bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender Differences in Quality of Life among Community-Dwelling Older Adults in Low- and Middle-Income Countries: Results from the Study on Global AGEing and adult health (SAGE)
Authors: Lee Kyung Hee , Xu Hanzhang , Wu Bei 
Published: July 2019

Abstract
Background: Quality of life (QoL) is an important component of individuals’ general well-being, particularly in older adults. However, factors influencing QoL among older adults in low- and middle-income countries (LMICs) have not been fully examined. Furthermore, the role of gender differences in relation to QoL in multiple LMICs has also not been examined in detail. Methods: This study used data from the World Health Organization’s Study on Global AGEing and adult health (SAGE), Wave-1. Based on a literature review of existing works, a set of variables—an independent variable and covariates—were selected. The study sample consisted of 33,019 participants aged 50 years and above from China, Ghana, India, Russia, and South Africa. Multivariate linear regression models were estimated with the World Health Organization QoL scores as the dependent variable. To preserve the analytical sample size, multiple imputation was used to account for missing data.
Results: L The results showed that generally, male older adults reported a better QoL than female older adults across all of the countries. The associations between QoL and sociodemographic factors, health-related factors, and social support factors among older adults differed according to country.
Conclusions: This study provides a better understanding of QoL among older adults in LMICs, which can help prepare LMICs to better address the QoL of older adults. The results of this study can be used to develop programs to promote better living standards and services to reduce gender disparities and ultimately, to improve the QoL among older adults in LMICs.

Keywords: Quality of life, gender inequality, older adults, low- and middle-income country
Evaluation of a Program Based on the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Model
Authors: Kaasalainen Sharon , Sussman Tamara , Thompson Genevieve , McCleary Lynn , Hunter Paulette , Wickson-Griffiths Abigail , Venturato Lorraine , Ploeg Jenny , Parker Deborah , Sinclair Shane , Haas Vanina Dal-Bello , Earl Marie , You John 
Published: July 2019

Abstract
Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that palliative approaches to care are currently suboptimal in these settings. The purpose of this study was to evaluate resident, family, and staff outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end-of-life discussions and planning.
Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents, families and staff of the LTC homes through chart reviews, surveys and interviews.
Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end-of-life and hospital deaths for those participating in SPA-LTC, an improvement in interdisciplinary communication between staff, support for both families and staff involved, and increased family involvement in the care of residents. However, there were no significant pre-post differences in staff collaboration or comfort in providing end of life care.
Conclusions: The benefits of SPA-LTC for families, residents and staff justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context.
Geographical distribution of family physicians in Japan: A nationwide cross-sectional study
Authors: Yoshida Shuhei , Matsumoto Masatoshi , Kashima Saori , Koike Soichi Soichi , Tazuma Susumu , Maeda Takahiro 
Published: July 2019

Abstract
Background

Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem.

Methods

We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists.

Results

519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001).

Conclusions

Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.
Preoperative prognostic nutritional index predicts both short and long-term outcomes after liver resection for hepatocellular carcinoma.
Authors: Saito Yu , Imura Satoru , Morine Yuji , Ikemoto Tetsuya , Yamada Shinichiro , Shimada Mitsuo 
Published: July 2019

Abstract
Background
The aim of this study was to investigate the prognostic significance of the prognostic nutritional index (PNI) for both short and long term outcomes after liver resection for hepatocellular carcinoma (HCC).
Methods
162 (without any previous treatment) of 229 surgically treated HCC patients were retrospectively analyzed. The cut off value of the preoperative PNI was 45.0. Patients were divided into two groups, PNI low (n=76) and high (n=86) group.
Results
Among some immune parameters such as PNI, neutrophil to lymphocyte ratio (NLR) and aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), PNI had most reliable parameters in terms with prediction of both short and long term outcomes. Preoperative PNI tended to correlate with low skeletal muscle mass (SMM). In short term outcomes, PNI low group were more likely to have postoperative complications. The disease-free survival rate in PNI low group was significantly worse than that in the PNI high group (20.5 vs. 48.7 %, 5 year SR, p=0.03). On multivariate analysis, Low PNI was an independent prognostic factor for disease free survival (HR 1.65, p= 0.04).
Conclusions
The preoperative PNI was the most significant prognostic factor for evaluating both short and long-term outcomes after liver resection for HCC.
Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective study from Kampala, Uganda
Authors: Nalwanga Damalie , Musiime Victor , Kizito Samuel , Kiggundu John Baptist , Musoke Philippa , Tumwine James K 
Published: July 2019

Abstract
Background:
Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM.
Methods:
This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14.
Results:
Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001).
Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
Common gastrointestinal symptoms and associated factors among under five children in Rural Dembiya, northwest Ethiopia: a community-based cross-sectional study
Authors: Gizaw Zemichael , Addisu Ayenew , Guadie Destaye 
Published: July 2019

Abstract
Background

Gastrointestinal (GI) symptoms such as abdominal discomfort, abdominal cramp, nausea, vomiting, gas in the GI tract, or changes in bowel habits (e.g., diarrhea) are common in the community. However, these symptoms may be misinterpreted and their impact and significance misunderstood, especially in the rural communities. This study was, therefore, conducted to assess common GI symptoms among children in rural Dembiya, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in May 2017 among 225 randomly selected under five children. The presence of GI symptoms among children was assessed by health professionals and mothers’ report. Direct stool examination technique was used to identify parasitic infections. Bacteriological analysis of drinking water was done to determine the quality of drinking water. Food safety, environmental sanitation and hygiene condition of children were assessed using standardized observation checklists. Multivariable binary logistic regression analysis was employed to identify factors associated with GI symptoms on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05.

Results

The current study depicted that 139 of 225(61.8%) of the children had GI symptoms. Abdominal discomfort [137 of 139(98.7%)], abdominal cramp [125 of 139(89.9%)] and diarrhea [118 of 139(84.9%)] were the highest GI symptoms reported. GI symptoms were significantly associated with childhood intestinal parasitic infections [AOR = 13.69, 95% CI = 3.31, 56.59)], unclipped and unclean finger nails [AOR = 2.28, 95% CI = (1.02, 5.10)], inadequate living environment sanitation [AOR = 2.37, 95% CI = (1.08, 5.18)], unclean living houses [AOR = 9.06, 95% CI = (2.60, 31.54)] and owning livestock [AOR = 4.68, 95% CI = (1.82, 12.03)].

Conclusion

The prevalence of GI symptoms among under five children in rural Dembiya, northwest Ethiopia was found to be high. GI symptoms were significantly associated with childhood intestinal parasitic infections, hand hygiene condition of children and sanitation condition of the living environment. Therefore, preventing intestinal parasitic infections, improving hand hygiene condition and promoting environmental sanitation will have overriding contributions to prevent symptoms among children in rural Dembiya.
Parents as carers on a neonatal unit: qualitative study of parental and staff perceptions in a low-income setting
Authors: Ndiaye Sokhna , Bosowski Johanna , Tuyisenge Lisine , Penn-Kekana Loveday , Moxon Sarah , Thorogood Nicki , Lissauer Thomas 
Published: July 2019

Abstract
Background. To determine parents’ experiences on a neonatal unit in a low-income country, how they and staff perceive the role of parents and if parent’s role as primary carers could be extended.
Methods. Qualitative analysis using semi-structured interviews with 12 parents and 16 staff.
Results. Parental themes were around their general impression, stress and discharge. They were satisfied with their baby’s care but feared their baby may die. Mothers were stressed from need to remain in the hospital throughout baby’s stay, to provide feeds day and night, comfort and clean their baby, and provide constant kangaroo mother care before discharge. They experienced loneliness from lack of visitors, difficulty finding food and somewhere to sleep, financial worries and concern about family and home. Mothers were desperate to be discharged. Staff were preoccupied with shortage of nurses limiting care provision and restricting their ability to educate parents as inpatients and after discharge and to provide follow-up, and their constant presence. Neither thought parent’s role could be extended.
Conclusion. Staff and parent perceptions on improving parent’s experience differed. Staff thought that the solution was increasing nurse numbers to improve care and educate parents, but is unlikely in near future. Parents were severely stressed by psychosocial concerns and practical issues around hospitalization. Our identification of parental concerns suggests greatest potential for improving their stay on the neonatal unit may be from psychosocial support, potentially from experienced mothers, mothers’ groups, allied health professionals and community health workers and from improved facilities, particularly providing food and accommodation.
The transfer of knowledge on integrated care between five European regions: a qualitative multi-method study
Authors: Grooten Liset , Vrijhoef Hubertus Johannes Maria , Alhambra-Borrás Tamara , Whitehouse Diane , Devroey Dirk 
Published: July 2019

Abstract
Background To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives.

Methods A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The frameworks of knowledge exchange and knowledge mobilisation were used for data analyses.

Results All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree.

Conclusions The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings.
Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study
Authors: Hashimoto Yoshitaka , Hamaguchi Masahide , Obora Akihiro , Kojima Takao , Fukui Michiaki 
Published: July 2019

Abstract
Background

Previous meta-analyses revealed that obesity confers a risk of gastric cancer. On the other hand, metabolically healthy obese (MHO) individuals, who are healthier than metabolically abnormal obese (MAO) individuals, have lower risks of colon cancer and breast cancer. However, the association between MHO and incident gastric cancer is unclear.

Methods

This historical cohort study included 19,685 Japanese individuals who participated in health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low high density lipoprotein-cholesterol). Obese (O) or non-obese (NO) was classified by a body mass index cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise.

