bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans’ Association With Viral Suppression
Authors: McManus Kathleen A , Christensen Bianca , Nagraj V Peter , Furl Renae , Yerkes Lauren , Swindells Susan , Weissman Sharon , Rhodes Anne , Targonski Paul , Rogawski McQuade Elizabeth , Dillingham Rebecca 
Published: November 2019

Abstract

Background
Healthcare delivery changes associated with viral suppression (VS) could contribute to the United States’ “Ending the HIV Epidemic” (EtHE) initiative. This study aims to determine whether Qualified Health Plans (QHPs) purchased by AIDS Drug Assistance Programs (ADAPs) are associated with VS for low-income people living with HIV (PLWH) across 3 states.

Methods
A multistate cohort of ADAP clients eligible for ADAP-funded QHPs were studied (2014–2015). A log-binomial model was used to estimate the association of demographics and healthcare delivery factors with QHP enrollment prevalence and 1-year risk of VS. A number needed to treat/enroll (NNT) for 1 additional person to achieve viral suppression was calculated.

Results
Of the cohort (n = 7776), 52% enrolled in QHPs. QHP enrollment in 2015 was associated with QHP coverage in 2014 (adjusted PR [aPR], 3.28; 95% confidence intervals [CIs], 3.06–3.53) and engagement in care in 2014 (aPR, 1.16; 1.04–1.28). PLWH who were engaged in care (n = 4597) and had QHPs had a higher VS rate than those who received medications from Direct ADAP (86.0% vs 80.2%). QHPs’ NNT for an additional person to achieve VS is 20 (14.1–34.5). Starting undetectable (adjusted risk ratio [aRR], 1.39; 1.28–1.52) and enrolling in QHPs in 2015 (aRR, 1.06; 0.99–1.14) was associated with VS.

Conclusions
Once enrolled in ADAP-funded QHPs, ADAP clients stay enrolled. Enrollment is associated with VS across states/demographic groups. ADAPs, especially in the South and in Medicaid nonexpansion states, should consider investing in QHPs because increased enrollment could improve VS rates. This evidence-based intervention could be part of EtHE.
Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs
Authors: Calonico Sebastian , Cattaneo Matias D , Farrell Max H 
Published: November 2019

Summary
Modern empirical work in regression discontinuity (RD) designs often employs local polynomial estimation and inference with a mean square error (MSE) optimal bandwidth choice. This bandwidth yields an MSE-optimal RD treatment effect estimator, but is by construction invalid for inference. Robust bias-corrected (RBC) inference methods are valid when using the MSE-optimal bandwidth, but we show that they yield suboptimal confidence intervals in terms of coverage error. We establish valid coverage error expansions for RBC confidence interval estimators and use these results to propose new inference-optimal bandwidth choices for forming these intervals. We find that the standard MSE-optimal bandwidth for the RD point estimator is too large when the goal is to construct RBC confidence intervals with the smaller coverage error rate. We further optimize the constant terms behind the coverage error to derive new optimal choices for the auxiliary bandwidth required for RBC inference. Our expansions also establish that RBC inference yields higher-order refinements (relative to traditional undersmoothing) in the context of RD designs. Our main results cover sharp and sharp kink RD designs under conditional heteroskedasticity, and we discuss extensions to fuzzy and other RD designs, clustered sampling, and pre-intervention covariates adjustments. The theoretical findings are illustrated with a Monte Carlo experiment and an empirical application, and the main methodological results are available in R and Stata packages.
Atrioventricular valve closure in Fontan palliation
Authors: King Gregory , Winlaw David S , Alphonso Nelson , Andrews David , Finucance Kirsten , Konstantinov Igor E , d’Udekem Yves 
Published: November 2019

Abstract

OBJECTIVES
Atrioventricular valve regurgitation is known to adversely impact outcomes of single-ventricle palliation, and valve repair rarely provides long-lasting results. Closure of a atrioventricular valve can sometimes be performed, but the long-term outcomes of this manoeuvre are unknown.

METHODS
This retrospective study was conducted using patient data extracted from an existing bi-national, population-based registry of survivors of the Fontan procedure.

RESULTS
Between January 1975 and June 2018, 1574 patients survived to hospital discharge with an intact Fontan circulation. Of these patients, 128 with a common atrioventricular valve were excluded. Thirty-eight patients underwent closure of an atrioventricular valve, and complete follow-up data were available for 36 patients. Twenty-nine patients underwent closure of the tricuspid valve and 7 patients underwent closure of the mitral valve. Seventeen patients underwent valve closure prior to Fontan, 13 patients underwent valve closure concomitant with Fontan and 6 patients underwent valve closure post-Fontan. Valve closure was performed using a patch technique in 29 cases and with direct suture in 7 cases. At the most recent echocardiography, 33 patients had no regurgitation, 2 patients had recurrent mild regurgitation and 1 patient had no echocardiographic follow-up. Six patients required reintervention post-valve closure and 7 patients required permanent pacemaker insertion post-valve closure. Freedom from reintervention at 1, 5 and 18 years post-valve closure was 86% [95% confidence interval (CI) 76–98%], 83% (95% CI 72–96%) and 83% (95% CI 72–96%), respectively.

