bluuebunny/crossref_metadata_2025_split huggingface dataset:
Underage alcohol drinking and medical services use in Hong Kong: a cross-sectional study
Authors: Wang Man Ping , Ho Sai Yin , Lam Tai Hing 
Published: June 2013

ObjectivesTo investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong.DesignCross-sectional study.SettingSecondary schools in Hong Kong.ParticipantsA total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools.Outcome measuresAn anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1–2 and 3–7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed.ResultsMore than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1–2 days/week and 1.70 (1.41 to 2.06) for 3–7 days/week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed.ConclusionsAlcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents.
Variation in severe maternal morbidity according to socioeconomic position: a UK national case–control study
Authors: Lindquist Anthea , Knight Marian , Kurinczuk Jennifer J 
Published: June 2013

ObjectivesThis study aimed to explore the independent association between socioeconomic position, defined by occupation, and severe maternal morbidity among women in the UK.DesignCase–control study.SettingThe analysis was conducted as a case–control analysis, using data from a series of studies of direct causes of severe maternal morbidity undertaken through the UK Obstetric Surveillance System (UKOSS), with data collected throughout all consultant-let obstetric units in the UK.ParticipantsThe analysis included 1144 cases and 2256 comparison women (controls). UKOSS studies from which data on case women were obtained included amniotic fluid embolism, acute fatty liver of pregnancy, eclampsia, peripartum hysterectomy, therapies for peripartum haemorrhage and uterine rupture.Primary outcome measureOdds of severe maternal morbidity by socioeconomic group, independent of ethnicity, maternal age, smoking, pre-existing medical condition, body mass index (BMI), multiple pregnancy and past pregnancy complications. Occupation was used to classify different socioeconomic groups.Secondary outcome measureOdds of morbidity related to ethnic group, maternal age, smoking, pre-existing medical condition, BMI, multiple pregnancy and past pregnancy complications.ResultsAcross the socioeconomic groups, compared with the ‘managerial/professional’ group, adjusted ORs were 1.17 (95% CI 0.94 to 1.45) for the ‘intermediate group’, 1.16 (95% CI 0.93 to 1.45) for ‘routine/manual’, 1.22 (95% CI 0.92 to 1.61) for ‘unemployed’ women and 1.51 (95% CI 1.18 to 1.94) for women with missing socioeconomic information. Women of non-white ethnicity, older maternal age (≥35 years), BMI ≥25 kg/m2and those with pre-existing medical condition/s, multiple pregnancy or past pregnancy complications were shown to have a significantly increased odds of severe maternal morbidity.ConclusionsThis study suggests that socioeconomic position may be independently associated with an increased risk of severe maternal morbidity, although the observed association was not statistically significant. Further research is warranted to confirm this and investigate why this association might exist in a country where healthcare is universal and free at the point of access.
Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study
Authors: Green Stephen T , Cladi Lorenzo , Morris Paul , Forde Donall 
Published: June 2013

ObjectiveTo determine if individual undergraduate schools of medicine in the UK and the Republic of Ireland provide any teaching to medical students about biological weapons, bioterrorism, chemical weapons and weaponised radiation, if they perceive them to be relevant issues and if they figure them in their future plans.DesignA cross-sectional study utilising an internet-based questionnaire sent to key figures responsible for leading on the planning and delivery of undergraduate medical teaching at all schools of medicine in the UK and Ireland.SettingAll identified undergraduate schools of medicine in the UK and Ireland between August 2012 and December 2012.Outcome measuresNumerical data and free text feedback about relevant aspects of undergraduate teaching.ResultsOf the 38 medical schools approached, 34 (28 in UK, 6 in Ireland) completed the questionnaire (89.47%). 4 (all in UK) chose not to complete it. 6/34 (17.65%) included some specific teaching on biological weapons and bioterrorism. 7/34 (20.59%) had staff with bioterrorism expertise (mainly in microbiological and syndromic aspects). 4/34 (11.76%) had plans to introduce some specific teaching on bioterrorism. Free text responses revealed that some felt that because key bodies (eg, UK's General Medical Council) did not request teaching on bioterrorism, then it should not be included, while others regarded this field of study as a postgraduate subject and not appropriate for undergraduates, or argued that the curriculum was too congested already. 4/34 (11.76%) included some specific teaching on chemical weapons, and 3/34 (8.82%) on weaponised radiation.ConclusionsThis study provides evidence that at the present time there is little teaching at the undergraduate level in the UK and Ireland on the subjects of biological weapons and bioterrorism, chemical weapons and weaponised radiation and signals that this situation is unlikely to change unless there were to be high-level policy guidance.
Violence, HIV risk behaviour and depression among female sex workers of eastern Nepal
Authors: Sagtani Reshu Agrawal , Bhattarai Sailesh , Adhikari Baikuntha Raj , Baral Dharanidhar , Yadav Deepak Kumar , Pokharel Paras Kumar 
Published: June 2013

ObjectivesThe primary objective of the study was to estimate the prevalence of depression among female sex workers (FSWs) of eastern Nepal. The secondary objective was to search for an association between depression, violence and HIV risk behaviour.DesignCross-sectional/observational study.Study settingThis study was carried out in five cities of eastern Nepal (Dharan, Itahari, Biratnagar, Damak and Birtamode). Both restaurant-based and street-based FSWs were recruited in the study.ParticipantsWomen who had been involved in commercial sex activity in the past 6 months and gave informed consent were included in the study.Primary outcome measureA score of more than or equal to 16 on the Centre for Epidemiological Studies Depression (CESD) scale was considered as depression.MethodologyFace-to-face interviews were conducted with respondents who were sought through a snowball sampling technique. Information regarding their depression status, HIV high-risk behaviour and violence was recorded. The estimated sample size was 210.ResultsWe interviewed 210 FSWs (both restaurant-based and street-based). The prevalence of depression among respondents was 82.4%. FSWs who had experienced violence were five times more likely to be depressed than those who were not victims of violence. The odds of depression were six times higher among respondents who were involved in any HIV risk behaviour compared with those who were not involved.ConclusionsThe present study reports a high prevalence of depression, HIV risk behaviours and violence among FSWs of eastern Nepal. The mental health of FSWs should also be regarded as an important aspect of HIV prevention efforts which can help to promote the overall health of this population.
Factors associated with breastfeeding in England: an analysis by primary care trust
Authors: Oakley Laura L , Renfrew Mary J , Kurinczuk Jennifer J , Quigley Maria A 
Published: June 2013

ObjectivesTo identify the sociodemographic factors associated with variation in area-based breastfeeding in England; to calculate the predicted breastfeeding rates adjusted for sociodemographic variations.DesignEcological analysis of routine data using random effects logistic regression.SettingAll 151 primary care trusts (PCTs) in England 2010–2011.Outcome measuresPCT level data on breastfeeding: initiation, any and exclusive breastfeeding at 6–8 weeks.ResultsThere was considerable variation in breastfeeding across PCTs (breastfeeding initiation mean 72%, range 39–93%; any breastfeeding at 6–8 weeks mean 45%, range 19–83%; exclusive breastfeeding at 6–8 weeks mean 32%, range 14–58%), with London PCTs reporting markedly higher rates. Maternal age was strongly associated with area-based breastfeeding, with a 4–6% increase in odds of breastfeeding associated with a unit increase in the percentage of older mothers. Outside London, the proportion of the local population from a Black and Minority Ethnic (BME) background, compared with those from a White British background, was associated with higher breastfeeding (1–3% increase in odds per unit increase in the proportion from a BME background). Area-based deprivation was associated with reduced odds of breastfeeding (21–32% reduced odds comparing most deprived quintile to least deprived quintile). Weaker associations were observed between sociodemographic factors and breastfeeding in London PCTs. Very few PCTs reported breastfeeding figures substantially above or below the national average, having adjusted for variations in sociodemographic factors.ConclusionsOur results show striking associations between sociodemographic factors and breastfeeding at the area level, with much of the variation in breastfeeding rates explained by the sociodemographic profile. The sociodemographic context of breastfeeding is clearly important at the area level as well as the individual level. Our findings can be used to inform decision-making relating to local priorities and service provision.
Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study
Authors: Bail Kasia , Berry Helen , Grealish Laurie , Draper Brian , Karmel Rosemary , Gibson Diane , Peut Ann 
Published: June 2013

ObjectivesTo identify rates of potentially preventable complications for dementia patients compared with non-dementia patients.DesignRetrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients.SettingPublic hospital discharge data from the state of New South Wales, Australia for 2006/2007.Participants426 276 overnight hospital episodes for patients aged 50 and above (census sample).Main outcome measuresRates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care.ResultsControlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium.ConclusionsCompared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions.
Results from the Upper Limb International Spasticity Study-II (ULIS-II): a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management
Authors: Turner-Stokes Lynne , Fheodoroff Klemens , Jacinto Jorge , Maisonobe Pascal 
Published: June 2013

ObjectiveTo describe real-life practice and person-centred outcomes in the treatment of poststroke upper limb spasticity with botulinum toxin A (BoNT-A).DesignObservational, prospective study.Setting84 secondary care centres in 22 countries.Participants456 adults (≥18 years) with poststroke upper limb spasticity treated with one cycle of BoNT-A.Methods/outcomesMuscle selection, BoNT-A preparation, injection technique and timing of follow-up were conducted according to routine practice for each centre. Primary outcome: achievement of the patient's primary goal for treatment using goal-attainment scaling (GAS). Measurements of spasticity, standardised outcome measures and global benefits were also recorded.ResultsThe median number of injected muscles was 5 (range 1–15) and the most frequently injected muscles were the long finger flexors, followed by biceps and brachioradialis. The median (range) follow-up time was 14 (2.6 to 32.3) weeks. The common primary treatment goals were passive function (132 (28.9%)), active function (104 (22.8%)), pain (61 (13.4%)), impairment (105 (23%)), involuntary movement (41 (9%)) and mobility (10 (2.2%)). Overall, 363 (79.6%) (95% CI 75.6% to 83.2%) patients achieved (or overachieved) their primary goal and 355 (75.4%) (95% CI 71.2% to 79.2%) achieved their secondary goal. Mean (SD) change from baseline in GAS T-scores was 17.6 (11.0) (95% CI 16.4 to 18.8; p<0.001). GAS T-scores were strongly correlated with global benefit and other standard measures (correlations of 0.38 and 0.63, respectively; p<0.001).ConclusionsBoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper-limb spasticity following stroke. The study confirms the feasibility of a common international data set to collect systematic prospective data, and of using GAS to capture person-centred outcomes relating to passive and active functions and to pain.RegistrationClinicalTrials.gov identifier:NCT01020500
Prevalence and factors associated with asymptomatic gonococcal and chlamydial infection among US Navy and Marine Corps men infected with the HIV: a cohort study
Authors: Carpenter Robert J , Refugio Oliver N , Adams Nehkonti , O'Brien Kevin P , Johnson Mark D , Groff Harold L , Maves Ryan C , Bavaro Mary F , Crum-Cianflone Nancy F 
Published: June 2013

ObjectivesNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) can facilitate transmission of HIV. Men who have sex with men (MSM) may harbour infections at genital and extragenital sites. Data regarding extragenital GC and CT infections in military populations are lacking. We examined the prevalence and factors associated with asymptomatic GC and CT infection among this category of HIV-infected military personnel.DesignCross-sectional cohort study (pilot).SettingInfectious diseases clinic at a single military treatment facility in San Diego, CA.ParticipantsNinety-nine HIV-positive men were evaluated—79% men who had sex with men, mean age 31 years, 36% black and 33% married. Inclusion criteria: male, HIV-infected, Department of Defense beneficiary. Exclusion criteria: any symptom related to the urethra, pharynx or rectum.Primary outcome measuresGC and CT screening results.ResultsTwenty-four per cent were infected with either GC or CT. Rectal swabs were positive in 18% for CT and 3% for GC; pharynx swabs were positive in 8% for GC and 2% for CT. Only one infection was detected in the urine (GC). Anal sex (p=0.04), male partner (OR 7.02, p=0.04) and sex at least once weekly (OR 3.28, p=0.04) were associated with infection. Associated demographics included age <35 years (OR 6.27, p=0.02), non-Caucasian ethnicity (p=0.03), <3 years since HIV diagnosis (OR 2.75, p=0.04) and previous sexually transmitted infection (STI) (OR 5.10, p=0.001).ConclusionsWe found a high prevalence of extragenital GC/CT infection among HIV-infected military men. Only one infection was detected in the urine, signalling the need for aggressive three-site screening of MSM. Clinicians should be aware of the high prevalence in order to enhance health through comprehensive STI screening practices.
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement
Authors: Lopez Vincent , Chamoux Alain , Tempier Marion , Thiel Hélène , Ughetto Sylvie , Trousselard Marion , Naughton Geraldine , Dutheil Frédéric 
Published: June 2013

ObjectivesTo assess residual long-term microcirculation abnormalities by capillaroscopy, 15 years after retiring from occupational exposure to vinyl chloride monomer (VCM).DesignCross-sectional study.SettingAllier, one of the major areas of polyvinyl chloride production in France.ParticipantsWe screened 761 (97% men) retired workers exposed to chemical toxics. Exposure to chemicals other than VCM excluded potential participants.Primary and secondary outcome measuresThese participants underwent a medical examination including a capillaroscopy, symptoms of Raynaud and comorbidities, as well as a survey to determine exposure time, direct or indirect contact, type of occupation, smoking status and time after exposure. A double blind analysis of capillaroscopic images was carried out. A control group was matched in age, sex, type of occupation.Results179/761 retired workers were only exposed to VCM at their work, with 21 meeting the inclusion criteria and included. Exposure time was 29.8±1.9 years and time after exposure was 15.9±2.4 years. Retired workers previously exposed to VCM had significantly higher capillaroscopic modifications than the 35 controls: enlarged capillaries (19% vs 0%, p<0.001), dystrophy (28.6% vs 0%, p=0.0012) and augmented length (33% vs 0%, p<0.001). Time exposure was linked (p<0.001) with enlarged capillaries (R2=0.63), dystrophy (R2=0.51) and capillary length (R2=0.36). They also had higher symptoms of Raynaud (19% vs 0%, p=0.007) without correlation with capillaroscopic modifications.ConclusionsAlthough VCM exposure was already known to affect microcirculation, our study demonstrates residual long-term abnormalities following an average of 15 years’ retirement, with a time-related exposure response. Symptoms of Raynaud, although statistically associated with exposure, were not related to capillaroscopic modifications; its origin remains to be determined.
Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR)
Authors: Embún R , Fiorentino F , Treasure T , Rivas J J , Molins L 
Published: June 2013

ObjectivesTo capture an accurate contemporary description of the practice of pulmonary metastasectomy for colorectal carcinoma in one national healthcare system.DesignA national registry set up in Spain by Grupo Español de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR).Setting32 Spanish thoracic units.ParticipantsAll patients with one or more histologically proven lung metastasis removed by surgery between March 2008 and February 2010.InterventionsPulmonary metastasectomy for one or more pulmonary nodules proven to be metastatic colorectal carcinoma.Primary and secondary outcome measuresThe age and sex of the patients having this surgery were recorded with the number of metastases removed, the interval between the primary colorectal cancer operation and the pulmonary metastasectomy, and the carcinoembryonic antigen level. Also recorded were the practices with respect to mediastinal lymphadenopathy and coexisting liver metastases.ResultsData were available on 543 patients from 32 units (6–43/unit). They were aged 32–88 (mean 65) years, and 65% were men. In 55% of patients, there was a solitary metastasis. The median interval between the primary cancer resection and metastasectomy was 28 months and the serum carcinoembryonic antigen was low/normal in the majority. Liver metastatic disease was present in 29% of patients at some point prior to pulmonary metastasectomy. Mediastinal lymphadenectomy varied from 9% to 100% of patients.ConclusionsThe data represent a prospective comprehensive national data collection on pulmonary metastasectomy. The practice is more conservative than the impression gained when members of the European Society of Thoracic Surgeons were surveyed in 2006/2007 but is more inclusive than would be recommended on the basis of recent outcome analyses. Further analyses on the morbidity associated with this surgery and the correlation between imaging studies and pathological findings are being published separately by GECMP-CCR.
The Crohn's disease: associated ATG16L1 variant andSalmonellainvasion
Authors: Messer Jeannette S , Murphy Stephen F , Logsdon Mark F , Lodolce James P , Grimm Wesley A , Bartulis Sarah J , Vogel Tiphanie P , Burn Melisa , Boone David L 
Published: June 2013

ObjectiveA common genetic coding variant in the core autophagy gene ATG16L1 is associated with increased susceptibility to Crohn's disease (CD). The variant encodes an amino acid change in ATG16L1 such that the threonine at position 300 is substituted with an alanine (ATG16L1 T300A). How this variant contributes to increased risk of CD is not known, but studies with transfected cell lines and gene-targeted mice have demonstrated that ATG16L1 is required for autophagy, control of interleukin-1-β and autophagic clearance of intracellular microbes. In addition, studies with human cells expressing ATG16L1 T300A indicate that this variant reduces the autophagic clearance of intracellular microbes.Design/ResultsWe demonstrate, using somatically gene-targeted human cells that the ATG16L1 T300A variant confers protection from cellular invasion bySalmonella. In addition, we show that ATG16L1-deficient cells are resistant to bacterial invasion.ConclusionsThese results suggest that cellular expression of ATG16L1 facilitates bacterial invasion and that the CD-associated ATG16L1 T300A variant may confer protection from bacterial infection.