Results

Over the median follow-up period of 5.5 years, 78 participants developed gastric cancer. Five-years cumulative incident rate of gastric cancer was 0.2% (case/n = 17/8,331) in MHNO, 0.2% (1/653) in MHO, 0.5% (35/7,276) in MANO and 0.7% (25/3,425) in MAO. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95%CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95%CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95%CI 1.10–3.97, p = 0.024) in MAO.

Conclusions

This study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer.
Bacterial Urinary Tract Infection among Adult Renal Transplant Recipients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Authors: kiros Teklehaimanot , Asrat Daniel , Ayenew Zeleke , Tsige Estifanos 
Published: July 2019

Abstract
Abstract
Background: Despite significant advances in surgical techniques, immunosuppression protocols follow up periods and antimicrobial stewardship in modern medicine; post-renal transplantation urinary tract infection remained a major public health problem globally. This multiple serious squeal includes asymptomatic bacteriuria, cystitis and pyelonephritis. Among these, the bacterial origin of infection complications accounts for the most significant clinical, socio-economic impacts in many countries of the world. Therefore, the aim of the study was to investigate the prevalence of bacterial isolates that cause urinary tract infections, assess antibiotic susceptibility pattern among symptomatic and asymptomatic renal transplant recipients attending at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Methods: A hospital-based cross-sectional study was conducted from December 2017 to August 2018 among 74 renal transplant recipients St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. A first morning voided clean-catch mid-stream urine specimens were collected and 0.001ml inoculated onto blood and MacConkey agar plates following the standard bacteriological protocols. It was incubated aerobically at 35–37°C for 24–48 hours. Cultural characteristics and series of biochemical tests were used for the identification of isolates to species level.
Results: Significant bacteriuria was found in 11/74 (14.9%, 95% CI =8.2-24.7) patients. The prevalence among females 6/32 (18.75%) was higher among males 5/42 (11.9%) without significant association (COR=2.09, 95% CI=1.04-8.45, P=0.253). Urinary tract infection was higher in the age group of 35–49 years old (19.3%). Age was statistically significant and stronger independent associated risk factor with crude odds ratio=3.67, 95% CI=2.89-20.07 and P= 0.003, respectively. The most prevalent bacteria isolates were Escherichia coli 2(18.2%), Staphylococcus aureus 2(18.2%), Acinetobacter spp. 2(18.2%), Enterococcus spp. 2(18.2%), Coagulase-negative Staphylococci 2(18.2%) followed by Portus mirabilis 1(9.1%). The majority (80%) of Gram-negative bacteria were resistant to ciprofloxacin, chloramphenicol, and trimethoprim/sulfamethoxazole.
Conclusions: In conclusion, the overall prevalence of urinary tract infection in the study participants was relatively low with a prevalence of 14.9%. Majority of the study participants were asymptomatic. The multidrug-resistant bacterial isolates in the present study account for 82%.
Keywords: Kidney Transplantation, Urinary Tract Infection, Antimicrobial Susceptibility Testing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
A 2/1 sunitinib dosing schedule provides superior antitumor effectiveness and less toxicity than a 4/2 schedule for metastatic renal cell carcinoma: A systematic review and meta-analysis
Authors: Deng Huan , Zeng Lianli , Wu Qian , Wang Li , Hong Zhengdong , Yi Fengming , Wei Yiping , Zhang Wenxiong 
Published: July 2019

Abstract
Background

The standard sunitinib schedule to treat metastatic renal cell carcinoma (mRCC) is 4 weeks on/2 weeks off (4/2). However, some studies revealed intolerable adverse events (AEs) in patients on this schedule. An alternative schedule, 2 weeks on/1 week off (2/1), may overcome this issue. This meta-analysis was performed to compare the effectiveness and toxicity between the 2/1 and 4/2 sunitinib dosing schedules.

Methods

We acquired relevant studies by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar. Our main endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs.

Results

We identified 9 medium- and high-quality studies. Both schedules were effective for mRCC, with comparable OS and similar ORR. However, the 2/1 schedule had better PFS (hazard ratio (HR) = 0.81, 95% confidence interval [CI]: 0.66-0.99, P= 0.04), higher DCR (risk rate (RR) = 1.22, 95% CI: 1.01-1.47, P= 0.04) and fewer dosage interruptions (RR= 0.60, 95% CI: 0.43-0.84, P= 0.003). Additionally, the 2/1 schedule elicited fewer specific severe AEs, including thrombocytopenia/platelet disorder, hand-foot syndrome, hypertension and fatigue. In our subanalysis, PFS was better among East Asians using the 2/1 schedule than among other populations (HR= 0.75, 95% CI: 0.58-0.98, P= 0.03), and patients administered an initial dosage of 50 mg/d on the 2/1 schedule had superior PFS (HR= 0.76, 95% CI: 0.59-0.97, P= 0.03) than those others.

Conclusions

These findings suggest that the 2/1 schedule is more suitable for mRCC than 4/2, due to superior PFS, better DCR and fewer AEs. Nevertheless, more large-scale studies with good quality are needed.