bluuebunny/crossref_metadata_2025_split huggingface dataset:
Municipal contraceptive services, socioeconomic status and teenage pregnancy in Finland: a longitudinal study
Authors: Jalanko Eerika , Gyllenberg Frida , Krstic Nikolas , Gissler Mika , Heikinheimo Oskari 
Published: February 2021

ObjectivesDeclining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking.Design and settingThis retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000–2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model.Primary outcome measuresAnnual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15–19 years old in the 100 largest municipalities in Finland from 2000 to 2018.ResultsThe following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively).ConclusionProviding free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.
Prescribed exercise regimen versus usual care and hypochlorous acid wound solution versus placebo for treating venous leg ulcers: study protocol for a randomised controlled trial (Factorial4VLU)
Authors: Jull Andrew , Wadham Angela , Bullen Chris , Parag Varsha , Parsons John G M , Laking George , Waters Jill , Klonizakis Markos , O"Brien Jane 
Published: February 2021

IntroductionCompression is the mainstay of treatment for venous leg ulcers (VLUs) and there are few effective adjuvant treatments. There is only observational evidence supporting the use of hypochlorous acid (HOCl) as a topical wound solution on VLU and some limited randomised evidence for the effect of a prescribed regimen of exercise.Methods and analysisThe Factorial4VLU trial is a pragmatic, blinded, factorial randomised controlled trial, with 380 participants receiving either a prescribed exercise regimen compared with usual care and either active HOCl wound solution or placebo wound solution at each dressing change for up to 24 weeks. All participants will receive compression therapy. The primary outcome is the proportion of participants with healed VLU at 12 weeks after randomisation as adjudicated by blinded review of ulcer photographs. Secondary outcomes are proportion healed at 24 weeks, time to healing, estimated change in ulcer area, change in 2-Minute Walk Test, change in health-related quality of life, incidence of infection and incidence of all-cause adverse events. If either of the interventions shows a statistically significant positive difference on healing outcomes, cost-effectiveness will be modelled using a health service perspective.Ethics and disseminationThe Factorial4VLU trial received ethical approval from the Northern B Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.Trial registration numbersAustralia and New Zealand Clinical Trials Register (http://www.anzctr.org.au) (ACTRN12620000116921); Universal Trial Number (WHO) (U1111-1236-2997).
Changes in prescribing rates of sodium-containing medications in the UK from 2009 to 2018: a cross-sectional study with interrupted time series analysis
Authors: Ju Chengsheng , Wei Li , Mackenzie Isla S , MacDonald Thomas M , George Jacob 
Published: February 2021

ObjectiveEffervescent, soluble, dispersible formulations contain considerable amounts of sodium. In 2013, we previously confirmed the association between sodium-containing medications and cardiovascular risks. This study aimed to determine the changes in the prescribing pattern in clinical practice following this publication.DesignA longitudinal cross-sectional study.SettingPrimary care in the UK from 2009 to 2018.ParticipantsPrescribing information in The Health Improvement Network (THIN) and Prescription Cost Analysis (PCA) databases in the UK.Outcome measurementsPrescription rates per 10 000 inhabitants were calculated using the number of prescriptions or the number of drug-using patients over the total number of inhabitants, and the prescription rates were measured at annual intervals. Prescribing trends from 2009 to 2018 were indexed with yearly data from THIN and PCA. Interrupted time series analysis (ITSA) was conducted with monthly data in THIN.ResultsFrom the THIN database, a total of 3 651 419 prescription records from 446 233 patients were included. The prescribing rate of sodium-containing medications changed from 848.3/10 000 inhabitants in 2009 to 571.6/10 000 inhabitants in 2018. The corresponding figures from PCA data were of 631.0/10 000 inhabitants in 2009 and 423.8/10 000 inhabitants in 2018. ITSA showed the prescribing trend reduced significantly during the postpublication period (prescribing rate: slope change=−0.26; 95% CI −0.45 to –0.07; p=0.009; proportion of patients: slope change=−0.22; 95% CI −0.35 to –0.09; p<0.001), but no change in postpublication level from baseline. The prescribing rates for the non-sodium-containing standard formulations were relatively stable over the study period. The reduction in the proportion of patients using sodium-containing medications was only significant in patients over 45 years old.ConclusionsThe prescribing of sodium-containing medications in the UK primary care has declined significantly during the postpublication period. Changes in the prescribing trends for sodium-containing medications varied across regions of the UK and patient age groups.
Impact of temperature and relative humidity on the transmission of COVID-19: a modelling study in China and the United States
Authors: Wang Jingyuan , Tang Ke , Feng Kai , Lin Xin , Lv Weifeng , Chen Kun , Wang Fei 
Published: February 2021

