bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Government Debt in China: Implications for Reform
Authors: Grewal Bhajan , Cheng Enjiang , Rasmussen Bruce
Published: May 2024

Since the 1994 fiscal reforms, China's national public finances have been in a strong position, but public finances of local governments (including provincial, city and county governments) have been always under stress. This is because local governments in China are responsible for financing the provision of basic economic and social services, as well as for urban infrastructure, but they have limited access to tax revenues, have no power to introduce new taxes or to increase rates of existing taxes, and are prohibited under the 1994 Budget Law from borrowing. Consequently, local governments are heavily dependent on non-tax revenues and fiscal transfers from the central government. In spite of the prohibition on borrowing, most local governments have been borrowing informally for many years and the central government has ignored this breach of the Budget Law. Now the size of local government borrowing has reached levels that are causing concerns for the sustainability of local public finances and the stability of the Chinese banking system. This situation raises many policy issues, some requiring urgent policy interventions and other requiring medium-term policy responses. Thus, there is a need for broadening provincial powers over taxation, reforming intergovernmental fiscal transfers, and formally recognizing provincial borrowing powers. However, the focus of this paper is on the incidence of local debt on provincial and sub-provincial public finances, an aspect of local debt that has not attracted sufficient attention in the literature. The concentration of local debt and contingent liabilities at sub-provincial levels and the new annual limit imposed by the State Council on local debt in 2015 are discussed. Lessons learned from Australia's experience in relation to the management of subnational borrowing are also discussed, as these appear to be highly relevant to China's current situation.
Symposium on Public Pensions
Authors: Mohan Nancy , Zhang Ting
Published: May 2024

Many defined benefit public pension plans, due to economic challenges and demographic trends, report significant underfunding of plan liabilities. This symposium addresses important issues surrounding the potential crisis such underfunding could cause. The articles that follow this introduction provide insights into the causes of underfunding and suggests changes that could mitigate underfunding without changing the structure of the plan.
The Influence of Research & Development Policy on Business-Sector Performance: The Baltic States in the EU
Authors: Reiljan Janno , Paltser Ingra , Puolokainen Tarmo
Published: May 2024

The success of business-sector research and development (R&D) activities and innovation performance is dependent on general development conditions (path dependency), but also on the efficiency of public R&D policy measures, which supports business-sector R&D activities directed towards innovation. In the current article we present a holistic approach based on macro-quantitative analysis for characterizing the role of the public sector in shaping business-sector R&D activities and innovation performance. The influence of R&D policy on business-sector R&D activities in EU member states (and countries closely associated with them) will be empirically analyzed with the combined methods of principal component analysis and multiple regression analysis. The goal of the article is to explore new possibilities of the macro-quantitative approach for policy-influence analysis and to assess on the basis of constructed models the situation in the Baltic States, which have, after the transformation from command to market economy, chosen different approaches to R&D policy. The article reports on the following research tasks: (1) an analysis of the role (needs and opportunities) of R&D policy for shaping business-sector R&D activities and innovation performance; (2) a presentation of the new opportunities to develop the macro-quantitative modelling of R&D policy influence through the combination of principal component analysis (PCA) and multiple regression analysis methods; and (3) an assessment of the results of R&D policy influence on business-sector R&D activities and innovation performance in the Baltic States, based on constructed statistical models. Data from 2004, 2006, 2008, and 2010 has been used. Large discrepancies can be found in both theoretical and empirical approaches to the formation of business-sector R&D activities and innovation performance. In the current study, available theoretical studies are systematized, the solution for some statistical modelling problems in available empirical studies is demonstrated, and finally, the assessment of the influence of R&D policy on the business sector in small Baltic States is provided in comparison to the sample of investigated countries.
Fiscal Federalism in Transition Countries: The Three Baltic States Compared
Authors: Groenendijk Nico , Jaansoo Annika
Published: May 2024

This paper analyzes three transition countries (Estonia, Latvia and Lithuania) regarding four essential features of fiscal federalism: (a) the administrative set-up, (b) the tasks and functions allocated to sub-national governments, (c) revenue structure and fiscal autonomy, and (d) fiscal discipline. The practices in the three countries are analyzed for the period 2001–2013 mainly, and compared to practices in the EU-28 at large. Compared to the EU average, fiscal disciplinary performance of the Baltic States (and of local governments) is adequate (and exemplary in Estonia). Tax autonomy of local governments is however very low in all three states; local governments rely heavily on their share in the personal income tax. The Baltic States differ significantly regarding their administrative set-up, but this is consistent with the huge variety in administrative set-up in Europe. In all three countries reform of the set-up is debated continuously. The overall absolute level of spending (in euro per inhabitant) by sub-national governments in the Baltic States is clearly below the EU-average. The shares of the main spending categories at sub-national level differ considerably from the EU-average. This is caused by specific choices regarding the division of tasks between local and central government (i.e. the result of relatively high or low levels of fiscal decentralization in certain policy fields) and/or general government differences (i.e. less or more spending in some policy fields in general).
Measuring the Flypaper Effect: The Interaction between Lump-Sum Aid and the Substitution Effect of Matching Aid
Authors: Ryu Jay E.
Published: May 2024

