bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-year surveillance of body mass index and cardiorespiratory fitness in UK primary school children in North West England and the impact of school deprivation level
Authors: Mann Steven , Wade Matthew , Jones Michelle , Sandercock Gavin , Beedie Chris , Steele James 
Published: January 2019

ObjectivesCardiorespiratory fitness (CRF) is independently associated with health and academic attainment in childhood and adolescence. Yet overweight/obesity remains the focus in public health policy. Surveillance of body mass index (BMI) and CRF considering school deprivation levels is limited. Therefore, we examined this in English primary schools.MethodsParticipants (n=409) were students (9–10 years) from 13 schools. BMI and CRF (20 m shuttle run) were measured at three time points across the academic year and a fourth after summer recess.ResultsBMI z-scores significantly decreased (p=0.015) from autumn (z=0.336 (95% CI 0.212 to 0.460)) to spring (z=0.252 (95% CI 0.132 to 0.371)), and then significantly increased (p=0.010) to summer (z=0.327 (95% CI 0.207 to 0.447)). CRF significantly increased (p<0.001) from autumn (z=0.091 (95% CI −0.014 to 0.196)) to spring (z=0.492 (95% CI 0.367 to 0.616)), no change (p=0.308) into summer (z=0.411 (95% CI 0.294 to 0.528)) and a significant decrease (p<0.001) into the following autumn term (z=0.125 (95% CI 0.021 to 0.230)). BMI was unaffected by deprivation; however, pupils from the most deprived areas saw significantly greater reductions in CRF compared with pupils from affluent areas. No time, or deprivation level, by sex interactions were found.ConclusionSignificant reductions in children’s CRF occurred over the summer recess and were greater among children from schools in the most deprived areas. This may help inform future research into interventions targeting physical activity of schoolchildren, particularly over the summer recess.
Retinal microvascular abnormalities in neurofibromatosis type 1
Authors: Moramarco Antonietta , Miraglia Emanuele , Mallone Fabiana , Roberti Vincenzo , Iacovino Chiara , Bruscolini Alice , Giustolisi Rosalia , Giustini Sandra 
Published: January 2019

PurposeThe aim of this study was to provide a classification of the different retinal vascular arrangements in neurofibromatosis 1 (NF1), with appropriate qualitative and quantitative information.MethodsThis study was conducted on 334 consecutive patients with NF1 and 106 sex-matched and age-matched healthy control subjects. Each patient underwent a comprehensive ophthalmological examination inclusive of near-infrared reflectance retinography by using the spectral domain Optical coherence tomography (OCT), a complete dermatological examination and 1.5 T MRI scan of the brain to assess the presence of optic nerve gliomas. To evaluate the predictability and the diagnostic accuracy of our identified retinal microvascular arrangements, we calculated the diagnostic indicators for each pattern of pathology, with corresponding 95% CI. In addition, we evaluated the association between the microvascular arrangements and each National Institutes of Health diagnostic criteria.ResultsMicrovascular abnormalities were detected in 105 of 334 NF1 patients (31.4%), the simple vascular tortuosity was recognised in 78 of 105 cases (74.3%) and whether the corkscrew pattern and the moyamoya-like type showed a frequency of 42.8% (45 of 105 cases) and 15.2% (16 of 105 cases), respectively. We found a statistically significant correlation between the presence of retinal microvascular abnormalities and the patient age (p=0.02) and between the simple vascular tortuosity, the patient age and the presence of neurofibromas (p=0.002 and p=0.05, respectively).ConclusionsWe identified microvascular alterations in 31.4% of patients and a statistically significant association with patient age. Moreover, the most frequent type of microvascular alterations, the simple vascular tortuosity, resulted positively associated with age and with the presence of neurofibromas.
Risk-stratified systemic surveillance in uveal melanoma
Authors: Davanzo Jacquelyn M , Binkley Elaine M , Bena James F , Singh Arun D 
Published: January 2019

