bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic disparities in birth weight and body mass index during infancy through age 7 years: a study within the Danish National Birth Cohort
Authors: Morgen Camilla Schmidt , Andersen Per Kragh , Mortensen Laust Hvas , Howe Laura D , Rasmussen Mette , Due Pernille , Sørensen Thorkild I A , Andersen Anne-Marie Nybo 
Published: January 2017

BackgroundSocioeconomic inequalities in birth weight and in body mass index (BMI) later in childhood are in opposite directions, which raises questions about when during childhood the change in direction happens. We examined how maternal and paternal education and household income were associated with birthweight z-scores and with BMI z-scores at age 5 and 12 months and 7 years, and we examined the socioeconomic differences in the tracking of these z-scores across infancy and childhood.MethodsThe associations were studied in a cohort of children in the Danish National Birth Cohort, single born between 1997 and 2003, for whom information on body size from at least 1 of 4 time points (n=85 062) was recorded.We examined the associations using linear mixed-effects modelling.ResultsChildren from families with a low maternal and paternal educational level changed their body size z-scores upwards between birth and age 7 years. At age 5 and 12 months, there were no educational gradient. A low maternal educational level was associated with lower birth weight for gestational age z-scores at birth for boys (−0.199; 95% CI −0.230 to −0.169) and girls (−0.198; 95% CI −0.229 to −0.167) and higher BMI z-scores at age 7 for boys (0.198; 95% CI 0.154 to 0.242) and girls (0.218; 95% CI 0.173 to 0.264). There was not a similarly clear pattern in the tracking between different household income groups. However, a low household income level was associated with higher z-scores of both birth weight and BMI at age 7 years, but with a much weaker gradient at 5 and 12 months.ConclusionsThe educational gradient shifts from positive with birth weight, to none during infancy to inverse with BMI at age 7 years. In contrast, the income gradient was positive at birth and at 7 years and much weaker during infancy.
Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria
Authors: Mia Mohammad Nahid , Hanifi S M A , Rahman M Shafiqur , Sultana Amena , Hoque Shahidul , Bhuiya Abbas 
Published: January 2017

BackgroundThe health hazards associated with the use of smokeless tobacco (SLT) are similar to those of smoking. However, unlike smoking, limited initiatives have been taken to control the use of SLT, despite its widespread use in South and Southeast Asian countries including Bangladesh. It is therefore important to examine the prevalence of SLT use and its social determinants for designing appropriate strategies and programmes to control its use.ObjectiveTo investigate the use of SLT in terms of prevalence, pattern and sociodemographic differentials in a rural area of Bangladesh.DesignPopulation-based cross-sectional household survey.Setting and participantsA total of 6178 individuals aged ≥13 years from 1753 households under the Chakaria HDSS area were interviewed during October–November 2011.MethodsThe current use of SLT, namelysadapatha(dried tobacco leaves) andzarda(industrially processed leaves), was used as the outcome variable. The crude and net associations between the sociodemographic characteristics of respondents and the outcome variables were examined using cross-tabular and multivariable logistic regression analysis, respectively.Results23% of the total respondents (men: 27.0%, women: 19.3%) used any form of SLT. Of the respondents, 10.4% used onlysadapatha,13.6% used onlyzardaand 2.2% used both. SLT use was significantly higher among men, older people, illiterate, ever married, day labourers and relatively poorer respondents. The odds of being asadapathauser were 3.5-fold greater for women than for men and the odds of being azardauser were 3.6-fold greater for men than for women.ConclusionsThe prevalence of SLT use was high in the study area and was higher among socioeconomically disadvantaged groups. The limitation of the existing regulatory measures for controlling the use of non-industrial SLT products should be understood and discussion for developing new strategies should be a priority.
Injuries caused by pets in Asian urban households: a cross-sectional telephone survey
Authors: Chan Emily Y Y , Gao Yang , Li Liping , Lee Po Yi 
Published: January 2017

ObjectivesLittle is known about pet-related injuries in Asian populations. This study primarily aimed to investigate the incidence rate of pet-related household injuries in Hong Kong, an urban Chinese setting.SettingCantonese-speaking non-institutionalised population of all ages in Hong Kong accessible by telephone land-line.ParticipantsA total of 43 542 telephone numbers were dialled and 6570 residents successfully completed the interviews.Primary and secondary outcome measuresData of pet-related household injuries in the previous 12 months, pet ownership and socio-demographic characteristics were collected with a questionnaire. Direct standardisation of the incidence rates of pet-related household injuries by gender and age to the 2009 Hong Kong Population Census was estimated. Univariate and multivariate analyses were performed to estimate risks of socio-demographic factors and pet ownership for the injury.ResultsA total of 84 participants experienced pet-related household injuries in the past 12 months, with an overall person-based incidence rate of 1.28%. The majority of the victims were injured once (69.6%). Cats (51.6%) were the most common pets involved. Pet owners were at an extremely higher risk after controlling for other factors (adjusted OR: 52.0, 95% CI 22.1 to 98.7). Females, the unmarried, those with higher monthly household income and those living in lower-density housing were more likely to be injured by pets.ConclusionsWe project a pet-related household injury incidence rate of 1.24% in the general Hong Kong population, with 86 334 residents sustaining pet-related injuries every year. Pet ownership puts people at extremely high risk, especially the unmarried. Further studies should focus on educating pet owners to reduce pet-related injuries in urban Greater China.
Validation of a clinical screening instrument for tumour predisposition syndromes in patients with childhood cancer (TuPS): protocol for a prospective, observational, multicentre study
Authors: Postema Floor A M , Hopman Saskia M J , de Borgie Corianne A J M , Hammond Peter , Hennekam Raoul C , Merks Johannes H M ,   on behalf of the TuPS study group, Aalfs Cora M , Anninga Jakob K , Berger Lieke PV , Bleeker Fonnet E , de Bont Eveline SJM , de Borgie Corianne AJM , Dommering Charlotte J , van Eijkelenburg Natasha KA , Hammond Peter , Hennekam Raoul C , van den Heuvel-Eibrink Marry M , Hopman Saskia MJ , Jongmans Marjolijn CJ , Kors Wijnanda A , Letteboer Tom GW , Loeffen Jan LCM , Merks Johannes HM , Olderode-Berends Maran JW , Postema Floor AM , Wagner Anja 
Published: January 2017

IntroductionRecognising a tumour predisposition syndrome (TPS) in patients with childhood cancer is of significant clinical relevance, as it affects treatment, prognosis and facilitates genetic counselling. Previous studies revealed that only half of the known TPSs are recognised during standard paediatric cancer care. In current medical practice it is impossible to refer every patient with childhood cancer to a clinical geneticist, due to limited capacity for routine genetic consultation. Therefore, we have developed a screening instrument to identify patients with childhood cancer with a high probability of having a TPS. The aim of this study is to validate the clinical screening instrument for TPS in patients with childhood cancer.Methods and analysisThis study is a prospective nationwide cohort study including all newly diagnosed patients with childhood cancer in the Netherlands. The screening instrument consists of a checklist, two- and three-dimensional photographic series of the patient. 2 independent clinical geneticists will assess the content of the screening instrument. If a TPS is suspected based on the instrument data and thus further evaluation is indicated, the patient will be invited for full genetic consultation. A negative control group consists of 20% of the patients in whom a TPS is not suspected based on the instrument; they will be randomly invited for full genetic consultation. Primary outcome measurement will be sensitivity of the instrument.Ethics and disseminationThe Medical Ethical Committee of the Academic Medical Centre stated that the Medical Research Involving Human Subjects Act does not apply to this study and that official approval of this study by the Committee was not required. The results will be offered for publication in peer-reviewed journals and presented at International Conferences on Oncology and Clinical Genetics. The clinical data gathered in this study will be available for all participating centres.Trial registration numberNTR5605.
Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study
Authors: Smith Isabelle L , Brown Sarah , McGinnis Elizabeth , Briggs Michelle , Coleman Susanne , Dealey Carol , Muir Delia , Nelson E Andrea , Stevenson Rebecca , Stubbs Nikki , Wilson Lyn , Brown Julia M , Nixon Jane 
Published: January 2017

ObjectiveTo explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development.DesignMulticentre prospective cohort study.SettingUK hospital and community settings.Participants inclusionConsenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU).ExclusionPatients too unwell, unable to report pain, 2 or more category ≥2 PUs.Follow-upTwice weekly for 30 days.Primary and secondary outcome measuresDevelopment and time to development of one or more category ≥2 PUs.ResultsOf 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001).ConclusionsThis is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development.
Stick or twist? Career decision-making during contractual uncertainty for NHS junior doctors
Authors: Spooner S , Gibson Jon , Rigby Dan , Sutton Matt , Pearson Emma , Checkland Kath 
Published: January 2017

