bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progress and scenario-based projections of health service availability and coverage towards UHC in the post-conflict and post-pandemic Iraq: a Bayesian hierarchical regression approach
Authors: Taniguchi Hiroko , Rahman Md Mizanur , Hussain Ashraf , Nomura Shuhei , Devanathan Ganan , Hashizume Masahiro 
Published: October 2024

BackgroundTwo decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The coronavirus disease (COVID-19) pandemic brought additional disruption to health service provision.ObjectivesAt the midpoint towards universal health coverage (UHC) in 2030, this study aims to gain a better understanding of the trends of UHC progress in Iraq in the context of the conflicts and the COVID-19 pandemic and to indicate possible pragmatic options.DesignThis study employed Bayesian hierarchical regression models to estimate trends and projections of health service availability and coverage indicators up to 2030. Furthermore, for health service coverage, four scenarios were defined based on the availability of health services, and projections were made for each scenario up to 2030.SettingOur approach used the yearly data from the Ministry of Health and four nationally representative household surveys between 2000 and 2020. We evaluated the subnational-level progress in three health service availability indicators and 13 health service coverage indicators in 18 governorates in Iraq from 2000 to 2030.ResultsThe findings from 2000 to 2020 revealed a lack of progress in the indicators of health facility and inpatient bed, and pronounced detrimental effects from major conflicts and the pandemic on all measured health service coverage indicators. Despite these setbacks, several health service coverage indicators demonstrated resilience and elasticity in their recovery. The projected trends for 2021 to 2030 indicated limited alternations in the health service availability. By 2030, five health service coverage indicators will achieve the designated 80% targets. A scenario-based analysis predicts improved coverage of antenatal care, and child immunisation and treatment if health service availability is bolstered to globally recommended standards. Under this scenario, several governorates—Anbar, Baghdad, Nainawa, Qadissiyah, Salahaddin, Thiqar and Wasit—presented improved health service coverage in more indicators.ConclusionStrengthened health service availability has the potential to significantly improve fragile health service coverage indicators and in more vulnerable governorates.
Qualitative study investigating the health needs of school-aged children and adolescents in Dubai
Authors: Alrahma Ali Muneer , Belal Sana Easa , Koko Fatima Hassan Mohamed , Alabady Kadhim 
Published: September 2024

BackgroundChildren’s health has been linked with morbidities such as cardiovascular events, type 2 diabetes and obesity in adulthood. Further efforts are needed to understand the current and emerging challenges due to the potential changes in the social context among school-aged children and adolescents at schools.ObjectiveThe study aims to investigate the health needs of school-aged children and adolescents in Dubai, United Arab Emirates (UAE).Design9 semistructured focus groups and 1 in-depth interview among 10 entities and 5 schools were used to investigate current health needs for schools. The participants were selected using purposive sampling. Data were analysed using a content analysis approach.SettingThe focus groups and the in-depth interviews were conducted face to face in Dubai, UAE, from February to May 2023.Participants52 participants representing different specialties and roles in school health, such as senior employees, managers, teachers, healthcare professionals, principals, social workers/counsellors and parents, participated in this study. Most participants were females, 41 (78.8%) compared with 11 males (21.2%).ResultsThe study identified six health themes that address the health needs in schools. The themes highlighted the importance of creating new school health services, programmes, health education sessions, policies, data quality measures and innovative technologies. The participants deemed developing and improving health services, programmes, health education sessions, policies in nutrition, social and mental health, physical activity, and health promotion necessary in schools. Training school staff to manage and handle data was also essential to improve data quality. Using innovative technologies such as applications and electronic student files linked to electronic medical systems may further support school health professionals in schools.ConclusionThe health needs assessment identified the gaps and challenges that must be addressed to improve students’ health. Policy-makers could use the key results from the six themes to develop effective school health strategies.
Trends in incidence and mortality for gynaecological cancers in Southeastern China during 2011–2020: a retrospective analysis of registry data
Authors: Liu Linying , Zhou Yan , Lin Jie , Xie Ning , Yu Haijuan , Deng Sufang , Sun Yang 
Published: September 2024

