bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengthening institutions for public health education: results of an SWOT analysis from India to inform global best practices
Authors: Miller Emily , Reddy Megha , Banerjee Preetika , Brahmbhatt Haley , Majumdar Piyusha , Mangal D. K. , Gupta Shiv Dutt , Zodpey Sanjay , Shet Anita , Schleiff Meike 
Published: February 2022

Abstract
Background
Developing public health educational programs that provide workers prepared to adequately respond to health system challenges is an historical dilemma. In India, the focus on public health education has been mounting in recent years. The COVID-19 pandemic is a harbinger of the increasing complexities surrounding public health challenges and the overdue need to progress public health education around the world. This paper aims to explore strengths and challenges of public health educational institutions in India, and elucidate unique opportunities to emerge as a global leader in reform.

Methods
To capture the landscape of public health training in India, we initiated a web-based desk review of available offerings and categorized by key descriptors and program qualities. We then undertook a series of in-depth interviews with representatives from a purposively sample of institutions and performed a qualitative SWOT analysis.

Results
We found that public health education exists in many formats in India. Although Master of Public Health (MPH) and similar programs are still the most common type of public health training outside of community medicine programs, other postgraduate pathways exist including diplomas, PhDs, certificates and executive trainings. The strengths of public health education institutions include research capacities, financial accessibility, and innovation, yet there is a need to improve collaborations and harmonize training with well-defined career pathways. Growing attention to the sector, improved technologies and community engagement all hold exciting potential for public health education, while externally held misconceptions can threaten institutional efficacy and potential.

Conclusions
The timely need for and attention to public health education in India present a critical juncture for meaningful reform. India may also be well-situated to contextualize and scale the types of trainings needed to address complex challenges and serve as a model for other countries and the world.
The association between health workforce availability and HIV-program outcomes in Côte d’Ivoire
Authors: Akoku Derick Akompab , Tickell Kirkby D. , Niamien Kouadio R. , Kemper Kathryn E. , Yacouba Doumbia , Kouyate Seydou , Kouassi Daniel A. , Balachandra Shirish , Swor Meghan , Luxenberg Audrey Knutson , Gloyd Steve , Kone Ahoua 
Published: February 2022

AbstractObjectiveThe purpose of this study was to assess the distribution of HIV-program staff and the extent to which their availability influences HIV programmatic and patient outcomes.MethodsThe study was a facility level cross-sectional survey. Data from October 2018 to September 2019 were abstracted from HIV program reports conducted in 18 districts of Côte d’Ivoire. The distribution of staff in clinical, laboratory, pharmacy, management, lay, and support cadres were described across high and low antiretroviral therapy (ART) volume facilities. Non-parametric regression was used to estimate the effects of cadre categories on the number of new HIV cases identified, the number of cases initiated on ART, and the proportion of patients achieving viral load suppression.ResultsData from 49,871 patients treated at 216 health facilities were included. Low ART volume facilities had a median of 8.1 staff-per-100 ART patients, significantly higher than the 4.4 staff-per-100 ART patients at high-ART volume facilities. One additional laboratory staff member was associated with 4.30 (IQR: 2.00–7.48,p < 0.001) more HIV cases identified and 3.81 (interquartile range [IQR]: 1.44–6.94,p < 0.001) additional cases initiated on ART. Similarly, one additional lay worker was associated with 2.33 (IQR: 1.00–3.43,p < 0.001) new cases identified and 2.24 (IQR: 1.00–3.31,p < 0.001) new cases initiated on ART. No cadres were associated with viral suppression.ConclusionsHCWs in the laboratory and lay cadre categories were associated with an increase in HIV-positive case identification and initiation on ART. Our findings suggest that allocation of HCWs across health facilities should take into consideration the ART patient volume. Overall, increasing investment in health workforce is critical to achieve national HIV goals and reaching HIV epidemic control.
Understanding the factors affecting attrition and intention to leave of health extension workers: a mixed methods study in Ethiopia
Authors: Tekle Merhawi Gebremedhin , Wolde Habtamu Milkias , Medhin Girmay , Teklu Alula M. , Alemayehu Yibeltal Kiflie , Gebre Esie Gebrewahd , Bekele Frehiwot , Arora Nikita 
Published: February 2022

Abstract
Background
The Health Extension Program (HEP) is Ethiopia’s flagship community health program, launched in 2003. Health Extension Workers (HEWs) are key vehicles for the delivery of the HEP. While it is believed that there is high attrition among HEWs, the magnitude of or reasons for attrition is unknown. Their intention to leave their jobs in the next 5 years has also never been investigated on a national scale. This study aimed to assess the magnitude of, and factors affecting HEWs’ attrition and intention to leave in Ethiopia.

Methods
The study used mixed methods to address the research objectives. Using stratified random sampling and regions as strata, 85 districts from nine regions were randomly selected in Ethiopia. Within each study district, six kebeles (village clusters) were randomly selected, and all HEWs working in these kebeles were interviewed to capture their 5-year intention to leave. The study team developed a data-extraction tool for a rapid review of district-level documents covering the period June 30, 2004 through June 30, 2019 to gather their attrition figures. We used survival analysis to model attrition data and checked model goodness-of-fit using the Cox–Snell residual test. We additionally collected qualitative data from HEWs who had left their positions.

Results
The attrition of HEWS over the lifespan of the HEP was 21.1% (95% CI 17.5–25.3%), and the median time to exit from HEWs workforce was 5.8 years. The incidence rate was 3.1% [95% CI 2.8–3.4]. The risk of attrition was lower amongst HEWs with level four certifications, with children, and among those working in urban settings. By contrast, HEWs who were not certified with a certificate of competency (COC), who were deployed after 2008, and those who were diploma/degree holders were more likely to exit the HEWs workforce. The magnitude of intention to leave was 39.5% (95% CI 32.5–47%) and the primary reasons to leave were low incentives, dearth of career development opportunities (50.8%), high workload (24.2%), and other psychosocial factors (25%).

Conclusion
Although the magnitude of attrition is not worryingly high, we see high magnitude in HEWs’ intention to leave, indicating a dissatisfied workforce. Multiple factors have contributed to attrition and intention to leave, the prevalence of many of which can be reduced to fit the needs of this workforce and to retain them for the sustained delivery of primary healthcare in the country. Ensuring HEWs’ job satisfaction is important and linked with their career development and potentially higher rates of retention.
Future health spending forecast in leading emerging BRICS markets in 2030: health policy implications
Authors: Jakovljevic Mihajlo , Lamnisos Demetrios , Westerman Ronny , Chattu Vijay Kumar , Cerda Arcadio 
Published: February 2022

Abstract
Background
The leading emerging markets of Brazil, Russia, India, China and South Africa (BRICS) are increasingly shaping the landscape of the global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during the 2020s. The purpose of the current research was to examine the decades-long underlying historical trends in BRICS countries’ health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030.

Methods
BRICS’ health spending data spanning 1995–2017 were extracted from the Institute for Health Metrics and Evaluation (IHME) Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and gross domestic product (GDP) share of total health spending were forecasted for 2018–2030. Autoregressive integrated moving average (ARIMA) models were used to obtain future projections based on time series analysis.

Results
Per capita health spending in 2030 is projected to be as follows: Brazil, $1767 (95% prediction interval [PI] 1615, 1977); Russia, $1933 (95% PI 1549, 2317); India, $468 (95% PI 400.4, 535); China, $1707 (95% PI 1079, 2334); South Africa, $1379 (95% PI 755, 2004). Health spending as a percentage of GDP in 2030 is projected as follows: Brazil, 8.4% (95% PI 7.5, 9.4); Russia, 5.2% (95% PI 4.5, 5.9); India, 3.5% (95% PI 2.9%, 4.1%); China, 5.9% (95% PI 4.9, 7.0); South Africa, 10.4% (95% PI 5.5, 15.3).

Conclusions
All BRICS countries show a long-term trend towards increasing their per capita spending in terms of purchasing power parity (PPP). India and Russia are highly likely to maintain stable total health spending as a percentage of GDP until 2030. China, as a major driver of global economic growth, will be able to significantly expand its investment in the health sector across an array of indicators. Brazil is the only large nation whose health expenditure as a percentage of GDP is about to contract substantially during the third decade of the twenty-first century. The steepest curve of increased per capita spending until 2030 seems to be attributable to India, while Russia should achieve the highest values in absolute terms. Health policy implications of long-term trends in health spending indicate the need for health technology assessment dissemination among the BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources will remain a core challenge in 2030 as well.
Rapid research response to the COVID-19 pandemic: perspectives from a National Institute for Health Biomedical Research Centre
Authors: Henderson Lorna R. , McShane Helen , Kiparoglou Vasiliki 
Published: February 2022

AbstractWith over 5 million COVID-19 deaths at the time of writing, the response of research leaders was and is critical to developing treatments to control the global pandemic. As clinical research leaders urgently repurposed existing research programmes and resources towards the COVID-19 pandemic, there is an opportunity to reflect on practices observed in Biomedical Research Centre (BRC) settings. BRCs are partnerships between leading National Health Service organizations and universities in England conducting translational research for patient benefit funded by the National Institute for Health Research (NIHR). Oxford BRC-supported researchers have led the rapid set-up of numerous COVID-19 research studies at record speed with global impact. However, the specific contribution of BRCs to the COVID-19 pandemic in the literature is sparse. Firstly, we reflect on the strategic work of clinical research leaders, creating resilient NIHR research infrastructure to facilitate rapid COVID-19 research. Secondly, we discuss how COVID-19 rapid research exemplars supported by Oxford BRC illustrate “capacity”, “readiness” and “capability” at an organizational and individual level to respond to the global pandemic. Rapid response research in turbulent environments requires strategic organizational leadership to create resilient infrastructure and resources. The rapid research exemplars from the Oxford BRC illustrate capability and capacity at an organizational and individual level in a dynamic environment to respond during the COVID-19 public health challenge. This response was underpinned by swift adaptation and repurposing of existing research resources and expertise by the Oxford BRC to deliver rapid research to address different aspects of COVID-19.
Estimating district HIV prevalence in Zambia using small-area estimation methods (SAE)
Authors: Mweemba Chris , Hangoma Peter , Fwemba Isaac , Mutale Wilbroad , Masiye Felix 
Published: February 2022

Abstract
Background
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.

Methods
We estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.

Results
The results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.

Conclusions
HIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
CRISPR screening of E3 ubiquitin ligases reveals Ring Finger Protein 185 as a novel tumor suppressor in glioblastoma repressed by promoter hypermethylation and miR-587
Authors: Lin Kun , Shen Shang-Hang , Lu Feng , Zheng Pengfeng , Wu Shizhong , Liao Jingwei , Jiang Xiaohang , Zeng Guangming , Wei De 
Published: February 2022

AbstractGlioblastoma (GBM) is the most common and aggressive malignant primary brain tumor. E3 ligases play important functions in glioma pathogenesis. CRISPR system offers a powerful platform for genome manipulation, while the screen of E3 ligases in GBM still remains to be explored. Here, we first constructed an E3 ligase small guide RNA (sgRNAs) library for glioma cells growth screening. After four passages, 299 significantly enriched or lost genes (SELGs) were compared with the initial state. Then the clinical significance of SELGs were validated and analyzed with TCGA glioblastoma and CGGA datasets. As RNF185 showed lost signal, decreased expression and favorable prognostic significance, we chose RNF185 for functional analysis. In vitro overexpressed cellular phenotype showed that RNF185 was a tumor suppressor in two glioma cell lines. Finally, the molecular mechanism of decreased RNF185 expression was investigated and increased miR-587 expression and DNA hypermethylation was evaluated. This study would provide a link between the molecular basis and glioblastoma pathogenesis, and a novel perspective for glioblastoma treatment.
Influence of education on sexual and reproductive health service utilization for persons with disabilities in nationwide Bangladesh: an explanatory sequential mixed-methods study
Authors: Du Katherine Coral , Mohosin Arifa Bente , Amin Amina , Hasan Md Tanvir 
Published: February 2022

Abstract
Background
Persons with disabilities comprise more than one billion people in the world, yet they are one of the most discriminated groups and face significant health disparities. Particularly in developing countries, which contain 80% of the entire population with disabilities, these individuals experience major barriers in accessing sexual and reproductive health (SRH) services. Education is an important factor that greatly affects individuals’ SRH service utilization. Hence, we sought to investigate the relationship between education and SRH service utilization for persons with disabilities in Bangladesh.

Methods
Using an explanatory sequential mixed-methods design, a total of 5000 persons with disabilities were surveyed for the quantitative component and 15 mini-ethnographic case studies were conducted with persons with disabilities for the qualitative component. Chi-squared tests and logistic regression analyses were performed on the survey data, while the qualitative interviews were coded and their SRH themes synthesized accordingly.

Results
Our quantitative findings show that education statistically significantly increases persons with disabilities’ SRH service utilization of antenatal care, delivery care, postnatal care, and family planning (P < 0.05). Interestingly, for persons with disabilities, primary education shows increased adjusted odds of family planning use but is likely not enough to increase antenatal care, delivery care, or postnatal care use; secondary or post-secondary education may be required to improve utilization of these latter services. Qualitative findings support the association between higher education levels and greater SRH service use. Persons with disabilities of lower educational attainment held misinformation and distrust in SRH services and experienced mistreatment by SRH healthcare providers, discouraging them from seeking future SRH services.

