bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes
Authors: Sieber Mattia , Rudiger Alain , Schüpbach Reto , Krüger Bernard , Schubert Maria , Bettex Dominique 
Published: March 2021

Abstract
Background: Whereas delirium in the general intensive care unit (ICU) population is common and well studied, knowledge on ICU delirium in patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy.Methods: This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Groups were compared with Fisher’s exact and Mann-Whitney U tests. Multivariate analysis included binary logistic regression, Cox regression and multiple linear regression. Results are given as number (percentage; confidence interval (CI)) and median (interquartile range).Results: Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Frequencies were high in patients with hepatic (13/21 [62%]; 95% CI 41-82%), lung (29/65 [45%]; 95% CI 33-56%) and colorectal malignancies (15/37 [41%]; 95% CI 24-56%). Delirious patients were older (66 [55-72] vs 61 [51-69] years, p = 0.001), had higher SAPS II (41 [27-68] vs 24 [17-32], p < 0.001) and more frequently sepsis (26/176 [15%] vs 6/312 [1.9%], p < 0.001) and / or shock (30/176 [6.1%] vs 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.366 [0.236-0.567], p < 0.001), longer ICU (HR [95% CI] 0.295 [0.234-0.371], p < 0.001) and hospital length of stay (HR [95% CI] 0.619 [0.500-0.765], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.401 [0.282-0.572], p < 0.001), higher ICU nursing workload (B [95% CI] 1.917 [1.665-2.206], p < 0.001) and ICU (B [95% CI] 2.077 [1.811-2.382], p < 0.001) and total costs (B [95% CI] 1.442 [1.301-1.597], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.263 [0.925-5.537], p = 0.074).Conclusions: In ICU patients with malignancy, delirium was a frequent complication independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.
Mr-Proadrenomedullin As Biomarker Of Renal Damage In Urinary Tract Infection In Children
Authors: Penedo Rafael Peñalver , Lucas Marta Rupérez , Welther Luis Antonio Álvarez-Sala , Benavent Alicia Torregrosa , Losada María Luisa Casas , Andrio Luis Bañuelos , Poves Ana Belén Rebolledo , Campaña María Mercedes Bueno 
Published: March 2021

Abstract
Background: Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Material and Methods: A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and chronic stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results: 62 pediatric patients (34 women) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66 – 1.59), while in patients without RS were 0.48 nmol/L (0.43 – 0.63) (p<0.01). The AUC in this case was 0.92 (95% CI 0.77 – 0.99). We stablished an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion: MR-ProADM has a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM showed as a very reliable biomarker for RS prediction. Keywords: Proadrenomedullin, biomarker, urinary tract infection, pediatric, renal scarring
Driving Factors for the Utilisation of Healthcare Services by People with Osteoarthritis: Results from A Nationwide Population-Based study
Authors: Costa Daniela , Rodrigues Ana M , Cruz Eduardo B , Canhão Helena , Branco Jaime da Cunha , Nunes Carla 
Published: March 2021

Abstract
Background: Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods: We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt . Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables.Results: In our sample, a high proportion of participants are overweight or obese (82,6%, n=748) and physically inactive (20,6%, n=201) and a small proportion had physiotherapy management (14,4%, n=141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. "GPUsers" represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations ( p <0,05) with the higher utilisation of healthcare services profiles. Conclusions: Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level.
An Analysis of Health Financial Protection in Ghana
Authors: Fuseini Sataru , Anthony Seddoh , Twumasi-Ankrah Kwame 
Published: March 2021

Abstract
BackgroundGhana introduced a state sponsored health insurance in 2005. The objectives of risk sharing through a prepaid mechanism was integral to the design, aimed at addressing the inequities in financial protection. Progress, however, has been predictably slow and complicated. The Scheme coexists alongside out-of-pocket spending, resulting in the persistence of catastrophic health expenditures and impoverishment. This study adds to the comparative literature on health financial protection in Ghana.MethodsThis study analysed data from Round 7 of the Ghana Living Standards Survey using ADePT. Out-of-pocket spending was used as the indicator for living standards. We estimated different headcount thresholds and concentration index for catastrophic health expenditure. Consumption was estimated to determine the poverty headcount and poverty gap. The distributive effect of health care expenditures on the different income quintiles was estimated to determine progressivity of health financing sources.ResultsSix percent of the households incurred catastrophic expenditures. The out-of-pocket health payments share reduced with total household resources. Those in the lowest quintile allocated a higher share of their total expenditures to health. This impoverished a significant proportion. The richer households had a higher share of health consumption. Therefore, the financing share rose the higher the quintile rank. The total redistributive effect of the expenditure on insurance, total expenditure on health and total payments showed an increase in income inequality between households. Expenditures on insurance and total health showed overall higher inequality for the bottom 25% and 50% of the population.ConclusionThe results highlighted multiple technical challenges related to the implementation of policies and interventions on health financial protection. Ghana can leverage its Scheme to strengthen implementation of its current health financing policies and create opportunities for investments in pro-poor interventions and actions. Other supporting social protection strategies and policies can help reinforce the ability and flexibility of poor households to cope with the uncertainties of health expenditures.
Does the reform of public hospitals' payment system increase the pay of medical personnel? A nationwide cross-sectional study
Authors: Dang Yong , Zhao Yaxin , Yan Hong , Wang Zhichao , Zhou Zhongliang 
Published: March 2021

Abstract
Background

The reform of public hospitals' payment system (RPHPS) is the focus of medical reform in China. The current medical personnel payment system was formulated under a framework including the whole public sector, and this cannot meet the demands of necessary reform. In 2017, the government piloted the RPHPS to raise the pay of medical personnel and mobilize their work enthusiasm. Here, we examine whether the RPHPS provides a way to influence the pay of medical personnel and examine the factors determining this pay.
Methods

This study used data from a cross-sectional survey of 699 public hospitals across 21 provinces of China in 2017, the China Public Hospitals Pay Reform Survey. We used a coarsened exact matching method and hierarchical linear analysis to enhance the comparability between groups. A total of 178,622 medical personnel were included in our study.
Results

We found that the RPHPS was significantly associated with total annual pay and annual performance pay. Those who worked in the treatment group had significantly higher total annual pay and annual performance pay than those in the control group. The pay of medical personnel was strongly associated with the average salary of an urban worker and the hospital type, and their gender, age, education status, work characteristics, position, professional titles, seniority in years and departments.
Conclusion

There was a strong relationship between the implementation of the RPHPS and the pay of medical personnel. From a policymaker perspective, this shows that there may be value in further promoting the development of the payment system in public hospitals. The government should scale up the piloted areas for RPHPS and increase the total salary and the total performance-based wage-control level of public hospitals to reflect the value of the technical and labor services provided by medical personnel.
Piloting a roving nurse mentor into community-based health programmes to capacitate community health workers: Findings from a realist evaluation in South Africa
Authors: Malatji Hlologelo , Goudge Jane , Griffiths Frances 
Published: March 2021

Abstract
Background
Many low- and middle- income countries (LMICs) are repositioning community health workers (CHW) programmes to provide promotive and preventive services and referrals to the formal health service. However, the CHW low literacy levels, insufficient supervision and fragmented programmes result in the under-performance of the programmes in many settings. In this paper, we report on the realist evaluation of an intervention to explain mechanisms that led to a change in CHW care and household coverage in a semi-rural area of South Africa.
Methods
Using a case study approach, we conducted in-depth interviews, focus group discussions and observations to document the experiences of CHWs, their supervisors, clients, facility staff and community representatives prior to the intervention, during, and after a 6 month post-intervention gap to assess how the benefits were generated and sustained.
Results
The nurse mentor (senior nurse) intervention operated in a complex and dynamic environment with resource shortages, conflicts between CHWs and facility staff, and a disruptive CHW labour union. Over 15 months, the mentor was able to overcome these issues and (1) create learning platforms for the CHWs and their supervisors to learn and practice new skills relating to priority activities, (2) address their fears of failing and (3) establish operational systems to address inefficiencies in the CHWs’ activities, resulting in improved service provision and household coverage. An increase in the CHWs’ stipend to the minimum wage improved their motivation, and their direct employment by the Department of Health led to their formal integration into the health care team working at their ‘home’ facility. However, given the volatile communities in which the teams operated, and the communities focus on demanding government housing, the nurse mentor was not able to establish a collaboration with the community structures.
Conclusions
A roving nurse mentor overseeing several CHW teams within a district healthcare system is a feasible option, particularly in a context where there is a shortage of qualified supervisors. However, the long term sustainability of the effects of intervention is dependent on CHWs’ formal employment by the Department of Health.
Population-based Comparison Study on the Costs of Stroke Care for Women with Dysmenorrhea
Authors: Lin Ya-Wen , Sung Fung-Chang , Lin Ming-Hung , Mou Chih-Hsin , Teng Yu-Kuei , Tzeng Ya-Ling 
Published: March 2021