ObjectivesThis study aimed to investigate the changes in the incidence and mortality trends of ovarian cancer (OC), cervical cancer (CC) and uterine cancer (UC) in the Fujian Province, southeastern China.DesignProvincial, population-based, retrospective observational study.SettingFujian province, southeastern China between 2011-2020.ParticipantsFrom 2011 to 2020, 6178 new cases and 2037 deaths caused by 3 gynaecological cancers were eligible for analysis.Primary and secondary outcome measuresThe primary outcome measures were the incidence and mortality rates, including the age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), of three gynaecological cancers. The secondary outcome measure was the prevalence (average annual per cent changes (AAPC)).ResultsThe incidence of all three gynaecological cancers increased from 2011 to 2020. CC had the slowest upward trend, with an AAPC of 2.54% over the period. However, it had the highest ASIR among the 3 cancers in 2020 (10.41/100 000). UC showed a rapid increase, with an AAPC of 15.15% from 2016 to 2020. While the mortality rate of UC remained stable, both CC and OC also exhibited rising trends, with the CC having the highest ASMR (3.05/100 000) in 2020. The ASMR for CC increased rapidly, with the highest AAPC of 5.51%. Conversely, changes in the ASMR for UC were not statistically significant (p=0.601). Moreover, high incidence rates were more common among perimenopausal women and older participants in the respective cancer groups where the increased mortality was observed.ConclusionsGynaecological cancer burden remains a public health issue in Fujian Province, with an increasing incidence. Improving the healthcare system and promoting a healthy lifestyle should be highlighted to reduce the cancer burden.
Prospective cohort for early detection of liver cancer (Pearl): a study protocol
Authors: Khanna Kartikeya , Barnes Eleanor , Benselin Jennifer , Culver Emma , Irving William , Innes Hamish , Pavlides Michael , Consortium DeLIVER 
Published: October 2024

IntroductionHepatocellular carcinoma (HCC) is the fastest-rising and fourth most common cause of cancer death worldwide. Liver cirrhosis is the largest underlying risk factor for HCC. Therefore, patients with cirrhosis should have regular ultrasound and biochemical screening to pick up early HCC. Early HCC can be cured; more advanced HCCs have limited treatment options and poor prognosis. Current screening methods are suboptimal with poor sensitivity in picking up early disease. In this study, the investigators aim to recruit people with liver cirrhosis into a Prospective cohort for early detection of liver cancer—the Pearl cohort. The investigators believe that by using state-of-the-art tests we can improve the detection of early HCC.Methods and analysisThis is a UK-based prospective, longitudinal, diagnostic, prognostic, multicentre, non-CTIMP study. Aiming to recruit 3000 patients with liver cirrhosis without a HCC diagnosis, the Pearl cohort will be followed actively for 3 years from recruitment and then passively via registry data for ten years thereafter. Blood and urine samples will be taken and information from routine care will be gathered. These will be used to assess novel diagnostic approaches for the detection early HCC and to develop models to identify those most at risk for developing HCC.Participants will be linked to national UK health registries to ensure long-term capture of HCC incidence and other relevant endpoints. Approximately 75 patients are predicted to develop de novo HCC within the 3-year follow up period. After this period, the study teams will obtain data on participants for at least 10 years after the last contact. This cohort will help develop an understanding of the incidence of HCC in a UK population stratified by underlying cirrhosis aetiology.Ethics and disseminationEthical approval has been granted by REC and the trial is registered on ClinicalTrials.gov. The results will be published in peer-reviewed journals and presented at relevant meetings.Trial registration numberNCT05541601.
Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful in preventing acute complications? A systematic review
Authors: Beccia Chiara , McMorrow Rita , Donald Andrew , de Mendonça Lucas , White Mary , Hunter Barbara , Manski-Nankervis Jo-Anne 
Published: October 2024

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit their general practitioner (GP) the week prior to developing DKA, with similar trends observed internationally.ObjectiveTo summarise interventions in general practice to reduce diagnostic delay in paediatric T1DM and to evaluate their effectiveness.MethodsSix databases (Ovid, Web of Science, CINAHL, Evidence-Based Medicine Reviews, Google Scholar and EMBASE) were searched. Any English language, less than 20 years study involving interventions targeting GPs specifically in the prevention of paediatric DKA, was included. Primary outcomes were (a) the number of children presenting to the hospital in DKA following diagnostic delay after a GP visit and (b) DKA rate. The secondary outcome was changes in GPs’ behaviour regarding timeliness of referrals. Two reviewers completed title, abstract and full-text review, with conflicts resolved by a third reviewer. ROBINS-I risk of bias was used for appraisal. High heterogeneity among studies rendered meta-analysis unsuitable. Structured tabulation of results was completed for analysis. The date of last search was 2 July 2023.ResultsEight studies were included (three conference abstracts and five peer-reviewed publications.) We identified six intervention types attempting to facilitate timely diagnosis of type 1 diabetes in the general practice setting: direct communication, indirect communication, education sessions, electronic clinical decision support tools, updated referral pathways and provision of glucose and/or ketone monitors. Due to the limited number of peer-reviewed studies identified by this review, we were not able to identify the extent to which these interventions were successful.ConclusionPaucity of information regarding study methodology and high heterogeneity among study design and outcome measures limited our conclusions regarding acceptability, effectiveness and reach. Future studies should include GPs in their design and consider the sustainability of interventions in the long term.PROSPERO registration numberCRD42023412504.
Building capacity and capability for quality improvement: insights from a nascent regional health system
Authors: Ng Yan Jun , Lew Kelvin Sin Min , Yap Adrian Ujin , Quek Lit Sin , Hwang Chi Hong 
Published: September 2024

ObjectivesQuality improvement (QI) is critical in facilitating advancements in patient outcomes, system efficiency and professional growth. This paper aimed to elucidate the underlying rationale and framework guiding JurongHealth Campus (JHC), a nascent Regional Health System, in developing its QI capacity and capability at all levels of the organisation.MethodsAn exhaustive analysis of high-performance management systems and effective improvement frameworks was conducted, and the principles were customised to suit the local context.A three-phased approach was applied: (1) developing the JHC QI framework; (2) building capacity through a dosing approach and (3) building capability through QI projects and initiatives using the model for improvement (MFI). Three components of the RE-AIM implementation strategy were assessed: (1) Reach—overall percentage of staff trained; (2) Effectiveness—outcomes from organisation-wide improvement projects and (3) Adoption—number of QI projects collated and presented.ResultsThe percentage of staff trained in QI increased from 11.3% to 22.0% between January 2020 and March 2024, with over 350 projects documented in the central repository. The effectiveness of the MFI was demonstrated by improving inpatient discharges before 12pm performance from 21.52% to 25.84% and reducing the 30-day inpatient readmission rate from 13.92% to 12.96%.ConclusionFour critical factors for an effective QI framework were identified: (1) establishing a common language for improvement; (2) defining distinct roles and skills for improvement at different levels of the organisation; (3) adopting a dosing approach to QI training according to the defined roles and skills and (4) building a critical mass of committed staff trained in QI practice. The pragmatic approach to developing QI capability is both scalable and applicable to emerging healthcare institutions.
Burden of the COVID-19 pandemic on adolescent mental health in the Lombardy Region, Italy: a retrospective database review
Authors: Clavenna Antonio , Cartabia Massimo , Fortino Ida , Bonati Maurizio 
Published: September 2024

