bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in the Composition of the Gut Microbiota and the Blood Transcriptome in Preterm Infants at Less than 29 Weeks Gestation Diagnosed with Bronchopulmonary Dysplasia
Authors: Ryan Feargal J. , Drew Damian P. , Douglas Chloe , Leong Lex E. X. , Moldovan Max , Lynn Miriam , Fink Naomi , Sribnaia Anastasia , Penttila Irmeli , McPhee Andrew J. , Collins Carmel T. , Makrides Maria , Gibson Robert A. , Rogers Geraint B. , Lynn David J.
Published: October 2019

Bronchopulmonary dysplasia (BPD) is a serious inflammatory condition of the lung and is the most common complication associated with preterm birth. A large body of evidence now suggests that the gut microbiota can influence immunity and inflammation systemically; however, the role of the gut microbiota in BPD has not been evaluated to date. Here, we report that there are significant differences in the gut microbiota of infants born at <29 weeks gestation and subsequently diagnosed with BPD, which are particularly pronounced when infants are stratified by birth mode. We also show that erythroid and immune gene expression levels are significantly altered in BPD infants. Interestingly, we identified an association between the composition of the microbiota and immune gene expression in blood in early life. Together, these findings suggest that the composition of the microbiota may influence the risk of developing BPD and, more generally, may shape systemic immune gene expression.
Metabolic Modeling of Streptococcus mutans Reveals Complex Nutrient Requirements of an Oral Pathogen
Authors: Jijakli Kenan , Jensen Paul A.
Published: October 2019

Tooth decay is the most prevalent chronic disease in the United States. Decay is caused by the bacterium
Streptococcus mutans
, an oral pathogen that ferments sugars into tooth-destroying lactic acid. We constructed a complete metabolic model of
S. mutans
to systematically investigate how the bacterium grows. The model provides a valuable resource for understanding and targeting
S. mutans
’ ability to outcompete other species in the oral microbiome.
Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study
Authors: Rauber Fernanda , Louzada Maria Laura da Costa , Martinez Steele Euridice , Rezende Leandro F M de , Millett Christopher , Monteiro Carlos A , Levy Renata B
Published: October 2019

Objectives

To describe dietary sources of free sugars in different age groups of the UK population considering food groups classified according to the NOVA system and to estimate the proportion of excessive free sugars that could potentially be avoided by reducing consumption of their main sources.

Design and setting

Cross-sectional data from the UK National Diet and Nutrition Survey (2008–2014) were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system.

Participants

9364 individuals aged 1.5 years and above.

Main outcome measures

Average dietary content of free sugars and proportion of individuals consuming more than 10% of total energy from free sugars.

Data analysis

Poisson regression was used to estimate the associations between each of the NOVA food group and intake of free sugars. We estimated the per cent reduction in prevalence of excessive free sugar intake from eliminating ultra-processed foods and table sugar. Analyses were stratified by age group and adjusted for age, sex, ethnicity, survey year, region and equivalised household income (sterling pounds).

Results

Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%.

Conclusion

Our findings suggest that actions to reduce the ultra-processed food consumption generally rich in free sugars could lead to substantial public health benefits.
Epidemiology and medical service use for spontaneous pneumothorax: a 12-year study using nationwide cohort data in Korea
Authors: Kim Doori , Jung Boyoung , Jang Bo-Hyoung , Chung Seol-Hee , Lee Yoon Jae , Ha In-Hyuk
Published: October 2019

Objective

This study aimed to promote an understanding of spontaneous pneumothorax by analysing the prevalence rate and medical service use by patients with spontaneous pneumothorax according to sociodemographic characteristics.

Design

A 12-year nationwide study.

Setting

Data obtained from the Korean National Health Insurance Service Sharing Service.

Participants

A total of 4658 participants who used medical services due to spontaneous pneumothorax between 2002 and 2013 in Korea.

Outcome measures

For those diagnosed with spontaneous pneumothorax, use of medical services, hospitalisation data, sociodemographics, comorbidity, treatment administered and medication prescribed were recorded.

Results

The annual prevalence of spontaneous pneumothorax ranged from 39 to 66 per 100 000 individuals, while the prevalence of hospitalisation due to spontaneous pneumothorax ranged from 18 to 36 per 100 000 individuals. The prevalence rate of spontaneous pneumothorax in Korea has increased since 2002. The male to female ratio was approximately 4–10:1, with a higher prevalence rate in men. By age, the 15–34 years old group, and particularly those aged 15–19 years old, showed the highest prevalence rate; the rate then declined before increasing again for those aged 65 years or older. In total, 47%–57% of patients with spontaneous pneumothorax underwent hospitalisation. The average number of rehospitalisations due to pneumothorax was 1.56 per person, and more than 70% of recurrences occurred within 1 year. Chronic obstructive pulmonary disease was the most common comorbidity. The average treatment period was 11 days as an outpatient and 14 days in-hospital. The average medical costs were $94.50 for outpatients and $2523 for hospital admissions. The most common treatment for spontaneous pneumothorax was oxygen inhalation and thoracostomy, and the most commonly prescribed medications were analgesics, antitussives and antibiotics.

Conclusions

We here detailed the epidemiology and treatments for spontaneous pneumothorax in Korea. This information can contribute to the understanding of spontaneous pneumothorax.
Incremental healthcare utilisation and costs among new senior high-cost users in Ontario, Canada: a retrospective matched cohort study
Authors: Muratov Sergei , Lee Justin , Holbrook Anne , Guertin Jason Robert , Mbuagbaw Lawrence , Paterson John Michael , Gomes Tara , Pequeno Priscila , Tarride Jean-Eric
Published: October 2019

Objectives

To describe healthcare use and spending before and on becoming a new (incident) senior high-cost user (HCU) compared with senior non-HCUs; to estimate the incremental costs, overall and by service category, attributable to HCU status; and to quantify its monetary impact on the provincial healthcare budget in Ontario, Canada.

Design

We conducted a retrospective, population-based comparative cohort study using administrative healthcare records. Incremental healthcare utilisation and costs were determined using the method of recycled predictions allowing adjustment for preincident and incident year values, and covariates. Estimated budget impact was computed as the product of the mean annual total incremental cost and the number of senior HCUs.

Participants

Incident senior HCUs were defined as Ontarians aged ≥66 years who were in the top 5% of healthcare cost users during fiscal year 2013 (FY2013) but not during FY2012. The incident HCU cohort was matched with senior non-HCUs in a ratio of 1 HCU:3 non-HCU.

Results

Senior HCUs (n=175 847) reached the annual HCU threshold of CAD$10 192 through different combinations of incurred costs. Although HCUs had higher healthcare utilisation and costs at baseline, HCU status was associated with a substantial spike in both, with prolonged hospitalisations playing a major role. Twelve per cent of HCUs reached the HCU expenditure threshold without hospitalisation. Compared with non-HCUs (n=5 27 541), HCUs incurred an additional CAD$25 527 per patient in total healthcare costs; collectively CAD$4.5 billion or 9% of the 2013 Ontario healthcare budget. Inpatient care had the highest incremental costs: CAD$13 427, 53% of the total incremental spending.

Conclusions

Costs attributable to incident senior HCU status accounted for almost 1/10 of the provincial healthcare budget. Prolonged hospitalisations made a major contribution to the total incremental costs. A subgroup of patients that became HCU without hospitalisation requires further investigation.
Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: results of a before/after survey study
Authors: Niederhauser Andrea , Züllig Stephanie , Marschall Jonas , Schweiger Alexander , John Gregor , Kuster Stefan P , Schwappach David LB
Published: October 2019

Objective

To evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project.

Design

Repeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017).

Setting

Seven acute care hospitals in Switzerland.

Participants

The survey was targeted at all nursing and medical staff members working at the participating hospitals at the time of survey distribution. A total of 1579 staff members participated in the baseline survey (T0) (49% response rate) and 1527 participated in the follow-up survey (T1) (47% response rate).

Intervention

A multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter need and staff training, was implemented over the course of 9 months.

Main outcome measures

Staff knowledge (15 items), perception of current practices and culture (scale 1–7), self-reported responsibilities (multiple-response question) and determinants of behaviour (scale 1–7) before and after implementation of the intervention bundle.

Results

The mean number of correctly answered knowledge questions increased significantly between the two survey periods (T0: 10.4, T1: 11.0; p<0.001). Self-reported responsibilities with regard to IUC management by nurses and physicians changed only slightly over time. Perception of current practices and culture in regard to safe urinary catheter use increased significantly (T0: 5.3, T1: 5.5; p<0.001). Significant changes were also observed for determinants of behaviour (T0: 5.3, T1: 5.6; p<0.001).