According to one theory, consumer-voters mistake lump-sum aid for matching aid such that lump-sum aid reduces their tax price of the aided service. Consumer-voters misunderstand that the substitution effect of matching aid comes from lump-sum aid, resulting in higher expenditures for the aided service. This flypaper effect is more likely when both lump-sum aid and matching aid (or equivalent tax-price reducing mechanisms) coexist and there is a high likelihood of interaction between the lump-sum aid and the substitution effect. However, surprisingly few studies have developed a clear formula to evaluate the flypaper effect while the literature generally assumes the interaction as one of potential causes for the flypaper effect. This paper fills in the huge gap in the literature by providing a formula to show whether and how lump-sum aid causes the flypaper effect.
Budgeting by Priorities: Balancing Stability with Economic Responsiveness
Authors: Jordan Meagan M. , Yusuf Juita-Elena , Hooshmand Somayeh
Published: May 2024

This article investigates how the budget priorities of Arkansas state government departments vary with changes in economic conditions. the Arkansas Revenue Stabilization Act (ARSA) of 1945 established a formalized method of state budgeting by priorities. State funds are allocated, meaning the funds are legally made available, according to priority levels established each year by the Governor and the General Assembly. Those allocated funds are later distributed, meaning released for spending, according to priority levels as funds become available. in this study, we ask the research question: Are departmental budget priorities driven by stability or are they responsive to economic condition? Incrementalism suggests that incremental annual changes in the budget are based on the previous year's budget, they take place across-the-board, and that there lacks an in depth consideration of priorities. However, ARSA requires explicit prioritization within each department. Perceptions of economic conditions are likely to play into this prioritization. We hypothesize that the higher priority items will follow a more incremental pattern of mostly being based on the previous year's budget in favor of stability. We also hypothesize that the economy has a greater impact on the lower priority items in favor of economic responsiveness. Our findings suggest that incrementalism is a persistent influence across priority levels. However, there is rational consideration during an economic downturn that results in a decline in funding for lower priority budget items.
Measuring the Burden of Indirect Taxation Including Consumption Tax in Japan by Income Group
Authors: Adachi Yoshimi , Uemura Toshiyuki , Saitoh Yurie
Published: May 2024

A consumption tax was introduced in Japan as a means to secure financing for social security programs. Japan introduced this as a value-added tax in April 1989 in response to its aging society. the tax has increased from 3% in 1989 to 5% in April 1997 and 8% in April 2014. A further rate rise to 10% is planned for April 2017. While consumption taxes are regressive, excise taxes also place a burden on household finances. in this study, we estimate the portion of income captured by consumption and excise taxes for different income groups, considering the proportion of the tax burden associated with excise taxes. the results indicate that regressivity is present for both consumption and excise taxes. in particular, indirect taxes on food are considered highly regressive, giving grounds for measures aimed at reducing the tax burden of low-income earners. Accordingly, we quantify the redistributive effects of several policy patterns aimed at lessening indirect tax burdens. For taxes on food, the redistributive effects of reduced taxes, zero rates of taxation, and tax refunds were not significant. This is because these measures lower the tax burden across all income groups and do not target only low-income earners. As a result, alleviating the regressivity of indirect taxes requires social security policies closely targeted at low-income earners.
An Exploration of the Great Recession's Impact on States’ Reliance on User Fees
Authors: Propheter Geoffrey , Levine Helisse , Fudge Marc
Published: May 2024

Drawing on a panel of US states from 2000 to 2013, we take advantage of the onset of the Great Recession to observe how states’ reliance on user fees changed as a result of the precipitous decline in tax revenue attending the global economic contraction. We further develop and test hypotheses exploring the relationship between various characteristics of states’ revenue and political systems—such as sales tax collections and political ideology— and user fee reliance. We find, among other things, evidence that states increased their reliance on user fees during and after the Great Recession but that the response is transitory with reliance slowly decreasing each year removed from 2008.
Evolution of Excise Taxation in the Usa since the Great Recession
Authors: Morozov Boris
Published: May 2024

