bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of translating routine health information system data into action in Mozambique: a qualitative study
Authors: Kawakyu Nami , Inguane Celso , Fernandes Quinhas , Gremu Artur , Floriano Florencia , Manaca Nelia , Ramiro Isaías , Felimone Priscilla , Alfandega Jeremias Armindo Azevedo , Isidor Xavier Alcides , Missage Santana Mário , Wagenaar Bradley H , Sherr Kenneth , Gimbel Sarah 
Published: August 2024

IntroductionRoutine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and middle-income country contexts. Determinants that influence RHIS data-informed decisions and actions are not well understood, and few studies have explored the relationship between RHIS data-informed decisions and actions.MethodsThis qualitative thematic analysis study explored the determinants and characteristics of successful RHIS data-informed actions at the health facility level in Mozambique and which determinants were influenced by the Integrated District Evidence to Action (IDEAs) strategy. Two rounds of qualitative data were collected in 2019 and 2020 through 27 in-depth interviews and 7 focus group discussions with provincial, district and health facility-level managers and frontline health workers who participated in the IDEAs enhanced audit and feedback strategy. The Performance of Routine Information System Management-Act framework guided the development of the data collection tools and thematic analysis.ResultsKey behavioural determinants of translating RHIS data into action included health worker understanding and awareness of health facility performance indicators coupled with health worker sense of ownership and responsibility to improve health facility performance. Supervision, on-the-job support and availability of financial and human resources were highlighted as essential organisational determinants in the development and implementation of action plans. The forum to regularly meet as a group to review, discuss and monitor health facility performance was emphasised as a critical determinant by study participants.ConclusionFuture data-to-action interventions and research should consider contextually feasible ways to support health facility and district managers to hold regular meetings to review, discuss and monitor health facility performance as a way to promote translation of RHIS data to action.
User perceptions and utilisation of features of an AI-enabled workplace digital mental wellness platform ‘mindline at work’
Authors: Yoon Sungwon , Goh Hendra , Low Xinyi Casuarine , Weng Janice Huiqin , Heaukulani Creighton 
Published: August 2024

BackgroundThe working population encounters unique work-related stressors. Despite these challenges, accessibility to mental healthcare remains limited. Digital technology-enabled mental wellness tools can offer much-needed access to mental healthcare. However, existing literature has given limited attention to their relevance and user engagement, particularly for the working population.AimThis study aims to assess user perceptions and feature utilisation ofmindline at work, a nationally developed AI-enabled digital platform designed to improve mental wellness in the working population.MethodsThis study adopted a mixed-methods design comprising a survey (n=399) and semistructured interviews (n=40) with office-based working adults. Participants were asked to usemindline at workfor 4 weeks. We collected data about utilisation of the platform features, intention for sustained use and perceptions of specific features.ResultsParticipants under 5 years of work experience reported lower utilisation of multimedia resources but higher utilisation of emotion self-assessment tools and the AI chatbot compared with their counterparts (p<0.001). The platform received a moderate level of satisfaction (57%) and positive intention for sustained use (58%). Participants regardedmindline at workas an ‘essential’ safeguard against workplace stress, valuing its secure and non-judgmental space and user anonymity. However, they wanted greater institutional support for office workers’ mental wellness to enhance the uptake. The AI chatbot was perceived as useful for self-reflection and problem-solving, despite limited maturity.ConclusionIdentifying the unique benefits of specific features for different segments of working adults can foster a personalised user experience and promote mental well-being. Increasing workplace awareness is essential for platform adoption.
All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors
Authors: Kruckow Sofie , Tolstrup Janne S 
Published: August 2024

