bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province
Authors: Jiang Weixi , Xu Xiaolin , Tang Shenglan , Xu Ling , Zhang Yaoguang , Elbers Chris , Cobelens Frank , Yan Lijing 
Published: November 2019

Abstract
Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication.
Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE).
Results : After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure ( P <0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service ( P <0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR=2.02, P <0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population.
Conclusions: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.
The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial
Authors: Mumma Jane Awiti Odhiambo , Simiyu Sheillah , Aseyo Evalyne , Anderson John , Czerniewska Alexandra , Allen Elizabeth , Dreibelbis Robert , Baker Kelly K. , Cumming Oliver 
Published: November 2019

Abstract
Background
Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, especially in low-income urban settings. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya.

Methods
This is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targets four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean.

Results
The primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria ( Enterococcus ) isolated and enumerated to assess the impact of the intervention on infant food contamination.

Conclusion
To our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the extension system can improve the health of young children.
Human papillomavirus type 18 oncoproteins exert their oncogenicity in esophageal and tongue squamous cell carcinoma cell lines distinctly
Authors: Boon Siaw Shi , Chen Zigui , Li Jintao , Ching Karen Lee Yin , Cai Liuyang , Zhong Rugang , Chan Paul Kay Sheung 
Published: November 2019

Abstract
Increasing evidence indicates an etiological role of human papillomavirus (HPV) in head and neck cancers, particularly oropharyngeal squamous cell carcinoma (OPSCC). However, the association between HPV and other cancers, including esophageal and tongue remains unclear. This study delineated the molecular characteristics of HPV18 E6 and E7 in esophageal (EC109 and EC9706) and tongue (Tca83) cancer cell lines with reference to cervical cancer (HeLa). Overall, the HPV transcription profiles of esophageal and tongue cancer cells mimicked that of cervical cancer cells, with notable disruption of E2, and expression of E6, spliced E6 (E6*), E7, E1 and L1 transcripts. As with cervical cancer cells, p53 and its downstream transactivation target, p21, were found to be the major targets of E6 in esophageal and tongue cancer cell lines. Intriguingly, E7 preferentially targeted p130 in the two esophageal cancer cell lines, instead of pRb as in cervical cancer. Tca83 exhibited an E7 to E6 transcript ratio comparable to HeLa (cervix), targeted the ERK1/2 and MMP2 pathways, and was dependent on E6 and E7 to survive and proliferate. In contrast, both the esophageal cancer cell lines were distinct from HeLa in these aspects. In conclusion, this is the first study that delineates transcript expression and protein interaction of HPV18 E6 and E7 in esophageal and tongue cancer cell lines, suggesting that HPV plays a role in inducing these cancers, albeit via distinct pathways than those observed in cervical cancer.
Serum levels of the chemokine CCL2 are elevated in malignant pleural mesothelioma patients
Authors: Kishimoto Takumi , Fujimoto Nobukazu , Ebara Takeshi , Omori Toyonori , Oguri Tetsuya , Niimi Akio , Yokoyama Takako , Kato Munehiro , Usami Ikuji , Nishio Masayuki , Yoshikawa Kosho , Tokuyama Takeshi , Tamura Mouka , Yokoyama Yoshifumi , Tsuboi Ken , Matsuo Yoichi , Xu Jiegou , Takahashi Satoru , Abdelgied Mohamed , Alexander William T. , Alexander David B , Tsuda Hiroyuki 
Published: November 2019

Abstract
Background: Malignant pleural mesothelioma (MPM) is a debilitating disease of the pleural cavity. It is primarily associated with previous inhalation of asbestos fibers. These fibers initiate an oxidant coupled inflammatory response. Repeated exposure to asbestos fibers results in a prolonged inflammatory response and cycles of tissue damage and repair. The inflammation-associated cycles of tissue damage and repair are intimately involved in the development of asbestos-associated cancers. Macrophages are a key component of asbestos-associated inflammation and play essential roles in the etiology of a variety of cancers. Macrophages are also a source of C-C motif chemokine ligand 2 (CCL2), and a variety of tumor-types express CCL2. High levels of CCL2 are present in the pleural effusions of mesothelioma patients, however, CCL2 has not been examined in the serum of mesothelioma patients.
Methods: The present study was carried out with 50 MPM patients and 356 subjects who were possibly exposed to asbestos but did not have disease symptoms and 41 healthy volunteers without a history of exposure to asbestos. The levels of CCL2 in the serum of the study participants was determined using ELISA.
Results: Levels of CCL2 were significantly elevated in the serum of patients with advanced MPM patients.
Conclusions: Our findings are consistent with the premise that the CCL2/CCR2 axis and myeloid-derived cells play an important role in MPM and disease progression. Therapies are being developed that target CCL2/CCR2 and tumor resident myeloid cells, and clinical trials are being pursued that use these therapies as part of the treatment regimen. The results of trials with patients with a similar serum CCL2 pattern as MPM patients will have important implications for the treatment of MPM.
WITHDRAWN: Successful implementation of an Enhanced Recovery After Surgery (ERAS) protocol reduces nausea and vomiting in patients after infratentorial craniotomy for tumour resection: a randomized controlled trial.
Authors: Lu Dan , Wang Yuan , Zhao Tianzhi , Liu Bolin , Ye Lin , Zhao Lanfu , Zhao Binfang , Li Mingjuan , Ma Lin , Li Zhengmin , Niu Jiangtao , Lv Wenhai , Zhang Yufu , Zheng Tao , Xue Yafei , Chen Lei , Chen Long , Sun Xude , Gao Guodong , Chen Bo , He Shiming 
Published: November 2019

