bluuebunny/crossref_metadata_2025_split huggingface dataset:
Students’ attitude and smoking behaviour following the implementation of a university smoke-free policy: a cross-sectional study
Authors: Chaaya Monique , Alameddine Maysam , Nakkash Rima , Afifi Rima A , Khalil Joanna , Nahhas Georges 
Published: April 2013

ObjectiveIn view of the high-smoking rate among university students in Lebanon and the known adverse effects of second-hand smoking, the American University of Beirut (AUB) decided to implement a non-smoking policy on campus. This study sought to examine the students’ compliance and attitudes following the ban.DesignCross-sectional study.SettingA private university in Lebanon.Participants545 randomly selected students were approached. A stratified cluster sample of classes offered in the spring semester of the 2008/2009 academic year was selected. Students completed a self-administered paper and pencil survey during class time.Primary and secondary outcome measuresThe main outcomes were compliance with and attitudes towards the ban. Other secondary outcomes were the perception of barriers to implementation of the ban and attitudes towards tobacco control in general.Results535 students participated in the study. Smokers were generally compliant with the ban (72.7%) and for some (20%) it led to a decrease in their smoking. Students' attitude towards the ban and the enforcement of a non-smoking policy in public places across Lebanon varied according to their smoking status whereby non-smokers possessed a more favourable attitude and strongly supported such policies compared with smokers; overall, the largest proportions of students were satisfied to a large extent with the ban and considered it justified (58.6% and 57.2%, respectively). While much smaller percentages reported that the ban would help in reducing smoking to a large extent (16.7%) or it would help smokers quit (7.4%). Perceived barriers to implementation of the non-smoking policy in AUB included the lack of compliance with and strict enforcement of the policy as well as the small number and crowdedness of the smoking areas.ConclusionsAn education campaign, smoking cessation services and strict enforcement of the policy might be necessary to boost its effect in further reducing students' cigarette use.
Maternal occupational exposure to asthmogens during pregnancy and risk of asthma in 7-year-old children: a cohort study
Authors: Christensen Berit Hvass , Thulstrup Ane Marie , Hougaard Karin Sørig , Skadhauge Lars R , Hansen Kirsten Skamstrup , Frydenberg Morten , Schlünssen Vivi 
Published: April 2013

ObjectivesThe objective of this study was to examine whether maternal exposure to asthmogens during pregnancy is associated with the development of asthma in 7-year-old Danish children, taking atopic status and sex into consideration.DesignThe study is a prospective follow-up of a birth cohort.Setting and participantsA total of 41 724 women and their children from The Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy and 18 months after pregnancy with a commonly used asthma Job Exposure Matrix.Primary and secondary outcome measuresPrimary outcome was parent-reported asthma among their 7-year-old children in an internet-based questionnaire. Secondary outcome was asthma among the same children with or without atopic dermatitis and among boys and girls, respectively.ResultsPrenatal exposure to low molecular weight (LMW) agents was borderline associated with asthma in children with OR 1.17 (0.95 to 1.44) for children with atopic dermatitis and 1.10 (0.98 to 1.22) for children without. Maternal postnatal exposure was associated with asthma (OR 1.15 (1.04 to 1.28). After mutual adjustment,postnatal exposure (OR 1.13 (0.99 to 1.29) and the combined effects of prenatal and postnatal exposure (OR 1.34 (1.19 to 1.51)) seem to increase the risk of asthma in children. No significant associations were observed for other prenatal or postnatal exposures. The gender of the child did not modify the aforementioned associations.ConclusionsMaternal occupational exposures during pregnancy do not seem to be a substantial risk factor for the development of asthma in 7-year-old children. Maternal prenatal and postnatal exposures to LMW agents may predispose the propensity of the children to develop asthma. Future studies should prioritise the characterisation of the timing of exposure in relation to the birth.
Specific antibodies against vaccine-preventable infections: a mother–infant cohort study
Authors: Jones Christine , Pollock Louisa , Barnett Sara M , Battersby Anna , Kampmann Beate 
Published: April 2013

ObjectivesTo determine maternal and neonatal specific antibody levels to selected vaccine-preventable infections (pertussis,Haemophilus influenzaetype b (Hib), tetanus and pneumococcus).DesignProspective cohort study.SettingA UK secondary care maternity unit (March 2011–January 2012).ParticipantsMothers and infants within 72 h of delivery were eligible. Unwell individuals, mothers less than 18 years of age, and infants born at less than 36 weeks gestation, or weighing less than 2500 g, were excluded. HIV-infected mothers were included. 112 mother–infant pairs were recruited. Samples from 111 mothers and 109 infants (108 pairs) were available for analysis.Outcome measuresSpecific antibody levels were determined using standard commercial ELISAs. Specific antibody to pertussis antigens (PT and FHA) of >50 IU/ml, defined as ‘positive’ by the test manufacturer, were interpreted as protective. Antitetanus antibody titres >0.1 IU/ml and anti-Hib antibody titres >1 mg/l were regarded as protective.ResultsOnly 17% (19/111) of women exhibited a protective antibody response against pertussis. 50% (56/111) of women had levels of antibody protective against Hib and 79% (88/111) against tetanus. There was a strong positive correlation between maternal-specific and infant-specific antibodies’ responses against pertussis (rs=0.71, p<0.001), Hib (rs=0.80, p<0.001), tetanus (rs=0.90, p<0.001) and pneumococcal capsular polysaccharide (rs=0.85, p<0.001). Only 30% (33/109) and 42% (46/109) of infants showed a protective antibody response to pertussis and Hib, respectively. Placental transfer (infant:mother ratio) of specific IgG to pertussis, Hib, pneumococcus and tetanus was significantly reduced from HIV-infected mothers to their HIV-exposed, uninfected infants (n=12 pairs) compared with HIV-uninfected mothers with HIV-unexposed infants (n=96 pairs) by 58% (<0.001), 61% (<0.001), 28% (p=0.034) and 32% (p=0.035), respectively.ConclusionsLow baseline antibody levels against pertussis in this cohort suggest the recently implemented UK maternal pertussis immunisation programme has potential to be effective.
Primary care follow-up and measured mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy: a quantitative questionnaire study
Authors: Moscrop Andrew , Harrison Sian , Heppell Victoria , Heneghan Carl , Ward Alison 
Published: April 2013

ObjectivesTo examine the extent of primary care follow-up and mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy, including those whose pregnancy is found to be viable on ultrasound assessment.DesignQuestionnaire study with prospective follow-up.SettingUrgent gynaecology clinic in secondary care, England.Participants57 women participated in the study. Entry criteria: referral to the urgent gynaecology clinic with pain and/or bleeding in early pregnancy; gestation less than 16 weeks (the clinic's own ‘cut-off’); no previous attendance at the clinic during the current pregnancy. Exclusion criteria: inability to understand English or to provide informed consent.Primary and secondary outcome measuresIncidence of primary care follow-up among women referred to the urgent gynaecology clinic; incidence of women with measured mental health scores suggesting significant symptoms of distress.ResultsFewer than 1 in 10 women referred for ultrasound assessment of pain and/or bleeding in early pregnancy had follow-up arrangements made with their general practitioner (GP). Most women who had GP follow-up found it helpful and a significant minority of women who did not have GP follow-up felt that it would have been helpful. Following ultrasound assessment, more than one-third of women had significant symptoms of distress. Symptoms of distress, particularly anxiety, were present among those women found to have viable pregnancies, as well as among those with non-viable pregnancies.ConclusionsGPs are advised to consider offering follow-up to all women referred for ultrasound assessment of pain and/or bleeding in early pregnancy. Researchers in this area are advised to consider the experiences of women with pain and/or bleeding in early pregnancy whose pregnancies are ultimately found to be viable on ultrasound scan.
Developing a community-based intervention to improve quality of life in people with colorectal cancer: a complex intervention development study
Authors: Gray Nicola M , Allan Julia L , Murchie Peter , Browne Susan , Hall Susan , Hubbard Gill , Johnston Marie , Lee Amanda J , McKinley Aileen , Macleod Una , Presseau Justin , Samuel Leslie , Wyke Sally , Campbell Neil C 
Published: April 2013

ObjectivesTo develop and pilot a theory and evidence-based intervention to improve quality of life (QoL) in people with colorectal cancer.DesignA complex intervention development study.SettingNorth East Scotland and Glasgow.ParticipantsSemistructured interviews with people with colorectal cancer (n=28), cancer specialists (n=16) and primary care health professionals (n=14) and pilot testing with patients (n=12).InterventionsA single, 1 h nurse home visit 6–12 weeks after diagnosis, and telephone follow-up 1 week later (with a view to ongoing follow-up in future).Primary and secondary outcome measuresQualitative assessment of intervention feasibility and acceptability.ResultsModifiable predictors of QoL identified previously were symptoms (fatigue, pain, diarrhoea, shortness of breath, insomnia, anorexia/cachexia, poor psychological well-being, sexual problems) and impaired activities. To modify these symptoms and activities, an intervention based on Control Theory was developed to help participants identify personally important symptoms and activities; set appropriate goals; use action planning to progress towards goals; self-monitor progress and identify (and tackle) barriers limiting progress. Interview responses were generally favourable and included recommendations about timing and style of delivery that were incorporated into the intervention. The pilot study demonstrated the feasibility of intervention delivery.ConclusionsThrough multidisciplinary collaboration, a theory-based, acceptable and feasible intervention to improve QoL in colorectal cancer patients was developed, and can now be evaluated.
Renal function estimations and dose recommendations for dabigatran, gabapentin and valaciclovir: a data simulation study focused on the elderly
Authors: Helldén Anders , Odar-Cederlöf Ingegerd , Nilsson Göran , Sjöviker Susanne , Söderström Anders , Euler Mia von , Öhlén Gunnar , Bergman Ulf 
Published: April 2013

ObjectivesThe thrombin inhibitor dabigatran is mainly excreted by the kidneys. We investigated whether the recommended method for estimation of renal function used in the clinical trials, the Cockcroft-Gault (CGold) equation and the estimated glomerular filtration rate (eGFR) modification of diet in renal disease equation 4 (MDRD4), differ in elderly participants, resulting in erroneously higher dose recommendations of dabigatran, which might explain the serious, even fatal, bleeding reported. The renally excreted drugs gabapentin and valaciclovir were also included for comparison.DesignA retrospective data simulation study.ParticipantsParticipants 65 years and older included in six different studies.Main outcome measureEstimated renal function by CG based on uncompensated (‘old Jaffe’ method) creatinine (CGold) or by MDRD4 based on standardised compensated P-creatinine traceable to isotope-dilution mass spectrometry, and the resulting doses.Results790 participants (432 females), mean age (±SD) 77.6±5.7 years. Mean estimated creatinine clearance (eCrCl) by the CGoldequation was 44.2±14.8 ml/min, versus eGFR 59.6±20.7 ml/min/1.73 m2with MDRD4 (p<0.001), absolute median difference 13.5, 95% CI 12.9 to 14.2. MDRD4 gave a significantly higher mean dose (valaciclovir +21%, dabigatran +25% and gabapentin +37%) of all drugs (p<0.001). With MDRD4 58% of the women would be recommended a full dose of dabigatran compared with 18% if CGoldis used.ConclusionsMDRD4 would result in higher recommended doses of the three studied drugs to elderly participants compared with CG, particularly in women, and thus increased the risk of dose and concentration-dependent adverse reactions. It is important to know which method of estimation of renal function the Summary of Products Characteristics was based on, and use only that one when prescribing renally excreted drugs with narrow safety window. Doses based on recently developed methods for estimation of renal function may be associated with considerable risk of overtreatment in the elderly.
The ‘time-out’ procedure: an institutional ethnography of how it is conducted in actual clinical practice
Authors: Braaf Sandra , Manias Elizabeth , Riley Robin 
Published: April 2013

BackgroundThe time-out procedure is a critically important communication interaction for the preservation of patient safety in the surgical setting. While previous research has examined influences shaping the time-out procedure, limited information exists on how actual time-out communication is performed by multidisciplinary surgical team members in the clinical environment.MethodsAn institutional ethnographic study was undertaken. The study was conducted over three hospital sites in Melbourne, Australia. In total, 125 healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data were generated through 350 h of observation, two focus groups and 20 semi-structured interviews. An institutional ethnographic analysis was undertaken.ResultsAnalysis revealed healthcare professionals adapted the content, timing and number of team members involved in the time-out procedure to meet the demands of the theatre environment. Habitually, the time-out procedure was partially completed, conducted after surgery had commenced and involved only a few members of the surgical team. Communication was restricted and stifled by asynchronous workflows, time restrictions, a hierarchical culture and disinclination by surgeons and anaesthetists to volunteer information and openly communicate with each other and nurses. Healthcare professionals became normalised to performing an abbreviated time-out procedure.ConclusionsPatient safety was relegated in importance as productivity, professional and hierarchical discourses configured the communication practices of surgical team members to limit active, open and direct communication. Examining how the time-out procedure was conducted in the clinical environment enables possibilities to emerge for facilitating compliance with hospital and WHO guidelines.
Interruptions in emergency department work: an observational and interview study
Authors: Berg Lena M , Källberg Ann-Sofie , Göransson Katarina E , Östergren Jan , Florin Jan , Ehrenberg Anna 
Published: April 2013

ObjectiveFrequent interruptions are assumed to have a negative effect on healthcare clinicians’ working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments.MethodTotally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis.ResultsThe interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses’ and doctors’ stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes.ConclusionsClinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.
Blood–brain barrier destruction determines Fisher/Bickerstaff clinical phenotypes: an in vitro study
Authors: Saito Kazuyuki , Shimizu Fumitaka , Koga Michiaki , Sano Yasuteru , Tasaki Ayako , Abe Masaaki , Haruki Hiroyo , Maeda Toshihiko , Suzuki Seiko , Kusunoki Susumu , Mizusawa Hidehiro , Kanda Takashi 
Published: April 2013

ObjectiveTo ascertain the hypothesis that the phenotypic differences between Bickerstaff's brainstem encephalitis (BBE) and Miller Fisher syndrome (MFS) are derived from the differences in the effects of sera on blood–brain barrier (BBB) and blood–nerve barrier.BackgroundAntibodies against GQ1b are frequently detected in BBE and MFS, and these two disorders may share the same pathogenesis, but the clinical phenotypes of BBE and MFS are substantially different.MethodsThe effects of sera obtained from BBE patients, MFS patients and control subjects were evaluated with regard to the expression of tight junction proteins and transendothelial electrical resistance in human brain microvascular endothelial cells (BMECs) and human peripheral nerve microvascular endothelial cells.ResultsThe sera obtained from BBE patients decreased the transendothelial electrical resistance values and claudin-5 protein expression in BMECs, although the sera obtained from MFS patients had no effect on BMECs or peripheral nerve microvascular endothelial cells. This effect was reversed after the application of matrix metalloproteinase (MMP) inhibitor, GM6001. The presence or absence of anti-GQ1b antibodies did not significantly influence the results. MMP-9 secreted by BMECs was significantly increased after exposure to the sera obtained from BBE patients, whereas it was not changed after exposure to the sera obtained from MFS patients.ConclusionsOnly the sera obtained from BBE patients destroyed BBB and it might explain the phenotypical differences between BBE and MFS. BBE sera disrupted BBB, possibly via the autocrine secretion of MMP-9 from BBB-composing endothelial cells.
Using Leo Plus stent as flow diverter and endoluminal remodeling in endovascular treatment of intracranial fusiform aneurysms
Authors: Pumar José Manuel , Arias-Rivas Susana , Rodríguez-Yáñez Manuel , Blanco Miguel , Ageitos Maria , Vazquez-Herrero Fernando , Castiñeira-Mourenza José Antonio , Masso Amaya 
Published: April 2013

Background and purposeTreatment of intracranial fusiform aneurysms is complex and controversial, and is associated with high morbidity and mortality rates. The goal of this study was to evaluate the strategy of stent only therapy.Materials and methodsA retrospective analysis of 20 patients with 20 intracranial fusiform aneurysms undergoing endovascular treatment using stent only therapy was undertaken. Feasibility, safety, and angiographic follow-up were evaluated.Results28 Leo Plus stents were successfully deployed in 20 patients. No technical difficulties in relation to stent navigation, placement, or detachment from the delivery system were observed. A 6 month, 1 year, and 2 year follow-up angiograms were performed in all patients. 15 aneurysms showed complete occlusion and five partial stable occlusion. During the follow-up period, there was no evidence of in-stent stenoses or occlusion of the incorporated branching vessels. In this study, no patient presented with subarachnoid hemorrhage or died during follow-up.ConclusionsStent only therapy in this study proved very useful as a flow diverter for the treatment of intracranial fusiform aneurysms in which parent artery occlusion or stenting–coiling was not feasible.
Long-term patency of venous sinus stents for idiopathic intracranial hypertension
Authors: Ducruet Andrew F , Crowley R Webster , McDougall Cameron G , Albuquerque Felipe C 
Published: April 2013

BackgroundRecent reports suggest that placement of a venous sinus stent improves symptoms in selected patients with idiopathic intracranial hypertension (IIH). We report our evaluation of the long-term patency of venous stents placed for IIH.MethodsWe retrospectively reviewed our clinical database for 30 patients (mean age 33±10 years) with IIH who underwent placement of 36 venous sinus stents between October 2006 and December 2012. Relevant clinical, demographic and radiographic data were extracted after review of these records. All patients underwent retrograde venography to confirm a >50% stenosis and a trans-stenosis pressure gradient. Follow-up catheter angiography was performed beginning 3 months after the procedure.ResultsFollow-up imaging was available for 23 (77%) of the 30 patients (mean 23 months). For seven patients, angiographic follow-up of >2 years (mean 45 months) was available. All stents remained patent with mild (<25%) in-stent stenosis observed in four patients. In five patients, however, we observed a narrowing of the sinus proximal to the stent. Although no patient underwent repeat stent placement for persistent or recurrent symptoms, cerebrospinal fluid diversion was performed in five cases.ConclusionsVenous sinus stent placement has emerged as a promising treatment option for the subgroup of patients with IIH with a pressure gradient across a stenotic venous sinus. We observed long-term patency of all stents placed in this patient population. Further prospective investigation is necessary to improve our understanding of the phenomenon of sinus narrowing upstream of a patent stent and to establish definitively the long-term clinical efficacy of venous sinus stent placement for IIH.