The most drastic crisis since the Great Depression put a significant amount of stress on states’ revenues. Within the existing framework of taxation systems', an increasing amount of attention from academics and politicians alike concentrates on public revenues from sales and use taxation. Such increased attention is not surprising as revenues from general sales taxes and excise taxation are the dominant group of revenues from own tax sources for states. the article's first contribution is that it shows the evolution of the structure of actual state revenues by sources of these revenues. the manuscript then describes the taxonomy of excise taxes by object of taxation (i.e. fuel taxes, alcohol taxes, and tobacco taxes). the second contribution of this paper stems from its detailed data on excises. We find that no-PIT states generate around 20% of their tax revenues from excises while PIT-states generate only 16.5%. the main difference is not in rates. the manuscript starts with the description of the evolution of states’ own revenues. the next section covers the period between 2005 and 2015. We concentrate exclusively on excises’ revenues. This section is followed by the presentation of excise rates. We conclude our manuscript with recommendations for policy changes.
Public Health Financing and Infant Mortality: Does Governance Quality Matter?
Authors: Sirag Abdalla , Nor Norashidah Mohamed , Abdullah Nik Mustapha Raja , Ghani Judhiana Abd
Published: May 2024

Public finance of health care is known to be one of the central factors for improving population health status. Since healthcare works through public institutions, the effect of public health financing on its outcome relies on the level of governance quality. the current paper examines the impact of public health financing on a health outcome (infant mortality) taking governance quality into consideration. the study uses panel data analysis for 171 countries categorized into three income levels: low-income, middle-income and high-income countries, for the period 1995–2012. in addition, some techniques that can help to reduce the bias associated with the potential endogeneity problem, such as GMM estimators, are adopted to obtain less biased results. the findings reveal the importance of public health financing in improving the population's health. in particular, public health financing is negatively associated with the infant mortality rate in all income groups. Moreover, socioeconomic factors, such as income and education, appear to be equally important in reducing the infant mortality rate. Most importantly, the quality of governance was found to be relevant in determining the effect of public health financing on the population's health. Our study provides partial evidence to show that public finance of healthcare is more efficient in improving the population's health in countries where governance quality is relatively high compared to countries with low quality of governance.
Local-Government Responses to the 2008 U.S. Fiscal Crisis: Strategic, Merely Predictable, Or Lifted from the Garbage Can?
Authors: Justice Jonathan B. , Yang Kaifeng
Published: May 2024

Many U.S. local governments experienced fiscal challenges in the wake of the 2007–2009 Great Recession. This article examines the resulting retrenchment choices, focusing on two research questions. First, are local governments’ choices in any meaningful way rational strategies? Some previous research has concluded that retrenchment behavior is the idiosyncratic product of irrational “garbage-can” decision making. Exploratory factor analysis of data from the International City/County Management Association's 2009 State of the Profession Survey identified patterns of retrenchment actions that are classifiable as coherent strategies. Second, do the strategies correspond to sector-specific or “generic” models of organizational choice and adaptation to circumstances? the observed strategies fit better with a generic resource-dependency framework of strategic choice than with public sector-specific, stages-of-retrenchment models. Regression results suggest modest associations between retrenchment strategies and several characteristics of local governments and their contexts identified by previous research as relevant.
Intra-Provincial Fiscal Disparities and the Role of the Provincial Fiscal Transfer System in China: A Case Study of Henan Province
Authors: Li Hui
Published: May 2024

This study seeks to explore intra-provincial fiscal disparities at the county level in Henan province and the extent to which the undesirable fiscal inequalities can be traced to the provincial fiscal transfer system. By employing the extended two-step Gini coefficient decomposition techniques, this study finds that only general-purpose transfers have an equalization effect, while both tax rebates and specific-purpose transfers have anti-equalization effects. in addition, the size of the general-purpose transfers ‘ equalization effect is too limited to mitigate the overall anti-equalization effect of total transfers. It also finds that so-called equalization transfers have not shown stronger equalization effects than other general-purpose transfers; tax rebates’ anti-equalization effect is limited, but specific-purpose transfers’ anti-equalization effect is significant due to its rapid growth during the study period of 2001–2011. the findings imply the important role of provincial policies in intra-provincial fiscal equalization in China.
Fiscal Decentralization and Capacity to Service Debt: Are They Tightly Linked?
Authors: Shi Yu , Hendrick Rebecca , Park HyungGun
Published: May 2024

