bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol
Authors: Aery Anjana , Rucchetto Anne , Singer Alexander , Halas Gayle , Bloch Gary , Goel Ritika , Raza Danyaal , Upshur Ross E G , Bellaire Jackie , Katz Alan , Pinto Andrew David 
Published: October 2017

ObjectivesAddressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?MethodsAn advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.Ethics and disseminationKey ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.Trial registration numberClinicaltrials.gov:NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.
Effect of levothyroxine on the progression of carotid intima-media thickness in subclinical hypothyroidism patients: a meta-analysis
Authors: Zhao Tong , Chen Baomin , Zhou Yingying , Wang Xinyi , Zhang Yuanyuan , Wang Haoyu , Shan Zhongyan 
Published: October 2017

BackgroundSubclinical hypothyroidism (SCH) has been associated with increased carotid intima-media thickness (C-IMT) in recent studies, but the effects of levothyroxine (L-T4) therapy on C-IMT in SCH patients are still controversial.AimTo evaluate the effect of L-T4 therapy on endothelial function as determined by C-IMT in patients with SCH.MethodsBeforeJuly 2016, we searched the PubMed, Embase, Cochrane Library and Google Scholar databases, selecting published randomised controlled trials (RCTs) and self-controlled trials for the meta-analysis.ResultsThree RCTs with 117 patients were considered appropriate for the meta-analysis. The results of the meta-analysis indicated that L-T4 significantly decreased the development of C-IMT (weighted mean difference (WMD) −0.05 mm, 95% CI −0.08 to –0.01 mm; p=0.025). We also analysed nine studies (self-controlled trials) with 247 patients and extracted the IMT of SCH patients before and after L-T4 treatment. After L-T4 therapy, the pooled estimate of the WMD of decreased C-IMT was −0.04 mm (95% CI −0.07 to –0.02 mm; p=0.05). Subgroup analysis showed that L-T4 therapy was associated with a decrease in C-IMT among patients of mixed genders (WMD −0.03 mm, 95% CI −0.06 to –0.01 mm; p=0.145). L-T4 therapy was associated with a decrease in C-IMT among female patients (WMD −0.07 mm, 95% CI −0.14 to –0.01; p=0.186). Longer treatment (>6 months) also resulted in a significant decrease in C-IMT (WMD −0.05 mm, 95% CI −0.08 to –0.02; p=0.335).ConclusionThis meta-analysis indicates that L-T4 treatment of SCH patients can reduce C-IMT, possibly as a result of the reduction of total cholesterol, triglyceride, low density lipoprotein, systolic blood pressure, diastolic blood pressure, lipoprotein(a), and flow-mediated dilatation. Decreased C-IMT was observed in SCH patients after long-term (>6 months) L-T4 treatment. RCTs with larger samples are needed to verify these observations.
Caregivers’ quality of life and psychological health in response to functional, cognitive, neuropsychiatric and social deficits of patients with brain tumour: protocol for a cross-sectional study
Authors: Ramirez Carole , Christophe Véronique , Dassonneville Charlotte , Grynberg Delphine 
Published: October 2017

IntroductionPatients with gliomas generally present cognitive, neuropsychiatric and functional deficits. Although previous research has shown that their caregivers present a poor quality of life and poor mental health, only a few studies have tested in a comprehensive way which deficits/preserved abilities of patients predominantly impact their caregivers. Furthermore, only a few studies have focused on the social impact of gliomas, which may also damage the caregivers’ quality of life. Therefore, this cross-sectional study aims to investigate which patients’ impairments are particularly deleterious for the caregivers and whether the histological characteristics of the gliomas also affect their quality of life.Methods and analysisIn order to examine these research questions, this study intends to include 180 patients (60 patients with grade II gliomas, 60 patients with grade III gliomas and 60 patients with grade IV gliomas), their caregivers and 60 healthy controls. While patients will complete a full battery of cognitive, neuropsychiatric, functional and social tests, caregivers will complete questionnaires about their quality of life, depression, anxiety and burden. Patients’ performances and caregivers’ reports of depression and anxiety will be compared with the scores of healthy controls. Eventually, our aim will be to provide specific care support both to reduce patients’ deficits and alleviate caregivers’ difficulties.Ethics and disseminationThe study has obtained the approval of the local faculty ethics committee (‘Comité d’éthique en sciences comportementales’; 2016–5 S41 and 2015–3 S37). On completion of the study, data will be kept by Lille University for 5 years before they are destroyed. Study findings will be disseminated through peer-reviewed journal publications and conference presentations with no reference to a specific individual.
Cross-sectional study of the provision of interventional oncology services in the UK
Authors: Zhong Jim , Atiiga Peter , Alcorn Des J , Kay David , Illing Rowland , Breen David J , Railton Nicholas , McCafferty Ian J , Haslam Philip J , Wah Tze Min 
Published: October 2017

ObjectiveTo map out the current provision of interventional oncology (IO) services in the UK.DesignCross-sectional multicentre study.SettingAll National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards.ParticipantsInterventional radiology (IR) departments in all NHS trusts/health boards in the UK.ResultsA total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures.ConclusionThe provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services.
Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study
Authors: Evandrou Maria , Falkingham Jane C , Qin Min , Vlachantoni Athina 
Published: October 2017

ObjectivesThis study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.DesignThe study uses a cross-sectional survey design.SettingThe data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states—Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu—in 2011.Statistical analysesSecondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.ResultsThe overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.ConclusionsElder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be ‘hidden’ within well-off households.
Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study
Authors: Zimbudzi Edward , Lo Clement , Ranasinha Sanjeeva , Fulcher Gregory R , Jan Stephen , Kerr Peter G , Polkinghorne Kevan R , Russell Grant , Walker Rowan G , Zoungas Sophia 
Published: October 2017

ObjectiveTo evaluate the extent of patient activation and factors associated with activation in adults with comorbid diabetes and chronic kidney disease (CKD).DesignA cross-sectional study.SettingRenal/diabetes clinics of four tertiary hospitals across the two largest states of Australia.Study populationAdult patients (over 18 years) with comorbid diabetes and CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2).Main outcome measuresPatients completed the Patient Activation Measure, the Kidney Disease Quality of Life and demographic and clinical data survey from January to December 2014. Factors associated with patient activation were examined using χ2or t-tests and linear regression.ResultsThree hundred and five patients with median age of 68 (IQR 14.8) years were studied. They were evenly distributed across socioeconomic groups, stage of kidney disease and duration of diabetes but not gender. Approximately 46% reported low activation. In patients with low activation, the symptom/problem list, burden of kidney disease subscale and mental composite subscale scores were all significantly lower (all p<0.05). On multivariable analysis, factors associated with lower activation for all patients were older age, worse self-reported health in the burden of kidney disease subscale and lower self-care scores. Additionally, in men, worse self-reported health in the mental composite subscale was associated with lower activation and in women, worse self-reported health scores in the symptom problem list and greater renal impairment were associated with lower activation.ConclusionFindings from this study suggest that levels of activation are low in patients with diabetes and CKD. Older age and worse self-reported health were associated with lower activation. This data may serve as the basis for the development of interventions needed to enhance activation and outcomes for patients with diabetes and CKD.
Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers
Authors: Gouweloos-Trines Juul , Tyler Mark P , Giummarra Melita J , Kassam-Adams Nancy , Landolt Markus A , Kleber Rolf J , Alisic Eva 
Published: October 2017

IntroductionPrehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support.MethodsThis cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis.ResultsOf the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=−0.01, 95% CI −0.01 to 0.00), having enough time to recover after critical incidents (b=−0.07, 95% CI −0.09 to −0.04) and perceived colleague support (b=−0.01, 95% CI −0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=−0.04, 95% CI −0.02 to −0.01).ConclusionsPrehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design.
High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B
Authors: Kim Gi-Ae , Lim Young-Suk , Han Seungbong , Choi Jonggi , Shim Ju Hyun , Kim Kang Mo , Lee Han Chu , Lee Yung Sang 
Published: October 2017

ObjectiveHigh serum HBV DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in patients with chronic hepatitis B (CHB). Although the immune-tolerant (IT) phase is characterised by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality.DesignThis historical cohort study included HBeAg-positive patients with CHB with high HBV DNA levels (≥20 000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogues.ResultsThe IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.ConclusionsUntreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients.
Primary schools and the amplification of social differences in child mental health: a population-based cohort study
Authors: Marryat Louise , Thompson Lucy , Minnis Helen , Wilson Philip 
Published: October 2017

