bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of pulse oximetry on diagnosis, management and outcomes of acute febrile illness in low-income and middle-income countries: a systematic review
Authors: Chew Rusheng , Zhang Meiwen , Chandna Arjun , Lubell Yoel 
Published: November 2021

BackgroundAcute fever is a common presenting symptom in low/middle-income countries (LMICs) and is strongly associated with sepsis. Hypoxaemia predicts disease severity in such patients but is poorly detected by clinical examination. Therefore, including pulse oximetry in the assessment of acutely febrile patients may improve clinical outcomes in LMIC settings.MethodsWe systematically reviewed studies of any design comparing one group where pulse oximetry was used and at least one group where it was not. The target population was patients of any age presenting with acute febrile illness or associated syndromes in LMICs. Studies were obtained from searching PubMed, EMBASE, CABI Global Health, Global Index Medicus, CINAHL, Cochrane CENTRAL, Web of Science and DARE. Further studies were identified through searches of non-governmental organisation websites, snowballing and input from a Technical Advisory Panel. Outcomes of interest were diagnosis, management and patient outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 tool for Cluster Randomised Trials and Risk of Bias in Non-randomized Studies of Interventions tools, as appropriate.ResultsTen of 4898 studies were eligible for inclusion. Their small number and heterogeneity prevented formal meta-analysis. All studies were in children, eight only recruited patients with pneumonia, and nine were conducted in Africa or Australasia. Six were at serious risk of bias. There was moderately strong evidence for the utility of pulse oximetry in diagnosing pneumonia and identifying severe disease requiring hospital referral. Pulse oximetry used as part of a quality-assured facility-wide package of interventions may reduce pneumonia mortality, but studies assessing this endpoint were at serious risk of bias.ConclusionsVery few studies addressed this important question. In LMICs, pulse oximetry may assist clinicians in diagnosing and managing paediatric pneumonia, but for the greatest impact on patient outcomes should be implemented as part of a health systems approach. The evidence for these conclusions is not widely generalisable and is of poor quality.
Patient and public engagement in decision-making regarding infectious disease outbreak management: an integrative review
Authors: Kemper Sophie , Bongers MEJ , Slok ENE , Schoonmade LJ , Kupper JFH , Timen A 
Published: November 2021

IntroductionWorldwide, people experience the effects of infectious disease outbreaks on a regular basis. These effects vary from direct impact of the virus on health, to indirect impact of control measures on day-to-day life. Yet, incorporating the experiences, views and ideas of patients and the public in decision-making in managing outbreaks does not take place on a structural basis. However, this might be beneficial. We examined the current incorporation of patient and public engagement (PPE) in decision-making regarding outbreak management (OM).MethodsA systematic search was executed in PubMed, Embase, APA PsycInfo, Web of Science, Scopus and other literature sources. Papers describing PPE in decision-making regarding OM on a collective level (group-level) were included. Relevant information about study characteristics, methods, impact and embedment of PPE in decision-making in OM was collected.ResultsThe search yielded 4186 papers of which 13 were included. The papers varied in study context and design. Remarkably, no substantial patient engagement was identified. Overall, public engagement (PE) in decision-making regarding OM was mostly executed by a mix of methods, for example, workshops, interviews and surveys. Knowledge and idea sharing between the public and experts was deemed beneficial for establishing well-informed discussions. The efforts resulted in either direct implications for practice or recommendations in policy papers. Most papers described their efforts as a first step. No structural embedment of collective PE in decision-making regarding OM was identified. Furthermore, the quality of most papers was low to moderate due to insufficient description.ConclusionOverall, various practices for PE can be potentially valuable, but structural embedment in OM decision-making on a collective level was low. Before PPE can be permanently embedded in OM, more evidence on its impact needs to be collected. Furthermore, reporting on the engagement process and used terminology needs to be harmonised to ensure reproducibility and transparency.
Natural history and associated early life factors of childhood asthma: a population registry-based cohort study in Denmark
Authors: Chen Qian , Chen Ji , Zhou Yingchun , Huang Lisu , Tang Yincai , Li Jiong , Zhang Jun 
Published: November 2021

ObjectiveAsthma is a common chronic disease that imposes a substantial burden on individuals and society. However, the natural history of childhood asthma in a large population remained to be studied. This study aimed to describe the natural course of childhood asthma and examine the association between early life factors and childhood asthma.DesignA population-based cohort study.SettingThis study was based on the national registry data in Denmark.ParticipantsAll liveborn singletons in Denmark during 1995–1997 were identified and followed them till the end of 2009. Finally, 193 673 children were eligible for our study.ExposuresThe following characteristics were examined as potential early life factors associated with childhood asthma, including parity, maternal asthma history, maternal smoking during pregnancy, maternal social status, delivery method and gender.Main outcomes and measuresAsthma cases were identified on the basis of hospitalisation for asthma and prescriptions for antiasthmatic medications. Asthma remission was defined as no hospitalisation or prescription recorded for 2 years. Cox proportional hazards’ regression and logistic regression were used to evaluate the association between early life factors and the occurrence and remission of childhood asthma.ResultsThe cumulative occurrence rate of asthma in children aged 3–14 years was 13.3% and the remission rate was 44.1%. The occurrence rate decreased with age. Being female had a lower risk of asthma (HR: 0.72, 95% CI 0.70 to 0.74) and higher remission rate of asthma (HR: 1.18, 1.13 to 1.22), while maternal asthma was associated with a higher risk of asthma (HR: 2.15, 2.04 to 2.26) and decreased remission rate of asthma (HR: 0.79, 0.73 to 0.85). These patterns remained the same for early onset asthma.ConclusionsFemale gender had a lower risk of asthma and a better chance of remission, while maternal asthma history had an opposite effect. The early life factors may influence the natural course of childhood asthma.
Towards universal health coverage for people with stroke in South Africa: a scoping review
Authors: van Niekerk Sjan-Mari , Kamalakannan Sureshkumar , Inglis-Jassiem Gakeemah , Charumbira Maria Yvonne , Fernandes Silke , Webster Jayne , English Rene , Louw Quinette A , Smythe Tracey 
Published: November 2021

ObjectivesTo explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).SettingSA.DesignScoping review.Search methodsWe conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results.ResultsFifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available.ConclusionThis review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.
BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study
Authors: Shrestha Rajan , Upadhyay Sanjib Kumar , Khatri Bijay , Bhattarai Janak Raj , Kayastha Manish , Upadhyay Madan Prasad 
Published: November 2021

ObjectiveThis non-inferiority study aimed to determine the burden of obesity in a hospital outpatient setting of a developing country, using three commonly employed metrics as predictors of hypertension (HTN).DesignA cross-sectional study design was adopted.SettingThis study was conducted in Health Promotion and Risk Factor Screening Services of a tertiary hospital for eye and ear, nose, throat in a semiurban area of Nepal.Participants2256 randomly selected outpatients between 40 and 69 years old.Outcome measuresThe three obesity metrics and HTN were analysed for association using correlation, the area under the receiver operating characteristic (ROC) curve and ORs.ResultsThe prevalence of obesity or overweight by body mass index (BMI) was 58.29%; by waist-to-height ratio (WHtR) was 85.95%, high waist circumference (WC) was observed among 66.76% of participants. Female participants had a greater prevalence of high WC (77.46%) than males (53.73%) (p<0.001). Prevalence of HTN and pre-HTN were 40.67% and 36.77%, respectively. The areas under the ROC curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602) and WC (0.610).ConclusionThis study showed that WHtR and WC measured were not inferior to BMI as a metric for obesity detection and HTN prediction. Because of its low cost, simplicity of measurement and better ability to predict HTN, it may become a more usable metric in health facilities of low-income and middle-income countries.
OPTIMISE: MS study protocol: a pragmatic, prospective observational study to address the need for, and challenges with, real world pharmacovigilance in multiple sclerosis
Authors: Dobson Ruth , Craner Matthew , Waddingham Ed , Miller Aleisha , Cavey Ana , Webb Stewart , Hemingway Cheryl , Hobart Jeremy , Evangelou Nikos , Scolding Neil , Rog David , Nicholas Richard , Marta Monica , Blain Camilla , Young Carolyn Anne , Ford Helen L , Matthews Paul M 
Published: November 2021

IntroductionThe power of ‘real world’ data to improve our understanding of the clinical aspects of multiple sclerosis (MS) is starting to be realised. Disease modifying therapy (DMT) use across the UK is driven by national prescribing guidelines. As such, the UK provides an ideal country in which to gather MS outcomes data. A rigorously conducted observational study with a focus on pharmacovigilance has the potential to provide important data to inform clinicians and patients while testing the reliability of estimates from pivotal trials when applied to patients in the UK.Methods and analysisThe primary aim of this study is to characterise the incidence and compare the risk of serious adverse events in people with MS treated with DMTs. The OPTIMISE:MS database enables electronic data capture and secure data transfer. Selected clinical data, clinical histories and patient-reported outcomes are collected in a harmonised fashion across sites at the time of routine clinical visits. The first patient was recruited to the study on 24 May 2019. As of January 2021, 1615 individuals have baseline data recorded; follow-up data are being captured and will be reported in due course.Ethics and disseminationThis study has ethical permission (London City and East; Ref 19/LO/0064). Potential concerns around data storage and sharing are mitigated by the separation of identifiable data from all other clinical data, and limiting access to any identifiable data. The results of this study will be disseminated via publication. Participants provide consent for anonymised data to be shared for further research use, further enhancing the value of the study.
Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers
Authors: Bhandari Buna , Schutte Aletta E , Jayasuriya Rohan , Vaidya Abhinav , Subedi Madhusudan , Narasimhan Padmanesan 
Published: November 2021

BackgroundUnderstanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.ObjectivesThis formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.DesignA qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.SettingThe study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.ParticipantsA total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30–70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.ResultsThe respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient’s essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient’s details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2–3 times/week) preferably in the morning or evening.ConclusionsWe found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.
Scoping review of food safety at transport stations in Africa
Authors: Ncama Busisiwe Purity , Kuupiel Desmond , Duma Sinegugu E , Mchunu Gugu , Guga Phindile , Slotow Rob 
Published: November 2021

ObjectiveThe WHO has declared food safety as a public health concern. Transport hubs such as taxi ranks, bus stations and other transport exchange sites are major food trading/purchasing sites, particularly in Africa. Research evidence is needed to improve food safety policies and ensure consumption of safe food, owing to the increasing burden of foodborne diseases, particularly in the WHO Africa Region. We systematically mapped and described research evidence on food safety at transport stations in Africa.DesignA scoping review guided by the Arksey and O’Malley framework.Data sourcesWe searched for original research articles in PubMed, Web of Science, and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source), SCOPUS, and Google Scholar from their inception to 25 October 2020.Eligibility criteria for selecting studiesWe included studies that focused on food safety, involved transport stations, involved African countries and were published in English.Data extraction and synthesisData extraction was performed by two reviewers using a piloted-tested form. Thematic analysis was used to organise the data into themes and subthemes, and a narrative summary of the findings is presented.ResultsOf the total 23 852 articles obtained from the database searches, 16 studies published in 6 countries met the inclusion criteria. These 16 studies were published between 1997 and 2019, with the most (5) in 2014. Of the 16 studies, 43.8% (7) were conducted in South Africa, 3 studies in Ghana, 2 in Ethiopia and 1 study each in Nigeria, Kenya, Lesotho and Zambia. Most (44.4%) of the included studies focused on microbial safety of food; few studies (22.2%) focused on hygienic practices, and one study investigated the perspective of consumers or buyers. Microbes detected in the foods samples wereSalmonellaspp,Escherichia coli,Shigellaspp,Bacillussp,Staphylococcus aureus, which resulted mainly from poor hygiene practices.ConclusionsThere is limited research that focused on food safety at transport stations in Africa, especially on aspects such as hygiene practices, food storage and occupational health and food safety. Therefore, we recommend more research in these areas, using various primary study designs, to inform and improve food safety policies and practices for transport stations in African countries alongside improving access to clean water/handwashing facilities, and undertaking structural changes to facilitate behaviours and monitoring for unintended consequences such as livelihoods of vulnerable populations.
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review
Authors: McCleskey Sara G , Shek Lili , Grein Jonathan , Gotanda Hiroshi , Anderson Laura , Shekelle Paul G , Keeler Emmett , Morton Sally , Nuckols Teryl K 
Published: November 2021

BackgroundHospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain.ObjectiveTo systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals.MethodsA search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study.ResultsFifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care.ConclusionsQI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.
Socioeconomic deprivation and ethnicity inequalities in disruption to NHS hospital admissions during the COVID-19 pandemic: a national observational study
Authors: Warner Max , Burn Samantha , Stoye George , Aylin Paul P , Bottle Alex , Propper Carol 
Published: November 2021

IntroductionHospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.MethodsWe conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.ResultsBetween March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.ConclusionsEven in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.