bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamics of health information-seeking behaviour among older adults with very low incomes in Ghana: a qualitative study
Authors: Agyemang-Duah Williams , Arthur-Holmes Francis , Peprah Charles , Adei Dina , Peprah Prince 
Published: June 2020

Abstract
Background
Exploration of health information-seeking behaviour among older adults with very low incomes is critical in shaping our understanding of how health information is sought in later life. Although studies have focused on health information-seeking behaviour among older people worldwide, subjective views of older adults, especially those with very low incomes in Ghana remain scant. Thus, this study aimed to fill this significant knowledge gap by exploring health information-seeking behaviour among older adults with very low incomes in Ghana.

Methods
In-depth interviews and focus group discussions were conducted with 30 older adults with very low incomes, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. A thematic analytical framework was used to analyse the data.

Results
The study revealed multiple sources of health information to include healthcare providers, family members, media and friends. The kind of health information sought by older adults with very low incomes consisted of information on diets, causes of chronic non-communicable diseases and medication dosage. The study also identified inadequate knowledge about the benefits of seeking health information, perceived poor attitude of healthcare providers and communication problems as the factors that limit older adults with very low incomes from acquiring health information.

Conclusion
An adequate and reliable source of information is essential to promoting the health of older people. Their inability to secure the right health information could further worsen their health status. Thus, the study provides the need for appropriate health policy interventions on the sources and types of health information sought by older adults with very low incomes in Ghana. Healthcare providers are recommended to remain open, friendly and receptive to older people to allow them to seek and obtain health information as they [healthcare providers] constitute the most reliable health information source.
Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania
Authors: Chao Christina A. , Huang Liuye , Visvanathan Kala , Mwakatobe Kisa , Masalu Nestory , Rositch Anne F. 
Published: June 2020

Abstract
Background
Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer.

Methods
A community-based survey was administered to conveniently sampled women aged 30 and older to assess women’s perspectives on breast cancer and care-seeking behavior.

Results
Among 1129 women with a median age of 37 (IQR: 31–44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1–4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively.

Conclusions
The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
Self-assessed life expectancy among older adults in Côte d’Ivoire
Authors: Moussa Richard K. , Diaby Vakaramoko 
Published: June 2020

Abstract
Background
The purpose of this study was to estimate individuals’ expected longevity based on self-assessed survival probabilities and determine the predictors of such subjective life expectancy in a sample of elderly people (50 years and older) in Côte d’Ivoire.

Methods
Paper-based questionnaires were administered to a sample (n = 267) of older adults residing in the city of Dabou, Côte d’Ivoire in May 2017. Information on subjective expectations regarding health, comorbidities, and self-assessed survival probabilities was collected. We estimated self-assessed life expectancy and its determinants using a two-pronged approach by: (i) estimating individuals’ life expectancy using the self-assessed survival probabilities (SSPs), and (ii) applying a finite mixture of regression models to form homogenous groups of individuals (clusters/components) and investigate the determinants.
A spline-based approach was used to estimate the overall distribution of life expectancy for each individual using two to four points of self-assessed survival probabilities. A finite mixture of regression models was used to identify homogeneous groups of individuals (i.e. clusters/components) of the overall subjective life expectancy distribution of the study participants.

Results
The mean subjective life expectancy in older people varied according to four components/clusters. The average subjective life expectancy among the elderly was 79.51, 78.89, 80.02, and 77.79 years in the first, second, third, and fourth component of the subjects’ overall subjective life expectancy, respectively. The effect of sociodemographic characteristics, comorbidities, and lifestyle on subjective life expectancy varied across components. For instance, a U-shape relationship between household per capita income and subjective life expectancy was found for individuals classified into the third component, and an inverse U-shape relationship was found for individuals classified into the fourth component.

Conclusions
We extended the estimation of subjective life expectancy by accounting for heterogeneity in the distribution of the estimated subjective life expectancy. This approach improved the usual methods for estimating individual subjective life expectancies and may provide insight into the elderly’s perception of aging, which could be used to forecast the demand for health services and long-term care needs.
Impact of a group-based intervention program on physical activity and health-related outcomes in worksite settings
Authors: Gu Ming , Wang Yejing , Shi Yan , Yu Jie , Xu Jiying , Jia Yingnan , Cheng Minna 
Published: June 2020

Abstract
Background
The benefits of physical activity (PA) have been well documented, and the worksite is a promising setting for PA promotion. The aims of this study were as follows: 1. To evaluate the effect of a group-based worksite intervention on PA and health-related outcomes by using pedometers. 2. To examine the associations between the change in vigorous physical activity (VPA)/moderate physical activity (MPA)/walking and health related outcomes.

Methods
A total of 398 participants (221 in the intervention group (IG) and 177 in the control group (CG)) from 17 worksites were recruited for a prospective self-controlled trial of a worksite physical activity intervention program in China. In the IG, a pedometer was utilized to self-monitor the PA, together with group competition, goal setting, and other incentives. No intervention was applied to the CG. Physical activity, sedentary behavior, and health-related outcomes were measured at baseline and immediately after the 100-day period intervention.

Results
A total of 262 participants completed the program (68.3% adherence). Adherence in the intervention group was 67.9% (n = 150/221). Improvements between baseline and follow-up among intervention participants were observed in the following parameters: VPA (+ 109.7 METs/week; p < 0.05), walking (+ 209.2 METs/week; p < 0.01), systolic blood pressure (SBP; − 2.1 mmHg; p < 0.01), waist circumference (WC; − 2.3 cm; p < 0.01), body fat percentage (BF); − 1.0%; p < 0.01), and body mass index (BMI; − 0.5 kg/m2; p < 0.01). VPA was related to changes in body fat percentage (p < 0.05) and body mass index (p < 0.05).

Conclusion
This integrated group-based intervention program contributed to comprehensive improvement in health-related outcomes. The study was useful for establishing associations between change in VPA/MPA/walking and health-related outcomes in a natural setting. Long-term evaluation is required to examine the potential of such an integrated intervention to promote PA.

Registration
This study was prospectively registered in the Chinese Clinical Trial Registry. Trial registration number: ChiCTR-1,800,015,529. Date of registration: April 5, 2018.
Stigma and discrimination: barriers to the utilisation of a nutritional program in HIV care services in the Tigray region, Ethiopia
Authors: Tesfay Fisaha , Javanparast Sara , Mwanri Lillian , Ziersch Anna 
Published: June 2020

Abstract
Background
In Ethiopia, stigmatising attitudes towards people living with HIV have reduced over time. This is mainly due to improved HIV knowledge and the expansion of access to HIV care and support services. However, HIV stigma and discrimination remain a key challenge and have negative impacts on access to and utilisation of HIV services including nutritional programs in the HIV care setting. A small number of studies have examined the experience of stigma related to nutritional programs, but this is limited. This study explored HIV status disclosure and experience of stigma related to a nutritional program in HIV care settings in Ethiopia and impacts on nutritional program utilisation.

Methods
As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff working in the nutritional program in three hospitals in the Tigray region of Northern Ethiopia. Framework thematic analysis was employed to analyse the data and NVivo 11 was used to analyse the qualitative interview data. This study is presented based on the consolidated criteria for reporting of qualitative research (COREQ).

Results
The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional program in terms of improving weight and overall health status, adults and caregivers of children living with HIV revealed experiences of stigma and discrimination that were amplified by enrolment to the nutritional program and concerns about unwanted disclosure of positive HIV status. This was due to: a) transporting, consuming and disposing of the nutritional support (Plumpynut/sup) itself, which is associated with HIV in the broader community; b) required increased frequency of visits to HIV services for those enrolled in the nutritional program and associated greater likelihood of being seen there.

