bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017
Authors: Ruzangi Judith , Blair Mitch , Cecil Elizabeth , Greenfield Geva , Bottle Alex , Hargreaves Dougal S , Saxena Sonia
Published: May 2020

Objective

To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017

Design

Population-based retrospective cohort study.

Methods

We used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.

Results

Between 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.

Conclusions

Over the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.
CHI study: protocol for an observational cohort study on ageing and mental health in community-dwelling older adults
Authors: Lee Rachael Zhi Yi , Yu Junhong , Rawtaer Iris , Allen Patrick Finbarr , Bao Zhiming , Feng Lei , Feng Qiushi , Lee Jeong Kyu , Lim Chin Tat , Ling Lieng Hsi , Thang Leng Leng , Naing Thet , Wang D Y , Yap Kai Zhen , Kua EH , Mahendran Rathi
Published: May 2020

Introduction

Ageing is associated with a multitude of healthcare issues including dementia, depression, frailty, morbidity associated with chronic disease and high healthcare utilisation. With Singapore’s population projected to age significantly over the next two decades, it has become increasingly important to understand the disease burden and etiological process among older adults. The Community Health and Intergenerational study aims to holistically examine ageing in place by investigating the resilience and vulnerability factors of the ageing process in the biological, psychological and social domains within the environment.

Methods and analysis

Using a cohort multiple randomised controlled trial design, comprehensive health profiles of community-dwelling older adults will be collected. The objective is to recruit 1000 participants (aged 60–99 years) living in the western region of Singapore within a period of 3 years (2018–2020). Assessments include basic sociodemographic, physical health and function (cardiac, oral and blood profiles and visual function), cognitive functioning, daily functioning, physical fitness, emotional state, free-flowing speech, sleep quality, social connectedness, caregiver burden, intergenerational communication, quality of life, life satisfaction, attitudes to ageing and gratitude and compassion. Results from the cohort will enable future studies to identify at-risk groups and develop interventions to improve the physical and mental health and quality of life of older adults.

Ethics and dissemination

Approval of the cohort study by the National University of Singapore Institutional Review Board (NUS-IRB Reference code: H-17-047) was obtained on 12 October 2017. Written consent will be obtained from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local stakeholders.
Impact of a farmers’ market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation
Authors: Aktary Michelle L , Caron-Roy Stephanie , Sajobi Tolulope , O'Hara Heather , Leblanc Peter , Dunn Sharlette , McCormack Gavin R , Timmins Dianne , Ball Kylie , Downs Shauna , Minaker Leia M , Nykiforuk Candace IJ , Godley Jenny , Milaney Katrina , Lashewicz Bonnie , Fournier Bonnie , Elliott Charlene , Raine Kim D , Prowse Rachel JL , Olstad Dana Lee
Published: May 2020

Introduction

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers’ market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers’ markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

Methods and analysis

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10–15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers’ markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25–30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants’ experiences with and perceived outcomes from the programme.

Ethics and dissemination

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

Trial registration number

NCT03952338.
Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines
Authors: Suzuki Hijiri G , Dewez Juan Emmanuel , Nijman Ruud G , Yeung Shunmay
Published: May 2020

Objectives

To appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence (LoE), astrength of recommendations (SoR), and consideration of antibiotic stewardship.

Design

Systematic review of the literature.

Data sources

Three-pronged search of (1) databases: Medline, Embase, Cochrane library, Guidelines International Network and Trip Medical Database; (2) websites of European national paediatric associations and (3) contact of European experts. Data were collected between January 2017 and February 2018.

Eligibility criteria

National guidelines of European countries for the clinical management of AOM in children aged <16 years.

Data extraction and synthesis

Data were extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. LoE and SoR were compared. Guidelines were assessed for principles of antibiotic stewardship.

Results

AOM guidelines were obtained from 17 or the 32 countries in the European Union or European Free Trade Area. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based on similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15; 93%). The majority (15/17; 88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17; 82%). Recommended treatment duration varied from 5 to 10 days. Seven countries advocated high-dose (75–90 mg/kg/day) and five low-dose (30–60 mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data.

Conclusions

Guidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and it often did not refer to country-specific antibiotic resistance patterns. Coordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance.
Response to physical rehabilitation and recovery trajectories following critical illness: individual participant data meta-analysis protocol
Authors: Jones Jennifer R A , Berney Sue , Berry Michael J , Files D Clark , Griffith David M , McDonald Luke A , Morris Peter E , Moss Marc , Nordon-Craft Amy , Walsh Timothy , Gordon Ian , Karahalios Amalia , Puthucheary Zudin , Denehy Linda
Published: May 2020

Introduction

The number of inconclusive physical rehabilitation randomised controlled trials for patients with critical illness is increasing. Evidence suggests critical illness patient subgroups may exist that benefit from targeted physical rehabilitation interventions that could improve their recovery trajectory. We aim to identify critical illness patient subgroups that respond to physical rehabilitation and map recovery trajectories according to physical function and quality of life outcomes. Additionally, the utilisation of healthcare resources will be examined for subgroups identified.

Methods and analysis

This is an individual participant data meta-analysis protocol. A systematic literature review was conducted for randomised controlled trials that delivered additional physical rehabilitation for patients with critical illness during their acute hospital stay, assessed chronic disease burden, with a minimum follow-up period of 3 months measuring performance-based physical function and health-related quality of life outcomes. From 2178 records retrieved in the systematic literature review, four eligible trials were identified by two independent reviewers. Principal investigators of eligible trials were invited to contribute their data to this individual participant data meta-analysis. Risk of bias will be assessed (Cochrane risk of bias tool for randomised trials). Participant and trial characteristics, interventions and outcomes data of included studies will be summarised. Meta-analyses will entail a one-stage model, which will account for the heterogeneity across and the clustering between studies. Multiple imputation using chained equations will be used to account for the missing data.

Ethics and dissemination

This individual participant data meta-analysis does not require ethical review as anonymised participant data will be used and no new data collected. Additionally, eligible trials were granted approval by institutional review boards or research ethics committees and informed consent was provided for participants. Data sharing agreements are in place permitting contribution of data. The study findings will be disseminated at conferences and through peer-reviewed publications.

PROSPERO registration number

CRD42019152526.
Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care
Authors: Augustsson Pia , Holst Anna , Svenningsson Irene , Petersson Eva-Lisa , Björkelund Cecilia , Björk Brämberg Elisabeth
Published: May 2020

Objectives

To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.

Design

A cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.

Setting

36 PCCs in south-west Sweden.

Participants

PCCs’ directors and clinicians.

Outcome

Data regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.

Results

Among the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.

Conclusions

Our study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.
Psychiatric hospital reform in low-income and middle-income countries Structured Individualised inTervention And Recovery (SITAR): a two-arm pragmatic randomised controlled trial study protocol
Authors: Raja Tasneem , Tuomainen Helena , Madan Jason , Mistry Dipesh , Jain Sanjeev , Singh Swaran
Published: May 2020

Introduction

Low-income and middle-income settings like India have large treatment gaps in mental healthcare. People with severe mental disorders face impediments to their clinical and functional recovery, and have large unmet needs. The infrastructure and standards of care are poor in colonial period psychiatric hospitals, with no clear pathways to discharge and successfully integrate recovered individuals into the community. Our aim is to study the impact of psychiatric hospital reform on individual patient outcomes in a psychiatric hospital in India.

Methods and analysis

Structured Individualised inTervention And Recovery (SITAR) is a two-arm pragmatic randomised controlled trial, focusing on patients aged 18–60 years with a hospital stay of 12–120 months and a primary diagnosis of psychosis. It tests the effectiveness of structural and process reform with and without an individually tailored recovery plan on patient outcomes of disability (primary outcome WHO Disability Assessment Scale), symptom severity, social and occupational functioning and quality of life. A computer-generated permuted block randomisation schedule will allocate recruited subjects to the two study arms. We aim to recruit 100 people into each trial arm. Baseline and outcome measures will be undertaken by trained researchers independent to the case managers providing the individual intervention. A health economic analysis will determine the costing of implementing the individually tailored recovery plan.

Ethics and dissemination

The study will provide answers to important questions around the nature and process of reforms in institutional care that promote recovery while being cognizant of protecting human rights, and dignity. Ethical approval for SITAR was obtained from a registered ethics committee in India (Institutional Ethics Committee VikasAnvesh Foundation, VAF/2018-19/012 dated 6 December 2018) and the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2019–2332, dated 21 March 2019), and registered on the Central Trial Registry of India (CTRI/2019/01/017267). Trial results will be published in
accordance to CONSORT guidelines.
Role of maternal mental health disorders on stillbirth and infant mortality risk: a protocol for a systematic review and meta-analysis
Authors: Adane Akilew A. , Bailey Helen D. , Marriott Rhonda , Farrant Brad M. , White Scott W. , Morgan Vera A. , Shepherd Carrington CJ.
Published: May 2020

Introduction

Maternal mental health disorders such as anxiety and depression are major public health concerns. Evidence shows a link between maternal mental health disorders and preterm birth and low birth weight. However, the impacts of maternal mental health disorders on stillbirth and infant mortality have been less investigated and inconsistent findings have been reported. Thus, using the available literature, we plan to examine whether prenatal maternal mental health disorders impact the risk of stillbirth and infant mortality.

Methods and analysis

This systematic review and meta-analysis will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews. Systematic searches will be conducted (from database inception to December 2019) in Medline, Embase, PsycINFO and Scopus for studies examining the association of prenatal mental health disorders and stillbirth and infant mortality. The search will be limited to studies published in English language and in humans only, with no restriction on the year of publication. Two independent reviewers will evaluate records and assess the quality of individual studies. The Newcastle–Ottawa scales and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to assess the methodological quality and bias of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess between-study heterogeneity in the estimated effect size.

Ethics and dissemination

As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.

PROSPERO registration number

159834.
Exercise interventions for mental disorders in young people: a scoping review
Authors: Pascoe Michaela C , Bailey Alan P , Craike Melinda , Carter Tim , Patten Rhiannon , Stepto Nigel K , Parker Alexandra G
Published: May 2020

Aims

This scoping review determines the breadth and outcomes of controlled trials testing the effect of physical activity/exercise interventions across mental health outcomes in young people with a mental disorder.

Methods

The literature search was conducted using the open-access ‘Evidence Finder’, a comprehensive youth mental health-specific database that is systematically populated from MEDLINE, Embase, PsycINFO and Cochrane CENTRAL databases.

Results

Sixteen publications were identified after meeting the following eligibility criteria: (1) participants were young people (mean age 12–25.9 years) with a mental disorder diagnosed by a trained clinician or by reaching a predefined cut score on a symptom measure, (2) interventions were exercise, (3) designs were randomised or non-randomised controlled trials, (4) outcomes were mental health related. Eight studies included young people with depression, three included people with psychosis/schizophrenia, three included people with eating disorders and two included people with anxiety. The available evidence suggests that moderate-to-vigorous-intensity exercise may be beneficial, particularly for reducing depression. The available evidence for other intervention intensities, and for other mental disorders, is mixed.

Conclusions

Overall, the evidence regarding the impact of exercise interventions on a range of mental health outcomes in clinical populations of young people with various mental disorders looks promising but requires further development. Findings from this scoping review can inform the development of future exercise interventions in the youth mental health field.
Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial
Authors: Carlton Edward Watts , Ingram Jenny , Taylor Hazel , Glynn Joel , Kandiyali Rebecca , Campbell Sarah , Beasant Lucy , Aziz Shahid , Beresford Peter , Kendall Jason , Reuben Adam , Smith Jason E , Chapman Rebecca , Creanor Siobhan , Benger Jonathan Richard
Published: May 2020

Introduction

The clinical effectiveness of a ‘rule-out’ acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown.

Methods

A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days.

Results

Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days.

Conclusion

The LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors.

Trial registration number

ISRCTN86184521.
CCR5 blockade inflames antitumor immunity in BAP1-mutant clear cell renal cell carcinoma
Authors: Zhou Quan , Qi Yangyang , Wang Zewei , Zeng Han , Zhang Hongyu , Liu Zhaopei , Huang Qiuren , Xiong Ying , Wang Jiajun , Chang Yuan , Bai Qi , Xia Yu , Wang Yiwei , Liu Li , Xu Le , Dai Bo , Guo Jianming , Zhu Yu , Zhang Weijuan , Xu Jiejie
Published: May 2020

Background

Patients with BRCA1-associated protein 1 (BAP1)-mutant clear cell renal cell carcinoma (ccRCC) have worse prognosis. C-C chemokine receptor 5 (CCR5) plays an important role in ccRCC development and its expression is elevated in BAP1-mutant tumors.

Methods

533 patients with ccRCC from The Cancer Genome Atlas cohort and 797 patients with ccRCC from the Shanghai cohort were enrolled. In vitro and in vivo studies were conducted with human ccRCC tumors and murine tumor models. The association between BAP1 and CCR5 or its ligands was assessed by immunohistochemistry, flow cytometry, real-time PCR and ELISA. Survival was compared between different subpopulations of patients using Kaplan-Meier curve. Therapeutic effect of CCR5 blockade was validated using human ccRCC tumors and murine models.

Results

Expression of CCR5 and its ligands were elevated in BAP1-mutant patients with ccRCC. High CCR5 expression was indicative of poor prognosis in BAP1-low group of patients. CCR5 blockade prolonged the survival of tumor-bearing mice, resulting in enhanced cytotoxicity of T cells and antigen presentation of dendritic cells but repressed immune checkpoint expression. CCR5 ligands could recruit CCR5+regulatory T cells to the tumor microenvironment. Additionally, BAP1-mutant ccRCC tumor cells secreted CCR5 ligands, which increased programmed cell death ligand 1 expression. However, both processes could be inhibited by CCR5 blockade. Study limitations include the unclear impact of CCR5 expressed by other cell populations.

Conclusions

CCR5 in BAP1-mutant ccRCC results in an immune-suppressive microenvironment. Targeting CCR5 could provide a potential therapeutic benefit for patients.

Trial registration number

NCT01358721, CA209-009.
Becoming a medical assistance in dying (MAiD) provider: an exploration of the conditions that produce conscientious participation
Authors: Oliphant Allyson , Frolic Andrea Nadine
Published: May 2020

The availability of willing providers of medical assistance in dying (MAiD) in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences (HHS) in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions.
Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study
Authors: Stefanou Maria-Ioanna , Sulyok Mihaly , Koehnlein Martin , Scheibe Franziska , Fleischmann Robert , Hoffmann Sarah , Hotter Benjamin , Ziemann Ulf , Meisel Andreas , Mengel Annerose Maria
Published: May 2020

Purpose

Scarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.

Materials and methods

A prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.

Results

8 (25%) physicians and 24 (75%) nurses participated in the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.

Conclusions

Our findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals.
Sex-specific risks and trends in lung cancer mortality across occupations and economic activities in Switzerland (1990–2014)
Authors: Bovio Nicolas , Richardson David B , Guseva Canu Irina
Published: May 2020

Objectives

To assess lung cancer mortality across occupations and economic activities/industries in Switzerland using three statistical estimates.

Methods

All Swiss residents aged 18–65 during the 1990 or 2000 censuses were followed through 2014 to ascertain information on date and cause of death. For every occupation and economic activity/industry, causal mortality ratios (CMR) and standardised mortality ratios (SMR) were computed using national cause-specific mortality rates. We also calculated relative SMR (rSMR) and conducted analyses stratified by socioeconomic variables, job skill level and calendar periods.

Results

The study sample comprised 5 834 618 participants (111 162 348 person-years). SMR and CMR led to similar results, while rSMR were generally higher. We found 18 occupations in men, 10 occupations in women and 3 industries in each sex with an excess of lung cancer mortality. Among men, rubber and plastic products machine operators, and workers in mining and quarrying, and construction industries were at high risk. Among women, motor vehicle drivers and workers in trade, repair of motor vehicles and of domestic articles and manufacture of goods industries showed the highest risks. In both sexes, hotel and restaurant workers presented an excess of lung cancer mortality.

Conclusion

Most of the activities and occupations in which we observed excess lung cancer mortality have previously been observed to involve occupational exposure to lung carcinogens. These findings suggest that the number of occupational lung cancer is likely underestimated by the official Swiss statistics. Further research should address this question and the exposure–effect relationships in the most at-risk occupational groups.
Effects of waist to height ratio, waist circumference, body mass index on the risk of chronic diseases, all-cause, cardiovascular and cancer mortality
Authors: Lo Kenneth , Huang Yu-Qing , Shen Geng , Huang Jia-Yi , Liu Lin , Yu Yu-Ling , Chen Chao-Lei , Feng Ying Qing
Published: May 2020

Background

Given the fat redistribution in later stages of life, how the associations between abdominal obesity and the risk of morbidity and mortality have changed with age have not been elucidated, especially for waist to height ratio (WHtR).

Objective

To compare the strength of association between obesity indices and chronic diseases at baseline, and the subsequent mortality risk among US adults.

Methods

We included 21 109 participants from National Health and Nutrition Examination Survey 1999–2014. We performed logistic regression and receiver operating curve analysis to examine the discriminatory power of obesity indicators on cardiometabolic diseases and cancer at baseline. Sex-stratified and age-stratified Cox models were constructed to explore the prospective association between obesity indices and all-cause, cardiovascular and cancer mortality.

Results

Elevated WHtR, elevated waist circumference (WC) and body mass index (BMI)-classified obesity are associated with higher odds of hypertension (OR: 1.37-2.13), dyslipidemia (OR: 1.06 to 1.75, all p<0.05) and diabetes (OR: 1.40-3.16, all p<0.05). WHtR had significantly better discriminatory power to predict cardiometabolic health than BMI, especially for diabetes (area under the curve: 0.709 vs 0.654). After multivariable adjustment, all obesity indicators are associated with lower risk of all-cause mortality among females aged ≥65 years (HR: 0.64 to 0.85), but the association was only significant for BMI when obesity indicators were mutually adjusted (HR: 0.79).

Conclusions

WHtR and WC appeared to be the better indicators for cardiometabolic health than BMI. However, BMI had a stronger and inverse association with a greater risk of all-cause mortality among older females.
Out-of-hospital cardiac arrests in the young population; a 6-year review of the Irish out-of-hospital cardiac arrest register
Authors: Tanner Richard , Masterson Siobhan , Galvin Joseph , Wright Peter , Hennelly David , Murphy Andrew , Bury Gerard , O'Donnell Cathal , Deasy Conor
Published: May 2020

Study purpose

Out-of-hospital cardiac arrests (OHCA) in the young population have only been examined in a limited number of regional studies. Hence, we sought to describe OHCA characteristics and predictors of survival to hospital discharge for the young Irish population.

Study design

An observational analysis of the national Irish OHCA register for all OHCAs aged ≤35 years between January 2012 and December 2017 was performed. The young population was categorised into three age groups: ≤1 year, 1–15 years and 16–35 years. Multivariable logistic regression was used to determine the independent predictors of survival to hospital discharge.

Results

A total of 1295 OHCAs aged ≤35 years (26.9% female, median age 25 (IQR 17–31)) had resuscitation attempted. OHCAs in those aged ≥16 years (n=1005) were more likely to happen outside the home (38.5% vs 22.8%, p<0.001) and be of non-medical aetiology (59% vs 27.6%, p<0.001) compared with those aged <16 years (n=290). Asphyxiation, trauma and drug overdoses accounted for over 90% of the non-medical OHCAs for those 16–35 years. Overall survival to hospital discharge for the cohort was 5.1%; survival was non-significantly higher for those aged 16–35 years compared with those aged 1–15 years (6.0%, vs 2.8% p=0.93). Independent predictors of survival to hospital discharge included bystander witnessed OHCA, a shockable initial rhythm and a bystander defibrillation attempt.

Conclusions

The high prevalence of non-medical OHCAs and the OHCA location need to be considered when developing OHCA care pathways and preventative strategies to reduce the burden of OHCAs in the young population.
A personal historical perspective of HIV
Authors: Welsby Philip D
Published: May 2020

All animal life on earth is thought to have a common origin and have common genetic mechanisms. Evolution has enabled differentiation of species. Pathogens likewise have evolved within various species and mostly come to a settled dynamic equilibrium such that co-existence results (pathogens ideally should not kill their hosts). Problems arise when pathogens jump species because the new host had not developed any resistance. These infections from related species are known as zoonoses. COVID-19 is the latest example of a virus entering another species but HIV (and various strains of influenza) were previous examples.
Chronic pain and psychedelics: a review and proposed mechanism of action
Authors: Castellanos Joel P , Woolley Chris , Bruno Kelly Amanda , Zeidan Fadel , Halberstadt Adam , Furnish Timothy
Published: May 2020

The development of chronic pain is a complex mechanism that is still not fully understood. Multiple somatic and visceral afferent pain signals, when experienced over time, cause a strengthening of certain neural circuitry through peripheral and central sensitization, resulting in the physical and emotional perceptual chronic pain experience. The mind-altering qualities of psychedelics have been attributed, through serotonin 2A (5-HT2A) receptor agonism, to ‘reset’ areas of functional connectivity (FC) in the brain that play prominent roles in many central neuropathic states. Psychedelic substances have a generally favorable safety profile, especially when compared with opioid analgesics. Clinical evidence to date for their use for chronic pain is limited; however, several studies and reports over the past 50 years have shown potential analgesic benefit in cancer pain, phantom limb pain and cluster headache. While the mechanisms by which the classic psychedelics may provide analgesia are not clear, several possibilities exist given the similarity between 5-HT2Aactivation pathways of psychedelics and the nociceptive modulation pathways in humans. Additionally, the alterations in FC seen with psychedelic use suggest a way that these agents could help reverse the changes in neural connections seen in chronic pain states. Given the current state of the opioid epidemic and limited efficacy of non-opioid analgesics, it is time to consider further research on psychedelics as analgesics in order to improve the lives of patients with chronic pain conditions.
Long-term safety, immunogenicity and efficacy comparing FKB327 with the adalimumab reference product in patients with active rheumatoid arthritis: data from randomised double-blind and open-label extension studies
Authors: Genovese Mark C , Kellner Herbert , Arai Yasumasa , Muniz Rafael , Alten Rieke
Published: May 2020

Background/Objective

FKB327 is a biosimilar of the antitumour necrosis factor adalimumab reference product (RP). A randomised, double-blind (DB) phase 3 study compared the efficacy of FKB327 with the RP in patients with active rheumatoid arthritis (RA) inadequately controlled with methotrexate (MTX). A subsequent randomised open-label extension (OLE) study with treatment switching assessed long-term safety, efficacy, pharmacokinetics and immunogenicity of FKB327 compared with the RP.

Methods

Patients with moderate-to-severe, active RA on a stable dose of MTX were randomised 1:1 to receive FKB327 or the RP (40 mg subcutaneously every other week) for 24 weeks. Patients who completed the DB study were enrolled in the OLE and rerandomised 2:1 to receive FKB327 or the RP; two-thirds continued on the same treatment and one-third switched for 30 weeks. All patients received FKB327 through Week 76. Long-term efficacy, safety and immunogenicity were assessed.

Results

Of 728 patients in the DB study, 645 were enrolled in the FKB327-OLE study. The American College of Rheumatology (ACR)20 response rates for all treatment groups at Week 30 in the OLE ranged from 83.2% to 85.9%. ACR20 response rates remained stable for all patients regardless of single- or double-switching treatment and were similar for all treatment sequences through Week 76. The safety profile and incidence of antidrug antibodies were comparable across sequences.

Conclusion

Efficacy, safety and immunogenicity were similar among patients with RA treated with FKB327 or the RP for up to 2 years, and were not affected by single- or double-switching treatment.
The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients with axial spondyloarthritis: 48-week interim results from C-VIEW
Authors: van der Horst-Bruinsma Irene , van Bentum Rianne , Verbraak Frank D , Rath Thomas , Rosenbaum James T , Misterska-Skora Maria , Hoepken Bengt , Irvin-Sellers Oscar , VanLunen Brenda , Bauer Lars , Rudwaleit Martin
Published: May 2020

Background

Acute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). C-VIEW investigates the impact of the Fc-free TNF inhibitor certolizumab pegol (CZP) on AAU flares in patients with active axSpA at high risk of recurrent AAU.

Methods

C-VIEW (NCT03020992) is a 96-week ongoing, multicentre, open-label, phase 4 study. Included patients had an axSpA diagnosis, a history of recurrent AAU (≥2 AAU flares, ≥1 flare in the year prior to study entry), HLA-B27 positivity, active disease, and failure of ≥2 non-steroidal anti-inflammatory drugs. Patients received CZP 400 mg at Weeks 0/2/4, then 200 mg every 2 weeks up to 96 weeks. This 48-week pre-planned interim analysis compares AAU flare incidence in the 48 weeks before and after initiation of CZP treatment, using Poisson regression to account for possible within-patient correlations.

Results

In total, 89 patients were included (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean axSpA disease duration: 8.6 years). During 48 weeks’ CZP treatment, 13 (15%) patients experienced 15 AAU flares, representing an 87% reduction in AAU incidence rate (146.6 per 100 patient-years (PY) in the 48 weeks pre-baseline to 18.7 per 100 PY during CZP treatment). Poisson regression analysis showed that the incidence rate of AAU per patient reduced from 1.5 to 0.2 (p<0.001). No new safety signals were identified.

Conclusions

There was a significant reduction in the AAU flare rate during 48 weeks of CZP treatment, indicating that CZP is a suitable treatment option for patients with active axSpA and a history of recurrent AAU.
Use of thermography for the diagnosis of chronic proliferative rhinitis in sheep and its application in the differential diagnosis of the first case affecting the dorsal turbinate
Authors: López‐Tamayo Silvia , Rubira Ines , De las Heras Marcelo , Castells Enrique , Lacasta Delia
Published: May 2020

Chronic proliferative rhinitis (CPR) is a fatal prognosis upper respiratory tract disease that affects sheep and is associated with Salmonella enterica subspecies diarizonae serotype 61:k:1, 5, (7). It may be unilateral or bilateral, and although minor changes have been seen in dorsal turbinate, the ventral turbinate is always affected, which makes it possible to observe the proliferative tissue emerging from the nares.

The following publication describes the case of an ewe severely affected by a bilateral inflammatory process of the upper respiratory tract. S enterica subspecies diarizonae was isolated from nasal swabs; however, the hottest area observed by a thermal imaging camera was not the ventral area, as usually seen in this process, but the middle area, where the dorsal turbinate is located. In addition, no proliferative tissue was seen through the nostril. At postmortem examination, it was confirmed that CPR seriously affected, for the first time, the dorsal turbinate and ethmoidal areas. Thermographic cameras are useful tools for the diagnosis of upper respiratory tract diseases in sheep.
Germination of Cenchrus ciliaris, Pennisetum divisum, and Panicum turgidum is seasonally dependent
Authors: Bhatt Arvind , Batista-Silva Willian , Gallacher David J. , Pompelli Marcelo F.
Published: May 2020

Knowledge of optimal conditions for germination facilitates more efficient practices, such as fodder production and restoration. We assessed seeds of three grass species harvested in winter and summer 2018. Germination ability was assessed under two night/day temperature regimes (15 °C/20 °C, 20 °C/30 °C) and two photoperiod regimes (0, 12 h light per day). Winter-maturing seeds had a slightly lower mass and reduced germination. Temperature and light requirements for optimal germination were dependent on species and harvest-time. Summer-maturing seeds of all three species had higher germination rates regardless of germination temperature. Interactions among treatment temperatures and species were 0.7- to 5.4-times higher than the control, as shown by heatmaps. Therefore, attention to these factors will improve the efficiency of seedling establishment for rehabilitation work.
The prospect of charm quark magnetic moment determination
Authors: Fomin A. S. , Barsuk S. , Korchin A. Yu. , Kou E. , Kovalchuk V. A. , Liul M. , Natochii A. , Niel E. , Robbe P. , Stocchi A.
Published: May 2020

In this paper, we discuss the theoretical framework and the experimental measurements of the magnetic moment of the charmed baryons. We first review the theoretical predictions of the $$\varLambda _c^{+}$$Λc+ magnetic moment and show that the measurements of the magnetic moments of other charmed baryons, such as $$\varXi _{c}$$Ξc, allow to perform detailed spectroscopy studies. The magnetic moment of the charm quark can be determined using radiative charmonium decay, which can be compared to the $$\varLambda _c^{+}$$Λc+ magnetic moment within theoretical models. The present results show a tension with majority of theoretical predictions. The magnetic moment of the charmed baryons could potentially be measured directly, using bent-crystal experiments at LHC. The possibility to measure precisely the magnetic moments of charmed baryons needs precise measurement of their polarisation and weak decay parameters. In this paper, we revisit the formalism of the angular analysis needed for these measurements and make a detailed evaluation of initial polarisation of deflected $$\varLambda _c$$Λc baryons as a function of crystal orientation. We found a special orientation of the crystal that gives the opportunity to measure the $$\varLambda _c$$Λc dimensionless electric dipole moment almost with the same precision as its g-factor, which is more than an order of magnitude more efficient than suggested before.
On the validity of strong cosmic censorship conjecture in presence of Dirac fields
Authors: Rahman Mostafizur
Published: May 2020

An well posed theory of nature is expected to determine the future of an observer uniquely from a given set of appropriate initial data. In the context of general relativity, this is ensured by Penrose’s strong cosmic censorship conjecture. But in recent years, several examples are found which suggest breakdown of the deterministic nature of the theory in Reissner–Nordström–de Sitter black holes under the influence of different fundamental fields. Nevertheless, the situation has been reassuring for the case of astrophysically meaningful Kerr–de Sitter black hole solutions which seems to respect the conjecture. However, the previous analyses were done considering only the effect of scalar fields. In this paper, we extend the study by considering Dirac fields in Kerr–de Sitter background and show that there exist a parameter space which does not respect the conjecture.
Classical and Quantum Markov Processes Associated with q-Bessel Operators
Authors: Bessadok Khadija , Fagnola Franco , Hachicha Skander
Published: May 2020

We study the fundamental properties of classical and quantum Markov processes generated by q-Bessel operators and their extension to the algebra of all bounded operators on the Hilbert space [Formula: see text]. In particular, we find a suitable generalized Gorini–Kossakowski–Sudarshan–Lindblad representation for the infinitesimal generator of q-Bessel operator and show that both the classical and quantum Markov processes are transient for α > 0 and recurrent for α = 0. We also show that they do not admit invariant states and, moreover that the support projection of any initial state instantaneously fills the full space.