Conclusion

We found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. Efforts now need to be targeted at sustaining and reinforcing these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.
Barriers and facilitators to recommended physical activity in lower-limb osteoarthritis: protocol for a qualitative study exploring patients and physiotherapist perspectives using the theoretical domains framework and behaviour change taxonomy
Authors: Willett Matthew James , Greig Carolyn , Rogers David , Fenton Sally , Duda Joan , Rushton Alison
Published: October 2019

Introduction

Osteoarthritis (OA) is the leading cause of disability and pain in older adults. Although increasing physical activity (PA) can help reduce symptoms, patients with lower-limb OA are less active than the general public. Although physiotherapists commonly deliver PA programmes, they lack knowledge of key barriers and facilitators to adherence to prescribed PA that patients with lower-limb OA experience while attending physiotherapy appointments (treatment period) and after discharge (post-treatment period). This study aims to explore the perspectives of patients with lower-limb OA of barriers and facilitators to adherence to physiotherapy prescribed PA in the treatment and post-treatment time periods to inform the development of intervention underpinned by behaviour change theory.

Methods and analysis

A qualitative study, based on phenomenology, will purposively recruit patients with lower-limb OA who have had physiotherapy. In-depth semi-structured interviews will be undertaken following discharge from physiotherapy at a single time point. Participants’ perspectives of physiotherapy interventions, including barriers and facilitators to prescribed PA and techniques that they felt optimised adherence to physiotherapist PA prescription will be explored (phase I). The acceptability and feasibility of delivering a physiotherapy intervention incorporating the techniques identified in the semi-structured interviews will then be explored through focus groups conducted with physiotherapists (phase II). Data will be coded following thematic analysis, with barriers and facilitators mapped to the constructs on the theoretical domains framework, and behaviour change techniques identified following definitions from Michie’s V1 taxonomy.

Ethics and dissemination

Findings from this study will inform development of a physiotherapy intervention underpinned by behaviour change theory aiming to optimise adherence to PA prescription in patients with lower-limb OA during the treatment and post-treatment time periods. This study has ethical approval (IRAS 247904) and results will be disseminated through publications in peer-reviewed journals and presentations at conferences and to study participants.
How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats
Authors: Okan Yasmina , Smith Samuel G , Bruine de Bruin Wändi
Published: October 2019

Objectives

To investigate whether UK websites about cervical cancer screening targeted to the public include (1) information about benefits and risks of screening, possible screening results and cervical cancer statistics, (2) quantitative presentation formats recommended in the risk communication literature and (3) appeals for participation and/or informed decision-making.

Design

Cross-sectional analysis of websites using a comprehensive checklist of information items on screening benefits, risks, possible results and cervical cancer statistics.

Outcome measures

We recorded the number of websites that contained each of the information items, and the presentation format used for probabilistic information (no quantification provided, verbal quantifiers only, different types of numerical formats and/or graphs). We also recorded the number of websites containing appeals for participation and/or informed decision-making.

Setting

Websites were identified through the most common Google search terms used in the UK to find information on cervical screening, according to GoogleTrends and a commercial internet-monitoring programme. Two additional websites were identified by the authors as relevant.

Results

After applying exclusion criteria, 14 websites were evaluated, including websites of public and private health service providers, charities, a medical society and a pharmacy. The websites mentioned different benefits, risks of screening and possible results. However, specific content varied between websites. Probabilistic information was often presented using non-recommended formats, including relative risk reductions to express screening benefits, and verbal quantifiers without numbers to express risks. Appeals for participation were present in most websites, with almost half also mentioning informed decision-making.

Conclusions

UK websites about cervical cancer screening were generally balanced. However, benefits and risks were presented using different formats, potentially hindering comparisons. Additionally, recommendations from the literature to facilitate understanding of quantitative information and facilitate informed decisions were often not followed. Designing websites that adhere to existing recommendations may support informed screening uptake.
Risk factors for cardiovascular disease in rural South India: cohort study
Authors: Kaur Prabhdeep , Ramachandra Rao Sudha , Venkatachalam Ramachandran , Kangusamy Boopathi , Radhakrishnan Ezhil , Kaliaperumal Kanagasabai , Thota Venkatarao , Gupte Mohan D
Published: October 2019

Background and objectives

Cardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India.

Design, setting and participants

We conducted a community-based cohort study among 6026 adults aged 25–64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005–2007) and two follow-up surveys in 2008–2009 and 2013–2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity.

Outcome measures

Outcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF).

Results

We followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF.

