bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative analysis of factors influencing health-seeking behavior of people living with HIV, hypertension and diabetes in an urban area of Ghana
Authors: Abdulai Martha Ali , Marable Julian K , Wadus Awudu , Asante Kwaku Poku 
Published: April 2022

Non-communicable diseases are rising globally and lower-middle-income countries are now facing a double-burden of communicable and non-communicable diseases like hypertension and diabetes. Patients with HIV/AIDS are at increased risk of developing hypertension and diabetes. Understanding how this double-burden influences persons living with HIV health-seeking behavior (HSB) is critical to identifying successful interventions and policies. To explore the factors that influence the health-seeking behavior of HIV patients with hypertension and diabetes in an urban setting of Ghana, we undertook a qualitative study consisting of sixteen in-depth interviews (five healthcare providers [HCP] and eleven patients); all recruited from Antiretroviral Therapy (ART) clinics in the Techiman South Municipality of Ghana. Interview questions were designed to explore cognitive, affective, social, and environmental factors that influence an individual’s decision-making process and behavior. All interviews were audio-recorded, transcribed, and analyzed thematically. Participants raised unique challenges while seeking treatment services for HIV, hypertension, and diabetes. Frequent appointments, increased pill burden, food restrictions, alternate sources of care (herbalist and pastors), and negative psychological wellbeing were some of the challenges noted for seeking treatment services. Challenges with the health facility, including separate clinic days for comorbid conditions, high costs of medications and transportation, and long waiting hours were also cited as influencing health-seeking behavior. Results indicate greater challenges for HIV patients living with hypertension and diabetes in accessing treatment services. Understanding this is critical to removing barriers and making treatment more accessible. Further integration of treatment for hypertension and diabetes into HIV care is essential to ensuring patient engagement in continuous care.
Evaluation of the combination therapy of hydroxyurea and thalidomide in β-thalassemia
Authors: Ansari Saqib H. , Ansari Iqra , Wasim Misbah , Sattar Amjad , Khawaja Shariqa , Zohaib Muhammad , Hussain Zeeshan , Adil Syed Omair , Ansari Ali H. , Ansari Usman H. , Farooq Fawad , Masqati Noor-un-Nisa 
Published: April 2022

Abstract
Transfusion-related complications and lack of resources in low-to-middle-income countries have led to a search for novel therapies to reduce the need for blood transfusions in patients with β-thalassemia. Hydroxyurea (HU) has demonstrated promising outcomes; additionally, thalidomide has also shown improvement in hemoglobin (Hb) levels for patients with β-thalassemia in some studies. This study presents the findings of a single-arm nonrandomized trial to evaluate the efficacy of combination therapy of HU and thalidomide in children with β-thalassemia. A total of 135 patients (median age, 6 [interquartile range, 3-10] years), 77 (57%) males and 58 (43%) females, were followed first using HU alone, for 6 months, and then using the combination of HU and thalidomide for another 6 months. The primary outcome was a response to therapy, as measured by the number of transfusions required and Hb levels, for patients while receiving HU alone and then while using the combination therapy. Study findings showed a significant decline in blood transfusion volume (P &lt; .001) and a significant increase in median Hb levels within 3 and 6 months of the combination therapy (P &lt; .001). Eighty-nine (65.93%) participants were good responders, 16 (11.85%) were responders, and 30 (22.22%) were nonresponders, whereas the responders had variable genetic mutations. A total of 38 adverse events were reported that resolved on supportive treatment or temporary hold of the intervention. The combination therapy demonstrated promising results and could be considered for a diverse patient population with β-thalassemia. This trial was registered at www.clinicaltrials.gov as #NCT05132270.
Remnant preservation may improve proprioception after anterior cruciate ligament reconstruction
Authors: Cho Eunshinae , Chen Jiebo , Xu Caiqi , Zhao Jinzhong 
Published: April 2022

Abstract
Aim
Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL tibial remnant-preserving reconstruction (ACLR-R) is more beneficial than standard technique (ACLR-S) in terms of postoperative proprioceptive function with various reported tests, including joint position sense (JPS) and threshold to detect passive motion (TTDPM).

Methods
An online search was performed in Embase, MEDLINE/PubMed, Cochrane, SPORTDiscus, and Web of Science databases before 5 October 2020, on the basis of the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Key terms [(‘ACLR’ or ‘ACL-R’ or ‘anterior cruciate ligament reconstruction’) AND (‘remnant’ or ‘stump’) AND (‘proprioception’ or ‘proprioceptive’)] were used. The Oxford Centre for Evidence-Based Medicine and The McMaster Critical Review Form for Quantitative Studies were used for quality assessment. In total, four articles comparing proprioceptive functions between ACLR-R and ACLR-S were included, two of which were randomized clinical trials rated as level of evidence II, and two were retrospective cohort studies rated as level of evidence III. The outcomes were then compared. Evaluation of proprioception involved joint position sense (JPS) [reproduction of active positioning (RAP) and reproduction of passive positioning (RPP)] and threshold to detect passive motion (TTDPM) tests.