This research examines the link between fiscal decentralization and government capacity to service debt, while controlling for fiscal, institutional, economic, and ideological factors that are associated with capacity to service debt held or issued by local governments alone, by state governments alone, and by state and local government combined at the state level. Using panel data from all 50 states in the U.S. from 1962 to 2012, we find a link between fiscal decentralization and capacity to service long-term debt outstanding held by local governments alone and by state and local governments combined. That is, fiscal decentralization is positively associated with state and local government capacity to service debt outstanding. Nevertheless, we do not find that fiscal decentralization has any relationship with government capacity to service debt issuance. Statistical results show that capacity to service debt issuance is primarily affected by capital expenditure and alternative capital financing resources such as special assessment.
Capitalization of Property Tax Relief: Some Equity Implications and Relevance to Policy Design
Authors: Propheter Geoffrey
Published: May 2024

Empirical research in the property tax capitalization literature focuses on estimating the degree to which property tax relief is capitalized into property prices on average; however, economic theory suggests that capitalization will vary across homeowners within a jurisdiction in systematic ways. By focusing on the extent of tax capitalization on average, then, there is a tendency to overlook that in the case of property tax relief, people will benefit differently from the same amount of statutory relief. This paper discusses some determinants of capitalization that contribute to property tax relief being enjoyed differently. Recent empirical research is drawn upon to support the presented arguments, and when such research is not available, analysis of novel data is offered instead. the paper also discusses tax relief policy design strategies for mitigating inequities, to the extent differential outcomes are undesirable.
Measuring Municipal Spending Efficiency: Evidence from Macedonia's Decentralization Reforms
Authors: Andonoska Ljubinka , Alda Erik
Published: May 2024

Debates have been ongoing for decades about the efficiency of municipal services in centralized or decentralized systems. the fundamental argument for decentralization is that it shifts decisionmaking authority to local governments which are closer to citizens’ needs and preferences and thus are better to know what is wanted. This study contributes to the growing literature on measuring local government efficiency by using data from 79 Macedonian municipalities from 2008 to 2015 and assessing whether decentralization results in greater efficiency. the results indicate that more decentralized municipalities are, on average, more efficient than less decentralized ones. There was, however, a significant disparity in performance throughout the decentralization period, with small municipalities often under-performing relative to larger ones. These results indicate that decentralization has limited effects on the efficiency of municipal spending, and does not reduce disparities across municipalities. the evidence suggests that many of the inequalities could be alleviated by implementing equalization programs as a substantial part of a regional development strategy.
Are Public Financial Managers Wired for Risk-Aversion?
Authors: Fennimore Anne , McCue Clifford
Published: May 2024

This research examines government finance professionals’ through a neuroscientific lens. Building on a Konorskian pattern of behavior, we develop a risk-taking model based on the neurobiology of four motivational states, i.e., prediction of reward (hope), prediction of aversive events (fear), omission of reward (frustration) and omission of aversive events (relief), based on reward or punishment sensitivity. It is posited herein that some financial managers are neurobiologically inclined to engage in risk-averse behaviors because they are motivated by fear of disrupting the status quo and seek relief by avoiding punishment. Other financial managers are neurobiologically inclined to engage in risk-seeking behaviors because they are motivated by hope for reward prospects and continue to engage in risky decisions despite frustrations of reward omission. in both cases, risk-taking behavior is learned based on cultural antecedences, and over time government financial managers’ risk tolerance becomes ‘hardwired’ neurologically, given their particular organizational environment.
Defined Benefit Public Pension Funding Determinants and Consequences: A Review of the Literature
Authors: Davidyan Julia Y.
Published: May 2024

Public employee pension funding in the United States continues to be a topic of interest to both practitioners and researchers. Early works in this area date back to Mumy (1978). However, it wasn't until the mid-1990s that the stream of research on public pension funding resurfaced. the objective of this essay is to provide an overview of the literature on defined benefit pension funding in the public employee pensions sector in the United States over the approximately past 20 years and to highlight research areas where there may be gaps. Empirical research on defined benefit pension funding has predominantly focused on the antecedents or determinants of the pension funded status, motivated in large part by the magnitude of underfunding. These studies are often concentrated on a subset of (typically) larger, state-wide systems, given existing data limitations. Thus, this essay outlines how research has evolved and aggregates the works on determinants of defined benefit pension funding at three levels: states’ plan level, local level across states, and local and/or specific state level. It also presents the research available on the consequences of defined benefit pension funding. This review reveals limited research on the consequences of pension funding and highlights opportunities for related future empirical research in this domain.
Longitudinal clinical decision support for assessing decisions over time: State-of-the-art and future directions
Authors: Loftus Tyler J , Balch Jeremy A , Marquard Jenna L , Ray Jessica M , Alper Brian S , Ojha Neeraj , Bihorac Azra , Melton-Meaux Genevieve , Khanna Gopal , Tignanelli Christopher J
Published: May 2024

Objective

Patients and clinicians rarely experience healthcare decisions as snapshots in time, but clinical decision support (CDS) systems often represent decisions as snapshots. This scoping review systematically maps challenges and facilitators to longitudinal CDS that are applied at two or more timepoints for the same decision made by the same patient or clinician.

Methods

We searched Embase, PubMed, and Medline databases for articles describing development, validation, or implementation of patient- or clinician-facing longitudinal CDS. Validated quality assessment tools were used for article selection. Challenges and facilitators to longitudinal CDS are reported according to PRISMA-ScR guidelines.

Results

Eight articles met inclusion criteria; each article described a unique CDS. None used entirely automated data entry, none used living guidelines for updating the evidence base or knowledge engine as new evidence emerged during the longitudinal study, and one included formal readiness for change assessments. Seven of eight CDS were implemented and evaluated prospectively. Challenges were primarily related to suboptimal study design (with unique challenges for each study) or user interface. Facilitators included use of randomized trial designs for prospective enrollment, increased CDS uptake during longitudinal exposure, and machine-learning applications that are tailored to the CDS use case.

Conclusions

Despite the intuitive advantages of representing healthcare decisions longitudinally, peer-reviewed literature on longitudinal CDS is sparse. Existing reports suggest opportunities to incorporate longitudinal CDS frameworks, automated data entry, living guidelines, and user readiness assessments. Generating best practice guidelines for longitudinal CDS would require a greater depth and breadth of published work and expert opinion.
Team-Based Approach to Successful Annual Wellness Visits
Authors: Passmore Rachael C. , Iqbal Asif , Rader Taylor L. , Ashley Kelly , Canoy Illies Allie J. , Madden Kathleen A. , Walter Jennifer L. , Crockett Eric D. , Stroebel Robert J.
Published: May 2024

Objective:

The purpose of this study was to implement a 2-phase approach to rapidly increase the number of annual wellness visits (AWVs) and build a sustainable model at 3 study units (Mayo Clinic in Rochester, Minnesota, and clinics in 2 regions of Mayo Clinic Health System), which collectively serve approximately 80 000 patients who qualify for an AWV annually.

Methods:

In the rapid improvement phase, beginning in July 2022, goals at the facilities were reoriented to prioritize AWVs, educate staff on existing AWV resources, and create low-effort workflows so that AWVs could be incorporated into existing patient appointments. Staff at all 3 study units worked independently and iterated quickly. In the second phase, all study units collaborated to design and implement a best-practice solution while they leveraged the engagement and lessons learned from the first phase and invested in additional system elements and change management to codify long-term success.

Results:

The number of AWVs completed monthly increased in each study unit. In the rapid improvement phase, the number of AWVs increased but then plateaued (or decreased at some study units). In April 2023, the final scheduled outreach automation and visit tools were implemented, and the number of AWVs was sustained or increased, while outreach and scheduling times were decreased. The number of completed AWVs increased from 1148 across all study units in the first 6 months of 2022 to 14 061 during the first 6 months of 2023.

Conclusions:

The lessons learned from this project can be applied to other health systems that want to provide more patients with AWVs while improving operational efficiency. The keys are to have a clear vision of a successful outcome, engage all stakeholders, and iterate quickly to find what works best for the organization.
Heart Transplantation for Ebstein Anomaly due to Late Surgical Presentation
Authors: Leng Tomas , Dearani Joseph A. , Stephens Elizabeth H. , Johnson Jonathan N.
Published: May 2024

Ebstein anomaly is a myopathy of the right ventricle characterized by failure of tricuspid valve delamination with accompanying tricuspid regurgitation. Its rarity, considerable anatomic variability, and frequent absence of symptoms can make the timing of surgery challenging. Contemporary tricuspid repair techniques can be performed with low mortality and bidirectional cavopulmonary anastomosis reduces the risk of operation when right ventricular function is poor. Here, we present a patient who presented late for surgery, failed high-risk conventional surgery and required heart transplantation.
The impact of nurse empowerment program on patient safety culture in general public hospital in Indonesia
Authors: Suryani Lilis , Letchmi Santhna , Said Faridah Binti Moch
Published: May 2024

Background

Patient safety is crucial to health-care quality and is one of the major parameters monitored by all health-care organizations around the world. Nurses play a critical role in improving the quality of care and patient safety because of their intensity in caring patients and families.

