bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage
Authors: Rahman Taslima , Gasbarro Dominic , Alam Khurshid 
Published: June 2022

Background
Ensuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh.

Methods
Using Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons.

Results
OOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%).

Conclusion
Financial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.
Motor control exercises versus general exercises for greater trochanteric pain syndrome: A protocol of a randomized controlled trial
Authors: Thomaz de Aquino Nava Guilherme , Baldini Prudencio Caroline , Krasic Alaiti Rafael , Mendes Tozim Beatriz , Mellor Rebecca , Rodrigues Pedroni Cristiane , Mércia Pascon Barbosa Angélica , Tavella Navega Marcelo 
Published: June 2022

Introduction
Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome.

Methods
The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life.

Conclusions
Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.
Radiomics for identifying lung adenocarcinomas with predominant lepidic growth manifesting as large pure ground-glass nodules on CT images
Authors: Xiong Ziqi , Jiang Yining , Tian Di , Zhang Jingyu , Guo Yan , Li Guosheng , Qin Dongxue , Li Zhiyong 
Published: June 2022

Purpose
To explore the value of radiomics in the identification of lung adenocarcinomas with predominant lepidic growth in pure ground-glass nodules (pGGNs) larger than 10 mm.

Methods
We retrospectively analyzed CT images of 204 patients with large pGGNs (≥ 10 mm) pathologically diagnosed as minimally invasive adenocarcinomas (MIAs), lepidic predominant adenocarcinomas (LPAs), and non-lepidic predominant adenocarcinomas (NLPAs). All pGGNs in the two groups (MIA/LPA and NLPA) were randomly divided into training and test cohorts. Forty-seven patients from another center formed the external validation cohort. Baseline features, including clinical data and CT morphological and quantitative parameters, were collected to establish a baseline model. The radiomics model was built with the optimal radiomics features. The combined model was developed using the rad_score and independent baseline predictors. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test. The differential diagnosis performance of the models was compared with three radiologists (with 20+, 10+, and 3 years of experience) in the test cohort.

Results
The radiomics (training AUC: 0.833; test AUC: 0.804; and external validation AUC: 0.792) and combined (AUC: 0.849, 0.820, and 0.775, respectively) models performed better for discriminating than the baseline model (AUC: 0.756, 0.762, and 0.725, respectively) developed by tumor location and mean CT value of the whole nodule. The DeLong test showed that the AUCs of the combined and radiomics models were significantly increased in the training cohort. The highest AUC value of the radiologists was 0.600.

Conclusion
The application of CT radiomics improved the identification performance of lung adenocarcinomas with predominant lepidic growth appearing as pGGNs larger than 10 mm.
Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand
Authors: Siewchaisakul Pallop , Sarakarn Pongdech , Nanthanangkul Sirinya , Longkul Jirapat , Boonchieng Waraporn , Wungrath Jukkrit 
Published: June 2022

Background
The roles of literacy, fear and hesitancy were investigated for acceptance of COVID-19 vaccine (AV) types among village health volunteers (VHVs) in Thailand.

Materials and methods
A cross-sectional study was conducted using an unidentified online questionnaire to assess literacy, fear and hesitancy of COVID-19 vaccine acceptance among Thai VHVs between 1 and 15 October 2021. The questionnaire was developed based on the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano) for vaccine literacy (VL), using an adult Vaccine Hesitancy Scale (aVHS) for COVID-19 vaccine hesitancy (VH) and Fear of COVID-19 scale (FCoV-19S) for the distress of COVID-19 vaccine. The effects of VL, VH and vaccine fear (VF) on AV were estimated using multivariable logistic regression.

Results
A total of 5,312 VHVs completed the questionnaire. After adjustment with variables in the multivariable analysis, the VL score was insignificantly associated with increased vaccination (aOR = 1.002; (95%CI: 0.994–1.01)), while VF and VH significantly decreased the chance of vaccination, aOR = 0.966 (95%CI: 0.953–0.978) and aOR = 0.969; (95%CI: 0.960–0.979), respectively and VF and VH were negatively associated with AV for all types of vaccine preference, with VL showing a reverse relationship only for mRNA-based vaccines.

