bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States
Authors: PORTELA MARIA , SOMMERS BENJAMIN D. 
Published: September 2015

Policy Points:
Puerto Rico is the United States’ largest territory, home to nearly 4 million American citizens, yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA).
We analyzed national survey data from 2011 to 2012 and found that despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of health care coverage and access to care.
While the ACA significantly increases federal resources in Puerto Rico, ongoing federal restrictions on Medicaid funding and premium tax credits in Puerto Rico pose substantial health policy challenges in the territory.
ContextPuerto Rico is the United States’ largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). This article presents an overview of Puerto Rico's health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States.MethodsWe analyzed 2011‐2012 data from the Behavioral Risk Factor Surveillance System, and 2012 data from the American Community Survey and its counterpart, the Puerto Rico Community Survey. Among adults 18 and older, we examined health insurance coverage; access measures, such as having a usual source of care and cost‐related delays in care; self‐reported health; and the receipt of recommended preventive services, such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the mainland United States, adjusted for age, income, race/ethnicity, and other demographic variables.FindingsUninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: −12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year, and fewer experienced cost‐related delays in care. Screening rates for diabetes, mammograms, and Pap smears were comparable or better in Puerto Rico, while colonoscopy rates were lower. Self‐reported health was slightly worse, but obesity and smoking rates were lower.ConclusionsDespite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of coverage and access. Congressional policies capping federal Medicaid funds to the territory, however, have contributed to major budgetary challenges. While the ACA has significantly increased federal resources in Puerto Rico, ongoing restrictions on Medicaid funding and premium tax credits are posing substantial health policy challenges in the territory.
Methadone enhances human influenza A virus replication
Authors: Chen Yun‐Hsiang , Wu Kuang‐Lun , Tsai Ming‐Ta , Chien Wei‐Hsien , Chen Mao‐Liang , Wang Yun 
Published: September 2015

AbstractGrowing evidence has indicated that opioids enhance replication of human immunodeficiency virus and hepatitis C virus in target cells. However, it is unknown whether opioids can enhance replication of other clinically important viral pathogens. In this study, the interaction of opioid agonists and human influenza A/WSN/33 (H1N1) virus was examined in human lung epithelial A549 cells. Cells were exposed to morphine, methadone or buprenorphine followed by human H1N1 viral infection. Exposure to methadone differentially enhanced viral propagation, consistent with an increase in virus adsorption, susceptibility to virus infection and viral protein synthesis. In contrast, morphine or buprenorphine did not alter H1N1 replication. Because A549 cells do not express opioid receptors, methadone‐enhanced H1N1 replication in human lung cells may not be mediated through these receptors. The interaction of methadone and H1N1 virus was also examined in adult mice. Treatment with methadone significantly increased H1N1 viral replication in lungs. Our data suggest that use of methadone facilitates influenza A viral infection in lungs and might raise concerns regarding the possible consequence of an increased risk of serious influenza A virus infection in people who receive treatment in methadone maintenance programs.
Nausea, vomiting and return of bowel function after colorectal surgery
Authors: Barclay Karen L. , Zhu Ying‐Yan , Tacey Mark A. 
Published: September 2015

AbstractBackgroundAlthough patterns of return of bowel function (ROBF) following colorectal surgery with enhanced recovery after surgery (ERAS) programmes have been well delineated, regular morphine use is uncommon. This study describes the patterns of post‐operative nausea and vomiting (PONV) and ROBF in this context.MethodPatients undergoing elective major colorectal surgery on an ERAS programme over 1 year were included. Patient details, intra‐operative course, post‐operative management, outcomes and complications were collected retrospectively from clinical records. Statistical analysis was performed using Stata version 12.ResultsA total of 136/142 (96%) patients received morphine for post‐operative analgesia. Most (112/142, 79%) experienced either no vomiting (87/142, 61%) or small amounts (25/142, 18%). On average, patients without an ileostomy passed flatus and opened their bowels after 2.4 and 4.3 days, those with an ileostomy taking 1.5 and 2.1 days. Vomiting was not related to ROBF (P = 0.370) or overall complications; wound complications (odds ratio (OR) = 8.1, 95% confidence interval (CI): 2.0–32.5), electrolyte abnormalities (OR = 2.9, 95% CI: 1.2–7.1) and length of stay (hazard ratio = 1.3, 95% CI: 1.2–1.5) were related.ConclusionMost patients do not experience PONV in this context. ROBF is predictable without prolonged delays. This information could be used to allow confident early discharge and identify patients whose deviation from normal may indicate complications.
Do all men with pathological Gleason score 8–10 prostate cancer have poor outcomes? Results from the SEARCH database
Authors: Fischer Sean , Lin Daniel , Simon Ross M. , Howard Lauren E. , Aronson William J. , Terris Martha K. , Kane Christopher J. , Amling Christopher L. , Cooperberg Matt R. , Freedland Stephen J. , Vidal Adriana C. 
Published: September 2015

ObjectiveTo determine whether there are subsets of men with pathological high grade prostate cancer (Gleason score 8–10) with particularly high or low 2‐year biochemical recurrence (BCR) risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathological features, such as surgical margin status, extracapsular extension (ECE) and seminal vesicle invasion (SVI).Materials and MethodsWe identified 459 men treated with RP with pathological Gleason score 8–10 prostate cancer in the SEARCH database. The men were stratified into five groups based on pathological characteristics: group 1, men with negative surgical margins (NSMs) and no ECE; group 2, men with positive surgical margin (PSMs) and no ECE; group 3, men with NSMs and ECE; group 4, men with PSMs and ECE; and group 5, men with SVI. Cox proportional hazards models and the log‐rank test were used to compare BCR among the groups.ResultsAt 2 years after RP, pathological group was significantly correlated with BCR (log‐rank, P < 0.001) with patients in group 5 (+SVI) having the highest BCR risk (66%) and those in group 1 (NSMs and no ECE) having the lowest risk (14%). When we compared groups 2, 3, and 4, with each other, there was no significant difference in BCR among the groups (~50% 2‐year BCR risk; log‐rank P = 0.28). Results were similar when adjusting for prostate‐specific antigen, age, pathological Gleason sum and clinical stage, or after excluding men who received adjuvant therapy.ConclusionsIn patients with high grade (Gleason score 8–10) prostate cancer after RP, the presence of either PSMs, ECE or SVI was associated with an increased risk of early BCR, with a 2‐year BCR risk of ≥50%. Conversely, men with organ‐confined margin‐negative disease had a very low risk of early BCR despite Gleason score 8–10 disease.
The development and reliability of an observational tool for assessing mother–child interactions in field studies‐ experience from Pakistan
Authors: Rasheed M. A. , Yousafzai A. K. 
Published: September 2015

SummaryBackgroundThis study describes the development and reliability testing of an observational tool to measure mother–child interactions with toddlers aged 2 years in a rural low‐income country setting.MethodsThe development protocol comprised five phases with iterative revisions: (1) identification of the theoretical framework for responsive behaviours and selection of items; (2) field testing; (3) expert review; (4) training of the data collection team; and (5) piloting. The final tool was a structured live observational measure assessing a 5‐min interaction of a shared picture‐book‐reading activity. Maternal behaviours assessed included affect, touch, verbal statements and language stimulation; child behaviours assessed included affect, communication and attention.ResultsFollowing development, the mother–child interaction tool was administered on a cohort of 1390 children at 2 years of age. Using a video strategy, inter‐observer reliability assessed by the Bland–Altman test for mother–child dyads suggested moderate agreement between expert and field assessors on total scores (r = 0.681**,P < 0.001,n = 154). Significant associations of the total interaction score correlations using Pearson's' correlations were found with the Responsiveness (r = 0.271**,P < 0.001,n = 1345) and Involvement (r = 0.325**,P < 0.001,n = 1345) subscales of the Home Observation for Measurement of Environment‐Infant Toddler Inventory, maternal knowledge (r = 0.203**,P < 0.001,n = 1345), maternal depression (r = .‐063**,P < 0.001,n = 1345), child cognitive development (r = 0.392**,P < 0.001,n = 1345) and language development (r = 0.620**,P < 0.001,n = 1345) assessed using the Bayley Scales for Infant and Toddler Development, Third Edition.ConclusionThe authors conclude that this tool can be reliably used by trained assessors to measure mother–child interactions in field studies.
Reduced fat mass and increased lean mass in response to 1 year of melatonin treatment in postmenopausal women: A randomized placebo‐controlled trial
Authors: Amstrup Anne Kristine , Sikjaer Tanja , Pedersen Steen B. , Heickendorff Lene , Mosekilde Leif , Rejnmark Lars 
Published: September 2015

SummaryObjectiveApart from regulating the circadian rhythm, melatonin exerts a variety of actions in the living organism. Among these functions, melatonin is believed to have a positive effect on body weight and energy metabolism. So far, the evidence for this relies mainly on animal models. In this study, we aimed to determine the effects of melatonin on body composition, lipid and glucose metabolism in humans.Design/methodsIn a double‐blind, placebo‐controlled study, we randomized 81 postmenopausal women to 1 year of treatment with melatonin (1 or 3 mg nightly) or placebo. Body composition was measured by DXA. Measures were obtained at baseline and after 1 year of treatment along with leptin, adiponectin and insulin. Markers of glucose homeostasis were measured at the end of the study.ResultsIn response to treatment, fat mass decreased in the melatonin group by 6·9% (95% CI: 1·4%; 12·4%, P = 0·02) compared to placebo. A borderline significant increase in lean mass of 5·2% was found in the melatonin group compared to placebo (3·3%, (IQR:−1·7; 6·2) vs −1·9%, (IQR: −5·7; 5·8), P = 0·08). After adjusting for BMI, lean mass increased by 2·6% (95% CI: 0·1; 5·0, P = 0·04) in the melatonin group. Changes in body weight and BMI did not differ between groups. Adiponectin increased borderline significantly by 21% in the melatonin group compared to placebo (P = 0·08). No significant changes were observed for leptin, insulin or markers of glucose homeostasis.ConclusionOur results suggest a possibly beneficial effect of melatonin on body composition and lipid metabolism as 1 year of treatment reduces fat mass, increases lean mass and is associated with a trend towards an increase in adiponectin.
A Wilderness Approach under the World Heritage Convention
Authors: Kormos Cyril F. , Bertzky Bastian , Jaeger Tilman , Shi Yichuan , Badman Tim , Hilty Jodi A. , Mackey Brendan G. , Mittermeier Russell A. , Locke Harvey , Osipova Elena , Watson James E.M. 
Published: September 2015

AbstractThe World Heritage Convention could make a bigger and more systematic contribution to global wilderness conservation by: (1) ensuring the World Heritage List includes full coverage of Earth's wilderness areas with outstanding universal value and (2) more effectively protecting the ecological integrity of existing World Heritage sites. Here, we assess current coverage of global‐scale wilderness areas within natural World Heritage sites and identify broad gaps where new wilderness sites should be identified for inclusion in the World Heritage List. We also consider how existing mechanisms under the Convention can improve the ecological integrity of existing sites by expanding or buffering them, and by promoting connectivity between World Heritage sites, between World Heritage sites and other protected areas, or both. We suggest that the Convention should consider a new mechanism called a “World Heritage Wilderness Complex” to facilitate a wilderness approach. Finally, we map three landscapes and one seascape to illustrate how World Heritage Wilderness Complexes might be implemented.
Interdisciplinary Priorities for Dissemination, Implementation, and Improvement Science: Frameworks, Mechanics, and Measures
Authors: Brunner Julian W. , Sankaré Ibrahima C. , Kahn Katherine L. 
Published: September 2015

