bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term impact of introducing a soft opt-out organ donation system in Wales: before and after study
Authors: Noyes Jane , McLaughlin Leah , Morgan Karen , Walton Philip , Curtis Rebecca , Madden Susanna , Roberts Abigail , Stephens Michael 
Published: April 2019

ObjectivesTo determine the short-term impact of a soft opt-out organ donation system on consent rates and donor numbers.DesignBefore and after observational study using bespoke routinely collected data.SettingNational Health Service Blood and Transplant.Participants205 potential organ donor cases in Wales.InterventionsThe Act and implementation strategy.Primary and secondary outcomesConsent rates at 18 months post implementation compared with 3 previous years, and organ donor numbers 21 months before and after implementation. Changes in organ donor register activity post implementation for 18 months.ResultsThe consent rate for all modes of consent was 61.0% (125/205), showing a recovery from the dip to 45.8% in 2014/2015. 22.4% (46/205) were deemed consented donors: consent rate 60.8% (28/46). Compared with the 3 years before the switch there was a significant difference in Welsh consent rates (χ2p value=0.009). Over the same time period, rest of the UK consent rates also significantly increased from 58.6% (5256/8969) to 63.1% (2913/4614) (χ2p value<0.0001), therefore the Wales increase cannot be attributed to the Welsh legislation change. Deceased donors did not increase: 101 compared with 104. Organ donation registration increased from 34% to 38% with 6% registering to opt-out.ConclusionThis is the first rigorous initial evaluation with bespoke data collected on all cases. The longer-term impact on consent rates and donor numbers is unclear. Concerns about a potential backlash and mass opting out were not realised. The move to a soft opt-out system has not resulted in a step change in organ donation behaviour, but can be seen as the first step of a longer journey. Policymakers should not assume that soft opt-out systems by themselves simply need more time to have a meaningful effect. Ongoing interventions to further enhance implementation and the public’s understanding of organ donation are needed to reach the 2020 target of 80% consent rates. Further longitudinal monitoring is required.
Day of the week to tweet: a randomised controlled trial
Authors: Jayaram Mahesh , Adams Clive E , Friedel Johannes S , McClenaghan Eimear , Montgomery Alan A , Välimäki Maritta , Schmidt Lena , Xia Jun , Zhao Sai 
Published: April 2019

ObjectiveTo assess the effects of using health social media on different days of the working week on web activity.DesignIndividually randomised controlled parallel group superiority trial.SettingTwitter and Weibo.Participants194 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. There were no human participants.InterventionsThree randomly ordered slightly different messages (maximum of 140 characters), each containing a short URL to the freely accessible summary page, were sent on specific times on a single day. Each of these messages sent on Tuesday, Wednesday, Thursday and Friday was compared with the one sent on Monday.OutcomeThe primary outcome was visits to the relevant Cochrane summary web page at 1 week. Secondary outcomes were other metrics of web activity at 1 week.ResultsThere was no evidence that disseminating microblogs on different days of the working week resulted in any differences in target website activity as measured by Google Analytics (n=194, all page views, adjusted ratios of geometric means 0.86 (95% CI 0.63 to 1.18), 0.88 (95% CI 0.64 to 1.21), 0.88 (95% CI 0.65 to 1.21), 0.91 (95% CI 0.66 to 1.24) for Tuesday–Friday, respectively, overall p=0.89). There were consistent findings for all outcomes. However, activity on the review site substantially increased compared with weeks preceding the intervention.ConclusionThere are no clear differences in the effect when 1 weekday is compared with another, but our study suggests that using microblogging social media such as Twitter and Weibo do increase information-seeking behaviour on health. Tweet any day but do Tweet.
Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014: two successive national cross-sectional surveys
Authors: Dong Yanhui , Ma Yinghua , Dong Bin , Zou Zhiyong , Hu Peijin , Wang Zhenghe , Yang Yide , Song Yi , Ma Jun 
Published: April 2019

