bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of acute myocardial infarction from electronic healthcare records using different disease coding systems: a validation study in three European countries
Authors: Coloma Preciosa M , Valkhoff Vera E , Mazzaglia Giampiero , Nielsson Malene Schou , Pedersen Lars , Molokhia Mariam , Mosseveld Mees , Morabito Paolo , Schuemie Martijn J , van der Lei Johan , Sturkenboom Miriam , Trifirò Gianluca ,   on behalf of the EU-ADR Consortium
Published: June 2013

ObjectiveTo evaluate positive predictive value (PPV) of different disease codes and free text in identifying acute myocardial infarction (AMI) from electronic healthcare records (EHRs).DesignValidation study of cases of AMI identified from general practitioner records and hospital discharge diagnoses using free text and codes from the International Classification of Primary Care (ICPC), International Classification of Diseases 9th revision-clinical modification (ICD9-CM) and ICD-10th revision (ICD-10).SettingPopulation-based databases comprising routinely collected data from primary care in Italy and the Netherlands and from secondary care in Denmark from 1996 to 2009.ParticipantsA total of 4 034 232 individuals with 22 428 883 person-years of follow-up contributed to the data, from which 42 774 potential AMI cases were identified. A random sample of 800 cases was subsequently obtained for validation.Main outcome measuresPPVs were calculated overall and for each code/free text. ‘Best-case scenario’ and ‘worst-case scenario’ PPVs were calculated, the latter taking into account non-retrievable/non-assessable cases. We further assessed the effects of AMI misclassification on estimates of risk during drug exposure.ResultsRecords of 748 cases (93.5% of sample) were retrieved. ICD-10 codes had a ‘best-case scenario’ PPV of 100% while ICD9-CM codes had a PPV of 96.6% (95% CI 93.2% to 99.9%). ICPC codes had a ‘best-case scenario’ PPV of 75% (95% CI 67.4% to 82.6%) and free text had PPV ranging from 20% to 60%. Corresponding PPVs in the ‘worst-case scenario’ all decreased. Use of codes with lower PPV generally resulted in small changes in AMI risk during drug exposure, but codes with higher PPV resulted in attenuation of risk for positive associations.ConclusionsICD9-CM and ICD-10 codes have good PPV in identifying AMI from EHRs; strategies are necessary to further optimise utility of ICPC codes and free-text search. Use of specific AMI disease codes in estimation of risk during drug exposure may lead to small but significant changes and at the expense of decreased precision.
Early life bereavement and childhood cancer: a nationwide follow-up study in two countries
Authors: Momen Natalie C , Olsen Jørn , Gissler Mika , Cnattingius Sven , Li Jiong 
Published: June 2013

ObjectiveChildhood cancer is a leading cause of child deaths in affluent countries, but little is known about its aetiology. Psychological stress has been suggested to be associated with cancer in adults; whether this is also seen in childhood cancer is largely unknown. We investigated the association between bereavement as an indicator of severe childhood stress exposure and childhood cancer, using data from Danish and Swedish national registers.DesignPopulation-based cohort study.SettingDenmark and Sweden.ParticipantsAll live-born children born in Denmark between 1968 and 2007 (n=2 729 308) and in Sweden between 1973 and 2006 (n=3 395 166) were included in this study. Exposure was bereavement by the death of a close relative before 15 years of age. Follow-up started from birth and ended at the first of the following: date of a cancer diagnosis, death, emigration, day before their 15th birthday or end of follow-up (2007 in Denmark, 2006 in Sweden).Outcome measuresRates and HRs for all childhood cancers and specific childhood cancers.ResultsA total of 1 505 938 (24.5%) children experienced bereavement at some point during their childhood and 9823 were diagnosed with cancer before the age of 15 years. The exposed children had a small (10%) increased risk of childhood cancer (HR 1.10; 95% CI 1.04 to 1.17). For specific cancers, a significant association was seen only for central nervous system tumours (HR 1.14; 95% CI 1.02 to 1.28).ConclusionsOur data suggest that psychological stress in early life is associated with a small increased risk of childhood cancer.
Adjusting the obesity thresholds for self-reported BMI in Ireland: a cross-sectional analysis
Authors: Madden David 
Published: June 2013

