bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thirty-six-year trends (1986–2022) in cigarette smoking and snus use in northern Sweden: a cross-sectional study
Authors: Sjödin Erica , Andersson Jonas , Nordendahl Maria , Wennberg Maria , Heldorsson Fjellström Lena , Lundholm Carolina , Söderberg Stefan , Oskarsson Viktor 
Published: December 2024

ObjectivesTo examine the 36-year trends in tobacco use in northern Sweden.Design and outcome measureCross-sectional analysis of the eight population-based surveys that constitute the northern Sweden MONICA study (1986, 1990, 1994, 1999, 2004, 2009, 2014 and 2022). Cigarette smoking and snus use were self-reported via questionnaires, and age-adjusted percentages of cigarette smoking (including occasional use) and snus use were calculated via logit models.SettingGeneral population of Norrbotten and Västerbotten (the two northernmost counties of Sweden).Participants6678 women and 6320 men, aged 25 to 74 years, were included for analysis. A total of 191 participants were excluded due to missing data on either cigarette smoking or snus use.ResultsCigarette smoking decreased on a survey-to-survey basis, reaching a minimum in 2022 of 4.9% among men and 9.7% among women, corresponding to a percentage point change of 26.3 and 20.8, respectively, compared with 1986 (pwithin-group<0.01). With respect to snus, the use increased steeply up until 1999 among men, after which it persisted around 25% to 30% (26.2% in 2022), with percentage point changes between 6.6 and 13.4 compared with 1986 (pwithin-group<0.01). The percentage of female snus users was extremely low in the first surveys but increased continuously over time, reaching a maximum of 13.0% in 2022 and a percentage point change of 12.5 since 1986 (pwithin-group<0.01). Cigarette smoking—but not snus use—was more common in Norrbotten than in Västerbotten in 2022 (pbetween-group<0.01).ConclusionsA substantial decline in cigarette smoking has occurred over time in northern Sweden, particularly among men and more notably in Västerbotten. In contrast, snus use has become increasingly common in both sexes and in both counties.
‘It overwhelms the system’: examining EMS provision in a South Texas border community
Authors: Blackburn Christine Crudo , Lee Miryoung , Rico Mayra , Hernandez Jessica , Knight Lauren 
Published: December 2024

ObjectiveExamine how the characteristics of border communities along the US southern land border impact Emergency Medical Services (EMS) personnel in these border communities.DesignUsing phenomenological approach, we conducted face-to-face, one-on-one interviews using a semistructured interview methodology.SettingAll participants worked as EMS providers in a city fire department along the Texas-Mexico border.Participants28 EMS providers participated in the study. 93% of participants were male and 7% were female. 50% of participants had more than 10 years of experience working as an EMS provider.FindingsWe found that local EMS personnel frequently provide medical support for Border Patrol due to the lack of medical capability within the agency. This care provision creates negative impacts for both the community and EMS personnel. These findings were shown through the overarching theme that the presence of federal law enforcement in the community is the primary characteristic that impacts the experiences and perspectives of EMS personnel. Additional primary themes include: (1) Customs and Border Protection (CBP) utilisation of local EMS strains the system, (2) CBP utilisation of local EMS is the result of a lack of medical training and (3) the presence of the international boundary creates a unique work environment.ConclusionThe lack of medical support within Border Patrol and relevant federal agencies creates a burden on local EMS resources and causes stress among EMS personnel.
Wilson disease in the USA: epidemiology and real-world patient characteristics based on a retrospective observational health claims study
Authors: Fang Shona , Strader Carey , Costantino Halley , Weiss Karl Heinz , Hedera Peter 
Published: December 2024

ObjectivesTo describe the epidemiology, patient characteristics and comorbidities in patients with Wilson disease (WD) in the USA.DesignRetrospective, population-based study.SettingThe study used the US Komodo claims database containing records regarding medical claims for over 120 million individuals.ParticipantsPatients with WD were identified via ICD-10 (10th revision of the International Classification of Diseases) code during the study period 2016–2019 and no age restriction was applied. A further stratification by disease subtype (‘hepatic’, ‘neurologic’ and ‘psychiatric’) was performed.Main outcome measuresWD prevalence was reported by age, sex and US census regions/divisions. Adjusted prevalence was calculated using age-specific prevalence standardised to the USA (2010 US census) and to the world (WHO 2000–2025) to enable comparisons across countries, using direct standardisation of prevalence estimates by age group.ResultsOverall, 2115 patients with WD were identified during the study period. Among them, 56.8% had hepatic symptoms, 57.0% neurologic symptoms and 47.4% psychiatric symptoms. The most frequent manifestations in hepatic patients were liver signs and symptoms (90.8%), in neurologic patients cognitive defects (50.7%) and in psychiatric patients mood disorders (86.4%). The mean age in the overall cohort was 39.9 years. Prevalence estimation was based on 1481 patients with WD between 2017 and 2019. The 2017–2019 crude period prevalence was 21.2 patients per million (95% CI: 20.1 to 22.3), with similar prevalence observed for both sexes.ConclusionsThis study provides important real-world data on the diagnosed prevalence of WD in the USA and revealed the comorbidities associated with various disease subtypes, thereby providing a comprehensive basis for guiding physicians and policy makers in the management of this chronic disease.
Risk factors and prediction model of breast cancer-related lymphoedema in a Chinese cancer centre: a prospective cohort study protocol
Authors: Shen Aomei , Ye Jingming , Zhao Hongmei , Qiang Wanmin , Zhao Hongmeng , Huang Yubei , Zhou Yujie , Wang Yue , Li Xin , Zhang Zhongning , Bian Jingru , Zhang Liyuan , Wu Peipei , Wang Ying , Lu Qian 
Published: December 2024

IntroductionLymphoedema is a distressing and long-term complication for breast cancer survivors. However, the reported incidence of lymphoedema varies, and its risk factors remain underexplored. Currently, a well-established risk prediction model is still lacking. This study aims to describe the rationale, objectives, protocol and baseline characteristics of a prospective cohort study focused on examining the incidence and risk factors of breast cancer-related lymphoedema (BCRL), as well as developing a risk prediction model.Methods and analysisThis study is an ongoing single-centre prospective observational cohort study recruiting 1967 patients with breast cancer scheduled for surgery treatment in northern China between 15 February 2022 and 21 June 2023. Assessments will be conducted presurgery and at 1, 3, 6, 12, 18, 24, 30 and 36 months postsurgery. Bilateral limb circumferences will be measured by patients at home or by researchers at the outpatient clinics during follow-up visits. The diagnosis of lymphoedema is based on a relative limb volume increase of ≥10% from the preoperative assessment. Self-reported symptoms will be assessed to assist in diagnosis. Potential risk factors are classified into innate personal traits, behavioural lifestyle, interpersonal networks, socioeconomic status and macroenvironmental factors, based on health ecology model. Data collection, storage and management were conducted using the online ‘H6WORLD’ data management platform. Survival analysis using the Kaplan-Meier estimate will determine the incidence of BCRL. Risk factors of BCRL will be analysed using log-rank test and COX-LASSO regression. Traditional COX regression analysis and seven common survival analysis machine learning algorithms (COX, CARST, RSF, GBSM, XGBS, SSVM and SANN) will be employed for model construction and validation.Ethics and disseminationThe study protocol was approved by the Biomedical Ethics Committee of Peking University (IRB00001052-21124) and the Research Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (bc2023013). The results of this study will be published in peer-reviewed journals and will be presented at several research conferences.Trial registration numberChiCTR2200057083.
Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden
Authors: Gernaat Sofie A M , Simard Julia F , Altman Maria , Svenungsson Elisabet , Arkema Elizabeth V 
Published: December 2024

