bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis
Authors: Ozim Christian Onyedikachi , Mahendran Rahini , Amalan Mahendran , Puthussery Shuby 
Published: March 2023

ObjectiveTo estimate prevalence of HIV infection in Nigeria and to examine variations by geopolitical zones and study characteristics to inform policy, practice and research.MethodsWe conducted a comprehensive search of bibliographic databases including PubMed, CINAHL, PsycINFO, Global Health, Academic Search Elite and Allied and Complementary Medicine Database (AMED) and grey sources for studies published between 1 January 2008 and 31 December 2019. Studies reporting prevalence estimates of HIV among pregnant women in Nigeria using a diagnostic test were included. Primary outcome was proportion (%) of pregnant women living with HIV infection. A review protocol was developed and registered (PROSPERO 2019 CRD42019107037).ResultsTwenty-three studies involving 72 728 pregnant women were included. Ten studies were of high quality and the remaining were of moderate quality. Twenty-one studies used two or more diagnostic tests to identify women living with HIV. Overall pooled prevalence of HIV among pregnant women was 7.22% (95% CI 5.64 to 9.21). Studies showed high degree of heterogeneity (I2=97.2%) and evidence of publication bias (p=0.728). Pooled prevalence for most individual geopolitical zones showed substantial variations compared with overall prevalence. North-Central (6.84%, 95% CI 4.73 to 9.79) and South-West zones (6.27%, 95% CI 4.75 to 8.24) had lower prevalence whereas South-East zone (17.04%, 95% CI 9.01 to 29.86) had higher prevalence.ConclusionsWhile robust national prevalence studies are sparse in Nigeria, our findings suggest 7 in every 100 pregnant women are likely to have HIV infection. These figures are consistent with reported prevalence rates in sub-Saharan African region. WHO has indicated much higher prevalence in Nigeria compared with our findings. This discrepancy could potentially be attributed to varied methodological approaches and regional focus of studies included in our review. The magnitude of the issue highlights the need for targeted efforts from local, national and international stakeholders for prevention, diagnosis, management and treatment.
All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study
Authors: Farrant Olivia , Baldeh Mamadu , Kamara Joseph Baio , Bailey Emma , Sevalie Stephen , Deen Gibrilla , Russell James Baligeh Walter , Youkee Daniel , Leather Andy JM , Davies Justine , Lakoh Sulaiman 
Published: March 2023

ObjectivesTo study the mortality of patients with COVID-19 in Sierra Leone, to explore the factors associated with mortality during the COVID-19 pandemic and to highlight the complexities of treating patients with a novel epidemic disease in a fragile health system.Study designA prospective single-centre cohort study. Data were extracted from paper medical records and transferred onto an electronic database. Specific indicators were compared between survivors and non-survivors, using descriptive statistics in Stata V.17.Study settingThe infectious diseases unit (IDU) at Connaught Hospital in Freetown, Sierra LeoneParticipantsParticipants were all patients admitted to the IDU between March and July 2020.Aims of studyThe primary outcome of the study was to examine the all-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone and the secondary outcome measures were to examine factors associated with mortality in patients positive for COVID-19.Results261 participants were included in the study. Overall, 41.3% of those admitted to the IDU died, compared with prepandemic in-hospital mortality of 23.8%. Factors contributing to the higher mortality were COVID-19 infection (aOR 5.61, 95% CI 1.19 to 26.30, p=0.02) and hypertension (aOR 9.30, 95% CI 1.18 to 73.27, p=0.03)ConclusionsThis study explores the multiple factors underpinning a doubling in facility mortality rate during the COVID-19 pandemic in Sierra Leone . It provides an insight into the realities of providing front-line healthcare during a pandemic in a fragile health system.
Risk factors for incident falls in Singaporean community-dwelling adult men and women: a prospective cohort study
Authors: Yip Wan Fen , Ge Lixia , Heng Bee Hoon , Tan Woan Shin 
Published: March 2023

ObjectivesOur study aimed to identify the risk factors of incident falls between men and women.DesignProspective cohort study.SettingThe study recruited participants from the Central region of Singapore. Baseline and follow-up data were collected via a face-to-face survey.ParticipantsCommunity-dwelling adults aged 40 years and above from the Population Health Index Survey.Outcome measureIncident falls were defined as the experience of a fall between the baseline and 1-year follow-up but having no falls 1 year prior to baseline. Multiple logistic regressions were performed to determine the association of sociodemographic factors, medical history and lifestyle with incident falls. Sex subgroup analyses were conducted to examine sex-specific risk factors for incident falls.Results1056 participants were included in the analysis. At 1-year follow-up, 9.6% of the participants experienced an incident fall. Incidence of falls in women was 9.8% compared with 7.4% in men. In the multivariable analysis for the overall sample, older age (OR: 1.88, 95% CI: 1.10 to 2.86), being pre-frail (OR: 2.13, 95% CI: 1.12 to 4.00) and having depression or feeling depressed/anxious (OR: 2.35, 95% CI: 1.10 to 4.99) were associated with higher odds for incident falls. In subgroup analyses, older age was a risk factor for incident falls in men (OR: 2.68, 95% CI: 1.21 to 5.90) and pre-frail was a risk factor for incident falls in women (OR: 2.82, 95% CI: 1.28 to 6.20). There was no significant interaction effect between sex and age group (p value=0.341) and sex and frailty status (p value=0.181).ConclusionOlder age, presence of pre-frailty and having depression or feeling depressed/anxious were associated with higher odds of incident falls. In our subgroup analyses, older age was a risk factor for incident falls in men and being pre-frail was a risk factor for incident falls in women. These findings provide useful information for community health services in designing falls prevention programmes for community-dwelling adults in a multi-ethnic Asian population.
Time spent on documenting quality indicator data and associations between the perceived burden of documenting these data and joy in work among professionals in intensive care units in the Netherlands: a multicentre cross-sectional survey
Authors: Hesselink Gijs , Verhage Rutger , Hoiting Oscar , Verweij Eva , Janssen Inge , Westerhof Brigitte , Ambaum Gilian , van der Horst Iwan C C , de Jong Paul , Postma Nynke , van der Hoeven Johannes G , Zegers Marieke 
Published: March 2023

ObjectivesThe number of indicators used to monitor and improve the quality of care is debatable and may influence professionals’ joy in work. We aimed to assess intensive care unit (ICU) professionals’ perceived burden of documenting quality indicator data and its association with joy in work.DesignCross-sectional survey.SettingICUs of eight hospitals in the Netherlands.ParticipantsHealth professionals (ie, medical specialists, residents and nurses) working in the ICU.MeasurementsThe survey included reported time spent on documenting quality indicator data and validated measures for documentation burden (ie, such documentation being unreasonable and unnecessary) and elements of joy in work (ie, intrinsic and extrinsic motivation, autonomy, relatedness and competence). Multivariable regression analysis was performed for each element of joy in work as a separate outcome.ResultsIn total, 448 ICU professionals responded to the survey (65% response rate). The overall median time spent on documenting quality data per working day is 60 min (IQR 30–90). Nurses spend more time documenting these data than physicians (medians of 60 min vs 35 min, p<0.01). Most professionals (n=259, 66%) often perceive such documentation tasks as unnecessary and a minority (n=71, 18%) perceive them as unreasonable. No associations between documentation burden and measures of joy in work were found, except for the negative association between unnecessary documentations and sense of autonomy (β=−0.11, 95% CI −0.21 to −0.01, p=0.03).ConclusionsDutch ICU professionals spend substantial time on documenting quality indicator data they often regard as unnecessary. Despite the lacking necessity, documentation burden had limited impact on joy in work. Future research should focus on which aspects of work are affected by documentation burden and whether diminishing the burden improves joy in work.
Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada
Authors: Movahedi Mohammad , Choquette Denis , Coupal Louis , Cesta Angela , Li Xiuying , Keystone Edward C , Bombardier Claire , Investigators OBRI 
Published: March 2023

ObjectivesThe similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries.DesignRetrospective cohort study.SettingPooled data from two rheumatoid arthritis (RA) registries in Canada.ParticipantsPatients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493).Outcome measuresTime to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects.ResultsThe mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users.ConclusionsIn this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users.
Impact of COVID-19 on care at the end of life during the first months of the pandemic from the perspective of healthcare professionals from different settings: a qualitative interview study (the CO-LIVE study)
Authors: Zee Masha S , Bagchus Lotje , Becqué Yvonne N , Witkamp Erica , van der Heide Agnes , van Lent Liza G G , Goossensen Anne , Korfage Ida J , Onwuteaka-Philipsen Bregje D , Pasman H Roeline 
Published: March 2023

