bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent physical symptoms reduction intervention: a system change and evaluation in secondary care (PRINCE secondary) – a CBT-based transdiagnostic approach: study protocol for a randomised controlled trial
Authors: Chalder Trudie , Patel Meenal , James Kirsty , Hotopf Matthew , Frank Philipp , Watts Katie , McCrone Paul , David Anthony , Ashworth Mark , Husain Mujtaba , Garrood Toby , Moss-Morris Rona , Landau Sabine 
Published: October 2019

Abstract

Background
Persistent physical symptoms (PPS), also known as medically unexplained symptoms (MUS), affect approximately 50% of patients in secondary care and are often associated with disability, psychological distress and increased health care costs. Cognitive behavioural therapy (CBT) has demonstrated both short- and long-term efficacy with small to medium effect sizes for PPS, with larger treatment effects for specific PPS syndromes, including non-cardiac chest pain, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). Research indicates that PPS conditions share similar cognitive and behavioural responses to symptoms, such as avoidance and unhelpful beliefs. This suggests that a transdiagnostic approach may be beneficial for patients with PPS.

Methods
A randomised controlled trial (RCT) will be conducted to evaluate the efficacy and cost-effectiveness of a transdiagnostic CBT-based intervention for PPS. 322 participants with PPS will be recruited from secondary care clinics. Participants stratified by clinic and disability level will be randomised to CBT plus standard medical care (SMC) versus SMC alone. The intervention consists of 8 CBT sessions delivered by a qualified therapist over a period of 20 weeks. Outcomes will be assessed at 9, 20, 40- and 52-weeks post randomisation. Efficacy will be assessed by examining the difference between arms in the primary outcome Work and Social Adjustment Scale (WSAS) at 52 weeks after randomisation. Secondary outcomes will include mood, symptom severity and clinical global impression at 9, 20, 40 and 52 weeks. Cost-effectiveness will be evaluated by combining measures of health service use, informal care, loss of working hours and financial benefits at 52 weeks.

Discussion
This trial will provide a powered evaluation of the efficacy and cost-effectiveness of a transdiagnostic CBT approach versus SMC for patients with PPS. It will also provide valuable information about potential healthcare pathways for patients with PPS within the National Health Service (NHS).

Trial registration
ClinicalTrials.gov NCT02426788. Registered 27 April 2015. Overall trial status: Ongoing; Recruitment status: No longer recruiting.
Investigating the association between occupational exposure to asbestos and ovarian carcinoma: results from a pilot study in Germany
Authors: Rajput Zara , Hering Kurt Georg , Kraus Thomas , Tannapfel Andrea , Sonnenschein Günter , Centmayer Alexandra , Radon Katja , Nowak Dennis , Weinmann Tobias 
Published: October 2019

Abstract

Background
The aim of this pilot study was to assess the feasibility of a large-scale epidemiologic investigation elucidating the quantitative association between occupational exposure to asbestos and ovarian cancer in former German asbestos workers.

Methods
Between December 2017 and May 2018, a random sample of one thousand insured woman registered at the health service of a German trade association as formerly occupationally exposed to asbestos were invited to participate in a pilot study. Participation included a phone interview using a standardised questionnaire. The feasibility of the project was evaluated using a priori defined criteria. They included response, number of cases, eligibility of the questionnaire data for exact estimation of asbestos fibre-years, and availability of relevant medical documentation (imaging procedures, medical reports, and histologic materials).

Results
The response (17%) was clearly below the intended number of 60%. With six tumour suspects, of which two could be confirmed by medical documents, the number of cases was within the expected range of two to eleven cases. Exact asbestos fibre-year estimations could be performed for 29% of all interviewees, but only for one suspected case. Medical documentation could be collected for only few participants, while no histology reports could be obtained for all cases. Thus, only the feasibility criterion of the expected number of cases was fulfilled.

Conclusion
The results of the pilot study indicate that the planned project is feasible only to a very limited extent. For further planning of the study, measures to improve recruitment of participants are necessary.
Age moderates the effect of socioeconomic status on physical activity level among south Korean adults: cross-sectional analysis of nationally representative sample
Authors: Lee Harold H. , Pérez Ashley E. , Operario Don 
Published: October 2019

Abstract

Background
In a nationally representative sample of South Korean adults, we investigated the association between socioeconomic status (SES) and physical activity level, and whether this association varied by age group.

Methods
We used data from 5065 subjects aged ≥19 years who participated in the 6th Korea National Health and Nutrition Examination Survey. Weighted logistic regression examined the SES-physical activity association. Using the International Physical Activity Questionnaire short form, physical activity level was categorized into two groups: meeting the guideline (≥150 min/week of moderate intensity physical activity) and not meeting the guideline. Annual household income quartile (first quartile = highest income) and education (elementary, middle school, high school, and college graduates) were used as SES indicators. Sociodemographic covariates included in the adjusted models were marital status, town type (rural/urban), dwelling type, perceived health, federal allowance support (yes/no), and working- and sleeping-hours.

Results
In unadjusted models, low income and low education were both associated with significantly lower odds of meeting the physical activity guideline. The income-physical activity association was moderated by age group in both unadjusted and adjusted models. Specifically, among those age < 45 years, those in the third quartile group had 41% higher odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. In contrast, among those age ≥ 45 years, those in the third quartile group had 16% lower odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. Furthermore, the education-physical activity association was moderated by age but only in the adjusted model. Specifically, among those age < 45 years, high school graduates had a 21% higher odds of meeting the physical activity guideline compared with college graduates (p = 0.08). In contrast, among those age ≥ 45 years, high school graduates had a 23% lower odds of meeting the physical activity guideline compared with college graduates (p = 0.01).

Conclusion
Future policies that aim to address SES-related health disparities in physical activity among adults in South Korea should consider the different patterns of physical activity in accordance with SES and age.
State-level income inequality and mortality among infants born in the United States 2007–2010: A Cohort Study
Authors: Pabayo Roman , Cook Daniel M. , Harling Guy , Gunawan Anastasia , Rosenquist Natalie A. , Muennig Peter 
Published: October 2019

Abstract

Background
United States state-level income inequality is positively associated with infant mortality in ecological studies. We exploit spatiotemporal variations in a large dataset containing individual-level data to conduct a cohort study and to investigate whether current income inequality and increases in income inequality are associated with infant and neonatal mortality risk over the period of the 2007–2010 Great Recession in the United States.

Methods
We used data on 16,145,716 infants and their mothers from the 2007–2010 United States Statistics Linked Infant Birth and Death Records. Multilevel logistic regression was used to determine whether 1) US state-level income inequality, as measured by Z-transformed Gini coefficients in the year of birth and 2) change in Gini coefficient between 1990 and year of birth (2007–2010), predicted infant or neonatal mortality. Our analyses adjusted for both individual and state-level covariates.

Results
From 2007 to 2010 there were 98,002 infant deaths: an infant mortality rate of 6.07 infant deaths per 1000 live births. When controlling for state and individual level characteristics, there was no significant relationship between Gini Z-score and infant mortality risk. However, the observed increase in the Gini Z-score was associated with a small but significant increase likelihood of infant mortality (AOR = 1.03 to 1.06 from 2007 to 2010). Similar findings were observed when the neonatal mortality was the outcome (AOR = 1.05 to 1.13 from 2007 to 2010).

Conclusions
Infants born in states with greater changes in income inequality between 1990 and 2007 to 2010 experienced a greater likelihood of infant and neonatal mortality.
Enhancing community preparedness: an inventory and analysis of disaster citizen science activities
Authors: Chari Ramya , Petrun Sayers Elizabeth L. , Amiri Sohaela , Leinhos Mary , Kotzias Virginia , Madrigano Jaime , Thomas Erin V. , Carbone Eric G. , Uscher-Pines Lori 
Published: October 2019

Abstract

Background
Disaster citizen science, or the use of scientific principles and methods by “non-professional” scientists or volunteers, may be a promising way to enhance public health emergency preparedness (PHEP) and build community resilience. However, little research has focused on understanding this emerging field and its implications for PHEP. To address research gaps, this paper: (1) assesses the state of disaster citizen science by developing an inventory of disaster citizen science projects; (2) identifies different models of disaster citizen science; and (3) assesses their relevance for PHEP.

Methods
We searched the English-language peer-reviewed and grey literature for disaster citizen science projects with no time period specified. Following searches, a team of three reviewers applied inclusion/exclusion criteria that defined eligible disasters and citizen science activities. Reviewers extracted the following elements from each project: project name and description; lead and partner entities; geographic setting; start and end dates; type of disaster; disaster phase; citizen science model; and technologies used.

Results
A final set of 209 projects, covering the time period 1953–2017, were included in the inventory. Projects were classified across five citizen science models: distributed or volunteer sensing (n = 19; 9%); contributory (n = 98; 47%); distributed intelligence (n = 52; 25%); collaborative research (n = 32; 15%); and collegial research (n = 8; 4%). Overall, projects were conducted across all disaster phases and most frequently for earthquakes, floods, and hurricanes. Although activities occurred globally, 40% of projects were set in the U.S. Academic, government, technology, and advocacy organizations were the most prevalent lead entities. Although a range of technologies were used, 77% of projects (n = 161) required an internet-connected device. These characteristics varied across citizen science models revealing important implications for applications of disaster citizen science, enhancement of disaster response capabilities, and sustainability of activities over time.

Conclusions
By increasing engagement in research, disaster citizen science may empower communities to take collective action, improve system response capabilities, and generate relevant data to mitigate adverse health impacts. The project inventory established a baseline for future research to capitalize on opportunities, address limitations, and help disaster citizen science achieve its potential.
Changes in weight status, quality of life and behaviours of South Australian primary school children: results from the Obesity Prevention and Lifestyle (OPAL) community intervention program
Authors: Bell Lucinda , Ullah Shahid , Leslie Eva , Magarey Anthea , Olds Timothy , Ratcliffe Julie , Chen Gang , Miller Michelle , Jones Michelle , Cobiac Lynne 
Published: October 2019

Abstract

Background
Childhood obesity is a serious public health concern worldwide. Community-based obesity prevention interventions offer promise due to their focus on the broader social, cultural and environmental contexts rather than individual behaviour change and their potential for sustainability and scalability. This paper aims to determine the effectiveness of a South Australian community-based, multi-setting, multi-strategy intervention, OPAL (Obesity Prevention and Lifestyle), in increasing healthy weight prevalence in 9 to 11-year-olds.

Methods
A quasi-experimental repeated cross-sectional design was employed. This paper reports on the anthropometric, health-related quality of life (HRQoL) and behaviour outcomes of primary school children (9–11 years) after 2–3 years of intervention delivery. Consenting children from primary schools (20 intervention communities, INT; 20 matched comparison communities, COMP) completed self-report questionnaires on diet, activity and screen time behaviours. HRQoL was measured using the Child Health Utility 9D. Body Mass Index (BMI) z-score and weight status were determined from children’s measured height and weight. A multilevel mixed-effects model, accounting for clustering in schools, was implemented to determine intervention effect. Sequential Bonferroni adjustment was used to allow for multiple comparisons of the secondary outcomes.

Results
At baseline and final, respectively, 2611 and 1873 children completed questionnaires and 2353 and 1760 had anthropometric measures taken. The prevalence of children with healthy weight did not significantly change over time in INT (OR 1.11, 95%CI 0.92–1.35, p = 0.27) or COMP (OR 0.85, 95%CI 0.68–1.06, p = 0.14). Although changes in the likelihood of obesity, BMI z-score and HRQoL favoured the INT group, the differences were not significant after Bonferroni adjustment. There were also no significant differences between groups at final for behavioural outcomes.

Conclusions
OPAL did not have a significant impact on the proportion of 9 to 11-year-olds in the healthy weight range, nor children’s BMI z-score, HRQoL and behaviours. Long-term, flexible community-based program evaluation approaches are required .

Trial registration
ACTRN12616000477426 (12th April 2016, retrospectively registered).
Burnout among healthcare providers in the complex environment of the Middle East: a systematic review
Authors: Chemali Z. , Ezzeddine F. L. , Gelaye B. , Dossett M. L. , Salameh J. , Bizri M. , Dubale B. , Fricchione G. 
Published: October 2019

AbstractBackgroundBurnout is a syndrome characterized by emotional exhaustion, increased depersonalization, and a diminished sense of personal accomplishment due to chronic emotional stress at work. Burnout impacts job satisfaction, job performance, vulnerability to illnesses, and interpersonal relationships. There is a gap in the systematic data on the burden of burnout among healthcare professionals from different sectors of healthcare in Middle Eastern countries. Our objective was to examine the burden of burnout among healthcare providers in the Middle East, how it was assessed, which sectors were included, and what interventions have been used.MethodsArticles were found through a systematic review of search results including PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO) using search terms reflecting burnout in Middle Eastern countries among populations of healthcare providers. Studies were included if they examined a quantitative measure of burnout among healthcare providers in the Middle East.ResultsThere were 138 articles that met our inclusion criteria for this systematic review. Studies focused on burnout in the Middle East among physicians (N = 54 articles), nurses (N = 55), combined populations of healthcare workers (N = 22), and medical students (N = 7). The Maslach Burnout Inventory was the most common tool to measure burnout. Burnout is common among physicians, nurses, and other healthcare professionals, with prevalence estimates predominantly ranging between 40 and 60%. Burnout among healthcare providers in the Middle East is associated with characteristics of their work environments, exposure to violence and terror, and emotional distress and low social support.ConclusionsBurnout is highly prevalent among healthcare providers across countries in the Middle East. Previous studies examining burnout in this region have limitations in their methodology. More thoroughly developed epidemiologic studies of burnout are necessary. Health system strengthening is needed in a region that has endured years of ongoing conflict, and there is an urgency to design and implement programs that tackle burnout among health professionals.
Finite element analysis comparison between superior clavicle locking plate with and without screw holes above fracture zone in midshaft clavicular fracture
Authors: Pengrung Nachapan , Lakdee Natthaphop , Puncreobutr Chedtha , Lohwongwatana Boonrat , Sa-ngasoongsong Paphon 
Published: October 2019

Abstract

Background
Midshaft clavicular fractures are common fractures and generally treated conservatively. Among the surgical options, plate fixation is the most popular and has been biomechanically and clinically proven in numerous studies. However, implant failures caused by plate deformations or breakage still occur in up to 16.7% of cases, and recent studies showed that screw holes above fracture zone (SHFZ) might be the at-risk location. Using finite element analysis, this study aimed to test the biomechanical property of the superior clavicle locking plate (SCLP) with and without SHFZ in comminuted midshaft clavicular fracture.

Methods
Finite element models of comminuted midshaft clavicular fracture fixed with standard 8-hole titanium SCLP with screw holes (SHFZ plate) and without screw holes above fracture zone (No-SHFZ plate) were built. Both groups were tested under three different loading models (100-N cantilever bending, 100-N axial compression, and 1-Nm torsion). The average peak stress on medial clavicle, fracture zone, and lateral clavicle, and the peak stress on each screw hole (or the same position in the No-SHFZ plate) were measured and compared.

Results
The highest average peak stress on the fracture zone was higher than those on medial and lateral clavicles under all loading conditions in both plates. However, the No-SHFZ plate significantly reduced the average peak stress value on the fracture zone, compared to the SHFZ plate (45.0% reduction in cantilever bending, 52.2% reduction in axial compression, and 54.9% reduction in axial torsion). The peak stress value on the maximal stress point in the SHFZ and No-SHFZ plates with cantilever bending, axial compression, and torsion loads were 1257.10 MPa vs. 647.21 MPa, 186.42 MPa vs. 131.63 MPa, and 111.86 MPa vs. 82.41 MPa, respectively.

Conclusion
The weakest link of the SCLP construct in comminuted midshaft clavicular fracture fixation is the SHFZ, especially in the cantilever bending load. Additionally, the biomechanical property of the SCLP without SHFZ model (No-SHFZ plate) is superior to the standard SCLP model (SHFZ plate), with a significantly lower peak stress on the SHFZ location in all loading conditions. We recommend a new SCLP design with SHFZ to prevent implant failure and improve surgical outcomes.
One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review
Authors: Kunutsor Setor K. , Beswick Andrew D. , Whitehouse Michael R. , Blom Ashley W. 
Published: October 2019

AbstractBackgroundProsthetic joint infection (PJI) is a challenging complication of total elbow replacement (TER). Potential surgical treatments include one- or two-stage revision; however, the best treatment for elbow PJI is not clearly defined. We conducted a systematic review in accordance with PRISMA guidelines to compare the clinical effectiveness of one- and two-stage revision surgery for elbow PJI using re-infection (recurrent and new infections) rates; mortality; clinical measures of function, pain, and satisfaction; and non-infection related adverse events.MethodsMEDLINE, Embase, Web of Science, and The Cochrane Library were searched up to June 2019 to identify observational cohort studies and randomised controlled trials (RCTs) that had recruited patients with elbow PJI following TER and treated with one- or two-stage revision. Of 96 retrieved articles, 2 one-stage and 6 two-stage revision studies were eligible. No RCT was identified. Arcsine transformation was used in estimating rates with 95% confidence intervals (CIs).ResultsStaphylococcus aureuswas the most common causative organism for PJI of the elbow (24 of 71 elbow PJIs). The re-infection rate (95% CI) for one-stage (7 elbows) ranged from 0.0% (0.0–79.3) to 16.7% (3.0–56.4) and that for two-stage revision (87 elbows) from 0.0% (0.0–49.0) to 20.0% (3.6–62.4). Non-infection related adverse event rate for one-stage (based on a single study) was 16.7% (3.0–56.4) and that for two-stage ranged from 11.8% (4.7–26.6) to 20.0% (3.6–62.4). There were no mortality events recorded following one- or two-stage revision surgery and postoperative clinical measures of function, pain, and satisfaction could not be effectively compared because of limited data.ConclusionsNo strong conclusions can be drawn because of limited data. The one-stage revision may be potentially at least as clinically effective as two-stage revision, but further data is needed. There are clear gaps in the existing literature and studies are urgently warranted to assess the clinical effectiveness of one- and two-stage revision strategies for PJI following TER.Systematic review registrationPROSPERO 2018:CRD42018118002.