bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moderate-to-severe household food insecurity is associated with depression among adolescent girls in northern Ghana: a cross-sectional analysis
Authors: Azupogo Fusta , Saeed Nawaf , Wemakor Anthony , Addae Hammond Yaw , Boah Michael , Brouwer Inge D 
Published: January 2023

ObjectiveHousehold food insecurity is positively associated with depression; however, the association among adolescents is not well known. We examined the association between household food insecurity and depression among adolescent girls in Northern Ghana.MethodsWe analysed data from the Ten2Twenty-Ghana randomised controlled trial end-line for adolescent girls aged 10–17 years (n=582). The girls were chosen at random from 19 primary schools in the Mion District of Ghana’s northern region. The children’s depression inventory and the Food Insecurity Experience Scale were used in face-to-face interviews to assess depression and household food insecurity. Hierarchical survey binary logistic regression and linear mixed models were used to examine the association between household food insecurity and depressive symptoms. We took into account a number of potential confounders in the analysis, such as life satisfaction, self-efficacy, self-esteem, health complaints, child’s age, menarche status, pubertal development, anaemia, stunting, frequency of consuming fruits and vegetables, frequency of consuming animal-sourced foods, maternal age, household wealth index and size, and the intervention group the girl was assigned to in the trial.ResultsAbout 20.1% of adolescent girls were classified as likely depressed, and 70.3% of their households were food insecure, with 22.9% and 18.0% being moderately and severely food insecure, respectively. Compared with girls from food-secure households, those from moderately (adjusted OR (AOR) 2.63, 95% CI (1.35 to 5.12)) and severely (AOR 3.28, 95% CI (1.66 to 6.49)) food insecure households had about three times the odds of being classified as depressed, after controlling for potential confounders. The odds of being likely depressed were about twice for adolescent girls from food-insecure households compared with their peers from food-secure households in both the crude and final adjusted model.ConclusionThe study discovered high levels of household food insecurity and depression in adolescent girls in Northern Ghana, with a dose-response association between the two.
Vitamin-K-antagonist phenprocoumon versus direct oral anticoagulants in patients with atrial fibrillation: a real-world analysis of German claims data
Authors: Warkentin Lisette , Klohn Florian , Deiters Barthold , Kühlein Thomas , Hueber Susann 
Published: January 2023

ObjectivesDirect oral anticoagulants (DOACs) were introduced based on randomised controlled trials (RCTs) comparing them to vitamin-K-antagonist (VKA) warfarin. In Germany, almost exclusively phenprocoumon is used as VKA. RCTs with phenprocoumon being absent we analysed the benefits and harms of DOACs and phenprocoumon for patients with atrial fibrillation (AF) in a real-world setting.DesignIn a retrospective observational cohort study, claims data covering inpatient and outpatient care from 2015 to 2019 were analysed by Cox regression and propensity score matching (PSM).SettingData from a group of small-sized to medium-sized health insurance companies in Germany.ParticipantsWe analysed datasets of 71 961 patients with AF and first prescription of phenprocoumon (n=20 179) or DOAC in standard dose (n=51 782). Patients with reduced dose of DOACs were excluded (n=21 724).Outcome measuresOutcomes were thromboembolic events, major bleeding and death during a 12-month follow-up period.ResultsThe regression analysis widely showed similarity between phenprocoumon and standard dose DOACs regarding effectiveness and safety. There were only three statistically significant differences: a lower bleeding risk with composite DOACs and apixaban (HR (95% CI) = 0.67 (0.59 to 0.76) and 0.54 (0.46 to 0.63), respectively) and a higher risk of death with rivaroxaban (1.21 (1.10 to 2.34)). The analysis after PSM was consistent with the first two results regarding composite DOACs and apixaban (number needed to treat, NNT 101 and 78) and showed a lower bleeding risk with rivaroxaban (NNT 156). Absolute differences were small.ConclusionsThe small superiority or non-inferiority of DOACs over warfarin seen in the RCTs might not translate into relevant advantages of DOACs over phenprocoumon. To confirm the hypothesis, an RCT with phenprocoumon is needed. Next to the safety and effectiveness assessments other factors might also play a substantial role in the decision on the right OAC for stroke prevention.
Correlation of IVF outcomes and number of oocytes retrieved: a UK retrospective longitudinal observational study of 172 341 non-donor cycles
Authors: Bahadur Gulam , Homburg Roy , Jayaprakasan Kanna , Raperport Claudia Joanne , Huirne Judith A F , Acharya Santanu , Racich Paul , Ahmed Ali , Gudi Anil , Govind Abha , Jauniaux Eric 
Published: January 2023

ObjectiveHow do numbers of oocytes retrieved per In vitro fertilisation (IVF) cycle impact on the live birth rate (LBR) and multiple gestation pregnancy (MGP) rates?DesignRetrospective observational longitudinal study.SettingUK IVF clinics.PopulationNon-donor IVF patients.Main outcome measuresLBR per IVF cycle and MGP levels against number of oocytes retrieved into subgroups: 0, 1–5, 6–15, 16–25, 26–49 oocytes and 50+ oocytes. Relative risk (RR) and 95% CIs were calculated for each group against the intermediate responder with ‘6–15 oocytes collected’.ResultsFrom 172 341 attempted fresh oocyte retrieval cycles, the oocyte retrieved was: 0 in 10 148 (5.9%) cycles from 9439 patients; 1–5 oocytes in 42 574 cycles (24.7%); 6–15 oocytes in 91 797 cycles (53.3%); 16–25 oocytes in 23 794 cycles (13.8%); 26–49 oocytes in 3970 cycles (2.3%); ≥50 oocytes in 58 cycles (0.033%). The LBRs for the 1–5, 6–15, 16–25 and 26–49 subgroups of oocytes retrieved were 17.2%, 32.4%, 35.3% and 18.7%, respectively. The RR (95% CI) of live birth in comparison to the intermediate group (6–15) for 1–5, 16–25 and 26–49 groups was 0.53 (0.52 to 0.54), 1.09 (1.07 to 1.11) and 0.58 (0.54 to 0.62), respectively. The corresponding MGP rates and RR were 9.2%, 11.0%, 11.4% and 11.3%, respectively and 0.83 (0.77 to 0.90), 1.04 (0.97 to 1.11) and 1.03 (0.84 to 1.26), respectively.ConclusionThere was only limited benefit in LBR beyond the 6–15 oocyte group going to the 16–25 oocytes group, after which there was significant decline in LBR. The MGP risk was lower in 1–5 group.
Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania – a cross-sectional survey
Authors: Swai Elia Asanterabi , Msuya Sia E , Moshi Haleluya , Lindkvist Marie , Sörlin Ann , Sahlén Klas-Göran 
Published: January 2023

ObjectivesTo describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania.DesignA cross-sectional community survey was conducted from November 2020 to June 2021. Trained research assistants interviewed primary children’s carers using a questionnaire based on the International Classification of Functioning, Disability and Health-Children and Youth Framework. Data were analysed using IBM SPSS Statistics V.27. The Pearson χ2test was used to examine differences between age, gender and self-reported needs. The independent t-test assessed difference in needs according to age and gender.SettingKilimanjaro region, Tanzania.ParticipantsChildren and adolescents, aged 2–18 years, with physical disabilities (n=212).ResultsAlmost 40% had severe speech (n=84) and joint mobility (n=79) impairments, and more than half (n=124) had severe or complete difficulties walking. In aspects of self-care (caring for body parts, toileting, dressing, eating and drinking), most had severe and complete difficulties. Almost 70% (n=135) of households were located near health facilities without rehabilitation services. About one-quarter (n=51) had never received rehabilitation services. More than 90% (n=196) needed assistive devices, and therapeutic exercises (n=193). Over three-quarters needed nutritional supplements (n=162).ConclusionChildren and adolescents with physical disabilities in North-Eastern Tanzania have impaired speech and joint mobility, and difficulties in communication, self-care and walking. Rehabilitation services essential for addressing these impairments and activity limitations are either scarce or inaccessible. Action is needed to facilitate urban and rural access to rehabilitation services in order to improve the well-being of children and adolescents with physical disabilities.
Prevention of physical restraints in the acute care setting (PROTECT): study protocol for a cluster-randomised controlled pilot study
Authors: Gottschalk Susan , Meyer Gabriele , Haastert Burkhard , Abraham Jens 
Published: January 2023

IntroductionPhysical restraints (PR) are regularly used in acute care settings, although evidence for their effectiveness and safety (eg, for prevention of falls) is lacking. Their use is associated with adverse events, such as decreased mobility and injuries for patients. We developed a complex intervention to prevent PR in acute care settings according to the UK Medical Research Council Framework, and investigated the feasibility. The intervention comprised the qualification of key nurses as multipliers and a short interprofessional information session. The intervention has proven to be feasible. It also became apparent that further development of the intervention and the study procedures is necessary. Therefore, this study aims to refine and pilot the complex intervention. Furthermore, the objective of this pilot study is to improve study procedures.Methods and analysisIn a preparatory phase, we will conduct focus groups and individual interviews with the target groups to explore the possibilities for adaption of the intervention and implementation strategies. Subsequently, a cluster-randomised controlled trial with a 6-month follow-up period will be conducted. It is planned to recruit eight general hospitals in Germany (area of Halle (Saale) and Leipzig) with 28 wards and 924 patients per observation period (2772 overall). Primary outcome is the proportion of patients with at least one PR after 6 months. Data will be collected by direct observation over a period of seven consecutive days and three times a day. Secondary outcomes are falls, interruptions in therapy and prescription of psychotropic medication. A comprehensive process evaluation will accompany the study.Ethics and disseminationThe Ethics committee of the Medical Faculty of the University of Halle (Saale) approved the study protocol. Results will be published in a peer-reviewed journal and presented at conferences. Study information and additional material will be freely available on an already existing website.Trial registration numberDRKS00027989.
Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study
Authors: Smith Rebecca M , Burgess Caroline , Tahtis Vassilios , Marsden Jonathan , Seemungal Barry M 
Published: January 2023

ObjectivesVestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine management of vestibular dysfunction in aTBI is not always standard practice. We aimed to identify and explore any healthcare professional barriers or facilitators to managing vestibular dysfunction in aTBI.DesignA qualitative approach was used. Data were collected using face to face, semi-structured interviews and analysed using the Framework approach.SettingTwo major trauma centres in London, UK.Participants28 healthcare professionals participated: 11 occupational therapists, 8 physiotherapists and 9 surgical/trauma doctors.ResultsVestibular assessment and treatment were not routinely undertaken by trauma ward staff. Uncertainty regarding responsibility for vestibular management on the trauma ward was perceived to lead to gaps in patient care. Interestingly, the term dizziness was sometimes perceived as an ‘invisible’ and vague phenomenon, leading to difficulties identifying or ‘proving’ dizziness and a tendency for making non-specific diagnoses. Barriers to routine assessment and treatment included limited knowledge and skills, a lack of local or national guidelines, insufficient training and concerns regarding the practical aspects of managing vestibular dysfunction. Of current trauma ward staff, therapists were identified as appropriate healthcare professionals to adopt new behaviours regarding management of a common form of vestibular dysfunction (benign paroxysmal positional vertigo). Strategies to support this behaviour change include heightened clarity around role, implementation of local or national guidelines, improved access to training and multidisciplinary support from experts in vestibular dysfunction.ConclusionsThis study has highlighted that role and knowledge barriers exist to multidisciplinary management of vestibular dysfunction in aTBI. Trauma ward therapists were identified as the most appropriate healthcare professionals to adopt new behaviours. Several strategies are proposed to facilitate such behaviour change.Trial registration numberISRCTN91943864.
Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database
Authors: Bo Dan , Wang Xinchun , Wang Yu 
Published: January 2023

ObjectiveTo find out the effect of different oral anticoagulation therapies (OAC) on mortality rate in patients with acute kidney injury (AKI) and atrial fibrillation (AF).DesignA retrospective study.SettingThis study was conducted in the Medical Information Mart for Intensive Care IV database.ParticipantsA total of 19 672 patients diagnosed with AKI.Main outcome measuresPatients were categorised into three groups: (1) AF; (2) AKI and AF, OAC−; (3) AKI and AF, OAC+. The primary endpoint was 30-day mortality. Secondary endpoints were the length of stay (LOS) in the intensive care unit (ICU) and hospital. Propensity score matching (PSM) and Cox proportional hazards model adjusted confounding factors. Linear regression was applied to assess the associations between OAC treatment and LOS.ResultsAfter PSM, 2042 pairs of AKI and AF patients were matched between the patients who received OAC and those without anticoagulant treatment. Cox regression analysis showed that, OAC significantly reduce 30-day mortality compared with non-OAC (HR 0.30; 95% CI 0.25 to 0.35; p<0.001). Linear regression analysis revealed that OAC prolong LOS in hospital (11.3 days vs 10.0 days; p=0.013) and ICU (4.9 days vs 4.4 days; p<0.001). OAC did not improve survival in patients with haemorrhage (HR 0.67; 95% CI 0.34 to 1.29; p=0.23). Novel OAC did not reduce mortality in acute-on-chronic renal injury (HR 2.03; 95% CI 1.09 to 3.78; p=0.025) patients compared with warfarin.ConclusionOAC administration was associated with improved short-term survival in AKI patients concomitant with AF.
Survival and health of children who are HIV-exposed uninfected: study protocol for the CHERISH (Children HIV-Exposed Uninfected - Research to Inform Survival and Health) dynamic, prospective, maternal-child cohort study
Authors: Slogrove Amy L , de Beer Shani Tamlyn , Kalk Emma , Boulle Andrew , Cotton Mark , Cupido Heinrich , Laughton Barbara , Marlow Marguerite , Mehta Ushma , Msolo Ncumisa , Myer Landon , Powis Kathleen M , Schoeman Elisma , Tomlinson Mark , Zunza Moleen , Williams Paige , Davies Mary-Ann 
Published: January 2023

IntroductionCHERISH is designed to establish a long-term sustainable system for measurement of in utero and postnatal exposures and outcomes in children who are HIV-exposed uninfected (HEU) and HIV-unexposed to compare survival, hospitalisation, growth and neurodevelopment in the Western Cape, South Africa.Methods and analysisDuring 2022–2025, the CHERISH dynamic cohort is prospectively enrolling pregnant people with and without HIV at 24–36 weeks gestation from one urban and one rural community, following mother–child pairs, including children who are HEU (target N=1200) and HIV-unexposed (target N=600) for 3 years from the child’s birth. In-person visits occur at enrolment, delivery, 12 months, 24 months and 36 months with intervening 3-monthly telephone data collection. Children and mothers without HIV are tested for HIV at all in-person visits. Data on exposures and outcomes are collected from routine standardised healthcare documentation, maternal interview, measurement (growth and neurodevelopment) at in-person visits and linkage to the Western Cape Provincial Health Data Centre (survival and hospitalisation). A priori adverse birth outcomes, advanced maternal HIV and maternal mental health are considered potential mediators of outcome disparities in children who are HEU and will be evaluated as such in multivariable models appropriate for each outcome.Ethics and disseminationMothers interested in joining the study are taken through a visual informed consent document for their and their child’s participation, with the option to consent to anonymised de-identified data being contributed to a public data repository. All data is captured directly into an electronic database using alphanumeric identifiers devoid of identifying information. The cohort study is approved by Human Research Ethics Committees of Stellenbosch University (N20/08/084), University of Cape Town (723/2021) and Western Cape Government (WC_2021_09_007). Findings will be shared with participants, participating communities, local and provincial stakeholders, child health clinicians, researchers and policymakers at local, national and international forums and submitted for publication in peer-reviewed journals.
Quality improvement initiative reduces overcrowding on labour and delivery unit in a university hospital in Haiti
Authors: Casella Jean-Baptiste Meredith , Millien Christophe , Sainterant Ornella , Dameus Kalinov Jim Rozensky , Julmisse Marc , Julmiste Thamar Monide , Fanfan Jeanne Ginette , Raymonville Maxi 
Published: January 2023

BackgroundFollowing the first COVID-19 peak in 2020, came the seasonal childbirth peak at Hôpital Universitaire de Mirebalais (HUM). This peak is associated with overcrowding on the labour and delivery (L&D) ward. Lack of sufficient bed-space for sick neonates in the neonatal ICU at HUM, has led to overcrowding and lengthy stays of sick newborns on L&D. These conditions contribute to the subsequent lack of bed-space for newly postpartum mothers and potentially decreases quality of care for both new mothers and neonates.MethodsA Maternity Task Force was created by hospital leadership to address these urgent needs. The team’s objective was to eliminate mothers and newborns laying on the floor in L&D. The Six-Sigma/DMAIC quality improvement methodology was used as the problem was urgent, demanded rapid results and centred around the process of patient flow in the institution. Process flow chart and Ishikawa diagrams were used to identify the root causes of the issues.ResultsAn average of 22% of postpartum women did not have a bed preintervention and 0% of postpartum women were laying on the floor post intervention. An average of 33% of newborns received paediatric care on the maternity ward pre-intervention compared with an average of 17% postintervention. The team did not achieve its objective for this second indicator, which was to have less than 10% of sick newborns on the maternity ward receiving paediatric care.ConclusionHUM hospital leadership took the vital decision to form the Maternity Task Force to make changes, which consequently led to a sustainable positive and lasting impact on the lives of new mothers and their babies at the institution. The objective of 0 postpartum mothers and newborns on the ground was achieved and fewer newborns receive intensive paediatric care on the maternity ward as a result of our interventions.
Порівняльна оцінка якості життя у пацієнтів, які перенесли трансплантацію нирки від родинного та трупного донора
Authors: Загрійчук М. С. , Марчук І. П. , Підопригора О. О. , Мигалега Т. С. 
Published: January 2023

