bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health benefits package selection in oncology: a clinical audit of palliative chemotherapy for breast cancer in an Indian health insurance scheme
Authors: Bauhoff Sebastian , Sengar Manju , Pramesh C. S. , Dhiman Anamika , Mehndiratta Abha 
Published: December 2024

Abstract
Background
The effective operation of health insurance requires functioning administrative processes, including appropriate filing for reimbursements. The unlisted palliative care package is one of the most utilized oncology packages within Indian state health insurance schemes. We conducted a clinical audit to evaluate the appropriateness of claims for this package for patients with breast cancer.

Methods
We obtained documentation submitted to support a random sample of insurance claims for the unlisted palliative care package for 50 patients (total) from one public and one private hospital, cataloged the available records, and assessed the appropriateness of package selection using clinical guidelines from India’s National Cancer Grid. Where sufficient documentation was available, we also assessed the clinical appropriateness of care. We also examined whether these patients received relevant care at other hospitals that participate in the scheme and, for five purposefully selected patients, whether additional documentation had been submitted alongside other claims.

Results
Claims for 45 of the 50 patients had sufficient documentation to assess whether the selected package was appropriate. Among these 45 claims only 33% were selected in accordance with guidelines; the public hospital had a relatively higher share of appropriate selections. In many cases (21 claims), the palliative care package was selected for adjuvant therapy and targeted therapy. While more than half of the sampled patients had multiple related encounters and sometimes received care from multiple hospitals, reviewing additional claims did not affect our conclusions.

Conclusion
Claims for the palliative chemotherapy unlisted package often had deficient documentation and were inappropriately selected.
Implementation of an advanced practice role for oxygen prescription by physiotherapists in pulmonary rehabilitation: an explanatory sequential mixed-method quality evaluation
Authors: Riegler Thomas F. , Marcin Thimo , Brun Patrick 
Published: December 2024

Abstract
Background
Physiotherapists play a key role in the administration of supplemental oxygen during physical activity in pulmonary rehabilitation. However, supplemental oxygen requires a medical prescription making processes cumbersome for physiotherapists. This study aimed to implement and evaluate an advanced practice role for physiotherapists (APO2) allowing them to prescribe oxygen during physical activity.

Methods
Training and certification process for respiratory physiotherapists employed in an inpatient rehabilitation clinic was implemented. A mixed-method approach for retrospective evaluation was used. Quantitative analysis included routine clinical data from oxygen prescriptions, titrations, and exercise capacity. Additionally, healthcare professionals’ experiences and perceptions of the new APO2 role was explored using a survey. Qualitative data included interprofessional interviews, survey comments, and data from the critical incidence reporting system.

Results
In 15% of patients during the evaluation period, certified APO2 were involved in oxygen prescription. These patients had more frequent titrations (median 8 [interquartile 6, 10] vs. 5 [4, 8]), prescription adjustments (3 [2, 4] vs. 1 [1, 2]), and narrower oxygen dosage ranges prescribed (2 [1, 3] vs. 4 [3, 4]). No significant difference in exercise capacity was observed and no adverse events reported. Survey data from 19 healthcare professionals and interviews indicated that the specialised expertise of APO2 positively impacts interprofessional collaboration and workflow efficiency.

Conclusions
Physiotherapy-led oxygen prescription during physical activity in pulmonary rehabilitation is feasible, safe, and perceived as beneficial for the workflow and interprofessional collaboration across healthcare professions.

Trial registration
According to Swiss law (Human Research Act, Art. 2), ethics approval for the study and informed consent were not required and were waived off. All methods were in accordance with the regulations and guidelines of the Swiss Human Research Act and Swiss ethics law.
Inequalities in the geographic access to delivery services in Brazil
Authors: Pinho Neto Valdemar , Machado Cecilia , Lima Felipe , Roman Soraya , Dutra Gilson 
Published: December 2024

Abstract
Background
Despite Brazil’s recent social progress, access to health services is still unequal. This article analyzes the inter-municipal distances traveled by pregnant women to access delivery services, documenting their magnitude and relationship to socioeconomic and risk factors for over a decade in Brazil.

