bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disease and demography: a systems-dynamic cohort-component population model to assess the implications of disease-specific mortality targets
Authors: Husain Muhammad Jami , Datta Biplab Kumar , Kostova Deliana 
Published: May 2021

IntroductionThe 2015 Sustainable Development Goals include the objective of reducing premature mortality from major non-communicable diseases (NCDs) by one-third by 2030. Accomplishing this objective has demographic implications with relevance for countries’ health systems and costs. However, evidence on the system-wide implications of NCD targets is limited.MethodsWe developed a cohort-component model to estimate demographic change based on user-defined disease-specific mortality trajectories. The model accounts for ageing over 101 annual age cohorts, disaggregated by sex and projects changes in the size and structure of the population. We applied this model to the context of Bangladesh, using the model to simulate demographic outlooks for Bangladesh for 2015–2030 using three mortality scenarios. The ‘status quo’ scenario entails that the disease-specific mortality profile observed in 2015 applies throughout 2015–2030. The ‘trend’ scenario adopts age-specific, sex-specific and disease-specific mortality rate trajectories projected by WHO for the region. The ‘target’ scenario entails a one-third reduction in the mortality rates of cardiovascular disease, cancer, diabetes and chronic respiratory diseases between age 30 and 70 by 2030.ResultsThe status quo, trend and target scenarios projected 178.9, 179.7 and 180.2 million population in 2030, respectively. The cumulative number of deaths during 2015–2030 was estimated at 17.4, 16.2 and 15.6 million for each scenario, respectively. During 2015–2030, the target scenario would avert a cumulative 1.73 million and 584 000 all-cause deaths compared with the status quo and trend scenarios, respectively. Male life expectancy was estimated to increase from 71.10 to 73.47 years in the trend scenario and to 74.38 years in the target scenario; female life expectancy was estimated to increase from 73.68 to 75.34 years and 76.39 years in the trend and target scenarios, respectively.ConclusionThe model describes the demographic implications of NCD prevention and control targets,estimating the potential increase in life expectancy associated with achieving key NCD reduction targets. The results can be used to inform future health system needs and to support planning for increased healthcare coverage in countries.
Rural family physician perspectives on communication with urban specialists: a qualitative study
Authors: Wilson Margo M , Devasahayam Augustine Joshua , Pollock Nathaniel J , Dubrowski Adam , Renouf Tia 
Published: May 2021

ObjectiveCommunication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision making. The aim of this study was to explore rural physicians’ perspectives on communication with urban specialists during consultations and referrals.SettingNewfoundland and Labrador, Canada.ParticipantsThis qualitative study involved semistructured, one-on-one interviews with rural family physicians (n=11) with varied career stages, geographical regions, and community sizes.ResultsFour themes specific to communication in rural practice were identified. The themes included: (1) understanding the contexts of rural care; (2) geographical isolation and patient transfer; and (3) respectful discourse; and (4) overcoming communication challenges in referrals and consultations.ConclusionsCommunication between rural family physicians and urban specialists is a critical task in providing care for rural patients. Rural physicians see value in conveying unique aspects of rural clinical practice during communication with urban specialists, including context and the complexities of patient transfers.
Use of carnosine in the prevention of cardiometabolic risk factors in overweight and obese individuals: study protocol for a randomised, double-blind placebo-controlled trial
Authors: Menon Kirthi , Cameron James D , de Courten Maximilian , de Courten Barbora 
Published: May 2021

IntroductionCarnosine, an over the counter food supplement, has been shown to improve glucose metabolism as well as cardiovascular risk factors in animal and human studies through its anti-inflammatory, antioxidative, antiglycating and chelating properties. The aim of this study is to establish if carnosine supplementation improves obesity, insulin sensitivity, insulin secretion, cardiovascular risk factors including arterial stiffness and endothelial function, and other risk factors related to diabetes and cardiovascular disease in the overweight and obese population.Methods and analysisFifty participants will be recruited to be enrolled in a double-blind randomised controlled trial. Eligible participants with a body mass index (BMI) between 25 and 40 kg/m2will be randomly assigned to the intervention or placebo group. Following a medical review and oral glucose tolerance test to check eligibility, participants will then undergo testing. At baseline, participants will have anthropometric measurements (BMI, dual X-ray absorptiometry and peripheral quantitative CT scan), measurements of glucose metabolism (oral glucose tolerance test, intravenous glucose tolerance test and euglycaemic hyperinsulinaemic clamp), cardiovascular measurements (central blood pressure, endothelial function and arterial stiffness), a muscle and fat biopsy, physical activity measurement, liver fibroscan, cognitive function and questionnaires to assess dietary habits, sleep quality, depression, and quality of life. Following baseline assessments, participants will be randomised to either 2 g carnosine or placebo for 15 weeks. In the 15th week, all assessments will be repeated. The preplanned outcome metric is the change between baseline and follow-up measures.Ethics and disseminationThis study is approved by the Human Research Ethics Committee of Monash Health and Monash University, Australia.Trial registration numberNCT02686996.
Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study
Authors: Cunningham David E , Ward Caroline , Kyle John , Yeoman Lynsey 
Published: May 2021

ObjectivesTo identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland.DesignQualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference.SettingGeneral practice in NHS Scotland.ParticipantsGPs, within the first 5 years of completion of GP training, who were working in NHS Scotland.ResultsThirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning.ConclusionsPreferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.
The Young Disability Questionnaire-Spine: item development, pilot testing and conceptualisation of a questionnaire to measure consequences of spinal pain in children
Authors: Meldgaard Emilie , Lauridsen Henrik Hein , Hestbaek Lise 
Published: May 2021

ObjectiveThe objective of the present study was to develop a questionnaire to measure the consequences of neck, midback and low back pain, relevant for schoolchildren aged 9–12 years.DesignThe development of the questionnaire was carried out in three phases: (1) generation of items, (2) pilot testing and (3) conceptualisation.SettingDanish primary schools.ParticipantsChildren aged 9–12 years from a local school were invited for completion of questionnaires and subsequent interviews.MethodsIn phase 1 an extensive literature search identified items from existing questionnaires measuring musculoskeletal disability in children. These were added to items from a previously conducted qualitative study and constituted the basis for the new questionnaire. In phase 2 two consecutive pilot tests were performed to test for comprehension and feasibility of the questionnaire. Phase 3 consisted of a categorisation of the newly developed items according to the WHO’s International Classification of Functioning, Disability and Health (ICF).ResultsThe combination of the previously conducted qualitative study and the literature review resulted in an item pool of 35 items. Through the process of item formulation and pilot testing, these were reduced to 28 items in the final questionnaire, which represented all categories in the ICF model. The qualitative study identified codes giving relative weight to four important domains. These were not included in any of the existing questionnaires but were added to the new questionnaire.ConclusionsWe developed the first version of a questionnaire to measure the consequences of back or neck pain in children. The process showed the importance of combining research methods, each adding important contributions to the final product. Subsequent work will finalise the questionnaire, allowing various options for use of the questionnaire.
Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys
Authors: Budu Eugene , Ahinkorah Bright Opoku , Aboagye Richard Gyan , Armah-Ansah Ebenezer Kwesi , Seidu Abdul-Aziz , Adu Collins , Ameyaw Edward Kwabena , Yaya Sanni 
Published: May 2021

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.ParticipantsA total of 60 964 mothers of children aged 11–23 months were included in the study.Outcome variablesThe main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).ResultsThe average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.ConclusionThe study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.
Cost-effectiveness analysis of 3 months of weekly rifapentine and isoniazid compared to isoniazid monotherapy in a Canadian arctic setting
Authors: Pease Christopher , Alvarez Gonzalo , Mallick Ranjeeta , Patterson Mike , Finn Sandy , Habis Yahya , Schwartzman Kevin , Kilabuk Elaine , Mulpuru Sunita , Zwerling Alice 
Published: May 2021

ObjectiveTo assess the cost effectiveness of once weekly rifapentine and isoniazid for 12 weeks (3HP) to the current standard care for latent tuberculosis (TB) infection (LTBI) in Iqaluit, Nunavut.DesignA cost-effectiveness analysis using a Markov model reflecting local practices for LTBI treatment.SettingA remote Canadian arctic community with a high incidence of TB.ParticipantsHypothetical patients with LTBI.InterventionsThe cost effectiveness of 3HP was compared with the existing standard of care in the study region which consists of 9 months of twice weekly isoniazid (9H) given by directly observed therapy.Outcome measuresEffectiveness was measured in quality-adjusted life years (QALYs) with model parameters were derived from historical programmatic data, a local implementation study of 3HP and published literature. Costs from the perspective of the Nunavut healthcare system were measured in 2019 US dollars and were obtained primarily from local, empirically collected data. Secondary health outcomes included estimated TB cases and TB deaths averted using 3HP versus 9H. One way and probabilistic sensitivity analyses were performed.ResultsThe 3HP regimen was dominant over 9H: costs were lower (US$628 vs US$924/person) and health outcomes slightly improved (20.14 vs 20.13 QALYs/person). In comparison to 9H, 3HP treatment resulted in fewer TB cases (27.89 vs 30.16/1000 persons) and TB deaths (2.29 vs 2.48/1000 persons). 3HP completion, initiation and risk of fatal adverse events were the primary drivers of cost effectiveness.ConclusionIn a remote Canadian arctic setting, using 3HP instead of 9H for LTBI treatment may result in cost savings and similar or improved health outcomes.
When COVID-19 enters in a community setting: an exploratory qualitative study of community perspectives on COVID-19 affecting mental well-being
Authors: Ali Naureen Akber , Feroz Anam Shahil , Akber Noshaba , Feroz Ridah , Nazim Meghani Salima , Saleem Sarah 
Published: May 2021

ObjectiveThe COVID-19 pandemic has resulted in an increased level of anxiety and fear among the general population related to its management and infection spread. Considering the relevance of present circumstances, we explored perceptions and attitudes of community members towards their mental well-being during the COVID-19 pandemic.SettingWe conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan.ParticipantsIn-depth interviews were conducted with community members including, young adults, middle-aged adults and older adults of both genders. Study data were analysed manually using the thematic analysis technique.Primary outcomeThe primary outcome is assessing community perception towards their mental well-being amidst the COVID-19 pandemic.ResultsA total of 27 in-depth interviews were conducted, between May and June 2020. Three overarching themes were identified: (1) impact of COVID-19 on the mental health of the general communities; (2) current coping mechanisms to adapt to the new reality and (3) recommendations to address the mental health of communities. Generally, community members underwent increased anxiety and fear due to the contagious nature of the virus. Alongside, social, financial and religious repercussions of the pandemic have also heightened psychological distress among community members. However, community members were able to point out some of the coping mechanisms such as getting closer to God, connecting with family, participating in mental health sessions and resetting lives by indulging in diverse activities. Simultaneously, they also recommended the need for remote mental health services for elders and continuous efforts by the government to address the mental health needs of the community.ConclusionCOVID-19-associated mental health consequences have hit every individual in society. The study finding has the potential to guide the development of context-specific innovative mental health programmes to overcome the pandemic repercussions.
Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study
Authors: Luckett Tim , Roberts Mary , Swami Vinita , Smith Tracy , Cho Jin-Gun , Klimkeit Ester , Wheatley John R 
Published: May 2021

ObjectivesThis study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support.DesignA qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach.SettingThe Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits.ParticipantsPatients with moderate to very severe COPD who had completed the WBS programme 6 months earlier.ResultsThirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A ‘chaos narrative’ appeared to be prevalent, and many participants had poor recall of the programme.ConclusionsSelf-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management.Trial registration numberACTRN12617000499381
Multiple rib fractures: does flail chest matter?
Authors: Daskal Yaakov , Paran Maya , Korin Alexander , Soukhovolsky Vladislav , Kessel Boris 
Published: May 2021

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.
Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool
Authors: Curtius Kit , Kabir Misha , Al Bakir Ibrahim , Choi Chang Ho Ryan , Hartono Juanda L , Johnson Michael , East James E ,   Oxford IBD Cohort Study Investigators, Lindsay James O , Vega Roser , Thomas-Gibson Siwan , Warusavitarne Janindra , Wilson Ana , Graham Trevor A , Hart Ailsa 
Published: May 2021

ObjectivePatients with ulcerative colitis (UC) diagnosed with low-grade dysplasia (LGD) have increased risk of developing advanced neoplasia (AN: high-grade dysplasia or colorectal cancer). We aimed to develop and validate a predictor of AN risk in patients with UC with LGD and create a visual web tool to effectively communicate the risk.DesignIn our retrospective multicentre validated cohort study, adult patients with UC with an index diagnosis of LGD, identified from four UK centres between 2001 and 2019, were followed until progression to AN. In the discovery cohort (n=246), a multivariate risk prediction model was derived from clinicopathological features using Cox regression. Validation used data from three external centres (n=198). The validated model was embedded in a web tool to calculate patient-specific risk.ResultsFour clinicopathological variables were significantly associated with AN progression in the discovery cohort: endoscopically visible LGD >1 cm (HR 2.7; 95% CI 1.2 to 5.9), unresectable or incomplete endoscopic resection (HR 3.4; 95% CI 1.6 to 7.4), moderate/severe histological inflammation within 5 years of LGD diagnosis (HR 3.1; 95% CI 1.5 to 6.7) and multifocality (HR 2.9; 95% CI 1.3 to 6.2). In the validation cohort, this four-variable model accurately predicted future AN cases with overall calibration Observed/Expected=1.01 (95% CI 0.64 to 1.52), and achieved 100% specificity for the lowest risk group over 13 years of available follow-up.ConclusionMulticohort validation confirms that patients with large, unresected, multifocal LGD and recent moderate/severe inflammation are at highest risk of developing AN. Personalised risk prediction provided via the Ulcerative Colitis-Cancer Risk Estimator (www.UC-CaRE.uk) can support treatment decision-making.