bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fasting Plasma Glucose Variability in Midlife and the Risk of Parkinson’s Disease: A Nationwide Population-Based Study
Authors: Chung Hye Soo , Lee Ji Sung , Kim Jung A , Roh Eun , Lee You-Bin , Hong So-Hyeon , Yoo Hye Jin , Baik Sei Hyun , Kim Nan Hee , Seo Ji A , Yu Ji Hee , Kim Sin Gon , Kim Nam Hoon , Choi Kyung Mook 
Published: March 2020

Abstract
Background — Athough an association exists between type 2 diabetes and Parkinson’s disease (PD), the implications of glycemic variability on PD are unknown. We assessed the future risk of incident PD according to visit-to-visit fasting plasma glucose (FPG) variability; this was calculated using standard deviation (FPG-SD), coefficient variance (FPG-CV), and variability independent of the mean (FPG-VIM). Methods — Using the Korean National Health Insurance Service–Health Screening Cohort, we followed 131,625 Korean adults without diabetes. This study population was divided into a midlife group (<65 years) and an elderly group (≥65 years), during a median follow-up of 8.4 years. Results — The adjusted hazard ratios (HRs) were calculated using a multivariable Cox proportional hazard analysis. In the midlife group, the HRs for incident PD in the highest quartile of FPG variability, as measured using SD, CV, and VIM, were 1.35 (95% confidence interval (CI), 1.07–1.70), 1.31 (95% CI, 1.04–1.65), and 1.33 (95% CI, 1.06–1.67), respectively, when compared to the lowest quartile group. However, the incident PD was not different depending on FPG variability in the elderly group. Kaplan–Meier curves of PD probability showed a progressively increasing risk of PD according to the higher FPG variability in the midlife group. According to a multivariable adjusted model, a 1-SD unit increment in glycemic variability was associated with a 9% higher risk for incident PD in the midlife group. Conclusions — Increased long-term glycemic variability is a preceding risk factor for developing PD in the midlife population without diabetes.
Effectiveness, Safety, and Major Adverse Limb Events in Atrial Fibrillation Patients with Concomitant Diabetes Mellitus Treated with Non-Vitamin K Antagonist Oral Anticoagulants
Authors: Chan Yi-Hsin , Lee Hsin-Fu , Li Pei-Ru , Liu Jia-Rou , Chao Tze-Fan , Wu Lung-Sheng , Chang Shang-Hung , Yeh Yung-Hsin , Kuo Chi-Tai , See Lai-Chu , Lip Gregory Y. H. 
Published: March 2020

Abstract
Background: Evidence of adverse clinical outcomes for non-vitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation (AF) and diabetes mellitus are limited. We investigated the effectiveness, safety, and major adverse limb events for NOACs versus warfarin among diabetic AF patients. Methods: In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, we identified a total of 20,967 and 5,812 consecutive AF patients with diabetes taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. We used propensity-score stabilized weighting to balance covariates across study groups. Results: NOAC was associated with a lower risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio (aHR):0.88; [95% confidential interval (CI):0.78-0.99]; P =0.0283), major adverse limb events (aHR:0.72;[95%CI:0.57-0.92]; P =0.0083), and major bleeding (aHR:0.67;[95%CI:0.59-0.76]; P <.0001) compared to warfarin. NOACs decreased MACE in patients of 75 but not in those aged <75 years ( P interaction=0.01), and in patients with ischemic heart disease (IHD) compared to those without IHD ( P interaction<0.01). For major adverse limb events, the advantage of risk reduction for NOAC over warfarin persisted in high risk subgroups including age 75 years, chronic kidney disease, IHD, peripheral artery disease, or use of concomitant antiplatelet drugs. Conclusion: NOACs were associated with a lower risk of effectiveness, safety, and major adverse limb events than warfarin among diabetic AF patients. Thromboprophylaxis with NOACs should be considered in the diabetic AF population with a high atherosclerotic burden.
From income inequality to social corrosion: impact on health levels in an international efficiency comparison panel
Authors: Schenkman Simone , Bousquat Aylene 
Published: March 2020