Conclusions

We described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.
Short implants (≤6 mm) versus longer implants with sinus floor elevation in atrophic posterior maxilla: a systematic review and meta-analysis
Authors: Yan Qi , Wu Xinyu , Su Meiying , Hua Fang , Shi Bin
Published: October 2019

Objectives

To compare the use of short implants (≤6 mm) in atrophic posterior maxilla versus longer implants (≥10 mm) with sinus floor elevation.

Design

A systematic review and meta-analysis based on randomised controlled trials (RCTs).

Data sources

Electronic searches were conducted in PubMed, Embase and the Cochrane CENTRAL. Retrospective and prospective hand searches were also performed.

Eligibility criteria

RCTs comparing short implants (≤6 mm) and longer implants (≥10 mm) with sinus floor elevation were included. Outcome measures included implant survival (primary outcome), marginal bone loss (MBL), complications and patient satisfaction.

Data extraction and synthesis

Risks of bias in and across studies were evaluated. Meta-analysis, subgroup analysis and sensitivity analysis were undertaken. Quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation.

Results

A total of seven RCTs involving 310 participants were included. No significant difference in survival rate was found for 1–3 years follow-up (RR 1.01, 95% CI 0.97 to 1.04, p=0.74, I²=0%, moderate-quality evidence) or for 3 years or longer follow-up (RR 1.00, 95% CI 0.97 to 1.04, p=0.79, I²=0%, moderate-quality evidence). However, short implants (≤6 mm) showed significantly less MBL in 1–3 years follow-up (MD=−0.13 mm, 95% CI −0.21 to 0.05; p=0.001, I²=87%, low-quality evidence) and in 3 years or longer follow-up (MD=−0.25 mm, 95% CI −0.40 to 0.10; p=0.001, I²=0%, moderate-quality evidence). In addition, short implant (≤6 mm) resulted in fewer postsurgery reaction (RR 0.11, 95% CI 0.14 to 0.31, p<0.001, I²=40%, moderate-quality evidence) and sinus perforation or infection (RR 0.11, 95% CI 0.02 to 0.63, p=0.01, I²=0%, moderate-quality evidence).

Conclusions

For atrophic posterior maxilla, short implants (≤6 mm) are a promising alternative to sinus floor elevation, with comparable survival rate, less MBL and postsurgery reactions. Additional high-quality studies are needed to evaluate the long-term effectiveness of short implants (≤6 mm).

Trial registeration number

The protocol has been registered at PROSPERO (CRD42018103531).
The use of information and communication technologies to promote healthy lifestyle behaviour: a systematic scoping review
Authors: Joseph-Shehu Elizabeth Musili , Ncama Busisiwe Purity , Mooi Nomaxabiso , Mashamba-Thompson Tivani Phosa
Published: October 2019

Introduction

Health-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults.

Methods

Eleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically.

Results

All the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health.

Conclusion

Our findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs.

PROSPERO registration number

CRD42016042568.
Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan
Authors: Lin Ching-Hsiung , Kuo Shu-Chen , Hsieh Ming-Chia , Ho Shang-Yun , Su Ih-Jen , Lin Sheng-Hao , Chi Chia-Yu , Su Shih-Li , Liao Chiung-Ying , Chen Yee-Chun , Hsu Shang-Ren , Huang Yuan-Chun , Tseng Fan-Chen , Wang Shu Yi , Dou Horng Yunn , Lin Shi-Dou , Lin Jen-Shiou , Tu Shih-Te , Yeh Yen-Po
Published: October 2019

Objective

To investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas.

Design

Community-based comparison study.

Setting

Outpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants.

Participants

A total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled.

Primary and secondary outcome measures

The interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis.

Results

Diabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95% CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95% CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95% CI 1.03 to 1.55) and history of TB (aOR=2.08; 95% CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95% CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI.

Conclusion

There was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.
Effects of photobiomodulation therapy combined to static magnetic field in strength training and detraining in humans: protocol for a randomised placebo-controlled trial
Authors: de Paiva Paulo Roberto Vicente , Casalechi Heliodora Leão , Tomazoni Shaiane Silva , Machado Caroline dos Santos Monteiro , Vanin Adriane Aver , Baroni Bruno Manfredini , de Carvalho Paulo de Tarso Camillo , Leal-Junior Ernesto Cesar Pinto
Published: October 2019

Introduction

In recent years, it has been demonstrated that photobiomodulation therapy (PBMT) using low-level laser therapy and/or light-emitting diode therapy combined to static magnetic field (sMF) has ergogenic effects, improving muscular performance and accelerating postexercise recovery. However, many aspects related to these effects and its clinical applicability remain unknown. Therefore, the aim of this project is to evaluate the ergogenic effects of PBMT/sMF in detraining after a strength-training protocol.

Methods and analysis

The study will be a randomised, triple-blind, placebo-controlled clinical trial. Healthy male volunteers will be randomly distributed into four experimental groups: PBMT/sMF before training sessions + PBMT/sMF during detraining, PBMT/sMF before training sessions + placebo during detraining, placebo before training sessions + PBMT/sMF during detraining and placebo before training sessions + placebo during detraining. Strength-training sessions will be carried out over 12 weeks, and the detraining period will occur during the 4 weeks after. The muscular strength and the structural properties of quadriceps will be analysed.

Ethics and dissemination

This study was approved by the Research Ethics Committee of Nove de Julho University. The results from this study will be disseminated through scientific publications in international peer-reviewed journals and presented at national and international scientific meetings.

Trial registration number

NCT03858179.
Female reproductive history in relation to chronic obstructive pulmonary disease and lung function in UK biobank: a prospective population-based cohort study
Authors: Tang Rosalind , Fraser Abigail , Magnus Maria Christine
Published: October 2019

Objectives

Sex differences in respiratory physiology and predilection for developing chronic obstructive pulmonary disease (COPD) have been documented, suggesting that female sex hormones may influence pathogenesis. We investigated whether aspects of female reproductive health might play a role in risk of COPD among women.

Design

Population-based prospective cohort study.

Setting

UK Biobank recruited across 22 centres in the UK between 2006 to 2010.

Primary and secondary outcomes measures

We examined a range of female reproductive health indicators in relation to risk of COPD-related hospitalisation/death (n=271 271) using Cox proportional hazards regression; and lung function (n=273 441) using linear regression.

Results

Parity >3 was associated with greater risk of COPD-related hospitalisation/death (adjusted HR 1.45; 95% CI: 1.16 to 1.82) and lower forced expiratory volume at 1 second/forced vital capacity ratio (FEV1/FVC) (adjusted mean difference −0.06; 95% CI: -0.07 to 0.04). Any oral contraception use was associated with lower risk of COPD-related hospitalisation/death (adjusted HR 0.85; 95% CI: 0.74 to 0.97) and greater FEV1/FVC (adjusted mean difference 0.01; 95% CI: 0.003 to 0.03). Late menarche (age >15) and early menopause (age <47) were also associated with greater risk of COPD-related hospitalisation/death (but not lung function), while endometriosis was associated with greater FEV1/FVC (not COPD-related hospitalisation/death). Early menarche (age <12 years) was associated with lower FEV1/FVC (but not COPD hospitalisation/death). Associations with polycystic ovary syndrome (PCOS) or ovarian cysts, any hormone replacement therapy (HRT) use, hysterectomy-alone and both hysterectomy and bilateral oophorectomy were in opposing directions for COPD-related hospitalisation/death (greater risk) and FEV1/FVC (positive association).

Conclusions

Multiple female reproductive health indicators across the life course are associated with COPD-related hospitalisation/death and lung function. Further studies are necessary to understand the opposing associations of PCOS/ovarian cysts, HRT and hysterectomy with COPD and objective measures of airway obstruction.
Utilisation of tools to facilitate cross-border communication during international food safety events, 1995–2019: a realist synthesis protocol
Authors: Savelli Carmen Joseph , Mateus Ceu
Published: October 2019

Introduction

Efficient communication and coordination between countries is needed for prevention, detection and response to international food safety events. While communication tools exist, current evidence suggests that they are only effective within certain contexts and only cover certain geographic areas. There is a need to unpack and explore the mechanisms of how and in what context such communication tools and their components are effective at facilitating international communication and coordination to keep food safe and mitigate the burden of foodborne disease around the globe.

Methods and analysis

A realist synthesis will be undertaken to understand how and why certain processes and structures of communication tools, used during international food safety events, influence their utility and effectiveness according to different contextual factors. The focus of this review is explanatory and aims to develop and refine theory regarding how contextual factors trigger specific processes and mechanisms to produce outcomes. Using the realist context–mechanism–outcome configuration of theory development, a range of sources have been used to develop the initial programme theory, including the author’s experience, a scoping review of published papers and grey literature and input from an expert reference committee. To support, expand or refute the initial theory, data will be synthesised from published literature and input from the expert reference committee.

