bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Acupuncture in the Usa: Changes over a Decade (2002–2012)
Authors: Cui Jia , Wang Shaobai , Ren Jiehui , Zhang Jun , Jing Jun 
Published: January 2017

Background The use of acupuncture has gained popularity in the USA. The number of acupuncture users and licensed acupuncturists increased by 50% and 100%, respectively, between 2002 and 2012, coinciding with increasing acknowledgement of the importance and efficacy of acupuncture over this time period. Methods This paper presents new findings from the complementary health approaches section of the 2012 National Health Interview Survey (n=33 373 respondents). In particular, data on the use of acupuncture and user characteristics were compared against data collected from an earlier survey in 2002. Statistical analyses included weighted distribution, logistical regression and Pearson's χ2 tests. Results The profile of the most common acupuncture users comprised the following sociodemographics age 41–65 years (47.4%); female gender (69.6%); and non-Hispanic (85.3%) and/or white (78.1%) ethnicity. Respondents also tended to be US citizens (92.1%) with some college education (57.1%) and in very good to excellent health (60.8%). The proportion of respondents using acupuncture for treatment of a specific health problem, as opposed to promotion of general wellness, was 84.7% in 2002 and 55.3% in 2012. Conclusions Our data suggest a growing development of acupuncture in the USA. We anticipate that the findings of our analysis of the changes in acupuncture use over the 10-year period from 2002 to 2012 will provide information for users, acupuncturists, researchers and the general public to help better understand the status of acupuncture and reasons for its usage, and to anticipate future trends for acupuncture use in the USA.
Exercise as treatment for alcohol use disorders: systematic review and meta-analysis
Authors: Hallgren Mats , Vancampfort Davy , Giesen Esther S , Lundin Andreas , Stubbs Brendon 
Published: January 2017

ObjectivesTo conduct a systematic review and meta-analysis investigating effects of exercise for people with alcohol use disorders (AUDs) across multiple health outcomes. We also investigated the prevalence and predictors of dropout from exercise studies in AUDs.DesignSystematic review and random effects meta-analysis with meta-regression analyses.Data sources3 major electronic databases were searched from inception until April 2016 for exercise intervention studies in adults with AUDs.Eligibility criteriaStudies of acute exercise in people with AUDs; and randomised and non-randomised trials examining effects of long-term (≥2 weeks) exercise.Results21 studies and 1204 unique persons with AUDs (mean age 37.8 years, mean illness duration 4.4 years) were included. Exercise did not reduce daily alcohol consumption (standardised mean difference (SMD) =−0.886, p=0.24), or the Alcohol Use Disorders Identification Test (AUDIT) total scores (SMD=−0.378, p=0.18). For weekly consumption (n=3 studies), a statistically significant difference was observed favouring exercise (SMD=−0.656, p=0.04), but not after adjustment for publication bias (SMD=−0.16, 95% CI −0.88 to 0.55). Exercise significantly reduced depressive symptoms versus control (randomised controlled trials (RCTs) =4; SMD=−0.867, p=0.006, I2=63%) and improved physical fitness (VO2) (RCTs=3; SMD=0.564, p=0.01, I2=46%). The pooled dropout rate was 40.3% (95% CI 23.3% to 60.1%) which was no different to control conditions (OR=0.73, p=0.52). Dropouts were higher among men (β=0.0622, p<0.0001, R2=0.82).LimitationsIt was not possible to investigate moderating effects of smoking.ConclusionsAvailable evidence indicates exercise appears not to reduce alcohol consumption, but has significant improvements in other health outcomes, including depression and physical fitness. Additional long-term controlled studies of exercise for AUDs are required.
Children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review and meta-ethnography of qualitative studies
Authors: Parslow Roxanne M , Harris Sarah , Broughton Jessica , Alattas Adla , Crawley Esther , Haywood Kirstie , Shaw Alison 
Published: January 2017

ObjectiveTo synthesis the qualitative studies of children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).DesignSystematic review and meta-ethnography.BackgroundCFS/ME is an important disabling illness, with uncertain cause and prognosis. As a result, children with CFS/ME can find themselves living with greater uncertainty and stigma, exacerbating the impact of the condition. There is a growing body of qualitative research in CFS/ME, yet there has been no attempt to systematically synthesis the studies involving children.MethodsStudies exploring the experiences of children diagnosed with CFS/ME, published or unpublished, using qualitative methods were eligible. MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched as well as grey literature, reference lists and contacting authors. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography.ResultsTen studies involving 82 children with CFS/ME aged 8–18 were included. Our synthesis describes four third-order constructs within children's experiences: (1) disruption and loss: physical, social and the self; (2) barriers to coping: suspension in uncertainty, problems with diagnosis and disbelief; (3) facilitators to coping: reducing uncertainty, credible illness narratives, diagnosis and supportive relationships and (4) hope, personal growth and recovery. CFS/ME introduces profound biographical disruption through its effects on children's ability to socialise, perform school and therefore how they see their future. Unfamiliarity of the condition, problems with diagnosis and felt stigma prevent children from forming a new illness identity. Children adopt coping strategies such as building credible explanations for their illness.ConclusionsPhysical, social, emotional and self-dimensions of life should be included when treating and measuring outcomes from healthcare in paediatric CFS/ME. There is a need for greater recognition and diagnosis of childhood CFS/ME, specialist advice on activity management and improved communication between health and education providers to help children cope with their condition.
Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study
Authors: Ho Sai-Wai , Teng Ying-Hock , Yang Shun-Fa , Yeh Han-Wei , Wang Yu-Hsun , Chou Ming-Chih , Yeh Chao-Bin 
Published: January 2017

ObjectivesIsolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.DesignNationwide population-based cohort study.SettingPatients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.ParticipantsNon-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.Main outcome measureThe primary end point was the occurrence of pneumonia within 30 days.ResultsThe incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.ConclusionsAlthough the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.
Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study
Authors: Borgström Anna , Nerfeldt Pia , Friberg Danielle , Sunnergren Ola , Stalfors Joacim 
Published: January 2017

ObjectivesThe objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.SettingA retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.ParticipantsAll Swedish children 1–<18 years registered in the NPR with a tonsil surgery procedure 1987–2013.Results167 894 tonsil surgeries were registered in the NPR 1987–2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1–3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.ConclusionsThere have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1–3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.
Prevalence of obesity and overweight in African learners: a protocol for systematic review and meta-analysis
Authors: Adom Theodosia , Puoane Thandi , De Villiers Anniza , Kengne André Pascal 
Published: January 2017

IntroductionObesity and overweight are an emerging problem in Africa. Obese children are at increased risk of developing hypertension, high cholesterol, orthopaedic problems and type 2 diabetes as well as increased risk of adult obesity. Prevention of childhood overweight and obesity therefore needs high priority. The review approach is particularly useful in establishing whether research findings are consistent and can be generalised across populations and settings. This systematic review aims to assess the magnitude and distribution of overweight and obesity among primary school learners within populations in Africa.Methods and analysisA comprehensive search of key bibliographic databases including MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost) and ISI Web of Science (Science Citation Index) will be conducted for published literature. Grey literature will be also be obtained. Full-text articles of eligible studies will be obtained and screened following predefined inclusion criteria. The quality of reporting as well as risk of bias of included studies will be assessed, data extracted and synthesised. The results will be summarised and presented by country and major regional groupings. Meta-analysis will be conducted for identical variables across studies. This review will be reported following the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies.Ethics and disseminationEthics is not a requirement since no primary data will be collected. All data that will be presented in this review are based on published articles. The findings of this systematic review will be submitted for publication in peer-reviewed journals and disseminated in national and international conferences and also in policy documents to appropriate bodies for decision-making, where needed. It is expected that the findings will identify some research gaps for further studies.
How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014
Authors: Monrouxe Lynn V , Grundy Lisa , Mann Mala , John Zoe , Panagoulas Eleni , Bullock Alison , Mattick Karen 
Published: January 2017

ObjectiveTo understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions.DesignA rapid review of the literature (registration #CRD42013005305).Data sourcesNine major databases (and key websites) were searched in two timeframes (July–September 2013; updated May–June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge.Eligibility criteria for selecting studiesPrimary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures.Data extractionAt time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013–2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes.ResultsMost studies comprised junior doctors' self-reports (65/87, 75%), few definedpreparednessand a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy.ConclusionsEducational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors.
Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: a cross-sectional analysis of adults at risk of type 2 diabetes
Authors: Edwardson Charlotte L , Henson Joe , Bodicoat Danielle H , Bakrania Kishan , Khunti Kamlesh , Davies Melanie J , Yates Thomas 
Published: January 2017

ObjectiveTo quantify associations between sitting time and glucose, insulin and insulin sensitivity by considering reallocation of time into standing or stepping.DesignCross-sectional.SettingLeicestershire, UK, 2013.ParticipantsAdults aged 30–75 years at high risk of impaired glucose regulation (IGR) or type 2 diabetes. 435 adults (age 66.8±7.4 years; 61.7% male; 89.2% white European) were included.MethodsParticipants wore an activPAL3 monitor 24 hours/day for 7 days to capture time spent sitting, standing and stepping. Fasting and 2-hour postchallenge glucose and insulin were assessed; insulin sensitivity was calculated by Homeostasis Model Assessment of Insulin Secretion (HOMA-IS) and Matsuda-Insulin Sensitivity Index (Matsuda-ISI). Isotemporal substitution regression modelling was used to quantify associations of substituting 30 min of waking sitting time (accumulated in prolonged (≥30 min) or short (<30 min) bouts) for standing or stepping on glucose regulation and insulin sensitivity. Interaction terms were fitted to assess whether the associations with measures of glucose regulation and insulin sensitivity was modified by sex or IGR status.ResultsAfter adjustment for confounders, including waist circumference, reallocation of prolonged sitting to short sitting time and to standing was associated with 4% lower fasting insulin and 4% higher HOMA-IS; reallocation of prolonged sitting to standing was also associated with a 5% higher Matsuda-ISI. Reallocation to stepping was associated with 5% lower 2-hour glucose, 7% lower fasting insulin, 13% lower 2-hour insulin and a 9% and 16% higher HOMA-IS and Matsuda-ISI, respectively. Reallocation of short sitting time to stepping was associated with 5% and 10% lower 2-hour glucose and 2-hour insulin and 12% higher Matsuda-ISI. Results were not modified by IGR status or sex.ConclusionsReallocating a small amount of short or prolonged sitting time with standing or stepping may improve 2-hour glucose, fasting and 2-hour insulin and insulin sensitivity. Findings should be confirmed through prospective and intervention research.Trial registration numberISRCTN31392913, Post-results.
AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury
Authors: Mason Suzanne , Kuczawski Maxine , Teare M Dawn , Stevenson Matt , Goodacre Steve , Ramlakhan Shammi , Morris Francis , Rothwell Joanne 
Published: January 2017

ObjectivesManagement of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.DesignMulticentre, observational study using routine patient records.Setting33 emergency departments in England and Scotland.Participants3566 adults (aged ≥16 years) who had suffered blunt head injury and were currently taking warfarin.Main outcome measuresPrimary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses.ResultsClinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2).ConclusionsIn alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome.Trial registration numberNCT02461498.
Ethnic differences in anthropometric measures and abdominal fat distribution: a cross-sectional pooled study in Inuit, Africans and Europeans
Authors: Rønn Pernille F , Andersen Gregers S , Lauritzen Torsten , Christensen Dirk L , Aadahl Mette , Carstensen Bendix , Jørgensen Marit E 
Published: January 2017

BackgroundEthnic variation in abdominal fat distribution may explain differences in cardiometabolic risk between populations. However, the ability of anthropometric measures to quantify abdominal fat is not clearly understood across ethnic groups. The aim of this study was to investigate the associations between anthropometric measures and visceral (VAT) and subcutaneous abdominal adipose tissue (SAT) in Inuit, Africans and Europeans.MethodsWe combined cross-sectional data from 3 studies conducted in Greenland, Kenya and Denmark using similar methodology. A total of 5275 individuals (3083 Inuit, 1397 Africans and 795 Europeans) aged 17–95 years with measures of anthropometry and ultrasonography of abdominal fat were included in the study. Multiple regression models with fractional polynomials were used to analyse VAT and SAT as functions of body mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage.ResultsThe associations between conventional anthropometric measures and abdominal fat distribution varied by ethnicity in almost all models. Europeans had the highest levels of VAT in adjusted analyses and Africans the lowest with ethnic differences most apparent at higher levels of the anthropometric measures. Similar ethnic differences were seen in the associations with SAT for a given anthropometric measure.ConclusionsConventional anthropometric measures like BMI and waist circumference do not reflect the same amount of VAT and SAT across ethnic groups. Thus, the obesity level at which Inuit and Africans are at increased cardiometabolic risk is likely to differ from that of Europeans.
Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?
Authors: Thern Emelie , de Munter Jeroen , Hemmingsson Tomas , Rasmussen Finn 
Published: January 2017

BackgroundIll health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates.MethodsA register-linked population-based cohort study was conducted including individuals aged 17–24 years. The crisis cohort (n=6410) took part in the Labour Force Survey during the economic crisis (1991–1994) in Sweden and the non-crisis cohort (n=8162) took part in the same survey before the crisis (1983–1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models.ResultsIn fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3–6 months (2.19; 1.43 to 3.37) and >6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found.ConclusionsYouth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.