ObjectiveTo assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups.DesignNationwide cohort study of socioeconomic predictors.SettingDenmark, 1 January 2010 to 31 December 2022ParticipantsAll Danes of ages 15 to 24 years during the study period summing to a total of 9 314 807 person years and 2297 deaths. Participant and parental information were linked to obtain information on socioeconomic background to investigate differences in parents' educational level, employment status, and family's disposable income, using annually updated nationwide registers.Main outcome measuresAll cause and cause specific mortality including natural deaths (ie, medical conditions and diseases) and unnatural deaths (accidents, suicides, and homicides). Poisson regression was used to calculate incidence rate ratios and 95% confidence intervals (CI).ResultsOverall mortality rate was 24.7 (95% CI 23.7 to 25.7) and higher for men (33.2 (31.5 to 34.8)) compared with women (15.8 (14.6 to 16.9)). All cause and cause specific mortality were higher in financially disadvantaged groups compared with more affluent groups, and consistently so for all three measures of socioeconomic position. Results generally reflected a dose dependent association showing a higher mortality with lower levels of socioeconomic position. For instance, incidence rate ratios of all cause mortality related to parents' education was 2.3 (95% CI 2.0 to 2.7) for elementary level, 1.5 (1.3 to 1.6) for low, and 1.3 (1.1 to 1.4) for medium level as compared with high level. For deaths, incidence rate ratios of elementary education level compared with the most well educated group were 2.2 (1.5 to 3.2) for natural causes, 3.3 (2.5 to 4.4) for accidents, 1.6 (1.2 to 2.2) for suicides, and 3.1 (0.8 to 12) for homicides. Associations were similar in strata of men and women and by age group (15-17v18-24 years). Mortality in young men was considerably higher than in young women for all of the causes.ConclusionYoung people from disadvantaged backgrounds have a markedly higher mortality from all causes than those from more affluent families. The socioeconomic position of their parents was associated with premature mortality in a dose dependent manner meaning that this effect is not only a concern for marginalised groups. Public health attention should be directed to respond to these inequities by strengthening advocacy for adolescent health, ensuring focus on adolescents in health policies and strategies, using the response to adolescent health as an indicator of equity, and prioritising research into the underlying mechanisms linking socioeconomic position in adolescence and mortality.
Deep brain stimulation for Parkinson’s disease: systematic review with meta-analysis and trial sequential analysis
Authors: Petersen Johanne Juul , Kamp Caroline Barkholt , Faltermeier Pascal , Juul Sophie , Løkkegaard Annemette , Gluud Christian , Jakobsen Janus C 
Published: August 2024

ObjectiveTo assess the benefits and harms of deep brain stimulation for Parkinson’s disease.DesignSystematic review with meta-analysis and trial sequential analysis.Data sourcesCochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and other sources, from inception to 9 May 2023.Eligibility criteria for selecting studiesRandomised clinical trials of deep brain stimulation with antiparkinsonian drug treatment use versus antiparkinsonian drugs only (primary comparison, seven trials) for Parkinson’s disease. Other comparisons were deep brain stimulation versus surgery with sham stimulation (three trials) and versus resective surgery (two trials).ResultsPrimary outcomes were all cause mortality, serious adverse events, and disease specific symptoms. In seven trials, 1125 participants were randomised to receive deep brain stimulation with antiparkinsonian drugs versus antiparkinsonian drugs only. All results had a high risk of bias and the certainty of the evidence was very low for all primary outcomes. Information size was insufficient for assessing all cause mortality (risk ratio 2.69, 95% confidence interval (CI) 0.79 to 9.24; I2=0.0%; τ2=0.00; P=0.12; four trials). Meta-analysis showed that deep brain stimulation increased the risk of serious adverse events (risk ratio 2.36, 95% CI 1.37 to 4.09; I2=73.7%; τ2=0.24; P<0.01; six trials) mainly because of an increased risk of perioperative complications, such as cerebral haemorrhages and postoperative confusion, and hardware related events, such as infection at the stimulator site, dislocation of the device, or reoperations. Meta-analyses indicated that deep brain stimulation might reduce some symptoms specific to Parkinson's disease, but assessment of disease specific symptoms in these trials had methodological limitations, including not reporting overall symptom scores.ConclusionsThe certainty of evidence was very low for all primary outcomes, and based on the included evidence, the beneficial effects were questionable because of methodological limitations. Compared with only antiparkinsonian drug treatment, deep brain stimulation with antiparkinsonian drugs seemed to increase the risk of serious adverse events, mainly because of perioperative complications and hardware related events. Conducting randomised clinical trials of adequate methodological quality to effectively evaluate the effects of deep brain stimulation is crucial.Systematic review registrationPROSPERO CRD42022306556.
COVID-19’s impact on food environment in the Indian states of Telangana, Maharashtra, West Bengal, Tamil Nadu and Punjab: a descriptive qualitative study to build further research in India’s food environment resilience building
Authors: Johnsen Jørgen Torgerstuen , Rafaela Lima do Vale Marjorie , Bhangaonkar Rekha , Nyaga Wanja , Ayyad Sally , Ray Sumantra 
Published: August 2024

Background and aimGlobally, COVID-19 has had a profound impact on food and nutrition security. This paper aims to gather the perspective from Transforming India’s Green Revolution by Research and Empowerment for Sustainable food Supplies (TIGR2ESS) Flagship Project 6 (FP-6) team on the impact of COVID-19 on the food systems in India. The responses collected will be used for further research projects after TIGR2ESS ends in March 2022.MethodMembers of the TIGR2ESS FP-6 team in India were invited to complete an online open-ended questionnaire with 21 questions exploring the impact of the COVID-19 pandemic on food systems and environments in India. The questionnaire and data analysis were guided by the food environment framework developed by Turneret aland the adaptations proposed by the United Nations System Standing Committee on Nutrition. Discussions and organisation of codes under the respective themes and subthemes were held online using the virtual platform Miro. 35 individual codes and 65 subcodes were agreed on. Responses were collated and analysed using the template with support from NVivo software and synthesised the relevant themes under Turneret al’s framework.ResultsThe organisation representatives from TIGR2ESS FP-6 (n=16) captured the perceived impact of the COVID-19 on food systems and the environment from the Indian states of Maharashtra, Punjab, Tamil Nadu, Telangana and West Bengal. Negative disruptions were caused by the COVID-19 restrictions across all the themes affecting food actors and consumers. Myths and misconception on dietary intake were reported across the state affecting especially the consumption of poultry. Positive aspects such as home cooking and awareness around healthy food emerged.ConclusionPotential research areas were identified and involve the effects of supply chain resilience buidling, farmers selling their produce directly to consumer and the revival of local and traditional food’s impact on diets, understanding the harm for consumers by implementing restrictions, how indigenous and local food may impact peoples’ diets, how to build on the encouragement of healthy home cooking during the pandemic, investigate the negative and positive effects of digital environments during the pandemic and dispelling myths and misconception while advocating for healthy diets.
Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium
Authors: Skogby Sandra , Goossens Eva , Johansson Bengt , Moons Philip , Bratt Ewa-Lena 
Published: August 2024

BackgroundYoung people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further knowledge of hospital and healthcare system factors is needed.AimThis study aims to explore patient-related, hospital-related and healthcare system-related factors affecting continued follow-up care after transfer, as perceived and experienced by paediatric cardiology and adult CHD (ACHD) healthcare providers (HCPs) in Sweden and Belgium.MethodsThis descriptive qualitative study included individual interviews with cardiologists, nurses and administrative staff, subjected to qualitative content analysis. A total of 30 HCPs from 13 specialist care outpatient clinics at 8 different centres in Sweden and Belgium were interviewed. HCPs were included if they had direct contact with patients and had at least 1 year of work experience.FindingsThe findings illuminate three main categories of factors perceived by HCPs to affect continued follow-up care after transfer, including ‘care structure’, ‘care processes’ and ‘patient characteristics and circumstances’. Success was described as multifactorial, emphasising processes and structures of care, with a focus on collaboration, organisation, joint responsibility, resources, care relationships and transitional care interventions. Few differences appeared between paediatric and ACHD HCPs and between Swedish and Belgian HCPs.ConclusionHCPs perceived factors on patient, hospital and healthcare system levels to influence continued follow-up. Process-related and structure-related aspects of care were perceived as more influential than individual patient characteristics. Hence, future research on discontinued follow-up care should focus on process-related and structure-related aspects of care delivery.
Learning environment and its relationship with quality of life and burn-out among undergraduate medical students in Pakistan: a cross-sectional study
Authors: Shahzad Saadia , Wajid Gohar 
Published: August 2024

ObjectiveThis study was conducted to determine the association between the learning environment, quality of life (QoL), and burn-out among students from selected public-sector and private-sector medical colleges in Lahore, Pakistan.DesignThis was a cross-sectional study.SettingThe study was conducted at six public-sector and private-sector medical colleges, selected randomly from a total of 21 medical colleges located in Lahore, Pakistan.ParticipantsStudy participants included a sample of 3400 undergraduate medical students from both genders and from all five classes of the programme. Data were collected using Google Forms after necessary ethical approval. The learning environment was the predictor variable, and QoL and burn-out were the outcome variables. The learning environment was measured by the Johns Hopkins Learning Environment Scale (JHLES). Students’ QoL was measured using a validated linear analogue self-assessment question adopted from larger inventories for QoL, and student burn-out was measured using a validated single-item linear question (adopted from the Maslach Burnout Inventory) to measure the two parts (emotional exhaustion and depersonalisation) of burn-out. All undergraduate medical students currently enrolled in the graduation programme were included. Students in allied health sciences, dentistry and nursing programmes were excluded.ResultsThe overall JHLES Score was 82.0 for men and 81.6 for women. The mean QoL score was 7.0±1.9; for burn-out, that is, emotional exhaustion and depersonalisation, the mean scores were 21.0±13.8 and 17.5±9.0, respectively. A significant correlation (p<0.05) was found between the overall JHLES mean score and QoL, emotional exhaustion, and depersonalisation. The logistic regression model showed that the odds of higher QoL were less with a higher level of class Adjusted Odd Ratio (AOR) 0.679 (0.51–0.91) (p<0.01) and with a higher JHLES Score AOR 0.9 (0.89–0.91) p<0.0001.ConclusionStudents were less likely to have a high QoL, even if they rated JHLES score on a higher side. They were more likely to have higher emotional exhaustion with successive higher class and residential status (boarders). Also, students had minimally high depersonalisation even when they rated higher scores on the JHLES scale. Based on this study, policies can be developed to improve students’ well-being. Further studies are suggested postpandemic, with a bigger scope of intrinsic and extrinsic influencing factors for QoL and burn-out associated with the learning environment.
Risk perception regarding social determinants of health among women with breast cancer in Iran: a qualitative study
Authors: Ashari Arezou , SoleimanvandiAzar Neda , Nojomi Marzieh , Ranjbar Hadi , Mirzaei Kamran , Nafissi Nahid , Roohravan Benis Mahshid , Rampisheh Zahra 
Published: August 2024

