bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Fundamental Movement Skill Test for Preschool Children With and Without Overweight: The SALTO Test Battery
Authors: Birklbauer Jürgen , Gniewosz Burkhard , Freudenthaler Thomas , Birklbauer Anita , Pötzelsberger Birgit , Wiesinger Hans-Peter , Weghuber Daniel , Ring-Dimitriou Susanne 
Published: November 2024

Purpose: This study aimed to evaluate a 3-factor model of fundamental movement skills in preschool children, incorporating both process- and product-oriented assessment methods, and to test the model’s invariance across subgroups of age, body weight and sex. Methods: The SALTO test battery was administered to 736 preschool children aged 3–6 years. A single-indicator multitrait–multimethod model was specified with Locomotion, Object Manipulation, and Balance as latent factors and a latent method factor to address the multimethod design. Measurement invariance was tested across subgroups using multigroup confirmatory factor analysis. Results: The 3-factor model yielded good fit indices, confirming the construct validity of the SALzburg Together against Obesity test battery. Strong measurement invariance was found across body mass index groups, whereas partial invariance was observed across age and sex groups. Older children outperformed younger ones in all skill domains, children with overweight had lower skills in Balance and Locomotion, and sex differences were found in Object Manipulation and Balance. Conclusion: The SALTO test battery is a structurally valid tool for evaluating and comparing fundamental movement skills in preschool children across age, weight status, and sex. The findings underscore the importance of considering these factors when designing interventions to enhance fundamental movement skills in early childhood.
Nationwide incidence of anterior cruciate ligament reconstruction in higher-level athletes in Sweden: a cohort study from the Swedish National Knee Ligament Registry linked to six sports organisations
Authors: Castellanos Dolk Daniel , Hedevik Henrik , Stigson Helena , Wretenberg Per , Kvist Joanna , Stålman Anders 
Published: November 2024

ObjectiveTo determine and compare the incidence rate (IR) of anterior cruciate ligament reconstruction (ACL-R) among higher-level athletes across six sports in the Swedish National Knee Ligament Registry (SNKLR).MethodsPatient data from the SNKLR, between 2005 and 2020, was linked to team and event data of six sports (football, handball, basketball, ice hockey, floorball and alpine sports) to identify higher-level athletes aged 15–40 with ACL-R. Unadjusted and adjusted IR ratios (IRRs) with 99% CIs were calculated between sports, sex, age and divisions.ResultsFemale athletes had a 3.3 times higher ACL-R IR compared with males (1.08 vs 0.32, IRR=3.33, 99% CI: 2.65 to 4.19) per 1000 athlete exposures (AE). Basketball had the largest difference in ACL-R IR per 1000 AE between females and males (1.26 vs 0.22, IRR=5.69, 99% CI: 2.79 to 11.60). Female second-division athletes had higher ACL-R IR per 1000 AE compared with female highest-division athletes (1.27 vs 0.76, IRR=1.67, 99% CI: 1.30 to 2.15). No significant association between age and IR was observed. Compared with football, lower ACL-R IR was observed in floorball and ice hockey in females, as well as in floorball, basketball and ice hockey in males.ConclusionFemale athletes had higher ACL-R IRs than males and second-division female athletes had higher ACL-R IRs than highest-division female athletes. Lower ACL-R IRs were observed in floorball and ice hockey compared with football for both sexes. The remaining sports had ACL-R IRs similar to football, except basketball where rates were lower for male athletes.
Undiagnosed major risk factors in acute ischaemic stroke patients in Qatar: analysis from the Qatar stroke registry
Authors: Tran Kim H , Akhtar Naveed , Joseph Sujatha , Morgan Deborah , Uy Ryan , Babu Blessy , Shuaib Ashfaq 
Published: November 2024

ObjectiveWe examined the presentation to hospital, subtypes of ischaemic stroke for patients admitted to stroke services in Qatar and their 90-day prognosis based on the modified Rankin Scale (mRS) for those with diagnosed and undiagnosed diabetes, hypertension and dyslipidaemia.MethodsWe conducted a retrospective analysis of patients admitted with acute ischaemic stroke from January 2014 to April 2024. The mRS was dichotomised with favourable outcome (0–2) and unfavourable outcome (3–6).ResultsA total of 9479 patients were included in the study. Patients with a prior history of hypertension and dyslipidaemia and untreated/undiagnosed for these risk factors on admission were more likely to present with a lower National Institute of Health Stroke Scale (NIHSS) score at admission (p<0.001). These patients were also more likely to present with small vessel disease (SVD) or subcortical stroke (p<0.001). Multivariate analysis revealed that age (adjusted OR 1.05, 95% CI 1.04 to 1.06) and hypertension (adjusted OR 1.44, 95% CI 1.07 to 1.96) were more likely to have an mRS score of 3–6 at 90 days while males (adjusted OR 0.56, 95% CI 0.46 to 0.69), prior antidiabetic therapy (adjusted OR 0.52, 95% CI 0.34 to 0.79) and undiagnosed diabetes (adjusted OR 0.46, 95% CI 0.22 to 0.99) were protective against an mRS score of 3–6 at 90 days after adjusting for covariates.ConclusionPatients with a prior history of hypertension and dyslipidaemia and undiagnosed on admission are more likely to present with a lower NIHSS score but have a worse outcome at 90 days. The lower NIHSS may be explained by a higher frequency of SVD.
Influence of learning stress on anxiety levels among high school students in China: the chain-mediated role of physical activity and mobile phone addiction
Authors: Chen Xianghe , Lu Pengcheng , Yi Xiaoyan , Zeng Xinyu , Shen Ziming , Li Wenxiu , Yin Rongbin 
Published: November 2024

ObjectivesThe objectives are to explore the relationship between study stress and anxiety in high school students and the mediating role of physical activity and mobile phone addiction.DesignA cross-sectional study.Setting129 high schools were randomly selected in 13 cities of Jiangsu province, China.ParticipantsHigh school students aged 16–19 years, age and gender balance. A total of 40 000 questionnaires were distributed, with 32 974 effectively recovered.Primary and secondary outcome measuresQuestionnaires were administered offline, covering four parts: General Demographics, Learning Stress Scale, International Physical Activity Questionnaire, Mobile Phone Addiction Scale and Generalized Anxiety Scale-7. Data analysis included path analysis and correlation analysis, along with descriptive statistics, independent sample t-test, correlation analysis and structural equation model.ResultsIn this study, the proportions of anxiety, high academic pressure, low physical activity level and high mobile phone addiction were 58.18%, 46.48%, 36.40% and 39.26%, respectively. Study stress was positively correlated with anxiety (r=0.130, p<0.01) and mobile phone addiction (r=0.049, p<0.01). Physical activity was negatively correlated with learning stress (r=−0.352, p<0.01), anxiety (r=−0.105, p<0.01) and mobile phone addiction (r=−0.040, p<0.01). The findings were tested by mediating effect analysis that the indirect effect size value of the path ‘learning stress → physical activity level → anxiety path’ was 0.461, 95% CI of Bootstrap (0.367, 0.554), the mediating effect was significant. The indirect effect size value of the path ‘learning stress → mobile phone addiction → anxiety’ was 0.072, 95% CI of Bootstrap (0.042, 0.102), and the mediating effect was significant. The indirect effect size value of the path ‘learning stress → physical activity level → mobile phone addiction → anxiety’ was 0.072, and the 95% CI of Bootstrap (0.226, 0.400), and the mediating effect was significant.ConclusionsHigh school students’ learning stress can significantly positively predict anxiety levels. High school students learning stress indirectly predicts anxiety through the independent mediating effect of physical activity and mobile phone addiction, as well as the chain mediating effect of physical activity and mobile phone addiction.
Exploring the barriers and facilitators to HIV information and health services among youth in N’Djamena, Chad: a qualitative descriptive study
Authors: Bedingar Esias , Bedingar Ngarossorang , Seli Djimet , Sudfeld Christopher R 
Published: November 2024

