bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis
Authors: Ogundele Oluwasegun Jko , Pavlova Milena , Groot Wim 
Published: April 2020

Abstract
Background Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored. Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis. Results The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR=2.54, 95% CI: 1.90−3.39) and in Ghana (OR=1.257, 95% CI: 0.77−2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR= 1.579, 95% CI: 1.081−2.307, p ≤0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services. Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.
The new cultural norm: reasons why UK foundation doctors are choosing not to go straight into speciality training
Authors: Hollis Alexander Conor , Streeter Jack , Hamel Clare Van , Milburn Louise , Alberti Hugh 
Published: April 2020

Abstract
Background The number of UK foundation doctors choosing to go straight into speciality training has fallen drastically over the last 10 years: We sought to explore and understand the reasons for this change. Methods We undertook semi-structured interviews with 16 foundation year two doctors, who had not applied to speciality training, from two regional foundation schools. Transcripts were thematically analysed.Results The reasons that foundation doctors are choosing not to go straight into speciality training centre around the themes of feeling undervalued, career uncertainty and a new cultural norm. They report major feelings of uncertainty regarding career choice at such an early stage of their profession and this challenge was magnified by a perceived lack of flexibility of training and the growing normality of taking time out from training. Trainees feel a lack of support in planning and undertaking an “FY3” year and being helped back into the workforce. Trainees overwhelmingly reported that they feel undervalued by their employers. Importantly, however, not going into training directly was not always a reflection of dissatisfaction with training. Many trainees spoke very positively about their planned activities and often saw a break in training as an excellent way to recharge, develop skills and prepare for the rest of their careers in medicine.Conclusions Taking a year or more out of training after foundation years has become the new cultural norm for UK junior doctors and reasons for this include feeling undervalued, career uncertainty and the perception that this is now “normal”. Exploring these factors with participants has generated a number of recommendations related to improving the workplace environment, allowing more flexibility in training and supporting those who chose to take an FY3.
Palliative Performance Scale: Cross cultural adaptation and psychometric validation for Polish hospice setting
Authors: Dzierżanowski Tomasz , Gradalski Tomasz , Kozlowski Michael 
Published: April 2020

Abstract
Background: Measuring functional status in palliative care may help clinicians to assess a patient’s prognosis, recommend adequate therapy, avoid futile or aggressive medical care, consider hospice referral, and evaluate provided rehabilitation outcomes. An optimized, widely used, and validated tool is preferable. The Palliative Performance Scale Version 2 (PPSv2) is currently one of the most commonly used performance scales in palliative settings. The aim of this study is the psychometric validation process of a Polish translation of this tool (PPSv2-Polish).Methods: Two hundred patients admitted to a free-standing hospice were evaluated twice, on the first and third day, for test-retest reliability. In the first evaluation, two different care providers independently evaluated the same patient to establish inter-rater reliability values. PPSv2-Polish was evaluated simultaneously with the Karnofsky Performance Score (KPS), Eastern Cooperative Oncology Group (ECOG) Performance Status (ECOG PS), and Barthel Activities of Daily Living (ADL) Index, to determine its construct validity. Results: A high level of full agreement between test and retest was seen (63%), and a good intra-class correlation coefficient of 0.85 (P<0.0001) was achieved. Excellent agreement between raters was observed when using PPSv2-Polish (Cohen’s kappa 0.91; P<0.0001). Satisfactory correlations with the KPS and good correlations with ECOG PS and Barthel ADL were noticed. Persons who had shorter prognoses and were predominantly bedridden also had lower scores measured by the PPSv2-Polish, KPS and Barthel ADL. A strong correlation of 0.77 between PPSv2-Polish scores and survival time was noted (P<0.0001). Moderate survival correlations were seen between KPS, ECOG PS, and Barthel ADL of 0.41; -0.62; and 0.58, respectively (P<0.0001).Conclusion: PPSv2-Polish is a valid and reliable tool measuring performance status in a hospice population and can be used in daily clinical practice in palliative care and research.
Use of Radial Extracorporeal Shock-Wave Therapy for Musculoskeletal Pain for daily practice: 1,580 Cases
Authors: Sugawara Andre Tadeu , Lima Moises da Cunha , Oliveira Margarida Sales Carneiro de , Dias Cristiane Bitencourt 
Published: April 2020

