bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of inconsistent ethnicity recordings on estimates of inequality in child health and education data: a data linkage study of Child and Adolescent Mental Health Services in South London
Authors: Wickersham Alice , Das-Munshi Jayati , Ford Tamsin , Jewell Amelia , Stewart Robert , Downs Johnny 
Published: March 2024

ObjectivesEthnicity data are critical for identifying inequalities, but previous studies suggest that ethnicity is not consistently recorded between different administrative datasets. With researchers increasingly leveraging cross-domain data linkages, we investigated the completeness and consistency of ethnicity data in two linked health and education datasets.DesignCohort study.SettingSouth London and Maudsley NHS Foundation Trust deidentified electronic health records, accessed via Clinical Record Interactive Search (CRIS) and the National Pupil Database (NPD) (2007–2013).ParticipantsN=30 426 children and adolescents referred to local Child and Adolescent Mental Health Services.Primary and secondary outcome measuresEthnicity data were compared between CRIS and the NPD. Associations between ethnicity as recorded from each source and key educational and clinical outcomes were explored with risk ratios.ResultsEthnicity data were available for 79.3% from the NPD, 87.0% from CRIS, 97.3% from either source and 69.0% from both sources. Among those who had ethnicity data from both, the two data sources agreed on 87.0% of aggregate ethnicity categorisations overall, but with high levels of disagreement in Mixed and Other ethnic groups. Strengths of associations between ethnicity, educational attainment and neurodevelopmental disorder varied according to which data source was used to code ethnicity. For example, as compared with White pupils, a significantly higher proportion of Asian pupils achieved expected educational attainment thresholds only if ethnicity was coded from the NPD (RR=1.46, 95% CI 1.29 to 1.64), not if ethnicity was coded from CRIS (RR=1.11, 0.98 to 1.26).ConclusionsData linkage has the potential to minimise missing ethnicity data, and overlap in ethnicity categorisations between CRIS and the NPD was generally high. However, choosing which data source to primarily code ethnicity from can have implications for analyses of ethnicity, mental health and educational outcomes. Users of linked data should exercise caution in combining and comparing ethnicity between different data sources.
Immunosuppressant medication behaviours in solid organ transplant recipients: a cross-sectional study from south-central China during COVID-19 reopening period
Authors: Zhao Qin , Dong Lei , Wang Liang , Zhao Hongyu , Zhu Xiao , Zhang Zhihao , Liu Jia 
Published: March 2024

ObjectiveMedication non-adherence to immunosuppressants threatens allograft survival and function maintenance among solid organ transplant (SOT) recipients. This study aimed to investigate the prevalence of immunosuppressant medication non-adherence and associated factors during the COVID-19 reopening period among Chinese SOT recipients.DesignCross-sectional study.SettingSouth-central China.PopulationAdult patients who received SOT with functioning graft.MethodsSociodemographic questionnaire and scales to measure physical activity, depression and medication non-adherence were used to collect data. Logistic regression analysis was conducted to identify factors associated with medication non-adherence. Mediation and moderated mediation analyses were performed to examine the potential mechanisms influencing medication behaviour during the pandemic reopening period using SPSS PROCESS macro 4.3 software.ResultsA total of 1121 participants were recruited and the prevalence of medication non-adherence was 36.3% in this study. Recipients who were men, had a higher monthly income, lived alone, had received transplantation for a minimum of 3 years, had received COVID-19 vaccination and experienced depressive symptoms exhibited an increased risk of non-adherence. Contrarily, those who engaged in high-intensity physical activity exhibited a decreased risk. Physical activity was negatively associated with medication non-adherence (r=−0.124, p<0.001) with depression fully mediating this relationship (B=−0.014, 95% CI: −0.032 to –0.003). COVID-19 vaccination significantly moderated the relationship between physical activity and depression (B=−0.303, 95% CI: −0.515 to –0.090).ConclusionThis study investigated the prevalence of medication non-adherence among SOT recipients during the COVID-19 reopening period in China, its associated factors and a potential mechanism. Depression fully mediated the association between physical activity and medication non-adherence, and COVID-19 vaccination moderated the relationship between physical activity and depression. These findings provide some insights for managing medication behaviour when confronting public health emergencies. However, relationships displayed in the moderated mediation model should be tracked after returning to normal life and other potential relationships should be explored to deeply understand medication non-adherent behaviour.
Tracking deaths of people who have experienced homelessness: a dynamic cohort study in an Australian city
Authors: Tuson Matthew , Vallesi Shannen , Wood Lisa 
Published: March 2024

ObjectiveLife expectancy and rates of premature death are fundamental markers of health and social equity globally, and measures on which people experiencing homelessness face enormous disparities. However, unlike for other population groups with similar disparities, concerted government action to reduce homeless mortality is rare, partly due to a lack of reliable, timely data. Contemporaneous tracking of homeless deaths is required to render such deaths less invisible and measure trends over time. Drawing on multiple data sources as recommended by the US National Health Care for the Homeless Council’s seminal Homeless Mortality Data Toolkit, we routinely and contemporaneously capture, verify and report on deaths occurring among people who have experienced homelessness in the Australian city of Perth.DesignDynamic cohort study.SettingPerth, Western Australia, Australia, between 2016 and 2022, with deaths examined between 2020 and 2022.ParticipantsFor this study, the cohort comprised 8753 people who experienced homelessness in Perth, with ‘recruitment’ into the cohort governed by engagement with one or more local homelessness services and programmes over the period.Outcome measuresNumber and median age-at-death statistics.ResultsThere were 360 deaths over the 3-year period, which is likely an undercount. The median age at death was 50 years, >3 decades below the current Australian median age at death of 82 years. Aboriginal people accounted for 30% of the deaths.ConclusionThe ongoing poor health and premature death of people who have experienced homeless are indictments on our society. Triangulation of multiple data sources is required to identify and monitor deaths among homeless populations. Timely, verified data on homeless mortality are important for galvanising action and accountability, and targets should be set to reduce the observed three-decade life expectancy chasm.
Enhancing pain care with the American Pain Society Patient Outcome Questionnaire for use in the emergency department (APS-POQ-RED): validating a patient-reported outcome measure
Authors: Hughes James A , Hazelwood Sarah , Lyrstedt Anna-Lisa , Jones Lee , Brown Nathan J , Jarugula Rajeev , Douglas Clint , Chu Kevin 
Published: March 2024

BackgroundIn general, the quality of pain care in emergency departments (ED) is poor, despite up to 80% of all ED patients presenting with pain. This may be due to the lack of well-validated patient-reported outcome measures (PROMs) of pain care in the ED setting. The American Pain Society-Patient Outcome Questionnaire-Revised Edition (APS-POQ-R), with slight modification for ED patients, is a potentially useful PROM for the adult ED, however it is yet to be completely validated.MethodsAdult patients, who had presented with moderate to severe acute pain, were recruited at two large inner-city EDs in Australia. A modified version of the APS-POQ-R was administered at the completion of their ED care. Responses were randomly split into three groups and underwent multiple rounds of exploratory and confirmatory factor analysis with testing for construct, convergent, divergent validity and internal consistency.ResultsA total of 646 ED patients (55.6% female), with a median age of 48.3 years, and moderate to severe pain on arrival, completed the ED-modified APS-POQ-R. Psychometric evaluation resulted in a reduced nine-question tool, which measures three constructs (pain relief and satisfaction (α=0.891), affective distress (α=0.823) and pain interference (α=0.908)) and demonstrated construct, convergent, divergent validity, and internal consistency.ConclusionsThis new tool, which we refer to as the American Pain Society-Patient Outcome Questionnaire-Revised for the ED (APS-POQ-RED), should form the basis for reporting patient-reported outcomes of ED pain care in future quality improvement and research.
Roles of gender and smoking in the associations between urinary phytoestrogens and asthma/wheeze and lung function: evidence from a cross-sectional study
Authors: Zhang Yin , Huang Tingxuan , Wang Ji , Wang Gang , Luo Fengming 
Published: March 2024

BackgroundThe role of phytoestrogens in asthma/wheeze and lung function remains controversial. Thus, we aimed to examine whether phytoestrogens have beneficial effects on asthma/wheeze, lung function for subgroups and mortality.MethodsParticipants in this study were individuals aged 20 years or older from the National Health and Nutrition Examination Survey. Multivariate logistic regression models were fitted to examine the associations of urinary phytoestrogens with the risk of asthma/wheeze and lung function in individuals with and without asthma/wheeze. Cox proportional hazards regression was used to examine the relationship between urinary phytoestrogens and all-cause mortality. Stratified analyses were conducted based on gender and smoking status.ResultsWe included 2465 individuals in this study. Enterolactone levels in the highest quartile were associated with a lower risk of asthma than those in the lowest quartile. As compared with the lowest quartile, the highest quartile of enterodiol and enterolactone was associated with a lower risk of wheeze. Significant associations were observed between subtypes of phytoestrogens (equol and enterolactone) and lung function (forced vital capacity (FVC) and forced expiratory volume in 1 s). Besides, FVC was higher in individuals with higher levels of enterodiol. The results were consistent in subpopulations without asthma/wheeze, while the significant difference was not observed in individuals with asthma/wheeze. The stratified analyses revealed that the associations between phytoestrogens and lung function differed by gender and smoking status among subgroups. No significant association was found between urinary phytoestrogens and all-cause mortality.ConclusionIn summary, subtypes of phytoestrogens were associated with lower risk of asthma/wheeze and beneficial for lung function improvement in individuals without asthma/wheeze. Furthermore, gender and smoking may interact in the relationship between phytoestrogens and asthma/wheeze, and lung function. Further researches are needed to confirm these associations and explain the results of stratified analyses.
Understanding parent and caregiver perceptions of paediatric vehicular hyperthermia: implications for public health messaging from a pilot study
Authors: Krase Piper , Grundstein Andrew , Stewart Alan , Williamsberg Castle , Ducre Katrina 
Published: March 2024

BackgroundPaediatric vehicular hyperthermia (PVH) is the leading cause of non-crash vehicle-related death of children in the USA. Public health messaging is an important mitigation strategy, yet it is difficult to assess the effectiveness in reducing deaths. Here, we seek to better understand parent/caregiver perceptions on PVH to guide risk communication.MethodsThis pilot study focuses on a subset of participants (n=127) from a national survey, comprising parents/caregivers who met specific eligibility criteria (ie, those who both drive and have children ≤5 years of age). Survey participants answered questions about the perceived severity of forgetting a child in a hot car and their susceptibility to doing so, with responses recorded on a 7-point Likert scale (1=strongly disagree and 7=strongly agree).ResultsOur findings indicate that while on average (mean responses of 2.45 and 2.49) parents/caregivers did not consider themselves susceptible, they did acknowledge the severity (mean response of 6.12) of leaving a child unattended in a vehicle. The results suggest that because of this low perceived susceptibility, parents/caregivers are less likely to take protective actions aimed at preventing these incidents from happening.ConclusionsPublic health messaging on PVH should emphasise the universal risk to all parents/caregivers so as to foster greater awareness of the need to take protective actions. Furthermore, engaging secondary audiences such as teachers and healthcare professionals can amplify this message and offer concrete behavioural interventions to mitigate the risk of forgetting a child in a car.
Investigating the 2016 surge in firearm violence in Illinois, USA, through community-based organisations: a qualitative study
Authors: Dastoor Jehannaz D , Thomas Arielle , Slocum John D , Regan Sheila , Stone Levon , Richardson Joesph B , Mason Maryann , Johnson Julie K , Lin Katherine , Stey Anne 
Published: March 2024

BackgroundIllinois experienced a historic firearm violence surge in 2016 with a decline to baseline rates in 2018. This study aimed to understand this 2016 surge through the direct accounts of violence prevention community-based organisations (CBOs) in Illinois.MethodsWe conducted semistructured interviews with 20 representatives from 13 CBOs from the south and west sides of greater Chicago metropolitan area. Interviews were audio recorded, coded and analysed thematically.ResultsWe identified lack of government-derived infrastructure and systemic poverty as the central themes of Illinois’s 2016 firearm violence surge. Participants highlighted the Illinois Budget Impasse halted funding for violence prevention efforts, leading to 2016’s violence. This occurred in the context of a strained relationship with the criminal justice system, where disengagement from police and mistrust in the justice system led victims and families to seek justice outside of the judicial system. Participants emphasised that systemic poverty and the obliteration of community support structures led to overwhelming desperation, which, in turn, increased risky behaviours perceived as necessary for survival. Participants disproportionately identified that this impacted the young people in their communities.ConclusionsLack of government-derived infrastructure and systemic poverty were the central themes of the 2016 firearm violence surge. The insights gained from the 2016 surge are applicable to understanding both current and future surges. CBOs focused on violence prevention offer insights into the context and conditions fuelling surges in the epidemic of violence.
Clinical outcomes and safety of immune checkpoint inhibitors in patients with solid tumors and paraneoplastic syndromes
Authors: Nassar Amin H , El Zarif Talal , Khalid Ahmed Bilal , Rahme Serena , Zhong Caiwei , Kwak Lucia , Salame Marita , Farhat Elias Bou , Freeman Dory , El-Am Edward , Ravishankar Arjun , Ahmad Bachar , Nana Frank Aboubakar , Kaldas David , Naqash Abdul Rafeh , Sharon Elad , LeBoeuf Nicole R , Cortellini Alessio , Malgeri Andrea , Gupta Shruti , Al-Hader Ahmad , Sparks Jeffrey A , Linnoila Jenny , Hamnvik Ole-Petter R , Mouhieddine Tarek H , Marron Thomas , Parikh Kaushal , McKay Rana R , Dilling Thomas , Choueiri Toni K , Adib Elio , Najem Elie , Kim So Yeon , Sonpavde Guru 
Published: March 2024

BackgroundPatients with paraneoplastic syndromes (PNS) are excluded from clinical trials involving immune checkpoint inhibitors (ICIs) due to safety concerns. Moreover, real-world data on efficacy and safety is scarce.MethodsIn this retrospective study, data were collected on patients with PNS and solid tumors receiving ICI between 2015 and 2022 at nine institutions. Patients were classified into: Cohort 1 (pre-existing PNS before ICI initiation), cohort 2 (PNS during ICI treatment), and cohort 3 (PNS after ICI discontinuation). Patients with metastatic non-small cell lung cancer (NSCLC) (mNSCLC) from cohort 1 were matched to patients who were PNS-free at each institution up to a 1:3 ratio for age, sex, type of ICI, use of concurrent chemotherapy, and number of lines of systemic therapy prior to ICI initiation. Kaplan-Meier method was used to assess overall survival (OS) and time-to-next treatment (TTNT).ResultsAmong 109 patients with PNS treated with ICIs, median age at ICI initiation was 67 years (IQR: 58–74). The most represented cancer type was NSCLC (n=39, 36%). In cohort 1 (n=55), PNS exacerbations occurred in 16 (29%) patients with median time to exacerbation after ICI of 1.1 months (IQR: 0.7–3.3). Exacerbation or de novo PNS prompted temporary/permanent interruption of ICIs in 14 (13%) patients. For cohort 2 (n=16), median time between ICI initiation and de novo PNS was 1.2 months (IQR: 0.4–3.5). Treatment-related adverse events (trAEs) occurred in 43 (39%) patients. Grade ≥3 trAEs occurred in 18 (17%) patients. PNS-directed immunosuppressive therapy was required in 55 (50%) patients. We matched 18 patients with mNSCLC and PNS (cohort 1) to 40 without PNS, treated with ICIs. There was no significant difference in OS or TTNT between patients with mNSCLC with and without PNS, although a trend was seen towards worse outcomes in patients with PNS. TrAEs occurred in 6/18 (33%) and 14/40 (35%), respectively. Grade ≥3 trAEs occurred in 4 (22%) patients with PNS and 7 (18%) patients without PNS.ConclusionsExacerbations of pre-existing PNS occurred in 29% of patients treated with ICIs and both exacerbations and de novo PNS occur early in the ICI course. TrAE from ICIs were similar between patients with and without PNS. Our data suggest that pre-existing PNS should not preclude consideration of ICI therapy although patients may not derive the same clinical benefit compared with patients without PNS.
Tobacco packaging littering behaviours among Australian adults who smoke: findings from cross-sectional and observational studies to inform the implementation of cigarette pack inserts
Authors: Gascoyne Claudia , Li Rain , Scollo Michelle , Wakefield Melanie A , Brennan Emily 
Published: March 2024

BackgroundCigarette pack inserts are small cards that highlight the benefits of quitting and promote use of smoking cessation support. With evidence from Canada that they increase self-efficacy to quit, quit attempts and sustained cessation, inserts are set to be introduced into tobacco packs sold in Australia. Some people have expressed concern that the introduction of inserts may create more litter if incorrectly disposed of on pack-opening.MethodsWe used a cross-sectional survey to assess self-reported pack-opening location and waste disposal behaviours of people who smoke to determine the potential for littering to occur when tobacco packs are first opened. We also visited a sample of supermarkets, convenience stores and tobacconists located throughout Melbourne, Australia, to discreetly collect observational data regarding pack-opening and waste disposal behaviours at the point of purchase.ResultsAmong participants in the cross-sectional study (N=369), the majority reported that they opened their most recent tobacco pack at home (70.9%) where there is little potential for littering, and this proportion was higher among those who smoke daily (78.6%) and men (74.3%). Self-reported behaviours that could result in littering were rare; 1.0% reported that they left tobacco packaging where they believed it would be collected for disposal. Of the 128 individuals observed at the point of purchase across 46 stores, 96.9% did not open the tobacco product immediately after purchase. One incident of littering was observed (0.8%).ConclusionThe introduction of cigarette pack inserts in Australia is unlikely to create a substantial amount of additional litter.
Building capacity for ATLS trauma education: role of nurse practitioners and physician assistants
Authors: Dunn Julie A , Wiley Alysia , McFann Kim , Baumgartner Craig , Chernock Brad , Capella Jeannette , Wilson Catherine , Hallman Melanie , Taylor Dennis , Sutyak John , Campo Theresa , Thorton Tim , Polk Travis 
Published: March 2024

ObjectivesAdvanced Trauma Life Support (ATLS) focuses on care of injured patients in the first hour of resuscitation. Expanded demand for courses has led to a concurrent need for new instructors. Nurse practitioners and physician assistants (NPs/PAs) work on trauma services and duties include patient, staff, and outreach education. The goal of this project was to assess NP/PA self-reported knowledge and skills pertinent to ATLS and identify potential barriers to becoming instructors.MaterialsThis was a voluntary 91-question survey emailed to NP/PA lists obtained from professional societies and online social media channels. NPs/PAs completed a survey reflecting self-reported knowledge, experience, comfort level, and barriers to teaching ATLS interactive discussions and skills. Responses were recorded using a Likert scale and results were documented as percentages. Number of years of experience versus perceived knowledge and comfort teaching were compared using a χ2test of independence.ResultsThere were 1696 completed surveys. Most NPs/PAs thought they had adequate knowledge and experience to teach interactive discussions and skills. Those with more years of experience and those who completed more ATLS courses had higher percentages. The number 1 barrier to teaching was lack of formal teaching experience followed by perceived hierarchy concerns. Experience and comfort with skills that fell below 50% were pediatric airway (49.5%), needle and surgical cricothyrotomy (49.8% and 44.8%), diagnostic peritoneal lavage (21.6%), and venous cutdown (20.8%).ConclusionNPs/PAs with experience in trauma reported having the knowledge and skill to teach ATLS. A majority are comfortable teaching interactive discussions and skills for which they are knowledgeable. The primary barrier to teaching was lack of formal teaching experience, which is covered in the ATLS Instructor course. Training NPs/PAs to become instructors would increase the instructor base and allow for increased promulgation of ATLS and trauma education.Level of evidenceIV.