Results
Only four studies were included, with a total of 234 patients (119 ACLR-R patients and 115 ACLR-S patients). High heterogeneity in characteristics and outcome measurements was observed among the studies. Three studies performed sparing technique, and one performed tensioning technique. One study tested RAP and reported better results at an average of 7 months follow-up in ACLR-R (P < 0.05). Three studies tested RPP, one of which measured RPP within 12 months after surgery and reported better results in ACLR-R than in ACLR-S (P < 0.05). The other two studies reported similar results; however, the findings of one study were statistically insignificant. TTDPM was tested in one study, with no statistically significant difference found.

Conclusion
The current literature, although limited, reported proprioception improvement after ACLR-R (compared with ACLR-S) in terms of JPS. However, owing to the heterogeneity of the relevant studies, further research is required to determine remnant preservation effect on knee proprioceptive restoration.

Level of evidence
Level III, systematic review of Level II and III studies.
Comparison of low-dose morphine intrathecal analgesia and sufentanil PCIA in elderly patients with hip fracture undergoing single spinal anesthesia — a randomized clinical trial
Authors: Xu Zhifei , Tang Zairong , Yao Juan , Liang Dongliang , Jin Feng , Liu Ying , Guo Kai , Yang Xiulu 
Published: April 2022

Abstract
Background
The complications of postoperative pain, such as hypertension, hypermetabolism, irritability, and postoperative cognitive dysfunction, significantly affect the postoperative rehabilitation of elderly patients. Intrathecal morphine prolongs analgesia after surgery, but has been implicated in nausea and vomiting, pruritus, postoperative respiratory depression, or apneic episodes. The present study explored the effect and safety of low-dose morphine used adjunctively with bupivacaine during single spinal anesthesia or sufentanil patient-controlled intravenous analgesia (PCIA) in elderly patients with hip fracture surgery. Since elderly patients often need anticoagulant therapy in the early postoperative period, single spinal anesthesia was involved in completing the operation in this study.

Methods
Eighty elderly patients aged 70–85 years who underwent elective hip fracture surgery with single spinal anesthesia were divided into two groups, 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of morphine (morphine group, group M) and 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of sufentanil PCIA (sufentanil group, group S). The analgesia scores using the visual analogue scale (VAS), the Brinell comfort scale (BCS) were evaluated at 6, 12, 24, and 48 h after operation, and adverse reactions were recorded such as nausea and vomiting, pruritus, sedation, respiratory depression, and POD (postoperative delirium) with Delirium Rating Scale-r 98.

Results
Within 24 h after operation, the analgesic and BCS scores of group M were better than those of group S (P < 0.05). Group M had higher frequency of skin pruritus than group S within 24 h, and the difference was statistically significant. The incidence of POD in group M (2 cases) was lower than that in group S (6 cases) (5.71% vs 18.18%) (P < 0.05) with the DRS-r 98 scores. No significant difference was observed in nausea and vomiting between the two groups, and the difference of severe respiratory depression was not found in both groups.

Conclusion
Compared with sufentanil PCIA, low-dose intrathecal morphine has a satisfactory analgesic effect, and little effect on the patient's cognitive function with low medical cost. Under effective respiratory monitoring, it can be used safely and effectively in elderly patients with hip fracture.

Trial registration
Registered with the Chinese Clinical Trial Registry under ChiCTR2100042706. 26/01/2021.
The ten-year risk of developing cardiovascular disease among public health workers in North-Central Nigeria using Framingham and atherogenic index of plasma risk scores
Authors: Olubiyi Olubunmi Abiola , Rotimi Bosede Folashade , Afolayan Munirat Ayoola , Alatishe-Muhammad Bilqis Wuraola , Olubiyi Olufemi Mubo , Balami Ahmed Dahiru 
Published: April 2022

Abstract
Background
Estimation of total cardiovascular disease (CVD) risk with the use of risk prediction charts such as the Framingham risk score and Atherogenic index of plasma score is a huge improvement on the practice of identifying and treating each of the risk factors such as high blood pressure and elevated blood cholesterol. The estimation of the total risk highlights that CVD risk factors occur together and thereby predicts who should be treated. There is scarcity of data on the risk scoring of adults in Nigeria including health workers. Therefore, this study was done to estimate the cardiovascular risks of health workers in public health services in north-central Nigeria.