Abstract
Background: Musculoskeletal pain is a quite common, benign, nonfatal condition that is the second leading cause of years lived with a disability worldwide. Despite all efforts, it continues to be a challenging public health problem, because the solutions currently available are complex or are of limited effectiveness, which makes them difficult to adopt. That situation perpetuates suffering and treatment seeking, as well as increasing the health care costs and burden associated with such pain. Therefore, new treatment options need to be tested and the interest in shock waves is growing, especially in places with few resources, with difficult access to medications and in countries where there is a need for new therapeutic options due to the opioid crisis.Methods: This was a retrospective observational study of 1,580 patients with musculoskeletal pain who underwent two weekly sessions of radial extracorporeal shock-wave therapy.Results: We found that the therapy tested decreased pain by 62.50% (P < 0.0001), with a high (91.59%) success rate and a low (2.1%) rate of pain worsening (2.1%). The effect was greatest for myofascial pain in the hip or shoulder (P < 0.05). Intense pain, myofascial pain (visual analogue scale score ≥ 70 mm), and high shock-wave frequency (≥ 15 Hz) correlated with best response. Conclusions: It is possible to implement a radial shockwave service that, with just two doses, promotes rapid and effective analgesia for up to 7 days after the last dose, with a high success rate and a low rate of abandonment of treatment. Representing a response to the management of service overload and a non-drug alternative in the era of the opioid crisis.Study registration: CAAE 51289115.2.0000.5463. Registered 7th October 2015 (prospectively registered).
Implementation, Experience, and Challenges of Urban Health Extension Program in Addis Ababa: A Case study from Ethiopia
Authors: Gizaw Abraham Tamirat , Zebre Getahun , Tareke Kasahun Girma , Lemu Yohannes Kebede 
Published: April 2020

Abstract
Background: Ethiopia started implementing the Urban Health Extension Program in urban areas since 2009 to provide health care services to the community members of the urban health extension professionals. But, limited evidence is there to the extent of this program implementation, acceptance, and utilization. Therefore, this study was aimed at exploring the implementation, experience, and challenges of the urban health extension program. Methods: A qualitative case study was conducted in Addis Ababa from November 15 – December 29, 2017. The study participants were recruited purposively that includes health extension professionals, health post supervisors, health development army leaders, Addis Ababa city health extension program administrators, and women of the community. A total of 4 focus group discussions and 31 in-depth and key informant interviews were conducted. The data were transcribed verbatim, translated into the English language, and analyzed by an inductive thematic analysis approach using Atlas ti7.1 software package. Result: This study found that there were 15 health service packages of the urban health extension program provided to the communities by the Urban Health Extension Professionals in Addis Ababa. The strategies used for the program implementation were a provision of training for UHEPs, conducting home to home visit, creation of model households, strengthening of health developmental army, conducting of regular supervision or monitoring, referral and feedback, and community mobilization. Lack of coordination between the health extension program and other sectors, poor supply management system, having no clearly defined career and education path and lack of motivation and incentives were some of the challenges posed in the program implementation. Conclusions: Although the urban health extension program has made a significant contribution to the health of the community through increasing access to public health services in urban settings, its implementation is affected by many challenges. Therefore, all stakeholders, governmental and non-governmental organizations should have support the system to increase the acceptability and utilization of the urban health extension services.
Acting between Checklists and Reality. Managers’ Balancing between Standardization and Adaptive Behaviour in Patient Safety Work- an Interview Study
Authors: Hedsköld Mats , Sachs Magna Andreen , Rosander Thorleif , von Knorring Mia , Harenstam Karin Pukk 
Published: April 2020

Abstract
Background Safety culture can be described and understood through its manifestations in the organisation as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how first line managers’ balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units.Methods Interview study with first line managers in intensive care units in in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used.Results We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote safety culture by acting as role models, designing everyday work and promoting psychological safety and a learning environment.Conclusions Our study shows the central role of front-line managers in designing the everyday work in the ICU. In our study both of Safety − 1 and Safety − 2 aspects emerged in the analysis. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit’s safety culture.
Determinants of Nutrition Knowledge, Attitude and Practices of Adolescent Sports Trainee: A Cross-sectional Study in Bangladesh
Authors: Bakhtiar Md. , Rahman Masud-ur , Kamruzzaman Md , Sultana Nargis , Rahaman Kh. Shafiur , Rahman Shaikh Shahinur 
Published: April 2020

Abstract
Background
Nutrition is an important predictor of an athlete’s performance. It is more important for particularly those athletes who are in the growing stage (adolescents). This study aimed to assess their current level of knowledge, attitude, and practices (KAP) of nutrition and to predict potential factor impact on the level of these KAP.
Methods
A cross-sectional study was conducted among adolescent trainee athletes selected conveniently from 11 sports departments (e.g. cricket, football, hockey etc.) of Bangladesh Krira Shikkha Protishtan (BKSP). A semi-structured interviewer-administered questionnaire was used for data collection. Anthropometric measurements (e.g. height, weight, BMI, BF %) were taken using appropriate methods. The data were analyzed using R (v3.6.1) and Python Jupyter Notebook. Descriptive statistics, t-test, analysis of variance (ANOVA) and logistic regression were used to determine the relationship between dependent and independent variables.
Results
A total number of 260 participants were enrolled in this study. Among them, 86% were male. Their mean age was 15.50 ± 1.83 ranging from 12–19 years. More than half of the participants had good nutrition knowledge (n = 149, 57.3%). Fifty-six percent participants had negative attitude (n = 146) and 42.3% (n = 110) had poor level of practices regarding nutrition. Age (p = 0.007), gender (p = 0.004) and duration of sports training (p = 0.004) of participants were significantly associated with knowledge, while only age and BMI were significantly associated with practices. Athletes with less body fat were more likely to have good nutrition practice behavior (AOR 0.895; 95% CI 0.83, 0.96; p < 0.05) and nutrition knowledge was positively associated with nutrition practice (AOR 2.335; 95% CI 1.405, 3.88; p = 0.001).
Conclusion
Insufficient knowledge, negative attitude, and poor practices were observed among many of our participants. Previous nutrition training was found as potential factor of good nutrition knowledge and practice. It is necessary to provide appropriate nutrition information to the adolescent athletes through proper educational intervention on a regular basis.
Catheter ablation of nonparoxysmal atrial fibrillation in patients with heart failure with reduced ejection fraction and functional mitral regurgitation
Authors: Li Teng , Huang Jun , Liang Jian , Peng Wenjie , Ding Ligang , Li Yifu 
Published: April 2020

Abstract
Background

The optimal treatment for patients with nonparoxysmal atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of catheter ablation (CA) of nonparoxysmal AF in patients with HFrEF and functional mitral regurgitation (MR).
Methods

This single-center, retrospective, and observational study enrolled 21 consecutive patients with nonparoxysmal AF, HFrEF and functional MR underwent CA༎The ablation strategy consisted of bilateral circumferential pulmonary vein isolation and empirical linear ablations.
Results

After a mean follow-up of 18.2 ± 8.5 months, stable sinus rhythm (SR) was achieved in 15 patients (71.4%) after the initial procedure and 17 patients (81%) after the final procedure. The NYHA class improved from 2.7 ± 0.7 before ablation to 1.2 ± 0.4 during follow-up (p < 0.001). Left ventricular ejection fraction increased from 36.5 ± 6.3% to 54.9 ± 6.6% (p < 0.001). Among 17 patients in continuous SR after the final procedure, MR severity decreased to mild or none,and 10 patients with decreased ventricular wall motion was completely restored to normal after the procedure. No serious complications occurred.
Conclusion

CA may be a safe and effective method for treating nonparoxysmal AF in patients with HFrEF and functional MR. It can significantly improve HF symptoms, functional MR and left ventricular function..
Comparative Evaluation of Methods to Determine Intra-Individual Reference Ranges in Nutrition Support Team (NST)-Related Tests
Authors: Hirabayashi Yoji , Tsukada Yutaka , Sakurai Takuya , Ohno Hideki , Kizaki Takako 
Published: April 2020

Abstract
Background The intra-individual reference range is generally narrower than the commonly used reference range. Consequently, close monitoring of changes in the laboratory test results of individuals based on the inter-individual reference range remains challenging.Methods We examined the determination of individual reference ranges using four indicators of nutritional conditions: transferrin (TRF), albumin (ALB), retinol-binding protein (RBP), and transthyretin (TTR). The subjects comprised 20 healthy individuals and blood samples were collected and tested five times at 2-week intervals. We used the measurement results for the four indicators and examined individual reference ranges using four methods, including calculation methods based on the reference change value and Bayesian inference.Results The resulting intra-individual reference ranges were narrower than the currently used inter-individual reference range for all measurements using four methods. Furthermore, the intra-individual coefficient of variation [CV (intra)] was smaller than the inter-individual coefficient of variation [CV (inter)] for TRF, RBP, and TTR for all subjects. The means CV (intra) for the four indicators were also lower than the corresponding CV (inter).Conclusions The intra-individual reference range can be used to validate the standard deviation and coefficient of variation for currently used indicators. Moreover, Bayesian methods are speculated to be the most versatile.
Factors Affecting for Lifestyle Adoption in Patients with Myocardial Infarction
Authors: mohsenipouya hossein , Jannati Yadollah , Ghaemian Ali , Yazdani-Charati Jamshid 
Published: April 2020

Abstract
Background

Epidemiological transition of acute and infectious diseases to non-communicable ones, aging population, together with rapid lifestyle changes all have given rise to prevalence rate of cardiovascular diseases (CVDs). Thus, it is of utmost importance to reflect on lifestyles especially in this period. The main purpose of this study was to assess lifestyle in patients affected with myocardial infarction (MI).
Methods

This cross-sectional study was examining health-related lifestyle behaviors in patients with MI in 2019. To this end, a total number of 176 patients were selected using purposive and convenience sampling methods. The research instrument was also the Health-Promoting Lifestyle Profile II (HPLP-II) as a standardized self-report questionnaire. To analyze the data, the IBM SPSS Statistics software (version 22) software and the generalized linear models were used. Moreover, the level of significance was set at 0.05 in this study.
Results

The results of Wilks’ lambda distribution revealed that the effect of gender on the linear combination of the dependent variable (i.e. lifestyle) was significant and 11.4% of changes in this variable had resulted from variation in gender. Besides, the results demonstrated that health responsibility scores in men were on average 2.703 lower than those obtained by women. This relationship was also significant and its effect size was by 3.3% (p = 0.016).
Conclusions and recommendations:

It was concluded that the concept of lifestyle can be an analysis tool to better understand differences between genders, as an effective variable in adopting a healthy lifestyle, especially in patients suffering from MI.
DRGs-based health system performance for breast cancer patients
Authors: Liu Xinkui , Liu Furong , Wang Lin , Wu MengFan , Yang LinPeng , Wei Le 
Published: April 2020

Abstract
Background: To evaluate health system performance for patients with breast cancer in Henan Province, China, using Diagnosis-Related Groups (DRGs) indicators and provide data to inform practices and policies for the prevention and control of breast cancer. Methods: The data were collected from the front pages of the medical records (FPMR) of all hospitals above class II that admitted breast cancer patients in Henan Province between 2016 and 2019. Breast cancer patients were the subjects in our study. China DRGs (CN-DRGs) were used as a risk adjustment tool. Three indicators, including the Case-Mix Index (CMI), number of DRGs, and total weight, were used to evaluate the range of available services for patients with breast cancer, while indicators including the Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG) were used to evaluate the medical service efficiency and medical safety.Results: Between 2016 and 2019, there were 103,760 cases of patients with breast cancer. The number of enrolled patients and total weight increased over the study period at an average annual rate of 21.38% and 21.88%, respectively. The TEI decreased over the study period by 15.60%. The CEI exhibited an increasing trend, but the average annual rate of increase was small (2.94%). The IMLRP was 0.02%, 0%, 0% and 0.01% in 2016, 2017, 2018 and 2019, respectively.Conclusion: The health system performance improved between 2016 and 2019 for breast cancer patients discharged from the study hospitals in Henan Province. The main areas of improvement were in the range of available services, but medical institutions must still make efforts to improve the efficiency of medical services and ensure medical safety. DRGs are an effective evaluation tool.