bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prioritization of public health financing, organization, and workforce transformation: a Delphi study in Canada
Authors: Dedewanou F. Antoine , Allin Sara , Guyon Ak’ingabe , Pawa Jasmine , Ammi Mehdi 
Published: March 2023

AbstractBackgroundThe increased scrutiny on public health brought upon by the ongoing COVID-19 pandemic provides a strong impetus for a renewal of public health systems. This paper seeks to understand priorities of public health decision-makers for reforms to public health financing, organization, interventions, and workforce.MethodsWe used an online 3-round real-time Delphi method of reaching consensus on priorities for public health systems reform. Participants were recruited among individuals holding senior roles in Canadian public health institutions, ministries of health and regional health authorities. In Round 1, participants were asked to rate 9 propositions related to public health financing, organization, workforce, and interventions. Participants were also asked to contribute up to three further ideas in relation to these topics in open-ended format. In Rounds 2 and 3, participants re-appraised their ratings in the view of the group’s ratings in the previous round.ResultsEighty-six public health senior decision-makers from various public health organizations across Canada were invited to participate. Of these, 25/86 completed Round 1 (29% response rate), 19/25 completed Round 2 (76% retention rate) and 18/19 completed Round 3 (95% retention rate). Consensus (defined as more than 70% of importance rating) was achieved for 6 out of 9 propositions at the end of the third round. In only one case, the consensus was that the proposition was not important. Proposition rated consensually important relate to targeted public health budget, time frame for spending this budget, and the specialization of public health structures. Both interventions related and not related to the COVID-19 pandemic were judged important. Open-ended comments further highlighted priorities for renewal in public health governance and public health information management systems.ConclusionConsensus emerged rapidly among Canadian public health decision-makers on prioritizing public health budget and time frame for spending. Ensuring that public health services beyond COVID-19 and communicable disease are maintained and enhanced is also of central importance. Future research shall explore potential trade-offs between these priorities.
The declining trend in HIV prevalence from population-based surveys in Cameroon between 2004 and 2018: myth or reality in the universal test and treat era?
Authors: Bekolo Cavin Epie , Kouanfack C , Ateudjieu J , Bechem ET , Ndeso SA , Tendengfor N , Nsagha DS , Choukem SP 
Published: March 2023

Abstract
Background
HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change.

Methods
We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients associated p-values and 95% confidence intervals were obtained using Microsoft Excel software.

Results
Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2018 at a rate of about 1.4% every septennium (β = -1.4, R² = 0.98, p = 0.03). Yet, the number of persons surviving with HIV increased from about 0.05 million in 1991 to 0.5 million in 2018 corresponding to an increase in access to antiretroviral therapy from less than 10% to universal coverage of 80% respectively. Concurrent reductions in risky sexual behaviours were observed: a delayed sexual debut by one year, decreased sexual violence by 7%, decreased polygamous unions by 16%, decreased multiple sexual partners by 15.3% and increased condom use by 26.3%.

Conclusion
The observed decline in HIV prevalence is statistically valid and reflects the observed decline in risky sexual behaviour that need to be sustained by the National HIV programme. Though universal access to ART has increased the number of persons surviving with HIV, this has not led to an increased prevalence of HIV in a setting with a rising population.
Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study
Authors: Vahwere Bienfait Mumbere , Ssebuufu Robinson , Namatovu Alice , Kyamanywa Patrick , Ntulume Ibrahim , Mugwano Isaac , Pius Theophilus , Sikakulya Franck Katembo , Xaviour Okedi Francis , Mulumba Yusuf , Jorge Soria , Agaba Gidio , Nasinyama George William 
Published: March 2023

Abstract
Background
Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda.

Methodology
This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis.

Results
The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5–10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively.

Conclusion
Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.
Perceived social support and compliance on stay-at-home order during COVID-19 emergency in Nepal: an evidence from web-based cross-sectional study
Authors: Shrestha Namuna , Koju Reena , K.C. Dirghayu , Mahato Namra Kumar , Poudyal Anil , Subedi Ranjeeta , Gautam Nitisha , Vaidya Anju , Karki Shristi 
Published: March 2023

Abstract
Background
After COVID-19 was declared a Public Health Emergency of International Concern by WHO, several non-pharmaceutical interventions were adopted for containing the virus. Success to which largely depend upon citizens’ compliance to these measures. There is growing body of evidence linking social support with health promoting behaviour. Hence, this research aimed to study the effects on compliance with stay-at-home order in relation to their perceived social support.

