bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moving Beyond Mean Levels: Associations Between Subject-Level Variability in Psychological Determinants and Physical Activity in Older Adults
Authors: Maher Jaclyn P. , Labban Jeffrey D. , Hudgins Brynn L. , Hevel Derek J. , Bittel Kelsey M. , Kennedy-Malone Laurie , Hedeker Donald 
Published: November 2024

Background: Research investigating the psychological determinants of physical activity (PA) tends to conceptualize determinants as stable, trait-like factors. Growing evidence suggests that people and the processes that regulate people’s behavior fluctuate over short timescales (eg, hours and days). This study explores the extent to which subject-level variability (vs stability) in determinants of PA, as well as the interaction between subject-level mean and variability in those determinants, is associated with moderate- to vigorous-intensity PA (MVPA) in older adults. Methods: Older adults (N = 202) enrolled in a measurement burst design study with 3 data collection waves occurring over a 1-year period. Each data collection wave consisted of accelerometers and ecological momentary assessment to capture MVPA and psychological determinants of MVPA, respectively. Mixed-effects location scale modeling was first used to estimate subject-level means and variability in psychological determinants. These estimates were then used as predictors of daily MVPA using multilevel modeling. Results: Subject-level variability in PA intentions (β = 0.199, SE = 0.062, P = .001), self-efficacy (β = 0.133, SE = 0.064, P = .037), and planning (β = 0.154, SE = 0.062, P = .014) were positively associated with daily MVPA. Associations between subject-level variability in PA intentions and self-efficacy decreased in strength, becoming nonsignificant at higher mean levels of PA intentions (β = −0.147, SE = 0.062, P = .018) and self-efficacy (β = −0.116, SE = 0.063, P = .062). Conclusions: Greater subject-level variability in psychological determinants may be adaptive for PA engagement, especially among older adults experiencing low levels of those determinants. Moving beyond mean levels to include subject-level variability in psychological determinants of PA may help to improve our understanding of the processes that drive PA engagement.
From prediction to practice: mitigating bias and data shift in machine-learning models for chemotherapy-induced organ dysfunction across unseen cancers
Authors: Watson Matthew , Chambers Pinkie , Steventon Luke , Harmsworth King James , Ercia Angelo , Shaw Heather , Al Moubayed Noura 
Published: November 2024

ObjectivesRoutine monitoring of renal and hepatic function during chemotherapy ensures that treatment-related organ damage has not occurred and clearance of subsequent treatment is not hindered; however, frequency and timing are not optimal. Model bias and data heterogeneity concerns have hampered the ability of machine learning (ML) to be deployed into clinical practice. This study aims to develop models that could support individualised decisions on the timing of renal and hepatic monitoring while exploring the effect of data shift on model performance.Methods and analysisWe used retrospective data from three UK hospitals to develop and validate ML models predicting unacceptable rises in creatinine/bilirubin post cycle 3 for patients undergoing treatment for the following cancers: breast, colorectal, lung, ovarian and diffuse large B-cell lymphoma.ResultsWe extracted 3614 patients with no missing blood test data across cycles 1–6 of chemotherapy treatment. We improved on previous work by including predictions post cycle 3. Optimised for sensitivity, we achieve F2 scores of 0.7773 (bilirubin) and 0.6893 (creatinine) on unseen data. Performance is consistent on tumour types unseen during training (F2 bilirubin: 0.7423, F2 creatinine: 0.6820).ConclusionOur technique highlights the effectiveness of ML in clinical settings, demonstrating the potential to improve the delivery of care. Notably, our ML models can generalise to unseen tumour types. We propose gold-standard bias mitigation steps for ML models: evaluation on multisite data, thorough patient population analysis, and both formalised bias measures and model performance comparisons on patient subgroups. We demonstrate that data aggregation techniques have unintended consequences on model bias.
Breast cancer and its determinants in Ethiopia: a systematic review and meta-analysis
Authors: Shama Adisu Tafari , Terefa Dufera Rikitu , Desisa Adisu Ewunetu , Lema Matiyos , Cheme Melese Chego , Geta Edosa Tesfaye , Feyisa Jira Wakoya , Feyisa Bikila Regassa , Biru Bayise 
Published: November 2024

