bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti
Authors: Klarman Molly , Schon Justin , Cajusma Youseline , Maples Stace , Beau de Rochars Valery E M , Baril Chantale , Nelson Eric J 
Published: November 2021

ObjectiveTo identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access.DesignCross-sectional study.Setting and participantsIn Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled.Outcome measuresHousehold questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis.ResultsHouseholds reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar’s χ2test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional.ConclusionAddressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.
Addressing rural and Indigenous health inequities in Canada through socially accountable health partnerships
Authors: Markham Ray , Hunt Megan , Woollard Robert , Oelke Nelly , Snadden David , Strasser Roger , Betkus Georgia , Graham Scott 
Published: November 2021

BackgroundThere are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations. Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population.InnovationOur innovative approach uses social accountability engagement to counteract persistent health inequities. This involves an adaptation of the Boelen Health Partnership model (policymakers, health administrators, health professionals, academics and community members) extended by addition of linked sectors (eg, industry and not-for-profits) to the ‘Partnership Pentagram Plus’. We used appreciative inquiry and deliberative dialogue focused on the rural scale and integrating Indigenous ways of knowing along with western scientific traditions (‘two-eyed seeing’). Using this approach, partners are brought together to identify common interests and direction as a learning community. Equitable engagement and provision of space as ‘peers’ and ‘partners’ were key to this process. Groups with varying perspectives came together to create solutions, building on existing strengths and new collaborative approaches to address specific issues in the community and health services delivery. A resulting provincial table reflecting the Pentagram Plus model has fostered policies and practices over the last 3 years that have resulted in meaningful collaborations for health service change.ConclusionThis paper presents the application of the ‘Partnership Pentagram Plus’ approach and uses appreciative inquiry and deliberative dialogue to bring about practical and positive change to rural and Indigenous communities.
What influences patient satisfaction after total knee replacement? A qualitative long-term follow-up study
Authors: Klem Nardia-Rose , Smith Anne , O'Sullivan Peter , Dowsey Michelle M , Schütze Robert , Kent Peter , Choong Peter FM , Bunzli Samantha 
Published: November 2021

ObjectivesTo explore whether a conceptual model of patient satisfaction previously developed 1–2 years post-total knee replacement (TKR) is still relevant 3–4 years post-TKR. Specifically, (i) what is the stability in satisfaction levels 3–4 years post-TKR? and (ii) does the existing conceptual model of patient satisfaction after TKR apply at this later follow-up?DesignA constructivist grounded theory qualitative follow-up study. The present study was theoretically governed by the findings of the initial qualitative inquiry. One-on-one semi-structured interviews were used to test the assumptions of the model developed from the findings of the previous study.SettingAn urban Australian public hospitalParticipantsFrom 40 people who participated in the original study, 11 participants were purposively sampled based on their level of satisfaction and factors driving satisfaction as reported in their first interview. There were six women and five men, the average time since TKR was 3 years and 5 months, and the average age at time of interview was 77 years.ResultsSatisfaction levels were mostly stable with the exception of three participants; two transitioned in a positive direction; one in a negative direction. The meaning of satisfaction and the factors that influenced satisfaction were consistent with the original findings. However, beliefs relating to the influence of ageing on persistent knee symptoms and functional limitations were more dominant in the present study.ConclusionsThe findings provide support for patient satisfaction being a multifactorial construct that is potentially modifiable over time. Clinicians may apply the conceptual model we have described to optimise satisfaction in patients up to 3–4 years post-TKR.
How do healthcare providers construe patient complexity? A qualitative study of multimorbidity in HIV outpatient clinical practice
Authors: Ben-Menahem Shiko , Sialm Anastassja , Hachfeld Anna , Rauch Andri , von Krogh Georg , Furrer Hansjakob 
Published: November 2021

IntroductionPatient complexity is an increasingly used concept in clinical practice, policy debates and medical research. Yet the literature lacks a clear definition of its meaning and drivers from the health provider’s perspective. This shortcoming is problematic for clinical practice and medical education in the light of a rising number of multimorbid patients and the need for future healthcare providers that are adequately trained in treating complex patients.ObjectivesTo develop an empirically grounded framework of healthcare providers’ perceptions of patient complexity and to characterise the relationship between case complexity, care complexity and provider experience as complexity-contributing factors.DesignQualitative study based on semistructured in-depth interviews with healthcare practitioners.SettingA Swiss hospital-based HIV outpatient clinic.ParticipantsA total of 31 healthcare providers participated. Participants volunteered to take part and comprised 17 nurses, 8 junior physicians (interns) and 6 senior physicians (residents, fellows and attendings).ResultsPerceived patient complexity arises from the combination of case complexity drivers, the provider’s perceived controllability, and a set of complexity moderators at the levels of the patient, the care provider and the broader care context. We develop a conceptual framework that outlines key relationships among these complexity-contributing factors and present 10 key questions to help guide medical professionals in making complexity more explicit and more manageable in daily practice.ConclusionsThe framework presented in this study helps to advance a shared understanding of patient complexity. Our findings inform curriculum design and the teaching of essential skills to medical students in areas characterised by high patient complexity such as general internal medicine and geriatrics. From a policy perspective, our findings have important implications for the design of more effective healthcare interventions for complex patients.
Quantification of disparities in the distribution of lifestyle and metabolic risk factors, prevalence of non-communicable diseases and related mortality: the Belgian Health Interview Surveys 1997–2018
Authors: Mertens Elly , Sagastume Diana , Peñalvo José L 
Published: November 2021

ObjectivesComprehensively measure the trends in health disparities by sociodemographic strata in terms of exposure to lifestyle and metabolic risks, and prevalence and mortality of non-communicable diseases (NCDs) during the last 20 years in Belgium.DesignCross-sectional analysis of periodic national-representative health interview surveys and vital statistics.SettingPopulation-based study of adult residents in Belgium between 1997 and 2018.ParticipantsAdults aged 25–84 years and resident in Belgium in the years 1997 (7256 adults), 2001 (8665), 2004 (9054), 2008 (7343), 2013 (7704) and 2018 (8358).Main outcome measureAge-standardised prevalence rates of modifiable lifestyle risks (poor diet, smoking, excessive alcohol use and leisure-time physical inactivity), metabolic risks (high body mass index (BMI), blood pressure and cholesterol levels) and major NCDs (type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVDs), cancer, asthma and chronic obstructive pulmonary disease (COPD)), with their relative health disparities across strata by age, sex, region of residence, nationality, education and income level, and according to high versus low engagement in the four lifestyle risks, calculated from a survey-weighted age-adjusted logistic regression.ResultsGreater avoidable disparities were observed between extremes of education and income strata. The most marked disparities were found for exposure to lifestyle risks (except excessive alcohol use), prevalence of high BMI as well as T2DM, asthma and COPD, with disparities of daily smoking and COPD worsening over time. Still, NCD-specific mortality rates were significantly higher among men (except asthma), residents of Wallonia and Brussels (except cerebrovascular disease), and among the native Belgians (except T2DM and asthma). High engagement in lifestyle risks was generally observed for men, residents of the region Wallonia, and among lower education and income strata. This subgroup (20%) had a worse health profile as compared with those who had a low-risk lifestyle (25%), shown by prevalence ratios varying between 1.1 and 1.6 for metabolic risks, and between 1.8 and 3.7 for CVD, asthma and COPD.ConclusionsImproving population health, including promoting greater health equity, requires approaches to be tailored to high-risk groups with actions tackling driving root causes of disparities seen by social factors and unhealthy lifestyle.
Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement
Authors: Yoshijima Nobuhiro , Saito Tetsuya , Inohara Taku , Anzai Atsushi , Tsuruta Hikaru , Shimizu Hideyuki , Fukuda Keiichi , Naganuma Toru , Mizutani Kazuki , Yamawaki Masahiro , Tada Norio , Yamanaka Futoshi , Shirai Shinichi , Tabata Minoru , Ueno Hiroshi , Takagi Kensuke , Watanabe Yusuke , Yamamoto Masanori , Hayashida Kentaro 
Published: November 2021

ObjectiveTranscatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR.MethodsA total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes.ResultsAmong the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3.ConclusionsPoor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI.Trial registration numberThis registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423).
What gets resident physicians stressed and how would they prefer to be supported? A best–worst scaling study
Authors: Wu Andrew , Parris Ritika S , Scarella Timothy M , Tibbles Carrie D , Torous John , Hill Kevin P 
Published: November 2021

AbstractIntroductionPhysician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy.MethodsThis cross-sectional study used best–worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020).ResultsTop-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as ‘would realistically consider intervention’) and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options.ConclusionBWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.
Sirtuin 5-Mediated Lysine Desuccinylation Protects Mitochondrial Metabolism Following Subarachnoid Hemorrhage in Mice
Authors: Xiao Zhi-Peng , Lv Tao , Hou Pin-Pin , Manaenko Anatol , Liu Yuandong , Jin Yichao , Gao Li , Jia Feng , Tian Yang , Li Peiying , Zhang John H. , Hu Qin , Zhang Xiaohua 
Published: November 2021

Background and Purpose:
Sirt5 (Sirtuin 5) desuccinylates multiple metabolic enzymes and plays an important role in maintaining energy homeostasis. The goal of this study was to determine whether Sirt5-mediated desuccinylation restores the energy metabolism and protects brain against subarachnoid hemorrhage (SAH).

Methods:

Male C57BL/6 or Sirt5
−/−
mice were used. The endovascular perforation SAH model was applied. Protein lysine succinylation in the brain cortex was examined using liquid chromatography-tandem mass spectrometry analysis. The brain metabolism was evaluated by measurement of brain pH as well as ATP and reactive oxygen species level. Neuronal cell death and neurobehavioral deficits were assessed 24 hours after SAH. The expression and desuccinylation activity of Sirt5, lysine succinylation of citrate synthase and ATP synthase subunits were investigated by Western blot, immunohistochemistry, and ELISA in SAH mice and patients. Furthermore, the benefits of resveratrol-mediated Sirt5 activation were investigated.

Results:
A total of 211 lysine succinylation sites were differentially expressed on 170 proteins in mice brain after SAH. Thirty-nine percent of these succinylated proteins were localized in mitochondria and they are related to energy metabolism. SAH caused a decrease of Sirt5 expression and succinylated citrate synthase as well as the subunits of ATP synthase, subsequently lowered brain pH, reduced ATP and increased reactive oxygen species production, leading to neuronal cell death, and neurological deficits. Knockdown of Sirt5 aggravated SAH-induced effects, mentioned above. Administration of resveratrol resulted in activation of Sirt5. The activation was accompanied both with restoration of the mitochondrial metabolism and alleviation of early brain injury as well as with desuccinylating citrate synthase and ATP synthase.

Conclusions:
Protein lysine succinylation is a biochemical hallmark of metabolic crisis after SAH, and disruption of lysine succinylation through activation of Sirt5 might be a promising therapeutic strategy for the treatment of SAH.
Mechanisms of Internal Atlantic Multidecadal Variability in HadGEM3-GC3.1 at Two Different Resolutions
Authors: Lai W. K. M. , Robson J. I. , Wilcox L. J. , Dunstone N. 
Published: November 2021

Abstract
This study broadly characterizes and compares the key processes governing internal Atlantic multidecadal variability (AMV) in two resolutions of HadGEM3-GC3.1: N216ORCA025, corresponding to ∼60 km in the atmosphere and 0.25° in the ocean, and N96ORCA1 (∼135 km in the atmosphere and 1° in the ocean). Both models simulate AMV with a time scale of 60–80 years, which is related to low-frequency ocean and atmosphere circulation changes. In both models, ocean heat transport convergence dominates polar and subpolar AMV, whereas surface heat fluxes associated with cloud changes drive subtropical AMV. However, details of the ocean circulation changes differ between the models. In N216 subpolar subsurface density anomalies propagate into the subtropics along the western boundary, consistent with the more coherent circulation changes and widespread development of SST anomalies. In contrast, N96 subsurface density anomalies persist in the subpolar latitudes for longer, so circulation anomalies and the development of SST anomalies are more centered there. The drivers of subsurface density anomalies also differ between models. In N216, the NAO is the dominant driver, while upper-ocean salinity-controlled density anomalies that originate from the Arctic appear to be the dominant driver in N96. These results further highlight that internal AMV mechanisms are model dependent and motivate further work to better understand and constrain the differences.
Effectiveness of IADL interventions to improve functioning in persons with Schizophrenia: A systematic review
Authors: John Annie , Gandhi Sailaxmi , Prasad Muliyala Krishna , Manjula Munivenkatappa 
Published: November 2021

Background of the study: Instrumental activities of daily living (IADL) are activities that are needed to live an independent life. Psychotic disorders are associated with deficits in everyday functioning, causing impairment/disability in activities of daily living. Activities play a crucial role to measure functional health or disability. People with Schizophrenia often present difficulties in social and occupational reintegration that may be associated with problems in performing daily activities, including independent living, education, working, and socializing. Activities of daily living and instrumental activities of daily living (life skills training) including leisure and social skills training intended to reintegrate the patient into the community to lead an everyday life. Aim: The aim of this review was to identify the effect of skill-based interventions on independent functioning in persons with Schizophrenia. Methods: The authors conducted database searches of Google Scholar, PubMed, Science Direct, ProQuest, EBSCO from 1st January 1992 to 31st December 2020. The researcher extracted data, and the quality of included studies was rated by two authors independently. We used the Cochrane Risk of Bias (ROB) tool for assessing the quality of selected studies. The search identified nine studies that met the inclusion criteria with 655 participants. The outcome measure was independent functioning skills. Results: The interventions in the review were multifaceted with different combinations of psychoeducation, cognitive-behavioral methods, training in social skills, and IADL. The interventions resulted in significant improvement in functioning skills and reduction in relapse rates. Conclusion: Results of this review have revealed moderate to strong evidence for skills training, either behavioral or social skills to improve social and independent functioning, reduce caregiver burden, and improve negative symptoms. The review also supported that interventions could be generalized across settings.
Premature rupture of membranes – A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis
Authors: dos Santos Flávia Cunha , Ignacchiti Marcela Lacerda , Rodrigues Bruna , Velarde Luis Guillermo , Levy Roger Abramino , de Jesús Guilherme Ramires , de Jesús Nilson Ramires , de Andrade Carlos Augusto Ferreira , Klumb Evandro Mendes 
Published: November 2021

Objective The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE. Methods A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched. The search was updated on 3 February 2020. Results Infections (relative risk (RR): 3.26, 95% confidence interval (CI): 1.5–6.7, p = .001), history of serositis (RR: 2.59, 95% CI: 1.31–5.11, p = .006) and anti-RNP positivity (RR: 3.08, 95% CI: 1.39–6.78, p = .005) were associated risk factors for PROM, while anti-RNP positivity (RR: 3.37, 95% CI: 1.35–8.40; p = .009) were associated with premature PROM (PPROM). The prevalence of PROM and PPROM was 28.7% and 12.9%, respectively. In the systematic review, the prevalence of PROM and PPROM was 2.7%–35% (I2 = 87.62%) and 2.8%–20% (I2 = 79.56%), respectively. Conclusions PROM, both at term and preterm, occurs more frequently in women with lupus than in the general population. A history of serositis, anti-RN, infections and immunosuppression during pregnancy may increase the susceptibility to PROM. The systematic review did not find any study with the main objective of evaluating PROM/PPROM in women with lupus.