bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research
Authors: Long Linda , Moore Darren , Robinson Sophie , Sansom Anna , Aylward Alex , Fletcher Emily , Welsman Jo , Dean Sarah Gerard , Campbell John L , Anderson Rob 
Published: May 2020

BackgroundUK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs’ leaving behaviour in the workforce as part of a wider mixed methods study (ReGROUP).ObjectiveTo identify factors that affect GPs’ decisions to leave direct patient care.MethodsQualitative interview-based studies were identified and their quality was assessed. A thematic analysis was performed and an explanatory model was constructed providing an overview of factors affecting UK GPs. Non-UK studies were considered separately.ResultsSix UK interview-based studies and one Australian interview-based study were identified. Three central dynamics that are key to understanding UK GP leaving behaviour were identified: factors associated with low job satisfaction, high job satisfaction and those linked to the doctor–patient relationship. The importance of contextual influence on job satisfaction emerged. GPs with high job satisfaction described feeling supported by good practice relationships, while GPs with poor job satisfaction described feeling overworked and unsupported with negatively impacted doctor–patient relationships.ConclusionsMany GPs report that job satisfaction directly relates to the quality of the doctor–patient relationship. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of autonomy within the workplace, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressure of increased patient demand and workload, together with other stress factors, has left many feeling unsupported and vulnerable to burn-out and ill health, and ultimately to the decision to leave general practice.
Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population
Authors: Reddy Krishna P , Bulteel Alexander J B , Levy Douglas E , Torola Pamela , Hyle Emily P , Hou Taige , Osher Benjamin , Yu Liyang , Shebl Fatma M , Paltiel A David , Freedberg Kenneth A , Weinstein Milton C , Rigotti Nancy A , Walensky Rochelle P 
Published: May 2020

Background and objectiveSimulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate a novel individual-level microsimulation model that would explicitly include smoking relapse and project cigarette smoking behaviours and associated mortality risks.MethodsWe developed the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, in which individuals transition monthly between tobacco use states (current/former/never) depending on rates of initiation, cessation and relapse. Simulated individuals face tobacco use-stratified mortality risks. For US women and men, we conducted cross-validation with a Cancer Intervention and Surveillance Modeling Network (CISNET) model. We then incorporated smoking relapse and calibrated cessation rates to reflect the difference between a transient quit attempt and sustained abstinence. We performed external validation with the National Health Interview Survey (NHIS) and the linked National Death Index. Comparisons were based on root-mean-square error (RMSE).ResultsIn cross-validation, STOP-generated projections of current/former/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE≤15%). After incorporating smoking relapse, multiplying the CISNET-reported cessation rates for women/men by 7.75/7.25, to reflect the ratio of quit attempts to sustained abstinence, resulted in the best approximation to CISNET-reported smoking prevalence (CV-RMSE 2%/3%). In external validation using these new multipliers, STOP-generated cumulative mortality curves for 20-year-old current smokers and never smokers each had CV-RMSE ≤1% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current/former/never smokers annually (1998–2009) was similar to that reported by NHIS (CV-RMSE 12%).ConclusionsThe STOP model, with relapse included, performed well when validated to US smoking prevalence and mortality. STOP provides a flexible framework for policy-relevant analysis of tobacco and nicotine product use.
Is healthcare-seeking with gynaecological alarm symptoms influenced by personal and professional relations? A Danish population-based, cross-sectional study
Authors: Vejlgaard Anja Schmidt , Rasmussen Sanne , Jarbøl Dorte Ejg , Balasubramaniam Kirubakaran 
Published: May 2020