AbstractMuch of dissemination, implementation, and improvement (DII) science is conducted by social scientists, healthcare practitioners, and biomedical researchers. While each of these groups has its own venues for sharing methods and findings, forums that bring together the diverse DII science workforce provide important opportunities for cross‐disciplinary collaboration and learning. In particular, such forums are uniquely positioned to foster the sharing of three important components of research. First: they allow the sharing of conceptual frameworks for DII science that focus on the use and spread of innovations. Second: they provide an opportunity to share strategies for initiating and governing DII research, including approaches for eliciting and incorporating the research priorities of patients, study participants, and healthcare practitioners, and decision‐makers. Third: they allow the sharing of outcome measures well‐suited to the goals of DII science, thereby helping to validate these outcomes in diverse contexts, improving the comparability of findings across settings, and elevating the study of the implementation process itself.
Cutaneous microcystic/reticular schwannoma: a poorly recognized entity
Authors: Luzar Boštjan , Tanaka Maiko , Schneider Johann , Calonje Eduardo 
Published: September 2015

BackgroundMicrocystic/
reticular schwannoma is exceptionally rare yet distinctive morphological variant of schwannoma with predilection for visceral sites lacking association with neurofibromatosis.AimsTo further delineate clinicopathological features of cutaneous microcystic/reticular schwannoma and to discuss its differential diagnosis.ResultsWe analyzed three cutaneous microcystic/reticular schwannomas, occurring in two males and one female (mean age: 37.6 years). The tumors presented as a non‐painful slightly raised papule (mean: 0.7 cm) on upper arm (n = 2) and back (n = 1). No recurrences were observed despite marginal excision (mean follow up: 42 months). Histopathologically, a multilobular proliferation was present in the dermis composed of bland tumor cells forming distinctive microcystic, reticular, lace‐like or pseudoglandular structures, containing abundant myxoid/mucinous material. By immunohistochemistry, tumor cells lining microcystic structures corresponded to Schwann cells (diffuse S100 positive, variable GFAP positivity). A discontinuous EMA‐positive perineurium was present at the periphery of some of the lobules.ConclusionCutaneous microcystic/reticular schwannoma expands the spectrum of benign peripheral nerve sheath tumors with reticular morphology encountered in the skin. Other tumors in this group include reticular perineurioma and hybrid tumors with reticular morphology, e.g. reticular perineurioma/schwannoma and reticular perineurioma/neurofibroma.
Incidence and causes of dental trauma in children living in the county of Värmland, Sweden
Authors: Lexomboon Duangjai , Carlson Christina , Andersson Ragnar , von Bultzingslowen Inger , Mensah Tita 
Published: September 2015

AbstractAimThe aims of this study were to determine the incidence of injuries to permanent incisors in 2011–2013 in children aged 8–10 years living in the county of Värmland, Sweden, and to compare it with the incidence rates in 1989/1990 in the county of Västmanland, as well as to determine the cause of dental trauma in relation to time and place.MethodThe study analysed the patient records from dental visits (2011–2013) of trauma to the permanent incisors in children aged 8–10 years. The incidence rates were the incidence per 1000 children at risk. Standardized incidence rates were calculated for the comparison between different years. Information about month, location where the trauma occurred as well as cause of trauma was recorded.ResultsA total of 2.2% of 21 721 children aged 8–10 years had experienced at least one trauma. The incidence rate in Värmland increased from 18.9 in 2011 to 21.3 in 2012 to 28.5 in 2013. The standardized incidence rate in Värmland in 2011 and 2012 was not significantly different than in Västmanland in 1989/1990 (P > 0.05), but the standardized rates in 2013 were significantly higher than in 1989/90 (P < 0.001). Dental trauma occurred most often outdoors, followed by sports arenas/sports fields, and more often at school than at home. Falling and slipping was the most common cause of trauma, followed by accidents during leisure activities, playing and sports.ConclusionThe incidence rate for dental trauma has not decreased in the past 20 years, and there is an indication that parents and teachers should be more aware of the risks of dental trauma at leisure times and at school as well as during sports and exercise.
Reliable assessment of forearm photoageing by high‐frequency ultrasound: a cross‐sectional study
Authors: Caetano L. de V. N. , Soares J. L. M. , Bagatin E. , Miot H. A. 
Published: September 2015

SynopsisObjectiveHigh‐frequency ultrasound is a non‐invasive tool used in skin ageing research to assess dermis thickness and echogenicity. This study evaluated the reliability of a range of high‐frequency ultrasound parameters and tested their correlation with age and a validated clinical scale for the assessment of forearm skin photoageing; the difference between two body sites according to environmental exposition patterns was also investigated.MethodsTwenty‐three volunteers aged 28–82 years were divided into three groups according to forearm photoageing degree. A 20 MHz ultrasound unit was used to obtain cross‐sectional images of the skin by two trained investigators on two different sites: the dorsal forearm (chronically photoexposed skin) and the proximal medial arm (non‐photoexposed skin). Several echogenicity parameters were studied for each skin compartment: total dermis, upper dermis and lower dermis, and the ratio between upper and lower dermis.ResultsThe intraclass correlation coefficient (for complete agreement) between investigators was higher for upper and total dermis echogenicity measures compared with the lower dermis. At the non‐photoexposed site, the upper and lower dermis parameter ratio was better correlated with age. At the photoexposed area, total dermis parameters demonstrated higher correlations with clinical score.ConclusionThe authors discuss the choice of parameters for forearm photoageing assessment using high‐frequency ultrasound.
Rheological properties, ginsenosides contents, sensory evaluations of Korean red ginseng extracts
Authors: Chang Yoon Hyuk , Kwak Han Sub , Yoo Byoungseung , Lee Youngseung 
Published: September 2015

SummaryRed ginseng extracts have gained popularity due to their positive impact on health. The objective of this study was to identify the rheological properties, ginsenosides contents and sensory characteristics of six different commercial red ginseng extracts in Korea. Ginseng extracts demonstrated different shear‐thinning flow behaviour (n = 0.59–0.78) with a consistency index (K = 46.77–105.78 Pa sn), which meant they had different viscosity. The amount of ginsenosides and total solid contents were highly correlated (r = 0.954). Six significant attributes (ginseng, angelica, bitterness, ginger flavour and astringency) were identified and can be used as sensory parameters for the determination of the product quality. Hedonic levels of the product were assessed by a group of ninety‐five consumers in their 20 s (n = 32) and over 30 (n = 63). Cluster analysis revealed that consumer acceptance was divided into two major clusters for those that preferred strong (n = 43) and weak (n = 42) ginseng characteristics in the extract.
Need for a roadmap for development of a coordinated national registry programme
Authors: Wilkins S. , Best R. L. , Evans S. M. 
Published: September 2015

AbstractClinical quality registries are an overlooked and under‐funded arm of clinical research in Australia. Registries are databases for patients with a particular disease, or who undergo a procedure, or use a health resource. Registries, where properly funded and universally adopted, have provided substantial benefits to the quality of healthcare and, in some cases, have had demonstrable effect in reducing costs. There is a lack of a coordinated programme for both funding and development of registries in Australia. A coordinated effort is required to address key gaps in registry coverage and ensure registries comply with appropriate technical and operating principles, and target areas where registries can add value to the health system. This will ensure that Australia is competitive with its international peers in this dynamic environment.
Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study
Authors: Lau Rosalind , McCauley Kay , Barnfield Jakqui , Moss Cheryle , Cross Wendy 
Published: September 2015

AbstractPerinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.