Objectives

This study aimed to determine the impact of nurse empowerment program on patient safety culture in general public hospital in Indonesia.

Methods

This study was designed as a quasi-experimental design in Indonesia. This program was conducted for three months with a five-day workshop (4 h for each day), followed by hanging up posters and handing out informative pamphlets to the experimental group's nurses and supervisors at their place of work in three common place that visited by nurses such as changing room, nurse station and near toilet.

Results

In the intervention group, patient safety culture practice score was significantly increased from 3.11(standard deviation [SD] = 1.43) before intervention to 4.89 (SD = 1.33) after three-month intervention (T2), with the t was 5.78, and p = .001. While in the control group, no significant increased score of patient safety culture practice before intervention and after three months intervention (3.05 ± 1.49 vs. 3.09 ± 1.25, t = 0.76, p = .516).

Conclusion

The implementation of this innovative empowerment program, which included nurses and supervisors, resulted in an increase in patient safety culture scores as well as growth in domain score. Therefore, this program can be used to advance these critical facets of patient safety culture, which are currently underdeveloped.
Exploring the Enablers of Organisational Inclusion: An Interpretive Structural Modelling Approach
Authors: Yadav Nisha , Tanwar Sunita
Published: May 2024

This research paper aims to identify and structure the enablers that promote organisational inclusivity, fostering a workplace that values diversity and inclusion. Using Interpretive Structural Modelling (ISM), the study identifies the following four clusters of enablers: autonomous, linkage, dependent and driving. Furthermore, the research findings suggest that inclusive leadership acts as a key driving factor for promoting inclusivity in the organisation. The study offers practical implications for human resource managers to develop targeted strategies to create an inclusive culture and enhance overall organisational performance by recognising and prioritising the identified enablers.
Development and initial validation of a disease-specific instrument to measure health-related quality of life in hypersensitivity pneumonitis
Authors: Aronson Kerri I. , Rajan Mangala , Varadarajan Janani , Paul Tessy K. , Swigris Jeffrey J. , Krishnan Jamuna K. , Kaner Robert J. , Martinez Fernando J. , Safford Monika M. , Pinheiro Laura C.
Published: May 2024

Rationale and objective

Disease-specific health-related quality of life (HRQOL) instruments enable us to capture domains that are most relevant to specific patient populations and are useful when a more individualised approach to patient assessment is desired. In this study, we assessed the validity and reliability of the first instrument specifically developed to measure HRQOL in hypersensitivity pneumonitis (HP).

Methods

A 39-item HP-HRQOL instrument and several anchors were collected from a cohort of patients with HP. Exploratory factor analysis and item reduction were utilised to construct a shortened version of the instrument. Several validity and reliability analyses were conducted on this version of the HP-HRQOL.

Measurements and main results

59 patients with HP completed the study. The revised HP-HRQOL instrument comprises 15 items composing two factors (domains): 1) impacts on daily life; and 2) mental wellbeing. Internal consistency reliability was strong for Factor 1 (Cronbach's α=0.94, 95% CI 0.92–0.96) and Factor 2 (Cronbach's α=0.89, 95% CI 0.85–0.94). Test–retest reliability was strong (ICC 0.94, 95% CI 0.89–0.97). The HP-HRQOL strongly correlated with other validated patient-reported outcome measures and moderately correlated with % predicted forced vital capacity. The HP-HRQOL distinguished between those with different severities of HP as determined by lung function and supplemental oxygen use.

Conclusions

The HP-HRQOL, the first patient-reported outcome instrument specific to adults with HP, possesses strong validity and reliability characteristics for measuring disease-specific HRQOL and distinguishes among patients with different severities of disease.
Emerging technology has a brilliant future: the CRISPR-Cas system for senescence, inflammation, and cartilage repair in osteoarthritis
Authors: Jia Shicheng , Liang Rongji , Chen Jiayou , Liao Shuai , Lin Jianjing , Li Wei
Published: May 2024

Osteoarthritis (OA), known as one of the most common types of aseptic inflammation of the musculoskeletal system, is characterized by chronic pain and whole-joint lesions. With cellular and molecular changes including senescence, inflammatory alterations, and subsequent cartilage defects, OA eventually leads to a series of adverse outcomes such as pain and disability. CRISPR-Cas-related technology has been proposed and explored as a gene therapy, offering potential gene-editing tools that are in the spotlight. Considering the genetic and multigene regulatory mechanisms of OA, we systematically review current studies on CRISPR-Cas technology for improving OA in terms of senescence, inflammation, and cartilage damage and summarize various strategies for delivering CRISPR products, hoping to provide a new perspective for the treatment of OA by taking advantage of CRISPR technology.
Moving together - benefits of an online dance program on physical and mental health for older women: an exploratory mixed-method study
Authors: Hansen Rasmus Kopp , Jochum Elizabeth , Egholm Ditte , Villumsen Morten , Hirata Rogerio Pessoto
Published: May 2024

Background

Previous studies show that in-person dance training is a beneficial form of physical activity that involves mental, social, and physical dimensions. This exploratory study investigated the benefits of a 12-week online dance training intervention on mental and physical health outcomes for older women.

