bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional analysis of respiratory ill-health among charcoal workers and its implications for strengthening occupational health services in southern Nigeria
Authors: Obiebi Irikefe Paul , Oyibo Patrick Gold 
Published: January 2019

ObjectivesThis study was conducted to assess the concentration of air pollutants at charcoal sites, the dose-response relationship between site-based exposure levels to air pollutants and prevalence of respiratory symptoms among charcoal workers, and the measures these workers employ to safeguard their health.DesignCross-sectional but comparative designSettingCharcoal production kiln sites in Sapele, Delta State, Nigeria.ParticipantsOverall 296 charcoal workers and age-matched, sex-matched and height-matched non-exposed traders (comparison group).Primary and secondary outcome measuresThe primary outcome measure was the prevalence of respiratory symptoms among charcoal workers while secondary outcomes included lung function indices as well as hazard control practices among charcoal workers.ResultsMajority (83.3%) of the sites had PM10and PM2.5values five times higher than the WHO standard. Charcoal workers were more likely to have respiratory symptoms; wheeze was statistically significant after adjusting for confounders, (OR 4.22; CI 1.37 to 12.99). The dose-response relationship between site-based exposure levels to air pollutants and the prevalence of respiratory symptoms among charcoal workers was statistically significant for all symptoms except chest tightness (p=0.167). Mean forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were considerably lower among workers with differences of −0.22 (−0.42 to −0.05) L and −0.52 (-0.76 to −0.29) L, respectively, whereas FEV1/FVC ratio and peak expiratory flow rate were higher among workers with mean differences of 5.68 (3.59–8.82)% and 0.31 (-23.70 to 24.43) L/min, respectively; but the mean difference was significant only for the FEV1/FVC ratio. Charcoal workers had poor hazard control practices; only 3.4% reportedly used personal protective equipment.ConclusionAir pollutants at kiln sites were higher than WHO standards. Despite the significantly higher prevalence of wheeze, chest tightness and chronic cough among charcoal workers, their hazard control practices were inadequate. Charcoal workers should adopt appropriate hazard control practices, and use improved devices which emit minimal pollutants.
Qualitative situational analysis of palliative care for adolescents with cancer and HIV in South Africa: healthcare worker perceptions
Authors: Ngwenya Nothando , Ambler Julia , Archary Moherndran 
Published: January 2019

ObjectivesThe unmet palliative care need is intensified in resource-limited countries where there is inequitable access to healthcare and adolescents and young adults (AYA) fall between the cracks of paediatric and adult services. We aimed to examine palliative care for AYA with cancer and/or HIV in South Africa.DesignIndividual and small group interviews using process mapping.SettingData were collected between November 2016 and March 2017 with staff from government hospitals, hospices and clinics from three provinces of South Africa.ParticipantsHealth and social care professionals (n=30) (eg, physicians, nurses, social workers, psychologists) from KwaZulu-Natal, Western Cape and Gauteng provinces.MethodsIn this qualitative situational analysis study, participants were recruited to interviews and process mapping used to try and identify palliative care pathways of AYA with palliative care needs. We developed a thematic framework using a deductive approach to analyse the interview data.ResultsPalliative care pathways were not easily identifiable, ambiguous and varied and participants reported on their experiences and perceptions of service provision. Participants expressed that resource challenges limited the service provision. A need for nurse prescribing of pain relief at community level was mentioned as AYA are reluctant to use hospitals and clinics. Lack of (1) palliative care education among professionals, (2) public awareness and (3) adolescent-specific care posed a challenge to service provision.ConclusionsThe changing burden of HIV and increase in cancer prevalence calls for integration of palliative care in mainstream health services. Despite good policies, the pragmatic aspect of training professionals will influence a change in practice. The main task will be to absorb palliative care philosophy and practice at all levels of care to avoid overburdening the care system and to integrate it in community care programmes.
Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys
Authors: Lai Francisco T T , Guthrie Bruce , Wong Samuel Y S , Yip Benjamin H K , Chung Gary K K , Yeoh Eng-Kiong , Chung Roger Y 
Published: January 2019

ObjectivesPrevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community.DesignSex-specific age-period-cohort analysis with repeated cross-sectional surveys.SettingA territory-wide population survey database.Participants69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008.Main outcome measuresMorbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions.ResultsFor both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955–1959. For men born after 1945–1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950–1954 vs 1935–1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970–1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935–1939). Similar results were found for dichotomous multimorbidity status.ConclusionsThe trend of lower risk starting from men born in 1945–1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.
Difficult patient–doctor encounters in a Swiss university outpatient clinic: cross-sectional study
Authors: Mota Pau , Selby Kevin , Gouveia Alexandre , Tzartzas Konstantinos , Staeger Philippe , Marion-Veyron Regis , Bodenmann Patrick 
Published: January 2019

IntroductionPrevious research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands.AimTo measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents.Design and settingCross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients.MethodWe identified difficult doctor–patient encounters using the validated Difficult Doctor–Patient Relationship Questionnaire (DDPRQ-10), and characterised patients using the patient’s vulnerability grid, a validated questionnaire measuring five domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics.ParticipantsWe analysed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date.OutcomeOne hundred and fifty-seven encounters (29.8%) were perceived as difficult.ResultsAfter adjusting for differences among residents, all five domains of the patient vulnerability grid were independently associated with a difficult encounter: frequent healthcare user; psychological comorbidity; health comorbidity; risky behaviours and a precarious social situation.ConclusionNearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents’ perception of difficult patient encounters.
More than experience: a post-task reflection intervention among team members enhances performance in student teams confronted with a simulated resuscitation task—a prospective randomised trial
Authors: Kündig Patrizia , Tschan Franziska , Semmer Norbert K , Morgenthaler Camille , Zimmermann Jasmin , Holzer Eliane , Huber Simon Andreas , Hunziker Sabina , Marsch Stephan 
Published: January 2019

BackgroundTeams that regularly step back from action and deliberately reflect on their performance and strategies show higher performance. Ad hoc emergency teams with changing team composition cannot develop such habits but may engage in short postaction reflection to discuss shortcomings of past performance and potential adaptations of their strategies for future similar tasks. This study aimed to test the effect of a short postaction self-led reflective team briefing on resuscitation performance in a simulator setting in terms of three performance parameters: hands-on time, coordination between chest compression and ventilation, and defibrillation.MethodsWe performed a randomised controlled trial including 56 ad hoc formed teams of three fourth-year medical students each. All groups performed a resuscitation task, followed by a self-guided reflective briefing, based on a general instruction (n=28 teams), or an unrelated discussion session (control condition; n=29), followed by a second resuscitation task in the same team composition.ResultsAdjusted for performance in the first task, teams in the reflection condition showed higher performance gain in the second resuscitation than teams in the control condition (6.21 percentage points (95% CI 1.31 to 11.10, p<0.001)) for basic hands-on performance; 15.0 percentage points (95% CI 2 to 28, p<0.001) for coordinative performance but non-significantly lower performance for defibrillation (−9%, 95% CI −27% to –9%, p=0.312).ConclusionEven very short self-led postaction reflective briefings enhance basic resuscitation performance in ad hoc groups but may not influence more complex aspects of the task. We recommend including short self-led team debriefings as part of simulator training.
Exposing medical students to various difficulty levels of simulated endotracheal intubations improves success rate: a randomised non-blinded trial
Authors: Kazan Roy , Giacalone Marilù , Liu Jiaru , Brogi Etrusca , Cyr Shantale , Hemmerling Thomas M 
Published: January 2019

ObjectiveSimulation training of endotracheal intubation (ETI) has proven to be an effective training tool. We used an adjustable airway mannequin that allows the achievement of various difficulty levels of laryngoscopy to train inexperienced medical students. The purpose of this study was to evaluate the effect of training using this novel airway mannequin on ETI success rates of medical students.MethodsThis was a randomised non-blinded trial conducted at the Steinberg Centre for Simulation and Interactive Learning. Twenty recruited medical students were randomly allocated to two different training groups. During training, the mixed training group was asked to perform successful intubations in three levels of difficulty; the standard training group was asked to perform the same number of successful intubations in one level of difficulty. After training, all participants were asked to perform intubations using both the adjustable airway mannequin and a standard mannequin. Success rates and airway surface area visualised were compared between the two groups.ResultsStudents in the mixed training group had a significantly higher success rate both in the adjustable airway mannequin (p=0.01) and in the standard mannequin (p=0.02). Students in the mixed group had 51%, 59% and 47% significantly more visual area surface than students in the standard group during standard and difficult setup of the adjustable airway mannequin and the standard airway mannequin, respectively.ConclusionsThe use of an adjustable airway mannequin to train medical students leads to superior ETI success rates and better glottis visualisation.
Tumour-associated macrophages-derived CXCL8 determines immune evasion through autonomous PD-L1 expression in gastric cancer
Authors: Lin Chao , He Hongyong , Liu Hao , Li Ruochen , Chen Yifan , Qi Yangyang , Jiang Qi , Chen Lingli , Zhang Peipei , Zhang Heng , Li He , Zhang Weijuan , Sun Yihong , Xu Jiejie 
Published: January 2019

ObjectiveOur previous studies have identified CXCL8 as the crucial chemokine responsible for gastric cancer metastasis mediated by loss of RACK1. However, the regulatory effect of CXCL8 on immune surveillance in gastric cancer remains obscure.DesignFlow cytometry analyses were performed to examine major source of CXCL8 and phenotypes of immune cells in fresh tumour tissues from 76 patients with gastric cancer. Real-time PCR was performed to analyse CXCL8 mRNA level in gastric cancer tissues. For immunohistochemical analyses, a total of 420 patients with gastric cancer undergoing curative resection were enrolled. In vitro culture of fresh tumour tissue was performed to evaluate the potential therapeutic effect of blocking CXCL8 pathway in gastric cancer.ResultsIncreased level of CXCL8 indicates poor clinical outcome and tumour progression in patients with gastric cancer. In gastric cancer tissues, CXCL8 is predominantly secreted by macrophages and colony stimulating factor 2 (CSF-2) facilitates macrophage-derived CXCL8 secretion. High level of CXCL8 is associated with decreased CD8+T cells infiltration and Ki67+CD8+T cells proportion. Moreover, CXCL8 also inhibits CD8+T cells function by inducing the expression of PD-L1 on macrophages. Finally, we show that a small-molecule CXCR2 inhibitor, reparixin, drives the decreased programmed death-ligand 1 (PD-L1+) macrophages and promotes antitumour immunity. Accordingly, high levels of CXCL8+macrophages are positively correlated with poor prognosis in patients with gastric cancer.ConclusionsCXCL8 is predominantly secreted by macrophages and contributes to the immunosuppressive microenvironment by inducing PD-L1+macrophages in gastric cancer. CXCL8 inhibitors may drive antitumour response, providing potential therapeutic effects for patients with gastric cancer.
Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms
Authors: Schafmayer Clemens , Harrison James William , Buch Stephan , Lange Christina , Reichert Matthias C , Hofer Philipp , Cossais François , Kupcinskas Juozas , von Schönfels Witigo , Schniewind Bodo , Kruis Wolfgang , Tepel Jürgen , Zobel Myrko , Rosendahl Jonas , Jacobi Thorsten , Walther-Berends Andreas , Schroeder Michael , Vogel Ilka , Sergeev Petr , Boedeker Hans , Hinrichsen Holger , Volk Andreas , Erk Jens-Uwe , Burmeister Greta , Hendricks Alexander , Hinz Sebastian , Wolff Sebastian , Böttner Martina , Wood Andrew R , Tyrrell Jessica , Beaumont Robin N , Langheinrich Melanie , Kucharzik Torsten , Brezina Stefanie , Huber-Schönauer Ursula , Pietsch Leonora , Noack Laura Sophie , Brosch Mario , Herrmann Alexander , Thangapandi Raghavan Veera , Schimming Hans Wolfgang , Zeissig Sebastian , Palm Stefan , Focke Gerd , Andreasson Anna , Schmidt Peter T , Weitz Juergen , Krawczak Michael , Völzke Henry , Leeb Gernot , Michl Patrick , Lieb Wolfgang , Grützmann Robert , Franke Andre , Lammert Frank , Becker Thomas , Kupcinskas Limas , D’Amato Mauro , Wedel Thilo , Datz Christian , Gsur Andrea , Weedon Michael N , Hampe Jochen 
Published: January 2019

ObjectiveDiverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease.DesignDiscovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Associations were replicated in a European sample of 3893 cases and 2829 diverticula-free controls and evaluated for risk contribution to diverticulitis and uncomplicated diverticulosis. Transcripts at top 20 replicating loci were analysed by real-time quatitative PCR in preparations of the mucosal, submucosal and muscular layer of colon. The localisation of expressed protein at selected loci was investigated by immunohistochemistry.ResultsWe discovered 48 risk loci, of which 12 are novel, with genome-wide significance and consistent OR in the replication sample. Nominal replication (p<0.05) was observed for 27 loci, and additional 8 in meta-analysis with a population-based cohort. The most significant novel risk variant rs9960286 is located near CTAGE1 with a p value of 2.3×10−10 and 0.002 (ORallelic=1.14 (95% CI 1.05 to 1.24)) in the replication analysis. Four loci showed stronger effects for diverticulitis, PHGR1 (OR 1.32, 95% CI 1.12 to 1.56), FAM155A-2 (OR 1.21, 95% CI 1.04 to 1.42), CALCB (OR 1.17, 95% CI 1.03 to 1.33) and S100A10 (OR 1.17, 95% CI 1.03 to 1.33).ConclusionIn silico analyses point to diverticulosis primarily as a disorder of intestinal neuromuscular function and of impaired connective fibre support, while an additional diverticulitis risk might be conferred by epithelial dysfunction.
Education level and outcomes after acute myocardial infarction in China
Authors: Huo Xiqian , Khera Rohan , Zhang Lihua , Herrin Jeph , Bai Xueke , Wang Qianying , Lu Yuan , Nasir Khurram , Hu Shuang , Li Jing , Li Xi , Zheng Xin , Masoudi Frederick A , Spertus John A , Krumholz Harlan M , Jiang Lixin 
Published: January 2019

ObjectiveTo assess the association between educational attainment and acute myocardial infarction (AMI) outcomes in China to inform future healthcare interventions.MethodsWe used data from the China Patient-centred Evaluative Assessment of Cardiac Events-Prospective AMI study of 3369 consecutive patients hospitalised with AMI from 53 hospitals. Educational attainment was categorised as: high (senior high school, college or postgraduate degree), intermediate (junior high school) or low (primary school or illiterate). We used survival models to assess the relationship between education and 1-year major adverse cardiovascular events (MACE), all-cause mortality, both unadjusted and after adjustment for demographic characteristics and cardiovascular risk factors.ResultsThe median participant age was 61 (52, 69) years, 23.2% were women, and 33.3% had high, 32.4% intermediate and 34.3% low educational attainment. In unadjusted analysis, compared with high educational attainment, low educational attainment was associated with a higher 1-year risk of MACE (HR 2.41, 95% CI 1.72 to 3.37) and death (HR for low vs high education 3.09, 95% CI 1.69 to 5.65). In risk-adjusted analyses, the association between education and death was attenuated and no longer statistically significant (adjusted HR 1.41, 95% CI 0.74 to 2.69, p=0.30). However, the risk of 1-year MACE (adjusted HR 1.68, 95% CI 1.18 to 2.41, p=0.004) remained significantly greaterin low educational attainment group.ConclusionsIn a national Chinese cohort of patients hospitalised with AMI, low educational attainment was associated with a higher risk of adverse events in the year following discharge. This association highlights the need to consider interventions to improve AMI outcomes in adults with low levels of education.Clinical trial registrationNCT01624909; Results.
Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality: A systematic review and meta-analysis of randomised controlled trials
Authors: Hernandez Adrian V , Emonds Erin E , Chen Brett A , Zavala-Loayza Alfredo J , Thota Priyaleela , Pasupuleti Vinay , Roman Yuani M , Bernabe-Ortiz Antonio , Miranda J Jaime 
Published: January 2019

ObjectiveA systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases.MethodsFive engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.Results21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD −7.81 mm Hg, 95% CI −9.47 to –6.15, p<0.00001) and DBP (MD −3.96 mm Hg, 95% CI −5.17 to –2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD −35.82 mmol/day, 95% CI −57.35 to –14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes.ConclusionsLSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes.