bluuebunny/crossref_metadata_2025 huggingface dataset:
Results from the Upper Limb International Spasticity Study-II (ULIS-II): a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management
Authors: Turner-Stokes Lynne , Fheodoroff Klemens , Jacinto Jorge , Maisonobe Pascal
Published: June 2013

Objective

To describe real-life practice and person-centred outcomes in the treatment of poststroke upper limb spasticity with botulinum toxin A (BoNT-A).

Design

Observational, prospective study.

Setting

84 secondary care centres in 22 countries.

Participants

456 adults (≥18 years) with poststroke upper limb spasticity treated with one cycle of BoNT-A.

Methods/outcomes

Muscle selection, BoNT-A preparation, injection technique and timing of follow-up were conducted according to routine practice for each centre. Primary outcome: achievement of the patient's primary goal for treatment using goal-attainment scaling (GAS). Measurements of spasticity, standardised outcome measures and global benefits were also recorded.

Results

The median number of injected muscles was 5 (range 1–15) and the most frequently injected muscles were the long finger flexors, followed by biceps and brachioradialis. The median (range) follow-up time was 14 (2.6 to 32.3) weeks. The common primary treatment goals were passive function (132 (28.9%)), active function (104 (22.8%)), pain (61 (13.4%)), impairment (105 (23%)), involuntary movement (41 (9%)) and mobility (10 (2.2%)). Overall, 363 (79.6%) (95% CI 75.6% to 83.2%) patients achieved (or overachieved) their primary goal and 355 (75.4%) (95% CI 71.2% to 79.2%) achieved their secondary goal. Mean (SD) change from baseline in GAS T-scores was 17.6 (11.0) (95% CI 16.4 to 18.8; p<0.001). GAS T-scores were strongly correlated with global benefit and other standard measures (correlations of 0.38 and 0.63, respectively; p<0.001).

Conclusions

BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper-limb spasticity following stroke. The study confirms the feasibility of a common international data set to collect systematic prospective data, and of using GAS to capture person-centred outcomes relating to passive and active functions and to pain.

Registration

ClinicalTrials.gov identifier:NCT01020500
Prevalence and factors associated with asymptomatic gonococcal and chlamydial infection among US Navy and Marine Corps men infected with the HIV: a cohort study
Authors: Carpenter Robert J , Refugio Oliver N , Adams Nehkonti , O'Brien Kevin P , Johnson Mark D , Groff Harold L , Maves Ryan C , Bavaro Mary F , Crum-Cianflone Nancy F
Published: June 2013

Objectives

Neisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) can facilitate transmission of HIV. Men who have sex with men (MSM) may harbour infections at genital and extragenital sites. Data regarding extragenital GC and CT infections in military populations are lacking. We examined the prevalence and factors associated with asymptomatic GC and CT infection among this category of HIV-infected military personnel.

Design

Cross-sectional cohort study (pilot).

Setting

Infectious diseases clinic at a single military treatment facility in San Diego, CA.

Participants

Ninety-nine HIV-positive men were evaluated—79% men who had sex with men, mean age 31 years, 36% black and 33% married. Inclusion criteria: male, HIV-infected, Department of Defense beneficiary. Exclusion criteria: any symptom related to the urethra, pharynx or rectum.

Primary outcome measures

GC and CT screening results.

Results

Twenty-four per cent were infected with either GC or CT. Rectal swabs were positive in 18% for CT and 3% for GC; pharynx swabs were positive in 8% for GC and 2% for CT. Only one infection was detected in the urine (GC). Anal sex (p=0.04), male partner (OR 7.02, p=0.04) and sex at least once weekly (OR 3.28, p=0.04) were associated with infection. Associated demographics included age <35 years (OR 6.27, p=0.02), non-Caucasian ethnicity (p=0.03), <3 years since HIV diagnosis (OR 2.75, p=0.04) and previous sexually transmitted infection (STI) (OR 5.10, p=0.001).

Conclusions

We found a high prevalence of extragenital GC/CT infection among HIV-infected military men. Only one infection was detected in the urine, signalling the need for aggressive three-site screening of MSM. Clinicians should be aware of the high prevalence in order to enhance health through comprehensive STI screening practices.
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement
Authors: Lopez Vincent , Chamoux Alain , Tempier Marion , Thiel Hélène , Ughetto Sylvie , Trousselard Marion , Naughton Geraldine , Dutheil Frédéric
Published: June 2013

Objectives

To assess residual long-term microcirculation abnormalities by capillaroscopy, 15 years after retiring from occupational exposure to vinyl chloride monomer (VCM).

Design

Cross-sectional study.

Setting

Allier, one of the major areas of polyvinyl chloride production in France.

Participants

We screened 761 (97% men) retired workers exposed to chemical toxics. Exposure to chemicals other than VCM excluded potential participants.

Primary and secondary outcome measures

These participants underwent a medical examination including a capillaroscopy, symptoms of Raynaud and comorbidities, as well as a survey to determine exposure time, direct or indirect contact, type of occupation, smoking status and time after exposure. A double blind analysis of capillaroscopic images was carried out. A control group was matched in age, sex, type of occupation.

Results

179/761 retired workers were only exposed to VCM at their work, with 21 meeting the inclusion criteria and included. Exposure time was 29.8±1.9 years and time after exposure was 15.9±2.4 years. Retired workers previously exposed to VCM had significantly higher capillaroscopic modifications than the 35 controls: enlarged capillaries (19% vs 0%, p<0.001), dystrophy (28.6% vs 0%, p=0.0012) and augmented length (33% vs 0%, p<0.001). Time exposure was linked (p<0.001) with enlarged capillaries (R2=0.63), dystrophy (R2=0.51) and capillary length (R2=0.36). They also had higher symptoms of Raynaud (19% vs 0%, p=0.007) without correlation with capillaroscopic modifications.

Conclusions

Although VCM exposure was already known to affect microcirculation, our study demonstrates residual long-term abnormalities following an average of 15 years’ retirement, with a time-related exposure response. Symptoms of Raynaud, although statistically associated with exposure, were not related to capillaroscopic modifications; its origin remains to be determined.
Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR)
Authors: Embún R , Fiorentino F , Treasure T , Rivas J J , Molins L
Published: June 2013

Objectives

To capture an accurate contemporary description of the practice of pulmonary metastasectomy for colorectal carcinoma in one national healthcare system.

Design

A national registry set up in Spain by Grupo Español de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR).

Setting

32 Spanish thoracic units.

Participants

All patients with one or more histologically proven lung metastasis removed by surgery between March 2008 and February 2010.

Interventions

Pulmonary metastasectomy for one or more pulmonary nodules proven to be metastatic colorectal carcinoma.

Primary and secondary outcome measures

The age and sex of the patients having this surgery were recorded with the number of metastases removed, the interval between the primary colorectal cancer operation and the pulmonary metastasectomy, and the carcinoembryonic antigen level. Also recorded were the practices with respect to mediastinal lymphadenopathy and coexisting liver metastases.

Results

Data were available on 543 patients from 32 units (6–43/unit). They were aged 32–88 (mean 65) years, and 65% were men. In 55% of patients, there was a solitary metastasis. The median interval between the primary cancer resection and metastasectomy was 28 months and the serum carcinoembryonic antigen was low/normal in the majority. Liver metastatic disease was present in 29% of patients at some point prior to pulmonary metastasectomy. Mediastinal lymphadenectomy varied from 9% to 100% of patients.

Conclusions

The data represent a prospective comprehensive national data collection on pulmonary metastasectomy. The practice is more conservative than the impression gained when members of the European Society of Thoracic Surgeons were surveyed in 2006/2007 but is more inclusive than would be recommended on the basis of recent outcome analyses. Further analyses on the morbidity associated with this surgery and the correlation between imaging studies and pathological findings are being published separately by GECMP-CCR.
The Crohn's disease: associated ATG16L1 variant andSalmonellainvasion
Authors: Messer Jeannette S , Murphy Stephen F , Logsdon Mark F , Lodolce James P , Grimm Wesley A , Bartulis Sarah J , Vogel Tiphanie P , Burn Melisa , Boone David L
Published: June 2013

Objective

A common genetic coding variant in the core autophagy gene ATG16L1 is associated with increased susceptibility to Crohn's disease (CD). The variant encodes an amino acid change in ATG16L1 such that the threonine at position 300 is substituted with an alanine (ATG16L1 T300A). How this variant contributes to increased risk of CD is not known, but studies with transfected cell lines and gene-targeted mice have demonstrated that ATG16L1 is required for autophagy, control of interleukin-1-β and autophagic clearance of intracellular microbes. In addition, studies with human cells expressing ATG16L1 T300A indicate that this variant reduces the autophagic clearance of intracellular microbes.

Design/Results

We demonstrate, using somatically gene-targeted human cells that the ATG16L1 T300A variant confers protection from cellular invasion bySalmonella. In addition, we show that ATG16L1-deficient cells are resistant to bacterial invasion.

Conclusions

These results suggest that cellular expression of ATG16L1 facilitates bacterial invasion and that the CD-associated ATG16L1 T300A variant may confer protection from bacterial infection.
Material, psychosocial and behavioural factors associated with self-reported health in the Republic of Ireland: cross-sectional results from the SLÁN survey
Authors: Niedhammer Isabelle , Kerrad Sarra , Schütte Stefanie , Chastang Jean-François , Kelleher Cecily C
Published: June 2013

Objectives

To explore the associations between various material, psychosocial and behavioural factors and self-reported health (SRH), and to determine whether these associations varied according to educational level.

Design

Representative national cross-sectional survey.

Setting

Republic of Ireland.

Participants

4369 men and 5995 women aged 18 or more (Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007).

Methods

SRH was measured using one single item. Three groups of factors were studied: material, psychosocial and behavioural factors. Statistical analyses were performed using logistic regression analysis and interaction testing, the sample design being taken into account. All results were adjusted for age and educational level and stratified on gender.

Results

When each group of factors was studied separately, non-working status, no private health insurance, inability to afford enough food, no car, being non-married, low social participation, serious neighbourhood problems, low social support, smoking, no alcohol consumption, illicit drug use, low physical activity and obesity were associated with poor SRH. When studied together, some material and psychosocial factors were no longer significant. Four significant interaction terms were found, suggesting that some factors might have a stronger association with SRH among low-educated people.

Conclusions

Various types of factors were found to be associated with SRH, and most of these associations were similar according to educational level. Behavioural factors might be intermediate factors in the causal pathways from material and psychosocial factors to SRH. Prevention policies should integrate a large number of factors comprehensively to improve SRH.
Mapping the 12-item multiple sclerosis walking scale to the EuroQol 5-dimension index measure in North American multiple sclerosis patients
Authors: Sidovar Matthew F , Limone Brendan L , Lee Soyon , Coleman Craig I
Published: June 2013

Objective

To map the 12-item Multiple Sclerosis Walking Scale (MSWS-12) onto the EuroQol 5-dimension (EQ-5D) health-utility index in multiple sclerosis (MS) patients participating in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry.

Design

Cross-sectional MSWS-12 to EQ-5D cross-walking analysis.

Setting

NARCOMS registry spring 2010 biannual update and supplemental survey.

Participants

North American patients completing both the MSWS-12 and the EQ-5D randomly split into derivation and validation cohorts.

Outcome measures

Ordinary least squares regression was performed within the derivation cohort, with participants’ EQ-5D as the dependent variable. Results of the MSWS-12 were input as independent variable(s) into six regression models. Model goodness-of-fit was subsequently assessed in the validation cohort using the mean absolute error (MAE), root mean square error (RMSE) and the adjusted R2. The best performing model was refined in the entire cohort and utilised for additional analyses.

Results

A total of 3505 NARCOMS participants were included. Their mean±SD EQ-5D and MSWS-12 scores were 0.74±0.18 and 50.8±33.5, respectively, and these assessments were found to be moderately correlated (r=–0.553, p<0.001). The model using all individual MSWS-12 item scores as independent variables was found to have the best fit (MAE=0.109±0.096, RMSE=0.145, adjusted R2=0.329). The percentage of EQ-5D estimates within 0.05 and 0.10 of the actual value were 30% and 61%, respectively. This mapping equation was more precise in patients with moderate mobility impairment (MAE=0.087±0.061 at patient-determined disease step (PDDS) of 3–6) and less precise in patients with no (MAE=0.141±0.128 at PDDS of 0–2) or severe mobility impairment (MAE=0.121±0.049 at PDDS ≥7).

Conclusions

The EQ-5D scores can be predicted using the MSWS-12 item scores with reasonable precision in North American patients with MS. Prediction estimates were more precise in patients with moderate mobility impairment.
On the time spent preparing grant proposals: an observational study of Australian researchers
Authors: Herbert Danielle L , Barnett Adrian G , Clarke Philip , Graves Nicholas
Published: June 2013

Objective

To estimate the time spent by the researchers for preparing grant proposals, and to examine whether spending more time increase the chances of success.

Design

Observational study.

Setting

The National Health and Medical Research Council (NHMRC) of Australia.

Participants

Researchers who submitted one or more NHMRC Project Grant proposals in March 2012.

Main outcome measures

Total researcher time spent preparing proposals; funding success as predicted by the time spent.

Results

The NHMRC received 3727 proposals of which 3570 were reviewed and 731 (21%) were funded. Among our 285 participants who submitted 632 proposals, 21% were successful. Preparing a new proposal took an average of 38 working days of researcher time and a resubmitted proposal took 28 working days, an overall average of 34 days per proposal. An estimated 550 working years of researchers' time (95% CI 513 to 589) was spent preparing the 3727 proposals, which translates into annual salary costs of AU$66 million. More time spent preparing a proposal did not increase the chances of success for the lead researcher (prevalence ratio (PR) of success for 10 day increase=0.91, 95% credible interval 0.78 to 1.04) or other researchers (PR=0.89, 95% CI 0.67 to 1.17).

Conclusions

Considerable time is spent preparing NHMRC Project Grant proposals. As success rates are historically 20–25%, much of this time has no immediate benefit to either the researcher or society, and there are large opportunity costs in lost research output. The application process could be shortened so that only information relevant for peer review, not administration, is collected. This would have little impact on the quality of peer review and the time saved could be reinvested into research.
‘The body we leave behind’: a qualitative study of obstacles and opportunities for increasing uptake of male circumcision among Tanzanian Christians
Authors: Downs Jennifer A , Fuunay Lucas D , Fuunay Mary , Mbago Mary , Mwakisole Agrey , Peck Robert N , Downs David J
Published: June 2013

Objectives

Male circumcision (MC) reduces HIV infection by approximately 60% among heterosexual men and is recommended by the WHO for HIV prevention in sub-Saharan Africa. In northwest Tanzania, over 60% of Muslims but less than 25% of Christian men are circumcised. We hypothesised that the decision to circumcise may be heavily influenced by religious identity and that specific religious beliefs may offer both obstacles and opportunities to increasing MC uptake, and conducted focus group discussions to explore reasons for low rates of MC among Christian church attenders in the region.

Design

Qualitative study using focus group discussions and interpretative phenomenological analysis.

Setting

Discussions took place at churches in both rural and urban areas of the Mwanza region of northwest Tanzania.

Participants

We included 67 adult Christian churchgoers of both genders in a total of 10 single-gender focus groups.

Results

Christians frequently reported perceiving MC as a Muslim practice, as a practice for the sexually promiscuous, or as unnecessary since they are taught to focus on ‘circumcision of the heart’. Only one person had ever heard MC discussed at church, but nearly all Christian parishioners were eager for their churches to address MC and felt that MC could be consistent with their faith.

Conclusions

Christian religious beliefs among Tanzanian churchgoers provide both obstacles and opportunities for increasing uptake of MC. Since half of adults in sub-Saharan Africa identify themselves as Christians, addressing these issues is critical for MC efforts in this region.
The influence of pregnancy termination on the outcome of subsequent pregnancies: a retrospective cohort study
Authors: Scholten Brenda L , Page-Christiaens Godelieve C M L , Franx Arie , Hukkelhoven Chantal W P M , Koster Maria P H
Published: June 2013

Objective

To compare the incidences of preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems (ie, placenta praevia, placental abruption and retained placenta) and postpartum haemorrhage between women with and without a history of pregnancy termination.

Design

 A retrospective cohort study using aggregated data from a national perinatal registry.

Setting

All midwifery practices and hospitals in the Netherlands.

Participants

All pregnant women with a singleton pregnancy without congenital malformations and a gestational age of ≥20 weeks who delivered between January 2000 and December 2007.

Main outcome measures

Preterm delivery, cervical incompetence treated by cerclage, placenta praevia, placental abruption, retained placenta and postpartum haemorrhage.

Results

A previous pregnancy termination was reported in 16 000 (1.2%) deliveries. The vast majority of these (90–95%) were performed by surgical methods. The incidence of all outcome measures was significantly higher in women with a history of pregnancy termination. Adjusted ORs (95% CI) for cervical incompetence treated by cerclage, preterm delivery, placental implantation or retention problems and postpartum haemorrhage were 4.6 (2.9 to 7.2), 1.11 (1.02 to 1.20), 1.42 (1.29 to 1.55) and 1.16 (1.08 to 1.25), respectively. Associated numbers needed to harm were 1000, 167, 111 and 111, respectively. For any listed adverse outcome, the number needed to harm was 63.

Conclusions

In this large nationwide cohort study, we found a positive association between surgical termination of pregnancy and subsequent preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems and postpartum haemorrhage in a subsequent pregnancy. Absolute risks for these outcomes, however, remain small. Medicinal termination might be considered first whenever there is a choice between both methods.
Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study
Authors: Dahlen Hannah , Priddis Holly , Schmied Virginia , Sneddon Anne , Kettle Christine , Brown Chris , Thornton Charlene
Published: June 2013

Objectives

To determine trends and risk factors for severe perineal trauma between 2000 and 2008.

Design

This was a population-based data study.

Setting

New South Wales, Australia.

Participants

510 006 women giving birth to a singleton baby during the period 2000–2008.

Main outcome measures

Rates of severe perineal trauma between 2000 and 2008 and associated demographic, fetal, antenatal, labour and delivery events and factors.

Results

There was an increase in the overall rate of severe perineal trauma from 2000 to 2008 from 1.4% to 1.9% (36% increase). Compared with women who were intact or had minor perineal trauma (first-degree tear, vaginal graze/tear), women who were primiparous (adjusted OR (AOR) 1.8 CI (1.65 to 1.95), were born in China or Vietnam (AOR 1.1 CI (1.09 to 1.23), gave birth in a private hospital (AOR 1.1 CI (1.03 to 1.20), had an instrumental birth (AOR 1.8 CI (1.65 to 1.95) and male baby (AOR 1.3 CI (1.27 to 1.34) all had a significantly higher risk of severe perineal trauma. Only giving birth to a male baby, adjusted for birth weight (AOR 1.5 CI (1.44 to 1.58), remained significant, when women with severe perineal trauma were compared with all other women not experiencing severe perineal trauma. This association increased over the study period.

Conclusions

To our knowledge, this is the first time that having a male baby has been found to exert such a strong independent risk for severe perineal trauma and the increasing significance of this in recent years needs further exploration.
The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial
Authors: Abbaszadeh-Amirdehi Maryam , Ansari Noureddin Nakhostin , Naghdi Soofia , Olyaei Gholamreza , Nourbakhsh Mohammad Reza
Published: June 2013

Introduction

Dry needling (DN) is an effective method for the treatment of myofascial trigger points (MTrPs). There is no report on the neurophysiological effects of DN in patients with MTrPs. The aim of the present study will be to assess the immediate neurophysiological efficacy of deep DN in patients with upper trapezius MTrPs.

Methods and analysis

A prospective, controlled clinical trial was designed to include patients with upper trapezius MTrPs and volunteered healthy participants to receive one session of DN. The primary outcome measures are neuromuscular junction response and sympathetic skin response. The secondary outcomes are pain intensity and pressure pain threshold. Data will be collected at baseline and immediately after intervention.

Ethics and dissemination

This study protocol has been approved by the Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences. The results of the study will be disseminated in a peer-reviewed journal and presented at international congresses.
A 12-month incidence of exercise-related injuries in previously sedentary community-dwelling older adults following an exercise intervention
Authors: Little Robert M D , Paterson Donald H , Humphreys David A , Stathokostas Liza
Published: June 2013

Objectives

Fear of injury is reported as a barrier to exercise by older adults. However, the literature is limited in describing exercise injuries in older adults.

Design

This study prospectively evaluated the 12-month incidence of exercise-related injuries to community-dwelling older adults (n=167 respondents; 63 men, 104 women; mean age 69±5 year).

Methods

A questionnaire developed for use in older adults was administered to document self-reported injuries. Linear regression analysis was conducted to identify covariates related to injury outcomes.

Results

23 people (14%) reported injuries. 41% of injuries were to the lower extremities, where the most common type was overuse muscle strains (32%, n=7). Overexertion was the most common cause of injury (n=9) and walking accounted for half of the activities during which injury occurred. 70% of injuries required medical treatment. 44% were not able to continue exercising after injury and return-to-activity time varied from 1 to 182 days. Sex, age and exercise volume were not significantly associated with injury occurrence.

Conclusions

These results showed similar, or lower, exercise-related injury rates as compared with previous reports on younger and middle-aged adults; however, the definition of, and criteria for, ‘injury’ reporting varies in the literature. This study indicates that older adults taking up exercise are not at increased risk of injury versus younger age groups.
Social determinants of syphilis in South China: the effect of sibling position on syphilis and sexual risk behaviours
Authors: Tucker Joseph D , Young Darwin , Yang Ligang , Yang Bin , Adimora Adaora A
Published: June 2013

Objective

This study evaluated the relationship between sibling position and sexual risk based on behavioural and syphilis infection data from sexually transmitted infection (STI) patients in South China.

Design

A cross-sectional study examining sexual behaviours and syphilis infection.

Setting

4 STI clinics in the Pearl River Delta of South China.

Participants

1792 Chinese men and women attending STI clinics.

Primary outcome measures

STI history, syphilis infection defined as positive non-treponemal and treponemal tests.

Results

Among all clinic patients, 824 (46.3%) were first-born, 354 (19.9%) were middle-born and 602 (33.8%) were final-born. Middle-born individuals had a higher percentage of reported STI history (44.7% compared to 34.7%, p<0.001) and syphilis infection (9.7% compared to 4.9%, p=0.01) among men (n=1163) compared to other sibling positions in bivariate analyses, but not in the final multivariate model. The relationship between sibling position and syphilis was independent of income and education level. There was no trend observed between middle-born position and female sexual risk behaviours (n=626). Higher education was significantly associated with syphilis among women and men in respective multivariate models.

Conclusions

This study suggests that middle-born men in China may have an increased sexual risk compared to other sibling positions. As Chinese family and social structures change, a more thorough understanding of how demographic factors influence sexual risk behaviours is needed.
Costs of surgical procedures in Indian hospitals
Authors: Chatterjee Susmita , Laxminarayan Ramanan
Published: June 2013

Objective

Despite a growing volume of surgical procedures in low-income and middle-income countries, the costs of these procedures are not well understood. We estimated the costs of 12 surgical procedures commonly conducted in five different types of hospitals in India from the provider perspective, using a microcosting method.

Design

Cost and utilisation data were collected retrospectively from April 2010 to March 2011 to avoid seasonal variability.

Setting

For this study, we chose five hospitals of different types: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed district hospital, a 655-bed private teaching hospital and a 778-bed tertiary care teaching hospital based on their willingness to cooperate and data accessibility. The hospitals were from four states in India. The private, charitable and tertiary care hospitals serve urban populations, the district hospital serves a semiurban area and the private teaching hospital serves a rural population.

Results

Costs of conducting lower section caesarean section ranged from rupees 2469 to 41 087; hysterectomy rupees 4124 to 57 622 and appendectomy rupees 2421 to 3616 (US$1=rupees 52). We computed the costs of conducting lap and open cholecystectomy (rupees 27 732 and 44 142, respectively); hernia repair (rupees 13 204); external fixation (rupees 8406); intestinal obstruction (rupees 6406); amputation (rupees 5158); coronary artery bypass graft (rupees 177 141); craniotomy (rupees 75 982) and functional endoscopic sinus surgery (rupees 53 398).

Conclusions

Estimated costs are roughly comparable with rates of reimbursement provided by the Rashtriya Swasthya Bima Yojana (RSBY)—India's government-financed health insurance scheme that covers 32.4 million poor families. Results from this type of study can be used to set and revise the reimbursement rates.
Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977–2010
Authors: Guldberg Rikke , Wehberg Sonja , Skovlund Charlotte Wessel , Mogensen Ole , Lidegaard Øjvind
Published: June 2013

Objective

To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation.

Design

A historical cohort study.

Setting

Denmark.

Participants

170 000 randomly selected women born 1947–1963 (10 000/year) were followed from 1977 until the end of 2010.

Main outcome measures

Effect of hysterectomy with retained fallopian tubes or sterilisation on the risk of salpingectomy. Both were modelled in a Cox proportional hazards model as time-dependent covariates, analysing time to first salpingectomy. End of follow-up period was 31 December 2010.

Results

Of 9591 hysterectomies, 6456 (67.3%) had both fallopian tubes retained. HRs for salpingectomy after hysterectomy with retained fallopian tubes and sterilisation were 2.13 (95% 1.88 to 2.42) and 2.42 (2.21 to 2.64), as compared with those for non-hysterectomised and non-sterilised women.

Conclusions

Women undergoing hysterectomy with retained fallopian tubes or sterilisation have at least a doubled risk of subsequent salpingectomy. Removal of the fallopian tubes at hysterectomy should therefore be recommended.
Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy
Authors: Duarte Rui V , Raphael Jon H , Southall Jane L , Labib Mourad H , Whallett Andrew J , Ashford Robert L
Published: June 2013

Objectives

This study aimed to investigate the hypothalamic-pituitary-gonadal axis in a sample of male patients undertaking intrathecal opioid delivery for the management of chronic non-malignant pain and the presence of osteopaenia and/or osteoporosis in those diagnosed with hypogonadism.

Design

Observational study using health data routinely collected for non-research purposes.

Setting

Department of Pain Management, Russells Hall Hospital, Dudley, UK.

Patients

Twenty consecutive male patients attending follow-up clinics for intrathecal opioid therapy had the gonadal axis evaluated by measuring their serum luteinising hormone, follicle stimulating hormone, total testosterone, sex hormone binding globulin and calculating the free testosterone level. Bone mineral density was measured by DEXA scanning in those patients diagnosed with hypogonadism.

Results

Based on the calculated free testosterone concentrations, 17 (85%) patients had biochemical hypogonadism with 15 patients (75%) having free testosterone <180 pmol/L and 2 patients (10%) between 180 and 250 pmol/L. Bone mineral density was assessed in 14 of the 17 patients after the exclusion of 3 patients. Osteoporosis (defined as a T score ≤−2.5 SD) was detected in three patients (21.4%) and osteopaenia (defined as a T score between −1.0 and −2.5 SD) was observed in seven patients (50%). Five of the 14 patients (35.7%) were at or above the intervention threshold for hip fracture.

Conclusions

This study suggests an association between hypogonadism and low bone mass density in patients undertaking intrathecal opioid delivery for the management of chronic non-malignant pain. Surveillance of hypogonadism and the bone mineral density levels followed by appropriate treatment may be of paramount importance to reduce the risk of osteoporosis development and prevention of fractures in this group of patients.
Identification of acute myocardial infarction from electronic healthcare records using different disease coding systems: a validation study in three European countries
Authors: Coloma Preciosa M , Valkhoff Vera E , Mazzaglia Giampiero , Nielsson Malene Schou , Pedersen Lars , Molokhia Mariam , Mosseveld Mees , Morabito Paolo , Schuemie Martijn J , van der Lei Johan , Sturkenboom Miriam , Trifirò Gianluca ,   on behalf of the EU-ADR Consortium
Published: June 2013

Objective

To evaluate positive predictive value (PPV) of different disease codes and free text in identifying acute myocardial infarction (AMI) from electronic healthcare records (EHRs).

Design

Validation study of cases of AMI identified from general practitioner records and hospital discharge diagnoses using free text and codes from the International Classification of Primary Care (ICPC), International Classification of Diseases 9th revision-clinical modification (ICD9-CM) and ICD-10th revision (ICD-10).

Setting

Population-based databases comprising routinely collected data from primary care in Italy and the Netherlands and from secondary care in Denmark from 1996 to 2009.

Participants

A total of 4 034 232 individuals with 22 428 883 person-years of follow-up contributed to the data, from which 42 774 potential AMI cases were identified. A random sample of 800 cases was subsequently obtained for validation.

Main outcome measures

PPVs were calculated overall and for each code/free text. ‘Best-case scenario’ and ‘worst-case scenario’ PPVs were calculated, the latter taking into account non-retrievable/non-assessable cases. We further assessed the effects of AMI misclassification on estimates of risk during drug exposure.

Results

Records of 748 cases (93.5% of sample) were retrieved. ICD-10 codes had a ‘best-case scenario’ PPV of 100% while ICD9-CM codes had a PPV of 96.6% (95% CI 93.2% to 99.9%). ICPC codes had a ‘best-case scenario’ PPV of 75% (95% CI 67.4% to 82.6%) and free text had PPV ranging from 20% to 60%. Corresponding PPVs in the ‘worst-case scenario’ all decreased. Use of codes with lower PPV generally resulted in small changes in AMI risk during drug exposure, but codes with higher PPV resulted in attenuation of risk for positive associations.

Conclusions

ICD9-CM and ICD-10 codes have good PPV in identifying AMI from EHRs; strategies are necessary to further optimise utility of ICPC codes and free-text search. Use of specific AMI disease codes in estimation of risk during drug exposure may lead to small but significant changes and at the expense of decreased precision.
Early life bereavement and childhood cancer: a nationwide follow-up study in two countries
Authors: Momen Natalie C , Olsen Jørn , Gissler Mika , Cnattingius Sven , Li Jiong
Published: June 2013

Objective

Childhood cancer is a leading cause of child deaths in affluent countries, but little is known about its aetiology. Psychological stress has been suggested to be associated with cancer in adults; whether this is also seen in childhood cancer is largely unknown. We investigated the association between bereavement as an indicator of severe childhood stress exposure and childhood cancer, using data from Danish and Swedish national registers.

Design

Population-based cohort study.

Setting

Denmark and Sweden.

Participants

All live-born children born in Denmark between 1968 and 2007 (n=2 729 308) and in Sweden between 1973 and 2006 (n=3 395 166) were included in this study. Exposure was bereavement by the death of a close relative before 15 years of age. Follow-up started from birth and ended at the first of the following: date of a cancer diagnosis, death, emigration, day before their 15th birthday or end of follow-up (2007 in Denmark, 2006 in Sweden).

Outcome measures

Rates and HRs for all childhood cancers and specific childhood cancers.

Results

A total of 1 505 938 (24.5%) children experienced bereavement at some point during their childhood and 9823 were diagnosed with cancer before the age of 15 years. The exposed children had a small (10%) increased risk of childhood cancer (HR 1.10; 95% CI 1.04 to 1.17). For specific cancers, a significant association was seen only for central nervous system tumours (HR 1.14; 95% CI 1.02 to 1.28).

Conclusions

Our data suggest that psychological stress in early life is associated with a small increased risk of childhood cancer.
Adjusting the obesity thresholds for self-reported BMI in Ireland: a cross-sectional analysis
Authors: Madden David
Published: June 2013

Objective

To investigate the optimal adjustment to be made to obesity thresholds when using self-reported body mass index (BMI).

Design

A cross-sectional study.

Setting

Data from the Survey of Lifestyle, Attitudes and Nutrition in Ireland, a nationally representative dataset using the Geodirectory (a listing of all residential addresses in Ireland compiled by the postal service) as the sampling frame.

Participants

A nationally representative sample of 10 364 adults aged 18+, carried out by face-to-face interview with clinical measurement applied to a number of outcomes to a representative subsample of 2174. After discarding the observations with missing values and errors, the eventual sample was 1874.

Primary and secondary outcome measures

BMI based on measured and self-reported weight and height.

Background

It is generally found that self-reported BMI understates true or measured BMI and accordingly revised obesity thresholds have been suggested.

Methods

Data from the 2007 Survey of Lifestyles, Attitudes and Nutrition in Ireland were used to analyse self-reported and measured BMI. The self-reported BMI threshold was adjusted to obtain the optimal signal for measured BMI using different criteria viz. efficiency (maximum number of correct classifications), maximisation of Youden's J, maximisation of OR, minimisation of cost of misclassification and constrained optimisation.

Results

The optimal threshold differed substantially depending on the criterion adopted for choosing it, with thresholds of 29.1 (efficiency criterion), 27.5 (Youden's J) and 26.0 (FN rate of 5%). Standard criteria such as Youden's J index were shown to implicitly impose relative costs of false-negatives and false-positives which may not always correspond to the values of the analyst.

Conclusions

When adjusting self-reported BMI thresholds in order to obtain the optimal signal for ‘true’ obesity, analysts should explicitly choose the relative costs of false-positives and false-negatives.
Canadian Study of Determinants of Endometabolic Health in ChIlDrEn (CanDECIDE study): a cohort study protocol examining the mechanisms of obesity in survivors of childhood brain tumours
Authors: Samaan M Constantine , Thabane Lehana , Burrow Sarah , Dillenburg Rejane F , Scheinemann Katrin
Published: June 2013

Background

Childhood obesity has reached epidemic proportions and is impacting children's health globally. In adults, obesity is associated with chronic low-grade inflammation that leads to insulin resistance, which is one of the important mechanisms through which dysregulation of metabolism occurs. There is limited information available about the contribution of inflammation to metabolic health in obese children, and how individual and lifestyle factors impact this risk. One of the paediatric groups at risk of higher rates of obesity includes the survivors of childhood brain tumours. The aim of this study was to evaluate the mechanisms that contribute to inflammation in obese survivors of childhood brain tumours.

Methods and analysis

This is a prospective cohort study. We will recruit lean and obese survivors of childhood brain tumours, and a control group composed of lean and obese children with no history of tumours. We will measure circulating and urinary cytokine levels and cytokine gene expression in monocytes. In addition, the methylation patterns of cytokine genes and that of toll-like receptor genes will be evaluated. These will be correlated with individual and lifestyle factors including age, sex, ethnicity, puberty, body mass index, fasting lipid levels, insulin sensitivity, diet, exercise, sleep, stress and built environment. The sample size calculation showed that we need 25 participants per arm

Ethics and dissemination

This study has received ethics approval from the institutional review board. Once completed, we will publish this work in peer-reviewed journals and share the findings in presentations and posters in meetings.

Discussion

This study will permit the interrogation of inflammation as a contributor to obesity and its complications in obese survivors of childhood brain tumours and compare them with lean survivors and lean and obese controls with no history of tumours, which may help identify therapeutic and preventative interventions to combat the rising tide of obesity.
Inattention and hyperactivity in children at risk of obesity: a community cross-sectional study
Authors: McWilliams Lorna , Sayal Kapil , Glazebrook Cris
Published: June 2013

Objective

There is a link between the symptoms of hyperactivity/inattention and overweight in children. Less is known about the factors which might influence this relationship, such as physical and sedentary activity levels or exercise self-efficacy. The aim of this study is to examine the associations between the symptoms of hyperactivity/inattention and risk factors for adult obesity in a sample of children with barriers to exercise.

Design

Children aged 9–11 years were recruited from 24 primary schools that participated in the Steps to Active Kids (STAK) physical activity intervention study. Study inclusion criteria were low exercise self-efficacy, teacher-rated overweight or asthma. Children with high levels of physical activity were excluded. Measures included parent and teacher-rated behavioural and emotional well-being using the Strengths and Difficulties Questionnaire, physical and sedentary activity levels, BMI (body mass index) and exercise self-efficacy.

Results

Of 424 participating children, 62% were girls and 39% were classified as overweight or obese. As compared with population norms, boys in this at-risk sample were more likely to receive an abnormal teacher-rated hyperactivity/inattention score (OR 1.48, 95% CI 1.01 to 2.17). Children with teacher-rated abnormal hyperactivity/inattention scores reported higher levels of sedentary activity (OR 1.13, 95% CI 1.02 to 1.17), but not physically active activity. The pattern of findings was similar for children with hyperactivity/inattention problems as rated by both parent and teacher (pervasive hyperactivity and impairment).

Conclusions

Although BMI was not directly related to hyperactivity/inattention, children with risk factors for adult obesity have more hyperactivity/inattention problems. In particular, hyperactivity/inattention is associated with higher levels of sedentary activity. Higher rates of pervasive hyperactivity and impairment were apparent in this at-risk group.
Influence of the US President’s Emergency Plan for AIDS Relief (PEPfAR) on career choices and emigration of health-profession graduates from a Ugandan medical school: a cross-sectional study
Authors: Bajunirwe Francis , Twesigye Leonidas , Zhang Michael , Kerry Vanessa B , Bangsberg David R
Published: June 2013

Objective

The purpose of this study was to determine the current work distribution of health professionals from a public Ugandan medical school in a period of major donor funding for HIV programmes. We explore the hypothesis that programmes initiated under unprecedented health investments from the US President's Emergency Plan for AIDS Relief have possibly facilitated the drain of healthcare workers from the public-health system of countries like Uganda.

Design

Cross-sectional study conducted between January and December 2010 to survey graduates, using in-person, phone or online surveys using email and social networks. Logistic regression analysis was applied to determine ORs for association between predictors and outcomes.

Setting

Located rurally, Mbarara University of Science and Technology (MUST) is one of three government supported medical schools in Uganda.

Participants

Graduates who completed a health-related degree at MUST.

Main outcome measure

Location of health profession graduates (Uganda or abroad) and main field of current job (HIV-related non-governmental organisation (NGO) or others).

Results

We interviewed 85.4% (n=796) of all MUST alumni since the university opened in 1989. 78% (n=618) were physicians and 12% (n=94) of graduates worked outside Uganda. Over 50% (n=383) of graduates worked for an HIV-related NGO whether in Uganda or abroad. Graduates receiving their degree after 2005, when large HIV programmes started, were less likely to leave the country, OR=0.24 (95% CI 0.1 to 0.59) but were more likely to work for an HIV-related NGO, OR=1.53 (95% CI 1.06 to 2.23).

Conclusions

A majority of health professionals surveyed work for an HIV-related NGO. The increase in resources and investment in HIV-treatment capacity is temporally associated with retention of medical providers in Uganda. Donor funds should be channelled to develop and retain healthcare workers in disciplines other than HIV and broaden the healthcare workforce to other areas.
What can qualitative research do for randomised controlled trials? A systematic mapping review
Authors: O'Cathain A , Thomas K J , Drabble S J , Rudolph A , Hewison J
Published: June 2013

Objective

To develop an empirically based framework of the aspects of randomised controlled trials addressed by qualitative research.

Design

Systematic mapping review of qualitative research undertaken with randomised controlled trials and published in peer-reviewed journals.

Data sources

MEDLINE, PreMEDLINE, EMBASE, the Cochrane Library, Health Technology Assessment, PsycINFO, CINAHL, British Nursing Index, Social Sciences Citation Index and ASSIA.

Eligibility criteria

Articles reporting qualitative research undertaken with trials published between 2008 and September 2010; health research, reported in English.

Results

296 articles met the inclusion criteria. Articles focused on 22 aspects of the trial within five broad categories. Some articles focused on more than one aspect of the trial, totalling 356 examples. The qualitative research focused on the intervention being trialled (71%, 254/356); the design, process and conduct of the trial (15%, 54/356); the outcomes of the trial (1%, 5/356); the measures used in the trial (3%, 10/356); and the target condition for the trial (9%, 33/356). A minority of the qualitative research was undertaken at the pretrial stage (28%, 82/296). The value of the qualitative research to the trial itself was not always made explicit within the articles. The potential value included optimising the intervention and trial conduct, facilitating interpretation of the trial findings, helping trialists to be sensitive to the human beings involved in trials, and saving money by steering researchers towards interventions more likely to be effective in future trials.

Conclusions

A large amount of qualitative research undertaken with specific trials has been published, addressing a wide range of aspects of trials, with the potential to improve the endeavour of generating evidence of effectiveness of health interventions. Researchers can increase the impact of this work on trials by undertaking more of it at the pretrial stage and being explicit within their articles about the learning for trials and evidence-based practice.