bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of a questionnaire measuring preschool children's reactions to and coping with noise in a repeated measurement design
Authors: Persson Waye Kerstin , van Kamp Irene , Dellve Lotta
Published: June 2013

Objectives

The aim of the study was to explore and describe the reliability and validity of an instrument to measure preschool children's reactions to and coping with indoor noise at preschools or day care centres.

Design

Data were derived from an acoustical before and after intervention study providing repeated measurements.

Setting

The study was performed at seven preschools in Mölndal, Sweden.

Participants

Children were recruited from these preschools and the final sample comprised 61 and 59 preschool children aged 4–5 years, with a response rate of 98% and 48% girls and 52% boys. Two children were excluded from analysis because they fell outside the age range.

Primary and secondary outcome measures

The instrument was developed based on a qualitative study performed in Swedish preschools. Questions pertained to preschool children's perception of noise when at school, their bodily and emotional reactions to it, non-specific symptoms and the coping strategies used by them to diminish the detrimental effects of the noise.

Results

Confirmative factor analysis yielded a three-factor model fitted to 10 items pertaining to angry reactions, symptoms and coping. The model fit was moderate to good (standardised root mean square residual=0.08, 0.12; adjusted goodness of fit=0.97/0.91) in the before and after conditions, respectively. The  scales showed moderate to good reliability in terms of internal consistency, with an α ranging between 0.52 and 0.67, and was stronger in the before condition. Concurrent validity was strongest for symptoms by comparing groups based on bodily reaction (general and sound specific).

Conclusions

Young children's emotional and bodily reactions to coping with noise can be reliably measured with this instrument. Like adults and older children, young children are able to distinguish between emotional reactions, bodily reactions, coping and unwell-being. Future research on larger groups of preschool children is needed to further refine the questions, in particular the questions pertaining to well-being.
Serum perfluoroalkyl acids concentrations and memory impairment in a large cross-sectional study
Authors: Gallo Valentina , Leonardi Giovanni , Brayne Carol , Armstrong Ben , Fletcher Tony
Published: June 2013

Objectives

To examine the cross-sectional association between serum perfluorooctanate (PFOA), perfuorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA) and perfluorohexane sulfonate (PFHxS) concentrations with self-reported memory impairment in adults and the interaction of these associations with diabetes status.

Design

Cross-sectional study.

Setting

Population-based in Mid-Ohio Valley, West Virginia following contamination by a chemical plant.

Participants

The C8 Health Project collected data and measured the serum level of perfluoroalkyl acids (PFAAs) of 21 024 adults aged 50+ years.

Primary outcome measure

Self-reported memory impairment as defined by the question ‘have experienced short-term memory loss?’

Results

A total of 4057 participants self-reported short-term memory impairment. Inverse associations between PFOS and PFOA and memory impairment were highly statistically significant with fully adjusted OR=0.93 (95% CI 0.90 to 0.96) for doubling PFOS and OR=0.96 (95% CI 0.94 to 0.98) for doubling PFOA concentrations. Comparable inverse associations with PFNA and PFHxS were of borderline statistical significance. Inverse associations of PFAAs with memory impairment were weaker or non-existent in patients with diabetes than overall in patients without diabetes.

Conclusions

An inverse association between PFAA serum levels and self-reported memory impairment has been observed in this large population-based, cross-sectional study that is stronger and more statistically significant for PFOA and PFOS. The associations can be potentially explained by a preventive anti-inflammatory effect exerted by a peroxisome proliferator-activated receptor agonist effect of these PFAAs, but confounding or even reverse causation cannot be excluded as an alternative explanation.
Vitamin C may alleviate exercise-induced bronchoconstriction: a meta-analysis
Authors: Hemilä Harri
Published: June 2013

Objective

To determine whether vitamin C administration influences exercise-induced bronchoconstriction (EIB).

Design

Systematic review and meta-analysis.

Methods

MEDLINE and Scopus were searched for placebo-controlled trials on vitamin C and EIB. The primary measures of vitamin C effect used in this study were: (1) the arithmetic difference and (2) the relative effect in the postexercise forced expiratory volume in 1 s (FEV1) decline between the vitamin C and placebo periods. The relative effect of vitamin C administration on FEV1was analysed by using linear modelling for two studies that reported full or partial individual-level data. The arithmetic differences and the relative effects were pooled by the inverse variance method. A secondary measure of the vitamin C effect was the difference in the proportion of participants suffering from EIB on the vitamin C and placebo days.

Results

3 placebo-controlled trials that studied the effect of vitamin C on EIB were identified. In all, they had 40 participants. The pooled effect estimate indicated a reduction of 8.4 percentage points (95% CI 4.6 to 12) in the postexercise FEV1decline when vitamin C was administered before exercise. The pooled relative effect estimate indicated a 48% reduction (95% CI 33% to 64%) in the postexercise FEV1decline when vitamin C was administered before exercise. One study needed imputations to include it in the meta-analyses, but it also reported that vitamin C decreased the proportion of participants who suffered from EIB by 50 percentage points (95% CI 23 to 68); this comparison did not need data imputations.

Conclusions

Given the safety and low cost of vitamin C, and the positive findings for vitamin C administration in the three EIB studies, it seems reasonable for physically active people to test vitamin C when they have respiratory symptoms such as cough associated with exercise. Further research on the effects of vitamin C on EIB is warranted.
Primary healthcare costs associated with sleep problems up to age 7 years: Australian population-based study
Authors: Quach J , Gold L , Hiscock H , Mensah F K , Lucas N , Nicholson J M , Wake M
Published: June 2013

Objectives

In Australian 0–7-year olds with and without sleep problems, to compare (1) type and costs to government of non-hospital healthcare services and prescription medication in each year of age and (2) the cumulative costs according to persistence of the sleep problem.

Design

Cross-sectional and longitudinal data from a longitudinal population study.

Setting

Data from two cohorts participating in the first two waves of the nationally representative Longitudinal Study of Australian Children.

Participants

Baby cohort at ages 0–1 and 2–3 (n=5107, 4606) and Kindergarten cohort at ages 4–5 and 6–7 (n=4983, 4460).

Measurements

Federal Government expenditure on healthcare attendances and prescription medication from birth to 8 years, calculated via linkage to Australian Medicare data, were compared according to parent report of child sleep problems at each of the surveys.

Results

At both waves and in both cohorts, over 92% of children had both sleep and Medicare data. The average additional healthcare costs for children with sleep problems ranged from $141 (age 5) to $43 (age 7), falling to $98 (age 5) to $18 (age 7) per child per annum once family socioeconomic position, child gender, global health and special healthcare needs were taken into account. This equates to an estimated additional $27.5 million (95% CI $9.2 to $46.8 million) cost to the Australian federal government every year for all children aged between 0 and 7 years. In both cohorts, costs were higher for persistent than transient sleep problems.

Conclusions

Higher healthcare costs were sustained by infants and children with sleep problems. This supports ongoing economic evaluations of early prevention and intervention services for sleep problems considering impacts not only on the child and family but also on the healthcare system.
Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model
Authors: Emina Jacques B O , Madise Nyovani , Kuepie Mathias , Zulu Eliya M , Ye Yazoume
Published: June 2013

Objectives

To identify HIV-socioeconomic predictors as well as the most-at-risk groups of women in Malawi.

Design

A cross-sectional survey.

Setting

Malawi

Participants

The study used a sample of 6395 women aged 15–49 years from the 2010 Malawi Health and Demographic Surveys.

Interventions

N/A

Primary and secondary outcome measures

Individual HIV status: positive or not.

Results

Findings from the Pearson χ2and χ2Automatic Interaction Detector analyses revealed that marital status is the most significant predictor of HIV. Women who are no longer in union and living in the highest wealth quintiles households constitute the most-at-risk group, whereas the less-at-risk group includes young women (15–24) never married or in union and living in rural areas.

Conclusions

In the light of these findings, this study recommends: (1) that the design and implementation of targeted interventions should consider the magnitude of HIV prevalence and demographic size of most-at-risk groups. Preventive interventions should prioritise couples and never married people aged 25–49 years and living in rural areas because this group accounts for 49% of the study population and 40% of women living with HIV in Malawi; (2) with reference to treatment and care, higher priority must be given to promoting HIV test, monitoring and evaluation of equity in access to treatment among women in union disruption and never married or women in union aged 30–49 years and living in urban areas; (3) community health workers, households-based campaign, reproductive-health services and reproductive-health courses at school could be used as canons to achieve universal prevention strategy, testing, counselling and treatment.
Suicide risk in relation to air pollen counts: a study based on data from Danish registers
Authors: Qin Ping , Waltoft Berit L , Mortensen Preben B , Postolache Teodor T
Published: June 2013

Objectives

Since the well-observed spring peak of suicide incidents coincides with the peak of seasonal aeroallergens as tree-pollen, we want to document an association between suicide and pollen exposure with empirical data from Denmark.

Design

Ecological time series study.

Setting

Data on suicide incidents, air pollen counts and meteorological status were retrieved from Danish registries.

Participants

13 700 suicide incidents over 1304 consecutive weeks were obtained from two large areas covering 2.86 million residents.

Primary and secondary outcome measures

Risk of suicide associated with pollen concentration was assessed using a time series Poisson-generalised additive model.

Results

We noted a significant association between suicide risk and air pollen counts. A change of pollen counts levels from 0 to ‘10–<30’ grains/m3air was associated with a relative risk of 1.064, that is, a 6.4% increase in weekly number of suicides in the population, and from 0 to ‘30–100’ grains, a relative risk of 1.132. The observed association remained significant after controlling for effects of region, calendar time, temperature, cloud cover and humidity. Meanwhile, we observed a significant sex difference that suicide risk in men started to rise when there was a small increase of air pollen, while the risk in women started to rise until pollen grains reached a certain level. High levels of pollen had slightly stronger effect on risk of suicide in individuals with mood disorder than those without the disorder.

Conclusions

The observed association between suicide risk and air pollen counts supports the hypothesis that aeroallergens, acting as immune triggers, may precipitate suicide.
Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008
Authors: Molina Honey Faith , Nakamura Keiko , Kizuki Masashi , Seino Kaoruko
Published: June 2013

Objective

To assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines.

Design

An analysis of four population-based data sets that were conducted between 1993 and 2008.

Setting

Philippines.

Participants

Women aged 15–49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209).

Outcomes

At least four visits of antenatal care, skilled birth attendance and delivery in a medical facility.

Results

The adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility.

Conclusions

Over a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.
Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study
Authors: Hjermstad Marianne Jensen , Kolflaath Jan , Løkken Aud O , Hanssen Sjur B , Normann Are P , Aass Nina
Published: June 2013

Objectives

Patients with advanced cancer are often admitted to hospital as emergency cases. This may not always be medically indicated. Study objectives were to register the reasons for the emergency admissions, to examine interventions performed during hospitalisation and self-reported symptom intensity at admission and discharge, and to assess patients’ opinions about the admission.

Design

This was a descriptive before-and-after study. Participating patients completed the Edmonton Symptom Assessment System (ESAS) twice, upon hospital admission and prior to discharge. All patients underwent a structured interview assessing their opinion about the emergency admission. Medical data were obtained from the hospital records.

Setting

The study was performed in two Norwegian acute care secondary hospitals with urban catchment areas.

Participants

44 patients with cancer (men 27 and women 17; mean age 69.2, SD 9.2) representing 50 emergency admissions were included.

Results

Median length of stay was 7 days (95% CI 7.4 to 11.4). Median survival was 50 days (95% CI 51 to 115). 90% were admitted from home, and 46% had been hospitalised less than 1 month earlier. Lung and gastrointestinal symptoms and pain were the most frequent reasons for admissions. Mean pain scores on ESAS were reduced by 50% from admission to discharge (p<0.01). Simple interventions such as hydration, bladder catheterisation and oxygen therapy were most frequent. Nearly one-third would have preferred treatment at another site, provided that the quality of care was similar. Home visits by the family doctor and specialised care teams were perceived by patients as important to prevent hospitalisation.

Conclusions

In most emergency admissions, relatively simple medical interventions are necessary. Specialised care teams with palliative care physicians, easier access to the family doctor and better lines of cooperation between hospitals and the primary care sector may make it possible to perform more of these procedures at home, thereby reducing the need for emergency admissions.
Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial
Authors: Lequin Michiel B , Verbaan Dagmar , Jacobs Wilco C H , Brand Ronald , Bouma Gerrit J , Vandertop William P , Peul Wilco C
Published: June 2013

Objective

This study describes the 5 years’ results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery.

Design

A randomised controlled trial.

Setting

Nine Dutch hospitals.

Participants

Five years’ follow-up data from 231 of 283 patients (82%) were collected.

Intervention

Early surgery or an intended 6 months of conservative treatment.

Main outcome measures

Scores from Roland disability questionnaire, visual analogue scale (VAS) for leg and back pain and a Likert self-rating scale of global perceived recovery were analysed.

Results

There were no significant differences between groups on the 5 years’ primary outcome scores. Despite at least 6 months of conservative treatment 46% of the conservatively allocated patients were treated surgically because of severe leg pain and disability. Forty-nine (21%) patients had an unsatisfactory recovery at 5 years and the recovery pattern showed that there was a variable group of 66 patients (31%) with at least one unsatisfactory outcome at 1, 2 or 5 years of follow-up. Multivariate logistic regression showed that age (>40; OR 2.42 (95% CI 1.16 to 5.02)), severity of leg pain (VAS >70; OR 3.32 (95% CI 1.69 to 6.54)) and the Mc Gill affective score (score >3; OR 6.23 (95% CI 2.23 to 17.38)) were the only significant predictors for an unsatisfactory outcome at 5 years.

Conclusions

In the long term, 8% of the patients with sciatica never showed any recovery and in at least 23%, sciatica appears to result in ongoing complaints, which fluctuate over time, irrespective of treatment. Prolonged conservative care might give patients a fair chance for pain and disability to resolve without surgery, but with the risk to receive delayed surgery after prolonged suffering of sciatica. Age above 40 years, severe leg pain at baseline and a higher affective Mc Gill pain score were predictors for unsatisfactory recovery. Trial Registry ISRCT No 26872154.
Asthma mortality in Australia in the 21st century: a case series analysis
Authors: Goeman Dianne P , Abramson Michael J , McCarthy Edwina A , Zubrinich Celia M , Douglass Jo A
Published: June 2013

Objective

As previous asthma mortality studies were undertaken between 1986 and 1997, and treatments have evolved since that time, in order to direct future asthma interventions, we investigated the reasons for asthma deaths between 2005 and 2009.

Design

We undertook a case series analysis by searching the National Coroners’ Information System using the most recent International Classification of Diseases-10 codes J45 and J46 and the keyword ‘asthma’ as the underlying cause of death.

Setting

Records for 283 cases aged 70 years and under were retrieved from each Australian state and territory. Coroner's findings, autopsy, toxicology and police reports were reviewed to determine: if the team agreed the death was due to asthma and whether the death was preventable or modifiable factors existed? Owing to the likelihood of comorbidities or alternative diagnoses contributing to deaths in those over 70 years of age, this group was excluded.

Results

Examination of available data in those aged under 70 years identified risk factors associated with asthma death. These included physical barriers (rural and remote location, institutionalised care), psychosocial issues (social disengagement, mental illness, living alone, being unemployed), smoking, drug and alcohol dependence, allergies, respiratory tract infections, inadequate treatment and delay in seeking help.

Conclusions

Our study provides a current assessment of death from asthma across Australia. Further reductions in the rate of asthma deaths will require interventions targeted at the personal, practice and policy levels. Asthma-related health literacy needs to be improved especially among those with episodic asthma. Reforms are also needed to address inequity in healthcare delivery to ‘reach the unreached’. Our study points to the dangers associated with smoking, drug and alcohol use and the consequences of delay in seeking care among those with asthma.
MRI and cerebrospinal fluid biomarkers for predicting progression to Alzheimer's disease in patients with mild cognitive impairment: a diagnostic accuracy study
Authors: Richard Edo , Schmand Ben A , Eikelenboom Piet , Van Gool Willem A
Published: June 2013

Objectives

To assess the incremental value of MRI and cerebrospinal fluid (CSF) analysis after a short memory test for predicting progression to Alzheimer's disease from a pragmatic clinical perspective.

Design

Diagnostic accuracy study in a multicentre prospective cohort study.

Setting

Alzheimer Disease Neuroimaging Initiative participants with complete data on neuropsychological assessment, MRI of the brain and CSF analysis.

Participants

Patients with mild cognitive impairment (MCI; n=181) were included. Mean follow-up was 38.9 months (range 5.5–75.9).

Main outcome measures

Diagnostic accuracy of individual instruments and incremental value of entorhinal cortex volume on MRI and p-τ/Aβ ration in CSFafteradministration of Rey's Auditory Verbal Learning Memory Test are calculated and expressed as the ‘Net Reclassification Improvement’ (NRI), which is the change in the percentage of individuals that are correctly diagnosed as Alzheimer or non-Alzheimer case.

Results

Tested in isolation, a short memory test, MRI and CSF all substantially contribute to the differentiation of those MCI patients who remain stable during follow-up from those who progress to develop Alzheimer's disease. The memory test, MRI and CSF improved the diagnostic classification by 21% (95% CI 15.1 to 26.9), 22.1% (95% CI 16.1 to 28.1) and 18.8% (95% CI 13.1 to 24.5), respectively.Afteradministration of a short memory test, however, the NRI of MRI is +1.1% (95% CI 0.1 to 3.9) and of CSF is −2.2% (95% CI −5.6 to −0.6).

Conclusions

After administration of a brief test of memory, MRI or CSF do not substantially affect diagnostic accuracy for predicting progression to Alzheimer's disease in patients with MCI. The NRI is an intuitive and easy to interpret measure for evaluation of potential added value of new diagnostic instruments in daily clinical practice.
An enhanced exercise and cognitive programme does not appear to reduce incident delirium in hospitalised patients: a randomised controlled trial
Authors: Jeffs Kimberley J , Berlowitz David J , Grant Shane , Lawlor Vicki , Graco Marnie , de Morton Natalie A , Savige Judith A , Lim Wen K
Published: June 2013

Objective

To determine if a programme of progressive resistance exercise, mobilisation and orientation, in addition to usual care, was superior to usual care alone in the prevention of incident delirium in older hospitalised patients.

Design

A randomised controlled trial.

Setting

The study was performed at a secondary referral hospital in Melbourne, Australia between May 2005 and December 2007.

Participants

648 consecutive medical inpatients aged 65 years or older who had been in hospital for less than 48 h and who did not have delirium.

Intervention

Participants were randomly allocated to a twice-daily programme of progressive resistance exercise tailored to individual ability, mobilisation and orientation in addition to usual care or to usual care alone.

Measurements

Delirium was measured using the Confusion Assessment Method at baseline and every 48 h until discharge. Secondary outcome measures were severity and duration of delirium, discharge destination and length of stay.

Results

Delirium occurred in 4.9% (95% CI 2.3% to 7.3%) of the intervention group (15/305) and in 5.9% (20/339; 95% CI 3.8% to 9.2%) of the group receiving usual care. No difference was observed between groups (χ2; p=0.5). The intervention had no effect on delirium duration, severity, discharge destination or length of stay.

Conclusion

A programme of progressive resistance exercise and orientation was not effective in reducing incident delirium in hospitalised elderly patients.
Cost of illness of patient-reported adverse drug events: a population-based cross-sectional survey
Authors: Gyllensten Hanna , Rehnberg Clas , Jönsson Anna K , Petzold Max , Carlsten Anders , Andersson Sundell Karolina
Published: June 2013

Objectives

To estimate the cost of illness (COI) of individuals with self-reported adverse drug events (ADEs) from a societal perspective and to compare these estimates with the COI for individuals without ADE. Furthermore, to estimate the direct costs resulting from two ADE categories, adverse drug reactions (ADRs) and subtherapeutic effects of medication therapy (STE).