ObjectivesWe aim to assess the impact of temperature and relative humidity on the transmission of COVID-19 across communities after accounting for community-level factors such as demographics, socioeconomic status and human mobility status.DesignA retrospective cross-sectional regression analysis via the Fama-MacBeth procedure is adopted.SettingWe use the data for COVID-19 daily symptom-onset cases for 100 Chinese cities and COVID-19 daily confirmed cases for 1005 US counties.ParticipantsA total of 69 498 cases in China and 740 843 cases in the USA are used for calculating the effective reproductive numbers.Primary outcome measuresRegression analysis of the impact of temperature and relative humidity on the effective reproductive number (Rvalue).ResultsStatistically significant negative correlations are found between temperature/relative humidity and the effective reproductive number (Rvalue) in both China and the USA.ConclusionsHigher temperature and higher relative humidity potentially suppress the transmission of COVID-19. Specifically, an increase in temperature by 1°C is associated with a reduction in theRvalue of COVID-19 by 0.026 (95% CI (−0.0395 to −0.0125)) in China and by 0.020 (95% CI (−0.0311 to −0.0096)) in the USA; an increase in relative humidity by 1% is associated with a reduction in theRvalue by 0.0076 (95% CI (−0.0108 to −0.0045)) in China and by 0.0080 (95% CI (−0.0150 to −0.0010)) in the USA. Therefore, the potential impact of temperature/relative humidity on the effective reproductive number alone is not strong enough to stop the pandemic.
Protocol of the COVID-19 Health and Adherence Research in Scotland (CHARIS) study: understanding changes in adherence to transmission-reducing behaviours, mental and general health, in repeated cross-sectional representative survey of the Scottish population
Authors: Den Daas Chantal , Hubbard Gill , Johnston Marie , Dixon Diane 
Published: February 2021

IntroductionCOVID-19 has unprecedented consequences on population health, with governments worldwide issuing stringent public health directives. In the absence of a vaccine, a key way to control the pandemic is through behavioural change: people adhering to transmission-reducing behaviours (TRBs), such as physical distancing, hand washing and wearing face covering. Non-adherence may be explained by theories of how people think about the illness (the common-sense model of self-regulation) and/or how they think about the TRBs (social cognition theory and protection motivation theory). In addition, outbreaks of infectious diseases and the measures employed to curb them are likely to have detrimental effects on people’s mental and general health. Therefore, in representative repeated surveys, we will apply behavioural theories to model adherence to TRBs and the effects on mental and general health in the Scottish population from June to November 2020, following the initial outbreak of COVID-19.Methods and analysisRepeated 20 min structured telephone surveys will be conducted with nationally representative random samples of 500 adults in Scotland. The first 6 weeks the survey will be conducted weekly, thereafter fortnightly, for a total of 14 waves (total n=7000). Ipsos MORI will recruit participants through random digit dialling. The core survey will measure the primary outcomes of adherence to TRBs, mental and general health, and explanatory variables from the theories. Further questions will be added, enabling more detailed measurement of constructs in the core survey, additional themes and questions that align with the evolving pandemic.Ethics and disseminationEthical approval for this study was granted by the Life Sciences and Medicine College Ethics Review Board (CERB) at the University of Aberdeen (CERB/2020/5/1942). Results will be made available to policy makers, funders, interested lay people and other researchers through weekly reports and three bimonthly bulletins placed on the CHARIS website and advertised through social media.
Changing trends in nutritional status of adolescent females: a cross-sectional study from urban and rural Bangladesh
Authors: Mostafa Ishita , Hasan Mahamudul , Das Subhasish , Khan Soroar Hossain , Hossain Md Iqbal , Faruque Abu , Ahmed Tahmeed 
Published: February 2021

ObjectivesMalnutrition remains a major problem among adolescents worldwide, but the types of nutritional problem impacting this group are changing significantly. This study aims to describe and analyse the trends in nutritional status and related epidemiological characteristics of 10 to 19 years old adolescent girls over time (2001 to 2018) in Bangladesh.MethodsWe extracted data from the Diarrhoeal Disease- Surveillance System of the International Centre for Diarrhoeal Disease Research Bangladesh. We performed χ2test for trend to test for statistical significance of the changing trends of undernutrition and overnutrition among the study participants. Multivariable logistic regression model was fit to measure the strength of association, reported as adjusted OR (aOR) and corresponding 95% CIs.ResultsA total of 1224 and 628 adolescent females attended urban and rural treatment facilities, respectively, between 2001 and 2018. The proportion of stunting and thinness decreased substantially, whereas overweight has been observed to increase (1.7% to 7.4%, p<0.001) over the study period. Factors independently associated with stunting were illiteracy (aOR 2.39, 95% CI (1.68 to 3.39), p<0.001), monthly family income of less than US$100 (aOR 1.54, 95% CI (1.25 to 1.9), p<0.001) and family belonging to poorest wealth quintile (aOR 1.45, 95% CI (1.13 to 1.87), p=0.004). Younger participants (aOR 2.69, 95% CI (2.10 to 3.45), p<0.001), rural participants (aOR 1.71 95% CI (1.23 to 2.38), p<0.001), longer hospital stay (aOR 1.52, 95% CI (1.16 to 1.98), p=0.002) and monthly family income less than US$100 (aOR 1.44, 95% CI (1.09 to 1.89), p=0.009) were significantly associated with thinness. Conversely, overweight/obesity was associated with monthly family income more than US$100, duration of diarrhoea and rural participants.ConclusionUndernutrition in adolescent girls has decreased with time, but the burden of overweight has increased. Higher literacy and better wealth status were found to be associated with the improved nutritional status of the participants.
Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020
Authors: Gopal Rao Guduru , Allen Alexander , Papineni Padmasayee , Wang Liyang , Anderson Charlotte , McGregor Alastair , Whittington Ashley , John Laurence , Harris Miriam , Hiles Stephen , Nicholas Thomas , Adams Katherine , Akbar Ayesha , Blomquist Paula , Decraene Valerie , Patel Bharat , Manuel Rohini , Chow Yimmy , Kuper Martin 
Published: February 2021

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.
COVID-19 in Ethiopia: a geospatial analysis of vulnerability to infection, case severity and death
Authors: Alene Kefyalew Addis , Gelaw Yalemzewod Assefa , Fetene Dagnachew Muluye , Koye Digsu N. , Melaku Yohannes Adama , Gesesew Hailay , Birhanu Mulugeta Molla , Adane Akilew Awoke , Muluneh Muluken Dessalegn , Dachew Berihun Assefa , Abrha Solomon , Aregay Atsede , Ayele Asnakew Achaw , Bezabhe Woldesellassie M , Gebremariam Kidane Tadesse , Gebremedhin Tesfaye , Gebremedhin Amanuel Tesfay , Gebremichael Lemlem , Geleto Ayele Bali , Kassahun Habtamu Tilahun , Kibret Getiye Dejenu , Leshargie Cheru Tesema , Mekonnen Alemayehu , Mirkuzie Alemnesh H. , Mohammed Hassen , Tegegn Henok Getachew , Tesema Azeb Gebresilassie , Tesfay Fisaha Haile , Wubishet Befikadu Legesse , Kinfu Yohannes 
Published: February 2021

BackgroundCOVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia.MethodsThirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km.ResultsThis study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples’ Region. The risk of COVID-19-related death is high in the country’s border regions, where public health preparedness for responding to COVID-19 is limited.ConclusionThis study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.
Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial
Authors: Kastner Monika , Makarski Julie , Hayden Leigh , Hamid Jemila S , Holroyd-Leduc Jayna , Twohig Margo , Macfarlane Charlie , Hynes Mary Trapani , Prasaud Leela , Sklar Barb , Honsberger Joan , Wang Marilyn , Kramer Gloria , Hobden Gerry , Armson Heather , Ivers Noah , Leung Fok-Han , Liu Barbara , Marr Sharon , Greiver Michelle , Desroches Sophie , Sibley Kathryn , Saunders Hailey , Isaranuwatchai Wanrudee , McArthur Eric , Harvey Sarah , Manawadu Kithara , Petricca Kadia , Straus Sharon E 
Published: February 2021

IntroductionIn response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called ‘KeepWell’ that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases.Methods and analysisWe will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness–implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability.Ethics and disseminationEthics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting.Trial registration numberNCT04437238.
Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial
Authors: Dryver Eric , Lundager Forberg Jakob , Hård af Segerstad Caroline , Dupont William D , Bergenfelz Anders , Ekelund Ulf 
Published: February 2021

BackgroundStudies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown.MethodsEight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs—of which two belong to an academic centre—and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed.ResultsA total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10−8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1–6, most participants agreed (gave a score of 5 or 6) with the statement ‘I would use the checklist if I got a similar case in reality’.ConclusionIn this multi-institution study, checklists markedly improved local resuscitation teams’ management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.