bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study
Authors: Vasconcelos Alexandra , Bandeira Nelson , Sousa Swasilanne , Pereira Filomena , Machado Maria do Ceu 
Published: April 2022

Abstract
Background
Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents’ characteristics and factors associated to early childbearing in STP.

Methods
A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers’ clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software.

Results
The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2–0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2–0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2–0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn’s danger signs (OR 15.7, 95% CI= 9–26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup.

Conclusions
Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents’ partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns’ danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl’s empowerment and awareness and, at the same time, reinforce boy’s role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn’t, simultaneously, improve educational and economic opportunities for girls.
Measurement of pregnancy-related anxiety worldwide: a systematic review
Authors: Hadfield Kristin , Akyirem Samuel , Sartori Luke , Abdul-Latif Abdul-Malik , Akaateba Dominic , Bayrampour Hamideh , Daly Anna , Hadfield Kelly , Abiiro Gilbert Abotisem 
Published: April 2022

Abstract
Background
The perinatal period is often characterized by specific fear, worry, and anxiety concerning the pregnancy and its outcomes, referred to as pregnancy-related anxiety. Pregnancy-related anxiety is uniquely associated with negative maternal and child health outcomes during pregnancy, at birth, and early childhood; as such, it is increasingly studied. We examined how pregnancy-related anxiety is measured, where measures were developed and validated, and where pregnancy-related anxiety has been assessed. We will use these factors to identify potential issues in measurement of pregnancy-related anxiety and the geographic gaps in this area of research.

Methods
We searched the Africa-Wide, CINAHL, MEDLINE, PsycARTICLES, PsycINFO; PubMed, Scopus, Web of Science Core Collection, SciELO Citation Index, and ERIC databases for studies published at any point up to 01 August 2020 that assessed pregnancy-related anxiety. Search terms included pregnancy-related anxiety, pregnancy-related worry, prenatal anxiety, anxiety during pregnancy, and pregnancy-specific anxiety, among others. Inclusion criteria included: empirical research, published in English, and the inclusion of any assessment of pregnancy-related anxiety in a sample of pregnant women. This review is registered on PROSPERO (CRD42020189938).

Results
The search identified 2904 records; after screening, we retained 352 full-text articles for consideration, ultimately including 269 studies in the review based on the inclusion and exclusion criteria. In total, 39 measures of pregnancy-related anxiety were used in these 269 papers, with 18 used in two or more studies. Less than 20% of the included studies (n = 44) reported research conducted in low- and middle-income country contexts. With one exception, all measures of pregnancy-related anxiety used in more than one study were developed in high-income country contexts. Only 13.8% validated the measures for use with a low- or middle-income country population.

Conclusions
Together, these results suggest that pregnancy-related anxiety is being assessed frequently among pregnant people and in many countries, but often using tools that were developed in a context dissimilar to the participants’ context and which have not been validated for the target population. Culturally relevant measures of pregnancy-related anxiety which are developed and validated in low-income countries are urgently needed.
Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol
Authors: Staal F. H. E. , Janssen J. , Brouwer C. L. , Langendijk J. A. , Ng Wei Siang K. , Schuit E. , de Jong I. J. , Verzijlbergen J. F. , Smeenk R. J. , Aluwini S. 
Published: April 2022

Abstract
Background
Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases.

Methods
The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of < 1.0 ng/mL and a recent negative PSMA PET/CT scan. Participants will be randomised in a 1:1 ratio between the conventional fractionated treatment arm (35 × 2 Gy) and the experimental hypofractionated treatment arm (20 × 3 Gy). The primary endpoint is the 5-year progression-free survival after treatment. The secondary endpoints include toxicity, quality of life and disease specific survival.

Discussion
Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed.

Trial registration
This study is registered at ClinicalTrials.gov (Identifier: NCT04642027). Registered on 24 November 2020 – Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants.
Exploring socio-demographic, physical, psychological, and quality of life-related factors related with fear of cancer recurrence in stomach cancer survivors: a cross-sectional study
Authors: Shin Jinyoung , Shin Dong Wook , Lee Jungkwon , Hwang JiHye , Lee Ji Eun , Cho BeLong , Song Yun–Mi 
Published: April 2022

Abstract
Background
Stomach cancer is one the most common neoplasms with high mortality. However, fear of cancer recurrence (FCR) in stomach cancer survivors has been scarcely evaluated. Thus, the aim of this study was to evaluate FCR and factors related to FCR in Korean stomach cancer survivors.

Methods
A total of 363 stomach cancer survivors who had completed primary treatment and had no metastasis or recurrence were recruited between September 2014 and March 2017 regardless of time lapse after the initial diagnosis. FCR was assessed using the Korean version of the FCR Inventory (FCRI). Participants were divided into two groups; clinical FCRI group (score of severity subscale of FCRI ≥ 13) and non-clinical FCRI group (the scores < 13). Socio-demographic factors, cancer stage, treatment, psychological factors, health-related quality of life (HRQoL), and health promotion and disease prevention behaviors were obtained using a self–administered questionnaire supplemented with face-to-face interview to fill out incomplete information. Factors associated with FCR were evaluated using linear regression analysis and multiple logistic regression analysis after adjusting for age, sex, cancer stage, time since cancer diagnosis, family cancer diagnosis, and comorbidities.

Results
Average (standard deviation) time interval between cancer diagnosis and study participation was 7.3 (3.2) years. The distribution of socio-demographic and cancer–related factors did not differ according to the level of FCR. The higher FCRI level was associated with lower levels of social support (β: -0.190, p < 0.001), lower emotional function (β: -0.356, p < 0.001), more severe fatigue (β: 0.333, p < 0.001), more sleep problems (β: 0.299, p = 0.002), higher anxiety (β: 0.443, p < 0.001), and higher depression (β: 0.207, p < 0.001). However, clinical level of FCR was not associated with health promotion and disease prevention behaviors.

Conclusions
FCR in stomach cancer survivors was associated with social, psychological, and HRQoL factors rather than demographic, socioeconomic, or cancer–related factors. This finding suggests that careful attention to FCR is necessary to provide more comprehensive survivorship care for stomach cancer survivors.
The BOOST paediatric advance care planning intervention for adolescents with cancer and their parents: development, acceptability and feasibility
Authors: van Driessche Anne , Gilissen Joni , De Vleminck Aline , Kars Marijke , Fahner Jurrianne , van der Werff ten Bosch Jutte , Deliens Luc , Cohen Joachim , Beernaert Kim 
Published: April 2022

Abstract
Background
Although advance care planning (ACP) has been widely recommended to support patient and family engagement in understanding the patient’s values, preferences and goals of care, there are only a few models in paediatric oncology that capture ACP as a process of behaviour change. We aimed to develop and test the acceptability and feasibility of BOOST pACP (Benefits of Obtaining Ownership Systematically Together in paediatric Advance Care Planning) – an intervention to improve ACP in adolescents with cancer, their parents and paediatric oncologists.

Methods
Several methods informed the intervention development process: 1) Problem identification: interviews with 11 healthcare professionals working in paediatric oncology; 2) Identification of evidence: literature review of existing pACP tools and barriers and facilitators in performing pACP; 3) Logic model and 4) Intervention design: collaborative expert meetings with researchers and professionals in pACP; 5a) Acceptability test of the materials: interviews with nine healthcare professionals, four adolescents and young adults with cancer and six parents; 5b) Feasibility test of core intervention components with three families, including interviews about their experiences.

Results
The BOOST pACP intervention was iteratively developed and adapted, based on feedback from families, healthcare professionals, and pACP experts (e.g., components were changed, deleted, and added; formulation of themes and associated questions were amended to enhance acceptability). The core components of the BOOST pACP intervention include: four ACP conversation sessions with the adolescent and/or parent(s) provided by a trained facilitator, structured by interactive conversation cards covering different ACP themes, followed by a transfer of information from the intervention facilitator to the paediatric oncologist. Core intervention components were deemed feasible by all participating families.

Conclusion
The BOOST pACP intervention was developed by close involvement of both adolescent patients and their parents, healthcare professionals and pACP experts. The final intervention and supporting materials are considered appropriate and feasible. Its effectiveness in improving parent-adolescent communication on ACP themes is currently being tested in a multi-centre randomised controlled trial. Researchers aiming to develop a complex psychosocial intervention for a vulnerable target group could use the step-by-step approach described in this paper.
Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial
Authors: Mathersul Danielle C. , Dixit Kamini , Schulz-Heik R. Jay , Avery Timothy J. , Zeitzer Jamie M. , Bayley Peter J. 
Published: April 2022

Abstract
Background
Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes.

Methods
We recently completed a non-inferiority design randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N = 85; per protocol N = 59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans.

Results
DERS-Total and all six subscales improved with small-to-moderate effect sizes (d = .24–.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max–min (average difference between maximum and minimum beats per minute), LF/HF (low-to-high frequency) ratio, and normalised HF-HRV (high frequency power) improved (moved towards a healthier profile; d = .42–.55).

Conclusions
To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly.

Trial registration
Secondary analyses of ClinicalTrials.gov NCT02366403.
Associations of clustered health risk behaviors with diabetes and hypertension in White, Black, Hispanic, and Asian American adults
Authors: Cook Won Kim , Li Libo , Tam Christina C. , Mulia Nina , Kerr William C. 
Published: April 2022

Abstract
Background
The clustering of Big Four contributors to morbidity and mortality—alcohol misuse, smoking, poor diet, and physical inactivity—may further elevate chronic health risk, but there is limited information about their specific combinations and associated health risks for racial/ethnic minority groups. We aimed to examine patterns of clustering in risk behaviors for White, Black, Hispanic, and Asian American adults and their associations with diabetes and hypertension. As these behaviors may be socioeconomically-patterned, we also examined associations between clustering and socioeconomic status (SES).

Methods
Latent class analyses and multinomial and logistic regressions were conducted using a nationally-representative sample of United States (US) adults ages 40–70 (N = 35,322) from Waves 2 (2004–2005) and 3 (2012–2013) of the National Epidemiologic Survey on Alcohol and Related Conditions. Obesity was used as a proxy for unhealthy diet. The outcomes were diabetes and hypertension.

Results
A relatively-healthy-lifestyle class was found only among White adults. Common patterns of unhealthy clustering were found across groups with some variations: the obese-inactive class among White, Black, and Hispanic adults (and the inactive class among Asian adults); the obese-inactive-smoking class among White, Black, and Hispanic adults; the smoking-risky-drinking class among White and Hispanic adults; and the smoking-risky-drinking-inactive class among Black and Asian adults. Positive associations of unhealthier clustering (having a greater number of risk behaviors) with lower SES (i.e., family income and education) and with health conditions were more consistent for Whites than for other groups. For racial minority groups, lower education than income was more consistently associated with unhealthy clusters. The associations between unhealthier clustering and diabetes and hypertension were less clear for Blacks and Asians than for Whites, with no significant association observed for Hispanics.

Conclusion
Concerted efforts to address clustered risk behaviors in most US adults, particularly in racial/ethnic minority groups given the high prevalence of unhealthy clustering, are warranted.
Exploring gender differences in medication consumption and mortality in a cohort of hypertensive patients in Northern Italy
Authors: Consolazio David , Gattoni Maria Elena , Russo Antonio Giampiero 
Published: April 2022

Abstract
Background
This paper aims to assess the presence of gender differences in medication use and mortality in a cohort of patients affected exclusively by hypertension, in 193 municipalities in the Lombardy Region (Northern Italy), including Milan's metropolitan area.

Methods
A retrospective cohort study was conducted (N = 232,507) querying administrative healthcare data and the Register of Causes of Death. Hypertensive patients (55.4% women; 44.6% men) in 2017 were identified; gender differences in medication use (treatment, 80% compliance) and deaths (from all causes and CVDs) were assessed at two-year follow-ups in logistic regression models adjusted for age class, census-based deprivation index, nationality, and pre-existing health conditions. Models stratified by age, deprivation index, and therapeutic compliance were also tested.

Results
Overall, women had higher odds of being treated, but lower odds of therapeutic compliance, death from all causes, and death from CVDs. All the outcomes had clear sex differences across age classes, though not between different levels of deprivation. Comparing patients with medication adherence, women had lower odds of death from all causes than men (with a narrowing protective effect as age increased), while no gender differences emerged in non-compliant patients.

Conclusions
Among hypertensive patients, gender differences in medication consumption and mortality have been found, but the extent to which these are attributable to a female socio-cultural disadvantage is questionable. The findings reached, with marked age-dependent effects in the outcomes investigated, suggest a prominent role for innate sex differences in biological susceptibility to the disease, whereby women would take advantage of the protective effects of their innate physiological characteristics, especially prior to the beginning of menopause.
The age and cause decomposition of inequality in life expectancy between Iranian provinces: application of Arriaga method
Authors: Mehregan Mehri , Khosravi Ardeshir , Farhadian Maryam , Mohammadi Younes 
Published: April 2022

AbstractBackgroundThis study aimed to decompose the age and cause inequality in life expectancy between two Iranian provinces with the highest and the lowest life expectancy using the Arriaga method.MethodsThe required data was extracted from the death registration system (DRS) and statistical center of Iran. First, we calculated life expectancy at birth for 31 provinces of Iran using life tables, and subsequently, two provinces with the highest and the lowest life expectancy were determined. To decompose the age and cause share in the life expectancy gap between the two provinces, we used Arriaga's method.ResultsTehran with 80.09 years and Sistan and Baluchistan with 72.9 years had the highest and the lowest life expectancy among Iranian Provinces respectively. As a result, the life expectancy gap between Tehran and Sistan and Baluchistan was 7.19 years. Results of age decomposition showed that the highest share in the life expectancy gap attributed to the age group under one year (1.25 years). In terms of the cause of death, the highest percentage belonged to hypertensive diseases with a share of 1.77 years.ConclusionsThere is a wide gap between two provinces with the highest and the lowest life expectancy. Age less than one year and hypertensive diseases were major factors in this inequality. Therefore, policy-makers should concentrate on improvement of survival in children and the reduction of hypertensive diseases to promote life expectancy in Sistan and Baluchistan.