bluuebunny/crossref_metadata_2025 huggingface dataset:
To Achieve Carbon Neutrality, What Do Individual Residents Say? A Case Study of Yunnan Province of China Based on Spatial Analysis
Authors: Yang Wei , Lu Yao , Wang Le , Xu Yang
Published: November 2024

This study aims to explore factors that affect individual residents’ behaviors contributing to reducing carbon emissions (low-carbon behaviors), based on the empirical analysis of the choice of adoption and the extent of adoption of low-carbon practices, such as using low-carbon transportation and energy-saving, in Kunming, China. We use spatial econometric regression models to consider positive spillover of low-carbon behaviors amongst residents as people tend to obtain knowledge and learn good actions from those located nearby. The results show the existence of positive spillover effects of low-carbon behaviors across several types of low-carbon practices. We find that location effects, such as access to parks, residents’ knowledge of carbon neutrality, and science communications in the local community are the most important determinants of residents’ low-carbon behaviors. The findings may provide insights into designing supporting policies to incentivize residents’ low-carbon behaviors and contribute to the pathway toward carbon neutrality from the micro-perspective.
“The Path is Made by Walking”: The Untapped Potential of (the Happiest) Spanish Self-Initiated Expatriates
Authors: Bastida Maria , Pinto Luisa H. , Vazquez Taín Miguel Á. , del Río Marisa
Published: November 2024

This study investigates the impact of cross-cultural adjustment and subjective well-being on the achievements and intentions of Spanish self-initiated expatriates (SIEs) regarding their decision to stay abroad or return to Spain. Using resource conservation theory, the research examines how SIEs’ agency influences their adjustment and well-being, thus affecting their achievement and propensity to repatriate. A tailored online survey was administered to Spanish SIEs, incorporating validated scales to cross-cultural adjustment, subjective well-being, and intention to stay abroad. Using non-probability sampling, a final sample of 309 SIEs was obtained. Data analysis employed partial least squares structural equation modelling (PLS-SEM) to validate the hypotheses. The results show that improved adjustment and well-being of SIEs correlate with improved achievement and reduced likelihood of repatriation. These results underline the importance of cultural adjustment and subjective well-being in shaping SIEs’ expatriation experiences and their intentions to stay abroad. Furthermore, the research lays the groundwork for future comparative studies and underlines the need for home institutions to facilitate the repatriation process. Moreover, the implications of the findings for management offer ideas for improving the experiences of SIEs abroad and recognising their value as assets to both national and global organizations, while addressing the challenges associated with repatriation.
The microstructure, composition, physical properties, and bioactivity of calcium silicate cement prototypes for vital pulp therapies
Authors: Vega-González Marina , Domínguez-Pérez Rubén Abraham , Higareda-Mendoza Ana Edith , Domínguez-Pérez Ricardo , Espinosa-Cristóbal León Francisco , Sánchez-Lara y Tajonar Roberto Gustavo
Published: November 2024

Hydraulic calcium silicate cements (HCSCs) are valuable for various dental procedures. However, several reports document inherent limitations and complaints about their high costs, hindering accessibility in low—and middle-income countries. This study aimed to characterize four low-cost HCSC prototypes to show their microstructure, composition, and fundamental physical properties. Four HCSC prototypes were formulated: 1- calcium silicate powder with 17.5 wt. % replacement of calcium tungstate, 2- calcium silicate powder with 17.5 wt. % replacement of zirconium oxide, 3- calcium silicate powder with 17.5 wt. % replacement of calcium tungstate and 2.5 wt. % of zirconium oxide and 4- calcium silicate powder with 10 wt. % replacement of calcium tungstate and 10 wt. % replacement of zirconium oxide. Scanning electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray diffraction were used to assess their microstructure and composition. Additionally, radiopacity, setting time, solubility, pH, and in vitro bioactivity were evaluated at different time points and contrasted with controls (Mineral trioxide aggregate –MTA Angelus- and Intermediate restorative material -IRM-). Their production cost was significantly lower than commercially available HCSCs. All prototypes exhibited a microstructure and composition comparable to MTA Angelus. All the prototypes exhibited radiopacity exceeding 3 mm of aluminum and shorter initial and final setting times than MTA Angelus. The solubility of some prototypes closely adhered to the ISO standard recommendation of 3% after 1 day, and all promoted an alkaline pH and the formation of calcium/phosphate precipitates. These promising findings suggest the potential clinical application of these prototypes. However, further research is necessary to evaluate their mechanical and biological properties for definitive clinical use.
Gastric Tuberculosis Masquerading as Persistent Epigastric Pain in an Immunocompetent Patient: A Case Report
Authors: Al-Obaidi Hasan , Al-Obaidi Ahmed Dheyaa , Moliya Pratiksha , Harb Hussein , Agha Iya , Merza Nooraldin , Hashim Hashim Talib , Al-Obaidi Mustafa Najah , Al-Obaidi Osamah
Published: November 2024

