bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Study: Long-Term Low-Carbohydrate, High-Fat Diet Impairs Performance and Subjective Well-Being in a World-Class Vegetarian Long-Distance Triathlete
Authors: Mujika Iñigo 
Published: August 2018

The aim of this case study was to report on the performance outcomes and subjective assessments of long-term low-carbohydrate, high-fat (LCHF) diet in a world-class long-distance triathlete who had been suffering from gastrointestinal distress in Ironman competition. The lacto-ovo vegetarian athlete (age = 39 years; height = 179 cm; usual racing body mass = 75 kg; sum of seven skinfolds = 36 mm) changed his usual high carbohydrate (CHO) availability diet to an LCHF diet for 32 weeks (∼95% compliance). He participated in three professional races while on the LCHF diet, but acutely restored CHO availability by consuming CHO in the preevent meals and during the race as advised. The athlete had his worst-ever half-Ironman performance after 21 weeks on the LCHF diet (18th). After 24 weeks on LCHF, he had his second worst-ever Ironman performance (14th) and suffered his usual gastrointestinal symptoms. He did not finish his third race after 32 weeks on LCHF. He regained his usual performance level within 5 weeks back on a high CHO diet, finishing second and fourth in two Ironman events separated by just 3 weeks. Subjective psychological well-being was very negative while on the LCHF diet, with feelings of depression, irritability, and bad mood. In conclusion, this long-term (32 weeks) LCHF intervention did not solve the gastrointestinal problems that the athlete had been experiencing, it was associated with negative performance outcomes in both the half-Ironman and Ironman competitions, and it had a negative impact on the athlete’s subjective well-being.
Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study
Authors: Mengesha Melkamu Merid , Dessie Yadeta , Roba Aklilu Abrham 
Published: August 2018

ObjectivesThe aim of this study was to assess the level and factors associated with caregivers’ disclosure of perinatally HIV-infected (PHIV+) children’s seropositive status.DesignWe conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05.ResultsThe study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children’s HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74).ConclusionOnly half of the caregivers disclosed their child’s PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children’s frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.
Effect of vitamin D on ventricular remodelling in heart failure: a meta-analysis of randomised controlled trials
Authors: Zhao Jin-Dong , Jia Jing-Jing , Dong Ping-Shuan , Zhao Di , yang Xu-Ming , Li Dao-Lin , Zhang Hui-Feng 
Published: August 2018

ObjectivesThe level of vitamin D is considered to be associated with the development and progression of heart failure (HF). However, it is still unclear whether supplementation of vitamin D could improve ventricular remodelling in patients with HF. This study aimed to systematically evaluate the influence and safety of additional vitamin D supplementation on ventricular remodelling in patients with HF.DesignThis study is a meta-analysis of randomised controlled trials (RCTs).SettingThe PubMed, EMBASE, CNKI, Cochrane library, Web of Science databases and grey literature were searched for RCTs regarding the effect of vitamin D on ventricular remodelling in patients with HF (from database creation to October 2017). RevMan V.5.3 software was employed for data analysis.ParticipantsSeven RCTs with a total of 465 patients, including 235 cases in the vitamin D group and 230 cases in the control group, were included.Primary and secondary outcome measuresLeft ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and the incidence of adverse reactions.ResultsCompared with the control group, a decrease in the LVEDD (mean difference (MD)=−2.31 mm, 95% CI −4.15 to −0.47, p=0.01) and an increase in the LVEF (MD=4.18%, 95% CI 0.36 to 7.99, p=0.03) were observed in the vitamin D group. Subgroup analysis also revealed a reduced LVEDD in adults (>18 years) and adolescents (<18 years) of the vitamin D group relative to that in those of the control group. High-dose vitamin D (>4000 IU/day) was more effective at reducing the LVEDD than low-dose vitamin D (<4000 IU/day). Moreover, vitamin D supplementation was more effective at reducing the LVEDD and increasing the LVEF in patients with reduced ejection fraction than in patients without reduced ejection fraction.ConclusionVitamin D supplementation inhibits ventricular remodelling and improves cardiac function in patients with HF.Trial registration numberCRD42017073893.
Validating traditional Chinese syndrome features in varied stages of chronic gastritis malignant transformation: study protocol for a cross-sectional study
Authors: Zhang Yin , Liu Yue , Song Rui , Zhang Li , Su Zeqi , Li Yannan , Chen Runhua , Shi Ning , Zhao Xia , Du Shiyu , Ding Xia 
Published: August 2018

