bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empowerment and health care access barriers among currently married women in Myanmar
Authors: Htun Nang Mie Mie , Hnin Zar Lwin , Khaing Win 
Published: January 2021

Abstract
Background
Although Myanmar is moving to attain UHC in 2030, health care utilization indicators are still low, especially among women. Women’s health outcomes are determined by the lack of access to health care, and many factors influence this condition. The objective of the present work was to identify the association between women’s empowerment and barriers to accessing health care among currently married women in Myanmar.

Method
We performed a secondary analysis using the Myanmar Demographic and Health Survey (2015–16), including 7759 currently married women aged 15–49 years. The outcome variable, barriers to accessing health care, were asked about in terms of whether the respondent faced barriers to getting permission to go, getting money to go, the distance to the health facility, and not wanting to go alone. The variables were recoded into zero, one, and more than one barrier. After performing the exploratory factor analysis for women’s empowerment indicators (decision-making power and disagreement to justification to wife-beating), a multinomial logistic regression was carried out.

Results
Among currently married women, 48% experienced no barriers when accessing health care services, 21.9% had one barrier, and 30.1% had more than one barrier. After the exploratory factor analysis, scores were recoded into three levels. Women with low and middle empowerment had 1.5 odds (AOR 1.5, 95% CI: 1.2–1.8) and 1.5 odds (AOR 1.5, 95% CI: 1.3–1.9), respectively, to have barriers to accessing health care when compared to those with high empowerment for one barrier group. For the women who had more than one barrier, women with low empowerment were 1.4 times more likely (AOR 1.4, 95% CI: 1.1–1.7) to experience barriers in comparison to women with high empowerment. The barriers were seen to be reduced in the case of women who had a high level of education, had fewer children, came from rich households, and lived in urban areas.

Conclusion
When women are more empowered, they tend to face fewer barriers when accessing health care services. This finding could contribute to the policy formulation for reducing health inequity issues by increasing women’s empowerment.
The role of sexual compulsivity in unprotected intercourse among STI patients in Shanghai, China
Authors: Ni Yang , Liu Hengan , Gong Ruijie , Shi Mei , Zhang Shuxian , Wang Suping , Cai Yong 
Published: January 2021

Abstract
Background
Sexual compulsivity (SC) and its relationship with unprotected intercourse (UI) have long been an intriguing topic, but its existential meaning in the management of public health or, more precisely, sexually transmitted infections (STIs) has rarely been studied to date. This study examines whether SC plays a role in UI among sexually active STI patients.

Method
A cross-sectional study was conducted in two sexual transmitted disease (STD) clinicals of Shanghai Skin Diseases Hospital in Shanghai. Totally 664 sexually active STI patients were included.

Results
The ages of the 664 participants ranged from 18 to 76 years, with 58.73% between 26 and 40 years old. 449 (191 male and 258 female) reported had UI during the past 6 months. Although the only statistically significant difference (p < 0.01) was in relation to UI with a casual sexual partner, the difference between male/female and regular/casual sexual partners remained evident.

Conclusions
SC is evidently a potential predictor of UI with a casual sexual partner in male STI patients, while the use of condoms is more likely to be affected by other factors. In addition to general sexual education, counseling interventions should be provided by health institutions, and specific intervention methods targeting gender and sexual partners should be considered.
Socioeconomic disparity and the risk of contracting COVID-19 in South Korea: an NHIS-COVID-19 database cohort study
Authors: Oh Tak Kyu , Choi Jae-Wook , Song In-Ae 
Published: January 2021

Abstract
Background
The relationship between socioeconomic status and the risk of contracting coronavirus disease (COVID-19) remains controversial. We aimed to investigate whether socioeconomic status affected the risk of contracting COVID-19 in the South Korean population.

Methods
The NHIS-COVID-19 database cohort was used in this population-based study. We collected the data of COVID-19 patients who were diagnosed between January 1, 2020 and June 4, 2020 and those of the control population. The income levels of all individuals as of February 2020 were extracted, and study participants were classified into four groups based on quartiles: Q1 (the lowest) to Q4 (the highest). Data were statistically analyzed using multivariable logistic regression modeling.

Results
In total, 122,040 individuals—7669 and 114,371 individuals in the COVID-19 and control groups, respectively—were included in the final analysis. The multivariable logistic regression model showed that the Q1 group had a 1.19-fold higher risk of contracting COVID-19 than the Q4 group, whereas the Q2 and Q3 groups showed no significant differences. In the 20–39 years age group, compared with the Q4 group, the Q3 and Q2 groups showed 11 and 22% lower risks of contracting COVID-19, respectively. In the ≥60 years age group, compared with the Q4 group, the Q1, Q2, and Q3 groups showed a 1.39-, 1.29-, and 1.14-fold higher risks of COVID-19, respectively.

Conclusions
Lower socioeconomic status was associated with a higher risk of contracting COVID-19 in South Korea. This association was more evident in the older population (age ≥ 60 years), whereas both lower and higher socioeconomic statuses were associated with higher risks of contracting COVID-19 in the young adult population (in the 20–39 year age group). Strategies for the prevention of COVID-19 should focus on individuals of lower socioeconomic status and on young adults of higher and lower socioeconomic status.
An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework
Authors: Kim Jieun , Shakya Prabin Raj , Choi Sugy , Park Joong Shin , Tamrakar Suman Raj , Heo Jongho , Kim Woong-Han 
Published: January 2021

Abstract
Background
Nepal has a high prevalence of congenital anomaly contributing to high infant mortality. Ultrasound, an important tool to detect congenital anomalies and manage maternity-related risk factors, is not properly used in Nepal because Nepali doctors have limited opportunities for learning ultrasound techniques. Hence, we developed and implemented an ultrasound education program from 2016 to 2018. The objective of this study is to evaluate the education program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Methods
We conducted a mixed-method study to evaluate each component of RE-AIM. The team collected quantitative data from administrative records, tests, surveys, and an online follow-up survey. Qualitative data were collected from individual in-depth interviews at least a year after the program. The proportions, means, and t-tests were used for quantitative data, and thematic coding for qualitative data.

Results
A total of 228 healthcare workers representing 27.3% of the districts of Nepal were reached from 2016 to 2018. The program improved participants’ knowledge (29.3, 8.7, and 23.8 increases out of 100, each year, p< 0.001, n=85) and self-confidence (0.6, 0.3, 1.3 increases out of 4.0, p< 0.01, n=111). The participants were highly satisfied with the program (4.2, 4.1, and 4.0 out of 5.0, n=162). Among the respondents of the online follow-up survey (n=28), 60.7% had used ultrasound in their daily practice after the education program, and a medical institution established an ultrasound training center. The absence of clear accreditation and practical guidelines in ultrasound use were presented as barriers for adoption and maintenance.

Conclusion
The program was successful in improving participant’s knowledge and self-confidence in ultrasound techniques and showed great potential for the adoption and maintenance of the techniques in their practice. Continuous implementation of the program and institutional policy changes to facilitate ultrasound use may increase the ultrasound use and improve ultrasound service quality in Nepal.
Optimising the integration of technology-enabled solutions to enhance primary mental health care: a service mapping study
Authors: LaMonica Haley M. , Davenport Tracey A. , Ottavio Antonia , Rowe Shelley C. , Cross Shane P. , Iorfino Frank , Jackson Tanya A. , Easton Michael A. , Melsness Jennifer , Hickie Ian B. 
Published: January 2021

Abstract
Background
Despite the widely acknowledged potential for health information technologies to improve the accessibility, quality and clinical safety of mental health care, implementation of such technologies in services is frequently unsuccessful due to varying consumer, health professional, and service-level factors. The objective of this co-design study was to use process mapping (i.e. service mapping) to illustrate the current consumer journey through primary mental health services, identify barriers to and facilitators of quality mental health care, and highlight potential points at which to integrate the technology-enabled solution to optimise the provision of care based on key service performance indicators.

Methods
Interactive, discussion-based workshops of up to six hours were conducted with representative stakeholders from each participating service, including health professionals, service managers and administrators from Open Arms – Veterans & Families Counselling Service (Sydney), a counselling service for veterans and their families, and five headspace centres in the North Coast Primary Health Network, primary youth mental health services. Service maps were drafted and refined in real time during the workshops. Through both group discussion and the use of post-it notes, participants worked together to evaluate performance indicators (e.g. safety) at each point in the consumer journey (e.g. intake) to indicate points of impact for the technology-enabled solution, reviewing and evaluating differing opinions in order to reach consensus.

Results
Participants (n=84 across participating services) created service maps illustrating the current consumer journey through the respective services and highlighting barriers to and facilitators of quality mental health care. By consensus, the technology-enabled solution as facilitated by the InnoWell Platform was noted to enable the early identification of risk, reduce or eliminate lengthy intake processes, enable routine outcome monitoring to revise treatment plans in relation to consumer response, and serve as a personal data record for consumers, driving person-centred, coordinated care.

Conclusions
Service mapping was shown to be an effective methodology to understand the consumer’s journey through a service and served to highlight how the co-designed technology-enabled solution can optimise service pathways to improve the accessibility, quality and clinical safety of care relative to key service performance indicators, facilitating the delivery of the right care.
The product of trunk muscle area and density on the CT image is a good indicator of energy expenditure in patients with or at risk for COPD
Authors: Shirahata Toru , Sato Hideaki , Yogi Sanehiro , Inoue Kaiji , Niitsu Mamoru , Akagami Tomoe , Soma Machika , Mio Tomohiko , Nagata Makoto , Nakae Satoshi , Nishida Yuki , Tanaka Shigeho , Katsukawa Fuminori , Nakamura Hidetoshi 
Published: January 2021

Abstract
Background
Physical inactivity due to cachexia and muscle wasting is well recognized as a sign of poor prognosis in chronic obstructive pulmonary disease (COPD). However, there have been no reports on the relationship between trunk muscle measurements and energy expenditure parameters, such as the total energy expenditure (TEE) and physical activity level (PAL), in COPD. In this study, we investigated the associations of computed tomography (CT)-derived muscle area and density measurements with clinical parameters, including TEE and PAL, in patients with or at risk for COPD, and examined whether these muscle measurements serve as an indicator of TEE and PAL.

Methods
The study population consisted of 36 male patients with (n = 28, stage 1–4) and at risk for (n = 8) COPD aged over 50 years. TEE was measured by the doubly labeled water method, and PAL was calculated as the TEE/basal metabolic rate estimated by the indirect method. The cross-sectional areas and densities of the pectoralis muscles, rectus abdominis muscles, and erector spinae muscles were measured. We evaluated the relationship between these muscle measurements and clinical outcomes, including body composition, lung function, muscle strength, TEE, and PAL.

Results
All the muscle areas were significantly associated with TEE, severity of emphysema, and body composition indices such as body mass index, fat-free mass, and trunk muscle mass. All trunk muscle densities were correlated with PAL. The product of the rectus abdominis muscle area and density showed the highest association with TEE (r = 0.732) and PAL (r = 0.578). Several trunk muscle measurements showed significant correlations with maximal inspiratory and expiratory pressures, indicating their roles in respiration.

Conclusions
CT-derived measurements for trunk muscles are helpful in evaluating physical status and function in patients with or at risk for COPD. Particularly, trunk muscle evaluation may be a useful marker reflecting TEE and PAL.
Sex and gender differences in nutrition research: considerations with the transgender and gender nonconforming population
Authors: Linsenmeyer Whitney , Waters Jennifer 
Published: January 2021

AbstractA sex- and gender-informed approach to study design, analysis and reporting has particular relevance to the transgender and gender nonconforming population (TGNC) where sex and gender identity differ. Notable research gaps persist related to dietary intake, validity and reliability of nutrition assessment methods, and nutrition interventions with TGNC populations. This is due in part to the conflation of sex and gender into one binary category (male or female) in many nutrition surveillance programs worldwide. Adoption of the Sex and Gender Equity In Research (SAGER) guidelines and the two-step method of querying sex and gender has the potential to exponentially increase the body of research related to TGNC health.
An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice
Authors: Moss Miss Charlotte L. , Aggarwal Ajay , Qureshi Asad , Taylor Benjamin , Guerrero-Urbano Teresa , Van Hemelrijck Mieke 
Published: January 2021

Abstract
Background
Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients’ quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically.

Methods
A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion.

Results
A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting.

Conclusions
This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.
Prenatal detection and molecular cytogenetic characterization of 19q13.42 microduplication: three reported cases and literature review
Authors: Zhang Xinyue , Yue Fagui , Shi Qingyang , Jiang Yuting , He Jing , Li Leilei , Liu Ruizhi 
Published: January 2021

Abstract
Background
Trisomy 19q is a recognizable syndrome and associated with a wide spectrum of clinical phenotypes in clinic. The purpose of this study was to explore the prenatal phenotypes of 19q13.42 duplication, which was rarely reported in clinic.

Case presentation
Three pregnant women presenting diverse indications for prenatal diagnosis accepted amniocentesis: increased nuchal translucency and fetal pyelic separation (case 2) and high risk of maternal serum screening for Down syndrome (case 1 and case 3). Case 1 and case 2 shared similar duplicated locus in the region of 19q13.42, encompassing part NLRP12 gene. The latter inherited the chromosomal duplication from the mother with normal phenotypes. Case 3 carried a 1.445 Mb duplication in the 19q13.42q13.43 region. It was proposed that evolutionary duplication of NLRP12 gene could have a causative role in autoinflammatory diseases development. The genotype–phenotype correlation depends mainly on the duplicated size and functional genes involved, which is still yet to be determined. All pregnant women chose to continue the pregnancy and delivered healthy children with no apparent abnormalities.

Conclusions
The 19q13.42 microduplications in our study were the smallest fragments compared to previous literature. Our findings enriched the prenatal phenotypes for this chromosomal microscopic imbalance. It was proposed that long term follow up analysis should be guaranteed till adulthood to determine whether there will be other emerging clinical symptoms and developmental-behavioral disorders for such carriers.
Visceral leishmaniasis outbreaks in Bihar: community-level investigations in the context of elimination of kala-azar as a public health problem
Authors: Priyamvada Khushbu , Bindroo Joy , Sharma Madan Prashad , Chapman Lloyd A. C. , Dubey Pushkar , Mahapatra Tanmay , Hightower Allen W. , Bern Caryn , Srikantiah Sridhar 
Published: January 2021

Abstract
Background
With visceral leishmaniasis (VL) incidence at its lowest level since the 1960s, increasing attention has turned to early detection and investigation of outbreaks.

Methods
Outbreak investigations were triggered by recognition of case clusters in the VL surveillance system established for the elimination program. Investigations included ascertainment of all VL cases by date of fever onset, household mapping and structured collection of risk factor data.

Results
VL outbreaks were investigated in 13 villages in 10 blocks of 7 districts. Data were collected for 20,670 individuals, of whom 272 were diagnosed with VL between 2012 and 2019. Risk was significantly higher among 10–19 year-olds and adults 35 or older compared to children younger than 10 years. Outbreak confirmation triggered vector control activities and heightened surveillance. VL cases strongly clustered in tolas (hamlets within villages) in which > 66% of residents self-identified as scheduled caste or scheduled tribe (SC/ST); 79.8% of VL cases occurred in SC/ST tolas whereas only 24.2% of the population resided in them. Other significant risk factors included being an unskilled non-agricultural laborer, migration for work in a brick kiln, living in a kuccha (mud brick) house, household crowding, habitually sleeping outside or on the ground, and open defecation.

Conclusions
Our data highlight the importance of sensitive surveillance with triggers for case cluster detection and rapid, careful outbreak investigations to better respond to ongoing and new transmission. The strong association with SC/ST tolas suggests that efforts should focus on enhanced surveillance in these disadvantaged communities.

Graphical Abstract
Assessing individual-level change in dementia research: a review of methodologies
Authors: Murray Aja Louise , Vollmer Marlena , Deary Ian J. , Muniz-Terrera Graciela , Booth Tom 
Published: January 2021

Abstract
Background
Whether in the context of monitoring disease progression or in assessing the effects of interventions, a major challenge in dementia research is determining when an individual has undergone meaningful change in symptoms and other relevant outcomes such as cognitive test performance. The challenge lies in differentiating genuine improvement or deterioration from change in scores due to random and systematic error.

Body
In this review, we discuss the advantages and limitations of available methods for assessing individual-level change in the context of key challenges, including imperfect and differential reliability of scores, and practice effects. We discuss indices of reliable change and the use of composite and item response theory (IRT) scores.

Conclusion
We conclude that IRT-based approaches hold particular promise because they have the flexibility to accommodate solutions to a wide range of issues that influence the accuracy of judgements of meaningful change. We close by discussing the practical implications of adopting IRT-based approaches.
Retinal imaging study diagnoses in COVID-19: a case report
Authors: Ortiz-Egea José M. , Ruiz-Medrano Jorge , Ruiz-Moreno José M. 
Published: January 2021

Abstract
Background
Hyperreflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by optical coherence tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection.

Case report
We report the case of a 42-year-old healthy Caucasian male anesthetist who had treated COVID-19 patients during the previous 5 weeks and suddenly presented with a temporal relative scotoma in his left eye. Best-corrected visual acuity was 20/20 for the left eye, and no discromatopsy or afferent pupillary defect was present. Visual field test was performed, with no significant findings associated with the focal loss of sensitivity described by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of the GCL and IPL was visible in OCT which spared the outer retina, at the time of diagnosis and 1 month later. An oropharyngeal swab test was performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA), immunoglobulin G (IgG) and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) determination. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive.

Conclusions
Ocular signs and symptoms in COVID-19 cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present a case of COVID-19 diagnosis based on retinal ophthalmic examination.