Conclusion
VL may not increase AV among VHVs. To increase attitudes toward receiving COVID-19 vaccination in Thailand, the government and health-related organizations should instigate policies to significantly reduce VF and VH among Thai VHVs.
Understanding the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda
Authors: Camlin Carol S. , Marson Kara , Ndyabakira Alex , Getahun Monica , Emperador Devy , Byamukama Ambrose , Kwarisiima Dalsone , Thirumurthy Harsha , Chamie Gabriel 
Published: June 2022

Background
Viral suppression among people living with HIV (PLHIV) is essential for protecting health and preventing HIV transmission, yet globally, rates of viral suppression are sub-optimal. Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold promise for improving these outcomes, yet to date, clinical trial results have been mixed.

Methods
This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda to test whether incentives are effective for achieving viral suppression in PLHIV, sought to enhance our understanding of the factors that influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to balance across gender, study arm, and viral suppression status, were interviewed to explore barriers and motivations for care engagement, adherence, and viral suppression, and attributions for decision-making, including perceived influence of incentives on behaviors.

Results
While many participants with undetectable viral load (VL) who received incentives said the incentives motivated their ART adherence, others expressed intrinsic motivation for adherence. All felt that incentives reduced burdens of transport costs, lost income due to time spent away from work, and food insecurity. Incentives may have activated attention and memory for some, as excitement about anticipating incentives helped them adhere to medication schedules. In comparison, participants who were randomized to receive incentives but had detectable VL faced a wider range, complexity and severity of challenges to care engagement. Notably, their narratives included more accounts of poor treatment in clinics, food insecurity, and severe forms of stigma. With or without incentives, adherence was reinforced through experiencing restored health due to ART, social support (especially from partners), and good quality counseling and clinical care.

Conclusions
In considering why incentives sometimes fail to achieve behavior change, it may be helpful to attend to the full set of factors- psychological, interpersonal, social and structural- that militate against the behavior change required to achieve behavioral outcomes. To be effective, incentives may need to be combined with other interventions to address the spectrum of barriers to care engagement.
Fatigue in incident peritoneal dialysis and mortality: A real-world side-by-side study in Brazil and the United States
Authors: Guedes Murilo , Wallim Liz , Guetter Camila R. , Jiao Yue , Rigodon Vladimir , Mysayphonh Chance , Usvyat Len A. , Barretti Pasqual , Kotanko Peter , Larkin John W. , Maddux Franklin W. , Pecoits-Filho Roberto , de Moraes Thyago Proenca 
Published: June 2022

Background
We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders.

Methods
We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country’s cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competing risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality.

Results
We used data from 4,285 PD patients (Brazil n = 1,388 and United States n = 2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR = 0.79 [95%CI 0.70 to 0.90] and United States HR = 0.90 [95%CI 0.88 to 0.93], pooled HR = 0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates.

Conclusions
Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.
Quantifying the stiffness of lumbar erector spinae during different positions among participants with chronic low back pain
Authors: Li Yapeng , Yu Jiafeng , Zhang Jun , Zhang Zhijie , Wang Xueqiang 
Published: June 2022

Objective
The purposes of this study were to (1) detect the intra- and inter-reliabilities of the lumbar erector spinae stiffness by MyotonPRO among participants with chronic lower back pain (CLBP); (2) compare the muscle stiffness between pain and non-pain sides during different positions; (3) explore the correlation between intensity of pain and muscle stiffness.

Design
Twenty participants with CLBP were recruited and the stiffness measurements were carried out by two experienced physiotherapists (operators Ⅰ and Ⅱ). Each participant was evaluated by the operatorⅠ in different postures (static prone and sitting). After a 5-day interval, the same participant was reassessed by the operatorⅠ in the static prone posture. For the inter-rater reliability test, each participant was quantified by both operators once, with 30 minutes between the measurements on the same day. The intensity of pain was evaluated using a 0–10 visual analog scale (VAS).

Results
The intra- and inter-rater reliabilities were excellent (ICC = 0.88–0.99). The MDC values ranged from 25.03 to 86.26 N/m. Examples of Bland-Altman plots showed good agreement. The erector spinae stiffness on the painful sides was higher with a marked increase in the sitting position (P < .05) when compared with the non-painful side. However, there was no significant difference in the prone position (P > .05). The intensity of pain among adults with CLBP was not associated with muscle stiffness of the lumbar erector spinae muscle.

Conclusions
Our findings indicated that the MyotonPRO is a feasible device in quantifying the stiffness of the lumbar erector spinae muscle in patients with CLBP. Meanwhile, the erector spinae stiffness on the painful sides was higher in the sitting when compared with the non-painful side.
Prevalence of depression and associated factors among adult cancer patients receiving chemotherapy during the era of COVID-19 in Ethiopia. Hospital-based cross-sectional study
Authors: Belete Abebe Muche , Alemagegn Anmut , Mulu Anemut Tilahun , Yazie Taklo Simeneh , Bewket Bekalu , Asefa Adisu , Shiferaw Wendimeneh Shibabaw 
Published: June 2022

Background
Depression is a major public health problem among cancer patients undergoing chemotherapy. It compromises patient outcomes, resulting in higher rates of mortality. Currently, there are little data on the prevalence of depression in Sub-Sharan countries. Therefore, the current study was done to assess the prevalence of depression among adult cancer patients and its associated factors in Ethiopia.

Method
An institutional based cross-sectional study was conducted among 420 adult cancer patients from 1st March to April 30, 2021. Systematic random sampling technique was used to recruit participants. Depression was assessed using the Patient Health Questionnaire-9. The collected data were coded and entered into Epi-data version 4.2 and exported to SPSS version 25 for analysis. Bivariate binary logistic regression was performed to select factors that will be included in multivariate analysis, and variables with a p-value < 0.05 were included in multivariate analysis. In multivariate analysis, odds ratios and their 95% confidence intervals were computed and variables with p-value < 0.05 were considered to declare a significant association.

Results
In this study, the prevalence of depression was 33.1% (95% CI = 0.2858, 0.3761). Minimal symptoms of depression, minor depression, moderate depression, moderate severe depression, and severe depression were found to be 272 (64.8%), 9 (2.1%), 104 (24.8%), 28 (6.7%), and 7 (1.7%), respectively. Those cancer patients who had unemployed status, sacked from jobs, and had stage IV cancer were most likely to develop depression, whereas patients who completed primary education, colon, prostate and cervical cancer were less likely to have depression.

Conclusion
Depression is found to be a major public health concern for adult cancer patients in Ethiopia. To reduce the occurrence of depression among cancer patients, special attention is needed.
Do inhabitants profit from integrating a public health focus in urban renewal programmes? A Dutch case study
Authors: Ruijsbroek Annemarie , Wong Albert , den Hertog Frank , Droomers Mariël , van den Brink Carolien , Kunst Anton E. , van Oers Hans A. M. , Stronks Karien 
Published: June 2022

Background
Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an additional focus on health, under the heading of Healthy District Experiments (HDE), within districts where an urban renewal programme was carried out.

Methods
We evaluated changes in health outcomes before the start of the HDE and after implementation, and compared these changes with health changes in control areas, e.g. districts from the urban renewal programme where no additional HDE was implemented. Additionally, we gathered information on the content of the experiments to determine what types of activities have been implemented.

Results
The additional activities from the HDE were mostly aimed at strengthening the health care in the districts and at promoting physical activity. When we compared the prevalence in general health, mental health, overweight, obesity, smoking, and physical activity during the study period between the HDE districts and control districts, we found no significant differences in the rate of change. The study is limited by a small sample size and the cross-sectional nature of the data. These and other limitations are discussed.

