bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection
Authors: Liu Lei , Wu Wenbin , Gong Longbo , Zhang Miao 
Published: September 2020

Abstract
Background: Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave's syndrome (BS), is rare after chest surgery.Case Presentation: A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment.Conclusions: Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.
Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta
Authors: Kaul Pankaj , Paniagua Rodolfo , Petsa Afroditi , Singh Raj 
Published: September 2020

Abstract
BackgroundPenetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case ReportWe report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure.We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management.ConclusionThis case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.
“I Don’t Want to go for an HIV Test Out of Fear that I Might be Positive”: Barriers and Facilitators to the Uptake of HIV testing Services Among Adolescents and Young Adults in Machinga District, Malawi.
Authors: Sakala Joseph Jasper , Stones William 
Published: September 2020

Abstract
Background: While studies generally indicate low utilization of HIV testing services (HTS) by young people in Sub-Saharan Africa, other reports also indicate a worrying HIV burden among the same group, evidenced by a recent trends in new infections. The low uptake of HTS among young people means that for many, new infections remain undiagnosed, hindering public health efforts for disease controlWe aimed to explore the factors that hinder – as well as those that encourage – HIV testing among adolescents and young adults in at individual, interpersonal, community and health system levels in a Malawi district.Methods: 24 In-depth interviews (IDIs) and 4 key-informant interviews (KIIs) were used to collect data, and purposive sampling was used to identify the respondents. IDIs targeted adolescents and young adults aged 15-24 years, whereas KIIs targeted HTS and youth-friendly health service (YFHS) providers. Coding and analysis were done using a modified Social-Ecological Framework.Results: Fear of a positive result, poor communication in relationships and families, cultural norms as well as lack of youth-friendly HIV testing services were key barriers to HIV testing. Perceived susceptibility to infection, presence of partner support, availability of community-level youth clubs or support groups, and the provision of HTS through outreach clinics were key facilitators for HIV testing. Conclusions: There is a pressing need for widespread mobile HIV testing at the community level to encourage uptake among young people who fail to visit health facilities for various reasons. Access to HIV self-testing through the distribution of kits at government health facilities is a promising strategy for young people who distrust service providers when it comes to maintaining the confidentiality of their results.
The Formulation of Minimal Clinically Important Differences in the Quality of Life Instrument for Patients with Chronic Renal Failure (QLICD-CRF) Based on Combinations of Anchor-Based and Distribution-Based Methods
Authors: Huang Xinping , Yang Zheng , Weng Min , Fan Xuejin , Xu Qingan , Wan Chonghua 
Published: September 2020

Abstract
Background Chronic renal failure is global problem and represents a major cause of morbidity and mortality. Studies of quality of life in patients with chronic renal failure can be helpful to improve patient survival rates. The minimal clinical important difference (MCID) is a score that reflects the effect of patient treatment or nursing care. Doctors or researchers use this factor to assess the validity of results, and this information reflects the combined importance of the patient's opinion and the doctor's explanation.Methods Patients diagnosed with chronic renal failure and able to read and understand the questionnaires at the First Affiliated Hospital of Kunming Medical University were included in this study and completed the questionnaires independently. Using the anchor-based method and the distribution-based method, the MCIDs of the QLICD-CRF were calculated based on the data from 164 valid questionnaires at the time of admission and 111 valid questionnaires at discharge. The medians of patients' quality of life scores calculated using the anchor-based method were referred to as MCIDs based on the anchor-based method, whereas the results calculated based on effect size (ES), standard error of measurement (SEM) and reliable change index (RCI) were referred to as MCIDs based on the distribution-based method. Then, the final results were calculated according to the weight of the calculation obtained using several methods. Results MCIDs of the physical domain (PHD), psychological domain (PSD), social domain (SOD), core/general domain (CGD), specific domain (SPD) and the total score (TOT) of the QLICD-CRF were 10, 9, 8, 7, 8 and 7, respectively. Conclusion Calculations of MCIDs of QLICD-CRF scores could compensate for insufficient P-values; thus, the interpretation of the outcomes in quality of life studies could be more objective and specific.
Cross-border Mobility in European Countries: Associations between Cross-border Worker Status and Health Outcomes
Authors: Nonnenmacher Lucas , Baumann Michele , Bihan Etienne le , Askenazy Philippe , Chauvel Louis 
Published: September 2020

Abstract
Background. Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status and countries of destination, and (3) confirm the positive association between wage and health index for both CBWs and non-cross border workers (NCBWs). Methods. Based on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking NCBWs as the reference group, controlling by demographic background and labour status variables.Results. A sample of 34,362 observations (3,453 CBWs vs. 30,909 NCBWs) was retained. The CBW status is positively associated with a better perceived health, activity limitation, chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Switzerland have the higher health outcomes among all CBWs. Commuters to Germany report lower disability and more leisure activities.Conclusion. CBWs are healthier and have more income. This main finding suggests (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union.
RNA N6-methyladenosine reader IGF2BP3 regulates cell cycle and angiogenesis in colon cancer
Authors: Yang Zhou , Wang Tingfeng , Wu Dejun , Min Zhijun , Tan Jingyun , Yu Bo 
Published: September 2020

Abstract
Background: N6-Methyladenosine (m6A) modification has been implicated in multiple processes for colon cancer development. IGF2BP3 was a newly reported m6A reader, whereas its role in colon cancer remains unclear. Methods: The expression of m6A associated enzymes and total m6A level were measured by Western Blotting analysis and m6A RNA Methylation Quantification Kit respectively. Cell cycle was analyzed by flowcytometry. The interaction of IGF2BP3 and related targets was analyzed by RNA immunoprecipitation (RIP) and m6A RNA immunoprecipitation (MeRIP) assays.Results: We investigated all m6A regulated enzymes in colon cancer and found only the overexpression of IGF2BP3 was associated with cancer progression and survival based on The Cancer Genome Atlas (TCGA) databases. Additionally, we also demonstrated IGF2BP3 was associated with DNA replication in the cell cycle. Knockdown of IGF2BP3 significantly repressed percentage of S phase of cell cycle as well as cell proliferation. Further research demonstrated IGF2BP3 binds to the mRNA of Cyclin D1 (CCND1, checkpoint of G1/S phase of cell cycle) and reduced its mRNA stability via reading m6A modification in the CDS region. Overexpression of Cyclin D1 in IGF2BP3 down-regulated cells completely rescued the inhibited percentage of S phase in cell cycle as well as cell proliferation. Additionally, we also demonstrated a similar role of IGF2BP3 at VEGF. IGF2BP3 binds to the mRNA of VEGF and reads m6A modification, thus regulated both expression and stability of VEGF mRNA. Knockdown of IGF2BP3 repressed angiogenesis in colon cancer via regulating VEGF. Conclusion: Knockdown of IGF2BP3 repressed DNA replication in the S phase of cell cycle and angiogenesis via reading m6A modification of CCND1 and VEGF respectively. IGF2BP3 was a possible prognosis marker and potential therapeutic target of colon cancer.
Effects of the Socio-Economic Transition on Health Professions Education: The Case of Mongolia
Authors: Amgalan Nomin , Shin Jwa-Seop , Lee Seung-Hee , Badamdorj Oyungoo , Ravjir Oyungerel , Yoon Hyun Bae 
Published: September 2020

Abstract
Background: Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. Methods: We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. Results: We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement.Conclusion: Mongolia continues to face the consequences of the socio-economic transition. Medical schools’ lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and introducing performance-based payments are recommended.
Adolescent and Caregiver Attitudes Towards Telemedicine Use in Pediatric Nephrology
Authors: Qiu Yi , Coulson Sherry , McIntyre Christopher William , Wile Brooke , Filler Guido 
Published: September 2020

Abstract
Background: Telemedicine is increasingly utilized as an alternative to in person consultation. Current pandemic conditions are providing additional impetus to virtual care delivery. We aimed at comparing both pediatric patient and caregiver attitudes towards telemedicine (here as tertiary center to remote health care location) as a crucial determinant of longer-term effectiveness. Methods: This mixed methods cohort study combined patient characteristics and analysis of transcribed structured telephone interviews with both pediatric nephrology patients (11-18 years) and their caregivers. Results: For 11 child-parent dyads, the median distances to tertiary center were 191 km (range 110-1378 km) and 1 km (1-54 km) to remote telemedicine location. Overall a ratio of 2:1 for telemedicine to in-person visits was favored; with caregivers more in favor of remote care than patients. Qualitative analysis found that experiences with telemedicine were distinguished by consultation-specific factors and contextual factors. Contextual factors (travel/cost savings) were valued for telemedicine by patients and caregivers. Consultation-specific factors, such as the ability to show the doctor physical symptoms, were more valued during in-person consultations, especially by patients. The overall visit type preference was related to the nature of the consultation. For regular check-ups, and for patients with less complex needs, participants felt that telemedicine offered a comparable experience to in-person visits. Conclusions: Indiscriminate transfer to chronic care predicated on mainly telemedicine approach is not compatible with user expressed attitudes (especially patients). Accurately mapping models of care to these attitudes is an essential determinant of effective management and longer-term engagement with potentially life-long health challenges.
Why Patients Dissatisfy with Medical Care in China--Evidence from the Patient Perceived Value
Authors: Qian Hui , Lu Wu , Zhang Daliang 
Published: September 2020

Abstract
- Background: Enlarged financial and managerial resources spending on medical improvement had rarely to decrease the crowed waiting line or increase the patient satisfaction. Investigating patients’ perceived value (PPV) gain an insight of patients’ satisfaction. PPV is a valuable perspective for hospitals to strategically improve medical care quality and performance from functional and emotional sides. - Methods: According to the theory of perceived value, an empirical study had been carried out by field survey and data collection in 7 well-known hospitals in Zhejiang Province China. 2586 questionnaires with valid data were analyzed according to PPV.- Results: Beside of the importance of functional values (effectiveness of treatment effect, reasonable and accurate prices, standardization and normalization, convenience and accessibility), the emotional values (communication with doctors/nurses, comfortable environment and facilitates) were highlighted. The preferences of patients’ perceived value were influenced by patients’ background features, and then the differentiation of patients’ satisfaction was proceeded. These patients, who are young, female, outpatient, light ill condition, high educational level and high income, tend to be relatively high demanding on medical care services but in high dissatisfaction level. Additionally, the findings show an advantage to pass the reasonability of waiting time to patients’ thought.- Conclusion: Classified convenience receiving approaches according to differentiated PPV and background features of patients, equipped up with e-enabled health care environment, can bring worthwhile patients’ satisfaction in Chinese hospitals .
What Influences the Outcome of Active Disinvestment Processes in Healthcare? A Qualitative Interview Study on five Recent Cases of Active Disinvestment
Authors: Rotteveel Adriënne Henderika , Lambooij Mattijs S. , de Rijt Joline J.A. van , Exel N.J.A. van , Moons Karel G.M. , de Wit G.A. 
Published: September 2020

Abstract
Background: Recent attempts of active disinvestment (i.e. withdrawal of reimbursement by means of a policy decision) of reimbursed healthcare interventions in the Netherlands have differed in their outcome: some were successful, with interventions actually being disinvested, while others were terminated at some point, implying continuation of reimbursement. This study aimed to obtain insight into recent active disinvestment processes, and to explore what aspects affect their outcome.Methods: Semi-structured interviews were conducted from January to December 2018 with stakeholders (e.g. patients, policymakers, physicians) who were involved in the policy process of five cases for which the full or partial withdrawal of reimbursement was considered in the Netherlands between 2007 and 2017: benzodiazepines, medication for Fabry disease, quit smoking programme, psychoanalytic therapy and maternity care assistance. These cases covered both interventions that were eventually disinvested and interventions for which reimbursement was maintained after consideration. Interviews were transcribed verbatim, double coded and analyzed using thematic analysis.Results: The 37 interviews showed that support for disinvestment from stakeholders, especially from healthcare providers and policymakers, strongly affected the outcome of the disinvestment process. Furthermore, the institutional role of stakeholders as legitimized by the Dutch health insurance system, their financial interests in maintaining or discontinuing reimbursement, and the possibility to relieve the consequences of disinvestment for current patients affected the outcome of the disinvestment process as well. No evidence was found of a consistent role of the formal Dutch package criteria (i.e. effectiveness, cost-effectiveness, necessity and feasibility) in active disinvestment processes.Conclusions: Contextual factors as well as the possibility to relieve the consequences of disinvestment for current patients are important determinants of the outcome of active disinvestment processes. These results provide insight into active disinvestment processes and their determinants, and provide guidance to policymakers for a potentially more successful approach for future active disinvestment processes.
Factors that influence natural menopause onset in China: a cross-sectional study
Authors: Wang Xuming , Gui Huawei , Yuan Chunyan , Liu Lijiang , Wei Jianguo , Huang Helin , Qiu Zhaohui , Yuan Xiaolu 
Published: September 2020

Abstract
BackgroundThis paper aimed to explore the average natural menopause age, the span of menopausal age, and the related factors that will probably affect the natural menopause age of Chinese women. MethodsA large-scale random sampling of menopausal women aged 32-75 years in 18 provinces or municipalities throughout China was conducted using paper questionnaire surveys to investigate the menopause age, menarche age, fertility status, illness history, and living habits. The SPSS 24.0 software package was used to carry out t test, chi-square test, logistic regression, and other statistical analyses. ResultsA total of 5852 questionnaires were collected. After excluding questionnaires having no menopause, questionnaires with incomplete or invalid information, and questionnaires that may directly affect the age of menopause, such as hysterectomy, oophorectomy, and other factors that may affect natural menopause, a total of 4426 effective questionnaires have been collected, and the average age of natural menopause was 49.49 ± 3.67 years old. ConclusionFactors that may affect the age of natural menopause are weight, menarche age, marital status, drinking tea or not (often and daily), eating supplements, oral contraceptive contraception, and safe contraception.