bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study
Authors: Hunter Michael L. , Knuiman Matthew W. , Musk Bill , Hui Jennie , Murray Kevin , Beilby John P. , Hillman David R. , Hung Joseph , Newton Robert U. , Bucks Romola S. , Straker Leon , Walsh John P. , Zhu Kun , Bruce David G. , Eikelboom Robert H. , Davis Timothy M. E. , Mackey David A. , James Alan L. 
Published: August 2021

Abstract
Background and objective
Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults.

Methods
Participants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated.

Results
The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0–13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) “Healthy” (70%) with average of 1.95 conditions; 2) “Respiratory and Atopy” (11%, 3.65 conditions); 3) “Non-cardiometabolic” (14%, 4.77 conditions), and 4) “Cardiometabolic” (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions.

Conclusion
Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.
The association of osteoporosis knowledge and beliefs with preventive behaviors in postmenopausal breast cancer survivors
Authors: Bailey Stacyann , Lin Jenny 
Published: August 2021

AbstractBackgroundPostmenopausal breast cancer survivors (PBCS) are at increased risk of bone loss and fractures due to age-related decline of estrogen, and this risk is compounded by aromatase inhibitor cancer therapy. Several patient-level targetable risk factors can mitigate osteoporosis risk; however, adequate health behavior and risk perception in this population are underreported. The goal of this study was to evaluate osteoporosis knowledge and beliefs and assess their association with engagement in osteoporosis preventive behaviors among PBCS.MethodsIn this cross-sectional descriptive study, early stage I–IIIA PBCS (ages 55–86 years) completed the Facts on Osteoporosis Quiz, Osteoporosis Health Beliefs Scale, and Osteoporosis Preventive Behaviors questionnaires. Participants who were non-English speaking or declined to participate were excluded. Clinical and sociodemographic information were obtained from chart review and baseline questionnaire, respectively. Fisher’s exact test, Student t-test, and Wilcoxon Mann–Whitney tests were used where appropriate to assess the association between knowledge and beliefs with engagement in osteoporosis preventive behaviors.ResultsThe mean participant age was 66.1 years with 20% self-reporting as non-Hispanic White, 40% non-Hispanic Black, 27% Hispanic, and 13% other. Approximately 83% of the cohort had estrogen receptor positive breast cancer and received a bone density scan within the last six years. Osteoporosis knowledge (10.5 ± 3.4), seriousness (14.9 ± 3.8), and susceptibility (14.0 ± 3.5) mean scores were low among PBCS. Most PBCS (75%) were adherent to calcium and vitamin D supplements, but only 47% reported engagement in strength-training exercises. Married/partnered, higher osteoporosis knowledge and health motivation scores were associated with strength-training exercise. After adjustment for marital status and osteoporosis knowledge, only health motivation score remained significantly associated with strength-training exercise (OR 5.56, 95% CI 1.35–22.93).ConclusionsPBCS are highly motivated to keep a healthy lifestyle despite limited osteoporosis knowledge, perceived risk, and susceptibility. However, < 50% participated in strength-training exercise. Our findings suggest that oncologic care should include osteoporosis and fracture prevention strategies, directed at encouraging cancer survivors to increase their engagement in osteoporosis preventive behaviors, particularly strength-training exercises.
Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda
Authors: Nishimwe Clemence , Mchunu Gugu G. 
Published: August 2021

Abstract
Background
While maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder’s perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement.

Methods
The convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse.

Results
There was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities.