ObjectivesBreast cancer is the most common cancer among women all around the world. Today, in addition to factors including hormones and genetics that are involved in the occurrence of breast cancer, special attention is paid to the role of social and non-medical determinants of health. This study aims to explore the perception of Social Determinants of Health (SDH) in women with breast cancer.DesignQualitative study design with a conventional thematic analysis approach.SettingThe study was conducted in Tehran, Iran, between December 2021 and February 2023.Participants19 women with breast cancer were selected through purposeful and snowball sampling with maximum variation. Sampling continued until data saturation was reached.Primary and secondary outcome measuresThe study categorised the extracted codes from interviews into three main categories and 12 subcategories related to SDH in women with breast cancer.ResultsThe study identified factors such as personal and family health records, health behaviours and lifestyles and medical screening and follow-up as key themes in the perception of SDH among women with breast cancer. The main categories were also categorised into 12 subcategories, ‘including family history’, ‘environmental factors’, ‘hormonal and medicinal changes’, ‘metaphysical factors’, ‘traditional medicine-related factors’, ‘stress’, ‘body weight’, ‘physical activity’, ‘nutrition’, ‘smoking and tobacco use’, ‘screening’, ‘self-examination’ and ‘barriers to medical follow-up’. ‘Near the telecommunications tower’, ‘Improper use of supplements’, ‘Being subjected to the evil eye regularly’, ‘Eating cold nature foods’, ‘Breast weight’ and ‘Being ashamed of the doctor’ were some examples of the codes.ConclusionsParticipants identified a number of environmental, personal and cultural factors as contributing to the disease. Woman’s screening behaviours were influenced by factors such as fear of disease and death, disbelief in getting sick and shame, depending on cultural context. The study suggests the need for further research to explore the impact of these factors on screening behaviours and outcomes in different cultural contexts.
Measuring the frequency and determinants of COVID-19 prevention behaviours: a cross-sectional assessment of large-scale programmes in seven countries, late 2020
Authors: Bick Sarah , White Sian , Hasund Thorseth Astrid , Friedrich Max N D , Gavin Ian , Prasad Gautam Om , Dreibelbis Robert 
Published: August 2024

ObjectivesThis multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The goal of this analysis is to inform future outbreak preparedness and pandemic response in low and middle-income countries.DesignCross-sectional study.SettingHouseholds in seven countries where WaterAid implemented a first-phase COVID-19 response programme in 2020 (Ethiopia, Ghana, Nepal, Nigeria, Rwanda, Tanzania and Zambia).Participants3033 adults (1469 men and 1564 women, alternately sampled from one household to the next to maintain gender balance) in specific programme areas (211 villages) surveyed between October and November 2020.Primary outcome measuresSelf-reported primary outcomes were: a composite measure of HWWS for prevention of respiratory infection/COVID-19 (total of 5 key moments); respondent increased HWWS behaviour after the COVID-19 pandemic; respondent always wears a mask in public spaces; respondent always practices physical distancing in public spaces.ResultsMost respondents (80%) reported increasing their handwashing behaviour after the pandemic, but practice of HWWS at COVID-19-specific prevention moments was low. Mask wearing (58%) and physical distancing (29%) varied substantially between countries. Determinants of key behaviours were identified, including age and socioeconomic status, perceived norms, self-regulation and the motive of protecting others. Incidence rate ratios or odds ratios and 95% CIs for a range of psychosocial determinants for each of the four primary outcomes are reported.ConclusionsThese findings highlight that leveraging behaviour-specific emotional drivers and norms, reducing common barriers and promoting targeted messages about specific behaviours and actions individuals can take to reduce risk are necessary to support large-scale behaviour change. Learning from the COVID-19 response to more effectively integrate novel behaviours into existing health promotion will be vital for disease prevention and outbreak resilience.