bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender inequality in the global mental health research workforce: a research authorship scoping review and qualitative study in Nepal
Authors: Gurung Dristy , Sangraula Manaswi , Subba Prasansa , Poudyal Anubhuti , Mishra Shelly , Kohrt Brandon A 
Published: December 2021

IntroductionAlthough women’s health is prioritised in global research, few studies have identified structural barriers and strategies to promote female leadership and gender equality in the global health research workforce, especially in low-income and middle-income countries.MethodsWe conducted a mixed-methods study to evaluate gender equality in the mental health research workforce in Nepal. The scoping review assessed gender disparities in authorship of journal publications for Nepal mental health research, using databases (PsycINFO, PubMed, Web of Science, NepJol, NepMed) for 5 years. Qualitative interviews were conducted with 22 Nepali researchers to identify structural barriers limiting women’s leadership.ResultsOf 337 articles identified, 61% were by Nepali first authors. Among Nepali first authors, 38.3% were women. Nepali women had half the odds of being first authors compared with men, when referenced against non-Nepali authors (OR 0.50, 95% CI 1.30 to 3.16). When limiting publications to those based on funded research, the odds were worse for first authorship among Nepali women (OR 0.37, 95% CI 0.19 to 0.71). The qualitative analysis supported the scoping review and identified a lack of gender-friendly organisational policies, difficulties in communication and mobility, and limited opportunities for networking as barriers to women’s leadership in global health research.ConclusionEfforts are needed for greater representation of Nepali women in global mental health research, which will require transformative organisational policies to foster female leadership. Those in leadership need to recognise gender inequalities and take necessary steps to address them. Funding agencies should prioritise supporting organisations with gender equality task forces, policies and indicators.
Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone
Authors: Hemingway Charlotte Devon , Bella Jalloh Mohamed , Silumbe Richard , Wurie Haja , Mtumbuka Esther , Nhiga Samuel , Lusasi Abdallah , Pulford Justin 
Published: December 2021

IntroductionDisease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results.MethodsA qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach.Results51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation.ConclusionHealth systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible.
Performance of risk scores for coronary artery disease: a retrospective cohort study of patients with chest pain in urgent primary care
Authors: Kleton Michelle , Manten Amy , Smits Iris , Rietveld Remco , Lucassen Wim A M , Harskamp Ralf E 
Published: December 2021

ObjectiveTo evaluate the diagnostic performance of the Marburg Heart Score (MHS), INTERCHEST, Gencer rule, Bruins Slot rule and compare these with unaided clinical judgement in patients with chest pain in urgent primary care.DesignRetrospective, cohort study.SettingRegional primary care facility responsible for out-of-hours primary care for a quarter-million people in the Netherlands.ParticipantsConsecutive patients aged ≥18 years who were evaluated for chest pain.Main outcome measuresDiscriminatory ability (C-statistic), sensitivity, specificity, positive and negative predictive values (PPV/NPV). The reference standard involved a composite endpoint of the occurrence of death, acute coronary syndrome or coronary revascularisation (=major adverse cardiac events; MACE) up to 6 weeks after initial contact.ResultsA total of 664 patients were included, of whom 4.8% (n=32) had a MACE event. C-statistics for MHS, INTERCHEST, Gencer and Bruins Slot rule were: 0.77 (95% CI 0.69 to 0.84), 0.85 (95% CI 0.78 to 0.92), 0.72 (95% CI 0.63 to 0.81) and 0.72 (95% CI 0.63 to 0.81), respectively. Optimal diagnostic accuracy was found for MHS ≥2 (sensitivity=81.3%, specificity=67.1%, PPV=11.1%, NPV=98.6%), INTERCHEST ≥2 (sensitivity=87.5%, specificity=78.8%, PPV=17.3%, NPV=99.1%), Gencer ≥2 (sensitivity=84.4%, specificity=37.8%, PPV=6.4%, NPV=98.0%) and Bruins Slot≥2 (sensitivity=90.6%, specificity=40.8%, PPV=7.2%, NPV=98.9%). Physicians referred 157 patients (23.6%) and missed 6 out of 32 MACEs (sensitivity=81.3%, specificity=79.3%, PPV=16.6%, NPV=98.8%). Using INTERCHEST with a referral threshold of ≥2 points, 4 MACEs would have been missed and 162 patients (24.4%) referred. The other risk scores resulted in far higher referral rates.ConclusionWhile available risk scores have reasonable to good discriminatory properties, they do not outperform unaided clinical judgment for evaluating chest pain in urgent primary care. Only the INTERCHEST score may slightly improve risk stratification.
Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study
Authors: Saygın Avşar Tuba , Jackson Louise , McLeod Hugh 
Published: December 2021

IntroductionTobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs.MethodsA qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method.ResultsIn practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making.ConclusionThe scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.
Identifying factors that promote and limit the effective use of real-time patient experience feedback: a mixed-methods study in secondary care
Authors: Khanbhai Mustafa , Flott Kelsey , Manton Dave , Harrison-White Stephanie , Klaber Robert , Darzi Ara , Mayer Erik 
Published: December 2021

ObjectivesThe Friends and Family Test (FFT) is commissioned by the National Health Service (NHS) in England to capture patient experience as a real-time feedback initiative for patient-centred quality improvement (QI). The aim of this study was to create a process map in order to identify the factors that promote and limit the effective use of FFT as a real-time feedback initiative for patient-centred QI.SettingThis study was conducted at a large London NHS Trust. Services include accident and emergency, inpatient, outpatient and maternity, which routinely collect FFT patient experience data.ParticipantsHealthcare staff and key stakeholders involved in FFT.InterventionsSemi-structured interviews were conducted on 15 participants from a broad range of professional groups to evaluate their engagement with the FFT. Interview data were recorded, transcribed and analysed for using deductive thematic analysis.ResultsConcerns related to inefficiency in the flow of FFT data, lack of time to analyse FFT reports (with emphasis on high level reporting rather than QI), insufficient access to FFT reports and limited training provided to understand FFT reports for frontline staff. The sheer volume of data received was not amenable to manual thematic analysis resulting in inability to acquire insight from the free text. This resulted in staff ambivalence towards FFT as a near real-time feedback initiative.ConclusionsThe results state that there is too much FFT free text for meaningful analysis, and the output is limited to the provision of sufficient capacity and resource to analyse the data, without consideration of other options, such as text analytics and amending the data collection tool.
Are sexual health survey items understood as intended by African and Asian migrants to Australia? Methods, results and recommendations for qualitative pretesting
Authors: Vujcich Daniel , Roberts Meagan , Brown Graham , Durham Jo , Gu Zhihong , Hartley Lisa , Lobo Roanna , Mao Limin , Moro Piergiorgio , Mullens Amy B , Offord Baden , Oudih Enaam , Reid Alison 
Published: December 2021

IntroductionMore research and policy action are needed to improve migrant health in areas such as sexual health and blood-borne viruses (SHBBV). While Knowledge, Attitudes and Practice Surveys (KAPS) can inform planning, there are no SHBBV KAPS suitable for use across culturally and linguistically diverse contexts. This study pretests one instrument among people born in Sub-Saharan Africa, South-East and North-East Asia living in Australia.MethodsEmployees of multicultural organisations were trained to collect data over three rounds using a hybrid qualitative pretesting method. Two researchers independently coded data. Researchers made revisions to survey items after each round. Responses to feedback questions in the final survey were analysed.ResultsSixty-two participants pretested the survey. Issues were identified in all three rounds of pretesting. Of the 77 final survey respondents who responded to a survey experience question, 21% agreed and 3% strongly agreed with the statement ‘I found it hard to understand some questions/words’.ConclusionIt is essential to pretest SHBBV surveys in migrant contexts. We offer the following pretesting guidance: (1) large samples are needed in heterogeneous populations; (2) intersectionality must be considered; (3) it may be necessary to pretest English language surveys in the participants’ first language; (4) bilingual/bicultural workers must be adequately trained to collect data; (5) results need to be interpreted in the context of other factors, including ethics and research aims; and (6) pretesting should occur over multiple rounds.
Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety
Authors: Bjurling‐Sjöberg Petronella , Göras Camilla , Lohela-Karlsson Malin , Nordgren Lena , Källberg Ann-Sofie , Castegren Markus , Condén Mellgren Emelie , Holmberg Mats , Ekstedt Mirjam 
Published: December 2021

IntroductionSince early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic’s rampage, the processes involved and the consequences on working conditions, ethics and patient safety.MethodsAn emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants’ first-person stories are complemented with data from the healthcare organisations’ internal documents and national and international official documents.AnalysisExperiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.Ethics and disseminationThis project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.
CCWORK protocol: a longitudinal study of Canadian Correctional Workers’ Well-being, Organizations, Roles and Knowledge
Authors: Ricciardelli Rosemary , Andres Elizabeth , Mitchell Meghan M , Quirion Bastien , Groll Diane , Adorjan Michael , Siqueira Cassiano Marcella , Shewmake James , Herzog-Evans Martine , Moran Dominique , Spencer Dale C , Genest Christine , Czarnuch Stephen , Gacek James , Heidi Cramm , Maier Katharina , Phoenix Jo , Weinrath Michael , MacDermid Joy , McKinnon Margaret , Haynes Stacy , Arnold Helen , Turner Jennifer , Eriksson Anna , Heber Alexandra , Anderson Gregory , MacPhee Renee , Carleton Nicholas 
Published: December 2021

IntroductionKnowledge about the factors that contribute to the correctional officer’s (CO) mental health and well-being, or best practices for improving the mental health and well-being of COs, have been hampered by the dearth of rigorous longitudinal studies. In the current protocol, we share the approach used in the Canadian Correctional Workers’ Well-being, Organizations, Roles and Knowledge study (CCWORK), designed to investigate several determinants of health and well-being among COs working in Canada’s federal prison system.Methods and analysisCCWORK is a multiyear longitudinal cohort design (2018–2023, with a 5-year renewal) to study 500 COs working in 43 Canadian federal prisons. We use quantitative and qualitative data collection instruments (ie, surveys, interviews and clinical assessments) to assess participants’ mental health, correctional work experiences, correctional training experiences, views and perceptions of prison and prisoners, and career aspirations. Our baseline instruments comprise two surveys, one interview and a clinical assessment, which we administer when participants are still recruits in training. Our follow-up instruments refer to a survey, an interview and a clinical assessment, which are conducted yearly when participants have become COs, that is, in annual ‘waves’.Ethics and disseminationCCWORK has received approval from theResearch Ethics Board of the Memorial University of Newfoundland(File No. 20190481). Participation is voluntary, and we will keep all responses confidential. We will disseminate our research findings through presentations, meetings and publications (e.g., journal articles and reports). Among CCWORK’s expected scientific contributions, we highlight a detailed view of the operational, organizational and environmental stressors impacting CO mental health and well-being, and recommendations to prison administrators for improving CO well-being.
Efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre non-inferiority randomised controlled trial (PVP Study)
Authors: Song Yunhe , Song Wulian , Zhang Yi , Zhang Hengli , Xiao Meichun , Zhao Xiaohuan , Lv Aiguo , Yan Xiaowei , Lu Ping , Zhu Xiaomin , Gao Xinbo , Hu Kun , Zhang Yingzhe , Liang Xiaohong , Zhang Xi , Tang Guangxian , Lu Lan , Zhou Minwen , Fan Sujie , Xie Lin , Jin Ling , Tang Li , Yuan Huiping , Zhang Xiulan 
Published: December 2021

IntroductionPrimary angle-closure glaucoma (PACG) has a high prevalence and blinding rate across Asia. The first-line treatment of PACG is surgery, and phacotrabeculectomy remains the mainstream surgery for advanced PACG. However, it may cause vision-threatening complications with long learning curve. Minimally invasive glaucoma surgery has been gradually used in PACG combined with cataract surgery and achieved efficacy without excessive injury, of which goniotomy is the most commonly performed. Therefore, this study aimed to conduct a multicentre, non-inferiority randomised controlled clinical trial to compare the efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced PACG.Methods and analysisThis is a non-inferiority multicentre randomised controlled trial and will be conducted at eight ophthalmic departments and institutes in China. 124 patients with advanced PACG will be enrolled and randomised to undergo phacotrabeculectomy or phacogoniotomy. Comprehensive ophthalmic examinations will be performed before and after the surgery. The primary outcome is the change of intraocular pressure at 12 months after surgery compared with the baseline intraocular pressure. An extended follow-up period of 36 months will be required. Cumulative success rate of surgery, intraoperative and postoperative complications, and number of anti-glaucomatous medications will also be compared between the groups as secondary outcomes.Ethics and disseminationEthical approval has been obtained from the ethical committee of Zhongshan Ophthalmic Center, Sun Yat-sen University, China (ID: 2021KYPJ090) and all subcentres. All the participants will be required to provide written informed consent. The results will be disseminated through scientific meetings and published in peer-reviewed journals.Trial registration numberNCT04878458.
Emerging spectrum of post-COVID-19 syndrome
Authors: Kunal Shekhar , Madan Manu , Tarke Chandrakant , Gautam Dinesh Kumar , Kinkar Jiwan Shriram , Gupta Kashish , Agarwal Ritu , Mittal Shruti , Sharma Shashi Mohan 
Published: December 2021

Abstract‘Post-COVID-19 syndrome’ refers to symptoms in the convalescent phase following initial COVID-19 infection. This term encompasses a wide array of presentation involving lungs, heart and the neuromuscular system. Pulmonary manifestations include post-COVID-19 fibrosis, which is akin to post acute respiratory distress syndrome fibrosis and may reflect the permanent damage to the lungs following an initial bout of infection. Cardiovascular system is often involved, and the presentation can be in terms of acute coronary syndrome, myocarditis and heart failure. Clinical manifestations are often varied and non-specific, which entails a detailed workup and a multidisciplinary approach. Post-COVID-19 syndrome adds to the overall disease morbidity and leads to a prolonged hospital stay, greater healthcare utilisation and loss of productivity marring the country's dwindling economy. Thus, it is imperative that post-COVID-19 syndrome be prevented and identified early followed by a prompt treatment.
Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study
Authors: Gohar Ashraf A , Knauert Melissa , Kalot Mohamad A , Khan Akram , Sider Darby , Javed Muhammad Ali , Wooldridge David , Eck Leigh , Buckhold Fred , Colaco Brendon , Bhat Abid , Castillo Dubier Matos , Newman Ross , Mustafa Reem A 
Published: December 2021

AbstractBackgroundMedical trainees’ work schedule is designed to cover duties without consideration of differences in circadian rhythms during a 24-hour period (chronotype).ObjectiveTo explore chronotype variation among medical trainees and understand its association with burn-out and schedule satisfaction.MethodsIn a multicentre observational study, we conducted two surveys between 1 October 2018 and 1 April 2019. Trainees from nine centres across the USA participated. We measured burn-out using Maslach Burnout Inventory (MBI), and trainee chronotype using the Morningness-Eveningness Questionnaire (MEQ).Results324 (32%) out of 1012 responded to our survey. Participants were 51% female and had a mean age of 30.8 years. Most participants had an intermediate MEQ type (65%). A large proportion of participants had burn-out on at least one of three tested MBI scales (62%); 5% of participants had burn-out on all three MBI scales. More participants with evening MEQ type had burn-out (66%) compared with morning MEQ type (55%), however, the results were not statically significant (p=0.294). Overall satisfaction with work shifts was 6.5 (95% CI 6.3 to 6.7), with higher satisfaction with day shift 7.7 (95% CI 7.5 to 7.9) and lowest satisfaction with overnight 24-hour call 3.5 (95% CI 3.2 to 3.9). Satisfaction was lower in trainees with burn-out 6.0 (95% CI 5.7 to 6.4), (p&lt;0.001). In the follow-up survey, burn-out was present in at least one scale in 64% compared with 60% of respondents in the initial survey.ConclusionBurn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out.