maternal services are gradually realized. However, several provinces (cities, autonomous regions) still have problems such as the mismatch between resource input and health needs, resource waste, over-utilization, etc. Therefore, specific policies should be formulated according to the actual types to promote the transformation into equalization regions.
Canadian dental hygienists’ experiences and perceptions of regulatory guidelines during the COVID-19 pandemic: a qualitative descriptive analysis
Authors: Macdonald Lindsay K. , Glogauer Michael , Allison Paul , Quiñonez Carlos , Madathil Sreenath , Rock Leigha D. 
Published: December 2022

Abstract
Background
In Spring of 2020, due to the COVID-19 pandemic, Canadian provincial dental hygiene regulatory bodies implemented new practice guidelines. Reports of stress, anxiety and conflict experienced by dental hygienists have been linked to miscommunication between oral health regulators at this time. Limited data exists on the perceptions and experiences of dental hygienists navigating new guidelines for dental hygiene care during the pandemic. Therefore, the objective of our study was to explore via descriptive thematic analysis how dental hygienists experienced and perceived: i) dental hygiene practice during the COVID-19 pandemic, and ii) their regulatory body’s COVID-19 guidelines.

Methods
Participants were identified through provincial dental hygiene licensing bodies. Online bi-monthly questionnaires were administered to participants (n = 876) from December 2021 to January 2022. Two open-ended questions were asked in the questionnaire. A qualitative descriptive thematic analysis was applied to these two questions.

Results
Major themes at baseline relayed challenges related to workplace compliance, patient treatment and communication of practice protocols. Across responses, hygienists confirmed conflicting messaging from regulators and guideline interpretations as stressors impacting their professional practice and satisfaction within the profession. Participant responses at endpoint cited increased satisfaction with regulatory guidelines as the pandemic evolved, yet inconsistencies in regulators’ messaging was noted as a prevailing issue.

Conclusion
Inconsistent guideline messaging reflects an increased need for collaboration amongst oral health care regulators to streamline protocols for practice and reduce interprofessional conflict in pandemic circumstances. A national unified approach is warranted in establishing guidelines for dental hygiene practice in Canada.
Associations between urinary concentrations of bisphenols and serum concentrations of sex hormones among US. Males
Authors: Zhang Chichen , Luo Yuehong , Qiu Shi , Huang Xinyi , Jin Kun , Li Jiakun , Yang Mi , Hu Dan , Zheng Xiaonan , Jiang Zhongyuan , Wang Mingda , Zou Xiaoli , Wei Qiang 
Published: December 2022

Abstract
Background
Bisphenol A (BPA) exposure and its structural analogs (BPS and BPF) might cause endocrine alterations and adverse physiological effects. Few studies to date have directly explored the association between its structural analogs (BPS, BPF) and sex hormones in adult male participants. Therefore, we aimed to assess the associations between BPA, BPS, BPF, and sex hormones in American adult men.

Methods
We used data from the U.S. National Health and Nutrition Examination Survey 2011–2016. We excluded participants without data available on sex hormones and urinary bisphenols. Furthermore, participants consuming sex hormone medications were excluded. Multivariable regression models were performed to assess the association between bisphenols and sex hormones.

Results
In this study, 2367 participants were included. Of 2367, in 1575 participants, the data on BPS and BPF were available. We found that a per unit increase in BPF was associated with 0.575 ng/dL higher total testosterone (TT) (Model 2: 95% CI: 0.047, 1.103, P = 0.033). However, there was no significant association between BPA or BPS and TT. Furthermore, increased BPA and BPS levels were associated with higher levels of sex hormone-binding globulin (SHBG) (Model 2: β = 0.364, 95% CI: 0.158, 0.571; β = 0.25, 95% CI: 0.071, 0.429, respectively). Additionally, participants in the highest BPA exposure quartile (quartile 4) had 4.072 nmol/L higher levels of SHBG than those in quartile 1 (Model 2: 95% CI: 0.746, 7.397, P = 0.017; P for trend =0.005). Both BPA and BPS were negatively associated with free testosterone (FT, nmol/L) after full adjustment (Model 2, β = − 0.01%, P = 0.0211, P = 0.0211; Model 2, β = − 0.01%, P = 0.0258, respectively). However, BPF was positively associated with FT (Model 2, β = 0.0029%, P = 0.0028).

Conclusion
Our study indicated that exposure to both BPA and its substitutions could alter sex hormone levels. This finding supports the possibility that human exposure to bisphenols at environmental levels might affect the endogenous hormone balance.
Dynamics of COVID-19 progression and the long-term influences of measures on pandemic outcomes
Authors: Lan Yihong , Yin Li , Wang Xiaoqin 
Published: December 2022

AbstractThe pandemic progression is a dynamic process, in which measures yield outcomes, and outcomes in turn influence subsequent measures and outcomes. Due to the dynamics of pandemic progression, it is challenging to analyse the long-term influence of an individual measure in the sequence on pandemic outcomes. To demonstrate the problem and find solutions, in this article, we study the first wave of the pandemic—probably the most dynamic period—in the Nordic countries and analyse the influences of the Swedish measures relative to the measures adopted by its neighbouring countries on COVID-19 mortality, general mortality, COVID-19 incidence, and unemployment. The design is a longitudinal observational study. The linear regressions based on the Poisson distribution or the binomial distribution are employed for the analysis. To show that analysis can be timely conducted, we use table data available during the first wave. We found that the early Swedish measure had a long-term and significant causal effect on public health outcomes and a certain degree of long-term mitigating causal effect on unemployment during the first wave, where the effect was measured by an increase of these outcomes under the Swedish measures relative to the measures adopted by the other Nordic countries. This information from the first wave has not been provided by available analyses but could have played an important role in combating the second wave. In conclusion, analysis based on table data may provide timely information about the dynamic progression of a pandemic and the long-term influence of an individual measure in the sequence on pandemic outcomes.
Feasibility and effectiveness of WhatsApp online group on breastfeeding by peer counsellors: a single-blinded, open-label pilot randomized controlled study
Authors: Fan Heidi S. L. , Ho M. Y. , Ko Rachel W. T. , Kwok Jojo Y. Y. , Chau P. H. , Wong Janet Y. H. , Wang M. P. , Lok Kris Y. W. 
Published: December 2022

AbstractIntroductionWith mobile technologies becoming more advanced and accessible, mobile health (mHealth) has been incorporated in delivering timely and convenient breastfeeding support. However, its feasibility and potential efficacy remain to be examined. Therefore, the primary objective of this study is to assess the feasibility and acceptability of an online instant messaging peer support group for breastfeeding. The secondary objective is to evaluate the effect of the intervention on breastfeeding outcomes.MethodsA pilot randomized controlled trial was conducted. A total of 33 primiparous women were recruited in the antenatal clinic at a public hospital in Hong Kong between March and April 2021. They were randomized to receive either standard care (n = 18) or standard care and receive peer-group support in an online instant messaging app (n = 15). Participants received telephone follow-up for up to six months postpartum or until they stopped breastfeeding. After completing the study, six participants in the intervention group were interviewed to understand their perceptions of the intervention.ResultsThis pilot study shows that online messaging peer support group is feasible and acceptable to women. In total, 54.4% of the eligible women agreed to participate, and 97.0% completed the follow-up. Participants perceived that providing peer support through instant messaging app is appropriate. It serves as a channel for the participants to ask questions and obtain information. Furthermore, meetings of the peer supporters and group members can be held to enhance the effectiveness of the intervention. In addition, no significant differences were found in any and exclusive breastfeeding rates, breastfeeding attitude, and breastfeeding self-efficacy between the two groups.ConclusionsThis study shows that online messaging peer support group is feasible and acceptable. A full-scale study should be conducted to understand the effect of the online instant messaging peer support group on breastfeeding outcomes.Trial Registration:The study protocol is registered onClinicaltrial.gov(NCT04826796) on 1 April 2021
Clinical and imaging characteristics of cardiac magnetic resonance presenting with myocardial infarction with non-obstructive coronary arteries in China
Authors: Zhao Xinxiang , Zeng Daobing , He Liping , Sun Wenjing 
Published: December 2022

Abstract
Background
The characteristics are still unclear due to lack of systematic research on patients with myocardial infarction non-obstructive coronary arteries (MINOCA) in China. This study aimed to explore the clinical and imaging features of MINOCA patients.

Methods
The patients who were diagnosed as suspected MI were studied. Cardiac magnetic resonance (CMR) was performed after coronary angiography or coronary computed tomographic angiography examination within one week. Myocardial infarction (MI) was determined by late gadolinium enhancement CMR.The patients with MI were divided into MINOCA and MICAD group according to whether the degree of coronary stenosis was greater than 50%. Cardiac function and imaging characteristics between the two groups were analyzed.

Results
21 patients with MINOCA and 30 patients with myocardial infarction with obstructive coronary artery disease (MICAD) were analyzed. MINOCA patients were younger, and the electrocardiogram was commonly featured by non-ST-elevation. The parameters of left ventricular function were significantly different between the two groups including left ventricular ejection fraction, stroke volume, cardiac output, myocardial mass, and peak ejection rate (P < 0.05). Besides, MINOCA patients had smaller area of MI, less score of transmural extent, fewer involved segments. Furthermore, the transmural extent of MI in MINOCA patients was mainly grade I, that is, most of them were subendocardial MI, which was significantly negatively correlated with the amount of first-pass perfusion.

Conclusions
The clinical characteristics combined with imaging features of CMR may be effective to evaluate the cardiac function in order to make clinical decision for MINOCA patients in China.
Trends in the prevalence, prenatal diagnosis, and outcomes of births with chromosomal abnormalities: a hospital-based study in Zhejiang Province, China during 2014–2020
Authors: Chen Xinning , Lin Dan , Ye Yinghui , Zhang Xiaohui , Chen Danqing 
Published: December 2022

Abstract
Background
To investigate the prevalence and prenatal diagnosis rate of chromosomal abnormalities (CA) in Zhejiang Province, China.

Methods
We estimated the annual changes in the detected prevalence of CA and prenatal diagnosis rate among 681,590 births in Zhejiang Province, China, between 2014 and 2020. Data were derived from the provincial birth defects surveillance system, which represents 30% of annual births in Zhejiang Province. The effect of maternal age was also evaluated.

Results
The detected prevalence of sex chromosomal abnormalities (1.70–7.30 per 10,000 births, Ptrend < 0.001) and microdeletion and microduplication (0.30–6.81 per 10,000 births, Ptrend < 0.001) gradually increased, contributing to an upward trend in overall CA (12.09–39.22 per 10,000 births). The diagnosis rate before 22 gestational weeks constantly increased from 20.8 to 70.1% for trisomy 21 (Ptrend = 0.003). The prevalence rate ratio for maternal age of ≥ 35 years was higher than that for maternal age of 25–29 years for trisomy 21 (5.40, 95% confidence interval [CI] 4.59–6.35) and sex chromosomal abnormalities (3.28, 95% CI 2.48–4.33).

Conclusions
The rising prevalence of CA in China may be attributable to the elevated maternal age and the innovation of prenatal diagnosis tools, Thus, studies should pay attention to the rare CA that were previously ignored, and select rational screening tools.