bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inequality of opportunity in healthcare expenditures: evidence from China
Authors: Zhang Yuyang , Coyte Peter C. 
Published: May 2020

AbstractBackgroundThe theory of equality of opportunity attributes total inequality to effort levels and circumstance factors. Inequality attributable to circumstance is defined as inequality of opportunity (IOp), namely inequity. Many studies have been pursued in this area but few concerning health care, especially in China. Despite Chinese health system reforms, healthcare inequity remains. This study explores the extent and sources of IOp in outpatient and inpatient expenditures in China.MethodsWe used three waves (2011, 2013 and 2015) of data from the China Health and Retirement Longitudinal Study that offer a nationally representative sample of Chinese residents aged 45 and older. Based on a pooled regression model, we estimated the contribution of circumstance factors to the inequality in outpatient and inpatient expenditures by defining a counterfactual distribution. The “circumstance-free effort” was introduced to deal with the correlation between circumstance and effort.ResultsWe report a decline in inequity from 2011 to 2015, and the IOp ratio to total inequality in outpatient and inpatient expenditures decreased 9.4% (from 28.6 to 25.9%) and 3.3% (from 49.1 to 47.5%), respectively. Social background, medical supply-side factors, including the type of basic medical insurance, region and community medical resources were important sources of IOp in outpatient and inpatient expenditures.ConclusionsThese findings provide information on which to base policies designed to reduce inequity in healthcare expenditures. It is necessary to transfer more subsidies to the New Co-operative Medical System, and to address the uneven regional distribution of medical resources. Additionally, increasing access to quality primary community clinics may be a pro-poor policy to alleviate inequity in the use of outpatient care. Compared to outpatient services, policies protecting vulnerable populations need to pay more attention to the financing and design of inpatient services.
Selection of private or public hospital care: examining the care-seeking behaviour of patients with private health insurance
Authors: Rana Rezwanul Hasan , Alam Khorshed , Gow Jeff 
Published: May 2020

Abstract
Background
This study aimed to examine the healthcare-seeking (hospital, primary and preventive care) and healthcare utilisation behaviour of patients with private health insurance (PHI) in Australia. It also aimed to examine the socioeconomic, demographic and lifestyle factors that influence the choice of hospital care in Australia.

Method
A logistic regression model with repeated measure t-test and Pearson’s Chi-square test were used to identify the factors that affect the choice of care. Data from waves 9 (2009) and 13 (2013) of the nationally-representative Household, Income and Labour Dynamics in Australia (HILDA) survey were used in the analysis.

Results
Patients with PHI had a higher number of hospital nights’ stay despite having a lower number of hospital admissions than those without private cover. Significant disparities were identified in preventive and specialist care use between patients with cover and without cover. No significant variations were observed in healthcare utilisation for PHI patients before and after dropping PHI. One in four patients chose to use public hospitals despite holding PHI cover. Moreover, those insured and from lower socioeconomic backgrounds and those who were younger and without long-term health conditions showed a higher probability of selecting public rather than private care.

Conclusions
It is evident that PHI cover encourages people to use private care. However, a considerable number of PHI patients are using public care, even though eligible for private care may indicate consumer information asymmetry.
Effect of two major health reforms on health care cost and utilization in Fars Province of Iran: family physician program and health transformation plan
Authors: Bayati Mohsen , Keshavarz Khosro , Lotfi Farhad , KebriaeeZadeh Abbas , Barati Omid , Zareian Shahram , Amiri Akbar , Delavari Sajad 
Published: May 2020

Abstract
Background
Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran’s health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services.

Methods
This longitudinal study was conducted on people insured by social security organization in Fars province during 2009–2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms.

Results
FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners’ and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods.

Conclusions
FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.
Selecting and tailoring implementation interventions: a concept mapping approach
Authors: Kwok Elaine Yuen Ling , Moodie Sheila T. F. , Cunningham Barbara Jane , Oram Cardy Janis E. 
Published: May 2020