Methods

A convergent parallel mixed-method design was used. Forty-five older adults (74.0 ± 5.3 yrs old, 44 women) were recruited through advertisements at activity and rehabilitation centers in the North Denmark region. The intervention consisted of two weekly 60-min classes of improvisation and salsa delivered online through video call applications. Changes in physical health outcomes (body mass and composition, resting blood pressure, Senior Fitness Test battery) and self-rated health and wellbeing (health-related quality of life (HRQOL), feelings of loneliness) were assessed prior to and after 12 weeks of dancing. Focus group interviews were conducted post-intervention to further explore the benefits as well as the participant’s experience of the intervention. Thematic analysis of the qualitative data was conducted.

Results

Thirty-two participants (all women) completed the study. Significant improvements in fitness were found for the number of arm curls performed (baseline: 12.3 ± 3.0; post-intervention: 13.7 ± 3.0, P = 0.005), 2-min step test performance (baseline: 66.5 ± 20.0 reps.; post-intervention: 73.8 ± 22.6 reps., P = 0.016), and chair sit-and-reach (baseline: 0.4 ± 11.3 cm; post-intervention: 5.5 ± 10.1 cm, P < 0.001). There was a significant increase in body mass from baseline to post-intervention (P < 0.015). The themes from the focus groups included (1) Participation, (2) Challenges, (3) Progression, (4) Motivation, (5) Perceived health and wellbeing, and (6) Online dance instruction. No significant changes were reported in HRQOL and loneliness from the quantitative data, although the qualitative data did reveal improved feelings of physical health and wellbeing.

Conclusions

The intervention improved several aspects of fitness in older women and improved the participants’ perceptions of their own physical abilities and wellbeing. While most participants found the online intervention enjoyable, several participants missed the feedback from the instructors that naturally occurs with in-person instruction.
Association between serum sodium trajectory and mortality in patients with acute kidney injury: a retrospective cohort study
Authors: Huang Shanhe , Li Xiaojing , Chen Baorong , Zhong Yaqi , Li Yuewei , Huang Tucheng
Published: May 2024

Introduction

Dysnatremia is strongly associated with poor prognosis in acute kidney injury (AKI); however, the impact of sodium trajectories on the prognosis of patients with AKI has not yet been well elucidated. This study aimed to assess the association between sodium trajectories in patients with AKI and mortality at 30-day and 1-year follow-up.

Methods

This retrospective cohort study used data from Medical Information Mart for Intensive Care (MIMIC)-IV database, and patients diagnosed with AKI within 48 h after admission were enrolled. Group-based trajectory models (GBTM) were applied to map the developmental course of the serum sodium fluctuations. Kaplan–Meier survival curve was used to compare differences in mortality in AKI patients with distinct serum sodium trajectories. Hazard ratios (HRs) were calculated to determine the association between trajectories and prognosis using Cox proportional hazard models.

Results

A total of 9,314 AKI patients were enrolled. Three distinct sodium trajectories were identified including: (i) stable group (ST, in which the serum sodium levels remained relatively stable, n = 4,935; 53.0%), (ii) descending group (DS, in which the serum sodium levels declined, n = 2,994; 32.15%) and (iii) ascending group (AS, in which the serum sodium levels were elevated, n = 1,383; 14.85%). There was no significant difference in age and gender distribution among the groups. The 30-day mortality rates were 7.9% in ST, 9.5% in DS and 16.6% in AS (p < 0.001). The results of 1-year mortality rates were similar (p < 0.001). In adjusted analysis, patients in the DS (HR = 1.22, 95% confidence interval [CI], 1.04–1.43, p = 0.015) and AS (HR = 1.68, 95% CI, 1.42–2.01, p = 0.013) groups had higher risks of 30-day mortality compared to those in the ST group.

Conclusion

In patients with AKI, the serum sodium trajectories were independently associated with 30-day and 1-year mortality. Association between serum sodium level trajectories and prognosis in patients with AKI deserve further study.
Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?
Authors: Shittu Khadijah A. , Ahmed Bolaji , Rabiu Kabiru Afolarin , Akinlusi Fatimat , Akinola Oluwarotimi I.
Published: May 2024

Background

The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.

Methods

Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.

Results

The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.

Conclusions

Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.

Trial registration

PACTR (www.pactr.org) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.
Relationship between socioeconomic status and hypertension incidence among adults in southwest China: a population-based cohort study
Authors: Luo Tao , Lin Shenrong , Zhang Wenying , Li Xuejiao , Wang Yiying , Zhou Jie , Liu Tao , Wu Guofeng
Published: May 2024

Purpose

To investigate the correlation between socioeconomic status (SES) and the incidence of hypertension among adults aged 18 or above in southwest China.

Methods

A multistage proportional stratified cluster sampling method was employed to recruited 9280 adult residents from 12 counties in southwest China, with all participants in the cohort tracked from 2016 to 2020. The questionnaire survey gathered information on demographics, lifestyle habits, and household income. The physical exam recorded height, weight, and blood pressure. Biochemical tests measured cholesterol levels. The chi-square test was employed to assess the statistical differences among categorical variables, while the Cox proportional hazards regression model was applied to evaluate the association between socioeconomic status (SES) and the incidence of hypertension.

Results

The finally effective sample size for the cohort study was 3546 participants, after excluding 5734 people who met the exclusion criteria. Adults in the highest household income group had a significantly lower risk of hypertension compared to those in the lowest income group (HR = 0.636, 95% CI: 0.478–0.845). Besides, when compared to individuals in the illiterate population, the risk of hypertension among adults with elementary school, junior high school, senior high school and associate degree educational level decreased respectively by 34.4% (HR = 0.656, 95%CI: 0.533–0.807), 44.9% (HR = 0.551, 95%CI: 0.436–0.697), 44.9% (HR = 0.551, 95%CI: 0.405–0.750), 46.1% (HR = 0.539, 95%CI: 0. 340–0.854). After conducting a thorough analysis of socioeconomic status, compared with individuals with a score of 6 or less, the risk of hypertension in participants with scores of 8, 10, 11, 12, and greater than 12 decreased respectively by 23.9% (HR = 0.761, 95%CI: 0.598–0.969), 29.7% (HR = 0.703, 95%CI: 0.538–0.919), 34.0% (HR = 0.660, 95%CI: 0.492–0.885), 34.3% (HR = 0.657, 95%CI: 0.447–0.967), 43.9% (HR = 0.561, 95%CI: 0.409–0.769).

Conclusion

The findings indicate a negative correlation between socioeconomic status and hypertension incidence among adults in southwest China, suggesting that individuals with higher socioeconomic status are less likely to develop hypertension.
Help-seeking processes related to targeted school-based mental health services: systematic review
Authors: McPhail Lauren , Thornicroft Graham , Gronholm Petra C.
Published: May 2024

Background

One in seven adolescents globally are affected by mental health conditions, yet only a minority receive professional help. School-based mental health services have been endorsed as an effective way to increase access to mental health support for people at risk, or currently presenting with mental health conditions, throughout adolescence. Despite this, low treatment utilisation prevails, therefore the aim of this review is to contribute insights into the processes related to adolescents’ accessing and engaging with essential targeted mental health support within schools.

Methods

This systematic review extracted qualitative, quantitative and mixed-methods data to determine what processes affect adolescents seeking help from targeted school-based mental health services (TSMS). Searches were conducted in EMBASE, Medline, PsycINFO, CINAHL, ERIC, Web of Science, in addition to manual searching and expert consultations. Data were synthesised following guidelines for thematic synthesis and narrative style synthesis.

Results

The search resulted in 22 articles reflecting 16 studies with participant sample sizes ranging from n = 7 to n = 122. Three main themes were identified: ‘access-related factors’, ‘concerns related to stigma’, and ‘the school setting’. These findings elucidate how help-seeking processes are variable and can be facilitated or hindered depending on the circumstance. We identified disparities with certain groups, such as those from low-socio economic or ethnic minority backgrounds, facing more acute challenges in seeking help. Help-seeking behaviours were notably influenced by concerns related to peers; an influence further accentuated by minority groups given the importance of social recognition. Conflicting academic schedules significantly contribute to characterising treatment barriers.

Conclusions

The findings of this review ought to guide the delivery and development of TSMS to facilitate access and promote help-seeking behaviours. Particularly, given the evidence gaps identified in the field, future studies should prioritise investigating TSMS in low- and middle-income settings and through quantitative methodologies.

Registration

The protocol for this systematic review was registered on PROSPERO (ID CRD42023406824).