bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-operative application of ultrasonography combined with limited radiography for the treatment of supracondylar humerus fractures in children: a randomized controlled trial
Authors: Li Yuan , Wu Zongyi , Yi Xianhong , Mao Chenghuang , Yan Guangkui , Fang Mingqiao , Pan Tianlong , Zhu Ruibo , Zhang Jingdong 
Published: November 2021

Aims: To introduce a new method of intra-operative application of ultrasonography (US) combined with limited radiography to treat supracondylar humerus fractures in children and evaluate its effect on radiation protection.Material and methods: Fifty patients were randomly divided into the radiography-only group (RO group, n = 22) and the US combined with the limited radiography group (UR group, n = 28). US was performed to evaluate fracture displacement and to guide reduction in the UR group. The primary outcome measures were the average number of radiography instances and the quantitative value of radiation emission. Secondary outcome measures were length of hospital stays, loss of range of motion, loss of carrying angle, loss of Baumann angle, fracture healing time, pin site infection, compartment syndrome, cubitus varus, cubitus valgus, and iatrogenic ulnar nerve injury.Results: Average number of radiography instances and quantitative value of radiation emission in the UR group decreased compared with the RO group (p<0.05). There were no significant differences between the groups regarding mean time to surgery, the average length of hospital stays, average surgery time, radiological union time, Flynn grade, or loss of Baumann angle. Pin site infection was seen in one patient in the RO group and two patients in the UR group. No other complications occurred.Conclusion: Intra-operative application of US combined with limited radiography decreases radiation exposure during treatment of supracondylar humerus fractures in children without compromising the therapeutic effect.
Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial
Authors: Nair Nirmala , Tripathy Prasanta K , Gope Rajkumar , Rath Shibanand , Pradhan Hemanta , Rath Suchitra , Kumar Amit , Nath Vikash , Basu Parabita , Ojha Amit , Copas Andrew , Houweling Tanja AJ , Haghparast-Bidgoli Hassan , Minz Akay , Baskey Pradeep , Ahmed Manir , Chakravarthy Vasudha , Mahanta Riza , Prost Audrey 
Published: November 2021

IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.MethodsWe did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.ResultsWe identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.ConclusionParticipatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.Trial registrationISRCTN99422435.
Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study
Authors: Barreno Mishell , Sisa Ivan , Yépez García Martha Cecilia , Shen Hua , Villar Mónica , Kovalskys Irina , Fisberg Mauro , Gomez Georgina , Rigotti Attilio , Cortés Lilia Yadira , Pareja Rossina G , Herrera-Cuenca Marianella , Guajardo Viviana 
Published: November 2021

ObjectiveTo assess the association between the physical activity level and the built environment by accessibility, microinfrastructure and security in Latin America (LA).DesignWe conducted a multicentre cross-sectional study to collect physical activity and built environment data. The levels of physical activity were calculated through the International Physical Activity Questionnaire survey. Using the Neighbourhood Environment Walkability Scale-Abbreviated, characteristics of the built environment were measured through three domains: accessibility, microinfrastructure and security. To estimate the association of the built environment and physical activity, we used mixed effects logistic regression analysis. In addition, likelihood ratio test to account for clustered effect within countries and/or cities was used.SettingEight countries in LA.ParticipantsAdults aged 15–65 years (n=9218) living in urban areas and consented to participate of the Latin American Study of Nutrition and Health.ResultsMost of the population in LA had access to a grocery store (97.2%), public transport stop (91.5%) and children’s playground (81.6%). Metropolitan parks were more accessible in Ecuador (59.8%) and Colombia (59.2%) than in Venezuela (33.5%). Individuals located within 20 min of walking from sport facilities or children’s playground areas were more likely to perform moderate-to-high physical activity OR 1.20 (95% CI 1.06 to 1.36) and OR 1.25 (95% CI 1.02 to 1.53), respectively. Only 14.5% of the population from the region considered that their neighbourhood had an adequate design for walking or cycling. Likewise, among adults living in LA, only 39.75% had the perception of living in a safe neighbourhood.ConclusionsThis multicentre study shows that currently, LA built environment does not promote physical activity in the region. Our findings provide the rationale to push forward, at regional and national levels, policies and interventions that will help to achieve a safe, healthy and friendly built environment to encourage participation in active recreation and sports in leisure time.Trial registration numberNCT02226627.
Longitudinal outcomes of gender identity in children (LOGIC): a study protocol for a prospective longitudinal qualitative study of the experiences and well-being of families referred to the UK Gender Identity Development Service
Authors: McKay Kathy , Kennedy Eilis , Lane Chloe , Wright Talen , Young Bridget 
Published: November 2021

IntroductionGender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system.Methods and analysisA prospective longitudinal qualitative study examining the experiences and well-being of CYP referred to the UK GIDS. A purposive sample of up to 40 families will be recruited. Families will be eligible for the study if the child or young person was aged 3–14 years at the time of referral to the GIDS. Semistructured interviews will be conducted with both the child/young person and their parents/caregivers. Analysis of anonymised interview transcripts will be interpretive and pluralistic, informed by both narrative and thematic approaches. This study forms part of a wider programme of research investigating longitudinal outcomes of gender identity in children (the LOGIC Study).Ethics and disseminationThe proposed study has been approved by the UK Health Research Authority and London–Hampstead Research Ethics Committee as application 19/LO/0857. The study findings will be published in peer-reviewed journals and presented at both conferences and stakeholder events.
I had to leave. I had to leave my clinic, my city, leave everything behind in Syria.Qualitative research of Syrian healthcare workers migrating from the war-torn country
Authors: Kallström Agneta , Al-Abdulla Orwa , Parkki Jan , Häkkinen Mikko , Juusola Hannu , Kauhanen Jussi 
Published: November 2021

ObjectivesTo explore the reasons why healthcare workers migrate from Syria, a country where conflict has been raging for over a decade.DesignA qualitative study was performed using semistructured interviews. Semistructured questions guided in-depth interviews. Content analysis was used.SettingParticipants were Syrian healthcare workers who had worked in the country after the conflict started in 2011, but at some point left Syria and settled abroad. The interviews took place in Turkey and Europe in 2016 and 2017.ParticipantsWe collected data from 20 participants (18 males and 2 females) through snowball sampling method.ResultsHealthcare workers migrated from Syria only because of security reasons. In most cases, the decision to leave resulted from the generalised violence against civilians by different warring parties, mainly the Government of Syria and the Islamic State. Intentional attacks against healthcare workers were also one of the main reasons for leaving. Some participants had a specific notable trigger event before leaving, such as colleagues being detained or killed. Many participants simply grew tired of living under constant fear, with their families also at risk.ConclusionsThis research adds to the body of literature on violence against healthcare workers in Syria. It helps to understand the reasons why healthcare workers leave the country. The study also indicates that the international community has failed to protect Syrian healthcare workers. The intensity of the conflict has left many healthcare workers with no other option than to leave. Understanding this migration will enable the discovery of new solutions for protecting healthcare workers in current and future conflicts.
Cross-sectional study evaluating the seroprevalence of SARS-CoV-2 antibodies among healthcare workers and factors associated with exposure during the first wave of the COVID-19 pandemic in New York
Authors: Bryan Alexander , Tatem Kathleen , Diuguid-Gerber Jillian , Cooke Caroline , Romanoff Anya , Choudhury Nandini , Scanlon Michael , Kishore Preeti , Sydney Elana , Masci Joseph , Bakshi Parampreet , Pemmasani Sahithi , Davis Nichola J , Maru Duncan 
Published: November 2021

ObjectiveEstimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health and Hospitals (NYC H+H) healthcare workers during the first wave of the COVID-19 pandemic, and describe demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers.DesignDescriptive, observational, cross-sectional study using a convenience sample of data from SARS-CoV-2 serological tests accompanied by a demographic and occupational survey administered to healthcare workers.SettingA large, urban public healthcare system in NYC.ParticipantsParticipants were employed by NYC H+H and either completed serological testing at NYC H+H between 30 April 2020 and 30 June 2020, or completed SARS-CoV-2 antibody testing outside of NYC H+H and were able to self-report results from the same time period.Primary outcome measureSARS-CoV-2 serostatus, stratified by key demographic and occupational characteristics reported through the demographic and occupational survey.ResultsSeven hundred and twenty-seven survey respondents were included in analysis. Participants had a mean age of 46 years (SD=12.19) and 543 (75%) were women. Two hundred and fourteen (29%) participants tested positive or reported testing positive for the presence of SARS-CoV-2 antibodies (IgG+). Characteristics associated with positive SARS-CoV-2 serostatus were Black race (25% IgG +vs 15% IgG−, p=0.001), having someone in the household with COVID-19 symptoms (49% IgG +vs 21% IgG−, p<0.001), or having a confirmed COVID-19 case in the household (25% IgG +vs 5% IgG−, p<0.001). Characteristics associated with negative SARS-CoV-2 serostatus included working on a COVID-19 patient floor (27% IgG +vs 36% IgG−, p=0.02), working in the intensive care unit (20% IgG +vs 28% IgG−, p=0.03), being employed in a clinical occupation (64% IgG +vs 78% IgG−, p<0.001) or having close contact with a patient with COVID-19 (51% IgG +vs 62% IgG−, p=0.03).ConclusionsResults underscore the significance that community factors and inequities might have on SARS-CoV-2 exposure for healthcare workers.
Weight change, cardio-metabolic risk factors and cardiovascular incidence in people with serious mental illness: protocol of a population-based cohort study in the UK from 1998 to 2020
Authors: Lee Charlotte , Waite Felicity , Smith Margaret C , Gao Min , Bankhead Clare , Aveyard Paul , Piernas Carmen 
Published: November 2021

IntroductionPeople with serious mental illness (SMI), which includes people with diagnoses of schizophrenia spectrum and bipolar disorders, face significant health inequality. This includes a life expectancy reduced by 15–20 years mostly due to premature cardiovascular disease (CVD) compared with the general population. Excess weight gain and related comorbidities are preventable risk factors for CVD. To improve the understanding and management of CVD in people with SMI, we will examine the association between SMI and: (1) weight change; (2) cardio-metabolic risk factors for CVD; and (3) incidence of and mortality from CVD. We will also (4) examine the incidence of referral to weight management services for people with SMI compared with people without SMI.Methods and analysisIn this retrospective cohort study, we will link general practice records from the UK Clinical Practice Research Datalink Aurum database. We will establish a cohort of patients diagnosed with SMI between 1998 and 2020 who are matched with up to four controls on age, sex, general practice and calendar year. We will use multivariable mixed-effects linear regression models and Cox proportional hazard models with sequential adjustment for potential confounders identified by separate directed acyclic graphs.Ethics and disseminationThis study has been reviewed and approved by the Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency database research. The results will be published in a peer-reviewed journal.
Establishing best practices in cancer online support groups: protocol for a realist review
Authors: Bender Jacqueline L , Babinski Stephanie , Wong Geoff , Tricco Andrea C , Englesakis Marina , Cyr Alaina B , Potts Henry , Perski Olga , Esplen Mary Jane , Young Colleen , Wassersug Richard , Forster Victoria , Papadakos Janet , Soobiah Charlene , Fox Colleen , Gothard-Huang Alison , Witteman Holly 
Published: November 2021

IntroductionConsiderable observational evidence suggests that cancer online support groups reduce feelings of isolation, depression and anxiety, enhance coping and self-management, and lead to better informed patients. Other studies indicate that cancer online support groups can increase distress. Yet no studies theorise the complex, context-dependent mechanisms by which cancer online support groups generate their—sometimes contrasting—outcomes.Methods and analysisGuided by an integrated knowledge translation approach and the strategy for patient-oriented research, we will conduct a realist review of cancer online support groups in partnership with stakeholders. We will follow Pawson’s five steps and existing quality standards to develop a program theory that explains how cancer online support groups work, for whom and in what circumstances. The specific research questions will be: what positive and negative outcomes have been reported on cancer online support groups? What are the mechanisms that are associated with these outcomes, in which contexts and for whom? Through a rigorous review of relevant scientific and grey literature, as well as ongoing dialogue with stakeholders, a program theory will be developed to explain who benefits from cancer online support groups and who does not, what benefits they derive (or do not), and the factors that affect these outcomes.Ethics and disseminationThe use of secondary data for this review precludes the need for ethical approval. Dissemination will be informed by the knowledge-to-action framework and will consist of tailored knowledge products that are conceived of collaboratively with stakeholders. These will include peer-reviewed publications on how cancer online support groups can be optimised and best practice recommendations to maximise the benefits experienced by people with cancer. These traditional scientific outputs, along with their respective evidence summaries, will be amplified through strategic social media events hosted and promoted by knowledge users.PROSPERO registration numberCRD42021250046.
Associations of obesity, physical activity level, inflammation and cardiometabolic health with COVID-19 mortality: a prospective analysis of the UK Biobank cohort
Authors: Hamrouni Malik , Roberts Matthew J , Thackray Alice , Stensel David J , Bishop Nicolette 
Published: November 2021

ObjectivesTo investigate the associations of physical activity level with COVID-19 mortality risk across body mass index (BMI) categories, and to determine whether any protective association of a higher physical activity level in individuals with obesity may be explained by favourable levels of cardiometabolic and inflammatory biomarkers.DesignProspective cohort study (baseline data collected between 2006 and 2010). Physical activity level was assessed using the International Physical Activity Questionnaire (high: ≥3000 Metabolic Equivalent of Task (MET)-min/week, moderate: ≥600 MET-min/week, low: not meeting either criteria), and biochemical assays were conducted on blood samples to provide biomarker data.SettingUK Biobank.Main outcome measuresLogistic regressions adjusted for potential confounders were performed to determine the associations of exposure variables with COVID-19 mortality risk. Mortality from COVID-19 was ascertained by death certificates through linkage with National Health Service (NHS) Digital.ResultsWithin the 259 397 included participants, 397 COVID-19 deaths occurred between 16 March 2020 and 27 February 2021. Compared with highly active individuals with a normal BMI (reference group), the ORs (95% CIs) for COVID-19 mortality were 1.61 (0.98 to 2.64) for highly active individuals with obesity, 2.85 (1.78 to 4.57) for lowly active individuals with obesity and 1.94 (1.04 to 3.61) for lowly active individuals with a normal BMI. Of the included biomarkers, neutrophil count and monocyte count were significantly positively associated with COVID-19 mortality risk. In a subanalysis restricted to individuals with obesity, adjusting for these biomarkers attenuated the higher COVID-19 mortality risk in lowly versus highly active individuals with obesity by 10%.ConclusionsThis study provides novel evidence suggesting that a high physical activity level may attenuate the COVID-19 mortality risk associated with obesity. Although the protective association may be partly explained by lower neutrophil and monocyte counts, it still remains largely unexplained by the biomarkers included in this analysis.
Manual QT interval measurement with a smartphone-operated single-lead ECG versus 12-lead ECG: a within-patient diagnostic validation study in primary care
Authors: Beers Lisa , van Adrichem Lisa P , Himmelreich Jelle C L , Karregat Evert P M , de Jong Jonas S S G , Postema Pieter G , de Groot Joris R , Lucassen Wim A M , Harskamp Ralf E 
Published: November 2021

ObjectiveTo determine the accuracy of QT measurement in a smartphone-operated, single-lead ECG (1L-ECG) device (AliveCor KardiaMobile 1L).DesignCross-sectional, within-patient diagnostic validation study.Setting/participantsPatients underwent a 12-lead ECG (12L-ECG) for any non-acute indication in primary care, April 2017–July 2018.InterventionSimultaneous recording of 1L-ECGs and 12L-ECGs with blinded manual QT assessment.Outcomes of interest(1) Difference in QT interval in milliseconds (ms) between the devices; (2) measurement agreement between the devices (excellent agreement <20 ms and clinically acceptable agreement <40 ms absolute difference); (3) sensitivity and specificity for detection of extreme QTc (short (≤340 ms) or long (≥480 ms)), on 1L-ECGs versus 12L-ECGs as reference standard. In case of significant discrepancy between lead I/II of 12L-ECGs and 1L-ECGs, we developed a correction tool by adding the difference between QT measurements of 12L-ECG and 1L-ECGs.Results250 ECGs of 125 patients were included. The mean QTc interval, using Bazett’s formula (QTcB), was 393±25 ms (mean±SD) in 1L-ECGs and 392±27 ms in lead I of 12L-ECGs, a mean difference of 1±21 ms, which was not statistically different (paired t-test (p=0.51) and Bland Altman method (p=0.23)). In terms of agreement between 1L-ECGs and lead I, QTcB had excellent agreement in 66.9% and clinically acceptable agreement in 93.4% of observations. The sensitivity and specificity of detecting extreme QTc were 0% and 99.2%, respectively. The comparison of 1L-ECG QTcB with lead II of 12L-ECGs showed a significant difference (p=<0.01), but when using a correction factor (+9 ms) this difference was cancelled (paired t-test (p=0.43) or Bland Altman test (p=0.57)). Moreover, it led to improved rates of excellent (71.3%) and clinically acceptable (94.3%) agreement.ConclusionSmartphone-operated 1L-ECGs can be used to accurately measure the QTc interval compared with simultaneously obtained 12L-ECGs in a primary care population. This may provide an opportunity for monitoring the effects of potential QTc-prolonging medications.