bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle strength in adolescent men and future musculoskeletal pain: a cohort study with 17 years of follow-up
Authors: Timpka Simon , Petersson Ingemar F , Zhou Caddie , Englund Martin
Published: June 2013

Objectives

Musculoskeletal pain is highly prevalent throughout adulthood with a major impact on health, function and participation in the society. Still, the association between muscle strength and development of musculoskeletal pain is unclear. We aimed to study whether overall muscle strength in adolescent men is inversely associated with self-reported musculoskeletal pain in adulthood.

Design

Cohort study with baseline data from the Swedish Conscription Register and outcome information from the random population-based Swedish Living Conditions Surveys.

Setting

Sweden, 1970–2005.

Participants

5489 men who at age 17–19 years tested their isometric muscle strength (hand grip, arm flexion and knee extension) during the compulsory conscription.

Outcome measures

The men were surveyed regarding self-reported musculoskeletal pain; mean follow-up time of 17 (range 1–35) years. Our primary outcome was a self-report of musculoskeletal pain, and secondary outcomes were a report of ‘severe pain’, ‘pain in back/hips’, ‘pain in neck/shoulders’ or ‘pain in arms/legs’, respectively. We categorised muscle strength into three groups: low, average and high, using the 25th–75th percentile to define the reference category (average). We estimated relative risks using log binomial regression with adjustment for smoking, body mass index, education and physical activity.

Results

In the adjusted model, men with low overall muscle strength had decreased risk of self-reported musculoskeletal pain (0.93, 95% CI 0.87 to 0.99). We observed no such association in men with high strength (0.99, 0.93 to 1.05). Furthermore, no statistically significant increase or decrease in risk was observed for any of the secondary outcomes.

Conclusions

In men, low overall isometric muscle strength in youth was not associated with an increased risk of future musculoskeletal pain. Contrarily, we observed a slightly decreased risk of self-reported musculoskeletal pain in adulthood. Our results do not support a model in which low muscle strength is a risk factor for future musculoskeletal pain.
Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study
Authors: Hanley Janet , Ure Jenny , Pagliari Claudia , Sheikh Aziz , McKinstry Brian
Published: June 2013

Objectives

To explore the experiences of patients and professionals taking part in a randomised controlled trial (RCT) of remote blood pressure (BP) telemonitoring supported by primary care. To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice.

Design

Qualitative study adopting a qualitative descriptive approach.

Participants

25 patients, 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring. A maximum variation sample of patients from within the trial based on age, sex and deprivation status of the practice was sought.

Setting

6 primary care practices in Scotland.

Method

Data were collected via taped semistructured interviews. Initial thematic analysis was inductive. Multiple strategies were employed to ensure that the analysis was credible and trustworthy.

Results

Prior to the trial, both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery. BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action. Patients using telemonitoring became more engaged in the clinical management of their condition. Professionals reported that telemonitoring challenged existing roles and work practices and increased workload. Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback.

Conclusions

BP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control. It increases patients’ engagement in the management of their condition, but supporting telemetry and greater patient engagement can increase professional workloads and demand changes in service organisation. Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practices. The embedded qualitative study was included in the protocol for the HITS trial registered with ISRCTN no. 72614272.
Antitubercular specific activity of ibuprofen and the other 2-arylpropanoic acids using the HT-SPOTi whole-cell phenotypic assay
Authors: Guzman Juan D , Evangelopoulos Dimitrios , Gupta Antima , Birchall Kristian , Mwaigwisya Solomon , Saxty Barbara , McHugh Timothy D , Gibbons Simon , Malkinson John , Bhakta Sanjib
Published: June 2013

Objectives

Lead antituberculosis (anti-TB) molecules with novel mechanisms of action are urgently required to fuel the anti-TB drug discovery pipeline. The aim of this study was to validate the use of the high-throughput spot culture growth inhibition (HT-SPOTi) assay for screening libraries of compounds againstMycobacterium tuberculosisand to study the inhibitory effect of ibuprofen (IBP) and the other 2-arylpropanoic acids on the growth inhibition ofM tuberculosisand other mycobacterial species.

Methods

The HT-SPOTi method was validated not only with known drugs but also with a library of 47 confirmed anti-TB active compounds published in the ChEMBL database. Three over-the-counter non-steroidal anti-inflammatory drugs were also included in the screening. The 2-arylpropanoic acids, including IBP, were comprehensively evaluated against phenotypically and physiologically different strains of mycobacteria, and their cytotoxicity was determined against murine RAW264.7 macrophages. Furthermore, a comparative bioinformatic analysis was employed to propose a potential mycobacterial target.

Results

IBP showed antitubercular properties while carprofen was the most potent among the 2-arylpropanoic class. A 3,5-dinitro-IBP derivative was found to be more potent than IBP but equally selective. Other synthetic derivatives of IBP were less active, and the free carboxylic acid of IBP seems to be essential for its anti-TB activity. IBP, carprofen and the 3,5-dinitro-IBP derivative exhibited activity against multidrug-resistant isolates and stationary phase bacilli. On the basis of the human targets of the 2-arylpropanoic analgesics, the protein initiation factor infB (Rv2839c) ofM tuberculosiswas proposed as a potential molecular target.

Conclusions

The HT-SPOTi method can be employed reliably and reproducibly to screen the antimicrobial potency of different compounds. IBP demonstrated specific antitubercular activity, while carprofen was the most selective agent among the 2-arylpropanoic class. Activity against stationary phase bacilli and multidrug-resistant isolates permits us to speculate a novel mechanism of antimycobacterial action. Further medicinal chemistry and target elucidation studies could potentially lead to new therapies against TB.
Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial
Authors: Stoddart Andrew , Hanley Janet , Wild Sarah , Pagliari Claudia , Paterson Mary , Lewis Steff , Sheikh Aziz , Krishan Ashma , Padfield Paul , McKinstry Brian
Published: June 2013

Objectives

To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS).

Design

Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach.

Setting

20 socioeconomically diverse general practices in Lothian, Scotland.

Participants

401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg).

Intervention

Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history.

Main outcome measures

Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced.

Results

Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient.

Conclusions

Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications.

Trial registration

International Standard Randomised Controlled Trials, numberISRCTN72614272.
Premature retirement due to ill health and income poverty: a cross-sectional study of older workers
Authors: Schofield Deborah J , Callander Emily J , Shrestha Rupendra N , Percival Richard , Kelly Simon J , Passey Megan E
Published: June 2013

Objectives

To assess the income-poverty status of Australians who were aged between 45 and 64 years and were out of the labour force due to ill health.

Design

A cross-sectional study using a microsimulation model of the 2009 Australian population (Health&WealthMOD).

Setting

2009 Australian population.

Participants

9198 people aged between 45 and 64 years surveyed for the 2003 Survey of Disability, Ageing and Carers.

Primary outcome measures

50% of the median equivalised income-unit-income poverty line.

Results

It was found that individuals who had retired early due to other reasons were significantly less likely to be in income poverty than those retired due to ill health (OR 0.43 95% CI 0.33 to 0.51), and there was no significant difference in the likelihood of being in income poverty between these individuals and those unemployed. Being in the same family as someone who is retired due to illness also significantly increases an individual's chance of being in income poverty.

Conclusions

It can be seen that being retired due to illness impacts both the individual and their family.
Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort
Authors: Coelho-Prabhu Nayantara , Shah Nilay D , Van Houten Holly , Kamath Patrick S , Baron Todd H
Published: June 2013

Objective

To determine utilisation of endoscopic retrograde cholangiopancreatography (ERCP); incidence of inpatient admissions for complications occurring within 30 days of ERCP and risk factors for procedural-related complications, in a population-based study.

Design

Retrospective cohort study.

Setting

Olmsted County, Minnesota.

Participants

All adult residents of Olmsted County, Minnesota, who underwent ERCP from 1997 to 2006.

Interventions

Diagnostic and therapeutic ERCPs were assessed.

Primary and secondary outcome measures

Patient and procedural characteristics and complications within 30 days; and rates of ERCP utilisation and unplanned admissions and risk factors for admissions.

Results

In 10 years, 1072 ERCPs were performed on 827 individual patients. Average utilisation of ERCP was 83.1 ERCPs/100 000 persons/year, with an increase from 58 to 104.8 ERCPs/100 000 persons/year over time, driven by increases in therapeutic procedures. Within 30 days after 236 procedures, 62 admissions were definitely related to the index ERCP. The complication rate was 5.3%, including pancreatitis (26, 2.4%), infection/cholangitis (16, 1.5%), bleeding (15, 1.4%) and perforation (4, 0.37%). 30-day mortality was 2.4%, none of which was directly related to the ERCP or complications thereof. Risk factors identified through multivariate analysis to be associated with adverse events included: age <45 years (p=0.0498); body mass index ≥35 (p=0.0024); pancreatic duct cannulation (p=0.0026); outpatient procedure (p<0.0001); intraprocedure sphincterotomy bleeding (p<0.0001); difficulty grade (p=0.115) and patient's first ERCP (p=0.0394).

Limitations

Retrospective study.

Conclusions

Population utilisation of ERCP rose during the study period, specifically in therapeutic procedures. Admissions within 30 days of ERCP are common but often unrelated. Complications of ERCP remain infrequent and deaths quite unusual.
Doctors’ understanding of individualisation of drug treatments: a qualitative interview study
Authors: Denford S , Frost J , Dieppe P , Britten N
Published: June 2013

Objective

To explore doctors’ understanding of individualisation of drug treatments, and identify the methods used to achieve individualisation.

Design

In this exploratory study, we used in-depth qualitative interviews with doctors to gain insight into their understanding of the term ‘individualised treatments’ and the methods that they use to achieve it.

Participants

16 general practitioners in 6 rural and 10 urban practices, 2 geriatricians and 2 clinical academics were recruited.

Setting

Primary and secondary care in South West of England.

Results

Understanding of individualisation varied between doctors, and their initial descriptions of individualisation were not always consistent with subsequent examples of the patients they had treated. Understandings of, and methods used to achieve, individualised treatment were frequently discussed in relation to making drug treatment decisions. Few doctors spoke of using strategies to support patients to individualise their own treatments after the consultation.

Conclusions

Despite its widespread use, variation in doctors’ understanding of the term individualisation highlights the need for it to be defined. Efforts are needed to develop effective methods that would offer a structured approach to support patients to manage their treatments after consultations.
Selective reporting of outcomes in randomised controlled trials in systematic reviews of cystic fibrosis
Authors: Dwan Kerry , Kirkham Jamie J , Williamson Paula R , Gamble Carrol
Published: June 2013

Background

Outcome reporting bias (ORB) in randomised trials has been identified as a threat to the validity of systematic reviews. Previous work highlighting this problem is limited to considering a single primary review outcome. The aim of this study was to assess ORB across all efficacy outcomes in the Cochrane systematic reviews of cystic fibrosis.

Methods

Systematic reviews of interventions for cystic fibrosis published on the Cochrane Library by the Cochrane Cystic Fibrosis and Genetic Disorders Group before 2010 were assessed for discrepancies in outcomes between review protocol and full review. ORB in eligible trials was also assessed for all efficacy review outcomes. Two authors independently classified each outcome using a nine-point classification system developed by the Outcome Reporting Bias In Trials study. These classifications were used to inform the assessment of the risk of bias for selective outcome reporting for each trial.

Results

–46 Cochrane cystic fibrosis systematic reviews were included. The median number of primary outcomes, number of trials and participants per trial in the reviews were 3 (IQR 2, 3), 4 (IQR 2, 8) and 21 (IQR 14, 41), respectively. 18 reviews (39%, 18/46) had a discrepancy in outcomes between protocol and full review. 37 reviews were eligible to be included in the ORB assessment. When considering review primary outcomes and all review outcomes, ORB was suspected in at least one trial in 86% and 100%, respectively.

Conclusions

Assessment of ORB within a systematic review of a single primary outcome underestimates the risk of ORB in comparison to the assessment of multiple primary and secondary outcomes. ORB in trials is highly prevalent within systematic reviews of cystic fibrosis when assessed across all outcomes. This could be reduced by the development of a core outcome set for trials and systematic reviews in cystic fibrosis.
Lay perspectives of successful ageing: a systematic review and meta-ethnography
Authors: Cosco Theodore D , Prina A Matthew , Perales Jaime , Stephan Blossom C M , Brayne Carol
Published: June 2013

Objectives

The aim of the current study was to conduct a systematic review of lay perspectives of successful ageing (SA), synthesise these data using a metaethnographic framework and to provide a snapshot of extant lay perspectives of SA.

Design

A systematic review of layperson perspectives of SA was conducted across MEDLINE, PsycInfo, CINAHL, EMBASE and ISI Web of Knowledge.

Participants

Peer-reviewed studies conducting qualitative investigations of lay perspectives of SA were included. Included studies were coded and analysed using NVivo V.9 to examine underlying themes of SA.

Results

The search strategy identified 7285 articles; 26 articles met the inclusion criteria. Laypersons identified psychosocial components, notably engagement (eg, social engagement), and personal resources (eg, attitude) as integral components of SA more often than ‘physiological’ components, such as longevity or physical functioning. These results also highlight the profound under-representation of non-Western countries and the cultural homogeneity of research participants.

Conclusions

The current study reveals the importance laypersons place on incorporating psychosocial components into multidimensional models of SA, as well as highlighting the need for increased research with under-represented populations.
An observational study of malaria in British travellers:Plasmodium ovale wallikeriandPlasmodium ovale curtisidiffer significantly in the duration of latency
Authors: Nolder Debbie , Oguike Mary C , Maxwell-Scott Hector , Niyazi Hatoon A , Smith Valerie , Chiodini Peter L , Sutherland Colin J
Published: June 2013

Objectives

Ovale malaria is caused by two closely related species of protozoan parasite:Plasmodium ovale curtisiandPlasmodium ovale wallikeriAlthough clearly distinct genetically, there have been no studies comparing the morphology, life cycle or epidemiology of these parasites. We tested the hypothesis that the two species differ in the duration of latency prior to presentation with symptoms of blood-stage infection.

Design

PCR was used to identifyP ovale curtisiandP ovale wallikeriinfections among archived blood from UK malaria patients. Latency periods, estimated as the time between entry into the UK and diagnosis of malaria, were compared between the two groups.

Setting

UK National Reference Laboratory.

Participants

None. Archived parasite material and surveillance data for 74P ovale curtisiand 60P ovale wallikeriinfections were analysed. Additional epidemiological data were taken from a database of 1045 imported cases.

Outcomes

None.

Results

No differences between the two species were identified by a detailed comparison of parasite morphology (N=9, N=8, respectively) and sex ratio (N=5, N=4) in archived blood films. The geometric mean latency period inP ovale wallikeriwas 40.6 days (95% CI 28.9 to 57.0), whereas that forP ovale curtisiwas more than twice as long at 85.7 days (95% CI 66.1 to 111.1; p=0.002). Further, the proportion of ovale malariasensu latowhich occurred in patients reporting chemoprophylaxis use was higher than forPlasmodium falciparum(OR 7.56; p<0.0001) orP vivax(OR 1.82; p<0.0001).

Conclusions

These findings provide the first difference of epidemiological significance observed between the two parasites which cause ovale malaria, and suggest that control measures aimed atP falciparummay not be adequate for reducing the burden of malaria caused byP ovale curtisiandP ovale wallikeri.
Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011
Authors: Clarke Aileen , Taylor-Phillips Sian , Swan Jacky , Gkeredakis Emmanouil , Mills Penny , Powell John , Nicolini Davide , Roginski Claudia , Scarbrough Harry , Grove Amy
Published: June 2013

Objectives

To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work.

Design

Cross-sectional survey of 345 National Health Service (NHS) staff members.

Setting

The study was conducted across 11 English Primary Care Trusts between 2010 and 2011.

Participants

A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey.

Main outcome measures

Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role.

Results

The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades).

Conclusions

Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service Frameworks) are important for decision-making, but practical sources of evidence such as local intelligence, benchmarking data and expert advice are also influential. New Clinical Commissioning Groups will need a variety of different evidence sources and expert involvement to ensure that effective decisions are made for their populations.
Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study
Authors: Humphriss Rachel , Hall Amanda , May Margaret , Zuccolo Luisa , Macleod John
Published: June 2013

Objective

To investigate the association of prenatal alcohol exposure with balance in10-year-old children.

Design

Population-based prospective longitudinal study.

Setting

Former Avon region of UK (Southwest England).

Participants

6915 children from the Avon Longitudinal Study of Parents and Children who had a balance assessment at age 10 and had data on maternal alcohol consumption.

Outcome measures

3 composite balance scores: dynamic balance (beam-walking), static balance eyes open, static balance eyes closed (heel-to-toe balance on a beam and standing on one leg, eyes open or closed).

Results

Most mothers (95.5%) consumed no-to-moderate amounts (3–7 glasses/week) of alcohol during pregnancy. Higher total-alcohol consumption was associated with maternal-social advantage, whereas binge drinking (≥4 units/day) and abstinence were associated with maternal social disadvantage. No evidence was found of an adverse effect of maternal-alcohol consumption on childhood balance. Higher maternal-alcohol use during pregnancy was generally associated with better offspring outcomes, with some specific effects appearing strong (static balance eyes open and moderate total alcohol exposure at 18 weeks, adjusted OR 1.23 (95% CI 1.01 to 1.49); static balance eyes closed and moderate total alcohol exposure at 18 weeks, adjusted OR 1.25 (95% CI 1.06 to 1.48). Similar results were found for both paternal and postnatal maternal alcohol exposure. A Mendelian-randomization approach was used to estimate the association between maternal genotype and offspring balance using the non-synonymous variant rs1229984*A (ADH1B) to proxy for lower maternal alcohol consumption; no strong associations were found between this genotype/proxy and offspring balance.

Conclusions

No evidence was found to indicate that moderate maternal alcohol consumption in this population sample had an adverse effect on offspring balance at age 10. An apparent beneficial effect of higher total maternal alcohol consumption on offspring balance appeared likely to reflect residual confounding.
Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study
Authors: Ruiz Jonatan R , Segura-Jiménez Víctor , Ortega Francisco B , Álvarez-Gallardo Inmaculada C , Camiletti-Moirón Daniel , Aparicio Virginia A , Carbonell-Baeza Ana , Femia Pedro , Munguía-Izquierdo Diego , Delgado-Fernández Manuel
Published: June 2013

Objectives

To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia.

Design

Cross-sectional study.

Setting

Local Association of Fibromyalgia (Granada, Spain).

Participants

The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent.

Primary outcome measures

Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA).

Results

The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (−6.6 min and −7 min, respectively, per BMI category increase, <25, 25–30, >30 kg/m2; p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051).

Conclusions

These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.
An assessment of the iPad as a testing platform for distance visual acuity in adults
Authors: Black J M , Jacobs R J , Phillips G , Chen L , Tan E , Tran A , Thompson B
Published: June 2013

Objectives

Visual acuity is a common measurement in general practice, and the advent of new technology such as tablet computers offers a change in the way in which these tests are delivered. The aim of this study was to assess whether measurements of distance visual acuity using LogMAR letter charts displayed on an iPad tablet computer were in agreement with standard clinical tests of visual acuity in adults with normal vision.

Design

Blinded, diagnostic test study.

Setting

Single centre (University) in Auckland, New Zealand.

Participants

University staff and students (n=85). Participants were required to have visual acuity better than 6/60 and wear habitual refractive correction during testing. Participants were excluded if there was any history of ocular pathology.

Primary and secondary outcome measures

Visual acuity measured under a number of conditions.

Results

The iPad tablet with its glossy screen was highly susceptible to glare resulting in acuity measurements that were significantly poorer (approximately 2 LogMAR lines) than those made using an ETDRS chart and a standard computerised testing system (n=56). However, fitting the iPad with an antiglare screen and positioning the device away from sources creating reflected (veiling) glare resulted in acuity measurements that were equivalent those made using gold standard charts (n=29).

Conclusions

Tablet computers are an attractive option for visual acuity measurement due to portability, the ability to randomise letters, automated scoring of acuity and the ability to select from a range of charts. However, these devices are only suitable for use in situations where sources of glare can be eliminated.
Parental comprehension of the benefits/risks of first-line randomised clinical trials in children with solid tumours: a two-stage cross-sectional interview study
Authors: Chappuy Hélène , Bouazza Naim , Minard-Colin Veronique , Patte Catherine , Brugières Laurence , Landman-Parker Judith , Auvrignon Anne , Davous Dominique , Pacquement Hélène , Orbach Daniel , Tréluyer Jean Marc , Doz François
Published: June 2013

Objectives

To analyse the parental understanding of informed consent information in first-line randomised clinical trials (RCTs) including children with malignant solid tumours and to assess parents’ needs for decision-making.

Design

Observational prospective study.

Setting

3 paediatric oncology centres in the Parisian region in France.

Participants

53 parents were approached to participate in a RCT for their child with malignant solid tumour, over a 1-year period. 40 parents have been interviewed in our study.

Primary and secondary outcome measures

Parental understanding of information in RCTs, parents’ needs for decision-making. Parents were questioned by a psychologist, independent of the paediatric oncology teams, using a semidirected interview, 1 (M1) and 6 months (M6) after the consent was sought.

Results

18 parents (45%) did not understand the concept of randomisation. Half of the parents could explain neither the aim of the clinical trial nor the potential benefit to their child of inclusion. 35 parents (87.5%) expressed very few specific risks related to the trial. Being mostly French-speaking (p=0.03) and the reading of the information sheet by the parents (p=0.0025) improved their understanding. The parental comprehension did not differ between M1 and M6. The principal factors underlying their decision were confidence in the medical team (39%), wish to access to the best treatment (37%) and the best quality of life (37%).

Conclusions

Despite medical explanations, parents have limited knowledge in some areas in first-line RCTs and improvements of information process are required. The risks specific to the randomised trial are underestimated by parents and the unproven nature of the treatment is not well-known or understood.
Assessment of blood clot formation and platelet receptor function ex vivo in patients with primary Sjögren's syndrome
Authors: Collins K S , Balasubramaniam K , Viswanathan G , Natasari A , Tarn J , Lendrem D , Mitchell S , Zaman A , Ng W F
Published: June 2013

Objectives

Primary Sjögren's syndrome (pSS) shares clinical features and pathogenetic mechanisms with systemic lupus erythematosus (SLE). SLE is associated with an increased thromboembolic risk; however, it is unclear whether pSS patients are susceptible to thromboembolic diseases. In this study, we examined ex vivo blood clot formation (clot strength, rates of clot formation and lysis) in pSS using thromboelastography (TEG) and platelet aggregation to common agonists using multiple electrode aggregometry (MEA). We also investigated the relationship between TEG/MEA parameters and clinical/laboratory features of pSS.

Design

Case control.

Setting

Secondary care, single centre.

Participants

34 pSS patients, 11 SLE patients and 13 healthy volunteers (all women) entered and completed the study.

Primary and secondary outcome measures

Primary outcomes: TEG and MEA parameters between three subject groups. Secondary outcomes: The relationships between TEG/MEA and clinical/laboratory parameters analysed using bivariate correlation analysis with corrections for multiple testing.

Results

All TEG and MEA parameters were similar for the three subject groups. After corrections for multiple testing, interleukin (IL)-1α and Macrophage inflammatory proteins (MIP)-1α remain correlated inversely with clot strength (r=−0.686, p=0.024 and r=−0.730, p=0.012, respectively) and overall coagulability (r=−0.640, p=0.048 and r=−0.648, p=0.048). Stepwise regression analysis revealed that several cytokines such as MIP-1α, IL-17a, IL-1α and Interferon (IFN)-γ may be key predictors of clot strength and overall coagulability in pSS.

Conclusions

Clot kinetics and platelet receptor function are normal in pSS. Several cytokines correlate with clot strength and overall coagulability in pSS.
Underage alcohol drinking and medical services use in Hong Kong: a cross-sectional study
Authors: Wang Man Ping , Ho Sai Yin , Lam Tai Hing
Published: June 2013

Objectives

To investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong.

Design

Cross-sectional study.

Setting

Secondary schools in Hong Kong.

Participants

A total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools.

Outcome measures

An anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1–2 and 3–7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed.

Results

More than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1–2 days/week and 1.70 (1.41 to 2.06) for 3–7 days/week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed.

Conclusions

Alcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents.
Variation in severe maternal morbidity according to socioeconomic position: a UK national case–control study
Authors: Lindquist Anthea , Knight Marian , Kurinczuk Jennifer J
Published: June 2013

Objectives

This study aimed to explore the independent association between socioeconomic position, defined by occupation, and severe maternal morbidity among women in the UK.

Design

Case–control study.

Setting

The analysis was conducted as a case–control analysis, using data from a series of studies of direct causes of severe maternal morbidity undertaken through the UK Obstetric Surveillance System (UKOSS), with data collected throughout all consultant-let obstetric units in the UK.

Participants

The analysis included 1144 cases and 2256 comparison women (controls). UKOSS studies from which data on case women were obtained included amniotic fluid embolism, acute fatty liver of pregnancy, eclampsia, peripartum hysterectomy, therapies for peripartum haemorrhage and uterine rupture.

Primary outcome measure

Odds of severe maternal morbidity by socioeconomic group, independent of ethnicity, maternal age, smoking, pre-existing medical condition, body mass index (BMI), multiple pregnancy and past pregnancy complications. Occupation was used to classify different socioeconomic groups.

Secondary outcome measure

Odds of morbidity related to ethnic group, maternal age, smoking, pre-existing medical condition, BMI, multiple pregnancy and past pregnancy complications.

Results

Across the socioeconomic groups, compared with the ‘managerial/professional’ group, adjusted ORs were 1.17 (95% CI 0.94 to 1.45) for the ‘intermediate group’, 1.16 (95% CI 0.93 to 1.45) for ‘routine/manual’, 1.22 (95% CI 0.92 to 1.61) for ‘unemployed’ women and 1.51 (95% CI 1.18 to 1.94) for women with missing socioeconomic information. Women of non-white ethnicity, older maternal age (≥35 years), BMI ≥25 kg/m2and those with pre-existing medical condition/s, multiple pregnancy or past pregnancy complications were shown to have a significantly increased odds of severe maternal morbidity.

Conclusions

This study suggests that socioeconomic position may be independently associated with an increased risk of severe maternal morbidity, although the observed association was not statistically significant. Further research is warranted to confirm this and investigate why this association might exist in a country where healthcare is universal and free at the point of access.
Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study
Authors: Green Stephen T , Cladi Lorenzo , Morris Paul , Forde Donall
Published: June 2013

Objective

To determine if individual undergraduate schools of medicine in the UK and the Republic of Ireland provide any teaching to medical students about biological weapons, bioterrorism, chemical weapons and weaponised radiation, if they perceive them to be relevant issues and if they figure them in their future plans.

Design

A cross-sectional study utilising an internet-based questionnaire sent to key figures responsible for leading on the planning and delivery of undergraduate medical teaching at all schools of medicine in the UK and Ireland.

Setting

All identified undergraduate schools of medicine in the UK and Ireland between August 2012 and December 2012.

Outcome measures

Numerical data and free text feedback about relevant aspects of undergraduate teaching.

Results

Of the 38 medical schools approached, 34 (28 in UK, 6 in Ireland) completed the questionnaire (89.47%). 4 (all in UK) chose not to complete it. 6/34 (17.65%) included some specific teaching on biological weapons and bioterrorism. 7/34 (20.59%) had staff with bioterrorism expertise (mainly in microbiological and syndromic aspects). 4/34 (11.76%) had plans to introduce some specific teaching on bioterrorism. Free text responses revealed that some felt that because key bodies (eg, UK's General Medical Council) did not request teaching on bioterrorism, then it should not be included, while others regarded this field of study as a postgraduate subject and not appropriate for undergraduates, or argued that the curriculum was too congested already. 4/34 (11.76%) included some specific teaching on chemical weapons, and 3/34 (8.82%) on weaponised radiation.

Conclusions

This study provides evidence that at the present time there is little teaching at the undergraduate level in the UK and Ireland on the subjects of biological weapons and bioterrorism, chemical weapons and weaponised radiation and signals that this situation is unlikely to change unless there were to be high-level policy guidance.
Violence, HIV risk behaviour and depression among female sex workers of eastern Nepal
Authors: Sagtani Reshu Agrawal , Bhattarai Sailesh , Adhikari Baikuntha Raj , Baral Dharanidhar , Yadav Deepak Kumar , Pokharel Paras Kumar
Published: June 2013

Objectives

The primary objective of the study was to estimate the prevalence of depression among female sex workers (FSWs) of eastern Nepal. The secondary objective was to search for an association between depression, violence and HIV risk behaviour.

Design

Cross-sectional/observational study.

Study setting

This study was carried out in five cities of eastern Nepal (Dharan, Itahari, Biratnagar, Damak and Birtamode). Both restaurant-based and street-based FSWs were recruited in the study.

Participants

Women who had been involved in commercial sex activity in the past 6 months and gave informed consent were included in the study.

Primary outcome measure

A score of more than or equal to 16 on the Centre for Epidemiological Studies Depression (CESD) scale was considered as depression.

Methodology

Face-to-face interviews were conducted with respondents who were sought through a snowball sampling technique. Information regarding their depression status, HIV high-risk behaviour and violence was recorded. The estimated sample size was 210.

Results

We interviewed 210 FSWs (both restaurant-based and street-based). The prevalence of depression among respondents was 82.4%. FSWs who had experienced violence were five times more likely to be depressed than those who were not victims of violence. The odds of depression were six times higher among respondents who were involved in any HIV risk behaviour compared with those who were not involved.

Conclusions

The present study reports a high prevalence of depression, HIV risk behaviours and violence among FSWs of eastern Nepal. The mental health of FSWs should also be regarded as an important aspect of HIV prevention efforts which can help to promote the overall health of this population.
Factors associated with breastfeeding in England: an analysis by primary care trust
Authors: Oakley Laura L , Renfrew Mary J , Kurinczuk Jennifer J , Quigley Maria A
Published: June 2013

Objectives

To identify the sociodemographic factors associated with variation in area-based breastfeeding in England; to calculate the predicted breastfeeding rates adjusted for sociodemographic variations.

Design

Ecological analysis of routine data using random effects logistic regression.

Setting

All 151 primary care trusts (PCTs) in England 2010–2011.

Outcome measures

PCT level data on breastfeeding: initiation, any and exclusive breastfeeding at 6–8 weeks.

Results

There was considerable variation in breastfeeding across PCTs (breastfeeding initiation mean 72%, range 39–93%; any breastfeeding at 6–8 weeks mean 45%, range 19–83%; exclusive breastfeeding at 6–8 weeks mean 32%, range 14–58%), with London PCTs reporting markedly higher rates. Maternal age was strongly associated with area-based breastfeeding, with a 4–6% increase in odds of breastfeeding associated with a unit increase in the percentage of older mothers. Outside London, the proportion of the local population from a Black and Minority Ethnic (BME) background, compared with those from a White British background, was associated with higher breastfeeding (1–3% increase in odds per unit increase in the proportion from a BME background). Area-based deprivation was associated with reduced odds of breastfeeding (21–32% reduced odds comparing most deprived quintile to least deprived quintile). Weaker associations were observed between sociodemographic factors and breastfeeding in London PCTs. Very few PCTs reported breastfeeding figures substantially above or below the national average, having adjusted for variations in sociodemographic factors.

Conclusions

Our results show striking associations between sociodemographic factors and breastfeeding at the area level, with much of the variation in breastfeeding rates explained by the sociodemographic profile. The sociodemographic context of breastfeeding is clearly important at the area level as well as the individual level. Our findings can be used to inform decision-making relating to local priorities and service provision.
Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study
Authors: Bail Kasia , Berry Helen , Grealish Laurie , Draper Brian , Karmel Rosemary , Gibson Diane , Peut Ann
Published: June 2013

Objectives

To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients.

Design

Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients.

Setting

Public hospital discharge data from the state of New South Wales, Australia for 2006/2007.

Participants

426 276 overnight hospital episodes for patients aged 50 and above (census sample).

Main outcome measures

Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care.

Results

Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium.

Conclusions

Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions.