bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study
Authors: Shi Ruoding , Meacham Susan , Davis George C. , You Wen , Sun Yu , Goessl Cody 
Published: November 2019

Abstract

Background
Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as “coal-county effect.” We also investigated what factors may accentuate or attenuate the coal-county effect.

Methods
An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.

Results
The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.

Conclusions
This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.
Prevalence and associated factors of burnout among Debre Berhan University medical students: a cross-sectional study
Authors: Haile Yohannes Gebreegziabhere , Senkute Amanuel Lemma , Alemu Berhanu Tadesse , Bedane Dawit Mamo , Kebede Kaleab Berhanu 
Published: November 2019

AbstractBackgroundBurnout, a measure of professional distress, is more common among medical professionals. About half of medical students have this problem. However, little is known about the burnout status of medical students in Ethiopia. Therefore, the aim of this study was to assess the prevalence and associated factors of burnout among medical students of Debre Berhan University (DBU).MethodsA cross-sectional study was conducted on randomly selected 151 medical students of DBU. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Participants were reported as having burnout if they scored ≥27 on Emotional Exhaustion (EE), ≥13 on Depersonalization (DP) sub-scales, and ≤ 31 on Personal Accomplishment (PA) sub-scale of the MBI-HSS. EpiData version 3.1 was used for data entry while SPSS version 20 and STATA version 13 for windows were used for data analysis. Both univariable and multivariable binary logistic regression analyses were conducted. The degree of association between variables was assessed using odds ratio (OR) with 95% confidence interval (CI) at two-tailedp-value of < 0.05.ResultOf 144 medical students took part, 34.0% had symptoms of burnout. Regarding domains of burnout, 61.8% scored high on EE, 47.9% scored high on DP and 59.7% scored low on PA. Dissatisfaction with practice lecturer (AOR = 3.8, 95% CI (1.3, 11.6)), moderate social support (AOR = 0.2, 95% CI (0.1, 0.8)), and satisfaction with their education (AOR = 0.1 95% CI (0.0, 0.7)) were associated with burnout.ConclusionMore than one-third of medical students at DBU had burnout. Individual and organizational level interventions targeting students who had poor social support, dissatisfied by their lecturer at the hospitals and their education are recommended.
Deep learning for pollen allergy surveillance from twitter in Australia
Authors: Rong Jia , Michalska Sandra , Subramani Sudha , Du Jiahua , Wang Hua 
Published: November 2019

Abstract

Background
The paper introduces a deep learning-based approach for real-time detection and insights generation about one of the most prevalent chronic conditions in Australia - Pollen allergy. The popular social media platform is used for data collection as cost-effective and unobtrusive alternative for public health monitoring to complement the traditional survey-based approaches.

Methods
The data was extracted from Twitter based on pre-defined keywords (i.e. ’hayfever’ OR ’hay fever’) throughout the period of 6 months, covering the high pollen season in Australia. The following deep learning architectures were adopted in the experiments: CNN, RNN, LSTM and GRU. Both default (GloVe) and domain-specific (HF) word embeddings were used in training the classifiers. Standard evaluation metrics (i.e. Accuracy, Precision and Recall) were calculated for the results validation. Finally, visual correlation with weather variables was performed.

Results
The neural networks-based approach was able to correctly identify the implicit mentions of the symptoms and treatments, even unseen previously (accuracy up to 87.9% for GRU with GloVe embeddings of 300 dimensions).

Conclusions
The system addresses the shortcomings of the conventional machine learning techniques with manual feature-engineering that prove limiting when exposed to a wide range of non-standard expressions relating to medical concepts. The case-study presented demonstrates an application of ’black-box’ approach to the real-world problem, along with its internal workings demonstration towards more transparent, interpretable and reproducible decision-making in health informatics domain.
Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study
Authors: Shawahna Ramzi 
Published: November 2019

Abstract

Background
Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs.

Methods
A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process.

Results
Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient’s identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis.