Design

Cross-sectional study.

Setting

The adult Swedish general population.

Participants

The survey was distributed to a random sample of 14 000 Swedish residents aged 18 years and older, of which 7099 responded, 1377 reported at least one ADE and 943 reported an ADR or STE.

Main outcome measures

Societal COI, including direct and indirect costs, for individuals with at least one self-reported ADE, and the direct costs for prescription drugs and healthcare use resulting from self-reported ADRs and STEs were estimated during 30 days using a bottom-up approach.

Results

The economic burden for individuals with ADEs were (95% CI) 442.7 to 599.8 international dollars (Int$), of which direct costs were Int$ 279.6 to 420.0 (67.1%) and indirect costs were Int$ 143.0 to 199.8 (32.9%). The average COI was higher among those reporting ADEs compared with other respondents (COI: Int$ 442.7 to 599.8 versus Int$ 185.8 to 231.2). The COI of respondents reporting at least one ADR or STE was Int$ 468.9 to 652.9. Direct costs resulting from ADRs or STEs were Int$ 15.0 to 48.4. The reported resource use occurred both in hospitals and outside in primary care.

Conclusions

Self-reported ADRs and STEs cause resource use both in hospitals and in primary care. Moreover, ADEs seem to be associated with high overall COI from a societal perspective when comparing respondents with and without ADEs. There is a need to further examine this relationship and to study the indirect costs resulting from ADEs.
Doctors’ willingness to give honest answers about end-of-life practices: a cross-sectional study
Authors: Merry Alan F , Moharib Magdi , Devcich Daniel A , Webster M Louise , Ives Jonathan , Draper Heather
Published: June 2013

Objectives

We aimed to (1) evaluate the extent to which doctors in New Zealand would be willing to answer honestly questions about their care of patients at the end of their lives and (2) identify the assurances that would encourage this. Results were compared with findings from a previous pilot study from the UK.

Design

Survey study involving a mailed questionnaire.

Setting

New Zealand hospital and community-based medical care settings.

Participants

The questionnaire was mailed to a random sample of 800 doctors in New Zealand who were vocationally registered with the Medical Council of New Zealand in disciplines involving caring for patients at the end of their lives.

Primary and secondary outcome measures

Willingness to provide honest answers about various aspects of end-of-life care; assurances that might increase willingness to provide honest answers to questions about end-of-life practices.

Results

Completed questionnaires were returned by 436 doctors. The majority of respondents (59.9–91.5%) indicated willingness to provide honest answers to such questions. However, more than a third of doctors were unwilling to give honest answers to certain questions regarding euthanasia. These results are comparable with the UK data. Complete anonymity was the assurance most likely to encourage honest answering, with most of the respondents preferring the use of anonymous written replies. Respondents were less reassured by survey endorsements from regulatory bodies. Themes in free comments included the deterrent effect of medicolegal consequences, fear of censure from society, peers and the media and concerns about the motivations and potential uses of such research.

Conclusions

Many New Zealand doctors were willing to give honest answers to questions about end-of-life practices, particularly if anonymity was guaranteed; others, however, expressed doubts or indicated that they would not be willing to provide honest answers to questions of this sort.
A nationwide Danish cohort study challenging the categorisation into right-sided and left-sided colon cancer
Authors: Jess Per , Hansen Iben Onsberg , Gamborg Michael , Jess Tine
Published: June 2013

Objectives

The categorisation of colon cancer (CC) into right-sided (RCC) and left-sided (LCC) disease may not capture more subtle variances in aetiology and prognosis. In a nationwide study, we investigated differences in clinical characteristics and survival of RCC versus LCC and of the complete range of CC subsites.

Design

Prospective nationwide cohort study.

Setting

The database of the Danish Colorectal Cancer Group (DCCG).

Participants

23 487 CC patients.

Outcome measures

Overall survival (Kaplan-Meier plots) and mortality (HR from Cox proportional hazards regression analysis) according to CC localisation. For adjustment and stratification, we used age, sex, ASA score (the American Society of Anaesthesiologists score), tumour location and stage, number of lymph nodes harvested at operation, number of lymph nodes with metastases and presence of distant metastases.

Results

Patients with RCC had a higher median age at diagnosis (74.3 years) than patients with LCC (71.8 years; p<0.0001). Overall, the proportion of patients who were women increased the closer the tumour site was to the small intestine. Although RCC patients had higher ASA scores than LCC patients (p<0.0001), the highest ASA scores were observed in patients with cancer in the transverse and descending colon and at both colon flexures. While RCCs overall were more advanced than LCCs (p<0.0001), the most advanced CCs were those of the descending colon, splenic flexure and caecum. RCC mortality was higher than LCC mortality only during the first 2 years (women: HR 1.13; 95% CI 1.06 to 1.20; men: HR 1.27; 95% CI 1.20 to 1.35), and relative to mortality from sigmoid CC, the highest mortality was observed from splenic flexure cancer (HR 1.75; 95% CI 1.54 to 2.00).