Methods
Using data between 2007 and 2017 from the Brazilian Information System of Live Births and a matrix of inter-municipal distances, we describe the evolution of (i) the share of pregnant women that traveled across municipalities and (ii) the average distance they traveled. Next, we assess which of the previous variables explains the changes in travel distance over time. Finally, we estimate the difference in the average travel distance by individual risk factors and use regression analysis to measure the association between this distance and municipal socioeconomic determinants from the Brazilian census.

Results
We observe that, on average, (i) the share of women traveling for childbirth increased, reaching 31% in 2017, and (ii) distances got longer, approaching the 60-kilometer mark by 2017. The increase in distance is mainly due to more women traveling. Nevertheless, regional disparities persist, especially between the north/inland and coastal regions. Women with high-risk pregnancies or newborns with risks such as low birth weight tend to travel longer distances. However, those residing in higher-development municipalities tend to travel shorter distances.

Conclusion
Long distances remain an obstacle to accessing delivery facilities. This matter affects the most vulnerable disproportionately. Policymakers must consider the geographic accessibility of mothers when expanding birth-related services. Additionally, more research is required to understand the decision to travel and the distance effectively traveled as different accessibility facets.
Narratives of health-promoting experiences by older husbands and wives providing care to their home-dwelling spouses receiving home-care services in Norway
Authors: Melilla Hege Stokmo , Sverre Beate Lie , Eilertsen Grethe , Tønnessen Siri 
Published: December 2024

Abstract
Background
In today’s healthcare systems, older family caregivers who care for their spouses at home are indispensable providers of healthcare. However, many of these caregivers are at risk of becoming ill themselves. To prevent this and to guide the development of targeted healthcare services, home-care personnel need knowledge on how to promote the health of older family caregivers. The purpose of this study was to understand the health-promoting experiences of older family caregivers who care for their home-dwelling spouses receiving home-care services.

Methods
The experiences of older family caregivers were explored using a narrative design that involved narrative interviews and a narrative thematic and structural analytical approach. The sample consisted of four husbands and six wives aged 79–91 years. In the analysis, two storylines of narratives were constructed: one by husbands and one by wives.

Findings
In the husbands’ narrative, continuation of everyday life and social support in everyday life were highlighted as being health-promoting. In the wives’ narrative, the importance of having time for oneself and being seen, heard and included by the home-care personnel were emphasized as promoting their health. The husbands’ narrative contained stories of the past and the present, while the wives’ narrative mainly comprised stories of the present.

Conclusion
This study has provided insights into the narratives of older husbands and wives acting as family caregivers regarding what promotes their health caring for their spouses at home. Their stories show variations in care style, coping style and experiences of the caregiver burden. These findings suggest that home-care services should consider providing customized health-promoting services to older family caregivers who are providing care to their home-dwelling spouses receiving home-care services. Given the sample size of only ten participants, further qualitative and quantitative research is needed.
Pheromone relay networks in the honeybee: messenger workers distribute the queen’s fertility signal throughout the hive
Authors: Richardson Thomas O. , Kay Tomas , Keller Laurent , Stroeymeyt Nathalie 
Published: December 2024

Abstract
Background
The harmonious operation of many insect societies depends upon colony-wide dissemination of a non-volatile pheromone produced by a single queen, which informs workers of her presence. This represents a major challenge in large colonies. Honeybee colonies, which can exceed 60,000 bees, are believed to solve this challenge using ‘messenger’ workers that actively relay the queen pheromone throughout the hive. However, little is known about the structure and effectiveness of the underlying relay network or the biology of messaging.

Results
Here, we combine automated tracking with modelling to address these outstanding questions. We find that both queen movement and worker messaging play fundamental roles in queen pheromone dissemination. Fine-grained analyses of worker behaviour confirmed the existence of active messaging, as physical contacts with the queen caused workers to move faster and straighter, thereby accelerating pheromone transmission. Finally, we show that messaging follows a stereotypical developmental trajectory, resulting in an age-dependent hierarchical relay network, with the most intense messaging observed between three and five days of age, when workers undergo a suite of physiological changes associated with queen rearing.