ObjectivesTo examine the extent, and nature, of impact on junior doctors' career decisions, of a proposed new contract and the uncertainty surrounding it.DesignMixed methods. Online survey exploring: doctors' future training intentions; their preferred specialty training (ST) programmes; whether they intended to proceed immediately to ST; and other plans. Linked qualitative interviews to explore more fully how and why decisions were affected.SettingDoctors (F2s) in second year of Foundation School (FS) Programmes in England.ParticipantsInvitations sent by FSs. Open to all F2s November 2015–February 2016. All FSs represented. Survey completed by 816 F2s. Sample characteristics broadly similar to national F2 cohort.Main outcome measuresProportions of doctors intending to proceed to ST posts in the UK, to defer or to exit UK medicine. Proportion of doctors indicating changes in training and career plans as a result of the contract and/or resulting uncertainty. Distribution of changes across training programmes. Explanations of these intentions from interviews and free text comments.ResultsAmong the responding junior doctors, 20% indicated that issues related to the contract had prompted them to switch specialty and a further 20% had become uncertain about switching specialty. Switching specialty choice was more prevalent among those now choosing a community-based, rather than hospital-based specialty. 30% selecting general practice had switched choice because of the new contract. Interview data suggests that doctors felt they had become less valued or appreciated in the National Health Service and in society more broadly.ConclusionsDoctors reported that contract-related issues have affected their career plans. The most notable effect is a move away from acute to community-based specialities, with the former perceived as more negatively affected by the proposed changes. It is concerning that young doctors feel undervalued, and this requires further investigation.
Screening for seemingly healthy newborns with congenital cytomegalovirus infection by quantitative real-time polymerase chain reaction using newborn urine: an observational study
Authors: Yamaguchi Akira , Oh-ishi Tsutomu , Arai Takashi , Sakata Hideaki , Adachi Nodoka , Asanuma Satoshi , Oguma Eiji , Kimoto Hirofumi , Matsumoto Jiro , Fujita Hidetoshi , Uesato Tadashi , Fujita Jutaro , Shirato Ken , Ohno Hideki , Kizaki Takako 
Published: January 2017

ObjectiveApproximately 8–10% of newborns with asymptomatic congenital cytomegalovirus (cCMV) infection develop sensorineural hearing loss (SNHL). However, the relationship between CMV load, SNHL and central nervous system (CNS) damage in cCMV infection remains unclear. This study aimed to examine the relationship between urinary CMV load, SNHL and CNS damage in newborns with cCMV infection.Study designThe study included 23 368 newborns from two maternity hospitals in Saitama Prefecture, Japan. Urine screening for cCMV infection (quantitative real-time PCR) and newborn hearing screening (automated auditory brainstem response (AABR) testing) were conducted within 5 days of birth to examine the incidence of cCMV infection and SNHL, respectively. CNS damage was assessed by MRI of cCMV-infected newborns.ResultsThe incidence of cCMV infection was 60/23 368 (0.257%; 95% CI 0.192% to 0.322%). The geometric mean urinary CMV DNA copy number in newborns with cCMV was 1.79×106copies/mL (95% CI 7.97×105to 4.02×106). AABR testing revealed abnormalities in 171 of the 22 229 (0.769%) newborns whose parents approved hearing screening. Of these 171 newborns, 22 had SNHL (12.9%), and 5 of these 22 were infected with cCMV (22.7%). Newborns with both cCMV and SNHL had a higher urinary CMV DNA copy number than newborns with cCMV without SNHL (p=0.036). MRI revealed CNS damage, including white matter abnormalities, in 83.0% of newborns with cCMV. Moreover, newborns with CNS damage had a significantly greater urinary CMV load than newborns without CNS damage (p=0.013).ConclusionsWe determined the incidence of cCMV infection and urinary CMV DNA copy number in seemingly healthy newborns from two hospitals in Saitama Prefecture. SNHL and CNS damage were associated with urinary CMV DNA copy number. Quantification of urinary CMV load may effectively predict the incidence of late-onset SNHL and neurodevelopmental disorders.
Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial
Authors: van Vugt Vincent A , van der Wouden Johannes C , Bosmans Judith E , Smalbrugge Martin , van Diest Willianne , Essery Rosie , Yardley Lucy , van der Horst Henriëtte E , Maarsingh Otto R 
Published: January 2017

IntroductionDizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages.Methods and analysisA single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners.Ethics and disseminationThe ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations.Trial registration numberPre-results,NTR5712.
Sublingual microcirculatory blood flow and vessel density in Sherpas at high altitude
Authors: Gilbert-Kawai Edward , Coppel Jonny , Court Jo , van der Kaaij Jildou , Vercueil Andre , Feelisch Martin , Levett Denny , Mythen Monty , Grocott Michael P. , Martin Daniel ,   Xtreme Everest 2 Research Group
Published: January 2017

Anecdotal reports suggest that Sherpa highlanders demonstrate extraordinary tolerance to hypoxia at high altitude, despite exhibiting lower arterial oxygen content than acclimatized lowlanders. This study tested the hypothesis that Sherpas exposed to hypobaric hypoxia on ascent to 5,300 m develop increased microcirculatory blood flow as a means of maintaining tissue oxygen delivery. Incident dark-field imaging was used to obtain images of the sublingual microcirculation from 64 Sherpas and 69 lowlanders. Serial measurements were obtained from participants undertaking an ascent from baseline testing (35 m or 1,300 m) to Everest base camp (5,300 m) and following subsequent descent in Kathmandu (1,300 m). Microcirculatory flow index and heterogeneity index were used to provide indexes of microcirculatory flow, while capillary density was assessed using small vessel density. Sherpas demonstrated significantly greater microcirculatory blood flow at Everest base camp, but not at baseline testing or on return in Kathmandu, than lowlanders. Additionally, blood flow exhibited greater homogeneity at 5,300 and 1,300 m (descent) in Sherpas than lowlanders. Sublingual small vessel density was not different between the two cohorts at baseline testing or at 1,300 m; however, at 5,300 m, capillary density was up to 30% greater in Sherpas. These data suggest that Sherpas can maintain a significantly greater microcirculatory flow per unit time and flow per unit volume of tissue at high altitude than lowlanders. These findings support the notion that peripheral vascular factors at the microcirculatory level may be important in the process of adaptation to hypoxia. NEW & NOTEWORTHY Sherpa highlanders demonstrate extraordinary tolerance to hypoxia at high altitude, yet the physiological mechanisms underlying this tolerance remain unknown. In our prospective study, conducted on healthy volunteers ascending to Everest base camp (5,300 m), we demonstrated that Sherpas have a higher sublingual microcirculatory blood flow and greater capillary density at high altitude than lowlanders. These findings support the notion that the peripheral microcirculation plays a key role in the process of long-term adaptation to hypoxia.
Microfluidic coagulation assay for monitoring anticoagulant therapy in acute stroke patients
Authors: Bluecher Annemarie , dos Santos Sascha Meyer , Ferreirós Nerea , Labocha Sandra , Meyer dos Santos Isabel Maria Rodrigues , Picard-Willems Bettina , Harder Sebastian , Singer Oliver C. 
Published: January 2017

SummaryReliable detection of anticoagulation status in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) is challenging but of importance especially in the emergency setting. This study evaluated the potential of a whole-blood clotting time assay based on Surface Acoustic Waves (SAW-CT) in stroke-patients. The SAW-technology was used for quick and homogenous recalcification of whole blood inducing a surface-activated clotting reaction quantified and visualised by real-time fluorescence microscopy with automatic imaging processing. In 20 stroke or transient ischaemic attack (TIA)-patients taking NOACs kinetics of SAW-CT were assessed and correlated to other coagulation parameters (PT, aPTT) and NOAC-plasma concentration measured by tandem mass spectrometry (LC-MS/MS). In 225 emergency patients with suspicion of acute stroke or TIA, SAW-CT values were assessed. Mean (± SD) SAW-CT in non-anticoagulated stroke patients (n=180) was 124 s (± 21). In patients on dabigatran or rivaroxaban, SAW-CT values were significantly higher 2 and 8 hours (h) after intake rising up to 267 seconds (s) (dabigatran, 2 h after intake) and 250 s (rivaroxaban, 8 h after intake). In patients on apixaban, SAW-CT values were only moderately increased 2 h after intake (SAW-CT 153 s). In emergency patients, SAW-CT values were significantly higher in NOAC and vitamin K antagonist (VKA)-treated as compared to non-anticoagulated patients. In conclusion, the SAW-CT assay is capable to monitor anticoagulant level and effect in patients receiving dabigatran, rivaroxaban and the VKA phenprocoumon. It has a limited sensitivity for apixaban-detection. If specific SAW-CT results were used as cut-offs, SAW-CT yields high diagnostic accuracy to exclude relevant rivaroxaban and dabigatran concentrations in strokepatients.