Conclusions

The present data challenge the simple categorisation of CC into RCC and LCC.
Exercise referral for drug users aged 40 and over: results of a pilot study in the UK
Authors: Beynon Caryl M , Luxton Amy , Whitaker Rhiannon , Cable N Tim , Frith Lucy , Taylor Adrian H , Zou Lu , Angell Peter , Robinson Scott , Holland Dave , Holland Sharon , Gabbay Mark
Published: June 2013

Objectives

To test whether older drug users (aged 40 and over) could be recruited to an exercise referral (ER) scheme, to evaluate the feasibility and acceptability and measure the impact of participation on health.

Design

Observational pilot.

Setting

Liverpool, UK.

Participants

(1) 12 men and 5 women recruited to ER. (2) 7 specialist gym instructors.

Outcome measures

Logistic feasibility and acceptability of ER and associated research, rate of recruitment, level of participation over 8 weeks and changes in health.

Results

22 gym inductions were arranged (recruitment time: 5 weeks), 17 inductions were completed and 14 participants began exercising. Attendance at the gym fluctuated with people missing weeks then re-engaging; in week 8, seven participants were in contact with the project and five of these attended the gym. Illness and caring responsibilities affected participation. Participants and gym instructors found the intervention and associated research processes acceptable. In general, participants enjoyed exercising and felt fitter, but would have welcomed more support and the offer of a wider range of activities. Non-significant reductions in blood pressure and heart rate and improvements in metabolic equivalents (METs; a measure of fitness) and general well-being were observed for eight participants who completed baseline and follow-up assessments. The number of weeks of gym attendance was significantly associated with a positive change in METs.

Conclusions

It is feasible to recruit older drug users into a gym-based ER scheme, but multiple health and social challenges affect their ability to participate regularly. The observed changes in health measures, particularly the association between improvements in METs and attendance, suggest further investigation of ER for older drug users is worthwhile. Measures to improve the intervention and its evaluation include: better screening, refined inclusion/exclusion criteria, broader monitoring of physical activity levels, closer tailored support, more flexible exercise options and the use of incentives.
A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women’s Health CoOp
Authors: Wechsberg Wendee M , Jewkes Rachel , Novak Scott P , Kline Tracy , Myers Bronwyn , Browne Felicia A , Carney Tara , Morgan Lopez Antonio A , Parry Charles
Published: June 2013

Objective

To assess the impact of the Women's Health CoOp (WHC) on drug abstinence among vulnerable women having HIV counselling and testing (HCT).

Design

Randomised trial conducted with multiple follow-ups.

Setting

15 communities in Cape Town, South Africa.

Participants

720 drug-using women aged 18–33, randomised to an intervention (360) or one of two control arms (181 and 179) with 91.9% retained at follow-up.

Interventions

The WHC brief peer-facilitated intervention consisted of four modules (two sessions), 2 h addressing knowledge and skills to reduce drug use, sex risk and violence; and included role-playing and rehearsal, an equal attention nutrition intervention, and an HCT-only control.

Primary outcome measures

Biologically confirmed drug abstinence measured at 12-month follow-up, sober at last sex act, condom use with main and casual sex partners, and intimate partner violence.

Results

At the 12-month endpoint, 26.9% (n=83/309) of the women in the WHC arm were abstinent from drugs, compared with 16.9% (n=27/160) in the Nutrition arm and 20% (n=31/155) in the HCT-only control arm. In the random effects model, this translated to an effect size on the log odds scale with an OR of 1.54 (95% CI 1.07 to 2.22) comparing the WHC arm with the combined control arms. Other 12-month comparison measures between arms were non-significant for sex risk and victimisation outcomes. At 6-month follow-up, women in the WHC arm (65.9%, 197/299) were more likely to be sober at the last sex act (OR1.32 (95% CI 1.02 to 1.84)) than women in the Nutrition arm (54.3%, n=82/152).

Conclusions

This is the first trial among drug-using women in South Africa showing that a brief intervention added to HCT results in greater abstinence from drug use at 12 months and a larger percentage of sexual activity not under the influence of substances.

Trial registration number

NCT00729391 ClinicalTrials.gov
Contributions of body mass index and exercise habits on inflammatory markers: a cohort study of middle-aged adults living in the USA
Authors: Strohacker Kelley , Wing Rena R , McCaffery Jeanne M
Published: June 2013

Objectives

Determine whether body mass index (BMI) and physical activity (PA) above, at or below MET minute per week (MMW) levels recommended in the 2008 Physical Activity Guidelines interact or have additive effects on interleukin (IL)-6, C reactive protein (CRP), fibrinogen, interleukin6 (IL-6) soluble receptor (IL-6sr), soluble E-selectin and soluble intracellular adhesion molecule (sICAM)-1.

Design

Archived cohort data (n=1254, age 54.5±11.7 year, BMI 29.8±6.6 kg/m2) from the National Survey of Midlife Development in the USA (MIDUS) Biomarkers Study were analysed for concentrations of inflammatory markers using general linear models. MMW was defined as no regular exercise, <500 MMW, 500–1000 MMW, >1000 MMW and BMI was defined as <25, 25–29.9, ≥30 kg/m2. Analyses were adjusted for age, sex, smoking and relevant medication use.

Setting

Respondents reported to three centres to complete questionnaires and provide blood samples.

Participants

Participants were men and women currently enroled in the MIDUS Biomarker Project (n=1254, 93% non-Hispanic white, average age 54.5 years).

Primary outcome measures

Concentration of serum IL-6, CRP, fibrinogen, IL-6sr, sE-selectin and sICAM.

Results

Significant interactions were found between BMI and MMW for CRP and sICAM-1 (p<0.05). CRP in overweight individuals was similar to that in obese individuals when no PA was reported, but it was similar to normal weight when any level of regular PA was reported. sICAM-1 was differentially lower in obese individuals who reported >1000 MMW compared to obese individuals reporting less exercise.

Conclusions

The association of exercise with CRP and sICAM-1 differed by BMI, suggesting that regular exercise may buffer weight-associated elevations in CRP in overweight individuals while higher levels of exercise may be necessary to reduce sICAM-1 or CRP in obese individuals.
Risk factors for hand injury in hurling: a cross-sectional study
Authors: Falvey Éanna , McCrory Paul , Crowley Brendan , Kelleher Aiden , Eustace Joseph , Shanahan Fergus , Molloy Michael G
Published: June 2013

Objectives

Hurling is Ireland's national sport, played with a stick and ball; injury to the hand is common. A decrease in the proportion of head injury among emergency department (ED) presentations for hurling-related injury has coincided with voluntary use of helmet and face protection since 2003. A similar decrease in proportions has not occurred in hand injury. We aim to quantify hurling-related ED presentations and examine variables associated with injury. In particular, we were interested in comparing the occurrence of hand injury in those using head and face protection versus those who did not.

Design

This study utilised a retrospective cross-sectional study design.

Setting

This study took place at a university hospital ED over a 3-month period.

Outcome measures

A follow-up telephone interview was performed with 163 players aged ≥16 years to reflect voluntary versus obligatory helmet use.

Results

The hand was most often injured (n=85, 52.1%). Hand injury most commonly occurred from a blow of a hurley (n=104, 65%), and fracture was confirmed in 62% of cases. Two-thirds of players (66.3%) had multiple previous (1–5) hand injuries. Most patients 149 (91.4%) had tried commercially available hand protection, but only 4.9% used hand protection regularly. Univariate analysis showed a statistically significant association between wearing a helmet and faceguard and hand injury; OR 2.76 (95% CI 1.42 to 5.37) p=0.003. On further analysis adjusting simultaneously for age, prior injury, foul play and being struck by a hurley, this relationship remained significant (OR 3.15 95% CI 1.51 to 6.56, p=0.002).

Conclusions

We report that hurling-related hand injury is common. We noted the low uptake of hand protection. We found that hand injury was significantly associated with the use of helmet and faceguard protection, independent of the other factors studied. Further studies are warranted to develop strategies to minimise the occurrence of this injury.
Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study
Authors: Eritsyan Ksenia , Heimer Robert , Barbour Russell , Odinokova Veronika , White Edward , Rusakova Maia M , Smolskaya Tatiana T , Levina Olga S
Published: June 2013

Objectives

To ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities.

Design

Cross-sectional survey with serological testing for HIV and hepatitis C virus prevalent infections.

Setting

8 Russian cities—Irkutsk, Omsk, Chelyabinsk, Yekaterinburg, Naberezhnye Chelny, Voronezh, Orel and St Petersburg.

Participants

In 2007–2009 active IDUs were recruited by respondent-driven sampling with a target sample size of 300 or more in each city.

Main outcome measures

Participants were administered a questionnaire covering sociodemographics, injection risk and protective behaviours, sexual behaviours, HIV knowledge, experiences with drug treatment and harm reduction programmes and social networks. Participants were tested for HIV and hepatitis C by enzyme immunoassay. Data were analysed to identify individual-level, network-level and city-level characteristics significantly associated with HIV prevalence. Factors significant at p≤0.1 were entered into a hierarchical regression model to control for multicollinearity.

Results

A total of 2596 active IDUs were recruited, interviewed and tested for HIV and hepatitis C virus infection. HIV prevalence ranged from 3% (in Voronezh) to 64% (in Yekaterinburg). Although individual-level and network-level variables explain some of the difference in prevalence across the eight cities, the over-riding variable that seems to account for most of the variance is the emergence of commercial, as opposed to homemade, heroin as the predominant form of opioid injected.

Conclusions

The expansion of commercial heroin markets to many Russian cities may have served as a trigger for an expanding HIV epidemic among IDUs in that country.
The incidence of eating disorders in the UK in 2000–2009: findings from the General Practice Research Database
Authors: Micali Nadia , Hagberg Katrina W , Petersen Irene , Treasure Janet L
Published: June 2013

Objectives

Few studies have investigated the incidence of eating disorders (EDs). Important questions about changes in the incidence of diagnosed disorders in recent years, disorder and gender-specific onset and case detection remain unanswered. Understanding changes in incidence is important for public health, clinical practice and service provision. The aim of this study was to estimate the annual (age-specific, gender-specific and subtype-specific) incidence of diagnosed ED: anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) in primary care over a 10-year period in the UK (2000–2009); to examine the changes within the study period; and to describe peak age at diagnosis.

