bluuebunny/crossref_metadata_2025 huggingface dataset:
Chinese residents’ educational disparity and social insurance coverage
Authors: Lee Yen-Han , Chiang Timothy , Shelley Mack , Liu Ching-Ti
Published: August 2018

Purpose

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.

Design/methodology/approach

Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.

Findings

The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.

Practical implications

The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.

Originality/value

This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.
Fostering a healthcare sector quality and safety culture
Authors: Santa Ricardo , Borrero Silvio , Ferrer Mario , Gherissi Daniela
Published: August 2018

Purpose

Quality issues, increasing patient expectations and unsatisfactory media reports are driving patient safety concerns. Developing a quality and safety culture (QSC) is, therefore, crucial for patient and staff welfare, and should be a priority for service providers and policy makers. The purpose of this paper is to identify the most important QSC drivers, and thus propose appropriate operational actions for Saudi Arabian hospital managers and for managers in healthcare institutions worldwide.

Design/methodology/approach

Quantitative data from 417 questionnaires were analyzed using structural equation modeling. Respondents were selected from various hospitals and managerial positions at a national level.

Findings

Findings suggest that error feedback (FAE) and communication quality (QC) have a strong role fostering or enhancing QSC. Findings also show that fearing potential punitive responses to mistakes made on the job, hospital staff are reluctant to report errors.

Practical implications

To achieve a healthcare QSC, managers need to implement preemptive or corrective actions aimed at ensuring prompt and relevant feedback about errors, ensure clear and open communication and focus on continuously improving systems and processes rather than on failures related to individual performance.

Originality/value

This paper adds value to national healthcare, as Saudi study results are probably generalizable to other healthcare systems throughout the world.
Audit and feedback in mental healthcare: staff experiences
Authors: Pedersen Monica Stolt , Landheim Anne , Møller Merete , Lien Lars
Published: August 2018

Purpose

Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences.

Design/methodology/approach

This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis.

Findings

Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator.

Practical implications

Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles.

Originality/value

Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle.
Reducing pharmacy patient waiting time
Authors: Alam Shoaib , Osama Muhammad , Iqbal Faheem , Sawar Irfan
Published: August 2018

Purpose

Pharmacy services start right from prescribing medicines and continue as the medication’s effect is monitored. Hospital and community pharmacy staff promote rational prescribing and medicine use. Consequentially, pharmacy is a complex and busy field. Often there are peak workload hours when patients must wait, which is associated with patient dissatisfaction that may negatively affect patient experience and the organisation’s reputation. The purpose of this paper is to enlist techniques, methods and technological advancements that have been successfully employed to reduce patient waiting time.

Design/methodology/approach

A database search was conducted in 2017 to locate articles addressing methods and technologies that reduce pharmacy waiting time. The literature revealed various techniques and technologies like queuing theory, tele-pharmacy, evidence-based pharmacy design, automated pharmacy systems (robotics), system modelling and simulation and the Six Sigma method for identifying potential problems associated with increased wait time.

Findings

The authors conclude that various techniques and methods, including automated queuing technology, tele-pharmacy, automated pharmacy devices/machines for quick and accurate filling and dispensing, computer simulation modelling, evidence-based pharmacy infrastructure for smooth workflow and Six Sigma can maintain customer satisfaction, reduce waiting time, attract new customers, decrease workload and improve the organisation’s reputation.

Practical implications

The authors conclude that various techniques and methods, including automated queuing technology, tele-pharmacy, automated pharmacy devices/machines for quick and accurate filling and dispensing, computer simulation modelling, evidence-based pharmacy infrastructure for smooth workflow and Six Sigma methodology can maintain customer satisfaction, reduce waiting time, attract new customers, decrease workload and improve the organisation’s reputation.

Originality/value

The authors carried out a literature search and identified the techniques that have been successfully implemented to reduce pharmacy patient waiting time and methods that can identify potential process behind medication dispensation delays.
Accreditation in one teaching hospital: a phenomenology study among Iranian nurses
Authors: Saadati Mohammad , Bahadori Mohammadkarim , Teymourzadeh Ehsan , Ravangard Ramin , Alimohammadzadeh Khalil , Mojtaba Hosseini Seyed
Published: August 2018

Purpose

Accreditation helps to ensure safe and high-quality services in hospitals. Different occupational groups have various hospital accreditation experiences. The purpose of this paper is to investigate nurses’ accreditation experience and its effects on Iranian teaching hospital service quality.

Design/methodology/approach

This was a qualitative study involving a phenomenological approach to studying nurses’ hospital accreditation experience and understanding the effects on Iranian teaching hospital service quality. Data were collected using two focus groups in which nurses were selected using purposive sampling. Transcripts were analyzed using content analysis.

Findings

Nurses’ experiences showed that hospital administrators and nurses had greater role in implementing accreditation than other occupational groups. Accreditation improved patient-centeredness, patient safety, logistics and managerial processes and decision making. However, a weak incentive system, extra documentation and work stress were negative experiences.