Conclusions
We report that higher formal education level is associated with greater SRH service use for persons with disabilities in Bangladesh. Formally educating persons with disabilities expands their SRH knowledge and familiarity with SRH services, as well as leads to more economic opportunities so they can afford SRH services. Increasing formal education levels for persons with disabilities, paired with integrating comprehensive sexuality education (CSE) in their schools, will likely help close the gap in SRH health disparities for this vulnerable population.
Local perception of ecosystem services and their conservation in Sudanian savannas of Burkina Faso (West Africa)
Authors: Nabaloum Assétou , Goetze Dethardt , Ouédraogo Amadé , Porembski Stefan , Thiombiano Adjima 
Published: February 2022

Abstract
Context
In Burkina Faso, Sudanian savannas are important ecosystems for conservation of plant diversity. Due to desertification and insecurity, population migration from the North has increased human density and anthropogenic pressure on southern savannas. This study aims to investigate knowledge of local populations on ecosystem services (ES) and perception of their conservation.

Method
Individual semi-structured interviews about knowledge on ES and ecosystem conservation issues were conducted. Informants were selected according to sociocultural groups and sex in three areas of different land use intensity: the communal area of Dano (CAD), the Total Wildlife Reserve of Bontioli (TWRB) and the Game Ranch of Nazinga (GRN). The use value and vulnerability index of each plant species were determined. A cluster analysis and a principal component analysis were carried out to identify the particular knowledge of different ethnic groups.

Results
Overall, 163 plant species were cited for fifteen ES. Provisioning services were most frequently cited (100%), regulating services second most frequently (92.47%). Entire plants were exclusively used for ES with non-material benefits (protection against wind, for shading, soil fertility, erosion prevention, tourism and religion). The ten species contributing most to ES provision were Vitellaria paradoxa, Parkia biglobosa, Diospyros mespiliformis, Adansonia digitata, Lannea microcarpa, Faidherbia albida, Khaya senegalensis, Afzelia africana, Ficus sycomorus, Pterocarpus erinaceus. Seven of them were identified as highly vulnerable. Around GRN, migrants and natives shared the same knowledge, while migrants in TWRB used the ES only to a small extent due to restricted contact with the native population. Migrants and natives of GRN had more knowledge on tourism and crafts services while the natives of CAD and TWRB made use of the services that sustain the quality of the agricultural land and meet their primary needs. To reduce further degradation, different communities suggested unanimously raising awareness of the importance of biodiversity and ecosystem conservation. The most quoted motivations to preserve ecosystems were vegetation sustainability and village development.

Conclusion
This study documented important local knowledge-based information to guide cultivation of local multipurpose species and initiation of communities to practice best management strategies for sustainable conservation of biodiversity.
Preoperative spirometry and BMI in deep inspiration breath-hold radiotherapy: the early detection of cardiac and lung dose predictors without radiation exposure
Authors: Koide Yutaro , Shimizu Hidetoshi , Aoyama Takahiro , Kitagawa Tomoki , Miyauchi Risei , Watanabe Yui , Tachibana Hiroyuki , Kodaira Takeshi 
Published: February 2022

Abstract
Background
This study aimed to investigate preoperative spirometry and BMI as early predictors of the mean heart and lung dose (MHD, MLD) in deep inspiration breath-hold (DIBH) radiotherapy.

Methods
Left-sided breast cancer patients underwent breast-conserving surgery followed by DIBH radiotherapy enrolled. Patients who were not available for preoperative spirometry were excluded. One hundred eligible patients were performed free-breathing (FB-) CT and DIBH-CT for plan comparison. We completed the correlative and multivariate analysis to develop the linear regression models for dose prediction. The residuals were calculated to explore the unpreferable subgroups and compare the prediction accuracy.

Results
Among the parameters, vital capacity (VC) and BMI showed the strongest negative correlation with MHD (r = − 0.33) and MLD (r = − 0.34), respectively. They were also significant in multivariate analysis (P < 0.001). Elderly and less VC were independent predictors of increasing absolute residuals (AR). The VC model showed no significant difference in AR compared to the model using the CT parameter of lung volume in FB (LV-FB): median AR of the LV-FB model vs. the VC model was 0.12 vs. 0.11 Gy (P = 0.79). On the other hand, the median AR of the MLD model was 0.38 Gy, showing no specific subgroups of larger AR.

Conclusion
Preoperative spirometry and BMI are significant predictors of MHD and MLD, respectively. Although elderly and low-VC patients may have larger predictive variations, spirometry might be a substitute for LV-FB as a predictor of MHD.