bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, attitude and practice of physical activity among patients with diabetes in Kilimanjaro region, Northern Tanzania: a descriptive cross-sectional study
Authors: Mwimo Julius Lucas , Somoka Suzana , Leyaro Beatrice J , Amour Caroline , Mao Experansa , Mboya Innocent B 
Published: September 2021

IntroductionDiabetes mellitus is one of the most common non-communicable diseases and is the fifth leading cause of death in most developing countries. Regular physical activity (PA) is strongly recommended for individuals with diabetes for its beneficial effects in improving blood glucose control and insulin sensitivity, prevention and reduction of morbidities and complications, and its cardiovascular benefits.ObjectiveTo assess the knowledge, attitude and practices of PA among patients with diabetes in the Kilimanjaro region, Northern Tanzania.Research design and methodsA cross-sectional study was conducted from June to September 2020 among 315 patients with diabetes aged 18 years and above receiving care from diabetic clinics in the Kilimanjaro region, Northern Tanzania. A systematic random sampling technique was used to select study participants who were interviewed using a modified version of the WHO-STEPS Survey for non-communicable diseases. Data were analysed using SPSS V.20. Categorical variables were summarised using frequencies and percentages, and continuous variables using means and SDs. The Χ2test was used to compare the proportion of PA across participant characteristics.ResultsThe vast majority (94.3%) of the participants were physically active, and from our findings, most of it was contributed by work (70%) and transport-related (20%) activities. Participants had high levels of knowledge (98.4%) and positive attitudes (95.6%) towards PA. These were mainly contributed by a healthcare provider or doctors’ advice (96%) on PA benefits to patients with diabetes. There was a strong statistical association (p<0.001) between knowledge and attitude towards PA with PA practice.ConclusionThe vast majority of the participants were physically active. High levels of PA were associated with a high level of knowledge and positive attitudes towards PA. Healthcare provider or doctors’ advice in diabetic clinics is essential in promoting PA practice in this population and in diabetes management.
Interaction of caregiver-expressed emotions and neuropsychiatric symptoms in persons with dementia: a longitudinal cohort study
Authors: Tan Eva YL , de Vugt Marjolein E , Deckers Kay , Schols Jos MGA , Verhey Frans RJ 
Published: September 2021

ObjectivesNeuropsychiatric symptoms (NPS) have a major impact in persons with dementia (PwD). The interaction between the caregiver and the person with dementia may be related to the emergence of NPS. The concept of expressed emotion (EE) is used to capture this dyadic interaction. The aim of the present study is to examine longitudinally the association between EE in caregivers and NPS in PwD living at home.DesignA longitudinal cohort study with 2 years of follow-up.SettingPwD and their informal caregivers living at home in the south of the Netherlands.Participants112 dyads of PwD and their caregivers from the MAAstricht Study of BEhavior in Dementia.Main outcome measuresEE was measured at baseline with the Five-Minute Speech Sample and was used to classify caregivers in a low-EE or high-EE group. Associations between EE and neuropsychiatric subsyndromes (hyperactivity, mood and psychosis) measured with the Neuropsychiatric Inventory (NPI) were analysed over time.ResultsSeventy-six (67.9%) caregivers were classified in the low-EE group and 36 (32.1%) in the high-EE group. There was no difference between the EE groups in mean NPI scores over time. In the high-EE group, hyperactivity occurred more frequently than in the low-EE group at baseline (p=0.013) and at the other time points, but the mean difference was not always significant. There were no differences for the mood and psychosis subsyndromes. PwD with caregivers scoring high on the EE subcategory critical comments had an increased risk of institutionalisation (OR 6.07 (95% CI 1.14 to 32.14, p=0.034)) in comparison with caregivers scoring low on critical comments.ConclusionsHigh EE in informal caregivers is associated with hyperactivity symptoms in PwD. This association is likely to be bidirectional. Future studies investigating this association and possible interventions to reduce EE are needed.
Timing of first antenatal care contact, its associated factors and state-level analysis in Nigeria: a cross-sectional assessment of compliance with the WHO guidelines
Authors: Fagbamigbe Adeniyi Francis , Olaseinde Olugbenga , Fagbamigbe Omon Stellamaris 
Published: September 2021

ObjectivesTo assess the compliance of WHO guidelines on the timeliness of antenatal care (ANC) initiation in Nigeria and its associated factors and to provide subcountry analysis of disparities in the timing of the first ANC in Nigeria.DesignCross-sectional.SettingNationally representative data of most recent pregnancies between 2013 and 2018 in Nigeria.ParticipantsWomen with pregnancies within 5 years before the study.Primary and secondary outcome measuresThe outcome variable was the trimesters of the first ANC contact. Data were analysed using descriptive statistics, bivariable and multivariable multinomial logistic regression at 5% significance level.ResultsOf all the 21 785 respondents, 75% had at least one ANC contact during their most recent pregnancies within the five years preceding the data collection. Among which 24% and 63% started in the first and second trimester, respectively. The proportion who started ANC in the first trimester was highest in Benue (44.5%), Lagos (41.4%) and Nasarawa (39.3%) and lowest in Zamfara (7.6%), Kano (7.4%) and Sokoto (4.8%). Respondents aged 40–49 years were 65% (adjusted relative risk ratio (aRRR: 1.65, 95 % CI: 1.10 to 2.45) more likely to initiate ANC during the first trimester of pregnancy relative to those aged 15–19 years. Although insignificant, women who participate in their healthcare utilisation were 4% (aRRR: 1.04, 95 % CI: 0.90 to 1.20) times more likely to have early initiation of ANC. Other significant factors were respondents’ and spousal educational attainment, household wealth quintiles, region of residence, ethnicity, religion and birth order.ConclusionsOnly a quarter of pregnant women, initiated ANC contact during the first trimester with wider disparities across the states in Nigeria and across the background characteristics of the pregnant women. There are needs to enhance women’s autonomy in healthcare utilisation. Concerted efforts on awareness creation and empowerment for women by all stakeholders in maternal and child healthcare are antidotes for early ANC contact initiation.
Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction
Authors: Mark Peter D , Frydland Martin , Helgestad Ole Kristian Lerche , Holmvang Lene , Møller Jacob Eifer , Johansson Pär I , Ostrowski Sisse R , Prickett Timothy , Hassager Christian , Goetze Jens Peter 
Published: September 2021

ObjectiveTo determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI).DesignProspective cohort study.SettingTwo University Hospitals in Denmark.Participants1760 consecutive patients (470 females and 1290 males) with confirmed STEMI.Main outcomes and measuresThe main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations.ResultsIn all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, Plogrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year2.6, 95% CI 1.5 to 4.6), Plogrank<0.001), whereas no differences were found in male patients (HR1 year1.1, 95% CI 0.7 to 1.9, Plogrank=0.66). After adjusting for potential risk factors, we found increased pro-CNP concentrations≥the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI −0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03).ConclusionsIn female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.
Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol
Authors: Dearden Helen , Baxter Mark A , Martin Sally , Rowe Michael , Zucker Kieran , Jones Christopher Mark , Olsson-Brown Anna C , Petty R D , Swinson Daniel 
Published: September 2021

IntroductionThe number of older adults diagnosed with cancer is increasing. Older adults are more likely to have pre-existing frailty, which is associated with greater chemotherapy-related toxicity. Early identification of those at risk of toxicity is important to reduce patient morbidity and mortality. Current chemotherapy toxicity prediction tools including the Cancer and Ageing Research Group (CARG) tool exist but are not in routine clinical use and have not been prospectively validated in a UK population. This study is the first prospective study to investigate the CARG tool in a UK population with cancer.Methods and analysisTolerance Of Anticancer Systemic Therapy In the Elderly is a prospective observational study of patients, aged ≥65 years, commencing first-line (any indication) chemotherapy for a solid-organ malignancy. Patients receiving other systemic anticancer agents or radiotherapy will be excluded. The primary objective will be to validate the ability of the CARG score to predict grade 3+ toxicity in this population. Secondary objectives include describing the feasibility of screening for frailty, as well as the prevalance of frailty in this population and assessing patient and clinician perception of chemotherapy toxicity risk. 500 patients will be recruited over a two year period. Baseline assessments will be recorded. At the end of the 6-month follow-up period, toxicity data will be retrospectively collected. A descriptive analysis of the recruited population will be performed. The validity of the CARG model will be analysed using receiver-operating characteristic curves and calculation of the area under the curve (c-statistic).Ethics and disseminationThe study has received ethical approval from the East of Scotland Research Ethics Service 20/ES/0114. Results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.
Publication practices of sub-Saharan African Cochrane authors: a bibliometric study
Authors: Mbuagbaw Lawrence , Schoonees Anel , Oliver Joy , Arikpo Dachi , Durão Solange , Effa Emmanuel , Hohlfeld Ameer , Kredo Tamara , Wiysonge Charles Shey , Young Taryn 
Published: September 2021

IntroductionCochrane Africa (https://africa.cochrane.org/) aims to increase Cochrane reviews addressing high priority questions in sub-Saharan Africa (SSA). Researchers residing in SSA, despite often drawing on Cochrane methods, training or resources, conduct and publish systematic reviews outside of Cochrane. Our objective was to investigate the extent to which Cochrane authors from SSA publish Cochrane and non-Cochrane reviews.MethodsWe conducted a bibliometric study of systematic reviews and overviews of systematic reviews from SSA, first by identifying SSA Cochrane authors, then retrieving their first and last author systematic reviews and overviews from PubMed (2008 to April 2019) and using descriptive analyses to investigate the country of origin, types of reviews and trends in publishing Cochrane and non-Cochrane systematic reviews over time. To be eligible, a review had to have predetermined objectives, eligibility criteria, at least two databases searched, data extraction, quality assessment and a first or last author with a SSA affiliation.ResultsWe identified 657 Cochrane authors and 757 eligible systematic reviews. Most authors were from South Africa (n=332; 51%), followed by Nigeria (n=126; 19%). Three-quarters of the reviews (71%) were systematic reviews of interventions. The intervention reviews were more likely to be Cochrane reviews (60.3% vs 39.7%). Conversely, the overviews (23.8% vs 76.2%), qualitative reviews (14.8% vs 85.2%), diagnostic test accuracy reviews (16.1% vs 83.9%) and the ‘other’ reviews (11.1% vs 88.9%) were more likely to be non-Cochrane reviews. During the study period, the number of non-Cochrane reviews increased more than the number of Cochrane reviews. About a quarter of the reviews covered infectious disease topics.ConclusionCochrane authors from SSA are increasingly publishing a diverse variety of systematic reviews and overviews of systematic reviews, often opting for non-Cochrane journals.
Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review
Authors: Rothwell Charlotte , Kehoe Amelia , Farook Sophia Farhene , Illing Jan 
Published: September 2021

ObjectivesWe aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision.DesignA rapid evidence review.Data sourcesFive databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals.Eligibility criteriaStudies identifying enablers and barriers to effective clinical supervision across healthcare professionals in a Western context between 1 January 2009 and 12 March 2019.Data extraction and synthesisAn extraction framework with a detailed inclusion/exclusion criteria to ensure rigour was used to extract data. Data were analysed using a thematic qualitative synthesis. These themes were used to answer the research objectives.ResultsThe search identified 15 922 papers, reduced to 809 papers following the removal of duplicates and papers outside the inclusion criteria, with 135 papers being included in the full review. Enablers identified included regular supervision, occurs within protected time, in a private space and delivered flexibly. Additional enablers included supervisees being offered a choice of supervisor; supervision based on mutual trust and a positive relationship; a cultural understanding between supervisor and supervisee; a shared understanding of the purpose of supervision, based on individual needs, focused on enhancing knowledge and skills; training and feedback being provided for supervisors; and use of a mixed supervisor model, delivered by several supervisors, or by those trained to manage the overlapping (and potentially conflicting) needs of the individual and the service. Barriers included a lack of time, space and trust. A lack of shared understanding to the purpose of the supervision, and a lack of ongoing support and engagement from leadership and organisations were also found to be barriers to effective clinical supervision.ConclusionsThis review identified several enablers of and barriers to effective clinical supervision and the subsequent benefits of effective clinical supervision in a healthcare setting.
One chance to get it right: improving clinical handovers for better symptom control at the end of life
Authors: Goldraij Gabriel , Tripodoro Vilma Adriana , Aloisio Melisa , Castro Sandra Analía , Gerlach Christina , Mayland Catriona Rachel , Haugen Dagny Faksvåg 
Published: September 2021

Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives’ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in Córdoba city, Argentina.By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (March–May 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to ‘Did doctors and nurses do enough for the patient to be comfortable during the night?’ increased from 75% to 100% between the first and the second QI cycle.In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients.
Why did some parents not send their children back to school following school closures during the COVID-19 pandemic: a cross-sectional survey
Authors: Woodland Lisa , Smith Louise E , Webster Rebecca K , Amlôt Richard , Rubin Antonia , Wessely Simon , Rubin James G 
Published: September 2021

BackgroundOn 23 March 2020, schools closed to most children in England in response to COVID-19 until September 2020. Schools were kept open to children of key workers and vulnerable children on a voluntary basis. Starting 1 June 2020, children in reception (4–5 years old), year 1 (5–6 years old) and year 6 (10–11 years old) also became eligible to attend school.Methods1373 parents or guardians of children eligible to attend school completed a cross-sectional survey between 8 and 11 June 2020. We investigated factors associated with whether children attended school or not.Results46% (n=370/803) of children in year groups eligible to attend school and 13% (n=72/570) of children of key workers had attended school in the past 7 days. The most common reasons for sending children to school were that the child’s education would benefit, the child wanted to go to school and the parent needed to work. A child was significantly more likely to attend if the parent believed the child had already had COVID-19, they had special educational needs or a person in the household had COVID-19 symptoms.ConclusionsFollowing any future school closure, helping parents to feel comfortable returning their child to school will require policy makers and school leaders to communicate about the adequacy of their policies to: (A) ensure that the risk to children in school is minimised; (B) ensure that the educational potential within schools is maximised; and (C) ensure that the benefits of school for the psychological well-being of children are prioritised.
Cardiovascular complications of prehospital emergency anaesthesia in patients with return of spontaneous circulation following medical cardiac arrest: a retrospective comparison of ketamine-based and midazolam-based induction protocols
Authors: King Christopher , Lewinsohn Asher , Keeliher Chris , McLachlan Sarah , Sherrin James , Khan-Cheema Hafsah , Sherren Peter 
Published: September 2021

BackgroundHypotension following intubation and return of spontaneous circulation (ROSC) after cardiac arrest is associated with poorer patient outcomes. In patients with a sustained ROSC requiring emergency anaesthesia, there is limited evidence to guide anaesthetic practice. At the Essex & Herts Air Ambulance Trust, a UK-based helicopter emergency medical service, we assessed the relative haemodynamic stability of two different induction agents for post-cardiac arrest medical patients requiring prehospital emergency anaesthesia (PHEA).MethodsWe performed a retrospective database review over a 5-year period between December 2014 and December 2019 comparing ketamine-based and midazolam-based anaesthesia in this patient cohort. Our primary outcome was clinically significant hypotension within 30 min of PHEA, defined as a new systolic BP less than 90 mm Hg, or a 10% drop if less than 90 mm Hg before induction.ResultsOne hundred ninety-eight patients met inclusion criteria. Forty-eight patients received a ketamine-based induction, median dose (IQR) 1.00 (1.00–1.55) mg/kg, and a 150 midazolam-based regime, median dose 0.03 (0.02–0.04) mg/kg. Hypotension occurred in 54.2% of the ketamine group and 50.7% of the midazolam group (p=0.673). Mean maximal HRs within 30 min of PHEA were 119 beats/min and 122 beats/min, respectively (p=0.523). A shock index greater than 1.0 beats/min/mm Hg and age greater than 70 years were both associated with post-PHEA hypotension with ORs 1.96 (CI 1.02 to 3.71) and 1.99 (CI 1.01 to 3.90), respectively. Adverse event rates did not significantly differ between groups.ConclusionPHEA following a medical cardiac arrest is associated with potentially significant cardiovascular derangements when measured up to 30 min after induction of anaesthesia. There was no demonstrable difference in post-induction hypotension between ketamine-based and midazolam-based PHEA. Choice of induction agent alone is insufficient to mitigate haemodynamic disturbance, and alternative strategies should be used to address this.
Escape from supercooling with or without bubbles: gravitational wave signatures
Authors: Lewicki Marek , Pujolàs Oriol , Vaskonen Ville 
Published: September 2021

AbstractQuasi-conformal models are an appealing scenario that can offer naturally a strongly supercooled phase transition and a period of thermal inflation in the early Universe. A crucial aspect for the viability of these models is how the Universe escapes from the supercooled state. One possibility is that thermal inflation phase ends by nucleation and percolation of true vacuum bubbles. This route is not, however, always efficient. In such case another escape mechanism, based on the growth of quantum fluctuations of the scalar field that eventually destabilize the false vacuum, becomes relevant. We study both of these cases in detail in a simple yet representative model. We determine the duration of the thermal inflation, the curvature power spectrum generated for the scales that exit horizon during the thermal inflation, and the stochastic gravitational wave background from the phase transition. We show that these gravitational waves provide an observable signal from the thermal inflation in almost the entire parameter space of interest. Furthermore, the shape of the gravitational wave spectrum can be used to ascertain how the Universe escaped from supercooling.