bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the exposure of street sweeping and potential risk factors for developing musculoskeletal disorders and related disabilities: a cross-sectional study
Authors: Salve Pradeep S , Chokhandre Praveen 
Published: December 2016

ObjectiveThis study aims to assess the exposure of those involved in street sweeping to the development of musculoskeletal disorders (MSDs) and related disabilities and tries to identify the individual risk factors thereof.DesignA cross-sectional survey was conducted among street sweepers together with a comparison group. A modified Standardized Nordic Questionnaire was adopted to measure the prevalence of MSDs and related disabilities. The impact of the occupation of sweeping on the development of MSDs and related disabilities was assessed using the propensity score matching (PSM) method. A multivariate logistic regression model was employed to identify the individual risk factors.ParticipantsStreet sweepers (n=180) and a comparison group (n=180), working for at least a year as formal employees of the Municipal Corporation of Greater Mumbai (MCGM), were randomly selected from 6 municipal wards.ResultsThe prevalence of the MSDs was significantly higher among the sweepers for shoulders (32%), wrists/hands (29%), elbows (27%) and neck (17%) compared with the comparison group, in which the prevalence was 11%, 19%, 9% and 11%, respectively. The disabilities too were significantly higher among the street sweepers for the lower back (27%), upper back (27%), wrists/hands (26%), shoulders (24%) and elbows (23%) compared with the comparison group, for which the figures were 18%, 19%, 13%, 9% and 6% respectively. The PSM method highlighted that the occupation of sweeping raised the risk of developing MSDs and disabilities particularly for the shoulders (17–16%), wrists/hands (14% each), elbows (13% each) and the upper back (12–13%). After adjusting the age, body mass index and the caste of the street sweepers, the number of years of engagement in street sweeping and the location of work emerged as potential risk factors in the development of MSDs and, thereby, related disabilities.ConclusionsThe study concluded that the occupation of street sweeping raises the risk of MSDs and related disabilities. This study recommends preventive and curative measures to deal with MSDs among street sweepers.
Social support as a mediator between problem behaviour and gambling: a cross-sectional study among 14–16-year-old Finnish adolescents
Authors: Räsänen Tiina , Lintonen Tomi , Tolvanen Asko , Konu Anne 
Published: December 2016

BackgroundDuring the adolescent period, risk-taking behaviour increases. These behaviours can compromise the successful transition from adolescence to adulthood. The purpose of this study was to examine social support as a mediator of the relation between problem behaviour and gambling frequency among Finnish adolescents.MethodsData were obtained from the national School Health Promotion Study (SHPS) from the years 2010 and 2011 (N=102 545). Adolescents were classified in the most homogeneous groups based on their problem behaviour via latent class analysis.ResultsPath analysis indicated that social support was negatively associated with problem behaviour, and problem behaviour and social support were negatively related (except for social support from friends among boys) to gambling. Social support from parents and school mediated, albeit weakly, the relations between problem behaviour and gambling among girls and boys.ConclusionsProblem behaviour may affect gambling through social support from school and parents. Thus prevention and intervention strategies should focus on strengthening adolescents' social support. In addition, because of the clustering of different problem behaviours instead of concentrating on a single form of problem behaviour multiple-behaviour interventions may have a much greater impact on public health.
Study protocol for a prospective, non-controlled, multicentre clinical study to evaluate the diagnostic accuracy of a stepwise two-photon excited melanin fluorescence in pigmented lesions suspicious for melanoma (FLIMMA study)
Authors: Fink Christine , Hofmann Maja , Jagoda Agata , Spaenkuch Iris , Forschner Andrea , Tampouri Ioanna , Lomberg Diana , Leupold Dieter , Garbe Claus , Haenssle Holger A 
Published: December 2016

