bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study
Authors: Taghizadeh Shahnaz , Farhangi Mahdieh Abbasalizad , Khodayari-Zarnaq Rahim 
Published: December 2021

AbstractBackgroundThe prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders.MethodsA qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran.ResultsThe identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents.ConclusionThe existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders.
The burden of mental health illnesses in Kerala: a secondary analysis of reported data from 2002 to 2018
Authors: Joseph Jaison , Hari Sankar D. , Nambiar Devaki 
Published: December 2021

AbstractBackgroundThe burden of mental health in India, as in other Low- and Middle-Income Countries (LMICs), is substantial. Secondary Analysis of survey data provides insight into trends in mental health morbidity over time, while administrative data can indicate corresponding trends in availability of infrastructure and services. We compared data from three national level surveys conducted in India to analyse trends in mental health morbidity and available institutional mechanisms to address mental health needs in Kerala, a south Indian state.MethodsWe compiled data from national and state level population surveys which reported mental health morbidity from 2002 to 2018. We compared the prevalence of mental health illness and disability reported in Kerala with national estimates. We also mapped the most recently available health human resource and infrastructure available in Kerala for mental health care. Basic descriptive statistics were computed for both sets of indicators using Microsoft Excel.ResultsIn 2002, Kerala had 194 persons per hundred thousand population with mental retardation and intellectual disability which increased to 300 persons per hundred thousand population in 2018. The number of individuals with mental health illness in the state increased from 272 person per hundred thousand to 400 persons per hundred thousand in the time period of 2002 to 2018. There were 5.53 beds available per ten thousand persons for treatment in Kerala in 2018.ConclusionKerala experienced a rapid rise in mental health morbidity between 2002 and 2018. The most recently reported health human resource and infrastructure availability in the state appears to be inadequate to cater to the requirements of mental health care, even as improvements and upgradations are underway. Service and system design changes will have to be mapped and evaluated over time.
The role of local business employees and community members in the HIV risk environment of female sex workers in an urban setting: associations between negative interactions and inconsistent condom use
Authors: Sherman Susan G. , Tomko Catherine , Silberzahn Bradley E. , White Rebecca Hamilton , Nestadt Danielle Friedman , Clouse Emily , Haney Katherine , Galai Noya 
Published: December 2021

Abstract
Background
The role of business employees and community members in the HIV risk environment of female sex workers (FSW) is underexplored, despite sex work often located in commercial and residential urban areas. We explored the effect of negative interactions between business employees and community members on inconsistent condom use with clients of female sex workers.

Methods
This study uses baseline data from the EMERALD study, a community empowerment intervention with FSW. We recruited a sample of 361 FSW in Baltimore, Maryland using targeted sampling techniques in ten zones characterized by high rates of sex work, located throughout the city. Participants were recruited between September 2017 and January 2019 and completed a survey, HIV rapid testing, and self-administered gonorrhea and chlamydia testing. The outcome, inconsistent condom use, was defined as not reporting “always” using condoms with paying clients. Poisson regressions with robust variance were used to model the effect of business employee and/or community member interactions on inconsistent condom use.

Results
Over half (54%) the sample was between 18 and 40 years old, 44% Black or another race, and experienced a range of structural vulnerabilities such as housing instability and food insecurity. Forty-four percent of the sample reported inconsistent condom use with clients. FSW reported being reported to the police weekly or daily for selling drugs (14% by employees, 17% by community), for selling sex (19% by employees, 21% by community), and experiencing weekly or daily verbal or physical threats (18% by employees, 24% by community). In multivariable models, being reported to the police for selling sex weekly or daily by community members (vs. never, aRR = 1.42, 95% CI = 1.08, 1.86) and business owners (vs. never, aRR = 1.36, 95% CI = 1.05, 1.76) increased risk of inconsistent condom use, as did monthly verbal or physical threats by community members (vs. never, aRR = 1.43, 95% CI = 1.08, 1.91).

Conclusions
Results show that both actors play important roles in FSWs’ HIV risk environment. Businesses and community members are important targets for holistic HIV prevention interventions among FSW in communities where they coexist in close proximity.
The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China
Authors: Li Changle , Mao Zhengzhong , Yu Caixia 
Published: December 2021

AbstractBackgroundPreventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China.MethodsThis research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis.ResultsThe results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88,p < 0.05; OR = 2.03,p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26,p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42;p < 0.1, OR = 2.98;p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11;p < 0.1, OR = 1.18;p < 0.1, respectively).ConclusionAmong Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.
“Deadly”, “fierce”, “shameful”: notions of antiretroviral therapy, stigma and masculinities intersecting men’s life-course in Blantyre, Malawi
Authors: Berner-Rodoreda Astrid , Ngwira Esther , Alhassan Yussif , Chione Boniface , Dambe Rosalia , Bärnighausen Till , Phiri Sam , Taegtmeyer Miriam , Neuhann Florian 
Published: December 2021

AbstractBackgroundStigma and masculinity represent persistent barriers in delivering successful HIV interventions to men. Our study examined community perceptions of HIV and anti-retroviral therapy (ART) and their implications for men on ART across the life course in Blantyre, Malawi.MethodsOur qualitative study is based on 72 face-to-face semi-structured interviews. Participants were selected purposively and included men on ART (with suppressed and unsuppressed viral loads), adult male community members irrespective of HIV status and other HIV stakeholders such as health personnel and program implementers. Interviews were conducted in Chichewa and English, transcribed verbatim and analyzed thematically in NVivo 12. We applied the socio-ecological model as our theoretical framework as well as a “life-course” perspective.ResultsOur findings highlight lingering negative perceptions towards ART in general and towards PLHIV irrespective of viral load suppression. With intersecting notions of masculinity and stigma, men’s descriptions of anticipated stigma in their relationships and when visiting health facilities dominated. Stigma was experienced at the personal, interpersonal, facility and community level. Yet, men living with HIV were perceived differently throughout the life-course, with young sexually active men seen as the most stigmatized group and older men seen as drawing resilience from a greater range of masculine norms. Some men of all ages displayed “transformative” masculinities independent of stigma and community expectations.ConclusionsWe propose the “life-course” as a useful concept for studies on masculinity, HIV and stigma. Considering gendered constructions of “respectable” midlife-older age vis-à-vis younger age, and how they influence stigma as well as uptake and adherence to ART might lead to more targeted services for men that build on “transformative masculinities”.
Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy
Authors: Karayama Masato , Inoue Yusuke , Yasui Hideki , Hozumi Hironao , Suzuki Yuzo , Furuhashi Kazuki , Fujisawa Tomoyuki , Enomoto Noriyuki , Nakamura Yutaro , Inui Naoki , Suda Takafumi 
Published: December 2021

Abstract
Background
The nutritional status can potentially affect the efficacy of cancer therapy. The Geriatric Nutritional Risk Index (GNRI), a simple index for evaluating nutritional status calculated from body weight and serum albumin levels, has been reported to be associated with the prognosis of various diseases. However, the relationships between GNRI and the efficacy of platinum-based chemotherapy in patients with non-small-cell lung cancer (NSCLC) are unknown.

Methods
The pretreatment levels of GNRI were retrospectively evaluated in 148 chemo-naïve patients with advanced NSCLC who received first-line platinum-based chemotherapy and scored as low or high.

Results
Patients with a high GNRI had a significantly higher overall response rate (ORR; 44.5% [95% confidence interval {CI} = 35.6%–53.9%] vs. 15.8% [95% CI = 7.4%–30.4%, p = 0.002), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of better ORR in multivariate logistic regression analysis and longer PFS and OS in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001).

Conclusions
GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.
Indirect costs associated with skin infectious disease in children: a systematic review
Authors: Lizano-Díez Irene , Naharro Jesús , Zsolt Ilonka 
Published: December 2021

Abstract
Background
There are limited data in the literature on the indirect costs associated with skin and soft tissue infections (SSTIs) in the pediatric population. This study aimed to conduct a systematic review of the indirect costs associated with SSTIs in children.

Methods
The search was conducted in PubMed, SCOPUS, and Web of Science up to January 2020. Thirteen search strategies were designed combining MeSH terms and free terms. SSTIs were defined as bacterial or viral infections, dermatomycoses, and parasitic infestations. Only primary studies were included. All analyzed costs were converted to 2020 Euros.

Results
Thirteen of the identified publications presented indirect costs of SSTIs in children and were conducted in Argentina, Australia, Brazil, Hungary, New Zealand, Poland, Spain, Taiwan, and the USA. Nine studies described indirect costs associated with infection of Varicella-zoster virus: lost workdays by outpatient caregivers ranged from 0.27 to 7.8, and up to 6.14 if caring for inpatients; total productivity losses ranged from €1.16 to €257.46 per patient. Three studies reported indirect costs associated with acute bacterial SSTIs (community-associated methicillin-resistant Staphylococcus aureus) in children: total productivity losses ranged from €1,814.39 to €8,224.06 per patient, based on impetigo, cellulitis, and folliculitis. One study of parasitic infestations (Pediculus humanus capitis) reported total indirect costs per patient of €68.57 (formal care) plus €21.41 due to time lost by parents in purchasing treatment.

Conclusions
The economic burden of SSTIs is highly relevant but underestimated due to the lack of studies reporting indirect costs. Further cost studies will allow a better understanding of the magnitude of the financial burden of the disease.
Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals
Authors: Marr Ruby , Goyal Anupama , Quinn Martha , Chopra Vineet 
Published: December 2021

Abstract
Background
Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals.

Methods
We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Telephone interviews were recorded, transcribed, and de-identified. To allow identification of both quantitative and qualitative themes that unified or distinguished programs with SVPs from each other, a content analysis approach was used.

Results
Of the Top 20 UNSWR hospitals, nineteen individuals with knowledge of or involvement in SVPs were identified. One individual represented two hospital systems for the same institution. Thirteen representatives agreed to participate, 12 declined, and 5 did not respond. One individual who initially agreed to participate did not attend the interview. Among twelve representatives interviewed, 10 reported establishment of SVPs at their hospitals between 2011 and 2016. Most program representatives reported that participants sought support voluntarily. Four domains were identified in the qualitative analysis: (a) identification of need for Second Victim Program (SVP); (b) challenges to program viability; (c) structural changes following SVP creation, and (d) insights for success. Driving SVP creation was the need support medical providers following a traumatic patient event. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of SVPs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating SVPs within quality improvement processes.

Conclusions
In this convenience sample, programs for healthcare providers that experience psychosocial or emotional trauma from clinical care were uncommon. Variation in structure, performance, and measures of success among SVPs was observed. A systematic approach to evaluating SVPs is needed to help inform institutions of how to best serve their second victims.
The price of curing cancer
Authors: Gandjour Afschin 
Published: December 2021

Abstract
Background
Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through pharmaceutical treatment were made available. The cancer cure was conceived to eliminate both cancer deaths and the underlying morbidity burden of cancer. Furthermore, the cure was hypothesized to arrive in incremental steps but at infinitesimally small time intervals (resulting, effectively, in an immediate cure).

Methods
The analysis used secondary data and was conducted from the viewpoint of the German social health insurance. As its underlying method, it used a cause-elimination life-table approach. To account for the age distribution of the population, the study weighted age-specific increases in remaining life expectancy by age-specific population sizes. It considered drug acquisition costs as well as savings and life extension costs from eliminating cancer. All cancer drugs that underwent a mandatory early benefit assessment in Germany between 2011 and 2015/16 and were granted an added benefit were included. Data on age- and gender-specific probabilities of survival, population sizes, causes of death, and health expenditures, as well as data on cancer costs were taken from the German Federal Office of Statistics and the German Federal Social Insurance Office.

Results
Based on the cause-elimination life-table approach and accounting for the age structure of the German population, curing cancer in Germany yields an increase in average remaining life expectancy by 2.66 life years. Based on the current incremental cost-effectiveness ratio of new cancer drugs, which is on average €101,493 per life year gained (€39,751/0.39 life years), the German social health insurance would need to pay €280,497 per insuree to eliminate cancer. Dividing this figure by current average remaining lifetime health expenditures yields a ratio of 2.07, which represents a multiplier of current health expenditures.

Conclusions
Eliminating cancer at current price levels would more than triple total health expenditures in Germany. As the current price of a cure requires a drastic reduction of non-health consumption, it appears that current prices for cancer drugs already on the market (i.e., small steps towards a cure) need careful reconsideration.
What is the level of safety culture in French nursing homes? The EHPAGE study
Authors: Teigné Delphine , Mabileau Guillaume , Moret Leila , Terrien Noémie 
Published: December 2021

Abstract
Background
French nursing homes (NHs) are in the early stages of implementing their risk management approach. The latter includes the development of a safety culture (SC) among professionals. A training package to support NHs in implementing a risk management strategy has been designed by QualiREL Santé, a regional body that provides support in quality and risk management. The aim is to improve SC. No data are available about the level of SC in French NHs. This study evaluates the level of SC and identifies predictors of SC scores in NHs that will subsequently benefit from the training package.

Method
The study was proposed to NHs who are members of QualiREL Santé in 2 French departments. Inclusion criteria were voluntary participation, the commitment of top management to benefit from the training package, and the absence of previous risk management support provided by QualiREL Santé. The NHSOPS-F questionnaire (22 items measuring 7 dimensions of SC) was administered to professionals between January and March 2016. 14 variables related to the structural profile of the NHs and the strategic choices of top management in terms of healthcare safety were recorded. Scores for 7 dimensions were calculated for all of the included NHs. Further modelling identified predictive factors.

Results
58 NHs were included. The response rate for the NHSOPS-F (n = 1946 professionals) was 64% (Q1-Q3 = [49.4;79.0]). Staffing was the least-developed dimension (11.8%), while scores were highest for Feedback and communication about incidents (84.8%). Being attached to a public hospital was associated with poorer perceptions of SC, notably for the dimension “Overall perceptions of resident safety and organizational learning” (β = − 19.59;p-value< 0.001). A less-developed SC was also significantly linked to existing Quality initiatives.

Conclusions
Overall, French NHs must prioritise issues of staffing, teamwork and compliance with procedures. The role of human factors within teams should be exploited by top management. Our initial findings will help to adapt improvement approaches and are particularly relevant to local and national policies during the ongoing pandemic.