Ethics and dissemination

Ethical approval is not required for this review as it does not involve primary research. However, it will be conducted according to the appropriate ethical standards of accuracy, utility, usefulness, accountability, feasibility and propriety. The RAMESES publication standards will be followed to report the findings of this review. On completion, the final manuscript will be shared with members of the FAO/WHO International Food Safety Authorities Network (INFOSAN) and published in a peer-reviewed journal.
Prevalence and types of sexual inactivity in Britain: analyses of national cross-sectional probability survey data
Authors: Ueda Peter , Mercer Catherine H
Published: October 2019

Objectives

To examine how prevalence and context of sexual inactivity varies across the life-course, assess dissatisfaction with sex life among those who are sexually inactive and identify associations with factors that may represent reasons for sexual inactivity.

Design

Analysis of cross-sectional probability sample survey data.

Setting

British general population.

Participants

14 623 participants (n men: 6045 unweighted, 7245 weighted), aged 16–74 years, of the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), undertaken in 2010–2012.

Main outcome measures

Sexual inactivity, defined as not reporting oral, vaginal or anal intercourse in the past year and further categorised into those who were sexually inexperienced (had never had sex), single or in a relationship.

Results

Overall, 15.9% (weighted n 1155/7245) of men and 22.2% (1646/7410) of women were sexually inactive (p<0.001). The proportion of sexually inactive individuals who were sexually inexperienced was larger among men than women (26.3% (304/1155) vs 16.3% (268/1646)), while the proportion who were singles was larger among women (49.8% (820/1646) vs 40.4% (467/1155)). Sexual inexperience was the most common type of sexual inactivity in early adulthood, with this declining with age. A minority of those who had sexual experience but were sexually inactive—34.8% (293/842) of men and 23.6% (319/1349) of women—reported being dissatisfied with their sex lives. Associations with sexual inactivity was observed for a range of sociodemographics and sexual behaviours/attitudes, for example, religion, ethnicity, Body mass index, height, employment status and index of multiple deprivation; these associations varied by type of sexual inactivity and gender.

Conclusions

While sex is important for well-being, a non-negligible proportion of the population at all ages are sexually inactive, yet many are not dissatisfied with their situation, with implications for sex and relationship counselling.
Prevalence of lifestyle characteristics in glucocorticoid users and non-users: a Danish population-based cross-sectional study
Authors: Laugesen Kristina , Petersen Irene , Pedersen Lars , Breinholt Larsen Finn , Jørgensen Jens Otto Lunde , Sørensen Henrik T Toft
Published: October 2019

Objectives

Lifestyle may affect observed associations between glucocorticoid use and adverse events. This study aimed to investigate whether lifestyle differ according to use of systemic glucocorticoids.

Design

Population-based cross-sectional study.

Setting

The Central Denmark Region.

Participants

30 245 adults (≥25 years of age) who participated in a questionnaire-based public health survey in 2010.

Outcome measures

Systemic glucocorticoid use was categorised as never use, current use (prescription redemption ≤90 days before completing the questionnaire), recent use (prescription redemption 91–365 days before completing the questionnaire), former use (prescription redemption >365 days before completing the questionnaire) and according to cumulative dose expressed in prednisolone equivalents (<100, 100–499, 500–999, 1000–1999, 2000–4999, ≥5000 mg). We computed the prevalence of lifestyle factors (body mass index, smoking, alcohol intake, physical activity and dietary habits) according to glucocorticoid use. We then estimated age-adjusted prevalence ratios (aPRs) and 95% CIs, comparing the categories of glucocorticoid users versus never users. All analyses were stratified by sex.

Results

Of the 30 245 participants (53% women, median age 53 years), 563 (1.9%) were current users, 885 (2.9%) were recent users, 3054 (10%) were former users and 25 743 (85%) were never users. Ever users of glucocorticoids had a slightly higher prevalence of obesity than never users (18% vs 14%, aPR=1.4, 95% CI 1.2 to 1.5 in women and 17% vs 15%, aPR=1.2, 95% CI 1.1 to 1.4 in men). In women, ever users of glucocorticoids had a slightly lower prevalence of high-risk alcohol consumption compared with never users (17% vs 20%, aPR=0.8, 95% CI 0.7 to 1.0). Smoking, diet and physical activity did not differ substantially according to use of glucocorticoids.