CONCLUSION
Atrioventricular valve closure is an effective surgical technique in selected patients with a single ventricle providing long-lasting competency in the majority of cases.
Aiming High and Missing the Mark? Educational Choice, Dropout Risk, and Achievement in Upper Secondary Education among Children of Immigrants in Denmark
Authors: Birkelund Jesper Fels 
Published: November 2019

Abstract
Although children of immigrant origin in many European countries are observed to choose higher levels of education than native-origin peers at similar levels of academic performance, little is known about the outcomes of these high-aspiring choices. Using administrative register data covering all children born in 1994–1995 in Denmark, I examine whether the high-aspiring educational choices of children of immigrants convert into educational success or, conversely, into low grades and increased dropout rates. I find that, compared with children of Danish origin, children of immigrants are not only more likely to enrol in academic upper secondary education but also make more ambitious track and subject choices at this educational level. These ethnic choice effects are particularly pronounced at low levels of academic performance. Applying a counterfactual re-weighting approach, I show that, although ethnic choice effects reduce the ethnic gap in overall attainment of academic upper secondary education, they also widen ethnic gaps in dropout rates and achievement. My findings indicate that high aspirations among ethnic minorities operate as a double-edged sword as they help close the educational gap between them and their native-origin peers but at the cost of inducing academically weaker students to embark on less feasible educational trajectories.
Exploring social inequalities in the use and experience of prenatal care in Brussels
Authors: Schönborn C , Racape J , Sow M , De Spiegelaere M 
Published: November 2019

Abstract

Background
The underlying mechanisms of perinatal health inequalities remain under-researched. A possible explanation is inadequate access to healthcare services and suboptimal care for certain groups. To explore this, our study analyses the mothers’ prenatal care trajectories and experiences of care in relation to socioeconomic and migration characteristics.

Methods
A survey of 750 migrant and non-migrant mothers interviewed in 4 maternity wards in Brussels. Based on the adaptation of the Migrant-Friendly Maternity Care Questionnaire, the survey focuses on mothers with a Belgian, North African (NA) and Subsaharan African (SSA) nationality. The data are analysed through descriptive statistics and logistic regression.

Results
This ongoing survey has a high response rate (83%). Preliminary subsample analyses (n = 276) show that the socioeconomic profiles of mothers vary substantially depending on nationality, with mothers from NA generally having a lower level of education, and mothers from SSA being strongly at risk of poverty. SSA women are particularly at risk of starting prenatal care late (32% compared to 4% of Belgians and NAs) and of having less than 7 recommended consultations (25% compared to 6% Belgians and 9% NAs). Low household income and maternal education were also strong predictors of late and infrequent prenatal care. Women from all three nationality groups had the same rate (10%) of planned C-sections, but women from SSA were much more likely to have an emergency c-section (16% vs 7% of Belgians and NAs). Women with a higher household income were less likely to have a c-section at all. Women from both NA and SSA were less likely to always have understood the information given by healthcare professionals. 90% of women with secondary school education understood all the information, compared to 60% of women without it.

Conclusions
Women’s care trajectories and experiences of care vary strongly depending on their nationality and socioeconomic situation.

Key messages
North African and Subsaharan African immigrants in Brussels live in different socioeconomic situations. Their care trajectories and experiences of care also show important differences. Socioeconomic characteristics, in addition to women’s migration status, are important factors affecting women’s perinatal care.
Gender inequality in self-reported health and its evolution in Europe between 2004 and 2016
Authors: Roxo L , Perelman J 
Published: November 2019

Abstract

Background
That women generally have worse health than men has long been shown. Yet, the situation in Europe might have changed recently. Gender inequalities have decreased in access to education, employment, and political representation. However, women have increasingly adopted traditionally masculine unhealthy behaviors, such as smoking. Also, the Great Recession may have hurt women harder, due to their greater socioeconomic vulnerability. This study aims to analyze gender inequalities in 30 European countries, and its evolution over the 2004-2016 period.

Methods
We used data from the Survey on Income and Living Conditions (SILC), from people between 25 and 64 years old (N = 3,109,150). We modeled the probability of bad/very bad self-reported health as function of gender, adjusting for age, country and year, using logistic regressions. We further adjusted for education and employment. Then, we included interactions of gender and year to test changes in inequalities over time. Finally, we stratified the analysis according to countries grouped based on the Gender Development Index (GDI).

Results
Women were 16.8% more likely to report bad health (OR = 1.17, p &lt; 0.01). Considering education and employment, women were 2.6% less likely to report bad health (OR = 0.97, p &lt; 0.01). Over time, adjusting for age, the gender gap reduced from 81.1% (OR = 1.81, p &lt; 0.01) in 2004 to 16.4% in 2016 (OR = 1.16, p &lt; 0.01), and from 31.5% to 2.5% with socioeconomic adjustment. The reduction was larger in countries with a greater GDI.

Conclusions
Gender inequality has decreased, but was still present in 2016, in favor of men. This thinning is partly explained by the narrowing of inequalities in education and employment. A greater GDI has favored a larger improvement.

Key messages
Gender inequalities in self-reported health have narrowed over 2004-2006, following the narrowing of socioeconomic inequalities. A greater GDI has favored a larger improvement in gender inequalities.
Intercultural opening: participant observation in two hospitals and two outpatient care services
Authors: Peppler L , Sonntag P T , Schenk L 
Published: November 2019

Abstract

Background
The German healthcare system is facing intercultural diversity, since numerous migrant patients, nurses, and doctors are involved. This raises the question as to what extent everyday processes, working cultures and institutional framework conditions change because of this and how intercultural healthcare can be improved.

Methods
The participant observation took place on 22 days during summer 2018 in two outpatient care services and two hospitals, which show different degrees of intercultural opening (e.g. more or less migrant employees and patients). The aim was to reconstruct the daily work routine of health staff as well as the patients’ daily routine. The anonymized records include meetings, care tours, handovers and visits. The observation protocols were analyzed by documentary method and compared on two levels: degree of intercultural opening and sector affiliation.

Results
The results show that intercultural opening has a sector-specific impact on organization and daily work processes. The health staff of the hospital with high intercultural opening showed routine handling and relaxed reactions to communication difficulties due to the regular care of migrant patients, whereas that of the hospital with low intercultural opening showed stress-related defensive stance due to rare cases. The situation in the outpatient sector is different: The care of migrant patients was perceived to be more costly in the institution with high intercultural opening, because the migrant employees repeatedly perform additional socio-educational work that is not covered by insurance.

Conclusions
The migration-specific knowledge of employees has a positive effect on patient care in both inpatient and outpatient sector. However, this may be financially disadvantageous for nursing services under the conditions of outpatient care.

Key messages
Synergy effects arise from the involvement of migrant health workers and the care of migrant patients. Framework conditions must support these synergy effects in order to improve cultural sensitive healthcare.
Does adolescents like modern sports experiences? A trivial question for a major public health stake
Authors: Luiggi M , Griffet M 
Published: November 2019

Abstract

Background
Improving adolescents’ levels of sport and physical activity ‘PA’ is an official public health issue. However, national and European studies showed decline in overall levels of PA of European adolescents. In France, a school-based study showed a decrease in sport participation among adolescents of Marseille and area. Despite of this decline, we do not know whether they have a positive appreciation of modern sports experiences promoted in clubs. In this study, we aimed to measure French adolescents’ athletes retrospective reports of pleasure in these experiences.

Methods
A previous data collection among a representative sample of adolescents’ students was used (n = 1132). Adolescents were separated into 4 subgroups based on sex (Boys/Girls) and socioeconomic status ‘SES’ (Low/High). The Sport Experiences Questionnaire was used to measure retrospective reports of pleasure in competition, progress and risk-taking experiences. Multivariate linear regressions were performed to show differences between sex, SES and setting of participation (competition/no-competition). Densities diagrams were also presented.

Results
Among girls and boys, the setting of participation was significantly positively linked to reported pleasure. This effect was greater for competition experiences, respectively 1.45-fold and 1.53-fold increase for competition than no-competition players, for boys and girls. Among girls, high-SES girls presented a lower appreciation of competition experiences than their counterparts with low-SES. This relationship was observed in non-competitive (B=-0.62, p-value=0.016) and competitive (B=-0.70, p-value=0.025) settings. Finally, progress experiences were appreciated by all.

Conclusions
These results may help to step back traditional instituted sports offer. They would help to develop sports initiatives adapted to adolescents’ tastes. Finally, progress experiences may be gold experiences in sport and should be promoted in all context of participation.