Abstract
Background Health equity, although addressed in several publications dealing with health efficiency analysis, usually does not usually remain as a relevant result in empirical studies, due to the difficulty in its operationalization. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequality was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequality levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth showed inequality and per capita health expenditure in the final model. The variable linfant mortality comprehended education, in association with care seeking due to diarrhea, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it increases the levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequalities affect society altogether, generating mistrust and reduced social cohesion.
Spillover Effect of Presence of Children on Parents Smoking Behavior among Chinese Couples: Empirical Evidence Based on China Family Panel Studies
Authors: LIN Haoxiang , Chang Chun , LIU Zhao , Tan Huaqing 
Published: March 2020

Abstract
Background: Previous studies found social-psychological factors affect smoking behaviors. However those studies mainly focused on marriage, family, education background and gender factors. Studies regarding the impact of children are lacking. This study explores how presence of children is associated with parents’ smoking behaviors. Methods: The data used in this study was from China Family Panel Studies. The method used for data analyses is panel regression with fixed effect. We firstly regressed the dependent variable on number of children with other covariates. Then, we divided our sample into several groups based on education attainment, occupation, age difference and urban or rural residents to examine heterogeneous effect. Results: Full sample regressions show that the number of children was significantly negatively associated with smoking behavior (OR=0.9292; P<0.01). Further subsample regression finds the spillover effect is only significant in the high-educated group (OR= 0.9151; P<0.01), high skilled workers (OR= 0.8891; P<0.05) and couples who had more than 2 years of age difference (OR=0.9148; P<0.01). Conclusions: This study confirmed that the presence of children indeed has an association with couple’s smoking behavior. Health promotional programs should take into account occupation, educational attainment and age difference of couples. For countries, stop smoking service is rare, if limited resources for cessation are to be used effectively then taking advantage of these ‘teachable moments’ becomes a necessity. Targeting cessation activities at those who presence children at early age is one such strategy.
Progress towards the 2020 Fast Track targets in Eastern sub-Sahara Africa region and in Ethiopia; using Global Burden of Disease 2017data
Authors: Mirkuzie Alemnesh H. , Ali Solomon , Abate Ebba , Worku Asnake , Misganaw Awoke 
Published: March 2020

Abstract
BackgroundSustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track millstones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in Eastern sub-Saharan Africa (ESSA) region and in Ethiopia across ages using Global Burden of Disease (GBD) 2017 data. Methods The National Data Management Center for health research team at Ethiopian Public Health Institute has analyzed the GBD 2017 data for the year 2010 to 2017 for Ethiopia and ESSA countries. GBD 2017 data sources were census, demographic and health surveys, prevention of mother-to-child HIV transmission and anti-retroviral treatment programs, sentinel surveillances and UNAIDS spectrum modeling. Age standardized and age specific HIV/AIDS incidence, prevalence, mortality, Disability Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence limits. Results Slow progress has been recorded in reducing new HIV infection in ESSA since 2010; only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania and Uganda have already achieved 75% mortality reduction target set for 2020. With incidence: prevalence ratio of < 0.03, Ethiopia, Rwanda and Uganda are on track to end HIV by 2030. Ethiopia has an incidence: mortality ratio <1 due to high mortality; while Kenya, Rwanda, Tanzania and Uganda, have a ratio >1 due to high incidence. Ethiopia has reduced the HIV incidence rate by 76% among under 5 children and seem to be on track to attain the 2020 national target but far behind achieving the target among the 15-49 age group. Conclusion The ESSA countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020 since 2010, although they progress poorly in reducing HIV incidence. Having an incidence:prevalence ratio of less than 0.03, Ethiopia, Rwanda and Uganda are well heading towards epidemic control. The high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to bring undiagnosed cases to treatment and care services across age. For sustainable epidemic control, Ethiopian needs to build strong institutional capacity to generate strong evidence to support policy decision.
Predictors of infant-survival practices among mothers attending paediatric clinics in Ijebu-Ode, Ogun State, Nigeria
Authors: Sokefun Eniolufolake Elizabeth , Atulomah Nnodimele Onuigbo 
Published: March 2020

Abstract
Background: Despite concerted global efforts towards achieving infant-survival, infant mortality lingers as a problem in developing countries. Environmental and personal-level factors are assumed to account for this situation. This study was undertaken to provide better understanding of the dynamics of predictors of infant-survival practices among mothers with infants attending paediatric clinics.Methods: A cross-sectional survey design was adopted. Data was collected from 386 consenting nursing mothers selected by stratified sampling technique. Interviewer-administered questionnaires were used for data collection. The questionnaire consisted of 38-items involving demographic information of respondents, health-literacy counsels received during antenatal care, social-support from significant others and self-efficacy to carry-out infant-survival instructions. Responses were transformed into rating scales for each variable and data analysis was conducted by linear regression analysis with test of hypotheses, at 5% level of significance.Results: The mean age of respondents was 29.79±5.84years. Majority (81.6%) were married. Yorubas (83.90%) were predominant. Participants had mean scores of 11.41±3.91, 10.61±3.67 and 16.61±4.56 respectively computed for levels of health-literacy, social-support and self-efficacy. The dependent variable measured was their level of infant-survival practices and respondents scored 16.53±4.71. The study found a significant association among variables. Self-efficacy was the major predictor variable of self-reported infant-survival practices (R=4.66; R2=0.217; P˂0.05).Conclusion: We conclude that participants had average levels of health-literacy, social-support, self-efficacy and infant-survival practices. Efforts should be made by healthcare providers to empower pregnant women on activities essential for infant-survival. Family members of nursing mothers should as well be knowledgeable about the advantages of supporting them.
Lack of Sexual Identity Disclosure in China May Distort Efforts to Combat STI Epidemics
Authors: Kumar Navin , Forastiere Laura , Zhang Tiange , Yang Fan , Li Katherine T , Tang Weiming , Tucker Joseph D , Christakis Nicholas A , Alexander Marcus 
Published: March 2020

Abstract
Background. To evaluate whether Chinese men who have sex with men (MSM) select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive role in anal sex). Methods. We studied uptake of gonorrhea and chlamydia testing among Chinese MSM (N=431) in a multi-site RCT (December 2018 to January 2019). We collected socio-demographics, relevant medical and sexual history, and disclosure of sexual identity (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision-making. Results. Among 431 MSM, mean age was 28 years (SD=7.10) and 65% were out to someone. MSM who indicated the versatile role and were out to someone had a 26.8% (95%CI=6.1, 47.5) increased likelihood for selecting the rectal test vs the urethral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI=6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. Conclusions. Anal sex role and identity disclosure may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community-based efforts may reduce stigma-based barriers to testing.
The effect of government financial investment on the development of traditional medicine: Evidence from public Traditional Chinese Medicine hospitals (PTHs) of Henan Province, China
Authors: Ren Weicun , Fu Xiaoli , Tarimo Clifford Silver , Kasanga Maisa , Wang Yanqing , Wu Jian 
Published: March 2020

Abstract
Background Traditional medicine has long been used to address relatively common illness, and Chinese government has been continually increasing its investments on Public Traditional Chinese Medicine hospitals (PTHs) in recent years. Objectives This study aimed to assess the scales and structure of investments on PTHs in Henan Province, China, in order to analyze the contribution of Government Financial Investment (GFI) to the revenue growth of PTHs, as well as raising practical investment strategies for decision-makers. Methods This study was a panel data research, conducted in Henan Province, China. By collecting 143 PTHs’ operational data from 2005 to 2017, the authors computed data with Barrow Economic Growth Model (BEG), Stochastic Frontier Analysis (SFA) and Vector Autoregressive Model (VAR), respectively.Results The study observed that the contribution of GFI to PTHs’ revenue growth was positive (average MPG=2.84), which means the scale of GFI hadn’t reached an optimal level. The scales of GFI on Grade III, Grade II A, Grade II B PTHs need to be increased by -5.96%, 4.88% and 11.51% respectively in order to maximize the input-output efficiency. The third year after the investment year may be a more effective period for conducting an effect evaluation of GFI in Henan Province.Conclusions GFI on PTHs usually has a long-term impact on PTHs. Government needs to adjust its GFI policy to maximize the input-output efficiency.
Awareness, use and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe
Authors: Johnson Cheryl Case , Neuman Melissa , MacPherson Peter , Choko Augustine , Quinn Caitlin , Wong Vincent J , Hatzold Karin , Nyirenda Rose , Ncube Getrude , Baggaley Rachel , Terris-Prestholt Fern , Corbett Elizabeth 
Published: March 2020

Abstract
Background Many southern African countries are nearing the global goal to diagnose 90% of people with HIV by 2020. In 2016, 84% and 86% of people with HIV knew their status in Malawi and Zimbabwe respectively. Despite this progress, gaps remain, particularly among men (≥25 years). We investigated awareness, use and willingness to HIV self-test (HIVST) prior to large scale implementation and explored sociodemographic associations.Methods We pooled responses from two of the first cross-sectional Demographic Health Surveys to include HIVST questions: Malawi and Zimbabwe in 2015-16. Sociodemographic factors and sexual risk behaviours associated with never testing for HIV, and awareness, past use and future willingness to self-test were investigated using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with completed questionnaire and a valid HIV result. Analysis of willingness to self-test was restricted to Zimbabwean men as Malawians and women were not asked this question.Results Of 31 385 individuals, the proportion never-tested was higher for men (31.2%) than women (16.5%), p<0.001. For men, having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2% and 12.6% respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio (aOR)=1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger age, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with having previously tested for HIV, high sexual risk, and being older (≥25 years) associated with greater willingness. Wealthy men had greater awareness of HIVST than poorer men (p<0.001). Men at higher sexual risk, compared to men at lower risk, had the greatest willingness to self-test (aOR=3.74; 95%CI: 1.39-10.03, p<0.009).Conclusions In 2015-16 many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience at that time, willingness to self-test was high, especially in older men with moderate to high sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale-up. Programmes introducing, or planning to introduce HIVST, should consider including questions in population-based surveys.
Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population
Authors: Agodirin Olayide , Olatoke Samuel , Rahman Ganiyu , Olaogun Julius , Olasehinde Olalekan , Katung Aba , Kolawole Oladapo , Ayandipo Omobolaji , Etonyeaku Amarachukwu , Habeeb Olufemi , Adeyeye Ademola , Agboola John , Akande Halimat , Oguntola Soliu , Akanbi Olusola , Fatudimu Oluwafemi 
Published: March 2020

Abstract
BACKGROUND: The help-seeking interval or the primary-care interval are points of delays in breast cancer presentation. To inform future breast cancer down-staging intervention, we described the contribution of each interval to the delay and the impact of delay on tumor progression.METHOD: Multicentered survey from June 2017 to May 2018. We hypothesized that most patients visited the First Healthcare Provider within 60days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression.RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230(60%, 95% CI 53-63). Most had long primary-care(237 of 377(64% 95%CI 59-68) and detection-to-specialist(293 (73% (95%CI 68-77)) intervals. The primary care interval(median 106days) was longer than the help-seeking interval( median 42days )Wilcoxon signed-rank test p= 0.001. There was strong correlation between length of primary care interval and the detection-to-specialist interval(r= 0.9, 95%CI 0.88- 0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor(>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm(95%CI 4.0-5.0). The instantaneous hazard of progressing from early to locally advanced disease was least in the first 30days(3%). The hazard was 31% in 90days.CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.
Efficacy of interventions to improve public support for evidence based public health and climate change policy measures: a systematic review.
Authors: Coleman Rachel , Clifford Rebecca , Hewitt Catherine , McCambridge Jim 
Published: March 2020

Abstract
Background Policies which reduce affordability and availability of alcohol are known to be effective in reducing alcohol harms. Public support is important in policy decision making and implementation, and it may be possible to intervene to improve public support for alcohol policy measures. This systematic review aims to explore the effects of interventions to increase public support for evidence based policy measures in relation to either public health or climate change, and to examine underpinning theory and content of effective interventions.Methods The electronic search strategy was built around the constructs "public support or opinion", "health or climate change policies" and "interventions". Backward and forward searching was conducted, and authors of included papers contacted. Studies were included if they aimed to intervene to improve public support for public health or climate change policy measures, were controlled trials, and targeted the general public.Results Sixteen studies were included in this review, of which 13 had sufficient data for inclusion in meta analyses. The pooled effect estimates for continuous and binary data both show improvements in public support for policy measures as a result of evaluated interventions. The pooled standardised mean difference (n=8 studies) is 0.13 (95% C.I. 0.08-0.17), and the pooled odds ratio (n=5 studies) is 1.72 (95% C.I. 1.33-2.21). Careful attention to message framing, with or without narrative persuasion, appears particularly important content for efficacious interventions.Conclusion This systematic review demonstrates the efficacy of interventions to improve public support for public health policies.