Conclusion
We found no evidence for a beneficial health impact of the activities that were initiated with a specific focus on health, within a Dutch urban renewal programme. Specific attention for network management and the integration of such activities in the wider programme, as well as an allocated budget might be needed in order to sort a health impact.
Latrine access and factors associated with it among people with physical disability in Kombolcha Town, Northeast Ethiopia: A mixed cross-sectional study
Authors: Getahun Abuneh , Kassie Genet Gedamu , Bunare Tsion Samuel 
Published: June 2022

Background
Although all people have the right to access basic sanitation services, people with disabilities often face additional barriers to accessing the service compared to people without disabilities. Over the last few years, with the focus of the sustainable development goals on universal access to water supply, sanitation, and hygiene facilities, awareness of the need for programs to reach and benefit everyone has been growing. But the current level of access to latrines is not known.

Objective
To determine latrine access and identify factors associated with it among people with physically disability in Kombolcha town, 2020.

Methods
A community-based mixed cross-sectional study was conducted among physically disabled people in Kombolcha town in April 2020. Quantitative data was collected from 374 randomly selected study participants using structured interviewer-administered questioners. The key informant and in-depth interviews were conducted with purposely selected individuals.The bivariate and multivariable logistic regression analyses were conducted. Thematic analysis was used for qualitative data

Results
Latrine access among people with a physical disability was found to be (22%), 95% CI (17.7–26.5). membershipto disability association (AOR = 2.162, 95% CI (1.231–3.799)),wealth status of study participants. (AOR = 4.169, 95% CI (1.96–8.864)) stigma and discrimination to get latrine in the last 12 months(AOR = 0.212, 95% CI (0.116–0.388)) and study participant’s knowledge to construct accessible latrine (AOR = 4.389, 95% CI (2.446–7.87)) werepredictor variables of latrine accessibility. Shared/publiclatrine, stigma and discrimination, poor wealth status,lack of own house, and lack of information provided regarding latrine accessibility supplementary barriersfor inaccessible latrinefrom In-depth and key informant interviews.

Conclusion
Latrine access among people with a physical disability was found to be very low. Poor knowledge of accessible latrine construction, poor wealth status, stigma and discrimination, and not beinga member of a disability association increased the risk of latrine inaccessibility.
Ischemic stroke in patients that recover from COVID-19: Comparisons to historical stroke prior to COVID-19 or stroke in patients with active COVID-19 infection
Authors: Akhtar Naveed , Abid Fatma , Singh Rajvir , Kamran Saadat , Imam Yahia , Al-Jerdi Salman , Salamah Sarah , Al Attar Rand , Yasir Muhammad , Shabir Hammad , Morgan Deborah , Joseph Sujatha , AlMaslamani Muna , Shuaib Ashfaq 
Published: June 2022

Background and purpose
Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic historical stroke (Pre-C), cases in acute COVID infection (Active-C) and in patients who have recovered from COVID-19 infection (Post-C).

Methods
We interrogated the Qatar stroke database for all stroke admissions between Jan 2019 and Feb 2020 (Pre-C) to Active-C (Feb2020-Feb2021) and Post-C to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. We used the modified Rankin Scale (mRS) to measure outcome at 90-days (mRS 0–2 good recovery and mRS 3–6 as poor recovery). For the current analysis, we compared the clinical features and prognosis in patients with confirmed acute ischemic stroke.

Results
There were 1413 cases admitted (pre-pandemic: 1324, stroke in COVID-19: 46 and recovered COVID-19 stroke: 43). Patients with Active-C were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to Pre-C and Post-C. Large vessel disease and cardioembolic disease was significantly more frequent in Active-C compared to PRE-C or post-C.

Conclusions
Stroke in Post-C has characteristics similar to Pre-C with no evidence of lasting effects of the virus on the short-term. However, Active-C is a more serious disease and tends to be more severe and have a poor prognosis.