Conclusions
These results suggest that the individuals that contribute most to advertising the presence of the queen are also the ones that control queen production.
Telomere length in relation to fecundability and use of assisted reproductive technologies: the Norwegian Mother, Father, and Child Cohort Study
Authors: Skåra Karoline H. , Lee Yunsung , Jugessur Astanand , Gjessing Håkon K. , Aviv Abraham , Brumpton Ben , Næss Øyvind , Hernáez Álvaro , Hanevik Hans Ivar , Magnus Per , Magnus Maria C. 
Published: December 2024

Abstract
Background
Telomere length (TL) has been reported to be associated with conditions such as endometriosis and polycystic ovary syndrome, with some studies finding associations with shorter TL and others with longer TL. In men, studies mostly report associations between shorter TL and sperm quality. To our knowledge, no studies have thus far investigated associations between TL and fecundability or the use of assisted reproductive technologies (ART).

Methods
This study is based on the Norwegian Mother, Father, and Child Cohort (MoBa) Study and uses data from the Medical Birth Registry of Norway (MBRN). We included women (24,645 with genotype data and 1054 with TL measurements) and men (18,339 with genotype data and 965 with TL measurements) participating between 1998 and 2008. We investigated associations between leukocyte TL (LTL) and fecundability (defined as the probability to conceive within a given menstrual cycle), infertility (defined has having spent 12 months or more trying to conceive without success), and ART use. We also repeated the analyses using instrumental variables for LTL consisting of genetic risk scores for LTL and genetically predicted LTL.

Results
Approximately 11% of couples had experienced infertility and 4% had used ART. LTL was not associated with fecundability in women (fecundability ratio [FR], 0.98; 95% confidence interval [CI], 0.92–1.04) or men (FR, 0.99; CI, 0.93–1.06), nor with infertility in women (odds ratio [OR], 1.03; CI, 0.85–1.24) or men (OR, 1.05; CI, 0.87–1.28). We observed an increased likelihood of using ART with increasing LTL in men (OR, 1.22; CI, 1.03–1.46), but not in women (OR, 1.10; CI, 0.92–1.31). No significant associations were observed using the instrumental variables for LTL.

Conclusions
We found no indication that LTL is a suitable biomarker for assessing fecundability, infertility, or ART use. Additional studies are required to replicate the association observed between LTL and ART use in men.
Identifying populations at high risk of malaria: a mixed-methods case–control study to inform targeted interventions in Senegal
Authors: Thiam Tidiane , Kande Demba , Ntuku Henry , Guinovart Caterina , Galles Natalie , Merriman Laura , Cissé Moustapha , Sall Abiboulaye , Diop Ndack , Diouf Aichatou Barry , Diaw Mama Moussa , Diop Mamadou , Camara Baba , Seck Niene , Ndour Aliou , Dieye Yakou , Smith Jennifer , Bennett Adam 
Published: December 2024

Abstract
Background
Senegal has made significant progress in reducing the burden of malaria, but transmission remains highly heterogeneous, with specific population subgroups likely at higher risk. Consultations with the National Malaria Control Programme (NMCP) and a review of available data identified nomadic pastoralists, gold miners, and Koranic school students as potential high-risk populations (HRPs). This study aimed to evaluate whether these populations are at higher risk of malaria and better characterize their exposure patterns to inform the design of targeted intervention strategies.

Methods
A mixed-methods study was conducted in the districts of Ranérou, Kaolack, and Saraya between November 2020 and December 2021. A formative assessment including key informant interviews (KII) and focus group discussions (FGD) was conducted with non-HRP and HRP members (nomadic pastoralists, gold miners, Koranic school students). A health facility-based case–control study was then conducted in nine health facilities across the three districts. 501 confirmed malaria cases and 1002 non-malaria controls were frequency matched by age and sex with a ratio of 1:2. A standardized questionnaire was administered to collect sociodemographic information, including occupation, use of malaria prevention measures, mosquito exposure, and travel history. Multivariable logistic regression was used to identify malaria risk factors.

Results
KIIs and FGDs indicated that nomadic pastoralists, gold miners and Koranic school students have high exposure to mosquito bites through outdoor sleeping, spending time outside at night and sleeping in informal structures, with important gaps in the coverage of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) and limited access to health services. Compared to controls, cases had higher odds of being a nomadic pastoralist (odds ratio (OR) 4.67 95% CI 1.96–11.11) or gold miner (OR 1.92 95% CI 1.20–3.07). No evidence was found of an association with being a Koranic school student (OR 1.39 95% CI 0.80–2.39).

Conclusions
Nomadic pastoralists and gold miners in the study areas are at higher risk of malaria. Targeted interventions are needed to cover gaps in malaria prevention coverage and access to health services.
Dyslipidemia and metabolic syndrome in childhood-onset systemic lupus erythematosus: is it time to screen?
Authors: Nuntasri Sirin , Charuvanij Sirirat , Lomjansook Kraisoon , Saengpanit Puthita , Chotipanang Kwanjai , Sukharomana Maynart 
Published: December 2024

Abstract

Background
Childhood-onset systemic lupus erythematosus (cSLE) is associated with significant morbidity and mortality. Dyslipidemia and metabolic syndrome are recognized risk factors for premature atherosclerosis. This study aimed to determine the prevalence of dyslipidemia and metabolic syndrome, and to explore the relationships between lipid profiles, anthropometry, and disease status in cSLE.

Methods
This cross-sectional study was conducted at a university-based tertiary referral center from April 2023-March 2024. Patients aged 10–19 years with cSLE diagnosed before 18 years and at least 1 year follow-up were enrolled, excluding those with other autoimmune disorders, chronic kidney disease, infections, receiving lipid lowering drugs prior, and pregnancy. Demographic data, metabolic laboratory tests, disease status, dietary intake, anthropometry, and body composition via bioelectric impedance analysis were evaluated. The prevalence of dyslipidemia and metabolic syndrome were documented. Variables were compared between patients with and without dyslipidemia. Correlations between lipid profiles, metabolic laboratory variables, and SLE disease-related variables were explored.

Results
A total of 132 cSLE patients (94.7% female, mean age 11.6 ± 2.6 years) were included. Dyslipidemia was present in 48.5%, hypertriglyceridemia being the most common (28.8%); metabolic syndrome and hyperuricemia were present in 3.8% and 20.5%, respectively. Patients with dyslipidemia were significantly younger at cSLE diagnosis, had higher percentage of hypertension and active features of organ involvement, lower percentage of Lupus Low Disease Activity State, more use of mycophenolate mofetil and antihypertensive medications, higher uric acid level, higher waist circumference, body mass index, body mass index z-score, and fat mass (P < 0.05). Triglycerides, low-density lipoprotein cholesterol, and total cholesterol correlated positively with urine protein-to-creatinine ratio (r = 0.472, 0.469, and 0.591, respectively; P < 0.001) and negatively with serum albumin (r = -0.372, -0.506, and − 0.528, respectively; P < 0.001). Total cholesterol and low-density lipoprotein cholesterol correlated positively with cumulative prednisolone equivalent dose (rho = 0.350 and rho = 0.351, respectively, P < 0.001).

Conclusions
Nearly half of cSLE patients had dyslipidemia, especially those with younger age at diagnosis, higher body mass index, proteinuria, and suboptimal-controlled disease. Metabolic syndrome and hyperuricemia were present. Lipid profile assessment in early adolescents is recommended to identify metabolic comorbidities in cSLE.
Enhancing multi-sectoral collaborations for the prevention and control of NCDs in Thailand with a new approach
Authors: Sornpaisarn Bundit , Chunharas Somsak , Sornpaisarn Sarnti , Saonuam Pairoj , Nipun Rifat Farzan , Butryee Chaniphun , Samutachak Bhubate , Chandarasorn Maneekwan , Supadulya Nattapon , Chunsuttiwat Suttikarn , Singha Sumonmarn , Rojanapithayakorn Wiwat , Ungchusak Kumnuan , Rehm Jürgen 
Published: December 2024

Abstract
Background
To achieve the Sustainable Development Goals (SDGs) by 2030, Thailand must engage in effective multi-sectoral collaboration (MSC). However, implementing MSC in Thailand presents significant challenges. Although Thailand had a 2011–2020 MSC strategic plan for the control of non-communicable diseases (NCDs) with the prime minister taking the lead, joined by many non-health ministers, not a single meeting was called over those 10 years. This paper describes the development of a new tool created to enhance MSC between health and non-health sectors in controlling NCDs in Thailand. Stakeholder-engaged research will be used to implement and evaluate this tool. This paper also describes the research planned to test the new approach.