Conclusion

Our study provides a framework for quantifying potential uncontrolled confounding by lifestyle factors in studies of systemic glucocorticoids.
Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials
Authors: Stausholm Martin Bjørn , Naterstad Ingvill Fjell , Joensen Jon , Lopes-Martins Rodrigo Álvaro Brandão , Sæbø Humaira , Lund Hans , Fersum Kjartan Vibe , Bjordal Jan Magnus
Published: October 2019

Objectives

Low-level laser therapy (LLLT) is not recommended in major knee osteoarthritis (KOA) treatment guidelines. We investigated whether a LLLT dose–response relationship exists in KOA.

Design

Systematic review and meta-analysis.

Data sources

Eligible articles were identified through PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Central Register of Controlled Trials on 18 February 2019, reference lists, a book, citations and experts in the field.

Eligibility criteria for selecting studies

We solely included randomised placebo-controlled trials involving participants with KOA according to the American College of Rheumatology and/or Kellgren/Lawrence criteria, in which LLLT was applied to participants’ knee(s). There were no language restrictions.

Data extraction and synthesis

The included trials were synthesised with random effects meta-analyses and subgrouped by dose using the World Association for Laser Therapy treatment recommendations. Cochrane’s risk-of-bias tool was used.

Results

22 trials (n=1063) were meta-analysed. Risk of bias was insignificant. Overall, pain was significantly reduced by LLLT compared with placebo at the end of therapy (14.23 mm Visual Analogue Scale (VAS; 95% CI 7.31 to 21.14)) and during follow-ups 1–12 weeks later (15.92 mm VAS (95% CI 6.47 to 25.37)). The subgroup analysis revealed that pain was significantly reduced by the recommended LLLT doses compared with placebo at the end of therapy (18.71 mm (95% CI 9.42 to 27.99)) and during follow-ups 2–12 weeks after the end of therapy (23.23 mm VAS (95% CI 10.60 to 35.86)). The pain reduction from the recommended LLLT doses peaked during follow-ups 2–4 weeks after the end of therapy (31.87 mm VAS significantly beyond placebo (95% CI 18.18 to 45.56)). Disability was also statistically significantly reduced by LLLT. No adverse events were reported.

Conclusion

LLLT reduces pain and disability in KOA at 4–8 J with 785–860 nm wavelength and at 1–3 J with 904 nm wavelength per treatment spot.

PROSPERO registration number

CRD42016035587.
Long-term outcomes in patients with acute pulmonary embolism after in-hospital treatment: study protocol of the prospective Lungenembolie Augsburg Studie (LEA study)
Authors: Meisinger Christa , Linseisen Jakob , Kirchberger Inge , von Scheidt Wolfgang , Berghaus Thomas M
Published: October 2019

Introduction

Acute pulmonary embolism (PE) is a frequent life-threatening event and an important cause of hospitalisation, morbidity and mortality worldwide. Limited information on the long-term course of PE patients is available so far. The Lungenembolie Augsburg study will provide a view on the predisposing and PE-provoking factors, diagnostic procedures and short as well as long-term treatment options. Especially, the data on the long-term course of the disease—in combination with omics data obtained in biospecimens—will generate new knowledge regarding triggers, disease progression, treatment, long-term sequelae, prognosis and prevention of disease recurrence.

Methods and analysis

In this prospective study, we will include about 1000 patients admitted to the university hospital of Augsburg, aged 18 years and older with a confirmed diagnosis of acute PE. At baseline, demographic information, symptoms on presentation, delay in diagnosis, predisposing and PE-provoking factors, comorbidity, quality of life, symptoms of anxiety and depression, information on invasive and non-invasive treatment procedures, complications and laboratory parameters will be collected. During the hospital stay, 30 mL blood will be collected from the patients, processed, aliquoted and frozen at −80°C. In a subgroup of patients, an eight-channel polygraphy will be carried out to assess sleep-disordered breathing. All study participants will be followed up for 60 months via postal questionnaires or telephone interviews after hospital discharge. Long-term survival, bleeding complications and PE recurrence during the follow-up are the primary study outcomes. To identify risk factors and determinants associated with these outcomes, confounder-adjusted Cox-regressions will be used for modelling and to estimate relative risks. Effect modification by age and sex will be examined.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the Ludwig-Maximilians-Universität München (Date of approval: 1 August 2017, Reference number: 17-378). Study results will be presented at national and international conferences and published in peer-reviewed scientific journals.
Assessing cardiovascular remodelling in fetuses and infants conceived by assisted reproductive technologies: a prospective observational cohort study protocol
Authors: Bi Wen-jing , Cui Li , Xiao Yang-jie , Song Guang , Wang Xin , Sun Lu , Qiao Wei , Ren Wei-dong
Published: October 2019

Introduction

Assisted reproductive technologies (ART), namely in vitro fertilisation and intracytoplasmic sperm injection, have become widely used to treat infertility. Although the use of ART is generally considered favourable, there are ongoing concerns about the prenatal and perinatal risks as well as long-term risks for the child. Epidemiological studies have demonstrated an association between pathological events during fetal development and future cardiovascular risk, raising concerns about cardiovascular remodelling in fetuses conceived by ART. The authors hypothesise fetuses conceived by ART present signs of cardioventricular dysfunction, which can be detected by deformation analysis. To address these issues, we will assess comprehensive cardiovascular structure and function in ART offspring and explore the role of speckle-tracking in myocardial deformation.

Methods and analysis

This prospective observational cohort study will include 100 singleton pregnancies conceived by ART and 100 controls identified in fetal life and followed up to 6 months old. At inclusion, a baseline assessment of the mothers and ART characteristics will be recorded by interview and review of medical records. Between 28 and 32 weeks gestation, a detailed fetal echography will be performed, including an assessment of estimated fetal weight, fetoplacental Doppler, fetal echocardiography and fetal abdominal artery ultrasound. On delivery, maternal and neonatal characteristics will be assessed. Within 60 days of birth, the first postnatal cardiovascular assessment will be conducted which will include echocardiography and abdominal artery ultrasound. At 6 months of age, the second infants’ follow-up evaluation will include the weight and length of the infant, echocardiography and abdominal artery ultrasound. Data will be presented as mean±SD, median or percentages where appropriate. A p<0.05 will be considered statistically significant.

Ethics and dissemination

Ethical approval has been obtained from the Ethics Committee of Shengjing Hospital of China Medical University. Findings will be disseminated through scientific publications and conference presentations.

Trial registration number

ChiCTR1900021672.
Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care
Authors: Starr Nichole , Carpenter Sarah , Carvalho Melissa , Souza Aileen , Chin Robin , Kasotakis George , Worku Mengistu
Published: October 2019

Objectives

The aim of this study was to characterise the resources and challenges for surgical care and referrals at health centres (HCs) in South Wollo Zone, Ethiopia.

Setting

Eight primary HCs in South Wollo Zone, Ethiopia.

Participants

Eight health officers and nurses staffing eight HCs completed a survey.

Design

The study was a survey-based, cross-sectional assessment of HCs in South Wollo Zone, Ethiopia and data were collected over a 30-day period from November 2014 to January 2015.

Primary and secondary outcome measures

Survey assessed human and material resources, diagnostic capabilities and challenges and patient-reported barriers to care.

Results

Eight HCs had an average of 18 providers each, the majority of which were nurses (62.2%) and health officers (20.7%). HCs had intermittent availability of clean water, nasogastric tubes, rectal tubes and suturing materials, none of them had any form of imaging. A total of 168 surgical patients were seen at the 8 HCs; 58% were referred for surgery. Most common diagnoses were trauma/burns (42%) and need for caesarean section (9%). Of those who did not receive surgery, 32 patients reported specific barriers to obtaining care (91.4%). The most common specific barriers were patients not being decision makers to have surgery, lack of family/social support and inability to afford hospital fees.

Conclusions

HCs in South Wollo Zone, Ethiopia are well-staffed with nurses and health officers, however they face a number of diagnostic and treatment challenges due to lack of material resources. Many patients requiring surgery receive initial diagnosis and care at HCs; sociocultural and financial factors commonly prohibit these patients from receiving surgery. Further study is needed to determine how such delays may impact patient outcomes. Improving material resources at HCs and exploring community and family perceptions of surgery may enable more streamlined access to surgical care and prevent delays.
Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study
Authors: Detering Karen M , Buck Kimberly , Sellars Marcus , Kelly Helana , Sinclair Craig , White Ben , Nolte Linda
Published: October 2019

Introduction

Advance care planning (ACP), an ongoing communication and planning process, aims to clarify a person’s values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices.

Methods and analysis

This is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person’s documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored.

Ethics and dissemination

Protocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings.