bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries
Authors: Adegbosin Adeyinka Emmanuel , Stantic Bela , Sun Jing 
Published: August 2020

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.
Objectively assessed physical activity patterns and physical function in community-dwelling older adults: a cross-sectional study in Taiwan
Authors: Hsueh Ming-Chun , Rutherford Ru , Chou Chien-Chih , Park Jong-Hwan , Park Hyun-Tae , Liao Yung 
Published: August 2020

ObjectivesTo objectively assess light physical activity (PA), moderate-to-vigorous PA (MVPA), step counts and number of 10 min MVPA bouts and their association with physical function among older adults.DesignCross-sectional design.SettingUrban community setting in Taiwan.Participants127 Taiwanese older adults aged over 65 years (mean age=70.8±5.3 years; 72% women).Primary and secondary outcome measuresTriaxial accelerometers were used to measure PA variables for 10 hours/day for seven consecutive days. Then, five physical function components (handgrip strength, single-leg stance, 5-metre walk speed, timed up and go and sit-to-stand test) were measured. Multiple linear regressions were used to perform separate analyses for older men and women.ResultsFor older women, daily MVPA time (β: 0.39, 95% CI: 0.12, 0.64; p=0.004), daily step counts (β: 0.46, 95% CI: 0.12, 0.78; p=0.009) and number of 10 min MVPA bouts (β: 0.27, 95% CI: 0.001, 0.53; p=0.049) were positively associated with handgrip strength after adjusting for accelerometer wear time, sedentary time and other confounders. Furthermore, daily MVPA time was positively associated with a single-leg stance (β: 0.25, 95% CI: 0.02, 0.49; p=0.036) and higher daily step counts were associated with shorter walking speed performance (β: −0.31, 95% CI: −0.57, −0.001; p=0.049). None of the variables of the objectively assessed PA patterns was associated with physical function outcomes among older men due to their small sample size.ConclusionsDaily MVPA, MVPA bouts of at least 10 min and accumulated daily steps are important for improving physical function among older women. Future prospective research should establish causal associations between PA patterns and functional ability among older adults.
How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A qualitative study
Authors: Lahham Aroub , Burge Angela T , McDonald Christine F , Holland Anne E 
Published: August 2020

ObjectivesClinical practice guidelines recommend that people with chronic obstructive pulmonary disease (COPD) should be encouraged to increase their physical activity levels. However, it is not clear how these guidelines are applied in clinical practice. This study aimed to understand the perspectives of respiratory healthcare professionals on the provision of physical activity advice to people with COPD. These perspectives may shed light on the translation of physical activity recommendations into clinical practice.DesignA qualitative study using thematic analysis.SettingHealthcare professionals who provided care for people with COPD at two major tertiary referral hospitals in Victoria, Australia.Participants30 respiratory healthcare professionals including 12 physicians, 10 physical therapists, 4 nurses and 4 exercise physiologists.InterventionsSemistructured voice-recorded interviews were conducted, transcribed verbatim and analysed by two independent researchers using an inductive thematic analysis approach.ResultsHealthcare professionals acknowledged the importance of physical activity for people with COPD. They were conscious of low physical activity levels among such patients; however, few specifically addressed this in consultations. Physicians described limitations including time constraints, treatment prioritisation and perceived lack of expertise; they often preferred that physical therapists provide more comprehensive assessment and advice regarding physical activity. Healthcare professionals perceived that there were few evidence-based strategies to enhance physical activity. Physical activity was poorly differentiated from the prescription of structured exercise training. Although healthcare professionals were aware of physical activity guidelines, few were able to recall specific recommendations for people with COPD.ConclusionPractical strategies to enhance physical activity prescription may be required to encourage physical activity promotion in COPD care.
I need to be who I am: a qualitative interview study exploring the needs of people with dementia in Norway
Authors: Telenius Elisabeth Wiken , Eriksen Siren , Rokstad Anne Marie Mork 
Published: August 2020

ObjectiveMany people with dementia receive community services. These services are often based on the needs of informal caregivers and professional caregivers’ assessment. User involvement and participation are main objectives in the Norwegian National Dementia Plan 2020. To enhance user involvement and individual tailoring of healthcare services, more information is required about the needs of people with dementia. The aim of this study was to explore the experienced needs of people with dementia in order to facilitate user involvement in provided services.MethodsAn explorative cross-sectional study design was used. We performed semistructured interviews with people with dementia who were recruited from all regions of Norway. The sample comprised 35 participants diagnosed with dementia. The interviews were audio-recorded and transcribed, and the data material was analysed using a qualitative content analysis.ResultsThree main categories emerged from the interviews: (1) to stay connected; (2) to be active and participate; and (3) to live for the moment. The overarching theme was: the need to be who I am.ConclusionsPeople with dementia participating in the study were heterogeneous regarding wants and requirements. Most of them expressed the need and wish to hold on to who they are. Close and robust relations with family and friends can give significant support to people with dementia. However, living with dementia might put considerable strain on relations. Services should provide support to enhance relationships, encourage existing networks to remain stable and facilitate participation in meaningful activities for people living with dementia.
Alcohol use and alcohol-related harm in rural and remote communities: protocol for a scoping review
Authors: Friesen Erik Loewen , Kurdyak Paul 
Published: August 2020

IntroductionAlcohol-related harm is a major public health concern and appears to be particularly problematic in rural and remote communities. Evidence from several countries has shown that the prevalence of harmful alcohol use and alcohol-attributable hospitalisations and emergency department visits are higher in rural and remote communities than in urban centres. The extents of this rural–urban disparity in alcohol-related harm as well as the factors that mediate it are poorly understood. The objective of this scoping review is to synthesise the international research on the factors that influence the prevalence or risk of alcohol-related harm in rural and remote communities. This will help to clarify the conceptual landscape of rural and remote alcohol research and identify the gaps in knowledge that need to be addressed.Methods and analysisThis scoping review will access published literature through search strategies developed for Medline, PsycINFO, Embase, CINAHL and Sociological Abstracts. There will be no date, country or language restrictions placed on the search. Title and abstract, followed by full-text screening, will be conducted by two independent reviewers to evaluate all identified articles against a set of prespecified inclusion and exclusion criteria. Data from selected articles will be extracted and compiled into a final manuscript that adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist guidelines.Ethics and disseminationThe results of this review will be helpful in guiding future research on rural and remote alcohol use and alcohol-related harm, which will inform more effective, evidence-based public health strategies to reduce alcohol-related harm in rural and remote communities. The results will be disseminated via field-specific conference presentations and peer-reviewed publication.
Translation to English, cross-cultural adaptation, and pilot testing of the self-report questionnaire on swallowing difficulties with medication intake and coping strategies (SWAMECO) for adults with polypharmacy
Authors: Arnet Isabelle , Messerli Markus , Oezvegyi Jana , Hersberger Kurt , Sahm Laura 
Published: August 2020

ObjectivesTo translate the SWAMECO from German into English; to complete content and face validity with healthcare professionals (HCPs) and with patients from the target population that is, community-dwelling adult patients taking three or more medicines for three or more months.DesignThe process followed guidance from Sousa et al and included translation and cross-cultural adaptation, and cognitive testing among selected HCPs and patients. As the SWAMECO questionnaire is a screening instrument, pilot testing was performed in the target population.SettingThree community pharmacies in and around Cork (Ireland) recruited patients for interviews and pilot testing.ParticipantsCommunity-dwelling patients with ≥3 oral medications for ≥3 months, aged ≥18 years.Outcome measuresAnswers to the SWAMECO questionnaire; clarity of each question, each instruction and each response format.ResultsIssues related to cultural and conceptual differences were resolved by rewording some items. Ten HCPs and 11 patients completed the questionnaire and gave their feedback and opinions on criteria according to Fitzpatrick et al. Revisions included rewording; deleting of two questions; using of colour to signpost that is, where to skip questions that were not applicable to the participants; and replacement of the A-14 medication adherence scale with three validated items. Of the 66 patients enrolled for pilot testing, eight (12.1%) indicated swallowing difficulties. Difficulties with ingesting foods or liquids correlated with swallowing difficulties (p=0.001). All patients perceived discomfort (mean 6.9 on a Visual Analogue Scale from 0 to 10). Patients with swallowing difficulties were significantly more likely to report modifying their medicines (p=0.004) and having poorer medication adherence (p=0.028) than those who had no swallowing difficulties.ConclusionsThe version of the SWAMECO questionnaire in English contains 28 items and is ready for use in adults with polypharmacy.
Comparing mental distress and help-seeking among first-year medical students in Norway: results of two cross-sectional surveys 20 years apart
Authors: Ruud Nora , Løvseth Lise Tevik , Isaksson Ro Karin , Tyssen Reidar 
Published: August 2020

ObjectiveTo investigate any changes in mental distress levels over 20 years among medical students, as well as the clinical importance of these changes.DesignTwo cross-sectional surveys 20 years apart.SettingThe surveys were performed at two Norwegian medical faculties in 1993 and 2015.ParticipantsOne hundred and seventy-four first-year medical students in 1993 were compared with 169 students in 2015.Main outcome measuresMental distress (Hopkins Symptom Checklist 5) and Mental Health Problems in Need of Treatment.ResultsMental distress increased from 1993 to 2015 (p<0.001) due to a larger increase among female students, which seemed to be of clinical importance (Cohen’sd=0.63). There was a significant gender difference in mental distress in 2015 (p=0.007), but not in 1993. Independent factors associated with mental distress in 2015 were female sex (p<0.001), low perceived social support from parents (p=0.023) and low perceived social support from other friends (p=0.048). Additional analyses showed that social support from friends was more important for female students than for their male peers. From 1993 to 2015, there was no significant increase in the proportion of female students reporting previous mental health problems in need of treatment (21.3% vs 27.8%), but we found a significant increase in help-seeking among those in need of treatment over these years from 30.0% (6/20) to 74.3% (26/35; p=0.003).ConclusionsWe found a significant increase in mental distress among female medical students over the past 20 years, but also a promising increase in help-seeking among those in need of treatment. The strong and important association between low social support and mental distress should urge both universities and students to maintain students’ social life after entering medical school.
Patient preferences for asthma management: a qualitative study
Authors: Baggott Christina , Chan Amy , Hurford Sally , Fingleton James , Beasley Richard , Harwood Matire , Reddel Helen K , Levack William Mark Magnus 
Published: August 2020

ObjectivePreference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences.DesignA qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups.SettingThree locations within the greater Wellington area in New Zealand.ParticipantsTwenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month.ResultsFour key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management.ConclusionsThis study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000601134).
Cross-sectional associations of neighbourhood socioeconomic disadvantage and greenness with accelerometer-measured leisure-time physical activity in a cohort of ageing workers
Authors: Halonen Jaana I , Pulakka Anna , Pentti Jaana , Kallio Minna , Koskela Sofia , Kivimäki Mika , Kawachi Ichiro , Vahtera Jussi , Stenholm Sari 
Published: August 2020

ObjectiveNeighbourhood characteristics may affect the level of physical activity (PA) of the residents. Few studies have examined the combined effects of distinctive neighbourhood characteristics on PA using objective data or differentiated between activity during working or non-working days. We examined the associations of socioeconomic disadvantage and greenness with accelerometer-measured leisure-time PA during working and non-working days.DesignCross-sectional study.SettingFinnish Retirement and Aging (FIREA) study.Participants708 workers (604 women, mean age 62.4 ranging from 58 to 64 years,) participating in the FIREA study who provided PA measurement data for at least 1 working and non-working day.Primary and secondary outcomesPA was measured with wrist-worn accelerometer on average of 4 working and 2 non-working days. Outcomes were total PA, light PA (LPA) and moderate-to-vigorous PA (MVPA). These measurements were linked to data on neighbourhood socioeconomic disadvantage and greenness within the home neighbourhood (750×750 m). Generalised linear models were adjusted for possible confounders.ResultsOn non-working days, higher neighbourhood disadvantage associated with lower levels of total PA (p value=0.07) and higher level of neighbourhood greenness associated with higher level of total PA (p value=0.04). Neighbourhood disadvantage and greenness had an interaction (p value=0.02); in areas of low disadvantage higher greenness did not associate with the level of total PA. However, in areas of high disadvantage, 2 SD higher greenness associated with 46 min/day (95% CI 8.4 to 85) higher total PA. Slightly stronger interaction was observed for LPA (p=0.03) than for the MVPA (p=0.09). During working days, there were no associations between neighbourhood characteristics and leisure-time total PA.ConclusionsOf the disadvantaged neighbourhoods, those characterised by high levels of greenness seem to associate with higher levels of leisure-time PA during non-working days. These findings suggest that efforts to add greenness to socioeconomically disadvantaged neighbourhoods might reduce inequalities in PA.
Value of lung ultrasound for the diagnosis of COVID-19 pneumonia: a protocol for a systematic review and meta-analysis
Authors: Yang Yujiao , Zhang Donghang , Zhou Cheng , Huang Han , Wang Rurong 
Published: August 2020

IntroductionIn the recent COVID-19 pandemic, cases have exceeded over one million, with the number of confirmed cases increasing by 50 000–60 000 per day. The virus has killed nearly 50 000 people all over the world in only 3 months. These reforms bring major challenges to the public health and healthcare system. The pulmonary pathological features during the initial phase of COVID-19 are alveolar oedema, pneumocyte hyperplasia, gravitational consolidations and interstitial thickening. The ability of lung ultrasound (LUS) and its evolving applications in the diagnosis of COVID-19 pneumonia are widespread. This study aims to evaluate the surveillance value of LUS in the diagnosis of COVID-19 pneumonia.Methods and analysisWe will perform a systematic search and meta-analysis on the use of LUS to diagnose and confirm COVID-19 pneumonia. We will search Ovid Medline, Ovid Embase, Web of Science, Cochrane Library, Scopus, Google Scholar, China Biology Medicine disc and WHO Global Health Library for studies on diagnostic accuracy from December 2019 to April 2021. Data collection and screening will be individually accomplished by two reviewers. The assessment of risk of bias for each outcome will be conducted using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Data will be synthesised and heterogeneity will be evaluated. Meta-analysis will be conducted when strong homogeneous data are accessible. Grading of Recommendations Assessment, Development and Evaluation(GRADE) will be used to assess quality of evidence.Ethics and disseminationApproval of ethics committee is not needed for this review. While results will be disseminated electronically, effective dissemination will be done through presentations and peer-reviewed publication.PROSPERO registration numberCRD42020177803; pre-results.
Long-term contribution of international electives for medical students to professional identity formation: a qualitative study
Authors: Hayashi Mikio , Son Daisuke , Nanishi Keiko , Eto Masato 
Published: August 2020

ObjectivesGlobalisation has given medical university students the opportunity to pursue international electives in other countries, enhancing the long-term socialisation of medical professionals. This study identified the long-term effects of international electives on the professional identity formation of medical students.DesignThis is a qualitative study.SettingThe authors interviewed Japanese medical professionals who had completed their international electives more than 10 years ago, and analysed and interpreted the data using a social constructivism paradigm.ParticipantsA total of 23 medical professionals (mean age 36.4 years; range 33–42 years) participated in face-to-face, semistructured in-depth interviews.ResultsDuring the data analysis, 36 themes related to professional identity formation were identified, and the resulting themes had five primary factors (perspective transformation, career design, self-development, diversity of values and leadership). It was concluded that international electives for medical students could promote reflective self-relativisation and contribute to medical professional identity formation. Additionally, such electives can encourage pursuing a specialisation and academic or non-academic work abroad. International electives for medical students could contribute to medical professional identity formation on the basis of cross-cultural understanding.ConclusionsThis study addressed a number of issues regarding the long-term impact of international elective experiences in various countries on the professional identity formation of Japanese medical professionals. This study offers some guidance to mentors conducting international electives and provides useful information for professional identity formation development in medical professionals.