bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, attitude and practices of ayurvedic medicine practitioners in Kerala towards millets and millet-based diet: a prospective cross-sectional online survey study
Authors: Chettiyam Kandy Saniya , Singhal Richa , V Krishna Kumar , Yadav Babita , Jameela Sophia , Deverakonda Sudhakar , Rao Bhogavalli Chandra Sekhar , Rana Rakesh Kumar , Sreekanth Narayanam , Acharya Rabinarayan 
Published: November 2024

IntroductionDiet and lifestyle play pivotal roles in Ayurveda’s preventive and therapeutic principles. The rich culinary heritage of Kerala harmoniously aligns with Ayurvedic dietetic principles. With the recent designation of 2023 as the International Year of Millets, there has been a surge of interest in integrating millets into dietary practices worldwide. Ayurveda physicians are poised to offer nutritional guidance to endorse health.MethodsA cross-sectional online survey was conducted from 26 July to 9 August 2023 among Ayurveda practitioners in Kerala. The survey used a semi-structured questionnaire finalised through the face and content validity, comprising eight items each for knowledge, attitudes and practices (KAP) domains. A target sample size of 422 participants was determined through convenience sampling methodology. Spearman’s rank correlation test was used to examine the correlations between KAP while binary logistic regression analyses were employed to identify determinants associated with favourable levels of KAP among participants.ResultsA total of 386 complete responses were used for analysis. The average scores for KAP items were 5.21, 6.36 and 5.34, respectively, (range 0–8). It was found that better Knowledge scores were associated with more favourable Attitudes towards the prescription of millet-based diet (MBD) (adjusted Odd’s Ratio (AOR): 3.04) and even more positive responses towards Practice (AOR: 8.59).ConclusionThe knowledge of Ayurveda practitioners in Kerala regarding the use of MBD is satisfactory. There is a significant relationship between Knowledge and Attitude as well as Practice. This study has underscored the importance of education and awareness in shaping favourable attitudes and practices related to MBD, aligning with Ayurvedic principles. Despite practitioners demonstrating good KAP behaviour towards MBD, gaps persist in certain aspects of contemporary knowledge and limitations in translating knowledge into practice. Addressing these gaps and barriers is essential to promote the widespread adoption and prescription of MBD.
Priorities and expectations of researchers, funders, patients and the public regarding the funding of medical research: results from the PERSPECT qualitative study
Authors: Cristall Nora , Drozdowska Bogna A , Fladt Joachim , Jaroenngarmsamer Tanaporn , Sehgal Arshia , Victoria McDonough Rosalie , Goyal Mayank , Ganesh Aravind 
Published: November 2024

BackgroundIdeally, medical research provides crucial data about disease processes, diagnoses, prognoses, treatment targets and outcomes, and systems of care. However, medical research is costly, and funding is difficult to receive because the processes are highly competitive. There is a paucity of data on the perspectives of researchers, funders, patients and the public about current funding paradigms. This study sought to understand the priorities and opinions of each group to better guide meaningful innovation in research funding processes.MethodIn this Priorities & Expectations of Researchers, Funders, Patients and the Public Regarding the Funding & Conduct of Stroke Research study, we conducted in-depth interviews with medical researchers, funders, patients and members of the general public to learn their opinions of the current funding process and thoughts about alternative approaches. We used both purposive and snowball sampling to recruit participants and conducted semistructured interviews. The study ended when thematic saturation was attained. Qualitative analysis followed inductive grounded theory methodology.Results41 interviews were completed (11 researchers, 10 funders, 10 patients, 10 members of the general public; 61% female). Interviewees expressed a high interest in supporting a comprehensive evaluation of the research grant funding process while integrating funding mechanisms that are more inclusive and reduce bias in topic selection and researchers who receive funds. Participants acknowledged a gap in patient and public involvement in setting a research agenda, choosing topics to be studied and focusing on specific outcomes. Crowdfunding was identified as an alternative strategy that could facilitate research democratisation; however, participants emphasised the importance of expert review of research proposals, as in current processes to continue to support rigour and trust in research proposal quality.ConclusionOur research revealed stakeholder concerns about the transparency and equity of current research funding paradigms. Suggestions to democratize research and explore alternative fundraising platforms necessitate a fundamental shift in traditional research funding processes.
Mediating role of inflammatory biomarkers on the association of physical activity, sedentary behaviour with chronic kidney disease: a cross-sectional study in NHANES 2007–2018
Authors: Peng Pan , Liu Zhisheng 
Published: November 2024

ObjectivesThis study aims to investigate the association of physical activity (PA) and sedentary behaviour (SB) with chronic kidney disease (CKD), and to illustrate whether inflammatory biomarkers play a mediating role.DesignA cross-sectional study.SettingThis study analysed cross-sectional data from the National Health and Nutrition Examination Survey 2007–2018.ParticipantsA total of 27 808 participants aged 20–80 years old were enrolled in the final analysis.Outcome measuresPA and SB were self-reported by participants using the Global Physical Activity Questionnaire. Inflammatory biomarkers including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were examined in subjects’ peripheral blood samples. Estimated glomerular filtration rate <60 mL/min/1.73 m2was defined as CKD. Multivariable logistic regression and medication model were performed to examine the associations of PA, SB and inflammatory biomarkers with CKD.ResultsPA was associated with CKD, with a 20% lower OR of CKD compared with inactive (p=0.002) and a 2% lower OR per 30 min moderate-to-vigorous PA increase (p=0.027). SB was also associated with CKD, with a significant 39% higher OR for high SB (p<0.001), and a 3% higher OR per 30 min SB increase (p<0.001). NLR and SII both significantly mediated the association of PA and SB with CKD. NLR explained 1.87% (medication effect: −0.0003, direct effect: −0.0162) and 2.73% (medication effect: 0.0005, direct effect: 0.0192) association of PA and SB with CKD (p<0.001), respectively. While SII explained 1.77% (medication effect: −0.0003, direct effect: −0.0162) and 1.22% (medication effect: 0.0002, direct effect: 0.0199) association of PA and SB with CKD (p<0.001), respectively. The results did not show any statistical association between PLR and CKD in this sample.ConclusionThis finding revealed increasing PA and shortening SB may be effective strategies in CKD prevention and early management through the regulation of systemic inflammation. NLR and SII may not only be prognostic indicators of CKD, but also novel potential markers in predicting CKD occurrence.
Temporal changes in the burden of leukaemia and lymphoma in the Australasia and Oceania regions, 2010–2019: an analysis of the Global Burden of Disease Study 2019
Authors: Ho Thi Quynh Anh , Lee Peter , Gao Lan 
Published: November 2024

ObjectivesLeukaemias and lymphomas are among the most prevalent and significant cancers in Australasia and Oceania. This study aims to examine the burden of leukaemias/lymphomas and its temporal trend in Australasia and Oceania from 2010 to 2019.DesignEpidemiological studyMethodsData from the Global Burden of Disease (GBD) 2019 were used to examine the burden of leukaemia/lymphoma key subtypes (acute lymphocytic leukaemia (ALL), acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL), chronic myeloid leukaemia (CML), Hodgkin-lymphoma (HL) and non-Hodgkin’s lymphoma (NHL)) by sex and 5 year age groups (from <5 years to 85 years+), in terms of incidence, prevalence, disability-adjusted life years (DALYs) and deaths. Estimated average percentage changes were calculated to assess the temporal trends of leukaemia/lymphoma burden (incidence/prevalence/DALYs/deaths) from 2010 to 2019 in Australasia and Oceania.ResultsAML and NHL were the leading causes of leukaemia/lymphoma burden in both regions. Age-standardised rates (ASRs) for AML versus NHL in Australasia were: incidence 4.72 versus 19.06, DALYs 89.01 versus 161.68 and deaths 4.15 versus 8.02 per 100 000 population. ASRs for AML versus NHL in Oceania were: incidence 1.36 versus 1.08, DALYs 49.16 versus 38.30 and deaths 0.91 versus 0.98 per 100 000 population. From 2010 to 2019, Australasia observed an increasing trend in incidence/prevalence/deaths across most leukaemias/lymphomas and increasing/stable trend in DALYs for AML/CLL/NHL, while Oceania observed increasing trends in incidence/prevalence/DALYs for CLL/NHL and stable trends in all outcomes (except for prevalence (stable)) for AML. Contrasting mortality trends for ALL/CML/HL were observed between the two regions (increasing/stable in Australasia and decreasing in Oceania). Statistically significant differences were observed in disease burden trends between sexes, with males experiencing a greater increase (or smaller decrease) in the burden for AML in both regions.ConclusionsDifferent temporal trends in leukaemia/lymphoma burden observed in two closely situated geographic regions with different sociodemographic indices highlight the necessity for region-specific intervention strategies to enhance the access to innovative disease treatments, reducing leukaemia/lymphoma burden.
A mindfulness-based, cognitive, social, digital relapse-prevention intervention for youth with depression in Australia: study protocol for a randomised controlled trial of Rebound
Authors: Mangelsdorf Shaminka N , Cagliarini Daniela , Lee Yong Yi , Mihalopoulos Cathrine , Liu Virginia , Valentine Lee , Bendall Sarah , Koval Peter , D'Alfonso Simon , Davey Christopher , Russon Penni , Phillips Jess , Gonzalez-Blanch Cesar , Pawsey Brendan , Ryan Richard M , Parker Alexandra , Hetrick Sarah , Rice Simon , Lederman Reeva , Herrman Helen , Murray Greg , Gleeson John , Alvarez-Jimenez Mario 
Published: November 2024

IntroductionMajor depressive disorder (MDD) causes significant disease burden and functional impairment during adolescence and young adulthood. While most young people recover from their first episode, around two-thirds will experience one or more relapses, which can become more severe and treatment-resistant with each episode. To address relapse in MDD, we developed a moderated online social therapy platform (titledRebound) that integrates: (i) peer-to-peer social networking; (ii) tailored third-wave therapeutic content targeting mindfulness, self-compassion and rumination; and (iii) three types of human support (clinicians, peer workers, career consultants), informed by self-determination theory. The aim of this trial is to determine whether, in addition to treatment as usual (TAU),Rebound, an 18-month complex digital intervention, is superior to 18 months of enhanced TAU in preventing relapse and managing depressive symptoms.Methods and analysisThis study is a rater-masked randomised controlled trial. The treatment conditions includeReboundplus TAU or enhanced TAU alone. We aim to recruit 255 young people with at least one episode of MDD, aged 14–27 years. The study includes monthly assessment points over 18 months. The study includes a 48-month recruitment period and an 18-month treatment phase. The primary outcome is depressive relapse at 18 months, as measured by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Research Version (SCID-5-RV). Secondary outcomes include the severity of depressive symptoms, time to relapse, time to remission, remission status, severity of anxiety symptoms, study and employment outcomes and cost-effectiveness. We will also examine four therapeutic mechanisms (mindfulness, self-compassion skills, social support and reduced rumination) to understand the ‘how and why’ of the intervention effects.Ethics and disseminationMelbourne Health Human Research Ethics Committee (HREC/42967/MH-2018) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website.Trial registration numberANZCTR, ACTRN12619001412123.
What are the unintended patient safety consequences of healthcare technologies? A qualitative study among patients, carers and healthcare providers
Authors: Abdelaziz Shahd , Garfield Sara , Neves Ana Luisa , Lloyd Jill , Norton John , van Dael Jackie , Wheeler Carly , McLeod Monsey , Franklin Bryony Dean 
Published: November 2024

ObjectiveTo identify patient-safety-related unintended consequences of healthcare technologies experienced by their primary users: patients, carers and healthcare providers (HCPs).DesignQualitative study based on data collected in online focus groups. Transcripts were analysed inductively after each focus group using reflexive thematic analysis, focusing on identifying unintended consequences of healthcare technologies with implications for patient safety. Patient safety was broadly conceptualised to include a more subjective concept of ‘feeling safe’ as well as risks of actual harm.SettingPatient/public and HCP participants from the UK with experience in healthcare technologies were recruited using a mixture of purposive, convenience and snowball sampling.Participants40 participants (29 patients/public, 11 HCPs) took part in 5 focus groups between November 2021 and February 2022.ResultsWe identified five main themes of unintended consequences with implications for patient safety: inequity of access, increased end-user burden, loss of the human element of healthcare, over-reliance on technology and unclear responsibilities. Both groups of participants identified unintended consequences directly affecting patients; HCPs also described those affecting themselves. Some unintended consequences are described in previous literature, including alert fatigue, the ‘illusion of communication’, reduced opportunities for face-to-face interactions and increased end-user burden. Others are potentially novel, including patients’ psychological dependence on technologies, ‘gaming’ of data entry and incorrect interpretation of health data.ConclusionsDrawing on the perspectives of patients/public as well as HCPs, we identified five areas of patient-safety-related unintended consequences associated with healthcare technologies. These should be considered when developing tools to identify and mitigate the patient-safety-related unintended consequences of healthcare technologies.
Who has the responsibility to inform relatives at risk of hereditary cancer? A population-based survey in Sweden
Authors: Grill Kalle , Phillips Amicia , Numan Hellquist Barbro , Rosén Anna 
Published: November 2024

ObjectivesHereditary cancer has implications not only for patients but also for their at-risk relatives (ARRs). In current clinical practice, risk disclosure to ARRs involves collaboration between patients and healthcare providers (HCPs). However, the specific responsibilities of each party are intertwined and at times unclear. In this study, we explored public attitudes regarding moral and legal responsibilities to disclose familial risk information to uninformed ARRs.DesignIn an online cross-sectional survey, participants were prompted with a hypothetical scenario where a gender-neutral patient learnt about their familial risk of colorectal cancer. The patient was advised to regularly undergo colonoscopy screening, and this recommendation was extended to both their siblings and cousins. While the patient informed their siblings, they had not spoken to their cousins in 20 years and did not want to contact them. The survey assessed respondents’ views on the patient’s and HCPs’ ethical responsibility and legal obligation to inform the cousins (ARRs).ParticipantsA random selection of 1800 Swedish citizens 18–74 years of age were invited. Out of those, 914 (51%) completed the questionnaire.ResultsIn total, 75% believed that HCPs had a moral responsibility to inform ARRs, while 59% ascribed this moral responsibility to the patient. When asked about the ultimate responsibility for risk disclosure to ARRs, 71% placed this responsibility with HCPs. Additionally, 66% believed that HCPs should have a legal obligation to inform ARRs, while only 21% thought the patient should have such an obligation. When prompted about a scenario in which the patient actively opposed risk disclosure, a majority believed that HCPs should still inform the ARRs.ConclusionOur study indicates that the Swedish public ascribes moral responsibility for informing ARRs to both the patient and HCPs. However, contrary to current practice, they believe HCPs hold the ultimate responsibility. The majority of respondents support disclosure even without patient consent.
Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics
Authors: Stevenson Fiona A , Pfeffer Paul , Walker Sarah , Ismaila Hadiza , Jegatheesan Vinosh , Mohammad Ibrahim , Blandford Ann , Linke Stuart , Hurst John R , Ricketts William , Hamilton Fiona L , Sunkersing David , Bradbury Katherine , Goodfellow Henry 
Published: November 2024

ObjectivesThe potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient-facing app and a digital dashboard for clinicians providing supported self-management for long COVID to support both clinicians and patients.DesignQualitative reflexive thematic analysis, mapped against Normalisation Process Theory.SettingFifty-five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.ParticipantsAllied health professionals, service delivery managers and members of the core team, including representatives from industry partners.ResultsThe DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working.Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face-to-face clinical input. The DHI was judged to have demonstrated the potential to affect long-established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.ConclusionsNPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people’s experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the ‘mess’ involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic).
Determinants of treatment-seeking behaviour and healthcare provider choice in Afghanistan in 2018: a cross-sectional study
Authors: van Gurp Margo , Abdianwall Mohammad Haris , Safi Sohrab , Saeedzai Sayed Ataullah , Juszkiewicz Konrad T , Arab Sayed Rahim , Sondorp Egbert , Alba Sandra 
Published: November 2024

IntroductionIn Afghanistan, remarkable achievements have been made in improving access to healthcare and health outcomes since the introduction of essential healthcare packages. Nonetheless, sociodemographic and geographical inequities persist, and out-of-pocket expenditures are high. This study investigates the client and provider determinants of access to care that affect treatment-seeking behaviour in 2018.MethodsSecondary data analysis using data on treatment-seeking behaviour in public and private healthcare from the Afghanistan Health Survey 2018 was combined with data on the quality of public healthcare facilities from a national healthcare facility assessment of the same year. Logistic regression analyses were performed to explore associations between client characteristics and accessibility of public healthcare facilities, and treatment-seeking behaviour and choice of public versus private healthcare provider.ResultsThe results suggest that the odds of seeking treatment are lowest among the rural poor. The odds of treatment-seeking and choosing a public healthcare provider are higher for pregnancy-related health needs but lower for chronic conditions. Affordability of healthcare was associated with lower odds of treatment-seeking (OR 0.96, 95% CI 0.95 to 0.98) and using private healthcare providers (OR 0.97, 95% CI 0.96 to 0.99). Increased satisfaction with opening hours (OR 1.04, 95% CI 1.02 to 1.05) and availability of a female nurse or doctor (OR 1.03, 95% CI 1.01 to 1.04) in public health facilities, and a higher level of trust in healthcare provider (OR 1.04, 95% CI 1.03 to 1.06) were associated with higher odds of using public healthcare.ConclusionAfghanistan’s public healthcare system is vital in providing care to the economically disadvantaged and managing infectious diseases and maternal health problems. The private sector plays a dominant role, particularly for those illnesses not covered under the essential healthcare packages. The study suggests opportunities for the public healthcare system to alleviate financial barriers to healthcare access and broaden its service offerings to encompass the management of chronic illnesses.