bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analyzing the effects of barriers to and facilitators of medication adherence among patients with cardiometabolic diseases: a structural equation modeling approach
Authors: Quaschning Katharina , Koerner Mirjam , Wirtz Markus Antonius 
Published: May 2022

AbstractBackgroundBased on the theoretical model of medication adherence (WHO, 2003), the aims of the study were (1) to develop and test a theory-based multidimensional model for the predictive power of barriers to and facilitators of medication adherence and (2) to identify the mediating effects of barriers to medication adherence on drug-related patient outcomes (barrier “MedAd- “: forget; facilitator “MedAd + ”: regular intake).MethodsWithin a cross-sectional study entitled “Increasing medication adherence to improve patient safety in cardiological rehabilitation (PaSiMed)”, the model was evaluated in structural analytical terms based on data collected online ofN = 225 patients with cardiometabolic diseases. The revised “Freiburg questionnaire on medication adherence (FF-MedAd-R)" was used to measure the latent constructs (e.g., facilitator: communication; barrier: reservations).”ResultsThe structural equation model proved to exhibit an appropriate data fit (RMSEA: .05; CFI: .92). For all first-order facilitators of medication adherence, a high proportion of variance (62–94%) could be explained by the second-order factor “Physician–patient relationship (PPR)”. All paths from “PPR” to the constructs depicting barriers to medication adherence showed significant negative effects. Facilitators (“MedAd + ”) and barriers (“MedAd-”) accounted for 20% and 12% of the variance, respectively, in global items of medication adherence. Whereas “Carelessness” showed a full mediation for “MedAd-”, ‘‘Reservations’’ showed a partial mediation for “MedAd + ”.Conclusions“PPR” is an important predictor of patient medication adherence. The results underline the importance of a trustful physician–patient relationship in reducing barriers and enhancing medication adherence.
Stakeholders’ perspectives and willingness to institutionalize linkages between the formal health system and informal healthcare providers in urban slums in southeast, Nigeria
Authors: Onwujekwe Obinna , Mbachu Chinyere , Onyebueke Victor , Ogbozor Pamela , Arize Ifeyinwa , Okeke Chinyere , Ezenwaka Uche , Ensor Tim 
Published: May 2022

Abstract
Background
The widely available informal healthcare providers (IHPs) present opportunities to improve access to appropriate essential health services in underserved urban areas in many low- and middle-income countries (LMICs). However, they are not formally linked to the formal health system. This study was conducted to explore the perspectives of key stakeholders about institutionalizing linkages between the formal health systems and IHPs, as a strategy for improving access to appropriate healthcare services in Nigeria.

Methods
Data was collected from key stakeholders in the formal and informal health systems, whose functions cover the major slums in Enugu and Onitsha cities in southeast Nigeria. Key informant interviews (n = 43) were conducted using semi-structured interview guides among representatives from the formal and informal health sectors. Interview transcripts were read severally, and using thematic content analysis, recurrent themes were identified and used for a narrative synthesis.

Results
Although the dominant view among respondents is that formalization of linkages between IHPs and the formal health system will likely create synergy and quality improvement in health service delivery, anxieties and defensive pessimism were equally expressed. On the one hand, formal sector respondents are pessimistic about limited skills, poor quality of care, questionable recognition, and the enormous challenges of managing a pluralistic health system. Conversely, the informal sector pessimists expressed uncertainty about the outcomes of a government-led supervision and the potential negative impact on their practice. Some of the proposed strategies for institutionalizing linkages between the two health sub-systems include: sensitizing relevant policymakers and gatekeepers to the necessity of pluralistic healthcare; mapping and documenting of informal providers and respective service their areas for registration and accreditation, among others. Perceived threats to institutionalizing these linkages include: weak supervision and monitoring of informal providers by the State Ministry of Health due to lack of funds for logistics; poor data reporting and late referrals from informal providers; lack of referral feedback from formal to informal providers, among others.

Conclusions
Opportunities and constraints to institutionalize linkages between the formal health system and IHPs exist in Nigeria. However, there is a need to design an inclusive system that ensures tolerance, dignity, and mutual learning for all stakeholders in the country and in other LMICs.
Diagnoses and procedures of inpatients with female genital mutilation/cutting in Swiss University Hospitals: a cross-sectional study
Authors: Horowicz Mathilde , Cottler-Casanova Sara , Abdulcadir Jasmine 
Published: May 2022

Abstract
Background
Female genital mutilation/cutting (FGM/C) can result in short and long-term complications, which can impact physical, psychological and sexual health. Our objective was to obtain descriptive data about the most frequent health conditions and procedures associated with FGM/C in Swiss university hospitals inpatient women and girls with a condition/diagnosis of FGM/C. Our research focused on the gynaecology and obstetrics departments.

Methods
We conducted an exploratory descriptive study to identify the health outcomes of women and girls with a coded FGM/C diagnose who had been admitted to Swiss university hospitals between 2016 and 2018. Four of the five Swiss university hospitals provided anonymized data on primary and secondary diagnoses coded with the International Classification of Diseases (ICD) and interventions coded in their medical files.

Results
Between 2016 and 2018, 207 inpatients had a condition/diagnosis of FGM/C. The majority (96%) were admitted either to gynaecology or obstetrics divisions with few genito-urinary and psychosexual conditions coded.

Conclusions
FGM/C coding capacities in Swiss university hospitals are low, and some complications of FGM/C are probably not diagnosed. Pregnancy and delivery represent key moments to identify and offer medical care to women and girls who live with FGM/C.
Trial registration: This cross-sectional study (protocol number 2018-01851) was conducted in 2019, and approved by the Swiss ethics committee.
Parent–adolescent discussion on sexual and reproductive health issues and its associated factors among parents in Sawla town, Gofa zone, Ethiopia
Authors: Malango Nigatu Teferi , Hegena Tadele Yohannes , Assefa Netsanet Abera 
Published: May 2022

Abstract
Background
Parent–adolescent discussion on sexual and reproductive health (SRH) issues leads to increased awareness on reproductive health matters and reduces risky behaviors among adolescents and also contributes to negative SRH outcomes. The aim of this study was to assess parent–adolescent discussion on SRH issues and its associated factors in Sawla town, Southern Ethiopia.

Methods
A community-based cross-sectional study was conducted among parents of 10–19-year-olds in Sawla town from March to April 2020. A simple random sampling technique was employed to select 697 study subjects. Data were collected using a pretested structured questionnaire, adapted from the 2016 Ethiopia Demographic Health Survey and other published literature. The questionnaire consisted of questions about socio-demographic factors, knowledge about SRH issues, attitudes towards SRH issues, and discussions between parents and adolescents concerning SRH issues and was administered by face-to-face interviews p-value < 0.05 and 95%CI for adjusted odds ratios (AOR) were used to declare the significance of the associations.

Results
Of the total participants, 168 (25.7%) respondents had reported discussion about at least two components of SRH issues in the last 6 months prior to the study. Multiple logistic regression model revealed that attending primary education (AOR 3, 95% CI: 1.10, 7.70), secondary education (AOR 9, 95% CI: 3.87, 20.64) and diploma and above (AOR 22.33, 95% CI: 9.49, 32.56), monthly income of above 2000 Ethiopian Birr (AOR 2.40, 95% CI: 1.30, 4.55), good knowledge (AOR 2, 95% CI: 1.14, 3.50)and positive attitude (AOR 4, 95% CI: 1.57, 10) towards SRH issues were statically significant factors associated with increased parent–adolescent discussion about SRH.

Conclusion
The occurrence of parent–adolescent SRH discussion is low in Sawla town. Educational status, average monthly income, knowledge and attitude on SRH issues were major factors affecting parent–adolescent discussion on SRH issues. Continuous capacity building on SRH issues for parents to increase the level of parental knowledge and attitude about SRH issues and sustainable advocacy should be provided about the importance of parent to the adolescent discussion. Moreover, it is important to support and scale up the adult learning program to decrease the level of illiteracy.
Secondary school students’ and peer educators’ perceptions of adolescent education in rural Tanzania: a qualitative study
Authors: Ito Keiko , Madeni Frida E. , Shimpuku Yoko 
Published: May 2022

Abstract
Background
In many African countries, cultural norms and values hinder conversations about sexuality among adolescents and their parents. Currently, there are no sex education classes in the curriculum at schools in Tanzania. Even when sex education is provided, the content is often abstinence-oriented, and there is a lack of in-depth instruction and exploration on the topic. To help overcome this, peer education is encouraged. After implementing peer-based adolescent education via a non-profit organization, this study aims to (1) identify students’ and peer educators’ perceptions of adolescent education and (2) identify the changes that occur as a result of adolescent education with peer educators.

Methods
This was a qualitative descriptive study using focus group discussions (FGDs). Secondary school students, including peer educators as well as students who received adolescent education, were asked about their perception of peer-based adolescent education. The FGDs were conducted in Swahili with the support of local collaborators. Data were transcribed and translated into English and Japanese. Content analysis was conducted to merge the categories and subcategories.

Results
A total of 92 students (57 girls and 35 boys) were included from three urban and three rural secondary schools where peer education was being implemented. Six FGDs were conducted for girls and four for boys, for a total of 10 FGDs. The students had both positive and negative perceptions of peer-based adolescent education. Both the peer educators and the other students felt that they gained more confidence through the process, based on the conversations they had and the trusting relationship that formed as a result. The peer educators were also successful in eliciting behavioral changes, and the students shared their sex-related knowledge with other peers as well.

Conclusion
The peer education process helped students gain confidence in teaching their peers and elicit behavioral changes. Adult supervision for peer educators is suggested.
Optimization of immune receptor-related hypersensitive cell death response assay using agrobacterium-mediated transient expression in tobacco plants
Authors: Huh Sung Un 
Published: May 2022

Abstract
Background
The study of the regulatory mechanisms of evolutionarily conserved Nucleotide-binding leucine-rich repeat (NLR) resistance (R) proteins in animals and plants is of increasing importance due to understanding basic immunity and the value of various crop engineering applications of NLR immune receptors. The importance of temperature is also emerging when applying NLR to crops responding to global climate change. In particular, studies of pathogen effector recognition and autoimmune activity of NLRs in plants can quickly and easily determine their function in tobacco using agro-mediated transient assay. However, there are conditions that should not be overlooked in these cell death-related assays in tobacco.

Results
Environmental conditions play an important role in the immune response of plants. The system used in this study was to establish conditions for optimal hypertensive response (HR) cell death analysis by using the paired NLR RPS4/RRS1 autoimmune and AvrRps4 effector recognition system. The most suitable greenhouse temperature for growing plants was fixed at 22 °C. In this study, RPS4/RRS1-mediated autoimmune activity, RPS4 TIR domain-dependent cell death, and RPS4/RRS1-mediated HR cell death upon AvrRps4 perception significantly inhibited under conditions of 65% humidity. The HR is strongly activated when the humidity is below 10%. Besides, the leaf position of tobacco is important for HR cell death. Position #4 of the leaf from the top in 4–5 weeks old tobacco plants showed the most effective HR cell death.

Conclusions
As whole genome sequencing (WGS) or resistance gene enrichment sequencing (RenSeq) of various crops continues, different types of NLRs and their functions will be studied. At this time, if we optimize the conditions for evaluating NLR-mediated HR cell death, it will help to more accurately identify the function of NLRs. In addition, it will be possible to contribute to crop development in response to global climate change through NLR engineering.
The diagnostic value of serum miR-21 in patients with ovarian cancer: a systematic review and meta-analysis
Authors: Qiu Lili , Weng Guangping 
Published: May 2022

Abstract
Objective
There have been a variety of published studies on the expression of serum miR-21 in patients with ovarian cancer associated with the diagnostic value of ovarian cancer, but the conclusions are not clearly elucidated. This study aims to evaluate the value of serum miR-21 expression in the diagnosis of patients with ovarian cancer by meta-analysis.

Methods
Databases, such as PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and China WanFang, were searched for relevant studies upon the correlation between the expression of serum miR-21 and the diagnostic value of ovarian cancer from inception to March 7, 2022. Statistical analysis was performed using Stata 15.0 software. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. The meta-regression analysis and subgroup analysis were used to explore the sources of heterogeneity. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) system was used to evaluate the quality of the included literature.

Results
A total of 6 articles were included in the meta-analysis. The results showed that the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.81 (95%CI: 0.73–0.88), 0.82 (95%CI: 0.75–0.87), 4.51 (95%CI: 3.22–6.31), 0.23 (95%CI: 0.16–0.33), and 19.87 (95% CI: 11.27–35.03), respectively. The area under the summary receiver operating characteristic curve was 0.89 (95%CI: 0.85–0.91). No significant publication bias was found (P > 0.05).

Conclusion
Serum miR-21 has a good diagnostic value for ovarian cancer, which can be an ideal diagnostic biomarker for ovarian cancer. However, we should gingerly use miR-21 as a diagnostic reference standard, due to the limited number of included studies and heterogeneity.
Development and evaluation of a package to improve hypertension control in Nigeria [DEPIHCON]: a cluster-randomized controlled trial
Authors: Ajayi IkeOluwapo O. , Oyewole Oyediran E. , Ogah Okechukwu S. , Akinyemi Joshua O. , Salawu Mobolaji M. , Bamgboye Eniola A. , Obembe Taiwo , Olawuwo Morenikeji , Sani Mahmoud Umar 
Published: May 2022

Abstract
Background
Nigeria’s healthcare system capacity to stem the increasing trend in hypertension is limited in coverage, scope and manpower. Use of trained community-based care providers demonstrated to be an effective complement in improving access to, and supporting healthcare delivery has not been adequately examined for hypertension care in Nigeria. This study is proposed to evaluate the effectiveness of using trained community-oriented resource persons (CORPs) to improve hypertension control in Nigeria.

