bluuebunny/crossref_metadata_2025_split huggingface dataset:
Migration, personal physical safety and economic survival: drivers of risky sexual behaviour among rural–urban migrant street youth in Kampala, Uganda
Authors: Bwambale Mulekya Francis , Birungi Deborah , Moyer Cheryl A. , Bukuluki Paul , van den Borne Bart 
Published: June 2022

Abstract
Background
Despite the vulnerabilities associated with the youth migration process, knowledge on the drivers of risky sexual behaviour among migrant street youth is limited. This study sought to explore the pathways driving risky sexual behaviour among rural–urban migrant street youth in Kampala, Uganda.

Methods
We conducted 11 focus-group discussions composed of 8–10 participants each, and 15 in-depth interviews with urban street adolescents and youth aged 12–24 years. We purposively recruited street youth who had migrated from other districts to Kampala, Uganda, and who identified themselves as street youth. Data were analysed thematically using an inductive approach facilitated by Dedoose software.

Results
The migration journey acted as a catalyst for risky sexual behaviour among the adolescents and youth moving from rural districts to Kampala. Three primary pathways were found to drive risky sexual behaviour of street youth: 1) rural–urban migration itself, through sexual exploitation of and violence toward street youth especially young girls during movement, 2) economic survival through engaging in casual jobs and sex work upon arrival in the city, and 3) personal physical safety through friendships and networks, which consequently lead to having multiple sexual partners and unprotected sex. Engagement in risky sexual behaviour, especially sex work, was found to be an adaptation to the challenging and complex street life within the city.

Conclusions
This study highlights the migration process, personal physical safety and economic survival as major pathways driving risky sexual behaviour among rural–urban street youth in Kampala. Interventions to improve sexual health, physical safety and protection of street youth during the migration process and within the city spaces should be prioritised.
“I have never talked to anyone to free my mind” – challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya
Authors: Toromo Judith J. , Apondi Edith , Nyandiko Winstone M. , Omollo Mark , Bakari Salim , Aluoch Josephine , Kantor Rami , Fortenberry J. Dennis , Wools-Kaloustian Kara , Elul Batya , Vreeman Rachel C. , Enane Leslie A. 
Published: June 2022

Abstract
Introduction
Adolescents living with HIV (ALHIV, ages 10–19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care.

Methods
This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized.

Results
Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9–20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure.

Conclusions
Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care.
Developing a framework for understanding health information behavior change from avoidance to acquisition: a grounded theory exploration
Authors: Sun Haixia , Li Jiao , Cheng Ying , Pan Xuelian , Shen Liu , Hua Weina 
Published: June 2022

AbstractBackgroundHealth information avoidance is common in real life, but because it is not always conducive to health promotion and maintenance, people often actively switch to health information acquisition. Understanding this process of active change can facilitate intervention in unreasonable avoidance behaviors. However, studies so far have mostly focused on why and how avoidance takes place, little is known about the process of active change from avoidance to acquisition. We thus use a grounded theory approach (GT) to explore how the active change takes place, and to generate a grounded theoretical framework capable of illustrating stages and influencing factors involved in the active change process.MethodsStraussian grounded theory (Corbin & Strauss, 2015) was used to analyze data collected through semi-structured interviews with 30 adults (14 in good health, 11 with disease, 5 in other health status) who had experienced health information behavior change from avoidance to acquisition. These interviews focused on how the change occurred and what effected the change.ResultsThe core category of Health Information Avoidance Change and 12 categories were identified and integrated to form a theoretical framework termed the Health Information Avoidance Change Model (HIACM). This model describes the process using five non-linear stage variables (initiation, preparation, action, maintenance, and abandonment) and seven moderating factor variables (cognitive change, social stimulus, beliefs and attitudes, intrapsychic literacy, social resources, information source, time and material resources).ConclusionsHIACM can be used to explain the process of active change from health information avoidance to health information acquisition. HIAC is a non-linear and holistic process, and it is necessary to dynamically analyze the impact of relevant factors and take targeted intervention measures in stages. HIAC is usually not only an individual behavior, but also a socialized behavior requiring the collaboration of individuals, families, health information providers, healthcare providers, and governments.
Knowledge, attitudes and practices of Iranian people about food safety and hygiene during covid-19 pandemic
Authors: Salehi Ali , Salmani Fatemeh , Norozi Ensiyeh , Sadighara Parisa , Zeinali Tayebeh 
Published: June 2022

Abstract
Aim
The objective of this study was to develop a cultural adopted questionnaire for evaluation of knowledge (K), attitude (A) and practice (P) of Iranian population toward food safety during Covid-19.

Methods
The study is based on an online questionnaire that filled by 712 Iranians over 16 years old. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and reliability assessment were performed. The construct validity of A and P determined by EFA and confirmed by CFA. Difficulty index was used for K.

Results
The reliability score of questionnaire was satisfactory. The three items of K-A-P questionnaire were significantly associated with the total score of questionnaire. The KAP questionnaire regarding food safety in covid-19 consisted of 27 items multidimensional scale with strong psychometric features. The respondent showed a satisfactory level of KAP during covid-19 pandemics.

Conclusion
The KAP questionnaire regarding food safety in covid-19 is a valid and reliable tool for measurement of knowledge, attitude and practice of people regarding food safety in covid-19.
Multiple breath washout lung function reveals ventilation inhomogeneity unresponsive to mechanical assisted cough in patients with neuromuscular disease
Authors: Steindor Mathis , Pichler Anna , Heitschmidt Laura , Pitsikoulis Eva , Kavvalou Alexandra , Orhan Eser , Olivier Margerete , Stehling Florian 
Published: June 2022

Abstract
Background
Respiratory involvement defines the clinical outcome of neuromuscular diseases (NMD). The lung clearance index (LCI) is a marker of lung ventilation inhomogeneity and indicates small airway disease. It is determined by mulitple breath washout lung function (MBW). The merit of LCI is undisputed for primary lung diseases like cystic fibrosis, but its role in NMD is unclear.

Methods
We investigated the role of MBW in patients with NMD and the effect of two different tracer gases and cough assist devices on the LCI. Patients and controls performed MBW with nitrogen (N2) and sulfur hexafluoride (SF6), whereas the latter analysis was repeated after the use of a cough assist device in the NMD group. LCI was compared to forced vital capacity (FVC) and peak cough flow (PCF).

Results
24 NMD patients (12 Duchenne Muscular Dystrophy, 8 Spinal Muscular Atrophy, 4 other NMDs) and 15 healthy controls were enrolled. In the NMD group, overall LCI N2 was higher than LCI SF6 (9.67 ± 1.56 vs. 8.71 ± 1.47; mean ± SD; p < 0.033). In controls, LCI N2 did not differ significantly from LCI SF6 (7.03 ± 0.37 vs. 7.05 ± 0.67; p = 0.882). Both LCI N2 and LCI SF6 were significantly higher in NMD patients as in controls (9.67 ± 1.56 vs. 7.03 ± 0.37, p < 0.001, and 8.71 ± 1.478.65 vs. 7.05 ± 0.67, p < 0.001). In the NMD group, both LCI N2 and LCI SF6 showed a negative correlation to FVC (r = − 0.525; p = 0.008 and r = − 0.526; p = 0.008, respectively) and PCF (r = − 0.590; p = 0.002 and r = − 0.641; p = 0.001, respectively). LCI N2 and LCI SF6 correlated well in the NMD group. LCI SF6 did not change significantly after the use of the cough assist in NMD patients (n = 22; 8.65 ± 1.52 pre vs. 8.79 ± 2.03 post, p = 0.667).

Conclusion
Lung involvement of patients with neuromuscular diseases goes beyond weakness of respiratory muscles. MBW with both N2 and SF6 is suitable to detect ventilation inhomogeneity in NMD patients with respiratory impairment. Cough assist devices with low to moderate pressure levels do not immediately improve the LCI.
Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: a scoping review of lateral hip musculature
Authors: Perraton Zuzana , Lawrenson Peter , Mosler Andrea B. , Elliott James M. , Weber Kenneth A. , Flack Natasha AMS. , Cornwall Jon , Crawford Rebecca J. , Stewart Christopher , Semciw Adam I. 
Published: June 2022

Abstract
Background
Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols.

Methods
Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections.

Results
From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles.

Conclusions
Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment.
Prognostic role of an inflammation scoring system in radical resection of oral squamous cell carcinoma
Authors: Wu Meng , Ye Pu , Zhang Wei , Zhu Hong , Yu Huiming 
Published: June 2022

Abstract
Background
Inflammatory markers can influence the postoperative prognosis and outcome of malignant tumors. However, the role of inflammatory factors in oral squamous cell carcinoma (OSCC) are still debatable. The primary objective of this investigation was to detect the preoperative blood fibrinogen and neutrophil–lymphocyte ratio (NLR) in OSCC patients and to determine the predictive validity of F-NLR (combined fibrinogen and NLR score).

Methods
A total of 365 patients with oral cancer after surgery were separated into three classes: F-NLR of 2, with hyperfibrinogenemia (> 250 mg/dL) and high NLR (> 3.2); F-NLR of 1, with only one higher index; and F-NLR of 0, with no higher indices. Univariate and multivariate analyses were used to identify risk factors for the demographic and clinical characteristics of patients in the three F-NLR groups. Kaplan–Meier survival analysis was used to assess the prognosis.

Results
Preoperative F-NLR showed a relatively better predictive role in oral cancer prognosis than fibrinogen and NLR alone. Multivariate analysis revealed that F-NLR has the potential to be an independent predictor for OSCC cancer-specific survival (P < 0.001). Patients with high scores had a relatively poorer prognosis than those with low scores (P < 0.001).

