bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of bariatric surgery on neural food processing and cognition: an fMRI study
Authors: Schulze Marcel , Sörös Peter , Vogel Wolfgang , Münte Thomas F , Müller Helge H O , Philipsen Alexandra 
Published: September 2018

IntroductionThe Roux-en-Y gastric bypass (RYGB) is one of the most widely used techniques for bariatric surgery. After RYGB, weight loss up to 50%–70% of excess body weight, improvement of insulin-resistance, changes in food preferences and improvements in cognitive performance have been reported. This protocol describes a longitudinal study of the neural correlates associated with food-processing and cognitive performance in patients with morbid obesity before and after RYGB relative to lean controls.Methods and analysisThis study is a pre–post case–control experiment. Using functional MRI, the neural responses to food stimuli and a working memory task will be compared between 25 patients with obesity, pre and post RYGB, and a matched, lean control group. Resting state fMRI will be measured to investigate functional brain connectivity. Baseline measurements for both groups will take place 4 weeks prior to RYGB and 12 months after RYGB. The effects of RYGB on peptide tyrosine tyrosine and glucagon-like polypeptide-1 will also be determined.Ethics and disseminationThe project has received ethical approval by the local medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-073). Results will be published in a peer-reviewed journal as original research and on international conferences.Trial registration numberDRKS00012495; Pre-results.
Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women’s Cohort Study (UKWCS)
Authors: Moy Foong Ming , Greenwood Darren C , Cade Janet E 
Published: September 2018

ObjectivesBreast cancer is associated with overweight and obesity after menopause. However, clothing size as a proxy of adiposity in predicting postmenopausal breast cancer is not widely studied. We aimed to explore the relationships between postmenopausal breast cancer risk with adipose indicators (including clothing sizes) and weight change over adulthood.DesignProspective cohort study.SettingEngland, Wales and Scotland.Participants17 781 postmenopausal women from the UK Women’s Cohort Study.Primary outcome measureIncident cases of malignant breast cancers (International Classification of Diseases (ICD) 9 code 174 and ICD 10 code C50).ResultsFrom 282 277 person-years follow-up, there were 946 incident breast cancer cases with an incidence rate of 3.35 per 1000 women. Body mass index (HR: 1.04; 95% CI: 1.02 to 1.07), blouse size (HR: 1.10; 1.03 to 1.18), waist circumference (HR: 1.07; 1.01 to 1.14) and skirt size (HR: 1.14;1.06 to 1.22) had positive associations with postmenopausal breast cancer after adjustment for potential confounders. Increased weight over adulthood (HR: 1.02; 1.01 to 1.03) was also associated with increased risk for postmenopausal breast cancer.ConclusionsBlouse and skirt sizes can be used as adipose indicators in predicting postmenopausal breast cancer. Maintaining healthy body weight over adulthood is an effective measure in the prevention of postmenopausal breast cancer.
Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis
Authors: Dawson Angela J , Krastev Yordanka , Parsonage William A , Peek Michael , Lust Karin , Sullivan Elizabeth A 
Published: September 2018

ObjectiveCardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services.MethodWe conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women’s experiences extracted from each publication to inform new healthcare practices and communication.ResultsEleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences.ConclusionsThere is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study
Authors: Lee Sang-Uk , Park Jong-Ik , Lee Soojung , Oh In-Hwan , Choi Joong-Myung , Oh Chang-Mo 
Published: September 2018

ObjectivesThe South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group.DesignA descriptive study using nationwide mortality rates.SettingData on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea.ParticipantsPeople living in South Korea.InterventionsImplementation of national suicide prevention policies (first: year 2004, second: year 2009).Primary outcome measuresSuicide was defined as ‘X60-X84’ code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate.ResultsFrom 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI −10.3% to −0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI −9.1% to −3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends.ConclusionOur results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
Nurse-led medicines’ monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines
Authors: Jordan Sue , Banner Timothy , Gabe-Walters Marie , Mikhail Jane M , Round Jeff , Snelgrove Sherrill , Storey Mel , Wilson Douglas , Hughes David 
Published: September 2018

IntroductionImproved medicines’ management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes.Methods and analysisThis process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method.Ethics and disseminationEthical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators.Trial registration numberNCT03110471.
What is the evolution of stroke unit’s accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases.
Authors: Istvan Marion , Lecoffre Camille , Bayat Sahar , Béjot Yannick , Le Strat Yann , De Peretti Christine , Gao Fei , Olié Valérie , Grimaud Olivier 
Published: September 2018