IntroductionNon-invasive, nanosecond, stepwise two-photon laser excitation of skin tissue was shown to induce melanin fluorescence spectra that allow for the differentiation of melanocytic nevi from cutaneous melanoma.Methods and analysisThis prospective, non-controlled, multicentre clinical study is performed to evaluate the diagnostic performance of the stepwise two-photon excited melanin fluorescence in the detection of cutaneous melanoma. The comparator will be the histopathological diagnosis. A total of 620 pigmented skin lesions suspicious for melanoma and intended for excision will be enrolled.Ethics and disseminationEthics approval was provided by the local ethics committees of the medical faculties of the University of Tuebingen, Heidelberg and Berlin.Study registrationThe FLIMMA studyNCT02425475.
Does oral polio vaccine have non-specific effects on all-cause mortality? Natural experiments within a randomised controlled trial of early measles vaccine
Authors: Aaby Peter , Andersen Andreas , Martins Cesário L , Fisker Ane B , Rodrigues Amabelia , Whittle Hilton C , Benn Christine S 
Published: December 2016

BackgroundBCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs). If an unplanned intervention with a vaccine (a natural experiment) modifies the estimated effect in a randomised controlled trial (RCT), this suggests NSEs. We used this approach to test NSEs of triple oral polio vaccine (OPV).MethodsDuring an RCT of 2 doses of MV at 4.5 and 9 months versus 1 dose of MV at 9 months of age, we experienced 2 natural experiments with OPV. We assessed whether these OPV experiments modified the effect of 2-dose MV in the MV trial.SettingMV RCT conducted in urban Guinea-Bissau 2003–2009.InterventionsNatural experiments with OPV due to missing vaccine and the implementation of OPV campaigns.Main outcome measureChanges in the mortality rate ratio (MRR) for 2-dose MV versus 1-dose MV.ResultsFirst, the MRR (2-dose/1-dose MV) overall was 0.70 (0.52 to 0.94), but the MRR was 1.04 (0.53 to 2.04) when OPV at birth (OPV0) was not given, suggesting that early priming with OPV was important for the effect of 2-dose MV. The effect of OPV0 depended on age of administration; the MRR (2-dose/1-dose MV) was 0.45 (0.29 to 0.71) for children receiving OPV0 in the first week of life, but 3.63 (0.87 to 15.2) for those receiving OPV0 after the first month of life (p=0.007, test of no interaction). Second, campaign-OPV may have reduced the difference between the randomisation groups since the MRR (2-dose/1-dose MV) was 0.60 (0.42 to 0.85) for children who had not received campaign-OPV before RCT-enrolment versus 0.72 (0.23 to 2.31) and 1.42 (0.70 to 2.90) for children who had received 1 or 2 doses of campaign-OPV-before-enrolment, respectively.ConclusionsBissau had no polio infection during this trial, so OPV0 and campaign-OPV may have NSEs since they modified the effect of 2-dose MV in an RCT. Different interventions may interact to a much larger effect than usually assumed.
Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study
Authors: Shen Hong , Liu Xiaohua , Chen Yan , HE Biwei , Cheng Weiwei 
Published: December 2016

ObjectiveTo assess associations of elevated lipid levels during gestation with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM).MethodsThis prospective cohort study was conducted in a tertiary maternal hospital in Shanghai, China from February to November 2014. Lipid constituents, including triglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) of 1310 eligible women were assessed in the first (10–13+ weeks), second (22–28 weeks) and third (30–35 weeks) trimesters consecutively. Associations of lipid profiles with HDP and/or GDM outcomes were assessed.ResultsCompared with the normal group, maternal TG concentrations were higher in the HDP/GDM groups across the three trimesters (p<0.001); TC and LDL-c amounts were only higher in the first trimester for the HDP and GDM groups (p<0.05). HDL-c levels were similar in the three groups. Compared with intermediate TG levels (25–75th centile), higher TG amounts (>75th centile) were associated with increased risk of HDP/GDM in each trimester with aORs (95% CI) of 2.04 (1.41 to 2.95), 1.81 (1.25 to 2.63) and 1.78 (1.24 to 2.54), respectively. High TG elevation from the first to third trimesters (>75th centile) was associated with increased risk of HDP, with an aOR of 2.09 (1.16 to 3.78). High TG elevation before 28 weeks was associated with increased risk of GDM, with an aOR of 1.67 (1.10 to 2.54). TG elevation was positively correlated with weight gain during gestation (R=0.089, p=0.005).ConclusionsControlling weight gain during pregnancy could decrease TG elevation and reduce the risk of HDP/GDM. TGs could be used as follow-up parameters during complicated pregnancy, while other lipids are meaningful only in the first trimester.
Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study
Authors: Shimoni Zvi , Cohen Regev , Avdiaev Ruslan , Froom Paul 
Published: December 2016

PurposeTo determine the consequences of treating febrile geriatric patients with a suspected urinary tract infection (UTI) with antibiotics that have high resistance rates due primarily to extended-spectrum β-lactamase (ESBL) producing bacteria.MethodsIn this cohort study, we selected 257 consecutive hospitalised patients aged ≥70 years with a chief symptom of fever, possibly due to a UTI and initially treated with antibiotics with rates in our hospital of urinary culture resistance >20%. Patients with severe sepsis were excluded. The main outcomes measures were in vitro bacterial resistance to initial antibiotic therapy (BRIAT), response to therapy, hospitalisation days and mortality.ResultsUrine cultures were positive in 64.2% (165 of 257) of the patients and BRIAT occurred in 28.0% (72 of 257). Response rates were 100% (93 of 93) in those with bacteria sensitive to initial antibiotic therapy, 95.7% (88 of 92) in the culture negative patients, and 66.7% (48 of 72) in those with BRIAT (p<0.001). There were no deaths due to deterioration during the initial treatment period because of BRIAT. In the patients with BRIAT, the median length of hospitalisation was 3 days longer than that in the other patients (7 and 4 days, respectively, p<0.001).ConclusionsWe conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3 days in many hospitalised geriatric patients without an extra-urinary tract source for their fever. This benefit needs to be balanced against the risk to the individual patient and to the general public of increasing bacterial resistance rates to broader spectrum antibiotics often held in reserve.
Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: a retrospective analysis
Authors: Li Bo , Qiu Guixing , Guo Shigong , Li Wenjing , Li Ye , Peng Huiming , Wang Chu , Zhao Yu 
Published: December 2016

ObjectivesTo investigate the incidence, distribution and radiological characteristics of dural ossification (DO) associated with ossification of ligamentum flavum (OLF) in the thoracic spine.DesignA retrospective radiographical analysis.SettingThis study was conducted at a single institution in China.Participants53 patients with OLF who underwent posterior decompression surgery between January 2011 and July 2015 in a single institution were enrolled in this study. The decompression segments were grouped according to imaging evaluation and intraoperative evidences.Outcome measuresThe demographic distribution, radiological data and detailed surgical records were collected. First, preoperative CT images of decompressed segments were evaluated to identify imaging signs of DO. The ‘tram tack sign’ (TTS), ‘comma sign’ and ‘bridge sign’ were considered as characteristic imaging findings of DO in OLF. 4 kinds of confusing signs (false TTS) were identified and excluded. Then detailed surgical records were reviewed to finally identify segments with DO.ResultsThe incidence of DO in patients with OLF was 43.4%. The incidence of DO in OLF segments was 21.5%. OLF was more common in the lower thoracic spine, and more than half (53.8%) of the DO was located in T9-T12. TTS was the most common sign, but it might be misdiagnosed. After excluding 4 kinds of false TTS, the sensitivity and specificity of imaging diagnosis were 94.23% and 94.21%, respectively.ConclusionsDO was relatively common in thoracic OLF, especially in T9-T12. TTS might be misdiagnosed. After excluding 4 kinds of false TTS, the accuracy of imaging diagnosis was relatively high.
Selling falsehoods? A cross-sectional study of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma
Authors: Murdoch Blake , Carr Stuart , Caulfield Timothy 
Published: December 2016

ObjectiveTo identify the frequency and qualitative characteristics of marketing claims made by Canadian chiropractors, naturopaths, homeopaths and acupuncturists relating to the diagnosis and treatment of allergy and asthma.DesignCross-sectional study.SettingCanada.Data set392 chiropractic, naturopathic, homeopathic and acupuncture clinic websites located in 10 of the largest metropolitan areas in Canada, as identified using 400 Google search results. Duplicates were not excluded from data analysis.Main outcome measuresMention of allergy, sensitivity or asthma, claim of ability to diagnose allergy, sensitivity or asthma, claim of ability to treat allergy, sensitivity or asthma, and claim of allergy, sensitivity or asthma treatment efficacy. Tests and treatments promoted were noted as qualitative examples.ResultsNaturopath clinic websites have the highest rates of advertising at least one of diagnosis, treatment or efficacy for allergy or sensitivity (85%) and asthma (64%), followed by acupuncturists (68% and 53%, respectively), homeopaths (60% and 54%) and chiropractors (33% and 38%). Search results from Vancouver, British Columbia were most likely to advertise at least one of diagnosis, treatment or efficacy for allergy or sensitivity (72.5%) and asthma (62.5%), and results from London, Ontario were least likely (50% and 40%, respectively). Of the interventions advertised, few are scientifically supported; the majority lack evidence of efficacy, and some are potentially harmful.ConclusionsThe majority of alternative healthcare clinics studied advertised interventions for allergy and asthma. Many offerings are unproven. A policy response may be warranted in order to safeguard the public interest.
Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication
Authors: Molton James S , Pang Yan , Wang Zhuochun , Qiu Boqin , Wu Pei , Rahman-Shepherd Afifah , Ooi Wei Tsang , Paton Nicholas I 
Published: December 2016

ObjectivesSuboptimal medication adherence for infectious diseases such as tuberculosis (TB) results in poor clinical outcomes and ongoing infectivity. Directly observed therapy (DOT) is now standard of care for TB treatment monitoring but has a number of limitations. We aimed to develop and evaluate a smartphone-based system to facilitate remotely observed therapy via transmission of videos rather than in-person observation.DesignWe developed an integrated smartphone and web-based system (Mobile Interactive Supervised Therapy, MIST) to provide regular medication reminders and facilitate video recording of pill ingestion at predetermined timings each day, for upload and later review by a healthcare worker. We evaluated the system in a single arm, prospective study of adherence to a dietary supplement. Healthy volunteers were recruited through an online portal. Entry criteria included age ≥21 and owning an iOS or Android-based device. Participants took a dietary supplement pill once, twice or three-times a day for 2 months. We instructed them to video each pill taking episode using the system.OutcomeAdherence as measured by the smartphone system and by pill count.Results42 eligible participants were recruited (median age 24; 86% students). Videos were classified as received—confirmed pill intake (3475, 82.7% of the 4200 videos expected), received—uncertain pill intake (16, <1%), received—fake pill intake (31, <1%), not received—technical issues (223, 5.3%) or not received—assumed non-adherence (455, 10.8%). Overall median estimated participant adherence by MIST was 90.0%, similar to that obtained by pill count (93.8%). There was a good relationship between participant adherence as measured by MIST and by pill count (Spearmansrs0.66, p<0.001).ConclusionsWe have demonstrated the feasibility, acceptability and accuracy of a smartphone-based adherence support and monitoring system. The system has the potential to supplement and support the provision of DOT for TB and also to improve adherence in other conditions such as HIV and hepatitis C.
Psychological Impact of Primary Screening (PIPS) for HPV: a protocol for a cross-sectional evaluation within the NHS cervical screening programme
Authors: McBride Emily , Marlow Laura , Forster Alice S , Moss Sue , Myles Jonathan , Kitchener Henry , Patnick Julietta , Waller Jo 
Published: December 2016

IntroductionThe NHS Cervical Screening Programme is now using human papillomavirus (HPV) testing as the primary test in six sentinel sites in England, with the intention of rolling this out across the whole of England. Previous research evaluating HPV testing in the cervical screening context suggests that an HPV-positive result may increase anxiety beyond that associated with abnormal cytology, but this has not been explored in the context of primary HPV testing. The main aim of this study is to explore the impact of the HPV primary screening programme on anxiety and distress.Methods and analysisA cross-sectional between-groups design (total N ∼ 673) will be employed to assess the psychological impact of different HPV and cytology results at three time points: shortly after receiving the results, and 6 and 12 months later. Women will fall into one of six groups based on their screening results. The primary outcomes will be anxiety and general distress. Secondary outcomes will include understanding of screening results, perceived risk of cervical cancer, psychosexual functioning, intention to attend future screening and knowledge of HPV. General linear modelling will be used to test for differences between groups and changes over the three time points.Ethics and disseminationHealth Research Authority approval was received on 26 September 2016. Ethical approval was received from London- Surrey Borders NHS Research Ethics Committee on 30 August 2016. Section 251 approval was received from the Confidentiality Advisory Group on 24 August 2016. Results will be disseminated via peer-reviewed publication and presentation at national and international conferences.
Reducing the incidence of Obstetric Sphincter Injuries using a hands-on technique: an interventional quality improvement project
Authors: Rasmussen Ole Bredahl , Yding Annika , Anhøj Jacob , Sander Andersen Charlotte , Boris Jane 
Published: December 2016

A main concern for women giving birth is the risk of obstetric anal sphincter injuries. In our department the incidence of sphincter injuries was around 8 % among vaginally delivering first time mothers. We aimed to halve the incidence to 4 % or less. A prospective interventional program was instituted. We implemented a hands-on technique with four elements in a bundle of care together with a certification process for all staff on the delivery ward. The incidence of episiotomies served as a balancing indicator.The adherence to three of the four elements of the care bundle rose significantly while the all-or-nothing indicator leveled around 80 %. The median number of deliveries between cases with a sphincter injury increased from 9.5 in the baseline period to 20 during the intervention period. This corresponded with a reduction in the incidence from 7.0 % to 3.4 %. The rate of episiotomy remained low at 8.4 % in this group. By implementing the hands-on technique, we halved the risk of obstetric anal sphincter injuries. Our data suggest that further improvement may be anticipated. The study has demonstrated how implementation of a hands-on technique can be carried out within a quality improvement framework with rapid and sustainable results.
Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan
Authors: Iqbal Nousheen , Irfan Muhammad , Zubairi Ali Bin Sarwar , Jabeen Kauser , Awan Safia , Khan Javaid A 
Published: December 2016

IntroductionPulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.MethodsTo determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.ResultsOf the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes mellitus (DM). The average length of hospital stay (LOS) was 10.61±9.08 days.Aspergillus fumigatuswas the most common (42.0%), followed byAspergillus flavus(28.9%). More than one-third of patients previously had tuberculosis (TB) (39.13%). The commonest pulmonary manifestation was chronic pulmonary aspergillosis (CPA) 47 (68.1%) followed by invasive pulmonary aspergillosis (IPA) 12 (17.4%) and subacute invasive aspergillosis (SAIA) 8 (11.6%). Surgical excision was performed in 28 patients (40.57%). Intensive care unit admission was required for 18 patients (26.08%). Case fatality rate was 14/69 (20.3%). DM, mean LOS and hypoxic respiratory failure were identified as independent risk factors of mortality on multivariate analysis.ConclusionA. fumigatuswas the most frequent species found especially in patients with prior TB. CPA was the commonest pulmonary manifestation seen as post TB sequel. Diabetes, hypoxic respiratory failure and increased LOS were independent predictors of poor outcomes. Overall patients had good outcome with CPA compared with SAIA and IPA.