bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to Accessing Health Care for People with Chronic Conditions: A Qualitative Study
Authors: Schwarz Tanja , Schmidt Andrea E. , Bobek Julia , Ladurner Joy 
Published: December 2021

Abstract
Background: There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to promote patient-centredness by gaining a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es while addressing the problem of fragmentation in Austria’s healthcare system.Methods: Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (e.g., patient advocates, family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.Results: The findings from the 25 expert interviews were organised within Levesque’s conceptual framework in four dimensions of barriers. They highlight the lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, but also later on. Barriers related to issues such as geography (e.g., longer distances and travel times as well as fewer healthcare services in remote rural regions), coordination of care (e.g., structural barriers and inconsistent care pathways), socioeconomic status (e.g., the ability to pay for healthcare services but also basic health literacy), and comorbidity (e.g., consideration of the patients’ state of mental health and holistic therapy approaches).Conclusions: Barriers to healthcare access are of particular concern for patients with chronic conditions, resulting in an urgent need to improve health services according to patients’ specific needs. For health services to be properly accessible, timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care are paramount. This study has important implications for policy and practice as it highlights provider, expert, and researcher perspectives on access to the healthcare system in Austria and offers a broader look at the changes required by stakeholders in the future.
Effect of Direct Transcranial Stimulation by Continuous Current (Tdcs) in “Kiss Nightclub Fire” Patients with Post-Traumatic Stress Disorder: Phase II Controlled Clinical Trial
Authors: Marcolin Kathy Aleixo dos Santos , Cunha Ângelo Batista Miralha , Yoneyama Beatriz Capparros , Ribeiro Tiango Aguiar 
Published: December 2021

Abstract
BackgroundVictims of disasters can develop post-traumatic stress disorder (PTSD) in 30-40% of cases. Application of repetitive transcranial magnetic stimulation (rTMS) shown promising results in PTDS. Transcranial direct current stimulation (tDCS) similar to rTMS, which is a neuromodulation technique, has shown promise in treatment of neuropsychiatric disorders.MethodA clinical trial conducted from March/2015-July-2016 in “KISS nightclub fire” disaster patients diagnosed with PTSD without complete remission of symptoms, over 18-years and who maintained pharmacological treatment. Electrodes positioned as cathode (right DLPFC) and extra-cephalic anode (contralateral deltoid muscle.) A current of 2mA used for 25cm² area (0.08mA/cm² current density) 30min once a day, for 10 continuous days. Patients were assessed pre-intervention, post-intervention, 30-days’ and 90-days’ post-intervention. PTSD Checklist-Civilian version (PCL-C); Montreal Cognitive Assessment (MoCA); Hamilton Depression and Anxiety Rating Scale (HAM-D and HAM-A) were used.Results145 subjects were initially screened and eight analysed. 87,5% were female. 30.88±7.74 years were the mean age (ranging 23-44). post-intervention results demonstrate: no cognitive impairment (MoCA); 60% reduction in HAM-D scale (patients diagnose as moderate depression turns normal diagnosis) (p <0.001); 54.39% reduction in HAM-A scale (moderate to severe symptoms of anxiety patients turns mild symptoms) (p<0.001) and 20% decrease in PCL-C scale values (patients with high severity symptoms of PTSD turns moderate to moderately high severity symptoms) (p<0.001). Improvement in PTSD symptoms were maintained 30-days post-intervention (PCL-C, p= 0.025) and improvement in symptoms of depression (HAM-D, p=0.006) and anxiety (HAM-A, p= 0.028) in 90-days post-intervention.ConclusionDespite decrease over time, this improvement in PTSD, depression and anxiety symptoms was maintained throughout the first month after treatment. tDCS adjuvant can be an alternative treatment to refractory PTSD, either as a monotherapy or as a treatment enhancement strategy. They can also be an option for patients who do not want or do not tolerate pharmacological management.RBR-2qpv74b, 01/07/2021, “retrospectively registered” 03/03/2015.
COLABORAÇÃO PREMIADA: APORTES TEÓRICOS E JURISPRUDENCIAIS, O CASO DO BRASIL E INSERÇÕES NO DIREITO COMPARADO
Authors: Gomes Fernando Soares , Barroso Ian Bernar Santos , Ravnjak Leandro Luciano Silva 
Published: December 2021