Methods
The authors used two main methods: (1) a narrative review on MSC enhancement and (2) a series of four consultation meetings with key stakeholders – in the health, non-health and academic sectors – to develop a research study to implement and evaluate the new approach.

Results
To address previous MSC implementation problems, the proposed novel MSC enhancement approach emphasizes three principles: (1) pursuit of committed-stakeholder involvement at the middle-management level, instead of relying on the top-management level, an approach which has never been successful; (2) production of knowledge to support specific, achievable target policies; and (3) use of a comprehensive set of knowledge-translation activities and knowledge brokers to solve the problem of ineffective routine official communications between members of the MSC. Using participatory consultations during the research proposal development, middle-level officials from three non-health ministries (the Ministries of Agriculture, Finance and Education) agreed to join the MSC to work together to solve specific problems regarding the control of NCDs. A target-advocated policy for each ministry was formulated and agreed upon by both non-health-sector and health-sector stakeholders.

Conclusions
This new approach (middle-management oriented), if implemented, may encourage more commitment from the Ministries’ representatives, policy-relevant knowledge generation and effective communications between ministries involved in an MSC. Ideally, it would complement the conventional approach (top-management oriented) in enhancing the MSC for controlling NCDs, and thereby bring hope for achieving the NCD-related SDGs for Thailand and possibly other countries as well.
In-vivo Raman microspectroscopy reveals differential nitrate concentration in different developmental zones in Arabidopsis roots
Authors: Fernández González Alma , Fang Ze Tian , Sen Dipankar , Henrich Brian , Nagashima Yukihiro , Sokolov Alexei V. , Okumoto Sakiko , Verhoef Aart J. 
Published: December 2024

Abstract
Background
Nitrate (NO3−) is one of the two major forms of inorganic nitrogen absorbed by plant roots, and the tissue nitrate concentration in roots is considered important for optimizing developmental programs. Technologies to quantify the expression levels of nitrate transporters and assimilating enzymes at the cellular level have improved drastically in the past decade. However, a technological gap remains for detecting nitrate at a high spatial resolution. Using extraction-based methods, it is challenging to reliably estimate nitrate concentration from a small volume of cells (i.e., with high spatial resolution), since targeting a small or specific group of cells is physically difficult. Alternatively, nitrate detection with microelectrodes offers subcellular resolution with high cell specificity, but this method has some limitations on cell accessibility and detection speed. Finally, optical nitrate biosensors have very good (in-vivo) sensitivity (below 1 mM) and cellular-level spatial resolution, but require plant transformation, limiting their applicability. In this work, we apply Raman microspectroscopy for high-dynamic range in-vivo mapping of nitrate in different developmental zones of Arabidopsis thaliana roots in-situ.

Results
As a proof of concept, we have used Raman microspectroscopy for in-vivo mapping of nitrate content in roots of Arabidopsis seedlings grown on agar media with different nitrate concentrations. Our results revealed that the root nitrate concentration increases gradually from the meristematic zone (~ 250 µm from the root cap) to the maturation zone (~ 3 mm from the root cap) in roots grown under typical growth conditions used for Arabidopsis, a trend that has not been previously reported. This trend was observed for plants grown in agar media with different nitrate concentrations (0.5–10 mM). These results were validated through destructive measurement of nitrate concentration.

Conclusions
We present a methodology based on Raman microspectroscopy for in-vivo label-free mapping of nitrate within small root tissue volumes in Arabidopsis. Measurements are done in-situ without additional sample preparation. Our measurements revealed nitrate concentration changes from lower to higher concentration from tip to mature root tissue. Accumulation of nitrate in the maturation zone tissue shows a saturation behavior. The presented Raman-based approach allows for in-situ non-destructive measurements of Raman-active compounds.