bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach
Authors: McCalman Janya , Bainbridge Roxanne , James Yvonne Cadet , Bailie Ross , Tsey Komla , Matthews Veronica , Ungar Michael , Askew Deborah , Fagan Ruth , Visser Hannah , Spurling Geoffrey , Percival Nikki , Blignault Ilse , Doran Chris 
Published: November 2020

Abstract
Background
Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4–17 years). This paper outlines a protocol for implementing such complex community-driven research.

Methods/design
Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children’s social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated.

Discussion
The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.
Proteasome inhibitors reduce thrombospondin-1 release in human dysferlin-deficient myotubes
Authors: Fernández-Simón Esther , Lleixà Cinta , Suarez-Calvet Xavier , Diaz-Manera Jordi , Illa Isabel , Gallardo Eduard , de Luna Noemí 
Published: November 2020

Abstract
Background
Dysferlinopathies are a group of muscle disorders causing muscle weakness and absence or low levels of dysferlin, a type-II transmembrane protein and the causative gene of these dystrophies. Dysferlin is implicated in vesicle fusion, trafficking, and membrane repair. Muscle biopsy of patients with dysferlinopathy is characterized by the presence of inflammatory infiltrates. Studies in the muscle of both human and mouse models of dysferlinopathy suggest dysferlin deficient muscle plays a role in this inflammation by releasing thrombospondin-1. It has also been reported that vitamin D3 treatment enhances dysferlin expression. The ubiquitin-proteasome system recognizes and removes proteins that fail to fold or assemble properly and previous studies suggest that its inhibition could have a therapeutic effect in muscle dystrophies. Here we assessed whether inhibition of the ubiquitin proteasome system prevented degradation of dysferlin in immortalized myoblasts from a patients with two missense mutations in exon 44.

Methods
To assess proteasome inhibition we treated dysferlin deficient myotubes with EB1089, a vitamin D3 analog, oprozomib and ixazomib. Western blot was performed to analyze the effect of these treatments on the recovery of dysferlin and myogenin expression. TSP-1 was quantified using the enzyme-linked immunosorbent assay to analyze the effect of these drugs on its release. A membrane repair assay was designed to assess the ability of treated myotubes to recover after membrane injury and fusion index was also measured with the different treatments. Data were analyzed using a one-way ANOVA test followed by Tukey post hoc test and analysis of variance. A p ≤ 0.05 was considered statistically significant.

Results
Treatment with proteasome inhibitors and EB1089 resulted in a trend towards an increase in dysferlin and myogenin expression. Furthermore, EB1089 and proteasome inhibitors reduced the release of TSP-1 in myotubes. However, no effect was observed on the repair of muscle membrane after injury.

Conclusions
Our findings indicate that the ubiquitin-proteasome system might not be the main mechanism of mutant dysferlin degradation. However, its inhibition could help to improve muscle inflammation by reducing TSP-1 release.
No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain – a longitudinal population-based register study from four to 25 years of age
Authors: Lundkvist Josenby Annika , Westbom Lena 
Published: November 2020

Abstract
Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored.

Method
In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not.
Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification.

Result
Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age.

Conclusion
Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.
Professional oral care in end-of-life patients with advanced cancers in a hospice ward: improvement of oral conditions
Authors: Wu Ting-Ying , Liu Hsiu-Yueh , Wu Chien-Yi , Chen Hung-Cheng , Huang Shun-Te , Chen Ping-Ho 
Published: November 2020

AbstractBackgroundIn end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified.MethodsThis prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected forCandidaexamination; furthermore, oral function was recorded.ResultsThe presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95–114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06–123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45–223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly.ConclusionsProper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families.
The evaluation of stomatology English education in China based on ‘Guanghua cup’ international clinical skill exhibition activity
Authors: Wang Xi , Liu Yangjingwen , Yang Le , Zhou Kai , Cao Yang , Hong Yun , Huang Shuheng , Lin Zhengmei 
Published: November 2020

Abstract
Background
English education in professional areas has become more and more important with the increasing internationalization of health profession education in countries around the world. In this study, we aimed to evaluate current Chinese stomatology English education based on Chinese participants’ ability to apply stomatology English during an international stomatology skill competition called the ‘Guanghua Cup activity’.

Methods
The registration rate of English and Chinese volunteers and the answer rate and accuracy of Chinese and international contestants on the English knowledge quiz were statistically described. A five-point Likert scale questionnaire was delivered to all participants. The data were analyzed using the Spearman test, Kruskal-Wallis rank sum test and Mann-Whitney U test.

Results
Among the 194 students, the English and Chinese volunteer registration rate was 7.73 and 30.93%, respectively. The answer rate of Chinese contestants and international contestants in the English quiz was 25 and 75%, with an accuracy rate of 50 and 66.70%, respectively. The questionnaire was graded by Likert five-level classification. There was a positive correlation between the use of English textbooks in classes and the communication with international teachers and students in the competition (Rs = 0.348, p = 0.016). English volunteers had more preparation in English before the competition, more opportunities to communicate with international peers, and greater improvement in English ability than the contestants and Chinese volunteers (p < 0.001). After the competition, all participants paid more attention to stomatology English (p < 0.001).

Conclusions
Chinese stomatology students have difficulty in stomatology English application. The ‘Guanghua Cup’ helps to improve English proficiency of English volunteers and arouses the interest of stomatology English for all participants. Chinese stomatology school needs to strengthen and reach a consensus in stomatology English education.
Changes in practitioners’ attitudes, perceived training needs and self-efficacy over the implementation process of an evidence-based parenting program
Authors: Côté Marie-Kim , Gagné Marie-Hélène 
Published: November 2020

AbstractBackgroundEvidence-based family support programs such as the Triple P – Positive Parenting Program have the potential to enhance the well-being of children and families. However, they cannot achieve their expected outcomes if insufficient attention is paid to the implementation process. It has been demonstrated that practitioners’ attitudes towards evidence-based programs (EBPs), perceived training needs and self-efficacy for working with parents influence implementation outcomes (e.g., program acceptability, adoption, adherence and sustainability). At the same time, the experience of being involved in the implementation process of an EBP could enhance practitioners’ perceptions of the initiative. This study aimed to assess changes in practitioner’s attitudes, perceived training needs and self-efficacy over a two-year EBP implementation process, in interaction with their appraisal of their organization’s capacity to implement the EPB.MethodsIn the province of Quebec, Canada, Triple P was implemented and evaluated in two communities. Ninety-nine practitioners from various organizations completed questionnaires shortly before their training in Triple P and two years later.ResultsFindings show that practitioners who displayed more initial skepticism regarding their organization’s capacity to implement the program reported greater improvements in attitudes over time, while practitioners who showed more optimism at baseline reported a greater decrease in their perceived training needs. Practitioners’ self-efficacy increased moderately regardless of perceived organizational capacity.ConclusionsThese results are encouraging given that more positive perceptions of EBPs could foster the systematic use of these programs in communities, for the potential benefit of a greater number of families.
Potentially inappropriate testing for vitamin D deficiency: a cross-sectional study in Switzerland
Authors: Essig Stefan , Merlo Christoph , Reich Oliver , Trottmann Maria 
Published: November 2020

Abstract
Background
There is consensus that vitamin D supplementation is often indicated but population-based screening by laboratory testing for vitamin D deficiency is inadequate. Testing should be restricted to people at high risk of severe deficiency. This study describes the current lab testing for vitamin D deficiency in the adult population of Switzerland.

Methods
We assessed Swiss health insurance data (SWICA) for incidence of lab testing for vitamin D levels, comparing the years 2015 and 2018. Claims were analyzed for associations between lab testing and age, sex, medical indications, insurance status and geographic location in multivariable regression analyses. We also estimated the costs of vitamin D testing.

Results
Data from 200,043 and 200,046 persons for 2015 and 2018, respectively, were analyzed. Vitamin D level was tested in 14% of the sample population in 2015 and 20% in 2018. Testing increased by 69% for individuals aged 26–30. Testing was associated with being middle-aged to young senior citizens, female, medical indications (pregnancy, renal disease, osteoporosis, hyperparathyroidism, HIV, glucocorticoid intake), more chronic conditions, having a mandatory insurance with a low deductible, additional insurance coverage, and living in urban areas. We estimate that the total laboratory cost to mandatory insurance was about 90 million Swiss francs in 2018.

Conclusions
Despite recommendations for routine vitamin D supplementation, vitamin D testing of low risk individuals is common and increasing in Switzerland.
Equity and efficiency of health care resource allocation in Jiangsu Province, China
Authors: Li Qian , Wei Jianjun , Jiang Fengchang , Zhou Guixiang , Jiang Rilei , Chen Meijuan , Zhang Xu , Hu Wanjin 
Published: November 2020

Abstract
Background
Jiangsu was one of the first four pilot provinces to engage in comprehensive health care reform in China, which has been on-going for the past 5 years. This study aims to evaluate the equity, efficiency and productivity of health care resource allocation in Jiangsu Province using the most recent data, analyse the causes of deficiencies, and discuss measures to solve these problems.

Methods
Data were extracted from the Jiangsu Health/Family Planning Statistical Yearbook (2015–2019) and Jiangsu Statistical Yearbook (2015–2019). The Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were chosen to study the fairness of health resource allocation in Jiangsu Province. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were used to analyse the efficiency and productivity of this allocation.

Results
From 2014 to 2018, the total amount of health resources in Jiangsu Province increased. The G of primary resource allocation by population remained below 0.15, and that by geographical area was between 0.14 and 0.28; additionally, the G of health financial resources was below 0.26, and that by geographical area was above 0.39. T was consistent with the results for G and Lorenz curves. The HRDI shows that the allocated amounts of health care resources were the highest in southern Jiangsu, except for the number of health institutions. The average value of TE was above 0.93, and the DEA results were invalid for only two cities. From 2014 to 2018, the mean TFPC in Jiangsu was less than 1, and the values exceeded 1 for only five cities.

Conclusion
The equity of basic medical resources was better than that of financial resources, and the equity of geographical allocation was better than that of population allocation. The overall efficiency of health care resource allocation was high; however, the total factor productivity of the whole province has declined due to technological regression. Jiangsu Province needs to further optimize the allocation and increase the utilization efficiency of health care resources.
Socio-emotional and adaptive behaviour in children treated for severe anaemia at Lira Regional Referral Hospital, Uganda: a prospective cohort study
Authors: Ssemata Andrew Sentoogo , Opoka Robert Opika , Ssenkusu John Mbaziira , Nakasujja Noeline , John Chandy C. , Bangirana Paul 
Published: November 2020

AbstractBackgroundSevere anaemia is a global public health challenge commonly associated with morbidity and mortality among children < 5 years of age in Sub-Saharan Africa. However, less is known about the behavioural performance of children < 5 years surviving severe anaemia in low resource settings. We investigated social-emotional and adaptive behaviour in children < 5 years diagnosed with severe anaemia in Northern Uganda.MethodsWe conducted a hospital based prospective cohort study among children 6—42 months who were treated for severe anaemia (n = 171) at Lira Regional Referral Hospital, Uganda. Socio-emotional and adaptive behaviour were assessed 14 days post discharge using the Bayley Scales of Infant and Toddler Development, 3rd edition. Age-adjusted z-scores for each domain were calculated using scores from healthy community children (n = 88) from the same environment for each age category. Multiple linear regression was used to compare z-scores in the social-emotional and adaptive behaviour scales between the two groups after adjusting for weight-for-age z-score, social economic status, mother’s education, father’s education and father’s employment on all the scales.ResultsCompared with healthy community controls, children with severe anaemia had poorer [adjusted mean scores (standard error)], socio-emotional [− 0.29, (0.05) vs. 0.01, (0.08), P = 0.002]; but not overall/ composite adaptive behaviour [− 0.10, (0.05) vs. − 0.01, (0.07), P = 0.343]. Within the adaptive behaviour subscales, children with SA displayed significantly poorer scores on the community use [adjusted mean score (standard error)], [− 0.63, (0.10) vs. − 0.01, (0.13), P < 0.001]; and leisure [− 0.35, (0.07) vs. − 0.02, (0.07), P = 0.036] skills.ConclusionThis study suggests that severe anaemia in children < 5 years is associated with poor social-emotional scores in the short-term post clinical recovery in Northern Uganda. We recommend long-term follow-up to determine the course of these problems and appropriate interventions to reduce the behavioural burden among children < 5 years surviving severe anaemia in Uganda.
Sun, sea and sex: a review of the sex tourism literature
Authors: Lu Timothy Siliang , Holmes Andrea , Noone Chris , Flaherty Gerard Thomas 
Published: November 2020

Abstract
Background
Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism.

Methods
The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles.

Results
With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad.

Conclusions
Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.
Governing the gold rush into emerging markets: a case study of Indonesia’s regulatory responses to the expansion of Chinese-backed online P2P lending
Authors: Tritto Angela , He Yujia , Junaedi Victoria Amanda 
Published: November 2020

AbstractPeer-to-peer (P2P) lending has the potential to boost financial inclusion in emerging markets. This paper contributes to the literature on fintech governance in emerging Asian markets. It examines the case of the Indonesian government’s approach in regulating the P2P lending sector using both primary interviews and secondary firm-level data. Driven by regulation tightening in China and regulatory gaps in Indonesia, Chinese investments became the largest in this sector contributing, however, to growing risks from illegal business practices. The Indonesian government responded by creating new regulations and institutions, mitigating risks without stifling the potential for financial inclusion. We conclude a proactive approach towards monitoring and regulating emerging high-tech industries should be sought by strengthening links with industry and civil society, and through international cooperation for policy and knowledge sharing.