ObjectivesBreast cancer is the leading cause of cancer morbidity and mortality among women. Still, there is a paucity of studies to know the magnitude of the problem in Ethiopia. Hence, this review was intended to pool the prevalence and identify the determinants of breast cancer in Ethiopia.DesignA systematic review and meta-analysis was conducted.Data sourcesDatabases like PubMed/MEDLINE, HINARI, Science Direct, and Google Scholar, as well as websites of organisationsI organizations,rewere searched between 25 February and 6 March 2023.Eligibility criteriaAll observational studies in Ethiopia that reported either the magnitude and/or determinants of breast cancer regardless of publication status were included.Data extraction and synthesisTwo authors independently assessed and extracted the data. The Joanna Briggs Institute meta-analysis of statistics assessment and review instrument quality appraisal tool was used to assess the quality of the articles. Effect estimates were done by using the random-effects model. The meta-analysis results were displayed by using forest plots.ResultsSeventeen articles were reviewed with 24 435 total participants. The pooled proportion of breast cancer morbidity among patients with cancer was 20. 58% (95% CI 17.25%, 23.90%) in Ethiopia. Consuming packed foods (POR=2.12, 95% CI 1.41, 3.17), presence of high cholesterol (POR=4.08; 95% CI 2.75, 6.07), physical inactivity (POR=3.27; 95% CI 1.80, 5.94), high body mass index (BMI) (POR=2.27; 95% CI 0.85, 6.03), postmenopause (POR=2.25; 95% CI 1.63, 3.10), family history of cancer (POR=3.65; 95% CI 0.85, 15.71) and lack of breastfeeding (POR=2.76; 95% CI 0.90, 7.92) were the determinants of breast cancer.ConclusionsOne of five patients with cancer is diagnosed with breast cancer in Ethiopia. Furthermore, more than a quarter of women with cancer suffer from breast cancer. Processed food consumption, high cholesterol in the body, lack of physical activity, high BMI, postmenopause, family history of cancer and lack of breastfeeding were the risk factors for breast cancer. The use of healthy food sources such as fruits and vegetables, and homegrown varieties of crops rather than seeking processed foods would help.PROSPERO registration numberCRD42023417733
Analysis of rational prescription of medicines by village clinics: a repeated cross-sectional study of a province in eastern China
Authors: Song Chunyan , Chen Zhongming , Yin Wenqiang , Feng Zhiqiang , Hao Xiaoning 
Published: November 2024

ObjectiveTo analyse the rational prescription of medicines by village clinics following China’s implementation of the New Healthcare System Reform (NHCSR).DesignRetrospective study.SettingVillage clinics in a province in eastern China.Primary and secondary outcome measuresOur evaluation was based on the core drug use indicators reported in the study ‘How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators’.ResultsThe level of rational use of medicines (RUMs) in village clinics improved in 2018 compared with 2009; the average number of drugs per prescription decreased from 3.66 to 2.77, the percentage of prescriptions including antibiotics decreased from 65.40% to 46.00%, and the percentage of prescriptions including injections decreased from 55.75% to 37.48% (all p<0.01), whereas the percentage of drugs prescribed from the list of essential medicines increased from 66.50% to 80.34%, and the percentage of drugs prescribed by generic names increased from 61.29% to 70.65% (all p<0.01).ConclusionThe level of RUMs improved after the implementation of the NHCSR, however, it was found that there was still a gap between the level of RUMs in 2018 and the international reference value. Financial investments, electronic prescription systems, improved supervision and regular training are essential actions that must be implemented.
Exploring the role of the built environment and psychosocial mediators on knee function in knee osteoarthritis patients in Singapore: a cross-sectional study
Authors: Sahrin Razeena , Ng Claire Jia Yi , Lim Chien Joo , Goh Zack Zhong Sheng , Pua Yong-Hao , Tan Bryan Yijia 
Published: November 2024

Objectives(1) To examine if a more accessible built environment (BE) is significantly associated with better knee function outcomes in knee osteoarthritis (OA) patients. (2) To assess if the relationship between BE and knee function is mediated by fear of movement and self-efficacy.DesignCross-sectional study.SettingTwo tertiary hospitals in Singapore.Participants212 knee OA patients (mean: 63.81±8.27 years old), majority female (69.8%). Inclusion criteria: (i) meets National Institute for Health and Care Excellence criteria for knee OA, (ii) independent community ambulant. Exclusion criteria: (i) alternative diagnosis to knee OA, (ii) secondary osteoarthritis, (iii) severe medical and/or cognitive comorbidity impairing activities of daily living, (iv) previous knee arthroplasty, (v) wheelchair bound, or (vi) pregnant.Primary and secondary outcome measures; StatisticsHow self-efficacy (Arthritis Self-Efficacy Scale-8 (ASES-8)) and fear of movement (Brief Fear of Movement (BFOM)) mediates impact of overall BE (IPAQ-Environment module: Access to Destinations) and five item-specific domains of BE accessibility on knee function (Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12)). For variables significantly correlated with BE and KOOS-12 in bivariate Pearson correlation tests, mediation analysis was performed with confounders adjusted.ResultsTotal BE (r=0.142, p=0.038) and accessibility to transit station (r=0.161, p=0.019) were positively correlated with KOOS-12. Structural barriers (r=−0.138, p=0.045) were negatively correlated with KOOS-12. ASES-8 was a significant mediator in the relationship between accessibility to transit station and KOOS-12 (coeff=0.87, 95% CI=(0.24, 1.69), p=0.005) and between total BE and KOOS-12 (coeff=0.25, 95% CI=(0.10, 0.45), p=0.004). BFOM was a marginally significant mediator between structural barriers and KOOS-12 (coeff=−0.36, 95% CI=(−0.86, –0.02); p=0.054).ConclusionMore accessible BE and lesser structural barriers in the BE are associated with better knee function. Self-efficacy mediates the relationship between overall BE accessibility and knee function. Fear of movement mediates the negative association between barriers in the BE and knee function.Applications include assessing BE barriers and psychosocial mediators in clinician consultations, developing multidisciplinary integrated care models and urban designers planning mobility friendly BEs.Trial registration numberThe study has been registered under clinicaltrials.gov registry (Identifier:NCT04942236).
Association between myopia and sleep duration among primary school students in minority regions of Southwest China: a school-based cross-sectional research
Authors: Huang Ying , Ge Zhengyan , Chang Litao , Zhang Qiang , Xiao Jie , Li Peiqian , Ma Zixue , Li Xixi , Luo Xiao , Huang Dafeng , Zhang Jinjiao 
Published: November 2024

ObjectiveTo investigate the relationship between sleep duration and myopia among primary school students in minority regions of Southwest China.MethodsThe school-based, cross-sectional study was conducted from October 2020 to January 2021. All participants underwent a comprehensive ocular examination and completed a questionnaire on demographic characteristics, ophthalmological history and major environmental factors for myopia. Spherical equivalent (SE) and ocular biometric parameters were measured after cycloplegia, with myopia being defined as SE ≤−0.5 D (Diopter). Multivariate regression models were used to examine the association of sleep duration with myopia, SE and axial length (AL).ResultsA total of 857 students from grades 2 to 4 were included in the analysis, of which 63.6% were myopic and 62.0% belonged to ethnic minorities. Boys had a slightly higher prevalence of myopia compared with girls (66.7% vs 60.6%, p=0.06). Myopic students had longer AL, deeper anterior chamber depth and thinner central corneal thickness compared with non-myopic students (all p<0.05). There was no significant association between sleep duration and myopia in both boys and girls (p=0.319 and 0.186, respectively). Moreover, girls with a sleep duration of 8–9 hour/day had higher SE and shorter AL compared with those with less than 8 hour/day of sleep (β=0.41 and −0.32, respectively, all p<0.05).ConclusionThis cross-sectional study did not find a significant association between sleep duration and myopia. However, it suggests that 8–9 hours of sleep per day may have a protective effect on SE progression and AL elongation in girls. Future studies with objectively measured sleep duration are needed to validate the findings.
Evaluating the social return on investment of dance movement for wellbeing in the prevention of burnout among healthcare staff: a study protocol
Authors: Lynch Mary , Filipponi Teresa , Wallace Carolyn 
Published: November 2024

IntroductionImprovement in the National Health Service (NHS) employees’ mental well-being and staff retention are current key issues. Evidence indicates that dance movement therapy (DMT) has been effective in improving mental health and well-being; however, a social return on investment (SROI) evaluation on DMT interventions aimed at NHS staff has not been performed. This protocol for an SROI study will explore the social value generated from DMT, specifically ‘The Body Moving Self-Compassion’ programme, as measured by the increase in personal well-being and resilience experienced by participants. The SROI evaluation aims to measure the monetary and social value generated through DMT by placing a monetary value which is essential for sound policy in accessing investment while contributing evidence of dance/movement’s impact on health.MethodsSROI is a pragmatic form of social cost-benefit analysis which uses quantitative and qualitative methods to value relevant costs, outcomes and associated impact. A mixed-methods approach design (focus group, online questionnaire and semistructured interviews) will be employed in this SROI study. SROI takes a societal perspective and considers relevant and significant outcomes for participants. Monetary values which often do not have a market price are then assigned to these outcomes. Contingent valuation is integrated into this study to estimate individuals’ choices, preferences and values associated with DMT. The social value generated by the identified outcomes will then be estimated in a similar way to cost-benefit analysis, and the ratio of social value generated per £1 invested is then calculated.Ethics and disseminationEthical approval for this study has been granted by the Faculty of Life Sciences and Education Ethics Subgroup at the University of South Wales, with Reference No. 230 236LR. The findings from this SROI study will result in a report and academic publications.
Impact of visualising healthcare quality performance: a systematic review
Authors: Yang Zijing , Alveyn Edward , Dey Mrinalini , Arumalla Nikita , Russell Mark D , Norton Sam , Galloway James B 
Published: November 2024

ObjectivePerformance visualisation tools are increasingly being applied in healthcare to enhance decision-making and improve quality of care. However, there is a lack of comprehensive synthesis of their overall effectiveness and the contextual factors that influence their success in different clinical settings. This study aims to provide a broad synthesis of visualisation interventions not limited to a specific department.DesignSystematic review.Data sourcesMEDLINE and Embase were searched until December 2022.Eligibility criteriaRandomised controlled trials (RCTs) and observational studies in English involving a visualisation intervention, either alone or as a core intervention, that reported quantitative outcomes including process and outcome indicators.Data extraction and synthesisData on study characteristics, intervention characteristics, outcome measures and results were extracted. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach, and risk of bias was evaluated with Risk of Bias 2 for RCTs and Risk of Bias in Non-randomised Studies - of Interventions for non-randomised studies.Results Of the 12 studies included, 2 were RCTs and 10 were observational studies, including 1 before-after study and 1 interrupted time series study. Five studies (42%) were conducted in teaching hospital settings. Compared with the control group or baseline, 10 studies reported a statistically significant change in at least one of their outcome measures. A majority of the studies reported a positive impact, including prescription adherence (6/10), screening tests (3/10) and monitoring (3/10). Visualisation tool factors like type, clinical setting, workflow integration and clinician engagement, may have some influence on the effectiveness of the intervention, but no reliable evidence was identified.ConclusionPerformance visualisation tools have the potential to improve clinical performance indicators. More studies with standardised outcome measures and integrating qualitative methods are needed to understand the contextual factors that influence the effectiveness of these interventions.
Effect of exercise referral schemes and self-management strategies on healthcare service utilisation among community-dwelling older adults: secondary analyses of two randomised controlled trials
Authors: Svensson Nanna Herning , Thorlund Jonas Bloch , Øllgaard Olsen Pia , Søndergaard Jens , Wehberg Sonja , Andersen Helene Støttrup , Caserotti Paolo , Thilsing Trine 
Published: November 2024

ObjectiveThe objective of this study is to explore whether offering an integrated self-management strategy and exercise referral scheme intervention (ERS+SMS) or a stand-alone ERS intervention is more effective in reducing healthcare service utilisation among community-dwelling older adults over time compared with a stand-alone SMS/control intervention.DesignSecondary analyses of two randomised controlled trials (RCTs) with linkage to Danish national health registries.SettingThree Danish municipalities: Esbjerg, Slagelse and Odense.ParticipantsDanish community-dwelling older adults, aged 65 years or older, were included in the study. Participants originated from two completed RCTs: the Welfare Innovation in Primary Prevention (WIPP, n=115) and the SITLESS project (SITLESS, n=333).InterventionParticipants in the two trials were randomly assigned to one of three intervention groups: ERS in combination with SMS (ERS+SMS), ERS alone or an SMS/control intervention.Main outcome measureAnnual number of days with contact to general practice (GP) and days hospitalised for all causes.ResultsNo statistically significant between-group difference was observed in the annual number of days with contact with GP between participants randomised to ERS+SMS (p=0.759) or ERS only (p=0.156) compared with those randomised to the SMS/control group. In addition, no statistically significant between-group differences in days hospitalised were observed when comparing the ERS+SMS (p=0.222) or ERS only (p=0.060) group to the SMS/control group.ConclusionNeither the integrated intervention (ERS+SMS) nor the ERS alone intervention was more effective in reducing healthcare service utilisation during a 2-year follow-up period compared with a stand-alone SMS/control intervention. A potential stabilising effect of ERS and/or SMS interventions on the general age-related increase in healthcare service utilisation cannot be ruled out but needs further exploration in future studies along with the exploration of the effects of long-term interventions.Trial registration numbersNCT04531852andNCT02629666.
Barriers and facilitators to antenatal care services utilisation in Somaliland: a qualitative study
Authors: Abdiwali Saad Ahmed , Adesina Olubukola A , Fekadu Gedefaw Abeje , Geta Teshome Gensa 
Published: November 2024

ObjectiveTo explore the barriers and facilitators of antenatal care (ANC) utilisation in Somaliland.DesignAn exploratory qualitative study design.SettingVarious settings were considered for study including maternal and child health clinics, hospitals and community.Methods74 study participants including 33 pregnant women, 22 healthcare providers, 10 community elders and ten religious leaders were purposively selected. Data was collected via focus group discussion and in-depth interviews in the local Somali language. The data was audio recorded, transcribed verbatim, translated into English and imported into NVivo V.12 software. Thematic framework analysis was used to assess barriers and facilitators of ANC utilisation.ResultsSix main themes were identified as barriers of ANC utilisation. These include lack of awareness, long distance and lack of transportation access, economic barriers, lack of social support, beliefs and thoughts and health facility-related factors such as caregivers approach, waiting time and inadequate skill of providers. Proper dissemination of ANC information, adequate spousal support and cheap pricing of services were found to be facilitators of ANC uptake.ConclusionA strategy that focuses on raising awareness about ANC, making it accessible by reducing the cost-of-service charge, encouraging partner involvement, improving the quality of services and making it customer-friendly will help to overcome the barriers of antenatal utilisation.