Resumo: O objetivo deste texto é analisar o instituto da colaboração premiada. Trata-se de uma abordagem qualitativa operacionalizada pela pesquisa bibliográfica e documental, com breve imersão em análise comparada. Observou-se que a colaboração premiada esteve presente em vários momentos na história e é um instituto que carrega imprecisões tanto sob o aspecto conceitual quanto classificatório, além do problema da dispersão normativa. No direito comparado, considera-se a Itália como pioneira quanto à utilização do instituto. No Brasil, a colaboração premiada recebe tratamento na perspectiva constitucionalista, utilitarista e probatória. Conclui-se que a colaboração premiada é instrumento em transformação, especialmente relacionado à sua sistematização conceitual e à sua unificação normativa.
Nanoscale Structures and Materials from the Self-assembly of Polypeptides
and DNA
Authors: Bernal-Chanchavac Julio , Al-Amin Md. , Stephanopoulos Nicholas 
Published: December 2021

Abstract:
The use of biological molecules with programmable self-assembly properties is an attractive
route to functional nanomaterials. Proteins and peptides have been used extensively for these
systems due to their biological relevance and a large number of supramolecular motifs, but it is still
difficult to build highly anisotropic and programmable nanostructures due to their high complexity.
Oligonucleotides, by contrast, have the advantage of programmability and reliable assembly, but
lack biological and chemical diversity. In this review, we discuss systems that merge protein or peptide
self-assembly with the addressability of DNA. We outline the various self-assembly motifs
used, the chemistry for linking polypeptides with DNA, and the resulting nanostructures that can
be formed by the interplay of these two molecules. Finally, we close by suggesting some interesting
future directions in hybrid polypeptide-DNA nanomaterials, and potential applications for these
exciting hybrids.
A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial
Authors: Yoon Esther S , Hur Scott , Curtis Laura M , Wynia Aiden H , Zheng Pauline , Nair Sumi S , Bailey Stacy C , Serper Marina , Reese Peter P , Ladner Daniela P , Wolf Michael S 
Published: December 2021

Background
Inadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant recipients is common, yet interventions are needed to support patients in sustaining adequate adherence to prescribed regimens and achieving optimal transplant outcomes.

Objective
We examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring strategy known as TAKE IT.

Methods
The TAKE IT strategy includes: (1) routine, online, monthly patient self-report adherence assessments; (2) care alerts directed to nurses; (3) quarterly reports monitoring tacrolimus values and adherence trends; (4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at two large transplant centers (N=449). To evaluate the initial fidelity of TAKE IT, we investigated patient uptake of monthly adherence assessments during the course of a 3-month period, whether any disparities emerged, and the nature of any reported adherence concerns.

Results
Among 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% (164/202) completed an adherence assessment, 73% (148/202) completed at least two, and 57% (116/202) completed all monthly assessments. Overall, 50% (82/164) of kidney transplant recipients reported at least one adherence concern over the 3-month assessment period. The most common barriers were classified as regimen-related (eg, regimen complexity), cognitive (eg, forgetfulness), and medical (eg, side effects). Higher-income participants were more likely to complete all surveys compared to lower-income participants (P=.01).

Conclusions
TAKE IT demonstrated 81% (164/202) completion of an adherence assessment, 73% (148/202) completion of at least two, and 57% (116/202) completion of all monthly assessments during this brief, initial observation period. Among those that did respond to the online assessments, the majority demonstrated sustained engagement. Additional monitoring modalities could also be offered to meet patient preferences to ensure all patients’ medication use can be properly monitored.

Trial Registration
ClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868
A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial
Authors: Black Melissa , Brunet Jennifer 
Published: December 2021

Background
Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed.

Objective
This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition.

Methods
Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests.

Results
A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable.

Conclusions
The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese.

Trial Registration
ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663
Privacy and Confidentiality Concerns Related to the Use of mHealth Apps for HIV Prevention Efforts Among Malaysian Men Who Have Sex With Men: Cross-sectional Survey Study
Authors: Shrestha Roman , Fisher Celia , Wickersham Jeffrey A , Khati Antoine , Kim Rayne , Azwa Iskandar , Mistler Colleen , Goldsamt Lloyd 
Published: December 2021

Background
The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs.

Objective
Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts.

Methods
A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program.

Results
Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app–based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate.

Conclusions
Overall, our results indicate that mHealth app–based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical–legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake.
The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study
Authors: Jones Amanda C , Grout Leah , Wilson Nick , Nghiem Nhung , Cleghorn Christine 
Published: December 2021

BackgroundEvidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations.ObjectiveThe aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand.MethodsWe used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment.ResultsAcross the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of –NZ $606,000 (–US $408,000; 95% uncertainty interval –NZ $2,540,000 [–US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori.ConclusionsA modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures.
Trends in Teledermatology Utilization in the United States
Authors: Patel Akash D , Rundle Chandler W , Kheterpal Meenal 
Published: December 2021

Background
Teledermatology is an effective health care delivery model that has seen tremendous growth over the last decade. This growth can be attributed to a variety of factors, including but not limited to an increased access to dermatologic care for those with socioeconomic or geographic barriers, a reduction in health care costs for both the patient and the physician, and the delivery of high-quality dermatologic care. However, the associated barriers include practice reimbursements, interstate licensing, and liability. Despite these apparent barriers, the emergence of COVID-19 afforded teledermatology a surge of demand and loosened regulations, allowing dermatologists to see higher volumes of teledermatology patients. In this paper, we analyzed the American Academy of Dermatology’s DataDerm registry teledermatology utilization and patient demographic trends throughout the COVID-19 pandemic.

Objective
The aim of this paper was to characterize national-level teledermatology demographic data in the setting of the COVID-19 pandemic.

Methods
National-level data were curated for all practices enrolled in the American Academy of Dermatology’s DataDerm registry from April 1, 2020, through June 30, 2021. Encounter utilization rates were collected for visit type (ie, teledermatology versus in person), sex, race, age, insurance provider, and location (ie, in state versus out of state). The aggregate total data, as opposed to individual encounter data, were collected.

Results
The proportion of women who utilized services via teledermatology (65,023/98,642, 65.9%) was greater than that of those who utilized in-person services (29,40,122/50,48,450, 58.2%). Non-White patients made up a higher percentage of teledermatology utilizers (8920/62,324, 15%) when compared with in-person utilizers (3,94,580/35,08,150, 11.7%). Younger patients (aged <40) contributed more to teledermatology service utilization (62,695/75,319, 83.2%) when compared with in-person services (13,29,218/33,01,175, 40.3%). Medicare was a larger payor contributor for in-person services (8232/1,53,279, 25.2%) than for teledermatology services (10,89,777/43,30,882, 5.4%). Utilization by out-of-state patients was proportionally higher for teledermatology services (19,422/1,33,416, 14.6%) compared with in-person services (5,80,358/1,38,31,400, 4.2%).

Conclusions
Teledermatology services may reach and benefit certain populations (female, younger patients, those with non-White racial backgrounds, and out-of-state patients) more so than others. These baseline demographics may also serve to highlight populations for potential future teledermatology outreach efforts.

Conflict of Interest
None declared.
Identification of strategies for enhancing member commitment in Greek agricultural cooperatives: The opinion of cooperative experts
Authors: Manousakis Tilemachos , Sergaki Panagiota , Dijk Gert Van 
Published: December 2021

In the era of globalization, where competition is growing intensively, the cooperation between small scale farmers can assist them to be sustainable and survive. However, the situation with cooperatives in Greece is found to be on a downward trend due to their poor economic performance, which is later expressed by the diminished commitment of their members. In order to address the described problem we employed a qualitative study consisted of 10 guided interviewees with “cooperative experts”. Through the interviews the participants were asked to clarify their opinions on two major themes: 1) Common Greek cooperative issues, and 2)
Suggestions on strategies employed by cooperatives to enhance members’ commitment. Through our analysis we identified the issues related to the poor management of the cooperatives of the past as the major problems of cooperative in Greece. Regarding the strategies for enhancing commitment of members, the majority of participants highlighted the importance of improving the communication and quality of information provided by the coop to its members for building strong bond of trust and ultimately enhancing their commitment. Although, the improvement of communication takes time and requires consistent effort. Hence, cooperatives may act on employing the appropriate experts in order to improve their process of production and marketing. Strengthening the levels of expertise in the economic activities of the cooperative may assist on the satisfaction of members and enhance their commitment to the coop.