ObjectivesWe aimed to study trends in stroke unit (SU) admission during a period of their deployment in France and to assess whether this led to better and more equitable access to this specialised care.DesignAnalysis of records from the national hospital database.SettingAll acute care hospitals in metropolitan France for the period 2009–2014.ParticipantsOver 600 000 patients admitted in acute care with a main diagnosis of stroke.Main outcome measuresAdmission to a SU.ResultsBetween 2009 and 2014, the number of stroke admissions rose from 93 728 to 109 456, and the proportion of SU admission from 23% to 44%. Overall, characteristics associated with higher probability of SU admission were: male gender, younger age, ischaemic stroke type, medium level of comorbidity and larger size of town of residence. Although likelihood of SU admission increased in all patients’ categories during the study period, we identified steeper positive temporal trends among older patients, those with more comorbidities and those residing in medium or small towns (all p values <0.001), suggesting a ‘catching up’ phenomena. Temporal trends of men and women did not differ however.ConclusionsAdmission to SU nearly doubled in France between 2009 and 2014. Faster trends observed for patients with lower admission to SU suggest that equity in access has improved over the period.
Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study
Authors: Beom Jin Ho , Kim Min Joung , You Je Sung , Lee Hye Sun , Kim Ji Hoon , Park Yoo Seok , Shin Dong Min , Chung Hyun Soo 
Published: September 2018

ObjectivesTo analyse changes in the quality of cardiopulmonary resuscitation (CPR) according to driving patterns encountered during ambulance transport, using a virtual reality simulator.DesignProspective, cross-over, randomised study.SettingThis study was conducted at the National Fire Service Academy, Cheonan-si, Korea.ParticipantsEmergency medical technicians (39 men and 9 women) attending the National Fire Service Academy for clinical training with ≥6 months field experience or having performed ≥10 CPR. Individuals who withdrew consent were excluded.Outcome measuresCPR quality parameters (eg, chest compression depth and its variability).ResultsChest compressions were performed for 8 min each in a stationary and driving state. The mean chest compression depths were 54.8 mm and 55.3 mm during these two states, respectively (p=0.41). The SD of the chest compression depth was significantly higher while in the driving (7.6 mm) than in the stationary state (6.5 mm; p=0.04). The compression depths in the speed bump and sudden stop sections were 51.5 mm and 50.6 mm, respectively, which was shallower than those in all other sections (p<0.001). The correct hand position rate was low in the speed bump, sudden stop and right-hand cornering sections (65.4%, 71.5% and 72.5%, respectively; p=0.001)ConclusionsAlthough we found no differences in chest compression quality parameters between the stationary and driving states, the variability in the chest compression depth increased in the driving state. When comparing CPR quality parameters according to driving patterns, we noted a shallower compression depth, increased variability and decreased correct hand position rate in the speed bump, sudden stop and right-hand cornering sections. The clinical significance of these changes in CPR quality during ambulance transport remains to be determined. Future studies on how to reduce changes in the quality of CPR (including research on equipment development) are needed.
Access to care for people with alcohol use disorder in France: a mixed-method cross-sectional study protocol (ASIA)
Authors: Costa Marie , Marcellin Fabienne , Coste Marion , Barré Tangui , Nordmann Sandra , Mora Marion , Maradan Gwenaëlle , Tanti Marc , Cutarella Christophe , Casanova Danielle , Levy-Bellaiche Sabrina , Polomeni Pierre , Simon Nicolas , Roux Perrine , Carrieri Maria-Patrizia 
Published: September 2018

IntroductionAlcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol,Accès aux Soins et Indifference à l’Alcoolin French), aims to improve knowledge about factors associated with access to care for AUD by exploring related GP and PWAUD practices, experiences and perceptions.Methods and analysisThe ASIA project is an ongoing cross-sectional multisite study based on a complementary mixed-method approach (quantitative and qualitative) using a convergent parallel design. The double-perspective design of the study will enable us to collect and compare data regarding both PWAUD and GP points of view. For the PWAUD quantitative study, 260 PWAUD will be interviewed using a telephone-based questionnaire. For the qualitative study, 36 PWAUD have already been interviewed. The GP quantitative study will include 100 GP in a 15 min survey. Fifteen GP have already participated in semistructured interviews for the qualitative study. Logistic regression will be used to identify predictors for access to care. With respect to data analyses, qualitative interviews will be analysed using semantic analysis while quantitative logistic regression will be used for quantitative interviews.Ethics and disseminationThis study was approved by the CNIL (French National Commission on Informatics and Liberties) (approval reference number: C16-10, date of approval: 17 July 2017), the CCTIRS (Advisory Committee on Information Processing in Material Research in the Field of Health) and the CEEI (Evaluation and Ethics Committee) (approval reference number: 16–312, date of approval: 8 July 2016) of INSERM (French National Institute of Health and Medical Research). Results from ASIA will be disseminated in peer-reviewed publications, conference presentations, reports and in a PhD thesis.
Recorded atypical hallucinations in psychotic and affective disorders and associations with non-benzodiazepine hypnotic use: the South London and Maudsley Case Register
Authors: Birnie Karen Isabel , Stewart Robert , Kolliakou Anna 
Published: September 2018

ObjectivesHallucinations are present in many conditions, notably psychosis. Although under-researched, atypical hallucinations, such as tactile, olfactory and gustatory (TOGHs), may arise secondary to hypnotic drug use, particularly non-benzodiazepine hypnotics (‘Z drugs’). This retrospective case-control study investigated the frequency of TOGHs and their associations with prior Z drug use in a large mental healthcare database.MethodsTOGHs were ascertained in 2014 using a bespoke natural language processing algorithm and were analysed against covariates (including use of Z drugs, demographic factors, diagnosis, disorder severity and other psychotropic medications) ascertained prior to 2014.ResultsIn 43 339 patients with International Classification of Diseases, Tenth Edition schizophreniform or affective disorder diagnoses, 324 (0.75%) had any TOGH recorded (0.54% tactile, 0.24% olfactory, 0.06% gustatory hallucinations). TOGHs were associated with male gender, black ethnicity, schizophreniform diagnosis and higher disorder severity on Health of the National Outcome Scales. In fully adjusted models, tactile and olfactory hallucinations remained independently associated with prior mention of Z drugs (ORs 1.86 and 1.60, respectively).ConclusionsWe successfully developed a natural language processing algorithm to identify instances of TOGHs in the clinical record. TOGHs overall, tactile and olfactory hallucinations were shown to be associated with prior mention of Z drugs. This may have implications for the diagnosis and treatment of patients with comorbid sleep and psychiatric conditions.
We want to know: patient comfort speaking up about breakdowns in care and patient experience
Authors: Fisher Kimberly A , Smith Kelly M , Gallagher Thomas H , Huang Jim C , Borton James C , Mazor Kathleen M 
Published: September 2018

ObjectiveTo assess patient comfort speaking up about problems during hospitalisation and to identify patients at increased risk of having a problem and not feeling comfortable speaking up.DesignCross-sectional study.SettingEight hospitals in Maryland and Washington, District of Columbia.ParticipantsPatients hospitalised at any one of eight hospitals who completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey postdischarge.Main outcome measuresResponse to the question ‘How often did you feel comfortable speaking up if you had any problems in your care?’ grouped as: (1)no problemsduring hospitalisation, (2)alwaysfelt comfortable speaking up and (3)usually/sometimes/neverfelt comfortable speaking up.ResultsOf 10 212 patients who provided valid responses, 4958 (48.6%) indicated they had experienced a problem during hospitalisation. Of these, 1514 (30.5%) did not always feel comfortable speaking up. Predictors of having a problem during hospitalisation included age, health status and education level. Patients who were older, reported worse overall and mental health, were admitted via the Emergency Department and did not speak English at home were less likely to always feel comfortable speaking up. Patients who were not always comfortable speaking up provided lower ratings of nurse communication (47.8 vs 80.4; p<0.01), physician communication (57.2 vs 82.6; p<0.01) and overall hospital ratings (7.1 vs 8.7; p<0.01). They were significantly less likely to definitely recommend the hospital (36.7% vs 71.7 %; p<0.01) than patients who were always comfortable speaking up.ConclusionsPatients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.
Outcome after myocardial infarction without obstructive coronary artery disease
Authors: Williams Michael J A , Barr Peter R , Lee Mildred , Poppe Katrina K , Kerr Andrew J 
Published: September 2018

ObjectiveThe medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).MethodsWe performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome—Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.ResultsOf the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.ConclusionsMINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.
British rubber and cable industry cohort: 49-year mortality follow-up
Authors: McElvenny Damien Martin , Mueller William , Ritchie Peter , Cherrie John W , Hidajat Mira , Darnton Andrew J , Agius Raymond M , de Vocht Frank 
Published: September 2018

BackgroundThe International Agency for Research on Cancer (IARC) has determined there is sufficient evidence that working in the rubber manufacturing industry increases the risk of cancers of the stomach, lung, bladder and leukaemia and lymphoma.ObjectivesTo examine mortality patterns of a prospective cohort of men from the rubber and cable manufacturing industries in Great Britain.MethodsSMRs were calculated for males aged 35+ years at start of follow-up in 1967–2015 using the population of England and Wales as the external comparator. Tests for homogeneity and trends in SMRs were also completed.ResultsFor all causes, all malignant neoplasms, non-malignant respiratory diseases and circulatory diseases, SMRs were significantly elevated, and also particularly for cancers of the stomach (SMR=1.26,95% CI 1.18 to 1.36), lung (1.25,95% CI 1.21 to 1.29) and bladder (1.16,95% CI 1.05 to 1.28). However, the observed deaths for leukaemia, non-Hodgkin’s lymphoma (NHL) and multiple myeloma were as expected. Bladder cancer risks were elevated only in workers exposed to antioxidants containing 1-naphthylamine and 2-naphthylamine.ConclusionsThis study provides evidence of excess risks in the rubber industry for some non-cancer diseases and supports IARC’s conclusions in relation to risks for cancers of the bladder, lung and stomach, but not for leukaemia, NHL or multiple myeloma.