bluuebunny/crossref_metadata_2025_split huggingface dataset:
Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study
Authors: Jin Yinzi , Xu Jin , Zhu Weiming , Zhang Yaoguang , Xu Ling , Meng Qingyue 
Published: August 2020

Abstract
Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.
Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers.
Results : Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.
Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.
Transtheoretical model-based nutritional interventions in adolescents: a systematic review
Authors: Langamer Jennifer Nakabayashi , Melo Giselle Rha-isa , Toral Natacha 
Published: August 2020

Abstract
Background: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake.Methods: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.Results: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.
Effectiveness and Tolerability of Repetitive Transcranial Magnetic Stimulation for Preventive Treatment of Episodic Migraine: A Single Centre, Randomised, Double-Blind, Sham-Controlled Phase 2 Trial (Magnet-EM).
Authors: Safiai Nabil Izzaatie Mohamad , Amir Nur Ain , Basri Hamidon bin , Mat Liyana Najwa Inche , Hoo Fan Kee , Khan Abdul Hanif Khan Yusof , Loh Wei Chao , Chia Peck Kee , Ramachandran Vasudevan , Din Hazwan Mat , Samsudin Intan Nureslyna , Fernandez Aaron , Mohamed Mohd Hazmi , Ching Siew Mooi , Hashim Hasnur Zaman , Sulaiman Wan Aliaa Wan 
Published: August 2020

Abstract
Background: This is a phase II randomised, double-blind, sham-controlled trial to evaluate the effectiveness and tolerability of repetitive transcranial magnetic stimulation for preventive treatment of episodic migraine among migraine subjects. Methods: Subjects age 18 to 60 years will undergo a baseline evaluation to establish the diagnosis of migraine based on International Classification of Headache Disorder 3rd Edition (ICHD-3). Those who fulfil the ICHD-3 criteria for episodic migraine and compliant to the headache diary during a month run-in period will be enrolled. A total of 76 subjects will be randomised to receive either transcranial magnetic stimulation or sham stimulation for 5 sessions within 2 weeks duration. Follow-up sessions will be conducted monthly for three consecutive months. Prior to treatment, subjects will be required to fill up questionnaires and undergo few procedures such as electroencephalography, transcranial doppler ultrasound and biochemical analysis for serum serotonin, serum calcitonin-gene related peptide and serum beta-endorphin. These procedures will be repeated at month 3 after receiving last treatment. The primary outcome measure of this study is the difference in mean monthly migraine days at baseline and at month 1, 2 and 3 after treatment sessions. Discussion: Following evidence from previous studies showing restoration of dorsolateral prefrontal cortex (DLPFC) activation to almost normal level, the rTMS intervention will target left DLPFC in this study. Meanwhile, the least number of treatment sessions reported which proved to be effective in reducing migraine days was three session of rTMS given in alternate days. Hence, an intermediate duration of treatment sessions is selected for this study. It is set to five treatment sessions given within 2 weeks duration. Trial registration: NCT03556722. Transcranial Magnetic Stimulation in Episodic Migraine (Magnet-EM) was registered on 27th April 2018. https://clinicaltrials.gov/ct2/show/NCT03556722.
Association between long-term exposure to air pollutants and cardiopulmonary mortality rates in South Korea
Authors: Hwang Jeongeun , Kwon Jinhee , Yi Hahn , Bae Hyun-Jin , Jang Miso , Kim Namkug 
Published: August 2020

Abstract
Background: The association between long-term exposure to air pollutants, including nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ozone (O3), and particulate matter 10 μm or less in diameter (PM10), and mortality by ischemic heart disease (IHD), cerebrovascular disease (CVD), pneumonia (PN), and chronic lower respiratory disease (CLRD) is unclear. We investigated whether living in an administrative district with heavy air pollution is associated with an increased risk of mortality by the diseases through an ecological study using South Korean administrative data over 19 years. Methods: A total of 249 Si-Gun-Gus, unit of administrative districts in South Korea were studied. In each district, the daily concentrations of CO, SO2, NO2, O3, and PM10 were averaged over 19 years (2001–2018). Age-adjusted mortality rates by IHD, CVD, PN and CLRD for each district were averaged for the same study period. Multivariate beta-regression analysis was performed to estimate the associations between air pollutant concentrations and mortality rates, after adjusting for confounding factors including altitude, population density, higher education rate, smoking rate, obesity rate, and gross regional domestic product per capita. Associations were also estimated for two subgrouping schema: Capital and non-Capital areas (77:172 districts) and urban and rural areas (168:81 districts). Results: For IHD, higher SO2 concentrations were significantly associated with a higher mortality rate, whereas other air pollutants had null associations. For CVD, SO2 and PM10 concentrations were significantly associated with a higher mortality rate. For PN, O3 concentrations had significant positive associations with a higher mortality rate, while SO2, NO2, and PM10 concentrations had significant negative associations. For CLRD, O3 concentrations were associated with an increased mortality rate, while CO, NO2, and PM10 concentrations had negative associations. In the subgroup analysis, positive associations between SO2 concentrations and IHD mortality were consistently observed in all subgroups, while other pollutant-disease pairs showed null, or mixed associations.Conclusion: Long-term exposure to high SO2 concentration was significantly and consistently associated with a high mortality rate nationwide and in Capital and non-Capital areas, and in urban and rural areas. Associations between other air pollutants and disease-related mortalities need to be investigated in further studies.
Anxiety Disorders and PTSD in Palestine: Litreture review
Authors: Marie Mohammad Mohammad-Zeyad , SaadAdeen Sana , Battat Maher 
Published: August 2020

Abstract
Background The WHO reports that anxiety disorders are the most common mental disorders worldwide. Most people who experience such events recover from them, but people with post-traumatic stress disorder (PTSD) continue to be severely depressed and anxious for months or even years following the event. Palestinians are especially at a higher risk for developing anxiety disorders and PTSD due to their chronic exposure to political violence, prolonged displacement, and others as a limited professional, educational, financial opportunities, and mental health services. This paper aims to provide a systematic review of the literature and established studies concerning Anxiety disorders besides PTSD in Palestine.Methods PubMed, Science Direct, Google Scholar was used to search for materials, for the critical analysis of empirical articles, the following aspects were considered: study type, sample, and the key findings.Results Twenty-four studies from Palestine (West Bank and Gaza) were included in this review. Five studies related to children, five related to Adolescent, three related to women, three related to physical diseases and four related to gender and age differences . Results showed that anxiety disorders and PTSD were one of the most common mental disorders in Palestine. Anxiety and PTSD develop from a complex set of risk factors, including genetics, personality, and life events. They are highly associated with poor quality of life and disability. The results indicate that a significant proportion of Palestinian experiencing serious psychological distress especially anxiety and PTSD. Therefore, a mental health policy for Palestinians must deal with several challenges. Distinct barriers including inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, and occupation need to be addressed.Conclusion As a primary prevention, occupation has to be considered as a main source of the anxiety and other mental health disorders in Palestine. Besides, there is a need to implement mental health care system through the multidisciplinary work and raising awareness regarding prevalent of mental disorders.
Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: A cross-sectional study
Authors: Gils Tinne , Laxmeshwar Chinmay , Duka Marve , Malakyan Khachatur , Siomak Olga Valentinovna , Didik Vitaly Stephanovich , Lytvynenko Natalia , Terleeva Yana , Donchuk Dimitri , Isaakidis Petros 
Published: August 2020

Abstract
Background: Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common comorbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine to provide good quality ambulatory care.
Methods: This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess service available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human-resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
Results: We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. Anti-TB-medicines and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
Conclusion: Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Traffic police officers’ use of first aid skills at work: a qualitative content analysis of focus group discussions in Dar es Salaam, Tanzania
Authors: Ndile Menti Lastone , Saveman Britt-Inger , Lukumay Gift G. , Mkoka Dickson A. , Outwater Anne H. , Backteman-Erlanson Susann 
Published: August 2020

Abstract
Background: The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several training programmes have been implemented to build lay responder first aid skills. Findings show that most programmes significantly improved participants’ first aid skills. However, there is a gap in knowledge of what factors influence the use of these skills in real situations. The current study aimed to describe police officers’ views on and experiences of factors that facilitate or hinder their use of trained first aid skills at work. Methods Thirty-four police officers participated in five focus group discussions. A structured interview guide was used to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative content analysis. Results: We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator; work situation and hospital atmosphere were considered hindrances; and the physical and social environments and the resources available for providing first aid could be either facilitators or hindrances. Conclusion: Practical exposure during training is perceived to improve police officers’ confidence in applying their first aid skills at work. However, contextual factors related to the working environment need to be addressed to promote this transfer of skills.
How do private practitioners in Pakistan manage children suspected having tuberculosis?
Authors: Yaqoob Aashifa , Hinderaker Sven , Fatima Razia , Najmi Hina , Haq Anwar 
Published: August 2020

Abstract
Background:Private providers provide a large portion of health care in Pakistan, including tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision and support. Diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods:This cross-sectional study was based on a national survey that measured under-reporting of children with TB in 12 selected districts in Pakistan from Apr-Jun, 2016. We explored the practices of private health care providers, like general practitioners, pediatricians, pulmonologists and chest specialists, involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB.Results:Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG scar was more common in female children. Private providers relied on chest X-ray in 46.1%, but tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP).Conclusion:This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but cases identified in investigations were often not notified to the NTP. This problem needs to be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.
Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal
Authors: Poudyal Indra Prasad , Khanal Pratik , Mishra Shiva Raj , Malla Milan , Poudel Prakash , Jha Raj Kumar , Phuyal Anil , Barakoti Abiral , Adhikari Bipin 
Published: August 2020

Abstract
Background The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. Methods This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. Results Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR=0.47; CI: 0.23-0.94), those from Gandaki Province (AOR=0.32; CI: 0.13-0.79) and literate (AOR=0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. Conclusions This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.
The psychometric properties of the Bergen–Yale Sex Addiction Scale for the Iranian population
Authors: Youseflu Samaneh , Kraus Shane W. , Razavinia Fatemeh , Afrashteh Majid Yousefi , niroomand soudabeh 
Published: August 2020

Abstract
Introduction

Background: The assessment of sex addiction among different populations requires a valid and reliable tool. Since the Bergen–Yale Sex Addiction Scale (BYSAS) was not available in Iran, this study aimed to evaluate the validity and reliability of the Persian version of the BYSAS.
Method: After translation/back-translation procedure, a total of 756 Iranian men and women completed the BYSAS. The structural validity of this tool was evaluated by exploratory and confirmatory factor analyses. An expert panel review also examined content validity of the items. Psychometric properties of the scale including validity, reliability (internal consistency [Cronbach’s alpha]) and test-retest) and factor structure were assessed.
Results: Content Validity Index (CVI) and Content Validity Ratio (CVR) scores for the BYSAS were 0.75 and 0.62, respectively. In the measure's structural validity, the results of exploratory and confirmatory factor analysis supported the One-factor structure. Data analysis demonstrated satisfactory internal consistency (Cronbach’s alpha ranging from 0.88 to 0.89).
Discussion: Study findings suggest that the BYSAS is a valid and reliable instrument for assessing sex addiction among Persian speaking adults. Replication of research findings is needed to expand the BYSAS for clinical and non-clinical Iranian populations.