Мета роботи: визначити показники якості життя в реципієнтів після трансплантації нирки від родинного та трупного донора, оцінити динаміку через 1, 2 та 3 місяці та порівняти отримані результати.
Матеріали і методи. Для оцінки якості життя використовували зручний та зрозумілий для пацієнта опитувальник 36-Item Short-Form Health Status (SF-36). Отримані дані були занесено у Microsoft™ Excel® 2016, сортовано, опрацьовано. Статистичну базу складав 41 пацієнт: 19 – у групі родинної трансплантації, де 8 чоловіків, 11 жінок (група 1), та 22 – у групі трупної трансплантації, де 11 чоловіків, 11 жінок (група 2). Групи порівнювали на однорідність за ризиком смертності та післяопераційних ускладнень (P-POSSUM). Середній показник складності операції у групі 1 складав 13,4 одиниці, тоді як в групі 2 14,8 одиниці за шкалою P-POSSUM. Середній вік реципієнтів у групі 1 склав 39,11 року, у групі 2 – 39,41 року.
Результати досліджень та їх обговорення. Аналіз результатів показав, що якість життя у пацієнтів після трупної трансплантації (у групі 2) був об’єктивно нижчим від відповідного показника в групі 1 до операції, у перші 2 місяці та вирівнювався і не відрізнявся статистично вже через 3 місяці.
Сучасний досвід виконання трансплантацій нирки, якісне та відповідне ведення листка очікування, а також сучасна фармакотерапія і реабілітація гарантують пацієнтам після трупної трансплантації нирки зіставну з родинною трансплантацією нирки якість життя через 3 місяці після трансплантації.
Вплив краніоскелетної травми на прояви цитолітичного синдрому в умовах краніоскелетної травми щурів різного віку
Authors: Сушко Ю. І. , Гудима А. А. , Зачепа О. А. 
Published: January 2023

Мета роботи: зʼясувати динаміку маркерів цитолізу за умов краніоскелетної травми в щурів різних вікових груп у динаміці травматичної хвороби.
Матеріали і методи. В експериментах на нелінійних білих щурах самцях трьох вікових груп (статевонезрілі віком 100–120 днів, статевозрілі щури віком 6–8 міс. і старі щури віком 19–23 міс.) в умовах тіопетал-натрієвого наркозу моделювали краніоскелетну травму. У тварин через 1, 3, 7, 14, 21 і 28 діб оцінювали аланін- і аспартатамінотрансферазну активність (АлАТ-, АсАТ-активність) сироватки крові.
Результати досліджень та їх обговорення. Під впливом модельованої травми незалежно від віку в сироватці крові піддослідних тварин суттєво зростала активність цитоплазматичних ферментів АлАТ та АсАТ, що свідчить про розвиток синдрому цитолізу. У статевонезрілих щурів показники досягали максимуму через 7 діб й до 28 доби знижувалися, досягаючи рівня контролю. Водночас у статевозрілих та старих щурів показники досягали максимальної величини пізніше – через 14 діб і у подальшому до 28 доби теж знижувалися, проте не досягали рівня контрольної групи і залишалися істотно більшими.
У гострий період травматичної хвороби – через 1–3 доби у статевозрілих і старих щурів спостерігали істотно більшу абсолютну величину та приріст АлАТ- та АсАТ-активності сироватки крові порівняно зі статевонезрілими. Через 7 діб величина досліджуваних показників ставала суттєво більшою у статевонезрілих щурів із подальшим більш вираженим зниженням, ніж в інших групах, що через 28 діб призводило до нормалізації показників. Водночас у статевозрілих і старих щурів показники теж знижувалися, проте істотно перевищували контрольну групу. Отримані результати вказують на вікові особливості перебігу травматичної хвороби, що вимагає подальшого поглибленого вивчення.
У щурів різного віку розвиток синдрому цитолізу внаслідок краніоскелетної травми характеризується різними часовими й амплітудними проявами. Їх критичними точками є поглиблення цитолізу у статевонезрілих щурів через 7 діб експерименту та більша амплітуда порушень у старих щурів у період пізніх проявів травматичної хвороби.