BackgroundPrevious research has assessed the impact of the COVID-19 pandemic on adolescent mental health (MH). How the pandemic changed healthcare resource utilisation for MH conditions was investigated less, however, in particular in Italy.MethodsData concerning outpatient visits in child and adolescent mental health services (CAMHSs), access to emergency departments (EDs), hospital admissions and drug prescriptions collected in administrative databases of the Lombardy Region, Italy, concerning adolescents 12–17 years old and occurring in the 2016–2021 period were analysed.Annual and monthly prevalence of healthcare (CAHMS/ED visits/hospital admissions) use for MH conditions and of psychotropic drug prescriptions were estimated. A negative binomial regression model was used to model the pre-pandemic monthly number of prevalent cases by gender. The total number of pandemic (1 March 2020 to 31 December 2021) cases predicted from the model was compared with the number of observed cases.ResultsThe overall annual rate of healthcare service utilisation slightly increased in the 2016–2019 period (from 63.8‰ to 67.8‰), decreased in 2020 (57.1‰) and returned to values similar to 2016 (64.9‰) the following year. A 2% relative increase was observed in girls, and a 10% decrease in boys, when comparing the prevalence in 2021 with that in 2019. Differences between genders were particularly evident for ED attendance, with an observed/predicted cases ratio in 2021 of 0.81 (95% CI 0.79 to 0.83) in boys, and 1.18 (95% CI 1.16 to 1.20) in girls, and for psychotropic drug prescriptions (0.83 (95% CI 0.82 to 0.84) and 1.24 (95% CI 1.23 to 1.25), respectively).ConclusionsThe current study confirms that the use of health services for MH conditions during the COVID-19 pandemic increased among adolescent girls but decreased among boys, and that gender differences emerged in the MH impact of the pandemic.
Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border
Authors: Bancone Germana , Gilder Mary Ellen , Win Elsie , Gornsawun Gornpan , Moo Paw Khu , Archasuksan Laypaw , Wai Nan San , Win Sylverine , Hanboonkunupakarn Borimas , Nosten Francois , Carrara Verena Ilona , McGready Rose 
Published: September 2024

BackgroundNeonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.MethodsA study was carried out at Shoklo Malaria Research Unit (SMRU) clinics along the Thailand–Myanmar border to evaluate a non-invasive test for diagnosis of NH in a low-resource setting. Performance of a transcutaneous bilirubinometer Dräger Jaundice Meter JM-105 was assessed against routine capillary serum bilirubin testing (with BR-501 microbilirubinometer) before phototherapy during neonatal care in the first week of life. Results were analysed by direct agreement and by various bilirubin thresholds used in clinical practice. Total serum bilirubin was also measured in cord blood at birth and tested for prediction of hyperbilirubinaemia requiring phototherapy in the first week of life.ResultsBetween April 2020 and May 2023, 742 neonates born at SMRU facilities were included in the study. A total of 695 neonates provided one to nine capillary blood samples for analysis of serum bilirubin (total 1244 tests) during the first week of life. Performance of transcutaneous bilirubinometer was assessed in 307 neonates who provided 687 paired transcutaneous capillary blood tests. Bilirubin levels were also measured in 738 cord blood samples. Adjusted values of transcutaneous bilirubinometer showed excellent agreement with capillary serum bilirubin concentration (intraclass correlation coefficient=0.923) and high sensitivity (>98%) at all clinical thresholds analysed across 3 years of sampling and multiple users. Concentrations of bilirubin detected in cord blood were not useful in identifying neonates at risk of hyperbilirubinaemia requiring treatment.ConclusionsThe transcutaneous bilirubinometer is a reliable tool to screen neonates and identify those needing confirmatory blood testing. Bilirubin concentrations in cord blood are not predictive of hyperbilirubinaemia in neonates.
Prevalence, symptomatology and factors associated with asthma in adolescents aged 13–14 years from rural Sri Lanka: an analytical cross-sectional study
Authors: Siriwardhana Tharusha Chamanthi , Sumanapala Vimansha , Subhanee Thiweda , Sulakkhana Savithri , Sridharan Periyasami Sivabalan , Thennakoon Sajeewa , Rajapakse Shashanka 
Published: September 2024

BackgroundAsthma is the most common chronic disease affecting children. However, the epidemiology of asthma in adolescents from rural geographies is lacking.MethodsAn analytical cross-sectional study was conducted in secondary schools located in the municipal council area of the rural district of Anuradhapura, Sri Lanka. Random sampling was used to select 32 grade 8 classes from 6 out of 9 schools. The prevalence and symptomatology of asthma were determined using the validated International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire and asthma symptom control using the asthma control test (ACT) translated into Sinhalese.ResultsThe study sample consisted of 1029 participants aged 13–14 years, including 528 (51.3%) boys and 501 (48.7%) girls. The prevalence of wheeze ever, current wheeze and wheeze while playing was 32.6% (n=335), 23.7% (n=244) and 25.2% (n=259), respectively. The prevalence of parent-reported physician-diagnosed asthma was 19.0% (n=196; 95% CI 16.7 to 21.6). Severe asthma was reported by 157 (15.3%; 95% CI 13.1 to 17.6) adolescents. The independent factors associated with severe asthma were sleeping on a cloth laid on the floor instead of a bed (p<0.02, adjusted-OR 9.72; 95% CI 1.56 to 60.78), cooking using sawdust (p=0.04, adjusted-OR 8.71; 95% CI 1.10 to 68.69) eczema (p<0.01; adjusted-OR 7.39; 95% CI 3.34 to 16.39) and allergic rhinitis (p<0.01; adjusted-OR 5.50; 95% CI 3.80 to 7.98). While having a cemented floor in the house (p<0.04; adjusted-OR 0.68; 95% CI 0.47 to 0.99) was a protective factor. Poor control of asthma symptoms was detected in 29 (29.9%) adolescents which was associated with comorbid allergic rhinitis (p<0.01; unadjusted-OR 5.40; 95% CI 1.84 to 15.82).ConclusionAlmost one in four adolescents had current wheeze, and 15.3% had severe asthma. Severe asthma was independently associated with allergic rhinitis, eczema, cooking using sawdust as fuel and sleeping on a cloth on the floor instead of a bed. Poor symptom control was found in 29.9% of severe asthmatics which was associated with comorbid allergic rhinitis.
Local area crime and alcohol consumption: longitudinal evidence from Australia
Authors: Churchill Rejoice E A , Koomson Isaac , Awaworyi Churchill Sefa 
Published: October 2024

BackgroundAlcohol misuse is a major public health issue. Understanding factors that contribute to alcohol misuse or risky drinking behaviour is important for policy. This study examined if crime rates in the neighbourhood (postcode) where a person lives influences their likelihood of engaging in risky drinking behaviour. We further explored social capital and mental health as channels through which neighbourhood crime influences risky drinking behaviour.MethodsUsing 18 waves of household longitudinal data from the Household, Income and Labour Dynamics in Australia Survey for the period 2002 to 2019 merged with official police statistics on neighbourhood crime rates, we adopted fixed-effect regression models that allow us to address concerns relating to endogenous sorting of participants as well as omitted variable bias.ResultsWe find that an increase in neighbourhood crime is associated with an increase in the likelihood of risky drinking (OR=1.107, 95% CI 1.073 to 1.120), alcohol expenditure (b=0.063, 95% CI 0.041 to 0.076), alcohol consumption frequency (b=0.071, 95% CI 0.055 to 0.083) and quantity (b=0.046, 95% CI 0.032 to 0.052). We present exploratory evidence that social capital and mental health mediate the relationship between neighbourhood crime and alcohol use. Specifically, our results suggest that by eroding the level of trust and decreasing mental health, neighbourhood crime tends to increase the probability that people engage in risky alcohol behaviour.ConclusionOur findings suggest that targeting crime and in particular the channels through which crime influences risky alcohol behaviour (ie, trust and mental health) can be instrumental in addressing alcohol misuse.