Conclusions
Our findings indicate that blood F-NLR may serve as an independent prognostic factor in OSCC patients.
“Building palliative care capacity in cancer treatment centres: a participatory action research”
Authors: Rao Seema Rajesh , Salins Naveen , Goh Cynthia Ruth , Bhatnagar Sushma 
Published: June 2022

Abstract
Introduction
There is a significant lack of palliative care access and service delivery in the Indian cancer institutes. In this paper, we describe the development, implementation, and evaluation of a palliative care capacity-building program in Indian cancer institutes.

Methods
Participatory action research method was used to develop, implement and evaluate the outcomes of the palliative care capacity-building program. Participants were healthcare practitioners from various cancer institutes in India. Training and education in palliative care, infrastructure for palliative care provision, and opioid availability were identified as key requisites for capacity-building. Researchers developed interventions towards capacity building, which were modified and further developed after each cycle of the capacity-building program. Qualitative content analysis was used to develop an action plan to build capacity. Descriptive statistics were used to measure the outcomes of the action plan.

Results
Seventy-three healthcare practitioners from 31 cancer treatment centres in India were purposively recruited between 2016 and 2020. The outcome indicators of the project were defined a priori, and were audited by an independent auditor. The three cycles of the program resulted in the development of palliative care services in 23 of the 31 institutes enrolled in the program. Stand-alone palliative care outpatient services were established in all the 23 centres, with the required infrastructure and manpower being provided by the organization. Morphine availability improved and use increased in these centres, which was an indication of improved pain management skills among the participants. The initiation and continuation of education, training, and advocacy activities in 20 centres suggested that healthcare providers continued to remain engaged with the program even after the cessation of their training cycle.

Conclusion
This program illustrates how a transformational change at the organizational and individual level can lead to the development of sustained provision of palliative care services in cancer institutes.
Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries
Authors: Shrestha Som Kumar , Thapa Subash , Vicendese Don , Erbas Bircan 
Published: June 2022

Abstract
Background
Intimate partner violence (IPV) adversely affects women’s reproductive health outcomes but to what extent women’s justification of IPV affects maternal health care service utilization is unexplored.

Methods
The secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women’s justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT).

Results
A total of 26,029 women aged 15–49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94).

Conclusions
Women’s justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women’s condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women’s utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.
Implementation of fixed-dose combination therapy for secondary prevention of atherosclerotic cardiovascular disease among Syrian refugees in Lebanon: a qualitative evaluation
Authors: Murphy Adrianna , Willis Ruth , Ansbro Éimhín , Masri Sahar , Kabbara Nour , Dabbousy Tonia , Bahous Sola , Molfino Lucas , Perel Pablo , Boulle Philippa 
Published: June 2022

Abstract
Background
We report findings of a qualitative evaluation of fixed-dose combination therapy for patients with established atherosclerotic cardiovascular disease (ASCVD) attending Médecins Sans Frontières (MSF) clinics in Lebanon. Cardiovascular disease is a leading cause of death and disability worldwide, and humanitarian actors are increasingly faced with the challenge of providing care for chronic diseases such as ASCVD in settings where health systems are disrupted. Secondary prevention strategies, involving 3–5 medications, are known to be effective for patients at risk of heart attack or stroke, but supply and adherence are challenging in humanitarian settings. Fixed dose combination therapy, combining two or more medications in one tablet, may be a strategy to address this.

Methods
The evaluation was nested within a prospective mixed-methods study in which eligible ASCVD patients were followed for 1 year during (i) 6 months of usual care then (ii) 6 months of fixed dose combination (FDC) therapy. After 1 year, we conducted in-depth interviews with a purposive sample of patients, MSF staff and external stakeholders. Interviews focused on acceptability and sustainability of the fixed dose therapy intervention. Interview data were analysed thematically, informed by thea Theoretical Framework of Acceptability. Additional attention was paid to non-typical cases in order to test and strengthen analysis.

Results
Patients and health care providers were positive about the FDC intervention. For patients, acceptability was related to ease of treatment and trust in MSF staff, while, for staff, it was related to perceived improvements in adherence, having a good understanding of the medication and its use, and fitting well with their priorities for patient’s wellbeing. External stakeholders were less familiar with FDC therapy. While external clinicals expressed concerns about treatment inflexibility, non-clinician stakeholder interviews suggested that cost-effectiveness would have a major influence on FDC therapy acceptability. Sustainability was tied to the future role of MSF care provision and coherence with the local health system.

Conclusions
For patients and clinic staff, FDC was an acceptable treatment approach for secondary prevention of ASCVD disease in two MSF clinics in Lebanon. Sustainability is more complex and calls for better alignment of care with public systems.