Conclusion
The study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country’s maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality.
Organisational responses to mitigate the effects of COVID-19 on healthcare workers: a qualitative case study from Bogotá, Colombia
Authors: Turner Simon , Niño Natalia , Segura Carolina , Botero-Tovar Natalia 
Published: August 2021

AbstractBackgroundHealthcare organisations have undergone organisational change to respond to COVID-19. This pandemic has presented challenges for employee adjustment, with impacts on the availability and coordination of human resources in healthcare. This study aimed to characterise the organisational actions regarding the coordination of human resources in healthcare within Bogotá, Colombia, to respond to the COVID-19 pandemic.MethodsWe followed a case study approach to understand the response to the emergency taking into account the narratives of managerial actors who have been directly involved in the planning of guidelines oriented to face the pandemic or in the implementation of health services for COVID-19. Twenty-two interviews with multiple health system organisations within Bogotá were conducted between May and September 2020 and analysed thematically.ResultsThree themes emerged from the analysis of the interview data: to retain human resources, to implement actions to improve the mental and physical health of the healthcare workers, and to enhance healthcare workers knowledge, skills and availability to respond to COVID-19.ConclusionsOrganisational actions led by hospital managers to retain, protect, and train human health resources in the dynamic context of the COVID-19 pandemic were identified. Other system-wide organisations like scientific associations contributed to the coordination of human resources across hospitals to respond to COVID-19 in Bogotá, Colombia. The actions of hospital managers, and roles of system-wide intermediary organisations, in coordinating human resources need to be explored in other health system contexts facing COVID-19.
Toceranib phosphate (Palladia) for the treatment of canine exocrine pancreatic adenocarcinoma
Authors: Musser Margaret L. , Johannes Chad M. 
Published: August 2021

AbstractBackgroundCanine pancreatic carcinoma is a rare, aggressive tumour that is often diagnosed late in the course of disease. Effective treatment strategies have been elusive, and overall survival time is short. In humans, treatment with tyrosine kinase inhibitors alone, or in combination with IV gemcitabine, have been moderately effective. As canine and human pancreatic carcinomas share many clinical aspects, strategies that mimic human treatment regimens may confer a better outcome in canine patients. The aim of this study was to assess the role of the veterinary tyrosine kinase inhibitor, toceranib phosphate, in the treatment of cytologically or histologically confirmed canine pancreatic carcinomas.ResultsRetrospectively, medical records of dogs with confirmed pancreatic carcinoma treated with toceranib were reviewed. Eight dogs were identified that fit the inclusion criteria. Toceranib was well-tolerated by all patients. Six were treated in the gross disease setting. Four had image-based evaluation of clinical benefit (complete response, partial response, or stable disease of > 10 weeks). Of those patients, 1 achieved a partial response, 2 stable disease, and 1 had progressive disease, for an overall clinical benefit rate of 75 %. An additional dog had clinically stable disease that was not confirmed via imaging. The toceranib-specific median overall survival time was 89.5 days (range: 14–506 days).ConclusionsAlthough limited in patient number, this small study suggests that toceranib may have biologic activity in dogs with pancreatic carcinoma. Larger, prospective studies are needed to confirm these preliminary results and define the use of toceranib in the microscopic disease setting.
Public health-relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: a scoping review
Authors: Heuschen Anna-Katharina , Lu Guangyu , Razum Oliver , Abdul-Mumin Alhassan , Sankoh Osman , von Seidlein Lorenz , D’Alessandro Umberto , Müller Olaf 
Published: August 2021

AbstractBackgroundThe COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. Malaria cases and deaths may increase due to the direct and indirect effects of the pandemic in malaria-endemic countries, particularly in sub-Saharan Africa (SSA). This scoping review aims to summarize information on public health-relevant effects of the COVID-19 pandemic on the malaria situation in SSA.MethodsReview of publications and manuscripts on preprint servers, in peer-reviewed journals and in grey literature documents from 1 December, 2019 to 9 June, 2021. A structured search was conducted on different databases using predefined eligibility criteria for the selection of articles.ResultsA total of 51 papers have been included in the analysis. Modelling papers have predicted a significant increase in malaria cases and malaria deaths in SSA due to the effects of the COVID-19 pandemic. Many papers provided potential explanations for expected COVID-19 effects on the malaria burden; these ranged from relevant diagnostical and clinical aspects to reduced access to health care services, impaired availability of curative and preventive commodities and medications, and effects on malaria prevention campaigns. Compared to previous years, fewer country reports provided data on the actual number of malaria cases and deaths in 2020, with mixed results. While highly endemic countries reported evidence of decreased malaria cases in health facilities, low endemic countries reported overall higher numbers of malaria cases and deaths in 2020.ConclusionsThe findings from this review provide evidence for a significant but diverse impact of the COVID-19 pandemic on malaria in SSA. There is the need to further investigate the public health consequences of the COVID-19 pandemic on the malaria burden.Protocol registered on Open Science Framework:https://doi.org/10.17605/OSF.IO/STQ9D
Becker’s nevus syndrome: a case report
Authors: Chikani Ugo N. , Ohuche Ijeoma N. , Bisi-Onyemaechi Ada I. 
Published: August 2021

Abstract
Background
Becker’s nevus syndrome is a syndrome characterized by the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. The nevus usually consists of a circumscribed, unilateral, irregularly shaped hyperpigmented macule, commonly occurring around the anterior upper trunk, with/without hypertrichosis and/or acneiform lesions. This rare syndrome has not been reported in our locality to the best of our knowledge.

Case presentation
We report the case of a 15-year-old Igbo female patient who presented to our pediatric endocrinology clinic, University of Nigeria Teaching Hospital, Enugu, with complaints of asymmetry of the breasts and hyperpigmented macules on the side. Based on her symptoms, diagnosis of Becker’s nevus syndrome was made. The diagnosis of Becker’s nevus syndrome is mostly clinical, based on the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. In our patient, there was a Becker’s nevus with ipsilateral breast hypoplasia. This syndrome, belonging to the class of epidermal nevus syndromes, is very rare, and is usually benign. She was placed on spironolactone tablets 50 mg daily, which have been associated with an improvement in the size of the hypoplastic breast, and her fears were allayed.

Conclusion
This syndrome has not been reported in our locality to the best of our knowledge and, therefore, has a propensity for misdiagnosis by clinicians because of its rarity. We therefore report this to create awareness among clinicians regarding this condition that is associated with much psychosocial trauma among patients, and that can be easily managed with oral spironolactone.
Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases
Authors: Gorobeiko Maksym , Dinets Andrii 
Published: August 2021

Abstract
Background
A detection of parathyroid glands by the evaluation of their autofluorescence in the near-infrared spectrum is considered as a promising tool in addition to their visual verification. The aim of this study was to evaluate the role of near-infrared autofluorescence application by using two different image-based systems for the identification of parathyroid glands during surgery of thyroid and parathyroid benign and malignant lesions.

Methods
Evaluation of near-infrared autofluorescence was performed in 15 patients by using two different image-based systems equipped with a near-infrared laser camera. Intravenous injection of fluorophore indocyanine green was used for the enhancement of near-infrared autofluorescence signal.

Results
Normal parathyroid glands were identified and mobilized after visual inspection in 12 (80%) patients, which was confirmed by near-infrared autofluorescence evaluation. Confident recognition of parathyroid glands by near-infrared autofluorescence signal and their subsequent distinction from lymph nodes was achieved in two (13%) patients with prior surgery for papillary thyroid carcinoma. In one (7%) case, parathyroid gland was identified as fragments of tissue within the postoperative scarring area by near-infrared autofluorescence evaluation, but not by visual inspection. A less intensive near-infrared autofluorescence signal was detected in the parathyroid gland owing to unintentional excision in one (7%) case. Better signal intensity from parathyroid glands was noticed after changes of the near-infrared camera in Fluobeam 800 image-based system in position to an angle of approximately 45–65° in relation to area of interest in all cases as compared with holding straight on the parathyroid gland. Fluobeam LX demonstrated a good near-infrared autofluorescence signal without any specific changes in the camera angle. Thyroid carcinoma demonstrated low-intensity signal in the case of invasion to thyroid capsule. No fluorescent signal was identified from metastatic, or from normal, lymph nodes.

Conclusions
The application of near-infrared autofluorescence imaging is considered as a useful, but additional, tool for the visual assessment of parathyroid gland in the case of primary neck exploration. The utility of near-infrared autofluorescence imaging for parathyroid detection is increased in the case of repeated surgical intervention owing to increased risk of unintentional parathyroid removal as well as for discrimination of parathyroids from the lymph nodes in cases of thyroid malignancy.
The impact of Israel’s Front-of-Package labeling reform on consumers' behavior and intentions to change dietary habits
Authors: Shahrabani Shosh 
Published: August 2021

Abstract
Background
In January 2020, Israel launched a reform mandating Front-of-Package (FOP) labeling on food products. The current study examined the factors affecting consumers’ decision-making regarding the use of FOP labels a year after the reform was implemented.

Methods
The survey was conducted between December 2020 and January 2021 and included a sample of 507 participants age 21 and over. The questionnaire included Health Belief Model (HBM) constructs related to food labeling, nutrition habits, media exposure and extent of support for the reform, frequency of using FOP labels, intention to change purchasing and consumption habits in the coming year, and personal details.

Results
The study found that 58.5% reported using the FOP labels to some extent. In addition, 70% indicated willingness to change to healthier products in the coming year. The results of the analytical model confirm the validity of the HBM and the other behavioral constructs. In particular, the frequency of using FOP labels increases as the following factors increase: levels of perceived benefits and perceived importance of reading FOP labels, level of perceived importance of healthy nutrition, frequency of conforming to healthy nutrition, and support for the reform.

Conclusions
The study's findings are important for understanding the impact of the new reform and for guiding future complementary actions to increase people’s motivation to use FOP labels. More advertisement about the FOP labels in the media and also through the HMOs is needed to increase people’s awareness of the reform. In addition, information about the reform provided to the public should emphasize the benefits and health implications of using FOP labels.
The association between hospital financial performance and the quality of care—a scoping review protocol
Authors: Dubas-Jakóbczyk Katarzyna , Kocot Ewa , Tambor Marzena , Quentin Wilm 
Published: August 2021

AbstractBackgroundHospitals operate under constant pressure to contain costs and improve the quality of care. The literature suggests that there is an association between health care providers’ financial performance and the quality of care. On the one hand, providers that are financially more stable might have better capacity to maintain reliable systems and resources for quality improvement. On the other hand, providing better quality of care might lead to financial gains in the form of increased revenues or achieved savings and, in consequence, a higher profitability. The general objective of this scoping review is to identify and map the available evidence on the association between hospital financial performance and the quality of care. It aims to (1) provide a broad overview of the topic and (2) indicate a more precise research question for a future systematic review.MethodsThis scoping review will follow five stages: (1) defining the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) the consultation process and engagement of knowledge users. The following databases will be searched: MEDLINE via PubMed, (2) EMBASE, (3) Web of Science, (4) Scopus, (5) EconLit, (6) ABI/INFORM, and (7) Business Source Premier. The reference lists of relevant papers will be visually scanned with the aim of identifying further studies of interest. Also, a gray literature search will be conducted by screening the websites of diverse organizations dealing with hospital performance and/or quality of care. The review will not apply a publication date limit and will include both quantitative and qualitative empirical studies as well as theoretical papers, technical reports, books/chapters, and thesis. The reporting will utilize the PRISMA extension for a Scoping Review checklist.DiscussionThis scoping review will provide an overview of the existing literature on the association between hospital financial performance and the quality of care. The review process will apply a rigorous methodological approach while broad inclusion criteria should assure comprehensive coverage of the available literature. The main limitation of the review is related to the general limitation of scoping reviews, i.e., the lack of a systematic quality and risk of bias assessment of included studies. In addition, the review will include only publications in English.Systematic review registrationOpen Science Frameworkosf.io/z25ag