bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of dementia in gout and hyperuricaemia: a meta-analysis of cohort studies
Authors: Pan Shu-Yue , Cheng Rui-Juan , Xia Zi-Jing , Zhang Qiu-Ping , Liu Yi 
Published: June 2021

ObjectivesGout, characterised by hyperuricaemia with monosodium urate crystal formation and inflammation, is the most common inflammatory arthritis in adults. Recent studies have found that elevated uric acid levels are related to the occurrence of dementia. We conducted a study to investigate the association between dementia and gout or hyperuricaemia.DesignSystematic review and meta-analysis of cohort studies.Data sourcesStudies were screened from inception to 28 June 2019 by searching Medline, Embase and the Cochrane Library databases.Eligibility criteriaCohort studies comparing the risk of dementia in patients with gout and hyperuricaemia versus non-gout and non-hyperuricaemia controls were enrolled.Data extraction and analysisTwo reviewers separately selected studies and extracted data using the Medical Subject Headings without restriction on languages or countries. The adjusted HRs were pooled using the DerSimonian and Laird random effects model. Sensitivity analyses were conducted to evaluate the stability of the results. Publication bias was evaluated using Egger’s and Begg’s tests. Quality assessment was performed according to the Newcastle-Ottawa Scale.ResultsFour cohort studies that met the inclusion criteria were included in our meta-analysis. We found that gout and hyperuricaemia did not increase the risk of dementia, with a pooled HR of 0.94 (95% CI 0.69 to 1.28), but might decrease the risk of Alzheimer’s disease (AD), with a pooled HR of 0.78 (95% CI 0.64 to 0.95). There was little evidence of publication bias. Quality assessment of the included studies was high (range: 6–8 points).ConclusionsOur study shows that gout and hyperuricaemia do not increase the risk of dementia. However, gout and hyperuricaemia might have a protective effect against AD. Due to the limited number of research articles, more investigations are needed to demonstrate the potential relationship between dementia and gout or hyperuricaemia.
Effect of bariatric surgery on employment status—a 7 years controlled nationwide registry study
Authors: Juhl Claus Bogh , Holst René , Mundbjerg Lene Hymøller , Stolberg Charlotte , Gran Jon Michael , Thomsen Gert Frank 
Published: June 2021

BackgroundSevere obesity is associated with a reduced ability to work. Bariatric surgery is the most effective method to achieve a sustained weight loss. Previous studies have reported conflicting results regarding the effect of bariatric surgery on employment status. To address this, we investigated the effect of bariatric surgery on employment status in the Danish population.MethodsIn this nationwide study, we identified 5450 subjects who underwent bariatric surgery and 10 900 control subjects matched for age, sex and municipality. From accessible registries, we extracted data regarding employment, absenteeism, sick leave and pension. Using a multistate model, we compared time in occupational states and transitions between these states to determine the effect of bariatric surgery on employment status.FindingsBefore surgery, cases had an absolute risk increase (95% CI)(ARI (CI)) and a relative risk (RR (CI)) of being in full-time employment of −0.12 (−0.14 to −0.10) and 0.84 (0.82 to 0.86) and were more often unemployed or in a subsidised job than the background population. Taking into account the employment status before surgery, the bariatric surgery group increased their probability of being in full-time employment 1–3 years after bariatric surgery. However, this positive effect was not present with a longer duration of follow-up. Being male, above 50 years of age, or employed as a craftsman or office worker were associated with a sustained positive effect of being in full-time employment (ARI (CI) and RR (CI) 0.05 (0.04 to 0.05) and 1.05 (1.04 to 1.06), 0.06 (0.06 to 0.07) and 1.08 (1.07 to 1.09) and 0.05 (0.05 to 0.06) and 1.05 (1.05 to 1.06), respectively).InterpretationCompared with a matched control group, those undergoing bariatric surgery did not improve their employment status in the long term. Certain subgroups had a more sustained positive effect.
Efficacy and safety of left bundle branch area pacing versus right ventricular apex pacing in patients with atrioventricular block: study protocol for a randomised controlled trial
Authors: Wang Zefeng , Du Xiao , Cheng Liting , Liang Zhuo , Dong Ruiqing , Hang Fei , Chen Jieruo , Wang Xinlu , Wang Ziyu , Chen Junjun , Wu Yongquan , Zhang Junmeng 
Published: June 2021

IntroductionLeft bundle branch area pacing (LBBaP) is a relatively new approach for physiologic pacing. A limited number of retrospective clinical studies, featuring small sample sizes, have shown that compared with right ventricular apex pacing (RVAP), the QRS duration of postoperative ECG in LBBaP patients is narrower and the cardiac systolic function is improved. However, there have been no randomised controlled trials (RCTs) evaluating the efficacy and safety of LBBaP in patients with atrioventricular block (AVB). Therefore, the current study intends to address the paucity in RCT data evaluating LBBaP versus RVAP in AVB patients.Analysis and methodsThis study is a single-centre, randomised controlled superiority trial to be conducted at the Cardiac Centre of Beijing Anzhen Hospital. From January 2021 to December 2023, 210 consecutive AVB patients meeting the inclusion criteria and receiving pacemaker implantation will be enrolled. Participants will be randomly divided into an experimental group (LBBaP) and a control group (RVAP) at a 1:1 ratio. The primary outcome is left ventricular ejection fraction (LVEF), which will be assessed by echocardiography. The secondary outcomes in this study are synchrony of left ventricular systole, NT-proBNP, LVEDD, the 6-min walk distance, quality of life (SF-36 scale), all-cause mortality, cardiovascular death events, rehospitalisation rate and major complication rate.Ethics and disseminationThis study was approved by the Medical Ethics Committee of Beijing Anzhen Hospital (No. 2020021X). The results of the trial will be presented at national and international conferences. We hypothesise that compared with RVAP, LBBaP will be superior for treating patients with AVB. This trial will provide evidence-based suggestion for the majority of electrophysiologists in pacing implantation.Trial registrationChiCTR2000034335.
Transcultural adaptation and psychometric evaluation of the mainland China version of Nursing Home Survey on Patient Safety Culture Questionnaire: a cross-sectional survey based on 50 nursing homes in China
Authors: Li Yaqin , Cheng Yufei , Hu Xiuying , Zhang Longhao 
Published: June 2021

ObjectiveTo provide a validated Chinese-language measurement of the Nursing Home Survey on Patient Safety Culture (NHSOPS) in mainland China. The primary goal is to carry out a transcultural adaptation of the NHSOPS Questionnaire into Chinese and evaluate its psychometric properties.DesignA psychometric evaluation study is constructed. First, the ‘translation–back-translation–cultural adaptation’ and the pretesting procedure were followed to introduce the NHSOPS. Second, a cross-sectional survey was used to assess the psychometric properties for the mainland China version of the NHSOPS (M-NHSOPS), and a test–retest survey was then applied.Setting and participantsThe survey was carried out among 1397 nursing home staff from 50 nursing homes in Southwest China.Outcome measuresExploratory factor analysis (EFA) was used to assess the potential structure, and confirmatory factor analysis (CFA) was then applied. Reliability was assessed by the content validity index, Cronbach’s α and the test–retest value.ResultsAmong the 1397 respondents, 1211 were included (86.7%). EFA was used, and a nine-factor structure was explored. Five factors (Cronbach’s α ＞0.6) were selected into the new structure for the M-NHSOPS. Moreover, data showed that it was suitable for CFA, and convergent validity and discriminant validity were satisfactory. On the other hand, M-NHSOPS contains five dimensions and 22 items. The overall Cronbach’s α value was 0.883; the values of each dimension ranged from 0.648 to 0.913. Additionally, content validity showed significant performance. Eventually, test–retest reliability was 0.892, and each dimension was 0.713, 0.809, 0.924, 0.795 and 0.859, respectively (p<0.001).ConclusionsM-NHSOPS has acceptable reliability and satisfactory validity among staff of nursing homes in Southwest China, and further verification among samples in other regions of mainland China is required.
Caregivers’ estimate of early childhood developmental status in rural Uganda: a cross-sectional study
Authors: Bonney Emmanuel , Villalobos Michele , Elison Jed , Sung Sooyeon , Wosu Adaeze , SSemugabo Charles , Pariyo George , Kajungu Dan , Rutebemberwa Elizeus , Hyder Adnan A , Gibson Dustin 
Published: June 2021

ObjectiveTo characterise developmental milestones among young children living in rural communities in Uganda.DesignCross-sectional study.SettingIganga-Mayuge Health and Demographic Surveillance Site in rural eastern Uganda.ParticipantsA total of 720 caregivers of children aged 3–4 years old from a health and demographic surveillance site in rural eastern Uganda were recruited into this study. Caregivers reported on their child’s developmental skills and behaviours using the 10-item Early Childhood Development Index (ECDI) developed by UNICEF. Childhood development was characterised based on the ECDI’s four domains: literacy-numeracy, learning/cognition, physical and socioemotional development. As an exploratory analysis, we implemented a hierarchical agglomerative cluster analysis to identify homogenous subgroups of children based on the features assessed. The cluster analysis was performed to identify potential subgroups of children who may be at risk of developmental problems.ResultsBetween November 2017 and June 2018, 720 caregivers of children aged 3–4 years completed the ECDI. The proportions of children at risk of delay in each domain were as follows: literacy-numeracy: 75% (n=538); socioemotional development: 22% (n=157); physical: 3% (n=22); and cognitive: 4% (n=32). The cluster analysis revealed a three-cluster solution that included 93% of children assigned to a low-risk group, 4% assigned to a moderate-risk group and 3% assigned to a high-risk group characterised by low scores in almost all domains.ConclusionThe findings suggest that a high proportion of children in rural eastern Uganda demonstrate poor literacy-numeracy skills. These results underscore the need to improve population-based screening and intervention efforts to improve early childhood developmental outcomes, particularly in literacy and socioemotional domains, in low-income and middle-income countries such as Uganda.
Models of care for patients with knee osteoarthritis in primary healthcare: a scoping review protocol
Authors: Costa Daniela , Cruz Eduardo B , Rodrigues Ana M , Gonçalves-Bradley Daniela , Gomes Luís A , Donato Helena , Nunes Carla 
Published: June 2021

IntroductionKnee osteoarthritis (OA) is a prevalent condition with associated high disability and healthcare costs. Evidence of major gaps in the implementation of evidence-based interventions in people with knee OA led several healthcare systems to implement models of care (MoCs) in order to improve knowledge translation and guaranty their economic sustainability. Nevertheless, there are few studies that analyse the existing body of evidence of MoCs for patients with knee OA in primary healthcare settings. Therefore, we aim to identify MoCs developed for patients with knee OA implemented in primary healthcare and, analyse their core components and outcomes. This scoping review will create knowledge about the components and outcomes of these MoCs which, in the future, will facilitate their transferability to practice.Methods and analysisWe will include studies that developed and implemented an MoC for people with knee OA in primary healthcare. We will use the PCC mnemonic, being ‘Population’—people with Knee OA, ‘Concept’—the MoCs and ‘Context’—the primary healthcare setting. We will conduct the search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, as well as grey literature databases and relevant institutions and organisations websites, for articles published after 2000. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess papers regarding their eligibility. We will evaluate the methodological quality of the included studies with the Mixed Methods Appraisal tool and apply a data abstraction form to describe and interpret the evidence.Ethics and disseminationAs a secondary analysis, this scoping review does not require ethical approval. Findings will be published in peer-review journal, presented in scientific conferences and as a summary through primary healthcare units.
‘You see the empty bed which means it’s either a transplant or a death’: a qualitative study exploring the impact of death in the haemodialysis community
Authors: Sutherland Sheera , Durley Kirsty E , Gillies Kirsty , Glogowska Margaret , Lasserson Daniel S , Pugh Christopher , Lowney Aoife C 
Published: June 2021

ObjectiveTo explore the impact of the death of a patient in the haemodialysis unit on fellow patients.MethodsWe interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings.Results10 participants completed the interviews (6 females and 4 males with an age range of 42–88 years). The four core themes that emerged from the interviews included: (1) patients’ relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients’ views on death and bereavement and (4) patients’ expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement.ConclusionStaff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient’s death and how they react to loss.
Impact of parents' education on variation in hospital admissions for children: a population-based cohort study
Authors: Olsen Frank , Balteskard Lise , Uleberg Bård , Jacobsen Bjarne K , Heuch Ivar , Moen Atle 
Published: June 2021

ObjectivesTo assess the impact of parental educational level on hospital admissions for children, and to evaluate whether differences in parents' educational level can explain geographic variation in admission rates.DesignNational cohort study.SettingThe 18 hospital referral areas for children in Norway.ParticipantsAll Norwegian children aged 1–16 years in the period 2008–2016 and their parents.Main outcome measuresAge- and gender-adjusted admission rates and probability of admission.ResultsOf 1 538 189 children, 156 087 (10.2%) had at least one admission in the study period. There was a nearly twofold (1.9) variation in admission rates between the hospital referral areas (3113 per 100 000 children, 95% CI: 3056 to 3169 vs 1627, 95% CI: 1599 to 1654). Area level variances in multilevel analysis did not change after adjusting for parental level of education. Children of parents with low level of education (maternal level of education, low vs high) had the highest admission rates (2016: 2587, 95% CI: 2512 to 2662 vs 1810, 95% CI: 1770 to 1849), the highest probability of being admitted (OR: 1.18, 95% CI: 1.16 to 1.20), the highest number of admissions (incidence
rate ratio: 1.05, 95% CI: 1.01 to 1.10) and admissions with lower cost (−0.5%, 95% CI: −1.2% to 0.3%).ConclusionsSubstantial geographic variation in hospital admission rates for children was found, but was not explained by parental educational level. Children of parents with low educational level had the highest admission probability, and the highest number of admissions, but the lowest cost of admissions. Our results suggest that the variation between the educational groups is not due to differences in medical needs, and may be characterised as unwarranted. However, the manner in which health professionals communicate and interact with parents with different educational levels might play an important role.
Misuse of medication in adult substance misuse services: a systematic review protocol
Authors: Gittins Rosalind , Missen Louise , Maidment Ian 
Published: June 2021

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.
Sustainment of a patient flow intervention in an intensive care unit in a regional hospital in Australia: a mixed-method, 5-year follow-up study
Authors: Ros Eva , Ros Axel , Austin Elizabeth E , De Geer Lina , Lane Paul , Johnson Andrew , Clay-Williams Robyn 
Published: June 2021

ObjectiveIn 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability.DesignA mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff.SettingICU with mixed surgical and non-surgical cases in a regional hospital in Australia.ParticipantsInterview participants: ICU nurses (four), ICU doctors (four) and hospital management (four).Main outcome measuresMonthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability.ResultsAfter a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ2=16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds.ConclusionImprovement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a ‘fix and forget’ solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.
Association between community-based self-reported COVID-19 symptoms and social deprivation explored using symptom tracker apps: a repeated cross-sectional study in Northern Ireland
Authors: McKinley Jennifer M , Cutting David , Anderson Neil , Graham Conor , Johnston Brian , Mueller Ute , Atkinson Peter M , Van Woerden Hugo , Bradley Declan T , Kee Frank 
Published: June 2021

ObjectivesThe aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community-level and area-level social deprivation.DesignSpatial mapping, generalised linear models, using time as a factor and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socioeconomic factors using a repeated cross-sectional study design.SettingIn the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or ‘lockdown’ in 2020.ParticipantsUsers of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK.Primary outcome measuresPopulation standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area.ResultsHigher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p<0.001) and with those areas with the lowest employment levels (p<0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18–24 and 25–34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions (‘lockdown’).ConclusionsThrough spatial regression of self-reporting COVID-19 smartphone data in the community, this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.