bluuebunny/crossref_metadata_2025_split huggingface dataset:
A review of the impact of financing mechanisms on maternal health care in Australia
Authors: Fox Haylee , Topp Stephanie M. , Callander Emily , Lindsay Daniel 
Published: November 2019

Abstract
Background
The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia.

Methods
We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia’s maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications’ full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis.

Results
A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search.

Conclusion
Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia’s maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance – typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.
A life satisfaction approach to valuing the impact of health behaviours on subjective well-being
Authors: Shi Yipu , Joyce Craig , Wall Ron , Orpana Heather , Bancej Christina 
Published: November 2019

Abstract
Background
Increasingly, decision-makers are interested in understanding the returns on investments in programs and policies that promote health and prevent chronic diseases. While the costs of these programs are more easily quantified, many of the outcomes they aspire to achieve are intangible and lack obvious market values. The subjective well-being (SWB) method was developed to value a wide range of non-market goods, including health outcomes directly in monetary terms. This paper presents an application of the SWB approach to estimate the monetary value of health-promoting behaviours as the intermediate outcomes of health promotion and chronic disease prevention programs and policies.

Methods
Life satisfaction (LS) was used as a proxy of individuals’ SWB. Based on the combined Canadian Community Health Survey 2009–10 data, we modeled LS as a function of income and healthy behaviours, controlling for the socio-demographic factors associated with LS at the individual level using ordinary least squares regression. Equivalent effects of income and healthy behaviours on LS derived from the models allowed us to estimate the trade-off between income and healthy behaviours.

Results
We found that income and healthy behaviours were positively associated with LS. The values of increased physical activity, an additional daily serving of fruits/vegetables, and not smoking are respectively $631, $115 and $563 per week. These represent the amounts of additional weekly income required to maintain an individual at their level of LS in the absence of each of these behaviours.

Conclusions
The SWB method holds promise as a method to monetize the value of a range of non-market goods, including healthy behaviours for which market values do not exist. The SWB method can be applied efficiently and cost-effectively using readily available survey data.
Deep sternal wound infection – latissimus dorsi flap is a reliable option for reconstruction of the thoracic wall
Authors: Spindler Nick , Kade Stefanie , Spiegl Ulrich , Misfeld Martin , Josten Christoph , Mohr Friedrich-Wilhelm , Borger Michael , Langer Stefan 
Published: November 2019

Abstract
Background
At present, data describing patients’ long-term outcomes, quality of life, and survival after deep sternal wound infection are rarely available.
The purpose of our study was to evaluate functional outcome and patient well-being after debridement and reconstruction of the sternal defect using a pedicled latissimus dorsi flap following deep sternal wound infection (DSWI).

Methods
This retrospective analysis reviewed 106 cases of DSWI after open-heart surgery treated between May 1, 2012, and May 31, 2015. The parameters of interest were demographic and medical data, including comorbidity and mortality. Follow-up consisted of physical examination of the patients using a specific shoulder assessment, including strength tests and measurements of pulmonary function.

Results
The population consisted of 69 (65%) male and 37 (35%) female patients. Their average age at the time of plastic surgery was 69 years (range: 35–85). The 30-day mortality was 20% (n = 21); after one-year, mortality was 47% (n = 50), and at follow-up, it was 54% (n = 58).
Heart surgery was elective in 45 cases (42%), urgent in 31 cases (29%) and for emergency reasons in 30 cases (28%). The preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE) averaged 16.3 (range: 0.88–76.76).
On the dynamometer assessment, a value of 181 Newton (N) (±97) could be achieved on the donor side, in contrast to 205 N (±91) on the contralateral side.
The inspiratory vital capacity of the lung was reduced to an average of 70.58% (range: 26–118), and the forced expiratory volume in 1 s was decreased to an average of 69.85% (range: 38.2–118).

Conclusions
Given that only small adverse effects in shoulder function, strength, and pulmonary function were observed, the latissimus dorsi flap appears to be a safe and reliable option for the reconstruction of the sternal region after DSWI.
Case report: a camouflaged parathyroid carcinoma with initial misdiagnosis
Authors: Cao Hongtao , Wang Weibin 
Published: November 2019

AbstractBackgroundParathyroid carcinoma is a rare malignancy with an increasing incidence. Most patients are characterized by the presence of severe primary hyperparathyroidism, especially hypercalcemia, while patients with normal level of serum calcium are extremely rare. Unfortunately, patients free of hypercalcemia are usually diagnosed at a later stage and suffer from a rather poor prognosis.Case presentationWe describe a patient diagnosed with intrathyroidal normocalcemic parathyroid carcinoma, whose preoperative ultrasonography suggests that the tumor is located inside the thyroid gland and present without obvious clinical manifestations, which makes it more challenging for diagnosis.ConclusionsPreoperative suspicion of malignancy is of great importance for advanced management while preoperative diagnosis is rather challenging with the limited contribution of imaging examinations. Any abnormality in serum level of calcium or parathormone may help to make an initial diagnosis especially when the level is extremely high. We introduce this case of initial misdiagnosis of an intrathyroidal parathyroid carcinoma, mimicking a suspicious thyroid nodule, to focus on the possible anomalous presentations of this rare condition and on its optimal management.
Reliable reconstruction of the complex high-location bile duct injury: a novel hepaticojejunostomy
Authors: Zhang Yuxin , Zhao Jianping , Chai Songshan , Zhang Zhanguo , Zhang Lei , Zhang Wanguang 
Published: November 2019

Abstract
Background
This study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI).

Methods
There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed.

Results
The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months).

Conclusions
The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.
Women’s perceived social support: associations with postpartum weight retention, health behaviors and depressive symptoms
Authors: Faleschini Sabrina , Millar Lynne , Rifas-Shiman Sheryl L. , Skouteris Helen , Hivert Marie-France , Oken Emily 
Published: November 2019

Abstract
Background
Social support may promote healthful behaviors that prevent excess weight at critical periods in women’s life. Our objective was to investigate associations of social support at 6 months postpartum with women’s health behaviors that have previously been shown to predict weight retention at 1 year postpartum.

Methods
At 6 months postpartum in Project Viva, a pre-birth prospective cohort in Massachusetts, women reported social support using the Turner Support Scale, depressive symptoms using the Edinburgh Postnatal Depression Scale, diet using PrimeScreen, average number of hours walking, light/moderate and vigorous physical activity, television viewing, and sleeping each day.

Results
Among 1356 women, greater partner support was associated with higher levels of walking (OR 1.36, 95% CI [1.01, 1.82]) and intake of fiber (OR 1.43, 95% CI [1.06, 1.91]) and lower intake of trans-fat (OR 1.49, 95% CI [1.11, 2.01]). Support from family/friends was marginally related to healthful levels of light/moderate physical activity (OR 1.26, 95% CI [0.96, 1.65]) and television viewing (OR 1.29, 95% CI [0.99, 1.69]). Both sources of support were strongly associated with lower odds of incident depression (OR 0.33, 95% CI [0.20, 0.55] and OR 0.49, 95% CI [0.30, 0.79], respectively). We did not find associations with vigorous physical activity or sleep duration.

Conclusions
Social support is important to the physical and mental health of new mothers and may promote behaviors that limit postpartum weight retention.
Evaluation of a mouthrinse containing guava leaf extract as part of comprehensive oral care regimen- a randomized placebo-controlled clinical trial
Authors: Nayak Namratha , Varghese Jothi , Shetty Seema , Bhat Vinutha , Durgekar Tejal , Lobo Richard , Nayak Usha Y. , U Vishwanath 
Published: November 2019

AbstractBackgroundThe control of biofilm adherence on tooth surface has always been the keystone of periodontal therapeutic systems. However, prevalence of gingivitis suggest inadequacy of self-performed oral hygiene measures and need for adjunctive aid for mechanical plaque control. Oral rinses containing chlorhexidine, has been widely used however, with certain limitations. Herbal products have been used widely reflecting its action as alternative and complementary remedy. Hence, the purpose of the present study was to evaluate the antimicrobial and antioxidant efficacy of a Guava leaf extract based mouthrinse in patients with chronic generalized gingivitis as an adjunct to oral prophylaxis.MethodsSixty subjects (n = 20) in compliance with the inclusion criteria were randomly assigned to one of the 3 study groups i.e. Group A- 0.15%Guava mouth rinse, Group B- 0.2% Chlorhexidine (CHX) mouth rinse, Group C- Distilled water (placebo). All the participants received professional oral prophylaxis and were dispensed with experimental mouth rinses and instructed to use for period of 30 days. Clinical parameters such as gingival index, plaque index along with microbial colony forming units using plaque samples and antioxidant levels in saliva were estimated at baseline, 30 and 90 days’ time intervals.ResultsAll 3 groups showed gradual reduction in GI, PI and microbial counts. Considering the mean scores of recorded parameters at the scheduled time intervals, notable changes were observed between chlorhexidine and guava mouth rinse compared to placebo group. Although there was improvement in the antioxidant status in all study participants, yet there was no statistically significant difference observed.ConclusionGuava mouth rinse can be used as an empirical adjunct to professional oral prophylaxis owing to its multifactorial properties and favourable acceptance. However, long term studies need to be conducted to validate its use for an extended period of time.Trial registrationThe clinical trial has been prospectively registered on 17th February 2017 by the Clinical Trials Registry-India (CTRI/2017/02/007898).
International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) - the propagation of knowledge in ultrasound for the improvement of OB/GYN care worldwide: experience of basic ultrasound training in Oman
Authors: Vrachnis Nikolaos , Papageorghiou Aris T. , Bilardo Caterina M. , Abuhamad Alfred , Tabor Ann , Cohen-Overbeek Titia E. , Xilakis Eleni , Mates Flora , Johnson Sarah P. , Hyett Jon 
Published: November 2019

Abstract
Background
The aim of this study is to evaluate effectiveness of a new ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) Outreach Teaching and Training Program delivered in Muscat, Oman.

Methods
Quantitative assessments to evaluate knowledge and practical skills were administered before and after an ultrasound course for sonologists attending the ISUOG Outreach Course, which took place in November, 2017, in Oman. Trainees were selected from each region of the country following a national vetting process conducted by the Oman Ministry of Health. Twenty-eight of the participants were included in the analysis. Pre- and post-training practical and theoretical scores were evaluated and compared.

Results
Participants achieved statistically significant improvements, on average by 47% (p < 0.001), in both theoretical knowledge and practical skills. Specifically, the mean score in the theoretical knowledge test significantly increased from 55.6% (± 14.0%) to 81.6% (± 8.2%), while in the practical test, the mean score increased from 44.6% (± 19.5%) to 65.7% (± 23.0%) (p < 0.001). Performance was improved post-course among 27/28 participants (96.4%) in the theoretical test (range: 14 to 200%) and among 24/28 (85.7%) trainees in the practical skills test (range: 5 to 217%).

Conclusion
Application of the ISUOG Basic Training Curriculum and Outreach Teaching and Training Course improved the theoretical knowledge and practical skills of local health personnel. Long-term re-evaluation is, however, considered imperative to ascertain and ensure knowledge retention.
Emergency nurses´ knowledge, attitude and perceived barriers regarding pain Management in Resource-Limited Settings: cross-sectional study
Authors: Kahsay Desale Tewelde , Pitkäjärvi Marianne 
Published: November 2019

Abstract
Background
Pain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management.

Methods
A cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results.

Result
In general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p <  0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics.

Conclusion
The emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.
Adult mental health provision in England: a national survey of acute day units
Authors: Lamb Danielle , Davidson Michael , Lloyd-Evans Brynmor , Johnson Sonia , Heinkel Samira , Steare Thomas , Pinfold Vanessa , Weich Scott , Morant Nicola , Kirkbride James , Marston Louise , Canaway Alastair , Madan Jason , Osborn David 
Published: November 2019

Abstract
Background
Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England.

Methods
English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions.

Results
Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services.

Conclusions
The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
Cost-utility analysis of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer in the Philippines
Authors: Genuino Anne Julienne , Chaikledkaew Usa , Guerrero Anna Melissa , Reungwetwattana Thanyanan , Thakkinstian Ammarin 
Published: November 2019

Abstract
Background
Breast cancer is the leading malignancy among Filipino women, with about 23.50% of cases characterized by human epidermal growth factor receptor-2 (HER2) overexpression. Trastuzumab, in addition to standard chemotherapy, is currently recommended as primary treatment for HER2-positive early-stage breast cancer (EBC) in the adjuvant settings, and has been listed in the Philippine National Formulary (PNF) since 2008, but with no current evidence yet on its value for money, to date. Hence, despite several policy enablers, its accessibility remains to be limited in the Philippines. We performed an economic evaluation to assess the cost-effectiveness and budget impact of adjuvant trastuzumab therapy for HER2-positive EBC in the Philippines, using healthcare system and societal perspectives, in aid of guiding coverage decisions.

Methods
A Markov model-based cost-utility and budget impact analyses were conducted to estimate the total costs incurred and outcomes gained in using 1 year of adjuvant trastuzumab added to standard chemotherapy versus standard chemotherapy alone, over a lifetime horizon. We discounted both costs and outcomes at 3.5% per annum. Parameters were estimated using country survival data, systematic review and meta-analysis of the relative treatment effect, local and international cost data, and published utility data. Univariate and probabilistic sensitivity analyses were used to account for parameter uncertainty.

Results
Trastuzumab therapy was dominated with an incremental cost-effectiveness ratio (ICER) at PHP 453,505 per QALY gained from a healthcare system perspective or PHP 458,686 per QALY gained from a societal perspective, with 10% cost-effectiveness probability at the country cost-effectiveness threshold of PHP 120,000 per QALY gained. National implementation will cost an additional amount of PHP 13,909 million in year one alone, plus about PHP 2000 to 3000 million annually for the succeeding fiscal years.

Conclusion
At its current cost, 1 year of adjuvant trastuzumab therapy compared to standard chemotherapy alone for HER2-positive EBC does not represent value for money in the Philippines. Its current cost will have to significantly lower down by one-half to achieve cost-effectiveness.