bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of an economic evaluation of diagnostic strategies: the case of monogenic diabetes
Authors: Peters Jaime L , Anderson Rob , Hyde Chris 
Published: June 2013

ObjectivesTo describe the development process for defining an appropriate model structure for the economic evaluation of test–treatment strategies for patients with monogenic diabetes (caused by mutations in the GCK, HNF1A or HNF4A genes).DesignExperts were consulted to identify and define realistic test–treatment strategies and care pathways. A systematic assessment of published diabetes models was undertaken to inform the model structure.SettingNational Health Service in England and Wales.ParticipantsExperts in monogenic diabetes whose collective expertise spans the length of the patient care pathway.Primary and secondary outcomesA defined model structure, including the test–treatment strategies, and the selection of a published diabetes model appropriate for the economic evaluation of strategies to identify patients with monogenic diabetes.ResultsFive monogenic diabetes test–treatment strategies were defined: no testing of any kind, referral for genetic testing based on clinical features as noted by clinicians, referral for genetic testing based on the results of a clinical prediction model, referral for genetic testing based on the results of biochemical and immunological tests, referral for genetic testing for all patients with a diagnosis of diabetes under the age of 30 years. The systematic assessment of diabetes models identified the IMS CORE Diabetes Model (IMS CDM) as a good candidate for modelling the long-term outcomes and costs of the test–treatment strategies for monogenic diabetes. The short-term test–treatment events will be modelled using a decision tree which will feed into the IMS CDM.ConclusionsDefining a model structure for any economic evaluation requires decisions to be made. Expert consultation and the explicit use of critical appraisal can inform these decisions. Although arbitrary choices have still been made, decision modelling allows investigation into such choices and the impact of assumptions that have to be made due to a lack of data.
From never to daily smoking in 30 months: the predictive value of tobacco and non-tobacco advertising exposure
Authors: Morgenstern Matthis , Sargent James D , Isensee Barbara , Hanewinkel Reiner 
Published: June 2013

ObjectiveTo test the specificity of the association between tobacco advertising and youth smoking initiation.DesignLongitudinal survey with a 30 month interval.Setting21 public schools in three German states.ParticipantsA total of 1320 sixth-to-eighth grade students who were never-smokers at baseline (age range at baseline, 10–15 years; mean, 12.3 years).ExposuresExposure to tobacco and non-tobacco advertisements was measured at baseline with images of six tobacco and eight non-tobacco advertisements; students indicated the number of times they had seen each ad and the sum score over all advertisements was used to represent inter-individual differences in the amount of advertising exposure.Primary and secondary outcome measuresEstablished smoking, defined as smoked >100 cigarettes during the observational period, and daily smoking at follow-up. Secondary outcome measures were any smoking and smoking in the last 30 days.ResultsDuring the observation period, 5% of the never-smokers at baseline smoked more than 100 cigarettes and 4.4% were classified as daily smokers. After controlling for age, gender, socioeconomic status, school performance, television screen time, personality characteristics and smoking status of peers and parents, each additional 10 tobacco advertising contacts increased the adjusted relative risk for established smoking by 38% (95% CI 16% to 63%; p<0.001) and for daily smoking by 30% (95% CI 3% to 64%; p<0.05). No significant association was found for non-tobacco advertising contact.ConclusionsThe study confirms a content-specific association between tobacco advertising and smoking behaviour and underlines that tobacco advertising exposure is not simply a marker for adolescents who are generally more receptive or attentive towards marketing.
A population-based cross-sectional study of the association between facial morphology and cardiometabolic risk factors in adolescence
Authors: Djordjevic Jelena , Lawlor Debbie A , Zhurov Alexei I , Toma Arshed M , Playle Rebecca , Richmond Stephen 
Published: June 2013

ObjectiveTo determine whether facial morphology is associated with fasting insulin, glucose and lipids independent of body mass index (BMI) in adolescents.DesignPopulation-based cross-sectional study.SettingAvon Longitudinal Study of Parents and Children (ALSPAC), South West of England.ParticipantsFrom the ALSPAC database of 4747 three-dimensional facial laser scans, collected during a follow-up clinic at the age of 15, 2348 white British adolescents (1127 males and 1221 females) were selected on the basis of complete data on cardiometabolic parameters, BMI and Tanner's pubertal stage.Main outcome measuresFasting insulin, glucose and lipids (triglycerides, high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc)).ResultsOn the basis of the collection of 63 x, y and z coordinates of 21 anthropometric landmarks, 14 facial principal components (PCs) were identified. These components explained 82% of the variation in facial morphology and were used as exposure variables. With adjustment for age, gender and pubertal stage, seven PCs were associated with fasting insulin, none with glucose, three with triglycerides, three with HDLc and four with LDLc. After additional adjustment for BMI, four PCs remained associated with fasting insulin, one with triglycerides and two with LDLc. None of these associations withstood adjustment for multiple comparisons.ConclusionsThese initial hypotheses generating analyses provide no evidence that facial morphology is importantly related to cardiometabolic outcomes. Further examination might be warranted. Facial morphology assessment may have value in identifying other areas of disease risk.
‘I can't be an addict. I am.’ Over-the-counter medicine abuse: a qualitative study
Authors: Cooper Richard J 
Published: June 2013

ObjectivesOver-the-counter (OTC) pharmacy medicines are considered relatively safe in contrast to prescribed and illicit substances, but their abuse and addiction potential is increasingly recognised. Those affected represent a hard to reach group, with little known about their experiences. Study objectives were to describe the experiences and views of those self-reporting OTC medicine abuse, and why medicines were taken, how they were obtained and associated treatment and support sought.DesignQualitative study using in-depth mainly telephone interviews.ParticipantsA purposive sample of 25 adults, aged 20–60s, 13 women.SettingUK, via two internet support groups.ResultsIndividuals considered themselves ‘addicted’, but socially and economically active and different from illicit substance misusers. They blamed themselves for losing control over their medicine use, which usually began for genuine medical reasons and not experimentation and was often linked to the cessation of, or ongoing, medical prescribing. Codeine, in compound analgesics, was the main medicine implicated with three distinct dose ranges emerging with decongestant and sedative antihistamine abuse also being reported. Subsequent use was for the ‘buzz’ or similar effects of the opiate, which was obtained unproblematically by having lists of pharmacies to visit and occasionally using internet suppliers. Perceived withdrawal symptoms were described for all three dose ranges, and work and health problems were reported with higher doses. Mixed views about different treatment and support options emerged with standard drug treatment services being considered inappropriate for OTC medicines and concerns that this ‘hidden addiction’ was recorded in medical notes. Most supported the continued availability of OTC medicines with appropriate addiction warnings.ConclusionsGreater awareness of the addiction potential of OTC medicines is needed for the public, pharmacists and medical prescribers, along with appropriate communication about, and reviews of, treatment and support options, for this distinct group.
The role of gender in housing for individuals with severe mental illness: a qualitative study of the Canadian service context
Authors: Kidd Sean A , Virdee Gursharan , Krupa Terry , Burnham Darrell , Hemingway Dawn , Margolin Indrani , Patterson Michelle , Zabkiewicz Denise 
Published: June 2013

ObjectiveThis study was undertaken to examine the role of gender as it relates to access to housing among individuals with severe mental illness (SMI) in Canada.DesignAn exploratory, qualitative approach was used to assess the perspectives of Canadian housing experts. The focus of inquiry was on the role of gender and associated intersections (eg, ethnicity) in pathways to housing access and housing needs for individuals with SMI.SettingA purposeful sampling strategy was undertaken to access respondents across all Canadian geographic regions, with diversity across settings (urban and rural) and service sectors (hospital based and community based).Participants–29 individuals (6 men and 23 women) considered to be experts in a housing service context as it pertains to SMI were recruited. On average, participants had worked for 15 years in services that specialised in the support and delivery of housing services to people with SMI.MeasuresSemistructured interviews with participants focused on the role gender plays in access to housing in their specific context. Barriers and facilitators were examined as were intersections with other relevant factors, such as ethnicity, poverty and parenthood. Quantitative ratings of housing accessibility as a function of gender were also collected.ResultsParticipants across geographic contexts described a lack of shelter facilities for women, leading to a reliance on exploitative circumstances. Other findings included a compounding of discrimination for ethnic minority women, the unique resource problems faced in rural contexts, and the difficulties that attend access to shelter and housing for parents with SMI.ConclusionsThese findings suggest that, along with a generally poor availability of housing stock for individuals with SMI, access problems are compounded by a lack of attention to the unique needs and illness trajectories that attend gender.
Changes in smoking behaviours following a smokefree legislation in parks and on beaches: an observational study
Authors: Okoli Chizimuzo , Johnson Andrew , Pederson Ann , Adkins Sarah , Rice Wendy 
Published: June 2013

ObjectiveTo examine the effect of an outdoor smokefree law in parks and on beaches on observed smoking in selected venues.MethodsThe study involved repeated observations in selected parks and beaches in Vancouver, British Columbia, Canada. The main outcome measure was changes in observed smoking rates in selected venues from prelaw to 12 months postlaw.ResultsNo venue was 100% smokefree at the 12-month postlaw observation time point. There was a significant decrease in observed smoking rates in all venues from prelaw to 12-month postlaw (prelaw mean smoking rate=20.5 vs 12-month mean smoking rate=4.7, p=0.04). In stratified analysis by venue, the differences between the prelaw and 12-month smoking rates decreased significantly in parks (prelaw mean smoking rate=37.1 vs 12-month mean smoking rate=6.5, p=0.01) but not in beaches (prelaw mean smoking rate=2.9 vs 12-month mean smoking rate=1.0, p=0.1).ConclusionsSmokefree policies in outdoor recreational venues have the potential to decrease smoking in these venues. The effectiveness of such policies may differ by the type and usage of the venue; for instance, compliance may be better in venues that are used more often and have enforcement. Future studies may further explore factors that limit and foster the enforcement of such policies in parks and beaches.
Predictors of good functional outcome in counterpulsation-treated recent ischaemic stroke patients
Authors: Lin Wenhua , Han Jinghao , Chen Xiangyan , Xiong Li , Leung Ho Wan , Leung Thomas W , Soo Yannie , Wong Lawrence Ka Sing 
Published: June 2013

ObjectivesExternal counterpulsation (ECP) is a non-invasive method being investigated for ischaemic stroke. We aimed to explore predictors of good functional outcome for ECP-treated ischaemic stroke patients who completed a minimum of 10 sessions.MethodsWe analysed our ECP registry of ischaemic stroke patients with cerebral large artery stenosis who underwent ECP therapy at the Prince of Wales Hospital from 2004 to 2010. We included 155 patients who completed at least 10 sessions of ECP and had 3-month follow-up data as well as 52 medical controls. Functional outcomes were dichotomised into good outcome (modified Rankin Scale (mRS) 0–2) and bad outcome (mRS 3–6). We compared the differences in two groups in terms of demographics, medical history and parameters of ECP treatment.ResultsAt 3 months after stroke, 70.5% of patients who finished the whole course of ECP had a good outcome (only 46.5% in the unfinished group and 38.5% in the medical group). Among all 207 recruited cases, 119 (57.5%) patients had a good outcome at 3 months after stroke. Compared with the bad outcome group, patients in the good outcome group were younger and had a lower baseline National Institutes of Health Stroke Scale (NIHSS) and longer ECP therapy duration. Multivariate logistic regression showed that ECP duration (OR 1.032), baseline NIHSS (OR 0.734) and age (OR 0.961) were independent predictors for a favourable outcome.ConclusionsDuration of ECP therapy is first found to be an important predictor for good outcome of ECP-treated ischaemic stroke patients, in addition to the well-known prognostic factors such as age and NIHSS.
Effect of low-protein diet on kidney function in diabetic nephropathy: meta-analysis of randomised controlled trials
Authors: Nezu Uru , Kamiyama Hiroshi , Kondo Yoshinobu , Sakuma Mio , Morimoto Takeshi , Ueda Shinichiro 
Published: June 2013

ObjectiveTo evaluate the effect of low-protein diet on kidney function in patients with diabetic nephropathy.DesignA systematic review and a meta-analysis of randomised controlled trials.Data sourcesMEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number (ISRCTN) Register and University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) from inception to 10 December 2012. Internet searches were also carried out with general search engines (Google and Google Scholar).Study selectionRandomised controlled trials that compared low-protein diet versus control diet and assessed the effects on kidney function, proteinuria, glycaemic control or nutritional status.Primary and secondary outcome measures and data synthesisThe primary outcome was a change in the glomerular filtration rate (GFR). The secondary outcomes were changes in proteinuria, post-treatment value of glycated haemoglobin A1C (HbA1c) and post-treatment value of serum albumin. The results were summarised as the mean difference for continuous outcomes and pooled by the random effects model. Subgroup analyses and sensitivity analyses were conducted regarding patient characteristics, intervention period, methodological quality and assessment of diet compliance. The assessment of diet compliance was performed based on the actual protein intake ratio (APIR) of the low-protein diet group to the control group.ResultsWe identified 13 randomised controlled trials enrolling 779 patients. A low-protein diet was associated with a significant improvement in GFR (5.82 ml/min/1.73 m2, 95% CI 2.30 to 9.33, I2=92%; n=624). This effect was consistent across the subgroups of type of diabetes, stages of nephropathy and intervention period. However, GFR was improved only when diet compliance was fair (8.92, 95% CI 2.75 to 15.09, I2=92% for APIR <0.9 and 0.03, 95% CI −1.49 to 1.56, I2=90% for APIR ≥0.9). Proteinuria and serum albumin were not differed between the groups. HbA1c was slightly but significantly decreased in the low-protein diet group (−0.26%, 95% CI −0.35 to −0.18, I2=0%; n=536).ConclusionsLow-protein diet was significantly associated with improvement of diabetic nephropathy. The adverse effects of low-protein diet were not apparent such as worsening of glycaemic control and malnutrition.
Surveys of the salt content in UK bread: progress made and further reductions possible
Authors: Brinsden Hannah C , He Feng J , Jenner Katharine H , MacGregor Graham A 
Published: June 2013

ObjectivesTo explore the salt reductions made over time in packaged bread sold in the UK, the biggest contributor of salt to the UK diet.Study designCross-sectional surveys were carried out on the salt content of breads available in UK supermarkets in 2001(40 products), 2006 (138) and 2011 (203).Main outcome measuresThe primary outcome measure was the change in salt content per 100 g over time. Further measures included the proportion of products meeting salt targets and differences between brands and bread types.ResultsThe average salt level of bread was 1.23±0.19 g/100 g in 2001, 1.05±0.16 in 2006 and 0.98±0.13 in 2011. This shows a reduction in salt/100 g of ≈20% between 2001 and 2011. In the 18 products which were surveyed in all 3 years, there was a significant reduction of 17% (p<0.05). Supermarket own brand bread was found to be lower in salt compared with branded bread (0.95 g/100 g compared with 1.04 g/100 g in 2011). The number of products meeting the 2012 targets increased from 28% in 2001 to 71% in 2011 (p<0.001).ConclusionsThis study shows that the salt content of bread has been progressively reduced over time, contributing to the evidence base that a target-based approach to salt reduction can lead to reductions being made. A wide variation in salt levels was found with many products already meeting the 2012 targets, indicating that further reductions can be made. This requires further progressive lower targets to be set, so that the UK can continue to lead the world in salt reduction and save the maximum number of lives.
An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol
Authors: Rogerson Bernadette , Copeland Jan , Buttner Petra , Bohanna India , Cadet-James Yvonne , Sarnyai Zoltan , Clough Alan R 
Published: June 2013

IntroductionCannabis use and dependence is a serious health and criminal justice issue among incarcerated populations internationally. Upon abrupt, enforced cessation of cannabis, prisoners may suffer irritability and anger that can lead to threatening behaviour, intimidation, violence, sleep disturbances and self-harm. Cannabis withdrawal syndrome, proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders in 2013, has not been examined in Indigenous populations. Owing to the exceptionally high rates of cannabis use in the community, high proportions of Australian Indigenous prisoners may suffer from withdrawal upon entry to custody.Methods and analysis60 male and 60 female Indigenous prisoners (18–40 years) at a high risk of cannabis dependence will be recruited upon entry to custody. A pictorial representation of the standard Cannabis Withdrawal Scale will be tested for reliability and validity. Cortisol markers will be measured in saliva, as the indicators of onset and severity of cannabis withdrawal and psychological distress. The characteristics will be described as percentages and mean or median values with 95% CI. Receiver operator curve analysis will determine an ideal cut-off of the Cannabis Withdrawal Scale and generalised estimating equations modelling will test changes over time. The acceptability and efficacy of proposed resources will be assessed qualitatively using thematic analysis.OutcomesA valid and reliable measure of cannabis withdrawal for use with Indigenous populations, the onset and time course of withdrawal symptoms in this population and the development of culturally acceptable resources and interventions to identify and manage cannabis withdrawal.Ethics and disseminationThe project has been approved by the James Cook University Human Research Ethics Committee (approval number H4651).The results will be reported via peer reviewed publications, conference, seminar presentations and on-line media for national and international dissemination.
Patients’ subjective concepts about primary healthcare utilisation: the study protocol of a qualitative comparative study between Norway and Germany
Authors: Herrmann Wolfram J , Haarmann Alexander , Flick Uwe , Bærheim Anders , Lichte Thomas , Herrmann Markus 
Published: June 2013

BackgroundIn Germany, utilisation of ambulatory healthcare services is high compared with other countries: While a study based on the process data of German statutory health insurances showed an average of 17.1 physician-patient-contacts per year, the comparable figure for Norway is about five. The usual models of healthcare utilisation, such as Rosenstock's Health Belief Model and Andersen's Behavioural Model, cannot explain these differences adequately. Organisational factors of the healthcare system, such as gatekeeping, do not explain the magnitude of the differences. Our hypothesis is that patients’ subjective concepts about primary healthcare utilisation play a major role in explaining different healthcare utilisation behaviour in different countries. Hence, the aim of this study is to explore these subjective concepts comparatively, between Germany and Norway.Methods/designWith that aim in mind, we chose a comparative qualitative study design. In Norway and Germany, we are going to interview 20 patients each with qualitative episodic interviews. In addition, we are going to conduct participant observation in four German and four Norwegian primary care practices. The data will be analysed by thematic coding. Using selected categories, we are going to conduct comparative case and group analyses.Ethics and disseminationThe study adheres to the Declaration of Helsinki. All interviewees will sign informed consent forms and all patients will be observed during consultation. Strict rules for data security will apply. Developed theory and policy implications are going to be disseminated by a workshop, presentations for experts and laypersons and publications.