Methods
An intervention study will be conducted in three states using a mixed method design. First is a baseline survey using a semi-structured pre-tested questionnaire to collect information on demographics, clinical data, knowledge, occurrence and risk factors of hypertension among 1704 adults ≥18 years. Focus group discussions (FGD) and key informant interviews (KII) will be conducted to explore a community’s experience of hypertension, challenges with hypertension management and support required to improve control in 10 selected communities in each state. The second is a cluster-randomized controlled trial to evaluate effect of a package on reduction of blood pressure (BP) and prevention of cardiovascular (CVD) risk factors among 200 hypertensive patients to be followed up in intervention and control arms over a 6-month period in each state. The package will include trained CORPs conducting community-based screening of BP and referral, diagnosis confirmation and initial treatment in the health facility, followed by monthly home-based follow-up care and provision of health education on hypertension control and healthy lifestyle enhanced by phone voice message reminders. In the control arm, the usual care (diagnosis, treatment and follow-up care in hospital of a patient’s choice) will continue. Third, an endline survey will be conducted in both intervention and control communities to evaluate changes in mean BP, control, knowledge and proportion of other CVD risk factors. In addition, FGD and KII will be used to assess participants’ perceived quality and acceptability of the interventions as delivered by CORPs.

Discussion
This research is expected to create awareness, improve knowledge, perception, behaviours, attitude and practices that will reduce hypertension in Nigeria. Advocacy for buy-in and scale up of using CORPs in hypertension care by the government is key if found to be effective.

Trial registration
PACTR Registry PACTR202107530985857. Registered on 26 July 2021.
Coproduction and enhancement of electricity and biobutanol using adsorption carrier solid-state fermentation
Authors: Feng Xinyu , Wang Lan , Chen Hongzhang 
Published: May 2022

Abstract
Background
Electric energy is not collected and utilized in biobutanol fermentation. The reason is that the yields of electron shuttles and nanowires are not enough to gather and transfer all electrons to the electrode in liquid fermentation. However, the solid matrix of the adsorption carrier may be conducive to the collection and transfer of electrons because of its good adsorption and conductivity. Therefore, this first-attempt study coupled microbial fuel cell (MFC) with adsorption carrier solid-state fermentation (ACSF). In addition, the effect and mechanism of adsorption carrier solid-state fermentation on power generation were explored.

Results
The power generation performance and fermentation performance were improved by ACSF. The power density by polyurethane and carbon felt carrier solid-state fermentation (PC) was 12 times that by no carrier fermentation (NC). The biobutanol yield of absorbent cotton and carbon felt carrier solid-state fermentation (ACC) was increased by 36.86%. Moreover, the mechanism was explored via metabolic flux analysis, cyclic voltammetry and scanning electron microscopy. The results of metabolic flux analysis showed that more electrons were produced and more carbon flowed to biobutanol production. The cyclic voltammetry results revealed that more riboflavin was produced to enhance extracellular electron transport (EET) by ACSF. The scanning electron microscopy image showed that the adsorption capacity and aggregation degree of bacteria were increased on the electrode and nanowires were observed by ACSF.

Conclusions
A new fermentation mode was established by coupling MFC with ACSF to improve substrate utilization, which will provide crucial insights into the fermentation industry. In addition, the ACSF is an effective method to enhance power generation performance and fermentation performance.

Graphical Abstract
Effect of low back pain on clinical-functional factors and its associated potential risk of chronicity in adolescent dancers of classical ballet: cross-sectional study
Authors: de Souza Brenda Luciano , de Souza Patricia Colombo , Ribeiro Ana Paula 
Published: May 2022

Abstract
Background
Low back pain (LBP) is a common symptom in classical ballet dancers, which can limit their daily activities and dance training routines. The purpose of the study was to verify the association and comparison of clinical-functional outcomes (spine flexibility and foot posture) between different levels of intensity low back pain in adolescents of classical ballet and the potential risk of chronicity using the STarT back tool.

Methods
Cross-sectional study. Participants: 78 adolescent girls who practice classical ballet were evaluated and divided into groups according to level of low back pain: mild (n = 21), moderate (n = 17), and high (n = 20), and a control group (n = 20). Main outcome measures: Pain, flexibility of the spine (thoracic and lumbosacral), risk of chronicity for low back pain, and foot posture were assessed using the visual analogue scale, clinical tests, STarT back screening tool (SBST) questionnaire, and foot posture index (FPI), respectively.

Results
Dancers with high-intensity low back pain showed a potential risk of chronicity by the SBST. The spine pain intensity was not different considering thoracic and lumbosacral flexibility in the sagittal plane, but was different with greater supine FPI when compared to control dancers. Mild low back pain was associated with greater supine FPI. The SBST score was associated with higher exposure time–frequency and time of dancing.

Conclusion
Adolescents of classical ballet with high-intensity low back pain showed a potential risk of chronicity by the SBST. The level of intensity low back pain did not influence the clinical-functional aspects of spine flexibility in the sagittal plane, but the level of intensity moderate pain promoted changes in foot posture (more supinated). The potential risk of chronicity using the SBST was also associated with higher exposure time–frequency and time of dancing, in adolescents of classical ballet.