bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels
Authors: Armstrong Megan , Shulman Caroline , Hudson Briony , Stone Patrick , Hewett Nigel 
Published: October 2021

IntroductionThe number of people living in homeless hostels in the UK has steadily increased over the past decade. Despite people experiencing homelessness often having considerable health problems and a range of complex needs frequently in association with addictions, the experiences of hostel staff and residents especially in relation to accessing health and social care support have seldom been explored. The aim of this paper is to identify the barriers and facilitators to accessing health and social care services for people living in homeless hostels.DesignExploratory qualitative baseline data were collected as part of an intervention to facilitate palliative care in-reach into hostels.Setting/participantsInterviews were conducted with 33 participants; 18 homeless hostel managers/support staff and 15 people experiencing homelessness, from six homeless hostels in London and Kent.ResultsThree themes were identified (1) internal and external service barriers to health and social care access due to stigma, lack of communication and information sharing from services and assumptions around capacity and the role of the hostel, (2) the impact of lack of health and social care support on hostel staff leading to burnout, staff going beyond their job role and continuous support given to residents, (3) potential facilitators to health and social care access such in-reach and support from those who understand this population and hostel staff training.DiscussionResidents have multiple complex needs yet both hostel staff and residents face stigma and barriers accessing support from external services. Positive relationships were described between hostel residents and staff, which can be an essential step in engaging with other services. People experiencing homelessness urgently need better access to person-centred, trauma-informed support ideally via in-reach from people who understand the needs of the population.
Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England
Authors: Smith Daniel , Willan Kathryn , Prady Stephanie L , Dickerson Josie , Santorelli Gillian , Tilling Kate , Cornish Rosie Peggy 
Published: October 2021

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.
Exploring linkages between climate change and sexual health: a scoping review protocol
Authors: Logie Carmen H , Toccalino Danielle , Reed Anna Cooper , Malama Kalonde , Newman Peter A , Weiser Sheri , Harris Orlando , Berry Isha , Adedimeji Adebola 
Published: October 2021

IntroductionThe effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.Methods and analysisFive electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms.Ethics and disseminationThere are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.
Type 1 diabetes incidence trends in children and adolescents aged 0–14 years in Europe: a systematic review and meta-analysis protocol
Authors: Díez‐Fernández Ana , Ruiz-Grao Marta Carolina , Mesas Arthur Eumann , Martinez-Vizcaino Vicente , Garrido-Miguel Miriam 
Published: October 2021

IntroductionMonitoring type 1 diabetes (T1D) trends across most European countries using objectively measured data and how this incidence has evolved over the past three decades should be considered a public health priority. This study protocol provides a standardised and transparent methodology to assess TD1 trends among 0–14-year-old children and adolescents across Europe from 1994 to 2021.Methods and analysisThis protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. The literature search will be conducted using MEDLINE, Embase, CINAHL and Web of Science databases from 1994 to 2021. Observational cohort studies providing incidence rates for European children and adolescents diagnosed with T1D aged ≤14.9 years and studies written in English, Spanish or Portuguese will be included. The risk of bias of the included studies will be assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute. Subgroup analyses will be performed based on gender, age, study year, country or European region. Metaregression analysis will be conducted using economic and geographic variables, such as gross national income of the country or geographic latitude.Ethics and disseminationThe systematic review based on this protocol will provide a comprehensive description of T1D incidence trends in children and adolescents across Europe from 1994 to 2021. The results will be disseminated in a peer-reviewed journal and in mass media. This study will exclusively use data from published research, so institutional ethical approval is not required.PROSPERO registration numberCRD42021239480.
End-stage organ disease–Healthcare utilisation: Impact of palliative medicine
Authors: Hum Allyn , Yap Chun Wei , Koh Mervyn Yong Hwang 
Published: October 2021

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.MethodsPatients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.ResultsPatients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (pall <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).ConclusionPalliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.
A severe case of Legionnaire’s Disease connected with the BBC outbreak in 1988
Authors: Richards N. C. G. , McKinley K. P. 
Published: October 2021

AbstractOn 1 May 1988 a senior Naval Officer, serving at HMS Warrior, was admitted to RAF Halton where a diagnosis of Legionnaire’s disease was made. He suffered severe pneumonia and neurological symptoms, and although he eventually responded to treatment, he still suffers sequelae. On 19 April, he was in the vicinity of the BBC at the time of the outbreak of Legionnaire’s disease. His clinical findings are reported in this article along with a brief history and discussion of the diagnosis and prevention of Legionnaire’s disease.
Practical Occupational Medicine: Astronaut Selection; A Diver’s perspective from 300 m below sea level to 300 km above
Authors: Brooks G. J. 
Published: October 2021

SummaryIn 1989, public selection of a team of four astronauts for the Anglo-Soviet Juno space mission took place. In this article, the author, a Navy Medical Officer, relates his experiences of taking part and discusses the rationale behind the exhaustive protocol of medical investigations involved.
Expedition ‘Idraren Draren’
Authors: Yeoman L. P. 
Published: October 2021

SummaryIn May 1990 a team of 12 personnel from the Royal Naval Medical Service flew to Marrakech and were then transported by truck to the village of Imlil to commence a 12-day trek into the High Atlas Mountains with the primary aim of ascending the summit of Mount Toubkal and encircling the Toubkal Massif. It was then the intention to get off the tourist tracks and to experience life among the Berber tribes, and to trek part of the high Atlas range.
Early return to work following highly selective vagotomy
Authors: Tulloch D. N. , Dewar E. P. 
Published: October 2021

SummaryIn the Royal Navy, after surgery, the time that servicemen spend away from work and the level of duty to whch they return are decisions made by the surgeon, not the general practitioner.In a prospective study, we have thus been able to assess the acceptability of return to full duty at decreasing intervals after highly selected vagotomy (HSV).Seventy-eight service men who underwent HSV for duodenal ulcer were studied in three periods, 1978–1980, 1981–1982, 1983–1986, each with a shorter interval to return to duty.There were no differences in the rates of ulcer recurrence, incisional hernia, or ability to perform full duties.After HSV the mean time to return to full duties for each group was 29.3, 16.4, and 4.2 weeks, respectively. Every patient returned to full duties at 28 days was able to perform any assigned task whether at sea or ashore.
The effect of hand immersion on body temperature when wearing impermeable clothing
Authors: Allsopp A. J. , Poole Kerry A. 
Published: October 2021

AbstractThe effects of hand immersion on body temperature have been investigated in men wearing impermeable NBC clothing. Six men worked continuously at a rate of approximately 490 J.sec−1 in an environmental temperature of 30°C. Each subject was permitted to rest for a period of 20 minutes when their aural temperature reached 37.5°C, and again on reaching 38°C, and for a third time on reaching 38.5°C (three rest periods in total). Each subject completed three experimental conditions whereby, during the rest periods they either:
a.Did not immerse their hands (control).b.Immersed both hands in a water bath set at 25°c.c.Immersed both hands in water at 10°C.Physiological measures of core temperature, skin temperature and heart rate were recorded at intervals throughout the experiment.Measures of mean aural temperature and mean skin temperature were significantly (P<0.05) reduced if hands were immersed during these rest periods, compared to non immersion. As a result, the total work time of subjects was extended when in the immersed conditions by some 10–20 minutes within the confines of the protocol.It is concluded that this technique of simple hand immersion may be effective in reducing heat stress where normal routes to heat loss are compromised.
Stress and infection
Authors: Riddell D. I. 
Published: October 2021

AbstractThe pattern of infective episodes during Royal Marines training over a four-year period has been established. There were 4,529 attendances at the Sickbay with apparent infective episodes. Peaks of infection tended to follow three or more nights in the field suggesting that the resistance to infective insult was lessened following these field exercises.The highest incidence of infection occurred during the final weeks of training when the physical and mental pressures were greatest, during the Commando course. This often manifested itself as skin sepsis. A judiciously-placed week of less stressful activity led to a major reduction in all infections at this stage of training.This is evidence that physical and mental stress may lead to infective episodes. The phenomenon is being more fully investigated by the Institute of Naval Medicine.
An audit of resuscitation and anaesthesia during Operation ‘Safe Haven’
Authors: Rudland S. V. , Tighe S. Q. M. , Pethybridge R. J. , Loxdale P. H. 
Published: October 2021

SummaryThe Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P<0.05). ICV patients recovered more quickly than with HTCV (P<0.05), but were significantly older and heavier (P<0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only £127. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.
Rhegmatogenous retinal detachment in Royal Naval personnel: A retrospective study
Authors: Low C. D. T. , Jeffrey M. N. 
Published: October 2021

AbstractA retrospective study was conducted to assess the various factors thought to influence the outcome of retinal detachment in RN personnel. A description of retinal detachment and its management, aimed at non-specialists, is given in the introduction.In the study period eight Servicemen had rhegmatogenous retinal detachments. All underwent conventional detachment surgery, but two required two further operations including vitrectomy. Important features of each patient’s detachment are discussed, as is post-operative progress. All patients spent a considerable time away from duty and three were discharged from the Service on medical grounds.Poor outcome could be related to myopia, trauma, delay in presentation to primary care, the number of operations performed and to post-operative complications.Advice is given regarding assessment and management of suspected cases by non-specialists. It is hoped that reporting this study will increase awareness within the RN of retinal detachment as a sight-threatening condition.
The obstetric course of elderly primigravidae—a review
Authors: McNeill Love R. M. C. 
Published: October 2021

AbstractAn increasingly large number of women are now delaying the start of their families until they reach the age of 35 years or older. They are then known as elderly primigravidae in obstetric parlance. This paper reviews recent literature and reports on a retrospective survey conducted by the author of such women at an RAF hospital and presents the findings concerning their ante-natal, intra-partum, post-partum and neonatal outcomes.
Diagnosis, progression, prognostic indication and classification of periodontal disease: A review (Part 1)
Authors: Priestland C. R. 
Published: October 2021

AbstractThis review is divided into a series of three papers. In the first, the prevalence of periodontal disease and the diagnostic problems in screening for high risk groups of patients will be reviewed. The difficulties encountered in differentiating between disease activity and historical evidence of past disease will also be considered along with the wide variation in disease progression rates. Having discussed diagnosis and disease activity markers, an accepted classification of periodontal diseases will be described. In the second paper, those periodontal diseases described as Gingivitis will be discussed. Finally in the third paper, Periodontitis will be reviewed with some emphasis being placed on the involvement of the periodontal tissues in systemic diseases.
Sick bay attendances by Royal Navy women at sea
Authors: Dorrell M. G. 
Published: October 2021

AbstractSick bay attendances in a warship have been monitored over a three-month period whilst on deployment. Women made 22% of all attendances. This was a significant reduction from over 50% in the ship’s first mixed manned deployment. The attendance rate per 100 persons at risk was 180 for females and 69 for men. Female specific problems accounted for 21% of their attendances.
Aspects of neurological decompression illness: A view from Bethesda
Authors: Broome J. R. 
Published: October 2021

AbstractA minority of divers with neurological decompression illness (DCI) fail to improve with recompression treatment. This is particularly seen in cases where features of severe spinal cord injury develop soon after surfacing. Haemorrhage into the spinal cord is implicated in the pathogenesis of these cases, and evidence is presented that supports the view that the bleeding coincides with shrinkage of autochthonous bubbles. The role of hyperbaric oxygen therapy in the treatment of spinal cord DCI is discussed with reference to posssible benefit in ischaemia-reperfusion (I-R) injury. Similarities and differences between the tissue injury of dysbaric and conventional spinal cord injury are outlined. The implications of advances in drug therapy for conventional spinal cord trauma are considered in the context of their potential application to treat neurological DCI.
Thrombophilia: Some recent advances in understanding
Authors: James C. M. 
Published: October 2021

AbstractThrombophilia is a term with many definitions although the majority include criteria such as thrombosis under the age of 45; recurrent thromboembolism and a positive family history. It reflects a disturbance in the normal delicate balance between pro- and anti-coagulation such as to favour inappropriate thrombosis. This review concentrates on the newly described phenomenon of activated protein C resistance while reviewing the natural anticoagulant system. It will also briefly examine the indications for ‘thrombophilia’ screening and the implications for individuals found to have an abnormality of their natural anticoagulants.
Is Testicular Cancer an Occupational Disease? A Case-Control Study of Royal Naval Personnel
Authors: Ryder S. J. , Crawford P. I. , Pethybridge R. J. 
Published: October 2021

AbstractTesticular cancer is the commonest malignancy arising in men actively serving in the Royal Navy. This study, which includes a literature review of the aetiology of the disease, is designed to determine the relative risk of developing testicular cancer in various occupational groups within the Service by means of a Case-Control study. All cases of testicular cancer occurring in serving personnel between 1976 and June 1994, inclusive, were identified. One hundred and ten cases were found. Four randomly selected controls were matched on the basis of date of birth and length of service to each case. Results reveal statistically significant increased Odds Ratios for members of the Fleet Air Arm (OR=1.90 95% CI: 1.04–3.48), Air Engineers (OR=2.32 95% CI: 1.20–4.48) and the Aircraft Handling sub-speciality (OR=7.31 95% CI: 1.81–29.53). It is speculated that exposure to glycol ethers in aviation fuel may be the causative mechanism. No associations were found in relation to ionising radiation exposures or length of time served in nuclear submarines.