PurposeThe urban-rural disparity for childhood overweight and obesity shows different patterns in most countries. This study aimed to examine the recent trend of urban-rural disparity for childhood overweight and obesity at national and subnational levels in Chinese children from 2010 to 2014.DesignTwo successive national cross-sectional studies. Overweight and obesity were classified using Chinese national age-specific and sex-specific body mass index reference. The prevalence of overweight and obesity was compared between urban and rural areas at national and subnational levels.SettingThirty-one provinces in China.ParticipantsData were obtained from the Chinese National Survey on Students’ Constitution and Health in 2010 and 2014 with 215 214 (107 741 in 2010 and 107 473 in 2014) children aged 7–12 years.ResultsThe overweight and obesity prevalence increased from 17.1% in 2010 to 22.5% in 2014. The overweight and obesity prevalence in both urban and rural areas was higher in the eastern provinces but lower in the western provinces. The urban-rural disparity in overweight and obesity decreased steadily from 2010 to 2014 (1.79 to 1.42 for prevalence OR). There was greater urban-rural disparity in western China than eastern China. A reversal occurred in 2014 in several eastern provinces where the overweight and obesity prevalence in rural children surpassed that of their urban peers.ConclusionsA narrowing urban-rural disparity and the reversal signal between urban and rural areas in overweight and obesity would contribute to a growing proportion of obese children in rural areas. Therefore, urgent region-specific policies and interventions with a forward-looking approach should be considered for Chinese children, especially in rural areas.
Media framing of childhood obesity: a content analysis of UK newspapers from 1996 to 2014
Authors: Nimegeer Amy , Patterson Chris , Hilton Shona 
Published: April 2019

BackgroundMedia can influence public and policy-makers’ perceptions of causes of, and solutions to, public health issues through selective presentation and framing. Childhood obesity is a health issue with both individual-level and societal-level drivers and solutions, but public opinion and mass media representations of obesity have typically focused on individual-level framings, at the cost of acknowledgement of a need for regulatory action.Objective and settingTo understand the salience and framing of childhood obesity across 19 years of UK national newspaper content.Design and outcome measuresQuantitative content analysis of 757 articles about childhood obesity obtained from six daily and five Sunday newspapers. Articles were coded manually for definitions, drivers and potential solutions. Data were analysed statistically, including analysis of time trends and variations by political alignment of source.ResultsThe frequency of articles grew from a low of two in 1996 to a peak of 82 in 2008, before declining to 40 in 2010. Individual-level drivers (59.8%) and solutions (36.5%) were mentioned more frequently than societal-level drivers (28.3%) and solutions (28.3%) across the sample, but societal solutions were mentioned more frequently during the final 8 years, coinciding with a marked decline in yearly frequency of articles.ConclusionsIncreased focus on societal solutions aligns with public health goals, but coincided with a reduction in the issue’s salience in the media. Those advocating public policy solutions to childhood obesity may benefit from seeking to raise the issue’s media profile while continuing to promote structural conceptualisations of childhood obesity.
I-ACT: Integrated study on effect of Activity on ComplicaTions in pregnancy: study protocol of a multiethnic prospective cohort study
Authors: Cai Meijin , Tan Kok Hian , Ang Seng Bin 
Published: April 2019

IntroductionPhysical activity (PA) during first 20 weeks of pregnancy may lower risks of gestational diabetes mellitus (GDM) and gestational hypertension (GH), though evidence of association remains inconclusive. Current studies rely heavily on subjective assessment of PA levels. Wearable activity trackers provide a convenient and objective surrogate index for PA validated by evidence-based steps/day categorisation along a physical inactivity/activity continuum. I-ACT primarily aims to examine objectively measured PA levels and patterns in first and second trimesters of pregnancy and the association with GDM and/or GH in Singapore, a multiethnic Asian population. Secondary aims include investigating the bio-socio-demographic factors associated with sedentary behaviour, and association of early pregnancy PA level with maternal weight at 6 weeks postdelivery. Results may facilitate identification of high-risk mothers-to-be and formulation of interventional strategies.Methods and analysisProspective cohort study that will recruit 408 women at first antenatal visit at <12 weeks’ gestation. Baseline bio-socio-demographic factors and PA levels assessed by participant characteristics form and the International Physical Activity Questionnaire (IPAQ), respectively. An activity tracker (Fitbit) will be provided to be worn daily from date of recruitment to end of 20 weeks’ gestation. Tracker-recorded data will be synchronised with an application on participant’s smartphone. Compliance will be reinforced with fortnightly reminders. After 20 weeks, a second IPAQ and a feedback form will be administered. GDM screened at 24–28 weeks’ gestation. GH diagnosed after 20-weeks gestation. Maternal weight assessed at 6 weeks postdelivery. Appropriate statistical tests will be used to compare continuous and categorical PA measurements between first and second trimesters. Logistic regression will be used to analyse associations.Ethics and disseminationEthical approval obtained from the Centralised Institutional Review Board of SingHealth (reference 2017/2836). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters and medical forums.
Agreement between capillary and venous lactate in emergency department patients: prospective observational study
Authors: Graham Colin A , Leung Ling Yan , Lo Ronson SL , Lee Kwok Hung , Yeung Chun Yu , Chan Suet Yi , Cattermole Giles N , Hung Kevin KC 
Published: April 2019

ObjectivesCapillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref).DesignA prospective observational study.SettingA university teaching hospital emergency department in Hong Kong.ParticipantsPatients triaged as ‘urgent’ (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited.Primary and secondary outcome measuresThe primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers.ResultsThe results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was −0.22 with 95% limits of agreement (LOA) of −2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of −1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being −0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA −0.01 to 1.66 mmol/L.ConclusionOur study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing.Trial registration numberNCT02694887.
Validation of non-participation bias methodology based on record-linked Finnish register-based health survey data: a protocol paper
Authors: McMinn Megan A , Martikainen Pekka , Gorman Emma , Rissanen Harri , Härkänen Tommi , Tolonen Hanna , Leyland Alastair H , Gray Linsay 
Published: April 2019

IntroductionDecreasing participation levels in health surveys pose a threat to the validity of estimates intended to be representative of their target population. If participants and non-participants differ systematically, the results may be biased. The application of traditional non-response adjustment methods, such as weighting, can fail to correct for such biases, as estimates are typically based on the sociodemographic information available. Therefore, a dedicated methodology to infer on non-participants offers advancement by employing survey data linked to administrative health records, with reference to data on the general population. We aim to validate such a methodology in a register-based setting, where individual-level data on participants and non-participants are available, taking alcohol consumption estimation as the exemplar focus.Methods and analysisWe made use of the selected sample of the Health 2000 survey conducted in Finland and a separate register-based sample of the contemporaneous population, with follow-up until 2012. Finland has nationally representative administrative and health registers available for individual-level record linkage to the Health 2000 survey participants and invited non-participants, and the population sample. By comparing the population sample and the participants, synthetic observations representing the non-participants may be generated, as per the developed methodology. We can compare the distribution of the synthetic non-participants with the true distribution from the register data. Multiple imputation was then used to estimate alcohol consumption based on both the actual and synthetic data for non-participants, and the estimates can be compared to evaluate the methodology’s performance.Ethics and disseminationEthical approval and access to the Health 2000 survey data and data from administrative and health registers have been given by the Health 2000 Scientific Advisory Board, Statistics Finland and the National Institute for Health and Welfare. The outputs will include two publications in public health and statistical methodology journals and conference presentations.
Living kidney donor and recipient perspectives on their relationship: longitudinal semi-structured interviews
Authors: Ralph Angelique F , Butow Phyllis , Craig Jonathan C , Wong Germaine , Chadban Steve J , Luxton Grant , Gutman Talia , Hanson Camilla S , Ju Angela , Tong Allison 
Published: April 2019

Background and objectivesMany donors and recipients report an improved bond posttransplantation; however, unexpected conflicts and tension may also occur. Insights into the lived experiences of the donor–recipient relationship can inform strategies for interventions and support. We aimed to describe donor and recipient expectations and experiences of their relationship before and after living kidney donor transplantation.Design, setting and participantsSemistructured interviews were conducted with 16 donor–recipient pairs before the transplant and 11–14 months post-transplant. Transcripts were analysed thematically.ResultsWe identified seven themes (with respective subthemes): donation as enacting familial responsibility for care; analytical decision making to mitigate regret (avoiding anticipated regret and maintaining control, removing emotional impulsivity); strengthened interpersonal ties (gaining a deeper appreciation among family members, stronger empathy for each other, improving social participation); instability of relational impacts (anger and aggression threatening dynamics, unanticipated stress and emotional lability, triggering familial tension); renegotiating social roles (unexpected continuation of caregiving responsibilities, inability to relinquish the caregiving role, disappointment with unfulfilled renewal of intimacy, dissatisfaction over discrepant energy levels); guilt over unmet expectations and inevitability of the gift relationship (vague and transient indebtedness, expectation of reciprocity, transferring kidney ownership).ConclusionsDonor–recipient relationships may be improved through increased empathy, appreciation, and ability to participate in life together; however, unfulfilled expectations and behavioural and emotional changes in recipients (a side effect related to immunosuppression) remain unresolved consequences of living kidney donor transplantation. Education and counselling to help donors and recipients adjust to potential changes in relationship dynamics may help protect and foster relational stability postdonation.
Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study
Authors: Jernberg Tomas , Lindholm Daniel , Hasvold Lars Pål , Svennblad Bodil , Bodegård Johan , Sundell Andersson Karolina , Thuresson Marcus , Erlinge David , Janzon Magnus 
Published: April 2019

ObjectivesTo compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).DesignCohort study linking morbidity, mortality and medication data from Swedish national registries.ParticipantsFirst-time users of GLD during 2007–2016.OutcomesPredicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.Results260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD—prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.ConclusionsT2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.
Health-related quality of life (HRQOL) in children and adolescents with congenital heart disease: a cross-sectional survey from South India
Authors: Raj Manu , Sudhakar Abish , Roy Rinku , Champaneri Bhavik , Sudevan Remya , Kabali Conrad , Kumar Raman Krishna 
Published: April 2019

ObjectiveThere are limited data on health-related quality of life (HRQOL) for children and adolescents with uncorrected congenital heart disease (CHD) from low-income and middle-income countries where late presentation is common. We sought to compare HRQOL of children and adolescents with uncorrected CHD to that of controls using the Pediatric Quality of Life Inventory (PedsQL 4.0).MethodsThe study design is a cross-sectional analytical survey. The study setting was (1) Hospital-based survey of patients with CHD and their parents. (2) Community survey of controls and their parents. Subjects included (1) Children/adolescents with CHD between the ages of 2 years and 18 years and their parents enrolled in a previous study (n=308). (2) Unmatched community controls (719 children/adolescents, aged 2–18 years) and their parents. Participants were given PedsQL 4.0 to fill out details. Parents assisted children 5–7 years of age in filling the questionnaires. Children younger than 5 years had only parent-reported HRQOL and those above 5 years had both self-reported and parent-reported HRQOL.ResultsThe median (IQR) total generic HRQOL from self-reports for CHD subjects and controls were 71.7 (62.0, 84.8) and 91.3 (82.6, 95.7), respectively. The corresponding figures for parent-reports were 78.3 (63.0, 90.5) and 92.4 (87.0, 95.7) respectively. The adjusted median difference was −20.6 (99% CI −24.9 to −16.3, p<0.001) for self-reported and −14.1 (99% CI −16.7 to −11.6, p<0.001) for parent-reported total HRQOL between patients with CHD and controls. Cardiac-specific HRQOL by self-reports was 75.0 (53.6, 92.9) for heart problems, 95.0 (73.8, 100.0) for treatment barriers, 83.3 (66.7, 100.0) for physical appearance, 87.5 (62.5, 100.0) for treatment-related anxiety, 91.7 (68.8, 100.0) for cognitive problems and 83.3 (66.7, 100.0) for communication. The values for parent-reports were 71.4 (53.6, 85.7), 100.0 (75.0, 100.0), 100.0 (75.0, 100.0), 81.3 (50.0, 100.0), 100.0 (81.2, 100.0) and 83.3 (50.0, 100.0), respectively.ConclusionsChildren and adolescents with uncorrected CHD reported significant reductions in overall quality of life compared with controls.
PP19 Opioid poisoning deaths: a national picture
Authors: Jones Matthew , Snooks Helen , Angela Evans Bridie , Watkins Alan , Fuller Gordon 
Published: April 2019

BackgroundThe factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents of opioid poisoning in Wales in 2015. Using anonymised linked data, we describe demographic characteristics, patterns of emergency service utilisation, and clinical presentation prior to death.MethodsDecedents of opioid poisoning in Wales in 2015 were identified from Office of National Statistics (ONS) mortality data. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymised Information Linkage (SAIL) databank. Data were accessed and analysed in the SAIL gateway.ResultsAge at death ranged from eighteen to seventy-eight years, with a mean of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-six percent of decedents were men (n=98/112).Eight-seven percent of decedents (n=112/129) attended the emergency department in the three years prior to death; eighty-nine in the previous year, ninety-nine in the previous two years and 112 in the previous three years. Eighty-four percent of male and ninety-three percent of female decedents attended the ED in the three years prior to death.In total 665 attendances were made, half of which involved conveyance by ambulance. Attendances per individual ranged from one to sixty, with over half of decedents attending more than three times.Diagnostic codes were mostly missing or non-specific, with only six and a half percent of attendances representing twenty seven decedents, coded as drug related.ConclusionsMatching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilisation. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.