bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana
Authors: Mohammed Shamsudeen , Yakubu Ibrahim , Fuseini Abdul-Ganiyu , Abdulai Abdul-Malik , Yakubu Yakubu H. 
Published: May 2023

AbstractBackgroundExclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0–6 months in Ghana.MethodsWe conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases’ inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0–6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger’s test assessed publication bias. The review is registered with PROSPERO, CRD42021278019.ResultsOut of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0–6 months in Ghana was 50% (95%CI 41.0–60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units.ConclusionIn Ghana, EBF rates are low, with only about half of all children aged 0–6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana.
Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990–2019: an age-period-cohort analysis for the global burden of disease 2019 study
Authors: Lou Zheng , Huang Yizhou , Li Shuting , Luo Zhou , Li Chunming , Chu Ketan , Zhang Tao , Song Peige , Zhou Jianhong 
Published: May 2023

Abstract
Background
Uterine fibroids are the most common benign neoplasm of the uterus and a major source of morbidity for women. We report an overview of trends in uterine fibroids of incidence rate, prevalence rate, years lived with disability (YLDs) rate in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.

Methods
The incident case, incidence rate, age-standardized rate (ASR) for incidence, prevalent case, prevalence rate, ASR for prevalence, number of YLDs, YLD rate, and ASR for YLDs were derived from the Global Burden of Disease 2019 (GBD 2019) study. We utilized an age-period-cohort (APC) model to estimate overall annual percentage changes in the rate of incidence, prevalence, and YLDs (net drifts), annual percentage changes from 10 to 14 years to 65–69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019.

Results
Globally, the incident cases, prevalent cases, and the number of YLDs of uterine fibroids increased from 1990 to 2019 with the growth of 67.07%, 78.82% and 77.34%, respectively. High Socio-demographic Index (SDI) and high-middle SDI quintiles with decreasing trends (net drift < 0.0%), and increasing trends (net drift > 0.0%) were observed in middle SDI, low-middle SDI, and low SDI quintiles in annual percentage change of incidence rate, prevalence rate and YLDs rate over the past 30 years. There were 186 countries and territories that showed an increasing trend in incidence rate, 183 showed an increasing trend in prevalence rate and 174 showed an increasing trend in YLDs rate. Moreover, the effects of age on uterine fibroids increased with age and peaked at 35–44 years and then declined with advancing age. Both the period and cohort effects on uterine fibroids showed increasing trend in middle SDI, low-middle SDI and low SDI quintiles in recent 15 years and birth cohort later than 1965.

Conclusions
The global burden of uterine fibroids is becoming more serious in middle SDI, low-middle SDI and low SDI quintiles. Raising awareness of uterine fibroids, increasing medical investment and improving levels of medical care are necessary to reduce future burden.
Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia
Authors: Kalayasiri Rasmon , Boonthae Suriyan 
Published: May 2023

AbstractBackgroundThailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed.MethodsCannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test.ResultsThe prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40–49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18–19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive.ConclusionsAlthough most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.
Comparison of antibiotic-impregnated bone cement coverage versus vacuum sealing drainage in semi-open bone grafting using for tibial fracture with infected bone and soft tissue defect: a retrospective analysis
Authors: Zhang Yanlong , Tian Shuwei , Liu Meiyu , Zhai Wenfang , Zhou Yujie , Peng Aqin 
Published: May 2023

Abstract
Objective
To compare antibiotic-impregnated bone cement coverage (bone cement surface technique; BCS-T) versus vacuum sealing drainage (VSD) for tibial fracture with infected bone and soft tissue defect.

Method
This retrospective analysis compared the clinical outcomes in patients undergoing BCS-T (n = 16) versus VSD (n = 15) for tibial fracture with infected bone and soft tissue defect at the Third Hospital of Hebei Medical University from March 2014 to August 2019. For BCS-T group, osseous cavity was filled with autograft bone graft after debridement, and then the wound was covered with a 3-mm layer of bone cement impregnated with vancomycin and gentamycin. The dressing was changed every day in the first week, and every 2 ~ 3 days in the second week. For VSD group, a negative pressure of -150 ~ -350 mmHg was maintained, and the dressing was changed every 5–7 days. All patients received antibiotics treatment based on bacterial culture results for 2 weeks.

Results
The 2 groups did not differ in age, sex and key baseline characteristics, including type of Gustilo-Anderson classification, size of the bone and soft tissue defect, the percentage of primary debridement, bone transport, and the time from injury to bone grafting. The median follow-up was 18.9 months (range:12–40). The time to complete coverage of bone graft by granulation tissue was 21.2 (15.0–44.0) and 20.3 (15.0–24.0) days in the BCS-T and VSD groups, respectively (p = 0.412). The 2 groups also did not differ in wound healing time (3.3 (1.5–5.5) versus 3.2(1.5–6.5) months; p = 0.229) and bone defect healing time (5.4(3.0-9.6) versus 5.9(3.2–11.5) months; p = 0.402). However, the cost of covering material was significantly reduced in the BCS-T group (2071 ± 134 versus 5542 ± 905 yuan; p = 0.026). Paley functional classification at 12 months did not differ between the 2 groups (excellent in 87.5% versus 93.3% in the 2 groups; p = 0.306).

Conclusion
BCS-T could achieve clinical outcomes similar to VSD in patients receiving bone graft for tibial fracture with infected bone and soft tissue defect, but material cost was significantly reduced. Randomized controlled trials are needed to verify our finding.
Reasons for modern contraceptives choice and long-acting reversible contraceptives early removal in Amhara Region, Northwest Ethiopia; qualitative approach
Authors: Gashaye Kiros Terefe , Gebresilassie Keflie Yohannes , Kassie Belayneh Ayanaw , Zenebe Chernet Baye , Mengistu Zelalem , Ferede Solomon Emyu , Andualem Zewudu , Merid Mehari W./Mariam , Taddese Asefa Adimasu , Abera Mikyas 
Published: May 2023

Abstract
Background
Women use modern contraceptive methods, mainly either to limit or space pregnancy and both are not identical in their choices. One method may not best fit an individual’s need irrespective of the time of spacing. Cognizant of this, the context with which women base in choice of contraceptives, their lived experiences in using, and factors for early removal/ discontinuation of long-acting reversible contraceptives (LARCs) are not much investigated in the study setting and our study aimed to bridge the gap through exploring the underlying reasons.

Method
A phenomenological study design was used to explore sampled women’s reasons and experiences. Reproductive-aged women (15–49 years) who removed long-acting methods in the past 6 months were included. A criterion sampling approach was employed to recruit study participants. Data was collected using an interview guide for in-depth (IDIs) and key informant interviews and were tape-recorded with interviewees' consent. Audio data were transcribed verbatim and translated into English. The data was first saved in plain text format and imported into Atlas.ti 7.0 software to facilitate coding and categorizing. The content analysis method was used to classify, organize data, and interpret the qualitative data according to key categories.

Results
Several misconceptions about contraceptives (e.g., implants are not appropriate for daily laborers, women who use contraceptives (such as injectables) can only bear girl-child, etc.) were reported by clients and health providers. These misconceptions might not have scientific merit but they are powerful enough to affect actual behaviors toward contraceptives, including early removal. The awareness, attitude, and use of contraceptives tend to be lower in rural areas. For premature removal of LARCs, side effects, and heavy menstrual bleeding, was the most commonly identified reason. The IUCD is the least preferred method and users said it is not comfortable during sex.

Conclusion and recommendation
Our study found different reasons and misconceptions for modern contraceptive methods’ non-use and discontinuation. Standardized counseling approaches like the REDI (Rapport Building, Exploration, Decision Making, and Implementation) framework should be implemented in the country consistently. Some of the concrete providers’ conceptions should be well-studied considering contextual factors to bring scientific evidence.
Trust in the provider and accurate self-reported PrEP adherence among adolescent girls and young women in South Africa and Zimbabwe: HPTN 082 study
Authors: Beauchamp Geetha , Donnell Deborah , Hosek Sybil , Anderson Peter L. , Chan Kwun C. G. , Dye Bonnie J. , Mgodi Nyaradzo , Bekker Linda-Gail , Delany-Moretlwe Sinead , Celum Connie 
Published: May 2023

Abstract
Background
Trust is an important cornerstone of patient-provider communication. Accurate reporting of pre-exposure prophylaxis (PrEP) adherence is vital for providers to determine who needs adherence support, especially adolescent girls and young women (AGYW) disproportionately affected by newly diagnosed HIV.

Methods
This is a secondary analysis of the HPTN 082 open-label PrEP demonstration trial. From 2016–2018, 451 AGYW aged 16–25 years were enrolled in South Africa (Cape Town and Johannesburg) and Zimbabwe (Harare). PrEP was initiated by 427, and 354 (83%) had month three patient-reported adherence responses and intracellular tenofovir diphosphate (TFV-DP) measurements. The patient-reported adherence response to ‘In the past month, how often did you take the tablet?’ was dichotomized as ‘high’ if the response was every day or most days, and ‘low’ if some days or not many days or never. The biomarker marker evidence of adherence in dried blood spots was defined as ‘high’ if TFV-DP ≥ 700, and ‘low’ if < 350 fmol/punch. We used multinomial logistic regression to examine if trust in the PrEP provider was associated with concordance between patient-reported adherence and intracellular tenofovir-diphosphate (TFV-DP).

Results
AGYW who reported trust in their providers were almost four-fold (aOR 3.72, 95% CI 1.20–11.51) more likely to have concordant adherence (high self-reported adherence and high TFV-DP concentrations) compared to discordant non-adherence (high self-reported adherence and low TFV-DP concentrations).

Conclusion
Education and training of providers to build trusting relationships with AGYW may lead to more accurate reporting of PrEP adherence. With accurate reporting, adequate support can be provided to bolster adherence.

Trial registration
ClinicalTrials.gov Identifier: NCT02732730.
The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis
Authors: Efendi Defi , Apriliyasari Renny Wulan , Prihartami Massie Juliana Gracia Eka , Wong Cho Lee , Natalia Regina , Utomo Bejo , Sunarya Chiyar Edison , Apriyanti Efa , Chen Kee-Hsin 
Published: May 2023

Abstract
Background
In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses.

Method
The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p < .05. The I2 statistic assessment was applied to identify the level of heterogeneity of the study.

Results
A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33–2.63; p = .011, I2 = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34–0.86; p < .001, I2 = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49–1.31; p < .001, I2 = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17–0.77; p = .002, I2 = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues.

Conclusions
VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.
Staff quality of working life and turnover intentions in municipal nursing care and social welfare: a cross-sectional study
Authors: Engström Maria , Jarnheden Sofia Hanberger , Tham Pia 
Published: May 2023

Abstract
Background
Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic.

Methods
A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses.

Results
Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession ‘rather often’ and ‘very often/always’. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34–36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, ‘exercise’, ‘recreation and relaxation’ and ‘improving skills’, the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used ‘recreation and relaxation’ more often than were reported by registered nurses.

Conclusions
More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions.
U-shaped association between the triglyceride–glucose index and atrial fibrillation incidence in a general population without known cardiovascular disease
Authors: Liu Xiao , Abudukeremu Ayiguli , Jiang Yuan , Cao Zhengyu , Wu Maoxiong , Ma Jianyong , Sun Runlu , He Wanbing , Chen Zhiteng , Chen Yangxin , Yu Peng , Zhu Wengen , Zhang Yuling , Wang Jingfeng 
Published: May 2023

Abstract
Objective
The triglyceride–glucose (TyG) index has been shown to be a new alternative measure for insulin resistance. However, no study has attempted to investigate the association of the TyG index with incident atrial fibrillation (AF) in the general population without known cardiovascular diseases.

Methods
Individuals without known cardiovascular diseases (heart failure, coronary heart disease, or stroke) from the Atherosclerosis Risk in Communities (ARIC) cohort were recruited. The baseline TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and incident AF was examined using Cox regression.

Results
Of 11,851 participants, the mean age was 54.0 years; 6586 (55.6%) were female. During a median follow-up of 24.26 years, 1925 incidents of AF cases (0.78/per 100 person-years) occurred. An increased AF incidence with a graded TyG index was found by Kaplan‒Meier curves (P < 0.001). In multivariable-adjusted analysis, both < 8.80 (adjusted hazard ratio [aHR] = 1.15, 95% confidence interval [CI] 1.02, 1.29) and > 9.20 levels (aHR 1.18, 95% CI 1.03, 1.37) of the TyG index were associated with an increased risk of AF compared with the middle TyG index category (8.80–9.20). The exposure-effect analysis confirmed the U-shaped association between the TyG index and AF incidence (P = 0.041). Further sex-specific analysis showed that a U-shaped association between the TyG index and incident AF still existed in females but not in males.

Conclusions
A U-shaped association between the TyG index and AF incidence is observed in Americans without known cardiovascular diseases. Female sex may be a modifier in the association between the TyG index and AF incidence.

Graphical Abstract