Abstract
Background

No study has investigated costs of stroke care for women with dysmenorrhea and stroke. This study compared types of stroke and costs of stroke care between women with and without dysmenorrhea, using the National Health Insurance Research Database of Taiwan.
Methods

From the insurance claims data, we identified women aged 15–44 to establish study cohorts with and without dysmenorrhea, frequency matched by age, with same sample size of 66048. Incidence of stroke and costs by stroke subtype were compared between the two cohorts at the end of follow-up.
Results

The incidence of stroke was 1.3-fold greater in the dysmenorrhea cohort than in comparisons. Proportionally, hemorrhagic stroke (HS) decreased with age, whereas ischemic stroke (IS) increased with age in both cohorts. Compared to comparisons, dysmenorrhea women had lower proportions of both HS (16.6% vs. 21.3%) and IS (19.8 vs. 20.1%), whereas dysmenorrhea women had higher proportion of transient cerebral ischemia (TIA) (31.3 vs. 24.2%). The average HS care and IS care cost ratios were 4.1 (3254/789, USD) for dysmenorrhea women, and 3.3-fold (3870/1171, USD) for comparisons. Hospitalization rate was lower in the dysmenorrhea than in comparisons (18.0 vs. 23.4%). Dysmenorrhea was associated with an increased risk of HS hospitalized (adjusted odds ratio (aOR) = 1.26, 95% confidence interval (CI) 0.71–2.23), but a lowered risk for IS (aOR = 0.48, 95% CI 0.21–0.69). Average costs for inpatient care, intensive care units, emergency and outpatient visits for dysmenorrheal women were all less than that for comparisons, but not significant.
Conclusion

The overall incidence of stroke was higher in dysmenorrheal women than in comparisons due to a higher proportion of TIA, but not HS and IS. However, costs for stroke care were slightly lower for dysmenorrhea women than for comparisons.
Empirically Identified Networks of Healthcare Providers for Adults with Mental Illness
Authors: Breslau Joshua , Dana Beth , Pincus Harold , Horvitz-Lennon Marcela , Matthews Luke 
Published: March 2021

Abstract
Background
Policies target networks of providers who treat people with mental illnesses, but little is known about the empirical structures of these networks and related variation in patient care. The goal of this paper is to describe networks of providers who treat adults with a mental illness in a multi-payer database based medical claims data in a U.S. state.
Methods
Provider networks were identified and characterized using paid inpatient, outpatient and pharmacy claims related to care for people with a mental health diagnosis from an all-payer claims dataset that covers both public and private payers.
Results
Three nested levels of network structures were identified, an overall network, which included 21% of providers (N = 8,256) and 97% of patients (N = 476,802), five communities and 24 sub-communities. Sub-communities were characterized by size, provider composition, continuity-of-care (CoC), and network structure measures including mean number of connections per provider (degree) and average number of connections who were connected to each other (transitivity). Sub-community size was positively associated with number of connections (r = .37) and the proportion of psychiatrists (r = .41) and uncorrelated with network transitivity (r=-.02) and continuity of care (r = .00). Network transitivity was not associated with CoC after adjustment for provider type, number of patients, and average connection CoC (p = .85).
Conclusions
These exploratory analyses suggest that network analysis can provide information about the networks of providers that treat people with mental illness that is not captured in traditional measures and may be useful in designing, implementing, and studying interventions to improve quality of care. Though initial results are promising, additional empirical work is needed to develop network-based measures and tools for policymakers.
Knowledge, Beliefs and&nbsp;Attitudes Towards Dementia and Dementia Risk Reduction Among Descendants of People with Dementia: A&nbsp;Qualitative Study Using Focus Group Discussions
Authors: Vrijsen Joyce , Maeckelberghe Els , Broekstra Reinder , de Vries Jeroen , Abu-Hanna Ameen , De Deyn Peter Paul , Voshaar Richard Oude , Reesink Fransje , Buskens Erik , de Rooij Sophia , Smidt Nynke 
Published: March 2021

Abstract
Background Individuals with a parental family history of dementia have an increased risk of developing dementia because they share their genes as well as their psychosocial behaviour. Due to this increased risk and their experience with dementia, they may be particularly eager to receive information regarding dementia risk reduction (DRR). This study evaluated the knowledge, beliefs and attitudes towards dementia and DRR among descendants of people with dementia.Method Using a semi-structured topic guide, three focus group discussions were conducted consisting of 12 female (80%) and 3 male (20%) descendants of people with dementia with a mean age of 48.8 ± 12.0 years. Focus group discussions were audio recorded and transcribed. Each transcript was analysed thoroughly, and where appropriate, a code was generated and assigned by two researchers independently. Then, similar codes were grouped together and categorized into themes.Results The items in the topic guide could only be addressed after participants had been given the opportunity to share their experiences of having a parent with dementia. Participants were unaware or uncertain about the possibility of reducing the risk of developing dementia and therefore hesitant to assess their dementia risk without treatment options in sight. Moreover, participants indicated that their general practitioner only gave some information on heritability, not on DRR. Although participants identified a large number of modifiable risk factors as a group during the group discussions, they were eager to receive more information on dementia and DRR. In the end, participants adopted a more positive attitude towards a DRR program and provided suggestions for the development of future DRR programs.Conclusions Although the research aim was to evaluate the knowledge, beliefs and attitudes towards dementia and DRR, sharing experiences of having a parent with dementia seemed a prerequisite for considering participants’ own risk of developing dementia and participating in a DRR program. Knowledge of dementia and DRR was limited. Due to unawareness of the possibility of reducing dementia risk, participants were hesitant about assessing their dementia risk. Group discussions positively changed the perception of dementia risk assessment and participants’ willingness to participate in a DRR program.
Alteration mRNA Expression Profile of Autophagy Related mTOR Pathway in Schizophrenic Patients with Olanzapine Treatment.
Authors: Cui Fengwei , Gu Shuguang , Gu Yue , Yin Jiajun , Fang Chunxia , Liu Liang 
Published: March 2021

Abstract
Background: mTOR signaling pathway involves in the pathogenesis of schizophrenia and the mechanism of extrapyramidal adverse reactions of antipsychotic drugs, which might mediate by mTOR-dependent autophagy impairment. This study aimed to examine the mRNA expression levels of Mammalian rapamycin target protein (mTOR) pathway genes in schizophrenia patients with olanzapine treatment, which is considered to be an mTOR inhibitor and autophagy inducer. Methods: Thirty-two acute schizophrenia patients had been treated with olanzapine for four weeks (average dose 14.24 ± 4.35 mg/d), along with 32 healthy volunteers. Before and after olanzapine treatment, the Positive and Negative Syndrome Scale (PANSS) was used to evaluate the symptoms of schizophrenia patients, and the mRNA expression levels of mTOR pathway-related genes, including MTOR, RICTOR, RPTOR, and DEPTOR, were detected by real-time quantitative PCR with the fasting venous blood of all the samples. Results: The MTOR and RICTOR mRNA expression levels of acute schizophrenia patients significantly decreased than them of healthy controls, and furtherly significantly decreased after four weeks of olanzapine treatment. While DEPTOR mRNA expression levels of acute schizophrenia patients had no significant difference with them of healthy controls, but significantly increased after treatment. And the mRNA expression levels of RPTOR had no significant difference in the three groups. The pairwise correlation of MTOR, DEPTOR, RPTOR, and RICTOR mRNA expression levels in acute schizophrenia patients and healthy controls showed significant correlationships. After olanzapine treatment, the correlationships of mRNA expression levels disappeared between DEPTOR and MTOR, and also between DEPTOR and RICTOR. Conclusions: The results inferred the abnormalities of mTOR pathway, especially DEPTOR, might play important roles in autophagy mechanism of the pathophysiology in schizophrenia and olanzapine treatment.