AbstractBackgroundTo improve the uptake of research into practice, knowledge translation frameworks recommend tailoring implementation strategies to address practice barriers. This study reports our experience pairing the Theoretical Domains Framework with information from multiple stakeholder groups to co-develop practice-informed strategies for improving the implementation of an evidence-based outcome measurement tool across a large community health system for preschoolers with communication impairments.MethodsConcept mapping was used to identify strategies for improving implementation of the Focus on the Outcomes of Communication Under Six (FOCUS) in Ontario Canada’s Preschool Speech and Language Program. This work was done in five stages. First, we interviewed 37 speech-language pathologists (clinicians) who identified 90 unique strategies to resolve practice barriers to FOCUS implementation. Second, clinicians (n = 34), policy-makers (n = 3), and members of the FOCUS research team (n = 6) sorted and rated the strategies by importance and feasibility. Third, stakeholders’ sorting data were analyzed to generate a two-dimensional concept map. Based on the rating data from stakeholders, we prioritized a list of strategies that were rated as highly important and highly feasible, and summarized the practice barriers addressed by each of the prioritized strategies. Fourth, we validated these findings with stakeholders via an online survey. Fifth, the mechanisms of action of the prioritized list of strategies were considered based on available evidence from the Theoretical Domains Framework and associated behavior change literature.ResultsStakeholders categorized the 90 unique implementation strategies into a six-cluster concept map. Based on stakeholders’ ratings, a list of 14 implementation strategies were prioritized. These implementation strategies were reported to resolve barriers within theenvironmental context and resourcesandbeliefs about consequencesdomains of the Theoretical Domains Framework. All but one of the prioritized strategies have a demonstrated link in resolving existing barriers according to the behavioral change literature.ConclusionsOur study contributes to a growing literature that demonstrates the process of tailoring implementation strategies to specific barriers. Practical drawbacks and benefits of using concept mapping as a way to engage stakeholders in implementation research are discussed.
Strengths and weaknesses of eye care services in sub-Saharan Africa: a meta-synthesis of eye health system assessments
Authors: Bechange Stevens , Jolley Emma , Virendrakumar Bhavisha , Pente Vladimir , Milgate Juliet , Schmidt Elena 
Published: May 2020

Abstract
Background
In sub-Saharan Africa (SSA), the delivery of eye care services continues to be undermined by health systems performance bottlenecks. There is a growing focus by partners in the sector on the analysis of the different components of eye care within the wider health system context to diagnose and manage interactions in ways that achieve more effective improvements. However, there has been no attempt to date to systematically synthesize these studies. In this study, we conducted a meta-synthesis of eye health system assessments to gain a more comprehensive understanding of the current systems and how they can be strengthened across different SSA contexts.

Methods
We conducted a comprehensive search for eye health system assessment reports using global and regional websites of the WHO and other organizations supporting eye care in sub-Saharan Africa. A range of online databases with no language restrictions (PubMed, EMBASE, MEDLINE, PsycINFO and CINAHL) were searched for peer-reviewed publications referring to eye health system assessment (EHSA) or eye care service assessment tool (ECSAT). Assessments were included if they used the ECSAT or EHSA tool; were conducted in sub-Saharan Africa; and had been completed with full reports available in the public domain by January 15, 2019. A combination of framework and thematic syntheses was used.

Results
Our search strategies yielded a total of 12 assessments conducted in nine countries using the ECSAT/EHSA tool in Sub-Saharan Africa. Eight assessments met our inclusion criteria: four were from West Africa, two from East Africa and two from Southern Africa. Across the eight countries, findings show considerable progress and improvements in the areas of governance, organisation, financing, provision, and coverage of eye care. However, several systemwide weaknesses were found to continue to impede quality eye health service planning and delivery across the countries included in this review.

Conclusions
These findings highlight the need for national governments and iNGOs to invest in conducting and wider use of these assessments. Such analyses are particularly useful in building links between different system elements and in finding innovative, more flexible solutions and partnerships – needed to address avoidable vision loss in resource poor settings.
Genomic evidence for a hybrid origin of the yeast opportunistic pathogen Candida albicans
Authors: Mixão Verónica , Gabaldón Toni 
Published: May 2020

AbstractBackgroundOpportunistic yeast pathogens of the genusCandidaare an important medical problem.Candida albicans, the most prevalentCandidaspecies, is a natural commensal of humans that can adopt a pathogenic behavior. This species is highly heterozygous and cannot undergo meiosis, adopting instead a parasexual cycle that increases genetic variability and potentially leads to advantages under stress conditions. However, the origin ofC. albicansheterozygosity is unknown, and we hypothesize that it could result from ancestral hybridization. We tested this idea by analyzing available genomes ofC. albicansisolates and comparing them to those of hybrid and non-hybrid strains of otherCandidaspecies.ResultsOur results show compelling evidence thatC. albicansis an evolved hybrid. The genomic patterns observed inC. albicansare similar to those of other hybrids such asCandida orthopsilosisMCO456 andCandida inconspicua, suggesting that it also descends from a hybrid of two divergent lineages. Our analysis indicates that most of the divergence between haplotypes inC. albicansheterozygous blocks was already present in a putative heterozygous ancestor, with an estimated 2.8% divergence between homeologous chromosomes. The levels and patterns of ancestral heterozygosity found cannot be fully explained under the paradigm of vertical evolution and are not consistent with continuous gene flux arising from lineage-specific events of admixture.ConclusionsAlthough the inferred level of sequence divergence between the putative parental lineages (2.8%) is not clearly beyond current species boundaries in Saccharomycotina, we show here that all analyzedC. albicansstrains derive from a single hybrid ancestor and diverged by extensive loss of heterozygosity. This finding has important implications for our understanding ofC. albicansevolution, including the loss of the sexual cycle, the origin of the association with humans, and the evolution of virulence traits.
Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis
Authors: Perski Olga , Beard Emma , Brown Jamie 
Published: May 2020

Abstract
Background
There is a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes across the UK, Europe and the US. It is important to assess whether this may influence the use of e-cigarettes. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade.

Methods
Respondents were from the Smoking Toolkit Study, which involves monthly cross-sectional household surveys of individuals aged 16+ years in England. Data were aggregated monthly on ~ 300 current tobacco smokers between 2014 and 2019. The outcome variable was the prevalence of e-cigarette use. The explanatory variable was the proportion of smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes. Covariates were cigarette (vs. non-cigarette combustible) current smoking prevalence, past-year quit attempt prevalence and national smoking mass media expenditure. Unadjusted and adjusted autoregressive integrated moving average with exogeneous variables (ARIMAX) models were fitted.

Results
For every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48% (βadj = 0.48, 95% CI = 0.25–0.71, p < .001). Marginal age and sex differences were observed, whereby significant associations were observed in older (but not in young) adults and in men (but not in women). No differences by social grade were detected.

Conclusions
Between 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use.
High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis
Authors: Greulich Timm , Tüffers Julia , Mager Sina , Eder Anna , Maxheim Michael , Alter Peter , Schmeck Bernd , Vogelmeier Claus F. 
Published: May 2020

Abstract
Background
In COPD, the course of the disease including morbidity and mortality is strongly associated with severe exacerbations. The current GOLD recommendations emphasize blood eosinophil counts as a marker for responsiveness to inhaled corticosteroids (ICS). Retrospective analyses from randomized clinical trials indicate a favorable response to systemic corticosteroids in exacerbated COPD patients with blood eosinophils > 2%, however data outside clinical trials are scarce.

Patients and methods
We retrospectively evaluated data from 1007 cases of patients who were admitted to the University Medical Center Marburg between 01/2013 and 12/2018. All patients had been diagnosed with an acute exacerbation of COPD (ICD-10 J44.0/J44.1). Our analysis was based on a subgroup of 417 patients in whom a full blood cell count was obtained at the day of admission. Patients were predominantly male (63.3%), had a median age of 74 years (IQR 65 years – 83 years) and a median FEV1 of 1.03 l (42.6% predicted). We compared the hospital length of stay and other outcome parameters using established thresholds for the eosinophil blood cell count (100 and 300 eosinophils/μl and 2%).

Results
Patients with low eosinophils (< 2%, <100 cells/μl) had a longer median time in hospital (length of hospital stay – LOS) as compared to patients with high eosinophils (< 2%: 9.31 vs. ≥2%:7 days, and < 100/μl: 10 vs. 100–300/μl: 8 vs. > 300/μl: 7 days). The median CRP was higher in patients with low eosinophils as compared to the other groups (< 2%: 22.7 vs. ≥2%: 9 mg/dl and < 100: 25 vs. 100–300: 13.5 vs. > 300: 7.1 mg/dl). Time to re-hospitalization or time to death did not differ between strata of eosinophils. Sensitivity analysis in a subgroup of patients in which pneumonia was excluded by chest x-ray did not significantly alter the results.

Conclusion
The results support the hypothesis that patients with severe COPD exacerbations and elevated blood eosinophil counts respond better to systemic corticosteroid treatment than patients with a non-eosinophilic exacerbation.
The relationship between carotid disease and retinopathy in diabetes: a systematic review
Authors: Drinkwater Jocelyn J. , Davis Timothy M. E. , Davis Wendy A. 
Published: May 2020

Abstract
Background
Since studies of the relationship between carotid disease and diabetic retinopathy (DR) have shown apparent inconsistencies, the aim of this study was to conduct a systematic review of available published data.

Methods
Electronic databases were searched independently by two reviewers, according to an iterative protocol, for relevant articles. The search term used was “diabetes AND (carotid disease OR intima-media OR carotid plaque OR carotid stenosis OR carotid arterial disease OR carotid artery disease OR carotid atherosclerosis) AND (retinopathy OR diabetic retinopathy)”.

Results
From 477 publications, 14 studies were included. There were differences in the variables used as markers of carotid disease and DR across the included studies. Ten studies used carotid disease as the dependent variable, and the remainder used DR. All but one study involved cross-sectional data. Most studies reported a statistically significant association between at least one parameter of carotid disease as assessed by ultrasound and DR presence or severity. Only four studies reported no significant association. A common limitation was the use of convenience participant sampling.

Conclusions
There appears to be an increased likelihood of DR when there is ultrasonographic evidence of carotid disease, and vice versa. The available studies suggest that there may be a direct relationship between DR and carotid macrovascular disease and/or that these complications co-exist due to shared risk factors. If carotid disease is detected, retinal assessment should be performed. If DR is identified, intensive cardiovascular disease risk management should be considered. Additional longitudinal studies are needed to assess the directionality of the association.
The additive effects of obesity on myocardial microcirculation in diabetic individuals: a cardiac magnetic resonance first-pass perfusion study
Authors: Jiang Li , Shi Ke , Guo Ying-kun , Ren Yan , Li Zhen-lin , Xia Chun-chao , Li Lei , Liu Xi , Xie Lin-jun , Gao Yue , Shen Meng-ting , Deng Ming-yan , Yang Zhi-gang 
Published: May 2020

Abstract
Background
The microvascular effects of obesity should be considered in diabetic individuals for elucidating underlying mechanisms and developing targeted therapies. This study aims to determine the effect of obesity on myocardial microvascular function in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) first-pass perfusion imaging and assessed significant risk factors for microvascular dysfunction.

Materials and methods
Between September 2016 and May 2018, 120 patients with T2DM (45.8% women [55 of 120]; mean age, 56.45 ± 11.97 years) and 79 controls (44.3% women [35 of 79]; mean age, 54.50 ± 7.79 years) with different body mass index (BMI) scales were prospectively enrolled and underwent CMR examination. CMR-derived perfusion parameters, including upslope, time to maximum signal intensity (TTM), maximum signal intensity (MaxSI), MaxSI (-baseline), and SI (baseline), and T2DM related risk factors were analyzed among groups/subgroups both in T2DM patients and controls. Univariable and multivariable linear and logistic regression analyses were performed to assess the potential additive effect of obesity on microvascular dysfunction in diabetic individuals.

Results
Compared with controls with comparable BMIs, patients with T2DM showed reduced upslope and MaxSI and increased TTM. For both T2DM and control subgroups, perfusion function gradually declined with increasing BMI, which was confirmed by all perfusion parameters, except for TTM (all P < 0.01). In multivariable linear regression analysis, BMI (β = − 0.516; 95% confidence interval [CI], − 0.632 to − 0.357; P < 0.001), female sex (β = 0.372; 95% CI, 0.215 to 0.475; P < 0.001), diabetes duration (β = − 0.169; 95% CI, − 0.319 to − 0.025; P = 0.022) and glycated haemoglobin (β = − 0.184; 95% CI, − 0.281 to − 0.039; P = 0.010) were significantly associated with global upslope in the T2DM group. Multivariable logistic regression analysis indicated that T2DM was an independent predictor of microvascular dysfunction in normal-weight (odds ratio[OR], 6.46; 95% CI, 2.08 to 20.10; P = 0.001), overweight (OR, 7.19; 95% CI, 1.67 to 31.07; P = 0.008) and obese participants (OR, 11.21; 95% CI, 2.38 to 52.75; P = 0.002).

Conclusions
Myocardial microvascular function gradually declined with increasing BMI in both diabetes and non-diabetes status. T2DM was associated with an increased risk of microvascular dysfunction, and obesity exacerbated the adverse effect of T2DM.