bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study
Authors: Alemayehu Mihiretu , Yakob Bereket , Khuzwayo Nelisiwe 
Published: November 2022

Abstract
Background
Globally, 11.4 million untreated obstetric complications did not receive Emergency Obstetric and Newborn Care (EmONC) services yearly, with the highest burden in low and middle-income countries. Half of the Ethiopian women with obstetric complications did not receive EmONC services. However, essential aspects of the problem have not been assessed in depth. This study, therefore, explored the various aspects of barriers and enablers to women’s EmONC services utilization in southern Ethiopia.

Methodology
A qualitative case study research design was used in nine districts of the Wolaita Zone. A total of 37 study participants were selected using a purposive stratified sampling technique and interviewed till data saturation. Twenty-two key informant interviews were conducted among front-line EmONC service providers, managers, community leaders, and traditional birth attendants (TBAs). Individual in-depth interviews were conducted among 15 women with obstetric complications. The trustworthiness of the research was assured by establishing credibility, transferability, conformability, and dependability. NVivo 12 was used to assist with the thematic data analysis.

Result
Five themes emerged from the analysis: service users’ perception and experience (knowledge, perceived quality, reputation, respectful care, and gender); community-related factors (misconceptions, traditional practices, family and peer influence, and traditional birth attendants’ role); access and availability of services (infrastructure and transportation); healthcare financing (drugs and supplies, out-of-pocket expenses, and fee exemption); and health facility-related factors (competency, referral system, waiting time, and leadership).

Conclusion
Many women and their newborns in the study area suffered severe and life-threatening complications because of the non-utilization or delayed utilization of EmONC services. A key policy priority should be given to enhancing women’s awareness, eliminating misconceptions, improving women’s autonomy, and ensuring traditional practices’ role in EmONC service utilization. Community awareness interventions are required to enhance service uptake. Furthermore, the health systems must emphasize improving the quality of care, inequitable distribution of EmONC facilities, and essential drugs. The financial constraints need to be addressed to motivate women from low socioeconomic status. Furthermore, intersectoral collaboration is required to maintain a legal framework to control and prohibit home deliveries and empower women.
Potential effects of adverse childhood experiences on school engagement in youth: a dominance analysis
Authors: Webb Nathaniel J. , Miller Thaddeus L. , Stockbridge Erica L. 
Published: November 2022

Abstract
Background
Adverse childhood experiences (ACEs) can have severe negative impacts on childhood and adult health via worsened school engagement and educational outcomes. This study seeks to identify the relative importance of various ACEs in predicting school engagement.

Methods
We analyzed data from the National Survey of Children’s Health for school-aged children (ages 6-17) for 2018 and 2019. The primary outcome was school engagement, measured through three variables: repeating a grade, doing required homework, and caring about doing well in school. We conducted three logistic regression models with dominance analyses to identify the relative importance of ACE variables in predicting school engagement outcomes.

Results
In unadjusted and adjusted dominance analyses, parental incarceration was the most important ACE in predicting repeating a grade. Living in a household in which it was hard to cover basics like food or housing was the most important ACE in predicting doing required homework and caring about doing well in school.

Discussion
Our study points toward the large influence of out-of-school factors on school engagement. Parental incarceration and economic hardship, the most important predictors of engagement, are issues that can be addressed and mitigated through policy interventions. With limited funds available for education and public health interventions, it is crucial that these two ACEs be priority considerations when developing policy. A multi-faceted approach that reduces the incarcerated population, encourages economic well-being, and emphasizes early-childhood education has the potential to significantly improve school engagement in vulnerable populations and ultimately advance social equity.
Impact of high-risk of obstructive sleep apnea on chronic cough: data from the Korea National Health and Nutrition Examination Survey
Authors: Kim Tae Hoon , Heo I Re , Kim Ho Cheol 
Published: November 2022

Abstract
Background
Chronic cough is an extremely common clinical symptom of various diseases. However, the relationship between obstructive sleep apnea (OSA) and chronic cough in the general population has not been sufficiently studied.