Conclusions
In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.
Establishing spatially-enabled health registry systems using implicit spatial data pools: case study – Uganda
Authors: Aturinde Augustus , Rose Nakasi , Farnaghi Mahdi , Maiga Gilbert , Pilesjö Petter , Mansourian Ali 
Published: November 2019

AbstractBackgroundSpatial epidemiological analyses primarily depend on spatially-indexed medical records. Some countries have devised ways of capturing patient-specific spatial details using ZIP codes, postcodes or personal numbers, which are geocoded. However, for most resource-constrained African countries, the absence of a means to capture patient resident location as well as inexistence of spatial data infrastructures makes capturing of patient-level spatial data unattainable.MethodsThis paper proposes and demonstrates a creative low-cost solution to address the issue. The solution is based on using interoperable web services to capture fine-scale locational information from existing “spatial data pools” and link them to the patients’ information.ResultsBased on a case study in Uganda, the paper presents the idea and develops a prototype for a spatially-enabled health registry system that allows for fine-level spatial epidemiological analyses.ConclusionIt has been shown and discussed that the proposed solution is feasible for implementation and the collected spatially-indexed data can be used in spatial epidemiological analyses to identify hotspot areas with elevated disease incidence rates, link health outcomes to environmental exposures, and generally improve healthcare planning and provisioning.
Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?
Authors: Clavel Nathalie , Pomey Marie-Pascale , Ghadiri Djahanchah Philip 
Published: November 2019

Abstract

Background
Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices.

Methods
In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers.

Results
Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement.

Conclusion
This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.
Hurricanes and healthcare: a case report on the influences of Hurricane Maria and managed Medicare in treating a Puerto Rican resident
Authors: Mellgard George , Abramson David , Okamura Charles , Weerahandi Himali 
Published: November 2019

Abstract

Background
While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria’s impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York.

Case presentation
A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient’s treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines.

Conclusions
We employ this patient’s narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.
Analysis of polymorphisms, promoter methylation, and mRNA expression profile of maternal and placental P53 and P21 genes in preeclamptic and normotensive pregnant women
Authors: Harati-Sadegh Mahdiyeh , Kohan Leila , Teimoori Batool , Mehrabani Mehrnaz , Salimi Saeedeh 
Published: November 2019

Abstract

Background
Preeclampsia (PE), as a multisystem disorder, is associated with maternal hypertension and proteinuria. Apoptosis seems to be involved in the pathophysiology of PE, although its precise pathogenic mechanisms are not well established. In this study, we aimed to identify the association between maternal TP53-rs1042522, P21-rs1801270, and P21-rs1059234 polymorphisms and PE. In addition, we examined the effects of promoter methylation and TP53 and P21 polymorphisms on placental mRNA expression in PE women.

Methods
The blood of 226 PE women and 228 normotensive pregnant women was examined in this study. In addition, the placentas were genotyped in 109 PE and 112 control women. The methylation status was assessed by a methylation-specific PCR assay, while mRNA expression was examined via Quantitative Real Time PCR.

Results
The maternal and placental P21-rs1801270 CA genotype had a significant association with the reduced risk of PE. In the dominant, recessive, and allelic models, maternal/placental P21-rs1059234 polymorphism had no statistically significant association with the risk of PE. On the other hand, the reduced risk of PE was associated with maternal, but not placental TP53-rs1042522 polymorphism in the dominant and recessive models. The maternal and placental P21-rs1801270 polymorphism was associated with PE risk. The maternal P21 Trs1059234Crs1801270 haplotype was associated with 3.4-fold increase in PE risk, However the maternal P21 Trs1059234Ars 1801270 haplotype and placental Crs1059234CA rs1801270 haplotype led to 0.5 and 0.4-fold decrease in PE risk, respectively. PE women showed 5.6 times higher levels of placental mRNA expression of TP53 gene, although it was not associated with rs1042522 polymorphism. The relative placental mRNA expression of P21 gene was 0.2 in PE women. It was also 2.4 times higher in individuals with rs1801270CA genotype than those with AA genotype. The hyper-methylation of P21 and TP53 genes in the promoter region was associated with a 3.4-fold and 3-fold increase in PE risk, respectively. However, no association was found between P21 and TP53 mRNA expression and promoter methylation.

Conclusion
In conclusion, P21-rs1801270 and TP53-rs1042522 polymorphisms were involved in reduced risk of PE. P21-rs1801270 was associated with decreased P21 mRNA expression. The hyper-methylation of P21 and TP53 genes in the promoter region was associated with a higher PE risk.
Acupuncture and herbal moxibustion for the treatment of ‘BiQiu’ (allergic rhinitis symptoms) in a Hong Kong Chinese medicine clinic: a randomized controlled trial
Authors: Yung Ting Yiu , Zhang Hongwei , Tang Lap Che , Zhang Lang , Law Chak On , Tam Wai Man , Chan Chun Wai , Chen Heng Chun , Lee Man Hork , Ziea Tat Chi , Ng Fung Leung , Lin Zhi Xiu 
Published: November 2019

Abstract
Background
Allergic rhinitis (AR) is a common disease. No evidence is available for the clinical application of acupuncture and moxibustion for the management of AR symptoms in Hong Kong. This study aimed to evaluate the clinical effectiveness of acupuncture with or without herbal moxibustion on relieving AR symptoms in the Hong Kong population.

Methods
A single-centre, randomized, assessor-blinded, controlled trial with three parallel arms (acupuncture alone, acupuncture combined with herbal moxibustion treatment and waitlist) was designed. Groups with acupuncture treatment received treatment 3 times per week for a total of 12 sessions in 4 weeks. Acupuncture combined with herbal moxibustion treatment group received herbal moxibustion once per week for a total of 4 sessions over 4 weeks in addition to acupuncture treatment. Participants in the waitlist group received no treatment. All patients received advice on healthy lifestyle, diet, and exercise.

Results
Ninety-six subjects were recruited and allocated randomly (1:1:1) into three study groups. Compared to the waitlist group, both treatment groups demonstrated statistically significant decreases in TNSS and RQLQ at the end of treatment as well as after follow-up period (all P < 0.01). However, there was no statistically differences between these two treatment groups. There was no difference in the change of total IgE levels among study groups before or after the treatment. Only one patient reported adverse effects with herbal moxibustion treatment, and no adverse effects were found in others.

Conclusions
This study supports that acupuncture could help relieve AR symptoms, but no evidence on additional treatment effect of herbal moxibustion was found.
Trial registration ChiCTR-INR-16010047 registered on November 25, 2016.
Risk factors and predicted distribution of visceral leishmaniasis in the Xinjiang Uygur Autonomous Region, China, 2005–2015
Authors: Ding Fangyu , Wang Qian , Fu Jingying , Chen Shuai , Hao Mengmeng , Ma Tian , Zheng Canjun , Jiang Dong 
Published: November 2019

Abstract

Background
Visceral leishmaniasis (VL) is a neglected disease that is spread to humans by the bites of infected female phlebotomine sand flies. Although this vector-borne disease has been eliminated in most parts of China, it still poses a significant public health burden in the Xinjiang Uygur Autonomous Region. Understanding of the spatial epidemiology of the disease remains vague in the local community. In the present study, we investigated the spatiotemporal distribution of VL in the region in order to assess the potential threat of the disease.

Methods
Based on comprehensive infection records, the spatiotemporal patterns of new cases of VL in the region between 2005 and 2015 were analysed. By combining maps of environmental and socioeconomic correlates, the boosted regression tree (BRT) model was adopted to identify the environmental niche of VL.

Results
The fitted BRT models were used to map potential infection risk zones of VL in the Xinjiang Uygur Autonomous Region, revealing that the predicted high infection risk zones were mainly concentrated in central and northern Kashgar Prefecture, south of Atushi City bordering Kashgar Prefecture and regions of the northern Bayingolin Mongol Autonomous Prefecture. The final result revealed that approximately 16.64 million people inhabited the predicted potential infection risk areas in the region.

Conclusions
Our results provide a better understanding of the potential endemic foci of VL in the Xinjiang Uygur Autonomous Region with a 1 km spatial resolution, thereby enhancing our capacity to target the potential risk areas, to develop disease control strategies and to allocate medical supplies.