Practical implications

Nurse experience, as the most important care team member, reveals accreditation’s strengths and weaknesses and its effects on service quality.

Originality/value

The author used a phenomenology approach to measure accreditation effects on service quality – a valuable tool for understanding a phenomenon among those that experience hospital accreditation processes.
My heart has no hurt: the health of young immigrants
Authors: Bergstrom-Wuolo Maya , Dahlström Josefin , Hertting Krister , Kostenius Catrine
Published: August 2018

Purpose

The purpose of this paper is to explore health from the perspective of young immigrants in Sweden.

Design/methodology/approach

A total of 25 newly arrived young immigrants attending Swedish language classes in northern Sweden participated by drawing and writing open letters. They continued the open-ended sentence “Now I’ll draw and describe a day when I was feeling good, that was […].”

Findings

The phenomenological analysis resulted in three themes: longing to be in control for a better life, searching for power in the good and the bad, and striving for a sense of belonging in the new society. The findings illuminate young immigrants’ perspectives of a health-promoting everyday life consisting of agency, reflection and a sense of community. The findings also highlight the young immigrants’ experiences when health-promoting aspects are lacking, characterized by disillusionment, anxiety and loneliness. The findings are discussed with health promotion, health literacy and young immigrants in mind.

Practical implications

According to young immigrants, meeting basic needs such as food, sleep and housing is health promoting but easily taken for granted. Being able to have a say in matters concerning everyday life, social inclusion and finding power in memories – positive and negative – can promote health in young immigrants.

Originality/value

The young immigrants were able to communicate via drawings and words to overcome language barriers.
The integration of immigrant nurses at the workplace in Malta: a case study
Authors: Buttigieg Sandra C. , Agius Kevin , Pace Adriana , Cassar Maria
Published: August 2018

Purpose

The purpose of this paper is to identify the extent to which immigrant nurses have integrated within the Maltese healthcare system.

Design/methodology/approach

This research consisted of a qualitative case study approach which was conducted within Malta’s four public entities in the secondary care sector. In this case study, data were collected through 34 semi-structured interviews with ten nursing managers, 12 Maltese nurses and 12 immigrant nurses. The data were analysed using content analysis. Data were collected between June 2015 and July 2015.

Findings

Four themes emerged from the data. These were: human resources management, language barrier, cultural differences and discrimination. The recruitment of nurses to Malta from other countries translated into several positive and favourable outcomes, such as the sharing of knowledge. However, a number of negative and unfavourable outcomes are also indicated in the data including language barrier and discrimination.

Research limitations/implications

This paper presents a discussion of the issues experienced within a healthcare system in relation to the mobility of nurses. Increasingly, the nursing workforce across the globe comprises of professionals from various nationality, origin, training, culture and professional ethos. The findings are presented in an effort to inform policy makers, management and administrative structures regarding the issues pertaining to the prevalent growing reality of mobility in nurse populations.

Originality/value

This research study provides a unique contribution to the literature regarding the phenomenon of nurse mobility because it embraces the integration of nurses as a two-way process. Since data was collected from immigrant nurses as well as from local nurses and nursing managers, this study hopes to offer a different point of view from previous studies which largely focused on the views of immigrant nurses only.
Impact of condition monitoring on reciprocating compressor efficiency
Authors: Townsend Jim , Badar M. Affan
Published: August 2018

Purpose

Reciprocating compressors offer an efficient method of compressing almost any gas composition in a wide range of pressures and have numerous applications. Condition monitoring of critical rotating machinery is widely accepted by operators of centrifugal compressors. However, condition monitoring of reciprocating machinery has not received the same degree of acceptance. An earlier study (Townsend et al., 2016) was conducted on temperature monitoring. The purpose of this paper is to examine the impact of continuous pressure monitoring on electric-driven compressors.

Design/methodology/approach

This research analyzes the impact of continuous pressure monitoring on a fleet of 14 compressors transporting CO2 for enhanced oil recovery. The reliability and efficiency data on 14 reciprocating compressors over a three-year period were analyzed for failures detectable by the condition monitoring technology. The engineering economic analysis is presented to determine the impact this technology will have on the productivity of the compressors.

Findings

The study considers utilizing condition monitoring technology to analyze the pressure of the swept volume of the compressor cylinders. The results of the study indicate that continuous pressure monitoring technology has a strong impact on the productivity of the compressor fleet. The internal rate of return not only exceeds the operators hurdle rate, but the payback period is also dramatic. Pressure monitoring was found to be economically better than temperature monitoring.

Originality/value

The study reveals the economic benefits of implementing condition monitoring in the form of continuous pressure monitoring on reciprocating compressors.
Development of framework for just-in-time implementation in maintenance
Authors: Phogat Sandeep , Gupta Anil Kumar
Published: August 2018

Purpose

The purpose of this paper is to propose an interpretive structural modeling (ISM) model which highlights the relationships between the identified just-in-time (JIT) elements useful for the implementation of JIT in maintenance and understand mutual influences of these identified JIT elements on JIT implementation in maintenance. Further, this paper seeks to identify dependence power and driving power of identified JIT elements using an ISM and Matrice d’Impacts Croisés Multiplication Appliquée á un Classement (MICMAC) analysis.

Design/methodology/approach

The methodology used in the paper is ISM with a view to evolving mutual relationships among JIT elements. The identified JIT elements have been further classified, based on their dependence power and driving power using MICMAC analysis.

Findings

This paper has developed the relationships among 16 identified JIT elements using the ISM methodology. Further, this paper analyses the driving power and dependence power of identified JIT elements with the help of MICMAC analysis. The incorporated approach is developed here, as the ISM provides only binary correlation among identified JIT elements. The MICMAC analysis is adopted here as it is useful in specific examination related to driving and the dependence power of identified JIT elements. The ISM developed model and MICMAC analysis finding are validated with the help of industrial experts.

Research limitations/implications

The weightage and validation for the ISM and MICMAC analysis are obtained throughout the opinion of academics and industry experts. Further hypothesis may be conducted to examine the validity of the planned model, and structural model may also be validated statistically with the help of structural equation modeling.

Practical implications

The ISM model development and MICMAC analysis of identified JIT elements provide academics and maintenance managers a macro picture of the profits gained by the organizations by the implementation of JIT in maintenance of an organization.

Originality/value

The results will be useful for maintenance managers to understand the process of implementation of JIT in maintenance and to gain benefits after the implementation of JIT in maintenance of an organization.
A decision model for warranted second-hand products considering upgrade level, past age, preventive maintenance and sales volume
Authors: Darghouth Mohamed N. , Chelbi Anis
Published: August 2018

Purpose

The purpose of this paper is to present a decision model for second-hand products to determine the optimal upgrade level, warranty period and preventive maintenance (PM) effort level which maximize the total expected profit generated by the dealer considering any given past age of the product and the effect of the sales volume.

Design/methodology/approach

A mathematical model is developed to derive the optimal triplet: upgrade level, warranty period and PM effort level, which maximize the total expected profit generated by the dealer for any second-hand product with a given past age. Numerical experimentations have been conducted to investigate the effectiveness of the proposed model and to explore the interactions among the model variables.

Findings

Numerical experimentations including a sensitivity analysis have been conducted on the model key parameters. The obtained results show that performing PM actions during the warranty period helps the dealers to provide extended warranty for older second-hand products without spending a significant effort on upgrade actions and therefore increase the volume of sales. Also, the interaction between the PM level and the profit margin threshold is demonstrated. Finally, the effect of the sales volume function parameters (the price and warranty elasticity parameters) on the optimal solution is characterized.

Research limitations/implications

Given the complexity of the profit function to be maximized involving a considerable number of decision variables with different nature, the authors limited the study to the case where the past age of the second-hand product is known.

Practical implications

The proposed model aims to provide second-hand product dealers with a modeling framework that enables them to have a realistic estimation of the generated profit by integrating the marketing and engineering key parameters of the second-hand product.

Originality/value

Most of the existing literature dealing with the reliability improvement of second-hand products does not take into account the fact that a realistic estimation of the total profit generated by the dealer requires the consideration of the sales volume. The latter is closely related to the marketing parameters characterized by the warranty period length and the second-hand product selling price. The proposed model introduces the effect of the total sales volume on the total expected profit. The authors also introduce the concept of discrete upgrade levels for a better control of the restoration degree. The authors study the impact of warranty and price elasticity parameters on the optimal solution and the resultant interaction with the customer purchase decision and consequently the sales volume.
Putting the contradictions back into leadership development
Authors: Vince Russ , Pedler Mike
Published: August 2018

Purpose

The purpose of this paper is to outline an alternative view of leadership development that acknowledges the likelihood of unintended and contradictory outcomes in leadership work. Helping leaders to engage with contradictions is as important as developing their positive capabilities. A focus on the contradictions of leadership can help to address the emotional and political limitations that development programmes unwittingly impose on learning.

Design/methodology/approach

The paper discusses how leadership development currently falls short in helping people to lead in complex organizational environments. This argument is illustrated by examples taken from MBA teaching programme in a School of Management together with an analysis of contradictions in the National Health Service Healthcare Leadership Model. The final section gives four examples of how to put the contradictions back into leadership development.

Findings

The paper does not seek to present empirical findings. The illustrations support an argument for changes in practice. Examples are provided of a different approach to leadership development.

Originality/value

The paper critiques approaches to leadership development on the grounds of its relentless positivity regarding leadership behaviour and that focusses primarily on the development of individuals. Attention is called to the contradictions inherent in leadership work which extend to the leadership development process itself. Once acknowledged, these contradictions offer important leadership learning opportunities for both individuals and organizations.
Global non-fossil fuel consumption: driving factors, disparities, and trends
Authors: Chen Jiandong , Wu Yinyin , Xu Chong , Song Malin , Liu Xin
Published: August 2018

Purpose

Non-fossil fuels are receiving increasing attention within the context of addressing global climate challenges. Based on a review of non-fossil fuel consumption in major countries worldwide from 1985 to 2015, the purpose of this paper is to analyze trends for global non-fossil fuel consumption, share of fuel consumption and inequality.

Design/methodology/approach

The similarities were obtained between the logarithmic mean divisia index and the mean-rate-of-change index decomposition analysis methods, and a method was proposed for complete decomposition of the incremental Gini coefficient.

Findings

Empirical analysis showed that: global non-fossil fuel consumption accounts for a small share of the total energy consumption, but presents an increasing trend; the level of global non-fossil fuel consumption inequality is high but has gradually declined, which is mainly attributed to the concentration effect; inequality in global non-fossil fuel consumption is mainly due to the difference between nuclear power and hydropower consumption, but the contributions of nuclear power and hydropower to per capita non-fossil fuel consumption are declining; and population has the greatest influence on global non-fossil fuel consumption during the sampling period.

Originality/value

The main contribution of this study is its analysis of global non-fossil fuel consumption trends, disparities and driving factors. In addition, a general formula for complete index decomposition is proposed and the incremental Gini coefficient is wholly decomposed.
Fashioning clothing with and for mature women: a small-scale sustainable design business model
Authors: Townsend Katherine , Kent Anthony , Sadkowska Ania
Published: August 2018

Purpose

An ageing population in the developed world has become a significant topic in the contemporary research agenda. The purpose of this paper is to report on the development of a new small-scale business model based on facilitating in-depth understanding and responding to mature female consumers’ needs and expectations towards fashionable clothing.

Design/methodology/approach

Two complementary approaches are used: interpretative phenomenological analysis allows the researchers to employ the life-course perspective and to develop in-depth understanding of individuals’ present experiences in relation to their past. Action research offers the possibility to develop participatory, co-design processes based on collective creativity and mutual knowledge exchange between the stakeholders.

Findings

The research finds a strong interest in fashionable clothing by women, irrespective of their age. The action-based co-design process involving collaborative encounters with mature consumers creates a dynamic capability for alternative fashion design methodologies. This approach can contribute to a small-scale fashion business model for the mature women’s fashion market.

Practical implications

The women in the study stress the need for a more inclusive design process and expressed a willingness to buy from a brand/retailer who would offer them such a collaborative opportunity. There are practical implications for how a more flexible sizing approach to the design of fashion for older women could be implemented.

Originality/value

This research makes a contribution to practice-based design solutions for mature women and a new inclusive business model based on emotional durability. The innovative methodological approach contributes to the field of ethical and sustainable fashion design.
Sequential decline in fruit resource allocation within inflorescences of Sagittaria trifolia: a test of non‐uniform pollination hypothesis
Authors: Dai Can , Li Le‐Na , Wang Zheng‐Xiang , Liao Kuo
Published: August 2018

Flowering plants often exhibit declining resource investment to floral organs, fruits and seeds temporally or spatially in an inflorescence. To account for such variances, non‐uniform pollination hypothesis, which highlights various mating environments each flower experiences, provides adaptive significance for allocation patterns but with controversial supports. Sagittaria trifolia (Alismataceae) was used to examine differences in seed number, seed weight and germination rate among sequential fruits within inflorescences. Ovule number was also investigated to evaluate allocation patterns in the floral stage. To test the non‐uniform pollination hypothesis, we used three polymorphic microsatellite loci of S. trifolia to estimate the seed outcrossing rate in proximal and distal fruits. The results showed that the seed number, average seed weight and seed germination rate of S. trifolia gradually decreased from proximal to distal fruits within inflorescences. The percent of decrease in seed number between two contiguous fruits was 14.68 ± 3.22%, which was much stronger than the percent of decrease in ovule number at 6.95 ± 1.60%. Both proximal and distal fruits within inflorescences had high outcrossing rates (81.5 ± 5.0%, proximal; 82.3 ± 6.9%, distal) and they did not differ significantly. Overall, there was an acropetal decline of resource allocation to fruits within inflorescences of S. trifolia. Allocation pattern to ovules was not a limiting factor for seed production. The lack of difference in outcrossing rate between proximal and distal fruits indicated that the allocation strategy was probably not caused by non‐uniform pollination, but more likely position effects.
Genetic responses to carbon and nitrogen availability in Anabaena
Authors: Herrero Antonia , Flores Enrique
Published: August 2018

Heterocyst‐forming cyanobacteria are filamentous organisms that perform oxygenic photosynthesis and CO2 fixation in vegetative cells and nitrogen fixation in heterocysts, which are formed under deprivation of combined nitrogen. These organisms can acclimate to use different sources of nitrogen and respond to different levels of CO2. Following work mainly done with the best studied heterocyst‐forming cyanobacterium, Anabaena, here we summarize the mechanisms of assimilation of ammonium, nitrate, urea and N2, the latter involving heterocyst differentiation, and describe aspects of CO2 assimilation that involves a carbon concentration mechanism. These processes are subjected to regulation establishing a hierarchy in the assimilation of nitrogen sources –with preference for the most reduced nitrogen forms– and a dependence on sufficient carbon. This regulation largely takes place at the level of gene expression and is exerted by a variety of transcription factors, including global and pathway‐specific transcriptional regulators. NtcA is a CRP‐family protein that adjusts global gene expression in response to the C‐to‐N balance in the cells, and PacR is a LysR‐family transcriptional regulator (LTTR) that extensively acclimates the cells to oxygenic phototrophy. A cyanobacterial‐specific transcription factor, HetR, is involved in heterocyst differentiation, and other LTTR factors are specifically involved in nitrate and CO2 assimilation.
Mapping the Australian Poverty Profile: A Multidimensional Deprivation Approach
Authors: Saunders Peter , Naidoo Yuvisthi
Published: August 2018

The limitations of income‐based poverty lines are widely acknowledged, but Australia lags behind many other countries in implementing new measures of social disadvantage based on the deprivation approach. A new suite of questions included in wave 14 of the Household, Income and Labour Dynamics in Australia (HILDA) survey allows the deprivation approach to be applied. This article describes the advantages of the deprivation approach and shows that while the income and deprivation approaches can produce similar overall results, the circumstances of some sub‐groups vary greatly according to which measure is used. A measure based on deprivation alone and/or a combined measure would be an important complement to conventional income‐based poverty rates.
A prokaryotic–eukaryotic relation in the fat body of Bombus terrestris
Authors: Parmentier Anneleen , Billiet Annelies , Smagghe Guy , Vandamme Peter , Deforce Dieter , Van Nieuwerburgh Filip , Meeus Ivan
Published: August 2018

The interaction between the insect host and its microbiota plays a central role in insect health and is mostly studied in relation to the digestive system. Nonetheless, there are numerous microorganisms occupying multiple habitats in and on insects. We studied microbial communities in the gut and fat body of bumblebees (Bombus terrestris) using the V4 region of the 16S rRNA gene on the Illumina MiSeq platform. In one of the two study locations, the fat body microbial composition was marked by the dominant presence of Arsenophonus sp. and Phyllobacterium sp. Bumblebees infected with Apicystis bombi, a eukaryotic parasite multiplying in the fat body, had a significant higher relative abundance of Arsenophonus sp. compared with the non‐infected individuals. In general, the infection of A. bombi correlated with a more interlinked microbial association network, as we observed an increase of significant associations between the relative abundance of bacteria present in the gut and fat body of infected bumblebees. The causality within this potential prokaryotic–eukaryotic relation is important when assessing the health impact on bees.
Association between perioperative hyperoxia and cerebrovascular complications after laparotomy—A post‐hoc follow‐up study
Authors: Kongebro Emilie Katrine , Jorgensen Lars N. , Siersma Volkert D. , Meyhoff Christian Sahlholt
Published: August 2018

Background

Perioperative hyperoxia has been linked to increased long‐term mortality. Vasoconstrictive and cellular side effects to hyperoxia have been suggested to increase the risk of coronary and cerebral ischemia. The aim of this post‐hoc analysis of a large randomized trial was to compare the effects of 80% vs 30% perioperative oxygen on the long‐term risk of stroke or transient cerebral ischemia (TCI) in patients undergoing abdominal surgery.

Methods

A total of 1386 patients were randomized to 80% or 30% perioperative oxygen during acute or elective open abdominal surgery. Median follow‐up was 3.9 years. Primary outcome was a composite of the long‐term occurrence of stroke or TCI. Secondary outcomes included long‐term mortality without stroke or TCI, and incidences of neurological admission, psychiatric admission, and dementia. Outcomes were analyzed in Cox regression models.

Results

Stroke or TCI occurred in 20 (3.0%) patients given 80% oxygen vs 22 (3.2%) patients given 30% oxygen with an adjusted hazard ratio (HR) of 0.96 [95% CI 0.52‐1.76]. Composite secondary outcome of death, stroke, or TCI had a HR of 1.21 [95% CI 1.00‐1.47] for 80% compared to 30% oxygen. HRs for secondary outcomes were HR 1.14 [95% CI 0.79‐1.64] for neurological admission, 1.34 [95% CI 0.95‐1.88] for psychiatric admission and 0.54 [95% CI 0.16‐1.80] for dementia.

Conclusion

Stroke or TCI did not seem related to perioperative inspiratory oxygen fraction. Due to few events, this study cannot exclude that perioperative hyperoxia increases risk of mortality, stroke, or TCI after abdominal surgery.
Cloninger's Temperament Dimensions and Longitudinal Alcohol Use in Early Midlife: A Northern Finland Birth Cohort 1966 Study
Authors: Vladimirov Daniel , Niemelä Solja , Keinänen‐Kiukaanniemi Sirkka , Ala‐Mursula Leena , Auvinen Juha , Timonen Markku , Miettunen Jouko
Published: August 2018

Background

Temperament is theorized to be an important factor contributing to the development of alcohol use disorder, but longitudinal studies on how temperament is related to alcohol use among general population in midlife are scarce. Our aims were to investigate potentially reciprocal associations between temperament and changes in alcohol use from age 31 to 46 using prospective birth cohort data.

Method

Within the Northern Finland Birth Cohort 1966, alcohol use and temperament were studied at ages 31 and 46. Participants (N = 5,274) were classified into moderate users, abstainers and heavy users based on their mean alcohol use (g/d). Additionally, participants were categorized as steady users, reducers, or increasers. Multinomial regression analyses were conducted with Cloninger's Temperament and Character Inventory (TCI) scores as factors influencing alcohol use using moderate and stable users as reference groups. Reciprocity of relations was assessed with cross‐lagged structural equation modeling.

Results

Temperament and alcohol use are rather stable in midlife. Novelty seeking (NS) predicted heavy use (OR = 1.4; CI: 1.3 to 1.6 for men, OR = 1.3; CI: 1.1 to 1.5 for women) and increasing use (OR = 1.2; CI: 1.1 to 1.4 for men, OR = 1.1; CI: 1.0 to 1.3 for women), whereas low NS predicted abstaining among women (OR = 0.7; CI: 0.6 to 0.8). High harm avoidance (HA) predicted abstaining (OR = 1.3; CI: 1.1 to 1.5) for men. Low persistence (P) among men predicted both abstaining (OR = 0.9; CI: 0.7 to 0.98) and heavy use (OR = 0.9; CI: 0.8 to 0.98). Among women, low reward dependence (RD) predicted heavy use (OR = 0.8; CI: 0.7 to 0.9). Among TCI scores, only NS predicted increasing use in the cross‐lagged models.

Conclusions

Temperament has an impact on alcohol use in midlife. Of the TCI dimensions, only NS seems to predispose to increased alcohol use and problem use throughout life. Additionally, RD among women and P among men are significant factors from a life‐course perspective. Our results did not support Cloninger's theory on type I alcoholism, as HA showed no relation to problematic alcohol use in midlife.
Mediators of the effect of nicotine pre‐treatment on quitting smoking
Authors: Hajek Peter , Lewis Sarah , Munafo Marcus , Lindson Nicola , Coleman Tim , Aveyard Paul ,   on behalf of the The Preloading Investigators
Published: August 2018

Background and aims

Using smoking cessation medications for several weeks prior to quitting smoking facilitates quitting success, but how it does so is not clear. Candidate theories are that pre‐cessation medication enhances self‐efficacy, facilitates medication adherence post‐quit, induces aversion to smoking, reduces reward from smoking or reduces the drive to smoke. We investigated these pathways using data from a large trial of nicotine pre‐loading, using mediation analysis.

Design

Randomized controlled trial of nicotine pre‐loading. Potential mediators were assessed at baseline and 1 week into the pre‐loading (3 weeks prior to quitting). In addition to this, urges to smoke in abstainers were assessed 1 week after the target quit date.

Setting

England.

Participants

A total of 1792 smokers who wanted to quit attending specialist smoking cessation services in England were enrolled between 13 August 2012 and 10 March 2015.

Intervention and comparator

Participants were randomized to either standard smoking cessation medications accompanied by behavioural support or the same treatment supplemented by nicotine ‘pre‐loading’, i.e. 4 weeks of 21 mg nicotine patch use prior to quitting.

Measurements

The primary outcome, selected for its proximity in time to potential mediators, was biochemically validated abstinence from smoking at 4 weeks post‐target quit date. Potential mediators included the Modified Cigarette Evaluation Questionnaire, with subscales assessing satisfaction, reward, craving and aversion; ratings of strength and frequency of urges to smoke; the Mood and Physical Symptoms Scale assessing cigarette withdrawal symptoms; two items from the Nicotine Dependence Syndrome Scale assessing smoking stereotypy; self‐reported reduction in cigarettes per day and in carbon monoxide (CO) reading; post‐target quit day (TQD) medication adherence; self‐efficacy; nausea.

Findings

Pre‐loading reduced urges to smoke at 3 weeks pre‐quit (P < 0.001) and exhaled CO concentrations (P < 0.001), and also urges to smoke post‐quit in abstainers (P = 0.001). At 3 weeks pre‐quit, it also reduced cigarette consumption, enjoyment of and satisfaction from smoking and smoking reward and increased nausea, aversion (all P < 0.001) and smoking stereotypy (P = 0.003). Only the first three variables, however (reduced smoke intake and reduced urges to smoke pre‐ and post‐quit), mediated abstinence from smoking at 4 weeks and only the latter two mediated abstinence at 6 months (indirect mediating effects P < 0.05).

Conclusions

Nicotine pre‐loading appears to facilitate smoking abstinence by reducing urges to smoke and smoke intake before quitting and urges to smoke after quitting.
Alcohol consumption and all‐cause mortality in older adults in Spain: an analysis accounting for the main methodological issues
Authors: Ortolá Rosario , García‐Esquinas Esther , López‐García Esther , León‐Muñoz Luz M. , Banegas José R. , Rodríguez‐Artalejo Fernando
Published: August 2018

Background and aims

Observational evidence that light‐to‐moderate alcohol consumption lowers mortality is questioned because of potential selection biases and residual confounding. We assess the association between alcohol intake and all‐cause death in older adults after accounting for those methodological issues.

Methods

Data came from 3045 individuals representative of the non‐institutionalized population aged ≥ 60 years in Spain. Participants were recruited in 2008–10, when they reported current and life‐time alcohol intake; drinkers were classified as occasional (< 1.43 g/day), light (≥ 1.43 but < 20 g/day for men and ≥ 1.43 but < 10 g/day for women), moderate (≥ 20 but < 40 g/day for men and ≥ 10 but < 20 g/day for women) or heavy (≥ 40 g/day for men and ≥ 24 g/day for women)/binge. Participants were followed‐up to 2017 to assess vital status. In analyses, ex‐drinkers were removed from the abstainer group and were classified according to their life‐time intake to address the ‘abstainer bias’. Moreover, analyses were replicated in individuals without functional limitations, and excluded deaths in the first year of follow‐up, to address reverse causation. Also, occasional drinkers were used as reference in some analyses to reduce the ‘healthy drinker/survivor’ bias. Results were adjusted for many covariates to minimize residual confounding.

Results

Compared with never‐drinkers, the hazard ratio (95% confidence interval) of mortality for light drinkers was 1.05 (0.71–1.56) and 1.20 (0.72–2.02) in those without functional limitations. Corresponding values for moderate drinkers were 1.28 (0.81–2.02) and 1.55 (0.87–2.75) and for heavy/binge drinkers 1.85 (1.07–3.23) and 2.15 (1.09–4.22). Results were consistent when occasional drinkers were used as reference. Among drinkers without functional limitations, the hazard ratio (95% confidence interval) of mortality per 10 g/day of alcohol was 1.12 (1.02–1.23).

Conclusion

After accounting for potential biases, light‐to‐moderate drinking among people 60+ years of age appears to have no statistically significant benefit on mortality compared with abstention from alcohol. By contrast, heavy/binge drinking shows a higher death risk compared with abstention from alcohol. Alcohol intake appears to have a positive dose–response with mortality among drinkers.
Gambling despite financial loss—the role of losses disguised as wins in multi‐line slots
Authors: Graydon Candice , Dixon Mike J. , Stange Madison , Fugelsang Jonathan A.
Published: August 2018

Background and Aims

Slot machines pose serious problems for a subset of gamblers. On multi‐line slots, many small credit returns are less than one's spin wager, resulting in a net loss to the player. These outcomes are called ‘losses disguised as wins’ (LDWs). We aimed to show that different proportions of LDWs could differentially affect gambling persistence (continuing to gamble despite financial loss), but that such LDW effects may depend on problem gambling symptomatology.

Design

Gamblers were randomized to play 100 spins on a game with few, moderate or many LDWs (between‐subjects design), then continued playing for as long as they wished during (unbeknown to players) a losing streak (to measure gambling persistence).

Setting

A custom‐built casino in a gambling research laboratory in Waterloo, Canada.

Participants

Experienced gamblers (n = 132) with varying levels of problem gambling symptomatology from the Waterloo, Canada community.

Measurements

We measured the number of voluntary spins participants played (persistence) during the losing streak following the 100‐spin playing sessions. We measured problem gambling symptomatology using the Problem Gambling Severity Index, and classified them as non‐problem (n = 53), low‐risk (n = 55) or higher‐risk (n = 24) gamblers.

Findings

Persistence trends differed depending on LDW frequency and problem‐gambling status (interaction: P = 0.037). High‐risk gamblers showed a ‘sweet spot’ for LDW reinforcement, persisting for longer in the moderate than few or many LDW games (quadratic trend across LDW games: P = 0.028). Non‐problem gamblers showed a linear trend across LDW games, gambling for longer in the few LDW game (P = 0.007). For low‐risk gamblers, the quadratic contrast was not significant, P = 0.032.

Conclusions

Multi‐line slots contain outcomes in which one gains less than the original wager (losses disguised as wins or LDWs). Moderate (versus few and high) proportions of LDWs appear to make higher‐risk players gamble for longer despite financial loss.
Pre‐operative carcinoembryonic antigen predicts survival following colorectal cancer surgery with curative intent
Authors: Gunawardene Ashok , Larsen Peter , Shekouh Ali , Dennett Elizabeth
Published: August 2018

Background

Circulating biomarkers may be of value in providing additional prognostic information to the TNM staging system. Previous population‐level studies suggest a prognostic role for pre‐operative carcinoembryonic antigen (CEA). The purpose of this study is to verify the prognostic role of pre‐operative CEA at the individual level, in a New Zealand cohort of colorectal cancer patients.

Methods

Retrospective cohort study of patients undergoing potentially curative surgery for colorectal adenocarcinoma between 2010 and 2012 at a tertiary hospital in New Zealand. One hundred and thirty‐nine patients had pre‐operative CEA data available and were included in the study. The main outcomes measured were overall survival (OS) and disease‐free survival (DFS) over a minimum of 5 years of follow up.

Results

Pre‐operative CEA was requested in 138 out of 237 (58.2%) patients undergoing surgery. The median age was 71 years and median follow‐up duration 61 months. High CEA was not associated with the incidence of disease recurrence (P = 0.69). A significant difference was found between high and low CEA for OS (P = 0.09) and DFS (P = 0.04). On multi‐variate survival analysis, pre‐operative CEA was identified as an independent predictor of OS (HR 2.50, 95% CI 1.17–5.36, P = 0.02) and DFS (HR 1.78, 95% CI 1.02–3.13, P = 0.04).

Conclusion

We identified pre‐operative CEA as an independent predictor of OS and DFS on an individual level. CEA offers additional prognostic value to TNM staging and should be requested routinely as part of the pre‐operative work‐up.
Women’s experiences of miscarriage related to diagnosis, duration, and type of treatment
Authors: Volgsten Helena , Jansson Caroline , Darj Elisabeth , Stavreus‐Evers Anneli
Published: August 2018

Introduction

Women with miscarriage experience several negative emotional feelings such as grief, isolation, coping, and despair. However, less is known about how the type of treatment and diagnosis of miscarriage influence the emotional experience.

Material and methods

The present study was a randomized prospective longitudinal cohort study, in which women with spontaneous miscarriage (n = 35), and women with missed miscarriage (n = 67), were included to answer three validated questionnaires: Revised Impact of Miscarriage Scale, Perinatal Grief Scale, and Montgomery and Åsberg Depression Rating Scale, concerning experience of miscarriage, psychological well‐being, and mental health 1 week and 4 months after finalized treatment.

Results

There was no difference between the 2 diagnosis groups in feelings as measured by Revised Impact of Miscarriage Scale, Montgomery and Åsberg Depression Rating Scale, and Perinatal Grief Scale 1 week after the miscarriage. However, the psychological well‐being improved significantly 4 months after the miscarriage. Separated by treatment, women treated with misoprostol alone had more depressive symptoms than women treated with misoprostol and subsequent vacuum aspiration.

Conclusions

It can be concluded that diagnosis of miscarriage had limited influence on the experiences of miscarriage, but shorter duration of treatment with misoprostol and subsequent vacuum aspiration resulted in fewer depressive symptoms.
Review shows that lipid disorders are associated with endothelial but not renal dysfunction in children
Authors: Kosmeri Chrysoula , Siomou Ekaterini , Vlahos Antonios P. , Milionis Haralampos
Published: August 2018

Aim

We undertook this review to assess the effects of lipid metabolism abnormalities on endothelial and renal function in children.

Methods

A search of relevant literature published in English from January 1988 to May 2018 was performed, and this included randomised controlled trials, observational cohort studies, systematic reviews and case reports.

Results

The search process identified 2324 relevant studies and 29 were finally included. Noninvasive ultrasound markers of endothelial dysfunction, such as flow‐mediated dilation and carotid intima‐media thickness, were impaired in children with dyslipidaemia. Dietary interventions and statin therapy reversed the effects of dyslipidaemia on endothelial function in children. Most data from adult studies failed to prove a causative relationship between dyslipidaemia and renal disease progression or a beneficial effect of lipid‐lowering treatment on renal outcomes. The limited paediatric data did not indicate dyslipidaemia as an independent risk factor for renal dysfunction, which was mainly estimated by cystatin C levels or proteinuria. Therefore, further investigation is needed to clarify a potential relationship.

Conclusion

In view of limited available paediatric evidence, dyslipidaemia may be adversely associated with endothelial function. However, the association between lipid metabolism disorders and renal function in childhood needs to be further investigated.