Conclusion
There was evidence of concerns about HIV-related stigma and discrimination among individuals enrolled in this program and their family members, which in turn negatively affected the utilisation of the nutritional program and the HIV service more broadly. Stigma and discrimination are a source of health inequity and undermine access to the nutritional program and other HIV services. Nutritional programs in HIV care should include strategies to take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of facilitating social inclusion to mitigate stigma and improve utilisation.
Knowledge of obstetric danger signs among Saudi Arabian women
Authors: Abu-Shaheen Amani , Heena Humariya , Nofal Abdullah , Riaz Muhammad , AlFayyad Isamme 
Published: June 2020

Abstract
Background
In the Middle East, tremendous efforts have been made to promote both maternal and child health. However, there is little information in the literature about maternal knowledge of obstetric danger signs. Thus, this study aims to investigate Saudi Arabian women’s knowledge of obstetric danger signs and their determinant factors.

Methods
A community-based, cross-sectional survey was conducted in primary health care centers (PHCCs) in Riyadh City. A proportionate random sample of women who have delivered during the past 2 years was selected from the PHCCs. Data were then collected through structured interviews; the questionnaire was developed based on the literature review.

Results
A random sample of 1397 women were included in the final analysis of this study. During pregnancy, 21.1% of the participants reported that they knew about swollen hands or faces. During labor, 23.1% of the participants reported that they knew about prolonged labor (> 12 h). At postpartum, 26.3% of the participants reported that they knew about foul-smelling vaginal discharge. In this study, women in the northern region of Riyadh who visited government hospitals had significantly higher odds of knowing at least one obstetric danger sign. A statistically significant difference was found between the participants’ knowledge of at least one obstetric danger sign and her 11–15 times of antenatal care visit.

Conclusions
A dedicated health education guide, and a kingdom-wide maternal and child health preventive care promotion program could improve the health and wellbeing of expectant mothers. In these programs, it is essential to focus on birth preparedness, with danger signs recognition, and the integrate health-related data for the whole kingdom.
Contextual effects of social integration and disintegration on health status: evidence from South Korea
Authors: Jo Eun-Bi , Kwon Rang Hee , Jung Minsoo 
Published: June 2020

Abstract
Background
Many studies have shown that various social integration variables represented by social capital are beneficial to communities, including collective health. However, the rapid decline in fertility rates and the breakup of familyism in developed countries require a new approach to social disintegration, but the literature is insufficient. Here, we explored the contextual effects of social integration and social disintegration on the health of individuals.

Methods
The research data consist of merged datasets of 6909 respondents who were quota-sampled by approximately 30 people from 229 local governments in Korea. The individual-level independent variable is a social integration measure consisting of 26 questions in four areas. The community-level independent variables are five integral and aggregate variables extracted from 81 indicators. The dependent variable is self-rated health status. Potential confounders are gender, age, annual income, educational attainment, district type, and the number of beds in medical institutions per 1000 people.

Results
The results showed that at the individual level, the higher the inclusive attitude of in- and out-of-networks, after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p < 0.001). At the community level, the higher the proportion of single-person households in a community after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p < 0.05). The effect size was 0.22.

Conclusion
Thus far, social integration has been preferred, with the positive aspects of social capital being emphasized. However, this study shows that in some cases, social disintegration can instead positively influence an individual’s health. Therefore, further studies of the various conditions of social context effects on health are necessary.
Locally implemented prevention programs may reverse weight trajectories in half of children with overweight/obesity amid low child-staff ratios: results from a quasi-experimental study in France
Authors: Constant Aymery , Boulic Gaëlle , Lommez Agnes , Chaillou Raphaëlle , Guy-Grand Bernard , Raffin Sandrine 
Published: June 2020

Abstract
Background
The aims of the present study were to assess changes in weight status between the first and last year of primary education among children with overweight/obesity in response to locally implemented school-based prevention programs, and to assess the influence of process indicators, expressed as child-staff ratios (CSRs), on these changes.

Methods
To meet the study objectives, a quasi-experimental design was used. Four municipalities that systematically monitored the weight status of schoolchildren and participated in the “Vivons en Forme” program agreed to provide the data available in their school medical service records. The local implementers involved in training sessions were mainly municipal staff in charge of serving midday school meals, which is compulsory in France, and those in charge of designing and facilitating creative, interactive activities at school between and after classes. CSRs were determined by occupation (school catering service/facilitator of extracurricular activities) and training session (healthy eating/physical activity) in each municipality program, and classified as low (1–5 children per adult) or moderate.

Results
During the 4 years of primary education, weight status improved in half of the children with overweight/obesity, and worsened in 6.6% of children with overweight/normal weight. In children who remained overweight, the BMI z-score diminished over time. Estimates of the positive 4-year weight changes were related to low CSRs in locally implemented variations of the program. Estimates increased with age and were significantly higher in low-to-moderate CSR multicomponent interventions than moderate CSR single-component intervention (reference). The moderate CSR multicomponent intervention had a similar effect as the reference. The estimated negative weight change decreased with age.

Conclusions
Our findings suggest that training ancillary school staff in experiential-focused interventions for healthy eating and physical activity in locally implemented school-based programs contributed positively to reducing childhood obesity during the four years of primary education without interfering with educational activities. The results also provide preliminary evidence that low CSRs could be pivotal for optimal outcomes, especially in deprived areas.
Forty years after Alma-Ata: how people trust primary health care?
Authors: Sadeghi Bazargani Homayoun , Saadati Mohammad , Tabrizi Jafar Sadegh , Farahbakhsh Mostafa , Golestani Mina 
Published: June 2020

Abstract
Background
Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran.

Methods
The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression.

Results
The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383.

Conclusions
Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual’s variables and experiences but also by health system and health providers’ characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.
Cancer development in patients with COPD: a retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea
Authors: Ahn Song Vogue , Lee Eunyoung , Park Bumhee , Jung Jin Hee , Park Ji Eun , Sheen Seung Soo , Park Kwang Joo , Hwang Sung Chul , Park Jae Bum , Park Hae-Sim , Park Joo Hun 
Published: June 2020

Abstract
Background
COPD is a well-known risk factor for lung cancer, independent of smoking behavior. By investigating the retrospective National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea, this study attempted to prove the hypothesis that COPD is a risk factor for major cancers developing outside of the lungs. We also aimed to investigate the environmental factors associated with the development of lung cancer in COPD patients.

Methods
This study analyzed data from the NHIS-NSC over a 12-year period. Among the 514,795 subjects in the NHIS-NSC, 16,757 patients who were diagnosed with any cancer from 2002 to 2003 were excluded. This cohort enrolled six arms consisting of never-smokers without COPD (N = 313,553), former smokers without COPD (N = 41,359), smokers without COPD (N = 112,627), never-smokers with COPD (N = 7789), former smokers with COPD (N = 1085), and smokers with COPD (N = 2677).

Results
Incident rate of lung cancer per 100,000 person-year was higher according to smoking and COPD (216 in non-COPD and 757 in COPD among never-smokers, 271 in non-COPD and 1266 in COPD among former smokers, 394 in non-COPD and 1560 in COPD among smokers, p <  0.01). Old age, male sex, lower BMI, low exercise level, history of diabetes mellitus, smoking, and COPD were independent factors associated with the development of lung cancer (p <  0.01). Multi-variable analyses showed that COPD, regardless of smoking status, contributed to the development of lung cancer, and colorectal cancer and liver cancer among other major cancers (p <  0.01).

Conclusion
Our data suggested that COPD was an independent risk factor for the development of lung cancer, and colorectal cancer and liver cancer among other major cancers in the Korean population, regardless of smoking status.