ObjectiveTo investigate the optimal adjustment to be made to obesity thresholds when using self-reported body mass index (BMI).DesignA cross-sectional study.SettingData from the Survey of Lifestyle, Attitudes and Nutrition in Ireland, a nationally representative dataset using the Geodirectory (a listing of all residential addresses in Ireland compiled by the postal service) as the sampling frame.ParticipantsA nationally representative sample of 10 364 adults aged 18+, carried out by face-to-face interview with clinical measurement applied to a number of outcomes to a representative subsample of 2174. After discarding the observations with missing values and errors, the eventual sample was 1874.Primary and secondary outcome measuresBMI based on measured and self-reported weight and height.BackgroundIt is generally found that self-reported BMI understates true or measured BMI and accordingly revised obesity thresholds have been suggested.MethodsData from the 2007 Survey of Lifestyles, Attitudes and Nutrition in Ireland were used to analyse self-reported and measured BMI. The self-reported BMI threshold was adjusted to obtain the optimal signal for measured BMI using different criteria viz. efficiency (maximum number of correct classifications), maximisation of Youden's J, maximisation of OR, minimisation of cost of misclassification and constrained optimisation.ResultsThe optimal threshold differed substantially depending on the criterion adopted for choosing it, with thresholds of 29.1 (efficiency criterion), 27.5 (Youden's J) and 26.0 (FN rate of 5%). Standard criteria such as Youden's J index were shown to implicitly impose relative costs of false-negatives and false-positives which may not always correspond to the values of the analyst.ConclusionsWhen adjusting self-reported BMI thresholds in order to obtain the optimal signal for ‘true’ obesity, analysts should explicitly choose the relative costs of false-positives and false-negatives.
Canadian Study of Determinants of Endometabolic Health in ChIlDrEn (CanDECIDE study): a cohort study protocol examining the mechanisms of obesity in survivors of childhood brain tumours
Authors: Samaan M Constantine , Thabane Lehana , Burrow Sarah , Dillenburg Rejane F , Scheinemann Katrin 
Published: June 2013

BackgroundChildhood obesity has reached epidemic proportions and is impacting children's health globally. In adults, obesity is associated with chronic low-grade inflammation that leads to insulin resistance, which is one of the important mechanisms through which dysregulation of metabolism occurs. There is limited information available about the contribution of inflammation to metabolic health in obese children, and how individual and lifestyle factors impact this risk. One of the paediatric groups at risk of higher rates of obesity includes the survivors of childhood brain tumours. The aim of this study was to evaluate the mechanisms that contribute to inflammation in obese survivors of childhood brain tumours.Methods and analysisThis is a prospective cohort study. We will recruit lean and obese survivors of childhood brain tumours, and a control group composed of lean and obese children with no history of tumours. We will measure circulating and urinary cytokine levels and cytokine gene expression in monocytes. In addition, the methylation patterns of cytokine genes and that of toll-like receptor genes will be evaluated. These will be correlated with individual and lifestyle factors including age, sex, ethnicity, puberty, body mass index, fasting lipid levels, insulin sensitivity, diet, exercise, sleep, stress and built environment. The sample size calculation showed that we need 25 participants per armEthics and disseminationThis study has received ethics approval from the institutional review board. Once completed, we will publish this work in peer-reviewed journals and share the findings in presentations and posters in meetings.DiscussionThis study will permit the interrogation of inflammation as a contributor to obesity and its complications in obese survivors of childhood brain tumours and compare them with lean survivors and lean and obese controls with no history of tumours, which may help identify therapeutic and preventative interventions to combat the rising tide of obesity.
Inattention and hyperactivity in children at risk of obesity: a community cross-sectional study
Authors: McWilliams Lorna , Sayal Kapil , Glazebrook Cris 
Published: June 2013

ObjectiveThere is a link between the symptoms of hyperactivity/inattention and overweight in children. Less is known about the factors which might influence this relationship, such as physical and sedentary activity levels or exercise self-efficacy. The aim of this study is to examine the associations between the symptoms of hyperactivity/inattention and risk factors for adult obesity in a sample of children with barriers to exercise.DesignChildren aged 9–11 years were recruited from 24 primary schools that participated in the Steps to Active Kids (STAK) physical activity intervention study. Study inclusion criteria were low exercise self-efficacy, teacher-rated overweight or asthma. Children with high levels of physical activity were excluded. Measures included parent and teacher-rated behavioural and emotional well-being using the Strengths and Difficulties Questionnaire, physical and sedentary activity levels, BMI (body mass index) and exercise self-efficacy.ResultsOf 424 participating children, 62% were girls and 39% were classified as overweight or obese. As compared with population norms, boys in this at-risk sample were more likely to receive an abnormal teacher-rated hyperactivity/inattention score (OR 1.48, 95% CI 1.01 to 2.17). Children with teacher-rated abnormal hyperactivity/inattention scores reported higher levels of sedentary activity (OR 1.13, 95% CI 1.02 to 1.17), but not physically active activity. The pattern of findings was similar for children with hyperactivity/inattention problems as rated by both parent and teacher (pervasive hyperactivity and impairment).ConclusionsAlthough BMI was not directly related to hyperactivity/inattention, children with risk factors for adult obesity have more hyperactivity/inattention problems. In particular, hyperactivity/inattention is associated with higher levels of sedentary activity. Higher rates of pervasive hyperactivity and impairment were apparent in this at-risk group.
Influence of the US President’s Emergency Plan for AIDS Relief (PEPfAR) on career choices and emigration of health-profession graduates from a Ugandan medical school: a cross-sectional study
Authors: Bajunirwe Francis , Twesigye Leonidas , Zhang Michael , Kerry Vanessa B , Bangsberg David R 
Published: June 2013

ObjectiveThe purpose of this study was to determine the current work distribution of health professionals from a public Ugandan medical school in a period of major donor funding for HIV programmes. We explore the hypothesis that programmes initiated under unprecedented health investments from the US President's Emergency Plan for AIDS Relief have possibly facilitated the drain of healthcare workers from the public-health system of countries like Uganda.DesignCross-sectional study conducted between January and December 2010 to survey graduates, using in-person, phone or online surveys using email and social networks. Logistic regression analysis was applied to determine ORs for association between predictors and outcomes.SettingLocated rurally, Mbarara University of Science and Technology (MUST) is one of three government supported medical schools in Uganda.ParticipantsGraduates who completed a health-related degree at MUST.Main outcome measureLocation of health profession graduates (Uganda or abroad) and main field of current job (HIV-related non-governmental organisation (NGO) or others).ResultsWe interviewed 85.4% (n=796) of all MUST alumni since the university opened in 1989. 78% (n=618) were physicians and 12% (n=94) of graduates worked outside Uganda. Over 50% (n=383) of graduates worked for an HIV-related NGO whether in Uganda or abroad. Graduates receiving their degree after 2005, when large HIV programmes started, were less likely to leave the country, OR=0.24 (95% CI 0.1 to 0.59) but were more likely to work for an HIV-related NGO, OR=1.53 (95% CI 1.06 to 2.23).ConclusionsA majority of health professionals surveyed work for an HIV-related NGO. The increase in resources and investment in HIV-treatment capacity is temporally associated with retention of medical providers in Uganda. Donor funds should be channelled to develop and retain healthcare workers in disciplines other than HIV and broaden the healthcare workforce to other areas.
What can qualitative research do for randomised controlled trials? A systematic mapping review
Authors: O'Cathain A , Thomas K J , Drabble S J , Rudolph A , Hewison J 
Published: June 2013

ObjectiveTo develop an empirically based framework of the aspects of randomised controlled trials addressed by qualitative research.DesignSystematic mapping review of qualitative research undertaken with randomised controlled trials and published in peer-reviewed journals.Data sourcesMEDLINE, PreMEDLINE, EMBASE, the Cochrane Library, Health Technology Assessment, PsycINFO, CINAHL, British Nursing Index, Social Sciences Citation Index and ASSIA.Eligibility criteriaArticles reporting qualitative research undertaken with trials published between 2008 and September 2010; health research, reported in English.Results296 articles met the inclusion criteria. Articles focused on 22 aspects of the trial within five broad categories. Some articles focused on more than one aspect of the trial, totalling 356 examples. The qualitative research focused on the intervention being trialled (71%, 254/356); the design, process and conduct of the trial (15%, 54/356); the outcomes of the trial (1%, 5/356); the measures used in the trial (3%, 10/356); and the target condition for the trial (9%, 33/356). A minority of the qualitative research was undertaken at the pretrial stage (28%, 82/296). The value of the qualitative research to the trial itself was not always made explicit within the articles. The potential value included optimising the intervention and trial conduct, facilitating interpretation of the trial findings, helping trialists to be sensitive to the human beings involved in trials, and saving money by steering researchers towards interventions more likely to be effective in future trials.ConclusionsA large amount of qualitative research undertaken with specific trials has been published, addressing a wide range of aspects of trials, with the potential to improve the endeavour of generating evidence of effectiveness of health interventions. Researchers can increase the impact of this work on trials by undertaking more of it at the pretrial stage and being explicit within their articles about the learning for trials and evidence-based practice.
Identifying admitted patients at risk of dying: a prospective observational validation of four biochemical scoring systems
Authors: Brabrand Mikkel , Knudsen Torben , Hallas Jesper 
Published: June 2013

ObjectivesRisk assessment is an important part of emergency patient care. Risk assessment tools based on biochemical data have the advantage that calculation can be automated and results can be easily provided. However, to be used clinically, existing tools have to be validated by independent researchers. This study involved an independent external validation of four risk stratification systems predicting death that rely primarily on biochemical variables.DesignProspective observational study.SettingThe medical admission unit at a regional teaching hospital in Denmark.ParticipantsOf 5894 adult (age 15 or above) acutely admitted medical patients, 205 (3.5%) died during admission and 46 died (0.8%) within one calendar day.InterventionsNone.Main outcome measuresThe main outcome measure was the ability to identify patients at an increased risk of dying (discriminatory power) as area under the receiver-operating characteristic curve (AUROC) and the accuracy of the predicted probability (calibration) using the Hosmer-Lemeshow goodness-of-fit test. The endpoint was all-cause mortality, defined in accordance with the original manuscripts.ResultsUsing the original coefficients, all four systems were excellent at identifying patients at increased risk (discriminatory power, AUROC ≥0.80). The accuracy was poor (we could assess calibration for two systems, which failed). After recalculation of the coefficients, two systems had improved discriminatory power and two remained unchanged. Calibration failed for one system in the validation cohort.ConclusionsFour biochemical risk stratification systems can risk-stratify the acutely admitted medical patients for mortality with excellent discriminatory power. We could improve the models for use in our setting by recalculating the risk coefficient for the chosen variables.
Effect of occupation on risk of developing MS: an insurance cohort study
Authors: Horwitz Henrik , Ahlgren Birgitte , Nærum Elisabeth 
Published: June 2013

ObjectiveThe aim of this study was to estimate the occupational risks in relation to multiple sclerosis (MS). The immediate background for this research was our finding that there had been a high number of critical illness insurance claims by patients diagnosed with MS within the agricultural segment of a Danish pension fund.DesignAn open insurance cohort. All payouts for the critical illness insurance from 2002 to 2011 were continuously registered.SettingsPensionDanmark; one of Denmark's largest pension funds.ParticipantsPensionDanmark insures more than 300 000 members of the Danish Confederation of Trade Unions against critical illness. All members are insured, and all policies are identical. The total exposure is 3.3 million person-years.Primary outcome measuresThe incidence of MS.ResultsDuring the 10-year period, 389 persons were diagnosed with MS. The crude incidence rate for men was 10.2/100 000; the corresponding figure for women was 16.1/100 000. We found signs of an overall effect of occupation on the risk of developing MS, and the high frequency found within the agricultural segment was attributed to dairy operators, who had an incidence of MS 2.0 times higher than the rest of the study's population (95% CI=1.2 to 3.0).ConclusionsOur results indicate some occupational risk factors in MS, and this should be investigated further.
Azithromycin and survival inStreptococcus pneumoniaepneumonia: a retrospective study
Authors: Shorr Andrew F , Zilberberg Marya D , Kan Jason , Hoffman Justin , Micek Scott T , Kollef Marin H 
Published: June 2013

ObjectiveStreptococcus pneumoniae(SP) represents a major pathogen in pneumonia. The impact of azithromycin on mortality in SP pneumonia remains unclear. Recent safety concerns regarding azithromycin have raised alarm about this agent's role with pneumonia. We sought to clarify the relationship between survival and azithromycin use in SP pneumonia.DesignRetrospective cohort.SettingUrban academic hospital.ParticipantsAdults with a diagnosis of SP pneumonia (January–December 2010). The diagnosis of pneumonia required a compatible clinical syndrome and radiographic evidence of an infiltrate.InterventionNone.Primary and secondary outcome measuresHospital mortality served as the primary endpoint, and we compared patients given azithromycin with those not treated with this. Covariates of interest included demographics, severity of illness, comorbidities and infection-related characteristics (eg, appropriateness of initial treatment, bacteraemia). We employed logistic regression to assess the independent impact of azithromycin on hospital mortality.ResultsThe cohort included 187 patients (mean age: 67.0±8.2 years, 50.3% men, 5.9% admitted to the intensive care unit). The most frequently utilised non-macrolide antibiotics included: ceftriaxone (n=111), cefepime (n=31) and moxifloxacin (n=22). Approximately two-thirds of the cohort received azithromycin. Crude mortality was lower in persons given azithromycin (5.6% vs 23.6%, p<0.01). The final survival model included four variables: age, need for mechanical ventilation, initial appropriate therapy and azithromycin use. The adjusted OR for mortality associated with azithromycin equalled 0.26 (95% CI 0.08 to 0.80, p=0.018).ConclusionsSP pneumonia generally remains associated with substantial mortality while azithromycin treatment is associated with significantly higher survival rates. The impact of azithromycin is independent of multiple potential confounders.
Sedentary behaviours and obesity in adults: the Cardiovascular Risk in Young Finns Study
Authors: Heinonen I , Helajärvi H , Pahkala K , Heinonen O J , Hirvensalo M , Pälve K , Tammelin T , Yang X , Juonala M , Mikkilä V , Kähönen M , Lehtimäki T , Viikari J , Raitakari O T 
Published: June 2013

ObjectiveSedentary behaviour may contribute to the development of obesity. We investigated the relations between different types of sedentary behaviour and adiposity markers in a well-characterised adult population after controlling for a wide range of potential confounders.DesignCross-sectional study.SettingThe Cardiovascular Risk in Young Finns Multicenter Study. Participants Sedentary time (TV viewing, computer time, reading, music/radio listening and other relaxation) was assessed with a questionnaire for 1084 women and 909 men aged 30–45 years. Other study variables included occupational and leisure-time physical activity, sleep duration, socioeconomic status, smoking, alcohol consumption, energy intake, adherence to the recommended diet, multiple individual food items, age and genetic variants associated with body mass index (BMI). Primary outcome measures BMI in kg/m2and waist circumference (WC in cm).ResultsOf the different sedentary behaviour types, TV viewing was most consistently related to higher BMI and WC, both in men and women. One additional daily TV hour was associated with a 1.81±0.44 cm larger WC in women and 2 cm±0.44 cm in men (both p<0.0001). The association with TV was diluted, but remained highly significant after adjustments with all measured covariates, including several potentially obesogenic food items associated with TV viewing. The intakes of food items such as sausage, beer and soft drinks were directly associated with TV viewing, while the intakes of oat and barley, fish, and fruits and berries were associated indirectly. After these adjustments, non-TV sedentary behaviour remained associated with adiposity indices only in women.ConclusionsOut of the different types of sedentary behaviour, TV viewing was most consistently associated with adiposity markers in adults. Partial dilution of these associations after adjustments for covariates suggests that the obesogenic effects of TV viewing are partly mediated by other lifestyle factors.