BackgroundThis paper examines socioeconomic inequalities in mental health at school entry and explores changes in these inequalities over the first 3 years of school.MethodsThe study utilises routinely collected mental health data from education records and demographic data at ages 4 and 7 years, along with administrative school-level data. The study was set in preschool establishments and schools in Glasgow City, Scotland. Data were available on 4011 children (59.4%)at age 4 years, and 3166 of these children were followed at age 7 years (46.9% of the population). The main outcome measure was the teacher-rated Goodman’s Strengths and Difficulties Questionnaire (4–16 version) at age 7 years, which measures social, emotional and behavioural difficulties.ResultsChildren living in the most deprived area had higher levels of mental health difficulties at age 4 years, compared with their most affluent counterparts (7.3%vs4.1% with abnormal range scores). There was a more than threefold widening of this disparity over time, so that by the age of 7 years, children from the most deprived area quintile had rates of difficulties 3.5 times higher than their more affluent peers. Children’s demographic backgrounds strongly predicted their age 7 scores, although schools appeared to make a significant contribution to mental health trajectories.ConclusionsAdditional support to help children from disadvantaged backgrounds at preschool and in early primary school may help narrow inequalities. Children from disadvantaged backgrounds started school with a higher prevalence of mental health difficulties, compared with their more advantaged peers, and this disparity widened markedly over the first 3 years of school.
A shared data approach more accurately represents the rates and patterns of violence with injury assaults
Authors: Gray Benjamin J , Barton Emma R , Davies Alisha R , Long Sara J , Roderick Janine , Bellis Mark A 
Published: October 2017

BackgroundTo investigate whether sharing and linking routinely collected violence data across health and criminal justice systems can provide a more comprehensive understanding of violence, establish patterns of under-reporting and better inform the development, implementation and evaluation of violence prevention initiatives.MethodsPolice violence with injury (VWI) crimed data and emergency department (ED) assault attendee data for South Wales were collected between 1 April 2014 and 31 March 2016 to examine the rates and patterns of VWI. Person identifiable data (PID) were cross-referenced to establish if certain victims or events were less likely to be reported to criminal justice services.ResultsA total of 18 316 police crimed VWI victims and 10 260 individual ED attendances with an assault-related injury were considered. The majority of ED assault attendances (59.0%) were unknown to police. The key demographic identified as under-reporting to police were young males aged 18–34 years, while a significant amount of non-reported assaults involved a stranger. The combined monthly age-standardised rates were recalculated and on average were 74.7 (95% CI 72.1 to 77.2) and 66.1 (95% CI 64.0 to 68.2) per 100 000 population for males and females, respectively. Consideration of the additional ED cases resulted in a 35.3% and 18.1% increase on the original police totals for male and female VWI victims.ConclusionsThis study identified that violence is currently undermeasured, demonstrated the importance of continued sharing of routinely collected ED data and highlighted the benefits of using PID from a number of services in a linked way to provide a more comprehensive picture of violence.
CSF β-amyloid and white matter damage: a new perspective on Alzheimer’s disease
Authors: Pietroboni Anna M , Scarioni Marta , Carandini Tiziana , Basilico Paola , Cadioli Marcello , Giulietti Giovanni , Arighi Andrea , Caprioli Michela , Serra Laura , Sina Clara , Fenoglio Chiara , Ghezzi Laura , Fumagalli Giorgio G , De Riz Milena A , Calvi Alberto , Triulzi Fabio , Bozzali Marco , Scarpini Elio , Galimberti Daniela 
Published: October 2017

ObjectiveTo assess the connection between amyloid pathology and white matter (WM) macrostructural and microstructural damage in demented patients compared with controls.MethodsEighty-five participants were recruited: 65 with newly diagnosed Alzheimer’s disease (AD), non-AD dementia or mild cognitive impairment and 20 age-matched and sex-matched healthy controls. β-amyloid1-42 (Aβ) levels were determined in cerebrospinal fluid (CSF) samples from all patients and five controls. Among patients, 42 had pathological CSF Aβ levels (Aβ(+)), while 23 had normal CSF Aβ levels (Aβ(−)). All participants underwent neurological examination, neuropsychological testing and brain MRI. We used T2-weighted scans to quantify WM lesion loads (LLs) and diffusion-weighted images to assess their microstructural substrate. Non-parametric statistical tests were used for between-group comparisons and multiple regression analyses.ResultsWe found an increased WM-LL in Aβ(+) compared with both, healthy controls (p=0.003) and Aβ(−) patients (p=0.02). Interestingly, CSF Aβ concentration was the best predictor of patients’ WM-LL (r=−0.30, p<0.05) when using age as a covariate. Lesion apparent diffusion coefficient value was higher in all patients than in controls (p=0.0001) and correlated with WM-LL (r=0.41, p=0.001). In Aβ(+), WM-LL correlated with WM microstructural damage in the left peritrigonal WM (p<0.0001).ConclusionsWM damage is crucial in AD pathogenesis. The correlation between CSF Aβ levels and WM-LL suggests a direct link between amyloid pathology and WM macrostructural and microstructural damage.