Key messages
Modern sport experiences are not appreciated by all subgroups of adolescents. Endeavors to improve sport participation of adolescents should adapt contents to adolescents’ tastes. Pleasure in competition and risk-taking are linked to setting of participation and adolescents’ SES. The progress experiences may be the gold standard of sports experiences.
Adolescents with intellectual disability (ID) and their perceptions of activity and sports
Authors: Hansen E , Nordén H , Ohlsson M 
Published: November 2019

Abstract

Background
Individuals with intellectual disability (ID) are less physically active than individuals without ID, and they rarely or never reach the recommended daily level of physical activity. It is understood that both social interaction and ability in performing work tasks affect participation in daily activity services among people with ID. Individuals with ID generally have a higher risk of hypertension and obesity-related cardiovascular disease than individuals without ID. Professional service providers and parents are often those being asked, it is more seldom that the knowledge comes from the target group (ID) themselves.

Aim
To identify experiences and feelings among adolescents with ID regarding activity and sports participation, and to identify how they express and perceive the opportunities they have for being active in the community and surroundings where they live, including body and health awareness.

Methods
12 adolescents with ID, boys and girls, from Mid-Sweden participated in the study. The participants took part in a semi-structured interview that focused on experiences and aspects regarding activity and sports in their surroundings. Interviews identified three aspects: Activity, Surroundings, and Body- and health awareness. Adolescents with ID seems motivated to participate in activities and sports. The role of significant others, family and friends, support and the feeling of joy all seem crucial when reporting being outdoors, participating in ball games and in music activities. They are aware of limitations, sometimes feel bullied and are afraid of being excluded. Participation in activities and sports may be positively associated with health, but limitations such as awareness and support from society challenge the perception of ‘fitting in’ experienced by adolescents with ID. There is a need for deeper understanding to implement and follow up on the UN convention on rights for individuals with ID, as well as the 2030 sustainable development goals.

Key messages
The project aims to identify how individuals with ID can increase their participation in societal activities and hence feel more active and included as citizens. Special attention is given to include stakeholders in order to promote implementation and long-term success.
Patients with more comorbidities have better detection but poorer management of chronic diseases
Authors: Sum G , Koh G C H , Mercer S W , Lim Y W , Majeed A , Oldenburg B , Lee J T 
Published: November 2019

Abstract

Background
The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have significant clinical implications as highlighted in the recent National Institute for Care Excellence (NICE) guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, intreated, and uncontrolled for NCDs, in six large MICs.

Methods
Cross-sectional analysis of WHO SAGE Wave 1 (2007-10), which consisted of adults aged ≥18 years from six populous MICs including, China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557).

Results
Higher number of comorbidities was associated with better detection of hypertension, angina and arthritis, and better odds of having treatment for hypertension and angina. However, increasing comorbidity had the opposite effect on being uncontrolled, and was associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Comorbidity with concordant conditions was not associated with decreased nor increased odds of being uncontrolled for all NCDs.

Conclusions
Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Improving continuity of care and monitoring treatment are priorities for health systems with ageing populations.

Key messages
Patients with more comorbidities have better diagnosis of chronic conditions. but this does not translate into better management and control of these conditions.
Activity-based hospital payments: a qualitative evaluation by Israeli managers and physicians
Authors: Waitzberg R , Quentin W , Busse R , Greenberg D 
Published: November 2019

Abstract

Background
Israel has expanded procedure-related group (PRG) payments instead of per-diem payments for hospitals. There is scarce literature that documents the process of adoption of DRGs and its entailed economic incentives according to hospital workers’ perspectives. Important issues remain underexplored such as how managers transmit the incentives and considerations to caregivers, how physicians embrace (or not) these new rules of the game.

Methods
We used qualitative, grounded-theory analysis based on 35 semi-structured in-depth interviews with managers, financial directors, surgical ward heads and physicians in 5 hospitals, sampled by maximum variation according to hospital characteristics.

Results
We found two main themes: incentives for change and barriers to change. The most significant change was the creation of a common professional language, which facilitates measurement and supervision of activities, outcomes, and profitability. Measurement enhances transparency and is essential for resource management. Respondents also reported barriers inhibiting their responsiveness to the economic incentives of PRGs: a complicated coding system; inappropriate pricing; dependency on numerous production factors; lack of transparency; lack of coordinated goals among players; and other medical or moral considerations that outweigh or co-exist with financial considerations.

Conclusions
The adoption of PRGs led to changes in managers’ and physicians’ actions and considerations, particularly in situations where it was possible to reprioritize elective procedures without harming patient health or quality of care. However, on a broader level, the impact was modest, leading mainly to a fairer redistribution of resources and the rearrangement of work, such as shifting patients to after-hours. It would be appropriate to allow hospitals and physicians to operate in a less restricted market where regulation allows suppliers some degree of discretion so they can react to the PRG reform.

Key messages
Provider payment reforms change economic incentives, behavior and decision-making. However, structural barriers and other non-economic considerations may lead to unintended consequences of such reforms.