Background/AimMolecular prognostication provides clinically applicable prognostic information for patients with uveal melanoma. Most ocular oncologists recommend intensive metastatic surveillance for patients with high-risk tumours. However, socioeconomic variables may limit a patient’s ability to adhere to recommended surveillance. We aim to analyse socioeconomic data from patients with uveal melanoma who underwent molecular prognostication to determine which variables influence adherence.MethodsThis was a retrospective review of 107 consecutive patients who were diagnosed and treated for uveal melanoma from January 2014 to June 2015. Patients were categorised into low/unknown risk and high risk for metastasis. The low-risk group was followed with hepatic ultrasonography every 6 months. The high-risk group was followed with more frequent hepatic imaging or incorporation of hepatic CT/MRI into the surveillance protocol. Adherence to surveillance recommendations was recorded for the first 2 years following primary treatment. Socioeconomic data including age at diagnosis, baseline systemic staging, gene expression profile status, marital status, insurance, distance of primary residence, median household income and Charlson Comorbidity Index score were recorded. Frequency/modality of imaging and metastatic status were also recorded.ResultsHigh-risk patients were more likely to develop metastasis than low-risk/unknown-risk patients (p<0.001). High-risk patients were more likely to have scans at baseline (p=0.008) and to have expected scans relative to low-risk/unknown-risk patients (p<0.001). There was no significant relationship between the likelihood of adhering to recommended surveillance and the other variables analysed.ConclusionsPrognostic risk level is a significant predictor of surveillance and remains significant after adjustment for socioeconomic variables. Adherence to surveillance recommendations for high-risk patients may translate into improved survival.
Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials
Authors: Sievert Katherine , Hussain Sultana Monira , Page Matthew J , Wang Yuanyuan , Hughes Harrison J , Malek Mary , Cicuttini Flavia M 
Published: January 2019

AbstractObjectiveTo examine the effect of regular breakfast consumption on weight change and energy intake in people living in high income countries.DesignSystematic review and meta-analysis.Data sourcesPubMed, Ovid Medline, and CINAHL were searched for randomised controlled trials published between January 1990 and January 2018 investigating the effect of breakfast on weight or energy intake. ClinicalTrials.gov and the World Health Organization’s International Clinical Trials Registry Platform search portal were also searched in October 2018 to identify any registered yet unpublished or ongoing trials.Eligibility criteria for selecting studiesRandomised controlled trials from high income countries in adults comparing breakfast consumption with no breakfast consumption that included a measure of body weight or energy intake. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random effects meta-analyses of the effect of breakfast consumption on weight and daily energy intake were performed.ResultsOf 13 included trials, seven examined the effect of eating breakfast on weight change, and 10 examined the effect on energy intake. Meta-analysis of the results found a small difference in weight favouring participants who skipped breakfast (mean difference 0.44 kg, 95% confidence interval 0.07 to 0.82), but there was some inconsistency across trial results (I2=43%). Participants assigned to breakfast had a higher total daily energy intake than those assigned to skip breakfast (mean difference 259.79 kcal/day, 78.87 to 440.71; 1 kcal=4.18 kJ), despite substantial inconsistency across trial results (I2=80%). All of the included trials were at high or unclear risk of bias in at least one domain and had only short term follow-ups (mean period seven weeks for weight, two weeks for energy intake). As the quality of the included studies was mostly low, the findings should be interpreted with caution.ConclusionThis study suggests that the addition of breakfast might not be a good strategy for weight loss, regardless of established breakfast habit. Caution is needed when recommending breakfast for weight loss in adults, as it could have the opposite effect. Further randomised controlled trials of high quality are needed to examine the role of breakfast eating in the approach to weight management.Study registrationPROSPERO registration number CRD42017057687.
CapeOX perioperative chemotherapy versus postoperative chemotherapy for locally advanced resectable colon cancer: protocol for a two-period randomised controlled phase III trial
Authors: Liu Fangqi , Tong Tong , Huang Dan , Yuan Weitang , Li Dechuan , Lin Jianjiang , Cai Sanjun , Xu Ye , Chen Wenbin , Sun Yueming , Zhuang Jing 
Published: January 2019

IntroductionAdjuvant chemotherapy with the CapeOX regimen is now widely used for treating colorectal cancer. However, prior studies have demonstrated better efficacy of pre-operative/neoadjuvant chemotherapy without increase of safety risks.Methods and AnalysisThis multicentre, open-label, parallel-group, randomised, controlled, phase III study aims to compare the efficacy and safety of perioperative CapeOX chemotherapy with the postoperative one for treating patients with locally advanced R0 resectable colon cancers in China. In total 1370 eligible patients will be randomised to: the test group, up to four cycles (every 3 weeks is a cycle, Q3W) of chemotherapy plus radical surgery plus up to four cycles of post-operative chemotherapy; or the control group, radical surgery first, then up to eight cycles of chemotherapy. In each cycle, oxaliplatin will be given at a dose of 130 mg/m2through continuous IV infusion for 2 hours on the first day. From day 1 to day 14, capecitabine will be taken orally every morning and evening at a dose of 1000mg/m2/d. The primary outcome measure is the 3-year disease free survival. The objective response rate, R0 resection rate, overall survival, as well as the adverse events will also be measured as second endpoints. The study may include two periods. If results of period 1 are not favourable, period 2 will be initiated, recruiting genetically sensitive patients and repeating the same process with period 1.Ethics and disseminationInformed consent will be required from, and provided, by all subjects. The study protocol has been approved by the independent ethics committee of Shanghai Fudan University Cancer Centre. This study will clearly demonstrate the potential benefit of perioperative chemotherapy with the CapeOX regimen. Results will be shared among all the participating centres, and with policymakers and the academic community to promote the clinical management of colon cancer.Trial registration numberNCT03125980.
Economic impact of potentially inappropriate prescribing and related adverse events in older people: a cost-utility analysis using Markov models
Authors: Moriarty Frank , Cahir Caitriona , Bennett Kathleen , Fahey Tom 
Published: January 2019

ObjectivesTo determine the economic impact of three drugs commonly involved in potentially inappropriate prescribing (PIP) in adults aged ≥65 years, including their adverse effects (AEs): long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines and proton pump inhibitors (PPIs) at maximal dose; to assess cost-effectiveness of potential interventions to reduce PIP of each drug.DesignCost-utility analysis. We developed Markov models incorporating the AEs of each PIP, populated with published estimates of probabilities, health system costs (in 2014 euro) and utilities.ParticipantsA hypothetical cohort of 65 year olds analysed over 35 1-year cycles with discounting at 5% per year.Outcome measuresIncremental cost, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios with 95% credible intervals (CIs, generated in probabilistic sensitivity analysis) between each PIP and an appropriate alternative strategy. Models were then used to evaluate the cost-effectiveness of potential interventions to reduce PIP for each of the three drug classes.ResultsAll three PIP drugs and their AEs are associated with greater cost and fewer QALYs compared with alternatives. The largest reduction in QALYs and incremental cost was for benzodiazepines compared with no sedative medication (€3470, 95% CI €2434 to €5001; −0.07 QALYs, 95% CI −0.089 to –0.047), followed by NSAIDs relative to paracetamol (€806, 95% CI €415 and €1346; −0.07 QALYs, 95% CI −0.131 to –0.026), and maximal dose PPIs compared with maintenance dose PPIs (€989, 95% CI -€69 and €2127; −0.01 QALYs, 95% CI −0.029 to 0.003). For interventions to reduce PIP, at a willingness-to-pay of €45 000 per QALY, targeting NSAIDs would be cost-effective up to the highest intervention cost per person of €1971. For benzodiazepine and PPI interventions, the equivalent cost was €1480 and €831, respectively.ConclusionsLong-term benzodiazepine and NSAID prescribing are associated with significantly increased costs and reduced QALYs. Targeting inappropriate NSAID prescribing appears to be the most cost-effective PIP intervention.
Inequalities in healthcare resources and outcomes threatening sustainable health development in Ethiopia: panel data analysis
Authors: Woldemichael Abraha , Takian Amirhossein , Akbari Sari Ali , Olyaeemanesh Alireza 
Published: January 2019