Design

Register-based study.

Setting

Primary care. Data were obtained from a primary care register, the General Practice Research Database, which contains anonymised records representing about 5% of the UK population.

Participants

All patients with a first-time diagnosis of AN, BN and EDNOS were identified.

Primary outcome

Annual crude and age-standardised incidence rates were calculated.

Results

A total of 9072 patients with a first-time diagnosis of an ED were identified. The age-standardised annual incidence rate of all diagnosed ED for ages 10–49 increased from 32.3 (95% CI 31.7 to 32.9) to 37.2 (95% CI 36.6 to 37.9) per 100 000 between 2000 and 2009. The incidence of AN and BN was stable; however, the incidence of EDNOS increased. The incidence of the diagnosed ED was highest for girls aged 15–19 and for boys aged 10–14.

Conclusions

The age-standardised incidence of ED increased in primary care between 2000 and 2009. New diagnoses of EDNOS increased, and EDNOS is the most common ED in primary care.
Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey
Authors: Lord Karen , Ibrahim Kausher , Kumar Sawan , Mitchell Alex J , Rudd Nicky , Symonds R Paul
Published: June 2013

Objectives

This cross-sectional survey investigated whether there were ethnic differences in depressive symptoms among British South Asian (BSA) patients with cancer compared with British White (BW) patients during 9 months following presentation at a UK Cancer Centre. We examined associations between depressed mood, coping strategies and the burden of symptoms.

Design

Questionnaires were administered to 94 BSA and 185 BW recently diagnosed patients with cancer at baseline and at 3 and 9 months. In total, 53.8% of the BSA samples were born in the Indian subcontinent, 33% in Africa and 12.9% in the UK. Three screening tools for depression were used to counter concerns about ethnic bias and validity in linguistic translation. The Hospital Anxiety and Depression Scale (HADS-D), Patient Health Questionnaire-9 (both validated in Gujarati), Emotion Thermometers (including the Distress Thermometer (DT), Mini-MAC and the newly developed Cancer Insight and Denial questionnaire (CIDQ) were completed.

Setting

Leicestershire Cancer Centre, UK.

Participants

94 BSA and 185 BW recently diagnosed patients with cancer.

Results

BSA self-reported significantly higher rates of depressive symptoms compared with BW patients longitudinally (HADS-D ≥8: baseline: BSA 35.1% vs BW 16.8%, p=0.001; 3 months BSA 45.6% vs BW 20.8%, p=0.001; 9 months BSA 40.6% vs BW 15.3%, p=0.004). BSA patients used potentially maladaptive coping strategies more frequently than BW patients at baseline (hopelessness/helplessness p=0.005, fatalism p=0.0005, avoidance p=0.005; the CIDQ denial statement ‘I do not really believe I have cancer’ p=0.0005). BSA patients experienced more physical symptoms (DT checklist), which correlated with ethnic differences in depressive symptoms especially at 3 months.

Conclusions

Health professionals need to be aware of a greater probability of depressive symptomatology (including somatic symptoms) and how this may present clinically in the first 9 months after diagnosis if this ethnic disparity in mental well-being is to be addressed.
Effects of train noise and vibration on human heart rate during sleep: an experimental study
Authors: Croy Ilona , Smith Michael G , Waye Kerstin Persson
Published: June 2013

Objectives

Transportation of goods on railways is increasing and the majority of the increased numbers of freight trains run during the night. Transportation noise has adverse effects on sleep structure, affects the heart rate (HR) during sleep and may be linked to cardiovascular disease. Freight trains also generate vibration and little is known regarding the impact of vibration on human sleep. A laboratory study was conducted to examine how a realistic nocturnal railway traffic scenario influences HR during sleep.

Design

Case–control.

Setting

Healthy participants.

Participants

24 healthy volunteers (11 men, 13 women, 19–28 years) spent six consecutive nights in the sleep laboratory.

Interventions

All participants slept during one habituation night, one control and four experimental nights in which train noise and vibration were reproduced. In the experimental nights, 20 or 36 trains with low-vibration or high-vibration characteristics were presented.

Primary and secondary outcome measures

Polysomnographical data and ECG were recorded.

Results

The train exposure led to a significant change of HR within 1 min of exposure onset (p=0.002), characterised by an initial and a delayed increase of HR. The high-vibration condition provoked an average increase of at least 3 bpm per train in 79% of the participants. Cardiac responses were in general higher in the high-vibration condition than in the low-vibration condition (p=0.006). No significant effect of noise sensitivity and gender was revealed, although there was a tendency for men to exhibit stronger HR acceleration than women.

Conclusions

Freight trains provoke HR accelerations during sleep, and the vibration characteristics of the trains are of special importance. In the long term, this may affect cardiovascular functioning of persons living close to railways.