ObjectivesIdentifying the barriers and facilitators for Chadian youth (aged 15–24 years) along the pathway of access to HIV information and health services.Study designQualitative descriptive study.Study settingThe study was conducted in N’Djamena, Chad, with 20 high schools purposefully selected based on participation in a Blue Cross Chad (BCC) peer-to-peer education programme.ParticipantsA total of four focus groups, each consisting of 12 participants, stratified by gender and BCC programme participation (two each among participating and non-participating high schools), were conducted.MethodsA descriptive qualitative study using thematic analysis of content was conducted. The qualitative software ATLAS.ti V.22 was used to organise and code the data.ResultsFive main categories of barriers and facilitators for HIV information and health services were identified, including (1) societal expectations and norms; (2) power dynamics; (3) social networks; (4) peer-education programmes; and (5) bypassing the system. Barriers and facilitators to information information-seeking and access to health services were observed at individual, community and system levels. High school students expressed that access to information and health services were important when it comes to HIV and AIDS prevention and treatment. Societal expectations and power dynamics were identified as key barriers, while trust through social networks and peer-education programmes were key facilitators to accessing information and health services.ConclusionThis study allowed for the identification of both barriers and facilitators of HIV information and health-seeking in the context of N’Djamena, Chad. Our findings highlight the importance of comprehensive community- and youth-led approaches that are youth-friendly and youth-centric and are needed to effectively communicate HIV information.
Evaluating the effectiveness of the National Health Insurance Subsidy Programme within Kenya’s universal health coverage initiative: a study protocol
Authors: Maritim Beryl , Nzinga Jacinta , Tsofa Benjamin , Musiega Anita , Mugo Peter Mwangi , Wong Ethan , Mazzilli Caitlin , Ng'an'ga Wangari , Hagedorn Brittany , Turner Gillian , Musuva Anne , Murira Felix , Ravishankar Nirmala , Barasa Edwine 
Published: November 2024

BackgroundLow-income and middle-income countries, including Kenya, are pursuing universal health coverage (UHC) through the establishment of Social Health Insurance programmes. As Kenya rolls out the recently unveiled UHC strategy that includes a national indigent cover programme, the goal of this study is to evaluate the impact of health insurance subsidy on poor households’ healthcare costs and utilisation. We will also assess the effectiveness and equity in the beneficiary identification approach employed.Methodology and analysisUsing a quantitative design with quasi-experimental and cross-sectional methods, our matched cohort study will recruit 1350 households across three purposively selected counties. The ‘exposure’ arm, enrolled in the UHC indigent programme, will be compared with a control arm of eligible but unenrolled households over 12 months. Coarsened exact matching will be used to pair households based on baseline characteristics, analysing differences in expenses and catastrophic health expenditure. A cross-sectional design will be employed to evaluate the effectiveness and equity in beneficiary identification, estimating inclusion errors associated with the subsidy programme while assessing gender equity.Ethics and disseminationEthical approval has been obtained from the Scientific and Ethics Review Unit at Kenya Medical Research Institute, with additional permissions sought from County Health Departments. Participants will provide written informed consent. Dissemination strategies include peer-reviewed publications, conference presentations and policy-maker engagement for broad accessibility and impact.
Anifrolumab Study for Treatment Effectiveness in the Real World (ASTER) among patients with systemic lupus erythematosus: protocol for an international observational effectiveness study
Authors: Mosca Marta , Emmas Cathy , Nekeman-Nan Cassandra , Stirnadel-Farrant Heide , Chen Samuel , Carty Lucy , Waratani Miina , Seo Caroline , Chen Stephanie , Sorrentino Alessandro 
Published: November 2024

IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with a diverse clinical presentation that involves multiple organ systems and may lead to organ damage and increased risk of mortality. SLE is associated with a high burden of disease that can include loss of productivity and employment and reduced health-related quality of life. The current standard of care for SLE is primarily based on immunosuppression and glucocorticoids and is associated with risk of toxicities and poor tolerability. Anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1, was recently approved as a new treatment for patients with moderate-to-severe SLE.Methods and analysisHere, we report the study design of the ongoing, multinational Anifrolumab Study for Treatment Effectiveness in the Real World (ASTER) that includes 3-years of follow-up beginning with the first infusion of anifrolumab and 1 year of retrospective baseline data. ASTER aims to enrol 500 adult patients receiving anifrolumab for SLE in Europe and Canada. The key study objective is to describe the real-world effectiveness of anifrolumab in routine clinical practice, including clinician-reported disease activity and patient-reported outcomes collected via mobile application. This mobile application also includes a medication diary, where patients report their prescription and non-prescription medication use for SLE on a weekly basis; these data will lend insights on treatment patterns for the study population.Ethics and disseminationThe design of the ASTER study was informed through consultations with patients with SLE who provided important insights to help maximise patient engagement, retention and the collection of key, patient-relevant endpoints. ASTER enrolment began in February 2023 and the study is expected to finish in 2029.Trial registration numberNCT05637112.
Longitudinal assessment of serum albumin levels with the risk of coronary artery calcification progression in an asymptomatic population of Korean adults: an observational cohort study
Authors: Won Ki-Bum , Choi Su-Yeon , Chun Eun Ju , Park Sung Hak , Sung Jidong , Jung Hae Ok , Chang Hyuk Jae 
Published: November 2024

ObjectivesThis study evaluated the association between serum albumin levels and coronary artery calcification (CAC) progression in asymptomatic adults without hypoalbuminaemia at baseline.DesignObservational cohort study.SettingData from the Korea Initiatives on Coronary Artery Calcification (KOICA) which is a retrospective, single ethnicity, multicentre and observational registry were analysed.ParticipantsA total of 12 344 Korean adults with baseline albumin level of ≥3.5 g/dL (51.7±8.5 years; 84.3% male) were included. The median interscan period was 3.0 (2.0–4.8) years. All participants were stratified into three groups based on serum albumin tertile.Primary and secondary outcome measuresAssociation of serum albumin with the risk of CAC progression was analysed using multivariate logistic regression models with adjustment of interscan period. CAC progression was defined as a square root (√) transformed difference between the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS) of ≥2.5. Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by interscan period.ResultsWith increasing serum albumin tertiles, the annualised Δ√transformed CACS (I (lowest): 0.16 (0–1.24) vs II: 0 (0–1.09) vs III (highest): 0 (0–1.01)) and the incidence of CAC progression (I: 36.6% vs II: 31.3% vs III: 25.0%) were decreased despite higher prevalence of hypertension, diabetes and hyperlipidaemia (all p<0.05). Serum albumin levels were inversely related to the annualised Δ√transformed CACS and the risk of CAC progression among overall participants. After adjusting for age, sex, hypertension, diabetes, hyperlipidaemia, obesity, current smoking, alcohol consumption, serum creatinine levels, baseline CACS and interscan period, this inverse association between serum albumin levels (per-1 g/dL increase) and the risk of CAC progression was consistently observed, especially in baseline CACS of 1–10 (OR: 0.392, 95% CI: 0.234 to 0.658) and 11–100 (OR: 0.580, 95% CI: 0.381 to 0.883) (all p<0.05).ConclusionsSerum albumin levels were inversely associated with the risk of CAC progression. This phenomenon was predominantly observed in CACS of 1–100 at baseline.
Electronic health record data analysis on the impact of rescue-triggered inhaled corticosteroids on controller therapy in Black and Latinx individuals from a pragmatic, open-label, patient-level randomised trial
Authors: Callen Elisabeth , Israel Elliot , Cardet Juan Carlos , Fuhlbrigge Anne L , Manning Brian , Gaona Gabriela , Staton Elizabeth , Pace Wilson D 
Published: November 2024

ObjectiveThe Person Empowered Asthma Relief (PREPARE) study found that as-needed inhaled corticosteroid (ICS) supplementation combined with participants’ usual controller and rescue therapy reduced asthma exacerbations for Black and Hispanic/Latinx individuals. We aimed to determine whether treatment assignment to the intervention group (Patient Activated Reliever-Triggered ICS (PARTICS)) versus the control group (usual care) influenced controller therapy based on clinicians’ written prescriptions.DesignSecondary data analysis of electronic health record data of a pragmatic, open-label, patient-level randomised trial.SettingPractices treating asthma.ParticipantsPREPARE study participants— Black and Hispanic/Latinx individuals with asthma.InterventionsEffects of adding ICS to rescue therapy among black and Hispanic adults with moderate-to-severe asthma.Outcome measuresFor PARTICS therapy impact on patients, each month is the 28-month period (12 months prior to enrolment, the month of enrolment and 15 months after enrolment), a patient was assigned to a controller step based on a six-step classification scheme. A linear mixed effect spline model was completed for before and after enrolment data to determine controller changes over a 28-month period between the two study arms.ResultsThis analysis included 713 participants. Of these, 49.1% were usual care patients and 50.9% were PARTICS patients. Throughout the study, the majority of patients changed asthma controller medications in both arms. By the end of the study, the usual care patients were at a significantly higher asthma controller medication step (0.20 step higher) than the PARTICS patients.ConclusionsClinicians’ prescribing patterns showed significant changes over time. Compared with usual care patients, PARTICS patients were on lower doses of asthma controller medications by the end of the study.Trial registration numberNCT02995733.
Comparing safety, performance and user perceptions of a patient-specific indication-based prescribing tool with current practice: a mixed methods randomised user testing study
Authors: Feather Calandra , Clarke Jonathan , Appelbaum Nicholas , Darzi Ara , Franklin Bryony Dean 
Published: November 2024

BackgroundMedication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-specific dosing recommendations. Objectives were to compare the incidence and types of erroneous medication orders, time to prescribe (TTP) and perceived workload using the NASA Task Load Index (TLX), in simulated prescribing tasks with and without this intervention. We also sought to identify the workflow steps most vulnerable to error and to gain participant feedback.MethodsA simulated, randomised, cross-over exploratory study was conducted at a London NHS Trust. Participants completed five simulated prescribing tasks with, and five without, the intervention. Data collection methods comprised direct observation of prescribing tasks, self-reported task load and semistructured interviews. A concurrent triangulation design combined quantitative and qualitative data.Results24 participants completed a total of 240 medication orders. The intervention was associated with fewer prescribing errors (6.6% of 120 orders) compared with standard practice (28.3% of 120 orders; odds ratio 0.18, p<0.01), a shorter TTP and lower overall NASA-TLX scores (p<0.01). Control arm workflow vulnerabilities included failures in identifying correct doses, applying maximum dose limits and calculating patient-specific dosages. Intervention arm errors primarily stemmed from misidentifying patient-specific information from the medication scenario. Thematic analysis of participant interviews identified six themes: navigating trust and familiarity, addressing challenges and suggestions for improvement, integration of local guidelines and existing CDSS, intervention endorsement, ‘search by indication’ and targeting specific patient and staff groups.ConclusionThe intervention represents a promising advancement in medication safety, with implications for enhancing patient safety and efficiency. Further real-world evaluation and development of the system to meet the needs of more diverse patient groups, users and healthcare settings is now required.Trial registration numberNCT05493072.
The Edinburgh Gastric Ulcer Score (EGUS): evaluation of a risk tool for gastric ulcer follow-up
Authors: Grant Rebecca K , Brindle William M , Watson Eleanor F , Penman Ian D , Church Nicholas I , Plevris John N , Shandro Benjamin M , McGowan Aaron P , Gordon-Walker Timothy T , Williams Michael J , Blair Carol S , Noble Colin L , Masterton Gail S M , Kalla Rahul 
Published: November 2024

ObjectiveIn May 2021 we implemented a locally developed gastric ulcer protocol. Patients with low Edinburgh Gastric Ulcer Scores (EGUS) and benign biopsy results at index oesophagogastroduodenoscopy (OGD1) were recommended to not undergo follow-up OGD (OGD2). We aimed to validate the EGUS and identify any gastric cancer diagnoses since protocol adoption.DesignPatients diagnosed with a gastric ulcer at OGD1 in NHS Lothian from 24 May 2021 to 24 June 2023 were identified. Data regarding the EGUS and biopsy rates were gathered and compared with the protocol. Electronic patient records were reviewed for subsequent diagnoses of gastric cancer.ResultsIn total, 236 patients were diagnosed with a gastric ulcer; 9.7% (n=23) were diagnosed with gastric cancer at OGD1. The EGUS produced a negative predictive value of 95.7%.OGD2s were performed in 46.0% (n=98/213) of patients; in 61.2% (n=60/98) this was in accordance with the protocol. No new pathology was identified at follow-up for OGD2s performed contrary to the protocol (median follow-up time 22 months (IQR 17–27)).OGD2s were not performed in 54.0% (n=115/213) of patients; in 83.5% (n=96/115) this was in accordance with the protocol. At follow-up (median 22 months, IQR 17–29), there were no gastric cancer diagnoses in these patients.ConclusionThe protocol is a safe and effective method to reduce the burden of repeat OGDs. Crucially, protocol adherence has demonstrated no missed gastric cancer diagnoses. Continued monitoring of patient outcomes is essential.