ObjectiveTo measure inequalities in the distributions of selected healthcare resources and outcomes in Ethiopia from 2000 to 2015.DesignA panel data analysis was performed to measure inequalities in distribution of healthcare workforce, infrastructure, outcomes and finance, using secondary data.SettingThe study was conducted across 11 regions in Ethiopia.ParticipantsRegional population and selected healthcare workforce.Outcomes measuredAggregate Theil and Gini indices, changes in inequalities and elasticity of healthcare resources.ResultsDespite marked inequality reductions over a 16 year period, the Theil and Gini indices for the healthcare resources distributions remained high. Among the healthcare workforce distributions, the Gini index (GI) was lowest for nurses plus midwives (GI=0.428, 95% CI 0.393 to 0.463) and highest for specialist doctors (SPDs) (GI=0.704, 95% CI 0.652 to 0.756). Inter-region inequality was the highest for SPDs (95.0%) and the lowest for health officers (53.8%). The GIs for hospital beds, hospitals and health centres (HCs) were 0.592(95% CI 0.563 to 0.621), 0.460(95% CI 0.404 to 0.517) and 0.409(95% CI 0.380 to 0.439), respectively. The interaction term was highest for HC distributions (47.7%). Outpatient department visit per capita (GI=0.349, 95% CI 0.321 to 0.377) and fully immunised children (GI=0.307, 95% CI 0.269 to 0.345) showed inequalities; inequality in the under 5 years of age mortality rate increased overtime (P=0.048). Overall, GI for government health expenditure (GHE) was 0.596(95% CI 0.544 to 0.648), and the estimated relative GHE share of the healthcare workforce and infrastructure distributions were 46.5% and 53.5%, respectively. The marginal changes in the healthcare resources distributions were towards the advantaged populations.ConclusionThis study revealed high inequalities in healthcare resources in favour of the advantaged populations which can hinder equal access to healthcare and the achievements of healthcare outcomes. The government should strengthen monitoring mechanisms to address inequalities based on the national healthcare standards.
Determinants of imbalanced sex ratio at birth in Nepal: evidence from secondary analysis of a large hospital-based study and nationally-representative survey data
Authors: Pradhan Elina , Pearson Erin , Puri Mahesh , Maharjan Manju , Maharjan Dev Chandra , Shah Iqbal 
Published: January 2019

ObjectivesTo quantify sex ratios at births (SRBs) in hospital deliveries in Nepal, and understand the socio-demographic correlates of skewed SRB. Skewed SRBs in hospitals could be explained by sex selective abortion, and/or by decision to have a son delivered in a hospital—increased in -utero investments for male fetus. We use data on ultrasound use to quantify links between prenatal knowledge of sex, parity and skewed SRBs.DesignSecondary analysis of: (1) de-identified data from a randomised controlled trial, and (2) 2011 Nepal Demographic and Health Survey (NDHS).SettingNepal.Participants(1) 75 428 women who gave birth in study hospitals, (2) NDHS: 12 674 women aged 15–49 years.Outcome measuresSRB, and conditional SRB of a second child given first born male or female were calculated.ResultsUsing data from 75 428 women who gave birth in six tertiary hospitals in Nepal between September 2015 and March 2017, we report skewed SRBs in these hospitals, with some hospitals registering deliveries of 121 male births per 100 female births. We find that a nationally representative survey (2011 NDHS) reveals no difference in the number of hospital delivery of male and female babies. Additionally, we find that: (1) estimated SRB of second-order births conditional on the first being a girl is significantly higher than the biological SRB in our study and (2) multiparous women are more likely to have prenatal knowledge of the sex of their fetus and to have male births than primiparous women with the differences increasing with increasing levels of education.ConclusionsOur analysis supports sex-selective abortion as the dominant cause of skewed SRBs in study hospitals. Comprehensive national policies that not only plan and enforce regulations against gender-biased abortions and, but also ameliorate the marginalised status of women in Nepal are urgently required to change this alarming manifestation of son preference.Trial registration numberNCT02718222.
Young people’s preferences for the use of emerging technologies for asymptomatic regular chlamydia testing and management: a discrete choice experiment in England
Authors: Eaton Sue , Biggerstaff Deborah , Petrou Stavros , Osipenko Leeza , Gibbs Jo , Estcourt Claudia S , Sadiq Tariq , Szczepura Ala 
Published: January 2019

ObjectiveTo undertake a comprehensive assessment of the strength of preferences among young people for attributes of emerging technologies for testing and treatment of asymptomatic chlamydia.DesignDiscrete choice experiment (DCE) with sequential mixed methods design. A staged approach to selection of attributes/levels included two literature reviews, focus groups with young people aged 16–24 years (n=21), experts’ review (n=13) and narrative synthesis. Cognitive testing was undertaken to pilot and adapt the initial questionnaire. Online national panel was used for final DCE survey to maximise generalisability. Analysis of questionnaire responses used multinomial logit models and included validity checks.SettingEngland.Participants1230 young people aged 16–24 from a national online panel (completion rate 73%).Outcome measuresORs for service attributes in relation to reference levels.ResultsThe strongest attribute influencing preferences was chlamydia test accuracy (OR 3.24, 95% CI 3.13 to 3.36), followed by time to result (OR 1.81, 95% CI 1.71 to 1.91). Respondents showed a preference for remote chlamydia testing options (self-testing, self-sampling and postal testing) over attendance at a testing location. For accessing treatment following a positive test result, there was a general preference for online (OR 1.21, 95% CI 1.15 to 1.28) versus traditional general practitioner (OR 1.18, 95% CI 1.12 to 1.24) or pharmacy (OR 1.15, 95% CI 1.10 to 1.22) over clinic services. For accessing a healthcare professional and receipt of antibiotics, there was little difference in preferences between options.ConclusionsBoth test accuracy and very short intervals between testing and results were important factors for young people when deciding whether to undergo a routine test for asymptomatic chlamydia, with test accuracy being more important. These findings should assist technology developers, policymakers, commissioners and service providers to optimise technology adoption in service redesign, although use of an online panel may limit generalisability of findings to other populations.
Accelerometer compared with questionnaire measures of physical activity in relation to body size and composition: a large cross-sectional analysis of UK Biobank
Authors: Guo Wenji , Key Timothy J , Reeves Gillian K 
Published: January 2019

ObjectivesPrevious studies of the association between physical activity and adiposity are largely based on physical activity and body mass index (BMI) from questionnaires, which are prone to inaccurate and biased reporting. We assessed the associations of accelerometer-measured and questionnaire-measured physical activity with BMI, waist circumference and body fat per cent measured by bioelectrical impedance and dual-energy X-ray absorptiometry (DXA).DesignCross-sectional analysis of UK Biobank participants.SettingUK Biobank assessment centres.Participants78 947 UK Biobank participants (35 955 men and 42 992 women) aged 40–70 at recruitment, who had physical activity measured by both questionnaire and accelerometer.Main outcome measuresBMI, waist circumference and body fat per cent measured by bioelectrical impedance.ResultsGreater physical activity was associated with lower adiposity. Women in the top 10th of accelerometer-measured physical activity had a 4.8 (95% CI 4.6 to 5.0) kg/m2lower BMI, 8.1% (95% CI 7.8% to 8.3%) lower body fat per cent and 11.9 (95% CI 11.4 to 12.4) cm lower waist circumference. Women in the top 10th of questionnaire-measured physical activity had a 2.5 (95% CI 2.3 to 2.7) kg/m2lower BMI, 4.3% (95% CI 4.0% to 4.5%) lower body fat per cent and 6.4 (95% CI 5.9 to 6.9) cm lower waist circumference, compared with women in the bottom 10th. The patterns were similar in men and also similar to body fat per cent measured by DXA compared with impedance.ConclusionOur findings of approximately twofold stronger associations between physical activity and adiposity with objectively measured than with self-reported physical activity emphasise the need to incorporate objective measures in future studies.