Methods
A cross-sectional survey was performed using validated Framingham risk score calculator and calculation of risk based on the lipid profile of 301 randomly selected health workers in North-central Nigeria. Descriptive analysis was done using frequency counts and percentages while inferential statistics were done using chi square and correlation analyses using statistical Package for Social Sciences (SPSS) version 21.0. The confidence level was 95% and the level of significance was set at 0.05.

Results
The 10-year risk of developing CVD was generally low in the health workers. Using Framingham risk score, 98.3% of health workers have low risk, 1.0% have moderate risk and 0.7% have high risk. Among the cadres of health workers, 1.5% of the nurses have moderate risk while 2.5% of the doctors and 3.3% of the CHEWs have high risk of developing CVD in 10 years. Using Atherogenic index of plasma scoring, only 2% of the health workers have high risk, 4.7% have intermediate risk while 93.4% have low risk. Across the cadres, 6.3% of the nurses and 3.3% of the CHEWs have intermediate risk while 2.4% of the nurses and 3.3% of the CHEWs have high risk. These findings were however not statistically significant.

Conclusions
The 10-year risk of developing cardiovascular disease was low in the health workers in this study using both Framingham’s risk score and atherogenic index of plasma scores.
Internet access is a necessity: a latent class analysis of COVID-19 related challenges and the role of technology use among rural community residents
Authors: Dow-Fleisner Sarah J. , Seaton Cherisse L. , Li Eric , Plamondon Katrina , Oelke Nelly , Kurtz Donna , Jones Charlotte , Currie Leanne M. , Pesut Barb , Hasan Khalad , Rush Kathy L. 
Published: April 2022

Abstract
Background
Rural and remote communities faced unique access challenges to essential services such as healthcare and highspeed infrastructure pre-COVID, which have been amplified by the pandemic. This study examined patterns of COVID-related challenges and the use of technology among rural-living individuals during the first wave of the COVID-19 pandemic.

Methods
A sample of 279 rural residents completed an online survey about the impact of COVID-related challenges and the role of technology use. Latent class analysis was used to generate subgroups reflecting the patterns of COVID-related challenges. Differences in group membership were examined based on age, gender, education, race/ethnicity, and living situation. Finally, thematic analysis of open-ended qualitative responses was conducted to further contextualize the challenges experienced by rural-living residents.

Results
Four distinct COVID challenge impact subgroups were identified: 1) Social challenges (35%), 2) Social and Health challenges (31%), 3) Social and Financial challenges (14%), and 4) Social, Health, Financial, and Daily Living challenges (19%). Older adults were more likely to be in the Social challenges or Social and Health challenges groups as compared to young adults who were more likely to be in the Social, Health, Financial, and Daily Living challenges group. Additionally, although participants were using technology more frequently during the COVID-19 pandemic to address challenges, they were also reporting issues with quality and connectivity as a significant barrier.

Conclusions
These analyses found four different patterns of impact related to social, health, financial, and daily living challenges in the context of COVID. Social needs were evident across the four groups; however, we also found nearly 1 in 5 rural-living individuals were impacted by an array of challenges. Access to reliable internet and devices has the potential to support individuals to manage these challenges.
Promoting healthy eating in Latin American restaurants: a qualitative survey of views held by owners and staff
Authors: Fuster Melissa , Abreu-Runkle Rosa , Handley Margaret A. , Rose Donald , Rodriguez Michelle A. , Dimond Emily G. , Elbel Brian , Huang Terry T. K. 
Published: April 2022

Abstract
Background
Restaurants, particularly independently-owned ones that serve immigrant communities, are important community institutions in the promotion of dietary health. Yet, these restaurants remain under-researched, preventing meaningful collaborations with the public health sector for healthier community food environments. This research aimed to examine levels of acceptability of healthy eating promotion strategies (HEPS) in independently-owned Latin American restaurants (LARs) and identify resource needs for implementing HEPS in LARs.

Methods
We completed semi-structured, online discussions with LAR owners and staff (n = 20), predominantly from New York City (NYC), to examine current engagement, acceptability, potential barriers, and resource needs for the implementation of HEPS. Verbatim transcripts were analyzed independently by two coders using Dedoose, applying sentiment weighting to denote levels of acceptability for identified HEPS (1 = low, 2 = medium/neutral, 3 = high). Content analysis was used to examine factors associated with HEPS levels of acceptability and resource needs, including the influence of the Coronavirus pandemic (COVID-19).

Results
The most acceptable HEPS was menu highlights of healthier items (mean rating = 2.8), followed by promotion of healthier items (mean rating = 2.7), increasing healthy offerings (mean rating = 2.6), nutrition information on the menu (mean rating = 2.3), and reduced portions (mean rating = 1.7). Acceptability was associated with factors related to perceived demand, revenue, and logistical constraints. COVID-19 had a mixed influence on HEPS engagement and acceptability. Identified resource needs to engage in HEPS included nutrition knowledge, additional expertise (e.g., design, social media, culinary skills), and assistance with food suppliers and other restaurant operational logistics. Respondents also identified potential policy incentives.

Conclusions
LARs can positively influence eating behaviors but doing so requires balancing public health goals and business profitability. LARs also faced various constraints that require different levels of assistance and resources, underscoring the need for innovative engagement approaches, including incentives, to promote these changes.
Do expectations of recovery improve risk assessment for people with whiplash-associated disorders? Secondary analysis of a prospective cohort study
Authors: Griffin Alexandra R. , Sterling Michele , Ritchie Carrie , Kifley Annette , Jagnoor Jagnoor , Cameron Ian D. , Rebbeck Trudy 
Published: April 2022

Abstract
Background
WhipPredict, which includes prognostic factors of pain-related disability, age and hyperarousal symptoms, was developed and validated for prediction of outcome in people with whiplash associated disorders (WAD). Patient expectations of recovery was not an included factor, though is known to mediate outcomes. The aim of this study was to determine whether the addition of expectations of recovery could improve the accuracy of WhipPredict.

Methods
Two hundred twenty-eight participants with acute WAD completed questionnaires (WhipPredict and expectations of recovery) at baseline. Health outcomes (neck disability index (NDI) and Global Perceived Recovery (GPR)) were assessed at 6- and 12-months post injury. Cut-off points for expectations of recovery predictive of both full recovery (NDI ≤10 % , GPR ≥ 4) and poor outcome (NDI ≥30 % , GPR ≤  − 3) were determined, and multivariate logistic regression analyses were used to compare models with and without this variable.

Results
Expectations of recovery improved or maintained the accuracy of predictions of poor outcome (6-months: sensitivity 78 to 83%, specificity maintained at 79.5%; 12-months: sensitivity maintained at 80%, specificity 69 to 73%). The sensitivity of predictions of full recovery improved (6-months: 68 to 76%; 12-months: 57 to 81%), though specificity did not change appreciably at 6 months (80 to 81%) and declined at 12 (83 to 76%). ROC curves indicated a larger and more consistent improvement in model performance when expectations of recovery were added to the pathway predictive of full recovery.

Conclusions
The addition of expectations of recovery may improve the accuracy of WhipPredict, though further validation is required.
Predicting in-hospital length of stay: a two-stage modeling approach to account for highly skewed data
Authors: Xu Zhenhui , Zhao Congwen , Scales Charles D. , Henao Ricardo , Goldstein Benjamin A. 
Published: April 2022

Abstract
Background
In the early stages of the COVID-19 pandemic our institution was interested in forecasting how long surgical patients receiving elective procedures would spend in the hospital. Initial examination of our models indicated that, due to the skewed nature of the length of stay, accurate prediction was challenging and we instead opted for a simpler classification model. In this work we perform a deeper examination of predicting in-hospital length of stay.

Methods
We used electronic health record data on length of stay from 42,209 elective surgeries. We compare different loss-functions (mean squared error, mean absolute error, mean relative error), algorithms (LASSO, Random Forests, multilayer perceptron) and data transformations (log and truncation). We also assess the performance of two stage hybrid classification-regression approach.

Results
Our results show that while it is possible to accurately predict short length of stays, predicting longer length of stay is extremely challenging. As such, we opt for a two-stage model that first classifies patients into long versus short length of stays and then a second stage that fits a regresssor among those predicted to have a short length of stay.

Discussion
The results indicate both the challenges and considerations necessary to applying machine-learning methods to skewed outcomes.

Conclusions
Two-stage models allow those developing clinical decision support tools to explicitly acknowledge where they can and cannot make accurate predictions.
The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study
Authors: Egilsdottir H. Ösp , Heyn Lena Günterberg , Brembo Espen Andreas , Byermoen Kirsten Røland , Moen Anne , Eide Hilde 
Published: April 2022

Abstract
Background
The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment.

Design
This was an explorative convergent mixed-methods study using both quantitative and qualitative methods.

Methods
Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied.

Results
The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the “red thread” between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse.

Conclusion
This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students’ preparedness for clinical hours. Virtual patients’ scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs.