bluuebunny/crossref_metadata_2025_split huggingface dataset:
Latent class analysis of the social determinants of health-seeking behaviour for delivery among pregnant women in Malawi
Authors: Yorlets Rachel R , Iverson Katherine R , Leslie Hannah H , Gage Anna Davies , Roder-DeWan Sanam , Nsona Humphreys , Shrime Mark G 
Published: March 2019

IntroductionIn the era of Sustainable Development Goals, reducing maternal and neonatal mortality is a priority. With one of the highest maternal mortality ratios in the world, Malawi has a significant opportunity for improvement. One effort to improve maternal outcomes involves increasing access to high-quality health facilities for delivery. This study aimed to determine the role that quality plays in women’s choice of delivery facility.MethodsA revealed-preference latent class analysis was performed with data from 6625 facility births among women in Malawi from 2013 to 2014. Responses were weighted for national representativeness, and model structure and class number were selected using the Bayesian information criterion.ResultsTwo classes of preferences exist for pregnant women in Malawi. Most of the population 65.85% (95% CI 65.847% to 65.853%) prefer closer facilities that do not charge fees. The remaining third (34.15%, 95% CI 34.147% to 34.153%) prefers central hospitals, facilities with higher basic obstetric readiness scores and locations further from home. Women in this class are more likely to be older, literate, educated and wealthier than the majority of women.ConclusionFor only one-third of pregnant Malawian women, structural quality of care, as measured by basic obstetric readiness score, factored into their choice of facility for delivery. Most women instead prioritise closer care and care without fees. Interventions designed to increase access to high-quality care in Malawi will need to take education, distance, fees and facility type into account, as structural quality alone is not predictive of facility type selection in this population.
‘Grandmother, aren’t you going to sing for us?’ Current childcare practices and caregivers’ perceptions of and receptivity to early childhood development activities in rural Burkina Faso
Authors: Hollowell Jennifer , Dumbaugh Mari , Belem Mireille , Kousse Sylvain , Swigart Tessa , Korsaga Chantal , Lankoande Pokiandi Solange , Lawson Kokovi Hogban , Hill Zelee 
Published: March 2019

IntroductionEffective stimulation and responsive caregiving during the first 2 years is crucial for children’s development. By age 3–4 years, over 40% of children in sub-Saharan Africa fail to meet basic cognitive or socioemotional milestones, but there are limited data on parenting and childcare practices. This study, conducted to inform the design of a mass media intervention, explored practices, perceptions, motivators and obstacles to childhood development-related practices among parents and caregivers of children aged 0–2 years in rural Burkina Faso.MethodsWe performed two rounds of six focus groups with 41 informants in two villages, using an adapted version of the Trials of Improved Practices methodology. These first explored beliefs and practices, then introduced participants to the principles and benefits of early childhood development (ECD) and provided illustrative examples of three practices (interactive ways of talking, playing and praising) to try with their children. One week later, further discussions explored participants’ experiences and reactions. Data were analysed inductively using thematic content analysis.ResultsExisting activities with young children were predominantly instructive with limited responsive interaction and stimulation. Participants were receptive to the practices introduced, noted positive changes in their children when they adopted these practices and found engagement with children personally rewarding.ConclusionInteractive, stimulating activities with young children did not appear to be widespread in the study area, but caregivers were receptive to information about the importance of early stimulation for children’s development. ECD messages should be tailored to the local sociocultural context and consider time limitations.
How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan
Authors: Ahmad Raheelah , Zhu Nina Jiayue , Lebcir Reda Mohamed , Atun Rifat 
Published: March 2019

BackgroundLimited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities.Methods and findingsA system dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse and switch antenatal care services in four provider sectors: public, private, traditional and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different subgroups by geographical locations and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences onif, when and whereto seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within trimester 2, but for rural women within trimester 1. Antenatal care access delayed to trimester 3 had no protective impact on neonatal mortality.ConclusionsSystem dynamics modelling enables capturing the complexity of health-seeking behaviours and impact on outcomes, informing intervention design, implementation of targeted policies and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts and strong social network influences.
Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan
Authors: Warsi Ibrahim , Ahmed Javeria , Younus Anjum , Rasheed Abdur , Akhtar Tayyab Saeed , Ain Qurrat Ul , Khurshid Zohaib 
Published: March 2019

ObjectiveGastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.SettingThis cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.ParticipantsIn total, 187 of 700 patients who underwent oesophago–gastro–duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.Primary and secondary outcome measuresAbnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.ResultsOral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).ConclusionPatients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.
Employment status and unmet dental care needs in South Korea: a population-based panel study
Authors: Choi Jae Woo , Choi Young , Lee Tae-Hoon , Lee Hyo Jung , Ju Yeong Jun , Park Eun-Cheol 
Published: March 2019

ObjectivesThis study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs.MethodsA total of 4620 workers were retrieved from Korea Health Panel data (2010–2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs.ResultsAmong the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income.ConclusionThis disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.
What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards
Authors: Pannick Samuel , Archer Stephanie , Long Susannah Jane , Husson Fran , Athanasiou Thanos , Sevdalis Nick 
Published: March 2019

ObjectivesTo compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.MethodsMultimodal qualitative evaluation of general medical wards and semi-structured interviews.SettingUK tertiary National Health Service (public) hospital.ParticipantsFourteen patients and carers on acute medical wards and geriatric wards.ResultsQuality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.ConclusionsThere is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
Reduced long-term care cost by social participation among older Japanese adults: a prospective follow-up study in JAGES
Authors: Saito Masashige , Aida Jun , Kondo Naoki , Saito Junko , Kato Hirotaka , Ota Yasuhiro , Amemiya Airi , Kondo Katsunori 
Published: March 2019

ObjectivesReducing costs related to functional disabilities and long-term care (LTC) is necessary in ageing societies. We evaluated the differences in the cumulative cost of public LTC insurance (LTCI) services by social participation.DesignProspective observational study.SettingOur baseline survey was conducted in March 2006 among people aged 65 or older who were not eligible for public LTCI benefits and were selected using a complete enumeration in Tokoname City, Japan. We followed up with their LTC services costs over a period of 11 years. Social participation was assessed by the frequency of participation in clubs for hobbies, sports or volunteering. We adopted a classical linear regression analysis and an inverse probability weighting (IPW), with multiple imputation of missing values.ParticipantsFunctionally independent 5377 older adults.Primary outcome measuresThe cumulative cost of public LTCI services for 11 years.ResultsEven when adjusting for the confounding variables, social participation at the baseline was negatively associated with the cumulative cost of LTCI services. The IPW model showed that in respondents who participated in hobby activities once a week or more, the cumulative cost of LTCI services for 11 years was lower, approximately US$3500 per person, in comparison to non-participants. Similarly, that in respondents who participated in sports group or clubs was lower, approximately US$6000 than non-participants.ConclusionsOlder adults’ participation in community organisations may help reduce future LTC costs. Promoting participation opportunities in the community could ensure the financial stability of LTCI services.
Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study
Authors: Kang Ruihua , Luo Liuhong , Chen Huanhuan , Zhu Qiuying , Liao Lingjie , Xing Hui , Zhu Jinhui , Shen Zhiyong , Lan Guanghua , Tang Zhenzhu , Shao Yiming , Yang Wenmin , Ruan Yuhua 
Published: March 2019

ObjectivesChina has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults.DesignObservational retrospective cohort study.SettingData from 2011 to 2013 in Guangxi, China.ParticipantsPatients aged ≥18 years (n=25 732) were selected.ResultsA total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir–ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based.ConclusionsOur study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens.
Diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to triage patients suspected of acute non-ST-segment elevation myocardial infarction: a systematic review protocol
Authors: Zhelev Zhivko , Ohtake Hirotaka , Iwata Mitsunaga , Terasawa Teruhiko , Rogers Morwenna , Peters Jaime L , Hyde Chris 
Published: March 2019

IntroductionAlthough the new generation of cardiac troponin assays have revolutionised the diagnosis of myocardial infarction (MI), their application in triaging patients with suspected acute coronary syndrome requires further investigation. The objectives of the current systematic review are to evaluate the diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to identify patients with non-ST-segment-elevation MI in the emergency department.Methods and analysisWe will conduct systematic searches of MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL database covering the period from 1 January 2006 to present, with no restrictions on language or publication status. Two review authors will independently screen studies for inclusion, extract data from eligible studies and assess their methodological quality using Quality Assessment of Diagnostic Accuracy Studies version 2. Studies will be included if they evaluate contemporary or high-sensitivity cardiac troponin assays used in serial testing, in patients presenting to the ED with suspicion of MI. Estimates of sensitivity and specificity from each study will be presented in forest plots and in the receiver-operating characteristics space. If appropriate, we will pool the results using Bayesian hierarchical models that allow correction for imperfect reference standard. We will obtain summary estimates of sensitivity and specificity of alternative testing protocols and compare their accuracy. We will also investigate the impact of prespecified sources of heterogeneity and methodological quality items. If pooling of results is considered inappropriate, we will present our findings in tables and diagrams and will describe them narratively.Ethics and disseminationNo formal ethical approval will be sought, but we will report on the ethical approval of the included studies. Dissemination of findings will be through publications in peer-reviewed journals, presentations at conferences and the websites of the universities.PROSPERO registration numberCRD42018106379.
Effectiveness of the Diagnose-Intervene- Verify-Adjust (DIVA) model for integrated primary healthcare planning and performance improvement: an embedded mixed methods evaluation in Kaduna state, Nigeria
Authors: Eboreime Ejemai Amaize , Nxumalo Nonhlanhla , Ramaswamy Rohit , Ibisomi Latifat , Ihebuzor Nnenna , Eyles John 
Published: March 2019

ObjectivesThis study evaluates the real-world effectiveness of Diagnose-Intervene-Verify-Adjust (DIVA), an innovative quality improvement mode, in improving primary healthcare (PHC) bottlenecks impeding health system performance in Kaduna, a northern Nigerian state.DesignAn embedded mixed method study design involving participant observation.SettingPHCs in 23 local government areas of Kaduna state, Nigeria.Participants138 PHC managers across the state (PHC directors and programme managers in the 23 local governments).InterventionDIVA is a four-step improvement model in which ‘Diagnose’ identifies constraints to effective coverage, ‘Intervene’ develops/implements action plans addressing constraints, while ‘Verify/Adjust’ monitor performance and revise plans.Primary and secondary outcome measuresThe model, as adapted in Nigeria, is designed to evaluate and improve the availability of health commodities, human resources, geographical accessibility, acceptability, continuous utilisation and quality of four PHC interventions (immunisation, integrated management of childhood illnesses, antenatal care and skilled birth attendance).Results183 bottlenecks were identified by local government teams across all interventions in 2013. 41% of bottlenecks concern human resources. Geographical access and availability of commodities ranked least. Availability of commodities was the most improved determinant although among the least constrained, probably indicating skewed implementation of operational plans. 1562 activities were planned to address identified bottlenecks in the state, of which only 568 (36%) were completely implementedConclusionOur study demonstrates that PHC planning using the DIVA model can potentially improve health system performance. However, effective implementation is critical and may require some central government oversight.
Methodological advantages and disadvantages of parallel and crossover randomised clinical trials on methylphenidate for attention deficit hyperactivity disorder: a systematic review and meta-analyses
Authors: Krogh Helle B , Storebø Ole Jakob , Faltinsen Erlend , Todorovac Adnan , Ydedahl-Jensen Erica , Magnusson Frederik Løgstrup , Holmskov Mathilde , Gerner Trine , Gluud Christian , Simonsen Erik 
Published: March 2019

ObjectiveTo assess the methodological advantages and disadvantages of parallel and crossover designs in randomised clinical trials on methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD).DesignSecondary analyses of a Cochrane systematic review.Setting and participantsWe searched relevant databases up to March 2015 and included data from parallel and crossover randomised trials assessing children and adolescents up to 18 years with ADHD.InterventionsMethylphenidate compared with placebo or no-treatment interventions.Primary and secondary outcomesThe primary outcomes were teacher-rated ADHD symptoms and serious adverse events. The secondary outcomes were non-serious adverse events.ResultsWe included 38 parallel trials (n=5111) and 147 crossover trials (n=7134). When comparing methylphenidate with placebo or no-treatment on ADHD symptoms, we found no differences between the end of parallel trials and the first-period from crossover trials (Χ²=1.06, df=1, p=0.30, I²=5.5%). We also found no differences when combining the end of first-period crossover trials with the end of parallel trials and comparing them to the end of last-period crossover trials (Χ²=3.25, df=1, p=0.07, I²=69.2%). We found no differences in serious and non-serious adverse events, and no risk of period and carryover effects. However, only two trials contributed data to the latter analyses.ConclusionsBoth parallel and crossover trials seem suitable for investigating methylphenidate in children and adolescents with ADHD, with comparable estimates on ADHD symptom severity and adverse events. However, parallel trials might still offer ethical and statistical advantages over crossover trials.