Methods
A web-based cross-sectional study was conducted among adult participants aged 18 years and above residing in Bagmati Province, Nepal. A convenient non-probability sampling method was adopted to select the required number of samples. The questionnaire was developed through an extensive review of literature, and consultations with the research advisor, subject experts, as well as peers and converted to online survey form using Google Forms. Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) scale whereas compliance was assessed using a single screening question. Statistical analysis was performed using SPSS version 20 involving both the descriptive and inferential statistics.

Results
Two fifth (40.2%) of the participants reported poor compliance with stay-at-home order which was found higher among participants who were not vaccinated against COVID-19 compared to those vaccinated (p value < 0.05). A significant difference was observed between sex and perceived support (p value < 0.05) with higher proportion (80.8%) of female participants reporting perceived support from family, friends, and significant others in comparison to male participants.

Conclusion
Overall, the results of this study suggest that the perceived support from family is higher compared to others. Further evidence might be helpful to understand contextual factors on compliance with public health measures. Tailoring behaviour change messages as per the community needs would help the response in such emergencies. The findings from this study might be useful as one of the evidence base for formulating plans and policy during emergencies of similar nature.
Mailing human papillomavirus self-sampling kits to women under-screened for cervical cancer improved detection in cervical cancer screening in a general population study in Japan
Authors: Nishimura Yoko , Matsuura Motoki , Terada Noriko , Nagao Sachiko , Shimada Hiroshi , Isoyama Kyoko , Tamate Masato , Iwasaki Masahiro , Saito Tsuyoshi 
Published: March 2023

Abstract
Background
One cause of the increase in cervical cancer rates in Japan is the long-term stagnation in the cervical cancer screening consultation rate. Therefore, improving the screening consultation rate is of urgent concern to reduce cervical cancer incidence. Self-collected human papilloma virus (HPV) tests have been successfully adopted in several countries, such as the Netherlands and Australia, as a measure of individuals who have not undergone cervical cancer screening in national programs. This study aimed to verify whether self-collected HPV tests presented an effective countermeasure for individuals who had not undergone the recommended cervical cancer screenings.

Methods
This study was conducted from December 2020 to September 2022 in Muroran City, Japan. The primary evaluated endpoint was the percentage of citizens who underwent cervical cancer screening at a hospital with positive self-collected HPV test results. The secondary endpoint was the percentage of included participants who were diagnosed with cervical intraepithelial neoplasia (CIN) or higher among those who visited a hospital and underwent cervical cancer screening.

Results
The included study participants were 7,653 individuals aged 20–50 years with no record of previous cervical cancer examination in the past 5 years. We mailed these participants information on self-administered HPV tests as an alternative screening procedure and sent the kit to 1,674 women who requested the test. Among them, 953 returned the kit. Among the 89 HPV-positive individuals (positive rate, 9.3%), 71 (79.8%) visited the designated hospital for an examination. A closer examination revealed that 13 women (18.3% of hospital visits) had a CIN finding of CIN2 or higher, among whom one each had cervical cancer and vulvar cancer, eight presented with CIN3, and three presented with CIN2; two cases of invasive gynecologic cancer were also identified.

Conclusions
We conclude that the self-collected HPV tests showed a certain efficacy as a measure of individuals who had not undergone the recommended cervical cancer screening. We devised ways to have the unexamined patients undergo HPV testing and ensure that HPV-positive individuals visited the hospital. Despite a few limitations, our findings suggest the effectiveness of this public health intervention.
Health litigation and cancer survival in patients treated in the public health system in a large Brazilian city, 2014–2019
Authors: de Castro Mônica Silva Monteiro , da Silva Gabriela Drummond Marques , Figueiredo Iara Veloso Oliveira , de Miranda Wanessa Debôrtoli , Magalhães Júnior Helvécio Miranda , dos Santos Fausto Pereira , de Sousa Rômulo Paes 
Published: March 2023

Abstract
Background
Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables.

Methods
A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model.

Results
In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33–0.80), prostate (HR = 0.50, 95%CI 0.30–0.85), colon (HR = 0.59, 95%CI 0.38–0.93), and lung (HR = 0.36, 95%CI 0.22–0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures.

Conclusion
When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment.
Adverse childhood experiences and health risk behaviours among adolescents and young adults: evidence from India
Authors: Maurya Chanda , Maurya Priya 
Published: March 2023

Abstract
Background
Adverse childhood experiences (ACEs) are traumatic and stressful events that occur in childhood. These experiences at home, school, or in the community may damage the cognitive health and emotional skills of children and adolescents.

Objective
The present study examines the association between Adverse childhood experiences and risky health behaviour indicators while controlling other background characteristics among boys and girls. This study also assesses outcomes in the aggregate to estimate the impact of cumulative adversity on various risky health behavioural factors among boys and girls among adolescents and young adults (age group 13–23) in India.

Data and methods
Data were drawn from the second wave of the “Understanding the lives of adolescents and young adults (2018–2019)” survey. Bivariate and logistic regression analysis were conducted to fulfill the objective.

Results
The findings show that nearly 30% of boys and 10% of girls had violent behaviour. Substance use prevalence was much higher among boys (34.11%) than girls (6.65%). More boys had negative gender attitudes. The majority of the study participants had multiple ACEs. Boys who experienced more than three or more childhood adversity had two times higher odds (OR: 2.04; CI: 1.01–4.16) of the early sexual debut, while the same figure for girls was thirteen times (OR: 13.13; CI: 3.95–43.69) than their male counterparts.

Conclusion
The study findings underlined the need for implementing outcome-oriented approaches to adolescents’ health care and behavioural risks. Therefore, identifying and intervening with adolescents and young adults who are at the highest risk of engaging in risky behaviors early in life may reduce the risk of these behaviors persisting into adulthood. In order to avoid health risk behavior in later stages among adolescents and young adults, policymakers need to focus on ACEs as risk factors and take action to reduce this burden. A potential model could be to create awareness among family members, caregivers, and communities to be more empathetic toward the children.
Multilevel proportional odds modeling of anaemia prevalence among under five years old children in Ethiopia
Authors: Zewude Bereket Tessema , Debusho Legesse Kassa 
Published: March 2023

Abstract
Background
Despite anaemia is the leading cause of child morbidity and mortality in Africa including Ethiopia, there is inadequate evidence on modelling anaemia related factors among under five years old children in Ethiopia. Therefore, this study is aimed to assess factors that affect the anaemia status among under five years old children and estimate the proportion of overall child-level variation in anaemia status that is attributable to various factors in three regions of Ethiopia, namely Amhara, Oromiya and Southern Nation Nationalities People (SNNP).

Methods
This is a cross-sectional study, and the data was extracted from the 2011 Ethiopia National Malaria Indicator Survey which is a national representative survey in the country. A sample of 4,356 under five years old children were obtained from three regions. Based on child hemoglobin level, anaemia status was classified as non-anaemia (>11.0g/dL), mild anaemia (8.0-11.0g/dL), moderate anaemia (5.0-8.0g/dL) and severe anaemia (<5.0g/dL). Various multilevel proportional odds models with random Kebele effects were adopted taking into account the survey design weights. All the models were fitted with the PROC GLIMMIX in SAS. The Brant test for parallel lines assumption was done using the function from package in R environment.

Results
The prevalence of anaemia status of under five years children varies among the three study regions, where the prevalence of severe child anaemia status was higher in Oromiya region as compared to Amhara and SNNP regions. The results of this study indicate that age (OR = 0.686; 95% CI: 0.632, 0.743), malaria RDT positive (OR = 4.578; 95% 2.804, 7.473), household had used mosquito nets while sleeping (OR = 0.793; 95%: 0.651, 0.967), household wealth status and median altitude (OR = 0.999; 95%: 0.9987, 0.9993), were significantly related to the prevalence of child anaemia infection. The percentage of Kebele-level variance explained by the region and median altitude, and child / household (Level 1) characteristics was 32.1 % . Hence, large part of the Kebele-level variance (67.9%) remain unexplained.

Conclusions
The weighted multilevel proportional odds with random Kebele effects model used in this paper identified four child/household and one Kebele level risk factors of anaemia infection. Therefore, the public health policy makers should focus to those significant factors. The results also show regional variation in child anaemia prevalence, thus special attention should be given to those children living in regions with high anaemia prevalence.
The immune evasion ability of Delta variant is comparable to that of Beta variant in South Africa
Authors: He Daihai , Chen Boqiang , Zhao Shi , Stone Lewi 
Published: March 2023

Abstract
Background
The high immune evasion ability of SARS-COV-2 Omicron variant surprised the world and appears to be far stronger than any previous variant. Previous to Omicron it has been difficult to assess and compare immune evasion ability of different variants, including the Beta and Delta variants, because of the relatively small numbers of reinfections and because of the problems in correctly identifying reinfections in the population. This has led to different claims appearing in the literature. Thus we find claims of both high and low immune evasion for the Beta variant. Some findings have suggested that the Beta variant has a higher immune evasion ability than the Delta variant in South Africa, and others that it has a lower ability.

Method
In this brief report, we re-analyse a unique dataset of variant-specific reinfection data and a simple model to correct for the infection attack rates of different variants.

Result
We find that a model with the Delta variant having an equal or higher immune evasion ability than Beta variant is compatible with the data.

Conclusion
We conclude that the immune evasion ability of Beta variant is not stronger than Delta variant, and indeed, the immune evasion abilities of both variants are weak in South Africa.
Evaluating the effectiveness of the safety experience room, an affordable interactive education intervention to prevent unintentional injury among rural preschoolers in China: protocol for a cluster randomized controlled trial
Authors: He Jieyi , Wang Wanhui , Ning Peishan , Schwebel David C. , Yang Yang , Cheng Peixia , Li Jie , Zhao Min , Li Weiqiang , Zhang Na , Liu Han , Hu Guoqing 
Published: March 2023

Abstract
Background
Interactive and experiential learning programs have proven effective to teach children safety and prevent child unintentional injury. However, previously-published programs were designed primarily to address safety concerns of children living in urban, well-resourced areas, and therefore might be less effective or economically infeasible to distribute to children in resource-limited areas, such as those living in rural areas or underdeveloped regions. This proposed study will evaluate the effectiveness of teaching children safety lessons to rural preschoolers in China through the preschool-based Safety Experience Room intervention that was developed based on relevant theories, the lessons of previous intervention research, the characteristics of child injuries in underdeveloped rural areas, and the needs and circumstances of rural families and preschools in China. The study will also evaluate the cost-effectiveness of delivering the program.

Methods and analysis
A single-blinded, 12-month follow-up, parallel-group cluster randomized controlled trial with a 1:1 allocation ratio will be implemented in two selected counties. In total, at least 2378 rural preschoolers aged 3–6 years old will be recruited from 12 preschools, 6 in Yang County and 6 in Shicheng County. Clusters will be randomized at the preschool level and allocated to the control group (routine school-based education) or the intervention group (routine school-based education plus the Safety Experience Room education). External support strategies will be implemented by local partners to minimize attrition. Data collection will be conducted at baseline and then every 3 months during a 12-month follow-up time period. Intention-to-treat (ITT) data analysis will be used. Generalized estimation equations (GEE) will evaluate the effectiveness of the program and generalized cost-effectiveness analysis (GCEA) will evaluate the cost-effectiveness of it. A per-protocol (PP) sensitivity analysis will assess the robustness of ITT results. Subgroup analyses will be performed to evaluate the impact of socio-demographic factors on the intervention effect, following the same strategies as the primary analyses.

Discussion
The newly-designed Safety Experience Room program is expected to be feasible, effective, and financially beneficial. If these hypotheses prove true, we will take steps to disseminate the program to rural preschools across China.

Trial registration
Chinese Clinical Trial Registry (http://www.chictr.org.cn), CHiCTR2000038025, registered on 8 September 2020.