ObjectivesThe objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.MethodsAn in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.ResultsSeveral aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.ConclusionThe palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.
Incidence and influencing factors of occupational pneumoconiosis: a systematic review and meta-analysis
Authors: Su Xuesen , Kong Xiaomei , Yu Xiao , Zhang Xinri 
Published: March 2023

ObjectivesTo determine the incidence of pneumoconiosis worldwide and its influencing factors.DesignSystematic review and meta-analysis.SettingCohort studies on occupational pneumoconiosis.ParticipantsPubMed, Embase, the Cochrane Library and Web of Science were searched until November 2021. Studies were selected for meta-analysis if they involved at least one variable investigated as an influencing factor for the incidence of pneumoconiosis and reported either the parameters and 95% CIs of the risk fit to the data, or sufficient information to allow for the calculation of those values.Primary outcome measuresThe pooled incidence of pneumoconiosis and risk ratio (RR) and 95% CIs of influencing factors.ResultsOur meta-analysis included 19 studies with a total of 335 424 participants, of whom 29 972 developed pneumoconiosis. The pooled incidence of pneumoconiosis was 0.093 (95% CI 0.085 to 0.135). We identified the following influencing factors: (1) male (RR 3.74; 95% CI 1.31 to 10.64; p=0.01), (2) smoking (RR 1.80; 95% CI 1.34 to 2.43; p=0.0001), (3) tunnelling category (RR 4.75; 95% CI 1.96 to 11.53; p<0.0001), (4) helping category (RR 0.07; 95% CI 0.13 to 0.16; p<0.0001), (5) age (the highest incidence occurs between the ages of 50 and 60), (6) duration of dust exposure (RR 4.59, 95% CI 2.41 to 8.74, p<0.01) and (7) cumulative total dust exposure (CTD) (RR 34.14, 95% CI 17.50 to 66.63, p<0.01). A dose–response analysis revealed a significant positive linear dose–response association between the risk of pneumoconiosis and duration of exposure and CTD (P-non-linearity=0.10, P-non-linearity=0.16; respectively). The Pearson correlation analysis revealed that silicosis incidence was highly correlated with cumulative silica exposure (r=0.794, p<0.001).ConclusionThe incidence of pneumoconiosis in occupational workers was 0.093 and seven factors were found to be associated with the incidence, providing some insight into the prevention of pneumoconiosis.PROSPERO registration numberCRD42022323233.
Key lessons learnt from COVID-19 intra-action reviews in the Republic of Moldova, Montenegro, Kosovo and North Macedonia 2020–2021: a qualitative study
Authors: Sane Jussi , Schmidt Tanja , Isla Nicolas , Ibrahim Rawi , Boshevska Golubinka , Mayigane Landry Ndriko , Perriat Delphine , Stauke Janina , Esquevin Sarah , Fehr Angela , Brajovic Mina , Bajić Borko , Galic Igor , Humolli Isme , Bunjaku Dafina Gexha , Gheorghita Stela , Kuli Arta , Manevska Suzana , Stavridis Kristina , Demiscan Daniela , Capmari Dumitru , Mengistu Abebayehu Assefa 
Published: March 2023

ObjectivesOur study described how the WHO intra-action review (IAR) methodology was operationalised and customised in three Western Balkan countries and territories and the Republic of Moldova and analysed the common key findings to inform analyses of the lessons learnt from the pandemic response.DesignWe extracted data from the respective IAR reports and performed a qualitative thematic content analysis to identify common (between countries and territories) and cross-cutting (across the response pillars) themes on best practices, challenges and priority actions. The analysis involved three stages, namely: extraction of data, initial identification of emerging themes and review and definition of the themes.SettingIARs were conducted in the Republic of Moldova, Montenegro, Kosovo and the Republic of North Macedonia between December 2020 and November 2021. The IARs were conducted at different time points relative to the respective pandemic trajectories (14-day incidence rate ranging from 23 to 495 per 100 000).ResultsCase management was reviewed in all the IARs, while the infection prevention and control, surveillance and country-level coordination pillars were reviewed in three countries. The thematic content analysis identified four common and cross-cutting best practices, seven challenges and six priority recommendations. Recommendations included investing in sustainable human resources and technical capacities developed during the pandemic, providing continuous capacity-building and training (with regular simulation exercises), updating legislation, improving communication between healthcare providers at all levels of healthcare and enhancing digitalisation of health information systems.ConclusionsThe IARs provided an opportunity for continuous collective reflection and learning with multisectoral engagement. They also offered an opportunity to review public health emergency preparedness and response functions in general, thereby contributing to generic health systems strengthening and resilience beyond COVID-19. However, success in strengthening the response and preparedness requires leadership and resource allocation, prioritisation and commitment by the countries and territories themselves.
Association of poor perceived work ability and psychosocial work-related factors in health and social service worker age groups: a cross-sectional study
Authors: Selander Kirsikka , Nikunlaakso Risto , Korkiakangas Eveliina , Sinervo Timo , Laitinen Jaana 
Published: March 2023

ObjectivePrevious work ability studies have primarily focused on old workers and physical health. This study investigated how poor perceived work ability (PPWA) is associated with work-related factors in different health and social service (HSS) worker age groups.DesignCross-sectional survey in 2020.SettingHSS employees (general HSS and eldercare) in nine Finnish public sector organisations.ParticipantsAll employees who were employed in the organisation completed self-reported questionnaires. Of the original sample (N=24 459, response rate 67%), 22 528 gave consent for research use.Primary and secondary outcome measuresParticipants evaluated their psychosocial work environment and work ability. Lowest decile of work ability was categorised as poor. The association between psychosocial work-related factors and PPWA in different age-groups of HSS workers, adjusting for perceived health, was analysed with logistic regression.ResultsThe proportion of PPWA was highest in shift workers, eldercare employees, practical nurses and registered nurses. Considerable variation between age groups exists in the work-related psychosocial factors associated with PPWA. Among young employees engaging leadership and working time and work task autonomy were statistically significant, whereas in middle-aged and old employees procedural justice and ethical strain were highlighted. The strength of the association with perceived health also differs in age groups (young: OR=3.77, 95% CI 3.30 to 4.30; middle-aged: OR=4.66, 95% CI 4.22 to 5.14; old: OR=6.16, 95% CI 5.20 to 7.18).ConclusionsYoung employees would benefit from engaging leadership and mentoring, and from more working time and work task autonomy. As employees get older they would benefit more from job modification and from ethical and just organisation culture.
Effectiveness and cost-effectiveness of a digital health intervention to support patients with colorectal cancer prepare for and recover from surgery: study protocol of the RecoverEsupport randomised controlled trial
Authors: Wyse Rebecca , Smith Stephen , Zucca Alison , Fakes Kristy , Mansfield Elise , Johnston Sally-Ann , Robinson Sancha , Oldmeadow Christopher , Reeves Penny , Carey Mariko L , Norton Grace , Sanson-Fisher Rob W 
Published: March 2023

IntroductionSurgery is the most common treatment for colorectal cancer (CRC) and can cause relative long average length of stay (LOS) and high risks of unplanned readmissions and complications. Enhanced Recovery After Surgery (ERAS) pathways can reduce the LOS and postsurgical complications. Digital health interventions provide a flexible and low-cost way of supporting patients to achieve this. This protocol describes a trial aiming to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention in decreasing the hospital LOS in patients undergoing CRC surgery.Methods and analysisThe two-arm randomised controlled trial will assess the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention compared with usual care (control) in patients with CRC. The intervention consists of a website and a series of automatic prompts and alerts to support patients to adhere to the patient-led ERAS recommendations. The primary trial outcome is the length of hospital stay. Secondary outcomes include days alive and out of hospital; emergency department presentations; quality of life; patient knowledge and behaviours related to the ERAS recommendations; health service utilisation; and intervention acceptability and use.Ethics and disseminationThe trial has been approved by the Hunter New England Research Ethics Committee (2019/ETH00869) and the University of Newcastle Ethics Committee (H-2015-0364). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team will facilitate its adoption within the Local Health District for widespread adaptation and implementation.Trial registration numberACTRN12621001533886.