bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of China’s universal two child policy with changes in births and birth related health factors: national, descriptive comparative study
Authors: Li Hong-tian , Xue Ming , Hellerstein Susan , Cai Yue , Gao Yanqiu , Zhang Yali , Qiao Jie , Blustein Jan , Liu Jian-meng 
Published: August 2019

AbstractObjectiveTo measure the association of China’s universal two child policy, announced in October 2015, with changes in births and health related birth characteristics.DesignNational, descriptive before-and-after comparative study.SettingEvery county in 28 of 31 provinces of mainland China.ParticipantsBirths included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017.Main outcome measuresMonthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries.ResultsThe study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (−3.5 to −2.5) among nulliparous mothers from 39.6% to 36.6%.ConclusionsSince its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.
Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review
Authors: Murphy Adrianna , McGowan Catherine , McKee Martin , Suhrcke Marc , Hanson Kara 
Published: August 2019

BackgroundExperiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more ‘coping strategies’, such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households.MethodsWe searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.ResultsForty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment.ConclusionsMonitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.
Current realities versus theoretical optima: quantifying efficiency and sociospatial equity of travel time to hospitals in low-income and middle-income countries
Authors: Wong Kerry LM , Brady Oliver J , Campbell Oona Maeve Renee , Jarvis Christopher I , Pembe Andrea , Gomez Gabriela B , Benova Lenka 
Published: August 2019

BackgroundHaving hospitals located in urban areas where people, resources and wealth concentrate is efficient, but leaves long travel times for the rural and often poorer population and goes against the equity objective. We aimed to assess the current efficiency (mean travel time in the whole population) and equity (difference in travel time between the poorest and least poor deciles) of hospital care provision in four sub-Saharan African countries, and to compare them against their theoretical optima.MethodsWe overlaid the locations of 480, 115, 3787 and 256 hospitals in Kenya, Malawi, Nigeria and Tanzania, respectively, with high-resolution maps of travel time, population and wealth to estimate current efficiency and equity. To identify the potential optima, we simulated 7500 sets of hospitals locations based on various population and wealth weightings and percentage reallocations for each country.ResultsThe average travel time ranged from 38 to 79 min across countries, and the respective optima were mildly shorter (<15%). The observed equity gaps were wider than their optima. Compared with the best case scenarios, differences in the equity gaps varied from 7% in Tanzania to 77% in Nigeria. In Kenya, Malawi and Tanzania, narrower equity gaps without increasing average travel time were seen from simulations that held 75%–90% of hospitals at their current locations.InterpretationsCurrent hospital distribution in the four sub-Saharan African countries could be considered efficient. Simultaneous gains in efficiency and equity do not necessarily require a fundamental redesign of the healthcare system. Our analytical approach is readily extendible to aid decision support in adding and upgrading existing hospitals.
Cross-cultural adaption and validation of the Chinese version of the Child Food Neophobia Scale
Authors: Zou JiaoJiao , Liu Yan , Yang Qiping , Liu Hanmei , Luo Jing , Ouyang Yufeng , Wang Joyce , Lin Qian 
Published: August 2019

ObjectiveTo adapt the Child Food Neophobia Scale (CFNS) cross-culturally for use among 12-36-month-old Chinese toddlers and to perform a preliminary assessment of its construct validity and reliability.BackgroundFood neophobia is the fear of eating new or unfamiliar foods, which affects the type and quality of individual dietary intake, especially during early childhood. However, measurements of child food neophobia have rarely been reported in China due to a lack of reliable and valid measurements.MethodsThe CFNS was translated and adapted into a Chinese version (CFNS-CN) through a forward translation, reconciliation, a back translation, expert review and pretesting. The construct validity and reliability of the CFNS-CN were tested in 390 caregivers of 12–36 months old Chinese toddlers through convenience sampling in Changsha Maternal and Child Health Care Hospital, Hunan Province, China. The internal consistency, confirmatory factor analysis (CFA) and reliability were estimated.ResultsThe kappa coefficients indicated moderate to perfect agreement between the test and retest, and Cronbach’s α coefficient was 0.91. A normal χ2/df, CMIN/DF=3.302, Comparative Fit Index, CFI=0.993, Tucker-Lewis Index, TLI=0.986 and root mean square error of approximation, RMSEA=0.077 were found. The CFA results showed that the model indicators were acceptable. High food neophobia was observed in 25.1% of individuals.ConclusionThe CFNS-CN showed good internal consistency reliability and construct validity. The CFNS-CN may become an effective tool for assessing food neophobia in Chinese toddlers.Trial registrationThis trial was pre-registered at the China Clinical Trial Registration Center under registration number ChiCTR1800015890.
Characterisation of the fibroinflammatory process involved in progression from acute to chronic pancreatitis: study protocol for a multicentre, prospective cohort study
Authors: Novovic Srdan , Borch Anders , Werge Mikkel , Karran David , Gluud Lise , Schmidt Palle Nordblad , Hansen Erik Feldager , Nøjgaard Camilla , Jensen Annette Bøjer , Jensen Frank Krieger , Frøkjær Jens Brøndum , Hansen Mark Berner , Jørgensen Lars Nannestad , Drewes Asbjørn Mohr , Olesen Søren Schou 
Published: August 2019

IntroductionChronic pancreatitis (CP) is thought to present the end stage of a continuous disease process evolving from acute pancreatitis (AP), over recurrent AP, to early and end-stage CP. Due to the irreversible nature of CP, early detection and prevention is key. Prospective assessment based on advanced imaging modalities as well as biochemical markers of inflammation, fibrosis and oxidative stress may provide a better understanding of the underlying pathological processes and help identify novel biomarkers of disease with the ultimate goal of early diagnosis, intervention and prevention of disease progression. This paper describes the protocol of a prospective multicentre cohort study investigating the fibroinflammatory process involved in progression from acute to CP using state-of-the-art diagnostic imaging modalities and circulating biomarkers of inflammation, fibrosis and oxidative stress.Methods and analysisAdult control subjects and patients at different stages of CP according to the M-ANNHEIM system will be recruited from outpatient clinics at the participating sites and form three cohorts: controls (n=40), suspected CP (n=60) and definitive CP (n=60). Included patients will be followed prospectively for 15 years with advanced MRI and contrast-enhanced endoscopic ultrasound with elastography, assessment of endocrine and exocrine pancreatic function, biochemical and nutritional assessment, and evaluation of pain processing using quantitative sensory testing. Blood samples for a biobank will be obtained. The purpose of the biobank is to allow analyses of potential circulating biomarkers of disease progression, including markers of inflammation, fibrosis and oxidative stress.Ethics and disseminationPermissions from the Regional Science Ethics committee and the Regional Data Protection Agency have been obtained. We will submit the results of the study for publication in peer-reviewed journals regardless of whether the results are positive, negative or inconclusive.
Identification of the optimal points for the acupuncture treatment of neck pain in China: protocol for a multicenter, matched, case-control study
Authors: Sun Mingsheng , Tao Siyuan , Geng Guoyan , Peng Jieru , Ma Xingsha , Yan Mingxi , Chen Jiao , Cai Dingjun , Zheng Hui , Yang Chunxia , Zhao Ling , Liang Fan-rong 
Published: August 2019

IntroductionNeck pain (NP) is a common condition that can be effectively treated by acupuncture. However, several treatment point prescriptions (ie, local acupoints, distal acupoints, and sensitised acupoints) may be used. The present study aims to identify the types of sensitisation and the distribution of sensitised points in patients with NP, to analyse the cut-off values and sensitisation rate for acupoint sensitisation, and to summarise the dominant forms of optimally sensitised points. This information will be helpful when choosing the optimal points to treat NP.Methods and analysisThis multicentre, matched, case–control study will enrol 224 patients with NP, and 224 age-matched and sex-matched healthy participants as controls. Body surface temperature, mechanical pain threshold, pressure pain threshold and skin resistance will be assessed at the 15 acupoints most frequently used to treat NP, and at the five body regions in which pain occurs most frequently. Hypothesis testing will be used to compare the differences in variables between cases and controls. In addition, receiver operating characteristic curve analysis will be used to explore the cut-off values of the sensitive states of heat, pain and electrical resistance, which indicate sensitisation of the acupoint. The optimal points will be comprehensively determined by the acupoint sensitisation rate and OR.Ethics and disseminationEthical approval of this study has been granted by the Research Ethical Committee of the Teaching Hospital of Chengdu University of Traditional Chinese Medicine (ID: 2018 KL-016). The outcomes of the study will be disseminated through peer-reviewed publications.Trial registrationChiCTR1800016220.
Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years
Authors: van Rijn Rick Robert , Affourtit Marjo J , Karst Wouter A , Kamphuis Mascha , de Bock Leonie C , van de Putte Elise 
Published: August 2019

ObjectiveCombined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes’ theorem and uses likelihood ratios in their conclusions.DesignWe present the implementation process of DECCA and cross-sectional data of the first 4 years.ParticipantsBetween 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.Results761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.ConclusionData show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.
Clinical trial data sharing: here’s the challenge
Authors: Kochhar Sonali , Knoppers Bartha , Gamble Carrol , Chant Alan , Koplan Jeffrey , Humphreys Georgina S 
Published: August 2019

ObjectiveAnonymised patient-level data from clinical research are increasingly recognised as a fundamental and valuable resource. It has value beyond the original research project and can help drive scientific research and innovations and improve patient care. To support responsible data sharing, we need to develop systems that work for all stakeholders. The members of the Independent Review Panel (IRP) for the data sharing platform Clinical Study Data Request (CSDR) describe here some summary metrics from the platform and challenge the research community on why the promised demand for data has not been observed.Summary of dataFrom 2014 to the end of January 2019, there were a total of 473 research proposals (RPs) submitted to CSDR. Of these, 364 met initial administrative and data availability checks, and the IRP approved 291. Of the 90 research teams that had completed their analyses by January 2018, 41 reported at least one resulting publication to CSDR. Less than half of the studies ever listed on CSDR have been requested.ConclusionWhile acknowledging there are areas for improvement in speed of access and promotion of the platform, the total number of applications for access and the resulting publications have been low and challenge the sustainability of this model. What are the barriers for data contributors and secondary analysis researchers? If this model does not work for all, what needs to be changed? One thing is clear: that data access can realise new and unforeseen contributions to knowledge and improve patient health, but this will not be achieved unless we build sustainable models together that work for all.
Urinary bisphenol A and incidence of metabolic syndrome among Chinese men: a prospective cohort study from 2013 to 2017
Authors: Wu Suyang , Wang Feng , Lu Shaoyou , Chen Yi , Li Wenbo , Li Zhimin , Zhang Liuzhuo , Huang Hongying , Feng Wenting , Arrandale Victoria H , Evans Greg J , Tse Lap Ah 
Published: August 2019

ObjectivesExperimental studies suggested that bisphenol A (BPA) exposure increased the risk of metabolic syndrome (MetS) through the mechanism of insulin resistance. All previous epidemiological studies of BPA and MetS were cross-sectional studies, and their findings were mixed. This study aims to provide further evidence on the association between urinary BPA and risk of MetS using a prospective cohort study in China.MethodsThe study population was from the Shenzhen Night shift workers’ cohort. A total of 1227 male workers were recruited from the baseline survey in 2013 and then followed until 2017. Modified Adult Treatment Panel III criteria were used to identify the cases of MetS. Urinary BPA concentration was assessed using high-performance liquid chromatography–tandem mass spectrometry, and it was categorised into three subgroups by tertiles to obtain the adjusted HR (aHR) and 95% CI using Cox proportional hazard model.ResultsDuring 4 years of follow-up, 200 subjects developed MetS. Compared with the lowest urinary BPA subgroup, a weakly increased risk of MetS was suggested among those with the middle (aHR=1.19, 95% CI 0.87 to 1.63) and high level of urinary BPA (aHR=1.16, 95% CI 0.84 to 1.59); however, the significant association with MetS was restricted primarily to the smokers, showing a positive gradient with urinary BPA (middle level: aHR=2.40, 95% CI 1.13 to 5.08; high level: aHR=2.87, 95% CI 1.38 to 5.98;p trend=0.010).ConclusionThis prospective cohort study provided further evidence that exposure to BPA may increase the risk of MetS, and this association was further positively modified by cigarette smoking.
Meflin-Positive Cancer-Associated Fibroblasts Inhibit Pancreatic Carcinogenesis
Authors: Mizutani Yasuyuki , Kobayashi Hiroki , Iida Tadashi , Asai Naoya , Masamune Atsushi , Hara Akitoshi , Esaki Nobutoshi , Ushida Kaori , Mii Shinji , Shiraki Yukihiro , Ando Kenju , Weng Liang , Ishihara Seiichiro , Ponik Suzanne M. , Conklin Matthew W. , Haga Hisashi , Nagasaka Arata , Miyata Takaki , Matsuyama Makoto , Kobayashi Tomoe , Fujii Tsutomu , Yamada Suguru , Yamaguchi Junpei , Wang Tongtong , Woods Susan L. , Worthley Daniel , Shimamura Teppei , Fujishiro Mitsuhiro , Hirooka Yoshiki , Enomoto Atsushi , Takahashi Masahide 
Published: August 2019

Abstract

Cancer-associated fibroblasts (CAF) constitute a major component of the tumor microenvironment. Recent observations in genetically engineered mouse models and clinical studies have suggested that there may exist at least two functionally different populations of CAFs, that is, cancer-promoting CAFs (pCAF) and cancer-restraining CAFs (rCAF). Although various pCAF markers have been identified, the identity of rCAFs remains unknown because of the lack of rCAF-specific marker(s). In this study, we found that Meflin, a glycosylphosphatidylinositol-anchored protein that is a marker of mesenchymal stromal/stem cells and maintains their undifferentiated state, is expressed by pancreatic stellate cells that are a source of CAFs in pancreatic ductal adenocarcinoma (PDAC). In situ hybridization analysis of 71 human PDAC tissues revealed that the infiltration of Meflin-positive CAFs correlated with favorable patient outcome. Consistent herewith, Meflin deficiency led to significant tumor progression with poorly differentiated histology in a PDAC mouse model. Similarly, genetic ablation of Meflin-positive CAFs resulted in poor differentiation of tumors in a syngeneic transplantation model. Conversely, delivery of a Meflin-expressing lentivirus into the tumor stroma or overexpression of Meflin in CAFs suppressed the growth of xenograft tumors. Lineage tracing revealed that Meflin-positive cells gave rise to α-smooth muscle actin-positive CAFs that are positive or negative for Meflin, suggesting a mechanism for generating CAF heterogeneity. Meflin deficiency or low expression resulted in straightened stromal collagen fibers, which represent a signature for aggressive tumors, in mouse or human PDAC tissues, respectively. Together, the data suggest that Meflin is a marker of rCAFs that suppress PDAC progression.

Significance:
Meflin marks and functionally contributes to a subset of cancer-associated fibroblasts that exert antitumoral effects.