IntroductionThe transition from chronic non-atrophic gastritis (CNAG) to chronic atrophic gastritis (CAG) and gastric carcinoma (GC) is regarded as a representative disease model of gastric mucosa malignant transformation led by uncontrolled inflammation. Traditional Chinese medicine (TCM) syndrome-targeted therapies have been applied in treating chronic gastritis (CG) malignant transformation in China with satisfying efficacy. This study aims to validate TCM syndrome features in each stage of CG malignant transformation. The findings may shed light on the TCM hypothesis of CG malignant transformation, and thus optimise syndrome-targeted treatment strategies of CNAG, CAG and GC, respectively.Methods and analysisThe present study is a cross-sectional study conducted in China. A total of 2000 eligible patients, including 500 CNAG cases, 1000 CAG cases and 500 GC cases, will be recruited from four TCM hospitals. Primary outcome measures include the prevalence of TCM syndrome patterns in varied stages of CG malignant transformation. Secondary outcome measures include prevalence and severity of all the presenting signs and symptoms collected by using TCM four diagnostic methods. Descriptive analysis, comparative analysis and correlation analysis of all the measurement data will be performed by biostatisticians. Unsupervised data mining analyses, including exploratory factor analysis, association rule analysis, hierarchical clustering analysis, complex system entropy clustering analysis, and so on, will also be performed by data scientists respectively for in-depth analyses of TCM syndrome-related indicators.Ethics and disseminationThe protocol has been approved by the Ethical Review Board of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (No ECPJ-BDY-2014-02). All the study outcomes will be disseminated through national conference reports and in the meantime published on peer-reviewed journals.Trial registration numberNCT03314038; Pre-results.
Defining good health and care from the perspective of persons with multimorbidity: results from a qualitative study of focus groups in eight European countries
Authors: Leijten Fenna R M , Hoedemakers Maaike , Struckmann Verena , Kraus Markus , Cheraghi-Sohi Sudeh , Zemplényi Antal , Ervik Rune , Vallvé Claudia , Huiĉ Mirjana , Czypionka Thomas , Boland Melinde , Rutten-van Mölken Maureen P M H 
Published: August 2018

ObjectivesThe prevalence of multimorbidity is increasing in many Western countries. Persons with multimorbidity often experience a lack of alignment in the care that multiple health and social care organisations provide. As a response, integrated care programmes are appearing. It is a challenge to evaluate these and to choose appropriate outcome measures. Focus groups were held with persons with multimorbidity in eight European countries to better understand what good health and a good care process mean to them and to identify what they find most important in each.MethodsIn 2016, eight focus groups were organised with persons with multimorbidity in: Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain and the UK (total n=58). Each focus group followed the same two-part procedure: (1) defining (A) good health and well-being and (B) a good care process, and (2) group discussion on prioritising the most important concepts derived from part one and from a list extracted from the literature. Inductive and deductive analyses were done.ResultsOverall, the participants in all focus groups concentrated more on the care process than on health. Persons with multimorbidity defined good health as being able to conduct and plan normal daily activities, having meaningful social relationships and accepting the current situation. Absence of shame, fear and/or stigma, being able to enjoy life and overall psychological well-being were also important facets of good health. Being approached holistically by care professionals was said to be vital to a good care process. Continuity of care and trusting professionals were also described as important. Across countries, little variation in health definitions were found, but variation in defining a good care process was seen.ConclusionA variety of health outcomes that entail well-being, social and psychological facets and especially experience with care outcomes should be included when evaluating integrated care programmes for persons with multimorbidity.
Prospective cohort study of overweight and obesity among rural Indian adults: sociodemographic predictors of prevalence, incidence and remission
Authors: Rai Rajesh Kumar , Jaacks Lindsay M , Bromage Sabri , Barik Anamitra , Fawzi Wafaie W , Chowdhury Abhijit 
Published: August 2018

ObjectivesTo assess sociodemographic predictors of prevalence, incidence and remission of overweight including obesity among adults (aged ≥18 years) in rural Eastern India.DesignProspective cohort study.SettingBirbhum Health and Demographic Surveillance System, West Bengal, India.ParticipantsSelf-weighted sample of 24 115 adults (men: 10915, women: 13200) enrolled in 2008 were followed up for body mass index (BMI) reassessment in 2017.Primary and secondary outcome measuresMeasured BMI was categorised as: underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2) and overweight including obesity (≥23 kg/m2; hereinafter overweight). Incident overweight was defined as transition from normal weight in 2008 to overweight in 2017, whereas if overweight individuals in 2008 measured normal BMI in 2017, it was classified as remission from overweight.ResultsIn 2008, 10.1% of men and 14.6% of women were overweight, whereas 17.3% of men and 24.7% of women were overweight in 2017. At the same time, in 2017, 35.6% of men and 33.3% of women were underweight. Incident overweight was 19.0% among men and 27.2% among women, whereas remission among men was higher (15.4%) than women (11.5%). Women were more likely to be overweight in 2008 and to experience incident overweight than men. For men and women, education level and wealth were positively associated with prevalence and incidence of overweight. Remission from overweight was less likely in Sainthia, a business hub in the district, as compared with Mohammad Bazar, a more rural area.ConclusionA nutrition transition to higher risk of overweight is evident in this rural setting in India, especially among women and individuals with high socioeconomic status. At the same time, a high prevalence of underweight persists, resulting in a significant double burden. Culturally sensitive interventions that address both ends of the malnutrition spectrum should be prioritised.
Neonatal intensive care nurses’ knowledge and beliefs regarding kangaroo care in China: a national survey
Authors: Zhang Yao , Deng Qingqi , Zhu Binghua , Li Qiufang , Wang Fang , Wang Hua , Xu Xinfen , Johnston Linda 
Published: August 2018

ObjectiveKangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the ‘Kangaroo Care Questionnaire’.MethodsA quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions.ResultsThe survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the ‘experienced in KC’ group showed an overall better understanding of KC and its benefits with a higher ‘correct response’ rate than those in the ‘not experienced in KC’ group. In the ‘experienced in KC’ group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The ‘not experienced in KC’ group perceived more barriers to KC implementation than did the ‘experienced in KC’ group.ConclusionAlthough most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention.
Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART): a multiarm phase IIb randomised, double-blind, placebo-controlled clinical trial comparing the efficacy of three neuroprotective drugs in secondary progressive multiple sclerosis
Authors: Connick Peter , De Angelis Floriana , Parker Richard A , Plantone Domenico , Doshi Anisha , John Nevin , Stutters Jonathan , MacManus David , Prados Carrasco Ferran , Barkhof Frederik , Ourselin Sebastien , Braisher Marie , Ross Moira , Cranswick Gina , Pavitt Sue H , Giovannoni Gavin , Gandini Wheeler-Kingshott Claudia Angela , Hawkins Clive , Sharrack Basil , Bastow Roger , Weir Christopher J , Stallard Nigel , Chandran Siddharthan , Chataway Jeremy 
Published: August 2018

IntroductionThe major unmet need in multiple sclerosis (MS) is for neuroprotective therapies that can slow (or ideally stop) the rate of disease progression. The UK MS Society Clinical Trials Network (CTN) was initiated in 2007 with the purpose of developing a national, efficient, multiarm trial of repurposed drugs. Key underpinning work was commissioned by the CTN to inform the design, outcome selection and drug choice including animal models and a systematic review. This identified seven leading oral agents for repurposing as neuroprotective therapies in secondary progressive MS (SPMS). The purpose of the Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART) will be to evaluate the neuroprotective efficacy of three of these drugs, selected with distinct mechanistic actions and previous evidence of likely efficacy, against a common placebo arm. The interventions chosen were: amiloride (acid-sensing ion channel antagonist); fluoxetine (selective serotonin reuptake inhibitor) and riluzole (glutamate antagonist).Methods and analysisPatients with progressing SPMS will be randomised 1:1:1:1 to amiloride, fluoxetine, riluzole or matched placebo and followed for 96 weeks. The primary outcome will be the percentage brain volume change (PBVC) between baseline and 96 weeks, derived from structural MR brain imaging data using the Structural Image Evaluation, using Normalisation, of Atrophy method. With a sample size of 90 per arm, this will give 90% power to detect a 40% reduction in PBVC in any active arm compared with placebo and 80% power to detect a 35% reduction (analysing by analysis of covariance and with adjustment for multiple comparisons of three 1.67% two-sided tests), giving a 5% overall two-sided significance level. MS-SMART is not powered to detect differences between the three active treatment arms. Allowing for a 20% dropout rate, 110 patients per arm will be randomised. The study will take place at Neuroscience centres in England and Scotland.Ethics and disseminationMS-SMART was approved by the Scotland A Research Ethics Committee on 13 January 2013 (REC reference: 13/SS/0007). Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numbersNCT01910259; 2012-005394-31;ISRCTN28440672.
What are the factors that contribute to the development of sexual dysfunction in breastfeeding women? A systematic scoping review protocol
Authors: Fuentealba-Torres Miguel , Cartagena-Ramos Denisse , Sierra Juan Carlos , Lara Lúcia Alves , Okano Sérgio Pires , Berra Thaís Zamboni , Alves Luana Seles , Leite Ana Carolina Andrade Biaggi , Yamamura Mellina , Silva Isília Aparecida , Nascimento Lucila Castanheira , Arcêncio Ricardo Alexandre 
Published: August 2018

IntroductionFemale sexual dysfunction is a public health problem. Evidence suggests that the population of nursing women is more vulnerable to the phenomenon due to breast feeding. Thus, this protocol was developed to explore the factors that contribute to the development of sexual dysfunction in breastfeeding women.Methods and analysisThe systematic scoping review will be conducted in six stages, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The databases used will be: PubMed, Excerpta Medica Database, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, Science Direct, Web of Science and Google Scholar. The searches were made until 1 June 2018, and no retrospective time limit was used. For the organisation of the literature retrieved from the databases, the EndNote Basic manager will be used. The Cochrane model will be used for the data extraction. The analysis of the quantitative data will be carried out through descriptive statistics and the qualitative data will be submitted to thematic analysis. The methodological quality of the empirical studies will be evaluated using the Mixed Methods Appraisal Tool.Ethics and disseminationAs it will be a review study, without human involvement, there will be no need for ethical approval. The results will be disseminated in a scientific journal, as well as in various media, such as: conferences, seminars, congresses or symposia.
Trends in gender and socioeconomic inequalities in mental health following the Great Recession and subsequent austerity policies: a repeat cross-sectional analysis of the Health Surveys for England
Authors: Thomson Rachel M , Niedzwiedz Claire L , Katikireddi Srinivasa Vittal 
Published: August 2018

ObjectiveIt is known that mental health deteriorated following the 2008 global financial crisis, and that subsequent UK austerity policies post-2010 disproportionately impacted women and those in deprived areas. We aimed to assess whether gender and socioeconomic inequalities in poor mental health have changed since the onset of austerity policies.DesignRepeat cross-sectional analysis of survey data.SettingEngland.ParticipantsNationally and regionally representative samples of the working-age population (25–64 years) from the Health Survey for England (1991–2014).Outcome measuresPopulation-level poor mental health was measured by General Health Questionnaire-12 (GHQ) caseness, stratified by gender and socioeconomic position (area-level deprivation and highest educational attainment).ResultsThe prevalence of age-adjusted male GHQ caseness increased by 5.9% (95% CI 3.2% to 8.5%, p<0.001) from 2008 to 2009 in the immediate postrecession period, but recovered to prerecession levels after 2010. In women, there was little change in 2009 or 2010, but an increase of 3.0% (95% CI 1.0% to 5.1%, p=0.004) in 2012 compared with 2008 following the onset of austerity. Estimates were largely unchanged after further adjustment for socioeconomic position, employment status and household income as potential mediators. Relative socioeconomic inequalities in GHQ caseness narrowed from 2008 to 2010 immediately following the recession, with Relative Index of Inequality falling from 2.28 (95% CI 1.89 to 2.76, p<0.001) to 1.85 (95% CI 1.43 to 2.38, p<0.001), but returned to prerecession levels during austerity.ConclusionsGender inequalities in poor mental health narrowed following the Great Recession but widened during austerity, creating the widest gender gap since 1994. Socioeconomic inequalities in poor mental health narrowed immediately postrecession, but this trend may now be reversing. Austerity policies could contribute to widening mental health inequalities.
Health Canada’s use of expedited review pathways and therapeutic innovation, 1995–2016: cross-sectional analysis
Authors: Lexchin Joel 
Published: August 2018

ObjectivesThis study examines the use of expedited approval pathways by Health Canada over the period 1995 to 2016 inclusive and the relationship between the use of these pathways and the therapeutic gain offered by new products.DesignCross-sectional study.Data sourcesTherapeutic Products Directorate, Biologics and Genetic Therapies Directorate, Notice of Compliance database, Notice of Compliance with conditions web site, Patented Medicine Prices Review Board, La revue Prescrire, WHO Anatomical Therapeutic Chemical classification system.Primary and secondary outcomesPercent of new drugs evaluated by Health Canada that went through an expedited pathway between 1995 and 2016 inclusive. Kappa values comparing the review status with assessments of therapeutic value for individual drugs.ResultsOf 623 drugs approved by Health Canada between 1995 and 2016, 438 (70.3%) drugs went through the standard pathway and 185 (29.7%) an expedited pathway. Therapeutic evaluations were available for 509 drugs. Health Canada used an expedited approval pathway for 159 of the 509 drugs, whereas only 55 were judged to be therapeutically innovative. Forty-two of the 55 therapeutically innovative drugs received an expedited review and 13 received a standard review. The Kappa value for the entire period for all 509 drugs was 0.276 (95% CI 0.194 to 0.359) indicating ‘fair’ agreement between Health Canada’s use of expedited pathways and independent evaluations of therapeutic innovation.ConclusionHealth Canada’s use of expedited approvals was stable over the entire time period. It was unable to reliably predict which drugs will offer major therapeutic gains. The findings in this study should provoke a discussion about whether Health Canada should continue to use these pathways and if so how their use can be improved.