ObjectivesTo identify the personal and professional relations of women experiencing gynaecological alarm symptoms, to analyse if involving a personal relation is related to healthcare-seeking with gynaecological alarm symptoms, and to analyse if having an available social network is associated with involvement of this relation.DesignWeb-based, population-based, cross-sectional questionnaire survey.SettingThe general population in Denmark.ParticipantsThe study invited 100 000 individuals randomly drawn from the Danish Civil Registration System. Pregnant women and women who did not answer relevant questions about social network were excluded. A total of 5053 women who experienced at least one gynaecological alarm symptom were included in the study.Primary and secondary outcomes(1) Personal and professional relations that women experiencing gynaecological alarm symptoms involve; (2) the association between involving a personal relation and healthcare-seeking; and (3) the association between having an available social network and involvement of this relation.ResultsThe general practitioner (GP) was the most involved professional relation, while the spouse/partner was the most involved personal relation. When experiencing gynaecological alarm symptoms, more than 50% of women did not involve a professional relation and 20% did not involve a personal relation. For all four gynaecological alarm symptoms, the odds of involving the GP were higher in the oldest age group. Women were two to seven times more likely to involve their GP if they had personal relation involvement. No statistically significant association was found between having an available social network and involving the GP.ConclusionInvolving a personal relation in healthcare-seeking was associated with increased involvement of the GP, who consequently was the most involved professional relation when experiencing gynaecological alarm symptoms. Spouse/partner was the most involved personal relation. The oldest age group had the highest odds of involving the GP. No association was found between having an available social network and involving the GP.
Cohort profile: the STOP HIV/AIDS Program Evaluation (SHAPE) study in British Columbia, Canada
Authors: Bever Andrea , Salters Kate , Tam Clara , Moore D M , Sereda Paul , Wang Lu , Wesseling Tim , Grieve Sean , Bingham Brittany , Barrios Rolando 
Published: May 2020

PurposeThe Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) Program Evaluation (SHAPE) study is a longitudinal cohort developed to monitor the progress of an HIV testing and treatment expansion programme across the province of British Columbia (BC). The study considers how sociostructural determinants such as gender, age, sexual identity, geography, income and ethnicity influence engagement in HIV care.ParticipantsBetween January 2016 and September 2018, 644 BC residents who were at least 19 years old and diagnosed with HIV were enrolled in the study and completed a baseline survey. Participants will complete two additional follow-up surveys (18 months apart) about their HIV care experiences, with clinical follow-up ongoing.Findings to dateAnalyses on baseline data have found high levels of HIV care engagement and treatment success among SHAPE participants, with 95% of participants receiving antiretroviral therapy and 90% having achieved viral suppression. However, persistent disparities in HIV treatment outcomes related to age, injection drug use and housing stability have been identified and require further attention when delivering services to marginalised groups.Future plansOur research will examine how engagement in HIV care evolves over time, continuing to identify barriers and facilitators for promoting equitable access to treatment and care among people living with HIV. A qualitative research project, currently in the formative phase, will compliment quantitative analyses by taking a strengths-based approach to exploring experiences of engagement and re-engagement in HIV treatment among individuals who have experienced delayed treatment initiation or treatment interruptions.
Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey
Authors: Ratcliffe Hannah L , Bell Griffith , Awoonor-Williams Koku , Bitton Asaf , Kim June-Ho , Lipstiz Stuart , Macarayan Erlyn , Ofosu Anthony , Otupiri Easmon , Schwarz Dan , Hirschhorn Lisa R 
Published: May 2020

IntroductionPerson-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries.MethodsA multistage cluster sample design was used to obtain a nationally representative sample of women of reproductive age in Ghana. Women were interviewed in their homes regarding their demographic characteristics, recent care-seeking characteristics, satisfaction with care, patient-reported outcomes, and—using questions from the World Health Survey Responsiveness Module—the seven domains of responsiveness of outpatient care to assess patient experience. Using Poisson regression with log link, we assessed the relationship between responsiveness and satisfaction, as well as patient-reported outcomes.ResultsWomen who reported more responsive care were more likely to be more educated, have good access to care and have received care at a private facility. Controlling for respondent and visit characteristics, women who reported the highest responsiveness levels were significantly more likely to report that care was excellent at meeting their needs (prevalence ratio (PR)=13.0), excellent quality of care (PR=20.8), being very likely to recommend the facility to others (PR=1.4), excellent self-rated health (PR=4.0) and excellent self-rated mental health (PR=5.1) as women who reported the lowest responsiveness levels.DiscussionThese findings support the emerging global consensus that responsiveness and patient experience of care are not luxuries but essential components of high-performing health systems, and highlight the need for more nuanced and systematic measurement of these areas to inform priority setting and improvement efforts.
Work-related asthma in the USA: nationally representative estimates with extended follow-up
Authors: Laditka James N , Laditka Sarah B , Arif Ahmed A , Hoyle Jessica N 
Published: May 2020

ObjectiveWe studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life.MethodsWe used the nationally representative Panel Study of Income Dynamics (1968–2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life.ResultsThe adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18–65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk.ConclusionAdults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.
Association of mean arterial pressure with all-cause and cardiovascular mortality in young adults
Authors: Sun Shuo , Lo Kenneth , Liu Lin , Huang Jiayi , Feng Ying Qing , Zhou Ying-ling , Huang Yu-Qing 
Published: May 2020

AbstractBackgroundMean arterial pressure (MAP) is a predictor of all-cause and cardiovascular disease (CVD) mortality in middle-aged population and elderly, but less evidence has been shown in young adults.ObjectivesWe examined the associations of MAP with all-cause and CVD mortality in young adults aged between 18 and 40 years.MethodsData were from the National Health and Nutrition Examination Survey (1999–2006) and participants were followed up to 31 December 2015. MAP was categorised by quartiles. Multivariable Cox proportional hazards models and Kaplan-Meier survival curves were performed to estimate the association between MAP, all-cause and CVD mortality.ResultsThere were a total of 8356 (4598 women (55.03%)) participants with the mean age of 26.63±7.01 years, of which 265 (3.17%) and 10 (0.12%) cases of all-cause and cardiovascular mortality occurred during a median follow-up duration of 152.96±30.45 months, respectively. There was no significant difference in the survival rate by MAP quartiles (p=0.058). When MAP was treated as a continuous variable, the multivariable adjusted HRs for all-cause and CVD mortality were 1.00 (95% CI 0.96 to 1.04; p=0.910) and 0.94 (95% CI 0.77 to 1.14; p=0.529), respectively. When using the lowest quartile (Q1) as referent, the adjusted HRs for all-cause mortality from Q2 to Q4 were 1.16 (95% CI 0.56 to 2.42), 1.06 (95% CI 0.48 to 2.32) and 0.91 (95% CI 0.37 to 2.24; p for tend was 0.749) after adjusting for potential confounders.ConclusionThere was no significant association of MAP with all-cause and CVD mortality in young adults with a relatively short follow-up time.
Status and situation of postgraduate medical students in China under the influence of COVID-19
Authors: Wang Shunda , Dai Menghua 
Published: May 2020

AbstractAt the beginning of 2020, the outbreak of COVID-19 in China has brought great impact on the society, economy and life. This article introduces current status of Chinese postgraduate medical students under this epidemic situation in combination with the author’s own experience from four aspects: professional spirit, professional knowledge, learning status and protective measures.
Continuing medical education during a pandemic: an academic institution’s experience
Authors: Kanneganti Abhiram , Sia Ching-Hui , Ashokka Balakrishnan , Ooi Shirley Beng Suat 
Published: May 2020

AbstractThe COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution’s experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year’s end.
Tobacco or not tobacco: predicting farming households’ income in Indonesia
Authors: Sahadewo Gumilang Aryo , Drope Jeffrey , Li Qing , Nargis Nigar , Witoelar Firman 
Published: May 2020

BackgroundRecent research in several countries has demonstrated that small-holder tobacco farming is typically not a profitable enterprise. Many farming households report losing money in this economic endeavour, even without incorporating the value of their household labour. Losses are typically considerably worse when household labour is considered. We take advantage of panel data that include information about both current and former tobacco farming households’ characteristics and economic decisions to be the first to rigorously estimate the effects of both tobacco and non-tobacco farming on income.MethodsWe designed and implemented a two-wave economic survey of current and former tobacco farming households in Indonesia’s two largest tobacco-growing regions. We use regression analysis to estimate the effects of tobacco farming on household income per farming area in both survey waves.ResultsWe find that former tobacco farming households are typically generating profits from their non-tobacco farming, while current tobacco farming households experience greater variability, including experiencing economic losses. Former tobacco farming households’ income were comparable to current tobacco farming households’ even in the period in which tobacco leaf production and prices of tobacco leaf were relatively high. We find a negative and significant effect of tobacco farming on household income.ConclusionsOne of the main arguments from those opposing tobacco control policies—especially increasing cigarette excise taxes—is their alleged effect on tobacco farming households’ livelihoods through a lower demand for tobacco leaves. Our finding that there is a negative effect of tobacco farming on household income shows that the narrative is grossly inaccurate. Shifting to non-tobacco farming would allow farming households to reallocate their resources to other more lucrative economic opportunities.
Roll-your-own smokers’ reactions to cessation-efficacy messaging integrated into tobacco packaging design: a sequential mixed-methods study
Authors: Blank Mei-Ling , Hoek Janet , Gendall Philip 
Published: May 2020

BackgroundAlthough loss-framed pictorial warning labels (PWLs) have increased knowledge of the health harms caused by smoking, they may elicit maladaptive responses among some smokers who have tried repeatedly, yet unsuccessfully, to quit smoking. However, research suggests that maladaptive responses may diminish if warnings are complemented with efficacy enhancing messages. Therefore, we explored New Zealand (NZ) adult roll-your-own (RYO) loose tobacco smokers’ reactions to self-efficacy and response efficacy messages integrated into the RYO packaging structure and designed to complement PWLs.DesignWe used a sequential mixed-methods design. In-depth interviews gauged participants’ (n=22) acceptance of the designs and informed stimuli development for an online survey. The survey (n=785) compared self-efficacy and response efficacy designs to standard Quitline information, and examined agreement with emotions, beliefs and projected behaviours associated with quit attempts.ResultsOur findings suggest placing gain-framed response efficacy messages on the inside flap of RYO tobacco pouches may stimulate specific emotional reactions, beliefs and projected behaviours associated with future quit attempts more effectively than NZ’s status quo Quitline information. Those potentially more likely to benefit include smokers who have high baseline response efficacy and who intend to make a quit attempt.ConclusionsIntegrating cessation-related messaging within tobacco packaging could be a high reach, just-in-time micro-intervention at the point of decision-making. Enhanced efficacy messages could complement and enhance PWLs, and support quitting among groups where smoking prevalence is especially high.
Theia: an advanced optical neutrino detector
Authors: Askins M. , Bagdasarian Z. , Barros N. , Beier E. W. , Blucher E. , Bonventre R. , Bourret E. , Callaghan E. J. , Caravaca J. , Diwan M. , Dye S. T. , Eisch J. , Elagin A. , Enqvist T. , Fischer V. , Frankiewicz K. , Grant C. , Guffanti D. , Hagner C. , Hallin A. , Jackson C. M. , Jiang R. , Kaptanoglu T. , Klein J. R. , Kolomensky Yu. G. , Kraus C. , Krennrich F. , Kutter T. , Lachenmaier T. , Land B. , Lande K. , Learned J. G. , Lozza V. , Ludhova L. , Malek M. , Manecki S. , Maneira J. , Maricic J. , Martyn J. , Mastbaum A. , Mauger C. , Moretti F. , Napolitano J. , Naranjo B. , Nieslony M. , Oberauer L. , Orebi Gann G. D. , Ouellet J. , Pershing T. , Petcov S. T. , Pickard L. , Rosero R. , Sanchez M. C. , Sawatzki J. , Seo S. H. , Smiley M. , Smy M. , Stahl A. , Steiger H. , Stock M. R. , Sunej H. , Svoboda R. , Tiras E. , Trzaska W. H. , Tzanov M. , Vagins M. , Vilela C. , Wang Z. , Wang J. , Wetstein M. , Wilking M. J. , Winslow L. , Wittich P. , Wonsak B. , Worcester E. , Wurm M. , Yang G. , Yeh M. , Zimmerman E. D. , Zsoldos S. , Zuber K. 
Published: May 2020

AbstractNew developments in liquid scintillators, high-efficiency, fast photon detectors, and chromatic photon sorting have opened up the possibility for building a large-scale detector that can discriminate between Cherenkov and scintillation signals. Such a detector could reconstruct particle direction and species using Cherenkov light while also having the excellent energy resolution and low threshold of a scintillator detector. Situated deep underground, and utilizing new techniques in computing and reconstruction, this detector could achieve unprecedented levels of background rejection, enabling a rich physics program spanning topics in nuclear, high-energy, and astrophysics, and across a dynamic range from hundreds of keV to many GeV. The scientific program would include observations of low- and high-energy solar neutrinos, determination of neutrino mass ordering and measurement of the neutrino CP-violating phase $$\delta $$δ, observations of diffuse supernova neutrinos and neutrinos from a supernova burst, sensitive searches for nucleon decay and, ultimately, a search for neutrinoless double beta decay, with sensitivity reaching the normal ordering regime of neutrino mass phase space. This paper describes Theia, a detector design that incorporates these new technologies in a practical and affordable way to accomplish the science goals described above.