Methods
Using the 2019 Korean National Health and Nutrition Examination Survey data, we identified a group at high-risk of OSA via the STOP-Bang questionnaire and determined the association between OSA and chronic cough by a regression model.

Results
Of the eligible 4,217 participants, 97.1% and 2.9% were classified into the non-chronic cough and chronic cough groups, respectively. The chronic cough group had higher STOP-Bang scores than those of the group without chronic cough (2.32 ± 1.38 vs. 2.80 ± 1.39; P < 0.001). In the group at high-risk of OSA, 40.4% and 52.0% of participants scored ≥ 3 in STOP-Bang, depending on the absence or presence of chronic cough (P = 0.012), respectively. Chronic cough independently correlated with impaired lung function (forced expiratory volume in one second ≥ 50–<80% predicted value, P = 0.001; <50, P < 0.001), low household income (P = 0.015), and a group at high-risk of OSA (STOP-Bang score 3–4, P = 0.004; 5–8, P < 0.001). Obesity I had a protective role against the occurrence of chronic cough (P = 0.023).

Conclusion
A high-risk for OSA is a significant risk factor for chronic cough. OSA should be considered when evaluating chronic cough patients.
A simple method for quick evaluation of the anterior tooth ratio: an observational study
Authors: Zhang Guanning , Feng Qingchen , Wei Xiaoyu , Xing Ke , Mei Hongxiang , Zhou Jiawei , Jiang Chen , Li Juan 
Published: November 2022

AbstractBackgroundAn ideal relationship of anterior teeth is closely related to postoperative function, stability, and aesthetics. Therefore, it is necessary to estimate the proportion of anterior teeth when communicating with patients about possible treatment plans and outcomes. This study aimed to establish a simple method for assessing the proportion of anterior teeth and to identify the standard ratio value to provide references for clinical work.MethodsFive hundred fourteen patients were divided into derivation, standard, and validation datasets. We first deduced our novel simplified anterior tooth ratio (SATR) by finding the key teeth with the derivation datasets, then established standard values by measuring the standard models, and finally validated the diagnostic performance of SATR. Independent sample t-test was used to select key teeth. Pearson’s correlation analysis and linear regression analysis was used to test and verify the correlation between SATR and the anterior Bolton ratio. Chi-square test and diagnostic test were used to verify the diagnostic results using SATR.Pvalues of < 0.05 were considered statistically significant.ResultsPatients with an abnormal anterior Bolton ratio were more likely to have variations in the maxillary and mandibular lateral incisors. Therefore, the ratio of maxillary and mandibular lateral incisors was chosen as a simple way to assess the anterior tooth ratio and was defined as SATR (simplified anterior tooth ratio). A positive correlation was observed between SATR and anterior Bolton ratio (r = 0.702,p < 0.001), with the linear regression equation as follows: y = 0.503 + 0.328x, x = SATR, y = anterior Bolton ratio. The standard value of SATR was established (85.69% ± 3.57%) and proven reliable in clinical practice.ConclusionsThe ratio of maxillary and mandibular lateral incisors can be used to estimate the anterior tooth ratio, which showed high reliability and efficiency.
Women empowerment and access to maternity and reproductive healthcare in Pakistan: cross-validation of a Survey-based Index in Afghanistan (SWEI-A)
Authors: Dadras Omid , Dadras Mohammadyasin , Jafari Leila , Nakayama Takeo , Dadras Fateme 
Published: November 2022

Abstract
Background
Despite the obvious violation of women’s rights in Pakistan and the vital necessity for women empowerment, a unified country-specific index measuring women empowerment is not yet available. This study cross-validated a survey-based women empowerment index from Afghanistan to be used in Pakistan.

Methods
The data for married Pakistani women aged 15–49 in the 2017–18 Pakistan demographic health survey was used to construct the final model using the explanatory and confirmatory factor analyses. The Cronbach’s alpha test examined the internal consistency of the developed index. To assess the convergence validity of the index, the association of each emerged domain with indicators of access to reproductive and maternity care was assessed by Poisson regression analysis adjusting for wealth index.

Results
The final index had six domains; namely, labor force participation, attitude toward violence, decision-making, access to healthcare, literacy, age at critical life events predicting women empowerment of married Pakistani women with decent reliability (Cronbach’s α = 0.70), and validity (SRSEA&SRMR < 0.05, CFI&TLI > 0.92). The emerged domains were significantly associated with at least one of four indicators for access to reproductive and maternity care; indicative of a favorable convergence validity.

Conclusion
Pakistan and Afghanistan are associated as brother countries with shared religious and ethnocultural identities in which women are perceived inferior to men and in critical need of empowering efforts. The results of this study reflect upon this resemblance in sociocultural structure by yielding similar domains for women's empowerment in Pakistan building upon an index previously developed for Afghan women. The developed index could inform the design of future policies, interventions, and research recognizing the important indicators of women empowerment in Pakistan and could enhance the comparability of the results across future studies.
Creation and evaluation of a participatory child abuse and neglect workshop for medical students
Authors: Giannakas Christos , Manta Aspasia , Livanou Maria Effrosyni , Daniil Vasiliki , Paraskeva Angeliki , Georgiadou Maria-Konstantina , Griva Nefeli , Papaevangelou Vassiliki , Tsolia Maria , Leventhal John M. , Soldatou Alexandra 
Published: November 2022

Abstract
Background
Since child abuse and neglect (CAN) is prevalent worldwide, medical students should acquire basic knowledge, skills, and confidence in identifying and addressing CAN. Although significant educational efforts have been previously described, none has focused on using participatory methods to teach medical students CAN.

Purpose
To: 1) develop a participatory educational workshop in CAN for medical students, 2) gather, train, and establish a peer-to-peer teaching group, and 3) assess the effectiveness of the workshop in gain of knowledge and improvement of self-confidence for participants.

Methods
A two-hour workshop was created with role-playing, the use of mannikins and peer-to-peer teaching. A 15-item knowledge and a 9-item self-confidence questionnaire were used before, right after, and six months after each workshop.

Results
Nine workshops in two academic pediatric departments with a total attendance of 300 6th year medical students were conducted. For the 69 students who completed the questionnaires at all three times, there were statistically significant gains in knowledge right after (p < .001) and six months after (p < .0001) the workshops. Similarly, self-confidence increased right after (p < .0001) and six months after (p < .001) the workshops. Self-selection bias testing indicated that these 69 students who completed all three questionnaires were representative of those who completed the pre-testing and the testing right after.

Conclusions
We successfully established a peer-to-peer teaching group to conduct nine participatory workshops that improved the participants’ knowledge and self-confidence in CAN. This feasible and novel active learning approach may help address inadequacies in medical curricula.
Estimating critical values from electrocardiogram using a deep ordinal convolutional neural network
Authors: Wei Guodong , Di Xinxin , Zhang Wenrui , Geng Shijia , Zhang Deyun , Wang Kai , Fu Zhaoji , Hong Shenda 
Published: November 2022

Abstract
Background
Critical values are commonly used in clinical laboratory tests to define health-related conditions of varying degrees. Knowing the values, people can quickly become aware of health risks, and the health professionals can take immediate actions and save lives.

Methods
In this paper, we propose a method that extends the concept of critical value to one of the most commonly used physiological signals in the clinical environment—Electrocardiogram (ECG). We first construct a mapping from common ECG diagnostic conclusions to critical values. After that, we build a 61-layer deep convolutional neural network named CardioV, which is characterized by an ordinal classifier.

Results
We conduct experiments on a large public ECG dataset, and demonstrate that CardioV achieves a mean absolute error of 0.4984 and a ROC-AUC score of 0.8735. In addition, we find that the model performs better for extreme critical values and the younger age group, while gender does not affect the performance. The ablation study confirms that the ordinal classification mechanism suits for estimating the critical values which contain ranking information. Moreover, model interpretation techniques help us discover that CardioV focuses on the characteristic ECG locations during the critical value estimation process.

Conclusions
As an ordinal classifier, CardioV performs well in estimating ECG critical values that can help people quickly identify different heart conditions. We obtain ROC-AUC scores above 0.8 for all four critical value categories, and find that the extreme values (0 (no risk) and 3 (high risk)) have better model performance than the other two (1 (low risk) and 2 (medium risk)). Results also show that gender does not affect the performance, and the older age group has worse performance than the younger age group. In addition, visualization techniques reveal that the model pays more attention to characteristic ECG locations.
Conceptual model for nurse educators to facilitate their presence in large class groups of nursing students through reflective practices: a theory synthesis
Authors: Froneman Kathleen , du Plessis Emmerentia , van Graan Anneke Catherina 
Published: November 2022

Abstract
Background
Nurse educators are required to be present and reflective while directly involving nursing students in teaching–learning using creative and innovative interaction. Heavy daily workloads (including the teaching of large classes, clinical supervision and research) could hamper facilitating their presence through reflective practices. There is insufficient information on how nurse educators can facilitate their presence through reflective practices in large class groups of nursing students.

Methods
The researchers followed Walker and Avant’s strategy of statement and theory synthesis to develop this model. Three iterative steps to theory synthesis involved identifying, defining, and classifying main and related concepts, defining relational statements, and organising the main and related concepts, relational statements, and the conceptual framework into an integrated and efficient representation. This was done by reviewing the literature. Conclusion statements were formulated using statement synthesis.

Results
A model to facilitate the presence of nurse educators in large class settings using reflective practices was developed as a theoretical framework to guide teaching–learning practices. Six conclusion statements emerged on the theoretical constructs presence and reflective practices of nurse educators.

Conclusions
The model addresses the gap in the literature and contributes substantially to deepening the body of knowledge in the nursing education domain of South Africa and internationally, to serve as a model for guiding nurse educators in their teaching–learning practices.
“You can kind of just feel the power behind what someone's saying”: a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges
Authors: Halsall Tanya , Daley Mardi , Hawke Lisa , Henderson Joanna , Matheson Kimberly 
Published: November 2022

AbstractBackgroundYouth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes.MethodsWe applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14–26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables.ResultsOur analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment.ConclusionsThis study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.
Attitude towards COVID-19 vaccination among healthcare workers: a cross sectional study from Egypt
Authors: Tharwat Samar , Nassar Dalia Kamal , Nassar Mohammed Kamal , Saad Ahmed Mohammed , Hamdy Fatma 
Published: November 2022

Abstract
Background
Herd immunity is necessary to contain the coronavirus disease 2019 (COVID-19) pandemic. Vaccination is the fastest and safest pandemic control strategy. Healthcare workers (HCWs) are essential in providing vaccination information. The aim of this study was to assess intent to be vaccinated against COVID-19 among HCWs in Egypt and to determine the factors that may influence their decision.

Methods
A questionnaire-based cross-sectional study was conducted among HCWs who care for patients in several hospitals in Delta region, Egypt. The questionnaire included sociodemographic, clinical, and occupational data, intention to receive the COVID-19 vaccine, and beliefs and attitudes towards COVID-19 and its vaccination.

Results
The study included 455 HCWs with a mean age of 36.55 years (SD = 10.31) and 80% were females. The acceptance rate for the COVID-19 vaccine was 70.5%, while hesitancy and resistancy were both 17.6 and 11.9% respectively. About one-third (33.4%) of the subjects had previously contracted COVID-19. Most participants believed that they had a higher risk of contracting COVID-19 (71.6%). More than 64% believed they were at risk for vaccination side effects. Fear of infection and being at high risk of infection were the main drivers for COVID-19 vaccination, while the major barriers were waiting for additional experience with these new vaccines and having doubts about the vaccines’ efficacy.

Conclusions
The acceptance of the COVID-19 vaccination among HCWs is very high. This crucial group needs to be the focus of educational initiatives and campaigns designed to increase public awareness of the safety and effectiveness of COVID-19 vaccination.