bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study
Authors: Hirschberg Angelica Lindén , Elings Knutsson Jona , Helge Torbjörn , Godhe Manne , Ekblom Maria , Bermon Stephane , Ekblom Björn 
Published: October 2019

ObjectiveTo investigate the effects of a moderate increase in serum testosterone on physical performance in young, physically active, healthy women.MethodsA double blind, randomised, placebo controlled trial was conducted between May 2017 and June 2018 (ClinicalTrials.gov ID:NCT03210558). 48 healthy, physically active women aged 18–35 years were randomised to 10 weeks of treatment with 10 mg of testosterone cream daily or placebo (1:1). All participants completed the study. The primary outcome measure was aerobic performance measured by running time to exhaustion (TTE). Secondary outcomes were anaerobic performance (Wingate test) and muscle strength (squat jump (SJ), counter movement jump (CMJ) and knee extension peak torque). Hormone levels were analysed and body composition assessed by dual energy X-ray absorptiometry.ResultsSerum levels of testosterone increased from 0.9 (0.4) nmol/L to 4.3 (2.8) nmol/L in the testosterone supplemented group. TTE increased significantly by 21.17 s (8.5%) in the testosterone group compared with the placebo group (mean difference 15.5 s; P=0.045). Wingate average power, which increased by 15.2 W in the testosterone group compared with 3.2 W in the placebo group, was not significantly different between the groups (P=0.084). There were no significant changes in CMJ, SJ and knee extension. Mean change from baseline in total lean mass was 923 g for the testosterone group and 135 g for the placebo group (P=0.040). Mean change in lean mass in the lower limbs was 398 g and 91 g, respectively (P=0.041).ConclusionThe study supports a causal effect of testosterone in the increase in aerobic running time as well as lean mass in young, physically active women.
effect of physical activity on independent living ability among community-dwelling elderly in urban areas of Liaoning Province in China: a population-based study
Authors: Wang Bowen , Wu Yijiao , Zhang Tianjiao , Han Jinsong , Yu Lianzheng , Sun Wei 
Published: October 2019

ObjectiveIndependent living ability is crucial for the elderly; however, its assessment performed in China employs various scales and lacks risk factors, especially behavioural and social-psychological factors, which could be improved through health education. This study aimed to assess the independent living ability of community-dwelling elderly in urban areas of China and to identify the association with behavioral and social-psychological factors.DesignA population-based study using random cluster sampling method was performed in two core cities in Liaoning Province during March–November 2012.Study population3686 individuals who were >=65 years old, had no dementia and cognitive impairment, had lived in the sampled communities for >=5 years and could take part in the study were enrolled.Main outcome measuresInterviews were conducted to collect information of independent living ability, indicated by the instrumental activity of daily living (IADL), behavioural factors, social-psychological factors and confounders (demographic characteristics and health status). The Mini-Mental State Examination was used to screen for cognitive impairment.ResultsThe independence rate was 46.3% in men and 41.1% in women. Structural equation modelling analysis showed that physical activity, drawn from taking a walk and doing exercise, had the strongest association with the IADL in both men (−0.34, SE 0.10) and women (−0.33, SE 0.11). Falling in the last year and worrying about falling were also significantly associated with IADL. The effects of regular drinking, feeling lonely and participating in entertainment were significant in men.ConclusionThe independent living ability of the elderly in urban areas in Liaoning Province in China was at a low level. Physical activity was one of the important roles in both men and women; whereas the role of social-psychological factors only existed in men. Gender-specific healthcare and education to avoid sedentary life should be advocated for the elderly to maintain/improve their independent living ability.
From menu to mouth: the decay pathway of nutrient intake from planned menu to consumed and characteristics of residents in an aged care facility with greater nutrient decay rates: a cross-sectional study
Authors: Nanayakkara Wathsala Sripali , Skidmore Paula , O'Brien Leigh , Wilkinson Tim , Frampton Chris , Gearry Richard 
Published: October 2019

ObjectivesTo observe the cascade of nutrient loss from meals planned to those provided and subsequently consumed by older people in residential care. A secondary aim was to determine the characteristics of residents with higher nutrient loss resulting in lower intake of key nutrients.DesignA single-centre cross-sectional study.SettingAn aged residential care facility in Christchurch, New Zealand.ParticipantsAll low and high level of care residents except those who are end of life, enterally fed or on short-term stay were invited to participate in the study. 54 of 60 selected residents who consumed all three main meals (breakfast, lunch and dinner) for three non-consecutive days were included in the analyses.Main outcome measuresNutrient contents of planned menu; nutrient contents of meals served and consumed using modified 3-day diet records; and percentage of planned nutrients served and consumed.ResultsVitamins C, B12 and folate had the greatest total decay rates of 50% or more from that planned to be consumed to what was actually consumed, while unsaturated fats, beta carotene, iodine and zinc had the lowest decay rates of 25% or less. Male participants and lower care level residents consumed significantly more nutrients, compared with female participants and those receiving higher level care. Increased age, female gender, higher level of care, smaller meal size, pureed diet and lower body mass index were associated with larger decay rates and lower nutrient intakes.ConclusionsNot all planned and served food and beverages are consumed, contributing to potential multiple nutrient deficiencies including energy and protein in the majority of aged-care residents. As a consequence, some nutrients may need to be oversupplied if consumption is to match planned intakes.
Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study
Authors: Chou Chien-Wen , Kung Pei-Tseng , Chou Wen-Yu , Tsai Wen-Chen 
Published: October 2019

ObjectivesA pay-for-performance (P4P) programme is a management strategy that encourages healthcare providers to deliver high quality of care. In Taiwan, the P4P programme has been implemented for diabetes, and certified diabetes physicians voluntarily enrol patients with diabetes into the P4P programme. The objectives of this study were to compare the risk of stroke and its related factors in patients with type 2 diabetes who were enrolled in a P4P programme compared with those who were not.Study designThis study is a natural experiment in Taiwan. A retrospective cohort investigation was conducted from 2002 to 2013, which included 459 726 patients with type 2 diabetes, who were grouped according to P4P enrolment status following a propensity score matching process.MethodsWe reviewed patients ≥45 years of age newly diagnosed with type 2 diabetes mellitus (DM) from the National Health Insurance Research Database in Taiwan. A Cox proportional hazards model was used to compare the relative risk of stroke between patients with type 2 DM enrolled in the P4P programme and those who were not enrolled.ResultsCompared with the patients not enrolled, there was a significantly lower stroke risk in P4P participants (HR=0.97, 95% CI 0.95 to 0.99). Although a significantly lower risk of haemorrhagic stroke was observed (HR=0.87, 95% CI 0.82 to 0.93) in P4P participants, no statistically significant difference for the risk of ischaemic stroke between P4P and non-P4P patients (HR=0.99, 95% CI 0.97 to 1.02) was found. Following stratification analysis, a significantly reduced stroke risk was observed in male patients with type 2 diabetes, but not in women.ConclusionsParticipants in Taiwan’s Diabetes P4P programme displayed a significantly reduced stroke risk, especially haemorrhagic stroke. We recommend the continual promotion of this programme to the general public and to physicians.
Physician Mental Workload Scale in China: Development and Psychometric Evaluation
Authors: Lu Chuntao , Hu Yinhuan , Fu Qiang , Governor Samuel , Wang Liuming , Li Chao , Deng Lu , Xie Jinzhu 
Published: October 2019

ObjectiveThe purpose of our study is to develop a mental workload scale for physicians in China and assess the scale’s reliability and validity.DesignThe instrument was developed over three phases involving 396 physicians from different tiers of comprehensive public hospitals in China. In the first phase, an initial item pool was developed through a systematic literature review. The second phase consisted of two rounds of Delphi expert consultations and a pilot survey. The third phase tested the reliability and validity of the instrument.SettingPublic hospitals in China.ParticipantsA total of 396 physicians from different tiers of comprehensive public hospitals in China participated in this study in 2018.Primary and secondary outcome measuresCronbach’s α, content validity index, item-total score correlation coefficient, dimension-total score correlation coefficient and indices of confirmatory factor analysis.ResultsSix dimensions (mental demands, physical demands, temporal demands, perceived risk, frustration level and performance) and 12 items were identified in the instrument. For reliability, Cronbach’s α for the whole scale was 0.81. For validity, the corrected item-content validity index of each item ranged from 0.85 to 1, item-total score correlation coefficients ranged from 0.31 to 0.75, and the correlation coefficients between the dimensions and total score ranged from 0.37 to 0.72. The results of the confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory.ConclusionThe instrument showed good reliability and validity, and it is useful for diagnosing the mental workload of physicians.
Barriers to the implementation of sexual and reproductive health education programmes in low-income and middle-income countries: a scoping review protocol
Authors: Mashora Moreblessing Chipo , Dzinamarira Tafadzwa , Muvunyi Claude Mambo 
Published: October 2019

IntroductionHealth education programmes (HEPs) have been associated with a number of benefits. These include providing individuals with information on matters related to their mental, social, physical as well as emotional health. HEPs also play a major role in preventing diseases and reducing the level of engagement of individuals in risky behaviours. While this is the case, there are barriers to the effective implementation of HEPs, especially in low-income and middle-income countries (LMICs) where resources are scarce. Available evidence has revealed socioeconomic challenges ranging from literacy issues, discomfort about issues of sexuality, and cultural barriers to financial constraints as key barriers to the implementation of sexual and reproductive health HEPs in LMICs. We will focus on HEPs related to sexual and reproductive health; all age groups will be considered with no restrictions on geographical setting nor model of HEP delivery. This review will map literature on the barriers to the effective implementation of HEPs in LMICs to guide future implementation research.MethodsArksey and O’Malley’s 2005 scoping methodological framework will act as the guide for this review. We will search the following electronic databases: EBSCOhost (Academic search complete, PsycINFO, Health Sources, CINAHL and MEDLINE with full text), Google Scholar, PubMed, SCOPUS, Science Direct and Web of Science. Grey literature from Mount Kenya University theses and dissertations, governments’ as well as international organisations’ reports, such as WHO, and reference lists of included studies will be searched for eligible studies. We will limit our search to publications from 1 January 2000 to 30 September 2019. Using thematic content analysis, we will employ NVivo V.12 to extract the relevant outcomes from the included articles. We will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) version 2018.Ethics and disseminationNo ethical approval is needed for the study as it will not include animal nor human participants. The results of the proposed scoping review will be disseminated electronically, in print and through conference presentation as well as at key stakeholder meetings.
Feasibility and implementation of a healthy lifestyles program in a community setting in Ontario, Canada: protocol for a pragmatic mixed methods pilot study
Authors: Alvarez Elizabeth , Qutob Majdi , Mbuagbaw Lawrence , Lavis John , Lokker Cynthia , Walli-Attaei Marjan , Samaan Zainab , Sutton Arielle , Singh Japteg , Feeny David , Fortuna John 
Published: October 2019

IntroductionRates of chronic conditions, such as diabetes, cardiovascular disease and obesity are increasing in Canada and internationally. There are effective lifestyle interventions that are known to improve chronic conditions. However, there is often a gap in ‘how to’ make lifestyle changes. Mental health and other determinants of health play a role in the development and progression of chronic conditions. Changing habits takes time and requires the use of multiple techniques, including mental health and behavioural change strategies, based on a person’s needs. A new, multidisciplinary, person-centred and evidence-based and practice-based programme has been created to address these needs. This proposal aims to evaluate the feasibility and implementation of this programme and to determine changes in participant-directed and clinical outcomes through a pilot study.Methods and analysisA pragmatic mixed methods design will be used to study multiple dimensions of the year-long healthy lifestyles programme. The pilot study includes a randomised controlled trial, with 30 participants randomised to either the programme or to a comparator arm, and qualitative components to determine the feasibility of the programme, including recruitment and retention, data missing rates and resources needed to run this programme. Changes in participant-directed and clinical outcomes will be measured. Descriptive statistics, t-tests and repeated measures analysis of variance (ANOVA) for within group comparisons and generalised estimating equations for between group analyses will be used. Qualitative interviews of programme staff and healthcare providers and family focus groups will be used to further enhance the findings and improve the programme.Ethics and disseminationApproval from the Hamilton Integrated Research Ethics Board (HiREB) has been obtained. Informed consent will be obtained prior to enrolling any participant into the study. Participant IDs will be used during data collection and entry. Peer-reviewed publications and presentations will target researchers, health professionals and stakeholders.Trial registration numberClinicalTrials.gov Identifier:NCT03258138.HiREB project number: 3793.
Codesigning a mobile gamified attention bias modification intervention: research protocol
Authors: Zhang Melvyn WB , Heng Sandor , Song Guo , Fung Daniel Shuen Sheng , Smith Helen 
Published: October 2019

IntroductionAdvances in experimental psychology has highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. While prior research has documented the effectiveness of cognitive bias modification, such interventions tend to be highly repetitive and individuals lack motivation to train over time. Participatory action research methods have been more widely applied in psychiatry to help design interventions that are of relevant to key stakeholders and end users. This study aimed to involve both healthcare professionals and patients in the joint codesign of a gamified mobile attention bias modification intervention.Methods and analysisThe participatory design research method adopted is that of a use-oriented design approach, in the form of a future workshop. 20 participants, comprising 10 healthcare professionals, 5 inpatients and 5 outpatients will be recruited to participate in three separate codesign workshops. In the first phase of the workshop, the participants share their critique of an attention bias modification intervention. In the second phase of the workshop, participants are asked to brainstorm features. The participants are also shown gamification approaches and are asked to consider if gaming elements could enhance the existing application. In the last phase, the participants are asked to sketch a new prototype.Ethics and disseminationEthical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (approval number 2018/01363). The findings arising from this study will be disseminated by means of conferences and publications.
Primary palliative care for older people in three European countries: a mortality follow-back quality study
Authors: de Nooijer Kim , Pivodic Lara , Deliens Luc , Miccinesi Guido , Vega Alonso Tomas , Moreels Sarah , Van den Block Lieve 
Published: October 2019

BackgroundMany older people with serious chronic illnesses experience complex health problems for which palliative care is indicated. We aimed to examine the quality of primary palliative care for people aged 65–84 years and those 85 years and older who died non-suddenly in three European countries.MethodsThis is a nationwide representative mortality follow-back study. General practitioners (GPs) belonging to epidemiological surveillance networks in Belgium (BE), Italy (IT) and Spain (ES) (2013–2015) registered weekly all deaths in their practices. We included deaths of people aged 65 and excluded sudden deaths judged by GPs. We applied a validated set of quality indicators.ResultsGPs registered 3496 deaths, of which 2329 were non-sudden (1126 aged 65–84, 1203 aged 85+). GPs in BE (reference category) reported higher scores than IT across almost all indicators. Differences with ES were not consistent. The score in BE particularly differed from IT on GP–patient communication (aged 65–84: 61% in BE vs 20% in IT (OR=0.12, 95% CI 0.07 to 0.20) aged 85+: 47% in BE vs 9% in IT (OR=0.09, 95% CI 0.05 to 0.16)). Between BE and ES, we identified a large difference in involvement of palliative care services (aged 65–84: 62% in BE vs 89% in ES (OR=4.81, 95% CI 2.41 to 9.61) aged 85+: 61% in BE vs 77% in ES (OR=3.1, 95% CI 1.71 to 5.53)).ConclusionsConsiderable country differences were identified in the quality of primary palliative care for older people. The data suggest room for improvement across all countries, particularly regarding pain measurement, GP–patient communication and multidisciplinary meetings.
Socioeconomic position and risk of atrial fibrillation: a nationwide Danish cohort study
Authors: Lunde Elin Danielsen , Joensen Albert Marni , Lundbye-Christensen Søren , Fonager Kirsten , Paaske Johnsen Søren , Larsen Mogens Lytken , Berg Johansen Martin , Riahi Sam 
Published: October 2019

AimTo examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens.MethodsRegister-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%).ResultsA total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: −0.28 (−0.43 to −0.14), −0.18 (−0.36 to −0.01), 3.04 (−0.55 to 6.64) and −0.74 (−3.38 to 2.49), respectively. Similar but weaker associations were found for income.ConclusionHigher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.
Evaluation and comparison of pain questionnaires for clinical screening of osteoarthritis in cats
Authors: Stadig Sarah , Lascelles B Duncan X , Nyman Gorel , Bergh Anna 
Published: October 2019

BackgroundFeline osteoarthritis (OA) is a common cause of long‐standing pain and physical dysfunction. Performing a physical examination of a cat is often challenging. There is a need for disease‐specific questionnaires or the so‐called clinical metrology instruments (CMIs) to facilitate diagnosis and evaluation of treatment of feline OA. The CMI provides the owners an assessment of the cat's behavioural and lifestyle changes in the home environment. The purpose of the study was to evaluate readability, internal consistency, reliability and discriminatory ability of four CMIs.MethodsThis is a prospective, cross‐sectional study with 142 client‐owned cats. Feline OA was diagnosed based on medical history, orthopaedic examination and radiography.ResultsThe results indicate that all four instruments have sound readability, internal consistency, are reliable over time and have good discriminatory ability. Preliminary cut‐off values with optimal sensitivity and specificity were suggested for each instrument. The osteoarthritic cats showed significant changes in behavioural response to pain during orthopaedic examination, compared with sound cats.ConclusionThe results indicate that all four questionnaires make an important contribution in a clinical setting, and that the cat's behavioural response to pain during physical examination should be a parameter to take into account as a possible indication of chronic pain.