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a leading infectious disease with varied manifestations. We report a rare presentation of gastric TB in a 50-year-old immunocompetent woman from the Middle East with no prior medical history. The patient presented with persistent epigastric pain, weight loss, nausea, and vomiting over a 2-month duration. Imaging studies and an infectious disease panel were inconclusive. However, upper endoscopy revealed a subepithelial lesion at the pylorus, with biopsies demonstrating caseating granuloma and multinucleated giant cells. A QuantiFERON test was subsequently positive for TB. The patient was successfully treated with standard TB quadruple therapy, resulting in significant improvement in symptoms during follow-up. This case underscores the importance of considering extrapulmonary TB in immunocompetent patients with atypical gastrointestinal symptoms and highlights the efficacy of prompt antitubercular therapy.
A National Survey on Congenital Hypothyroidism Newborn Screening in Pakistan
Authors: Khan Sabeen Abid , Aftab Sommayya , Khan Yasir Naqi , Yasir Mehrunnisa , Arshad Kashan , Mehak Noor ul Ain , Rehman Syed Kaleem ur , Faiztalpur Abida , Bahar Shazia , Abdul Razzaq Ayesha , Habibullah Sajjad , Naseem Aamir , Hussain Syed Saddam , Sattar Hina , Usman Mohammed , Ayub Aqeela , Waris Rehmana , Butt Taeed Ahmed
Published: November 2024

Objective. Congenital hypothyroidism (CH) is a treatable condition with a good outcome if diagnosed promptly. However, neonatal screening programs are not routinely available in developing countries in Pakistan. Method. To highlight the practices of newborn screening in Pakistan, an online survey was conducted. Google forms were circulated to national pediatric societies and hospitals. Results. Out of 341 respondents most were consultant pediatrician (n = 212, 62.17%) followed by residents (n = 80, 23.41%). Majority, (n = 309, 90.6%) believed it was essential to screen all newborns for CH. However, in practice only (n = 141, 41.3%) were offering screening. The most common reasons cited for not screening was the cost of test (n = 110, 32.2%), non-availability of testing services (n = 29, 8.5%) and lack of any implemented screening policies in the hospitals or national guidelines (n = 20, 5.8%). Differences in practice were also observed at provincial levels ( P < .05). Conclusion. This survey highlights marked variation in CH newborn screening practices.
Perspectives of Pediatric Vaccination Among the Batwa Community in Western Uganda: A Qualitative Study
Authors: Kigongo Eustes , Opollo Marc Sam , Nalwoga Viola , Musinguzi Marvin , Kwizera Gad , Kabunga Amir
Published: November 2024

Background. Vaccine-preventable diseases contribute significantly to under-five deaths, particularly in low- and middle-income countries. In Uganda, immunization coverage disparities persist among marginalized communities like the Batwa. This study explores perspectives on pediatric vaccination within the Indigenous Batwa in western Uganda. Methods. A qualitative phenomenological approach was used, with data from 15 mothers/caretakers, 8 health extension workers, and 3 community leaders in Kisoro district. Interviews were conducted privately, audio-recorded, and analyzed thematically. Results. Three themes emerged: (1) Misconceptions and concerns about vaccine safety and distrust in Western medicine; (2) Cultural beliefs favoring traditional healing; and (3) Access challenges, including geographical and socioeconomic barriers. Trust and comfort with healthcare providers, especially Batwa, were vital to reducing stigma. Conclusion. Addressing misconceptions, educating on vaccine safety, and building trust are key. Culturally sensitive programs and engaging Batwa care providers can improve vaccine uptake and acceptance by enhancing comfort and trust in vaccination efforts.
Influence of MWCNT/ZnO hybrid nanofluids’ thermo-physical characteristics for heat transfer applications
Authors: Maheshbabu Pidaparthy , Ramkrishnan Ramkumar , Krishna Varma Kola Poornodaya Venkata
Published: November 2024

Hybrid nanofluids (HNF’s) can perform as promising heat transfer fluids because of their enhanced thermo-physical characteristics. However, there are certain limitations of using them at higher concentrations. Moreover, lot of works on hybrid nanofluids focussed greatly on assessing thermal conductivity and viscosity. But the other parameters like specific heat and density also play an important role in heat transfer applications in addition to the volume concentration. Also, the effect of the combination of different nano particles on heat transfer is also a crucial area. Hence in this work, it is aimed to determine the thermo-physical characteristics of MWCNT/ZnO hybrid nanofluids (70:30) at varied loading and temperatures. Two step strategy was employed to prepare the (HNF’s) at distinct loadings varying in the range of 0.01%–0.05% and at a range of temperatures of 30°C–70°C with base fluid as water. The mixture’s ratios were 30:70 of MWCNT and ZnO, respectively. HNF’s exhibited an improved thermal conductivity in comparison to the original fluid, which was 80% more than the base fluid. With the rise in the temperature, the density, viscosity and specific heat all trended downward. There is an increase in the density and viscosity with the increase in the volume concentration of the hybrid nano particles. This work suggested that the MWCNT and ZnO hybrid nanofluids are better heat transfer fluids for enhancing the heat transfer and can emerge as efficient coolants for the applications of heat transfer.
Computational study with neural networks to double diffusion in Prandtl thermal nanofluid flow adjacent to a stretching surface design with numerical treatment
Authors: Sher Akbar Noreen , Zamir Tayyab , Bilal S , Muhammad Taseer
Published: November 2024

The study focuses on the implementation of neural networks in analyzing the behavior of Prandtl nanofluid near a extending surface in the existence of dual diffusion. The research investigates the merged consequence of thermal and concentration gradients on the fluid flow and heat transfer characteristics using advanced computational techniques. The investigation delves into the phenomenon of double diffusion in the flow of Prandtl nanofluid near a stretching surface (DD-PNSS), employing the Levenberg-Marquardt scheme with Artificial Neural Networks (LMS-ANNs). The application of similarity variables converts the non-linear partial differential equations into non-linear ordinary differential equations. Through the application of the Lobatto IIIa formula in a three-stage process, various data sets are generated for the LMS-ANNs by varying parameters such as the Prandtl fluid parameter ([Formula: see text]), Prandtl number (Pr), Brownian motion parameter (Nb), thermophoresis parameter (Nt), and Dufour-solutal Lewis number (Ld). The range of parameter α is from 2 to 3.5, parameter β from 0.1 to 0.9, Nb is from 0.1 to 0.4, Nt is from 0.1 to 0.7, Le is from 1 to 3 and Ld is from 0.1 to 0.5. The intrinsic behavior of embedded parameters on dimensionless velocity, temperature, solutal concentration, and nanoparticle concentration profiles is graphically evaluated. The proposed LMS-ANNs model is meticulously tested, validated, and trained using a multi-stage approach, and its performance is compared to established references to ensure its reliability. The effectiveness of the suggested LMS-ANNs model is further affirmed through regression analysis, Mean Squared Error (MSE) evaluation, and histogram studies, showcasing an exceptional accuracy level ranging from 10−08 to 10−10, setting it apart from alternative approaches and reference models.
3D Analysis of Metatarsal Torsion by Computed Tomography in Normal, Hallux Valgus, and Hallux Rigidus Feet
Authors: Kimura Tadashi , Kubota Makoto , Kihara Takumi , Suzuki Naoki , Hattori Asaki , Saito Mitsuru
Published: November 2024

Background:

One factor contributing to rotational deformity of the first metatarsal in hallux valgus is torsion of the metatarsal itself. Hallux rigidus also involves reduction of the longitudinal arch, but metatarsal torsion has not been discussed. We hypothesized that metatarsal torsion may be a morphologic change unique to hallux valgus. We compared 3-dimensional (3D) torsion of the first to fifth metatarsals between feet with hallux valgus, feet with hallux rigidus, and healthy control feet to investigate differences in the effects on pathologic conditions.

Methods:

Participants were women of East Asian descent. There were 16, 16, and 14 feet in the control, hallux valgus, and hallux rigidus groups, respectively. One randomly selected control foot was designated as the reference foot. For comparison, nonweightbearing computed tomography images of the metatarsals were reconstructed in 3D, and the proximal and distal areas were superimposed on the reference foot. Torsion angle was defined as the rotational angle of the distal part of the articular axis relative to the proximal area. In the hallux valgus group, correlations of torsion angle with hallux valgus angle and intermetatarsal angle were calculated.

Results:

The hallux valgus group had greater average pronation torsion in the first metatarsal than the control group and hallux rigidus group (11 and 13 degrees greater, respectively, P < .01). No significant differences were observed for the second to fifth metatarsals ( P > .05). There was no significant correlation with hallux valgus angle or first-second intermetatarsal angle in the hallux valgus group ( P > .05).

Conclusion:

Hallux valgus feet had pronation deformities in the first metatarsals not observed in control or hallux rigidus feet, meaning that torsion toward pronation (eversion) in the first metatarsal was unique to hallux valgus. Improved surgical correction to diminish pronation may be necessary in patients with hallux valgus patients because of first metatarsal pronation in the first tarsometatarsal to normalize mechanical first-ray alignment. Level of Evidence: Level III, case-control stud.
Palliative care consultation in the last week of life and associated factors: a cross-sectional general population study
Authors: Böling Susanna , Gyllensten Hanna , Engström My , Lundberg Emma , Berlin Johan , Öhlén Joakim
Published: November 2024

Background:

Knowledge of access to palliative care services, such as palliative care consultation teams, is crucial to identify areas of improvement for policy and practice. Research on general populations spanning all disease groups and multiple healthcare contexts is needed.

Objective:

The objective was to investigate the sociodemographic, disease- and care-related, and care structure-related factors associated with palliative care consultations for adult patients in the last week of life.

Design:

Cross-sectional, general population-level study based on linked Swedish national public authority registers and a national palliative care quality register.

Methods:

The study population included all adult patients deceased in Sweden between 2013 and 2019 and registered in the Swedish Register of Palliative Care, with an anticipated death, and not enrolled in specialised palliative care. Multivariable logistic regression analyses to investigate association with palliative care consultations.

Results:

In total, 8.2% of the 265,129 participants had received a palliative care consultation in the last week of life. The main multivariable analysis (Model 1) showed that those dying from neoplasms were more likely to receive a palliative care consultation (odds ratio (OR) 8.55, 95% CI 8.15–8.98) than those dying from circulatory diseases. Palliative care consultation was more likely with an increasing number of symptoms (OR 1.35, CI 1.32–1.37). Patients of old age and patients deceased in hospitals were less likely to receive a palliative care consultation. Moreover, factors such as educational attainment, healthcare region, living in a single-person household, and year of death were also associated with a palliative care consultation in the last week of life.

Conclusion:

Our findings show inequities in access to palliative care consultations in the last week of life. Considering changes to policy and clinical practice is motivated.
The role of socioeconomic status in uterine fibroid awareness and treatment: a narrative review
Authors: Evans Joyvina , Jones Kennedy
Published: November 2024

Uterine fibroids, known as leiomyomas, are non-cancerous tumors in women. Uterine fibroids disproportionately affect African American women, as they are more common and severe. Uterine fibroids are the leading cause of hysterectomy in African American women. Over 80% of African American women will receive a uterine fibroids diagnosis before 50. Myomectomies (removal of uterine fibroids) and hysterectomies (removal of the uterus) are more prevalent in African American women due to more significant symptoms. Socioeconomic status, including education and income, influences access to healthcare, with some treatments directly affected by insurance coverage and the cost of the procedure. This review aimed to characterize the socioeconomic disparities and inequities regarding uterine fibroids awareness, perceptions, and treatment and to understand how socioeconomic status impacts knowledge and treatment of uterine fibroids. Recognition of the treatment barriers and decisions due to socioeconomic status is a critical step in ensuring equitable treatment options for women diagnosed with uterine fibroids. A narrative literature review was conducted using PubMed, MedLine, and Google Scholar. A total of 98 articles were returned. After adjusting for the exclusion criteria, 10 articles were included in this review. The review demonstrated the disparities in treatment options based on race and socioeconomic status. Low-income women were more likely to receive more invasive treatment, which resulted in more time off work and increased medical bills. In addition, women in lower-income brackets frequented the emergency department at an increased level. This review underscored the need for additional research to learn about the role of socioeconomic status in uterine fibroid awareness and treatment.
Infrastructuring informal urbanism: Negotiation of water, electricity, and natural gas in urban villages in Chengdu, China
Authors: Yan Xiang , Zhang Can , Zhao Wei
Published: November 2024

Infrastructure such as water, electricity, and natural gas fundamentally underpins informal housing and industrial development in urban villages. Yet how the infrastructure is built, maintained, and governed, and what are the underlying mechanisms, remain peripheral to existing literature and policy agenda. This study addresses this gap by incorporating a socio-technical approach to infrastructure into informal urbanism to understand the negotiation of water, electricity, and natural gas in two neighboring urban villages in Chengdu, China. Four rounds of fieldwork and in-depth interviews with various stakeholders found highly precarious provision of infrastructure in urban villages. Its spatial layout, facilities, charges, quality control, and maintenance rest uneasily on, and then in turn shape, the development of informal renting markets and industries in different urban villages, especially when considering the cross-sectional interactions between different types of infrastructure. These processes are dominated by stakeholders’ commercial logics embedded in informal urbanism, including the urban village and infrastructure providers’ profit-seeking strategies, enterprises and migrants’ cost-saving behaviors, and the governments’ purposive absence in governing infrastructure, which leads to difficulties in meeting urban village residents’ needs for qualified infrastructure. This study unravels the “black box” of infrastructure in urban villages and puts forward inclusive planning strategies to promote infrastructure in urban villages.
Reliability of Ultrasonographically Acquired Muscle Morphology Based on a Cohort of Men and Women
Authors: Fröhlich Matias , Rabello Rodrigo , Bueno Ingrassia Aline Felicio , Allein Zago Marcolino Miriam , Vaz Marco Aurélio
Published: November 2024

Objective:

The objective was to evaluate intrarater and inter-rater reliability of ultrasonography muscle morphology measurements in men and women, considering morphological differences between the genders.

Materials and Methods:

Thirty-two healthy subjects (16 male; 16 female; 26.6 ± 4.9 years) participated in two evaluation days. On day 1, subjects were evaluated by a single experienced rater, who repeated the evaluation on the next testing day along with two other raters. Muscle morphology of quadriceps femoris (QMT), rectus femoris (RFMT), vastus intermedius (VIMT), vastus medialis (VMMT), and vastus lateralis (VLMT) muscle thickness, rectus femoris muscle cross-sectional area (RFCSA), vastus lateralis muscle fascicle length (VLFL), and pennation angle (VLPA) were obtained. Reliability was evaluated by intraclass correlation coefficients (ICCs).

Results:

All intrarater comparisons demonstrated good reliability (ICC >0.90), even after participants’ gender stratification (ICC >0.81). Inter-rater comparisons for RFCSA, and muscle thickness showed good reliability (ICC >0.76). Male’s VLFL and VLPA reliability was considered insufficient (ICC = 0.58 and 0.60, respectively), while female’s was slightly higher (ICC = 0.79 and 0.75, respectively).

Conclusion:

Ultrasonography has potential to be used to observe changes in muscle size, but pennation angle and fascicle length should be evaluated by the same rater.
USP15 regulates radiation-induced DNA damage and intestinal injury through K48-linked deubiquitination and stabilisation of ATM
Authors: Zhu Ruiqiu , Li Mingyue , Wang Difan , Liu Chengzhi , Xie Liwei , Yang Yinyin , Gu Xuhao , Zhao Kui , Tian Ye , Cai Shang
Published: November 2024

Background

Radiation-induced intestinal injury (RIII) interrupts the scheduled processes of abdominal and pelvic radiotherapy (RT) and compromises the quality of life of cancer survivors. However, the specific regulators and mechanisms underlying the effects of RIII remain unknown. The biological effects of RT are caused primarily by DNA damage, and ataxia telangiectasia mutated (ATM) is a core protein of the DNA damage response (DDR). However, whether ATM is regulated by deubiquitination signaling remains unclear.

Methods

We established animal and cellular models of RIII. The effects of ubiquitin-specific protease 15 (USP15) on DNA damage and radion-induced intestinal injury were evaluated. Mass spectrometry analysis, truncation tests, and immunoprecipitation were used to identify USP15 as a binding partner of ATM and to investigate the ubiquitination of ATM. Finally, the relationship between the USP15/ATM axes was further determined via subsequent experiments.

Results

In this study, we identified the deubiquitylating enzyme USP15 as a regulator of DNA damage and the pathological progression of RIII. Irradiation upregulates the expression of USP15, whereas pharmacological inhibition of USP15 exacerbates radiation-induced DNA damage and RIII both in vivo and in vitro. Mechanistically, USP15 interacts with, deubiquitinates, and stabilises ATM via K48-linked deubiquitination. Notably, ATM overexpression blocks the effect of USP15 genetic inhibition on DNA damage and RIII progression.

Conclusions

These findings describe ATM as a novel deubiquitination target of USP15 upon radiation-induced DNA damage and intestinal injury, and provides experimental support for USP15/ATM axis as a potential target for developing strategies that mitigate RIII.
The optimal approach for retrieving systematic reviews was achieved when searching MEDLINE and Epistemonikos in addition to reference checking: a methodological validation study
Authors: Heinen Lena , Goossen Käthe , Lunny Carole , Hirt Julian , Puljak Livia , Pieper Dawid
Published: November 2024

Background

Systematic reviews (SRs) are used to inform clinical practice guidelines and healthcare decision making by synthesising the results of primary studies. Efficiently retrieving as many relevant SRs as possible is challenging with a minimum number of databases, as there is currently no guidance on how to do this optimally. In a previous study, we determined which individual databases contain the most SRs, and which combination of databases retrieved the most SRs. In this study, we aimed to validate those previous results by using a different, larger, and more recent set of SRs.

Methods

We obtained a set of 100 Overviews of Reviews that included a total of 2276 SRs. SR inclusion was assessed in MEDLINE, Embase, and Epistemonikos. The mean inclusion rates (% of included SRs) and corresponding 95% confidence intervals were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking. Features of SRs not identified by the best database combination were reviewed qualitatively.

Results

Inclusion rates of SRs were similar in all three databases (mean inclusion rates in % with 95% confidence intervals: 94.3 [93.9–94.8] for MEDLINE, 94.4 [94.0-94.9] for Embase, and 94.4 [93.9–94.9] for Epistemonikos). Adding reference checking to MEDLINE increased the inclusion rate to 95.5 [95.1–96.0]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (98.1 [97.7–98.5]). Among the 44/2276 SRs not identified by this combination, 34 were published in journals from China, four were other journal publications, three were health agency reports, two were dissertations, and one was a preprint. When discounting the journal publications from China, the SR inclusion rate in the recommended combination (MEDLINE, Epistemonikos and reference checking) was even higher than in the previous study (99.6 vs. 99.2%).

Conclusions

A combination of databases and reference checking was the best approach to searching for biomedical SRs. MEDLINE and Epistemonikos, complemented by checking the references of the included studies, was the most efficient and produced the highest recall. However, our results point to the presence of geographical bias, because some publications in journals from China were not identified.

Study registration

https://doi.org/10.17605/OSF.IO/R5EAS (Open Science Framework).
The hazard of using the Poisson model to cope with immortal time bias in the case of time-varying hazard
Authors: Rea Federico , Morabito Gabriella , Corrao Giovanni , Cantarutti Anna
Published: November 2024

Background

A time-dependent analysis, usually by means of Poisson and Cox regression models, can be applied to prevent immortal time bias. However, the use of the Poisson model requires the assumption that the event rate is constant over time. This study aims to assess the potential consequences of using the Poisson model to cope with immortal time bias on estimating the exposure-outcome relationship in the case of time-varying risks.

Methods

A simulation study was carried out. Survival times were assumed to follow a Weibull distribution, and the Weibull parameters were chosen to identify three different scenarios: the hazard of the event is constant, decreases, or increases over time. A dichotomous time-varying exposure in which patients can change at most once from unexposed to exposed was considered. The Poisson model was fitted to estimate the exposure-outcome association.

Results

Small changes in the outcome risk over time (as denoted by the shape parameter of the Weibull distribution) strongly affected the exposure-outcome association estimate. The estimated effect of exposure was always lower and greater than the true exposure effect when the event risk decreases or increases over time, and this was the case irrespective of the true exposure effect. The bias magnitude was positively associated with the prevalence of and time to exposure.

Conclusions

Biased estimates were obtained from the Poisson model to cope with immortal time. In settings with a time-varying outcome risk, the model should adjust for the trend in outcome risk. Otherwise, other models should be considered.
The impact of COVID-19 on private healthcare service utilisation: time series analysis in the capital region of Finland during 2020–2022
Authors: Niemenoja Oskar , Ämmälä Antti-Jussi , Riihijärvi Sari , Lillrank Paul , Bono Petri , Taimela Simo
Published: November 2024

Background

Most current studies on COVID-19 have focused on the first weeks or months of the pandemic or have addressed specific diseases. The long-term effects of the COVID-19 pandemic on healthcare services are insufficiently understood. We analysed the long-term effects of the COVID-19 pandemic on outpatient healthcare utilisation in the full spectrum of diseases in Uusimaa, the capital region of Finland.

Methods

Our data included 632 466 individual patients between the ages of 18 and 65 and 6 521 394 visits to healthcare personnel from electronic health records. We fitted an autoregressive integrated moving average (ARIMA) model to pre-2020 data to predict the expected quantity of diagnoses for the period between 1 January 2020 and 16 June 2022. Expected and observed quantities of diagnoses were compared.

Results

The overall quantity of diagnoses declined by one-fourth immediately following the onset of the pandemic and remained around 15% below predicted values for most of the pandemic. After the pandemic-related restrictions were lifted, the total diagnostic activity started to recover to pre-pandemic projection levels. However, this recovery has been mainly driven by upper respiratory system-related activity. The number of diagnoses for many diagnosis groups has remained below the predicted levels, even after the concurrent removal of mobility restrictions and increased coverage of vaccinations in this population.

Conclusions

The pandemic resulted in an overall reduction in outpatient healthcare utilisation which persisted for 30 months. While the overall diagnostic activity has eventually recovered to predicted levels, many classes of diagnoses display reduced levels in the study population over the follow-up period. Some diseases that may have long-lasting effects when left untreated seem to remain underdiagnosed, potentially increasing pressure on the healthcare system in the future.
Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study
Authors: Clarke Kirsty , Borges Karen , Hatab Sultan , Richardson Lauren , Taylor Jessica , Evans Robyn , Chung Bethany , Cleverdon Harriet , Xyrichis Andreas , Cook Amelia , Meyer Joel , Rose Louise
Published: November 2024

Background

During the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting. This study aimed to explore the anticipated or unanticipated ethical issues raised by using virtual visiting in the ICU, such that healthcare professionals can be informed about how to carry out virtual visits ethically, safely and productively.

Methods

We used a descriptive exploratory qualitative research approach recruiting a convenience sample of newly-graduated junior doctors facilitating ICU virtual visits in a tertiary academic centre. Eight newly graduated junior doctors, seven female and one male, aged 23–27, participated in semi-structured interviews. We analysed transcripts using an inductive coding approach.

Results

Five overarching themes emerged. Two of the themes namely, ‘fulfilling a moral instinct to connect families’ and ‘promoting autonomy’, arose from participants’ descriptions of how virtual visits aligned with healthcare standards and practices they considered ethical. Three further themes, ‘preserving dignity and privacy’, ‘managing emotional distress’, and ‘providing equitable access’ to virtual visiting technologies, highlight how virtual visits might exacerbate ethical issues related to family communications.

Conclusion

Virtual visiting may potentially both ameliorate and exacerbate aspects of ethical healthcare delivery for ICU patients and family members. ICU team members should consider unique ethical considerations related to using virtual visiting. We recommend virtual communications skills training for staff and advocate for the use of easily accessible educational resources for families who wish to visit critically unwell patients remotely.
Rehabilitation coordinator – managers’ experiences of a new function in health care
Authors: Strid Catharina , Benner Rosie , Stefansdotter Ronja , Stigmar Kjerstin
Published: November 2024

Background

Several actions have been taken to improve the sick listing process, patient safety and return to work. One of them is the implementation of the rehabilitation coordinator function, of which the benefits have not yet been fully explored. Neither has the role of the manager, who has significant impact on the implementation and support of a new function. This study aimed to explore how first line managers’, who employed a rehabilitation coordinator that had completed a one-year specialized study program, perceived, and experience the function rehabilitation coordinator.

Methods

This is an interview study using a semi structured interview guide for data collection and thematic analysis was applied to the data. Ten first line managers in health care were interviewed.

Results

Four themes were identified: The Saviour, A personalized function, Change takes time and Strengthen status and legitimacy. The managers experienced the rehabilitation coordinator as a valuable function who facilitates collaboration in the team and with external stakeholders and perceived them as a much-needed resources, supporting physicians with sick leave issues. The assignment was ambiguous and dependent on the rehabilitation coordinators individual characteristics, which may result in a risk of overload. The managers were engaged in the implementation process, but this required time. They considered it important to strengthen legitimacy for the function which required support and encouragement to take part in specialized education and training.

Conclusions

The managers experienced the rehabilitation coordinators as playing a crucial role in the return-to-work process. They were willing to support how this new function will improve and develop. The results from this can serve as a guidance for the implementation and support of the function rehabilitation coordinator.
Societal uses of the main water bodies inhabited by malaria vectors and implications for larval source management
Authors: Kahamba Najat F. , Tarimo Felista S. , Kifungo Khamisi , Mponzi Winifrida , Kinunda Siaba A. , Simfukwe Alfred , Mapua Salum , Msugupakulya Betwel , Baldini Francesco , Ferguson Heather M. , Okumu Fredros O. , Finda Marceline F.
Published: November 2024

Background

Larval source management (LSM) effectively reduces mosquito populations at their breeding sites, addressing issues like insecticide resistance that limit the effectiveness of primary interventions such as insecticide-treated nets (ITNs). Although traditionally used in urban and dry areas, recent research suggests it might also be effective in rural settings in eastern and southern Africa, where Anopheles funestus thrives in permanent water bodies that sustain year-round transmission. Targeting these habitats could enhance LSM, but it requires understanding local community practices, as mosquito breeding sites often overlap with community water resources. This study examined how communities use aquatic habitats and how these practices may impact LSM strategies, with a focus on habitats used by An. funestus.

Methods

This study was conducted in three villages in the Ulanga and Malinyi districts of southeastern Tanzania using a mixed-methods approach. Quantitative data were collected through cross-sectional surveillance, and qualitative data through unstructured interviews, focus group discussions, and field observations. Data analysis integrated both quantitative and qualitative findings to develop a comprehensive understanding of community perspectives.

Results

A survey of 931 aquatic habitats found mosquito larvae in 73% of them, with late instar An. funestus present in 23%. River streams made up 41% of the habitats, while ground pools accounted for 4%. Most habitats (90%) were used by communities, including 95% of those with An. funestus larvae, for activities such as domestic chores, agriculture, livestock rearing, brickmaking, and fishing. Focus group discussions revealed a willingness to adopt LSM, with a preference for larviciding and habitat modification over habitat removal, as the water sources were vital for daily use. Community concerns centered on the safety of larvicides for humans and animals, the environmental impact, and the need for better awareness of how LSM affects health and livelihoods.

Conclusion

This study highlights community perspectives on LSM, focusing on the dual function of aquatic habitats as mosquito breeding sites and essential community water sources. This dual role presents both challenges and opportunities, suggesting that LSM strategies must balance public health needs with socio-economic realities. There was a clear preference for larviciding and habitat modification over removal, with a strong emphasis on health and environmental safety. The study emphasizes the importance of educating communities on the safety and effectiveness of LSM, and tailoring LSM strategies to fit the needs and preferences of local communities.
Examining malaria treatment and prevention spending efficiency in malaria-endemic countries, 2000–2020
Authors: Apeagyei Angela E. , Cogswell Ian , Patel Nishali K. , O’Rourke Kevin , Tsakalos Golsum , Dieleman Joseph L.
Published: November 2024

Background

In 2021, an estimated 750,000 people died from malaria. Despite this significant burden, globally, malaria incidence and mortality rates have substantially dropped over the last 30 years. However, growth in spending on malaria and improved outcomes have recently stagnated. This development has made it more important than ever to understand what constitutes efficient spending on malaria.

Methods

Data from various sources, including disaggregated data on malaria spending from the WHO Global Malaria Programme, National Health Accounts, and the Global Burden of Disease 2021 study was used in this study. The National Health Account report is produced at the end of a national accounting exercise that aims to map the flow of financial resources from all perspectives—incl. sources, agencies—in the health sector. Malaria spending estimates for all malaria-endemic countries from 2000 to 2020, with government and donor spending disaggregated into 11 key programme areas were generated in this study. Then, these spending estimates were combined with outcome data and estimated country efficiency using robust non-parametric stochastic frontier analysis and linear regression to examine the types of malaria spending associated with better malaria outcomes.

Results

Across malaria-endemic countries, there is wide variation in malaria spending, with spending associated with the malaria burden within the country. Argentina, Paraguay, and Turkmenistan stood out as examples of low spending relative to their respective malaria incident per person at risk rates, while the Philippines, Guatemala, and Sri Lanka stood out as countries with case fatality ratios that were low relative to their malaria spending. Having a greater proportion of malaria spending sourced from donors or on prevention was associated with increases in incidence efficiency, while having a greater proportion of spending on anti-malarial medicines was associated with increases in case fatality efficiency.

Conclusions

Prioritization of spending on prevention, anti-malarial medicines, and health systems strengthening can fight incident cases and fatalities simultaneously, especially in resource-scarce, malaria-endemic countries. Furthermore, improving the availability, frequency of collection, and quality of detailed disaggregated spending data is essential to support work that strengthens the evidence base on spending efficiency and work that improves understanding of how spending on malaria could be leveraged to bridge gaps in equity across population groups.
Cost of treating severe malaria in children in Africa: a systematic literature review
Authors: Mori Amani Thomas , Mallange Grace , Kühl Melf-Jakob , Okell Lucy
Published: November 2024

Background

Malaria is a major cause of ill health and death in children in Africa. The disease also imposes a severe social and economic burden on households and health systems and is strongly associated with poverty. This study summarizes the most up-to-date cost of treating severe malaria in children in Africa.

Methods

A systematic search was conducted in PubMed, Embase, Cinahl, and Web of Science databases. Google and Google Scholar were searched for grey literature followed by scanning of the reference lists of the previous systematic reviews. The search was limited to children < 12 years, malaria-endemic countries in Africa, and the English language. All costs were adjusted to the year 2023.

Results

19 studies conducted in 12 countries were identified: 14 reported provider costs, and 11 household costs. Out of the 19 studies found, 11 were published before 2018 while 11 reported data that are currently more than ten years old. Studies varied methodologically and in the scope of resources included to estimate the cost. The provider costs ranged from USD 27 in Uganda to USD 165 per patient in Kenya (median value USD 90), while household costs ranged from USD 13 in Kenya to USD 245 per patient in Gabon (median value USD 50). All identified household malaria treatment costs except one represented catastrophic health expenditure, making out more than 10% of the monthly Gross National Income per capita in the respective countries.

Conclusion

Evidence on the cost of treating severe malaria in children in Africa is scarce. However, the few existing studies show that severe malaria in children imposes a significant economic burden on the providers and households. More studies are needed, particularly in high-burden high-impact countries, to inform resource allocation decisions.
Problematizing content moderation by social media platforms and its impact on digital harm reduction
Authors: Gomes André Belchior , Sultan Aysel
Published: November 2024

Recent years have marked a shift in selling and buying illicit psychoactive drugs from darknet cryptomarkets to publicly accessible social media and messaging platforms. As more users turn to procuring drugs this way, the role of digital harm reduction has become particularly urgent. However, one of the main obstacles complicating the implementation of digital harm reduction is the increasingly automated content moderation by the social media platforms. While some platforms are less restrictive about harm reduction content (e.g., TikTok), others implement higher degrees of moderation, including the removal of individual content and banning of entire profile pages (e.g., Instagram). This article discusses community guidelines of five popular social media and messaging platforms and their content moderation tools. It aims to highlight how these guidelines may be inadvertently curbing the dissemination of harm reduction and health promotion materials, and erroneously interpreting it as a promotion of drug use and sales. The discussion concludes that digital harm reduction requires transdisciplinary collaboration of professional organizations, researchers, and social media platforms to ensure reliable implementation of digital harm reduction, and help build safer digital communities.
Factors associated with under-5 mortality in the south-south region of Nigeria
Authors: Airemen Iziengbe , Danat Isaac M.
Published: November 2024

Purpose

Under-5 mortality rates (U5MR) have declined drastically globally. However, it remains high in Nigeria, with variations across the Country’s six geo-political zones. Understanding the factors associated with under-5 mortality (U5M) among lesser-explored subpopulations will inform strategies to curtail U5M. We investigated the factors associated with U5M in the south-south geopolitical zone (SSGZ) of Nigeria and population attributable risk percent (PAR%).

Method

We analyzed population-based data from the Nigeria Demographic and Health Survey (NDHS) for 2013 and 2018. Logistic regression analysis was used in SPSS version 26.0 to calculate the Odds Ratios (OR) with 95% Confidence Intervals (CI) for U5M associated with various factors, while the PAR% was computed using Levine's formula.

Results

The adjusted logistic regression analysis model showed maternal overweight (OR = 1.39, 95% CI 1.12–1.72, p < 0.05), primary education (OR = 2.18, 95%CI 1.18–4.04 p < 0.05) and secondary education (2.05, 95%CI 1.13–3.72, p < 0.05) levels, male gender (OR=1.22, 95%CI 1.01–1.47, p < 0.05), birth interval of less than two years (OR = 2.93, 95%CI 2.10–4.10, p < 0.001), and small birth size (OR = 2.54, 95% CI 1.94–3.31, P < 0.001) significantly increased U5M risk, while having seven or more household members (OR = 0.73, 95%CI 0.59–0.89, p < 0.05) and 2 under-five children in the household (OR = 0.66, 95% CI 0.52–0.83, p < 0.001) were protective factors, with PAR% for the factor significantly associated with U5M ranging from 4.5% to 47.1%.

Conclusion

Increased interventions on maternal weight, maternal education, low birth size, and child spacing could reduce U5M in the SSGZ of Nigeria.