Abstract

Objectives: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV.
Methods: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications.
Results: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group.
Conclusion: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications.
Association of Maternal Ethnicity and Urbanicity on Severe Pediatric Disease: A Nationwide Cohort Study
Authors: Chang Ya-Ting , Wang Huei-Shyong , Liu Jia-Rou , Tseng Chi-Nan , Chou I-Jun , Luo Shue-Fen , Kuo Chang-Fu , See Lai-Chu 
Published: November 2019

Abstract
Background A healthy migrant effect on birth outcomes has been reported, however, whether this protective effect persists throughout childhood is unknown. The effect of urbanicity on child health among an immigrant population is unclear. Objectives We compared the incidence rate and cumulative incidence of severe diseases among urban children of Taiwan-born mothers, rural children of Taiwan-born mothers, urban children of foreign-born mothers, and rural children of foreign-born mothers. Methods A nationwide cohort study was conducted for children born in Taiwan during 2004-2011 and follow-up till age 4 to 11 years old by linkage the Taiwan Birth Registry 2004-2011, Taiwan Death Registry 2004-2015, and National Health Insurance Research Database 2004-2015. Cox proportional hazards model (multivariable) was used to examine differences among the four study groups. Results There were 682,982 urban children of Taiwan-born mothers, 662,818 rural children of Taiwan-born mothers, 61,570 urban children of foreign-born mothers, 87,473 rural children of foreign-born mothers. Children of foreign-born mothers had a lower incidence of vasculitis, mainly Kawasaki disease. The incidences of congenital disorders did not differ between children of foreign-born mothers and children of Taiwan-born mothers. The incidence of psychotic disorders was higher in urban children. However, children in rural areas had a higher incidence of major trauma/burn and a higher mortality rate. Conclusions A healthy migrant effect was only seen for Kawasaki disease. The mental health of urban children born to immigrant mothers warrants concern.
Genetic Diversity and Population Structure of Asian and European Common Wheat Accessions Based on Genotyping-By-Sequencing
Authors: Yang Xiu , Xi Ling , Tan Binwen , Zhu Wei , Xu Lili , Wang Yi , Fan Xing , Sha Lina , Zhang Haiqin , Zeng Jian , Chen Guoyue , Ma Jian , Hu Xigui , Zhou Yonghong , Kang Houyang 
Published: November 2019

Abstract
Background Availability of information on the genetic diversity and population structure of germplasm facilitates its use in wheat breeding programs. Recently, with the development of next-generation sequencing technology, genotyping-by-sequencing (GBS) has been used as a high-throughput and cost-effective molecular tool for examination of the genetic diversity of wheat breeding lines. In this study, GBS was used to characterize a population of 180 accessions of common wheat originating from Asia and Europe between the latitudes 30° and 45°N.Results In total, 24,767 high-quality single-nucleotide polymorphism (SNP) markers were used for analysis of genetic diversity and population structure. The B genome contained the highest number of SNPs, followed by the A and D genomes. The polymorphism information content ranged from 0.1 to 0.4, with an average of 0.26. The distribution of SNPs markers on the 21 chromosomes ranged from 243 on chromosome 4D to 2,337 on chromosome 3B. Structure and cluster analyses divided the panel of accessions into two subgroups (G1 and G2). G1 principally consisted of European and partial Asian accessions, and G2 comprised mainly accessions from the Middle East and partial Asia. Molecular analysis of variance showed that the genetic variation was greater within groups (99%) than between groups (1%). Comparison of the two subgroups indicated that G1 and G2 contained a high level of genetic diversity. The genetic diversity of G2 was higher as indicated by the Shannon’s information index ( I ) = 0.512, diversity index ( h ) = 0.334, observed heterozygosity ( H o ) = 0.226, and unbiased diversity index (uh) = 0.338.Conclusion The present results will not only help breeders to understand the genetic diversity of wheat germplasm on the Eurasian continent between the latitudes of 30° and 45°N, but also provide valuable information for wheat genetic improvement through introgression of novel genetic variation in this region.
Ginsenosides facilitate the anti-cancer efficacy of cyclophosphamide via modulating intestinal bacteria and alleviating intestinal mucositis in mammary carcinoma mice
Authors: Zhu He , He Yi-Sheng , Zhou Jing , Ma Jiang , Wu Cheng-Yin , Kong Ming , Mao Qian , Lin Ge , Li SongLin 
Published: November 2019

Abstract
Background: Ginsenosides has been reported to facilitate the chemotherapy of cyclophosphamide (CTX), but the underlying mechanism is still elusive. Here, ICR mice bearing subcutaneous 4T1 tumor (mouse mammary carcinoma cells) were used to investigate the enhanced chemotherapeutic effects and underlying the mechanism of concurrent administration of ginsenosides and CTX. Results: Combinational treatment with ginsenosides in mice enhanced the anti-cancer efficacy of CTX as observed by elevated tumor growth inhibition rate, prolonged survival rate, decreased tumor burden and increased apoptosis in tumor tissues. The mechanism underlying the enhancing effects involved the elevation of the anti-cancer immunity, which manifested as accelerating anti-cancer cytokines (IL-2, IL-6, IL-17, TNF-α and INF-γ) that was further ascribed to the ginsenosides-induced generation of intestinal probiotics including Bifidobacterium, Akkermansia and Lactobacillus. Moreover, through activating Nrf2 and inhibiting NFκB pathways, ginsenosides reversed CTX-induced intestinal mucositis by maintaining normal intestinal permeability and junction proteins function. Conclusion: Ginsenosides ameliorate CTX-induced intestinal mucositis and promote anti-cancer immunity via maintaining intestinal homeostasis, consequently enhancing the anti-cancer efficacy of CTX.
Medical Debt and Catastrophic Health Expenditures among Middle- and Low-Income Families in China
Authors: Li Jiajing , Jiao Chen , Xu Lizheng , Nicholas Stephen , Wang Jian 
Published: November 2019

Abstract
Background Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low and middle-income households.Method Data was obtained from the 2015 China Household Finance Survey and medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence.Results We found that 2.42% of middle-income families had a medical debt, averaging US$6278.25, or 0.56 times household yearly income; and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poor households deeper into poverty. While catastrophic health expenditure was the single most important factor in medial debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt.Conclusions Using a narrow definition of medical debt, the incidence of medical debt in Chinese low and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify basic medical insurance schemes to manage out-of-pocket medical expenses better and take account of pre-existing medical debt when addressing this problem.
A Systematic Review on the Feasibility of Salivary Biomarkers for Alzheimer’s Disease
Authors: Bouftas Mohamed 
Published: November 2019

Abstract
Background: Early AD diagnosis is critical for ameliorating prognosis and treatment. The analysis of CSF biomarkers yields accurate results, but it necessitates a lumbar puncture procedure. Screening for peripheral biomarkers in saliva is advantageous since this medium is noninvasive and inexpensive to obtain. The objective of this systematic review is to analyze saliva biomarker studies which aim to diagnose AD.

Methods: Titles, abstracts, and reference lists for publications from February 2004 to March 2019 were screened for by searching Google Scholar and PubMed. The inclusion criteria involved published studies that consisted of both AD and control groups.

Results: 77 studies were screened, and 13 publications fulfilled the inclusion criteria. These selected publications were scrutinized and included in this review. Numerous biomarkers were analyzed, including Aβ42, tau, and various salivary metabolites.

Conclusion: Aβ42, tau, lactoferrin, and various metabolites might serve as a reliable biomarkers for AD diagnosis. However, these studies must be replicated with a large sample size. It is also important to standardize the analytical methods of measuring salivary biomarkers to establish coherence for the selection of valid AD biomarkers. Saliva composition can be affected by production rate, circadian rhythms, and oral health, so their cumulative effect on the accuracy of saliva testing requires further investigation.

Keywords: Alzheimer, biomarker, saliva
International Palliative Care Research Priorities: A Systematic Review
Authors: Hasson Felicity , Nicholson Emma , Muldrew Deborah , Bamidele Olufikayo , Payne Sheila , McIlfatrick Sonja 
Published: November 2019

Abstract
Background : There has been increasing evidence and debate on palliative care research priorities and the international research agenda. To date, however, there is a lack of synthesis of this evidence, examining commonalities, differences, and gaps. To identify and synthesize literature on international palliative care research priorities mapped to a quality assessment framework.Methods: A systematic review of several academic and grey databases were searched from January 2008- June 2019 for studies eliciting research priorities in palliative care in English. Two researchers independently reviewed, critically appraised, and conducted data extraction and synthesis.Results: The search yielded 10,325 of which ten were included for appraisal and review.Priority areas were identified: service models; continuity of care; training and education; inequality; communication; living well and independently; and recognising family/carer needs and the importance of families. Methodological approaches and process of reporting varied. There was little representation of patient and caregiver driven agendas. The priorities were mapped to the Donabedian framework for assessing quality reflecting structure, process and outcomes and key priority areas. Conclusions : Limited evidence exists pertaining to research priorities across palliative care. Whilst a broad range of topics were elicited, approaches and samples varied questioning the credibility of findings. The voice of the care provider dominated, calling for more inclusive means to capture the patient and family voice. The findings of this study may serve as a template to understand the commonalities of research, identify gaps, and extend the palliative care research agenda.