ObjectivesThe objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.DesignThis is a register-based cohort study.SettingLiveborn singletons born in Sweden, 2006–2021, were included in the study.Participants1248 infants born to mothers with SLE (≥2 International Classification of Diseases-coded visits in the National Patient Register (NPR) and Medical Birth Register, with ≥1 visit before pregnancy) and 34 886 infants born to women without SLE from the general population were included.Primary and secondary outcome measuresThe primary outcome was any visit for infection in the NPR or anti-infectives in the Prescribed Drug Register. The secondary outcome was hospitalised infection. Infection risks within 72 hours, within 1 month and within 1 year were estimated.ResultsSLE offspring had a higher risk of infection in the first 72 hours compared with non-SLE (2.1% vs 1.2%; risk ratios (RR) (95% CI) 1.62 (1.09 to 2.42)), the first month (5.2% vs 4.5%; RR 1.12 (0.88 to 1.43)) and first year of life (38.2% vs 37.2%; RR 1.09 (1.01 to 1.17)). The hospitalised infection risk for SLE offspring was similar to that of non-SLE (5.8% vs 5.5%, first year of life). The percentage of the total effect of maternal SLE on infant infection mediated through preterm birth was 86% for infection in the first 72 hours and 27% in the first year of life.ConclusionsThe risk of infection in SLE offspring is most increased in the first 3 days after birth, and a proportion of this association can be explained by preterm birth. To prevent early neonatal infections, maternal SLE could be considered as a risk factor before allowing early discharge from postnatal care.
Pre-eclampsia as a predictor of early-onset cardiovascular impairment among young women (PREECARDIA study): protocol for a prospective cohort study
Authors: Turé Ruben , Damasceno Albertino , Rodrigues Amabelia , Barai Eunice , Cissé Almame , Sanca Gabriel , Iafa Tida , Jalo Waldir , Embalo Bubacar , Dju Marcos , Iala Vasco , Lunet Nuno 
Published: December 2024

IntroductionPre-eclampsia is a pregnancy-related complication estimated to affect up to 8% of pregnancies worldwide. It is associated with an increased risk of postpartum sustained hypertension, coronary artery disease, cerebrovascular disease, peripheral arterial disease and cardiovascular-related mortality. Nevertheless, these associations have seldom been addressed in younger women from sub-Saharan Africa (SSA). Hence, this study aims to assess the association between pre-eclampsia and cardiovascular impairment within the first year after delivery, among younger women in SSA.Methods and analysisThis is a prospective cohort study conducted at Hospital Nacional Simão Mendes in Bissau, Guinea-Bissau. A total of 230 pregnant women aged below 25 years (115 diagnosed with pre-eclampsia and 115 normotensive age-matched pregnancies), will be enrolled after their 20th gestational week. Exclusion criteria include diabetes, hypertension or other serious maternal diseases present before pregnancy. Participants will be assessed at baseline (pre-labour period), 4 and 12 months after delivery; evaluations started in March 2023 and are expected to end in December 2026. At each follow-up assessment, the women will have their blood pressure measured with a digital sphygmomanometer and a 24-hour ambulatory blood pressure monitor. Cardiac and renal function will be assessed using echocardiography and laboratory testing, respectively. Primary outcomes include the mean differences in cardiovascular and renal parameters between women who had pre-eclampsia and those who had normotensive pregnancies. Age, parity, age at first pregnancy, family history of cardiovascular diseases, smoking habits, gestational diabetes diagnosed before pre-eclampsia, body mass index and labour complications will be considered a priori as potential confounders of the association between pre-eclampsia and postpartum cardiovascular impairment.Ethics and disseminationThis study was approved by the Comité Nacional de Ética em Pesquisa na Saúde, Guinea-Bissau (008/CNES/INASA/2023), and participants provide written informed consent. Results will be disseminated among the scientific community and the public.
Burden of digestive congenital anomalies among children aged 0–14 years in 204 countries and territories, 1990–2021: results from the Global Burden of Disease Study 2021
Authors: Luo Xi , Luo Jie , Zhao Jinhua , Du Jun , Lu Deqin , Gu Huajian 
Published: December 2024

ObjectivesWe aim to delineate the digestive congenital abnormalities burden in children under 14 years old between 1990 and 2021.DesignWe implemented data from the Global Burden of Disease (GBD) 2021 database to evaluate digestive congenital abnormalities burden with different measures in 204 countries and territories from 1990 to 2021. We present precise estimations with 95% uncertainty intervals. In addition, we computed the estimated annual percentage change (EAPC) to examine the temporal patterns of these indicators.SettingIt uses prevalence, deaths and disability-adjusted life years (DALYs) data from the GBD study to analyse this issue.ParticipantsPatients with digestive congenital abnormalities diagnosis.OutcomesTotal numbers, age-standardised rates (ASRs) of prevalence, mortality and DALYs and their EAPCs were the main outcomes among children aged 0–14 years.ResultsIn 2021, 2206.79 thousand prevalent cases were reported worldwide, with digestive congenital anomalies accounting for 47.16 thousand deaths and 4324.56 thousand DALYs among children aged 0–14 years. Digestive congenital anomalies prevalence was mitigated by 8.15% between 1990 and 2021, with the global ASR of prevalence declining to 40.09 per 100 000. Digestive congenital anomalies mortality was mitigated by 35.35% between 1990 and 2021, with an ASR of deaths declining to 0.77 per 100 000. The worldwide burden of digestive congenital anomalies decreased by 34.96% in terms of DALYs from 1990 to 2021, with an ASR of 70.44 DALYs per 100 000 population. There was a significant hindrance in the prevalence, particularly among older children. The likelihood of digestive congenital abnormalities peaked during infancy (2–4 years) in all regions.ConclusionWe highlight promising global declines in the digestive congenital anomalies burden among children over the past 32 years. Prevalence, deaths and DALYs associated with these anomalies have shown consistent decreases, although regional variations persist. These findings offer crucial insights for shaping effective prevention and management strategies for paediatric digestive congenital anomalies.
Cost efficiency of inpatient rehabilitation following acquired brain injury: the first international adaptation of the UK approach
Authors: Lannin Natasha A , Crotty Maria , Cameron Ian D , Chen Zhibin , Ratcliffe Julie , Morarty Jacqui , Turner-Stokes Lynne 
Published: December 2024

ObjectivesTo adapt and apply a model for evaluating the functional benefits and cost efficiency of specialist inpatient rehabilitation to the Australian context, comparing functional outcomes and savings in the cost of ongoing care after acquired brain injury.DesignAn observational cohort analysis of prospectively collected clinical data from admission to discharge, with follow-up to 3 years.SettingA newly established state-wide inpatient postacute rehabilitation unit in Victoria, Australia for patients with moderate to severe acquired brain injury.ParticipantsThis study included consecutive patients admitted to the programme during its first 2 years’ operation (January 2016 to December 2017). Inclusion criteria consisted of complete outcome measures recorded on admission and discharge, total n=196, mean age 44.6 years (range 17–78), males:females 72:28%, aetiology:trauma n=124 (63%), stroke n=42 (21%), diffuse n=18 (9%) and other-mixed n=12 (7%).InterventionsSpecialist inpatient multidisciplinary rehabilitation.Outcome measuresDependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPCNA); Functional independence: UK Functional Assessment Measure. Cost efficiency: (a) Time is taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care and (b) net projected lifetime savings.ResultsMedian length of stay 75 (IQR: 33.5–169.5) days, mean episode costs were $A147 044 (95% CI $A126 436, $A167 652). There was a significant reduction in dependency between admission and discharge on all measures (Holm-Bonferroni corrected p<0.001) which was sustained at follow-up in those traced at 1–3 years. Savings were greatest in the highest-dependency group. Estimated mean overall reduction in ‘weekly care costs’ was $A7206, offsetting the cost of rehabilitation within 5.53 months (95% CI 2.27, 8.78). Mean projected net lifetime savings were $A13.4 million (95% CI $A11.4, $A15.4) per patient.ConclusionsThis study provides proof of principle for use of the NPCNA cost-efficiency model outside the UK and yields further evidence that rehabilitation for patients with complex disabilities represents value for money. For every dollar spent on inpatient rehabilitation in this cohort, an estimated $A91 was saved in ongoing care costs.
Compliance to international guidelines and rational use of antibiotics in urinary tract infections in a country without national guidance: a cross-sectional study
Authors: El Khoury Joe , Saleh Nadine , Lahoud Nathalie , Maison Patrick , Hleyhel Mira 
Published: December 2024

BackgroundUrinary tract infections (UTIs) are among the most common bacterial infections, and appropriate antimicrobial therapy with agents that minimise resistance is crucial. Despite international concern, adherence to guidelines is still suboptimal. This study aims to determine the effect of the absence of national guidelines and the rate of conformity to international guidelines among physicians in antibiotic (ATB) prescriptions for the treatment of UTIs in adults and detect the factors that are associated with a higher rate of non-compliance.MethodsPatient-related characteristics and the prescribed ATBs were gathered from patients' medical files, and a questionnaire was directed to physicians to elicit the factors involved in decision-making. Four criteria were evaluated: molecule conformity, daily dose conformity, duration conformity and global conformity.Results37 Lebanese physicians and 185 prescriptions were included. The most prevalent class of ATBs was fluoroquinolones (30.3%). Global conformity to guidelines was 31.4%, while conformity on drug choice, daily dose and duration of treatment was 83.2%, 74.7% and 41.6%, respectively. There were no differences in conformity rates according to the physician’s specialty (p=0.135). Physicians who studied in an American-system university had an increased risk of non-conformity (adjusted OR (aOR=2.107, p=0.018). Patients with higher education levels, or presenting with fever or chills, were more likely to get a non-compliant prescription (aOR=2.140, p=0.032 and aOR=4.947, p=0.033, respectively).ConclusionIn a country with no local guidelines, non-conformity to international guidelines is high. Larger national studies are needed with immediate interventions to enhance physicians’ prescribing practices. After local guidelines were established, it would be interesting to compare the rate of adherence to these guidelines.
Multifaceted approach to reduce duplicate therapy errors in the emergency department
Authors: Huang Huiling , Sunku Srivatsava , Ong Hui Shan , Chan Jonathan Kim Yang , Sim Guek Gwee 
Published: December 2024

Medication errors continue to pose a significant risk to patient safety, accounting for half of the avoidable harm in healthcare systems around the world. In emergency departments (EDs), factors such as high patient loads and emergent nature of care increase the likelihood of such errors. An audit conducted at the ED of Changi General Hospital Singapore from January 2019 to July 2022 revealed that the duplicate therapy error comprised 31% of all reported medication errors. Therapeutic duplication occurs when the same or pharmacologically equivalent agents are prescribed concurrently to a patient. These errors not only jeopardise patient safety but also place additional strain on healthcare resources and lead to stress among the staff involved.This quality improvement (QI) project aims to reduce duplicate therapy error by 50% 3 months post-intervention at the ED. Beginning in August 2022 and continuing through December 2023, the project followed a structured approach comprising four phases: problem identification, identifying root causes, developing of targeted interventions and ensuring sustainability. Phase 1 involved an audit from January 2019 to July 2022 to determine the extent and types of medication errors in the ED. In phase 2, a root cause analysis (RCA) of the medication error identified key issues such as system knowledge deficits, inadequate IT processes, environment, policies and procedures and gaps in care coordination. Based on these findings, targeted interventions were developed and implemented in phase 3. Phase 4 focused on sustaining improvements through ongoing audits.The QI project successfully met its goal of reducing duplicate therapy error rates by 50% post-intervention. Additionally, it completely eliminated duplicate therapy errors in certain medication categories.In conclusion, through targeted interventions, active engagement of relevant stakeholders and ongoing efforts to sustain and enhance improvement, a safer healthcare environment can be achieved for patients.