bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018–2020)
Authors: James Michaela , Marchant Emily , Defeyter Margaret Anne , Woodside Jayne , Brophy Sinead 
Published: October 2021

ObjectivesThis study aimed to explore the relationship between initial school closures and children’s health by comparing health and well-being outcomes collected during school closures (April–June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey.SettingThe study was conducted online with 161 primary schools across Wales involved in the ‘HAPPEN At Home’ Survey.ParticipantsData were collected via the ‘HAPPEN At Home’ Survey capturing the typical health behaviours of children aged 8–11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)).Primary and secondary outcome measuresPrimary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM.ResultsComparing responses between April–June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures.ConclusionsThis study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures.
Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study
Authors: Peng Yang , Hu Hai 
Published: October 2021

ObjectiveThe use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.DesignData in the Huaxi Earthquake Casualty Database were analysed retrospectively.SettingThis study was conducted in China.ParticipantsData on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.Primary outcome measureThe receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.ResultsThe ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.ConclusionAll methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.
Women’s acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross-sectional online survey results
Authors: Smith Laurie W , Racey C Sarai , Gondara Lovedeep , Krajden Mel , Lee Marette , Martin Ruth Elwood , Stuart Gavin , Peacock Stuart , Coldman Andrew J , Franco Eduardo L , van Niekerk Dirk , Ogilvie Gina S 
Published: October 2021

ObjectiveTo study participant’s acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening.DesignCross-sectional online survey of clinical trial participants.SettingPrimary care, population-based Cervix Screening Program, British Columbia, Canada.ParticipantsA total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit.Outcome measuresAcceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary).ResultsMost respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4–5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable.ConclusionsIn this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening.Trial registration numbersISRCTN79347302andNCT00461760.
Sharps injuries and splash exposures among healthcare workers in Arab countries: protocol of a systematic review and meta-analysis
Authors: Karkaz Ibtisam , Elbarazi Iffat , Östlundh Linda , Paulo Marília Silva , Sheek-Hussein, Mohamud , Al-Rifai Rami H , Ádám Balázs 
Published: October 2021

IntroductionSharps injuries, including needlestick injuries and splash exposures, constitute serious occupational health problems for healthcare workers, carrying the risk of bloodborne infections. However, data on such occupational incidents and their risk factors in healthcare settings are scarce and not systematically summarised in the Arab countries.The aim of this study is to conduct a systematic review and meta-analysis to review published literature about sharps injuries and splash exposures of healthcare workers in Arab countries, with the objectives to determine the incidence and/or prevalence of these events, their identified risk factors and the applied preventive and postexposure prophylactic measures.Methods and analysisThe protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. A comprehensive presearch developed in January to March 2021 in the database PubMed will be followed by a systematic search of six, core medical and health science databases: PubMed, EMBASE, Scopus, CINAHL, Web of Science and Africa-Wide Information in May 2021. The search will be performed without any filters or restrictions for publication years. Covidence systematic review tool will be used for document management, blinded screening and study selection. Two reviewers will independently screen the records, extract data and conduct risk of bias assessment. Results will be synthesised narratively in summary tables, and, if findings allow, meta-analysis will be conducted on the incidence and/or prevalence of sharps injuries and splash exposures, and on the effect size of risk factors.Ethics and disseminationThe systematic review methodology does not require ethics approval due to the nature of the study design based only on published studies. The results of the systematic review will be published in a peer-reviewed journal, disseminated to stakeholders and made publicly available.PROSPERO registration numberCRD42021242416.
Cigarette prices in eight sub-Saharan African countries in 2018: a cross-sectional analysis
Authors: Chang Kiara , Mayne Emily , Laverty Anthony A , Agaku Israel , Filippidis Filippos T 
Published: October 2021

ObjectiveWhile the trend in smoking prevalence is decreasing worldwide, the number of male tobacco smokers is growing in Africa. This study compares the cigarette market in eight sub-Saharan African countries. This includes examining cigarette prices, pricing differentials, pack sizes and affordability at national and subnational levels.Design and settingA cross-sectional data analysis using data from the Data on Alcohol and Tobacco in Africa (DATA) Project. The DATA Project was centrally coordinated by project supervisors following a standardised protocol. University students were recruited to conduct data collection and a total of 22 347 retail cigarette price data points collected between June and August 2018 were analysed (including Botswana, Ethiopia, Lesotho, Namibia, Nigeria, South Africa, Zambia and Zimbabwe). Prices were converted to US$ and standardised to the price of a 20-cigarette pack.ResultsThis research found large price differentials within provinces/states, with the gap between medium and minimum prices per 20-cigarette pack exceeding 50% of the medium price in 18 out of 24 provinces/states. Single cigarettes were widely available, especially in Lesotho and Ethiopia. Results of multivariable regression suggest prices (per 20-cigarette pack) were lower for cigarettes sold in packs than single sticks (−US$0.27, 95% CI: −US$0.39 to −US$0.23) and lower in less populated areas (−US$0.28 in rural compared with urban settings, 95% CI: −US$0.41 to −US$0.15). Availability of cheaper single cigarettes (lower per unit price than packed cigarettes) were identified for Lesotho and South Africa.ConclusionsThese findings identify a varied picture in cigarette pricing in studied countries and suggest measures to tackle pricing differentials and availability of single sticks are warranted. These measures should counteract the potential health consequences of the increasing penetration of tobacco industry in these sub-Saharan African countries.
Perinatal factors and hospitalisations for severe childhood infections: a population-based cohort study in Sweden
Authors: Videholm Samuel , Kostenniemi Urban , Lind Torbjörn , Silfverdal Sven-Arne 
Published: October 2021

ObjectiveTo examine the association between perinatal factors and hospitalisations for sepsis and bacterial meningitis in early childhood (from 28 days to 2 years of age).DesignA population‐based cohort study. The Swedish Medical Birth Register was combined with the National Inpatient Register, the Cause of Death Register, the Total Population Register and the Longitudinal integration database for health insurance and labour market studies. Associations between perinatal factors and hospitalisations were examined using negative binomial regression models.SettingSweden.Participants1 406 547 children born in Sweden between 1997 and 2013.Main outcome measuresHospital admissions for sepsis and bacterial meningitis recorded between 28 days and 2 years of life.ResultsGestational age was inversely associated with severe infections, that is, extreme prematurity was strongly associated with an increased risk of sepsis, adjusted incidence rate ratio (aIRR) 10.37 (95% CI 6.78 to 15.86) and meningitis aIRR 6.22 (95% CI 2.28 to 16.94). The presence of congenital malformation was associated with sepsis aIRR 3.89 (95% CI 3.17 to 4.77) and meningitis aIRR 1.69 (95% CI 1.09 to 2.62). Moreover, children born small or large for gestational age were more likely to be hospitalised for sepsis and children exposed to maternal smoking were more likely to be hospitalised for meningitis.ConclusionsPrematurity and several other perinatal factors were associated with an increased risk of severe infections in young children. Therefore, clinical guidelines for risk assessment of infections in young children should consider perinatal factors.
Patients’ and psychiatrists’ perspectives on clozapine treatment—a scoping review protocol
Authors: Jakobsen Michelle Iris , Storebø Ole Jakob , Austin Stephen Fitzgerald , Nielsen Jimmi , Simonsen Erik 
Published: October 2021

IntroductionThe atypical antipsychotic clozapine has shown superior efficacy compared with other antipsychotics and is the gold standard for treating otherwise treatment resistant schizophrenia. However, multiple studies have found that clozapine is underutilised in most parts of the world. A few reviews of literature addressing barriers to clozapine prescribing have been conducted. While there is some variation in the literature included in these reviews, a common feature of the studies included is that they primarily focus on clinical staff’s attitudes and perceived barriers for prescribing. Studies of patient perspectives are only sparsely included. A preliminary literature search revealed though, that additional literature on the subject exists, including literature on patient perspectives. It is therefore difficult to conclude if the formerly synthesised literature is representative of current evidence or if the topic has been adequately investigated to inform clinical practice. A scoping review is warranted in order to map and synthesise primary literature on patients’ and psychiatrists’ perspectives on clozapine treatment, and to identify gaps for future research.Methods and analysisThe electronic databases Cochrane Library, CINAHL, Web of Science, Psychinfo, MEDLINE and EMBASE will be searched for relevant publications, supplied with searches of Google scholar, The Networked Digital Library of Theses and Dissertations and OpenGrey. Citation tracking of selected studies will furthermore be undertaken. Two researchers will independently screen and extract data. Data will be collated to provide a descriptive summary of the literature, along with a qualitative content analysis of key findings. Identified gaps in research will be accompanied by recommendations for future investigations.Ethics and disseminationFindings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.
Establishment of a consensus definition for mesenchymal stromal cells (MSC) and reporting guidelines for clinical trials of MSC therapy: a modified Delphi study protocol
Authors: Renesme Laurent , Cobey Kelly D , Le Maxime , Lalu Manoj M , Thebaud Bernard 
Published: October 2021

IntroductionDespite being more than two decades of research, mesenchymal stromal cell (MSC) treatments are still struggling to cross the translational gap. Two key issues that likely contribute to these failures are (1) the lack of clear definition for MSC and (2) poor quality of reporting in MSC clinical studies. To address these issues, we propose a modified Delphi study to establish a consensus definition for MSC and reporting guidelines for clinical trials of MSC therapy.Methods and analysisWe will conduct a three-round international modified Delphi survey. Findings from a recent scoping review examining how MSCs are defined and reported in preclinical and clinical studies were used to draft the initial survey for round 1 of our Delphi. Participants will include a ‘core group’ of individuals as well as researchers whose work was captured in our scoping review. The core group will include stakeholders from different research fields including developmental biology, translational science, research methods, regulatory practices, scholarly journal editing and industry. The first two survey rounds will be online, and the final round will take place in person. Each participant will be asked to rate their agreement on potential MSC definition characteristics and reporting items using a Likert scale. After each round, we will analyse the data to determine which items have reached consensus for inclusion/exclusion, and then develop a revised questionnaire for any new items, or items that did not reach consensus.Ethics and disseminationThis study received ethical approval from the Ottawa Health Research Network Research Ethics Board. To support the dissemination of our findings, we will use an evidence-based ‘integrated knowledge translation’ approach to engage knowledge users from the inception of the research. This will allow us to develop a tailored end-of-project knowledge translation plan to support and ensure dissemination and implementation of the Delphi results.
Dutch multicentre, prospective follow-up, cohort study comparing the neurological and neuropsychological sequelae of hospitalised non-ICU- and ICU-treated COVID-19 survivors: a study protocol
Authors: Klinkhammer Simona , Horn Janneke , Visser-Meily Johanna M A , Verwijk Esmée , Duits Annelien , Slooter Arjen J C , van Heugten Caroline M 
Published: October 2021

IntroductionOwing to the novelty of COVID-19, there are still large knowledge gaps concerning its effect on the brain and the resulting impact on peoples’ lives. This large-scale prospective follow-up study investigates COVID-19-associated brain damage, neuropsychological dysfunction and long-term impact on the well-being of patients and their close ones. It is hypothesised that structural brain damage and cognitive dysfunction primarily occur in severely ill patients, as compared with moderately ill patients. Cognitive complaints, emotional distress and impact on well-being are hypothesised to be less dependent on illness severity.Methods and analysisFor this multicentre study, 200 patients with COVID-19 (100 intensive care unit (ICU) patients and 100 non-ICU patients) formerly hospitalised in one of the six recruiting hospitals during the first European infection wave (ie, March to June 2020) and their close ones will be recruited. At minimally 6 months posthospital discharge, patients will perform a set of neuropsychological tests and are subjected to a 3T MRI scan. Patients and close ones will fill out a set of questionnaires, also at minimally 6 months posthospital discharge and again another 6 months thereafter. Data related to COVID-19 hospitalisation will be extracted from the patients’ medical records. MRI abnormalities will ultimately be related to neuropsychological test performance and questionnaire outcomes.Ethics and disseminationEthics approval was granted by the medical research ethics committee of Maastricht University Medical Centre and Maastricht University (NL75102.068.20). The project is sponsored by The Brain Foundation Netherlands. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals.Trial registration numberNCT04745611.
Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar
Authors: Alabdulla Majid , Reagu Shuja , Elhassan Nahid M , Shinith Dhanya , Shiekh Saba T , Abbas Maha O , Chandrappa Nirvana Swamy Kudlur 
Published: October 2021

ObjectivesThis study attempts the first in a series of investigations into the misuse of alcohol and substances in Qatar. This study explores the emergency presentations of alcohol and substance abuse to all the state funded emergency departments (EDs) in the country which serve around 90% of the population over a 22-month period. Due to legal penalties for alcohol and substance use, and lack of subsidised community-based facilities, ED presentations are a good starting point to explore this burden.Design and participantsA retrospective population-based, cross-sectional study, analysing electronic patient records of all state funded EDs spanning a period of 22 months, from 1 January 2019 to 31 October 2020 was carried out. The study included all eligible individuals aged 18 or over. Primary reason/diagnosis for presentation containing any of the alcohol or substance use key words were included in the study using composite data capture forms by trained clinicians.ResultsAn overwhelming majority (95.5%) of the total 1495 cases presenting to the EDs with substance abuse were using alcohol. Only 2.1% of the cases were females. Those of Asian (non-Arab) constituted 70% of this group. Qatari citizens presented with highest proportion of substance abuse other than alcohol (23%). Overall, 2.26% of all presentations to the EDs were related to alcohol and substance abuse and this amounted to 3 ED visits per 10 000 of population per year. 56.6% of the cases presented over the weekend. Less than 1% were referred to psychiatry and no other meaningful rehabilitative interventions were offered to others.ConclusionAs Qatar moves towards establishing community-based rehabilitative resources for alcohol and substances abuse, the findings from this study will help in shaping these developments. These can include ED-based routine screening for alcohol abuse and referral to rehabilitation services without fear of legal penalties.
Public knowledge and attitudes concerning palliative care
Authors: Zimmermann Camilla , Wong Joanne L. , Swami Nadia , Pope Ashley , Cheng YiQin , Mathews Jean , Howell Doris , Sullivan Richard , Rodin Gary , Hannon Breffni , Moineddin Rahim , Le Lisa W. 
Published: October 2021

ObjectiveWHO recommends early integration of palliative care alongside usual care to improve quality of life, although misunderstanding of palliative care may impede this. We compared the public’s perceived and actual knowledge of palliative care, and examined the relationship of this knowledge to attitudes concerning palliative care.MethodsWe analysed data from a survey of a representative sample of the Canadian public, accessed through a survey panel in May–June 2019. We compared high perceived knowledge (‘know what palliative care is and could explain it’) with actual knowledge of the WHO definition (knew ≥5/8 components, including that palliative care can be provided early in the illness and together with life-prolonging treatments), and examined their associations with attitudes to palliative care.ResultsOf 1518 adult participants residing in Canada, 45% had high perceived knowledge, of whom 46% had high actual knowledge. Participants with high (vs low) perceived knowledge were more likely to associate palliative care with end-of-life care (adjusted OR 2.15 (95% CI 1.66 to 2.79), p<0.0001) and less likely to believe it offered hope (0.62 (95% CI 0.47 to 0.81), p=0.0004). Conversely, participants with high (vs low) actual knowledge were less likely to find palliative care fearful (0.67 (95% CI 0.52 to 0.86), p=0.002) or depressing (0.72 (95% CI 0.56 to 0.93), p=0.01) and more likely to believe it offered hope (1.88 (95% CI 1.46 to 2.43), p<0.0001).ConclusionsStigma regarding palliative care may be perpetuated by those who falsely believe they understand its meaning. Public health education is needed to increase knowledge about palliative care, promote its early integration and counter false assumptions.